United Natives Healthcare App

Native American/Alaska Native (NA/AN) communities are culturally, socially, communally, linguistically, and politically distinct from mainstream communities in the United States (U.S.). There are an estimated 4.3 million alone NA/ANs and 7.1 million in-combination with another racial/ethnic group in the U.S. NA/ANs have experienced poorer health status when compared to other Americans due to disproportionate disease burden that result in lower life expectancies. For example, according to the National VItal Statistics System (2021), the leading causes of death for Native Americans are COVID-19, heart disease, and cancer. 

Studies have demonstrated that NA/ANs have less healthcare services utilization than non-Hispanic whites driven by adverse social determinants of health conditions. Specifically, NA/ANs lack access to healthcare services and quality of healthcare services for both urban and reservation/rural based communities. It is important to indicate that approximately 75% of NA/ANs reside in urban areas while only 1% of Indian Health Service (IHS) funding is allocated to urban healthcare services. In addition, it is challenging to recruit and retain qualified healthcare providers in the reservation/rural  areas under the IHS system that exacerbate the existing challenges. United Natives is honing in on the lack of access to healthcare and quality of healthcare services that are a severe unmet need for NA/ANs communities nationwide. 

United Natives created the first healthcare app for NA/ANs in the U.S. This app features four main categories, which are tele-health, self-monitoring, research, and resources. 

Tele-health. This app has the ability to work individually with any clinic/hospital in the U.S. (or anywhere in the world) to connect their healthcare services to tribal communities. We would work with each clinic/hospital to create their own administrative dashboard that has the ability to: 1) Input their service providers and associated schedules; 2) Input their own intake patient documents that the patient can complete using the app; 3) Monitor their previous and upcoming appointments that tracks who the provider was/is, who the patient was/is, date/time of their appointment (past, future), and the duration of their previous appointments that can be printed in a PDF and/or transferred into an excel spreadsheet. The app is HIPPA compliant and has a separate login for the provider, patient, and clinic/hospital administration, in which all of them have to login with their email, password, and a pin. Lastly, once the appointment is scheduled, both the provider and the patient click a button on their end that will automatically link them via video to conduct their scheduled appointment. 

Self-Monitoring. The app has a section where users can self-monitor different aspects of their personal health (i.e, sleep patterns, physical activity, glucose levels, mental health, etc.). The app has the ability to link their ihealth and/or android health data to the self-monitoring data section. In addition, there is a section where you can manually input your own internal notes that include your appointment notes and prescription notes. 

Research. The app has the ability to collect both  qualitative and quantitative data using surveys and videos for the qualitative interviews. This app can work with tribes, tribal organizations, state/federal stakeholders, and/or researchers to collect data. It has the ability to input the proper screening questions beforehand to ensure the correct target population are completing the surveys and the data can be extracted as needed to give back to the community stakeholder(s). This would be a case-by-case basis ensuring that data sovereignty is practiced. 

Resources. This app has all the Indian Health Services, 638 Facilities, and Urban Health Facilities listed including their website, location, and other information. The app has the ability to post culturally informed messaging and/or videos, including but not limited to health, community resources, culture, etc. 

The target population is working with all NA/ANs nationwide. There have been multiple research studies conducted that identify similar challenges in accessing healthcare, which are proximity of healthcare services, lack of providers, and  lack of culturally-informed care. This app will have the ability to provide a large database for NA/ANs to identify healthcare services (i.e., specialty care), healthcare providers and/or culturally-informed care (i.e., Native providers). This solution is 100% Indigenous developed and led by our United Natives CEO/Founder, Dr. Crystal Lee, who is an enrolled member of the Navajo Nation. 

United Natives is a national non-profit organization that largely progressed during COVID-19 due to all the relief efforts conducted, especially in Arizona and New Mexico. Our partnerships were working with both Native American and non-Native American healthcare providers that were working the frontlines at the Indian Health Service and/or 638 Tribal Facilities. United Natives distributed over 3 million dollars of PPE products to over 120 tribal communities in Arizona and New Mexico. Due to the level of work United Natives done during COVID-19, we got recognized as one of USA Today’s leading non-profit helping Indian Country. 

Mental health services were highly needed post COVID-19 due to our communities suffering from adverse mental health (i.e., trauma, grief) and behavioral health behaviors (ie., substance use, domestic violence). Therefore, we currently initiated a national tele mental-health program that works with licensed clinical therapists nationwide to provide two free mental health assessments and 10 free therapy sessions per individual. We would like to use our current mental health initiative to pilot the app. 

Dr. Crystal Lee is an enrolled tribal member of the Navajo Nation, born/raised on the Navajo Nation, and founded the United Natives non-profit organization in 2017. United Natives has a Board of Directors, team members, volunteers, partners, and interns who come from diverse tribal backgrounds and various community-based experiences. United Natives has strong partnerships with tribal organizations and tribes nationally and Indigenous communities globally. The design and implementation of our solution is 100% led by the United Natives CEO, who has a strong background in working with communities and health. The communities’ input, ideas, and agendas have been developed by examining previous and current research conducted by Indigenous researchers, including Dr. Crystal Lee’s health-based research, and by meeting with tribal health organizations and tribal leaders who all indicate that improving our community’s health is a priority by ensuring there is proper access to quality healthcare services. 

The prototype stage was chosen because we have developed the healthcare app and conducted preliminary beta testing on the app with our internal United Natives team. We have not yet served customers or beneficiaries to date. 

MIT Solve has created a platform that multiple Indigenous communities can benefit from. The cost to develop this app has been expensive and the platform to acquire funding from Solve and access to additional funding is important to continue our vision and our impact.. In addition, the ability to participate in a tailored program that offers software licenses and legal services would be a huge asset to United Natives because there may be oversight on licenses/services we have not identified. Lastly, the ability to connect with other peers and leaders in this field is beneficial because we understand networking and gaining support and insight for our initiative is essential. 

Dr. Crystal Lee is an enrolled member of the Navajo Nation and 1-of-5 infectious disease research doctors in the U.S. and has been chosen by Scientific American as 1-of-3 people in the U.S. changing health equity. Dr. Lee’s career has been centered on addressing NA/AN and Indigenous health disparities in various capacities through research, providing direct healthcare services, community-based efforts, and political advocacy. Dr. Lee has worked with NA/AN communities nationwide and Indigenous communities globally via: 1) Being a Principal Scientific Investigator on research projects that address NA/AN and/or Indigenous health disparities; 2) Being published in various academic, peer-reviewed journals that resulted from her scientific engaged work; 3) Conducting grassroot community-based efforts through United Natives that are focused on housing, health, education, civic engagement, culture, and leadership; 4) Sitting on the United Nations Global Indigenous Women’s Caucus and  North American Caucus; 5) Former Co-Chair to the United Nations Indigenous Youth Caucus from 2007-2008; 6) An Advisor to different political diplomats, such as Obama/Biden Administration, U.S. Congressman/woman, and U.S. Senators based on her expertise of her work and her engagement in working with tribal communities. 

Dr. Lee is also an Assistant Professor at the University of New Mexico, College of Population Health. Her research projects are based on community wants and needs and conducts Community-Based Participatory Research projects. For example, the transgender Native American community approached Dr. Lee to conduct a qualitative study titled, Examining Health and Social Indicators Among Native American Cisgender and Transgender Women Who Engage in Sex Work in an Urban Environment, so their community can allocate more funding and improve policies that can help their initiatives. 

The closest initiative that has been developed for NA/ANs to access healthcare is an interactive map app launched by the Indian Health Service and the Department of Veterans Affairs, so Native American Veterans can find healthcare and resources. Therefore, this health care app would be the first ever healthcare app developed that every NA/AN could utilize to either utilize our tele-health services, self monitor their own health, participate in research, and/or identify resources. Additionally, this app has the ability to work with thousands of health clinics, hospitals, and individual providers (i.e., mental health therapists, physical therapists) to deliver health care to our communities. Another integration is that we will also integrate veterinarians in this app as many NA/ANs have small household pets to livestock and do not have access to veterinary medicine, especially in rural/reservation based areas. Lastly, we will integrate “Alternative and Complementary Medicine”, otherwise known as Native American traditional healers into this app. United Natives is currently using a traditional healer via tele-health as part of our nationwide services. 

A study titled “Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population” published in 2023 in Journal of Ethnic Health Disparities found:

-One of the top three services deemed important by 64.7% of the respondents were specialty care, including any medical subspecialty beyond primary care. 

-Respondents indicated they have traveled from Los Angeles County (where they reside) 

to Alaska, Arizona, Montana and New Mexico, and other surrounding counties to access health care. 

-Respondents indicated limited hours, excessive paperwork, and lack of transportation as barriers to accessing and using the Indian Health Service. 

Assumptions: NA/ANs do not have adequate access to healthcare services. 

Inputs: United Natives app will partner with clinics, hospitals, and providers nationwide to input their services on the app that NA/AN’s can utilize. 

Activity: Increase access to healthcare services utilization. 

Goal Outcomes: 

a. Minimize mortality 

b. Optimize health care utilization

c. Maximize personal health growth and development 

Goal Impact: 

1. Provide access to the highest quality of care for NA/ANs

   a. Improve access to both primary health and subspecialty healthcare

   1. Improve access to NA/AN healthcare providers for culturally informed care

   2. Improve access to Complementary and Alternative Medicine (i.e., NA/AN traditional practitioners) 

The impact goal is to provide access to the highest quality of care for NA/ANs nationwide to help facilitate decreasing health disparities, improving nationwide health equity, and improving individual health while simultaneously decreasing mortality incidence and prevalence rates. To support our monitoring progress, we plan to:

Monitor how many NA/ANs register to use the app yearly while accounting for; 

a. Active status

b. Deactivation status

c. Active registration but is not actively using the app

Track patient's monthly average time and pattern use of the app; 

a. Track patient's time use of the tele-health services

b. Track patient's time use of the health monitoring

c. Track patient's time use of the resources

Integrate a brief survey when patient's first register for the app asking baseline questions, which would be;

a. Are you currently using an IHS, 638 Tribal Facility, or Urban Health Facility? 

b. Are you currently using a NON IHS, 638 Tribal Facility, or Urban Health Facility? 

Our technology is phone app based that works with Android and iPhone. This technology would enable more opportunities for NA/ANs to access cultural/language services via Traditional Health Practitioners, which is a combination of modern and ancestral methods. 

This app would be available for use nationwide in the US. 

United Natives health app has the ability to be utilized in Canada and/or globally. Preliminary initiative would be for us to start examining the Canadian national policies and international policies from the US.

United Natives has 2 full-time team members, 2 part-time team members, and 7 contracted support team members. 

We have been working on our solution for almost 4 years. Please see our timeline below. 

Timeline.

June 2020-December 2020 - Concept building with the app developers.

January 2021-present - App development

January 2022-January 2023 - Alpha testing and continuation of app development ideas. 

January 2024-present - Beta testing 

In the non-technical, non-Westernized aspect of ensuring a diverse, equitable, and inclusive work environment is our Indigenous philosophical approach stemming from the Navajo (Dine’) system of thought as a daily practice that produces a healthy, supportive and inclusive environment. The Dine’ fundamental concept is “K’e” that refers to affective action and solidarity, including such concepts as love, compassion, respect, kindness, friendliness, generosity, and peacefulness. The knowledge and practice of “K’e” has been passed down for generations and is crucial for the survival of the traditional ways of the Dine’ people.  Dr. Crystal Lee from the Dine’ Nation integrates this important practice into the work place as she is Founder/CEO of this organization, and she sits on the L’Oreal USA Board of Diversity and Inclusion that offers continuous training related to diversity, equity, and inclusion. Lastly, our entire team works remotely nationwide.

Key Resources

People (patients, community members)

Native American tribes

Tribal organizations 

Clinics, hospitals, individual providers

Business advertisers

Researchers

Partners + Key Stakeholders

Native American tribes, tribal organizations

Indian Health Service, 638 Tribal Facilities, Urban Health Facilities

Clinics, hospitals, individual providers 

Cost Structure 

Costs of developing the app

Costs of updating the app and the features

Costs of updating licenses, trademarks, etc.

Key Activities

List current Indian Health Service funded health facilities 

Can self-monitor their health. 

Can find a hospital, clinic, or provider to do tele-health 

Can engage in research initiatives 

Type of Intervention

Connect individuals to healthcare services

Channels

Social media (i.e., IG, facebook, tiktok, etc)

Website

Community events 

Meeting w/ tribes and tribal organizations

Surplus

Payback SBA loan(s)

Update the app and the features

Pay for license, trademark, etc. 

Create new innovations that could be integrated into the app

Segment - Beneficiary

Native Americans/Alaska Native individuals

Segment - Customer

IHS-funded and non-IHS funded clinics, hospitals, and providers.

Business advertisers

Researchers 

Value Proposition 

Get access to quality healthcare services 

Value Proposition - Impact Measures

# of NA/ANs who register

# of NA/ANs who use tele-health

# of clinics, hospitals and providers who partner with us

Value Proposition - Customer Value Proposition

More access to patients to increase their revenue

More access to marketing their business

Complete their research to report to their funding source

Revenue

Hospitals, clinics, proviers (80%)

Business advertisers (15%)

Researchers (5%)

I have a United Natives (501C3) and United Natives LLC. The non-profit organization provides free mental health and other services through our organization. The United Natives health app is housed under our United Natives LLC (not the non-profit organization sector).  We used grant funding to develop sub-sections of the app, such as our non-profit individual dashboard for our providers providing the free tele-health services and their associated patients. In addition, we used the grant funds to input the resources that list all of the Indian Health Services, 638 Tribal Facilities, and Urban Tribal Health Facilities. 

We will charge for in-app advertising for companies to display sponsored content and/or ads on the app. We will charge hospitals, clinics, and providers a monthly subscription to use our app as a platform to expand and increase their patient load. In addition, we will charge to build their individual dashboard specific to their hospital, clinic, or provider, so they can track/monitor their own patient load. Lastly, we will charge the researchers to input their survey and/or the ability to conduct interviews using our app as their platform to collect data.