Administrative burden in tribal healthcare: A hidden barrier to access, workforce sustainability and health equity

Reflections from the National Tribal Health Conference on sovereignty, listening and creating more capacity for care

Last week, I had the opportunity to attend the 2026 National Tribal Health Conference (NTHC) in Phoenix, and I left with a deeper appreciation for the priorities, strengths and complexities of tribal healthcare.

One theme was woven through nearly every plenary panel and breakout session: sovereignty.

Tribal sovereignty. Healthcare sovereignty. Food sovereignty. Data sovereignty.

Again and again, speakers reinforced that history, culture and the government-to-government relationship are not background context. They are essential to understanding how healthcare is delivered, funded, governed and experienced in Indian Country.

For healthcare leaders looking to address administrative burden, these conversations offered an important reminder: solutions must begin with listening, respect for local priorities and a commitment to supporting community-led care.

Tribal sovereignty is foundational to healthcare delivery

I naturally gravitated toward sessions led by organizations such as the Indian Health Service (IHS), the Health Resources and Services Administration (HRSA), the U.S. Department of Health and Human Services (HHS) and other federal partners.

These sessions provided valuable perspectives, including:

• A Centers for Medicare & Medicaid Services (CMS) listening session focused on legislative priorities for American Indian and Alaska Native Medicare and Medicaid reform
• A National Institutes of Health (NIH) session exploring inclusive research and data modernization opportunities for Indigenous communities

Some of my most meaningful takeaways, however, came from sessions that extended beyond federal programs and policy.

Conversations about tribal public health, Indigenous determinants of health, traditional healing practices and data sovereignty reinforced an important message: supporting tribal health means listening first and recognizing that priorities may differ across tribal nations and communities.

Healthcare solutions are most effective when they align with the needs, goals and values of the communities they are intended to serve.
 

Healthcare teams are being asked to do more with less

While every discussion was unique, a common challenge surfaced repeatedly: healthcare teams are being asked to do more with limited resources.

This challenge extends far beyond tribal healthcare. Across the country, health systems continue to navigate:

• Growing documentation requirements
• Workforce shortages
• Reimbursement complexity
• Regulatory requirements
• Increasing operational pressures

For tribal health organizations, these pressures may be amplified by additional challenges such as provider shortages, geographic barriers, resource constraints and access issues.

As a result, administrative burden can have a significant impact on both care delivery and organizational sustainability.

The question administrative burden raises for tribal healthcare

One question stayed with me long after the conference ended: How much of our healthcare workforce is spending time on care, and how much is spending time on the work surrounding care?

Behind every patient encounter is a growing list of administrative responsibilities:

• Clinical documentation
• Coding reviews
• Revenue cycle management
• Quality reporting
• Prior authorization activities
• Information management tasks
• Manual workflows

These activities are necessary, but they compete for clinicians' time and attention.

In tribal healthcare settings, that time often carries additional meaning. Time with patients may also be time spent building trust, honoring culturally informed care, strengthening relationships and supporting whole-person care.

When administrative work becomes more burdensome than necessary, the effects extend beyond operations. It can reduce the capacity healthcare teams have to serve their communities in the ways that matter most.

Why administrative burden matters for health equity

Administrative burden is often discussed as an operational challenge, but it is also a health equity issue. When clinicians and staff spend excessive time on paperwork, organizations may have fewer resources available for:

• Patient engagement
• Care coordination
• Community outreach
• Preventive services
• Workforce support initiatives

For communities already facing healthcare access challenges, reducing administrative burden can help expand capacity without requiring additional clinical hours.

In that way, workflow efficiency becomes more than a productivity goal. It becomes a strategy for improving healthcare access and supporting better health outcomes.
 

Technology should create more capacity for care

When discussions turn to improving healthcare access, workforce sustainability and patient outcomes, technology often enters the conversation.

The most impactful innovations, however, are not always the most visible. Sometimes the greatest opportunity lies in removing friction from everyday work. Technology is one tool among many and is most effective when combined with investments in workforce, infrastructure and community priorities.

Technology should help healthcare professionals focus on patients, not paperwork. That is why many tribal health organizations are exploring solutions that simplify workflows, reduce administrative burden and help teams make the most of limited resources. 

Potential areas of impact include:

• Clinical documentation improvement
  Reducing documentation complexity can help clinicians spend less time completing records and more time with patients.
  
  
• Coding and revenue cycle support
  Automation and intelligent workflows can improve coding accuracy while reducing manual effort.
  
  
• AI-powered information management
  AI can help streamline information retrieval, organization and workflow management, enabling staff to work more efficiently.
  
  
• Workflow automation
  Automating repetitive administrative tasks can reduce bottlenecks, improve consistency and support workforce sustainability.

The goal is not simply greater efficiency. The goal is creating more capacity for care.

AI and automation must support tribal priorities, not replace them

The conversations at NTHC reinforced another important point: technology creates value when it serves people.

AI and automation should support clinicians, strengthen organizations and help communities advance their own health priorities. They should adapt to local needs rather than impose a one-size-fits-all approach.

This principle felt especially important during discussions about data modernization and data sovereignty.

More data is not automatically better if tribal nations do not retain appropriate authority over how that information is collected, governed, shared and used.

For healthcare technology partners, this means approaching innovation with:

• Humility
• Transparency
• Collaboration
• Respect for tribal governance
• Commitment to listening

As healthcare continues to evolve, tribal health organizations offer a powerful example of how to balance innovation, culture and community-centered care.

What healthcare can learn from tribal health organizations

Tribal health organizations continue to demonstrate what it means to deliver person-centered care while navigating complex operational realities.

There is much the broader healthcare industry can learn from this approach:

• Listen before implementing solutions.
• Respect local priorities and governance.
• Design technology around people, not processes.
• Reduce administrative burden wherever possible.
• Use innovation to support, not replace, human connection.

These principles help ensure that technology remains practical, flexible and grounded in the communities it is meant to serve.

Creating more time for what matters most

I am grateful for the opportunity to learn from leaders who are advancing health in their communities every day.

Those conversations reinforced a simple but important reminder: improving health outcomes often starts by giving healthcare professionals more time to do what brought them into healthcare in the first place, caring for people.

Reducing administrative burden will not solve every challenge facing tribal healthcare. But it can create more room for the work that does:

• Listening
• Healing
• Care coordination
• Workforce support
• Community-centered services

As these conversations continue at TribalNet and throughout the year, I look forward to learning more about how tribal organizations are strengthening care delivery, supporting their workforce and shaping the future of healthcare on their own terms.

Aras Eftekhari is a senior federal account manager at Solventum.