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Status Report Prison Medical Care

Status Report Prison Medical Care. J. Clark Kelso Federal Receiver January 26, 2011. Overview. Summary of Court Orders Key Performance Measures Accountability for Costs of Medical Care Road Map Forward. Summary of Court Orders. 2002 Stipulated Injunction (Plata)

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Status Report Prison Medical Care

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  1. Status ReportPrison Medical Care J. Clark Kelso Federal Receiver January 26, 2011

  2. Overview • Summary of Court Orders • Key Performance Measures • Accountability for Costs of Medical Care • Road Map Forward

  3. Summary of Court Orders • 2002 Stipulated Injunction (Plata) • Requires compliance with CDCR Medical Policies & Procedures consistent with 8th Amendment. • 2006 Order Appointing Receiver • Receivership shall cease when Court is satisfied that State has the will, capacity and leadership to maintain a system of providing constitutionally adequate medical care services to class members. • 2008 Order Approving 5-Year Turnaround Plan of Action • Court finds the Plan’s six goals to be necessary to bring system up to constitutional standards. • Other Cases (Coleman, Perez, and Armstrong).

  4. Key Performance Measures:Turnaround Plan Progress • Overall • 70% of Action items completed (33 of 47) • 9% On schedule (4 of 47) • 21% Behind schedule (10 of 47) • Elements of the Turnaround Plan of Action • Clinical staffing • Medical care • Custody access to care • Allied support • Facilities • Quality accountability

  5. Key Performance Measures: Turnaround Plan Progress • Clinical Staffing (substantially complete) • Hiring: 90% target for approved clinical positions • Physicians • Mid-Levels • Nurses • Turnover: <10% Target • Physicians • Mid-Levels • Nurses • High use of registry contracts and overtime • Medical Loss Ratio = 81%

  6. Key Performance Measures: Turnaround Plan Progress • Medical Care (50% complete) • Primary care (50% complete) • Chronic care (40% complete) • Emergency medical response system (complete) • Specialty care and hospitalization (75% complete) • Telemedicine expansion (15% complete) • Focus on Cost Containment and Quality Improvement ($408 million savings/cost avoidance) • Outside providers ($340 million savings/cost avoidance) • Third-party administrator • Capped rates/statewide network provider • Utilization management • Registry use • Other measures ($68 million savings)

  7. Key Performance Measures: Turnaround Plan Progress • Custody Access to Care (substantially complete) • Every month, 500,000 inmates have appointments for medical, mental health, dental and specialty services. • To ensure access, we hired approximately 2,000 “health care access officers” to assist in escorts. • Target is to escort 85% or more of inmates to appointments. Target currently being met. • Custody issues block < 1% of appointments. • In mental health, still have large backlogs of inmates waiting for beds for treatment.

  8. Key Performance Measures: Turnaround Plan Progress • Allied Support (30% complete) • Electronic health care scheduling (25% complete) • Electronic medical records (25%) • Dictation and transcription (50% complete) • Mental health tracking system (substantially complete) • Basic electronic medication administration records and central pharmacy (15% complete) • Labs and radiology (30% complete)

  9. Key Performance Measures: Turnaround Plan Progress • Facilities (30% complete) • San Quentin construction completed by December 2009 – delivered early and under budget (completed) • Avenal State Prison projects (completed) • AB 900 Health care-related construction ($2.362 billion) underway • 1 Consolidated care center (1,722 beds) • 3 Renovated Juvenile Justice facilities (3,894 beds) • Improvements at prisons • Designation of health care hub prisons with inmates assigned pursuant to new medical classification system

  10. Key Performance Measures: Turnaround Plan Progress • Facilities Timeline • 2006-2008: Planning for 10,000-bed project ($6 billion) and facility upgrade ($1 billion) • February 2009 – August 2009: Begin downsizing for smaller scope (first down to 3 new facilities, then down to 1 new and 3 DJJ) • September 2009 – Present: Delegation of construction from Receiver to CDCR and further downsizing to reflect change in project methodology and achieve greater efficiencies.

  11. Key Performance Measures: Turnaround Plan Progress • Quality Accountability (40% complete) • Dashboard (substantially complete) • All institution CEOs hired (complete) • Annual OIG assessments (1st round complete, second round just starting) • Annual death reports (complete) • Chronic care reports (30% complete)

  12. Key Performance Measures:OIG Inspections • 33 of 33 Institutions Completed • Average Score = 71.9% (slight upward trend over the year – trend line goes from 69% to 74.5%) • High score=83.2% (Folsom) • Low score=62.4% (High Desert) • Low Scores in: • Access to providers (overcrowding related); • Medication management (overcrowding related). • High Scores in: • Continuity of care; • Primary care provider responsibilities; • Nurse responsibilities.

  13. Key Performance Measures:Death Reports Overall death rate has dropped 10-12%.

  14. Key Performance Measures:Death Reports Rate of likely preventable deaths decreased by 82%. Rate of possibly preventable deaths decreased by 7%.

  15. Key Performance Measures:Chronic Care • Diabetes Control – Red • HbA1c Goal: 85% of patients have HbA1c < 8%. • For 2009, only 76% had < 8%. • LDL-C Goal: 85% have LDL-C < 100 mg/dL. • For 2009, only 66% had < 100 mg/dL. • Microalbumin screen goal: 85% of patients screened. • For 2009, only 57% had received screening. • Asthma Control -- Green • Goal: Ratio of short-acting beta agonist (SABA) to inhaled corticosteroid (ICS) prescription < 2:1. • As of August 2010, ratio was 1.75. • 21 institutions met goal; 3 outliers near or above 3:1 being examined. • Colon cancer screening and breast cancer screening – Red • Soon to come: HepC treatment; HIV treatment.

  16. Accountability for Costs of Medical Care • From 2006 to 2008, Receiver initiatives were funded through informal “Genest Letters” outside normal process. • In 2008, the current Receiver began reintegrating planning and expenditures back into normal budget process. Receiver has invited audits by SCO, BSA and OIG. • The Receiver began cost-containment initiative in early 2009, and expenditures, which were spiraling upward, came down. • We have largely completed the process of working with Finance to bring our budgeting back into normal process. • The $811 million cut in last year’s budget was a figure set by the Governor’s Office (an additional reduction of $9 million was approved by the Legislature). I promised to do whatever I could to secure savings.

  17. Accountability for Costs of Medical Care 2nd Receiver 1st Receiver Data points for 2010-11 and 2011-12 are budgeted amounts; all other points are actual expenditures.

  18. Road Map Forward • Plata – Medical • Fund and finish Turnaround Plan. • Clear process hurdles to construction, complete construction, and activate. • Improve OIG inspection scores. • Reduce population to reduce overcrowding.

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