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Dream Team

September 1, 2006
by Mark Hagland
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Glenn Miller and Robert Rubeck have been spreading health services access across the Great Plains.

Sometimes, it takes more than one individual to actualize an important idea. That certainly is the case when it comes to Glenn Miller and Robert Rubeck, Ph.D., two innovators whose teamwork has helped impoverished health care consumers.

Miller and Rubeck are colleagues and professors at the University of North Dakota, in Grand Forks. Miller, who works out of the School of Business and Public Administration at UND, and Rubeck, a professor in the School of Medicine & Health Sciences, were brought together by grants issued to improve the delivery of public services to rural residents in that state's far reaches.

Miller had received a federal grant to improve access to federal services for those residents, while Rubeck had received a grant for telemedicine project development.

Pooling their talents and grant funding, Miller and Rubeck established the Center for Rural Service Delivery, which they co-direct. And then they got down to the business of helping those rural residents, most of whom live in very harsh conditions on Indian reservations. And that's how the Video Claims Taking (VCT) program was born.

The VCT program allows residents to apply for Social Security benefits while physically visiting a local hospital, via broadband videoconferencing technology.

As Rubeck explains it, "The mission of the Center is to enhance the vitality of rural communities through the electronic delivery of government and healthcare services. So we found out, for example, that the (Turtle Mountain band of the Chippewa) tribe (on the Turtle Mountain Reservation) did want high-resolution angiography of the back of the eye, and retinal imaging. And we bought them a camera, and were able to provide them access to that important service. And we began working with Quentin N. Burdick Memorial Hospital in Belcourt, a 200-bed hospital that is the nearest non-Indian Health Service healthcare facility, and the only full-service hospital in the immediate area of the Turtle Mountain Reservation. And in a conversation with the hospital's CEO, I said, 'What is your greatest need?' And she said, 'Money.' Because of the ways the Indian Health Service is funded, local hospitals that primarily serve Native Americans tend to be continuously severely underfunded. And, because of a host of practical and transportation-related challenges, tribal members rarely completed the Social Security applications that allowed them to access the Medicare and Medicaid services for which they are fully eligible. This, of course, also increases hospitals' reimbursements.

The solution? To use videoconferencing technology to provide face-to-face Social Security application interviews to tribal members in the local hospital, connecting them with a federal administrator hundreds of miles away in Minot. As a result, in the 30 months (as of press time) in which the videoconferencing link has been live, it has generated $2.1 million for the local Belcourt community: $1.4 million to the hospital in enhanced Medicare and Medicaid revenues, and $700,000 directly to the community of 20,000 people. Using a multiplier of 2.25 to figure in the spillover benefit of such investment in the local community, he adds, the overall economic impact has been nearly $4.5 million.

Since then, Rubeck and Miller have helped replicate the Belcourt-Minot videoconferencing link several times over, in order to help, among others, the Northern Arapaho and Eastern Shoshone Indians living on the Wind River Reservation in Wyoming; and soon to help the Blackfeet tribe of Montana connect with the Indian Health Service facility in Browning, Mont. What's more, the success of facilitating Medicare, Medicaid and Social Security applications has led to a broader interest in using such technology in the Denver Social Security Administration office, to better serve Native Americans across the rural Great Plains.

Author Information:

Mark Hagland is a contributing writer based in Chicago.