Cesar Arriaza has a passion for helping people. In his role as a service coordinator and community health worker in King County, Washington, he helps people understand their health benefits to better treat conditions like diabetes or substance abuse. He also lets them know what services might be available to help them lead a healthier life, like access to nutritious food, a ride to a doctor’s appointment or a safe place to stay.
However, his workplace isn’t in a traditional office building or clinic. It’s in a jail.
“I come in, introduce myself, interview them and see how they’re doing,” he said. “If they need to talk to someone, I can also refer them to a nurse.”
That nurse might be someone like Mandy Herreid. Besides providing medical care when needed, she runs a “Medicaid 101” workshop with Cesar. The topics go beyond how to receive health care benefits upon release.
“This population a lot of times doesn’t have a checking account or knows how to make an appointment,” Mandy said. “I mean there’s a lot of these basic life skills that they just don’t have or haven’t been taught yet. So by having somebody help them out … with some of those little things, gives them an extra helping hand.”
Mandy and Cesar are UnitedHealthcare employees with the Jail Transition program, a small team of committed health care coordinators working with inmates before they’re released in an effort to break the cycle of relapse. They have focused their efforts at the South Correctional Entity Regional (SCORE) Jail in Des Moines, Washington where the same inmates may return multiple times a year.
“We see quite a few people who come back again and again and again for various reasons,” said Lt. Jeffrey Gepner of the SCORE jail. “Sometimes … they’re stealing food because they can’t get any (otherwise).”
The old model in many jurisdictions was to not think about people after they were released, Gepner said. This meant not addressing the possible systemic conditions of poverty, homelessness and substance abuse that may leave people with little hope, and often on a path back behind bars.
So how can this cycle be broken in a state with a 34% recidivism rate? There is no one-size-fits-all approach. And, communities are innovating with public-private partnerships — including with managed care organizations like UnitedHealthcare.
That’s where Cesar and Mandy come in.
“We’ve found that a lot of the inmates feel about health care like they feel about finances when they leave their childhood home,” Mandy said. “They didn’t learn about it. And so they don’t know how it works … We learn from them just as much as they learn from us.”
But the care doesn’t stop once they are released. Cesar makes sure they get connected to resources that can help with housing, food and other social services outside of jail, when necessary.
“We follow them for six months,” Cesar said. “If they want to meet with me somewhere in the community we can meet with them … If there are some barriers, I like to help them and see how I can help them to break the barrier.”
For Lt. Gepner, the work Cesar and Mandy have done in the jail has already made a positive impact. Gepner notes that he has seen a reduction in ER utilization with people who were recently incarcerated.
“It used to be a mindset of ‘we’re corrections, you’re medical, we don’t care.’ (But) if you have that combined working relationship with all of us trying to pull on the same end of the rope, you see a lot of successes,” he said.
Mandy said it really comes down to a personal connection.
“We are making them feel valued,” she said. “The fact that somebody says ‘You know, you cared about me today,’ that’s what it’s about.”