Legislature(2019 - 2020)BARNES 124
02/21/2020 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB113 | |
| HB235 | |
| HB229 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 113 | TELECONFERENCED | |
| += | HB 24 | TELECONFERENCED | |
| += | HB 229 | TELECONFERENCED | |
| *+ | HB 235 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 229-HEALTH INFORMATION/DATABASE/PUBLIC CORP.
4:21:05 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE BILL NO. 229, "An Act establishing the Alaska Health
Care Transformation Corporation; relating to an all-payer claims
database; and providing for an effective date."
4:21:54 PM
SANDRA HEFFERN, Project Coordinator, Alaska Healthcare
Transformation Project, began by discussing the numerous efforts
to address Alaska's health care system by the last three
administrations. She noted the Alaska Healthcare Commission
under the Palin administration that studied issues related to
health care in Alaska and reported recommendations and
activities to the legislature. The commission was defunded in
2015 and is no longer active. Additionally, under the Parnell
administration there was a Medicaid taskforce in 2010, as well
as a Medicaid reform advisory group in 2014. The purpose of
those groups was to look at the stability and predictability in
budgeting, increase the ease and efficiency of navigating the
system by providers, and provide whole care for the patient by
uniting physical and behavioral health treatment. She also
mentioned SB 74, the omnibus Medicaid reform bill that was
signed into law in 2016 during the Walker administration. She
said that while there have been incremental improvements, the
Anchorage Economic & Development Corporation found that since
2010 the rising cost of employee health has been reported as the
number two issue in hindering business growth. Furthermore, the
cost of health care in Alaska continues to be close to the most
expensive in the U.S. She reported that the per capita spending
on health care is higher than other high-income countries, which
could lead one to believe that Alaska has some of the highest
health care costs in the world.
MS. HEFFERN directed attention to her PowerPoint presentation,
entitled "Alaska Healthcare Transformation Project." She
informed the committee that the Alaska Healthcare Transformation
project is a cross sector collaboration of payers, providers,
policymakers, and patient advocates working together to
transform Alaska's health care system (slide 2). The project
management committee consists of 7 people, including
Representative Spohnholz and Senator von Imhof. The committee's
role is to provide overall direction, guidance, and support to
the project, and to monitor it to ensure successful delivery of
expected outputs and outcomes within the scope and budget (slide
3).
4:27:20 PM
REPRESENTATIVE FIELDS asked how many of the project management
committee members' employers have endorsed the current version
of HB 229.
MS. HEFFERN replied that both the Mat-Su Health Foundation and
the Alaska Primary Care Association support HB 229.
4:28:31 PM
REPRESENTATIVE STUTES asked if HB 229 is meant to be a precursor
to health care reform.
MS. HEFFERN said to effectuate change within Alaska's health
care system with a small population, it will require looking at
the entire health care system rather then just one siloed area,
like Medicaid.
REPRESENTATIVE STUTES questioned whether the intent of this
project is to reform the health care system to work more
efficiently.
MS. HEFFERN answered yes, the focus is to look at the entire
health care system instead of focusing only on one area.
CHAIR SPOHNHOLZ clarified that the Alaska Healthcare
Transformation Project's effort is to transform the entire
health care system; however, the all-payer claims database
(APCD) will not necessarily do that work. She reiterated that
they are discussing two separate topics.
4:31:16 PM
MS. HEFFERN resumed her presentation. She related the projects
vision, which is to improve Alaskan's health while also
enhancing patient and health professional's experience of care
and lowering the per capita health care growth rate (slide 4).
The project's guiding principles are to focus on improving
individual and population health, consider health coverage with
common basic benefits for all, focus on whole person and
integrated systems of care, use evidence-based practices, and
recognize the effect of social determinants of health (slide 5).
She went on to paraphrase slide 6, the project's goals, which
read as follows [original punctuation provided]:
Healthy Alaskans:
? The percentage of Alaskan residents with a usual
source of primary care will increase by 15% within
five years
Healthy Economy:
? Reduce overall per capita healthcare growth rate to
the greater of 2.25% or CPI within five years
Everybody's Business:
? Align all payers, public and private, towards value-
based alternative payment models with streamlined
administrative requirements within five years
MS. HEFFERN directed attention to a graph on slide 7, entitled
"Alaska Healthcare Per Capita Growth Rate." She stated that
from 1991 to 2014 the health care cost growth rate was 7.8
percent in Alaska compared to 6 percent in the U.S., indicating
that medical prices in Alaska are growing faster than in the
rest of the country. The Alaska Healthcare Transformation
Project narrowed its focus to five strategy areas: increasing
primary care utilization, coordinating patient care, changing
the way health care is paid for in Alaska, increasing data
analytics capacity, and addressing social determinants of health
(slide 8). The project gathered a strategy development team
that decided to assemble the previous work that had been done in
Alaska. Slide 6 highlights the research compiled by the NORC,
which read in its entirety as follows [original punctuation
provided]:
Meta-Analysis. Identify and assess a group of
Alaska-focused reports and studies issued over the
past decade (2008 to the present) that focus on
delivery system reform related to the triple aim of
improved health, improved quality of care and
experience with care delivery (for patients as well as
the health care workforce), and reduced per capita
costs.
Alaska Historical Project Scan. Identify and assess
selected delivery system reform experiments in Alaska
over the past decade (2008 to the present), with
priority to characterizing regional innovation within
the state.
National Scan. Develop case studies for selected
states where delivery system reform relevant to
Alaska's five key topics of interest offers lessons
for prospective innovation.
Drivers of the Health Care Costs and Spend in
Alaska. Review health care spending in the state and
the prospects and limitations of available data
sources that would support a fine-grained analysis of
cost drivers relevant to these reforms. Based on this
review, prepare a set of estimates of potential
reform-related savings and a draft roadmap with
proposed short-term (within one year) and long-term
steps that comprise one or more pathways to reform.
MS. HEFFERN reported that they narrowed eight NORC
recommendations down to three areas: set multi-payer goals for
value-based payment using the Health Care Payment Learning
Action Network framework; develop the details, parameters, and
build consensus around the collection of cost and quality data
and ensuring sufficient analytic capacity to effectively analyze
and use the data; and determine the structure and
responsibilities of leadership governance (slide 10). From
those recommendations, she said, they decided to consider an
all-payer claims database (APCD). The recommendation was to
develop a corporation that was connected to state government
while remaining dependent of state government. She stated that
the result is HB 229. In closing, she said Alaska is not alone
in its efforts to collect, analyze, and report health care data.
Nationally, people are trying to get a handle on the cost of
health care and an APCD is one of the ways to do that. She
added that President Trump issued an executive order in June
2019, with the focus on improving price and quality transparency
in American health care.
4:43:14 PM
MS. HEFFERN said, in closing, there are states in the process of
transforming or reforming their health care system that have
utilized their health care cost data to set a statewide growth
rate, which can't be done without data. She reiterated that the
recommendation for establishing an APCD would require a trusted
entity so all parts of the health care industry would support
the information and the story that the data is telling.
4:44:28 PM
REPRESENTATIVE HANNAN asked where Mark Foster derived the data
for his study, which found that Alaska has spent $8.5 billion on
health care.
MS. HEFFERN said she can provide a copy of that report, which
cites all his references. She added that it further supports
the need for an APCD.
4:45:54 PM
REPRESENTATIVE FIELDS questioned whether the project has
performed an analysis to find the percentage of rising health
care cost that is related to Alaska's aging population. He
offered his understanding that it's the most rapidly aging
population on a per capita basis in the country.
MS. HEFFERN replied they couldn't get to that level of detail
because they couldn't get their hands on the data.
REPRESENTATIVE FIELDS questioned whether it's possible to
establish an all or most-payer claims database with or without a
corporation.
MS. HEFFERN opined that an APCD could be established in several
different ways. Other states have done it through an office of
financial management, division of insurance, healthcare
authority, and a nonprofit organization. The issue is finding a
trusted entity that everyone in the state will trust to produce
accurate and fair data that won't be used against them.
REPRESENTATIVE FIELDS asked how many states have a something
like the project's proposed corporation that has regulatory
power.
4:48:27 PM
NORM THURSTON, Executive Director, National Association of
Health Data Organizations, addressed questions from the previous
bill hearing. First, he said of the 10 smallest states by
population, four of them have all-payer claims databases. He
noted that this has traditionally been a movement coming out of
the smaller states and into the larger states. Second, he said
states that have a good relationship with the business community
tend to do very well, some getting upwards of 30-40 percent of
businesses to participate voluntarily. He said it's not
unreasonable to think that a state like Alaska could easily be
at 60 percent of its population with the possibility of going
much higher.
4:50:53 PM
REPRESENTATIVE STUTES asked of the states that participate in
all-payer plans, how many have shown quantifiable savings in
their medical expenses.
MR. THURSTON stated it's a difficult question to answer because
data is collected, analyzed, and released, followed by the cost
- not decreasing - but increasing less rapidly, which is bending
the cost curve down. He approximated that one-third of the
participating states have had a major strategic effort to use
the data to bend the cost curve with varying degrees of success.
4:52:23 PM
REPRESENTATIVE FIELDS inquired as to how many states have
corporations with regulatory power that manage their all-payer
claims databases.
MR. THURSTON said he does not know. He noted that Colorado has
an independent regulatory agency that has the ability to make
rules of its governance. Mr. Thurston informed the committee
that he is a legislator in Utah, adding that most of the APCDs
can regulate within their sphere to set standards for data
submission and enforce compliance.
REPRESENTATIVE FIELDS asked how many of the 20 states manage
their APCDs through some entity within state government versus a
standalone corporation.
MR. THURSTON approximated that half of them are embedded in a
state agency, while the other half do something else.
REPRESENTATIVE FIELDS asked how much it costs those states with
a standalone corporation.
MR. THURSTON recounted from his experience in Utah that the core
operations of a database costs roughly $600,000. He added that
the database costs the same regardless of the population. He
said it would be consistent as a fixed cost of operations.
4:56:36 PM
REPRESENTATIVE HANNAN inquired as to the first state to have an
APCD.
MR. THURSTON offered his belief that Maine and Massachusetts
were the pioneers.
REPRESENTATIVE HANNAN questioned whether APCDs have addressed
policy issues related to people leaving a jurisdiction for
medical cost reasons.
MR. THURSTON said he is not aware of any state where that has
been a policy priority.
4:59:03 PM
REPRESENTATIVE FIELDS asked of the 20 states with an APCD, which
is most similar to Alaska in the sense that there are a low
percentage of people with private health insurance plans and a
high percentage of residents on IHS health care, tri-care, and
Medicaid.
MR. THURSTON answered New Mexico.
5:00:52 PM
REPRESENTATIVE STORY asked what the framework is for creating an
APCD within a state department.
MR. THURSTON explained that the Utah APCD is a bureau within the
Utah Department of Health. He said it's a sister agency to the
Medicaid agency and is set up with a bureau director that
reports to a division director. He said Utah's APCD is the
quintessential example of an APCD embedded within the
government. He added that most of the work is done by a
contracted vendor, leaving the [Utah] Department of Health to
focus mainly on project management.
REPRESENTATIVE STORY asked how much that costs.
MR. THURSTON said the contracted cost for an outside vendor is
roughly $400,000 per year. Furthermore, there's the agency
staff to manage the contract and analyze the data.
5:02:50 PM
CHAIR SPOHNHOLZ asked if there are other states that have put
their APCD within another agency like, for example, the Division
of Insurance.
MR. THURSTON said in Arkansas they developed everything in the
Arkansas Center for Health Improvement, which is part of the
state government. He noted that Arkansas doesn't do any
contract outsourcing at all.
CHAIR SPOHNHOLZ asked for the advantages and disadvantages of
both routes.
MR. THURSTON explained that the advantage of using an outside
vendor is that the technology already exists, which makes it
easier to set up. He added that the analytics tools that an
outside vendor offers will be much more powerful than a state
could develop on its own. The disadvantages of working with an
outside vendor is the lack of stability.
REPRESENTATIVE FIELDS asked if there is a consistent time lag in
the data.
MR. THURSTON stated that most states now have monthly submission
processes, so claims that were processed in January would be
submitted to the APCD by February 15th. Subsequently, by the
end of March, the January payments should be available in a
preliminary format. He noted that the lag is not as big on the
data collection and processing site as it is on the claim
payment site. Most states allow claims to be submitted for
payment up to one or two years after service is rendered. He
added that any service provided in October would be ready for
examination in six months.
5:07:35 PM
JOHN CULLEN, MD, Valdez Medical Clinic, LLC; Board Member,
Alaska Academy of Family Physicians, stated that the American
Academy of Family Physicians is in favor of an APCD. He
reported that he has seen it work in practice, adding that it's
a necessary step towards health transformation. He said that
family physicians have a strong interest in reducing the cost of
health care for their patients. He noted that other states have
had success with mandatory primary care investment. He offered
his belief that creating an APCD is a necessary first step in
figuring out why the cost of health care is so high.
5:11:29 PM
REPRESENTATIVE FIELDS surmised that much of the high cost of
health care in America is related to federal policies that allow
"big pharma" to consistently rip people off and private health
insurers that have higher administrative costs compared to
Medicaid, for example. He questioned what is within the state
government's control versus what is outside its control at the
federal level. He asked where the relative opportunities for
achievable cost saving rests.
DR. CULLEN opined that the reason America's health care is so
expensive is due to pharmaceutical costs, administration costs,
and high-volume/high-cost procedures, like MRIs and CT scans.
He said from a primary care perspective, having and APCD that
could provide information on which of those procedures are
excessively expensive could help them better choose the right
providers for their patients. He added that the administrative
and pharmaceutical costs are controlled at the federal level.
REPRESENTATIVE FIELDS expressed interest in state innovation
regarding high drug prices in the context of this conversation.
CHAIR SPOHNHOLZ noted that Alaska's health care costs have grown
significantly more than the rest of the country. She said it
would be difficult to argue that those are completely driven by
the federal government. She pointed out that Alaska adopted
several rules that were designed to incentivize increased access
to specialty care by allowing specialists to increase their
rates, which has increased access to Alaska for specialists,
like cardiologists and pulmonologists, while also growing the
cost of health care in the state.
5:15:35 PM
LAURA YOUNG, Executive Director, HealtheConnect Alaska,
explained that HealtheConnect is the health information exchange
for the state of Alaska that was set up under SB 133 and has
been in operation since 2013. The organization is public,
nonprofit, and independent and has a similar structure and
governance as the "health care transformation corporation" that
is being proposed. HealtheConnect collects and exchanges real
time clinical data versus claims data. She said it's their
believe both efforts should be complementary. She further noted
that they've set standards for how data is collected and
exchanged and established privacy and security requirements. To
conclude, she offered her belief that "the independent, neutral
organization of such an effort is really critical rather than
aligning it to any one entity or agency is crucial for keeping
the data neutral."
5:18:19 PM
[HB 229 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 229 Bill Text Version M.pdf |
HHSS 2/20/2020 3:00:00 PM HL&C 2/21/2020 3:15:00 PM |
HB 229 |
| HB 229 Sectional Analysis v.M.pdf |
HHSS 2/20/2020 3:00:00 PM HL&C 2/21/2020 3:15:00 PM |
HB 229 |
| HB 229 Sponsor Statement v.M.pdf |
HHSS 2/20/2020 3:00:00 PM HL&C 2/21/2020 3:15:00 PM |
HB 229 |
| HB 229 and supporting documents.pdf |
HL&C 2/20/2020 3:00:00 PM HL&C 2/21/2020 3:15:00 PM |
HB 229 |
| HB 229 Testimony Dr. Cullen CV.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 229 |
| HB229 Testimony Dr. Cullens.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 229 |
| HB 113 v. S Amendment #1 HL&C 2.21.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 113 |
| HB 113 v. S Amendment #2 HL&C 2.21.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 113 |
| HB 113 Powerpoint The Blue Star and Gold Star Families Act 1.31.20.pdf |
HL&C 2/19/2020 3:15:00 PM HL&C 2/21/2020 3:15:00 PM |
HB 113 |
| HB113 Backup Document NCSL veterans' state hiring preference 1.31.20.pdf |
HL&C 2/19/2020 3:15:00 PM HL&C 2/21/2020 3:15:00 PM |
HB 113 |
| HB 235 Fiscal Note DOLWFD-AVTEC 2.14.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Fiscal Note DOLWFD-CAS 2.15.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Fiscal Note DOLWFD-WD 2.14.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Fiscal Note DOLWFD-UI 2.14.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Fiscal Note EED-SSA 2.14.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Fiscal Note UA-SYSBRA 2.18.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Sponsor Statement 2.21.2020.pdf |
HL&C 2/21/2020 3:15:00 PM HL&C 3/9/2020 3:15:00 PM |
HB 235 |
| HB 235.Backup Flow Chart 2.21.2020.pdf |
HL&C 2/21/2020 3:15:00 PM HL&C 3/9/2020 3:15:00 PM |
HB 235 |
| HB 235.Backup UA TVEP Advocacy 2.21.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Backup Distribution Sheet 2.5.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 TVEP Annual Report 2019.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 Backup Intro Presentation 2.21.2020.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| AHCTP House L and C 2.21.20.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 229 |
| HB 235 UA TVEP Background Information.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |
| HB 235 TVEP Univ. of Alaska Presentation 02.20.20.pdf |
HL&C 2/21/2020 3:15:00 PM |
HB 235 |