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 Administrator 1.0 FTE Sioux Falls MDSP RC Minimum Yankton Minimum Women 41.8 FTE 24.4 FTE 4.0 FTE 1.5 FTE 14.3 FTE 2

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 3

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 Cost Analysis of Avoided ER visits FY16 Percent of Avoided Transfers per FY Avoided 54% ER visits: 235 FY17 YTD 63.37% Average Cost per ER Visit 3,272 Estimated savings 768,944 FY16 54.15% FY15 56.87% Expenses: Nursing FTE Cost 204,456 FY14 49.86% eCare Contract Cost 150,000 FY13 47.88% Total Expenses 354,456 *Since inception of eCare, 54.27% of transfers were avoided. Total Estimated Savings 414,487 4

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 eConsultations per FY FY17 YTD 190 FY16 334 FY15 300 FY14 192 FY13 21 *1,037 total eConsults since April 2013 5

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. 6

CHC Top 25 History $3,000,000 FY17 YTD – through 12/31/16 $2,509,713 $2,500,000 $2,329,129 $2,056,123 $1,899,603 $1,884,601 $2,000,000 $1,674,620 $1,663,552 $1,497,048 $1,384,886 $1,500,000 $1,000,000 $500,000 $- FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 YTD 7

Top 25 Inmates FY16 - July 1, 2015 - June 30, 2016 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 Diabetes 6 111,392.53 Surgery due to infection 10% Cancer 7 109,234.86 Hepatitis C 22% 8 107,323.86 Spinal abscess 9 104,711.62 Hepatitis C 10 96,241.40 Cancer 11 87,307.32 Hepatitis C Hepatitis C Liver Disease 12 84,648.20 Diabetes 23% 3% 13 79,875.15 Liver Disease 14 74,366.40 Prostate Cancer Intestinal 15 71,992.91 Kidney and Heart disease Disease 16 71,706.05 Multiple Sclerosis 13% 17 70,661.73 Chrohns Disease Spinal issues 18 69,322.66 Breast Cancer 10% 19 65,529.52 Cellulitis 20 64,087.26 Hepatitis C Other Multiple Heart Disease 21 61,459.39 Chrohns Disease 10% sclerosis 6% 22 60,103.88 Spinal cord lesions 3% 23 56,593.04 Spinal surgery 24 56,273.47 Heart Disease 25 55,469.00 Blood clots Grand Total $ 2,329,129 8

Top 25 Inmates FY17 YTD - July 1, 2016 - Dec. 31, 2016 Diagnosis 1 129,732.30 Hepatitis C 2 82,770.96 Hepatitis C 3 76,938.81 Liver disease and Hepatitis C Lung Disease Liver Disease Diabetes Ulcerative 4 76,532.85 Hepatitis C 5% 3% 1% colitis 5 76,144.88 Hepatitis C Cancer 4% 6 74,152.57 Hepatitis C Kidney Disease 7% 7 64,776.41 Hepatitis C Infection 3% 8 55,666.74 Surgery due to infection 7% Heart Disease 9 54,765.01 Emphysema 7% 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 Other 16 46,306.61 Multiple Sclerosis 18% 17 40,799.53 Infection Hepatitis C 18 39,676.09 Kidney and Liver disease, COPD 42% 19 39,471.76 Kidney and Heart disease 20 38,866.36 Seizures 21 37,498.39 Emphysema & Diabetes Multiple 22 37,368.38 Ulcerative colitis sclerosis 23 37,363.57 Prostate cancer 3% 24 37,006.46 Hernia repair 25 32,311.72 Total knee replacement Grand Total $ 1,384,887 9

Inmate ADC increase 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 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 10

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 11

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 12

Inmate Health Care Total Expenditures DSS (light color) & DOH (dark color) 30,000,000 4,753,547 25,000,000 5,139,264 4,372,329 4,456,965 4,533,169 20,000,000 4,322,475 3,539,547 3,620,786 3,659,059 3,599,660 15,000,000 23,564,581 19,045,492 19,910,914 20,648,775 21,241,656 10,000,000 14,445,846 14,959,368 14,162,686 14,431,612 15,908,948 5,000,000 - 13

FY18 Correctional Healthcare Recommended Budget 14