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Whole-Person Care: Value-based Care for the Justice-Involved

Today we recognize the importance of providing whole-person care to treat not only a person’s physical health, but also their behavioral and social needs. This becomes especially important as we think about how to provide cost-effective treatment for the over 11 million individuals who come in and out of county jails every year. According to NACo, approximately two-thirds of these justice-involved individuals suffer from a mental illness or substance use disorder, and often both.

Some mental health conditions, such as schizophrenia and serious bipolar disorder, meet the diagnostic criteria of serious mental illness (SMI), depending on their duration and disability. Research by the SAMHSA GAINS Center in collaboration with the CSG Justice Center shows that 16 percent of the overall inmate population has a SMI, often accompanied by substance use disorders and co-occurring physical health conditions. With these statistics approximately three times higher than the general population, many are describing our correctional facilities as the new mental health hospitals.

Value-based care (VBC) – sometimes referred to as value-based contracting or value-based purchasing – is focused around patients, and pays providers on improved outcomes and recovery. This approach focuses on the value of the overall care to the individual, with the goal of ensuring that the treatment is evidence-based, recovery-focused and cost-effective.

The VBC model also aligns well with counties incorporating the Sequential Intercept Model (SIM). The SIM, developed by Mark R. Munetz, M.D. and Patricia A. Griffin, Ph.D., in conjunction with the SAMHSA GAINS Center, provides a conceptual framework for communities to develop targeted strategies for justice-involved individuals with behavioral health disorders. Within the criminal justice system, there are numerous intercept points — opportunities to link to needed services and prevent further penetration into the justice system. The VBC and SIM models both identify gaps in care and focus on interventions to reduce readmissions/recidivism, and thus better outcomes and lower costs.

Critical to the success of VBC is a longitudinal view of an individual’s complete health information (including current and past diagnoses, treatments and medications). As counties implement Stepping Up (a national initiative to reduce the number of people with mental illness in jails), diversion programs, mental health courts or re-entry programs, the need to share this health information between entities, while adhering to privacy laws such as HIPAA and 42 CFR Part 2, becomes critical to ensure individuals are linked to appropriate services needed for recovery. Many counties now incorporate data from previously-siloed departments, and are using data analytics to identify needs and predict trends for strategic planning and budgeting.

Counties and their community partners are also recognizing the value of collaborating and sharing information to provide fully-informed care for persons before, during and after incarceration. The justice system needs to be thought of as part of the collaborative team that extends to community resources like mental health and addiction treatment centers, as well as other health providers. Applying this approach that goes beyond physical care to include social and behavioral health care is providing whole-person care.

To implement this change, counties need to look beyond just the immediate data — they need the right organizational participation, community linkages and technology connections to coordinate, communicate and exchange care information across departments, acute facilities, community services and other service providers. This eliminates gaps in care, reduces costs and drives coordination, allowing for seamless transitions of care with the ability to measure and improve. Whole-person care helps counties improve the control of taxpayer dollar spending by focusing on health outcomes for justice-involved individuals and utilizing the full spectrum of available services across the community.

View this on-demand webinar to learn more about value-based care.