4 JANUARY 15, 2009
Smoke Signals
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By Dean Rhodes
Smoke Signals editor
A second briefing by Tribal Health
Executive Director Mark Johnston
on the Tribe's hiring of a new third
party administrator to process
health claims evolved into a broad
ranging discussion about lifestyles
and their monetary effects on the
Tribal member health plan at the
Jan. 4 General Council meeting
held at the Monarch Hotel & Con
ference Center in Clackamas.
Johnston made his first presenta
tion about the third-party admin
istrator changeover at the Dec. 7
General Council meeting (see Dec.
15 Smoke Signals).
Johnston and Health & Well
ness Administrative Officer Allyson
Lecatsas repeated the presentation,
as well as expanded on details in re
sponse to Tribal member questions.
Tribal Elder Les McKnight asked,
after hearing that the new provider
network, First Choice Network, only
enrolls doctors in Washington, Ida
ho, Oregon and Alaska, about Tribal
members living in other states.
Lecatsas said that there are corre
sponding provider networks in other
states that Tribal members use.
'Tribal members who live outside
of that area have received different
information," Johnston added.
Tribal member Joseph Brisbois
asked what Tribal members should
do if they require medical care while
traveling outside of the network's
four-state Northwestern region.
Lecatsas said that Tribal mem
bers, in an emergency situation,
should go to the nearest provider
regardless of the doctor's network
affiliation.
"Since it is an emergency, it will
be paid as in-network," she said.
Lecatsas added that health care
while traveling abroad is more
complicated. Tribal members would
probably need to pay for their health
treatment upfront perhaps with
a credit card and then submit
their bills to Shasta Administrators
of Bend for reimbursement.
Johnston repeated the reminder
. - I V
o J f
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Photo by Michelle Alaimo
Tribal member Bryan Mercier questions whether the Tribal Health
Department is planning on educating Tribal members on healthy lifestyle
choices during the General Council meeting held at the Monarch Hotel &
Conference Center in Clackamas on Sunday, Jan. 4.
that the Tribal member health
plan is self-funded, meaning that
when Tribal members go to a doc
tor or hospital, they are spending
Tribal funds.
"Shasta is just a claims proces
sor, not an insurance company,"
he said.
Johnston said the Tribe also will
continue to work on making the
Tribal member health plan a sec
ondary payer for Tribal members
who have other health insurance,
thereby reducing Tribal costs.
In response to another question,
Lecatsas said that Tribal members
who are also Tribal employees only
received one health card - the Trib
al employee health card and that
Shasta will automatically make
the employee health plan primary
and the Tribal member health plan
secondary for that group of Tribal
members.
Tribal Council member Valorie
Sheker said that one of the reasons
the Tribe selected Shasta Adminis
trators as the Tribe's new third party
administrator is that the company
agreed to possibly hire a Tribal mem
ber as its onsite representative and
teach that employee how to manage
Tribal health care claims.
"It's a very complicated process,"
Sheker said.
But the discussion turned on a
dime when Tribal member Bryan
Mercier asked if the Tribal Health
Department has expanded plans on
educating Tribal members about
making healthy lifestyle decisions,
such as not smoking, drinking or
using drugs, as well as getting ad
equate amounts of exercise. ,
"They are the ones that draw down
Tribal funds," Mercier said, point
ing out that health care expenses
account for about 25 percent of the
Tribe's overall governance budget.
Tribal Chairwoman Cheryle A.
Kennedy said that, based on her
experience in the medical field, it is
a well-known fact that some demo
graphic groups, such as teenagers,
have very little effect on health care
plans while others, such as women
of child-bearing age, have more.
In addition, Kennedy said, Grand
Ronde Tribal members have the
same rate of diabetes and heart
disease as other Native American
populations.
"And our population tends to live
longer," Kennedy said, referring to
a healthy stock gene. "During the
elimination of Native Americans,
only the healthiest survived."
Tribal Council member Kathleen
Tom agreed with Mercier, saying
that many illnesses, from lung
cancer to heart disease to diabe
tes, are preventable by changing
lifestyles.
But Sheker asked if the discus
sion meant that eventually the
Tribe would segregate Tribal mem
bers who smoke andor drink.
"Would it mean we would not
cover them? Or they would have
a co-pay? What is the point of this
discussion?" Sheker asked.
Kennedy said segregation was
not the intention. "We need to build
a plan that is responsive to Tribal
members' needs, not segregate
them," she said.
Mercier agreed, saying that the
Tribe needs to work at making
Tribal members aware enough of
their health status to make good
lifestyle choices that would contrib
ute to reduced health care costs.
And Tribal Council member Wink
Soderberg said the Tribe needs to
investigate use of alternative, na
turopathic medicines in its health
care arsenal.
Johnston wrapped up the discus
sion, saying many of those items
would be good questions for the
Tribal Health Care Task Force to
address.
In other action, it was announced
that the next Tribal Council meet
ing will be held at 10 a.m. Sunday,
Feb. 8, at the Tribal Gymnasium in
Grand Ronde.
Tribal members Bryan Mercier,
Robert Nagel and Dan Stroebel
won the $50 door prizes and Tribal
Elder Marilyn Portwood won the
$100 door prize. Stroebel donated
his door prize to the Veterans'
Special Event Board and Portwood
donated her winnings to the Tribal
Library. B
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