Cost savings of a primary care program for individuals recently released from prison: a propensity-matched study

Abstract

Background Criminal justice system costs in the United States have exponentially increased over the last decades, and providing health care to individuals released from incarceration is costly. To better understand how to manage costs to state budgets for those who have been incarcerated, we aimed to assess state-level costs of an enhanced primary care program, Transitions Clinic Network (TCN), for chronically-ill and older individuals recently released from prison. Methods We linked administrative data from Connecticut Department of Correction, Medicaid, and Department of Mental Health and Addiction Services to identify a propensity matched comparison group and estimate costs of a primary care program serving chronically-ill and older individuals released from incarceration between 2013 and 2016. We matched 94 people released from incarceration who received care at a TCN program to 94 people released from incarceration who did not receive care at TCN program on numerous characteristics. People eligible for TCN program participation were released from incarceration within the prior 6 months and had a chronic health condition or were over the age of 50. We estimated 1) costs associated with the TCN program and 2) costs accrued by Medicaid and the criminal justice system. We evaluated associations between program participation and Medicaid and criminal justice system costs over a 12-month period using bivariate analyses with nonparametric bootstrapping method. Results The 12-month TCN program operating cost was estimated at $54,394 ($146 per participant per month). Average monthly Medicaid costs per participant were not statistically different between the TCN ($1737 ± $3449) and comparison ($1356 ± $2530) groups. Average monthly criminal justice system costs per participant were significantly lower among TCN group ($733 ± $1130) compared with the matched group ($1276 ± $1738, p < 0.05). We estimate every dollar invested in the TCN program yielded a 12-month return of $2.55 to the state. Conclusions Medicaid investments in an enhanced primary care program for individuals returning from incarceration are cost neutral and positively impact state budgets by reducing criminal justice system costs.

Interventions for the detection, monitoring, and management of chronic non-communicable diseases in the prison population: an international systematic review

“…Numerous chronic non-communicable conditions are represented in the included literature, encompassing diabetes ( n = 11) [ 45 , 49 – 51 , 53 , 55 , 56 , 59 , 60 , 63 , 67 ], gynaecological diseases ( n = 10) [ 26 , 27 , 29 – 33 , 38 , 43 , 70 ], cardiovascular disease (CVD) ( n = 6) [ 34 , 37 , 42 , 61 , 62 , 83 ], chronic kidney disease (CKD) ( n = 5) [ 35 , 52 , 66 , 72 , 73 ], dermatological conditions ( n = 4) [ 64 , 74 , 78 , 75 ], ophthalmological conditions ( n = 3) [ 57 , 58 , 77 ], respiratory illnesses ( n = 3) [ 48 , 54 , 68 ], oral cancer ( n = 1) [ 25 ], and colorectal cancer ( n = 1) [ 28 ]. Approximately one third of studies ( n = 22) covered several diseases and/or general long-term prisoner health [ 36 , 39 – 41 , 44 , 46 , 47 , 65 , 69 , 71 , 76 , 79 – 82 , 84 – 89 ]. A minority of research focused on specific populations with prison, including women ( n = 12) [ 26 , 27 , 29 – 33 , 38 , 42 , 43 ,…”

“…Eight studies investigated community-based healthcare programmes for people leaving prison, often termed ‘transitions clinics’ [ 81 , 82 , 84 – 89 ]. These programmes typically involve primary care by physicians in the first two weeks of release, referrals to community organisations, and case management from community health workers (CHW) with histories of incarceration.…”

Medicaid Inmate Exclusion Policy and Infectious Diseases Care for Justice-Involved Populations

“…The process of such handoffs is intended to reduce apprehension about stigmatizing experiences in the community and to improve engagement in postrelease care. The approach used by the Transitions Clinic Network, with 48 clinics across the country, serves as a model for hiring, training, and supporting a workforce dedicated to health at the time of re-entry ( 48 , 49 ).…”

Public Health and Prisons: Priorities in the Age of Mass Incarceration

“…Yet, many people return to society without health insurance, doctor’s appointments, medical records, or a continuity of care plan. The Transitions Clinic Network (TCN), a coordinated care model between correctional and community health care systems, has demonstrated that proactive linkages to primary care upon release leads to lower acute care utilization and decreased costs ( 71 , 128 ). Wraparound programs that provide health care and assist with housing, education, and employment are promising interventions for people released from prison ( 35 ).…”

“…Wraparound programs that provide health care and assist with housing, education, and employment are promising interventions for people released from prison ( 35 ). Hiring formerly incarcerated community health workers to help people navigate health care and social services during reentry is an essential component of TCN that state public health systems can expand to reduce health inequalities and build bridges between community and correctional health providers ( 71 , 128 ). State officials should revitalize or expand initiatives for ensuring that people are enrolled into insurance programs before release from prison and create capacity in state and local health systems that is tailored to the needs of currently and formerly incarcerated people and their community contexts.…”