Four of the six Tribes have IHS compacts and two of the Tribes have 638 contracts. The Tribes have managed components of health care for a minimum of four years. Each of the sites indicated that individuals knowledgeable about the Tribe’s experience in self-governance or management of health care are available and could provide historical background and other information for an evaluation.
Accounting and personnel data concerning health programs were available at all sites. Detailed accounting data were available at all sites including cost information by cost component (e.g., administrative costs, personnel costs, and other) and funding allocations by source over time. Personnel data including staff turnover information are available at all six sites but are not generally available electronically. This information would, in most cases, have to be recreated by knowledgeable managers.
All six Tribes use the RPMS system for collecting patient-care data. A few tribes were also using RPMS data for third party billing or looking into using RPMS for third party billing activities. Follow-up information gathering with the Indian Health Service revealed that most Tribes/Tribal organizations with self-governance compacts (78 of 81 compacts) do submit data to the RPMS.
However, a few of those interviewed expressed concern over the quality of the data collected through the RPMS. These Tribal interviewees suggested that, without intensive effort at the facility-level to enhance quality, the data were not extremely useful. One site had enhanced the RPMS data by training staff members in its use, collecting additional outcome data, and conducting a separate patient satisfaction survey.