Cell Service: Continuity of Care for Inmates

Among the medically vulnerable in our communities, it’s easy to forget those who’ve run afoul of the criminal justice system. Long-term prison inmates often have chronic conditions that are controlled to varying degrees, but those in local jails—generally for lesser offenses or even held pending trial—are often the kinds of folks who can benefit from greater care coordination.

In Georgia’s Chatham County Detention Center, for instance, around 20% of the population at any given time have behavioral-health issues, 45% have chronic illness, and 90% are uninsured. “It’s our county that pays for this population,” speaker Lisa Hayes, formerly executive director of the Chatham County Safety Net Planning Council, told HIMSS attendees Wednesday. “That’s a lot of local responsibility.”

Better controlling these inmates’ problems while in custody can reduce their burden once they’re out, which is why the council became one of the first in the U.S. to incorporate a correctional facility into a health information exchange—its Chatham Health Link (CHL).

With Georgia declining Medicaid expansion under the Affordable Care Act, its jailed individuals often have had limited access to primary and behavioral care. Their needs, though, can be complex, involving things like mental health issues, substance abuse, and infectious disease. And they can languish in the center for long periods even without a conviction if they can’t make bail.

CHL has received funds for indigent care from Chatham County since 2011, and four years later connected to the state’s premier HIE, GRAChIE (the Georgia Regional Academic Community Health Information Exchange), which connects to more than 400 locations and covers 2.8 million unique patients. Their shared mission of improved care coordination helped build a strong network in South Georgia, where more than 70% of local providers now contribute data. That data is now available to jail authorities, and the jail’s medical data to others in the exchange.

There were some hurdles to making it happen, though. It took political buy-in from a county manager who recognized a need to improve jail health outcomes and the support of a new sheriff, as well as complaints from local hospitals and FQHCs (federally qualified health centers) that kept seeing the same patients. Better continuity of care, it became clear, could reduce this burden.

Onboarding the detention center to CHL required converting all its paper records to EMRs, plus finding a reliable way to identify patients who might not be forthcoming about their true identities. (Their longitudinal records were ultimately linked to fingerprints.) EMR licenses can cost millions, a dilemma resolved when a local FQHC relinquished its GE Centricity license, which was repurposed at a cost of just $300,000. Also needed were performance metrics, an accountability structure, and training of staff.

Now all detainees are queried in the HIE at booking, and there turned out to be a high level of crossover between inmates and patients seen at Savannah’s Memorial Health University Medical Center: Some 62% of the jail’s 18,000 annual census were also seen at the hospital. Some local FQHCs also saw a lot. The jail must maintain minimum staffing levels of qualified medical personnel or face financial penalties.

That accountability structure and meaningful performance measures are among the keys to making such an effort work, Hayes said. Medical stabilization of new inmates is critical but can carry a lot of liability. “There’s a lot that can go wrong,” warned Hayes. Other keys include the political will of leaders and subject-matter experts who can work through barriers and set things up correctly.