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Delco jail reports rising medical needs, expands medication-assisted treatment while relying on Wellpath contract
Summary
Delaware County Jail health officials said the inmate population is older and sicker year over year, and described services provided by Wellpath including expanded MAT; county and Jail Oversight Board members discussed comparisons with peer facilities and data-sharing limits.
Warden Paul Williams and the jail’s health services administrator told the Delaware County Jail Oversight Board on March 12 that the facility’s incarcerated population is getting older and presenting more chronic and behavioral-health needs, and that the county extended a one-year contract with Wellpath for correctional health services.
The health services administrator, Kristen Grady, said the jail’s medical unit has a seven-bed infirmary and a 49-bed sheltered housing unit, daily pill call staffed around the clock, dental care five days a week, lab services Monday through Friday, mobile x-ray and ultrasound availability, and telehealth arrangements for specialty care. "Each new commit that comes into the facility is screened by a nurse practitioner or an RN," Grady said, describing intake screening and continuity of care practices.
Grady said the jail runs a growing medication-assisted treatment (MAT) program for opioid use disorder that currently serves about 200 people and that pharmaceutical costs for MAT are the facility’s largest pharmacy expense. "We have about 200 patients in that program. We have more that are interested, and we are inducting, so that will continue to grow," Grady told the board.
Warden Williams said county leaders and the board previously supported a one-year extension with Wellpath, the jail’s contracted correctional health-care provider. He asked Wellpath staff to present contextual population-health slides to help the board understand needs and costs and to guide future oversight and improvements.
Grady presented health metrics drawn from Wellpath reports using HEDIS benchmarks (Health Effectiveness Data and Information Set). She said the jail’s average population age rose 3% year over year; recidivism per 1,000 bookings rose 31% year over year; patients per 1,000 with mental-health problems rose 18%; and patients per 1,000 with chronic-care problems rose 25%.
On comparative performance, Grady said the jail ranks at the top in many HEDIS categories when compared to Wellpath facilities of similar size east of the Mississippi, but that hemoglobin A1C control for diabetes is an area needing improvement. "We're doing great across the board, but what we need to focus on with our population is that their A1Cs are out of control," she said.
Board members asked how Wellpath’s comparisons are constructed; Williams and Grady said the peer comparisons come from Wellpath’s internal data and are limited to other county facilities served by Wellpath. "This is comparing to other Wellpath facilities... not necessarily every county correctional agency," Williams said, noting HIPAA and contract differences limit broader comparisons.
Board members asked about stat labs and off-site care. Grady said the jail does not perform stat labs on-site and that, in urgent cases, the facility typically sends patients to an emergency room. "We typically send them to the ER," Grady said when asked how stat labs are handled.
Public comment and board discussion flagged MAT operations and logistics. A public speaker, Kimberly Brown Cowan, criticized the timing of MAT dosing on housing units and urged more stringent program controls; she also urged urine testing for participants, saying it should be standard practice.
Williams reiterated that the jail is expanding MAT staffing and services and that some costs have increased as the program grows. He also said Wellpath provides detailed population-health reports that the board can review and asked the board to help shape what benchmarks and presentations they want from the contractor.
The board and staff agreed to circulate the full Wellpath health report and to continue discussions about benchmarks, off-site consult partnerships, and the jail’s role in addressing the complex health needs of an aging and more medically complex incarcerated population.
Ending: Board members said they want the full Wellpath report and additional context about peer comparisons; Williams said staff will provide slides and work with the county health department on data-sharing where feasible.
