The Foundation to Improve Care Access for Native Americans

Proof of Concept in the Fight Against Disparity of Care

Joel Rainwater, MD

Founder and CMO

Comprehensive Integrated Care

“People Are Dying Here:”

Federal Hospitals Fail TribesIndian Health Service facilities sanctioned for dangerous, faulty care, leaving often-

impoverished patients on remote reservations without services required by law

Oliver Semans, a member of the Rosebud Sioux tribal health board, at a cemetery on the South Dakota reservation.

By Dan Frosch and Christopher Weaver

July 7, 2017 10:16 a.m.

Re-stratification of the challenge• Disease states progress

unchecked due to systemic failure of early detection and treatment

• Patients with poor or no access to preventative care

• Expensive Disaster management is the norm

• Facilities not equipped

• Too few facilities

• Remote locations

• Limited and underpaid staff

• Care seeking behaviors not rewarded

• Absent communication platform

• IHS Facilities not designed for specialty focus

• Patients at risk are not identified

Foundation to Improve Care Access for Native AmericansF • I • C • A • N • A

FICANA Timeline

• Origin and Application: May 2017

• Legal Documents defended August 2017

• Board elections December 2017

• 501 (c) (3) Status Granted February 2019

Advancing Health Equity in Native America though Creative, Compassionate,

Community-Based Solutions

Why Peripheral Arterial Disease and Amputation as a Marker for

the FICANA Program?• Native Americans suffer this condition 3 X compared to

the US average

• Native Americans have markedly decreased access to preventative care

• Less than 5% are treated with interventional or endovascular methods

• It is THE HARBINGER of future expensive and dangerous conditions

Navajo Nation & Hopi Tribe

• Population: > 300K

• ~ 27,425 miles2

• 5 agencies & 110 chapters in 3 states

• Population: ~ 12K

• ~ 1.5 million acres

• 12 villages on 3 mesas

Navajo Area IHS

Our Challenge•AI/AN amputation rates are 3-4 times higher than general population. •AI/AN mortality rates from the complications of Diabetes are 3 times the national average.

-National Limb Loss Information Center

Disease Burden• Admission for diabetic foot/leg disease is

the single largest component of hospital bed usage by diabetics.

• 50% of diabetes-related admissions are for lower limb disease.

• More inpatient days spent treating pedal wounds than any other diabetic complication

Our Mission

•Direct Care•Education•Resources •Research

• Education and the Transfer of Knowledge are Vital to the role of the healer living in Native communities.

• Overcome all barriers with FICANA

Major Amputation down 85%

3000+ endovascularprocedures in 3+ years.

Over 20 providers now part of the Network

Local, Native-Led Foundation

500+ microgrants completed

RESOLUTION OF THE

NAABIK' IYATI' STANDING COMMITTEE OF THE

23rd NAVAJO NATION COUNCIL -- Fourth Year, 2018

AN ACTION RELATING TO HEALTH , EDUCATION AND HUMAN SERVICES ;

NAABIK'IYATI'COMMITTEE ; SUPPORTING THE FOUNDATION TO IMPROVE

CARE ACCESS FOR NATIVE AMERICANS (FICANA) IN ITS INITIATIVES TO

REDUCE THE NEED FOR AMPUTATION ON THE NAVAJO NATION THROUGH

INTERVENTION CARE IN THE AREAS OF LIMB PRESERVATION AND OTHER

DISEASE STATES BEST TREATED BY MINIMALLY-INVASIVE CARE

FICANA will assist S-COE Facilities to deliver superior medical care to all Native beneficiaries in a progressive, academic setting in a manner both culturally appropriate and practical in the Reservation setting.

Our Vision

Thank you!