Soaring medical costs, mounting prison populations, shrinking public funds and a judicial mandate to improve prison conditions drove Texas to inaugurate a novel approach to healthcare for the inmates of the state’s prison system, who now number more than 145,000.

It worked. Among other major improvements in prisoners’ health, this new way of delivering healthcare has led to greatly reduced blood sugar rates for diabetes patients, significantly lower blood pressure readings among hypertension patients, sizeable reductions in AIDS-related deaths and complete elimination of asthma-related deaths. Meanwhile, over the past decade, this correctional managed care program has saved Texas taxpayers an estimated $750 million, according to a recent report by the office of the Texas Comptroller of Public Accounts.

An article to be published this week in the Journal of the American Medical Association (JAMA) by two physician-administrators at the University of Texas Medical Branch at Galveston (UTMB) credits these and other successes to an innovative approach developed by UTMB starting in in partnership with the Texas Department of Criminal Justice and Texas Tech University Health Sciences Center at Lubbock.

“We turned around healthcare delivery in a correctional system that is one of the largest in the Western world,” said Dr. Ben G. Raimer, UTMB vice president of community outreach and co-author of “Health Care Delivery in the Texas Prison System: The Role of Academic Medicine,” in the July 28, , issue of JAMA.

The ground-breaking arrangement enables UTMB specialists in Galveston using sophisticated videoconferencing technologies to treat patients at prison clinics, obviating the need for long trips in which guards ferry prisoners to the hospital in Galveston. Physicians have instant access to the healthcare history of prisoner-patients via an electronic medical records system. They use evidence-based medicine to treat prisoner-patients—ensuring that the therapies utilized are ones proven by medical studies to be the best and most cost-effective. Because they employ standard disease management approaches, doctors need not “reinvent the wheel” when patients have conditions known to respond best to established protocols. Doctors treating prisoner-patients also prescribe from lists of the best and most cost-effective drugs. Finally, health care workers treat patients with persistent diseases at chronic care clinics, and both doctors and patients receive education programs to inform them of the appropriate and up-to-date disease management techniques.

UTMB provides healthcare for 78 percent of the inmates in Texas, while Texas Tech’s physicians treat the remaining 22 percent. “Even before they entered the prison system, these men and women hadn’t taken the best care of themselves or received regular physicals,” Raimer noted. “Their lifestyles weren’t conducive to healthy living. We were faced with medical scenarios that required immediate solutions—a rapidly-aging population and large numbers of individuals with HIV, hepatitis, asthma, diabetes and such—chronic diseases that require management. We knew it would take more than conventional methods to achieve success; to have any hope of helping these people.”

Leaders at UTMB believe the Texas model may have important implications for improving the nation’s patchwork health care delivery system, particularly among patients in areas underserved by doctors and for patients with chronic illnesses or conditions.

“The medically underserved in Texas, and across the nation—including those enrolled in Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and especially, the uninsured and under-insured, need better access to primary physicians and specialists,” said the paper’s co-author, Dr. John D. Stobo, UTMB president and a longtime advocate of universal access. “We believe this approach to providing healthcare could help open the door to allow such treatment to be provided effectively and inexpensively to those who need it.”

In addition to significant cost savings and improved medical and psychiatric care, the UTMB-devised plan also has succeeded in stabilizing health care staffing. Unfilled prison health care jobs once hovered at rates between 30-40 percent, according to the JAMA report; now they have fallen on average to between 8 and 12 percent.

A report recently released by the California Corrections Independent Review Panel entitled Reforming California's Youth and Adult Correctional System recommends that California adopt a university-based correctional managed care program similar to the one pioneered by UTMB. The report stated “… the Texas Department of Criminal Justice improved access to care, improved chronic care compliance, and saved dollars by contracting with the University of Texas Medical Branch.”

Currently, Texas spends $315 million a year on healthcare for more than 145,000 inmates. Meanwhile, California expects to spend approximately $1 billion to provide medical care for its 160,000 offenders. According to the Corrections Yearbook, Texas pays less per prisoner to provide high-quality, comprehensive health care than any state in the nation.

Source: University of Texas Medical Branch at Galveston