Legislature(2009 - 2010)CAPITOL 106

03/11/2010 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved Out of Committee
Moved HSC SB 101(HSS) Out of Committee
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Heard & Held
         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                                                              
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                                                              
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                                                              
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  savingsā€¦"  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                                                              
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                                                              
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                                                              
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                                                              
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