reports, and the staff on the ground managed these complex efforts well. CT DOC’s broad scale testing efforts and management of COVID‐19 should be a model for other correctional jurisdictions in the country. It should be added that HSU’s COVID‐19 mitigation efforts were recently noted in a New England Journal of Medicine article, “Risk Factors for SARS‐CoV‐2 in a Statewide Correctional System.”3 As an organization that is committed to performance improvement, HSU is using this data to enhance the safety and care of their inmates during the current pandemic. At the time of this writing, the CT DOC is addressing the second wave of COVID‐19 to affect the Department of Correction and, based on its earlier response, they are in a good position to continue to be proactive and respond quickly to new unexpected challenges. 4. Another laudable infectious disease intervention that must be highlighted has been HSU’s approach to Hepatitis C Virus (HCV). Unlike many other correctional jurisdictions, CT DOC moved to an “opt‐out” approach of HCV testing. New admissions (except for a small percentage of those who declined) are automatically screened for HCV, which allows for early identification of the disease/disease state and to initiate necessary treatment protocols. In 2019 alone, over 9,000 offenders were tested and over 500 inmates were receiving antiviral protocols. HSU’s protocol to identify early stages of HCV should be considered an excellent public health approach and intervention. 5. CT DOC’s move to Diamond pharmacy from its previous pharmacy provider is another example of process improvement and good fiscal intervention. Diamond’s clinical pharmacist and staff have been instrumental in spearheading process improvements, on‐site training, production of high‐cost medication reports and suggestions for equally efficient and lower cost substitutes, competitive pricing (near 340b pricing) for high cost medicines and clinical problem‐solving for complex medical conditions. In addition, Diamond and the HSU have utilized blister packs and barcode scanning to confirm patient identification with medication orders with accuracy. These efforts have resulted in a savings of $500‐700K per month, or $6M‐8.4M per year. 3 https://www.nejm.org/doi/full/10.1056/NEJMc2029354 13 6. CT DOC also made a positive decision to change laboratory vendors to a new contractual relationship with Quest. Reports from staff have noted that Quest has proven to be an excellent partner in the care team as demonstrated by its instant responsiveness, flexibility in adapting procedures to CT DOC needs, bundled (and lowered) rates for expensive labs, and have played a critical role in HSU’s COVID‐19 response. They have added “stat” pick up for urgent lab tests, on‐ site lab tech training and have provided a portal for reporting of test results and data mining. Collectively, CT DOC has seen a savings of $300‐400K per month or $3.6M‐4.8M per year. 7. Although we will discuss the nuances and challenges with chronic care later in the report, HSU has already begun to make some positive changes to strengthen their ability to prevent and/or slow down some degenerative medical conditions (e.g., untreated diabetes). For example, they have asked and received permission to hire a podiatrist. This specialist will be able to flag early foot and vascular conditions in patients with diabetes and other conditions, allowing earlier interventions. The podiatrist will be able to work closely with the provider to order tests, adjust medication, and alter treatment plans proactively. 8. The HSU has recognized the need to make changes to its Utilization Management (UM) procedures to make better use of specialty referrals and resources. At the time of this report, they had initiated discussions with a sister agency, DSS/Medicaid, to potentially assume a UM role, and at a minimum, review their UM processes and procedures for possible CT DOC adaptation. HSU understands the role of pre‐authorization for maximizing resources for specialty care. 9. Similarly, HSU has begun discussions about the possibility of DSS/Medicaid assisting CT DOC with “third‐party” administrative/billing functions. This would allow an independent party to manage claims/billing and collections for hospital and specialty services. This would significantly assist CT DOC in its budget projections. 10. HSU’s adoption of an EHR is an extremely important and positive move that will ultimately improve their ability to monitor patient care and system performance. Similarly, the Electronic Medication Administration Record (eMAR) is linked to the EHR which facilitates providing integrated and holistic care. 11. Although HMA will discuss the challenging impact of the transition of health care from University of Connecticut (UConn) to the DOC later in the report, one notable and positive legacy of UConn’s departure is that staff across the system have taken interest in problem‐ solving and system change. As a result, the HMA team saw numerous examples of quality improvement (QI) projects and practice changes that produced meaningful information and/or change. 14 12. CT DOC, along with its sister agency, Department of Mental Health and Addiction Services, should be recognized for its contribution to the development of the 60 West model, whereby offenders with nursing home care