NCUIH Health Tech for Urban AI/AN

NCUIH is a 501(c)(3) organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/AN) living in urban settings.

The Problem: The COVID-19 pandemic has upended many parts of the Indian health system and is intensifying health inequities for urban AI/AN communities. Support to urban AI/AN is critically-needed now more than ever. 

The Solution: Telehealth bridges the gap between urban AI/AN, physicians and health systems, providing critically-needed access to health care through virtual channels. By using telehealth solutions, urban AI/AN can receive care from home while minimizing the risk of contracting (or spreading) the COVID-19 virus.

How solution will positively change lives if it was scaled globally: NCUIH’s solution will provide a framework for urban AI/AN in diverse settings across the country by improving access to culturally-competent health care through telehealth going forward, beyond the current pandemic.

AI/AN face some of the starkest disparities in health outcomes of any racial population the U.S. and are more vulnerable to infectious disease outbreaks as a result of a lack of access to critical public health infrastructure and resources. Urban Indian Organizations (UIOs) strive to address the social, cultural, and access barriers by providing culturally appropriate healthcare designed to meet the unique needs of urban AI/AN. Despite large health disparities among the AI/AN population, there are significant funding gaps. The most critical and primary source of funding for AI/AN health care is the Indian Health Service (IHS); however, IHS is significantly under-resourced, usually funded at between 50% and 60% of need, forcing patients to forego serious care and delay basic care.

Although more than two-thirds of AI/AN live off reservations, IHS spends less than 1% of its budget on the provision of health care to urban AI/AN. This impacts more than 70% of the total the AI/AN population in the U.S., which includes approximately 4 million people.  

Additionally, COVID-19 presents new barriers to accessing health care. Telehealth reduces health care barriers to urban AI/AN and delivers care safely during health emergencies.

The National Council of Urban Indian Health (NCUIH) is the national organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/AN) living in urban settings. NCUIH provides high-quality and up to date technical assistance and representation to UIOs, and provides updated regulatory, technology-related and public health topics that are impacting UIOs’ capacity to serve the urban AI/AN community using culturally competent and responsive approaches.

As a result of COVID-19, and for future emergency preparedness, NCUIH is working to strengthen urban AI/AN access to quality, culturally-competent health care through telehealth platforms. NCUIH’s solution supports telehealth capacity building and establishes a sustainable telehealth infrastructure to insure equitable policies for flexible implementation of telehealth. As telehealth continues to evolve during the COVID-19 pandemic, NCUIH advocates for regulations to ensure that UIOs are included in emergency funding packages to meet emerging and unique needs of urban AI/AN. In addition, NCUIH provides training and technical assistance to UIOs through a Community of Learning series to support and strengthen access of telehealth to urban AI/AN.  The use of technology for capacity building within UIOs improves access to and delivery of telehealth services to urban AI/AN.

NCUIH serves AI/AN communities with a special focus on those living in urban areas, which is about 3⁄4 of the total Native U.S. population. According to the last U.S. census, over 70 percent of AI/AN people live in urban areas, which is over four million people. However, urban AI/AN are frequently left out of the national discussion and, as a result, omitted from key legislation intended to benefit all Indian health. This structural exclusion has debilitating health consequences on urban AI/AN and is amplified as the UIO patient population continues to increase. 

 As the only national organization advocating for the health of urban AI/AN, NCUIH provides critically-needed technical assistance, training, policy support, and other services to the 41 Urban Indian Organizations (UIO) that provide health services throughout the United States. UIOs value AI/AN culture, beliefs, spirituality, traditions and strive for the overall health and well-being of their patients. Telehealth provides effective communication and comprehensive connection to patients in a meaningful way and allows urban AI/AN to access health care that understands and appreciates the patient’s culture and values.

AI/AN face some of the starkest health disparities of any racial group in the country. AI/AN communities are more vulnerable to infectious disease outbreaks as a result of a lack of access to critical public health infrastructure and resources. Because of a lack of funding for urban AI/AN health systems, providing access to affordable, quality and culturally-competent health care is a critical need, especially during a health pandemic. NCUIH’s solution is well-aligned to the Challenge because it directly focuses on preventative and mitigation measures that strengthen access to quality healthcare and improves the health care supply chain for urban AI/AN.

NCUIH was created in 1998 to think outside of the traditional telehealth box. For example, NCUIH uses technology to address new challenges in the healthcare system through incremental improvements, refinements and modifications so that all urban AI/AN have access to culturally-competent telehealth services during the current pandemic and beyond. There are partner nonprofit organizations in the public health sector, but only NCHUIH engages with urban AI/AN at the breadth and scale to meet this population’s current health policy and health care challenges. NCUIH offers UIOs health policy guidance, health maintenance and preventative care using remote learning technologies, including telehealth technology that is culturally competent. NCUIH is unique in its approach to health education and health policy delivery as the core of our mission is to provide healthy solutions to a variety of physical and mental health challenges that are unique to AI/AN urban communities.

NCUIH understands that our AI/AN communities are typically under-resourced with respect to technology. Therefore, the core technology that powers NCUIH’s solution includes common use software that allows our organization to communicate policy updates, available funding and training to our UIO partners. This is done through a bi-weekly Community of Learning series using Adobe Connect. We also regularly use Sharepoint to share up-to-date information with UIO partners. NCUIH also offers regular training and technical assistance through existing technology to UIO partners that includes telehealth support and best practices.

NCUIH’s technology works and allows our organization to regularly connect with UIO partners to provide updates, training and technical assistance. Adobe Connect are Sharepoint are two widely-used products and allows for active participation throughout each Community of Learning and/or training session. Our seminars are routinely evaluated and participants provide feedback regarding the utility of sessions that have served to improve their healthcare challenges at the patient level and through health policy outcomes.

NCUIH’s theory of change (TOC) is a thoughtful and strategic approach to defining healthy outcomes for our AI/AN communities. The TOC helps NCUIH make decisions that are aligned with our mission and strategic goals. One strategic goal is to identify innovative technology that will enable NCUIH to better serve Urban Indian Organizations throughout the United States. NCUIH’s proposed solution will help UIOs plan and implement emergency preparedness for health security during the current pandemic and to prepare for future emergencies. NCUIH activities are designed to provide policy and technical assistance to over 41 UIOs with divergent needs and health care capacities. It is our responsibility to leverage our resources for coordinated and individual outreach within our 41 UIOs, using competent and culturally sensitive technologies.

NCUIH currently serves 41 Urban Indian Organizations throughout 22 states. Over the next five years, NCUIH has the opportunity to impact up to 4 million people.

NCUIH is the primary resource center on urban Indian health care. Our goal within the next year is to continue to identify and advocate for health priorities across urban AI/AN communities. NCUIH’s goal within the next five years is expand the reach of our organization to continue to grow and positively impact the lives of urban AI/AN. NCUIH envisions a nation where comprehensive, culturally competent personal and public health services are available and accessible to all AI/AN living in urban communities throughout the United States.

The largest barrier to accomplishing our goals and strategic growth in the next year and in the next five years include future fundraising. While NCUIH is a financially sound organization, we are concerned about the long-term impacts COVID-19 will have on the economy and the long-term health of affected patient populations

To prepare for and overcome these challenges, we are ramping up our fundraising efforts to support additional COVID-19 projects and diversify our funding sources. NCUIH is also using technology to keep our communities informed on the most up to date information on the physiological and sociopsychological impacts of COVID-19 through webinars and interactive seminars.

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10 – full time

With over 20 years of experience, NCUIH is the only national organization advocating for the health of urban AI/AN and crafts policies in a unique way to account for the federal obligation to AI/AN regardless of place of residence. NCUIH is governed by an experienced Board of Directors deeply committed to the agency’s mission. The board is 100% minority owned and includes 91% AI/AN. NCUIH’s Executive Director, Francys Crevier, JD, oversees administrative, operational, and programmatic activities to ensure alignment with NCUIH’s strategic plan. Ms. Crevier’s up-bringing as an urban AI/AN, her legal training (including a Certificate in Indigenous Peoples Law and Policy) as well as over ten years of experience serving Indian Country has provided her the expertise to guide NCUIH’s efforts to advocate for urban AI/AN.

Collaboration is a key component to NCUIH’s work allowing us to provide enhanced, high-quality advocacy and support to UIOs, without unnecessary duplication of cost and effort. National partners include the central hub of efforts to improve urban Indian health in the US. NCUIH has longstanding partners across federal agencies including the Indian Health Service (IHS), the U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Disease Control (CDC), among any others. NCUIH has countless partners both at the national level and local level. Local partners include John Hopkins University, the University of North Dakota, and the University of Chicago as well as countless partners in Native communities making us uniquely situated to convene these key institutions to achieve increasing urban AI/AN access to health care through telehealth.

NCUIH is a 501(c)(3) nonprofit that raises revenue to achieve our mission, to support development of quality, accessible, and culturally-competent health services for AI/AN living in urban settings. The organization is financed through grant funding provided by government entities and philanthropic foundations. Grant funding generally supports all ongoing operational costs of NCUIH. Our key beneficiaries are urban AI/AN communities throughout the United States. As the only national organization advocating for the health of urban AI/AN, NCUIH provides critically-needed policy support, technical assistance, training, and other services to the 41 Urban Indian Organizations (UIO) that provide health services throughout the United States.

NCUIH employs a dedicated development department with strategic fundraising goals to support financial sustainability. Our fundraising is through sustained donations and grants, which include public grants through federal agencies and private grants through foundations and corporate giving initiatives. 

NCUIH is applying to Solve to improve protocols related to health emergency preparedness among urban AI/AN communities. One of the most significant barriers Indian Country faces is limited funding and support. As COVID-19 cases continue to rise in Indian County, including among urban AI/AN populations, the use of telehealth is critically important. Solve funding will fund our critically-needed initiative to expand telehealth availability to urban AI/AN across the country.

NCUIH is interested in partnering with MIT to use technology to improve access to culturally-competent health services for urban AI/AN. We would welcome the opportunity to meet with MIT faculty to learn more about initiatives and other partnership opportunities to enhance programs and services to urban AI/AN communities throughout the country.

The National Council of Urban Indian Health (NCUIH) is the national organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/ANs) living in urban settings. NCUIH envisions a nation where comprehensive, culturally competent personal and public health services are available and accessible to American Indians and Alaska Natives living in urban communities throughout the United States. As the only national organization advocating for the health of urban AI/AN, NCUIH provides critically-needed technical assistance, training, policy support, and other services to the 41 Urban Indian Organizations (UIO) that provide health services throughout the United States.