November 16, 2023

Growing up on an Indian reservation with his sights on healthcare
Growing up in northern Michigan on the tribal lands of the Sault Ste. Marie Tribe of Chippewa Indians, Nicholas Cushman, PharmD ‘16, MHA, BCACP, decided early on to carve a path that would lead to opportunities beyond the reservation.

Healthcare seemed like a promising field, and he had a chance to shadow a pharmacist in a hospital, which led to a job as a pharmacy technician. A close relationship with his grandmother gave him an affinity for relating to older generations. Putting those things together, he envisioned a career in the traditional pharmacist’s role at the corner store.

Today, his impact is enhancing healthcare for American Indians and Alaska Natives far beyond the local pharmacy. Nick finds himself in the position to touch nearly every aspect of Indigenous health at the local, community, regional, and national levels.

Elevating skills, knowledge, and cultural competence with Indian Country ECHO
Nick is impacting care for Indigenous populations at every level as Clinical Program Coordinator for Indian Country ECHO, a program of the Northwest Portland Area Indian Health Board. ECHO is an interactive virtual learning model that brings clinicians throughout the Indian healthcare system together to improve care. With ECHO, clinicians can convene virtually to learn from each other and from a multidisciplinary panel of faculty experts through didactic presentations and de-identified patient case presentations.

The sessions differ from webinars because all participants have the opportunity to both teach and learn. By sharing expertise, the sessions elevate the skill and knowledge of clinicians across many centers while being grounded in the context of culturally appropriate care specific to the patient community. “Eventually, participants become comfortable enough to provide the services we discuss, but they continue to join in and share on a peer-to-peer level,” Nick says.

The ECHO model was developed two decades ago at the University of New Mexico when a hepatitis C expert realized that patients were dying of a treatable and curable disease due to a lack of access and specialist knowledge. The Northwest Portland Area Health Board adopted the model to enhance care for American Indians and Alaska Natives. Since Nick joined the program in November 2020, ECHO has rapidly expanded well beyond hepatitis and now offers nearly 30 programs related to various conditions and topics, from maternal and child health to dementia and rheumatoid arthritis.

“We’ve branched into the national priority of the interrelationship between substance use, hepatitis C, sexually transmitted infections, and HIV, and how they all work together to worsen the burden of disease. The main goal has been to bring things that were once considered specialty care into primary care and make it a one-stop shop for our patients,” he says. With ECHO bringing expertise to teams throughout the system, “we’re finding that the majority of cases can be treated effectively by the PCP.”

Enhancing access to clinical expertise is a huge contribution, but ECHO does much more. Another area of his role is to develop, coordinate, and manage technical assistance programs, helping providers build and strengthen the systems and infrastructure necessary to provide quality healthcare. Nick notes, "We help with writing policy and procedures, workflow processes, medication procurement, and reimbursement, hoping to make those systems sustainable.”

Striving for health and prosperity in Indigenous communities
A final component of his role is advocacy, supporting legislation, and negotiating for adjustments to state Medicaid requirements and limitations. “The goal is to reduce barriers and obstacles to healthcare by avoiding things such as a lack of funding and insurance coverage or long commutes to access care,” he notes. “We also work on reducing the bias and stigma that American Indians and Alaska Natives experience when they are receiving care outside the system. Time and again, we've been able to help increase access so that our patients and community members receive comprehensive and culturally appropriate care within their communities from the providers they know and trust. It’s that collective mission of striving towards health and prosperity for these communities.”

Impacting and giving back to Indigenous communities is incredibly rewarding
He’s grateful for the opportunities that helped him break out of the cycle of dependency and limited horizons he has seen all too often on reservations.

Knowing education was key, he earned his bachelor’s degree at U-M, then enrolled in the PharmD program. He was named an Indian Health Service Health Professional Scholar after his first year -- an award that covered his tuition and living expenses for the final three years of his doctoral program. In exchange, he committed to working for the Indian Health System, which includes federal, tribal, and urban health centers.

Upon graduation, he started as a staff pharmacist in Albuquerque and completed his PGY1 residency the following year. At the same time, he joined the U.S. Public Health Service (USPHS) Commissioned Corps. He later served as Deputy Chief Pharmacist in southwest Colorado before moving into his current role in 2020. He is now a Lieutenant Commander in the USPHS.

Going to U-M changed the course of my life
“The College of Pharmacy provided the well-rounded education and training I needed to excel in the pharmacy profession and healthcare as a whole, and has genuinely meant everything to me. The opportunity to go to U-M changed the course of my life and the life of my family. I am extremely grateful that they took a chance on me.”

In gratitude, he makes time to give back to the College and inspire young people to follow in his footsteps. He shares his story with students through speaking engagements, serves as a preceptor, and is an advisory committee member of the College’s novel Pharmacy Community College Connect Program.

“We (American Indians and Alaska Natives) have such low representation in higher education and in the healthcare profession. There’s a lot of uncertainty and self-doubt that goes with being a trailblazer and the first in your family to do something. It is a big passion of mine to set an example. I share my story hoping to influence others in a similar situation — in particular, our Indigenous youth, to offer them an example of what's possible.”