Homeland security/Law enforcement: Bureau of Prisons Health Care Costs (2018-22)
The Federal Bureau of Prisons could improve the oversight and management of its health care costs to more efficiently and effectively acquire health care goods and services and potentially save millions of dollars annually.
Year Identified: 2018
Area Number: 22
Area Type: Cost Savings & Revenue Enhancement
3 Total Action(s)
To identify the most effective method for collecting inmate health care utilization data, the Federal Bureau of Prisons (BOP) should conduct a cost-effectiveness analysis of potential solutions, and take steps toward implementation of the most effective solution.
To identify the most effective method for collecting inmate health care utilization data, the Federal Bureau of Prisons (BOP) should conduct a cost-effectiveness analysis of potential solutions, and take steps toward implementation of the most effective solution.
BOP agreed with GAO's June 2017 recommendation and took steps to implement it. In 2018, BOP contracted with a management consulting firm to undertake an independent expert assessment, which would, in part, provide a cost-effectiveness analysis of potential solutions for collecting inmate health care utilization data. This assessment produced five reports. The first two were completed in October 2019 and assessed BOP's organizational alignment with health care operations and provided effective practices in strategic planning and change management for the Health Services Division within BOP. The last three reports were completed in September 2020 and focused on providing data analytics solutions, including recommendations for methods to collect health care utilization data.
In May 2021, BOP took steps, based on recommendations in the reports, to work towards improving data analytics capabilities. For example, BOP stated that it had committed resources to evaluate a potential upgrade to the existing data analytics platform, which will streamline the processing of raw data and provide operational data and additional tools for analytics to BOP staff. Additionally, BOP entered into a contract in May 2021 with an organization to conduct an examination of critical functions that are the foundation of an effective medical data management system. This system will enable the collection, management, and governance of medical and financial data. By taking steps to implement a solution for collecting inmate health care utilization data, BOP will be better positioned to understand and control health care costs.
To better understand the available opportunities for controlling health care costs, the Federal Bureau of Prisons (BOP) should implement its guidance to conduct "spend analyses" of BOP's health care spending, using data sources already available.
To better understand the available opportunities for controlling health care costs, the Federal Bureau of Prisons (BOP) should implement its guidance to conduct "spend analyses" of BOP's health care spending, using data sources already available.
BOP agreed with GAO’s June 2017 recommendation and took steps to implement it that exceeded the scope of the recommendation. For example, in 2018, BOP contracted with a management consulting firm. The goal was to undertake an independent assessment to identify opportunities to strengthen data analytics of sources already available and to improve organization alignment for improved control of health care costs. This assessment produced five reports. The first two were completed in October 2019 and assessed BOP's organizational alignment with health care operations and provided effective practices in strategic planning and change management for the Health Services Division within BOP. The last three reports were completed in September 2020 and focused on providing data analytics solutions.
BOP provided an update in April 2021 stating that it had implemented an organizational change recommended in one of the reports. Specifically, it placed BOP’s National Health Service Administrator in a direct line of authority over BOP’s Regional Health Service Administrators, which provided BOP’s headquarters access to regional health care spending data, among other benefits. BOP also stated that the Health Services Division staff now has full access to financial data regarding health care spending and are able to review Federal Procurement Data System-Next Generation award data, which BOP will use to analyze data on a monthly basis to track BOP’s health care spending.
BOP also identified strategic sourcing opportunities for national contracts. For example, BOP entered into a national contract in January 2021 for lab services such as blood work analysis, drug testing, and COVID-19 testing, among others. Additionally, as of May 2021, BOP was deliberating on two additional national contracts—one for medical equipment and one for a Pharmacy Benefit Management program for Residential Reentry Centers.
Finally, BOP has conducted multiple spend analyses, including an analysis of savings realized as a result of BOP adopting use of a nationwide Medical Surgical Prime Vendor contract, which is a collection of contracts for an array of medical, surgical, dental, and lab supplies. BOP has also conducted multiple analyses on pharmaceutical expenditures, among others. By implementing an organizational change, conducting spend analyses, and pursuing national contracts, BOP is better positioned to understand available opportunities for controlling health care costs.
To determine the actual or likely effectiveness of its ongoing or planned health care cost control initiatives, the Federal Bureau of Prisons (BOP) should evaluate the extent to which its initiatives achieve their cost control aim.
To determine the actual or likely effectiveness of its ongoing or planned health care cost control initiatives, the Federal Bureau of Prisons (BOP) should evaluate the extent to which its initiatives achieve their cost control aim.
BOP agreed with GAO’s June 2017 recommendation and took steps to implement it. BOP established the Health Services Division Initiatives Program Management Advisory Group (IPMAG) in January 2021 to evaluate the effectiveness of its ongoing and planned health care cost control initiatives. The IPMAG meets every two weeks to review and track the Health Services Division’s current and planned initiatives. Each initiative is assigned a point of contact and is routinely assessed during IPMAG meetings regarding overall status, current action steps, target dates for completion, and continued feasibility and forecasted effectiveness.
According to BOP, IPMAG will also ensure consistent practices across BOP and oversee the progress and ultimate completion of health care initiatives to ensure BOP Central Office programs evolve in a direction that optimizes patient outcomes, with a cost-effective, consistent approach to health care delivery. Additionally, BOP officials stated that the Health Services Division staff now has full access to financial data regarding health care spending, which will allow BOP to evaluate cost control initiatives.
Finally, BOP has already evaluated two initiatives—the pharmaceutical program and the national Medical Surgical Prime Vendor contract, which is a collection of contracts for an array of medical, surgical, dental, and lab supplies. By establishing the IPMAG to regularly track and monitor BOP’s health care cost initiatives, BOP is better positioned to evaluate the extent to which its initiatives achieve their cost control aim.
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