Health Care & Prison Reform: The Connection

Part I of a 3-part ‘Social Determinants of Health’ Series

Inviting criminal justice expert Anne Milgram to address our senior leadership team raised more than a few eyebrows. Anne traveled to Danville, Pa., this past year as part of our ongoing Rock Stars in Health Care speaker series.

Her resume is impressive, mind you. She’s a distinguished scholar at New York University’s School of Law. She served as New Jersey’s Attorney General. She oversaw – and significantly reformed – the Camden Police Department.

She’s also the technical advisor on criminal prosecutions for Law & Order Special Victims Unit.

But what are the parallels between a federal prosecutor dedicated to reforming the American criminal justice system and a team of Geisinger leaders dedicated to reforming the American healthcare system? The analogies proved astonishing and as I looked out at the audience, I witnessed light bulbs going off.

Anne shared the story of a patient, diagnosed with major depressive disorder, alcohol dependent and homeless. Hospitalized 25 times within three years, he was hit by a car and taken to the ER with a broken ankle. After discharge, he didn’t take his antibiotics as prescribed and returned with an infection, ultimately spending 45 days in the hospital at a cost of $450,000.

She also spoke of a defendant, incarcerated 15 times over three years mostly for petty theft.  Cited for drunken disorderly, he never received paperwork for his scheduled hearing because he was homeless. Thus, a warrant was issued and he was once again incarcerated.

We shouldn’t have been surprised to learn both tales involve the same man.

Geisinger’s analytics teams are finding ZIP codes are as important as genomic codes when it comes to predicting health and mortality in our patients. The social determinants of health – a patient’s income, education, employment status, ethnicity, etc. – provide us a holistic understanding that allows us to predict health outcomes. 

We already know there’s a huge diversity of life expectancy if you’re poor.  If you have a patient who routinely comes in and out of the emergency department, often the catalyst is lack of housing, food insecurity, social isolation. While these are considered nonmedical needs, they are all vital to positive health outcomes.

And the unfolding correlation between the national healthcare system and the prison system is astounding.  We use the term “frequent utilizer.” They use the term “high rate of recidivism.” Current analytics demonstrate there’s a 67 percent overlap. And those arrested more than seven times have a 77 percent likelihood of ending up in a hospital. In other words, health care high utilizers are judicial system high utilizers.

The root causes are almost always the same: mental illness, substance abuse, homelessness. And yet both systems continue to treat the symptoms but not the underlying cause. Integrated data could provide us with actionable information, whether from an arrest record or an electronic health record. Keeping our population healthy – financial and physical – would help defeat the underlying cause.

I challenge my leadership team every day to create opportunities to address our patient’s social determinants of health. Today, the national criminal justice system and the national healthcare system are both massive, oftentimes bureaucratic entities that impact millions of lives and are incredibly expensive – criminal justice costs run in the billions while healthcare costs run in the trillions.

Clearly, there are multiple opportunities for us to learn from each other to prevent avoidable readmissions, whether it’s a jail cell or a hospital bed.