Range of Care

Northern Arizona Healthcare is dedicated to bringing accessible, cost-effective, and quality care to its population, especially its large communities of Native Americans and seniors. According to its president and CEO, managing healthcare for such a diverse population can be as rich in its rewards as its challenges.

A diverse range of communities turn to Northern Arizona Healthcare (NAH), the region’s largest healthcare organization and primary hospital serving the Navajo and Hopi nations. By staying loyal to a philosophy of unity, president and CEO Rob Thames works to ensures that each receives equally efficient, effective, and easily accessible care.

Thames had a fateful encounter at seventeen years old after his father enabled him to sit with a CEO of a large HMO in Minnesota that managed the healthcare of a population. “I didn’t realize at the time how formative that was for me,” Thames says.

NAH includes two hospitals and over thirty ambulatory sites, and it manages a Critical Access Hospital. One of its hospitals, Flagstaff Medical Center, serves a large population of Native Americans, which account for 35–40 percent of its patients. Treating a diverse population creates unique challenges, Thames says, namely related to communication, culture, and geography.

To facilitate the communication issue, NAH uses full-time and part-time interpreters for its Native American patients. While they help to bridge the communication gap, there are still difficulties.

“Our industry has grown up as the sickness industry. . . . We need to provide exceptional care for patients and figure out how to transform the health of the communities we serve.”

Among them is the fact that in Native American culture, conversations of disease and death are often avoided. These discussions at NAH are discussed in third person by interpreters because of the belief that speaking in first person could bring misfortune. “To adhere to Native traditions, we have placed a symbol of the sacred mountain to designate the East direction, which symbolizes sacredness for prayer. Annually, we have a hospital-wide blessing by a traditional Native healer to bless our patients, facility, and colleagues,” Thames explains.

Because Northern Arizona, especially the Grand Canyon and Sedona, attracts millions of tourists from all over the world, NAH’s interpreters cover 300 languages.

The other challenge is geography. Flagstaff is a rural hub for Northern Arizona. Covering such a wide range of physical territory can become tricky, but Thames has solutions.

NAH has the only telemedicine outreach program in the Grand Canyon for the Havasupai, the only tribe that lives in the Canyon. They use it to receive quicker and better medical feedback from patients.

STAT SHEET

3.5k

colleagues, volunteers, and physicians

30
Native American interpreters trained in medical terminology

75k

patients served annually

The system has additional programs for outreach including their Care Beyond Walls & Wires program, their Community Care Network, which consists of care professionals who check on high-risk patients in their homes post discharge, and a community-integrated paramedics program.

A new and exciting development for NAH is virtual visits with physicians. “If you can wait to get in to see your physician, great! But sometimes you don’t have the luxury of it,” Thames explains. “Virtual visits are a recommended service to reach out to folks so they can access the system easier and quicker to meet their needs.”

The Verde Valley in Northern Arizona has a disproportionately higher number of seniors because many people choose to retire there. One-third of those seniors live alone. To ensure the seniors are receiving quality care, NAH partners with county health departments as well as other care providers as a collaborative measure.

NAH is working to collaborate with other partners, including Northern Arizona University, Northern Arizona Behavioral Health Association Institute, and community agencies to conduct a community health needs assessment (CHNA). The potential for a real robust CHNA will result in a more accurate assessment that reflects true needs—and one with broader support. “The solutions aren’t always something that any one of us can do, but maybe all of us together can help address.”

This isn’t the only way Thames and NAH plan to create value; he also has three main initiatives, and what he calls NAH’s “20/20” vision.

The first initiative is to be “the choice” for consumers. Thames understands that people want, deserve, and expect a choice when it comes to their treatment. “We want to earn that choice based on the triple aim: the best clinical health outcome, the best experience, cost, and total value package,” Thames says.

The second is to be “the destination.” This is more specific to NAH’s selected tertiary services like trauma, orthopedics, and cardiovascular. People still require specialty care, and in order to become the destination, it takes a high level of infrastructure, skill set and specialty commitment. NAH makes sure it’s rivaling alternative choices to become the selected destination by patients and companies alike. The third and final initiative is be “the integrator”—in this case, for payers. While at one time insurance companies would take on the utilization risk and pay hospitals for a procedure, they now want to share some of that risk.

But it’s not only NAH’s employees and dependent population at risk. It’s also NAH’s unfunded population. Thames explains this population has little or no coverage. Rather than waiting for them to become sick and show up in the emergency department, NAH tries to reach out to make sure they’re receiving services first to prevent disease escalation.

For higher quality care with easier access for everyone, Thames believes mind-sets have to change. “Our industry has grown up as the sickness industry,” he says. “We need to provide exceptional care for patients and figure out how to transform the health of the communities we serve, not waiting until people are sick or need a procedure and then taking care of them.” AHL