How to make the Affordable Care Act work for you Agenda • Who makes up the pre-adjudicated population? • How will the ACA affect this population? • Clients/inmates responsibility to engage in health care decisions • Providers responsibility to engage clients/inmates in health care decisions • How to use technology to make these links • Overview of benefits of the ACA for both clients and providers • Closing thoughts Who makes up the pre-adjudicated population? • Largely male, people of color and poor • People are often at their sickest when detained • 80% of detained individuals with chronic illnesses have not received the treatment they need in the community prior to their arrest • High chronic care needs which include medical, mental health and addiction Population Statistics • 11.7 million annually cycle though local jails • 4.7 million on community supervision through probation and parole • Historically, vast majority of clients/inmates who leave correctional facilities (jail, state, federal prison) leave without health insurance • Justice system has become the new “mental health” facility due to lack of resources for treatment in the community Treatment Advocacy Center Statistics People with Serious Mental Illness • Jails and Prisons 356,368 • Mental Hospitals 35,000 Substance Abuse Substance Abuse and Mental Health Services Administration (SAMHSA) 22 million Americans need substance abuse treatment 1.6 million will receive treatment How will ACA affect this population? • ACA is the biggest change to our health care system in 50 years • Opens a door between health care and criminal justice systems • Requires all criminal justice systems to learn about health care, including probation and parole departments • ACA provides opportunities for payment for treatment in mental health and substance abuse treatment programs • Pays for prenatal care • Pays for preventive care • Pays for prescriptions • Provides protection for people with pre-existing health conditions—no denials • **Savings when sending someone to the hospital past 24 hours/Medicaid eligible** Clients/Inmates responsibility in health care decisions • Clients/Inmates oftentimes do not have a history of talking with providers about their health care needs • Some have no history in their families of going to a health care provider except during times of crisis or births • Taking care of their health care needs isn’t part of their behavior • Often see the provider in the jail/prison as their PC provider • Clients often have added incentives to not be honest with a provider (want prescriptions) • Difficult time communicating with providers because of their mental illness • Clients are used to not being believed when sharing their health care story • They are used to demanding that they receive care How to help clients/inmates talk to health care providers • Talk with clients about the ACA • What’s in it for them • Walk through the process; making an appointment, showing up on time for the appointment, having all paperwork needed for the intake process • Advocate for yourself, don’t let them brush you off • Follow up with the treatment care plan • Fill and take your prescriptions as prescribed Providers’ responsibility in providing health care to this population • Understand the population isn’t used to receiving care except on an emergency basis • Complex health care needs; often co; and tri-morbid conditions • Learn about mental health and addiction • If you’re going to treat this population on an ongoing basis provide an environment for them that is welcoming (get better outcomes) Providers in the Criminal Justice system need to make referrals to outside agencies • Don’t wait for Primary Care Providers to call you • Give outside Providers tours of the institution • Let them know what you do in the jail/prison • Co-locate staff • Grand Rounds • Conferences Electronic Linkages • Google map • Discharge paperwork to client • Referral paperwork to providers; use their forms • Enroll clients in the ACA, complete necessary tests, labs before the client is referred • Use the Electronic Medical Record to your advantage • Use mid-level health care staff to help client’s navigate the system Benefits of the ACA for clients • Treatment of chronic care conditions (substance abuse, mental health, medical issues) • A chance to address the issues that contribute to arrest and recidivism • Opportunities to make long term changes in their behavior which benefits themselves and future generations Benefits to Health Care Providers • Providers want to be able to address client’s health care needs. Clients with insurance have the ability to follow through with treatment care plans • Cuts the cost of health care, use that money to build back the staff that have been lost due to reductions that have been necessary to pay for health care costs Benefits to the criminal justice system • Clients/inmates in the jail will have fewer high cost health care needs, keeps health care costs lower • Addresses some of the core issues around criminal behavior—keeps communities safer • Jail/prison—meet their missions again, no longer de facto mental health agencies Closing Thoughts • The ACA saves money! • It will take time to change the way clients in the criminal justice system relate to their health care providers • It will take time for health care agencies to adjust to working with the criminal justice population Thank you Nancy Griffith Director of Corrections Health Multnomah County Health Department Portland, OR 97204 Nancy.griffith@multco.us Office number: 503.988.5821 Cell number: 503.260.4080