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Friday, September 21, 2018

NOTES FROM THE SENATE, SEPTEMBER 21, 2018

HEALTHCARE FOR PRISON INMATES

Georgia contracts with the Regents University System to provide its Correctional Healthcare. The Department of Corrections (GDC) contracts with Georgia Correctional Healthcare (GCHC), which is a subsidiary of Augusta University. GDC also contracts with a private provider, MHM, to provide its mental health and dental services. Overall the Department's agreement with GCHC has been an important cost containment strategy for many years and has helped the Department contain its healthcare costs over the years as the cost of healthcare has increased. The contract has allowed the spending for correctional healthcare to be relatively steady over the years, especially when compared to medical inflation rates.

HOW STATES PAY FOR HEALTHCARE

Prison Health Care: Costs and Quality, a 2017 Report by the Pew Charitable Trusts, compiled healthcare spending on a per inmate basis for all State Departments of Corrections. The results were interesting primarily due to the vast differences in the amount States spend per inmate as well as the different methods States utilize to provide correctional healthcare. Georgia is one of only four States that contract with their University system to provide healthcare, the others being Texas, Connecticut, and New Jersey. The Report found that 17 States directly provided care to their inmates, 20 States contracted with private providers, and eight States had a hybrid model including some level of direct provision and contracted services.

INMATE SPENDING VARIES WIDELY

The report found that per inmate spending varied from a high of $19,796 per inmate in California versus $2,173 per inmate in Louisiana, a $17,623 difference per inmate. The Report also points out that while healthcare costs have been rising between FY2010 and FY2015, States have had very different experiences with some seeing large growth and others including Georgia seeing reductions in per inmate spending. To provide an example, over that time period Tennessee saw an increase in spending of 22% while Georgia's per inmate spending went down seven percent. Georgia's 2015 per inmate figure was $3,610 which put it 44th overall and below the 49 state median of $5,720 for FY2015. Since FY2015 Georgia has seen increases in healthcare spending primarily related to increased pharmaceutical costs and the implementation of an Electronic Health Records (EHR) system.

QUALITY MONITORING

The report also reached out to States to measure their efforts to monitor the quality of care inmates receive. The monitoring of quality is important both to identifying ways to reduce costs but also ensuring that the proper level of care is being offered to maintain public safety. Pew defined a quality monitoring system "as a uniform, standardized, and ongoing set of policies, metrics, benchmarks, and data sources used and monitored by state officials". The report then goes on to point out Georgia as a state that stands out for its quality monitoring system as an expansive and consistent system. The study notes that Georgia had objectives in each of the following areas: overarching purpose, better management, constructive administration, and targeted priorities. It is possible that as the Department fully implements its new Electronic Health Records (EHR) system it can continue to improve upon its quality monitoring.

Overall the report shines a positive light on Georgia's quality monitoring of its healthcare, especially when compared to the amount some other States are paying on a per inmate basis compared to Georgia. While there are and always will be difficulties and missteps when providing healthcare in prison settings, from a budgeting perspective, the partnership between Corrections and Augusta University has helped shield the State from some of the increases other States have experienced.

TRENDS TO KEEP AN EYE ON

AGING PRISON POPULATION

There are a couple of trends that have contributed to challenges in the costs of providing cost effective healthcare in the State's prisons. The first is the continued aging of the prison population. According to the Bureau of Justice Statistics the number of older prisoners across the country grew by 280% from 1999 to 2016 (defining older prisoners as those 55 and older). Georgia is certainly not an exception to this nationwide trend. Research has long established that inmates age faster behind the bars and often come into the system with more ailments than the general population. In fact, according to a report on the costs of aging prison populations by the Pew Charitable Trusts, the costs of elder inmates with a chronic condition is commonly cited at two to three times more than younger inmates to incarcerate, but recent research has suggested that the variation may be much wider than that.

INCREASED PHARMACEUTICAL COSTS

Over the last few years, one of the areas where the Department has seen surging prices is the cost of pharmaceuticals for inmates. The biggest factor in the increasing costs of medications was the release of a new generation of Hepatitis C medications, which, while extremely expensive, are capable of curing the disease. The increase in aging prisoners can also be a contributor to higher drug costs, due to an increased prevalence in chronic conditions among older inmates. Despite these increases, the Department does utilize recognized cost containment strategies for medications, such as buying through a consortium to reduce costs through bulk purchases, the use of formularies, as well as utilizing the Federal 340B drug pricing program. According to a Pew survey on pharmaceuticals in December 2017, Georgia is one of only 16 States to take advantage of the 340B drug-purchasing program, which has helped mitigate some of the increases in pharmaceutical prices.

Georgia spends just under 20% of its total Corrections budget on healthcare for inmates.

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