Monitoring: An Essential Component of Health Services

In a recent session I moderated at the National Conference on Correctional Health Care, we were fortunate to have the perspectives of Sheriff Earnell Lucas and Jail Commander Aaron Dobson of Milwaukee County and County Counsel Don Battista and Assistant County Administrator Oscar Aviles from Hudson County.

Milwaukee County and Hudson County are unique in that they sought out NCCHC Resources to assist them in third-party monitoring of their health care operations, rather than having it imposed on them by a court. A team from NCCHC Resources audits and monitors systems, processes, and even individual cases on an ongoing basis for each county. It’s been an effective way to be preventative, rather than reactive and to head off small issues before they grow to be big problems.

Their experiences may be helpful as you evaluate options to build on the strengths and weaknesses of your own health care program.

Following is a short summary of how our conversation went during the session:

Why hire an outside monitor?

Sheriff Lucas: Prior to taking office in 2019, there were seven deaths in the jail in 18 months. It was critically important to make things right for our community. We brought in NCCHC Resources to help us create the RFP and evaluate the proposals for a new health care vendor. Our expertise is in security and administration, so it made sense to bring in actual health care experts.

Commander Dobson: Correctional health care is complicated. Including staff, visitors and inmates, we have 32,000 people in and out of the jail annually. You can’t assure safety in the facility if you don’t have good medical and mental health care. We thought it was too important not to have someone with expertise oversee it.  There’s nothing more important than making sure the vendor is doing the right thing.

Mr. Battista: We had a big problem with six deaths in six months in the jail prior to engaging NCCHC Resources. My feeling was that getting the lowest price from a health care vendor wouldn’t assure quality. We use a community-based approach to evaluate our vendor and use the expertise of NCCHC Resources as a “stick” to ensure that the contract is adhered to and certain benchmarks are met.

How does the monitor work with your health care vendor?

Sheriff Lucas: NCCHC Resources has been incredibly helpful in creating a collaborative environment. We need to have the vendor meet quality benchmarks, and NCCHC Resources can help them identify problems before they become big issues. They’re working objectively with our best interests in mind and the vendor sees the value of their expertise.

Mr. Aviles: I agree on having a collaborative approach, but it’s really important to keep pushing the vendor to perform well. One thing we found is that having an objective third party review cases really helps us with a pretty vocal advocacy community and patients and their families. If they have a question on something, there’s a timely review of what happened and whether the actions were appropriate.

Commander Dobson: The reports from NCCHC Resources show almost in real-time how well the vendor is doing and it gives them a sense of security that there shouldn’t be any surprises down the road and that someone is taking note of the progress we’re all making.

How has monitoring helped you in 2020?

Sheriff Lucas: Having the contract monitoring resource in place in 2020 was quite fortunate. My staff was very insightful and saw that COVID was going to a big problem early on, but we still had to make adjustments to our processes. Even if we’re doing a good job, it just has to be even better with that type of stress on the system. NCCHC Resources was really helpful for both security and the medical vendor as we had to rethink everything about intake.

Mr. Aviles: Even working virtually, NCCHC Resources can eliminate systemic problems and nip things in the bud before bad outcomes present themselves. We have not had a death in the facility since we started working with them. A good vendor wants someone to help you do better, and that’s been our experience.

Is monitoring right for you?

Many thanks to Sheriff Lucas, Commander Dobson, Mr. Battista and Mr. Aviles for being so candid in the presentation. Our philosophy is to work collaboratively and to hold people accountable. We’re not there to point fingers or check a box. When we take all the needs and perspectives into account, we can make a real impact on the quality of care.

Watch the full session or contact me to talk about NCCHC Resources health services contract monitoring at [email protected].

By Brent Gibson, MD, MPH, CCHP-P
Managing Director, NCCHC Resources