Pew Charitable Trusts just released Jails: Inadvertent Health Care Providers, a research report that looks at how counties and local jails provide health care through contracted health services and other arrangements. Pew analyzed a sample of requests for proposals (RFPs) to identify what counties seek in the delivery of health care to people in jails, including service models, payment models and partnerships with other county agencies. The analysis of RFPs also identified what types of staff counties seek to deliver health services and the processes counties utilize for ensuring the quality of health care delivered.
Following the Supreme Court’s decision in Estelle v. Gamble, which held that correctional facilities must adequately attend to the medical conditions of individuals while they are incarcerated, federal courts have extended a jail’s constitutional responsibilities to include mental health and dental conditions. Most of the RFPs that Pew researchers analyzed sought a health provider that would deliver all three services—medical, mental and dental. This request would bring an integrated care model into the jail, which may result in better health outcomes since physical, oral and mental health influence each other.
Pew also found that counties requested proposals from providers for one or more health services while also contracting with a county agency or a community-based provider to provide another health service. This approach with community-based providers supports continuity of care during and after incarceration by integrating jail-based services with services available in the community. Because there is oftentimes overlap between the high-utilizers of jails and community health services, using a local organization that can provide health services in and out of the jail is an opportunity to establish linkages to care that may reduce future emergency room use and jail stays.
The report also details the common payment models counties use to finance health care services delivered in jails, including hourly rates, fees for service, flat fees and capitated rates. Pew also found that RFPs for jail health services varied in whether they included previous levels of health care use by the jail population and notes that when included, this information can help bidders better understand demand for health services and more accurately develop their bid, as well as ensure that counties receive bids for services that match their needs.
Some of the RFPs released by counties seek services that help individuals plan for how they will receive health care after release from jail. Some examples of these types of services are patient education, discharge planners that develop a referral network for people leaving jail and follow-up communication such as letters directing the individual to contact jail medical services for information. The report details four critical ways counties can help address health needs at release: helping people in jail access health insurance, facilitating connections to care, sharing health information and providing evidence-based treatment to those with opioid use disorders.
The report concludes that although counties are different in how they pay for and deliver health care to individuals in jail, jails are a source of health care for some county residents and can play a vital role in linking individuals to needed services. County leaders should carefully evaluate and request services that will ensure high-value care that helps them achieve their public safety missions and public health goals.