Virginia’s 2017 Budget Bill HB 1500 Item 393 #1c states:

“The Department of Corrections, through its contract with the Virginia Commonwealth University Department of Health Administration, shall review the management of a selected number of inmates who account for the largest share of total inpatient and outpatient medical care costs within the department. The review shall include inmates who have been enrolled in Medicaid for qualifying inpatient hospitalizations; for these individuals, the Department of Medical Assistance Services shall provide the requisite enrollee data. The review shall address the number and characteristics of these inmates (including demographic background, offense history, and security classification) who account for the highest costs for medical care. The review shall also consider, to the extent available, their medical history and current medical issues and address potential case management strategies and other steps to reduce costs for these inmates in the long term. Copies of the review shall be provided by October 1, 2017 to the Secretary of Public Safety and Homeland Security, the Secretary of Health and Human Resources, the Chairman of the Joint Commission on Health Care, and the Chairmen of the House Appropriations and Senate Finance Committees."

This report is intended to assist the Virginia Department of Corrections (DOC) in fulfilling its obligations to respond to this legislative mandate. We use data supplied by DOC including demographic, sentencing, security level, and documented disability and disease data, as well as paid claims data provided to DOC from its third-party administrator, Anthem Blue Cross and Blue Shield and from Diamond Pharmacy and Medical Supply. The study period for which claims data were provided is the 12-month period ending June 30, 2017. Our work was conducted following the human subjects protocols approved for this project by Virginia Commonwealth University’s Institutional Review Board July 28, 2017 (IRB HM20010830).

We begin with an analysis of these data, then present the results of a literature search regarding best practices for disease management specific to the correctional setting. The literature review targeted journals and resources related to population health and correctional settings, especially those merging the two. Included resources were located using the National Criminal Justice Reference Center, the Federal Bureau of Prisons, the American Correctional Association, and the Centers for Disease Control and Prevention among others. Finally, we discuss possible programs and strategies to mitigate costs and improve inmate health outcomes via care coordination and peer-to-peer counseling, and offer some conclusions.