Most counties' jail health systems are expensive yet not working as efficiently as their managers would like. The most pressing issues tend to be lawsuits, rising levels of infectious diseases, jail crowding and rising costs.
In 1996 ILPP was awarded a grant from the Robert Wood Johnson Foundation (RWJF) to do a pilot national study of jail medical programs, aimed at the issues of accreditation and public health, and the question of integration of jail medical services with county public health activities.
The study found that the lack of coordination and integration of medical service between jail medical and community and public health clinics resulted in inmates, with known active TB cases, not completing treatment once released. It also addressed the larger cost issue due to inefficiencies in the two health care systems, which had many overlapping services. ILPP’s study was directly instrumental to initiation of a national study conducted by the Center for Disease Control and Prevention, “Evaluation of CDC Guidelines for Tuberculosis in Jails.” The design and methods of the national study were modeled after the design for the RWJF study. As a result of this important work and expertise, ILPP’s Medical Director, Dr. Wong, was asked to serve as an advisor on studies evaluating 20 large county jail systems.
Approaching a Solution
ILPP has developed an approach for managing such situations. First, ILPP conducts a policy and procedure performance review of a jurisdiction's correctional medical services guided by the following questions:
Is service delivery appropriate?
This is an important step to determine that the right services are being provided in the most timely and efficient way possible. How can you contain costs and provide better care?
These two goals often seem mutually exclusive but in fact they go hand-in-hand. The bottom line is getting the patients as directly as possible to the right provider to receive the right treatment. This requires effective triage from the moment of presentation.
How is the system managed?
Is there an internal review mechanism and is it used? Is the county getting the best rates for hospital and provider service?
Then ILPP provides the client with a set of concrete recommendations tailored to the particular system. Previous projects have saved correctional systems millions of dollars while also improving the quality of service given.
ILPP recently completed a study of jail medical services in Hillsborough County, Florida (Tampa). The following is our client's response:
"When we entered the contract with your firm, we could not have anticipated that the results of the study could produce such significant savings for the taxpayers of Hillsborough County.
The Sheriff's Office, utilizing information included in your study, in two separate actions has achieved an overall savings in the contract amount of $1,500,000. We are most pleased to have achieved that kind of reduction."
Senior Assistant County Administrator
Hillsborough County, FL (Tampa)