ASCA/CCHA Training September 11, 2014 P-PACA-Cost Containment 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 Expansion under 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 ODRC ODRC • Operates independently of county jails and the Department of Youth Services • Comprised of 27 facilities • 25 state operated • 2 privately owned • Current Healthcare Model – State operated/controlled ODRC Prison Population July 1 2011-July 1, 2014 50,510 50,627 50800 50,419 50600 50400 50200 49,713 50000 49800 49600 49400 49200 July 1, 2011 July 1, 2012 July 1, 2013 July 1, 2014 Agency Demographics – Commitments by Age & Average Age Commitments by Age FY 2014 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 - Male Female Average Age of DRC Inmates: Male Inmates – 36 years old Female Inmates – 35 years old Agency Demographics – Bureau of Medical Services Medical Needs: • 39% of the population is enrolled in a specialized Chronic Care Clinic • Operate 325 high acuity medical beds Mental Health Needs: • 20% of all inmates are on the mental health caseload • Operate 500 Residential Treatment Unit beds for SMI inmates Recovery Service Needs of Inmates entering ODRC: • 80% of all inmates have a history of substance abuse related issues • 41% have a considerable (chronic) need for treatment Agency Demographics – Offender Costs Offender Costs FY 2014 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 $68.19 $67.90 $1,249,941,168.00 Total 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 Annual Cost Per Inmate $7,000.00 $6,000.00 $5,750.00 $4,705.00 $5,000.00 $4,000.00 FY2009 FY2014 $3,000.00 $2,000.00 $1,000.00 $0.00 FY2009 FY2014 Our agency has reduced our annual healthcare cost by $54 million since 2009. Maximizing Correctional Healthcare Quality with Strategic Business Planning 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 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 ODRC Medical Spend Diverse Business Strategy to Maintain Quality and Efficiency Managed Care - Bill re-pricing Insourcing Outsourcing - Collegial Review - Data analysis & reporting - Evidence based medicine - Medicaid Impact - Metrics - Advanced Level Providers - 2 Privatized facilities - 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 Medical Supplies Lab Electronic Health Record Partnership with the Ohio Department of Mental Health & Addiction Services Partnership with the Ohio Department of Mental Health & Addiction Services Multi-agency bid to increase volume / lower pricing Other state agencies joining the ODRC contract (DYS) Ohio Department of Rehabilitation & Correction One Patient, One Team Other Strategies: Contract Simplification • Contracts reduced from 375 in 2010 to 65 currently PET-CT-MRI • Purchased / leased equipment for these diagnostics to be done in house. • Greater control over scheduling at reduced cost Urgent Care • ODRC operates UC during off hours • Prevents some ER trips for things like sutures & minor procedures • Keeps inmate patients within ODRC security Ohio State University Medical Center • Reduced overall contract costs by $10million/year last contract Contract Compliance • 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 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?