# Presentation: 228664

## “You Are The Essential Piece”

**8th Annual**
**IHS, Tribal & Urban Partnership Conference**
**“****You Are The Essential Piece”**

## Missions

_**IHS:**_
**Raise the physical, mental, social and spiritual Health of AI/AN to the highest level, in Partnership with the population we serve**
_**ORAP:**_
**Enhance funding for AI/AN health care delivery by effective collection of third party funds, efficient use of contract health service funds and maximizing partnership.**

## Goals

_**IHS:**_
**Assure that comprehensive, culturally acceptable personal and public health services are available and accessible to the service population**
_**ORAP:**_
**Provide quality health care to AI/ANs by maximizing all sources of funding and resources.**
**Implement business practices that improve efficiency and effectiveness, as well as quality health care.**
**Expand partnerships to build a dynamic AI/AN health network.**

## Director, IHS Initiatives

- 	_[Behavioral Health](http://www.ihs.gov/NonMedicalPrograms/DirInitiatives/index.cfm?module=fact_bhealth)__ _
- 	_[Chronic Disease Management](http://www.ihs.gov/NonMedicalPrograms/DirInitiatives/index.cfm?module=fact_chronic)__ _
- 	_[Health Promotion/Disease Prevention](http://www.ihs.gov/NonMedicalPrograms/DirInitiatives/index.cfm?module=fact_hpdp)__ _
- 	“These Initiatives are linked togetherand have the potential toachieve positive improvementsin the health of Indian people “

## Cascade of objectives,  Director’s Performance Plan

**Increase in third party collections by 3% (1. a1)**
**Increase Partnerships/alliances by 4% (1. a2)**
**Maintain Accreditation at 100% for IHS operated hospitals & clinics (1. a3)**
**Facilitate enrollment of 5,000AI/AN Medicare beneficiaries in Part D**
**Expand Faith Based and community partnerships (17. b)**

## Provide leadership and direction to increase access to health care for AI/AN people in support of the IHS Mission.

Increased collections
Increased utilization of alternate resources
Increased purchasing power in CHS (appropriations and savings)
Increase Partnerships
Increase compliance and efficiencies

**Increased collections**
**Increased utilization of alternate resources**
**Increased purchasing power in CHS (appropriations and savings)**
**Increase Partnerships**
**Increase compliance and efficiencies**

**Primary Objectives, ORAP**

## ORAP organizational structure

**Notes:**
Reorganization August 23, 2004

## ORAP FY 2006 Budgets

- Collections over - 		$671M
- CHS- 				$518M
- Partnerships - 		 _$40M_ (HQTR’s)
-    Total				 $1.2 Billion

**Notes:**
From Medicare, Medicaid, private insurance, and all other alternate resources (AR) for which AI/ANs are eligible.

Reimbursements from these AR, in addition to the IHS appropriations will be directed to improve the health status of AI/AN

## DBOE 2006 Priorities/Actions

- 3rd Party revenue Internal Control Policy
**Training**
**Technical Assistance Evaluations**
- Federal Medical Care Recovery Act Policy
- Debt Collection Policy
- Cost Reports
- CMS Partnership
- IT Systems (PAMS/Patient Reg./3M)
- ROM (Revenue Operations Manual)

## IHS Eligibility, 1.435 Million Users  2005 

**IHS Eligibility, 1.435 Million Users  2005**

## 5 year Collection History

| Fiscal Year | Collection
Total | % chg over PY |
| --- | --- | --- |
| 2001 | $472,142,761 |  |
| 2002 | $529,134,698 | 12.07% |
| 2003 | $585,796,694 | 10.71% |
| 2004 | $628,246,937 | 7.25% |
| 2005 | $671,322,033 | 6.86% |
| 2006 | $677,831,000 (estimate) | 0.97% |

## Mid Year Comparison(3rd Party Collections)

|  | 2004 | 2005 | 2006 |
| --- | --- | --- | --- |
| Aberdeen | $32,649,502 | $34,099,924 | $29,736,892 |
| Albuquerque | $19,606,921 | $19,852,173 | $19,668,602 |
| Bemidji | $9,372,305 | $12,764,863 | $11,096,948 |
| Billings | $16,090,125 | $18,210,137 | $17,925,791 |
| Navajo | $70,912,606 | $76,131,763 | $77,213,412 |
| Oklahoma | $29,983,136 | $28,742,973 | $30,022,218 |
| Phoenix | $42,830,829 | $43,192,913 | $48,223,854 |
| Portland | $6,316,390 | $7,003,459 | $7,145,732 |
| Tucson | $6,638,765 | $6,887,549 | $6,786,605 |
|    Total: | $234,400,578 | $246,885,754 | $247,820,053 |

## Mid Year Comparison (3rd Party Collections) 

|  | 2005 Vs 2004 | 2006 Vs 2005 |
| --- | --- | --- |
| Aberdeen | 104.44% | 87.21% |
| Albuquerque | 101.25% | 99.08% |
| Bemidji | 136.20% | 86.93% |
| Billings | 113.18% | 98.44% |
| Navajo | 107.36% | 101.42% |
| Oklahoma | 95.86% | 104.45% |
| Phoenix | 100.85% | 111.65% |
| Portland | 110.88% | 102.03% |
| Tucson | 103.75% | 98.53% |
|    Total: | 105.33% | 100.38% |

## Mid year collection comparison2005 vs. 2006

## Medicare-Like Rates
Departmental Contract Information System (DCIS)
UFMS
PRISM
CHS Manual Update
CHSDA Update
CHEF
FI

- Departmental Contract Information System (DCIS)
- UFMS
- PRISM
- CHS Manual Update
- CHSDA Update
- CHEF
- FI

**Division of Contract Care Priorities**

## CHS Budget $’s in Millions

## Denials: Eligible care not within medical priority

- _Fiscal Year_			_# of Denials_
- 	2002		  			19,695
- 	2003					19,121
- 	2004					23,368
- 	2005					33,106

## Savings to IHS			  FY 2005

Total billed charges		  $678 M
Contract Savings		 	    318 M
Total Allowed		  	     360 M
AR Savings			  	     138 M
Total Paid				    $222 M (all FYs)

Figures do not include Medicaid payments
All claims paid (for any FY PDO) within FY 2005
5 Tribal programs use the FI

**Total billed charges****	****	****  $678 M**
**Contract Savings****	****	**** ****	****    318 M**
**Total Allowed****	****	****  ****	****     360 M**
**AR Savings****	****	****	****  ****	****     **_**138 M**_
**Total Paid****	****	****	****	****    $222 M (all FYs)**
- Figures do not include Medicaid payments
- All claims paid (for any FY PDO) within FY 2005
- 5 Tribal programs use the FI

- Maximizing CHS Funds

## CHS Overview

- 	The CHS budget does not keep pace with inflation
**CHS is funded at the OMB medical inflation rate of 3.9%**
**IHS, FI reports an inflation rate of 10.33%**
- 	CHEF- Catastrophic Health Emergency Fund
**Supplements CHS by paying high cost cases**
**$18M - FY 2006 Funding**
**CHEF Threshold=$25,000 for FY 2006**

## Partnerships

- ORAP Partnerships—being further developed in 2006
**VA Partnerships**
**HRSA Rural Health Care Task Force**
**Inter Agency Agreements with CMS ie., Outreach and Education Training IHS –wide, Satellite training, TTAG, MMPC**
**Other....NIH, CMS,NIKE**
- Inter-Agency Agreement Area wide Tracking System
- Partnership Web Page

## Partnerships

**Increase partnerships 4% over the FY 05 base in the areas of disease prevention, health disparities and health infrastructure **
_**HQs Current:**_**  36 out of 83 (FY 05 Base) (42%)**
_**Areas Current:**_**  231 out of 247 (FY 05 Base) (93%****	****)**
**	**
**Develop FY 05 base line for Faith and Community Based Agreements by 4th Qtr – (100% complete)**
**Develop Web Site by 4th Qtr – Draft 50% complete**
**Continue rewrite of manual chapter  – Draft 50% complete**

## FY 2005 HQ’s and Area Agreements

- Total Number:  			    324
- Total Dollar Amount:  		$93.8M
- Incoming Dollar Amount:  	$41.2M
- Outgoing Dollar Amount:  	$52.6M

## 
Support Center
OMB A-123 Internal Controls Workgroup
Standardize PD and Skill sets
Partnerships
Implementing:
DCIS
PRISM
UFMS
Medicare like rates
IT systems

**Support Center**
**OMB A-123 Internal Controls Workgroup**
**Standardize PD and Skill sets**
**Partnerships**
**Implementing:**
**DCIS**
**PRISM**
**UFMS**
**Medicare like rates**
**IT systems**

**Overall ORAP Activities**

## Increased funding/purchasing power
Fully utilizing alternate resources
State Medicaid programs decreasing services
Aging population
Meeting medical inflation needs
Implementation of New Systems

**Fully utilizing alternate resources**
**State Medicaid programs decreasing services**
**Aging population**
**Meeting medical inflation needs**
**Implementation of New Systems**

**Challenges**