OPINION: Physician pay plan positions CN health care for better future

BY BILL JOHN BAKER
Principal Chief
11/01/2017 12:00 PM
The Cherokee Nation recently took a major step towards a stronger and brighter future for our health system. By boosting the compensation of the doctors and other health care professionals who care for our Cherokee people, we have laid a stronger foundation for consistent quality care. The professionals in our system are responsible with caring for our patients. They improve, and literally save, so many Cherokee and Native lives each year.

The new plan increases pay and incentives for doctors and advanced providers. The increase includes raising base pay, about a $35,000 increase for physicians in primary care, as well as providing a quarterly incentive based on work quality. Under this plan, every physician and advanced practitioner will see a raise. It will raise the threshold pay to the region’s market rate, which will affect about 120 doctors and advanced level providers who administer care in the tribe’s nine health centers and W.W. Hastings Hospital.

We devised a plan to raise salaries that is responsible and affordable. Our health leadership team, led by Connie Davis and Dr. Charles Grim, along with my Cabinet leaders, studied the issue, listened to our doctors and sought input from the Tribal Council. Collectively, we are all committed to providing the best health care possible to the Cherokee people. We want our citizens to have access to the best quality care, and that starts with our physicians. Building a level of trust and peace of mind for our doctors will only improve health care opportunities for our people in the long term.

To meet the growing demands on our system, we need to recruit and retain the best doctors we can. We recognize that in the competitive environment of rural health care, we had to take immediate steps in order to attract and retain quality doctors.

The CN operates the largest tribal health system in the United States, and our hospital and clinics see more than 1 million patient visits per year, and we are growing rapidly. We are investing $200 million to build a new facility through a joint venture with Indian Health Service. IHS will provide more than $90 million annually for staffing and operations. It will make Hastings the largest tribal health campus in the United States. It will open in 2019, and we will need to fill close to 900 new health care jobs.

This will only help us maximize our substantial commitment and investment to improved health care. In the end, these dollars will come back to us in the form of better health for the Cherokee people, more competitive applicants and more stability within our health facilities.

Opinion

BY KEITH AUSTIN
Tribal Councilor
04/03/2018 12:30 PM
In today’s world, the term “information super highway” refers to the internet. While this term is modern, the idea behind it is as old as civilization. The idea is to create the shortest and most efficient route to move information. For as long as a thousand years, Indigenous people have used a route of travel not far from here because it was the most efficient route to deliver information and supplies. This route has been referred to at various times as the Osage Trail, the Seminole Trail, the Texas Road and the Military Highway. A decade before the Trail of Tears, the Cherokee Nation’s first Supreme Court Justice, John Martin, brought his family from their home in New Echota, Georgia, to Indian Territory. His son, Joe, was only 8 years old in 1828 when they settled on the Grand River. He took to his new home quickly. In 1840 when he was just 20, he had already established a ranch that would become known as Greenbrier near the community of Strang. To call Greenbrier a ranch is a bit of an understatement. By the time the Civil War started in 1861, the Martin family ranch and the river beside it both could be referred to as Grand. It consisted of around 100,000 acres of leased Cherokee land, about the size of what is now Mayes County. On this land was a good portion of the route then referred to as the Texas Road or the Military Highway. Before the war, the route saw many cattle drives from Texas to Kansas. As the war progressed, it was described as “a critical route for information and supplies” for troops of both the North and the South. It was the shortest route from Fort Scott, Kansas, to Fort Gibson, Indian Territory, and Fort Worth, Texas. Two battles during the war were fought on the route. The North was the victor of the first battle. A year later the South had a much bigger victory by capturing hundreds of mules and wagons. This victory also interrupted supplies bound for Fort Gibson valued at over $1.5 million. After the War Between the States ended, Greenbrier never regained its former glory. Today there is little more than a few historical markers to prove it once was there. Within a few years of the end of the war, the KATY Railroad followed the route from Kansas to Texas. In the early years of statehood the route developed into what is now known as U.S. Highway 69 and remained a critical route for information and supplies. In recent years, technology giant Google established a data center complex in Mayes County. This data center could be described as a key component of the “information super highway.” It is fitting that the data center sits a short distance from the Grand River, within sight of Highway 69 and the railroad once known as the KATY. Now, as then, this route can accurately be described as “a critical route for information and supplies.”
BY BILL JOHN BAKER
Principal Chief
04/01/2018 02:00 PM
As the chief of the Cherokee Nation and the son of public schoolteachers, it has troubled me to see the inaction at the state level as teachers across our great state struggle. The time for action is now, and the CN is taking the lead by granting our certified teachers the pay raise they deserve. Recently, I proposed – and the Tribal Council approved – a lump sum payment of $5,000 to all certified teachers, effective immediately. Additionally, certified teacher pay will increase by $5,000, effective the beginning of teacher contracts in fiscal year 2018-19. Over the past decade, the state of Oklahoma has made drastic budget cuts to public education. At the same time, teachers continue to meet additional demands beyond simply fulfilling the daily lesson plans. From monitoring student safety to test preparation to finding ways to help students in need of food or school supplies, Oklahoma teachers go above and beyond the call of duty each day and with fewer resources each year. We have the best colleges in Oklahoma (several in our jurisdiction such as Northeastern State University and Rogers State University), which train our brightest minds for the educational workforce. Yet, sadly, when they graduate, they often leave to teach in other states or are forced to leave the children they love teaching for higher-paying jobs. The state absolutely must address teacher pay this legislative session because we are in a crisis. However, the CN will not wait any longer. This pay raise is in keeping with the CN’s longstanding commitment and support of public education. We started the first institution of higher learning for females west of the Mississippi River. We established a system of free public education well before Oklahoma statehood. We continue to achieve excellence today at Sequoyah High School, the Cherokee Immersion Charter School and through our support of public schools and students across northeastern Oklahoma. In addition, we recently issued $5.4 million to 108 schools through our car tag compact. The amount given annually has doubled since 2010, and since 2003, the CN has contributed more than $50 million to public education through the compact. The CN is unwavering in its commitment to public schools, students and teachers. Our pay raise reaffirms that commitment and, I hope, sends a message to state leaders that they should follow the CN’s lead and raise pay for all certified teachers in the state. The CN understands the role of teachers. It is a profession that we know is of extreme value and importance. Teachers impact so many lives and should be rewarded as such.
BY KAREN COODY COOPER
Cherokee Nation citizen
03/03/2018 12:00 PM
In the Cherokee language we have called ourselves aniyunwiya, the Real People. According to one author, “…the Cherokees, in common with the Caucasian race, had a high regard for their tribe, and were not too modest to proclaim themselves the ‘principal people’” (Walker 1931:2). Since our beliefs have served us well and our ancestors’ tenacity has done the same, our strong ego is an earned quality. The Cherokee language is in the Iroquoian language family. Various Iroquoian speaking tribes now live in the eastern Great Lakes region of the U.S. and Canada. Although there are shared tenets among most American Indians, Native nations experienced different histories, spoke different languages, were comprised of a variety of compelling individuals and lived in particular environments all of which serve to provide particular qualities and practices making each nation profoundly unique. According to early Cherokee oral history our arrival in our homeland involved travelling over a sea, or through a flood (Meredith and Sobral 1997: 33). The displaced Cherokee population ultimately settled in the forested terrain of what is now the southeastern United States. Surrounded by tribes speaking other languages, we were compelled to display superior strength in order to thrive. Our successes at adapting to change proved useful throughout time. James Mooney, an early anthropologist, cited a remark provided by a Cherokee man in late 19th century, “…the animals and plants were first made . . . we do not know by whom (Mooney 1898: 240).” The lack of commitment to a single creator is often noted in early Cherokee thinking. The flood story includes statements that Cherokees “commenced to repair the damage done by the gods.” It was also noted they sought to build a structure reaching to the heavens. It seems Cherokees believed they could live equally with their gods and maybe the reference refers to the building of mounds, which could be useful if a future epic flood occurred. Large earthen mounds were serving as Cherokee ceremonial centers when European colonists arrived in the Americas. Cherokee governance in early colonial times consisted of clan council representatives electing a war chief and a peace chief in each village, and groups of villages linked within geographic districts. As the U.S. government developed after the Revolutionary War, we Cherokee immediately emulated the new U.S. government model by electing a principal chief, legislative representatives and forming our own supreme court. Our history with Europeans includes Hernan DeSoto in 1540, serving the British during the French and Indian War, fighting colonists in the Revolutionary War, allying with Andrew Jackson in the War of 1812, suffering removal to Indian Territory after President Jackson refused to enforce a U.S. Supreme Court ruling respecting Cherokee sovereignty, the divisive Civil War, which split the Cherokee Nation into two armies, joining a plan to create an Indian-run U.S. state of Sequoyah, but instead being made citizens of Oklahoma. There are currently three federally recognized Cherokee governments (one in North Carolina and two in Oklahoma). Through generations of turmoil, the CN played the cards it was dealt, persevered and today has over 350,000 enrolled citizens, and is one of the major financial engines fueling northeastern Oklahoma. Lt. Henry Timberlake observed of the Cherokees in the 1760s, “As to religion, every one is at liberty to think for himself; whence flows a diversity of opinions amongst those that do think, but the major part do not give themselves that trouble (King 2007, 34).” During colonization a number of Cherokee women married Scotsmen and Englishmen. In a matrilineal society, children born to Cherokee women were members only of the mother’s clan without regard to whether the father was Cherokee or not, however, matrilineality began to erode along with clans. Cherokee leaders initially resisted missionary incursions, and then relented by accepting missions that would provide schools. It is difficult to sort out the natural threads of culture from the introduced threads at a time when traditional practices were being driven underground. Anthropologist James Mooney concluded, “There is change indeed in dress and outward seeming, but the heart of the Indian is still his own (Mooney 1898: 12).” As the Cherokee faced the 20th century, he noted, “there are still several thousand full-blood Cherokee… who speak only their native language and in secret bow down to the nature-gods of their fathers (147).” A polytheistic (belief in many gods) doctrine should not have been disparaged or forbidden, but missionaries generally termed such beliefs as pagan and savage. The work of missionaries was sometimes deemed by early Cherokee traditionalists to be a self-gratifying undertaking whereby foreigners passed judgment and imposed their own will upon a people imperiled by colonialism. Many Cherokee did become willing members of Christian churches (Moravian, Baptist, Methodist, Presbyterian). Some congregations encouraged hymns in the Cherokee language, and Cherokee-speaking preachers existed (and continue to exist). Some Christian churches accepted that their congregants would also attend traditional stomp grounds, while some pastors forbade such attendance. New generations often yearn to revive what was lost. Redbird Smith began an effort at the end of the 19th century to re-establish traditional Cherokee stomp grounds. Smith ultimately focused on reclaiming seven ancient wampum belts from the CN archives to establish ceremonies based on what was remembered of those belts’ original messages. He and his sons prepared a stomp ground where he rekindled a sacred fire for the revivalist movement he called Nighthawk Keetoowah. Altogether 22 ceremonial grounds were developed and thrived for a time. Modern life and political strife, however, served to reduce the movement. It continues today among a number of traditional Cherokee adherents, and the ancient wampum belts reside in their care. Smith noted before his death in 1918, “I have endeavored … for my people to remember that any religion must be an unselfish one… This religion does not teach me to concern myself of the life that shall be after this, but it does teach me to be concerned with what my everyday life should be (Hendrix 1983: 76-85).” The following tenets, noted in our mythology have been, and are, important components of Cherokee core beliefs. <strong>· All living things play a role in a dynamic world.</strong> Cherokee stories detail close relationships with animals and plants. So close that one story cites tracking a bear and seeing its footprints become human. Another cites a wife who transforms from deer to woman and back. Another wife and mother saves her starving family by becoming the gift of corn, and another cites strawberries lightening the heart of a woman after an argument with her husband. Science now tells us that we share DNA with all living things. <strong>· All natural parts of the world are sacred.</strong> In addition to animals, other natural components are essential. Earth, water, air, minerals, the sun and stars deserve our respect because we are all interdependent in our relationships. One enduring practice of Cherokee traditionalism is “going to water.” At the start of each day, adherents attend a source of water to rinse their faces in a sacrament of connection. Early Cherokee villages were located on a water source and the community’s council house faced the water, as does today’s historical Cherokee Capitol Building in Tahlequah (Tellico/Diligwa), completed in 1869. The form of the building may have changed to one made of brick, but its spiritual and social contract was preserved. Benny Smith, Cherokee professor and spiritualist, after being asked if the surviving ancient Cherokee wampum belts are sacred, simply stated, “everything is sacred” (Smith, Strickland 2010, 24). <strong>· Cherokee women warrant respect equal to Cherokee men.</strong> In early days, the division of labor found women to be equal contributors to the economy through their work in agriculture, weaving and basketry, and they were especially honored for gestation and childbirth, which provided future generations. The Cherokee population consisted of matrilineal clans, and all children were raised by their mother’s family. Today, Cherokee women attain professional and political lives equal to Cherokee men. <strong>· Elders are keepers of knowledge and respected for having experienced life’s path.</strong> In clan society, extended families cared for elders, and elders spoke their wisdom during council meetings. We are a family of relatives; our genealogies link us to shared ancestors; elders preserve traditional knowledge. Respect for others and listening to people is a courtesy of a united people. <strong>· Family and community are pillars of Cherokee strength.</strong> Although Cherokee clan life diminished due to exogamous marriages, there had been seven long-enduring clans. Seven serves as an important number for the Cherokee, and the CN’s seal and flag depict a seven-sided star. There are seven directions: east, west, north, south, above, below, and here. There are admonishments to make decisions based on how our choices affect seven generations forward. Our community and our children are our future, and remembering our clan heritage is not to be forgotten. <strong>· Ceremonies, legends and symbolism are integral to Cherokee identity.</strong> Cherokee art includes symbols derived from our guiding mythology. Water spider is an enduring motif (she risked her life to bring fire to the beings, and her success reminds us that the smallest among us can often contribute mightily). Social and ceremonial dances are conducted in a circle (unity and eternity) with a central fire (like a sun warming us). The dance circle is an earthen path, the drumbeat is earth’s heartbeat, and the women’s shell-shakers provide responsive rhythm. Sharing food, labor and resources at gatherings is a practice of bonding and commitment to community. Present-day Cherokee arts, crafts and storytelling reflect Cherokee philosophy amidst challenging dichotomies. We cannot remain in the past, nor can we abandon our past. We must maintain the threads connecting us to all that is vital to being Cherokee. <strong>· Technology, knowledge and opportunities should be used to advance Cherokee concerns.</strong> Sequoyah developed letter symbols for syllable sounds of the Cherokee language, and we were able to publish the first American Indian newspaper in our native language at a critical time when information was essential. Early survival arts such as making fire from friction, twisting fiber to make twined bags, knowing when to gather the bounty of wild plants is knowledge that enriches our lives and must be preserved and passed down the ensuing generations. Knowledge of our history is a tool to propel us forward rather than catch us in eddies of repeated errors. Computers and electronic devices can serve Cherokee causes. We must continue to be smarter than those who would harm us. In summary, our ancient gods were not ones to sit in judgment, therefore we did not pine for forgiveness nor did we ask for more than had been provided. There was no afterlife to risk or to bargain for. The gods had no eye upon the sparrow, so there was little need for continuous conversation between citizens and gods. Ceremonies were the rare time to engage in rhetoric, to impress upon the youth and the wayward the lessons derived from our past. We possess vagaries of personality, and being human we err in judgment from time to time. Serving to sustain us as individuals is primarily an act of our fellows, not our gods. Our fellow citizens keep us in line by rewarding us when deserved, and troubling us when we stray. We live for each other, for our family and our community, and strive to keep our world in balance by respecting its elements. There were joyful ceremonies including the Green Corn festival and the mid-winter renewal where we expressed gratefulness for sustainability. We had a mindfulness of the natural world surrounding us. This is how we were and how we should be. While it is possible to embrace an introduced religion alongside Cherokee beliefs, it is not necessary to do so. If we follow basic Cherokee tenets, we will remain the ever-proud Principal People. <strong>References</strong> Hendrix, Janey B. “Redbird Smith and the Nighthawk Keetowahs,” Journal of Cherokee Studies, Museum of the Cherokee Indian, Cherokee NC, 1983. King, Duane H. The Memoirs of Lt. Henry Timberlake, Museum of the Cherokee Indian, NC, 2007. Meredith, Howard and Virginia Milam Sobral. Cherokee Vision of Elohi, Noksi Press, OKC, Oklahoma, 1997. Mooney, James. Myths of the Cherokee, Nashville TN, 1982. Smith, Chad and Rennard Strickland. Building One Fire, Cherokee Nation, 2010. Walker, Robert Sparks. Torchlights to the Cherokees, MacMillan Co., 1931.
BY BILL JOHN BAKER
Principal Chief
03/01/2018 06:00 PM
Cherokee Nation Health Services offers our citizens some of the best care available in Indian Country. Folks in northeast Oklahoma know this, but recently we changed a few things that are creating more and better health services for Cherokee families. I am proud to say we are reaping the benefits of those efforts. When someone comes to a CN health center and needs something that our own clinics do not provide, like a knee replacement for example, we send them to a specialist who is outside our network of CN doctors and health care providers. Under that system, we negotiate with insurance companies, hospitals, doctors and other vendors and pay for those services. When patients have a primary insurance, Medicare Part A and Part B, or Medicaid we are able to spend significantly less on the required service and then spend those dollars on other patients. In recent history, the growth of referrals has been dramatic. In 2004, our system averaged 87 of these referrals per day. In 2017, those referrals had grown to an average of 410 per day. Because of this growth in needed referrals, our programs have had to manage their available resources. Some of the services that were being declined over the past year include elective orthopedics and some of the related diagnostic tests to those procedures. To help address some of the recent limitations we had on issuing referrals for outside costly, nonlife-threatening treatments, we changed our records system, moving all patient health and medical records to a digital format. When a patient comes in, our newly installed software communicates with all payment systems, private insurance companies, Medicare and Medicaid. The new efficiency has helped enable the tribe to collect almost $9.5 million in the first three months of FY2018 in third-party billing. Those additional funds will translate to more contract health dollars to approve referrals for surgeries, MRIs and other related tests and help cover a portion of more elective orthopedic referrals for our patients, who visited CN Health Services more than 1.2 million times last year. It also allowed us to measure quality outcomes and efficiency, so doctors can earn more incentives when patients are treated and get what they need. The strategic changes in the physician salary structure reward our doctors for the quality and quantity of patients they see. Quality is up across the board at CN Health Services, and we have more funds dedicated to contract health needs. I am proud of the strategic efforts we made to modernize our health system and collect more from private insurance, Medicaid and other third-party billing streams. The increase in collections also comes from our successful outreach to sign up more patients for Affordable Care Act marketplace insurance, SoonerCare and Medicare. These aggressive efforts to enroll more CN Health Services patients have been successful and are helping provide better health care services for our people. Our patients have more health needs than we could ever possibly meet, so we are evolving with the times. There is continuing growth in the demand for health care, especially as the “baby boomer” generation matures and needs more and more care. And there are Cherokees retiring from the workplace all over the country and moving back to their roots in the Cherokee Nation. We want all our patients – Cherokees as well as other Natives in northeast Oklahoma – to live healthier lives. To address these growing challenges, we have been resolute in committing more gaming revenue dollars specifically for contract health services, which now is an annual commitment of about $7 million. We feel that these changes will set Cherokee health on a path for unprecedented financial security and open up more dollars for specialty care, including visits to cancer doctors and heart doctors and a return to covering a range of bone and joint surgeries. Soon we will open the largest tribal health care facility ever built in America. A topping out ceremony is planned on March 9, and in 2019, when the facility (located at the W.W. Hastings campus in Tahlequah) is opened, it will house more health care specialists of our own and have two MRI machines. Currently, CN does not have either of those specialty services in-house, and we use contract health dollars to help pay for citizens needing those medical services. Patients can get more information about additional coverage options by contacting their patient benefits coordinator at any CN Health facility or visiting <a href="http://www.CherokeeCare.com" target="_blank">www.CherokeeCare.com</a>.
BY BILL JOHN BAKER
Principal Chief
02/01/2018 10:15 AM
Preserving the Cherokee language is preserving Cherokee identity, as the heritage and traditions of the tribe are rooted in our language. Our language allows us to pass along traditional Cherokee knowledge and values to our children and grandchildren. That is why I am so proud that Cherokee Nation Businesses has pledged unprecedented financial support to the Cherokee Language Master Apprentice Program. Through a signed memorandum of understanding, CNB is providing $180,000 to cover the costs of a language program called the 14th Generation Master Apprentice Program, a pilot program designed for students who originally learned to speak Cherokee at the tribe’s Cherokee Immersion Charter School. We hope it encourages language usage as they progress through junior high and high school. CNB’s monetary commitment will further advance the preservation and usage of the Cherokee language, as graduates of the adult master apprentice program are placed in supervised teaching and mentoring roles. The new endeavor can be a bridge that unites the mission of our Cherokee Immersion Charter School and the Cherokee Language Master Apprentice Program, which has graduated six students since it began three years ago and is expected to graduate six more students in 2018 and another eight students in 2019. Both programs have proven successful in their respective area, and now we can connect their goals and participants. This multigenerational effort will help preserve and promote the use of the Cherokee language for generations to come and fill the gap between the immersion school and high school. Our youth, who have been educated in the immersion school, are among the most valuable Cherokee language assets going forward. We have made significant investments in these children, and we must keep exposing them to language-learning opportunities after completing the sixth grade. Now that we have graduates of the Cherokee Language Master Apprentice Program, we have developed an expert pipeline and grown the personnel to keep our youth engaged after immersion school graduation. That means language lessons can be utilized at Sequoyah High School as well as within community settings. Creating new Cherokee speakers, and in turn letting them pass along what they have learned, will keep our language flourishing for generations to come. Supporting cultural education and growing the language curriculum will help Cherokee children succeed on their lifelong journey and allow them to reach their God-given potential in school, in life and as Cherokee speakers. The 14th Generation Master Apprentice Program already has about a dozen Sequoyah High School students gathering for lessons after school. Plans are in place for a summer program with participants gathering from 8 a.m. to 5 p.m. for 10 weeks. Those students, if they participate over multiple summers, could potentially get about 2,000 hours of language education just through summer participation. CNB continues to support the tribe in its pursuit of preserving Cherokee culture and heritage. Without the aggressive commitment from our tribal government and our business endeavors, the future of the Cherokee language would be in jeopardy.
BY MARK DREADFULWATER
Multimedia Editor – @cp_mdreadfulwat
01/01/2018 02:00 PM
I am Cherokee. I know this because I have a Certificate of Indian Blood card that says so. I also have a blue card that says I’m a citizen of the Cherokee Nation. I have identified as Cherokee my entire life but I have not immersed myself enough in the culture, or most regrettably, the language. I grew up hearing the Cherokee language, as my dad is a first-language speaker. Cherokee was the only language my paternal grandmother chose to speak on a daily basis. She knew English, but hardly ever spoke it. I heard it so often as a child I was able to understand what my grandmother and dad were saying but never learned to speak, read or write. My granny died when I was 11 and that’s when my knowledge of the language died for me. My dad still spoke it to my aunts and uncles, but for a reason I can’t remember, I stopped really listening to understand it. He would try to get me to learn by giving me directives or asking common questions in Cherokee, but I didn’t take the time to sit down and learn. As an adult, when people ask if I know how to speak, I tell them I was too busy as a kid playing sports and doing other things to learn. I also took Cherokee I and Cherokee II while at Northeastern State University, but none of the teachings resonated with me. Hearing me say that, and now typing it, I’ve come to realize that is a lame excuse. I’ll be honest and say I really didn’t see the need to learn the language. I didn’t think knowing Cherokee would get me any further in life. Other than speaking to a few people, I would rarely use it, so why learn. I’ve worked for the Cherokee Phoenix for 11 years. We publish Cherokee stories in our monthly paper and when time allows, we have the translators record audio of the stories in order for readers to hear it spoken by scanning a QR code from a smartphone. I’ve not paid as much attention to it as I should. It’s a great way to see and hear the language. Now that I’m older, I regret not paying attention to the language growing up and taking the time to learn. I think my generation has made a huge contribution to the downfall of the language. But all is not lost. Although it’s more difficult, it’s not too late to learn. I realize how vital the language is to Cherokees as a people. It is more than a way to communicate. It’s embodies our identity and soul of our tradition, history and the Cherokee way of life. With the New Year fast approaching, my resolution will be to learn Cherokee. The CN has several outlets as well as online options that are available to learn the language. I also know my dad and aunts will be eager to teach me and I believe they will say, “It’s about time.”