Legislature(2015 - 2016)CAPITOL 106
01/27/2015 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Department of Health & Social Services Tele-health Program | |
| HB39 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 39 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 39-PUBL EMPL HEALTH INS; WELLNESS COMMITTEE
3:46:34 PM
CHAIR SEATON announced that the next order of business would be
HOUSE BILL NO. 39, "An Act establishing the Advisory Committee
on Wellness; and relating to the administration of state group
health insurance policies."
Chair Seaton passed the gavel to Vice Chair Vazquez.
3:47:26 PM
The committee took a brief at-ease.
3:48:31 PM
CHAIR SEATON, as the bill sponsor, introduced HB 39, and
paraphrased from the sponsor statement, which read, in part
[Included in members' packets]:
HB 39 requires the Commissioner of the Department of
Administration to implement procedures for decreasing
the incidence of disease in Alaska in order to hold
the inflation of healthcare costs of active and
retired Alaska state employees to 2 percent per year.
HB 39 creates an Advisory Committee on Wellness which
is charged with making recommendations to the
Commissioner of Administration on ways to decrease the
incidence of disease in Alaska.
CHAIR SEATON directed attention to Section 1 of the Sectional
Analysis [Included in members' packets] and explained that the
legislative findings and the intent language state that we can
prevent disease by lowering the incidence of disease, and that
prevention will slow the rate of health care cost in the state.
He referenced House Concurrent Resolution 5, passed unanimously
in 2011, which called upon the governor to use prevention of
disease as the primary model of health care by making people
aware of prevention strategies, including Vitamin D use. He
stated that the previous administration had not pursued this
goal, but he was hopeful that the current administration would
work toward this. He moved on to Section 2 which required the
Department of Administration (DOA), to the extent legally and
reasonably practical, to implement the recommendations of the
Advisory Committee on Wellness and reduce the annual escalation
of health care costs to no more than 2 percent.
3:50:51 PM
CHAIR SEATON explained that Section 3 listed these same
requirements to be applied for self-insurance and excess loss
insurance. In Section 4, the Advisory Committee on Wellness in
the Department of Administration was established, requiring the
DOA to respond within six months to the recommendations. He
allowed that there had been an advisory committee in the past,
but there had not been any requirement for accountability to
address the recommendations. He pointed out that a similar
panel, the Citizens Review Panel, made suggestions to the Office
of Children's Services in the Department of Health and Social
Services. The department was required to respond to these
recommendations, and it was this accountability structure that
he wanted to duplicate in Section 4 of the bill. The proposed
bill did not mandate anything except a wellness committee that
would make recommendations to DOA to the extent legally and
reasonably practical to lower the escalating health care costs.
He allowed that he had focused on Vitamin D and the many studies
that showed its ability to prevent disease. In the proposed
bill, this committee would be established to focus on state
workers and retirees, as the state has a contractual
relationship with them. Directing attention to slide 2 of a
PowerPoint presentation titled "HB 39 Prevention of Disease
Decreasing the Alaska Healthcare Liability," he referenced the
huge estimated annual growth in costs for healthcare liability.
Moving on to slide 3, he pointed out that $3.8 billion was
related to the unfunded liability for PERS/TRS health care
because the contribution rates had been established for an
estimated 2 percent annual growth in cost. All the cost beyond
this 2 percent was an unfunded liability. He opined that it was
possible to keep the growth under 2 percent, and this could
eliminate the $3.8 billion of unfunded liability. He stated
that there were more than 17,000 active state employees and
64,000 retired employees and dependents covered by the State of
Alaska health care, slide 4, "Why are we here?" Moving on to
slide 5, "Alaska's Health-Care Bill: $7.5 Billion and Climbing,"
he pointed to Government Employees, Other, and Medicaid Expenses
as the target areas for proposed HB 39, pointing out that more
than 60 percent of health care dollars were spent on hospital
care, clinical services, and doctors, as shown on slide 6.
Moving on to slide 7, he asked the question: "How can we avoid
disease and prevent illness instead of just paying for sick
care?"
CHAIR SEATON directed attention to slide 8, "Active Plan," and
pointed to the studies that showed 66 percent of the total
grouping of diseases directly related to low Vitamin D. Slide
9, "Retiree Plan," also reflected on diseases with studies that
reflected responses related to low Vitamin D.
CHAIR SEATON moved on to slide 10, "Meta-analysis of breast
cancer risk," which showed five different studies stating that
the meta-analysis showed a 50 percent reduction, while a
Grassroots Health clinical trial of women above age 60 showed
there was a 75 percent reduction for breast cancer, when Vitamin
D levels were 50ng/ml or above. On slide 11, he noted that the
monetary savings for a 50 percent reduction of breast cancer
would save more than $3 million annually, and a 72 percent
reduction of breast cancer would recognize a $4,355,000 savings.
3:59:48 PM
CHAIR SEATON directed attention to slide 12, "Meta-analysis,"
which depicted a 50 percent reduction in colorectal cancer when
Vitamin D levels were 34 ng/ml, even lower than breast cancer.
Reviewing the costs on slide 13, a 50 percent reduction in
colorectal cancer would save about $2 million each year. Moving
on to slide 14, "Type 2 Diabetes," a clinical trial showed the
NHANES (National Health and Nutrition Examination Survey) in
2006 showed the new incidence of Diabetes to be 8.5 per thousand
people, whereas an average of 48 ng/ml showed an average of less
than 1 incident per thousand people. He pointed out that this
was a 90 percent reduction in type 2 Diabetes. He pointed to
the cost savings, slide 15, which reflected more than $4 million
in savings with a 90 percent reduction, and almost $2 million
savings for a 38 percent reduction in Type 2 Diabetes.
4:01:56 PM
CHAIR SEATON moved on to slides 16 and 17, and discussed the
incidence of pre-term birth in Alaska. He shared that March of
Dimes was working on lowering the rate of pre-term birth to 9.3
percent, while an eight year study in South Carolina sponsored
by the National Institutes of Health (NIH) suggested that the
use of Vitamin D could reduce this to 7 percent, a 32 percent
reduction from the current rate in Alaska. He reported that the
savings in Alaska could be about $1,300,000 per year. Directing
attention to slide 18, "Upper Respiratory Tract Infections," he
allowed that, although not expensive diseases, studies showed
that there were 50 percent fewer infections, including
pneumonia, tuberculosis, flu, and colds, for those who had a
higher level of Vitamin D. He declared that this could be very
significant for Alaska. He spoke about "inflammatory gum
disease," slide 19, reporting that the body protected against
most inflammation by laying on plaque, and pointed out that 80
percent of gingivitis was eliminated in 90 days when Vitamin D
use was more than 2000 IU/day. He shared that, as heart disease
also started from inflammation, this study on gingivitis could
be a good indicator of how increasing Vitamin D levels could
save a lot on other diseases, as well.
4:06:22 PM
CHAIR SEATON pointed to slide 20, "House Bill No. 39," and
focused on Section 2 of the proposed bill, slide 21, which read
in part: "to the greatest extent legally and reasonably
practicable..." He declared that the proposed bill was not
trying to mandate anything, instead proposing to move forward
with better health to help lower the annual rate increase of
health care cost.
4:06:54 PM
REPRESENTATIVE FOSTER stated that he would like to have someone
from his district appointed to the proposed advisory committee,
and asked how regions for the committee would be delineated.
CHAIR SEATON replied that there was not any guideline for
regional appointments and, as it was a volunteer position, any
interested persons would be welcome to apply.
REPRESENTATIVE FOSTER, in reference to the best, new, and
innovative practices, asked for suggestions on how information
about the benefits of adequate Vitamin D could become more
mainstream.
CHAIR SEATON clarified that the aforementioned wellness
committee would be at least seven members, and it could be
expanded. He suggested that the proposed committee could meet
telephonically, in order to save travel expenses. He expressed
his hope that the proposed bill would engage the state
workforce. He opined that public recognition and understanding
for such a dramatic decrease in a variety of diseases would lead
to an increased use of Vitamin D. He pointed out that, although
the federal government already mandated that Vitamin D be added
to milk to aid in the prevention of rickets, the proposed bill
did not include any mandates. He suggested that generating talk
in the communities, villages, and town councils would go a long
way toward broadening the education, and would lead to a
healthier Alaska.
REPRESENTATIVE FOSTER noted that the proposed advisory committee
had a zero fiscal note. He added that he would tout Vitamin D
in his next constituent newsletter.
4:13:26 PM
REPRESENTATIVE TARR referenced an existing informal wellness
committee within DOA, and she asked if the proposed committee
would transition this existing committee toward more permanence.
She stated that it was obvious how this would work for state
health plan beneficiaries, but asked how the recommendations
from the wellness committee would influence Medicaid recipients.
CHAIR SEATON, in response to Representative Tarr, opined that
the current informal committee had been less active over time,
as there was not any formal committee report or response
necessary. He compared this to the effectiveness from the
Citizen Review Panel report to the Office of Children's
Services, with its requirement of a response from DHSS. He
offered his belief that expensive recommendations could come to
the committee, which may not be possible for the administration
and the department to utilize. He noted that, however, there
could also be huge benefits at very little cost. He offered a
few incentive ideas, which included a co-pay and agreement to
increase Vitamin D, pointing out that ideas which did not
require a big change in your lifestyle were much easier to
attain.
4:17:54 PM
VICE CHAIR VAZQUEZ declared that she was a big fan of wellness
and prevention, and that she was delighted to see the proposed
bill come before the committee. She asked how to get the
concept for the importance of Vitamin D to the Medicaid
population, acknowledging that there could be many complex
issues. She suggested that Legislative Legal Services could
offer guidance.
CHAIR SEATON suggested that, as the Alaska state employees and
retirees addressed in this bill were almost 10 percent of the
population, the Department of Administration lowering healthcare
cost escalation would be instrumental in leading the Department
of Health and Social Services to take this approach, as well,
which is where the Medicaid population would be impacted. He
opined that other employers throughout Alaska would also respond
to any savings. He directed attention to a study for
presenteeism and its impact on work productivity [Included in
members' packets].
4:22:27 PM
REPRESENTATIVE TARR suggested that care coordination for
pharmaceutical use by Medicaid recipients in other states could
be a model.
CHAIR SEATON shared that many of his constituents had declared
appreciation for this information.
VICE CHAIR VAZQUEZ added that this was also a "compassion
issue."
REPRESENTATIVE TALERICO reported that an Alaska labor
organization had instituted a wellness policy that required
physical examinations, and that the rate of co-pay was increased
if healthy attributes were not attained. He opined that it was
necessary to improve the cost effectiveness in order to continue
to pay for services, especially during times of budget
constraints.
CHAIR SEATON stated that it was good to have Vitamin D levels
checked, and he shared that DOA had been more receptive than
DHSS in the recent past for the financial impact from
prevention. He relayed that soft tissue responded best to daily
doses of Vitamin D, which only had a 24 hour half-life. He
noted that there was sufficient data for the ingestion of
various amounts of Vitamin D, and that it had been shown to be
most effective for 83 percent of the people to be above 40 ng/ml
of Vitamin D.
CHAIR SEATON, in response to Representative Foster, directed
attention to page 2, line 24, of the proposed bill, which stated
its goal to slow the escalation of health care costs to less
than 2 percent annually by administering the policies.
4:30:24 PM
REPRESENTATIVE WOOL asked for clarification that the proposed
bill would set up an advisory committee on wellness to guide the
administration, and that this would be enforced through group
health insurance to increase the overall health of its
recipients. He asked if there would be other healthy
recommendations from the advisory committee.
CHAIR SEATON expressed his agreement, noting that there could be
many simple solutions. He shared that previously there had been
a focus on exercise as a solution. He reported that the
aforementioned studies were an example that would allow numbers
and percentages to be put on "this pretty simple and cheap thing
that we could do for Alaskans."
REPRESENTATIVE WOOL mused that research supported that it was
necessary to get people to take Vitamin D daily and maintain
that level, although a big part of the issue was to "get people
educated about it."
CHAIR SEATON expressed his agreement that compliance was
difficult, even as the Vitamin D studies showed a decrease in
fatigue, pain, and bone breakage. He pointed to six new studies
which showed that the rate of dementia and Alzheimer's was cut
in half with a good level of Vitamin D. He stated that sharing
this information in newsletters would allow a better
understanding of the benefits, and would help with compliance.
4:34:41 PM
Vice Chair Vazquez returned the gavel to Chair Seaton.
4:34:56 PM
REPRESENTATIVE FOSTER asked if someone from Department of
Administration would coordinate the proposed wellness committee.
MICHELE MICHAUD, Chief Health Official, Division of Retirements
and Benefits, Department of Administration, replied that
currently there was a wellness coordinator who chaired the
committee, and she opined that, at the least, the wellness
coordinator would serve on the committee, if not serve as the
chair. In response to Representative Tarr, she said that the
wellness newsletter was sent electronically to active employees
and posted on Facebook for the retired employees. She pointed
out that many retired employees did not use electronic means,
and, as postage was expensive, the department was somewhat
limited in the frequency for its communications with the retiree
population.
REPRESENTATIVE TARR offered to include the information in her
newsletters.
REPRESENTATIVE VAZQUEZ asked Ms. Michaud for her opinion to
consideration of an amendment to the proposed bill which would
require an annual report be sent to the Alaska State Legislature
from both the advisory committee and the DOA.
MS. MICHAUD offered her belief that this would not change the
fiscal note.
4:38:02 PM
CHAIR SEATON asked if the Department of Administration had
reviewed the proposed bill other than for the fiscal note, and
if so, was DOA supportive of it.
MS. MICHAUD said that DOA supported wellness and wellness
measures, but there were challenges to hold under an annual 2
percent cost growth.
CHAIR SEATON clarified that, although this was a goal, exceeding
the 2 percent was not a violation of the proposed statute.
4:39:37 PM
CHAIR SEATON opened public testimony.
4:39:58 PM
CHAIR SEATON, in response to Representative Foster, said he
would like to hold the bill until the committee meeting on
February 5, as there would be further testimony for lowering
health care costs.
REPRESENTATIVE VAZQUEZ noted that her research, while working on
her MBA in health care services administration, showed that
wellness programs were often very effective in cost savings.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SDS Tele-Health Presentation_1-27-2015.pptx |
HHSS 1/27/2015 3:00:00 PM |
HSS presentation |
| Continuum of Care_7 2014_Telehealth handout.pdf |
HHSS 1/27/2015 3:00:00 PM |
HSS presentation |
| HB 39_Ver A.PDF |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |
| HB 39 SponsorStatement.pdf |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |
| HB 39 Sectional.pdf |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |
| HB 39 supporting document_Mayo Clinic review.pdf |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |
| HB 39 Supporting Documents_Background Materials by Seaton.pdf |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |
| HB 39 Wellness Presentation.pdf |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |
| HB 39 Support KPBSD.pdf |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |
| HB039-DOA-DRB-01-21-15.pdf |
HHSS 1/27/2015 3:00:00 PM |
HB 39 |