T-HIP Director Annie Wagner has assembled a crack team of professionals who are addressing health disparities in Blackfeet Country through a partnership between the Montana Department of Health and Human Services and the Blackfeet Nation.

Folks driving along N. Piegan St. in Browning have likely noticed new activity at the old Bingo Hall (a.k.a. Buttrey’s), with the old roof coming off and a new one being installed. R Construction is doing the work, which is part of a “three-tier” program headed up by the Tribal Health Improvement Program (T-HIP), and which also includes renovating the old Child Protection Services building at the corner of Piegan and Central in Browning.

The Tribal Health Improvement Program (T-HIP) is a historic partnership between the Tribal, State and Federal governments to address factors that contribute to health disparities in the American Indian population eligible for Medicaid and residing on a reservation. It is a health promotion, disease prevention program. Federally recognized tribes in Montana are the only eligible entities able to participate in and administer the Tribal Health Improvement Program (T-HIP).

T-HIP is a three tier program. A tribe may choose which level they wish to participate at. Tier 1 focuses on high-risk, high-cost members identified by the Department. Services provided under Tier 1 seek to improve the health of members who have chronic illnesses or are at risk of developing serious health conditions through intensive care coordination of individual members. One of the duties in Tier 1 is to enhance the communication and coordination link between the member and the Passport primary care provider. Tier 2 and Tier 3 address specific health focus areas that contribute to health disparities.

The program applies to American Indians/Alaska Natives living on the Reservation who are enrolled in Medicaid and the Passport to Health Program, who are also IHS eligible and who have not opted out of T-HIP.

In Tier 1, the focus is on moving into the new building that is larger and  more centrally located and establishing staffing for the program. They hope to move into Tier 2 next month and focus on areas that contribute to health disparities.

They receive a list every month from Medicare of people, ages 0 to 65, who are rated at highest risk because of frequent ER visits and/or chronic illness. These clients, who are selected by the state, enter the program which works to connect them with doctors by providing transportation so they can keep their appointments. T-HIP even supplies transportation to Great Falls and Kalispell.

Annie Wagner, a nurse with 30 years experience with IHS, heads up the program. She has assembled a team that includes four RNs, four CNAs, two drivers and one security person, in addition to a medical director.

Currently, T-HIP operates out of the green building behind Coop’s Corner. While it has served the purpose so far, Wagner notes a lack of sufficient space for her staff and its inconvenient location as issues to be resolved. Her program is in the process of buying the property at the old CPS building. Renovation there will include a new floor, lighting, paint, plumbing and bathrooms. The building has been abandoned the last five years.

While Tier 1 involves connecting the most expensive and at-risk Medicare clients with the services they need, Tier 2 concentrates on addressing specific areas that surveys have identified as contributing to health disparities. Having picked substance abuse as a primary focus, renovation at the Bingo Hall and creating a Youth Center are seen as answers to that issue.

At the old Bingo Hall, plans are to create a series of rooms, each with a Blackfeet name, for various activities. One room, for example, will feature comfortable seating for the addiction counselors and other groups with families. A studio for traditional dancing as well as Pilates and yoga is envisioned for community members, but still with a focus on grades 1-12. Another room may be dedicated to elders who will use sewing machines to teach the skill to youngsters. In addition, the kitchen will be restored for nutritional education, and there will be a mental health office.

“Young people are teachable,” Wagner said, “so this is an educational and prevention program.”

Finally, Wagner says she hopes to achieve and maintain a Tier 3 presence, which will employ the most people and pay the most per client. T-HIP can select another pair of Programs at that level, and Wagner says she is interested in creating a wellness center when the program has matured.

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