Health care is expensive no matter the setting, but in corrections it is especially important to provide health care that strikes a balance between the standards of care and budget requirements. 

According to Cary Shames, Chief Medical Officer for the Colorado Department of Corrections (DOC), correctional healthcare won't work if practitioners and administrators focus solely on cost.

“The most important thing is to do two things at the same time: improving quality, and also being efficient with cost,” says Shames. “It's faulty to look at cost as the main drive in health care – you need to focus on quality as the main drive. There have been a number of studies that have shown focusing on quality directly cuts down cost as well.”

In the last year, the Colorado DOC has established a managed health care model for inmate care, developing a cost efficient health care system that reduces “over-utilization” by inmates and raises quality in a number of ways.  

“Over-utilization occurs often unless you monitor inmates. If someone doesn't need a procedure done, or need to see a specialist, that means they do not meet the guidelines we have established,” Shames says. “We go by national guidelines and national criteria to make these decisions. We make sure we're doing the best – for the patient and the system.”

Improving the System

The DOC's managed health care model raises the standards of care through quality assurance committees that maintain health care guidelines and criteria for inmates, an electronic medical records system that reduces duplication of services, and by focused inmate monitoring that ensures inmates receive proper treatment. As a result of this approach, the DOC has reduced unnecessary procedures for inmates who may not need them – and saved Colorado $1.6 million in medical spending for inmates.

According to Carolyn Sutherland, Chief of Nursing Services at the Colorado DOC, a total staff effort to monitor inmate medical claims and ailments has cut down significantly on medical costs and procedures.

“We've really gotten security staff at the facility involved,” says Sutherland. “We've become more observant. We have inmates who come in using a walker, and then they leave carrying the walker over their heads. We've become much more aware of that, which has obviously cut down on time and money.”

By becoming more observant and establishing new health care guidelines, staff can follow specific criteria for procedures and ensure only necessary procedures are done. This can be clearly seen in orthopedic medicine.

“Everyone says they have back pain, knee pain,” says Shames. “Everyone says they need physical therapy, they want to see a specialist – but now we have a list of nine criteria in Colorado that they have to meet before they get that extra care. Part of that criteria is pain behavior and objective visualization – which ties back to the way they act in your office versus the way they act [outside].”

According to Shames, inmates deserve the same kind of care and attention as anyone in the general public, but in corrections health care, where care is guaranteed to offenders, providers need better tools for objectively diagnosing medical needs.

“In general, if your doctor wants you to have an MRI scan, but he cannot show the need for you to have one, you're not getting an MRI scan. So why would we expect this particular group of patients to get something in terms of health care that we would never get [in the general public]?” Shames says. “We want to provide all the care that is necessary – but not provide any care that is unnecessary. That's one of the precepts of managed care – we determine what is appropriate care and what is not. We want these inmates to get exactly what they need.”

Monitoring false claims and unnecessary procedures is only a small part of providing quality managed care.

In order to help provide adequate care, the DOC's new electronic medical record system now allows all health care providers involved in an inmate's case to have access to their medical history – saving time, money and reducing duplication of services.

“Even with the best of intentions, these smaller things can fall between the cracks,” Shames says.”You need to have checks and balances in your system to make sure things happen the way they should – computerizing this helps that process.”

Shames said the DOC is also looking into inpatient hospital contracts with outside health care providers to streamline those agreements and reduce costs.

And, with the implementation of quality assurance committees that focus on infectious disease and morbidity and mortality peer reviews, the Colorado DOC is constantly reviewing the quality of care and determining if there are problems within the system.

“We are getting more and more sophisticated every month as we continue to work within the system,” Shames says. “You cannot change everything right away but we have methodology to become more and more sophisticated each day.”

And Shames says that with these advancements, the future of managed health care in Colorado looks bright – and he hopes other states will follow suit, saving time and money on inmate care.

“We have providers working with us to stretch the healthcare dollar and to provide appropriate, good care,” Shames says. “We would love to see this standardized – and we would hope this sets an example. We've had many people request information about the program – but what's most important is that we provide all the care that is necessary to inmates, but not to provide care that is unnecessary.”