11 - Correctional Health Presentation Tuesday, February 17, 2015 5:30 PM Department of Health Department of Social Services Department of Corrections Correctional Health Joint Appropriations - 2/19/15 11:00 AM
Co rrect iona l Health Department of Health Dep.:irtment of Heal th Correct iona l Health 87.0 FTE Administr.:itor I 1.0 FT E I I I I I I Sioux Fal ls MDSP RC Minimum Yankton Min i mum Women Custer 39.5 FTE 24.9 FTE 2.0 FT E 1.5 FT E 14.1 FTE 4.0 F TE 2
Correctional Health • Provide of a full continuum of health care services Medical services - chronic disease management, acute care, infirmary care, long-term care, eEmergency, eConsultation Mental health care - DSS Dental Care Optometry • Payer of health care services Medical case management Utilization review Cost savings measures • negotiated reimbursement rates • formulary management • FTE utilization 3
eEmergency • Minimize transfers to hospital ER • 24/7 availability of board-certified emergency physicians and ER nurses through the Avera eCare hub • Treat emergencies and trauma within walls of prison • Streamline transfers when needed 4
eEmergency Utilization July 2012 - December 2014 Time Frame SD Womens Mike Durfee Jameson The Hill eEmerg en cy # Avoi ded eE m er ge ncy # Avo id ed eEme rg en cy # Avo i ded eE mergency # Avo id ed F Y13 51 24 185 102 64 24 30 8 F Y1 4 38 18 1 93 106 90 38 35 15 F Y15 th ro ugh 12-3 1- 14 27 17 120 80 54 27 47 21 Total FY13-FY15 YTD 116 59 498 288 208 89 112 44 FY 13 FY 15 YTD (Dec. 31, 2014) • 47.88% Avoided transfers to ER • 58.47% Avoided transfers to ER • 330 Video encounters • 248 Video encounters • 158 Avoided transfers to ER • 145 Avoided transfers to ER FY14 Tota l {July 2012-Dec. 2014): • 49.72% Avoided transfer to ER • 51.59% Avoided transfer to ER • 356 Video encounters • 934 Video encounters • 177 Avoided transfers to ER • 480 Avoided transfers to ER 5
eConsultation • Minimize transfer of inmates to outside medical appointments through Avera 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 • Allows CH nurses immediate medical direction 6
eConsult Utilization Time Frame SD Womens M i ke Durfee Jameson The Hill FY14 21 82 42 47 FYlS through 12-31-14 13 42 24 36 Total - May-13 - Dec - 14 39 130 71 88 • 328 eConsultations to date • Continue to add specialists 7
CHC T op 25 Histo ry $2,500,000 ~-------------------------- --,>.L ,, \0 56, 12 3, ,,_ ______ _ $1, 899 ,6 0 $1,88 , 601 $2,000,000 $1,574,.620 $~ 910 48 $1,500,000 $1,000,000 $500 ,000 1 l $- FY09 Act uals F YlO Act uals FYll Ac tua ls FY12 Actua ls FY13 Actua ls FY14 Actua ls FYlS YTD * FY!S Y TD - thro ugh January 31" 8
Top 25 Inmates FY14 - July 1, 2013 - June 30, 2014 FY14 Actuals Diagnosis $ 1 249,544.18 Post tr auma, mu ltip le surger i es $ 2 170,310 . 43 Ca ncer 3 $ 134,922.10 Diab et ic with kidney failur e, on dialysis Other ""\ $ 4 126,508 .65 B ra in cancer 5% \ 5 $ 106,910 .74 Ca nc er 6 $ 102,102. 40 Congestive h eart fa ii ure $ 7 100,556 . 94 Liver disease $ 8 89,563.74 Liver disease 9 $ 85,603.73 7% Hepa titi s C 10 $ 78,034.99 Hepa titi s C HI V 11 $ 68,810.45 Ca ncer 4% 12 $ 68,737.27 Cancer 13 $ 64,316.10 Pros trate cancer Mu lti ple 14 $ 62,410. 38 sclerosis Liver and kidney disease 15 $ 61,112.62 6% Prostrate cancer 16 $ 59,877 . 87 Mu lti pie sclerosis 17 $ 54,571 . 85 Mu lti pie sclerosis 18 $ 50,739.36 Trauma 19 $ 48,686.49 A bd omi nal f istula $ 46,868.11 20 Tu bercu losis $ 21 45,948 . 91 H IV $ 22 45,687.76 Kidney failure $ 44,992.69 23 H IV $ 44,750.42 24 Trauma $ 25 44,554.84 H ea rt Disease Grand $ 2,056 ,123.01 Total 9
To p 25 Inmates FY15 YTD - July 1, 2014 through January 31, 2015 FY 20 15 To Date Di ag n osis 189,373.83 1 Cancer 100, 500 . 56 2 Lu ng can cer 3 64,191. 07 Bo ne infection 4 54,737. 54 Cancer 5 53,495.02 Benign in ner ear t umor Mul tip le 6% 6 52,136.66 Colon cancer 7 46,353. 46 Liver disease sclerosis 8 46,24 9.91 Kidney d is ease 6% 9 42,742 . 30 Cancer 10 42,408 . 97 Hepatitis C 11 41,183. 38 Canc er Canc er 12 40,957 . 09 Gallblad de r removed 43% 13 40 ,109.22 Multi pie sclerosis Oth er 14 38,890.45 Heart di sease 21% 15 38,080.99 Liver disease 16 37,755.69 Seizures 17 37,271 . 68 Stroke 18 36,654 . 37 Tra u ma 19 36,401.25 Pneumon ia 20 35,938 .13 Tra u ma In testinal 21 35,214 . 24 Hepatitis C D is ease 22 34,557 . 29 Ulcerative colitis 3% 7% 23 33,661.77 Mul tiple sclerosis 24 33,177.82 Severe drug react i on 25 32,536 . 64 Repair of abdom inal aort ic aneurysm Grand $ 1 ,24 4,579.34 To t al 10
Other Trends • Increased cancer cases FY13 - 17% of top 25 inmate costs - FY14 - 32% of top 25 inmate costs - FY15 YTD - 43% of top 25 inmate costs - • More inmates incurring higher costs - Numbe r of inmates with healthcare costs greater than $15,000 14 0 116 120 100 r 80 60 40 20 0 FY09 FYlO FY ll F Y12 FY13 F Y14 FY15 YT D - FY 13 per inmate cost range - $15,233 - $154,148 FY14 per inmate cost range - $15,238 - $249,544 - 11
Prescription Drugs • Presc ription cost increase due to sicker inmates • Top 25 inmates - drugs only FY13 - $618,707 FY14 - $795,406 • 29% increase *FYTD 2015 FACILITY 2010 2011 2012 2013 2014 Pierre 480,5 14 424,870 485,443 460,664 463,129 267 ,879 957,969 815 , 587 760,624 824 ,655 1,196,837 635,369 Springfield Sioux Falls 1,425,022 1,223, 946 1,216,1 86 1,368,191 1,791,326 1,020 ,7 38 Total 2,863,505 2,464,403 2,462,253 2,653,511 3,451,292 1,923,985 "' FYTD - th ro ugh Janua ry 31, 2015 12
Hepatitis C • Hepatitis C vir us (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 year s. When left untreated, chronic Hepatitis C, can lead to liver damage and potentially even li ver cancer. • According to The New England Journal of Medicine, 1 in 6 inmates (or 17%) are infected. • The i ntroduction of Sovaldi in December, 2013 significantly changed treatment, but comes with a significant cost of $1,000 per pill per day • The cost to treat an inmate using Sovaldi is between $90,000 or $180,000, depending on patient genome type Rich, M D, MPH, J. , Alle n, MD , S ., & Williams. M D, B. (2014). Res pondi ng to Hepati ti s Ct hroug h the Cr iminal Ju s tic e System. The Nev England Journal of Medicine, 370(20), 1872-1874. 13
Hepatitis C • 31 inmates being evaluated for treatment • Inmates are evaluated on a case-by-case basis • Level of disease (grade/stage/prognosis) is used to help determine treatment • Length of sentence considered so inmate fully completes treatment and post-treatment follow-up 14
Hepatitis C • Three inmates currently on Hepatitis C medications, each at $180,000 (total $540,000} • One inmate starting Hepatitis C medications in February, at $90,000 • Two inmates entered pre-treatment monitoring phase, expected to start Hepatitis C medications in FY16 15
Inmate Health Care Total Expenditures DSS (light color) & DOH (dark color) }" 20, 000 , 000 4, 322,475 I ~ ''° ·' 15 , 000 , 000 I 10 , 000 , 000 15,908,9 14 ,9 59 ,3 1 4,431,6 14, 162 ,6 5, 000 , 000 ** FY16 FYlO F Y 12 F Y13 F Y09 FYll FY14 FYl S Actua ls Actuals Actuals Act uals Actua ls Ac tuals Budget Gov. Rec. 16
~ FY16 Correctional Healthcare Recommended Budget FTE GF FF OF Total Fu nds oss FY15 Base Budget 67.S 2, 95 3,204 140,619 1,717,653 4,811,476 2% Provid er I nflation - 990 6,654 7 ,644 oss TO TAL F Y16 Recommended 67.S 2,954,194 140,619 1,724,307 4,819,120 OOH 18,730,869 • . . FY15 Base Budget 87.0 18,730,869 2% Provi der Inflation - - 21,756 21,756 - - Hepa titis C 500,000 500 ,000 . . In flatio n 312,029 312,029 OOH T OTAL FY16 Recommended 87.0 - - 19,564,654 19,564,654 - --- . . .. DOCT_.,_. 140,519 I - -- I I · F'Wlllt+DOH 154.S 2,954,194 24 ,383,n4 DOC FY15 Base Budget 19, 98 2,155 - 466,367 20,448,522 2% Provider Infla tion 28,410 28,410 Hepa titis C 5 00 ,000 500 ,000 In flation 312,029 312,029 466,367 I n.211 ... - DOC TOTA L FY16 Recommended 20,822,594 17
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