OU TH DAKO TA HEA[JH S DEPARTMENT OF FY2015 BUDGET RECOMMENDATION - - PDF document

SLIDE 1

2 Agency Presentation - Health - FY15

Monday, February 10, 2014 8:30 AM

S

OUTH DAKOTA HEA[JH DEPARTMENT OF

FY2015 BUDGET RECOMMENDATION AND OVERVIEW MATERIALS Presented to Joint Appropriations Committee February 12, 2014

SLIDE 2

DIVISION OF ADMINISTRATION

Joan Adam DATA, STATISTICS, AND VITAL RECORDS PUBLIC HEAL TH LABORATORY FINANCIAL MANAGEMENT

Kali Wiliams

CORRECTIONAL HEALTH

SOUTH DAKOTA DEPARTMENT OF HEALTH

SECRETARY Doneen B. Hollingsworth

STATE EPIDEMIOLOGIST

• Dr. Lon Kightlinger
• ·-----·

·-··---··1 DIVISION OF HEALTH AND MEDICAL SERVICES

Colleen Winter DISEASE PREVENTION FAMILY AND COMMUNITY HEAL TH CHRONIC DISEASE PREVENTION & HEAL TH PROMOTION

DIVISION OF

HEALTH SYSTEMS DEV.

AND REGULATION

Tom Martinec HEAL TH PROTECTION LICENSURE AND CERTIFICATION PUBLIC HEAL TH PREPAREDNESS AND RESPONSE RURAL HEAL TH

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PROFESSIONAL AND OCCUPATIONAL BOARDS

CHIROPRACTIC EXAMINERS DENTISTRY HEARING AIO DISPENSERS FUNERAL SERVICES MASSAGE THERAPY MEDICAL & OSTEOPATHIC NURSING NURSING FACILITY ADMIN. OPTOMETRY PHARMACY PODIATRY EXAMINERS SPEECH/LANG. PATHOLOGY

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SLIDE 3

DEPARTMENT OF HEALTH FY15 FUNDING SOURCES

OTHER

$39,384,370 44.07%

FEDERAL

$42,328,090 47.37%

GENERAL

$7,653,375 8.56%

Total Funds

$89,365,835

3

SLIDE 4

South Dakota Department of Health 2020

Promot@, protKt, and fmprov@ th@ hHlth and w@ll·beinc of all South Dakotans lmpnwe Birth outc-•

and Hulth of lnfanb, Children and Adolesc.nts In South Dakota

+ lnct'lhl5e ow......,... of the 1,,.,art,,nce of hHlthy IHestyle choices """'"I

_,,.,,,

• f chll<l>Hrlnc aee

+ Promote ow.....,.. and l...,i.,montatlo of Inf-

safe sleep practlaK

+ 1...,...,... South Doliota'• 9

• appropriate i11111U1ization rate

+ Roduce risky beNvlon """'"I

chlldo-en and ..iolesc:ents

Key Performance Hea.sures

• RtclKe iafant morutity ra, from II

prr I IOI birthe in 2012 to 6t bJ 2t20

• lncfe• prol)OftlO!t of PrtQNim ,.'Clmtl'l •1'1o reur,e Qttl'latll C¥e tn tne fir,; tnme:ster frO"'l

71.W. • 2012 tolK bf 2121

• lncrHN perc:,em oft6'1).ye¥ o.tt ._t,o lrt 9~ely

i ll'lf'JUlued from mm

"'12 to

• t,y2121
• bCtust p«cmt ofildolncmss aiges 13,17 ,,.,'hoh.i'W recesved ill

l!ll 1 doH afldlpfrom

11' h 2tl2to-t,y2t2t

• RiwrN trend and reduct tM peteffll of~

chddrm & adolnctl'lts "-1IO ••

• bne

from li"Jii in llt 21'2-ll KflOol ye¥ 10 U% by2'21 · RtckK• i,.rctnt.age ofyo.ith ll'I grade, t.t2-.+.ocootnttJwooke hom 11~ in 2013to1n

.. -

Str•nctlwn ti.. HHlth Car• O.liv•ry Syst•m in South Dakota

~

ProYide effective o-.ight and assistance to assure quality health facilities, professionals, and servk:es

~

Sustain essential healthcare services In n

• .-.1 ond underserved oreas

+ ProYide effective coordination of health informotion technology (HIT) and

health information exchange (HIE) efforts among pmlic and private

stakeholders

Key Performaoce Measures

• baeax numbcf ofScn.m ~

tll'cet" Q?f1Plltttldeet frMf7l lfl tbt 2912-1] tehool

Vt•.,1•1,ymo

• lnue.He oercent of Souffi OMN MWlQ rat

Illa ~t

ii restoent«ecrec:1 or

pmon.ct!Vfflld c•e from '1% at 20li to 11h by 2020

_...,._ 1dotutt ,...ofutobntralMSP4* dtttrmlntd tobt·acctS, cntic:11

..

• Inert• p«ctntagl of hu.thrxt prowle~TKi

I wt Mt nmi,Vul 1ntr1 of tf/'11flld etectronk Mittn rec«dled'l"IOlogy trorri""' 112t1S toM b;2t2t

• hcrene rt.

p.1centq of hullhura prowknifdtin p,wtitlplti1111111 Soudl 0.AIU

HC' di lint: Cllrta Met Poire of C.-e fxcN"'Ot HMC:tS troro, Mm

2t1J 10 7t% 1Jrt 212'

Gufdinc Principl@s

Reduce Health Disparities Maximize Use of Technolocy f:mphaslze Customer Service Work In Partnership

doh.sd.cov

Key Perfomwmce Measures

• ~

d'lt btnd Ind rt«.te.e lie PtfCtre of tOJtts "'~ ere obne fror121.l'r. tn 2112 tom t,y202t

• euuse 1M pe,ttN of id'*'.._

me« me a.irren1 fUidtlna of Ht

!Mutes of 1)1'1)""11

actMty per~ ftofl 4' 1 1' 112111 IO SW by 2t28

• ~

the trend Md ll'KfQN &lie pment of DID"' o NI l Of fllOl't "'VNl>let J CAy"

fr01119 ft

1ft 201

t to tn. in 2l20

• Reduce me perc t of idultt 'flftOsmoke cto¥enn ftomUJi 11 211210 1

9% I

• 2020
• tncteaw:lhe:unbcretldutttoYlfagt 5twtlohl'<'thlidCCMOffCtalscrMnlRIQ trornM'l.in

2'121011'11 W 2t2e Key Performance Measures:

• nut*

tntrlleofdiHJM rtOO«lno tf«tronlUUy lrom 64'1' ofreoon:, w,,2ttJ to Wt. by 2111 ·DoUbielhenunlberofftelllhureYOMllttr1fe,I etec:l wtSERV-SOttom911 l1 201Jto 1,2M t,y 202t

• huu,e .ne e,;pem,e of DOtt enwonment.r he_,. ttllt t,y 10ewrc, ,.,.
• f~

fflffll"1I the q1.1111fielb0na of ba'IG I RegtS1t1ed EnvirOl\ffl!ntJJ Htilh Spaa.,ili• KCOnllr,g to mt! ""'°""E""'°"""""'Hu\lll ...... ..,..t,y202tllfli M1 211lJ

4

SLIDE 5

Strat~ iM for Achi~vin

....,,..,.., Birth Outcomes and HHlth of Inf-•. Chilchn and Adolelcents in South Dok.oh

+ ncr9'e hlar~

d tf'lf' I~ r# "91.tny I ff-st,'1f' cncnce,s to 'NDff'lffl of c.htLd .....,. ... (-5',,,(ff)

• ~te

tne W'1)0t""'..ance of pr~tal care for Soutn Olt<otA fflOCMt's

• MltntMr l'OUat>orabon betweer PlbiC proararM S9fW'C J)r91f'1Ml ""'°"*" and pnmar, c,a,. p,c'IICltts to
• -"""""'"'

.. £Marao actMttes ana ,~

PIAW:: ewaterN!U 'fl&tCIWIC tht d&,..n Of tct.:co 1M t,y pre,pwtt

WOfflffl .-ld ·~·

to~

imokP

• Prcmom ~

ana ~

• f W'lfll'lt 1ate s.eep pracuces tPt-tW Stv'ff'J
• ~.op
• :ob dtstnbutior pr...-n for '"""'" .., r....a of s,fti slftp envtronr'lft"t tor tNtr ,rt...rt
• ~

c.Offlf7~ we ii~

NUtat)On proe--am to,~

tne rtsk of trJwy ard de-at!\ of Infant! due to IMUfe 51"1) pnctv:es;

• Wor1"" ,r pa,~1p to~

safe si.eep anfmnauon tfYOulnOUl con"mJttnts

• mp,o-.1t Soult' Dlkatls •·approcriat.9' 'lffWl'll.l"lmbon rite,.,,..,~ .kJmnorJ
• !u.te

pnMdfn ~ u,e. Edkk IDOUl t~

lfflC)Or'.Ma r:A '""""11llnons

·CrNteo tntm~ twtween l!t«:lrOMC Mia1tt\ rKords Md tht lrntrU"lilaHon re,rt,:

• J tiff N:lf'-tl'liClticn. .-~

tor pr~

ChfLdQ)d tfflr"U'«unons

• Reduce nay betllYion ~

d'nllhfl .-'Id adoll'SCtnts (Dan~ &rr!'tfttnJ

• !rNlf'lee ac 1WI :o ~

U.

1nt1CJeree r:A chtd-ood obnlty Ind U. U5f' at tobKal ~

cnu~

...,__,,.,

• Enflll"'« .:m'lhPs ~

to reQKe ~ttos of P'~ rod wJQ.tMI)' trlftsm!tte\1 ~ lfflOl'll

.oole,c..,u

• .Entaru pw'lrient11PS/cot.a>Or"at1on With CJttwf" state~

to adO'Ms nskY ~

Strengthen the Heolthcare Delivery System in South Dakota

• Provide effective oversight and assisunce to assure qua Ii

health facilities, professtonals and

services (Chris QJJa/mJ

·Assure l'lealtne..-e fac1Jtte-s meet mtnlmlm standards for quai.tty

• Ema,,ce tKflnkat amnance. tramlllf and resourus for hN,tklre fK1uhe>s ard provi~ :Omc!'et
• tlfloOneeds
• Asstn triformabon rep~l"I hH,thcar~ faciibes, prcr.ide-rs, and serw:::n is ,..ftable lo th! public in a

COO"a1

rated, ~t. and e-Gl; aoc:,e,ssttMe manner

• inCrr&W coordina ion WTth N'a.th p,ofe-:s.:s10N.I IK'ffim1 boards to addrrs.s ~ttty of care and .cces.s to

care tSsues

• SUstaln essential healthcare services in rural and undersem,d areas (Holley Ltt)
• Build and MtJln South Dakolll'I ht1lthure woridOfte
• De\e..op and promote s-;stems °' ure to 15SWe r-1,r, QU It"/, readlt· aca,s.s™"·

tnd

• coorOina.:ed

~

... the.a~ w~s statewidt

• ~.op

1no promote WVIGYI °" p,1ma,y cue ~

mode\S tn """' areas

• '.)e,w,.op and iff1hement quality il'l'IPfO'Vffl'lt propamrrunc and~
• ~tSt healthcare orpnizanons ioen

resow"Ce, for oper,uo,,, m,1nt.enilf'«. ~t

• f

~

thar~ fadllbes

• Provide ef ective coordination of HIT I HIE efforts ami,ng public and private stakollolders

(Ke>in DeWo/dJ

• Enmuratt> adoptton 6nd me.an1rttful i.u of et«tronk: hta\th r«ords thrOUCfl us.e of federal tnce-nb~

_,..,..

• ?tOtnOte partk.,._hOn In/use of so ttea1

th Ur,k Dtr«t

and Poirt of C&re Dcd1ain~

• unk tio5tNtals ano pro-.iders W'ith ~rionat

ind edvolC.M mesbinc;eo r~ces for 1mplffl'l«!t1.UOO of ~rt1fled HER tedU'OloC)' .....

1uae t.rvoocn HealthPOl"'T and ottff" r~c.es 51....,..i-South-'•~

to~

• IJMrtlnl Publlc HNllh

Tllrwm

• _and_tlw_ .

...........

• 1. and-loC...-and

.........

poO>lic .. llltll 111'

.... /l.otl,C,,,Wt.,.../

• •-"""""""'and oflecu,.,..,, ct_,..

and c°"""" ct IU)llC l>NIIII tllrNU

• -and-S- Plbtc- Ul>ol'oto,yp,allclency tolll-eui.,,--,

"-

• ~.,
• 11'<'

...... ..,.._ __

and ___

..,._ot«t,-_

repo,'!lrc~-tlw-ct_,,,

• Cfthlnce thl C.M•'s uoetlly to •ffecttwty c.oord!Nte the tf1POl'\tl' to c.unent and emefllnl pubUt l'INllh

tll'MIS 1111 I Cnolcrofl/

• lmprCM 1N 0.0.,,:,,..,. ot HNtth'1 ll:llttty to eltctrontQlly "'°""°' and 1rad1 ,..,.,.... t'fforu and
• Enhanc.e the Otplftment of HNlth's Ability to C;Clnh,INCM• wwh plftn«l lbout. ......-111,. p,bhc

tftl.thtl'lrfft:s

• ldNttlfy, coordlNte. and trllr\ the state. lOc.ll, g,t\'9le', ..cl~

Pl,&ltlc hellth workfortt

• EstabtJSfl • dedicated enwar'IMl'ltal helltf'I prop-am wttt,a,, tM Dllpartmer,t al .....

.,, to respond ta

~

l'!Ntth 1S5'Jft (Ml~ SmftllJ

• C)eyftop ~

CIPICI

to rt,pOl'd to CU'1ent ll'ld ~

~

"'81U'l 1Ssuts (I.e

• • IHO,

maid, irclcD"aw. ~

etc.,

• Identify, tran1 a'\d maw1tari staff prohetent in dNlffll wrtti enwuwnental hNlth mues

Jonl.lG')' 2014

5

SLIDE 6

DEPARTMENT OF HEAL TH FY2015 GOVERNOR RECOMMENDED BUDGET

FTE General Federal Other Total FY2014 Budget Base 419.2 $7,451,416 $44,550,252 $34,644,816 $86,646,484 Expansion/Reduction Increase/Decrease Health Administration 765 1,536 586 2,887 Health Systems Regulation and Development 200,327 2,827 1,700,016 1,903,170 Health and Medical Services 867 (1,769,178) 890 (1,767,421 ) Laboratory Services 2,276 5,257 7,533 Correctional Health 2,479,880 2,479,880 Tobacco Prevention and Control (459,639) 500,206 40,567 Informational Budgets for DOH Boards 16 52,719 52,735 Inflation/Expansion-Reduction Total 201,959 (2,222,162) 4,739,554 2,719,351 Total FY2015 Recommended Budget 419.2 $7,653,375 $42,328,090 $39,384,370 $89,365,835

6

SLIDE 7

Rural Experience for Healthcare Students (REHPS)

• $148,540 general funds
• Includes grant to AHEC to administer program and provide student stipends*
• *24 students in 12 communities
• $251 ,280 projected In-Kind
• Includes housing and preceptor time
• One of the recommendations of the Governor's Primary Care Task

Force is to create opportunities for students to experience rural practice

• The Rural Experiences for Health Professions Students (REHPS)

program was a 3-year federally-funded program through the Yankton Rural Area Health Education Center

• REHPS program places medical, physician assistant, pharmacy and

advanced practice nursing students in a four week experience with preceptors established in rural or frontier areas of South Dakota

7

SLIDE 8

Rural Experience for Healthcare Students (REHPS)

10 l

9

Number of Students

8

2011: 6 Students

Participating

6

by Year

6

5

4

4

3

2

T

MD PharmD

Placement

Disdpline

P A D p

Pharm

MD

100%

100% 33% 0% have graduated

2011 REHPS C.irununitl« Rtdfield, Wel15ingllll Sp1ngund ~itsn,;6studfnts

2012

REH PS C.tnmunitl

Redflel4, Wel15ingllll Sjmg\ PWIDII, ~ Worjne(. ¥Id

nt1; 12 i1udtliu

2013

REH PS C 1111n1n1tl8: llfdfifld, Wfsslng10n Spr1ng5. PMtslon, W;igntt, Wm,~ eusi.r.

~

Mid ShitD1;

"sludenb

T

2

1

T

DNP 2 2 PA

• 2012: 12 Students

2013: 18 Students

• 2014: 24 Students

(projected)

2014 REHPS Communities: Bowdle, Custer,

Miller, Parkston, Philip, Platte, Redfield, Sisseton, Wagner, Webster, Wessington Springs, and Winner

8

SLIDE 9

2012REHPS Studont

" The R£HPS Program relnfOICed to me the

Importance of sm.ill town medicine. Rt.al medtal dlnlcs are the fooodatlon for routine wellness and medk31 care, and I am honored to be able to contltbute to the well being of rural South

D.ikotans. "

Tia Haines

Pll,sldal Aslislanl fir #Ni"ddts and""'· Plitt• 1"'dkal0iolo

0Because students are more likely to return to a

community where they had a positive experience, It is important to provide opportunities for healthcare students to experience living and practidng in a rural community during training."

• Governor Oaugaard's Primary Care Task Force Oversight

Committee's Annual Report /November 2013

2012 REH PS Swdont

" I had an Incredible time during my REHPS Internship with Ot

• Owens. I

loved Redfield, and I was delinltely motivated as a result

• f that Internship to have more contact with the community

....

Whlle I was In Redfield working With the staff and the providers, I realized that I wanted the chance to make a career In the facllfty, and more Importantly, that they would benefit from employing a full ume pharmacist In their hospital and dlnle. "

Alyssa Osborn

!\lsiK<!!M! m,pioJ,nml afta grad!Ali:ilUI Rtdfitld Sta l'tlamildslnt14

20 11 REHPS Student

'~

.• I

am wcri.lnq In Wessington Springs this afternoon and was able to mentor a REHPS DNP student today. Great to give back to the REHPS piogram that helped me In so many ways! "

Len Wonnenberg

PbysldanAmtinl lor li11<5Yill<,CatllnlM)' lf<iltll Cnlerln -

for Had.Im lf<Jh1IC.1t*"lrstnHl lUU,ng11AIIIJDl1lrllibts

9

SLIDE 10

West Nile Virus in South Dakota

• West Nile virus is endemic in South Dakota and

will continue to be for foreseeable future

• Since 2002 in SD:
• 2,

111 cases

• 452 neuroinvasive cases
• 32 deaths
• Historically, South Dakota has one of the highest

incidence rate of severe West Nile virus disease

in US.

10

SLIDE 11

Average annual incidence of West Nile virus neuroinvasive disease by County 1999 - 2012

• .o

0.01 - 049 0.50 - 099

• 1.00 - 149
• 1.SO 199
• >•2.00

11

SLIDE 12

9

8

7 6 5 4

3 -

2

88 69

West Nile virus activity,

United States, 2013

South Dakota (6.9)

/

29 2.8 17 16 07 06 06 05 05

WNV neuroinvasive incidence (cases per 100,000 population) n,,,.:~ o-4'._:

~4 Ot 03 03 03 0.3 03 02 02 02

O::J:IJ::Cb:::to

~2~0 ;1 ~ 0~ 1 ~

• 1

~ 0 ~ 1 ~0~ 1 ~

• 1

~ 0 ~1~0:1 !oo

:.,o

~o~o ~

• !

00 ~ 00~ 0 ~0~00

N S N W C O N K M M I I L I C M A A T M U O W N I T M M O V U M N R N V N S P N C O K F G 0 0 E Y O K M S T S O A A L A N R Z X O S E I V N N I O H T T A J I H A Y C A C T R Y L A

A

12

SLIDE 13

South Dakota WNV human cases

2002-2013 (cumulative)

.............. 2002 (n=37)

• ---> 2003 (n=1038)

2004 (n=51)

• -····· 2005 (n=229)
• ------ 2006 (n=113)
• --- 2007 (n=208)

2008 (n=39) ······· 2009 (n=21)

• 201 O

(n=20) ······· 201 1 (n=2)

• 2012 (n=203)
• 2013 (n=149)

!

2003

'

'

' '

I

'

' '

.

' '

. .

.

'

.

'

' '

.

. .

'

'

i

,'

," ,.,

:

,'

l ,,,,,

j ,' :'

"71 ,

/ ,,,,'

2005 2007

:.:.:-----,-1012

2013 2006

• 2004

> ': ,' ,,,,-'

,,,

• ----~

7 ././ _..//

..... ...... ,

,., ........................ i88~

,,' ,/ .....

__ .....

... .. ..... --····· .,

2009

• ----'·::···==--::::::·

.':: .. ~

• ~;;;:.::

~

• :
• .

:

~=···"·

• ---····
• ~

~

• -----------------~

~6~1

r--

r----T ;--- r-- r---,

May Jn1 Jn2 Jn3 Jn4 Jl1 Jl2 Jl3 Jl4 Ag1 Ag2 Ag3 Ag4 Sp1 Sp2 Sp3 Sp4 Oct

Weeks of WNV season May-October

13

SLIDE 14

South Dakota West Nile virus cases, 2002-2013

2002

.

. .. : .. ;____._;., .

. .

~

2005. 2006

• "•
• ,.•.

4'1o

. .

.

. . ~,. ...

,.

.,

... .

• . ·:: ~;

. .

. :· .·::.

2008 2009

2011

..

(

2012

Each dot= 1 case by Zip Code random distribution

2004 2007

.. .

.

.. . .

.

· ... ..

·

..-:

... : .. .

2010 2013 ·

·

...

.. .

.

• ~!-:,

.. ·.::

.:~ ···:,-? :·~~:

. .. ·

.:".·:

.,,. . .........

.

• ~ .

·. :~

·

..

' .

....

·:·

;,

..... . . :-. . .

.

.

·.

.

:: ·: ... :

..

. , ..

~ .

_ _

...... ·~ ··, .. ~·:·

·. ·:,

'l

' ' -4 ••

14

SLIDE 15

West Nile Virus Prevention Request

• Enhance local West Nile virus (WNV)

prevention and mosquito control programs

• $500,000 grants to local mosquito control

programs (

• ther fund authority)
• $50,000 surveillance (general funds) (10

communities)

15

SLIDE 16

Helmsley Grant for Automated Chest Compression System

• $1,200,000 other fund authority
• Helmsley Trust funds will be used to equip all hospitals and

ambulance services with LUCAS chest compression devices.

• DOH & DPS will lead this effort
• Funds will be used to purchase devices for
• hospitals. Coordination, training , and evaluation activities

involved as well.

16

SLIDE 17

LUCAS™2 Device

LUCAS™2 Device Usage: EMS LUCAS™2 Device Usage: Cath Lab LUCAS™2 Device Usage: ED

17

SLIDE 18

Correctional Health

FY2015 Governor Recommended

FY14 Base Budget

Medical Inflation

• Contractual Services: A 3.0% inflation rate for contracted medical

provider services.

Increase in utilization and significant events Bureau billings

FY15 Budget Request FY15 Requested Other Funds Increase $15,804,767

$

30,713

$

2,446,226

$

2,941

$18,284,647 $ 2,479,880

18

SLIDE 19

FY14 Correctional Healthcare

Shortfall and Reserve

• FY14 General bill amendment (HB1040):
• Shortfall: $2,000,000 in general funds/other fund

expenditure authority

• Shortfall due to costs associated with significant

inmate healthcare events

• Reserve: $1,500,000 in general funds
• Equivalent to approximately one-month expenditures

19

SLIDE 20

18,000,000 16,000,000 14,000,000 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000

CHC Total Expenditures

20

SLIDE 21

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

FY08

Actuals

CHC Top 25 History

$1 , 63

FY09

Actuals

$1, 99

FY10

Actuals

FY11

Actuals

FY12

Actuals

FY13

FY14

Actuals Projection

FY14

YTD*

*FY14 YTD - through Dec. 31st

21

SLIDE 22

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

21 22

23 24 25

Grand Total:

Top 25 Inmates Expenses using Out-Sourced Services

July 1, 2012 - June 30, 2013

FY 2013

$

154,148.86

$

153,168.38

$

151,454.24

$

143,263.45

$

120,128.47

$

106,538.52

$

84,583.66

$

81 ,838.88

$

79,130.26

$

72,795.66

$

67,877.44

$

67,194.48

$

66,717.93

$

65,370.74

$

64,828.69

$

48,060.60

$

47,737.65

$

46,537.23

$

45,351.17

$

41 ,901 .95

$

38,160.87

$

37,705.95

$

35,397.08

$

32,695.54

i

32,013.58 $ 1,884,601.27

Diagnosis

End stage renal failure, on dialysis, diabetes Diabetic with kidney failure, on dialysis ER/hospitalization/gastrointestinal surgery Surgery for small bowel perforation with colostomy placement Acute renal failure, Hepatitis C Rectal cancer Lung cancer Cirrhosis (liver disease) Hypothyroidism, hypertension, hospitalization for pneumonia Cancer Bowel obstruction surgery Multiple sclerosis, asthma, Crohn's disease Heart Disease Heart valve surgery Brain cancer Multiple sclerosis Kidney failure/lung disease Spinal abscess with paralysis HIV Hepatitis C Spinal fracture Coronary artery disease Legrand-psoriatic arthritis Ulcerative colitis (bowel disease) HIV

22

SLIDE 23

1 2 3 4 5 6 7 8 9 10

11

12 13 14 15 16 17 18 19 20

21

22 23 24 25

Grand Total:

Top 25 Inmates Expenses using Out-Sourced Services

July 1, 2013 through December 31, 2014

FY2014 To Date Diagnosis

248,679

Post trauma; multiple surgeries

165,961

Cancer

123,099

Diabetic with kidney failure, on dialysis

115,817

Brain cancer

98,591

Pneumonia, cirrhosis, liver disease

68,043

Lymphoma (cancer)

63,246

Prostate cancer

54,538

Colon cancer

42,002

Hepatitis C

41 ,412

Liver disease

30,909

Trauma

30,349

Trauma

30,255

Hospitalized for stint placement

29,938

HIV and renal failure

29,242

Congestive heart failure/ER, hospitalization

28,305

Multiple sclerosis, asthma, Crohn's disease

24,359

Trauma

23,262

Legrand-psoriatic arthritis

23,194

Heart valve surgery

22,904

Stroke

22,776

Prostate cancer

22,775

Kidney failure, lung disease

21 ,945

Surgery

21,847

Bowel obstruction surgery

20,783

Tuberculosis

$1,404,231

23

SLIDE 24

Re-Negotiated Reimbursement Rates

10 month trend

Date 03/1 0-12/1 0 03/13-12/13 Billed 3,831,701 5,660,345 Paid % Discount 2,006,447 49.08% 2,277,867 58.53%

*Without increase in discount, an additional $933,877 would have been paid during CY2013.

24

SLIDE 25

eEmergency Utilization

April 2012-December 2013

• Time Frame 11

SD Women's Mike Durfee Jameson The HIii

'!1. '!1. '!1.

T rans12orted Trans12orted Trans12orted eEmeraencv to ER eEmeraencv to ER eEmeraencv to ER eEmeraencv April 2012-Dec. 2012

36 15 121 58 64 34 27

• Jan. 2013-Dec. 2013

30 19 153 74 55 29 24

Total: April 2012-Dec. 2013

66 34 274 132 119 63

51 April2012-Dec. 2012 248 Video encounters

Total:

124 Avoided transfers to ER

• 510 Video encounters
• Jan. 2013 - Dec. 2013

250 Avoided transfers to ER

262 Video encounters 136 Avoided transfers to ER *eEmergency links Correctional Health clinics to Avera's central eCare hub providing emergency- trained physicians and specialists, 24 hours a day, seven days a week

'!1.

Trans12orted to ER

17 14

31

25

SLIDE 26

eConsult Utilization

March 2013 - December 2013

• Live at all sites in May 2013
• Pierre Women's Prison
• Springfield - Mike Durfee
• Sioux Falls - Hill and Jameson
• To date, 132 eConsultations
• Continue to add specialists
• Results in reduced transports for DOC

*eConsutt links Correctional Health clinics to Avera's specialty providers including infectious disease, cardiology, pulmonology, oncology and others.

26

SLIDE 27

CHC Prescription Drug History

FACILITY FY2009 FY2010 FY2011 FY2012 FY2013 Pierre 411 ,364 480,514 424,870 485,443 460,664 Springfield 966,117 957,969 815,587 760,624 824,655 Sioux Falls 1,508,774 1,425,022 1,223,946 1,216,186 1,368,191

Total

2,886,255 2,863,505 2,464,403 2,462,253 2,653,510 27

SLIDE 28

Tobacco Programming

• $500,000 other fund authority increase
• Enhance work around priority populations:
• Pregnant women
• Youth
• Medicaid recipients
• American Indians
• Spit tobacco users
• Expand outreach/cessation services to:
• Families with infants in NICU and newborn nursery
• People with mental health conditions
• Enhance work site wellness efforts with SD health plans

and insurers to reduce chronic disease

28

SLIDE 29

Protecting Public Health