Correctional Managed Care sets standard for Texas, nation
By Mary Havard
MARCH 5, 2007--“Flexible,” “adaptive” and “innovative” aren’t words normally associated with prison settings, but they aptly describe a 14-year-old program responsible for providing care to approximately 80 percent of Texas’ prison population. And, these qualities have enabled UTMB Correctional Managed Care (CMC) to improve patient care outcomes, save taxpayer dollars and set the national standard for correctional care.
Since 1983, UTMB has been home to the Texas Department of Criminal Justice Hospital—the only health facility both dedicated to prisoners and located on a medical school campus. In 1993, TDCJ entered into a contract with UTMB and Texas Tech University to develop a statewide health care network to provide inmates with timely access to a constitutionally mandated level of care while also controlling costs.
The contract afforded UTMB a powerful combination of clinically complex cases in an environment where patients’ compliance with treatment plans can be carefully monitored. CMC became a proving ground for standardized, evidence-based treatment protocols to streamline and improve the quality of care, as well as for such innovations as telemedicine, comprehensive electronic medical records and a fully automated pharmacy.
Today’s CMC
The result has been the creation of a full-scale health system within the existing UTMB system. The 3,400 CMC employees account for about a third of UTMB’s total work force. They provide care for more than 126,000 individuals in more than 100 sites and record 4 million patient encounters each year. Agencies served include TDCJ, the Texas Youth Commission and the Federal Bureau of Prisons in Beaumont, Texas.
Services include the wide range of primary, specialty and therapeutic services one would expect from an academic health center. Unlike UTMB Hospitals and Clinics, CMC also offers general dental care and operates an intrastate transportation system for its patients. It even takes responsibility for funeral arrangements when an inmate dies.
The program operates two 500-bed mental health facilities (in Rusk and Sugar Land), along with its own dialysis unit that can serve up to 155 patients at a time in Huntsville. (As an example of the cost savings CMC has been able to realize, the program spends $20,000 per patient per year on dialysis, compared to “free-world” Medicare reimbursement rates of more than $50,000 per patient per year.) In addition to the TDCJ Hospital in Galveston, it runs the Carol Young Facility in Texas City, which serves the health needs of female inmates.
Positive Results
CMC’s results are hard to ignore. In 2005, the Texas Medical Foundation released results of a six-month review of prison health services provided by UTMB, saying that CMC “consistently meets or exceeds community standards for managed care organizations.” The non-profit organization of licensed physicians found that CMC had succeeded in improving inmates’ access to care, reducing wait times for medical appointments, speeding the scheduling of specialty consultations, improving health care coordination and continuity of care, and decreasing costs.
In terms of quality of care, rates of compliance with proven disease management guidelines for a host of conditions—ranging from asthma and high blood pressure to seizure disorders and heart disease—have improved dramatically under CMC. In 2003, nearly half of inmates with hypertension were able to reduce their blood pressure to acceptable levels, compared with only 17 percent of the population when CMC was created. Likewise, mean levels of “bad” cholesterol decreased by 25 percent over the same time span. And, a consistently high percentage of diabetic patients in Texas prisons receives recommended interventions, as defined by national performance measures set forth by the Diabetes Quality Improvement Project.
In addition, all UTMB prison sites, in partnership with TDCJ, have passed their American Correctional Association accreditation with a minimum 96 percent compliance rating over the past five years.
Meanwhile, the program has held the line on costs. In FY2006, Texas paid approximately $7.64 per inmate per day for medical, dental and mental health services, while Ohio pays $11.64 and California pays more than $19 for the same services—without the positive health outcomes.
Advancing correctional care
Innovation has been key to such success. John Allen, assistant vice president and chief operations officer, says CMC has for years been using many of the advances now being implemented in UTMB’s general clinical areas. “CMC has the largest electronic medical record system in a correctional setting, and it’s been in place for six and a half years. We can sympathize with our campus colleagues who are learning the new system, but based on our long-term experience, we can assure them the effort will be worth it.”
The UTMB telemedicine technology that’s finding its way into the lives of free-world patients also got its start in prison settings, at first to bring subspecialty care to the units to eliminate the time delay and costs of transporting inmates to Galveston. However, even that technology is evolving in the CMC health system.
Allen says, “We’re using it between prison facilities in the field to help address a shortage of nurses and providers, especially in the rural areas. These types of encounters now account for the highest percentage of CMC-related telemedicine consultations. It may not be as glamorous as treating someone at the South Pole from a hospital in Galveston, but it helps us make the best use of our staff and improves our patients’ access to providers who are well-versed in our treatment protocols and systems.”
CMC’s fully automated, robotic pharmacy processes more than 15,000 prescriptions a day for the entire TDCJ system, including the region served by Texas Tech. The pharmacy, headquartered in Huntsville, also offers an accredited residency program, training one resident a year in using the facility’s state-of-the-art technology.
Meeting Challenges
Such success has not come easy. The high-security work environment aside, it can be difficult to find adequate numbers of properly trained caregivers in the rural areas where many Texas prisons are located. (One unit has more positions for R.N.s than there are R.N.s living in the county.) Telehealth technology helps. And, CMC supports its employees with a comprehensive training program, including an online resource guide and more than 100 web-based continuing education courses designed specifically for caregivers in correctional settings.
In addition to staffing challenges, the offender population is increasing and aging, requiring CMC to develop ways to effectively serve a growing number of patients with complex chronic conditions, such as HIV infection, hepatitis C, tuberculosis, cardiovascular disease and diabetes. For this reason, upgrades to facilities and equipment will be needed in order to maintain the quality of care.
But the challenges strengthen the program. “CMC is staffed by a fine group of professionals who take their commitment to their patients very seriously,” said Dr. Ben G. Raimer, who, as chief executive officer and vice president for community health services, oversees all aspects of the program. “In true UTMB fashion, they meet challenges with resolve, creativity and skill. They not only improve the lives of their patients, but they present solutions we can often adapt to improve care in the free world. Although most CMC employees live miles from Galveston, they most definitely are valued members of the UTMB family.”
For more information on CMC, visit the web site.