ASCA/CCHA Training September 11, 2014

P-PACA-Cost Containment The Ohio Experience

Gary C. Mohr, Director

Ohio Department of Rehabilitation & Correction

The Ohio Experience

Patient Affordable Care Act & Medicaid Expansion

ODRC Demographics

Cost of Healthcare Services

Cost Containment & Other Opportunities

Patient Protection Affordable Care Act & Medicaid Expansion

• P-PACA – – Attempts to control rising healthcare costs

– Protect consumers

– Expand insurance coverage

– Shifts focus to wellness prevention

– Increase the healthcare workforce

– Serves as the platform for Medicaid expansion

Current Status: Medicaid Expansionunder PPACA – The Ohio Story

• Medicaid expansion under PPACA in Ohio has been a key initiative of Governor Kasich’s Office of Health Transformation (OHT)

– July 1, 2013 – DRC began activating Medicaid coverage for

• Hospitalized more than 24 hours• Under 21 years old• Over 65 years old• Pregnant

– September 26, 2013 – Ohio’s Medicaid Director submitted a State Plan Amendment to extend Medicaid coverage to childless adults beyond traditional categories (pregnant, disabled, over 65, etc)

– October 21, 2013 – State Plan Amendment to extend Medicaid coverage approved by the Controlling Board, thus becoming effective

– January 1, 2014 – Governor Kasich authorized the expansion of Medicaid Services to all residents living within Ohio.

The DRC strongly believes that access to continuing treatment & healthcare services is critical to reentry efforts of Ohio offenders.

Patient Affordable Care Act & Medicaid Expansion

• DRC’s Office of Correctional Healthcare has partnered with the Ohio Department of Medicaid (ODM) for several reasons including:

– Assess the impact of Medicaid expansion on the state’s offender population. *Nearly every Ohio offender will be eligible for Medicaid Based on their financial eligibility upon release from incarceration.

– Achieve a shared goal of enrollment of every eligible offender into Medicaid 90 days prior to their release.

– Recidivism reduction by preparing offenders for successful transition back to the community after release from prison

Ohio Department of Rehabilitation & Correction – Agency Overview

ODRC

• Operates independently of county jails and the Department of Youth Services

ODRC

• Comprised of 27 facilities• 25 state operated• 2 privately owned

ODRC

• Current Healthcare Model – State operated/controlled

ODRC Prison Population July 1 2011-July 1, 2014

49200

49400

49600

49800

50000

50200

50400

50600

50800

July 1, 2011 July 1, 2012 July 1, 2013 July 1, 2014

50,627

49,713

50,419

50,510

Agency Demographics – Commitments by Age & Average Age

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Commitments by Age FY 2014

Male Female

Average Age of DRC Inmates:

Male Inmates – 36 years old

Female Inmates – 35 years old

Agency Demographics – Bureau of Medical Services

• 39% of the population is enrolled in a specialized Chronic Care Clinic

• Operate 325 high acuity medical beds

Medical Needs:

• 20% of all inmates are on the mental health caseload• Operate 500 Residential Treatment Unit beds for SMI inmates

Mental Health Needs:

• 80% of all inmates have a history of substance abuse related issues

• 41% have a considerable (chronic) need for treatment

Recovery Service Needs of Inmates entering ODRC:

Area FY13 FY14 Grand Total

Security $29.17 $29.93 $551,000,143.00

Medical Services $10.98 $10.45 $192,397,702.00

Administration* $6.59 $7.12 $130,983,575.00

Support Services $8.89 $7.75 $142,684,810.00

Facility Management $5.15 $5.21 $95,822,164.00

Mental Health $2.61 $2.62 $48,292,382.00

Unit Management $2.68 $2.71 $49,843,644.00

Education Services $1.64 $1.68 $30,839,748.00

Recovery Services $0.48 $0.44 $8,076,999.00

Total $68.19 $67.90 $1,249,941,168.00

Offender Costs FY 2014

Agency Demographics – Offender Costs

The Department of Rehabilitation and Corrections is anticipating a savings of over 18 million a year due to Medicaid paying for a 24 hour or more in-patient

hospital stay; this allows us to reinvest money into other evidenced based programs, which will help incarcerated and offenders within the community.

ODRC Healthcare Cost Comparison

$0.00

$1,000.00

$2,000.00

$3,000.00

$4,000.00

$5,000.00

$6,000.00

$7,000.00

FY2009FY2014

$5,750.00

$4,705.00

FY2009 FY2014

Our agency has reduced our annual healthcare cost by $54 million since 2009.

Annual Cost Per Inmate

Maximizing Correctional Healthcare Quality with Strategic Business PlanningThe Ohio Experience

Stuart Hudson, Managing Director of Healthcare & Fiscal Operations

Office of Correctional Healthcare

Ohio Department of Rehabilitation & Correction

Correctional Healthcare Reality Today

• Increase in aging offenders & associated chronic disease burden• Rising pharmaceutical costs (Sovaldi, HIV meds, etc.)• Continuous scrutiny from stakeholders• Legal liability (deliberate indifference and/or mal-practice)

And……

Decreased or tight funding that impacts correctional healthcare

ODRC Medical Spend Past Decade

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

ODRC Medical Spend

Diverse Business Strategy to Maintain Quality and Efficiency

Managed Care

- Bill re-pricing

- Collegial Review

- Data analysis & reporting

- Evidence based medicine

- Medicaid Impact

- Metrics

Insourcing- Advanced Level

Providers

- 2 Privatized facilities

Outsourcing- Lab services

- Allied Health

- Dietary

State Agency Partnerships

- Pharmacy

- Medical supplies

- Lab contract

- EHR

Other- OSUMC

- Contract simplification

- CT-MRI-PET

- Urgent Care

- Contract compliance

In-sourcing:

• Advanced Level Provider (ALP) Services:– Civil servant ALPs invested in leadership / long-term success– This change was key to exiting Fussell Stipulation– ODRC spend was less in FY14 than in FY08 with more ALPs

in a civil servant system (11.8 vs. 11.3 million for savings of .5 million)

– Increased utilization of NPs for ALP coverage• Converted Private Healthcare Services to Civil Servant:

– Affected 2 facilities– Savings of approximately 1million per facility

Ohio Department of Rehabilitation & Correction - One Patient, One Team

Out-Sourcing:

Lab Services- Closed internal COLA accredited lab

- Multi-agency RFP, LabCorp is provider

- Maintained quality, increased savings & efficiency

Allied Health Services- Includes HITs, Phlebotomists, Radiology techs, aides

- Significant savings while maintaining quality

- Prioritization of lead clinical staff (nursing, ALPs)

Dietary Services- Transitioned from civil servant diet techs to contract

- Services part of overall foodservice RFP

- Menu and clinical protocols controlled by ODRC

Ohio Department of Rehabilitation & Correction - One Patient, One Team

Partnership with other State Agencies

Pharmacy

Partnership with the Ohio Department of Mental Health

& Addiction Services

Medical Supplies

Partnership with the Ohio Department of Mental Health

& Addiction Services

Lab

Multi-agency bid to increase volume / lower

pricing

Electronic Health Record

Other state agencies

joining the ODRC

contract (DYS)

Ohio Department of Rehabilitation & Correction - One Patient, One Team

Other Strategies:

• Contracts reduced from 375 in 2010 to 65 currentlyContract Simplification

• Purchased / leased equipment for these diagnostics to be done in house.

• Greater control over scheduling at reduced costPET-CT-MRI

• ODRC operates UC during off hours• Prevents some ER trips for things like sutures & minor procedures• Keeps inmate patients within ODRC security

Urgent Care

• Reduced overall contract costs by $10million/year last contractOhio State University Medical Center

• ODRC maintains a contract compliance division at the central level• All contracts are routinely monitored for compliance / quality• Multiple options to improve compliance or handle non-compliance

Contract Compliance

Ohio Department of Rehabilitation & Correction - One Patient, One Team

Results of Strategy

• The value of people – Clinical staffing is at an all-time high

• Quality is maintained/enhanced• Reduced legal liability• Costs are contained• Business is manageable• ODRC is positioned for the future

– Medicaid moving forward– EHR moving forward

Questions?