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Gary C. Mohr, Director Ohio Department of Rehabilitation & Correction.

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Presentation on theme: "Gary C. Mohr, Director Ohio Department of Rehabilitation & Correction."— Presentation transcript:

1 Gary C. Mohr, Director Ohio Department of Rehabilitation & Correction

2 The Ohio Experience Patient Affordable Care Act & Medicaid Expansion ODRC Demographics Cost of Healthcare Services Cost Containment & Other Opportunities

3 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

4 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.

5 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

6 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

7 ODRC Prison Population July July 1, 2014

8 Agency Demographics – Commitments by Age & Average Age Average Age of DRC Inmates: Male Inmates – 36 years old Female Inmates – 35 years old

9 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:

10 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.

11 ODRC Healthcare Cost Comparison Our agency has reduced our annual healthcare cost by $54 million since Annual Cost Per Inmate

12 Stuart Hudson, Managing Director of Healthcare & Fiscal Operations Office of Correctional Healthcare Ohio Department of Rehabilitation & Correction

13 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

14 ODRC Medical Spend Past Decade

15 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

16 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 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

17 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

18 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

19 Other Strategies: Contracts reduced from 375 in 2010 to 65 currently Contract Simplification Purchased / leased equipment for these diagnostics to be done in house. Greater control over scheduling at reduced cost PET-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 contract Ohio 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

20 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

21 Questions?


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