Grantmakers in Health Workshop November 17, 2006 Steve Rosenberg, President Community Oriented Correctional Health Services COCHS and Inmate Re-entry

2 Community Oriented Correctional Health Services Keith BartonStaff Physician Ben ButlerChief Technology Officer Kathryn Saenz DukeGeneral Counsel Steve ScheibelMedical Director Paul SheehanChief Operating Officer COCHS Staff

3 Community Oriented Correctional Health Services  In last decade, U.S. jail population increased 31% per capita –193 incarcerated in jail per 100,000 residents; 1995 –252 incarcerated in jail per 100,000 residents; 2005  At midyear 2005, 800,000+ people in local jails  7+ million people released from jails every year More People Being Jailed

4 Community Oriented Correctional Health Services  1.5 million people released every year from incarceration with a communicable disease.  10% of jail population has 1+ serious mental disorders that needs treatment. High disease burden with inmates

5 Community Oriented Correctional Health Services  Jails’ budget and administration separate from other community health and social services.  Correctional health care (jails and prisons) is required and protected by U.S. constitution. U.S. Supreme Court in 1976 articulated the government’s constitutional obligation to provide medical care to people it has incarcerated.  $67.2 billion spent on corrections in  $6-10 billion (est.) correctional health care expenditures in Jail administration and health services

6 Community Oriented Correctional Health Services  Majority of jail inmates from five zip codes.  Contracts created for a community health center in each zip code area to provide physicians and some case managers to treat inmates from their catchment area.  As chronically ill inmates’ release dates approach, health center appointments made for continuing care. Hampden County History

7 Community Oriented Correctional Health Services Cited as a national model of correctional health care by  Confronting Confinement, A Report on Safety and Abuse in America’s Prisons, June  Report of the Reentry Policy Council: Charting the Safe and Successful Return of Prisoners to the Community – Co-funded by the Dept. of Justice, Labor, Health and Human Services, Response to Hampden County model

8 Community Oriented Correctional Health Services Community Oriented Correctional Health Services (COCHS) Developed and supported by the Robert Wood Johnson Foundation COCHS

9 Community Oriented Correctional Health Services “Jail inmates”  “People temporarily displaced from their community.” “Jail”  “Site with leverage to find/create medical homes for temporarily displaced residents.” Connectivity is the key: connecting jail and community services. COCHS model reframes thinking

10 Community Oriented Correctional Health Services Create RHIO Contract with Unity Health  Discharge planning / Case Mgmt.  Continuity of care - Jail - Jail - Health Center - Health Center - Hospitalization - Hospitalization Expanded Public Health Screening Dept. of Health  Orasure HIV  Urine GC - Chlamydia Link to Health Insurance Enrollment Income Maintenance Dept.  Alliance cards issued upon discharge DC DC JAIL Past (history intake) Present (EMR) Future (discharge planning / case management ) D.C. is first COCHS site

11 Community Oriented Correctional Health Services JAIL CHC(s) SHARED DATA Supported by the Langeloth Foundation Regional Health Information Organization (RHIO)

12 Community Oriented Correctional Health Services Current activity  Primary Care Redesign & Linkage Future opportunities  Behavioral Health  Substance Abuse  Juveniles  Community Corrections Connectivity Key to Post Release System of Care