By Monica E. Oss
Consider these six facts:
- 2.2% of the U.S. adult population, or seven million, is in prison or jail, on probation, or on parole (see Correctional Population In The United States, 2012).
- The total justice-involved correctional population was 6.9 million in 2012, with an average daily cost per offender estimated at $77.49 in the federal system ($28,283 annually), $79.84 in the state systems ($29,141 annually), and total spending of $86 billion (see The U.S. Corrections Market: 7 Million Adults In Correctional Systems & $86 Billion In Annual Spending).
- About 30% of the current Medicaid expansion is the justice-involved population (see Federal Estimates Indicate Former Inmates & Detainees Will Constitute About 30% Of People In The Medicaid Expansion Population).
- The U.S. Sentencing Commission in a January news release (see U.S. Sentencing Commission Seeks Comment On Potential Reduction To Drug Trafficking Sentences) recommended reducing prison sentences for low-level drug dealers by 11 months.
- In California alone, a 2001 lawsuit recommended reducing the in-prison population by 34,000, including 9,600 by the end of 2013 (see Supreme Court Denies Stay, California Must Continue Reducing Prison Population Pending Appeal).
- 16% of the U.S. adult population in prisons or jails are estimated to have a mental illness, or an addictive disorder (35%) or both (45%) (see Addiction & The Criminal Justice System).
These statements may seem unrelated. But, I was struck by the possibilities for new services here. Not narrow mental health treatment services for the recently released individual, or addiction treatment services, or HIV management services. But the need for integrated care coordination – medical, behavioral, and social – for this special population.
Why is this an opportunity now – and not in the past? In the past, most of the individuals released from prison or jail rarely had health insurance. They were unemployed, without financial resources, often not disabled enough to qualify for Medicare, and waiting for the Medicaid enrollment process to happen. Now, these newly-released individuals are immediately eligible for Medicaid due to provisions of the Patient Protection and Affordable Care Act (PPACA) (see Health Care Reform Regs Streamline Medicaid Eligibility For State Prison Inmates). And, given the trends in Medicaid, they belong to some organization’s Medicaid managed care organization.
These consumers are very likely to fall in that category of “complex” consumers using a high proportion of health care resources. In addition to the high prevalence of behavioral disorders, over one third of inmates in federal prisons (39%), state prisons (43%) and local jails (39%) reported a chronic medical condition (see Medical Problems Of Jail Inmates). Among 34 to 49 year old men and women in prison, the leading chronic conditions were hypertension (24.7%), obesity (24.7), arthritis (23.1%), asthma (13.9%), and hepatitis (12.9%). In addition, 1.5% of the population is HIV positive – four times the general population (see HIV In U.S. Jails & Prisons: Building A National Dialogue For Change).
But this population also has other issues that affect their ability to manage their health and behavioral health conditions. About 80% of prison inmates are reported to be functionally illiterate; 11% of prisoners reported having learning disabilities, compared with only 3% of the general population (see Literacy Behind Prison Walls); and the incidence of hearing loss in prisoners is approximately 30% (see Special Populations: Prison Populations).
I think the opportunities for improving the health (and social) outcomes of these individuals could be addressed through some of the elements of medical home management models (see The Medical Home As Gateway To The Future Of Health Integration and Health Homes Vs. Medical Homes: Big Similarities & Important Differences). And, in a market that is moving from “carve-outs” based on service type to “carve-outs” based on unique consumer populations, the management of the health of this population is both a challenge and an opportunity.
