[A] top state official says there is “no missing money” in Vermont’s contract with a prison health provider, rebutting concerns raised by the Health Care Advocate Office.
Human Services Secretary Al Gobeille also said the state’s arrangement with Centurion, despite recent complaints about addiction and hepatitis C treatment behind bars, has been positive both from a financial and a health care perspective.
“I think this contract has been good for the state of Vermont, and I think if you take a sincere look at it, you’ll come to the same conclusion,” Gobeille told members of the Legislative Joint Fiscal Committee.
But Mike Fisher, the state’s chief health care advocate, said he still wants more information about the contract’s financials. He’s hoping that the debate leads to better care for inmates – especially those who have hepatitis C and have not yet received care.
“Our position is that it’s a public health concern and that everyone should be treated,” Fisher said.
The state’s pact with Centurion has come under scrutiny several times in recent weeks.
First, prisoners’ advocates said the Corrections Department and its contractor were not fully complying with a new state law expanding access to medication assisted addiction treatment in prison. Corrections officials have responded by saying the new program is still evolving and Centurion is following nationally accepted treatment standards.
Then, the Health Care Advocate’s office produced documents showing that only one inmate was treated for hepatitis C in 2017, though there were 258 inmates who had the disease. The advocate also raised concerns about more than $2.2 million in state money that appeared to be unaccounted for in certain areas of Centurion’s contract that year.
On the hepatitis C front, state officials say they’re working to address the problem. The Joint Fiscal Committee on Thursday approved Gobeille’s request for $200,000 in substance use disorder funding to treat more inmates who have the disease, and he’s planning to ask legislators for another $1.8 million for treatment when it’s time for mid-fiscal year budget adjustments.
Officials have said the complexity and length of hepatitis C treatment has made it difficult to implement in prison. But Gobeille acknowledged that it has taken time for the state to adopt changing treatment standards for the disease.
“I don’t want anyone to have the impression that (Centurion administrators) haven’t met their contract. That would not be fair,” Gobeille said. “When the contract was signed, and all of the services were determined, the current standard of care for hepatitis C was not what it is now. So that had to be amended and changed.”
Gobeille’s defense of Centurion, however, went beyond hepatitis C. He also wrote a letter to the committee about the state’s inmate health care contract, arguing that it has benefitted Vermont in several ways.
He said the majority of Centurion’s contract is structured around “value-based payments,” which are advance payments for the estimated, total cost of health care. This is the same setup used in the state’s new all-payer model of health care payment, which is meant to emphasize preventative care and move away from the traditional “fee for service” model.
Gobeille said the Centurion cost and spending information cited by the Health Care Advocate was “from a chart that was poorly labeled on our part” and not an accurate representation of how value-based health care payments work under the prison contract.
In reality, Gobeille wrote, the state has accounted for all of the $4.83 million in state spending cited by the Health Care Advocate. He said Centurion had claim expenditures of $2.62 million and spent another $2.21 million “for other cost centers within the contract.”
“There are no unaccounted-for dollars under this contract,” Gobeille wrote.
Overall, Centurion made $445,554 in profit in 2017 plus additional “corporate overhead” built into the contract. Gobeille said the profit is appropriate because the contractor also is assuming financial risk associated with providing health care to inmates.
“The (state’s) plan for correctional health care contracting is a forward-looking effort to move the department away from (fee for service), integrate mental and physical health services, improve outcomes and provide fiscal predictability to the state budgeting process,” Gobeille wrote.
The Centurion deal also is saving the state millions of dollars, Gobeille said.
In the eight years prior to the contract, the cost of inmate health services jumped from $15.5 million to $21.3 million, according to state statistics. It since has stayed steady and even declined slightly, while the previous years’ trend would have boosted annual costs above $25 million by now.
Several legislators remained skeptical.
“If it’s a great deal, why are we the second-highest per inmate cost for medical care in the nation?” asked Sen. Dick Sears, D-Bennington and Senate Judiciary Committee chair. He was referring to a Pew Charitable Trusts study issued last year showing that Vermont ranked only behind California in per-inmate health costs.
Gobeille said some of the state’s higher cost is due to the fact that Vermont has a unified correctional system with no county jails. But he also said it’s partly because “we’re better, not because we’re worse” than other states.
He referenced the pending removal of Vermont’s out-of-state inmates from a facility in Pennsylvania.
“We went to Pennsylvania to a state-run system, and we’ve been very dissatisfied with the level of health care,” Gobeille said. “We’d much rather have them in our facilities, the way that we run it, even though it’s more expensive.”
Rep. Bill Lippert, D-Hinesburg and House Health Care Committee chair, asked Gobeille repeatedly whether Centurion had complied with the standards of care in its contract. Gobeille said he believed the company has met those standards, but Lippert called for “careful analysis” given the similarities between Centurion’s deal and the state’s all-payer experiment.
“This has reverberations for the larger health care reform that we’re entering into,” Lippert said. “People have the fear that, in fact, the way these contracts will play out is by having less care and inadequate care.”
Sen. Jane Kitchel, D-Caledonia and Senate Appropriations Committee chair, noted that Centurion’s contract expires soon and the state is preparing a bid process for inmate health care.
“This is a really critical time to make sure that the concerns we’re talking about today are really accommodated and reflected in any proposal that goes out for bid,” Kitchel said.
