Our second priority is to bring reform to IHS. This priority has two parts — the first part includes how the Affordable Care Act (ACA) will help us reform IHS. American Indians and Alaska Natives can benefit from the ACA in many ways, whether they have insurance now, want to purchase affordable insurance through the exchanges or choose to access the Indian Health System. The ACA also contains the permanent reauthorization of the Indian Health Care Improvement Act, which modernizes and updates IHS with new and expanded authorities for a variety of healthcare services.

The focus in 2013 will be on implementation of and ensuring access to the benefits in the ACA for both American Indian and Alaska Native individuals and the Indian health system. Efforts are focusing on preparing our health facilities to assist patients in understanding their health-coverage options, reassuring them that IHS will always be an option for them and improving our business practices around eligibility, enrollment and third-party collections. If more patients have health coverage and continue to use IHS facilities, more resources will be available to improve services for all patients.

 The second part of this priority is about bringing internal reform to IHS. We are focused on improving the way we do business and how we lead and manage our staff, based on input from staff and the Tribes we serve. Overall, we have implemented many improvements over the past few years, including setting a strong tone at the top for change, greater coordination and communication among leadership, implementation of more consistent business practices, improvements in budget and financial management and a stronger performance management process focused on agency priorities and measurable outcomes.

To improve how we lead and manage staff, IHS has implemented new supervisory training and reduced the average overall hiring time from 140 days to 81 days. We also are working on improvements to our compensation systems and strategies to improve recruitment and retention. These improvements are important because it has been historically difficult for IHS to recruit and retain healthcare providers, due to remote locations and noncompetitive salaries. Recommendations from the 2010 Senate Committee on Indian Affairs investigation of the IHS Aberdeen Area are helping us make improvements in business practices systemwide through area-management reviews. All of these improvements will help us more efficiently and effectively meet our mission and ensure responsible use of federal resources. In fiscal year 2013, we will continue progress on our reform activities.