Dr. Jeffrey Alvarez, NaphCare Chief Medical Officer, on the National Commission on Correctional Health Care

NaphCare is pleased to share a conversation with our Chief Medical Officer, Dr. Jeffrey Alvarez, MD, CCHP. Dr. Alvarez came to NaphCare in 2018 as a corporate physician, quickly advancing to Corporate Medical Director for Western States and, most recently, to the role of Chief Medical Officer. He uses his National Commission on Correctional Health Care (NCCHC) expertise to help NaphCare partners abide by NCCHC standards and recommend correctional facilities to obtain accreditation, earning NaphCare a 100% success rate in acquiring and maintaining accreditation for our partners.

Dr. Alvarez became involved with the NCCHC in 2010 when he began working as a surveyor to help correctional facilities achieve and maintain NCCHC accreditation. Since then, he has taken on various leadership roles with the NCCHC, serving on the Board of Directors and helping amend and update the standards to remain current.

In our conversation with Dr. Alvarez, he spoke about the importance of NCCHC accreditation, NaphCare’s partnership in helping correctional facilities succeed, and his desire to improve public health through individualized care.

How have you been involved in NCCHC, and what is your role with NCCHC at NaphCare?

“Before my time at NaphCare, I was the Medical Director at a correctional facility that had lost their accreditation. Upon talking to the staff, I noticed that everyone felt down; morale was low because they thought their problems were insurmountable.

I reached out to NCCHC and went to one of the conferences. I also talked to them about regaining and applying for accreditation at my site, which ultimately did regain accreditation within about a year and a half. In the process, I met people who were in leadership positions for NCCHC. One NCCHC Surveyor believed in me and encouraged me to apply to be a surveyor. I ended up having a hand in writing the current NCCHC standards by chairing the Standards Revision Committee in 2018. I was on the Board of Directors for a six-year term, and now I continue on the Accreditation Committee reviewing facility accreditation reports for compliance, along with training other physicians to become surveyors for NCCHC.

When I joined NaphCare in 2018, one of my duties was to lead the Accreditation Department, which are a group of NaphCare auditors who work with site-level Health Services Administrators to help jails and prisons achieve certification. I now travel to different facilities to educate our staff and partners about NCCHC and encourage our facilities to seek accreditation or reaccreditation. We have gone from 25% of our facilities accredited to about 75%. Ultimately, the goal is 100%. We are proud to report the success of our partner facilities in gaining accreditation and even those who go beyond accreditation. In 2021, NaphCare partner Hillsborough County, FL, won NCCHC’s first ever Pinnacle Award for achieving three NCCHC accreditations – jail health services, mental health services and opioid treatment programming. Most recently, another NaphCare partner, the Pima County Adult Detention Complex, won 2023 NCCHC Facility of the Year.

Why is NCCHC accreditation important for jails and prisons?

“Accreditation provides outside, independent validation of the medical services being provided in the correctional facility. NCCHC is an independent group that comes in and audits your facility purely for healthcare and how you're delivering healthcare. You can feel successful in knowing that someone in the field, separate from your company, is saying, “You're doing a good job.” And it gives the staff some positive reinforcement.”

How does NaphCare align with the National Commission on Correctional Health Care?

All NaphCare policies are aligned with NCCHC standards. Our policies are numbered exactly the same way as the NCCHC standards, so as long as our facilities are aligning with NaphCare policy, they are aligning with NCCHC standards.”

Why would a correctional facility want to achieve specialized accreditations?

“There are a few specialized accreditations: mental health, juvenile, and opioid treatment. NCCHC Opioid Treatment Program accreditation can be with or without Substance Abuse and Mental Health Services Administration (SAMHSA) certification. Some of NaphCare’s client facilities have achieved these specialized accreditations for juvenile health, mental health, and opioid treatment with and without SAMHSA certification.

Adding Mental Health or Opioid Treatment Program (OTP) accreditation via NCCHC allows a facility to highlight special programs in their facilities that go beyond the “basics.” For example, Hillsborough County, FL has a mental health unit with a very successful track record of improving the care for seriously mentally ill patients. NCCHC Mental Health accreditation highlights that accomplishment.

As I said earlier, NCCHC also accredits correctional facilities for Opioid Treatment Programs. This encompasses providing Medication-Assisted Treatment (MAT) and Medications for Opioid Use Disorder (MOUD) services. There are two types of these accreditations – one is providing full services (i.e. prescribing methadone) onsite via an OTP certified by SAMHSA. These sites need to complete a complex process that includes approval by each State and DEA agency on top of the SAMHSA/NCCHC accreditation and certification. They cannot independently prescribe methadone for opioid substance use disorder without it.

A few of NaphCare’s client facilities have this type of accreditation, with others awaiting final certification. The other type of OTP accreditation uses a community program as the SAMHSA-certified partner to the jail program. NaphCare has some sites accredited with this model as well.

What is the most promising thing happening in correctional healthcare right now?

“Seeing correctional facilities team up with public health departments to screen, test for, and treat different types of sexually transmitted diseases, whether they be HIV, Hepatitis C, Syphilis or other things that are highly untreated in the corrections population. I think this not only leads to a general improvement in the health of the correctional population, but also the community public health by keeping diseases from spreading by helping people when they're in our care within the correctional facility.

Also, the large opioid epidemic and seeing how the field of corrections is heading towards accepting the mentality that substance use disorder is a chronic relapsing illness, not necessarily something that is a deficiency of a person. By seeing it as a chronic condition, we're treating it and helping decrease the other side effects.”

For more information about NCCHC, visit ncchc.org.