DON KASHEVAROFF: Thank you, Niel. You know, my first time at Commonwealth North, so forgive me if I make any faux pas. My first order would be a plug for Niel. He just was able to find me a house before it even came on the market, and so that was nice, and then sold my old house, so that was really nice of him to do. And he said he's going to -- he's doing it for free, too, I think he told me. That counts, right?

NEIL THOMAS: Tell him it's a baby gift. He just had a baby a week ago.

MR. KASHEVAROFF: Yeah, we just -- I'm a new dad. First one, so I am finding out all the fun that everybody else already knew about, and everyone always told me that, every time there was a kid crying around, you know, and I always said, you know, that kid keeps crying, he said, well, just wait until you have your own, then you'll understand. Well, now I understand how that works.

I do want to thank everybody for taking the time and allowing us to come here and present kind of on the Native Tribal Health System, and the -- what we've been doing at ANTHC and over the years, we'll go into it. We've been trying to build a better health system in Alaska, and I know that Commonwealth North is going to have a study that looks at health care in Alaska. The Native system is an integral part and a very large part of the system in this state, and I think we've been doing a good job, getting better and better.

I guess you can start wit the first slide. Way back when the Indian Health Service used to manage all the Native health care. They used to have about six hospitals and some community health centers around the state. Back in '76 a law was past that allowed the tribes or the Indians to start taking over and contracting for some of those services. And then in '94 we had what we call self-governance, and self-governance allowed the tribes under compact, which is a -- we negotiate once a year with the Indian Health Service. Once we get the negotiation done, they hand us a lump sum of money, assuming Congress doesn't have continuing resolutions, but we get a lump sum of money, and we manage our own health Service. And that started in about '94.

Next slide, please. And there a number of different organizations throughout Alaska. It's just not one running the whole thing. We have at least 12 smaller communities that run their own shop. We have regional health organizations. You might have heard of Yukon-Kuskokwim Health Corporation, Norton Sound Health Corporation, Bristol Bay Area Health Corporation. There's a lot of regional health corporations out there, and we serve -- YKC is the largest, they have over 58 villages, 25,000 people out in the Yukon Delta. And so it's quite the mixture.

Next slide, please. And basically we've broken up the state into different regions, and each region is basically -- has control or responsibility for their own area, so the very top of the -- the map, Arctic Slope Native Association, they get to provide the health care up north. As you go around the Chain, it's APIA, Eastern Aleutian Tribes, they get to provide the health care up there. So we kind of separated Alaska into areas, and everybody's in charge of their own area.

Next slide. What we end up doing though, even though we're all in charge of our areas, we all work together, and we have the referral system. So if you are in a village, on the very -- one of those tips of the spokes, and you need service, we have a lot of clinics in the villages. You can walk into the clinic, and they might be able to treat you there. If you have a sprained ankle or something like that, they're going to treat you there. If you have a broken ankle, they might not treat you there. They might refer you to their regional hub. Some places even have subregional, but they refer you to a regional hub, and so that's where the spokes go into the center out on the various spaces. And then the regional hospital will treat you.

Occasionally the regional hospital can't treat everything. They can't do a number of surgeries, a lot of the cancer, chemotherapy, things like that, they can't do that. So that's when they refer into Anchorage. And the Alaska Native Medical Center in Anchorage is getting referrals from all these different places in the State. And this has been going on for many, many hears, and it's getting quite I guess sophisticated and efficient for how we refer folks up.

We even started -- Paul will talk about telehealth where we don't have to refer folks up now. We have the telehealth system to allow folks to stay in their own villages.

Next slide, please. Alaska Native Tribal Health Consortium was formed in 1997. We were the last to take over what was left of the Indian Health Service. Back in '94, every region out there took over part of -- whatever was happening in their area, they took it over and they became self-governance. Well, in '97 the rest of the state went, which was in Anchorage. And in Anchorage there's a lot of statewide health care that's provided. As I said, people refer in to us. So in order to keep it governed by those who use it, a consortium board was set up that represents the whole state. And so we took it over. We were also the largest Indian health care provider in the nation. We have 1700 employees, and a very large budget that Tom -- or that Paul will talk about.

Next one, please. So right now what we have in Alaska is, Indian Health Service is a minority in the picture. They are still here in Anchorage. They still help us with advocacy. They still help us with reporting back to D.C., being a coordinator for us. But right now the health system, the Native health system is run by the natives. And basically we have tribal ownership.

We have local priority setting, and we have local budget allocation. And that's one of the hardest things, of course, when you don't have enough money, which we haven't had enough money in years. I don't think we ever had enough money. But if you don't have enough money, somebody has to make a hard decision on what service you provide. And now instead of having that decision made back in D.C., we're making it on the local level with local input.

We also are able to have more culturally relevant programs, and that might be a -- well, you're all Alaskans, so you know what we're talking about with culturally relevant. Most folks would go, why do you have any culturally relevant? Well, a lot of our patients, who are our customers, who are also our owner, we need to treat them right. There's a lot of language barriers, there's cultural barriers, and our job is to make sure that those are taken away. Many of our physicians throughout the whole system are not native, but we work with our physicians, we work with our customer/owners to make sure that there isn't any friction in there, that we can provide the right service for our people.

I'll also quickly mention that we have about 6,000 employees in the system, and ANTHC employs about a quarter of those.

Next slide. We recently got together and signed an MOU that more solidified the health system, saying that we're all going to continue to work together, and work with each other. Here's a picture of folks from all around the state running their own health systems, and that's where we end up getting to. There's only two ties in that whole outfit, the whole picture, there. I'm one of them. People always wonder why I'm wearing a tie. I say while I'm in Anchorage, I wear a tie. As soon as I leave Anchorage, it's off.

Next picture. Here's a nice little clinic we have over in CHignik Lake. Another one. And in Newtok. And that one as you can see isn't necessarily as nice as the first one. We are, with the help of Denali Commission, replacing many of the clinics throughout the state, but there are a lot of them that haven't been -- that are about 50 years old, and are very tiny, and, you know, we get reports of people stepping through the floors, or putting their hand through the walls and things like that, so it's been a very big rush the last couple years to see how many clinics we can get replaced with the help of Denali Commission, with the help of Senator Stevens. Liz Cannell (ph), thank you very much for your input on that, and we're kind of having a race to modernize Alaska in the next couple years.

Next slide, please. Here's another community clinic, more of a subregional, that can handle several villages they've put them into.

The next, please. Maniilaq just has a nice new hospital up there. Well, I guess it's probably five, six, seven years old now, but it's still kind of new to me compared to the rest of the system.

And next. And, of course, ANMC which consists of Alaska Native Medical Center, the hospital building, and the primary care center is across the street.

So you can see we went from a very small clinic, subregional, to the regional Maniilaq, to ANMC. And that's kind of how the referral pattern goes. If you're out and you get hurt, that's what's going to happen to you. So if you're fishing in one of those villages, the same thing can happen to you even though you're not probably Native here. The same thing could happen to you. If you get hurt out there, they're going to do the same thing. They're going to treat you at the village clinic if they can, or they're going to refer you out. Of course, you won't get referred to ANMC in the end, you'll get referred to Providence or Regional.

Next up. All right. Here is some of the other things that ANTHC does, and also the health system that we have problem with, and that is our living conditions out in the villages, and, of course, sewer and water problems. Many villages do not have running water, nor running sewer systems, and here's a few of them that don't. And they don't look too pretty.

Next picture. And here's something that we've been working on for a good number of years. Everyone remembers Governor Knowles saying, if I put the honey bucket in the museum. This is helping put the honey bucket in the museum right there. We've been out with water/sewer projects for a number of years, and we expect we still have another 10 or 15 more years of building water and sewer projects out in the Bush.

Next. Okay. Just some demographics about the Native population. 125,000 Natives in this state. And the median age is lower than most other races. Even lower than Alaska. We had 35,000 living in the urban areas, many in Anchorage. That means 85,000 folks live out in the rural communities. So we kind of have two different populations of folks. Folks living in Anchorage, we have a nice hospital for them. If you're living out in the villages, you have a nice little clinic, sometimes a really old clinic.

Funding for us. We have funds from the IHS. We also supplement that with Medicare/Medicaid, third-party insurance. We do bill, just like a private hospital bills. Matter of fact, we're required by law to bill as many insurances as we can, that IHS is the payer of last resort. We also are getting grants. There is some self-pay for some certain items that no one else is able to cover. We're having funds to do the water and sewer, sanitation facilities. And we're up over about 700, $750 million that comes in the state because of the Native Health System. And I mentioned the 6,000 employees. The Native Health System is quite the economic impact.

Am I at 10 minutes? Because I'm not timing myself.

UNIDENTIFIED VOICE: I believe so. Keep going.

MR. KASHEVAROFF: Okay. I can keep going. Well, I want to bring up my CEO, Paul Sherry, to continue on and just talk mainly about what we're doing here in Anchorage, so, Paul?

PAUL SHERRY: Thanks, Don. Just a few other slides. I'd also like to add my thanks to the Commonwealth North for inviting us here today, and giving us a chance to update you on what we're doing in the system. My job is to talk about the local part of the program. Go ahead.

So the consortium is an amalgam of different service lines that support the Tribal Health System statewide. I'm not going to read these, but we're a mix of different, what would be different separate companies doing different things. So I run a hospital and I manage a construction company. It's a pretty interesting mix.

Let's keep going. This is our board, a subset of the larger picture you saw earlier. About 15 people. We meet six times a year.

Keep going. So the consortium is a nonprofit 501(c)(3). We've grown from 1200 staff when we started, who were all federal employees assigned to me, to about 1700 today. One-third of those folks are federal employees that we buy their service from the Federal Government. So we consider them our employees, even though on the list in the paper we don't show up, because only our directly hired people are registered. Okay. So from our perspective, we're right about even with Alaska Airlines and Fred Meyer's in terms of the size of our company.

Our budget is 300 million annually. We spend about 100 million of that in rural Alaska. And we've got offices from Ship Creek where we have our yards to Old Seward, to the hospital to south Bragaw and the old Alyeska complex.

Let's go. Together with Southcentral Foundation, we manage the hospital here in Anchorage.

Keep going. On our side, we do the inpatient specialty care work. Every day I've got 125 patients in the hospital. We provide a lot of specialty clinic services, about 50,000 visits a year. Every day we deliver four new babies over here. About 1,000 surgical cases a month. And our physicians and other specialists travel to the rural hospitals that Don was talking about.

Next slide. On the health, sanitation facilities improvement side, in any given summer we're building about $50 million worth of projects out in the Bush. We distribute funds, we do engineering work for improvement of the rural hospitals and clinics, and Don mentioned the Denali Commission work.

What a lot of prole don't know is we've built up our whole health research, medical research part of our campus, bringing National Institute of Health, CDC, SAMSA, HERSA type funds into the program.

Over the last couple of years we built the largest single telehealth system in the world. We've deployed about 260 sites in the VA, Department of Defense, Native Health systems, at Coast Guard sites. We put a telemedicine cart on a cutter in the Gulf. So it's something we're really proud of, and we're starting to market this system elsewhere in the world.

We do a lot of training here. We've trained health aides. We have residency agreements for physicians and nursing staff, et cetera.

Let's keep going. A lot of our work is focused on growing Native health providers. Only about 10 percent of our professional medical providers are Native. Only about 40 percent of our managers are Native. And raising those numbers up through a means of approaches is part of our objective.

Another part of what we do is support the Tribal Health System, so we have a single patient data information system that interconnects these hospitals and clinics around the state. And those that have problems generating bills for their services, we help them do it, because of recruiting of professionals, et cetera.

A more recent business that we're in is working with Homeland Security in the state on rural emergency preparedness and bioterrorism, you name it in that arena.

Keep going. I want to pump ourselves up for a minute or two. We think we've accomplished a lot in the last six years. Our hospital has been designated as a magnet hospital. There's I think 70 in the country out of over 1100 hospitals that have that designation. And what it means is that we have excellence in nursing, and engagement of our nursing staff in our administration. We are the trauma center for the state.

Keep going. This telemedicine project I talked about, two months in Orlando, Florida we received American Telemedicine Association's President's award. And our lab recently got some recognition as being highest -- you know, in the highest quality in the country.

One more I think. So there's our future. There's all those little kids out in Tuntatuliak or Sleetmute, I can't remember where, but that's who we're doing this work for.

I'll quit there and open it up for questions that you have, and I'd like to cover any areas that we might not have covered in our over-all presentation. So, are we doing all right?

MR. KUMIN: You're doing great. Thank you.

MR. SHERRY: Thanks, Jon.