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
512-609-8046
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