Welcome from the Executive Director of Health - Ho

Transcription

Welcome from the Executive Director of Health
Hinikara gi wii.
Hello:
It has been a great pleasure to have been asked by the outgoing President, Jon Greendeer, to fill
in as the Executive Director of Health in September of 2014. It has been awesome to see the
work and accomplishments of all Division Directors and the work they do in regard to Strategic
Plans and the way they get their Goals and Objectives completed.
The real work is to try to get the best health care we can possibly give to our Ho-Chunk Nation
and our Tribal Employees and members of other tribes we are affiliated with. We have a
tremendous amount of work to do beginning with our infants, youth, and adults on through the
elder years. Our challenges are to alleviate the illness that affect our people such as heart, cancer
and diabetes and strive toward better health for all.
We need to re-emphasize our focus on our very young in the area of well-child visits and dental
care. Our children should have access and be our number one priority in teaching healthful ways
so as not to incur illnesses of the heart, cancer and diabetes as they grow older.
We also have a concern for our tribal members who at the age of 60 are considered elders. We
encourage our elders to enroll in Medicare and our Elder insurance program. We have provided
Home health care for the elder who can no longer do the daily chores that we were accustomed
to see them perform for us, as children, for grandchildren and great grandchildren. Their
teachings has carried us through difficult times and as they reach declining mobility we want to
treat them well and curtail entry into nursing homes and remain in their homes as long as they
can.
Behavioral Health efforts are to address the damaging effects of drug abuse on our youth, young
adults and the babies that are born with drug addictions. We also must meet the need to provide
preventive and other care services for the addicted and try to assist them back to a healthy way of
life.
There is much work to do and I thank all the employees who work in the Health Department
daily to help us maintain our good health and a long life.
Pinagigiwii.
Ona M. Garvin
Interim Executive Director of Health 2015
Medical Services Division Annual Report
Ho-Chunk Health Care Center and House of Wellness
Medical Services Division provides medical, dental, optical, and podiatry care to our patients.
Our healthcare team of providers include: Internist, Pediatrician, and Family Practice Doctors,
Family Nurse Practitioners, Physician Assistant, Podiatrist, Dentists, Optometrists and
supportive staff. All of our healthcare providers within the Department of Health are committed
to providing excellence in care and service.
The following services are performed by the healthcare team:
Medical Clinic Services Provided:
Optical Services Provided:
Acute Care for Injury and Illness
Immunizations
Diabetes Wellness Clinics
Infections
Prenatal Care
Reproductive Health
Adolescent Health/Well Child Care
Physical Exams for All Ages
Sports Physicals
Smoking Cessation
Maintenance
Weight Management
Laboratory Services
Podiatry Services
Radiology Services
CDL Examinations
Benefits Coordinator/Advocate
Routine Eye Exams
Adjustments & Minor Eyeglass Repair
Evaluation & Treatment of Minor Eye
Order Eyeglasses & Contact Lenses
Dilated Diabetic Eye Exams
Dental Services Provided:
Routine Exams and Cleanings
Scaling & Root Planing/Periodontal
Dental Fillings and Sealants
Oral Surgery
Fluoride Treatments
Root Canal Therapy
Teeth Whitening
Oral Cancer Screening
Mouth and Night Guard Fabrication
Crowns
Bridges
Dentures & Partials
Patient Visits
Ho-Chunk Health Care
Center
Patient Visits
House of Wellness
Optical
Dental
5521
5410
Medical
5237
4437
Optical
8139
2114
790
700
2011
849
2012
1912
920
2013
Dental
Medical
4944
1909
1097
1991
1068
2014
2015
7904
8129
7488
7809
1630
639
1594
603
1885
633
2039
740
2060
841
2011
2012
2013
2014
2015
Accomplishments for FY 2015 for the Ho-Chunk Health Care Center (HHCC):
 Conducted the mobile health unit visits in Nekoosa, Wittenberg, Tomah and La Crosse.
Assessed the mobile clinic unit operations due to financial constraints closed operation in
January 2015
 Participated in the Native American Health Careers Camp
 Reappointed two (2) Family Nurse Practitioners (FNPs), one (1) Optometrist and one (1)
Dentist to the Medical Team
 Appointed the Physician and one (1) Family Nurse Practitioner to the Medical Team
 Implemented the use of digital x-ray equipment for radiology
 Expanded the hours of the Optical Clinic
 Established the Reach Out and Read program
 Implemented the Triage Nurse into the Medical Clinic workflow
Future Goals for the HHCC:
 Hire a Family Practice Physician
 Start the use of telemedicine for specialty appointments (oncology)
 Enhance Dental Services (endodontics)
Accomplishments for FY 2015 for the House of Wellness (HOW):
 Using a diabetes registry, a streamlined system model is operating for diabetic patients
 Established, and continuously work to improve cultural awareness training for staff and
clinical students
 Implemented the Reach Out and Read program
 Reappointed two (2) Physicians, one (1) Physician Assistant, one (1) Optometrist and one
(1) Dentist to the Medical Team
 Appointed one (1) Physician to the Medical Team
 Implemented the use of digital x-ray equipment for radiology
 Collaborated with the Dental Clinic and devised a recall system to expand Optometry
services to patients
 Hosted an Integrative Team Site Visit with Indian Health Services Division of Behavioral
Health/Office of Clinical & Preventative Services to share best practices and lessons
learned information
 Promoted a healthy initiative to replace junk food options with healthier items in vending
machines
Future Goals for the HOW:
 Provide an additional dental specialty service (simple orthodontics)
 Be instrumental in expanding “Healthy Initiatives,” such as obtaining a “Public Health”
policy for the Ho-Chunk Nation and continue leadership in the “Healthy is a Ho-Chunk
Tradition” collaborative committee
Accomplishments for FY 2016 for HHCC and HOW clinics:
 Established “Freedom From Smoking” program in the Black River Falls and Baraboo
areas
 Implemented the use of digital x-ray equipment at both clinics.
 Expanded the Reach Out and Read program in both clinics
 Expanded collaborative Integrated Patient Care team concept in both clinics to combat
prescription drug abuse
Future Goals for the HHCC and HOW clinics:
 Obtain recertification of Accreditation by the Accreditation Association of Ambulatory
Healthcare Centers (AAAHC)
 Continue to evaluate methods to decrease no-show rates for all services
 Continue to establish and advance relationships with schools to provide clinical
experiences for students
 Staff from HHCC and HOW will continue to collaborate at various health fairs and
conferences and cultural events
Report is respectfully submitted by Joan Greendeer-Lee, Director of Medical Services
Finance Division Annual Report 2015
Functions:
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Department of Health
Billing and collecting revenue for the
Uses of Funds as a percentage - FYE
Department of Health direct services
06/30/15
Monitoring the overall finances for the
Clinics
Filing statistical and financial reports with the
27%
Centers of Medicare and Medicaid Services.
Behavorial
65%
Managing third party payer contracts with
8%
Health
Medicare, Medical Assistance and commercial
insurance companies.
Organizing and Disbursing Indian Health Service monies to Department of Health
programs.
Overseeing all Department of Health’s State and Federal grants to ensure compliance
with grantee rules, regulations and reporting.
Managing the Net Profit Distribution allocated from the Ho-Chunk Nation to all Health
departments.
Cost Reports:
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Sources of Funds as a percentage - FYE
06/30/15
The Department of Health has completed and
Service
filed Medicare cost reports thru 2014.
43%
45%
Revenue
Medicare cost reports are up to date and the
Department of Health is actively billing and
getting paid from the Medicare program.
12%
The Department of Health has completed and
filed Medicaid cost reports thru 2014.
Medicaid cost reports are up to date and the Department of Health is actively billing and
getting paid from the State of Wisconsin Medicaid program.
Goals:
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Become self-sustainable through the generation and collection of third party revenues as
to no longer rely on the Net Profit Distribution Allocation.
We encourage all eligible tribal members to enroll in Medicare, Medicaid, and other private
insurance to reduce the amount of Net Profit Distribution allocations necessary to operate the
Department of Health.
This report was respectfully submitted by Wally Apland III, Director of Finance
Quality
Improvement Division
The Department of Health continually strives toward achieving excellence by interacting with all
programs. Its purpose is to identify areas of deficiency, create plans for improvement, and see
those plans through to completion. Plan-Do-Study-Act is the credo of the program. We plan
projects that will address areas of needed improvement; we do the project as a research study; we
study the results of the program to see if the improvement did take place—or, if it didn’t why
not. We then act to adopt, adapt, or abandon (if the change did not improve results) the project
so that the needed improvement can, and does take place.
This past year, the Quality Improvement division has also been assisting with the certification of
accreditation for our public health services of completing the three prerequisites: Community
Health Assessment, Community Health Improvement Plan, and Department Strategic Plan. The
purpose of this accreditation is to: improve the quality of practice and performance; develop
leadership, strengthen relationships essential to public health services as a framework.
Accomplishments in 2015:
 Participated in the review and approval of policies and procedures submitted to the
Health Department committee
 Submittal of approved Health Department-wide policies and procedures for finally Health
Accreditation Board approval
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Disseminated revised Annual HIPAA training test for all Health Department staff
Conducted annual patient satisfaction surveys to study patient responses to services
provided by our clinics
Hired a new Quality Improvement Supervisor
Created a notification tool alarming the QI division when employee credentials are due
Verified licensing credentials and background checks for Health Department staff as
needed
Monitored Patient complaints to ensure that concerns are addressed to meet care of
patients
Convened routine Quality Improvement meetings for numerous performance
improvement projects underway in the department
Disseminated the department wide strategic plan
Developed a Commendable Service and Awards program for Health employees
Successfully applied for re-accreditation from the Accreditation Association for
Ambulatory Health Care
Goals in 2016:
 Continue to monitor quality improvement projects and peer reviews
 Achieve re-accreditation from AAAHC and conduct annual audits of our programs
 Continue to review Patient Complaints to ensure patient health care satisfaction
 Conduct annual patient satisfaction surveys and distribute results with Health staff
 Continue active participation in the Safety and Policies and Procedures committees
 Continue to verify licensing credentials and background checks as necessary.
 Disseminate a workforce development plan meeting Public Health Accreditation Board
standards
 Develop a Hocak Culture and Language program for the Department of Health
This report was respectfully submitted by Dashell Thunder, Quality Improvement
Supervisor
Pharmacy Department Annual Report 2015
Department Description:
The Ho-Chunk Nation (HCN) Pharmacy Department consists of pharmacy operations located
at the Health Care Center in Black River Falls, WI and the House of Wellness in Baraboo,
WI. Each location provides pharmacy services to distinct patient populations, which include
Native American/American Indian enrolled members of any Federally Recognized Tribe as
well as non-Tribal HCN Employees and any person presenting with a valid prescription.
Each pharmacy operation has two pharmacies within the pharmacy operation area, one State
retail pharmacy and one Federal Indian Health Service pharmacy. This innovative and
complex pharmacy model creates a special opportunity for revenue generation and enhanced
clinical pharmacy services to all of the patients served and provide the highest level of health
care.
Pharmacy Services:
 One Board Certified Psychiatric Pharmacist Prescriber to provide specialized psychiatric
pharmacy coordination of care and psychotropic medication therapy management.
 Patient specific counseling tailored to provide education about medical conditions and
medication therapy.
 Pharmacist coordination with medical providers to assist each patient with medical
concerns.
 Mail out services across the country.
 Non-Tribal member Prescription Co-Payment Incentive: Zero (0) co-pay for all generic
medications, $10 co-payment for 30 day and $20 for 90 supply of brand medications.
Future Goals and Development:
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Continue to develop and implement marketing initiatives to increase pharmacy utilization
and revenue generation for the Ho-Chunk Nation.
Implement a mandatory chronic medication mail order program for HCN employees that
will significantly increase revenue return to the Ho-Chunk Nation by approximately $2
million annually.
Change pharmacy management software system to improve pharmacy services and
accomplish medication delivery quicker.
Increase pharmacy contracting with Medicare Part D, Private, and Affordable Care Act
pharmacy insurance plans to increase revenue.
Annual Accomplishments;
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Developed clinical pharmacy services such as pain management, psychiatric pharmacy,
diabetes management, and medication therapy management, and an antibiotic
stewardship program through specialized pharmacist training and credentialing and
Indian Health Service Improving Patient Care Model.
Increased access to pharmacy services by extending pharmacy hours of operation.
Maintained 100% pharmacist and technician staffing, creating a stable and proficient
pharmacy department team to best serve our patients.
House of Wellness Pharmacy program mentored 4 University of Wisconsin APPE
students.
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Increased utilization of the Tribal Pharmacies by non-Tribal employees and enrolled
members as well as Tribal members.
Received a $150,000 grant to participate in the Wisconsin Prescription Drug Monitoring
Program that allows medical providers and pharmacist to access information for all
controlled substance dispensing from every pharmacy in Wisconsin.
Pharmacy division and finance division began close partnership to maximize revenue
generation and co-payment collections. Pharmacy able to begin taking credit card
payments for prescription co-payments.
Clinical Pharmacists increased participation on the medical team to provide the highest
level patient care to Tribal Members and employees by participating in clinic visits with
the providers and staffing case management meetings.
Pharmacist staff being part of the Integrated Case Management monthly meetings
assisting with patient-centered care plans and improving the quality of health care
provided to our consumers.
Pharmacy Director was assigned as the Indian Health Service principle contact on the
Executive Office of the President/Office of National Drug Control Policy (ONDCP)
National Heroin Task Force attending meetings at the White House in Washington, D.C.
HHCC Pharmacy Manager was assigned by the Wisconsin State Board of Pharmacy as a
member to the Wisconsin State National Governors Association Policy Academy on
Reducing Prescription Drug Abuse.
Increased revenue generation by approximately $750,000 over Fiscal Year 2014
Total Prescriptions Dispensed and Revenue Generation:
Total Prescriptions Dispensed:
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F.Y. 2009- 34,836
F.Y. 2010- 36,391
F.Y. 2011- 55,738
F.Y.2012- 59,513
F.Y. 2013- 61,693
F.Y. 2014- 65,882
F.Y. 2015- 66,367
Total Number of Prescriptions Dispensed
70,000
60,000
50,000
40,000
Total Number of
Prescriptions
30,000
20,000
10,000
0
2009
2010
2011
2012
2013
2014
2015
Total Revenue Generated:
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F.Y. 2009- $2.34 Million
F.Y. 2010- $2.10 Million
F.Y. 2011- $3.34 Million
F.Y. 2012- $4.61 Million
F.Y. 2013- $ 3.64 Million
F.Y. 2014- $ 5.03 Million
F.Y. 2015- $ 5.79 Million
Total Revenue Generation
7
6
5
4
$ Million
3
2
1
0
2009
2010
2011
2012
2013
2014
This report is respectfully submitted by Ted Hall, Director of Pharmacy
2015
Health Information Systems (HIS) Department Annual Report 2015
For the FY 2014-2015, the HIS division implemented a new communication service
(Citrix) for access to all of the primary Health applications, which includes Nextgen, EDR,
GuardianRX, and Harvest. This improved access times and the quality of patient care. HIS
continues to plan for the federally mandated ICD-10 conversion, in October 2015. In addition,
HIS continues to assist in conversions to a paperless environment, via system changes and
process/procedure changes. Finally, HIS added four (4) additional staff positions, HIS
Administrators and Database Administrator, to assist with the conversion to independent IT
support, of the electronic health records, communications, and network for the Health
Department
This report is respectfully submitted by Brady Twobears, Director of HIS
Health Benefit Specialist and Health Benefit Coordinator/Advocates Annual
Report 2015
There are four staff in these positions. Joyce Rockman and Sandy Lanier are located at the HoChunk Health Care Center; Stephanie Swallow and Cindy Tack are at the House of Wellness.
Our goal is to assist Ho-Chunk tribal members as well as other Native Americans find alternative
resources to pay for their medical expenses incurred at the Ho-Chunk Nation Health facilities or
any other medical facility.
We assist with the application process for
 Medicaid,
 BadgerCare
 Medicaid Disability and Elderly
 Blind and Disabled applications
 BadgerCare reviews
 Wisconsin Well Woman Program
 Wisconsin Chronic Disease Program
 Social Security Disability Programs (SSI and SSDI).
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We also may assist with Wisconsin Well Woman Medicaid and Medicare D when
needed.
Many of these programs work together so a number of applications may be applied for
simultaneously. We also assist with Marketplace applications; which is Wisconsin’s Affordable
Care Act option.
This past year the Health Benefits Program has received about 1900 tasks/referrals on patients
coming to the clinic without health insurance. Of those we have assisted, about 47 percent have
received some type of health coverage through Contract Health, BadgerCare, Medical
Assistance, Wisconsin Well Woman Program, Social Security Disability programs and the
Marketplace.
Our ultimate goal in assisting the Tribal member with health coverage is to provide affordable
coverage options that do not deplete the tribal member’s economic resources.
This report is respectfully submitted by Joyce Rockman, Health Benefits Supervisor
Contract Health Services Annual Report 2015
Funded by the Indian Health Service (IHS) the Contract Health Services (CHS) Program is for
medical/dental care provided away from the Ho-Chunk Health Care Center (HHCC), House of
Wellness (HOW), or other tribal health care facility. Medical/dental care provided at HHCC,
HOW, or other tribal health care facility is called Direct Care. CHS is neither an entitlement
program nor insurance plan and is to be considered the payer of last resort.
The need for CHS must be determined by your Primary Care Provider (PCP) at the HHCC,
HOW, or other tribal health care facility. Your PCP will issue a referral to CHS; CHS will
present referrals each week to the Managed Care Committee (MCC); MCC will determine the
outcome of referrals; and, return to CHS for processing and meeting minutes. CHS will not be
responsible for or authorize payment for services that are available at HHCC, HOW, or other
tribal health care facilities.
CHS eligible individual: An enrolled Ho-Chunk Tribal Member residing within the Contract
Health Service Delivery Area (CHSDA); or enrolled member of a Federally Recognized Tribe
residing within the CHSDA and determined to have social and economic affiliation with the HoChunk Nation.
Social and economic affiliation: Enrolled member of other Federally Recognized Tribe residing
within the CHSDA who are legally married to an enrolled Ho-Chunk Tribal Member. Copy of
the marriage certificate or court records are required to confirm marriage. Other enrolled
member of a Federally Recognized Tribe residing within the CHSDA for 6 months or longer as
evidenced by providing a lease, utility bill, driver’s license, or state I.D. For tribal members
residing outside of the CHSDA, they are eligible for Direct Care at any IHS or tribal health
clinic, and may apply to the At-Large Health Management (ALHM) Program. ALHM is funded
by the Ho-Chunk Nation, is for low income families, and is considered as payer of last resort.
Alternate resources must be applied to, prior to qualifying for the ALHM Program.
CHS Covered Services:
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Affordable Care Act Premiums
Cardiology
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Cataract Surgery
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Chiropractic Care
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CT Scans
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Dental
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Durable Medical
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Endodontics
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Ear, Nose, and Throat Specialty
Gastroenterology
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MRI
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Ophthalmology
Pain Management
Pathology and Laboratory
CHS Future Goals
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Promoting CHS in outlying areas
Promoting the Affordable Care Act
Collaborating with Dental, Optical, and Medical Clinics
Patient Transport
Physical Medicine and
Rehabilitation
Prosthetic & Orthopedic Devices
Urology
Respectfully submitted by Lynette Bird, CHS Administrator
Environmental Health Program Annual Report 2015
Overall Goal: The goal of the Environmental Health Services Program is to identify and alleviate any environmental
hazards that may harm the health of the Ho-Chunk Tribal Members.
The Ho-Chunk Nation Environmental Health Program is a comprehensive program which works to identify
environmental hazards which affect the health of tribal members and the general public served by Ho-Chunk Nation
Enterprises. Programs and initiatives are directed toward assessing environmental conditions, remediating existing
hazards, and preventing environmental problems.
Wazee Wastewater Construction
Wazee Subdivision Construction
Badger Ammunitions Land Transfer
Key Tasks
The following environmental areas are addressed by the program: Water Quality, Solid Waste Management, Wastewater
Management, Food Sanitation, Vector Control, Air Pollution, Institutional Environmental Health, Code Compliance in
Facilities, Community Injury Prevention, Underground Storage Tanks, Environmental Assessment, Emergency
Preparedness, Surface Water Monitoring, Wetlands Delineation, and Construction Projects.
Highlights for 2014-2015
 The Wazee Wastewater Treatment Plant Expansion was completed 2014 and will provide additional capacity for
future development and more housing in the communities of Sandpillow and Indian Mission. The project was
funded by a Clean Water Fund Loan from the State of WI in the amount of $10.4 Million dollars, of which the
Department of Corrections will pay $3.2 Million dollars for debt service.
 An Indian Community Block Grant and NPD funding was used to install sewer and water services in the Wazee
Subdivision located west of Sandpillow. The project began in November of 2014 and will be completed by
September of 2015.
 A study was funded by the EPA to study the Community Wells at Winnebago Heights and to plan for nitrate
removal equipment in the pumphouse if that becomes necessary. Nitrate Levels in the community have remained
below the standard set by the Safe Drinking Water Act; however, they are nearing the maximum contaminate
level at which time the water would not be considered safe to drink. Results of the study indicated that one well
was responsible for the high levels and that well was taken out of service. It will be replaced in the upcoming
year under a capital project funded by the Nation.
 Each year surveys are conducted on ninety-two facilities to assure that they are meeting recognized standards.
Other departments rely on these surveys to meet the requirements of their funding agencies or the gaming
compacts. In addition, 29 environmental assessments were completed for BIA, IHS, HUD and NPD projects.
 The Community Health Improvement Plan and a Health Department Strategic Plan were completed during the
past year. These will meet the pre-requirements for Public Health Accreditation. On-going meetings and
trainings have been held to assist us in meeting the requirements for Public Health Accreditation.
 Water Quality Assessments including chemical, biological and habitat monitoring were completed on 18 streams.
 Wetlands were delineated and assessed on 16 trust parcels.
 Invasive plant treatments were initiated on 900 acres of tribal land in Shawano and Clark Counties. $285,813 in
grant funds have been received to address invasive species on other tribal lands.
 Randy Poelma has provided technical support to the Office of the President, Legislature and D.C. Representation
to facilitate the transfer of 1552.5 acres of land from the Badger Ammunition Plant.
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A grant was received from the EPA under the Clean Air Act 103 Program to establish an Air Program for the HoChunk Nation. The Air Quality Specialist job description was approved and will be hired by September 2015.
The Environmental Health Program has partnered with several counties and the Institute for Wisconsin’s Health
to complete a Health Impact Assessment on Industrial Sand Mining.
A new Injury Prevention Coordinator was hired to replace a vacated position. Programs have been rejuvenated
and results have been positive. Child Safety Seat use has increased from 34% to 78.3% since 2011. Over the
same time period, seatbelt use has increased from 77% to 89.7%.
The Environmental Health Department currently manages $2,745,259 in grant funding. In addition, we are
managing $2.8 million in capital project funding and $842,000 to manage the seven wastewater treatment plants
and $813,000 in NPD Funding.
What’s in the Future?
 The Environmental Health Program will be working on the following initiatives in the next year:
 A new satellite health office has been approved in the community of Nekoosa. In addition, the health staff in
Wittenberg will have offices in the new community building.
 An expansion of the Ho-Chunk Healthcare Center was approved and will begin design this fall. The expansion
will allow Pharmacy to expand and create a larger revenue base.
 Continue to work toward Public Health Accreditation.
 Continue to work on the Sustainable Energy Task Force to construct a renewable energy facility.
 Transition to a new Director of Environmental Health.
Respiratory Fit Testing
Celebrating Earth Day
In 2015, the methodology changed for collecting this data.
This report is respectfully submitted by Carol Rollins, Director of Environmental Health
Behavioral Health Annual Report 2014 – 2015
Brief Description
Behavioral Health (DBH) has 6 State of Wisconsin dual licensed Department of Health Services 75 Community
Substance Abuse Service standards and DHS 35 Outpatient Mental Health Clinics located in Black River Falls,
Baraboo, Tomah, La Crosse, Nekoosa and Wittenberg. DBH provides standards of best practice in the delivery
of behavioral health services and brings a uniqueness that integrates Ho-Chunk cultural values with current
evidence-based practices.
Accomplishments
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State Urban Rural Women’s Grant – Behavioral Health received funding from the state of WI for the
Urban Rural Women’s grant which has continued to provide wrap around services to women and their
families. The women are referred by the behavioral health clinical staff to URWG to assist the referent
in helping with their everyday needs in becoming self-sufficient during the time that Behavioral Health
services are being followed up on.
SAMSHA System of Care - HCN Behavioral Health received a planning grant award from the federal
government Substance Abuse and Mental Health Services Administration (SAMSHA) for Systems of
Care in addressing severe mental health issues with children and young adults. This planning grant
addressed the needs only in Black River Falls and Baraboo areas. The grant ended the end of April
2014. The program coordinator and program assistant were vital in establishing the infrastructure to
encourage a sustainable, community based, family and youth driven system of care. Memorandums of
Understanding were developed to programs under the HCN and to 2 school districts. Community Youth
and Parent meetings were developed and held in 2 areas. 102 parents and 49 youth provided input on
the community questionnaire that was developed to address the needs. An advisory committee was
developed to establish the MOU’s, strategic plan for the implementation of Systems of Care, policies
and procedures and youth/family questionnaire.
House of Wellness integrative team leader assisted in coordinating the organization of BH and HoChunk Care Center health staff with their integrative team. Out of the integrated team at the HOW they
have developed mini-teams that meet with the client when developing some treatment plans. Dr. Ais
Murray, Public Health Advisor for IHS Behavioral Health in Bemidji, MN made a sit visit to explore
how we developed our integrated team and how it has evolved. His purpose is to analyze integrated
teams and how to help other facilities develop integrated teams.
The Behavioral Health Division has been utilizing NextGen for electronic health records and third party
billing. Despite upgrades that caused difficulty for BH staff we are able to learn and overcome.
Behavioral Health promoted the September Recovery Month activities and had a family fun day in
Black River Falls. April we had social dances in BRF, Tomah and HOW to promote Alcohol
Awareness. Family participation was the key so everyone was involved in these activities.
BH was involved in several activities throughout the areas: community education and outreach such as
health fairs, Diabetes Conference, Family Wellness and General Council.
BH is still working on the elimination of stigma, or a negative attitude towards seeking help for
addiction or mental health issues. The stigma keeps people away from help when they need it. As with
other medical problems, substance abuse and mental health issues are easier to mend when identified
and treated early.
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HCN BH continues to provide Motherhood/Fatherhood is Sacred groups at the HOW and Black River
Falls offices. We have also implemented Seven Challenges groups in the Black River Falls, HOW and
Nekoosa areas for Ho-Chunk young people.
BH will provide services to the Family Wellness Court, Coordinated Services Team Program, and HCNBH will be the primary provider for the Jackson Co. Adult Treatment Court, WI Department of
Corrections Cognitive Behavioral groups in Jackson Co. and Jackson Co. probation and parole. We had
6 BH staff attend the Intoxicated Driver Program training in Keshena last fall and we hope to provide
IDP assessment at all 6 sites by fall 2015.
HCN-BH assisted 37 enrolled tribal members with inpatient, detox services and outpatient services with NPD
treatment funding with total costs to the Nation was $207,038.
The following are the number of clients seen at our Behavioral Health offices:
Unique BH Patients by Encounter
Ho Chunk Health Care Center
247
House Of Wellness
281
La Crosse Health Office
26
Nekoosa Health Office
44
Tomah Health Office
34
Wittenberg Health Office
16

Through the Urban Rural Women’s grant 34 Ho-Chunk enrolled women were referred from Behavioral
Health.

Behavioral Health has helped with information to provide for the Kijiire Nagu Healing Center which is
still in process.
This report is respectfully submitted by Terry Greendeer, Director of Behavioral Health
Health and Wellness Program Annual Report 2015
The mission of the Ho-Chunk Diabetes Prevention Team is to promote a healthy lifestyle among the Ho-Chunk
People. Health promotion activities will be performed through an interdependent partnership between the HoChunk Nation Health Care Delivery System and Ho-Chunk communities. The partnerships will facilitate
Nation-wide efforts to raise the level of wellness among Ho-Chunk tribal members. The purpose of the team is
to develop, implement and evaluate a comprehensive health promotion program targeted toward educating,
energizing, and empowering communities.
HIGHLIGHTS AND ACTIVITIES:
Diabetes Basic Classes
 7 classes to learn the basics of diabetes management.
 193 Participants have completed all seven classes.
 Black River Falls, Wittenberg, Tomah, Baraboo, Nekoosa, Madison and La Crosse
 112/194 or 58% showed improvement in A1C.
 98/194 or 51% stayed managed at 7% or less.
 A total of 399 have signed up for the Basic’s program and completed at least one class, receiving
diabetes education.
 Of all participants with pre and post knowledge tests, 84% showed improvement.
 Completed Participants by area:
18%
51%
31%
Showed
Improvement
Stayed Managed at
7% or less
Not Improved
“Hįįxgąxgąkjawi – Let’s Move”
 In July of 2014, the Health and Wellness Team offered the employees Hįįxgąxgąkjawi an eight-week
pedometer step challenge. Participants had the opportunity to compete against one another to see who
could accumulate the most steps each week. The pedometers helped to give participants’ a visual
perception of how much activity they were getting each day, and the competition helped to keep people
accountable throughout the program. Overall, the program was a great success and left participants
hungry for more.
 The following November, offered the same program a second time, but expanded beyond employees and
offer it to members of the community.
 Two eight week campaigns took place this year.
 654 participants for the first campaign
Weight Loss Classes
 8% of Weight Loss Class participants lost at least 5% of their body weight over the course of 16 weeks.
 21 classes completed in BRF, Dells, Wittenberg, Nekoosa, and Tomah.
 214 participants have completed at least 1 class receiving weight loss education.
Diabetes Awareness Walk- November 2014
 Wisconsin Dells, Black River Falls
 72 participants in Black River Falls and 41 participants in Wisconsin Dells
 One mile walk and lunch
Annual Canoe Trip – June 2014
 Kickapoo River
 51 total participants
 Two hour canoe trip, lunch and education.
Annual Journey of Hope Conference – November 2014
 In November 2014 the Health and Wellness Team offered the Annual Journey of Hope Conference.
 237 Participants
 69 Conference Workers
Diabetes Learning Circles and Diabetes Wellness Clinics
 Black River Falls and Wisconsin Dells
 Bi-Weekly breakfast offered with an education piece.
 285 Natives have attended since April 1st, 2014 in Black River Falls and Baraboo.
Exercise Classes
 Offer a number of exercise classes
 Exercise Light
 Hunter Fitness
 Headstart Centers
 Tribal Aging Units
 Body Shapers
 Youth Education
 Get Strong Classes
 Boot Camp Classes
 Yoga classes
 Classes offered off site
 Since April 2014 we have offered 376 exercise classes
Continued participation in the Minutes in Motion program sponsored by Gunderson Lutheran
 99 signed up
 69 Contributed Minutes
 114,343 minutes were logged
Collaboration with Jackson County
 “Jackson in Action” collaboration developed in January 2012 continues.
 “Harvest of the Month” collaboration with the Ho-Chunk Nation Nutrition Program.
 The 2nd Annual “Pace and Pedal” was held on May 30th with 223 participants. This is held in
collaboration with Jackson County
Collaboration with Stockbridge Munsee Clinic
 Provided education classes for their community
 Promoted Basics classes to the clinic providers
Pallet Garden Program
 135 pallet gardens were distributed or set up for community members located in Black River Falls, La
Crosse, Tomah, Wisconsin Dells, Nekoosa and Wittenberg.
 10 Pallet Gardens were provided to community members through the “Jackson in Action” program.
 Two gardens were set up for the Nekoosa TAU
 Community Supported Agriculture (CSA)
 CSA is an opportunity for Ho-Chunk Nation members to purchase “shares” of a farm. This will allow a
member with a share to receive a box of vegetables weekly. This year was run as a pilot project and will
be offered again next spring. This program is open to all Ho-Chunk Nation members.
 94 Participants in 2015 Season
Fitness Membership Program
 The Ho-Chunk Nation has added this
program to encourage members of the HoChunk Nation to increase activity levels.
 Members may apply for a 6 month
membership to a local fitness facility.
 363 Fitness Membership Holders
GOALS FOR FY2015 - 2016
 Continue annual canoe trip and family events.
 Continue our Journey of Hope Wellness
Conference.
 Complete Diabetes Program Accreditation.
 Complete “Hįįxgąxgąkjawi – Let’s Move” worksite wellness campaign.
 Begin Pathways to Wellness Program.
SHORT TERM GOALS
 By June 2016, 25% of Pathway to Wellness program participants will achieve a 7% or greater loss of
body weight by six months after completion of classes.
 By March 2016 increase provider referrals from 6% to 10% for Diabetes Basics classes.
 By April 2016 increase the percentage of participants that have met at least one behavioral goal for
Diabetes education from 10% to 13%.
LONG TERM GOALS
 Offer the Pathways to Wellness to Ho-Chunk Nation members.
 Decrease the prevalence rate of diabetes diagnosis
This report was respectfully submitted by Karena Thundercloud, Health and Wellness Program Supervisor
Community Health Nursing (CHN) Annual Report 2015
The Community Health Nursing (CHN) Program promotes and preserves the health of the Ho-Chunk population by combining skills
and knowledge relevant to both nursing and public health. The practice is comprehensive and general; not limited to a particular age or
disease related group.
Emphasis in practice is on promotion and maintenance of the population’s health and on the prevention and limitation of disease.
Nursing services are divided between care for the individual, care for the particular community, and care for the population.
Goals of the Program: To provide health education and care for all Ho-Chunk and other Native Americans who reside within the
contract service areas. Home visits will be made in each area by the CHN according to priority in need. Group screening and
education will be conducted as arranged by the Community Health Nurse or by referral. Public Health Services will be provided as
indicated by community need.
All Locations: CHN Responsibilities
HIV Tests (190)
Foot Care (529)
MCH Visits (1,684)
WIC Visits (350)
Caregiver Transports (4,837)
Caregiver Home visits (12,151)
Case Management (5,823)
Immunizations (767)
Nurse Office visits (1470)
Telephone calls (18,943)
Patient Education Hours(1,248.5)
Nurse Home Visits (3148)
0
2000
4000
6000
8000 10000 12000 14000 16000 18000 20000
ALL LOCATIONS:
CHN over the last fiscal year has provided the following services:
 3,173 Home Visit and 34,621 total patient contacts
Caregivers over the last fiscal year have provided the following services:
 4,837 transports for medical services
 12,151 home visits (cleaning, medication reminders, meal prep, etc.)
Contract Services for In Home Care:
 Contracted Services have allowed for over 40,000 hours of after-hours services to our tribal elders in
need of care in the home after hours.
 28 contracts placed (82% of Contract Service Providers are HCN Tribal Members)
 28 elders served from contracts
 20 continue to be active
BRF CHN/Caregiver Contacts & Services
Foot Care (73)
MCH Visits (26)
WIC Visits (180)
Caregiver Transports (1,610)
Case Management (548)
Immunizations (230)
Patient Education Hours (126)
0
1000
2000
3000
4000
5000
6000
7000
8000
 709 Home visits and 8,544 total patient contacts
 346 unduplicated elders received home care
Caregiver over the last fiscal year has provided the following services:
Accomplishments:
 Contracts with Managed Care Organizations in CHSDA to receive reimbursement for services rendered.
Reimbursement Revenue received: $18,720.42.
 Personal Care Agency application submitted.
 Megan, RN, BSN:
 Trainings and Certifications: Foot and Nail Care Education, Statewide Quality Improvement conference,
FEMA: Isolation and Quarantine in Rural Communities.
 Provided screenings at Community Health Fairs and is on the Contract Health Committee.
HOW CHN/Caregiver Contacts & Services
Foot Care (168)
MCH visits (800)
WIC (91)
Caregiver Transportation (1,961)
Case Management (4,192)
Immunizations (220)
Patient Education Hours (517.5)
0
1000
2000
3000
4000
5000
6000
Caregiver over the last fiscal year has provided the following
services:
 4,167 home visits (cleaning, medication reminders, meal prep,
etc.)
Accomplishments:
 Kandi, RN:
 Trainings: Wisconsin Public Health Nursing Conference, Geriatric Symposium, Pain/Addition Webinar,
Isolation and Quarantine in Rural Communities
 Preceptor for UW-Madison and Edgewood Nursing Students
 Lisa, RN, BSN:
 Training: Statewide Quality Improvement conference, FEMA: Isolation and Quarantine in Rural
Communities
 Allie, RN, BSN, CLC, CPS:
 MCH Block grant co-coordination; HCN local coalition, HCN Breastfeeding Coalition
 Training: WALC Breastfeeding Conference, Statewide Quality Improvement conference, FEMA:
Isolation and Quarantine in Rural Communities, Life Savers Conference, PNCC Regional Meetings
 Certification: maintained Certified Lactation Counselor and Child Passenger Safety Seat Technician,
First Breath and My Baby and Me trained
 Partners In Parenting classes monthly at House of Wellness
Tomah CHN/Caregiver Contacts & Services
Foot Care (107)
MCH Visits (60)
Caregiver Transports (300)
Caregiver Home visits (779)
Immunizations (23)
Patient Education Hours (150.5)
Telephone Calls (4,460)
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
 300 transports for medical services
 779 home visits (cleaning, medication reminders, meal prep, etc.)
Accomplishments:
 Jessica, RN, BSN, CLC (CHN Supervisor):





Member of: HCN Task Force for Drug Free Communities, Wisconsin Statewide HIV Action Plan
Group: advisory board to Wisconsin Department of Health
Co-Coordinator HCN HIV Prevention Program/Grant and SafeLink Needle Exchange
Training: Safe, Healthy Strong Conference, Transgender Awareness, National Rural Institute on Drug
and Alcohol Abuse, Quarterly HIV Tribal Coordinator
Certification: maintained Certified Lactation Counselor, First Breath and My Baby and Me trained
Preceptor: Viterbo and Western Technical College Nursing students.
Nekoosa CHN/Caregiver Contacts & Services
Foot Care (39)
WIC (79)
MCH (36)
Caregiver Transports (783)
Immunizations (139)
Office visits
Telephone calls (425)
0
500
1000
1500
2000
2500
3000
Accomplishments:
 Pam, RN, CLC, CPS:
 Co-Coordinator HCN HIV Prevention Program/Grant, CPR Instructor
 Training: Safe, Healthy Strong Conference, Quarterly HIV Tribal Coordinator, Statewide Quality
Improvement conference, FEMA: Isolation and Quarantine in Rural Communities, WALC
Breastfeeding Conference
 Certification: Child Passenger Safety Seat Technician, maintained Certified Lactation Counselor, First
Breath and My Baby and Me trained
La Crosse CHN/Caregiver Contacts & Services
Foot Care (53)
MCH (533)
Caregiver Transports (54)*
Caregiver Home visits (89)*
Immunizations (22)
Nurse Office Visits (111)
Education (133.5)
0
200
400
600
800
1000
1200
1400
1600
1800
 *No Caregiver in La Crosse Area July 2014-March 2015
Accomplishments:
 Shawn, RN, BSN, CLC (CHN Supervisor):
 MCH Block grant co-coordination; HCN local coalition, HCN Breastfeeding Coalition
 Training: USBC Annual Conference as Tribal Rep, Statewide Quality Improvement conference,
FEMA: Isolation and Quarantine in Rural Communities, WALC Breastfeeding Conference, PNCC
Regional Meetings
 Certification: maintained Certified Lactation Counselor, First Breath and My Baby and Me trained
 Preceptor for Viterbo and Winona State Nursing Students
 Partners In Parenting classes monthly at House of Wellness
Wittenberg CHN/Caregiver Contacts and Services
Foot Care (89)
MCH (75)
Caregiver Transportation (129)
Caregiver Home visits (102)
Immunizations (133)
Nurse Office Visits (146)
Telephone calls (186)
0
100
200
300
400
500
600
Accomplishments:
 Judy, RN, BSN, CLC, CPS, CDE:
 Shawano County Family Health Coalition, Coordinates Wittenberg Health Fair
 Training: Statewide Quality Improvement conference, FEMA: Isolation and Quarantine in Rural
Communities, WALC Breastfeeding Conference
 Certification: maintained Certified Lactation Counselor, First Breath and My Baby and Me trained,
Smoking Cessation
Respectfully Submitted by: Jessica Tyler and Shawn Meyer, Community Health Nursing Supervisor
Community Health Representative (CHR) Program Annual Report 2015
The Community Health Representative (CHR) Program is an Indian Health Service (IHS) funded, tribally contracted and
directed program of well-trained, community-based, health care providers who provide health promotion and disease
prevention services in their communities.
♦♦ CHR Goal: To improve and maintain the quality of health and life within the Ho-Chunk Nation to its members
through their dedication and accountability to meet
the needs of the People.
Major Program Services:
Indian Health Service (IHS) monies provide for the
1. Home visits to assess/monitor client’s health status
2. Provides transportation for client to access health care
budget of the CHR Program annually. The IHS
3. Takes BPs/BSs, referrals, health screenings, follow-ups
budget for FY 15 includes funds which pay for the
4. Assists, plans, coordinates community health
salary of one (1) CHR Supervisor and eight (8) CHRs
activities/events
and other program costs. This year the program
5. Provides health education to programs/communities
became fully staffed in the IHS Contract Health
6. Provides 3 WIC clinics for eligible participants
Service Delivery Area (CHSDA). The Ho-Chunk
7. Provides carseat safety education/distributes carseats
8. Care coordination with appropriate health care
Nation CHR Program will only provide services in
provider(s)
those designated counties to stay in compliance
with the IHS CHSDA as stated in the Federal Register.
The CHR Program participated in several online webinar trainings this past
funding year. The most important online training was the 60 modules that
were completed by all CHRs called Indian Health Service (IHS) CHR Basic
Training. Due to IHS fiscal cut backs for CHR national trainings online
webinars are now becoming the norm for the National CHR Program and
are offered through IHS.
We strive to accomplish our programmatic goals on a daily, weekly, and
monthly basis to ensure the health needs of the Ho-Chunk People are
linked to services. As community members themselves they are the first
avenue for contact and they have the ability to do an assessment of
situations and provide the appropriate responses or services.
This report is respectfully submitted by Ruth Puent, CHR Supervisor.
Services – FY14
Done
#
attend
Home Visits
Office Visits
Phone Contacts
WIC Clinics
Care Coordination
Health Education
Referrals
Transports
Blood Pressures
Blood Sugars
2,818
1,129
3,702
1,464
2,079
132
1,685
239
804 = Requests
539 = Done
(265 = Referred)
1,752
1,394
Sub-totals
Total
16,052
17,737
1,685
Nutrition Program Annual Report 2015
Program Description and Services:
The Ho-Chunk Nation Nutrition Program is dedicated to serving HCN Tribal members, employees and their
families by providing nutrition education at community events, diabetes classes, health fairs, and conferences
and offering one-on-one Medical Nutrition Therapy (MNT) for a variety of medical conditions such as diabetes,
heart disease, and obesity.
Accomplishments:
 Provided community outreach and nutrition education at Blue Wing & Indian Heights Organic Community
Gardens, General Council, Diabetes Wellness Conference, Pallet Gardens, Pedal & Pace, HCN Health Fairs,
Partners in Parenting, HOW & Nekoosa Youth Gardens, Digital Story Telling Projects, TOB Harvest of the
Month, DM Canoe Event, Jackson In Action, Jackson Co. Health Fair, etc.
 In an effort to combat obesity, and prevent chronic disease and health related complications, expanded
community outreach serving 1447 new contacts by providing a variety of nutrition services such as
education, handouts, displays, booths, and cooking demos to the following: La Crosse Craft Group,
Mauston Youth, BRF Cancer Support Group, Madison Elders,
La Crosse Foot Clinic, Urban Women’s Grant, Youth & Head Start Family Nights, Tribal Office Building,
and HC-Gaming BRF & Dells.
 Provided monthly nutrition education at WIC Clinics, Head Starts, Youth Services, Tribal Aging Units,
Food Distribution tailgates, TOB, HC- Gaming, Community Gardens, etc.
Group


WIC
Head
Start
Youth
Food
Dist
Adults Elders
Age
<5
Age
5-17
Age
1859
Age
≥ 60
Direct
Contacts 192
794
1385
813
1306
734
794 1385 2311 734
Indirect
Contacts 305
321
177
288
1702
406
321
177 2295 406
Facilitated, and provided diabetes-related nutrition education at Diabetes BASICS classes, Weight Loss
classes, Munch & Motivate classes, Breakfasts, Learning Circles, Wellness Clinics, Awareness Walk, and
Wellness Conference; to also include preparation/selection of healthy recipes/meals/snacks.
HHCC/HOW/FIELD
Direct Contacts
Diabetes
1229
Classes/Clinics/Breakfasts/Walks/Conference
Continued community outreach by coordinating with Health and Wellness, Youth Services, HHCDA, and
Dept. of Education to expand community gardens and by offering cooking demos/presentations on
gardening/CSAs/Farmers Markets, by providing cooking demos using commodity ingredients at Food
Distribution, and by submitting bi-monthly nutrition articles for publication in the Hocak Worak, Youth,
Elder, and Branch Office newsletters.
Partnerships/Networking/Memberships:
 WI Academy of Nutrition & Dietetics, WI Nutrition Educators, Viterbo University, WI Breastfeeding
Coalition,
HCN Breastfeeding Coalition, HCN Dept. of Education, HHCDA, GLITC, Public Health Accreditation
Board, WI Nutrition & Physical Activity Workgroup, Nat’l Academy of Nutrition & Dietetics, and Jackson
In Action.
Future Goals and Development:
 During the 2015 growing season the Nutrition Program will support community gardening projects to
improve access to, and encourage use of, locally grown produce.
 In 2015, increase by 10% Medical Nutrition Therapy (MNT) Referrals to HCN Registered Dietitian
Nutritionists (RDNs).
 Will provide current calendar of events, nutrition education, recipes, cooking demo videos, etc. on the
Health internet webpage to promote healthier eating and lifestyles and to increase access to nutrition related
information by Tribal members; especially those who are At-Large.
Additional Services Provided:
HHCC/HOW/FIELD
Medical Nutrition Therapy/Counseling
Women, Infant & Children Clinics
Referrals Received
Direct Contacts
1875
480
190
This report is respectfully submitted by Denise Dodson, Nutrition Program Director
Food Distribution Program Annual Report 2015
Program Description:
The Food Distribution Program of the Ho-Chunk Nation continues to provide USDA commodity foods to
eligible participants meeting lowered income guidelines and are federally recognized Native Americans or
elderly persons residing on, or near, Indian reservation lands.
The Food Distribution Program provides families with a food package and offers up to 75 food items in canned,
dried, or fresh produce items consisting of fruit, vegetable, dairy, pasta, poultry, beef, cereal and flour.
The Food Distribution Program’s main office is in Black River Falls where program services are available daily
at the main office/warehouse or on Wednesday’s during regularly scheduled distribution sites referred to as
“tailgate”. The tailgate services are offered in the communities of Wisconsin Dells, Wittenberg, Tomah, and
Nekoosa.
The Food Distribution Program has a total of 5 employees: 1 Supervisor, 1 Secretary, and
3 Warehousemen. All employees are very knowledgeable and skilled in their respective responsibilities and
tasks. The staff are trained and certified annually in CPR(Cardio Pulmonary Resuscitation), Forklift Operation,
AIS(Automated Inventory System), Civil Rights, OSHA(Occupational Safety & Health Administration) Safety,
HIPAA(Health Insurance Portability and Accountability Act), and are CDL(commercial drivers license)
qualified.
Accomplishments:
 July 1, 2014 – June 30, 2015 – 4,771 certifications 3,225 households and 8,550 participants.
 The Food Distribution Program issued 18,173 cases/557,495 pounds totaling $498,730.29.
Areas:
Area I
Area II
LaCrosse,
Counties: Wood
Portage Monroe,
Trempealeau,
Vernon
Families
Served
325
433
Area III Area IV Area V
Adams,
Marathon Clark,
Juneau,
Shawano Eau
Sauk,
Claire,
Columbia
Jackson
761
281
Total
Served
3,250
1450
Future Goals:
 The Food Distribution Program will continue to offer quality service to our communities and families in
the 5 service areas.
 Small building improvements; installing offices for Food Distribution staff, install sidewalk at the
loading dock area for shipments.
1600
1400
1200
Region 1
1000
Region 2
800
Region 3
600
Region 4
400
Region 5
200
0
2014
Region I
Region 2
2015
Region 3
Region 4
Region 5
2014
245
347
648
223
1387
2015
325
433
761
281
1450
Counties:
WOOD
LA CROSSE
ADAMS
MARATHON
CLARK
PORTAGE
MONROE
JUNEAU
SHAWANO
JACKSON
VERNON
SAUK
TREMPEALEAU COLUMBIA
EAU CLAIRE
2015 “Commod Squad” pictured left to right: Robin Flick/Warehouseman, Andrew Rave/Supervisor, Gabriel
Casey/Warehouseman, Susan Wilcox/Secretary III, Kym Meltesen/Warehouseman, Alejandro Rodriquez,
Youth Worker.
Respectfully submitted by Andrew Rave, Supervisor - Food Distribution Program Supervisor

Welcome from the Executive Director of Health - Ho

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