Legislature(2009 - 2010)CAPITOL 106
03/11/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB284 | |
| HB260 | |
| SCR12 | |
| SB101 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SCR 12 | TELECONFERENCED | |
| += | SB 101 | TELECONFERENCED | |
| *+ | HB 260 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 284 | TELECONFERENCED | |
HB 260-MEDICAID: PREVENTIVE CARE/DISEASE MGT.
3:09:51 PM
CO-CHAIR HERRON announced that the next order of business would
be HOUSE BILL NO. 260, "An Act relating to preventive care and
disease management services for medical assistance recipients;
and providing for an effective date."
3:11:14 PM
JIM POUND, Staff to Representative Wes Keller, Alaska State
Legislature, introduced HB 260 and said "health care by way of
prevention would save the state money in the long run. By
detecting an acute disease early in the process, the disease can
either be stopped or possibly reversed." He stated that the
preventative care costs could save money without cutting
services. He explained that this would apply to Medicaid
recipients.
3:12:54 PM
REPRESENTATIVE T. WILSON asked if the state would pay for this
or was it in addition to Medicaid.
MR. POUND replied that it was a part of Medicaid but that the
state would pay for the preventative aspect. He allowed that
there would be an increase in upfront costs, but that early
prevention and early detection would balance the long term
costs.
3:13:46 PM
REPRESENTATIVE T. WILSON asked what the cost would be.
3:14:17 PM
CO-CHAIR KELLER shared that the bill was not yet in its final
format.
3:14:46 PM
REPRESENTATIVE SEATON asked to clarify that the preventative
care was 100 percent state funded for Medicaid recipients.
MR. POUND agreed.
REPRESENTATIVE SEATON pointed to page 2, line 11, and read from
subsection (d): "The department shall evaluate the projected
and actual savings…" and he asked if the referenced annual
report would be on the savings and not on the cost.
MR. POUND agreed.
3:15:38 PM
REPRESENTATIVE CISSNA reported reading that other states had
waivers for preventative work, and expressed her delight. She
said "this is pioneering."
3:16:13 PM
CO-CHAIR KELLER moved to adopt the proposed Committee Substitute
(CS) for HB 260, Version 26-LS1128\R, Mischel, 2/4/10 as the
working document. Seeing no objection, it was so ordered.
3:16:43 PM
REPRESENTATIVE HOLMES asked if the changes had been explained.
3:17:11 PM
CO-CHAIR HERRON replied that testimony would be taken first.
3:17:48 PM
BILL STREUER, Deputy Commissioner, Director's Office, Division
of Health Care Services, Department of Health and Social
Services, said that Medicaid expenses would continue to rise and
he announced that there needed to be "a better, smarter way to
do things." He stated his mantra: "the right care, the right
time, the right place, for the right people, at the right
price." He offered a basic primer to activities that would fit
into this bill.
3:19:04 PM
MR. STREUER compared programs for preventive care: the medical
home program; all inclusive care for the elderly (PACE);
expanded coverage; and, pricing and rate strategies. He stated
that he would only speak about the first two programs. The
first program, the medical home, was a managed care program
which included: physician directed medical practices; a whole
person orientation, focusing entirely on the person and their
particular health conditions, needs, and wants; integrated and
coordinated care; quality and safety; and enhanced access. He
shared that the medical home program had been around since 1967.
He estimated that it would save $67 billion each year. In 2007,
the principles of the patient centered medical home were
released: a personal physician, with an ongoing relationship
with the individual; physician directed medical practices for
the team responsible for care; and whole person orientation, to
include all the patient's health care needs. He described this
gateway for an individual to receive care to include quality and
safety, care planning, evidence based medicine, clinical
decision support, and performance measurement. He spoke about
open scheduling, which included expanded hours and new
communication techniques, on-line and blackberry to blackberry.
He stated that the payment needed to be appropriate to the
providers. He shared that the Centers for Disease Control (CDC)
had concluded that continuous enrollment of children in medical
homes resulted in higher vaccination rates, and that medical
homes provided better access, improved communication, better
satisfaction, reduced duplicate procedures, and lower medical
errors. He stated criticism of medical homes to include: a
potential shifting of financial and other resources with adverse
affects on sectors of the health care system; access to vision
care may be restricted; and careful consideration was needed for
the role of non-physician providers. He opined that the medical
home model needed to take into account all the health care needs
of the individual. He opined that the startup costs would be
minimal and could be accomplished with existing staff. He
reported the necessity of a project coordinator, and that a
pilot project with the Indian Health Services should be
initiated no later than January 1, 2011.
3:24:40 PM
MR. STREUER detailed the Program of All Inclusive Care for the
Elderly (PACE), and stated that it was provided by non-profit or
public entities. He listed the requirements to include:
regulation by the Centers for Medicare and Medicaid Services
(CMS), a governing board, a complete service package, a defined
service area, safeguards against conflict of interest, and
participants must be at least 55 years of age with a need for
nursing facility level of care. He expressed that all Medicaid
and Medicare services plus 16 additional services had to be
provided.
3:26:47 PM
REPRESENTATIVE CISSNA asked if the PACE program was structured
for rural Alaska.
3:27:30 PM
MR. STREUER replied that the PACE program was an urban service
model.
REPRESENTATIVE T. WILSON asked if this was a new program.
MR. STREUER replied that it was a new program in Alaska.
REPRESENTATIVE T. WILSON asked what the program would cost.
MR. STREUER opined that there would not be an increase in costs
over the currently provided services.
3:28:32 PM
CO-CHAIR KELLER asked if there was a pilot program for the
medical home model.
3:29:13 PM
MR. STREUER expressed a desire to develop a program with the
community health centers.
CO-CHAIR KELLER asked about a timeline for the PACE program, and
he offered any help necessary from the committee.
MR. STREUER offered his belief that contacts with CMS would
begin shortly to initiate the pilot program.
3:30:09 PM
REPRESENTATIVE SEATON asked if the wait list for Medicaid
waivers would affect the program.
MR. STREUER replied that the wait list was for individuals, and
that this was a different waiver request.
3:31:41 PM
WARREN TODD, Executive Director, International Disease
Management Alliance, spoke about his background.
3:34:35 PM
MR. TODD said that there was a wealth of experience from the
Lower 48 for Alaska to draw on, though it was difficult to
decipher. He expressed the difficulty for measuring performance
of the programs. He stated that the costs of the programs have
been too high as they have been delivered through for-profit
organizations. He reflected that management of disease
prevention and wellness programs had devoted attention to the
current problems of the elderly. He opined that disease
management programs had a greater chance to demonstrate economic
savings in the short term.
3:37:50 PM
MR. TODD shared that the disease management industry would soon
expand into prevention and wellness programs. He expressed
concern for the core issue that chronic disease was viewed as a
medical problem, although it was a social problem, and could not
be solved in the medical infrastructure. He expressed his
desire for newly designed state programs to address the social
issues. He recommended that it was necessary to design medical,
social, and economic programs for "the very, very specific and
unique needs of your populations throughout your state" in order
for there to be any benefit from the programs.
3:40:50 PM
MR. TODD, in response to Representative Cissna, said that
obesity was a global epidemic.
3:42:45 PM
REPRESENTATIVE CISSNA opined that these programs required
creativity.
MR. TODD agreed.
3:43:44 PM
REPRESENTATIVE T. WILSON asked if these PACE management home
programs had been offered by the private sector.
MR. TODD hesitantly said yes, and referred to the Medicare
program to implement the MHS pilot programs for the elderly,
which were discontinued. He proposed that it was most important
to have an understanding of why these failed.
REPRESENTATIVE T. WILSON asked if any there were any successful
privately run programs.
MR. TODD said that 2 or 3 of the pilot programs generated
results which exceeded expectations, a net 5 percent savings.
REPRESENTATIVE T. WILSON asked for Mr. Todd to forward a list of
these programs.
3:46:42 PM
SHELLEY HUGHES, Government Affairs Director, Alaska Primary Care
Association (APCA), declared this to be the best bill in the
building. She explained that the APCA mission was to promote
health care access to all Alaskans, with a focus of support to
primary care and safety net providers for underserved and low
income populations. She detailed that APCA was the regular
source of primary care for 23 percent of the Medicaid
population. She pointed out that APCA represented the community
health centers which she determined would become the patient
centered healthcare home models, and noted that the patient
would be personally involved with their own care. She stated
that the community health centers were non-profits in the
private sector, and that APCA would partner with the state as a
solution. She relayed that data from other states indicated a
10 -33 percent savings when Medicaid patients use a health
center as the regular source for primary care. She opined that
although the savings may not be that high for Alaska, even a 3-5
percent savings on the 2029 projected Medicaid budget of $3.5
billion would be millions of dollars. She stated that this was
"a very good bill." She pointed to page 2, and stated support
for an annual report as accountability was an important aspect
of the bill. She emphasized the importance of disease
management and the cost savings generated by prevention.
3:51:34 PM
CO-CHAIR KELLER said that this was "an idea whose time has
come." He summarized that PACE, medical home, and disease
management were ways to improve the quality of life and save
money.
3:52:59 PM
[HB 260 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 260 sponsor statement.doc |
HHSS 3/11/2010 3:00:00 PM |
HB 260 |
| HB 260 backup - Preventive Health Care_An Ounce of Prevention by Eve Scheffenacker.doc |
HHSS 3/11/2010 3:00:00 PM |
HB 260 |
| HB 260 backup - Cohen article in New England Journal of Medicine 2-14-2008.pdf |
HHSS 3/11/2010 3:00:00 PM |
HB 260 |