Legislature(2015 - 2016)Anch LIO Auditorium

05/13/2015 03:00 PM LEGISLATIVE BUDGET & AUDIT

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Audio Topic
03:07:39 PM Start
03:07:58 PM Public Testimony: Department of Health and Social Services Performance Review
03:54:36 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Dept. of Health & Social Services Performance TELECONFERENCED
Review - Public Input
-- Anchorage & Statewide Testimony --
Public comment on the performance of the Dept.
of Health & Social Services in the delivery of
its behavioral health & long-term care services &
on the department's overall organizational &
administrative structure
-- Testimony <Time Limited to 3 min.> --
                    ALASKA STATE LEGISLATURE                                                                                  
             LEGISLATIVE BUDGET AND AUDIT COMMITTEE                                                                           
                       Anchorage, Alaska                                                                                        
                          May 13, 2015                                                                                          
                           3:07 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mike Hawker, Chair                                                                                               
Representative Kurt Olson                                                                                                       
Representative Lance Pruitt                                                                                                     
Representative Steve Thompson                                                                                                   
Representative Sam Kito                                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Anna MacKinnon, Vice Chair                                                                                              
Senator Lyman Hoffman                                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Bert Stedman                                                                                                            
Senator Click Bishop                                                                                                            
Senator Pete Kelly (alternate)                                                                                                  
                                                                                                                                
Representative Mark Neuman (alternate)                                                                                          
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                                
Representative Liz Vazquez                                                                                                      
Representative Paul Seaton                                                                                                      
Representative Cathy Munoz                                                                                                      
Representative Tammie Wilson                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PUBLIC TESTIMONY:  DEPARTMENT OF HEALTH AND SOCIAL SERVICES                                                                     
PERFORMANCE REVIEW                                                                                                              
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
MARY SHIELDS, Chair                                                                                                             
Alaska Commission on Aging                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified during  the public review  of the                                                             
Department of Health and Social Services.                                                                                       
                                                                                                                                
BRETT GLIDDEN                                                                                                                   
Homer, Alaska                                                                                                                   
POSITION STATEMENT:   Testified during  the public review  of the                                                             
Department of Health and Social Services.                                                                                       
                                                                                                                                
DAVID MORGAN, Director                                                                                                          
Alaskan Center for Sustainable Health Care Spending and Policy                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified during  the public review  of the                                                             
Department of Health and Social Services.                                                                                       
                                                                                                                                
ELIZABETH VAZQUEZ                                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified during  the public review  of the                                                             
Department of Health and Social Services.                                                                                       
                                                                                                                                
REPRESENTATIVE PAUL SEATON                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Testified during  the public review  of the                                                             
Department of Health and Social Services.                                                                                       
                                                                                                                                
JIM WALDINGER                                                                                                                   
Public Consulting Group                                                                                                         
Boston, Massachusetts                                                                                                           
POSITION  STATEMENT:   Shared  background information  explaining                                                             
their  involvement  with  the Department  of  Health  and  Social                                                               
Services performance review.                                                                                                    
                                                                                                                                
JENNY WALL                                                                                                                      
Public Works                                                                                                                    
Austin, Texas                                                                                                                   
POSITION  STATEMENT:   Shared  background information  explaining                                                             
their  involvement  with  the Department  of  Health  and  Social                                                               
Services performance review.                                                                                                    
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:07:39 PM                                                                                                                    
                                                                                                                                
CHAIR  MIKE  HAWKER  called  the  Legislative  Budget  and  Audit                                                             
Committee meeting to order at  3:07 p.m.  Representatives Hawker,                                                               
Kito,  Pruitt, and  Olson  were  present at  the  call to  order.                                                               
Representative Thompson  arrived as the meeting  was in progress.                                                               
Also in  attendance were Representatives Vazquez,  Munoz, Wilson,                                                               
and Seaton.                                                                                                                     
                                                                                                                                
^Public  Testimony:   Department  of Health  and Social  Services                                                             
Performance Review                                                                                                            
  Public Testimony:  Department of Health and Social Services                                                               
                       Performance Review                                                                                   
                                                                                                                                
3:07:58 PM                                                                                                                    
                                                                                                                                
CHAIR HAWKER announced  that the only order of  business would be                                                               
public testimony on  the performance review of  the Department of                                                               
Health and  Social Services (DHSS)  conducted in  accordance with                                                               
House  Bill 30,  the statutory  requirement that  every State  of                                                               
Alaska agency be  reviewed for its ongoing  performance every ten                                                               
years.   He  reported  that the  DHSS process  had  begun at  the                                                               
beginning of  2015, with  anticipation of a  final report  by the                                                               
end  of  the year.    He  explained  that the  Legislative  Audit                                                               
Division  had  hired  consulting  groups to  work  alongside  the                                                               
division on  this report,  and that  these contractors  were also                                                               
listening and available on-line.                                                                                                
                                                                                                                                
3:10:13 PM                                                                                                                    
                                                                                                                                
CHAIR  HAWKER  said that  the  Department  of Health  and  Social                                                               
Services was the  largest agency at the State of  Alaska and, due                                                               
to  its size  and  its  scope, the  performance  review would  be                                                               
focused  on   three  critical   components  of   the  department:                                                               
behavioral   health,   long   term    care,   and   the   overall                                                               
organizational administrative  structure of  the department.   He                                                               
stated  that  the  purpose  of these  hearings,  as  required  by                                                               
statute, was to  give the contractors for  the performance review                                                               
the opportunity to  hear any public comments.   He reported that,                                                               
although the  meeting was being  held in Anchorage, it  was being                                                               
teleconferenced statewide,  providing the opportunity  for anyone                                                               
to participate.   He reiterated that the purpose  of this meeting                                                               
was to  provide public feedback  to the consultants, not  for any                                                               
individual committee  action, and was focused  on the performance                                                               
operations and  interaction of the  DHSS with the community.   He                                                               
stated  that   this  meeting  was   not  to  debate   any  issues                                                               
specifically related  to budget  items.   He clarified  that this                                                               
would provide information for the  contractors to review the DHSS                                                               
organizational structure and its  implementation and whether this                                                               
promoted  or inhibited  the efficiency  and effectiveness  of the                                                               
department in  achievement of its  mission.  He pointed  out that                                                               
anyone wishing to submit written testimony could do so.                                                                         
                                                                                                                                
3:13:54 PM                                                                                                                    
                                                                                                                                
CHAIR HAWKER opened public testimony.                                                                                           
                                                                                                                                
3:14:43 PM                                                                                                                    
                                                                                                                                
MARY SHIELDS, Chair, Alaska Commission on Aging, paraphrased                                                                    
from a prepared statement, which read:                                                                                          
                                                                                                                                
     My name  is Mary Shields.   I currently serve  as Chair                                                                    
     of the Alaska Commission on Aging.                                                                                         
                                                                                                                                
     The Commission  on Aging is a  Governor-appointed board                                                                    
     under  the Department  of  Health  and Social  Services                                                                    
     with   the   mission   to  ensure   the   dignity   and                                                                    
     independence of all older Alaskans,  and to assist them                                                                    
     in   leading  useful   and  meaningful   lives  through                                                                    
     planning,   advocacy,    education,   and   interagency                                                                    
     cooperation.  The Commission was established in 1982.                                                                      
                                                                                                                                
     The Commission  consists of 11  members, seven  of whom                                                                    
     are public  members mostly of  senior age  appointed by                                                                    
     the Governor  to serve four-year  terms based  on their                                                                    
     knowledge and demonstrated interest  in the concerns of                                                                    
     older Alaskans.                                                                                                            
                                                                                                                                
     The   Commission  also   has   four  designated   seats                                                                    
     including  one seat  for the  Department of  Health and                                                                    
     Social  Services.     Duane  Mayes,  Director   of  the                                                                    
     Division  of Senior  and Disabilities  Services, serves                                                                    
     in  that  position  and  keeps  ACoA  informed  of  the                                                                    
     Department's programs and services for Alaska seniors.                                                                     
                                                                                                                                
     The  Department   is  an   important  partner   to  the                                                                    
     Commission on Aging.   As Alaska's State  Unit on Aging                                                                    
     designated  by  the   Governor,  the  Department  works                                                                    
     closely with  the Division  of Senior  and Disabilities                                                                    
     Services  and  the  Commission on  Aging  to  carry-out                                                                    
     these responsibilities which  include administration of                                                                    
     funds for  senior programs,  development of  the Alaska                                                                    
     State Plan  for Senior Services, advocacy  for policies                                                                    
     that affect  Alaska seniors, outreach,  and educational                                                                    
     activities.   Currently, the  Commission is  working in                                                                    
     close  partnership  with  several of  the  Department's                                                                    
     divisions within  the Department  of Health  and Social                                                                    
     Services, including  Senior and  Disabilities Services,                                                                    
     the  Division   of  Public  Health,  the   Division  of                                                                    
     Behavioral Health,  and others  to finalize  the Alaska                                                                    
     State Plan for Senior  Services, FY2016-2019.  Division                                                                    
     staff  who contributed  to  the  Plan were  responsive,                                                                    
     honest, and  hard-working in their efforts  to forecast                                                                    
     the needs of  seniors for the next 4 years.   This Plan                                                                    
     satisfies a  federal mandate for all  states to receive                                                                    
     funding through  the Older  Americans Act  for programs                                                                    
     serving people age 60+.                                                                                                    
                                                                                                                                
     The Alaska  Commission on Aging, with  support from the                                                                    
     Alaska  Mental  Health   Trust  Authority,  Alzheimer's                                                                    
     Resource of  Alaska, and the  Department of  Health and                                                                    
     Social  Services   collaborated  to   develop  Alaska's                                                                    
     Roadmap  to  Address  Alzheimer's Disease  and  Related                                                                    
     Dementia that was  published this year.   As the result                                                                    
     of our  fast-growing senior population,  Alzheimer's is                                                                    
     one  of the  most  pressing health  care challenges  we                                                                    
     face  in Alaska  today.   Several divisions  within the                                                                    
     Department were  represented in the  Roadmap's Steering                                                                    
     Committee  and  will continue  to  be  involved in  the                                                                    
     Roadmap's implementation.                                                                                                  
                                                                                                                                
     Based  on my  observations, the  Department is  working                                                                    
     successfully  to  provide   much  needed  programs  for                                                                    
     seniors in  a timely and  fair manner.  They  work hard                                                                    
     to address current issues  with providers through face-                                                                    
     to-face meetings, teleconferences, and email E-Alerts.                                                                     
                                                                                                                                
       The Department is a leader in adopting the Results-                                                                      
     Based  Accountability management  framework.   The  RBA                                                                    
     framework  enables the  Department  to deliver  quality                                                                    
     services while making the best  use of public resources                                                                    
     and measuring  its impact on the  health and well-being                                                                    
     of  Alaskan  individuals,  families,  and  communities.                                                                    
     Using the  RBA framework, the Department  has developed                                                                    
     strategies  to  work  across   divisions  in  order  to                                                                    
     leverage  resources  and   build  more  cost  effective                                                                    
     programs.                                                                                                                  
                                                                                                                                
     During this  very difficult fiscal time  in Alaska, the                                                                    
     Department  will need  to be  innovative and  make some                                                                    
     very difficult funding decisions.   We believe that the                                                                    
     current leadership of the  department well qualified to                                                                    
     take on this very difficult task.                                                                                          
                                                                                                                                
3:19:26 PM                                                                                                                    
                                                                                                                                
CHAIR HAWKER  relayed that it was  good to hear when  things were                                                               
"working right  and well" within an  agency.  He said  that there                                                               
had  not  been  a  lot  of response  generated  for  this  public                                                               
testimony.                                                                                                                      
                                                                                                                                
3:20:04 PM                                                                                                                    
                                                                                                                                
BRETT  GLIDDEN said  that  she had  worked  for several  agencies                                                               
delivering behavioral  health services,  and that,  as she  was a                                                               
certified  chemical  dependency  counselor  in  Alaska,  she  was                                                               
testifying both  as a  citizen and  as a  service provider.   She                                                               
reported that  she had seen  remarkable programs funded  by DHSS.                                                               
Recently, she had  been working with a  local coalition reviewing                                                               
community  access to  behavioral health  and other  related human                                                               
services,  and she  had been  researching specific  grant funding                                                               
for  substance abuse.   She  reported that  she had  been working                                                               
closely  with the  Department of  Health and  Social Services  to                                                               
outline   the  current   funding   and  its   use  with   current                                                               
programming.  She relayed that she  had "hit a couple of walls as                                                               
a community  member that have  made it difficult."   She declared                                                               
that  it  was  specifically  difficult   to  find  out  what  was                                                               
happening  with  funding  in administration  versus  programming.                                                               
She  stated that  her approach  was not  from an  audit point  of                                                               
view,  but as  a concerned  community member  with experience  in                                                               
non-profits and  an understanding of fiscal  responsibility.  She                                                               
stated  that  she  had  often  been frustrated  with  a  lack  of                                                               
transparency for understanding the  amount of money allocated for                                                               
her  region.    She  pointed to  the  difficulty  of  interfacing                                                               
between the general community and  the department for finding out                                                               
anything but  general public  figures.  She  noted that  her last                                                               
request had  not been responded  to for more  than a month.   She                                                               
asked for  a more  user friendly approach  to the  interface with                                                               
Department  of  Health and  Social  Services.   She  offered  her                                                               
belief that she should not have  to work so hard for answers from                                                               
public agencies.                                                                                                                
                                                                                                                                
3:25:25 PM                                                                                                                    
                                                                                                                                
DAVID MORGAN,  Director, shared his background  in healthcare and                                                               
healthcare finance,  which included service on  the Alaska Health                                                               
Care  Commission,  and Chair  of  the  Municipality of  Anchorage                                                               
Health Care  Commission.  He added  that he was also  a fellow of                                                               
the  national Healthcare  Financial Management  Association.   He                                                               
stated  that he  wanted to  discuss the  management overview  and                                                               
philosophy of the  Department of Health and Social  Services.  He                                                               
declared that  the real question was  for the quality of  what we                                                               
were getting for our dollars.   He relayed that the actual amount                                                               
paid  by the  state on  health  care for  employee insurance  and                                                               
Medicaid  payments was  about  $2.6  billion.   He  added on  the                                                               
Indian  Health System  payments  of $800  million, the  community                                                               
health center  payment of  $40 million,  and the  aggregate total                                                               
became $7.6  billion.   He declared  that he  was not  asking for                                                               
money,  but instead  he shared  the  need for  discussion of  the                                                               
overall  management philosophy.   He  pointed to  the legislative                                                               
audit of Department of Health  and Social Services which revealed                                                               
confusion with  no clear  metric or  goal.   He stated  that many                                                               
individuals  in the  department were  not even  aware of  the key                                                               
performance indicators report.   He reported that his discussions                                                               
with   John   Boucher,   author   of  the   report,   had   found                                                               
inconsistencies  of cost  and  operational  data that  conflicted                                                               
with presentations on  projections given to the  legislature.  He                                                               
offered his belief  that there should not be  a reorganization of                                                               
the  organization  or the  payment  structure,  but that  it  was                                                               
necessary  to transform  what was  being done,  and to  develop a                                                               
system  that  met  the  needs   of  those  people  receiving  the                                                               
services.   He advocated  the Nuka  System of  Care, a  style and                                                               
philosophy  of  care  that  could  drop costs  between  30  -  40                                                               
percent.  He  suggested that the legislative  leadership meet for                                                               
discussions regarding  this system  of health  care, as  the goal                                                               
was to  give people the  health care they  need and want,  and to                                                               
use best evidence  medicine.  This would improve  the quality and                                                               
lower the cost by improving health.                                                                                             
                                                                                                                                
MR. MORGAN, in response to  Chair Hawker, explained that Nuka was                                                               
a [Alaska] native word meaning health,  that it was a concept and                                                               
philosophy of  care management, and  that it was  the development                                                               
of  systems  that  would  allow people  to  avail  themselves  of                                                               
activities  that would  make  people healthier.    He offered  an                                                               
example  of   diabetes  management,   which  included   a  health                                                               
nutrition  education  program that  taught  people  how to  check                                                               
blood, review diet, and learn  to cook, among other things, which                                                               
would  improve health,  reduce dependency,  and  result in  fewer                                                               
emergency room (ER)  visits.  He declared that  although this was                                                               
hard work  for health professionals,  it paid off  with healthier                                                               
populations and  lower costs.   He said  that a reshaping  of the                                                               
delivery system to  focus on health care would take  a few years,                                                               
but was better than throwing more  money at the current system as                                                               
this just  created more problems.   He recommended  an evaluation                                                               
based on the  existing key performance indicators,  and work with                                                               
the Nuka  Institute, to develop  these programs for  Medicaid and                                                               
public  health.   He declared  that state  and retired  employees                                                               
would ask for  it once it became successful.   He suggested using                                                               
the  $2.6 billion  to work  through health  professionals in  the                                                               
Department of  Health and  Social Services,  as the  remainder of                                                               
the  other programs  were  administrative, for  a  change in  the                                                               
philosophy to one of integrating a  program of better health.  He                                                               
acknowledged that this was a lofty goal.                                                                                        
                                                                                                                                
3:37:26 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
3:38:39 PM                                                                                                                    
                                                                                                                                
ELIZABETH VAZQUEZ  stated that she  was testifying as  a citizen,                                                               
not  as a  legislator, and  she shared  her educational  and work                                                               
background that reflected her "passion for health care."                                                                        
                                                                                                                                
CHAIR HAWKER reminded her that this was a performance review.                                                                   
                                                                                                                                
MS. VAZQUEZ suggested  that the consultants look  more closely at                                                               
prevention, as  there was a  lot of  research that low  levels of                                                               
Vitamin D contributed to depression,  cancer, and other diseases.                                                               
She stated that there were  also extensive studies on the effects                                                               
from low levels  of Vitamin B12 and other B  vitamins.  She asked                                                               
that the  consultants find  a way to  make the  healthcare system                                                               
sustainable, as Alaska  has been able to fund  many programs that                                                               
other states cannot provide.  She  offered her belief that it was                                                               
critical  to know  how Alaska  was doing  in comparison  to other                                                               
states.   She  acknowledged  that, as  seniors  were the  fastest                                                               
growing segment of the population,  there were problems including                                                               
dementia, the  rate for which  increased with age.   She declared                                                               
that the  Medicaid budget was  not sustainable, and she  asked to                                                               
look into means of more prevention.   She stated that the cost of                                                               
nursing  homes was  disconcerting, and  she asked  what could  be                                                               
done to make them more affordable.                                                                                              
                                                                                                                                
REPRESENTATIVE PRUITT  asked if there  were any other  areas that                                                               
would  benefit from  a review  committee analysis.   He  asked if                                                               
some  of  the  departments  were   not  working  at  the  highest                                                               
efficiency.                                                                                                                     
                                                                                                                                
MS. VAZQUEZ  said that  she would send  in some  suggestions from                                                               
her legislative office.                                                                                                         
                                                                                                                                
3:45:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PAUL  SEATON, Alaska State  Legislature, suggested                                                               
that the review  committee look at the lack of  follow through by                                                               
the  Department   of  Health  and   Social  Services   for  House                                                               
Concurrent Resolution  5, passed unanimously by  the Alaska House                                                               
of  Representatives   and  Senate  in  2011,   which  called  for                                                               
prevention of  disease as  the primary model  for health  care in                                                               
Alaska.   He declared that  the previous administration  had done                                                               
little or nothing to advance  this prevention of disease model in                                                               
Alaska.    He pointed  out  that,  although the  legislature  had                                                               
spoken strongly, this  had been ignored by DHSS in  the past, and                                                               
that  this should  be  reviewed  again.   He  suggested that  the                                                               
current administration also be reviewed  to ensure that they were                                                               
being more pro-active with moving  in the direction called for by                                                               
the aforementioned resolution.  He  offered his belief that there                                                               
had not been much action toward  prevention or Vitamin D use from                                                               
the previous  DHSS commissioner.   He expressed his  concern that                                                               
the  standards of  care for  Alaska in  the public  health system                                                               
were not being  based on comparisons of the  best available data,                                                               
or science.   He stated that a high standard  was being placed on                                                               
a  change  from the  status  quo  even  though there  was  little                                                               
evidence to  justify the current  levels, especially  with regard                                                               
to nutrition.                                                                                                                   
                                                                                                                                
3:49:49 PM                                                                                                                    
                                                                                                                                
JIM  WALDINGER,  Public  Consulting  Group,  offered  an  update,                                                               
stating  that the  performance review  team  had been  collecting                                                               
information  and   data  while  talking  with   state  staff  and                                                               
providers in  Alaska over the  past few  months.  He  pointed out                                                               
that there  were two teams,  one team was leading  the behavioral                                                               
health  performance review  and the  other team  was leading  the                                                               
long term  care performance  review.   He declared  that everyone                                                               
they  had met  with  had been  very  accommodating, helpful,  and                                                               
open.   He stated that the  review team will likely  release some                                                               
of its findings during the summer.                                                                                              
                                                                                                                                
CHAIR  HAWKER   clarified  that  the  performance   reviews  were                                                               
actually conducted  by the state's legislative  auditor, although                                                               
there  were contractors  engaged to  provide additional  "mission                                                               
specific knowledge  on the  agencies."  He  pointed out  that the                                                               
final reports would come from the Legislative Audit Division.                                                                   
                                                                                                                                
3:52:54 PM                                                                                                                    
                                                                                                                                
JENNY WALL, Public Works, reported  that her company had assisted                                                               
state and local  governments, as well as  individual agencies, in                                                               
more than  12 states  with performance reviews.   She  noted that                                                               
her  group was  specifically  working on  the organizational  and                                                               
administrative portions  of this performance review.   She shared                                                               
that  the field  work, which  included extensive  interviews with                                                               
staff at all levels, as well as comparative and best practices                                                                  
research for comparable agencies, was being completed.                                                                          
                                                                                                                                
3:54:36 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the                                                                       
Legislative Budget and Audit Committee meeting was adjourned at                                                                 
3:54 p.m.                                                                                                                       

Document Name Date/Time Subjects
Agenda_LBA_13May15_ANC DHSS Testimony.pdf JBUD 5/13/2015 3:00:00 PM