Specialty and surgical care your members can reach at a cost your nation can predict.
Longitude partners with Tribal health programs to replace fragmented, authorization-heavy specialty referrals with a direct, relationship-based network — giving members timely access to high-quality specialists and surgeons at a fixed monthly cost that fits how Tribal health programs are actually funded.
Tribal health programs have built strong primary care. Specialty access is where the system falls short.
Most Tribal health programs have invested meaningfully in primary care infrastructure. The persistent challenge is what happens after a referral is written: long waits, PRC authorization delays, travel burdens to distant specialists, and members who disengage before their care plan is ever completed. Longitude was built to close that gap — not to replace what Tribal programs have built, but to extend it into the specialty and surgical access that has been hardest to secure.
Geographic Distance
For many Tribal communities, the nearest high-quality specialist or surgical center requires hours of travel — creating a barrier that goes beyond cost, affecting absenteeism, family burden, and appointment completion rates.
PRC Authorization Delays
Purchased/Referred Care authorization processes introduce delays that are clinically consequential. By the time a referral is approved, a condition has often progressed — and the member may no longer pursue the appointment.
PRC Funding Constraints
PRC funds are historically underfunded relative to the specialty care needs they are meant to cover. Tribal programs must make difficult prioritization decisions, with real consequences for members whose needs fall below the PRC funding threshold.
What Longitude changes — and what it costs compared to what you're already spending.
The case for Longitude isn't that it adds a new cost to your health program. It's that a predictable PMPM arrangement replaces the most unpredictable, administratively burdensome, and member-disruptive part of the current model. For Tribal Nations already managing PRC funding, the question isn't "can we afford this?" — it's "what are we getting for what we're already spending, and is this better?"
| PRC-Dependent Specialty Access (Current Model) | Longitude PMPM Specialty Access |
|---|---|
| Authorization required case-by-case before specialty care can proceed | Covered services accessed without individual authorization for PMPM-enrolled members |
| Funding limited and inconsistent — denials and deferrals are routine | Fixed monthly cost covers up to 90% of the most common specialty, surgical, and outpatient needs |
| Wait times for approval add weeks to an already delayed referral process | Routine appointments available within 14 days per contract |
| High administrative burden on PRC managers and clinic staff | Administrative workload shifted to Longitude — PRC staff freed for complex cases outside the network |
| Members left to navigate scheduling and transportation on their own | Dedicated care coordinator works with Tribe to assist with referral needs |
| Unpredictable annual spend makes multi-year specialty planning difficult | Predictable annual PMPM budget enables multi-year Tribal health planning |
| Limited leverage with specialty providers — referrals are transactional, not relational | Contracted specialist relationships — volume commitments improve access and continuity |
| Members with chronic specialty needs cycle through repeated authorizations | A clearer operational decision for clinic staff: covered services routed through Longitude, complex cases routed through PRC |
Cost neutral is the floor, not the ceiling.
Longitude's PMPM rate is designed to be offset by what the current system costs in ways that don't always appear on a single PRC line item: avoidable ER visits when specialty access fails, hospitalizations from deferred surgical conditions, and the administrative cost of processing authorizations that Longitude eliminates entirely for covered services.
For Tribal Nations already spending PRC funds on the same specialty categories Longitude covers, the PMPM is a restructuring of existing spend — not new money — with better access, better member experience, and better administrative outcomes as a result.
We build a customized cost comparison for each Tribal partner using available PRC utilization data, so the financial case is specific to your nation — not a generalized estimate.
The offsets are real and measurable.
- PRC redirected to complex cases only. When Longitude covers routine specialty and surgical needs, PRC funds are freed for the highest-acuity cases that genuinely require them — stretching the same budget further.
- Fewer ER visits. Timely specialty access prevents the ER utilization that results when members can't get a specialist appointment in time for a manageable condition.
- Fewer avoidable hospitalizations. Early surgical intervention for orthopedic, GI, and cardiovascular conditions is consistently less expensive than the acute episode that results from deferral.
- Authorization overhead eliminated. PRC manager time, documentation burden, and the administrative cost of processing denials are substantially reduced for covered Longitude services.
- Third-party coverage captured first. Where members have Medicaid, Medicare, or private insurance coverage for a given service, those are billed first — so Tribal funds are applied only where they are actually needed.
The Tribe governs this program. That is not a talking point — it is how the contract is structured.
Longitude operates as a contracted specialty access partner to the Tribal Nation — not as a plan administrator, not as an insurer, and not as an intermediary that sits between your members and their care. The Tribal health program retains full governance over which services are included, which providers are in the network, and how the program is operated. Longitude brings the specialist relationships, the care navigation infrastructure, and the operational model. The Tribe directs it.
High-quality specialists who have committed to serving your members — not transactional referrals to whoever will accept.
Longitude's contracted network is built around the specialty and surgical services that generate the most referrals, the most PRC spend, and the most unmet need in Tribal health populations. Providers participate because the PMPM model makes serving this population financially sustainable and clinically meaningful — not because they're the only ones who will accept Medicaid rates.
A structured path from approval to access — built around how Tribal governance actually works.
Longitude's implementation model is designed for Tribal health programs — with a governance structure that begins with Tribal Council and Health Board approval, and moves through a joint gap assessment and contract development phase. Every phase is led by the Tribe.
What Longitude Brings
You lead. We operate.
- Contracted specialty network — relationships already established with regional specialists and surgical centers across the Oklahoma City metro and surrounding areas
- Care Navigation infrastructure — program design, training materials, tracking systems, and coordination protocols ready to deploy with Tribe-based staff
- PMPM contract framework — standard agreement structure with defined access commitments, quality metrics, and annual renegotiation triggers
- PRC integration guidance — clear protocols for which services are covered by Longitude versus which require separate PRC authorization, simplifying the decision for clinic staff
- Medicaid and third-party billing coordination — ensuring eligible members' Medicaid and Medicare coverage is captured before Tribal funds are applied
- Performance reporting — monthly utilization dashboards, quarterly outcomes reports, and annual Health Board review packages built into the standard partnership
- Visiting specialist facilitation — logistics coordination for on-site specialist visits at Tribal facilities when geography makes travel an ongoing barrier
Designed for Tribal Nations that are ready to be purchasers of specialty care — not just recipients of whatever the referral system offers.
Longitude works with Tribal Nations that have an active health program, a PRC function, and a primary care foundation — and that have recognized the gap between what their members need in specialty and surgical care and what the current system reliably delivers.
Self-Governed Tribal Health Programs
Tribal Nations operating under 638 contracts or compacts who function as direct purchasers of healthcare services and want a specialty access model that fits their governance structure and budget authority. Longitude's PMPM arrangement is structured as a Tribal health program contract — not an insurance product.
Tribal Nations with Active PRC Programs
Nations already managing Purchased/Referred Care authorization whose leadership has identified specialty access delays, PRC funding shortfalls, or administrative burden as priorities. Longitude's most direct value is in programs where the PRC comparison is visible and the gap between referral and specialist appointment is measurable.
Tribal Employers & Self-Funded Plans
Tribal Nations that offer health benefits to Tribal employees through a self-funded or level-funded arrangement and want to add predictable specialty and surgical coverage that eliminates member cost-sharing — the same model Longitude offers commercial employers, applied to the Tribal employment context.
Multi-Tribal Collaboratives
Neighboring Tribal Nations exploring shared specialty access solutions. The PMPM model scales with enrolled member population, and Longitude has experience structuring arrangements that allow multiple Tribal health programs to benefit from shared specialist relationships and combined volume commitments.
Start the Conversation
Every Tribal Nation operates differently. A first conversation is the best way to see how a partnership could be shaped to fit your program.