From $35M in Unpaid Bills to No Receipts: It’s Past Time for Oversight on MDOC Healthcare Spending
Transcripts
[00:00:00] Andrew Minegar: Hello and welcome to Facts Matter podcast by Citizens Research Council of Michigan. I’m Andrew Minniger, administrative reporter for Murr’s news service politics and policy. publication in Lansing, Michigan. I’m guest hosting the facts matter podcast today with Carly Abramson, research analyst focusing on health policy.
She’s with the citizens research council of Michigan. How are you doing today, Carly?
[00:00:29] Karley Abramson: I’m good. Thank you for hosting.
[00:00:31] Andrew Minegar: Oh yeah, no problem. it’s an interesting subject that we’re diving in today,
[00:00:36] Karley Abramson: and
[00:00:37] Andrew Minegar: I understand, you did some research on~ on a, a~ the prison health care system.
And I had done ~a, ~a piece on kind of the third party vendor ~that, ~that owed money all over town or by the state as it were. So, ~I’m, ~I’m wondering~ what, ~what was your experience like in researching~ the, ~the prison health care system?
[00:01:03] Karley Abramson: Yeah, so a little bit frustrating at the beginning because we really wanted to tackle a lot of issues that we were not able to tackle, simply because there was a lack of.
Data available to us we had reached out to the department for some you know, we kind of laid out the kind of data that we would want. And at 1st, they responded and kind of asked us to clarify, you know, what. a little bit more about what we wanted. We responded and then we just didn’t really hear back.
So we just moved forward with our report using just publicly available data, but we found that that was pretty insufficient for the types of questions that we wanted to ask because we were really interested in figuring out, is the state fulfilling its legal obligation? To you know, provide for the health care of prisoners.
Is it doing so efficiently? Is it being good stewards of public resources? We wanted to really get into the data and try to answer those questions. We found, you know, that the kind of data that would really track prisoners health. Over time, with the kinds of services that they’re receiving to see if we were getting the right bang for our buck was not really available.
Once we published the report, we did meet with the department. They reached out to us and essentially, we learned that the biggest problem is that this data is not really being tracked. It’s not that they’re withholding information from us for any reason. They just are not adequately tracking the spending and health care data as efficiently as would be necessary to really do this kind of analysis.
And so are urging the legislature to, you know, be a little bit more active in the oversight and in the process. Of how we. Can keep track of what is going on because this is a pretty large expenditure of public money. And while the general cost of. Like, health care in prison has been going down, the cost per prisoner has been rising and there are a lot of different reasons.
potentially for that. You know, it could be the aging prison population. It could be staffing shortages. It could be a rise of infectious diseases. There’s a lot of different reasons that could be contributing to that rise. And without the data and the oversight and kind of the push by the legislature to really keep tabs on what is going on, we won’t have the data to answer any of those questions.
So that’s where, that’s the perspective we came from with the, Paper itself.
[00:03:36] Andrew Minegar: So ~who, ~who do you feel should be responsible ~for, ~for that data? I mean, ~the obviously the, ~it’s the legislature’s responsibility ~to, ~to make sure ~that ~that data is being taken care of, but ~who, ~who do you feel is ultimately ~the, the, ~the responsible party here?
[00:03:51] Karley Abramson: Well, yeah, I mean, definitely the state and the legislature, right. ~They, there’s not, ~nothing’s really going to happen unless they enforce it. And. ~push, ~push the issue. But that’s when it comes to how the data is tracked really depends on the kind of structure of the delivery model. And in this case, the fact that Michigan has this contracted vendor would potentially change how that data is tracked and what kind of system that they use.
~So ~different States have, ~you know, ~different models of healthcare delivery ~for, ~for prisons. Michigan is one of about. 8 states that has this hybrid model that uses ~some ~some services ~are ~provided directly through the department. Some are provided through a contracted vendor. Most states, ~I think, ~are directly through the department, but at least about half the states provide some kind of contracted.
Vendor services, ~and ~so the question then is~ you know, ~what is the best method? For tracking that data, who should be responsible? Should it be the vendors responsibility? Should there be an app? Should it be the state? Should it be ~kind of ~an outside firm that comes in to track that data ~that, you know, ~how you actually go about keeping tabs on that.
I think can vary. I’m not sure. The best way to do that, but in terms of ~the ~responsibility, it really is ~just ~largely on the state.
[00:05:11] Andrew Minegar: So these, the, the prisoners are essentially wards of the state. And with, with them being wards of the state ~what does, ~what does this kind of point to as far as~ as the.~
The Department of Corrections, you know being responsible for the health of the prisoners. Like, what are the impacts ~of the, ~of this overall?
[00:05:32] Karley Abramson: Very wide, because we’re not just talking about the impact. On the health of these individuals, right? Like, that’s that’s a component of it. The state is responsible for their health.
And, you know, there’s the 8th amendment that prohibits cruel and unusual punishment and lack of health care and lack of adequate health care, you know, can be a form of cruel and unusual punishment if it reaches a certain point. And so the state has that general legal obligation, some say an ethical or moral obligation to the.
Incarcerated person themselves, right to take care of them, but there’s a larger responsibility to the state and taxpayers. Most of these individuals are going to be re released back into the community, and it’s really in the state’s best interest and everyone’s best interest that they are as healthy and productive as possible.
When that happens, just being generally good stewards of public resources is something that everyone should be aware of. Invested in and having a well functioning prison system is kind of 1 of those things. That is really, really important. It’s not something that we like to talk about or focus on as much.
It’s not as exciting of a policy area. It’s kind of like buying a. You know, when you’re looking at someone’s wedding gift registry and they want a trash can, and no one wants to be the person to buy the trash can, but they need it. It’s a very important thing. That’s kind of what this is, at least how I see it.
But it is, it’s a very important part of a functioning government and institution having a prison system that is efficient and one that people trust in. And, you know, so making sure ~that ~that we are executing that ~in ~in the right way is really important, you know, for. Society as a whole.
[00:07:17] Andrew Minegar: No, as you’re saying, you know, it is important, but there are, of course, a lot of people that say, Oh, they’re just prisoners, you know, don’t worry about them, you know, but there’s also another component to this and that’s ~the, the, the, ~the component ~that, that of the, ~of the funding, which there are a large swath of people that are like, well, ~we, we should, ~we should take care of the funding.
~So, ~so even if they don’t care about the. People’s lives. ~They, ~they care about ~the, the, the, ~the funding that’s going on behind this. And it seems like, ~it seems like this is the, ~this is the area where~ it, ~it’s really kind of fallen down ~and that, ~and that, you know who’s keeping track of the money and this through my reporting as well, you know, ~I, ~I found ~that, ~that, you know, it just, they owe money all over town.
You know, there’s, ~there’s, You know, ~quite a bit of money. So I guess my question is, what would this research do to help? Or what would this argument have toward making this funding more efficient?
[00:08:17] Karley Abramson: Right. So generally, you know, having a closer eye on how these mechanisms work~ in ~with a contracted.
Vendor ~is ~would be really important. ~I didn’t go into many, like, ~I didn’t go into the nitty gritty details of the contract to know ~kind of ~what legal options they have in there for when someone doesn’t pay, ~you know, ~so ~I’m, ~I don’t know as much about ~kind of ~what the remedy and the redress all ~was ~in the contract.
And so it might be that the terms are there, and it’s just, ~it’s ~hard to enforce, but I think the bigger issue, the kind of data that we actually need. Is more national data on the best structures and models for how to deliver health care in prisons, because we don’t really have national data across states about the pros and cons of a contracted vendor versus doing it.
In house, ~and ~this is potentially ~1 ~of the risks of having a contracted vendor is that we’re in this situation where. They owe money, they haven’t been paying the providers, ~you know, ~and so that is a potential risk that you take when you decide to use a contracted vendor. Now, the reasons for using a contracted vendor often are it’s more efficient and cost effective.
But the state is balancing a lot of different interests because they want that high quality health care that is going to protect them from potential lawsuits. They also want to do it efficiently, but they also want to make sure that they are able to collect money ~when they, ~when they need it. They want to have control over the entities that are~ you know, ~participating ~in.~
Delivering these services. And so the best way ~to ~to know if we’re kind of on the right track would be having that kind of more national data on how other States are doing how their systems are running. Is this a problem in other states that people are encountering? And if so, maybe the cost of contracted vendors ~isn’t ~isn’t worth the efficiency.
It’s that kind of analysis that we would want to do to know, you know, should Michigan be doing something different?
[00:10:17] Andrew Minegar: You know, ~I, I would also ~I would also say ~there, ~there might be a argument to be made about comparing and contrasting the 2 sections of whether or not a 3rd party, ~you know, ~private vendor~ It ~has ~better, ~better control over what is being done on prisoner health versus ~the, ~the government backed vendor or ~the, the, ~the government itself stepping in to do this.
And I think ~that that would be, ~that would be an absolutely fascinating. Portion of research there.
[00:10:50] Karley Abramson: Definitely. I mean, and it’s very interesting because there’s different incentive structures ~in, ~in both models. And, you know, when you use a private vendor, there’s going to be ~a, you know, ~a profit margin incentive that isn’t necessarily there.
And so ~kind of ~maximizing efficiency. With maybe less quality care ~is, ~is a potential risk there, but then there’s risks on the other side. You know, if you work for the department, you might not be incentivized to really get the most bang for your buck because ~it, you know, you’re, ~you’re not, the ~1 ~writing the check anyway and so it really depends. And I don’t know, in terms of kind of what data we could get from that to try to figure out what ~the best. ~the best route is, but definitely thinking about those different pros and cons of each model is something the legislature should be thinking about especially as issues like this arise and they’re having trouble with the vendors that they’re contracting with.
[00:11:47] Andrew Minegar: You know, and ~it also, ~it also rises an interesting question ~about, ~about what other contracts there are ~that ~That have ~this, ~this problem or what are the other problems that arise from ~the, ~these contracts like, are there others that are just, you know, not, and it doesn’t have to be ~the, ~the prison system.
It could be, you know, other, ~other different, ~different areas ~of, ~of the government,
[00:12:12] Karley Abramson: right? And ~we don’t, ~we don’t really know. ~Is this a, ~Is this a one off? Is there a problem with this particular vendor or is a problem with the kind of structure of contracted vendors where this is a risk? And this is something that can happen.
We don’t, ~I don’t think we ~have enough information to know. ~Kind of the route, ~if this is just ~kind of ~this particular vendor. ~Or, you know, ~because ~we did, ~they did switch, their contract to a new vendor, ~so whether, you know, ~time will ~kind of ~tell if this is something that continues to be a problem, looking into other states would be really interesting to if this is a problem other states encounter, because then we could ~just kind of ~figure out, ~do ~we ~just ~need to change the vendor?
Or is there a bigger problem that we need to think about and maybe reconsider the structure?
[00:12:46] Andrew Minegar: You know, anecdotally I was told when I was doing my story ~that, ~that right off of the get go~ the, ~the new vendor, there was problems paying, but then after they kind of got into the swing of it, ~that they, the, ~the payments started coming through just fine.
So I mean, And that’s just 1 anecdote, a story that, you know as you said, there’s no real, you know, right. And they,
[00:13:12] Karley Abramson: if you correct me, they grant grand Perry, ~they were, ~they were paying for a while, right? Like, it was working out. Well, for a certain amount of time, it wasn’t that they never paid. It just something happened along the way that things started to go south.
Right? Is that correct? Yeah.
[00:13:29] Andrew Minegar: ~From what I, ~from what I saw, ~they, ~they were paying. And then it seemed they got their contract. And then their contract was told 2026, I believe. And they. Silently were switched out by MDOC at some point and ~I, you know, and then ~this ~new, ~new company vital core took over.
So, but then now, you know, grand prayers getting sued by ~several, you know, ~several larger entities that want their money.
[00:14:02] Karley Abramson: Right? Right. Yeah, and again, whether it’s, you know, particular malfeasance somehow ~in this, ~in this vendor, or this is just kind of what happens sometimes when, you know, the incentive is more profit based.
~It’s, ~it’s hard. It’s really hard to know.
[00:14:18] Andrew Minegar: So, I guess ~the, the, the. ~The last thing that I have for you is, ~is what, ~what was the most interesting thing that you found ~when, ~when researching this? ~What, what was, ~what was it that you found fascinating?
[00:14:28] Karley Abramson: Honestly, the fact that the data wasn’t being tracked. At home ~was ~was the part that I think surprised me the most at least I kind of expected that maybe there would be a little bit of trouble ~of ~getting access to the kind of data that we were asking for, because we were asking for a really broad specific, you know, a whole range ~of ~of different kind of data about individual health.
And ~I. ~I expected there to be you know, some kind of hurdle to getting a hold of that data, but to learn that, ~that the, ~the system of tracking, because ~they’ve, ~they’ve kind of changed how they have tracked things over time. There hasn’t been a consistent way of organizing the data and storing it and preparing it for analysis.
It’s the fact that we have decades and decades of prisoner health data, but. None that is available and it would be, even if we started now, even if we implemented a system to consistently track data and spending, it would be 10 years before we’d be able to really use that data for an analysis. And so that, to me, was the part that I think was the most surprising because we would have to act now to get some sort of benefit or analysis.
~for joining us. ~a decade from now. And so that’s why I think it’s really important that the legislature for a variety of reasons, ~you know, ~take a little bit more initiative in making sure that we are keeping an eye ~on, ~on what is happening in the prison system.
[00:16:02] Andrew Minegar: So there’s an old adage that says if you want to shade tree today, the best place, the best 20 years ago.
~I, ~the second best time is today.
[00:16:13] Karley Abramson: Exactly.
[00:16:15] Andrew Minegar: So thank you very much, Carly. ~I, I, ~I appreciate talking with you today. ~My name’s Andy Menninger and ~my name’s Andrew Menninger. And I’ve been speaking with Carly Abramson with the CRC of Michigan online at CRC, mish. org on Twitter at. CRC Mish this is Facts Matter podcast presentation by the Citizens Research Council.
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Thank you very much again.