Improving correctional health care: Health information exchange, health homes and the affordable care act

Approximately 9 million people cycle through US jails annually. These people represent high utilizers of emergency medical and mental health care in their local communities, due to high prevalence of disease as well as poor access to care. The significant amount of care provided to these patients within jails often remains fragmented from their community care. In the NYC jail system, 2 areas of innovation in the health care system (overseen by the NYC DOMHMH's bureau of correctional health services, CHS) are underway. These systems reforms are designed to promote continuity of care and meeting the provisions of the Affordable Care Act (ACA).

CHS, with its partner bureau Information Technology Initiatives, is connecting the comprehensive jail electronic health record to several community sources of medical information. The most significant connection is the statewide health information exchange known as the State Health Information Network of New York (SHINY). This connection allows for accessing of patient medical summaries from health systems statewide. Other technological connections include accessing Medicaid claims data for patients in the mental health service and community medication lookup on all admissions. These initiatives will increase the level and continuity of care provided to CHS patients, however a central challenge is effectively managing this influx of data. In response, CHS has redesigned the medical intake process to include dedicated steps for information management.

The second area of innovation involves CHS partnerships with local health homes. Health homes represent the effort of NY to match high needs patients with health systems that can provide comprehensive case management. Thus far, there are 26 health homes in NY who have each received at least one list of high needs patients for whom they will receive financial incentives for effective case management and improved clinical outcomes. The first jail-based health homes partnership involves CHS transitional care team finding patients in the jail system who are on a health home's list of patients, making contact with them in jail and either facilitating enrollment for those not yet actually enrolled or providing case management and information transfer for those who are already enrolled. These two areas of innovation stand to significantly increase continuity of care for individual patients and meet core objectives of the ACA. Among the top priorities of the ACA are to improve health care quality, facilitate linkages to primary care using community services, reduce costs while promoting high-value care.