Legislature(2005 - 2006)Anch LIO Conf Rm
09/27/2006 08:30 AM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Using Alaska's Health Care Dollars Wisely: Medicaid and Long-term Care | |
| Using Alaska's Health Care Dollars Wisely: Chronic Disease | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
Anchorage, Alaska
September 27, 2006
8:35 a.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Carl Gatto
Representative Vic Kohring
OTHER LEGISLATORS PRESENT
Senator Bettye Davis
COMMITTEE CALENDAR
USING ALASKA'S HEALTH CARE DOLLARS WISELY: MEDICAID AND LONG-
TERM CARE; CHRONIC DISEASE
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JERRY FULLER, Project Director
Office of Program Review
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented the topic of Medicaid and long-
term care.
JON SHERWOOD, Medical Assistant
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Responded to questions regarding the topic
of Medicaid and long-term care.
CHUCK BURNHAM, Legislative Analyst
Legislative Research
Legislative Legal and Research Services
Legislative Affairs Agency (LAA)
Juneau, Alaska
POSITION STATEMENT: Responded to a question during the
discussion regarding Medicaid and long-term care.
TAMMY GREEN, Chief
Chronic Disease
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Presented the topic of chronic disease.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 8:35:28 AM.
Representatives Wilson and Gardner were present at the call to
order. Representative Cissna arrived as the meeting was in
progress. Senator Davis was also in attendance.
^Using Alaska's Health Care Dollars Wisely: Medicaid and Long-
Term Care
8:37:30 AM
CHAIR WILSON announced that the first topic the committee would
consider would pertain to using Alaska's health care dollars
wisely with regard to Medicaid and long-term care.
8:37:43 AM
JERRY FULLER, Project Director, Office of Program Review, Office
of the Commissioner, Department of Health and Social Services
(DHSS), began by stating that the committee should have the
executive summary of a report by the Lewin Group on the cost of
the Medicaid program. The committee should also have an
executive summary from the Public Consulting Group (PCG), which
was a study commissioned to review the actions the [department]
might take to improve the long-term care system. The committee
should also have a one-page quote from the Commonwealth Fund
Forum regarding the challenges facing Medicaid financing, new
flexibilities under the federal laws and regulations, as well as
the challenges facing states in terms of sustainability,
quality, and meeting the needs of the people. He said he
included the quote because it seems to encapsulate the current
situation, although the quote was penned in 1981.
MR. FULLER then thanked the committee for its support for the
Medicaid program and the long-term care system. The
aforementioned supports the most vulnerable and needy citizens.
The Medicaid system has evolved from a program that originally
only provided for nursing home services to an industry unto
itself. In the early 1980s, waivers were developed allowing
people to choose long-term care services within their own
community and in their own home. In the mid 1990s Alaska joined
the waiver alternative and as a result has been able to restrain
the growth of nursing home beds in the state.
MR. FULLER highlighted that the Lewin report clearly showed that
the growth in Medicaid services for Alaska's elderly and
disabled population will quadruple in the next 20 years or so,
which is a nationwide issue. Mr. Fuller acknowledged that the
state could assume that the federal government will assume the
long-term care costs much like it did with the drug costs for
seniors. In fact, former U.S. Secretary of Health and Human
Services Tommy Thompson has put forth a proposal stating that
the federal government should take over the long-term care
system. However, one can't assume that will happen any time
soon. Therefore, the state needs to adjust its system in order
to make it as sustainable as possible in the long term. He
explained that by sustainable, he means that the costs can be
reduced. The demographics of the senior population are pushing
the cost of and the need for the long-term care system. He
noted that the first Baby Boomers are turning 60 and most states
haven't prepared for the upcoming onslaught of services and
needs for the aging Baby Boomer population. Additionally, the
number of people over age 85 is rapidly increasing. Adding to
this situation is that employers are dropping insurance or the
benefits are becoming reduced such that there is less
availability of the employer-sponsored insurance to cover the
other medical needs of these aging populations.
8:44:22 AM
MR. FULLER commented that there are a multitude of drivers of
this issue. Furthermore, there isn't much control over the
aging population, he said. He then related that the Lewin
report assumed the same program without any significant policy
changes throughout its projection. However, the issue of
Medicare coverage for retired folks may change because it has
been reported that fewer physicians are accepting Medicare.
Medicare is a primary payer, and therefore when a Medicare
physician can't be found, the secondary payer won't pay. The
aforementioned situation results in people having to pay cash to
see a physician or practitioner. If that continues, one might
suggest that these individuals might move to locations where
they can obtain Medicare benefits, which could change Alaska's
demographics.
8:47:12 AM
REPRESENTATIVE GARDNER relayed that she has been hearing from a
lot of constituents who are experiencing difficulty finding
physicians who are taking Medicare patients. One of the
problems in such situations is that the [secondary] insurance
refuses to cover the gap. Therefore, she suggested that one
solution could be a program by which the [secondary] insurance
would cover what the physician can't obtain from Medicare.
MR. FULLER said that he isn't the appropriate individual to
address that, although he concurred with Representative
Gardner's summation.
8:48:20 AM
JON SHERWOOD, Medical Assistant, Department of Health and Social
Services (DHSS), relayed that relatively recent federal law
requires physicians who accept Medicare payments to accept the
Medicare rate for payment. He related his understanding,
"Unless you take just a very small percentage of Medicare
clients, you're required to accept the Medicare rates. So, you
cannot charge ... your patient or an insurance company an
additional rate." Mr. Sherwood noted that he had just reviewed
his mother's Medicare statement, which seemed to imply the
aforementioned. He said that of the bills he reviewed, Medicare
paid 30-60 percent of the physician charge.
REPRESENTATIVE GARDNER commented that it's not surprising then
that physicians aren't willing to take Medicare patients.
8:50:11 AM
SENATOR BETTYE DAVIS, Alaska State Legislature, inquired as to
what is different about Alaska's system [with regard to Medicare
patients] as compared to other states. She inquired as to how
seniors in other states would be allowed to use their primary
insurance before using Medicare.
MR. FULLER answered that generally the charges for the health
care services in other states are closer to what Medicare will
pay and thus practitioners are more able to accept that.
"Alaska's high cost of everything appears to be driving the gap
between what Medicare will reimburse and the usual and customary
charges," he said.
SENATOR DAVIS maintained that it seems to be more than that.
She related that [she has been told] that patients who have been
on a physician's case load for some time are being told that the
physician can no longer see them because if the physician
doesn't accept the Medicare, then the physician can't have the
patient's private insurance pay. She attributed the
aforementioned situation to something that [the state has
established].
MR. FULLER explained that the change that occurred January 1 was
a reduction in Medicare reimbursement. He related his
understanding that there was a two-year adjustment upwards in
Medicare that expired in January, which dropped the Medicare
reimbursement. He related that [Alaska's congressional]
delegation is working on this.
8:52:37 AM
CHAIR WILSON surmised then that this situation with Medicare is
occurring nationwide, but since Alaska has such high costs many
Alaskan physicians aren't accepting [Medicare] patients.
MR. FULLER said that appears to be the case. In further
response to Chair Wilson, Mr. Fuller reiterated that [Alaska's
congressional] delegation is working on the issue. He explained
that he brought this matter to the committee's attention because
without correction, the demographics of Alaska will be changed.
He opined that Alaskans will head south to obtain health care.
He pointed out that the Lewin report is based on the status quo,
and factors such as this may cause [different results].
CHAIR WILSON asked if a letter from the committee [to Alaska's
congressional delegation] would be helpful.
MR. FULLER responded that it wouldn't hurt.
8:54:30 AM
REPRESENTATIVE CISSNA, recalling her visit to Washington, D.C.,
about three years ago, noted that U.S. Senator Stevens' office
had indicated that they'd not received enough support for the
increase in Medicaid payments to the practitioners.
Representative Cissna also related that she has received
constituent concerns about access to physicians. Therefore, she
questioned how this issue could be made a more high profile
issue. She related her belief that people didn't realize that
[Medicaid payments] were being supplemented above the normal
payments. The loss of that must have really increased the
problem and may not be realized at this point yet. She then
questioned how this problem can be tracked in order to be able
to inform the general public.
8:56:50 AM
MR. FULLER continued his testimony by reiterating that the
overall demographic is driving the Lewin projection, including
inflation, increased aging, et cetera. Furthermore, within the
PCG report and previous reports, there are recommendations with
regard to changes to Alaska's system to be able to sustain the
system long term. Mr. Fuller pointed out that one of the
primary areas is entry into the long-term care system. He then
recalled recent testimony to Congress from Arizona's governor in
which she related that Arizona has a vigorous medical
eligibility pool, which means that the state has a rigorous
objective screening of individuals prior to determining the
level of care required. The aforementioned is the gateway into
the waiver system. Alaska, he opined, needs to improve such
that there is better enforcement when individuals don't need to
be in nursing home care.
MR. FULLER then explained that in Alaska and the nation the
primary source of long-term care is the daughter and the
daughter-in-law. Any system changes shouldn't disrupt the
aforementioned, but instead should support that. Mr. Fuller
opined, "While the Medicaid costs for long-term care is
increasing rapidly, we still have this huge unpaid pool out
there, the relatives - the unsung heroes, if you will. And
whatever changes we want to make in the future that make it
sustainable, we don't want to disrupt that. We want to support
that as best we can."
CHAIR WILSON remarked on the issue of burnout with regard to
relatives taking care of older relatives after coming home from
a job.
8:59:48 AM
REPRESENTATIVE GARDNER related her understanding that those
providing care to family members are now being paid by the
state, which has resulted in more people being paid for
services. The aforementioned could be attributing to rising
costs, she indicated.
MR. FULLER acknowledged that the system is not perfect, but
assured the committee that [the department] will continue to
make improvements.
REPRESENTATIVE CISSNA highlighted that she has observed a
demographic shift in Alaska from the time when people left the
state to take care of their family. However, now it seems that
more people are deciding to stay in the state, bring family
members to the state, and even retire in the state. There is
also the situation in which older Alaskans are filling jobs and
there is a gap due to the lack of a younger middle age sector in
the state. Therefore, it would seem that if the policies are
changed enough, there will be a decrease in the middle-aged
individuals who bring family members into the state. Those
individuals will leave the state with family members, she
opined.
MR. FULLER acknowledged those points, but said that he doesn't
have any data. Across the nation in terms of employment, there
will be large retirement booms across the country in the next
five years. Moreover, there are much fewer younger people
moving along with the expertise or even the desire to take over
some of these rather important jobs. This is all part of the
Baby Boom. When social security began, 40-50 workers supported
each retired person while now only 2-3 workers support each
social security beneficiary.
9:03:51 AM
CHAIR WILSON remarked that Alaska might be the only state in
which those 65 and older don't pay property taxes. Furthermore,
there is no state income or state sales tax in Alaska and thus
the state doesn't receive any revenue from older Alaskans.
Therefore, the more people who come to the state, the more
difficult it is for the state to provide services because there
is no more money received by the increased population. She
opined that the state can't sustain [this situation].
9:05:37 AM
REPRESENTATIVE CISSNA emphasized that there's a distinction
between what is good for the state and what is good for the
local economies. For the state, it would be best if no one came
to Alaska at all because of the pressure on the state created by
an increase in population. However, in small communities the
retired and elderly population is doing the unpaid volunteer
work. The seniors are the ones with real money in the community
and create the ability for small communities to exist, she
related. If the aforementioned is true, the legislature should
know that because it will have a large impact. She reminded the
committee that a legislator's job is to "keep the state okay"
and to build the local economy.
MR. FULLER continued his testimony by mentioning the
recommendations in the PCG report regarding the need to modify
and improve the service array to best support people in their
own homes as long as reasonably and financially practical.
Furthermore, the assisted living array of services needs to be
appropriate to keep people out of nursing homes. Mr. Fuller
said that these reports provide numerous recommendations to
consider, and it would be impossible to simply institute those
of even one report. He estimated that it would require a
transition of three to five years in order to reach the goal of
a sustainable system. He suggested that now, while the budget
is solid, is the time to figure out this situation.
9:11:10 AM
CHAIR WILSON mentioned that she has recently spoken with one of
the House Finance Committee co-chairs who has indicated that as
early as next year there will be cuts in the budget if things
don't improve. She emphasized the need to know the
ramifications of the changes.
MR. FULLER noted that in the health care system one can cut
services, but if someone is sick that individual will receive
services and those services are likely to be received in the
highest cost setting, the emergency room. Therefore, he
suggested that the committee review possible unintended
consequences because they can cost more in the short-term and
the long-term. Additionally, the quality assurance system must
be modified and improved in order to work in conjunction with
the new system. He pointed out that the over age 85 group
probably doesn't have many relatives to check on them no matter
where they live and thus a quality assistance structure to
ensure that people are safe and not being abused or taken
advantage of by others is necessary.
MR. FULLER then turned attention to the tribal health care
system in Alaska. He explained that when the tribal health care
system provides services to an American Indian or Alaskan Native
it's 100 percent federally funded. The tribal system is only
beginning to look at the long-term care system as a service
array that it might be able to provide to its members. If the
state can work closely with the tribal health corporations and
support them in their expansion of long-term care services for
members, those organizations and the state win. However, he
acknowledged that federal funding is fairly flat and thus tribes
have their own financial issues to deal with as they try to meet
the needs of their members.
9:15:34 AM
MR. FULLER informed the committee that the Deficit Reduction
Act, which was passed earlier this year, includes some
provisions to assist states in helping middle class Americans
not spend down or hide assets in order to become eligible for
Medicaid. Furthermore, [the Act] has opened up the possibility
of long-term care partnerships, which have been utilized in four
states for some time, such that those who can afford long-term
care insurance can use it to shelter an equal amount of assets
compared to the benefit of the insurance they have. Although
the savings are only a few million, the middle class folks who
obtain and use this insurance generally don't enter the Medicaid
system.
MR. SHERWOOD, in response to Chair Wilson, explained that if one
qualifies for Medicaid to pay for long-term care, the individual
has to meet financial eligibility criteria. Any money [the
state] would spend on long-term care is subject to estate
recovery, and therefore the state can make a claim against an
individual's estate once he/she dies. If someone purchases a
long-term care insurance policy under this partnership, the
individual receives a dollar-for-dollar credit when applying for
Medicaid, and thus reduces that individual's assets that are
counted for Medicaid. Furthermore, under this program when an
individual dies, the state will disregard the credit established
under the long-term care partnership from the estate recovery
procedure. Moreover, if the long-term care partnership policy
proves to be inadequate, Medicaid can still pay. In further
response to Chair Wilson, Mr. Sherwood said that individuals
using the long-term care partnership can do what they want with
those assets they have set aside. He informed the committee
that those states who implemented this program in 1993 are just
beginning to see savings because relatively small numbers of
individuals who purchased this insurance are using long-term
care. Although it's uncertain how much states will save in the
long term, the program is a way to encourage the middle class to
take more responsibility for providing for their long-term care
along with a backup system with the Medicaid system.
CHAIR WILSON suggested that Legislative Research may need to
look into the aforementioned.
9:21:09 AM
CHUCK BURNHAM, Legislative Analyst, Legislative Research,
Legislative Legal and Research Services, Legislative Affairs
Agency (LAA), agreed to do so.
MR. FULLER informed the committee that a second option for those
with estates with assets is reverse mortgages. However, those
are very high cost loans. He suggested that perhaps reverse
mortgages could be made more consistent and governed by the
Division of Insurance in order to cause people to be more
willing to utilize that approach. With regard to other general
incentives, he expressed the option of implementing incentives
that would encourage individuals to utilize their permanent fund
dividend with a state supplement in order to purchase long-term
care. Again, the notion is that individuals have to be
responsible for him/herself as best as possible. Mr. Fuller
acknowledged that there are individuals who will never be able
to save or acquire assets to take care of themselves in old age.
Medicaid should take care of such people. However, the other
population should be educated with the fact that they can't
necessarily count on the government taking care of them. Along
those lines, he related the following quote: "If I knew I was
going to live so long, I would have taken better care of
myself." Mr. Fuller then highlighted that there are other
issues, including that the workforce consists of fewer younger
people available to take care of the rapidly growing older
population. Therefore, the question becomes who will provide
the services to this older population. He emphasized that the
aforementioned is a national issue with no simple answer for
Alaska.
9:25:18 AM
CHAIR WILSON, drawing upon her nursing background, related the
higher cost for traveling medical professionals such as nurses.
If this is the situation now, she questioned what will happen
when the long-term care situation worsens.
CHAIR WILSON asked if the department could specify to the
committee which recommendations have been put in place.
MR. FULLER answered that he could provide that to the committee.
^Using Alaska's Health Care Dollars Wisely: Chronic Disease
9:28:25 AM
CHAIR WILSON announced that the last topic the committee would
consider would pertain to using Alaska's healthcare dollars
wisely with regard to chronic disease.
9:28:46 AM
TAMMY GREEN, Chief, Chronic Disease, Division of Public Health,
Department of Health and Social Services (DHSS), referred to a
PowerPoint presentation entitled, "Chronic disease in Alaska."
She began by emphasizing that chronic disease is impacting the
health care system in multiple ways. In order to review the
scope of chronic disease, one needs to review the number of
deaths, the quality of life, and the economic burden related to
chronic disease. In fact, in 2004 58 percent of all deaths were
related to chronic disease. Cancer is the top cause of death in
Alaska. She then expressed the need to review the long-term
impacts of chronic diseases because chronic diseases impact
people's lives beyond just death as related in the slide
entitled, "Years of Productive Life Lost to Chronic Diseases
Alaska 2004." For instance, due to deaths from the top seven
chronic diseases, 8,630 years of productive life was lost in
Alaska in 2004. Furthermore, Alaskans who die from cancer lose
an average of 4.5 years of productive life and Alaskans who die
from diabetes lose an average of 7.1 years of productive life.
Moreover, chronic diseases limit activity as related in the
slide entitled, "Chronic Disease Limits Activity." In response
to Chair Wilson, Ms. Green emphasized the need to relate to
people that once an individual is diagnosed with a chronic
disease, there are many opportunities for self care and choices
that enhance that individual's health and productivity.
9:33:49 AM
REPRESENTATIVE CISSNA asked if there is a comparison of how much
more or less Alaskan's are at risk as compared to other states.
MS. GREEN said that a comparison of risk factors could be
provided. She noted that she will review one of Alaska's major
risk factors, smoking.
CHAIR WILSON opined that what physicians tell patients makes a
difference. She indicated the need for physicians to relay to
patients [to take proactive steps to manage chronic diseases].
MS. GREEN concurred, and noted that some physicians may not have
been trained in any nutrition, lifestyle, or preventative
medicine. Physicians have an opportunity to educate patients,
particularly older patients who look to their physicians for
answers, she noted.
9:36:47 AM
MS. GREEN then continued with the slide entitled, "Chronic
Disease Reduces Quality of Life," which relates that diabetic
Alaskans report 11.7 poor health days per month and Alaskans
with arthritis report 6.8 poor health days per month. She
highlighted that often individuals have multiple chronic
diseases, which creates a synergistic impact on health. The
next slide "Chronic Disease Increases Health Care Costs" relates
that 75 percent of health care costs in the U.S. are directly
related to chronic disease. Therefore, chronic diseases have to
be addressed. For a large portion of the population, healthier
lifestyle choices are key.
9:39:13 AM
MS. GREEN moved on to the slide entitled, "How We Got There,"
which relates the following three major risk factors: tobacco,
inactivity, overweight and obesity. If the aforementioned
factors could be eliminated or people could be engaged in
healthier behaviors, Alaska and the nation would be on its way
to a healthier society.
REPRESENTATIVE CISSNA recalled that when she was diagnosed with
cancer she was told that the number one risk factor is aging.
Alaska has an aging population.
MS. GREEN agreed that as people age, they are more at risk for
certain [diseases/conditions]. However, the earlier mentioned
major risk factors speed up [chronic diseases] as well as the
aging process. In response to Representative Gardner, Ms. Green
explained that alcoholism, although it's a problem in Alaska,
isn't directly associated to chronic disease as the three major
risk factors listed. However, the section tries to partner with
those working on alcoholism and keep it in mind with chronic
disease.
9:41:33 AM
MS. GREEN turned attention to the slides reviewing adolescent
and adult smoking in Alaska and the U.S. The slides illustrate
that adolescent smoking has decreased and is approaching the
Healthy Alaskans 2010 goal of 17 percent. However, the national
trend with adolescent smoking has been to increase. There
hasn't been any adolescent smoking data for Alaska since 2003.
She explained that the lacking data is related to the active
parental consent requirements of the Youth Risk Behavior Survey,
which make it difficult to obtain enough parental consent to
survey students. With regard to adult smoking, the rates among
adults have flattened out close to the national rates. However,
the Alaska Native adult population has about twice the smoking
rate. Ms. Green moved on to the slides related to overweight
adolescents and adults in Alaska and the U.S. About 27 percent
of Alaska's students are overweight or at risk for being
overweight. Nationally [and in Alaska] the percentage of adults
over the last 10 years who are overweight or obese is climbing.
In fact, 63 percent of Alaskan adults are either overweight or
obese, which will impact Alaska's health care system in multiple
areas.
MS. GREEN continued with the slide entitled, "How Are We
Addressing It," and opined that it's very difficult to get
people to change behaviors that have developed over a lifetime.
She explained that one route is to identify the places where
unhealthy behaviors occur and can be impacted while recognizing
the role of individual choice. There seem to be four settings
in which the agency can impact: the community, the school, the
worksite, and the health care [environment]. She then related
some of the initiatives currently under way, including the
formation of the Section of Chronic Disease Prevention & Health
Promotion. The formation of the section has provided the
opportunity for integration and "more bang for our buck." Other
initiatives under way are as follows: employee health
improvement, school wellness initiative, community-based
prevention, disease management, chronic disease self management.
She mentioned that most of the section's programs are primarily
funded by the federal Centers for Disease Control and
Prevention.
MS. GREEN then reviewed the initiatives under way with regard to
employee health improvement. She informed the committee that
the section is doing a pilot project with BlueCross BlueShield
of Alaska to help it develop a set of best practices for small
businesses in Alaska to ensure that health promotion can be
accomplished in an effective and fiscally manageable manner.
She suggested that perhaps in the next six months there will be
a how to handbook for small businesses in Alaska in terms of
employee wellness. In response to Chair Wilson, Ms. Green
clarified that this pilot project is separate from the state
employees as it is working with very small businesses having
less than 200 employees.
9:49:02 AM
MS. GREEN continued her presentation with the initiatives in the
school environment. As most would agree, the youth of today are
the future and need to be healthy. However, children today are
adopting a lifestyle that is not conducive to longevity and
health. Ms. Green agreed with Chair Wilson that the coming
generation will be the first generation that isn't expected to
live as long as their parents. She then informed the committee
of the federal legislation that mandated in the Women, Infants,
and Children (WIC) reauthorization that schools need to develop
wellness policies by the summer of 2006. Therefore, the section
staff has been working diligently with the [U.S.] Department of
Education to produce an Alaska wellness tool kit. In fact, just
recently there was a wellness institute that was well attended
with over 65 participants. In response to Chair Wilson, Ms.
Green confirmed that the aforementioned federal mandate doesn't
include funding specifically, which is why some school districts
are just taking the sample policy established by the Alaska
Association of School Boards. However, other school districts
are fully embracing this and utilizing it as an opportunity to
push forward efforts already under way. For example, in
Anchorage huge strides have been made to switch out vending
machines. She noted that the Mat-Su and Kodiak school districts
have done similar things. She noted that there are some small
pots of money from the U.S. Department of Agriculture (USDA) for
the Team Nutrition Grant. Again, getting support for the YRBS
is important in order to provide strong foundational arguments
for changes and determine if those changes are making a
difference. Within the community environment there are several
initiatives under way, most of which are community-based tobacco
prevention programs since that's from where the most funding
comes. She mentioned that currently there is review of a
collaborative effort between the school and the community in
order to launch some initiatives regarding tobacco prevention in
rural Alaska. Hopefully, with that initiative the section will
be able to utilize some of the other broader and comprehensive
health education initiatives.
9:53:44 AM
REPRESENTATIVE GARDNER asked if the funds being used for these
tobacco initiatives are from the tobacco settlement monies.
MS. GREEN replied yes.
REPRESENTATIVE GARDNER asked if the fact that the tobacco
settlement monies have been used in these other programs has
impacted the ability to move forward with programs.
MS. GREEN opined that there is a very good base at this point,
although there's always a need for more. She noted that in the
future she anticipates increased funding. She acknowledged the
need to be judicious when spending money and thus the things on
which the money is being spent should be evaluated as to whether
they are having an impact. Ms. Green further opined that at
this point the section is keeping up with what it can do and
ensuring that it's good quality work. As an aside, she
expressed that it would be great if there was the opportunity to
use some of the funds in a broader sense for other chronic
diseases.
REPRESENTATIVE CISSNA echoed comments regarding the fact that at
the seat of many of these habitual choices is the use of
alcohol. Therefore, it would be interesting to know the impact
of drinking and smoking on prevention dollars.
9:56:13 AM
MS. GREEN, in response to Representative Gardner, clarified that
there simply aren't enough funds to do broader approaches. She
opined that it would be great to have enough funds to perform
community-based programs in other areas [of chronic disease],
such as with obesity prevention.
REPRESENTATIVE GARDNER asked whether the state's use of the
tobacco settlement funds is adversely impacting the section's
ability to do what the funds were designed to do.
MS. GREEN answered that currently the tobacco settlement funds
are being used in a functional, judicial way. She further
clarified that it would be nice to have the flexibility the
tobacco settlement funds offer with other funding streams in
order to do what is done with tobacco for other issues. Ms.
Green then moved on to the health care environment and related
that the section is just starting to review what can be done in
the area of disease management. She explained, "Disease
management is a system of coordinated health care interventions
and communications for populations with conditions in which
patient self-care efforts are significant." She highlighted
that disease management supports the provider/patient
relationship and plan of care; emphasizes prevention utilizing
evidence-based practice guidelines and patient empowerment
strategies; and evaluates clinical, humanistic, and economic
outcomes. The aforementioned merely means that disease
management is a system that's designed to intervene at a patient
level in order to help patients manage their disease. Disease
management is being used not only to improve costs but also to
improve the quality of the health care outcomes. She noted that
within Health Care Services, there is an individual dedicated to
reviewing how disease management will look in Alaska. In
response to Chair Wilson, Ms. Green related that there are about
45 staff in the Section of Chronic Disease. In further
response, Ms. Green confirmed that all the programs are
scientifically based.
10:00:45 AM
MS. GREEN, in response to Representative Cissna, related that
the cause of most health care expenditures is related to
lifestyle choices and issues. However, the amount of money
spent on prevention on the medical system is less than 1 percent
while 90-some percent of money spent on the medical system is on
after-treatment. She explained that the goal with disease
management is to focus on the individual's quality of life
because those at the disease management stage have moved past
prevention. Ms. Green emphasized that she would like to see
more effort made with regard to prevention, although she
acknowledged that it is difficult to quantify what is not going
to happen with regard to prevention.
10:04:02 AM
CHAIR WILSON recalled that earlier testimony related that
chronic disease health care costs account for about 75 percent
of health care in the U.S.
MS. GREEN said that she doesn't have an exact cost of chronic
disease health care in Alaska, but estimated that it is fairly
close to or a bit higher than the national cost.
CHAIR WILSON opined that the state has to look toward prevention
because chronic disease health care costs are expensive and it's
growing.
MS. GREEN concurred, offering her preference to put funds toward
[prevention]. Ms. Green continued with her presentation and
turned to the self-management component of disease management.
She informed the committee that a nationally known professor who
developed a model of chronic disease self-management was brought
to the state to train the federally qualified health centers,
other community health care centers, providers, and community
members. The six-week self-management course teaches people how
to eat correctly, manage stress, exercise, and ensure
medications are taken. Ms. Green highlighted that much work
remains, including working more with communities, providing
communities with prevention information and tools to help them
manage their own health care, and continue partnering with
schools to promote healthy lifestyles among youth. In
conclusion, Ms. Green said that if nothing is done and health
care costs continue to rise "The youth of today may, on average,
live less healthy and possibly even shorter lives than their
parents." She questioned whether that's the legacy desired for
the next generation.
10:07:04 AM
SENATOR DAVIS inquired as to the percentage of state funds that
the section receives.
MS. GREEN answered that 5-10 percent of the section's total
budget comes from general funds.
SENATOR DAVIS indicated that the legislature should look into
[what funds it could provide] to this section.
REPRESENTATIVE CISSNA commented that often the people who give
money are those who have already invested in the program. If
the state doesn't invest more funds into the health of the
state, it won't follow through and do what is really necessary.
Until health is viewed as more important in the state, the state
won't invest in it. Representative Cissna then provided the
committee with a copy of the last Health Caucus meeting, which
reviewed how to decrease costs through prevention.
CHAIR WILSON mentioned that she had provided the committee with
a copy of a Newsweek article entitled, "The Monster at Our
Door."
[Following was a brief discussion regarding the committee's next
meeting.]
ADJOURNMENT
10:21:10 AM
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 10:21 a.m.
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