Insight in Indian Country

Send us a text [https://www.buzzsprout.com/twilio/text_messages/1767544/open_sms] Sage Memorial Hospital's journey from a four-room adobe building in 1911 to a state-of-the-art healthcare facility represents more than a century of serving the Ganado community. This episode, REDW National Tribal Practice Leader Wes Benally welcomes Melinda White, CEO of Sage Memorial Hospital, to discuss the hospital's remarkable transformation and its commitment to blending Western medicine with traditional Navajo healing practices. Melinda, who was born at Sage and returned as CEO three years ago, shares how the hospital is redefining healthcare in Indian Country—from building sweat lodges and hiring traditional healers to implementing cutting-edge technology and expanding critical services like ICU, dialysis, and elder care. She discusses workforce challenges, the importance of keeping patients close to home, and the vision for continued growth while maintaining the strong foundation of traditional values. Chapters * 00:00 - Introduction and Welcome * 01:03 - Melinda's Background and Connection to Sage Memorial Hospital * 03:54 - The History: From 1911 Mission to Modern Healthcare * 08:47 - Incorporating Traditional Values in Modern Care * 12:34 - Innovation and Modernizing Healthcare Delivery * 15:55 - Workforce Challenges and Hiring the Right People * 19:49 - Patient Stories and Keeping Families Closer to Home * 23:16 - Measuring Success: KPIs and Quality Indicators * 26:55 - Vision for the Next 5-10 Years Takeaways * At Sage Memorial Hospital, traditional healing programs, including sweat lodges, medicine men/women, and future hooghan construction, are being integrated with Western medical care. * The new facility achieved a complete transition to paperless operations with comprehensive electronic health records encompassing clinical and financial systems. * Key expansion services include ICU, inpatient dialysis, swing beds, elder care facilities, and future plans for labor and delivery and surgical units. * The hospital's core mission focuses on reducing patient transfers and keeping families closer to home, lessening the financial and emotional burden of traveling to distant facilities. * Quality initiatives are measured through hospital-wide KPIs across four pillars: finance, community, people (HR), and quality. Quality Services. Quality Outcomes. REDW was honored to support Sage Memorial Hospital's transformation through our Client Advisory and Accounting Services [https://www.redw.com/client-accounting-advisory-services/] (CAAS), Business Valuation [https://www.redw.com/valuation-transaction-advisory/], and Risk Advisory expertise [https://www.redw.com/risk-advisory-services/]. This journey demonstrates a powerful truth: investing in quality advisory services yields the best return. If your tribal healthcare organization is navigating growth or transformation, our team is here to help. 👉 Connect with Wes [https://www.redw.com/team/wesley-benally] REDW Advisors and CPAs is proud to bring you the Insight in Indian Country Podcast, covering important advisory, accounting, and finance topics that impact Tribal Nations and business affairs. Thanks for listening!

Send us a text [https://www.buzzsprout.com/twilio/text_messages/1767544/open_sms] Revenue cycle management isn't just a back-office operation—it's a strategic tool for strengthening care delivery in Tribal communities. This episode, REDW National Tribal Practice Leader Wes Benally sits down with Melissa C. Goad, CRCR, CPA, MBA, a healthcare finance veteran with 30 years of experience spanning both payer and provider perspectives. Melissa shares her transformative journey as CFO of a 638 Tribal Healthcare Facility on the Navajo Reservation, where she led a comprehensive revenue cycle optimization initiative that delivered a tenfold return on investment. From fixing data flow challenges and reducing denials by up to a third, to implementing culturally sensitive front-end operations and embracing industry best practices, Melissa's insights offer a practical roadmap for Tribal healthcare organizations looking to maximize reimbursements and close gaps in care. Her approach? Take it layer by layer, build cross-functional teams, and remember that optimizing revenue cycles ultimately means securing the resources needed to serve the community better. Chapters ·        00:00 - Introduction and Melissa's Healthcare Background ·        02:05 - The Importance of Revenue Cycle Management ·        04:45 - Assessing Opportunities in Tribal Healthcare Settings ·        06:36 - Embracing Industry Best Practices ·        12:24 - Denials Management and Registration Challenges ·        17:37 - Data Flow and EHR Customization Issues ·        20:13 - The Power of Cross-Functional Teams ·        25:05 - Cultural Considerations in Tribal Healthcare Takeaways ·        Revenue cycle optimization is about ensuring continuity of care and honoring commitments to the community, not just financial health. ·        Tribal healthcare facilities face unique challenges including geographic isolation, staffing limitations, complex billing regulations like the All-Inclusive Rate (AIR), and often inadequate technology. ·        Starting with a thorough assessment before implementing changes prevents costly assumptions and builds a strong foundation for improvement. ·        Registration is one of the most critical points in the revenue cycle—if data starts wrong, it ends wrong. ·        Cross-functional teams that include both clinical and revenue cycle staff are essential for identifying and fixing denial patterns. ·        Cultural sensitivity in patient-facing operations, including language support and understanding Tribal-specific requirements like CBI collection, strengthens both patient experience and reimbursement accuracy. ·        Organizations can expect to see returns within 6 months of implementing systematic fixes, with some facilities achieving tenfold ROI on revenue cycle investments. Ready to Strengthen Your Revenue Cycle? Whether you're considering a 638 transition or looking to improve existing operations, connect with REDW's Tribal healthcare advisors to explore how we can help strengthen your organization's financial health and expand care for your community.  👉  Learn more about 638 Healthcare Transition Support [https://www.redw.com/tribes/638-healthcare-transition-support/]  👉  Explore Accounting Advisory Services [https://www.redw.com/tribes/accounting-advisory/] REDW Advisors and CPAs is proud to bring you the Insight in Indian Country Podcast, covering important advisory, accounting, and finance topics that impact Tribal Nations and business affairs. Thanks for listening!

Send us a text [https://www.buzzsprout.com/twilio/text_messages/1767544/open_sms] The 105(l) lease program has become one of the most transformative funding mechanisms available to Tribal Nations—but it's widely misunderstood. This episode, REDW National Tribal Practice Leader Wes Benally sits down with Geoff Strommer, partner at Hobbs Straus Dean Walker, to demystify this critical provision of the Indian Self-Determination Act. Despite the name, 105(l) "leases" aren't leases at all in the traditional sense—they're funding agreements that enable Tribes to receive resources for maintaining, repairing, and even constructing healthcare and administrative facilities. Geoff, who litigated the landmark Maniilaq cases that established Tribes' rights to fully funded 105(l) agreements, shares the fascinating journey from dormant statutory provision to nearly $1 billion in total lease value across Indian Country. Learn about the three compensation methodologies, how Tribes are using projected 105(l) revenue to finance major new construction projects, and what barriers (and opportunities) exist in this evolving landscape. Chapters * 00:00 - Introduction and Geoff’s Background in Tribal Law * 02:44 - What Are 105(l) Leases? Breaking Down the Basics * 06:46 - The Landmark Maniilaq Litigation Cases * 16:19 - Establishing Mandatory Lease Requirements * 17:15 - Three Compensation Methodologies Explained * 24:34 - Barriers and Negotiation Issues * 28:44 - Congressional Appropriations and Future Sustainability * 31:31 - Looking Forward: Financing New Facilities Takeaways * 105(l) leases are funding agreements, not traditional leases—the federal government transfers funds to Tribes for facility maintenance and operations * The Maniilaq litigation established that 105(l) leases are mandatory, not discretionary, and must be fully funded * Three compensation methodologies exist: fair market appraisal, hybrid appraisal, and cost reimbursement * Nearly $1 billion in total 105(l) lease value has been achieved across Indian Country in recent years * Tribes are now using projected 105(l) revenue streams to finance new construction projects, transforming the facilities landscape From Legal Right to Financial Reality Geoff and his team at Hobbs Straus Dean Walker establish the legal framework for 105(l) leases [https://hobbsstraus.com/professionals/geoffrey-d-strommer/]—REDW helps you put that framework into action. Our 638 Healthcare Transition Support [https://www.redw.com/tribes/638-healthcare-transition-support/] team guides Tribes through self-governance transitions, while our Advisory & Accounting specialists [https://www.redw.com/tribes/accounting-advisory/] help you document costs, prepare lease proposals, and build financial packages that leverage 105(l) revenue streams for new facility construction. Ready to turn 105(l) opportunities into reality? Reach out [https://www.redw.com/tribes/contact-us/] to learn how we can help you maximize available resources.  REDW Advisors and CPAs is proud to bring you the Insight in Indian Country Podcast, covering important advisory, accounting, and finance topics that impact Tribal Nations and business affairs. Thanks for listening!

Send us a text [https://www.buzzsprout.com/twilio/text_messages/1767544/open_sms] Employee voice is transforming HR practices across Indian Country, creating both opportunities and challenges for Tribal organizations. This episode, REDW National Tribal Practice Leader Wes Benally welcomes Taryn Reynolds, MSL, THRP II, and Jessica Goodfox, THRP, TMP, from REDW's Human Resource Consulting [https://www.redw.com/hr-human-resources-consulting/] team to discuss the heightened focus on HR accountability, proper documentation practices, and the unique cultural considerations that shape Tribal workplace policies.  From developing bereavement policies that honor four-day traditional burial practices to managing investigations in close-knit communities where "everyone knows everyone," Taryn and Jessica share practical insights for HR professionals navigating these complex dynamics. They also preview their upcoming presentations at the NNAHRA Conference, including executive coaching for HR practitioners and compensation clarity [https://www.redw.com/navigating-compensation-creative-strategies-amid-uncertainty/] sessions. Whether you're a seasoned HR professional or a new manager dealing with employee relations for the first time, this conversation offers valuable guidance on documentation best practices, cultural competency, and leveraging external expertise when needed. Chapters * 00:00 - Introduction and Welcome * 02:04 - The Rise of Employee Voice in Indian Country HR * 07:17 - Top Three Things for New Managers * 10:22 - Cultural Competency Beyond Buzzwords * 13:21 - NNAHRA Conference Experience and Networking * 16:38 - What to Expect at NNAHRA 2025 Takeaways * Employee needs and investigations are increasing across Indian Country, requiring proper documentation and legal compliance * HR professionals should document employee interactions immediately and avoid promising complete confidentiality during investigations * Cultural competency in Tribal HR means aligning policies with traditional practices, such as four-day bereavement periods for burial ceremonies * The NNAHRA Conference provides transformative networking opportunities and professional development for Tribal HR professionals * External HR consulting can help remove bias and provide objective investigation services in close-knit Tribal communities Resources * Learn how to design effective compensation strategies amid ongoing financial uncertainty in our latest blog, “Navigating Compensation: Creative Strategies Amid Uncertainty” | READ MORE [https://www.redw.com/navigating-compensation-creative-strategies-amid-uncertainty/] * Download our FREE white paper, “Addressing Pay Compression: Strategies and Best Practices” | LEARN MORE [https://web.redw.com/pay-compression-strategies] NNAHRA'S 29th Annual Conference - September 29 - October 1 - Pechanga Resort Casino REDW's Human Resource Consulting team will be front and center at NNAHRA’s 29th Annual Conference with presentations on executive coaching and compensation clarity, plus our popular booth featuring chair massages and great swag. Stop by to learn how REDW can support your Tribal organization's HR needs. | Connect with REDW at NNAHRA [https://www.redw.com/nnahra-29th-annual-conference/] REDW Advisors and CPAs is proud to bring you the Insight in Indian Country Podcast, covering important advisory, accounting, and finance topics that impact Tribal Nations and business affairs. Thanks for listening!

Send us a text [https://www.buzzsprout.com/twilio/text_messages/1767544/open_sms] John James, CEO of Navajo Nation Gaming Enterprise (Navajo Gaming), joins Wes Benally this episode to discuss the evolution of tribal gaming. They discuss the importance of customer experience and the role of innovation in the industry. John shares insights on navigating economic uncertainty, balancing technology with team development, and the significance of non-gaming amenities in enhancing customer experiences. A must-listen for aspiring leaders in the gaming sector! Chapters ·        01:18 - Evolution of Tribal Gaming Over the Decade ·        04:53 - The Experience of Brick-and-Mortar Casinos ·        08:25 - Customer-Centric Operations in Gaming ·        11:54 - Navigating Economic Uncertainty in Gaming ·        14:42 - The Role of Innovation in Gaming Operations ·        17:32 - Balancing Technology and Team Development ·        19:21 - Non-Gaming Amenities and Customer Experience ·        25:01 - Future Trends in Tribal Gaming ·        29:14 - Advice for Aspiring CEOs in the Gaming Industry REDW Advisors and CPAs is proud to bring you the Insight in Indian Country Podcast, covering important advisory, accounting, and finance topics that impact Tribal Nations and business affairs. Thanks for listening!