Legislature(2011 - 2012)CAPITOL 106
03/20/2012 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: the Federal Health Law and Alaska: What You Need to Know. | |
| Overview: Health Care | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 20, 2012
3:03 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Charisse Millett
MEMBERS ABSENT
Representative Beth Kerttula
Representative Bob Miller
OTHER LEGISLATORS PRESENT
Senator Cathy Giessel
COMMITTEE CALENDAR
PRESENTATION: THE FEDERAL HEALTH LAW AND ALASKA: WHAT YOU NEED
TO KNOW.
- HEARD
OVERVIEW: HEALTH CARE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
CHRISTIE HERRERA, Director
Health and Human Services Task Force
American Legislative Exchange Council (ALEC)
Washington, DC
POSITION STATEMENT: Presented a PowerPoint titled, "The Federal
Health Law and Alaska: What you need to know."
WILLIAM STREUR, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Health Care
and Fiscal Sustainability" and answered questions.
BECKY HULTBERG, Commissioner
Office of the Commissioner
Department of Administration (DOA)
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Health Care
and Fiscal Sustainability" and answered questions.
ACTION NARRATIVE
3:03:58 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Keller, Seaton, and Dick were present at the
call to order. Representatives Herron and Millett arrived as
the meeting was in progress.
^Presentation: The Federal Health Law and Alaska: What you
need to know.
Presentation: The Federal Health Law and Alaska: What you need
to know.
3:04:24 PM
CHAIR KELLER announced that the first order of business would be
a presentation on "The Federal Health Law and Alaska: What you
need to know." He offered his belief that the rising costs of
health care were a "huge threat to us, and its spooky." He
noted that although anyone could go to an emergency room, that
cost was not sustainable. He reported that ALEC (American
Legislative Exchange Council) wrote model legislation for health
care.
3:07:27 PM
CHRISTIE HERRERA, Director, Health and Human Services Task
Force, American Legislative Exchange Council (ALEC), said that
she was going to explain how the PPACA (Patient Protection and
Affordable Care Act) would affect Alaska. She displayed slide
2, "An Overview," explaining that she would address the
individual and employer mandates, the expansion of Medicaid, and
the health insurance exchanges. Moving on to slide 3, "PPACA's
Individual Mandate," she defined the individual mandate as a
federal requirement that you purchase health insurance, and
stated that individuals who did not comply would be fined the
greater of $95 or 1 percent of their annual income, increasing
to 2.5 percent of income in 2016. She reported that individuals
with insurance which did not meet "minimum essential coverage"
criteria would also be subject to fines. She opined that the
penalties were not strict enough and, as the supply of health
insurance had not increased enough to meet the demand, there had
not been resolution to the "free rider" problem. She reported
that emergency room usage in Massachusetts increased by 17
percent after its health insurance mandate went into effect.
She pointed out that the U.S. Supreme Court would hear six hours
of oral argument on this federal health care law. She shared
that 14 states had passed the "Health Care Freedom Act" which
prohibited an individual mandate, and she noted that 67 percent
of Americans disapproved of the individual mandate.
3:11:24 PM
CHAIR KELLER, offering his belief that the individual mandate
was "the heart of ObamaCare," declared that there was no
incentive to pre-purchase insurance with an individual mandate,
as insurance could be purchased at any time and had to cover
every pre-existing condition for an individual.
MS. HERRERA suggested that individuals with pre-existing
conditions could be taken care of through measures other than
the individual mandate, including purchase of insurance through
state high risk pools, extra subsidies to purchase health
insurance, and buying into a state Medicaid program. She moved
on to slide 4, "PPACA's Employer Mandate," which stated that any
business with more than 50 employees had to provide government
defined benefits, or pay a fine. She declared that states would
also be subject to this employer mandate.
3:14:23 PM
MS. HERRERA, moving on to what she declared to be the second leg
of the PPACA stool, slide 5, "PPACA = Skyrocketing Medicaid
Enrollment," said that states would be required to extend
Medicaid to anyone earning up to 133 percent of the federal
poverty level, the equivalent of an income of $30,000 for a
family of four. She directed attention to the map on slide 5,
and said that 15 states would have increases to the Medicaid
roles by 30 percent, while 9 states would experience increases
of 40 percent.
3:15:33 PM
REPRESENTATIVE SEATON posed that, as the State of Alaska was
currently extending Medicaid coverage for 150 percent of the
federal poverty level, what would be the affect for the
aforementioned coverage of 133 percent.
MS. HERRERA, in response, said that it would be necessary for
Alaska to apply for a federal waiver for matching funds to any
funding over the 133 percent coverage.
3:16:51 PM
MS. HERRERA moved on to slide 6, "Tightening Budgets," a map of
the United States which showed the state by state percentages of
state budgets spent on Medicaid in FY 2010. She reported that,
although the average state spending on Medicaid was 17 percent,
Alaska only spent 6 percent of its budget on Medicaid, the
fourth lowest Medicaid budget in the U.S. She offered her
belief that PPACA would increase the Medicaid budget, which
could result in budget cuts to other programs.
3:17:54 PM
MS. HERRERA reviewed slide 7, "The Problem with Federal
Funding," and acknowledged that federal funding would pay 100
percent of the Medicaid expansion costs until FY 2020, with 90
percent funding after that. She said that although this would
be paid through taxes, it would not cover everyone. She
reported that, nationally, 25 percent of the uninsured were
eligible for Medicaid but had not yet enrolled; however, if they
did apply, there would not be additional federal funding. She
guesstimated that this could cost about $70 million in Medicaid
expansion costs through 2020.
3:19:14 PM
MS. HERRERA, directing attention to slide 8, "PPACA = More
Crowded ERs," shared that many people had suggested a need for
the individual mandate in PPACA in order to relieve the
congestion in emergency rooms. She offered her belief that
Medicaid recipients were most often the users of emergency rooms
for non-emergency care, which she attributed to the scarcity of
physicians for Medicaid patients due to the low reimbursement
rates to doctors from Medicaid. She directed attention to a
study about the frequent users of emergency rooms, more than
four visits annually for non-emergency care, and reported that
67 percent of those patients were Medicaid or Medicare
recipients. She reflected on the difficulties of finding a
physician, even with Medicaid coverage.
MS. HERRERA spoke about slide 9, "PPACA = Poor Health Outcomes,"
which listed various studies for the lower quality of care and
the difficulties for access of care for Medicaid patients.
3:20:58 PM
MS. HERRERA identified slide 10, "Exchanges: In Theory," and
defined a health care exchange as a neutral health insurance
market place for the buyer to use the pre-tax, defined
contributions from an employer toward the purchase of a personal
health insurance policy. This would allow the patient to
maintain policy coverage with the same health insurance carrier,
regardless of job situation.
MS. HERRERA reviewed slide 11, "Exchanges: In Practice," and
noted that there were private health insurance exchanges,
including e-health insurance.com, which gave the buyer a list of
health care options available. She summarized that the PPACA
health insurance exchange would subsidize the individual mandate
for the purchase of health insurance and would impose price
controls and standardize benefits. She offered her belief that
this could restrict choices for coverage and could limit
innovation by health insurers. She declared the Massachusetts's
Health Connector to be a model for the PPACA model. This plan
determined that only plans of "high quality" and "good value"
could be sold. She shared that the annual operating cost for
the Massachusetts exchange was more than $40 million, but that
since its inception in 2006, the annual premiums for a family
had only increased by $2500. She presented that the Utah Health
Exchange model had also provided a list of health care options,
and that it had provided coverage for 5,500 people.
3:24:41 PM
MS. HERRERA, providing slide 12, "Federal Exchange = State
Exchange," shared that many states looked to implement state
health insurance exchanges in lieu of a federal solution. She
offered her belief that many factors pointed to the formation of
a federal health insurance exchange which would be operated,
administered, and paid by the states. She noted that a state
health insurance exchange had to be approved by the Department
of Health and Human Services using federal rules and standards.
She confirmed that federal subsidies would be proffered to the
state exchanges.
3:26:03 PM
MS. HERRERA indicated slide 13, "How PPACA Controls State
Exchanges," which listed the federal regulations on the state
exchanges, including the benefits, the plans offered, and the
preferred providers. She explained slide 14, "The Threat of a
Federal Exchange?" She opined that, although there was not any
current funding for federal exchanges, Congress had previously
funded the exchanges. She noted that PPACA did not mention the
offer of any subsidies to a federal exchange.
3:27:09 PM
CHAIR KELLER asked if states were creating health insurance
exchanges.
3:27:32 PM
MS. HERRERA said that 15 states had enacted legislation for the
health insurance exchanges, and she opined that the Department
of Health and Human Services (DHHS) had changed the time table
for compliance.
3:28:36 PM
MS. HERRERA assessed slide 15, "The Threat of a Federal
Exchange?" She referred to a recent report from DHHS that $1
billion had been granted to states for health insurance
exchanges, with an additional $150 million for a federal
exchange for coordination of benefits, eligibility, subsidies,
and premiums. She reflected that even more funding could be
necessary.
3:29:19 PM
MS. HERRERA introduced slide 16, "State Exchanges Can Strengthen
PPACA," and reported that the federal court judge in Florida had
refused to stop implementation of PPACA because eight of the
plaintiff states would continue to implement it regardless of
the ruling. She explained that the federal government had
argued that the exchanges were critical as they would be used to
determine support for the individual mandate in PPACA.
3:30:24 PM
MS. HERRERA, referring to the aforementioned $1 billion federal
grant to states, explained that this funding would expire in
2015. She offered examples of ways states could increase
revenue for funding, including user fees, provider taxes, sin
taxes, naming rights, and reallocation of other funding, slide
17, "State Exchanges Can Be Costly."
3:31:10 PM
MS. HERRERA presented slide 18, "Other Considerations," and
spoke about other initial concerns for the health exchanges,
which included early adopter risks, technological snafus, high
costs, and other unanswered questions.
3:32:48 PM
MS. HERRERA analyzed the U.S. map on slide 19, "Exchange
Implementation in the States," which depicted that 17 states had
enacted legislation for an exchange, 11 had established Exchange
planning, and 10 had not taken any action to this point.
3:33:37 PM
MS. HERRERA relayed that slide 20, "Exchange Grants in the
States," depicted the use of exchange grants throughout the
states. She pointed out that every state, except Alaska, had
accepted the $1 million planning grant. She shared that 26
states had already accepted money to establish an exchange, with
4 states refusing the exchange grants.
3:34:41 PM
MS. HERRERA introduced slide 21, "Action Stalled in 2/3 of
Exchange States," and assessed the progress of the health
exchanges in 15 states: West Virginia, Rhode Island, and three
others were "pretty far along;" California had signed its
exchange into law; Colorado, Illinois, Indiana, North Carolina,
and Virginia had either enacted the exchange or its intent.
3:36:12 PM
MS. HERRERA moved on to slide 22, "More States are
Reconsidering." Referring to the aforementioned 11 states that
had established Exchange planning, she reported that Alabama,
Mississippi, and Arkansas had determined to start an Exchange,
while North Dakota had passed legislation for an exchange but
then voted against its establishment.
^Overview: Health Care
Overview: Health Care
3:37:47 PM
CHAIR KELLER announced that the final order of business would be
an overview of health care.
3:38:54 PM
WILLIAM STREUR, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), presenting a
PowerPoint titled "Health Care and Fiscal Sustainability," said
that the health care issues in the State of Alaska were not
strictly related to Medicaid, or state employees, but to
everyone. He referred to slide 2, "By 2037, health insurance
will swallow your entire paycheck," and noted that, by 2037, at
the current rate of inflation, the cost of health care would
swallow the entire household paycheck.
3:40:38 PM
BECKY HULTBERG, Commissioner, Office of the Commissioner,
Department of Administration, directing attention to the
PowerPoint titled "Health Care and Fiscal Sustainability,"
announced slide 3, "Why are we here?" and explained that this
was "a bigger picture of health care than if you would just look
at Medicaid or one of our plans, or even two of our plans." She
reported that Alaska spent money on health care plans for active
employees, retires, Medicaid, inmates, state employees who were
members of union health trusts, and state workers' compensation
claims.
COMMISSIONER HULTBERG offered slide 4, "State Budget: 2001 -
2010," as a context for the remainder of the presentation. She
noted that state spending for capital and operating budgets had
doubled in that time, an annual rate of growth of 7.5 percent,
which included an annual CPI (Consumer Price Index) rate of 2.6
percent. She declared that there were growing wants and needs
for state general fund dollars.
COMMISSIONER HULTBERG directed attention to slide 5, "State
Revenue," which stated that oil revenue had subsidized Alaska,
slide 6, "State oil production: 2001 - 2010," which graphed the
annual 5 percent decline of oil production in Alaska, and slide
7, "State Health Care Spend: 2001 - 2011," which showed that
health care spending had doubled in the last decade, an annual
increase of 8 percent, whereas annual inflation was only 2.6
percent.
3:43:47 PM
COMMISSIONER HULTBERG summarized slide 8, "State health care
spend," which plotted the amounts spent for health care to the
aforementioned plans, and estimated that 25 percent of the $2
billion health care dollars were paid by the State of Alaska.
3:44:25 PM
COMMISSIONER HULTBERG indicated slide 9, "Where does our current
path lead?" She declared that, should the increase in health
care cost continue at a 9 percent rate, it would double to $4
billion by 2020. She pointed out that this did not include an
anticipated increase in Medicaid or a boom in the state retiree
plan population.
3:45:18 PM
COMMISSIONER STREUR clarified that slide 10, "Challenge:
Medicaid" did not reflect any increase to Medicaid cost under
PPAPC. He stated that the projected cost increase was founded
on the current growth history while implementing some recent
program changes. He declared "we are trying to bend that
curve."
3:46:00 PM
COMMISSIONER STREUR, furnishing slide 11, "AK DHSS 10- year plan
operating budget," projected the FY2013 Department of Health and
Social Services (DHSS) budget to be $2.6 billion, the largest
department budget in the state. He projected that, in FY2022,
the DHSS budget would be $6.6 billion. He said that although
the cost of PPACA to Alaska was unknown, there was a projection
for 35,000 new enrollees in the state, at a cost of between
$6600 and $17,000 per recipient. He shared that the non-service
related costs for increasing the Medicaid enrollees was also
unknown. He observed that the population of Alaska was aging,
and that public assistance could be increasing.
3:48:31 PM
COMMISSIONER STREUR reviewed slide 12, "Medicaid direct services
Beneficiaries and expenditures," and noted that there was a
continual increase to the number of enrollees, and the
subsequent cost, for Medicaid. He reported that there was more
access and utilization of health care.
3:49:41 PM
COMMISSIONER HULTBERG called attention to slide 13, "Challenge:
PERS/TRS," which charted the projected growth for the retirement
system. She declared this to be the largest plan managed by the
Department of Administration (DOA). She noted that, as the
retirement system was growing, it was a difficult plan to
manage; as most health plans were dynamic in response to a
changing market, the Alaska retirement plan was safeguarded by
the diminishment clause in the Alaska State Constitution, and
consequently, changes were rare and often contested in court.
3:50:45 PM
COMMISSIONER HULTBERG selected slide 14, "Retiree medical
expense growth," which depicted two areas, other than population
growth, that influenced medical expense growth. She noted that
the medical cost per member had increased 5.4 percent in the
prior year. She expressed concern that there had been a 4.3
percent decrease in utilization of services, but an increase of
10 percent in provider costs. She stated that utilization would
not decrease indefinitely; therefore, it was imperative that
provider costs not increase at this same rate.
3:52:33 PM
COMMISSIONER STREUR considered slide 15, "Controlled growth in
Medicaid," and indicated that the options were limited to
control Medicaid growth. He noted that the state was restricted
in making any changes to eligibility for Medicaid. He reported
that utilization controls, such as pharmacy and chronic care
management, could be focused upon for controlling costs, whereas
the federal government was focused on compliance/ anti-fraud.
He declared that the opportunity for innovations in service
delivery, including chronic care management, adequate pricing,
generic medications, bundling of services, and patient centered
medical home, could change health care delivery in Alaska. He
offered his belief that new technology in and between hospitals,
and between states, was still not fully operational for optimum
service.
3:56:19 PM
CHAIR KELLER asked if there was any good news.
3:57:06 PM
COMMISSIONER STREUR replied that, as the status quo was not
acceptable, hard choices were necessary for smarter ways to
deliver health care.
3:57:35 PM
REPRESENTATIVE MILLETT asked for specific examples of choices
for smarter health care delivery.
COMMISSIONER STREUR asked that he respond to this later in the
presentation.
COMMISSIONER STREUR, directing attention back to slide 15,
declared that it was necessary to maximize revenue, and he
intoned, "right care, right time, right place, right amount of
money." He advised that DHSS had a lot of room for improvement
in health care delivery.
3:58:34 PM
COMMISSIONER STREUR moved on to slide 16, "State policy actions
implemented in FY 2011 and adopted for FY 2012." He said that
states were taking different measures to better provide health
care, including adjustment of provider payments, increased
primary care focus "at the front door, where they should have
been all the time," increased eligibility, reviews of benefits,
and initiatives to provide long term care in a more strategic
manner.
4:00:35 PM
COMMISSIONER STREUR, reflecting on slide 17, "Medicaid
Services," said that it was tough to determine whether services
would be mandatory or optional. Addressing optional services,
he declared that the reduction or elimination of transportation
services would affect the 60 percent of the state population
which was off the road system. He noted that inpatient
psychiatry for patients under 21 years of age was very
important. He stated that health care in Alaska was a good
package, but not a super generous package.
4:02:05 PM
COMMISSIONER HULTBERG presented slide 18, "Controlled growth in
AlaskaCare" and explained the costs associated with each plan.
She indicated the AlaskaCare retiree plan, and said that any
plan changes to retirees had to be a net benefit to the
retirees, or be offset by enhancements. She stated that this
had to be managed the same as any other health plan, taking into
consideration the many changing variables in health care. She
opined that preventive care should be covered in this plan, but
that it was not.
4:04:41 PM
COMMISSIONER HULTBERG, in response to Representative Seaton,
said that comprehensive changes could be made to the whole plan,
or the state could either offer a side by side plan for
selection of various coverages, or a package of benefits to
purchase. She opined that, although most retirees would not
select a package to purchase, the state was going to explore all
three options with the goal to provide a health plan with the
best quality care foremost. She questioned whether the current
plan promoted wellness and health. She declared a need to
manage the plan in a sustainable way because of the significant
impacts to the state's long term fiscal situation.
REPRESENTATIVE SEATON asked if a package of health care options
was available on a pilot plan basis, in order to review its
efficacy, yet not require a full plan amendment.
4:06:18 PM
COMMISSIONER HULTBERG replied that the concept had been
discussed, but that DOA had not yet spoken with the Department
of Law.
REPRESENTATIVE SEATON expressed his concern for the necessity of
to have a program in place for a while, before you could
determine its effectiveness.
COMMISSIONER HULTBERG stated her agreement with this option.
She opined that the likelihood of an optional package for
purchase would be selected by those already taking pro-active
measures for health. She expressed the need to enlist retirees
who were not actively managing their own health. She declared
that the challenge was not only to make the plan available, but
to ensure that there was an incentive for those who did not seek
preventive care to now do it.
REPRESENTATIVE SEATON suggested that "a real good deal" could
sometimes motivate more effectively than a mandated plan change.
COMMISSIONER HULTBERG reported that some plans, in jurisdictions
other than Alaska, actually paid their members to participate in
primary care.
4:09:17 PM
CHAIR KELLER declared that it was necessary to come up with
ideas.
4:09:31 PM
COMMISSIONER HULTBERG, returning attention to slide 18,
discussed the AlaskaCare active plan, which covered about 6200
state employees, and stated that, other than eligibility, the
DOA had many options to make adjustments to the plan for any
changes in cost or quality. She moved on to Union Trusts, and
stated that the majority of State of Alaska employees were in
this category. She reported that this payment was negotiated,
based on the premium cost for AlaskaCare members. She stated
that the State of Alaska did not provide the coverage for Union
Trusts, and that limited the controls placed on the plan. She
discussed Political subdivisions, which were PERS/TRS retirees
inherited into the retiree plan. She declared this to be
significant, as encouragement for wellness and healthy behaviors
while active employees resulted in healthier retirees; however,
as the State of Alaska did not manage the health care plans for
political subdivisions, there was no control of the wellness
plans, yet the state had to then inherit this group as retirees.
4:11:50 PM
COMMISSIONER HULTBERG, in response to Representative Seaton,
explained that the asterisks on slide 18 denoted areas which
allowed controls of the variable, though "not necessarily
straightforward." She noted that the diminishment clause for
the AlaskaCare retiree plan and the premiums for the Union
Trusts both allowed limited controls.
4:12:20 PM
COMMISSIONER STREUR called attention to slide 19, "Payment
comparisons," comparing the costs of Medicaid and Medicare in
Alaska to other plans throughout the Pacific Northwest,
including Washington, North Dakota, and Idaho. Noting that the
cost of Alaska Commercial Mean payments for high level, complex
office visits was far more than the cost in other states, he
clarified that it was difficult to pinpoint because the various
insurance payment systems often bundled rates. He reported that
the Medicaid population could be more difficult to manage,
because of missed appointments, non-compliance with doctor
orders, and other concerns; hence, Alaska Medicaid maintained
"ready and open access to care." He pointed out that Alaska
payment for obstetrical care was good.
4:14:45 PM
COMMISSIONER HULTBERG moved on to slide 20, "Payment
comparisons: by procedure," which compared costs of physician
fees between the Seattle area and the Anchorage area. Although
these procedures had significant cost differentials, she
reported that there were other procedures with even greater
discrepancies. She stated this to be a core area of cost
drivers which needed to be addressed. Even though Alaska was
deemed to be more expensive, this cost variance for compensation
was problematic.
CHAIR KELLER suggested the necessity for patient incentives, and
"empowering the market forces to be able again to have an
effect."
COMMISSIONER HULTBERG considered slide 21, "The hidden cost of
health care," and stated that, as health care costs grew at a
greater rate than other services, it was crowding out other
state investments, such as roads, public safety, and schools.
She declared the necessity of maintaining a healthy balance
among the state's obligations.
4:18:35 PM
COMMISSIONER STREUR directed attention to slide 23, "Innovations
in service delivery/payment," stating that, although he would
speak about Medicaid, much of it also applied to commercial
health care. He opined that patient centered medical home was
bringing patient care management back into the primary care
arena, which he called "effective steerage for right care, right
time, right place." He applauded the DHSS relationship with its
tribal health partners, declaring them to be innovative leaders.
He declared that the Alaska Medicaid program benefited from this
relationship, as every tribal member who received care in a
tribal facility was reimbursed at 100 percent from the federal
government, saving Alaska's general fund dollars. He emphasized
the difficulty for care in rural areas, and he lauded the tribal
health program for filling in this void. He offered his belief
that Medicaid services also needed to be bundled, as this most
often resulted in lower rates. He declared that better
integration of behavioral health and primary care services was a
necessity for better treatment. He spoke about pay for
performance and centers of excellence, the need to review what
worked and then only pay for that. He explained that more
observation during utilization reviews would control which
provided services were offered. He stated "the closer to home
we are, the better we are" and he touted the benefits of
community based long term care. He affirmed the need for better
management of chronic care and disease states to ensure
effective programs that guaranteed the proper care, in order to
decrease the number of emergency room visits. He established
the necessity for maximizing the Medicare reimbursement by
better managing those who were dual eligible.
4:24:36 PM
COMMISSIONER HULTBERG, addressing slide 24, "Innovations in
service delivery /payment," stated that AlaskaCare was seeking
low cost alternatives and, as the State of Alaska paid about 25
percent of the total health care expenditures in the state,
better leverage with collective purchasing power. She shared
considerations for the option of expanded travel benefits, as
well as the creation of Centers of Excellence for bundled health
care services. She reported that an employee wellness program
was being developed. She indicated that DOA would continue to
aggressively pursue contractual discounts, following its success
with this in FY2011. She endorsed to align contracting
strategies around innovative care for delivery models. She
expressed her goal of the provider community bringing forward
lower cost innovative ideas for care improvement. She declared
that the State of Alaska was working to develop a comprehensive
health management strategy that optimally managed health for
quality and cost.
4:27:37 PM
COMMISSIONER HULTBERG summarized slide 25, "The State's
approach," stating that the challenge was to lower the rate of
growth for health care spending to a sustainable level, which,
she surmised, was at, or slightly above, the rate of inflation.
She stated a desire to work cooperatively with the providers,
the stakeholders, and the legislature for creative solutions to
high-quality, cost-effective health care delivery in Alaska.
4:28:53 PM
REPRESENTATIVE MILLETT asked when preventative health care plans
for retirees would be implemented.
COMMISSIONER HULTBERG, in response, relayed that this would
possibly be addressed later in the year.
4:29:41 PM
REPRESENTATIVE SEATON asked whether the lack of occupational
licensing for paraprofessionals prevented programs from being
implemented.
COMMISSIONER STREUR expressed agreement, offering the tribal
partnership as a good example. He noted that a community health
aide was the entry contact who meted out and scheduled service
to the necessary level of care. He declared that too much
insistence was placed on seeing a physician, when other
professionals were sufficient in the majority of cases. He
allowed that the health industry was seriously reviewing the
roles of these adjunct staff.
4:34:12 PM
REPRESENTATIVE SEATON emphasized that the health industry had
never suggested a lower level of health care contact,
illustrated by the failure of various naturopath bills
introduced in the Alaska State Legislature. He opined that it
would be necessary for DHSS to implement this change.
4:35:42 PM
COMMISSIONER STREUR replied that there was not any choice but to
partner with the providers for a more efficient, more effective
way to provide health care. He shared that a long list of
providers had requested discussion about this topic.
4:36:34 PM
REPRESENTATIVE MILLETT shared that it would take re-education of
patients to break with medical inclinations, as well. She
lauded the tribal health care program for its education of
patients to a better understanding of the necessary care level.
4:38:49 PM
COMMISSIONER STREUR expressed his agreement with the need for
the state to provide better patient education to understand the
various levels of health care delivery. He praised the Canadian
health care system for its scheduling to health care need,
noting that the Canadians had a better mortality rate than the
U.S.
4:39:57 PM
CHAIR KELLER suggested a need for the elimination of the
confusion for the budget review process. He expressed concern
"that we can't pay for the sickest and the neediest because of
the utter turmoil, because everything had been turned on its
head." He declared that it was difficult for the legislature to
recognize the needs and where the money was going, and then look
for the "places where we can make a difference." He suggested a
presentation to the providers sharing that DHSS and the
legislature were working together to better understand the
budget and review process.
4:41:59 PM
COMMISSIONER HULTBERG said that the legislature had more
visibility regarding Medicaid than the other areas in the
budget. She reported that DOA did not have a health care line
item in the budget because health care costs were built into
personnel costs; consequently, there was not specific visibility
around employee and retiree health care cost. She pointed to
the magnitude of overall spending as a more comprehensive
picture of the health care demands on the state. She agreed
that Medicaid was "the lion's share," and would most likely
become a greater percentage of health care spending. She
offered her belief that it was necessary to review all the areas
of health care spending, even though these areas were not as
visible as Medicaid. She offered for DOA to give health care
presentations about costs and cost management.
4:44:45 PM
MS. HERRERA, in response to Chair Keller, declared her agreement
with all the solutions offered by DOA and DHSS, although she was
ambivalent regarding pay for performance for Medicaid doctors.
She reported that nationally almost 50 percent of doctors did
not accept new Medicaid patients. Directing attention to the
testimony that doctors did not quickly accept new health
technology, she opined that the addition of pay for performance
might further limit access to care. She expressed agreement
with the suggestions for utilization review for radiology and
prescription drugs. She noted that it was necessary to balance
access for care with cost; that home and community based care
would trigger a federal match; that managed care had to be done
"the right way", opining that fee for service contracts with one
company were not the solution; and that occupational licensing
would ensure that patients could connect with providers of
necessary services, even those not accepted by the "medical
cartels." She reported on an agreement for occupational license
reciprocity, when charity care was also offered, between
Tennessee and Illinois.
4:48:42 PM
REPRESENTATIVE SEATON, referencing an article regarding salaried
positions, declared a need for adequate salary and motivation.
He suggested pilot programs for salaried medical personnel in
order to allow them to focus solely on medicine. Directing
attention to an earlier reference by Ms. Herrera about an
increase in medical premiums of $2500 in Massachusetts from
2006 - 2011, he declared that his health care premium for
private insurance, notwithstanding an increase to his deductible
amounts, had risen that much in one year, much less than the
referenced Massachusetts increase for five years. He offered
his belief that the health exchange could dramatically slow the
increase of insurance premiums.
4:52:34 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:52 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Christie Herrera's Alaska Presentation.ppt |
HHSS 3/20/2012 3:00:00 PM |
|
| HealthCare-HouseHSS_03-20-2012.pdf |
HHSS 3/20/2012 3:00:00 PM |