Department of Health Department of Social Services Department of - - PowerPoint PPT Presentation

Department of Health Department of Social Services Department of Corrections

Correctional Health Joint Appropriations – 1/24/17 10:00 AM

Correctional Health Department of Health

Department of Health Correctional Health 87.0 FTE Women 14.3 FTE RC Minimum 4.0 FTE MDSP 24.4 FTE Sioux Falls 41.8 FTE Yankton Minimum 1.5 FTE Administrator 1.0 FTE

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Correctional Health

• Provide a full continuum of health care services

– Medical services – chronic disease management, acute care, infirmary care, long-term care, eEmergency, eConsultation – Behavioral health care – DSS – Dental Care – Optometry

• Payer of health care services

– Medical case management – Utilization review – Cost savings measures

• Negotiated reimbursement rates
• Formulary management
• Providing care on-site

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eCare

eEmergency implemented in April 2012

• Pierre – Women’s Prison Clinic
• Springfield – MDSP Clinic
• Sioux Falls – SDSP Hill Clinic
• Sioux Falls – SDSP Jameson Clinic
• 24/7 availability of board-certified emergency physicians and ER nurses through

the eCare hub

• Minimize transfers to hospital ER

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FY17 YTD 63.37% FY16 54.15% FY15 56.87% FY14 49.86% FY13 47.88%

*Since inception of eCare, 54.27% of transfers were avoided.

FY16 Avoided 54% ER visits: 235 Average Cost per ER Visit 3,272 Estimated savings 768,944 Expenses: Nursing FTE Cost 204,456 eCare Contract Cost 150,000 Total Expenses 354,456 Total Estimated Savings 414,487

Cost Analysis of Avoided ER visits Percent of Avoided Transfers per FY

eCare

eConsultation implemented in April 2013

• Minimize transfer of inmates to outside medical

appointments through eCare two-way video technology

• Allows access to specialists including infectious disease,

cardiology and oncology without inmates leaving prison

• Allow consultations and follow-up medical appointments in

prison clinic

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eConsultations per FY FY17 YTD 190 FY16 334 FY15 300 FY14 192 FY13 21

*1,037 total eConsults since April 2013

Hepatitis C

• Hepatitis C virus (HCV) is the most common chronic blood borne

infection in the United States

• Hepatitis C is a slow progressing disease, with symptoms that may

not appear for years. When left untreated, chronic Hepatitis C, can lead to liver damage and potentially even liver cancer

• According to The New England Journal of Medicine, 1 in 6 inmates

(or 17%) are infected

• The introduction of Sovaldi in December 2013 significantly changed

treatment, but came with a significant cost of $90,000 to $180,000 per case

• CH’s ability to purchase drugs through the Minnesota Multistate

Contracting Alliance (MMCAP) has reduced Hepatitis C costs

• Treatment costs now range between $56,000 to $150,000 per case

Rich, MD, MPH, J., Allen, MD, S., & Williams, MD, B. (2014). Responding to Hepatitis C through the Criminal Justice System. The New England Journal of Medicine, 370(20), 1872-1874.

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CHC Top 25 History

$- $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000

FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 YTD

$1,663,552 $1,899,603 $1,674,620 $1,497,048 $1,884,601 $2,056,123 $2,509,713 $2,329,129 $1,384,886

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FY17 YTD – through 12/31/16

Top 25 Inmates

FY16 - July 1, 2015 - June 30, 2016

Cancer 22% Liver Disease 3% Intestinal Disease 13% Heart Disease 6% Other 10% Multiple sclerosis 3% Spinal issues 10% Hepatitis C 23% Diabetes 10%

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FY 2016 Actuals Diagnosis 1 169,076.11 Surgical repair of abdominal fistula 2 164,055.24 Colon Cancer 3 161,471.76 Hepatitis C 4 157,480.49 Diabetes 5 118,745.28 Lung Cancer 6 111,392.53 Surgery due to infection 7 109,234.86 Hepatitis C 8 107,323.86 Spinal abscess 9 104,711.62 Hepatitis C 10 96,241.40 Cancer 11 87,307.32 Hepatitis C 12 84,648.20 Diabetes 13 79,875.15 Liver Disease 14 74,366.40 Prostate Cancer 15 71,992.91 Kidney and Heart disease 16 71,706.05 Multiple Sclerosis 17 70,661.73 Chrohns Disease 18 69,322.66 Breast Cancer 19 65,529.52 Cellulitis 20 64,087.26 Hepatitis C 21 61,459.39 Chrohns Disease 22 60,103.88 Spinal cord lesions 23 56,593.04 Spinal surgery 24 56,273.47 Heart Disease 25 55,469.00 Blood clots Grand Total $ 2,329,129

Top 25 Inmates

FY17 YTD - July 1, 2016 - Dec. 31, 2016

Cancer 7% Liver Disease 3% Ulcerative colitis 4% Heart Disease 7% Other 18% Multiple sclerosis 3% Hepatitis C 42% Kidney Disease 3% Infection 7% Diabetes 1% Lung Disease 5%

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Diagnosis 1 129,732.30 Hepatitis C 2 82,770.96 Hepatitis C 3 76,938.81 Liver disease and Hepatitis C 4 76,532.85 Hepatitis C 5 76,144.88 Hepatitis C 6 74,152.57 Hepatitis C 7 64,776.41 Hepatitis C 8 55,666.74 Surgery due to infection 9 54,765.01 Emphysema 10 54,143.82 Colon Cancer 11 53,383.66 Ulcerative colitis 12 51,410.50 Heart Disease 13 50,559.74 Liver and Heart disease 14 49,756.51 Bleeding disorder 15 47,483.17 Spinal abscess 16 46,306.61 Multiple Sclerosis 17 40,799.53 Infection 18 39,676.09 Kidney and Liver disease, COPD 19 39,471.76 Kidney and Heart disease 20 38,866.36 Seizures 21 37,498.39 Emphysema & Diabetes 22 37,368.38 Ulcerative colitis 23 37,363.57 Prostate cancer 24 37,006.46 Hernia repair 25 32,311.72 Total knee replacement Grand Total $ 1,384,887

Inmate ADC increase

FY17 General Bill amendment: Increase in $1,755,707 to cover the shortfall in CH due to costs associated with providing inmate healthcare and higher ADC projections. *188 increase in ADC from FY17 budget

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FY16 FY17 Budget FY17 Est. FY18 Average Daily Count 3,586 3,607 3,795 3,845 Total Costs/Estimates $ 20,167,711 $ 21,241,656 $ 22,997,363 $ 23,564,581 Average Cost per Inmate $ 5,624 $ 5,889 $ 6,060 $ 6,129

Correctional Health

• 2.0 FTE and $146,798 other fund expansion

request

• Nurse II – Jameson Unit

– Increase in intakes – Additional demand for services – Continued focus on providing care inside the walls

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Correctional Health

FY2018 Governor’s Recommended Budget

Summary

FY17 Base Budget $21,241,656

2.0 FTE – Nurses $ 146,798 Medical Inflation

• Contractual Services: A 1.0% inflation rate for contracted medical

provider services. $ 14,915 Inflation/inmate expansion $ 2,803,800 Juvenile reduction $ (642,588)

FY18 Budget Recommendation $23,564,581 FY18 Recommended Other Fund Increase $ 2,322,925 LRC budget briefing - Pg. 19-21

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Inmate Health Care Total Expenditures

DSS (light color) & DOH (dark color)

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• 5,000,000

10,000,000 15,000,000 20,000,000 25,000,000 30,000,000

14,445,846 14,959,368 14,162,686 14,431,612 15,908,948 19,045,492 19,910,914 20,648,775 21,241,656 23,564,581 3,620,786 3,539,547 3,599,660 3,659,059 4,322,475 4,533,169 4,456,965 4,372,329 5,139,264 4,753,547

FY18 Correctional Healthcare Recommended Budget

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