Correctional Care: MIH Behind Bars
Correctional facilities are a setting of potential value for community paramedic and mobile integrated healthcare programs. One such program in Colorado is demonstrating the possible benefits: UCHealth EMS has partnered with Larimer County and Rocky Mountain Health Plans to provide a service that saves taxpayers’ money and reduces emergency room visits and readmissions for its target population.
In September 2015 UCHealth approached Larimer County Community Corrections to help tackle LCCC residents’ high use of ambulance services and UCHealth’s emergency rooms, and to better manage medical needs within the correctional facility. LCCC reported more than 332 medical events from March to December 2015 that required transport to the ER by either ambulance or the facility’s staff.
“We were going frequently to pick up patients who didn’t necessarily need emergency care,” says Julie Bower, paramedic for UCHealth EMS. “Many of these people were using the ER as their primary care.”
The solution: a once-a-week clinic hosted by UCHealth EMS at the correctional facility. The first clinic happened in September 2016.
“We see first those who have been to the emergency room the week before,” Bower says. “We go over their discharge paperwork, review their case and see if they understand and are following their instructions and have filled prescriptions. Then we communicate that visit with their case manager at the correctional facility.”
Each visit takes about 5–15 minutes and includes taking a full set of vitals and a health exam. The EMS team spends about one hour each in the men’s and women’s units.
LCCC has a residential facility that averages about 290 clients per day. These people are transitioning out of prison prior to being released on parole, or they have been sentenced to the correctional facility as an alternative to prison.
“There are people who are coming into this program who have not been taking care of themselves and need to learn how to live again without being high,” Bower says. “We spend a lot of our visits educating on urgent vs. emergent and proper utilization of an emergency room—both to the residents and the staff.”
The clinic sees an average of 15–20 patients per week, with complaints that range from sprains or fractures to symptoms of the common cold to hypertension, she says. Some of these patients are transitioning in from state-run facilities and are given only a week’s worth of their chronic medications for such things as seizures, diabetes or high blood pressure, so establishing them with a primary care physician in the community who can take over the management of those conditions is very important in maintaining clients’ health, Bower adds.
Bower manages triage during the clinic, making sure each patient receives an appropriate level of care. For residents who have acute issues but don’t need emergency care, she can schedule a virtual visit with a physician through the clinic’s partnership with Rocky Mountain Health Plans. This also helps patients become established with a primary care provider in the community.
As a result of the program, LCCC residents’ ER visits decreased by 25% from September 2016 to January 2017 compared with the same time period the previous year, and their ambulance use dropped by 41%. During that same time, LCCC’s utilization of staff transports to the ER increased by about 11%, demonstrating staff’s increased understanding of when an ambulance is necessary, says Joe Ferrando, assistant director of LCCC. That’s amounted to about $80,000 in savings, he reports.
The program was recognized as a success for the county, and in May the Board of Larimer County Commissioners awarded it with their 2017 Innovation Grand Prize Award, an honor given to employees who show ingenuity and improve processes for the county through resourceful, groundbreaking or novel approaches.
Because the population at the correctional facility is always changing—residents stay between 90 days to nine months or more—the need for the clinic’s services won’t be going away, Bower says. A flu shot clinic was added this year, and in the coming year the clinic will be held earlier in the flu season to provide protection against the virus that causes the flu.
The Affordable Care Act’s expanded Medicaid coverage for nondisabled adults without dependent children, a category that many correctional facility residents fall into, helps with clinic costs. “How we run the clinic may change as our UCHealth EMS community paramedics program evolves,” Bower says.
UCHealth EMS also has a community paramedic program that allows paramedics to make house calls to at-risk residents throughout Larimer County, helping them with such things as medication reconciliation, health exams, home safety checks and vaccinations. It allows people to stay in their homes and has decreased unnecessary visits to the emergency room.
Currently CP patients, most of whom are elderly, have to be referred through the UCHealth Aspen Club. However, new legislation may change that and allow the program to be expanded, which could then benefit the LCCC clinic program by allowing UCHealth EMS an expanded scope of practice, which in turn will help even more people at the correctional facility avoid the ER.
Kati Blocker is a journalist and PIO for UCHealth and covers health topics in northern Colorado, Wyoming and Nebraska.
Julie Bower is a paramedic for UCHealth Emergency Medical Services, which covers northern Colorado.