January 10, 2001 Immigration Health Services Managed-Care Team Wins Hammer Award Cost-cutting Health Care Program Saves Taxpayers Millions WASHINGTON – Creative interagency partnering by the Immigration and Naturalization Service (INS) and the U.S. Department of Health and Human Services’ Public Health Service (PHS) has won a Hammer Award for successfully controlling health care costs for INS detainees. Hammer awards are presented by Vice President Al Gore’s National Performance for Reinventing Government in recognition of federal workers who have made significant contributions in putting customers first, cutting red tape, empowering employees and getting back to basics. The award is designed to recognize the efforts of federal employee teams who have successfully reinvented a process or program in order to make it work better and cost less, said Morley Winograd, senior policy advisor to Vice President Gore and director of the National Partnership for Reinventing Government. INS has won a total of 14 Hammer Awards since 1994. The INS/PHS Managed Care Team redefined health care for 20,000 INS detainees housed in nine Service Processing Centers, seven contract detention facilities and more than 225 local jails throughout the United States, reining in uncontrolled health care costs and demonstrating that the promise of managed care can be achieved, saving government and the taxpayer millions of dollars in unnecessary expenses. This team decreased costs by establishing a health care provider network and centralized medical claims payment. A conservative estimate of the savings achieved since the program’s inception in 1997 is $17.5 million. The team improved the overall quality of health care for the INS detained population through utilization management, providing the right care for the right price with the right outcome. The team enabled universal accessibility of health care for INS detainees, which number some 20,000 on a daily basis, by establishing the right mix of specialists and facilities (both hospitals and mental health facilities). "I’m proud not only of what we have achieved, providing better service at less cost, but how we achieved this with INS and other federal agencies working together to improve government service," said Mary Ann Wrysch, Acting INS Commissioner. INS’ Office of Detention and Removal, in an extraordinary and creative approach to problem solving, delegated to the PHS, Division of Immigration Health Service full authority for managing the health care for INS detainees and implementing a five-step program to regain control over its health care expenditures. The team identified and implemented a program to allow and gain significant control and cost containment for detainee health care, the acting commissioner said. INS is responsible for about 20,000 aliens who are either awaiting deportation or not eligible to be released into the local community. INS relies on its own facilities, contract detention providers, and more than 225 state, county and local jails nationwide to provide for the care and housing for these individuals. "A local jail just isn’t equipped, in many cases, to address the health needs of this population," said Ruben Cortina, Director, Custody Operations Division of the INS Office of Detention and Removal. "Instead, they escort a detainee to a local physician or hospital for treatment and pass 100 percent of the charges back to INS. Not only is this expensive, it makes INS vulnerable to waste, fraud and abuse. With a fully decentralized procedure, lack of adequate accounting attribution and no medical consultants, we had no information on what was happening. We only knew our expenses were skyrocketing." The emergence of drug-resistant tuberculosis in 1996/97 sparked discussions among law enforcement agencies to help each other in preventing the spread of TB. The INS/PHS Managed Care Team expanded these discussions to establish and implement national guidelines defining what medical treatments INS would authorize for their detainees who were housed in local jails. Gene Migliaccio, Director of the U.S. Public Health Service’s Division of Immigration Health Services, noted that the partnership has resulted in a health services program that is quality driven, accessible and cost-effective. "Working with INS on developing managed care cost programs has enabled us to provide our patients with the best in health services while keeping our health costs down," he said. Previously, local jails received little guidance and detainee care ranged from what the detainee requested, to that consistent with the local jailed population, to that below the local standard for the jailed population. By adopting these standards, INS was able to dramatically contain costs through limiting health care to those treatments that were indicated to restore the health of the detainee and by reducing litigation stemming from perceived disparities in treatment. – INS –