Corizon Health Inc. is the largest provider of correctional health care in the country. All told, it is responsible for the care of 345,000 jail and prison inmates. The privately held company rode a wave of prison privatization, but has come under fire for putting profits ahead of quality care. Most recently, Corizon lost a contract to manage the care of prisoners at New York City’s Rikers Island, which we reported is part of a larger trend of cities choosing to go with local providers. Maura Ewing spoke with Corizon CEO Dr. Woodrow Myers about his take on Corizon’s recent setbacks, the pros and cons of privatization, the company’s penchant for secrecy, and the challenges of correctional health care.
Corizon has had some serious setbacks lately. You just lost the contract for Rikers. Since 2012, you lost contracts in Maine, Maryland, Minnesota, and Pennsylvania. You’re getting flak in Florida. How do you explain the company’s turn of fortune?
You're right. There have been some losses. There have also been a number of gains as well. There are a total of 40 that have come in since 2012. We’re the largest entity in the nation that does this kind of work, we're very responsive, we have to respond to RFPs [requests for proposals] that state and city governments put up. We have 114 contracts now in 27 states. It's a lumpy business, you win some, you lose some. We trade some with our competitors, we take some away from our competitors.
You would argue that there has not been a turn of fortune?
How do you characterize turn of fortune? Certainly we would have preferred to stay in New York. If at all possible, one day we'd love to get back. We'd prefer to have kept all the contracts that you listed. In the last 18 months since I've been here, we've taken the contract with Missouri, we took the mental health contract there. It's a lumpy business, it's a tough business, our competitors are strong and we're in the marketplace working as hard as we can every day. If you're suggesting that we're on the ropes, that's not true. Since 2011, we've retained or won nearly 40 state and county contracts. More than half our clients have been with us for 10 years or more. That's not the profile of a loser, that's the profile of a competitor.
You spent a year, in 1990-91, as health commissioner for Mayor Dinkins of New York. Is Rikers fairly typical of big urban jails, or does it present unusual challenges?
With respect to Corizon in New York, the way that the contract was structured was particularly challenging because we technically reported — and we still do — to the Department of Health and Mental Hygiene, and they had the primary relationship with Health and Hospitals Corporation (HHC1), and they had the primary relationship with the Department of Corrections (DOC) and all the other entities that touched on what we did. So there are currently many layers in New York that aren't present in our other contracts.
In addition, New York State requires a separate corporation to employ the actual providers of care. So there is a common misconception that the physicians, the dentists, and the nurses belonged to Corizon. That's not true. It's a separate corporation that contracts with the city. Corizon's contract was to provide oversight of management services for payroll, benefits, those kinds of things.
No one knows yet how the mayor intends to structure the relationship for Health and Hospitals Corporation (HHC) or how HHC plans to execute its responsibility. If his intent is to have a single agency manage all the health care related issues for the inmates in the city, that will certainly reduce complexity.
Were there any specific decisions while you were in New York that were made more difficult by the structure?
Just look at the Department of Investigations (DOI) report2. Our responsibility was to hire individuals, but Corizon has nothing to do with issuing credentials for the individuals who actually work on the island or in the prison. Nobody goes on Rikers Island without credentials issued by the Department of Corrections, so we follow the processes that we are told to follow by the Department of Health and Mental Hygiene: the Department of Corrections was supposed to do background checks and issue credentials for our employees to work on the island. And of course for a long period of time, we assumed they were doing exactly that, because the credentials were issued and people were allowed to work.
I don't think there was any malice, and, I don't want to belittle any agency because, it is really hard to do all the things that are required to be done and to make this a successful venture, but it's just one example of the kind of complexity that we encounter in that kind of environment.
Do you have any advice for the city as it turns to Health and Hospitals Corporation?
Lots. I think I’m in the unique position of having done this twice, and have learned a lot about how tough it is. If I could sum it up in two words: better collaboration. I think there has to be much, much, much more collaboration between Health and Hospitals Corporation and the Department of Corrections than ever existed between the multiple entities that operated it before.
I think that the number one piece of advice I would give to the city moving forward is they need to establish an oversight process by the leadership of HHC and the leadership of DOC that is inviolable, and that those two leaders must be involved in the tough decisions and must make sure their people are following through on the efforts that they want to put in place.
Mayor Bill de Blasio seems to feel (at least one of his deputies has said) that basic services like health care for jail inmates should not be outsourced to for-profit companies, which don’t have roots in the community and have an incentive to skimp on quality service.
For-profit companies, not-for-profit companies, we all have similar challenges in that we have to find a way to provide services to a very difficult population in the glare of the public spotlight.
What would you say to the specific critique that Corizon can't do a good job because it doesn't have roots in the community?
The huge, overwhelming majority of folks that are actually providing the care were born, raised, lived in, were educated in, love, and will stay in New York. So the notion that folks from one of those red states out in the Midwest that we're in are taking care of New Yorkers is just wrong. Our staff in New York loves New York. Our staff in Arizona loves Arizona. The staff in Florida loves Florida — it's not as if the folks that are providing the care are foreign in some way to the city. They are not.
Is there any advantage to having affiliates or subsidiaries in the city you're serving?
We have a headquarters in New York City. It's an office where all of the leaders for that contract work and so the leadership for the Corizon health team in New York City is right there, it’s like a block from the jail. The notion that things are being run from Tennessee is just wrong.
Does Corizon have a relationship with local clinics?
We are taking care of city patients, so the vast majority of the care that's provided while they're incarcerated is through HHC facilities in New York City when it's not through us. So for instance, let's say a guy gets appendicitis in the jail. We say okay, he needs an appendectomy. We send him to Bellevue or to one of the other New York City hospitals depending on where he's located. HHC physicians will confirm the diagnosis, take him to the operating room, take out his appendix, help him to start recovering and then take him back to the island to finish his or her sentence.
If we had been asked to stay, I would have continued talking with HHC to get them more involved in the continuity of care, especially after release. We would also have worked to collaborate more with them because I think that's a good thing for our patients. And not just for when patients are in custody — with the Affordable Care Act and with Medicaid expansion, we have more tools to connect inmates with providers and services on the outside after they’re released, which is important. Shoring up that continuity-of-care will serve the city well.
Do you sense that privatization in the field of incarceration — prisons and prison services — is on the rise, or is it suffering some kind of backlash? Do you sense that the momentum has shifted one way or the other since you became CEO in October 2013? What’s the advantage of having these facilities run and serviced by for-profit companies?
The total number of patients in jails and prisons being taken care of by private companies today is as high as it's ever been, as states and cities figure out that healthcare provision is hard work. There are lots of rules, lots of regulations, lots of changes that are being made to protect patients. The costs are very difficult to manage if you don't do this kind of work every day, which is why we have about 350,000 patients nationwide.
The states and cities that had been doing this work have figured out, “Hey look, we don't have the skill or the expertise to stay as close to this as you guys, so help us out.” We also are very involved in the challenges of recruiting these physicians and nurses and providing them the support that they need in order to stay current in the field. That's not a core competence of city or state government so it's a very difficult challenge.
It's more challenging outside of New York than inside because New York does have HHC, which is an entity that is very strong and is very involved in all of the above, so New York is a little different situation. But in most places they have decided in recent years, “Hey look, we would rather have you guys help us out with this rather than continue to try and figure out how to do it ourselves.”
Do you sense that the momentum has shifted since you became CEO in 2013?
I think that the advocacy has intensified. Social media certainly contributed to that. We get a lot more inquires now from concerned media outlets, a greater variety of sources than we ever have, absolutely. Since I've become CEO, we have worked even harder to tell our story so that our team members know that our number one goal is to deliver terrific clinical outcomes, that our patients, we treat them with dignity and respect.
Is it a very tough business for us? Absolutely it is. Is it probably going to get tougher before it gets easier. Do we succeed 100 percent every day? No, we do not. The hundreds of thousands of visits that we have, we succeed far more often than most folks know. When those failures do occur, we try to make sure that we learn from them. That's the same thing that happens every day in every single clinic or hospital across the country. Some people want to portray us as an industry whose goal it is to provide as little care as possible and make as much money as possible. That’s simply not true. Our vision is that we'll provide quality health care and reentry services that will improve the health and safety of our patients, reduce recidivism, and better the communities where we all live and work.
Corizon is simultaneously being accused by critics of cutting corners on health care, and by business analysts for not making enough money (Moody’s bond rating for Corizon was recently downgraded). What’s got to give?
You've nailed it. Our job is to walk the line. Our job is to provide all the care that a patient needs and only the care that a patient needs. Our job is to use the funds that are provided in the most efficient way possible. And we get hit from both sides. We get hit not just from some of the ratings agencies and the advocates that you cited, but from the everyday citizen that ask the question, Why can't inmates get whatever care they need? And let's get them completely serviced up in whatever elective procedures they want because now they're your responsibility and you should just give them whatever they or their families can possibly imagine. Then you've got folks on the other side saying, Why are you giving them anything at all? These are people who have committed very bad crimes and done very bad things, why should they get their disease treated, and I can't get mine treated? Why should my tax dollars pay for their care and they're not paying for my care? We get it from all sides. But that’s the business that we're in, so we've got to be tough.
One of the complaints about for-profit providers generally, especially those that are privately held like Corizon, is a lack of transparency. When Corizon was questioned by the news media in Florida during a contract renewal, the company initially tried to prevent the release of its litigation history3, claiming it was a “trade secret.”
Private companies are not under the same obligation to release documents as are public companies. True fact, legally correct, and it's different in every environment. If you're a federal contractor, it's different than if you're a state contractor, it's different if you're a county contractor, it's different if you're in New York vs. Florida vs. wherever you are. So, number one, we follow the law whatever that law is in whatever jurisdiction we're in.
Secondly, we don't provide information that in a competitive business environment can be used by our competitors, that can be used to figure out what innovations we are offering, how we're pricing, what our costs are etc., etc., because the more information they have on us, the easier it is to compete against us. We don't want to make that easy for them at all. The Ford Motor Company doesn't go around and show its plans for a Taurus to GM. GM doesn’t show its plan for its new Chevy Volt upgrade to Ford. It's that kind of a business issue that we face in our business as well.
How would litigation history be useful to your competitors?
Litigation is a very complicated area, but the bottom line is that the vast majority of lawsuits are unfounded — are either dismissed or settled. That is because in the United States of America, it is very easy to sue people and to make allegations in statements, especially when it comes to health care, because the laws allow the individual making the accusation to say whatever the heck they want and the laws prevent us from telling what we believe to be the truth because of issues concerning privacy. So if you say that your dad was mistreated in my care and I didn't, as a doctor or the nurse, do the requested test or procedure, folks like yourself will write that down dutifully and come to me and ask the question: is it true or not? I always have to say to you by law I cannot comment on that because of the HIPAA privacy rules, that's the way it works in the United States today. It clearly puts us in an awkward position because we actually know the answers to the questions. That's why it looks as if we are hiding stuff when we're not legally able to give an answer proving we did what we thought was right.
Every single one of my patients has a lawyer, and most of them haven't been paid. They're hungrily looking for any opportunity that they can to find a way to take advantage — in my opinion — to take advantage of our legal system. So we are a frequent target for accusations of something happening in the facility that may or may not have been related to us or that we may or may not have been involved in. But remember that these guys come — and some women, but mostly men — having not had health care in many cases for a long period of time.
The interview has been edited for length and clarity.