TMC PULSE

t m c » p u l s e | a p r i l 2 0 1 7 25 15 years, 6 inches, and 60 pounds apart. Like everything the prison system does, it's deliber- ate. It is not like it is in the movies. Doling out prescription drugs to inmates is no different. Early on, UTMB determined that the most efficient and cost-effective way to dispense drugs to inmates was through its own pharmacy, now housed in an unmarked Huntsville building that used to be part of a strip mall. It's a huge, highly organized production with custom-made conveyor belts and automated machines that fill, seal and label 30-day-supply blister packs, which is how almost every drug in the prison system is bundled. The method is proven to enhance sanitation, safety and accountability throughout the supply chain. The blister packs also allow for reclamation; facilities can return unopened pills for credits, which has saved the state an aver- age of $8.2 million a year, according to Melanie Roberts, assistant director of operations at the pharmacy. Orders are sent through the electronic medi- cal record system, and the pharmacy fills approx- imately 20,000 prescriptions a day, serving 130 facilities throughout the state, includ- ing TDCJ and the Texas Juvenile Justice Department, as well as a handful of county jails. "It's another example of where we're taking full responsibility," said Murray, who has been working in the prison system for nearly 30 years. "We've realized the cost of dollars we can save by doing it ourselves is much more of a value to the state than contracting it out." And because UTMB runs the entire opera- tion, they are eligible for 340B Drug Discount Program pricing, which requires drug manufac- turers to extend the lowest possible cost to hospi- tals with substantial low-income patient loads. The pharmacy offers a 24-hour next-business- day turnaround time and works in conjunction with the Correctional Managed Care program's robust telemedicine practice to ensure patients in need of pharmaceuticals—everything from amoxicillin to Zyrtec—receive them as quickly as possible. Since most facilities in the state cannot cater to medical needs the way the Estelle Unit does, telemedicine fills the gaps, allowing inmates to be seen quickly without spending additional dollars staffing full-time providers or reimburs- ing mileage. The telehealth program serves 83 facilities across the state. "As a primary care provider, I can take care of most cases through telemedicine," explained Ruth Brouwer, a physician assistant who transitioned to the UTMB telehealth team after being attacked by a cuffed inmate with a knife. She now works in an office building in Conroe and serves far more patients on a daily basis than she did in the field. "I can order labs, follow up on labs, talk directly to patients and share data through the EMR." According to Murray, efficient delivery of primary care services is one of the most import- ant aspects of the telehealth program, for both quality and cost. "If we didn't have telemedicine, we may miss an opportunity for early intervention and treatment," Murray said. "Seeing Ruth provides a great opportunity for us to improve care and decrease cost." In addition to cost savings, general health compliance has surged, as well. Compared to national benchmarks like HEDIS—the Healthcare Effectiveness Data and Information Set, a tool used by the vast majority of health plans in the U.S. to measure performance—the Correctional Managed Care program surpasses national benchmarks in the management of diabetes, hypertension and asthma. "We compare incredibly well, and rightly so, probably because we know where our patients are, we don't lose them to follow up, and I can tell whether they're taking their meds or not," Murray said. "So we've got some controls in place that really do help us do a better job than compared to the free world, where I'd see you in my office and I just hope that you're going to take your meds and follow your diet and come back." ARE OVERWEIGHT, OBESE, OR MORBIDLY OBESE* 74% of u.s. prisoners New tricks Despite the program's victories, challenges threaten its momentum. Diseases like HIV and hepatitis C strain its resources. HIV drugs account for 40 percent of the pharmacy's total budget, with less than 2 percent of the offender population infected. "HIV drugs are always changing, the disease is changing, and every year we get new guys coming in so we're always starting the clock again, always doing more workups, always find- ing more disease," Murray said. Frustratingly, all too often he sees offenders whose disease was controlled in prison neglect treatment after being released. (continued) The Texas Correctional Managed Care program operates its own pharmacy, using a custom-made conveyor belt and automated machines to fill approximately 20,000 prescriptions a day. We've looked at every aspect of our care provision and our health system and are always looking for ways to improve things and cut costs, but eventually, you kind of run out of new tricks. — OWEN MURRAY, D.O., MBA Executive director of clinical services and chief physician executive for the UTMB Correctional Managed Care program

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