1. Gary C. Mohr, Director Ohio Department of Rehabilitation & Correction
ASCA/CCHA Training September 11, P-PACA-Cost Containment The Ohio Experience
My journey into becoming the Director of the Ohio Department of Rehabilitation and Correction (DRC). Appointed by Governor John Kasich in January 2011, I recently celebrated over 40-years of correctional experience. I start each day with the thought; “It’s a great day to be alive, as each day provides an opportunity to impact the future of tomorrow. With that in mind, DRC staff have dedicated their time and talents to implementing a multitude of strategies to reduce violence, establish stability and decrease recidivism. I am committed to maintaining and strengthening partnerships formed with Reentry Coalitions, Judicial Stakeholders, Faith- Based Community, as well as key players who take an active interest in the success of an offender’s reentry into society. ODRC is proud to national leader in offender recidivism with a record low of 27.1%.
Gary C. Mohr, Director
Ohio Department of Rehabilitation & Correction

2. The Ohio Experience ODRC Demographics Cost of Healthcare Services
Patient Affordable Care Act & Medicaid Expansion
ODRC Demographics
Cost of Healthcare Services
Cost Containment & Other Opportunities

3. Patient Protection Affordable Care Act & Medicaid Expansion
P-PACA –
Attempts to control rising healthcare costs
Protect consumers
Expand insurance coverage
Shifts focus to wellness prevention
Increase the healthcare workforce
Serves as the platform for Medicaid expansion
Governor Kasich’s (RP), passion and desire to help the most vulnerable citizens in our state has been the driving force of Ohio’s Medicaid expansion.

4. Current Status: Medicaid Expansion under PPACA – The Ohio Story
Medicaid expansion under PPACA in Ohio has been a key initiative of Governor Kasich’s Office of Health Transformation (OHT)
July 1, 2013 – DRC began activating Medicaid coverage for
Hospitalized more than 24 hours
Under 21 years old
Over 65 years old
Pregnant
September 26, 2013 – Ohio’s Medicaid Director submitted a State Plan Amendment to extend Medicaid coverage to childless adults beyond traditional categories (pregnant, disabled, over 65, etc)
October 21, 2013 – State Plan Amendment to extend Medicaid coverage approved by the Controlling Board, thus becoming effective
January 1, 2014 – Governor Kasich authorized the expansion of Medicaid Services to all residents living within Ohio.
We would not be here today without the passage of the Governor’s passage of the expansion of Medicaid Services to all Ohioans.
Based on the expansion most offenders within ODRC will now qualify for Medicaid.
Medicaid expansion broadened the categories of eligibility allowing most offenders within ODRC to now qualify.
The DRC strongly believes that access to continuing treatment & healthcare services is critical to reentry efforts of Ohio offenders.

5. Patient Affordable Care Act & Medicaid Expansion
DRC’s Office of Correctional Healthcare has partnered with the Ohio Department of Medicaid (ODM) for several reasons including:
Assess the impact of Medicaid expansion on the state’s offender population. *Nearly every Ohio offender will be eligible for Medicaid Based on their financial eligibility upon release from incarceration.
Achieve a shared goal of enrollment of every eligible offender into Medicaid 90 days prior to their release.
Recidivism reduction by preparing offenders for successful transition back to the community after release from prison

6. Ohio Department of Rehabilitation & Correction – Agency Overview
ODRC
Operates independently of county jails and the Department of Youth Services
Comprised of 27 facilities
25 state operated
2 privately owned
Current Healthcare Model – State operated/controlled

7. ODRC Prison Population July 1 2011-July 1, 2014

8. Agency Demographics – Commitments by Age & Average Age
Average Age of DRC Inmates:
Male Inmates – 36 years old
Female Inmates – 35 years old

9. Agency Demographics – Bureau of Medical Services
39% of the population is enrolled in a specialized Chronic Care Clinic
Operate 325 high acuity medical beds
Medical Needs:
20% of all inmates are on the mental health caseload
Operate 500 Residential Treatment Unit beds for SMI inmates
Mental Health Needs:
80% of all inmates have a history of substance abuse related issues
41% have a considerable (chronic) need for treatment
Recovery Service Needs of Inmates entering ODRC:

10. Agency Demographics – Offender Costs
This graph supports our agency as a whole has decreased overall costs per offender while continuing to provide for their daily needs in a manner
In 2009, Ohio Prison’s healthcare expenditures reached a peak of 292 million dollars. Over the past four years while general health care cost have increased throughout the country and while we were in litigation for providing inadequate health care; we were able to decrease our health care cost by 54 million dollars while increasing the quality of health care and life longevity of an inmate.
The Department of Rehabilitation and Corrections is anticipating a savings of over 18 million a year due to Medicaid paying for a 24 hour or more in-patient hospital stay; this allows us to reinvest money into other evidenced based programs, which will help incarcerated and offenders within the community.

11. ODRC Healthcare Cost Comparison
Annual Cost Per Inmate
Stu Hudson, Managing Director of Healthcare and Fiscal Operations is going to share how we have made cost reductions while increasing quality medical care and optimizing staffing levels.
Our agency has reduced our annual healthcare cost by $54 million since 2009.

12. Maximizing Correctional Healthcare Quality with Strategic Business Planning The Ohio Experience
Stuart Hudson, Managing Director of Healthcare & Fiscal Operations
Office of Correctional Healthcare
Ohio Department of Rehabilitation & Correction

13. Correctional Healthcare Reality Today
Increase in aging offenders & associated chronic disease burden
Rising pharmaceutical costs (Sovaldi, HIV meds, etc.)
Continuous scrutiny from stakeholders
Legal liability (deliberate indifference and/or mal-practice)
And……
Decreased or tight funding that impacts correctional healthcare

14. ODRC Medical Spend Past Decade
Fussell Stipulation beginning 2006, ending 2012
Staffing higher now than during stipulation, while costs are lower

15. Diverse Business Strategy to Maintain Quality and Efficiency
Managed Care
- Bill re-pricing
- Collegial Review
- Data analysis & reporting
- Evidence based medicine
- Medicaid Impact
- Metrics
Insourcing
- Advanced Level Providers
- 2 Privatized facilities
Outsourcing
- Lab services
- Allied Health
- Dietary
State Agency Partnerships
- Pharmacy
- Medical supplies
- Lab contract
- EHR
Other
- OSUMC
- Contract simplification
- CT-MRI-PET
- Urgent Care
- Contract compliance
Managed Care:
Pre Medicaid: Billing retrospective reviews, Pre-certification of specialty consultation, 3rd party case management of in-patient stays
Post Medicaid: Bill re-pricing by 3rd party, Collegial Review, Permedion – billing data analysis, surveillance, & reporting, Medicaid Impact
In-Sourcing:
Advanced Level Provider (ALP) Services: This change was key to exiting Fussell Stipulation, ODRC spend was less in FY14 than in FY08 with more ALPs in a civil servant system (11.8 vs million for savings of .5 million
Converted Private Healthcare Services to Civil Servant: Affected 2 facilities, Savings of approximately 1million per facility
Out-Sourcing:
Lab Services - Closed internal COLA accredited lab, Multi-agency RFP, LabCorp is provider, Maintained quality, increased savings & efficiency
Allied Health Services - Includes HITs, Phlebotomists, Radiology techs, aides
Dietary Services - Transitioned from civil servant diet techs to contract, Services part of overall foodservice RFP, Menu and clinical protocols controlled by ODRC
State Agency Partnerships:
Pharmacy and Medical Supplies – ODMHAS (Current costs are at $29.7 million for FY14. They were $30.8 million in 2008 – and we have more CCC patients and higher acuity now), Lab – multi-agency bid for increased volume / decreased pricing, EHR – DYS
Other /Miscellaneous:
OSUMC contract decreased by 10 million
Contract simplification – reduced contracts from 375 in 2010 to 65 currently – easier to manage
CT-MRI-PET – Purchased or leased in house , decreased costs and easier scheduling – secure
Urgent Care – off hours UC services to decrease ER trips and costs, minor procedures / sutures, secure
Contract Compliance – division at central level, all contracts monitored for quality, multiple options for handling non-compliance or need for improvement – leads to stability and accountability

16. Ohio Department of Rehabilitation & Correction - One Patient, One Team
In-sourcing:
Advanced Level Provider (ALP) Services:
Civil servant ALPs invested in leadership / long-term success
This change was key to exiting Fussell Stipulation
ODRC spend was less in FY14 than in FY08 with more ALPs in a civil servant system (11.8 vs million for savings of .5 million)
Increased utilization of NPs for ALP coverage
Converted Private Healthcare Services to Civil Servant:
Affected 2 facilities
Savings of approximately 1million per facility
Ohio Department of Rehabilitation & Correction - One Patient, One Team

17. Ohio Department of Rehabilitation & Correction - One Patient, One Team
Out-Sourcing:
Lab Services
- Closed internal COLA accredited lab
- Multi-agency RFP, LabCorp is provider
- Maintained quality, increased savings & efficiency
Allied Health Services
- Includes HITs, Phlebotomists, Radiology techs, aides
- Significant savings while maintaining quality
- Prioritization of lead clinical staff (nursing, ALPs)
Dietary Services
- Transitioned from civil servant diet techs to contract
- Services part of overall foodservice RFP
- Menu and clinical protocols controlled by ODRC
Ohio Department of Rehabilitation & Correction - One Patient, One Team

18. Partnership with other State Agencies
Pharmacy
Partnership with the Ohio Department of Mental Health & Addiction Services
Medical Supplies
Lab
Multi-agency bid to increase volume / lower pricing
Electronic Health Record
Other state agencies joining the ODRC contract (DYS)
Pharmacy – ODMHAS (Current costs are at $29.7 million for FY14. They were $30.8 million in 2008 – and we have more CCC patients and higher acuity now)
Medical Supplies – ODMHAS (Current costs are at $1.3 million for FY14. They were $2.2 million in FY2010
Ohio Department of Rehabilitation & Correction - One Patient, One Team

19. Contract Simplification Ohio State University Medical Center
Other Strategies:
Contracts reduced from 375 in 2010 to 65 currently
Contract Simplification
Purchased / leased equipment for these diagnostics to be done in house.
Greater control over scheduling at reduced cost
PET-CT-MRI
ODRC operates UC during off hours
Prevents some ER trips for things like sutures & minor procedures
Keeps inmate patients within ODRC security
Urgent Care
Reduced overall contract costs by $10million/year last contract
Ohio State University Medical Center
ODRC maintains a contract compliance division at the central level
All contracts are routinely monitored for compliance / quality
Multiple options to improve compliance or handle non-compliance
Contract Compliance
Ohio Department of Rehabilitation & Correction - One Patient, One Team

20. Results of Strategy
The value of people – Clinical staffing is at an all-time high
Quality is maintained/enhanced
Reduced legal liability
Costs are contained
Business is manageable
ODRC is positioned for the future
Medicaid moving forward
EHR moving forward
Tie into overall core values and mission/vision
Medicaid impact certainly impacts our mission and vision
Future concerns and considerations:
Impact of Sovaldi
Ability to get 340B
Ongoing impact of Medicaid on budgets

21. Questions? Future concerns and considerations: Impact of Sovaldi
Ability to get 340B
Ongoing impact of Medicaid on budgets