Two clinics. One integrated model.
The dual-site model pairs the Los Angeles clinic with a tribally-owned clinic in rural Northern California. Together they carry the specialty depth, patient volume, operational infrastructure, and cultural grounding that neither site could sustain alone. Both sites are the work.
Two problems most tribal communities face. One design that solves both.
The rural problem
Rural tribal communities often cannot sustain a full-service clinic alone. Patient volume is too low for specialty depth, reimbursement is too fragile for a standalone balance sheet, and workforce recruitment is too hard without scale. Result: care is partial, referrals are distant, and tribal sovereignty over health operations is structurally limited.
The urban problem
Urban Indian populations often cannot access tribally-specific care at all. Urban Indian health organizations exist, but the patient is navigating a system that was not built with tribal identity as a starting point. Result: cultural disconnect, treatment gaps, and erosion of the tribal health relationship in cities where most tribal members now live.
Two sites, two roles, one model.
In hub-and-spoke terms: the LA clinic plays the hub role, the Northern California clinic plays the spoke role. In practical terms: each clinic is a full-service site in its own right. Cross-site infrastructure is what makes either clinic viable.
Los Angeles Clinic
Runs in Los Angeles under a physician-owned Professional Corporation operated by IHA. Carries the specialty depth, patient volume, and operational infrastructure that stabilize the dual-site balance sheet. Provides specialty referral access, telehealth backstop, shared credentialing, centralized revenue cycle, and cross-site clinical governance. Also serves urban Indian patients directly as its own patient population.
- Integrated behavioral health, medical, dental, traditional health
- Physician-owned, IHA-operated MSO structure
- Specialty referral and telehealth support for the Northern California clinic
- Shared credentialing, RCM, and compliance
Northern California Clinic
A tribally-owned clinic in rural Northern California. Runs under tribal ownership with IHA management services, structured from day one to transition to a 638 self-determination contract in July 2026. Delivers primary care, cultural care, behavioral health, and public health inside the tribal community, staffed by tribal employees.
- Medical, dental, behavioral health, traditional health, public health
- Tribally-owned, tribally-employed staff
- Cultural care integrated, not bolted on
- Built for 638 self-determination transition
Why two integrated sites pencil when one alone does not.
A rural tribal clinic run alone fights the math every month. Patient volume is low. Specialty depth requires subsidy. Recruiting is brutal. Reimbursement alone rarely closes the gap.
The dual-site model changes the math. Specialty services that a standalone rural clinic cannot sustain get delivered via telehealth from the LA clinic. Patient volume at the LA site carries fixed costs that would otherwise sit on the rural site's balance sheet. Shared RCM, credentialing, and IT stop every small clinic from rebuilding the same operational stack. The result: neither site has to pencil as a standalone business. They are integrated components of a model that does.
Why care has to happen inside the community.
Scale is not the only reason clinics fail in tribal communities. A clinic that is structurally disconnected from tribal identity, tribal governance, and tribal cultural care will never earn the trust of the community it is supposed to serve.
The Northern California clinic sits inside the community, under tribal ownership, staffed by tribal employees, with traditional health integrated as a first-class service line. The Los Angeles clinic supports that work with specialty infrastructure; it does not replace it. Care happens where the community is, the way the community needs it.
Three dates. One integrated launch.
The model is replicable. And we're scoping it.
The dual-site design is not specific to Los Angeles and Northern California. Any urban Indian center paired with a rural tribal community faces the same financial and cultural problems, and the hub-and-spoke model solves them in the same way.
Evaluating this model for your community?
We can share what we are learning in real time, including what pencils, what does not, and what the 638 transition actually looks like.
Book a discovery callWant to see the sites?
Read the LA clinic and Northern California clinic pages for the site-level detail.
See the LA clinic