Presentation on theme: "Gary C. Mohr, Director Ohio Department of Rehabilitation & Correction"— Presentation transcript:
1 Gary C. Mohr, Director Ohio Department of Rehabilitation & Correction ASCA/CCHA Training September 11, P-PACA-Cost Containment The Ohio ExperienceMy journey into becoming the Director of the Ohio Department of Rehabilitation and Correction (DRC). Appointed by Governor John Kasich in January 2011, I recently celebrated over 40-years of correctional experience. I start each day with the thought; “It’s a great day to be alive, as each day provides an opportunity to impact the future of tomorrow. With that in mind, DRC staff have dedicated their time and talents to implementing a multitude of strategies to reduce violence, establish stability and decrease recidivism. I am committed to maintaining and strengthening partnerships formed with Reentry Coalitions, Judicial Stakeholders, Faith- Based Community, as well as key players who take an active interest in the success of an offender’s reentry into society. ODRC is proud to national leader in offender recidivism with a record low of 27.1%.Gary C. Mohr, DirectorOhio Department of Rehabilitation & Correction
2 The Ohio Experience ODRC Demographics Cost of Healthcare Services Patient Affordable Care Act & Medicaid ExpansionODRC DemographicsCost of Healthcare ServicesCost Containment & Other Opportunities
3 Patient Protection Affordable Care Act & Medicaid Expansion P-PACA –Attempts to control rising healthcare costsProtect consumersExpand insurance coverageShifts focus to wellness preventionIncrease the healthcare workforceServes as the platform for Medicaid expansionGovernor Kasich’s (RP), passion and desire to help the most vulnerable citizens in our state has been the driving force of Ohio’s 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 forHospitalized more than 24 hoursUnder 21 years oldOver 65 years oldPregnantSeptember 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 effectiveJanuary 1, 2014 – Governor Kasich authorized the expansion of Medicaid Services to all residents living within Ohio.We would not be here today without the passage of the Governor’s passage of the expansion of Medicaid Services to all Ohioans.Based on the expansion most offenders within ODRC will now qualify for Medicaid.Medicaid expansion broadened the categories of eligibility allowing most offenders within ODRC to now qualify.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 ODRCOperates independently of county jails and the Department of Youth ServicesComprised of 27 facilities25 state operated2 privately ownedCurrent Healthcare Model – State operated/controlled
8 Agency Demographics – Commitments by Age & Average Age Average Age of DRC Inmates:Male Inmates – 36 years oldFemale Inmates – 35 years old
9 Agency Demographics – Bureau of Medical Services 39% of the population is enrolled in a specialized Chronic Care ClinicOperate 325 high acuity medical bedsMedical Needs:20% of all inmates are on the mental health caseloadOperate 500 Residential Treatment Unit beds for SMI inmatesMental Health Needs:80% of all inmates have a history of substance abuse related issues41% have a considerable (chronic) need for treatmentRecovery Service Needs of Inmates entering ODRC:
10 Agency Demographics – Offender Costs This graph supports our agency as a whole has decreased overall costs per offender while continuing to provide for their daily needs in a mannerIn 2009, Ohio Prison’s healthcare expenditures reached a peak of 292 million dollars. Over the past four years while general health care cost have increased throughout the country and while we were in litigation for providing inadequate health care; we were able to decrease our health care cost by 54 million dollars while increasing the quality of health care and life longevity of an inmate.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 Annual Cost Per InmateStu Hudson, Managing Director of Healthcare and Fiscal Operations is going to share how we have made cost reductions while increasing quality medical care and optimizing staffing levels.Our agency has reduced our annual healthcare cost by $54 million since 2009.
12 Maximizing Correctional Healthcare Quality with Strategic Business Planning The Ohio Experience Stuart Hudson, Managing Director of Healthcare & Fiscal OperationsOffice of Correctional HealthcareOhio Department of Rehabilitation & Correction
13 Correctional Healthcare Reality Today Increase in aging offenders & associated chronic disease burdenRising pharmaceutical costs (Sovaldi, HIV meds, etc.)Continuous scrutiny from stakeholdersLegal liability (deliberate indifference and/or mal-practice)And……Decreased or tight funding that impacts correctional healthcare
14 ODRC Medical Spend Past Decade Fussell Stipulation beginning 2006, ending 2012Staffing higher now than during stipulation, while costs are lower
15 Diverse Business Strategy to Maintain Quality and Efficiency Managed Care- Bill re-pricing- Collegial Review- Data analysis & reporting- Evidence based medicine- Medicaid Impact- MetricsInsourcing- Advanced Level Providers- 2 Privatized facilitiesOutsourcing- Lab services- Allied Health- DietaryState Agency Partnerships- Pharmacy- Medical supplies- Lab contract- EHROther- OSUMC- Contract simplification- CT-MRI-PET- Urgent Care- Contract complianceManaged Care:Pre Medicaid: Billing retrospective reviews, Pre-certification of specialty consultation, 3rd party case management of in-patient staysPost Medicaid: Bill re-pricing by 3rd party, Collegial Review, Permedion – billing data analysis, surveillance, & reporting, Medicaid ImpactIn-Sourcing:Advanced Level Provider (ALP) Services: 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 millionConverted Private Healthcare Services to Civil Servant: Affected 2 facilities, Savings of approximately 1million per facilityOut-Sourcing:Lab Services - Closed internal COLA accredited lab, Multi-agency RFP, LabCorp is provider, Maintained quality, increased savings & efficiencyAllied Health Services - Includes HITs, Phlebotomists, Radiology techs, aidesDietary Services - Transitioned from civil servant diet techs to contract, Services part of overall foodservice RFP, Menu and clinical protocols controlled by ODRCState Agency Partnerships:Pharmacy and Medical Supplies – ODMHAS (Current costs are at $29.7 million for FY14. They were $30.8 million in 2008 – and we have more CCC patients and higher acuity now), Lab – multi-agency bid for increased volume / decreased pricing, EHR – DYSOther /Miscellaneous:OSUMC contract decreased by 10 millionContract simplification – reduced contracts from 375 in 2010 to 65 currently – easier to manageCT-MRI-PET – Purchased or leased in house , decreased costs and easier scheduling – secureUrgent Care – off hours UC services to decrease ER trips and costs, minor procedures / sutures, secureContract Compliance – division at central level, all contracts monitored for quality, multiple options for handling non-compliance or need for improvement – leads to stability and accountability
16 Ohio Department of Rehabilitation & Correction - One Patient, One Team In-sourcing:Advanced Level Provider (ALP) Services:Civil servant ALPs invested in leadership / long-term successThis change was key to exiting Fussell StipulationODRC 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 coverageConverted Private Healthcare Services to Civil Servant:Affected 2 facilitiesSavings of approximately 1million per facilityOhio Department of Rehabilitation & Correction - One Patient, One Team
17 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 & efficiencyAllied 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 ODRCOhio Department of Rehabilitation & Correction - One Patient, One Team
18 Partnership with other State Agencies PharmacyPartnership with the Ohio Department of Mental Health & Addiction ServicesMedical SuppliesLabMulti-agency bid to increase volume / lower pricingElectronic Health RecordOther state agencies joining the ODRC contract (DYS)Pharmacy – ODMHAS (Current costs are at $29.7 million for FY14. They were $30.8 million in 2008 – and we have more CCC patients and higher acuity now)Medical Supplies – ODMHAS (Current costs are at $1.3 million for FY14. They were $2.2 million in FY2010Ohio Department of Rehabilitation & Correction - One Patient, One Team
19 Contract Simplification Ohio State University Medical Center Other Strategies:Contracts reduced from 375 in 2010 to 65 currentlyContract SimplificationPurchased / leased equipment for these diagnostics to be done in house.Greater control over scheduling at reduced costPET-CT-MRIODRC operates UC during off hoursPrevents some ER trips for things like sutures & minor proceduresKeeps inmate patients within ODRC securityUrgent CareReduced overall contract costs by $10million/year last contractOhio State University Medical CenterODRC maintains a contract compliance division at the central levelAll contracts are routinely monitored for compliance / qualityMultiple options to improve compliance or handle non-complianceContract ComplianceOhio Department of Rehabilitation & Correction - One Patient, One Team
20 Results of StrategyThe value of people – Clinical staffing is at an all-time highQuality is maintained/enhancedReduced legal liabilityCosts are containedBusiness is manageableODRC is positioned for the futureMedicaid moving forwardEHR moving forwardTie into overall core values and mission/visionMedicaid impact certainly impacts our mission and visionFuture concerns and considerations:Impact of SovaldiAbility to get 340BOngoing impact of Medicaid on budgets
21 Questions? Future concerns and considerations: Impact of Sovaldi Ability to get 340BOngoing impact of Medicaid on budgets