HMA’s report lays out recommendations for CT DOC to develop a well‐informed staffing plan that is customized to the unique needs at each facility and considers the many inputs and influences shown in the figure. HMA also recommends that CT DOC explore additional categories of staffing such as health care scribes and Emergency Medical Techs who can “stretch” the capacities of providers and nurses. The Department would benefit from a comprehensive, universally adopted, vision and approach (plan) to guide and inform all staffing decisions, policies, processes, and reports. Recommended Medical Model HMA recommends CT DOC implement a “medical model of care” that is rooted in evidence‐based practice and would enhance the quality and efficiency of inmate health care. The proposed model produces measurable improvements in patient outcomes and satisfaction as well as health care team member job satisfaction. The model aligns with and incorporates the CT DOC stated vision for the future of health care services, building on the strengths and addressing inherent risks in the current state of health care operations. The recommended medical management model is built on three key components and embeds elements that have become the foundations of successful health care delivery in community health. The components are: Population health management, whereby each facility’s health care staff “own” the population therein and are responsible for proactively managing the risk of every person, population sub‐group, and disease state using risk‐based metrics and practices. Team‐based care, whereby every member of the facility health care team and representatives of custody operate as an integrated team whose duty is to ensure that all patient needs are met every day through team huddles and other features of the Patient‐Centered Medical Home. Continuous learning and quality improvement, whereby the facility‐specific team, supported by the region and the state, continuously evaluate their individual and collective performance of duties and in the provision of health care to continuously improve patient outcomes and efficiency. The proposed model would provide CT DOC leadership with actionable, real‐time information to support improved care, better outcomes, facility and provider‐specific performance metrics, higher productivity, and enhanced recruitment and retention. 9 HMA CHARGE AND METHODOLOGY CT DOC contracted with Health Management Associates (HMA) to assess the current inmate medical services delivery system and make recommendations for how to improve its structure, operations, and outcomes. It is the Department’s goal to provide health care services that align with national standards, best practices, and high medical quality. In this report, HMA provides CT DOC with 1) an operational assessment, staffing analysis, and medical chart review that characterize the current state and 2) recommendations for an improved overall model for delivering inmate medical care and improvements to the current state. HMA has partnered with NCCHC Resources, Inc. (NRI) for this important work. The full team includes correctional health experts – clinicians and administrators – with deep knowledge of all aspects of correctional health care design, delivery, evaluation, and accreditation. The team also has extensive expertise in models of care, clinical tools, and innovations used in community settings that can be translated to correctional settings. Team bios are included as Appendix 1. The project work plan included reviews of 632 inmate medical records, interviews with leadership and line staff, and extensive document and data review. The team developed interview templates by discipline and captured interview data by facility, discipline, and topic. The team created a uniform methodology for chart reviews that included 15 areas of review and a database for collecting the findings. The staffing analysis involved review of historic and current staffing, current vacancies, staff structure, scopes of practice, and comparisons with other correctional systems. Throughout the project, team members reviewed emerging themes and cross‐referenced these findings with the interviews, document and data review, and chart reviews. We returned many times to CT DOC for additional data and clarifications. This enabled the team to analyze a large volume of many types of information under a rubric that produced clear, comprehensive, integrated, and defensible findings. The original project plan also included site visits to all CT DOC facilities by multi‐disciplinary project team members. Due to COVID‐19 and the resulting restrictions, we could not conduct site visits. The team was also unable to conduct virtual tours of several facilities due to a second wave of COVID‐19, which impacted the facilities and required DOC staff to focus on essential operations. Nonetheless, the team was able to evaluate the system and is confident of our findings and recommendations. However, the absence of on‐site observation and interactions has left some gaps in our understanding of operations and relationships. Although this assessment did not include a review of behavioral health or dental services, the HMA team notes that integration of