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
•
•
•
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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?