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Dec. 12, 2011
Kansas has used a managed care company to provide prison health care services since 1988.
Correct Care Solutions, the current provider, signed its current contract with Kansas in 2005, which is up for renewal in 2018.
Officials said the long-term contract allows for more stability and better cost control.
"This is an excellent managed care model," said Viola Riggin, who heads the state office charged with overseeing the work of Correct Care Solutions. “It doesn't expose the state to risks or surprises.
"If every two or three years you're turning over a contract, you lose employees in doing that,” she said. "That destabilizes the staff." But with a longer-term contract, “employees build up sick time and vacation time and can have benefits.”
The state’s initial managed care contract for inmates was with Correctional Medical Services. It lasted for just its first term, from 1988 to 1992.
Then, Kansas switched to a six-year contract, signing on with Prison Health Services in 1993.
Prison Health Services had financial troubles.
"They were losing a reported $1 million a month on this contract,” Riggin said. “The contract was $14 million underbid from what the current market was providing everywhere else."
By the time the company’s contract ended in 2003, the fallout was $5 million in unpaid bills to various Kansas hospitals where inmates were transported for emergency surgeries and other services not available within prison walls.
Though the company paid off its hospital debts over the next two years, the experience left the hospitals and other outside providers suspicious of prison managed care companies, Riggin said.
"They feel that we're paying a for-profit company for a service for indigent care and (managed care companies have) not been historically a good bill payer," she said.
Correct Care Solutions also underbid its initial contract, Riggin said, and subsequently it had to be adjusted upward. Over three years, the contract cost jumped 39 percent, from $8.98 per inmate per day to $13.13.
Since then, though, the rate increases have been 5 percent in 2007, 7 percent in 2008 and 2 percent in 2009.
In 2010, the cost per inmate fell 2 percent, reflecting a reduction in staff from 402 full-time employees to 358. Riggin said some services were cut along with staff. Among the staff positions cut were eight clerks, six activity therapists, six medication aides and two forensic psychologists. So far, outcomes have not been noticeably affected by the reduction.
“We would know it pretty quickly” if there had been an effect, Riggin said.
Patrick Cummiskey, a spokesman for Correct Care Solutions, said the company is able to control costs in part thanks to a population whose health care needs can be closely managed with close attention to preventive services.
"The free world in the last few years has placed an emphasis on disease management, wellness exams, access to clinicians and ensuring a relationship with a practitioner. In the corrections world, these things are the norm and built into national standards," Cummiskey said.
Since starting its business with Kansas, Correct Care Solutions has signed contracts for managing inmate health care in 18 other states.
Apart from the lump sum Kansas pays Correct Care Solutions each year, many aspects of the contract are a black box. For example, the company declined to disclose what percentage of its costs is from services provided in community hospitals.
Company officials also declined to say how much Correct Care Solutions has paid in settlements to inmates who sued over issues of care.
Riggin said managed care companies are known for rationing care. But she said the oversight from her office helps prevent that.
“But we do not have to wonder because we are in the trenches with them every day, watching them do their work," she said.
Riggin’s oversight office has seven employees, including her. Technically, the University of Kansas Department of Family Medicine oversees them. But they work from Department of Corrections offices in the Landon State Office Building in Topeka and the corrections department pays their salaries. The cost of the seven employees is not factored into the inmate health care costs. If it were, it would be about an additional 25 cents per day per inmate, Riggin said.
Her staff monitors the services to ensure that prison clinic staff follow Medicaid guidelines for indigent care, or the “community standard of care,” she said.
The contract guidelines for what is considered “medically necessary” are drawn from three sources: the National Commission on Correctional Health, the American Correctional Association and case law.
For example, Riggin said, an inmate who needs non-emergency care should have to wait no longer than four weeks to see the dentist or seven days to see a physician.