02/01/2012 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB144 | |
| Presentations: Alaska Health Care Commission Report Update | |
| Department of Health and Social Services Report | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 144 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
JOINT MEETING
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 1, 2012
1:35 p.m.
MEMBERS PRESENT
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Senator Bettye Davis, Chair
Senator Dennis Egan
Senator Johnny Ellis
Senator Kevin Meyer
Senator Fred Dyson
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Wes Keller, Chair
Representative Bob Miller
Representative Charisse Millett
MEMBERS ABSENT
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Beth Kerttula
COMMITTEE CALENDAR
SENATE BILL NO. 144
"An Act temporarily reinstating the child and adult immunization
program in the Department of Health and Social Services; and
providing for an effective date."
- MOVED SB 144 OUT OF COMMITTEE
- UNIFORM RULE 23 WAIVED
PRESENTATIONS: ALASKA HEALTH CARE COMMISSION REPORT UPDATE
- HEARD
OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES REPORT
- HEARD
REVIOUS COMMITTEE ACTION
BILL: SB 144
SHORT TITLE: STATE IMMUNIZATION PROGRAM
SPONSOR(s): SENATOR(s) GIESSEL, OLSON
01/17/12 (S) PREFILE RELEASED 1/6/12
01/17/12 (S) READ THE FIRST TIME - REFERRALS
01/17/12 (S) HSS, FIN
01/30/12 (S) HSS AT 1:30 PM BUTROVICH 205
01/30/12 (S) Heard & Held
01/30/12 (S) MINUTE(HSS)
02/01/12 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
WARD HURLBURT, M.D., Director and Chief Medical Officer
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Commented on the fiscal note for SB 144.
DEBORAH ERICKSON, Executive Director
Alaska Health Care Commission
Anchorage, Alaska
POSITION STATEMENT: Informed the committee about the Cost of
Health Care in Alaska.
WILLIAM STREUR, Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented an overview of the Department of
Health and Social Services.
ACTION NARRATIVE
1:35:06 PM
CHAIR BETTYE DAVIS called the joint meeting of the Senate and
House Health and Social Services Standing Committees to order at
1:35 p.m. Present at the call to order were Senators Ellis,
Egan, Dyson, and Chair Davis, and Representative Millet, and
Chair Keller. Senator Meyer and Representative Miller arrived
shortly thereafter.
SB 144-STATE IMMUNIZATION PROGRAM
1:35:55 PM
CHAIR DAVIS announced that SB 144 was before the committee.
SENATOR GIESSEL, sponsor of SB 144, thanked the committee for
hearing the bill and sharing the concern about the importance of
the bill. She said the fiscal note was prepared by the
Department of Health and Social Services (DHSS). Here to address
the fiscal note is Dr. Ward Hurlburt.
1:36:49 PM
WARD HURLBURT, M.D., Director and Chief Medical Officer,
Division of Public Health, Department of Health and Social
Services (DHSS), explained the fiscal note for SB 144. He said
that it would put a vaccination program into place and replace
some of the lost federal funding. The fiscal note is sensitive
to the cost effectiveness of individual immunizations for
children and adults. He pointed out that, overall, a dollar
spent for vaccines saves over $8 in health care costs and over
$16 in time lost from work.
He noted that three vaccines are included in the bill for
uninsured adults: influenza, pneumococcal, and Tdap, but not
shingles due to expense. For children, all vaccines required for
school entry are included, but not rotavirus, HPV, or
meningococcal due to high costs. The fiscal note totals $2.9
million and there is some flexibility in the program. For
example, if more funds were to be available, the rotavirus
vaccine could be added back in.
1:41:17 PM
SENATOR EGAN asked if the three vaccinations not included for
children could be added back into the program.
DR. HURLBURT responded that they may be added at a later date.
REPRESENTATIVE KELLER noted the arrival of Representative
Miller.
CHAIR DAVIS noted the arrival of Senator Meyer.
CHAIR DAVIS said she felt the goals of the committee had been
met, and SB 144 would have further review in the Senate Finance
Committee. She pointed out that the bill has a sunset date of
2015, which would allow time for a long-term solution to be
developed in order to provide immunizations to those who need
them. She said she understood that as money becomes available,
it can immediately go toward funding more vaccinations.
DR. HURLBURT agreed. He said DHSS will continue to try to find
other sources of funding for the program. He listed possible
options; turn the program back to the state or cover additional
vaccines.
1:44:41 PM
SENATOR EGAN moved to report SB 144 from committee with
individual recommendations and attached fiscal note. There being
no objection, SB 144 was reported from the Senate Health and
Social Services Committee.
^Presentations: Alaska Health Care Commission Report Update
PRESENTATIONS: ALASKA HEALTH CARE COMMISSION REPORT UPDATE
1:46:09 PM
CHAIR DAVIS invited the executive director of the Alaska Health
Care Commission to give an update.
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission (AHCC), addressed concerns about the increasing cost
of health care in Alaska and the sustainability of the health
care system. She related that in the past five years, total
spending for health care has increased 40 percent and is
projected to double again by 2020. A comparison to the value of
oil output shows that in 2020, total health care spending will
be about 75 percent of the value of oil. She noted that spending
on health care represents the transfer of wealth with fewer
resources available to spend on health care in the future.
1:49:04 PM
MS. ERICKSON spoke of the affordability of health care for U.S.
families versus Alaskan families. Nationwide, over the past 12
years inflation has increased 38 percent and workers' earnings
have increased 50 percent, although over that same time period
the cost of health insurance premiums have increased 160 percent
and workers' contributions to premiums have increased 168
percent. Over the past decade the health care cost growth has
wiped out real income gains for the average U.S. family.
For Alaskan families, since 1982 prices for medical services in
Anchorage have increased 320 percent and the consumer price
index (CPI) has increased 95 percent. For Alaskan employers who
provide health benefits for their employees, between 2003 and
2010, the number of large employers who provided benefits
dropped from 95 percent to 93 percent and the number of small
employers who provided benefits dropped from 35 percent to 30
percent. She shared a story about a family that lost insurance
coverage, pointing out that there are real people behind the
numbers.
1:51:48 PM
MS. ERICKSON described the value in Alaska's health system.
Alaska has the highest per capita total health spending and is
second in the nation for personal health expenditures, behind
Massachusetts. She compared Alaska to Massachusetts's health
care program. She emphasized that Alaska's health care system is
perfectly designed to deliver the results it is getting. She
questioned how the system could be redesigned to deliver the
best possible health care at the lowest possible cost. She
voiced concern about how to control costs. The department's
focus is on ways to make health care work better for the
providers and the patients.
1:55:19 PM
MS. ERICKSON highlighted a vision of a future health care
system. Part of the service will be to enhance the consumer's
role and support healthy life styles. She discussed ways to
diagnose problems and described two related studies, an economic
analysis by Institute of Social and Economic Research (ISER) and
an actuarial analysis by Milliman, Inc.
She addressed what Alaska's health care dollars currently buy.
Hospital care and physician services represent the greatest
proportion of spending. Premiums in Alaska are 30 percent higher
per member than comparison state averages. She reported on cost
drivers such as utilization, which is not a major driver behind
higher premium rates, according to Milliman's study. However,
Alaska prices are significantly higher than comparison states.
Physician services are 69 percent higher than all of the
comparison states for commercial payers and 60 percent higher
for all payers combined. Facility services are also higher than
comparison states; they cost cost 37 percent more for commercial
payers and 36 percent higher for Medicare payers.
She showed sample comparisons of mean commercial allowed charges
for non-facility-based professional services. She also showed
sample comparisons by payer within Alaska.
2:02:03 PM
MS. ERICKSON shared information on health care cost (price)
drivers such as operating costs, like medical salaries, cost of
living, and hospital operating costs, and provider discounts,
which are lower in Alaska.
She reported on Milliman's cost driver conclusions: private
hospital sector prices in Alaska are high relative to comparison
states, physician services (non-facility-based) prices for
commercial payers are very high relative to comparison states,
and low Medicare rates create upward pressure on prices for
other payers.
2:04:19 PM
MS. ERICKSON shared statistics on health care solutions that
focus on value and health. About 5 percent of the U.S.
population required 50 percent of all health care spending in
2009, while 50 percent of the population required 3 percent of
health care spending in that same year. She stressed that the
solution is to focus resources on prevention in the healthy
population, but also to improve effectiveness of care for those
with complex health care issues. AHCC recommends fostering the
use of evidence-based medicine.
MS. ERICKSON listed AHCC's recommendations and solutions
regarding health care expense by enhancing quality and
efficiency of care on the front end. She said this can be done
by using a patient-centered primary care model and supporting
all components of a strong trauma system.
Another area of importance to AHCC is to increase price and
quality transparency to empower both the consumers and the
providers. This can be achieved by encouraging full
participation in a hospital discharge database and possibly an
all-payers claims database.
2:07:43 PM
MS. ERICKSON continued to discuss health care solutions by
focusing on a pay-for-value solution. AHCC studied a payment
reform system that would focus on outcomes rather than services.
Other areas of focus for AHCC are how to build the foundation of
a strong health care system, and prevention. Obesity is the most
significant public health challenge facing Alaska today. AHCC
recommends implementing evidence-based programs to address
obesity. Another way to support healthy lifestyles is to ensure
adequate funding for immunization programs. A third goal for
promoting healthy lifestyles is to address behavioral health
issues by integrating behavioral health and primary care
services, support new payment methodologies, and screen using
evidence-based tools.
MS. ERICKSON concluded with AHCC's 2012 agenda, which includes
continuing to learn about current health care system challenges
and considering additional strategies for future
recommendations. She discussed the Affordable Care Act which
AHCC is tracking, and provided web sites for more information.
2:10:27 PM
CHAIR DAVIS asked if anyone else present is on the commission.
MS. ERICKSON replied that David Morgan and Representative Keller
are on the commission.
REPRESENTATIVE MILLETT wondered which recommendations the
commission has worked on that have proved to be successful.
MS. ERICKSON explained that AHCC was established in statute in
2010 and just recently began to meet.
DR. HURLBURT noted that one of the recommendations was related
to increasing primary care providers because there were so few,
yet Alaska spends more than 50 percent to 100 percent more than
any other industrialized country. Another recommendation was to
look at the value of Medicaid.
2:13:31 PM
CHAIR DAVIS asked if there was a dollar amount attached to all
of AHCC's recommendations.
MS. ERICKSON replied that no dollar amounts have been set. AHCC
is still trying to strike a balance between policy
recommendations and operational expenses.
CHAIR DAVIS asked Ms. Erickson to highlight recent public health
initiatives.
DR. HURLBURT answered the question. He spoke of the benefits of
a current wellness program in the Division of Public Health. He
shared a vision of a statewide program. He maintained that
healthy employees are more productive.
2:15:48 PM
CHAIR DAVIS said the idea of a wellness program came from the
Senate Health and Social Services Standing Committee. She asked
if there was a plan for a statewide employee program.
DR. HURLBURT said there was a statewide plan that would grow out
of Public Health's model. He compared the plan to an infectious
disease that would spread in a positive way throughout the
state.
SENATOR ELLIS pointed out that for many years, people have asked
the question as to why health care costs were so much higher in
Alaska. He said he understood that there was federal money
available to the Division of Insurance that was either not
applied for or not accepted. He questioned if the work DHSS is
doing is being done with state resources. He also wondered if
the commission's work would continue and what source of funding
would be used.
2:17:25 PM
MS. ERICKSON replied that state resources were used to establish
the commission and for the studies done. Future studies will
also use state general funds.
SENATOR ELLIS suggested researching if federal funds were still
accessible.
CHAIR DAVIS thanked the presenters.
^Department of Health and Social Services Report
DEPARTMENT OF HEALTH AND SOCIAL SERVICES REPORT
2:19:19 PM
CHAIR DAVIS introduced the commissioner of the Department of
Health and Social Services (DHSS).
WILLIAM STREUR, Commissioner, Department of Health and Social
Services (DHSS), presented an overview of the department. He
emphasized the fact that change is needed in the department in
many areas. He said that the cost of Medicaid is approaching $6
billion. He noted that woven through the presentation will be
the topic of change.
COMMISSIONER STREUR detailed the DHSS organizational structure.
He mentioned the Chief Medical Officer, Dr. Ward Hurlburt, and
introduced Kim Poppe-Smart, Deputy Commissioner for Medicaid and
Health Care Policy. He pointed out that Medicaid services
currently fall under the responsibilities of one deputy
commissioner, a change from the past. Medicaid represents $1.6
billion of the $2.6 billion DHSS budget for 2013.
COMMISSIONER STREUR listed several of the support services for
the department: public information, legislative relations,
health policy, special assistant, and AHCC. He introduced the
Deputy Commissioner for Family, Community and Integrated
Services, Ree Sailors, and listed the divisions under her
supervision. Finally, he mentioned the Assistant Commissioner
for Finance Management Services, Nancy Rolfzen.
2:23:53 PM
COMMISSIONER STREUR discussed the core services the department
provides, which he stressed would change due to a focus on
partnerships, integration, and families. Core services include
providing the highest quality of life in a safe home environment
for older Alaskans and veterans. In the last 10 years, the
percentage of veterans in Alaska has increased exponentially.
The percentage of veterans has increased by 14 percent across
the nation compared to an increase of 70 percent in Alaska,
which is going to present a challenge.
He related that another core service is to manage an integrated
and comprehensive behavioral health system based on sound
policy, effective practices, and open partnerships. He suggested
the core service needed to be changed to say "manage an
integrated and comprehensive health system" because behavioral
health is a part of everything that is done in health care.
He said other core services are to promote safe children and
strong families, and to manage health care coverage for Alaskans
in need. He questioned the allocation of the department's budget
of $1.5 billion and the uncertainty if it is being spent on "the
right care, at the right time, at the right place, for the right
people." He emphasized that there needs to be a significant
effort to drive care back to the primary care physician and
services, such as through Native health partners or community
health centers or private practitioners.
COMMISSIONER STREUR listed additional core services: hold
juvenile offenders accountable for their behavior, promote the
safety and restoration of victims and communities, and assist
offenders and their families in developing skills to prevent
crime; provide self-sufficiency and basic living expenses to
Alaskans in need; protect and promote the health of Alaskans;
promote the independence of Alaskan seniors and persons with
physical and developmental disabilities; and provide quality
administrative services in support of the department's mission.
2:26:36 PM
COMMISSIONER STREUR addressed the department's four priorities:
integrated health and wellness; health care access and delivery;
sustainable long-term care delivery system; and safe and
responsible families and communities. He shared a story about
the importance of dentures. He related a story about the
effectiveness of a vaccination program dealing with the H1N1
virus. He highlighted the efforts taken to address childhood
obesity.
2:28:48 PM
COMMISSIONER STREUR talked about improved health care access and
delivery with the use of a Medicaid Task Force that deals with
patient-centered medical homes, the effective use of generic and
formula drugs in pharmacies, and the Community First Choice
program. He discussed sustainable long-term care delivery
systems for Alaska seniors and veterans in Pioneer Homes. About
30,000 recipients were served through senior and disabilities
service programs. The department partnered with Native
organizations for nursing home care in Kotzebue, Nome, and
Bethel.
2:32:20 PM
COMMISSIONER STREUR spoke of a department priority to promote
safe and responsible families and communities. He opined that
the Office of Child Services (OCS) has one of the toughest jobs
there is. The department supports child advocacy centers, the
child welfare system's Family-to-Family (F2F), Families First,
and Bring the Kids Home. It works on juvenile justice through
the Alaska Native Recidivism Committee and through Behavioral
Health Services for juveniles within detention and treatment
centers. It also promotes heating assistant grants and home and
community-based senior and disabilities services.
COMMISSIONER STREUR showed a slide depicting Medicaid's increase
in cost to the state from $1.6 billion to more than $5 billion
by 2030. He said there are ways to address this problem by
working with partnerships.
2:36:04 PM
COMMISSIONER STREUR showed a slide depicting costs to the
department by category, with Medicaid being by far the largest
at 61.9 percent of total costs. He listed the services provided
by the department. He praised the high quality of life in the
Alaska Pioneer Homes. He highlighted the challenges in the
Division of Behavioral Health, such as substance abuse. He noted
the Office of Children's Services also has challenges. He
reported on a recent OCS public hearing as a successful
opportunity to discuss solutions. He spoke highly of the
director, Christy Lawton. He called the issues in OCS "a work in
progress" with no easy solutions when dealing with kids.
He described the various programs within the Division of Health
Care Services, a large part of which are direct interactions
with providers. He said the Medicaid Management Information
System (MMIS) continues to be under development.
He noted that the Division of Juvenile Justice (DJJ) facilities
are spread throughout Alaska. He shared a story about taking DJJ
kids caribou hunting this year.
2:42:24 PM
COMMISSONER STREUR talked about the programs within the Division
of Public Assistance. He called the division the gateway to an
array of services that the department provides. He described the
Division of Public Health as the most interactive division with
other departments. Senior and Disabilities Services is quickly
increasing in size, and he spoke of a need to enhance the
services there. He spoke of misunderstood regulations that had
to be withdrawn and refined. He said that the Finance and
Management Services is the "budget shop."
COMMISSIONER STREUR concluded that the overriding theme for the
future direction of the Alaska Department of Health and Social
Services is helping individuals and families create safe and
healthy communities. It is all about partnerships and moving
forward.
2:46:32 PM
SENATOR DYSON highlighted the Chugiak Senior Center as one of
the better centers in the state. He asked Commissioner Streur to
comment on medical benefit fraud.
COMMISSIONER STREUR responded that nationally benefit fraud has
become a part of major crime. He reported on the federal crime
status of benefit fraud in New York and Florida. He said the
state needs to continue to develop systems to detect fraud and
start benchmarking providers for quantity. The new MMIS system
will have capabilities to detect fraud.
2:48:44 PM
SENATOR ELLIS appreciated the pullback of senior services
regulations. He brought up detox regulations that require a
higher level of nursing services which are hard to come by and
afford. He asked the commissioner to look closer at those
regulations.
COMMISSIONER STREUR spoke of his efforts to meet this challenge.
He shared his previous experience running a detox center and
maintained that detox is not child's play and effective care is
needed. He said he would look further at the issue.
2:51:03 PM
SENATOR ELLIS spoke of federal money for states to develop their
own health exchanges in order to comply with federal law. The
administration chose to use state resources instead. He asked
what the cost in state dollars has been so far, and what the
cost projections would be to develop a health exchange for
Alaska. He also requested an update on the process so far.
COMMISSIONER STREUR reported that the money spent so far has
been incremental in that it has been largely Josh Applebee's
salary. A consultant has been hired for up to $300,000 to
develop the health exchange. He said he hoped it was as simple a
process as he could make it. The department is currently
identifying the target population.
He related that the Medicaid expansion will occur on January 1,
2014, where every man, woman, or child under 138 percent of
poverty level will be eligible for Medicaid. That will cost
$35,000 off an estimated $100,000 of uninsured. Probably another
25 percent will choose not to buy insurance. A finite population
would be eligible for this program.
He described the high and low ends of other states' health
exchange costs. At the low end is Utah at $500,000 and at the
high end is Massachusetts at $30 million. Washington is at about
$26 million. He did not know what Alaska's costs would be. He
said he wanted to make the health exchange as electronic as
possible. A new EIS enrollment system could be used for the
exchange because it looks at a person's resources and determines
eligibility for services. The levels can be stratified. A
linkage to the broker community to help those seeking insurance
could be a reality.
COMMISSIONER STREUR concluded that Alaska is unique with a small
insurable population and a high level of self-insured. The first
report from the consultant will be done by March 30. A request
for proposal to solicit a vendor could be out by June or July
and the information could come before the legislature at that
time. An interim report will be out by early summer.
2:55:55 PM
CHAIR DAVIS noted there was a bill to establish an exchange. She
wondered if the administration is considering that bill, and she
requested a comparison of the bill's costs and the consultant's
recommendations on cost.
COMMISSIONER STREUR said the administration is not considering
that bill and is waiting for more information from the
consultant regarding Alaska's needs.
2:57:08 PM
There being no further business to come before the committee,
Chair Davis adjourned the Joint Senate and House Health and
Social Services Standing Committees at 2:57 pm.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS_overview-1-2012.pptx |
SHSS 2/1/2012 1:30:00 PM |
|
| Commission Report 2011.pptx |
SHSS 2/1/2012 1:30:00 PM |
lsncceh |