ON THE OUTSIDE LOOKING IN: HEALTH-CARE MODEL OFFERS PROMISE FOR RETURNING INMATES, COMMUNITY
Volume 28, Issue 502 October 29, 2007
Matthew Gever
Officials in Hampden County, Massachusetts, have devised a program to improve inmates’ health, protect communities and lower health-care costs. While controlled studies have not yet been conducted, the model is so impressive that a number of states and cities plan to replicate it.
Federal law requires that states and municipalities provide health care for inmates while they are in lockup. However, this care stops at the gate, which means that the roughly 500,000 inmates who re-enter society each year have their care interrupted or stopped. This can lead to serious deteriorations in former inmates’ health and it can also put the surrounding community at risk of contracting a communicable disease such as tuberculosis. Conditions such as TB, Hepatitis C and HIV/AIDS are three times more common in state and federal prisons than in the general population, according to former Surgeon General Kenneth Moritsugu.
In the early 1990s, officials at the Hampden County Correctional Center began exploring ways to manage these issues. They learned that the majority of their inmates came from one of four zip codes, each of which had its own community health center. In 1994, the facility began pairing inmates with health-care professionals from those centers. The doctors enter the jail to treat inmates, and inmates who have served their time are encouraged to continue their care at their local health center.
Thus, inmates with serious conditions can avoid the problems that can develop when care is interrupted. Prescriptions that were written during incarceration can be filled or refilled in the community, and the ex-felons gain access to the preventive and primary care provided by the center. Since the provider is the same on both ends, HIPPA issues (privacy regulations regarding sharing of medical information) are nearly eliminated. The correctional facility reimburses the health centers for their services while the inmate is incarcerated.
“Without some kind of continued care, that money that we have to spend on their care in jail is wasted,” said Paul Sheehan, COO of Community Oriented Correctional Health Services (COCHS) and former employee of the Hampden County Sheriff’s Department. Sheehan also noted that COCHS works with and encourages counties to sign up those eligible for Medicaid, especially inmates with chronic illnesses. Individuals lose these benefits upon incarceration but regain them upon release. Starting the sign-up process before reentry allows for a smoother transition.
Officials believe the program has saved money by keeping former inmates out of emergency departments. “Around the country, $6 billion to $10 billion is spent on correctional health care [per year],” Sheehan said. “Without connecting them to the community health centers, where else are they going? They’re going to the emergency room down the road for treatment, which is the most ineffective and expensive means of care available,”
Sheehan also pointed out that states and cities can save even more money if a health center is designated as a federally qualified health center. This allows the facility to qualify for the federal 340B prescription drug program, which provides access to reduced-price prescription drugs.
Replication
A new $7.4 million grant from The Robert Wood Johnson Foundation is enabling Sheehan and others from the COCHS to provide technical assistance to other states and localities that want to establish a similar model.
The program is already being replicated in Washington, D.C. and Ocala, Florida. D.C. initiated its program in 2006. Providers from Unity Health Care visit the inmates in jail to identify their health problems, establish a plan for treatment and provide follow-up visits on the outside. “Healthier inmates are less likely to spread disease when they are out of jail, which means that the community is healthier,” said D.C. City Councilman David Catania in an op-ed piece in The Washington Post. Ocala will begin its program in January 2008.
© Copyright 2007, State Health Notes
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