1. Corrections Health Services FY 2012-13 Budget Worksession July 16, 2012

2. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

3. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

4. Organization Chart Health Services Administrator Jane Jenkins, B.S.N. Health Services Administrator Jane Jenkins, B.S.N. Mental Health Services Leonard Branch, Ph.D. Mental Health Services Leonard Branch, Ph.D. Pharmacy Services Shari Hopwood, Pharm.D. Pharmacy Services Shari Hopwood, Pharm.D. Physicians and Mid-level Providers Medical Director Robert Buck, D.O. Medical Director Robert Buck, D.O.

5. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

6. Proposed FY 2012-13 Budget Current FY 12$ Change Proposed FY 13 Personal Services$12.3M($0.1)$12.2M Operating Budget8.7M0.18.8M Budget Change0.0% Staffing175(5)170

7. Position Deletions – (5) –Medical Assistant (2) –Admin Specialist (1) –Nursing Unit Supervisor (1) –Manager, CHS (1) Pharmacy Budget Increase –$100K Proposed FY 2012-13 Budget

8. Offsite Medical Other Medications Lakeside 16% 14% 53% Operating Budget $ 8.8M Proposed FY 2012-13 Budget

9. Offsite Medical 53% Operating Budget $ 8.8M Hospitalization ($ 4.6M) Specialist referrals Inpatient days Offsite diagnostics Consultant fees Proposed FY 2012-13 Budget

10. 16% Operating Budget $ 8.8M Over half of Rx Costs are for HIV meds Mental health meds Many chronic meds About 6000 pills daily Medications Proposed FY 2012-13 Budget

11. Lakeside14% Operating Budget $ 8.8M 9 Beds at Lakeside –Acute mental health treatment –Forced medication –Therapeutic environment Proposed FY 2012-13 Budget

12. Other Operating Budget $ 8.8M Dialysis Medical supplies X-rays & ultrasounds Ambulance transport Laboratory tests Proposed FY 2012-13 Budget

13. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

14. Accomplishments (FY11) Initial Screenings (45,444) Initial Screenings (45,444) Triage Medical Screening Formal Physical Assessment

15. Accomplishments (FY11) Initial Screenings (45,444) Initial Screenings (45,444) Telephone Sick Call (29,211) Telephone Sick Call (29,211) 24/7 Assigned to a nurse or provider within 24 hours

16. 74,655 contacts Accomplishments (FY11) Initial Screenings (45,444) Initial Screenings (45,444) Telephone Sick Call (29,211) Telephone Sick Call (29,211)

17. Over 112,000 contacts Accomplishments (FY11) Initial Screenings (45,444) Initial Screenings (45,444) Telephone Sick Call (29,211) Telephone Sick Call (29,211) Mental Health (34,766) Mental Health (34,766) Dental (2,655) Dental (2,655)

18. Accomplishments Enhanced Community Partnerships –Offering HIV testing to inmates at no cost to the County Hospitalization Length of Stay –Consistently lower than the community average Increased use of generic medications to reduce pharmacy cost

19. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

20. Budget Challenges Rising Cost of Healthcare –Hospitalization –Specialist referrals –Pharmaceuticals Older, sicker inmate population 25% of inmates require mental health intervention

21. Budget Challenges Staffing –Affected by jail population & growth –Competitive salaries –Private sector is hiring

22. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

23. Corrections Health Services proposed budget $21M –5 positions deleted Budget Challenges –Rising cost of healthcare –Older, sicker population –High percentage of mental health patients –Staffing based on population Pictures Summary

24. FY 2012-13 Budget Worksession July 16, 2012 Corrections Health Services

25. BUDGET CHALLENGES Per capita health care spending in the US Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (Historical data from NHE summary including share of GDP, CY 1960-2008, file nhegdp08.zip; Projected data from NHE Projections 2009-2019, Forecast summary and selected tables, file proj2009.pdf). http://www.cms.hhs.gov/NationalHealthExpendData/