Correctional Managed Care Overview

Lauren Sheer Director of Legislative Affairs

Office of Health Policy and Legislative Affairs

The University of Texas Medical Branch

The University of Texas Medical Branch

Governor & Legislature

Texas Department of Criminal Justice (TDCJ)

University of Texas Medical Branch

(UTMB)

Texas Tech University Health Science Center

(TTUHSC)

Correctional Managed Health Care

Committee (CMHCC)

Texas Correctional Health Care Organization

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Geographic Responsibility

JA

BC, KN

HV, WY, E1, E2, DU, NF, GR

C & HM

DH

JN

RH

CM CL TO

FB, WR

LC, JM

TH, RS

SM

DL

WL, DW RB, NE

RZ

N5, LH

SO

NI & NH

CY DB

TE

BX

LC KY

TI

BB

GV, HT, AH, MV, LM, WM, N2

TH

N1, HB

BL

P1 & P2

CG HG

J1, J2, J3, J4

R1, R2, R3 , DA RV

AJ

CV

TL

SB

BJ, BA, ST

FE

EA

N6

GL

GG

BY

B1, B2, CO, ND, MI

HD, SV

JD HJ

VS

BR SY

LN

BH

BM

JT

LJ, LT, HI

N4

N3

WI

RL

ML

HF

CN

• Texas has a total of

112 prison units with

approximately

150,000 offenders

• UTMB provides

service to Eastern

portion of State at 83

units

• TTUHSC provides

service to Western

portion of State at 25

units

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• Legislatively created partnership in 1994

• FTEs: 3,000

• Patients: 120,000

• 83 facilities: full medical, dental and psych

• 2 inpatient medical and 2 inpatient mental health units

• Dialysis, infectious disease, geriatric and assistive

disability programs

• Medical transportation

• EMR, telemedicine and radiology

• Pharmacy

• Hospital Galveston and Free World hospital network

UTMB Correctional Managed Care

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PMPD Expenses

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• Estelle v. Gamble (1976) – Texas case that went to

Supreme Court and set national standard for

correctional health care

• Prior to 1994 Texas’ prison health care was largely

provided by the prison system

o Faced challenges recruiting and retaining health

care professionals

• Funding of correctional health care

o Correctional health care expenses often exceed

appropriations and require supplemental/emergency

appropriations

o Health care expenses often difficult to project

Historical Challenges

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• State Commitment to a Model of Care

• Hospital Galveston

• Pharmacy Program & 340B Pharmaceutical

Pricing

• Strategic Technology Investments

• Dedicated Staff

Keys to Success

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• Manages tertiary hospital and planned offender

care

• Secure facility accommodating all custodies

• Utilizes corrections knowledgeable medical staff

• Allows care to be balanced with available

resources

• All specialty clinical services are available

• Reduces risk and litigation

Hospital Galveston

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Pharmacy Program & 340B Pharmacy Pricing

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• 340B Drug Pricing Program

o FY13 savings of $50.4M or 56.9%

o UTMB is the eligible entity

o Disproportionate share hospital, employ prescribers,

manage the medical record

• Reclamation of pharmaceuticals

o FY13 $8M in drugs

• Formulary Management

o FY13 $3.58M in savings

• 91% generic utilization

340B Savings

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0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

$0

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

FY09 FY10 FY11 FY12 FY13

340B Savings % Savings

Estimated average annual savings over the

last 5 years is $38.9 million or 48%.

• Telemedicine has increased access to care,

decreased offender movement, and increased public

safety

• Provided 100K encounters in FY13

• Primary care services drive volume

• Improved recruitment and retention

• EMR has improved productivity and continuity of care

• EMR has improved patient outcomes and reduced

state risk

Strategic Technology

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• Texas has the lowest staff per offender ratio in

the nation – 1:40

• CMC has had to reduce FTEs by 33% since

1994

• All facilities are ACA accredited

• Clinical outcomes remain exemplary

• Commitment to the delivery model has improved

retention

Dedicated Staff

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• Workforce Competition and need for market

salaries

• New Hepatitis C treatments

• Growth of 55 and older population

• Growth in Chronic Disease and Cancer

o End Stage Liver Disease

o Dialysis and Chronic Kidney Disease

• Increasing Hospital Utilization

o Hospital admission and sub-specialty

clinic growth

Rising Cost of Prison Health Care

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$0

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

FY

09

FY

10

FY

11

FY

12

FY

13

Pote

ntial

HCV Cost

Potential Hepatitis C (HCV) Drug Cost

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8,099

9,373 10,131

10,761 11,565

12,342 13,108 13,441

14,106 14,973

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

TDCJ* Population 55 and Older

* Includes all offenders in UTMB and TTUHSC sectors

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TDCJ* Population with Chronic Disease

34

,54

4

17

,58

3

7,5

58

6,3

34

4,2

57

2,2

56

44,0

11

17

,41

9

9,5

95

9,6

10

5,0

88

2,1

20

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

2006 2014

* Includes all offenders in UTMB and TTUHSC sectors

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Questions or Comments:

Lauren Sheer

UTMB - Director of Legislative Affairs

lesheer@utmb.edu

512-609-8046

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