Innovative Economic Opportunities
for Tribal Health Care Centers
With Indian Self-Determination and Education Assistance Act (P.L. 93-638) authority and under the Indian Health Care Improvement Act (IHCIA), tribal organizations have a unique opportunity to ensure an accessible and appropriate network of health care providers for their tribal members, while building a business that benefits the tribal community.
This class is designed for tribes operating a P.L. 93-638 health care contract or for those tribes considering health care as a business opportunity.
From this hands-on class, tribes will conceptualize a culturally-appropriate and community-responsive network of care; identify key supports, including other tribes; learn best practices for contracting care with medical groups and independent providers; and frame health care as a business, an employer and a resource for their communities.
|T O P I C S C O M I N G S O O N!
Growing the Health Care Business
- Building relationships with medical groups and MCOs
- Seizing opportunities under PPACA
- CMS addendums and Section 206 of the IHCIA
- Procured/Referred Care (formerly CHS) program design
- Forward-funded health systems with revenue opportunities:
- Maximizing Medicaid and Medicare enrollment and billable moments
- Marketing and outreach
- Medicaid expansion
- Educating the workforce (billers, benefits coordinators)
- Payment for service (full-cost recovery)
- Third-party revenue goal setting
Leveraging Federal Funding and Federal Status
- Exploring target populations:
- Section 813 of the IHCIA (reach others)
- Getting paid:
- Section 206 of the IHCIA
- CMS addendums - compelling payment without the commitment
- Looking for the opportunity:
- Health insurance exchanges (insurance products, payment strategies and billing opportunities)
- Tribal organization advantages (HRSA funding, business beyond health care)
- Higher revenue for higher quality
- Health care compliance (from the front door to the bottom line)
- Medicare/Medicaid conditions for participation
- Quality care standards
- Third-party revenue expenditure
- Tribal cooperatives (business building and resource sharing)
- Payment strategies (a customer and a provider)
- Quality improvement plan
- Tribal opportunities
*Topics subject to change.