Legislature(2013 - 2014)CAPITOL 106

03/20/2014 03:00 PM House HEALTH & SOCIAL SERVICES

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Heard & Held
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSHB 324(HSS) Out of Committee
             HB 356-ADVISORY COMMITTEE ON WELLNESS                                                                          
4:12:33 PM                                                                                                                    
VICE  CHAIR KELLER  announced that  the final  order of  business                                                               
would be  HOUSE BILL NO.  356, "An Act establishing  the Advisory                                                               
Committee  on Wellness;  and relating  to  the administration  of                                                               
state group health insurance policies."                                                                                         
4:13:09 PM                                                                                                                    
REPRESENTATIVE SEATON, as sponsor of proposed HB 356,                                                                           
paraphrased from the sponsor statement:                                                                                         
     HB 356 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% per year.                                                                             
     According to the Institute of Social and Economic                                                                          
     Research, total health care spending in Alaska topped                                                                      
     $7.5 billion in Alaska in 2010, with state government                                                                      
     employers paying over $400 million.  A major component                                                                     
     of our $12 billion unfunded pension liability is                                                                           
     retiree healthcare costs.  HB 356 requires the                                                                             
     Commissioner of Administration to put in place                                                                             
     programs that will decrease the incidence of disease                                                                       
     in State of Alaska employees, both current and                                                                             
     retired, in order to hold the inflation of costs to 2%                                                                     
     per year.                                                                                                                  
     This bill focuses on preventing the incidence of                                                                           
     disease as opposed to treatment of disease.                                                                                
     Prevention of disease is the policy approach                                                                               
     unanimously requested of the Governor by the                                                                               
     legislature through HCR 5 in 2011.  This is an area of                                                                     
     healthcare where the most economic impact can be                                                                           
     achieved.  For instance, recent studies show that an                                                                       
     action as simple as taking a daily supplement of 5,000                                                                     
     IU of vitamin D can dramatically reduce the risk of                                                                        
     heart disease, diabetes, cancer, autism, gingivitis,                                                                       
     and many other conditions.                                                                                                 
     HB 356 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.  HB 356 will enforce a                                                                     
     paradigm shift for the Department of Administration                                                                        
     and the Department of Health and Social Services.  It                                                                      
     will require the agencies to implement policies to                                                                         
     keep Alaska state employees healthy by preventing                                                                          
     disease, rather than the common, reactive policy of                                                                        
     waiting until people get sick and then treating them.                                                                      
REPRESENTATIVE   SEATON  directed   attention  to   a  PowerPoint                                                               
presentation entitled,  "HB 356 Prevention of  Disease Decreasing                                                               
the Alaska  Healthcare Liability," and the  unfunded liability in                                                               
the  PERS  and  TRS  accounts.    He  addressed  slide  1,  "$3.8                                                               
Billion," which he declared to  be the current amount of unfunded                                                               
liability for health care costs,  with an annual increase of more                                                               
than 2  percent.   Directing attention  to slide  2, "Why  are we                                                               
here?"  he noted  that  the  state was  spending  more than  $100                                                               
million annually  for active employees,  and almost  $500 million                                                               
for retirees.   He pointed  out that  the state also  paid health                                                               
care  costs  for  inmates, state  employees  under  union  health                                                               
trust,  Medicaid,   and  workers  compensation,  slide   3.    He                                                               
explained  that  the  current   discussion  would  be  about  DOA                                                               
policies  for workers  and retirees  for Alaska,  and noted  that                                                               
almost  60 percent  of the  $7.5 billion  of the  state cost  for                                                               
health care  was spent  on hospital  care, doctors,  and clinical                                                               
REPRESENTATIVE SEATON  moved on to slide  5, "This is the  way we                                                               
currently  contain  costs:"  and   pointed  out  that  the  state                                                               
insurance  focused   on  limitations  of  coverage   for  certain                                                               
conditions  or limitations  on compensation  for procedures.   He                                                               
stated  that  the Department  of  Labor  & Workforce  Development                                                               
tried  to prevent  accidents  by  limiting time  on  the job  and                                                               
requiring  safe  job conditions.    He  said that  Department  of                                                               
Health  and   Social  Services  had  some   prevention  programs,                                                               
including  voluntary  childhood vaccinations,  prescription  drug                                                               
safety, and  voluntary lifestyle changes,  which he deemed  to be                                                               
tough  accomplishments.    He  pointed  out  that  Department  of                                                               
Environmental  Conservation and  Department of  Natural Resources                                                               
worked on food safety  requirements, including shellfish testing,                                                               
pasteurized milk requirements, and  restaurant and food processor                                                               
inspections.   He  stated that  the Department  of Public  Safety                                                               
enforced the laws.   He pointed out that  the aforementioned $3.8                                                               
billion expense was  created by the institution  of these current                                                               
REPRESENTATIVE  SEATON  asked  "How  can we  avoid  diseases  and                                                               
prevent  illness  instead of  just  reacting  to and  paying  for                                                               
Sickcare," slide  6.   Moving on  to slide  7, "Active  Plan," he                                                               
noted  that  these were  the  aggregate  risk profiles  and  risk                                                               
drivers  of the  plan,  with a  contribution  percentage for  the                                                               
direct relation of each to Vitamin  D levels.  He stated that the                                                               
total of  diseases directly  related to Vitamin  D levels  was 66                                                               
percent.   Moving to  slide 8, "Retiree  Plan," the  risk factors                                                               
related to low  vitamin D levels was 61 percent.   He spoke about                                                               
slide  9,  "Meta-analysis of  breast  cancer  risk," a  group  of                                                               
studies that  combined data and  then segregated these  into five                                                               
groups by  blood serum Vitamin  D.   The national average  was 21                                                               
ng/ml, yet the  rate for blood cancer was decreased  by half when                                                               
Vitamin D rates moved up to 52 ng/ml.                                                                                           
REPRESENTATIVE SEATON  reported on  slide 10, stating  that, with                                                               
Vitamin D  use, there  was a  50 percent  reduction to  the costs                                                               
resulting from breast cancer.                                                                                                   
REPRESENTATIVE  SEATON projected  slide 11,  "Meta-analysis," and                                                               
noted the 50 percent reduction  in incidence of colon cancer with                                                               
Vitamin D use, an almost $2  million savings for the state, slide                                                               
12.     He  discussed  slide  13,   "Diabetes  Incidence:"  which                                                               
reflected  a  clinical trial  for  Type  2  Diabetes and  the  90                                                               
percent reduction  of incidences with  the increase of  Vitamin D                                                               
to 48 ng/ml, slide 14, "Type  2 Diabetes."  Slide 15, reflected a                                                               
$4  million  per year  savings  with  this  Vitamin  D use.    He                                                               
stressed the importance of raising  Vitamin D levels to the 40-60                                                               
4:26:28 PM                                                                                                                    
REPRESENTATIVE  SEATON pointed  to  slide 16,  "march of  dimes,"                                                               
which reflected  the reduction of  preterm births in  Alaska with                                                               
an increase  of Vitamin  D.   The savings to  the state  was $1.3                                                               
million, slide 17.   He spoke about slide  18, "Upper Respiratory                                                               
Tract  Infections," and  compared levels  of Vitamin  D above  30                                                               
ng/ml  with   the  relative  risk  of   upper  respiratory  tract                                                               
infections.   He reviewed slide  19, "Inflammatory  gum disease,"                                                               
and spoke about  tooth loss and infection,  and that relationship                                                               
to other  illnesses in the  body.  He  pointed to the  80 percent                                                               
reduction in inflammation in 90  days with an increase in Vitamin                                                               
D levels to 50 ng/ml.                                                                                                           
REPRESENTATIVE  SEATON stated  that individual  Alaskans and  the                                                               
State shared a  burden for the increasing health care  costs.  He                                                               
declared that  the state had  not adequately focused on  a policy                                                               
of avoiding  disease and maintaining  health, slide 20.   He read                                                               
from  the  proposed  bill,  slide 21,  "to  the  greatest  extent                                                               
legally   and   reasonably   practicable,   the   Department   of                                                               
Administration shall work  to hold down the  escalation of health                                                               
care  costs to  less  than 2  percent  annually by  administering                                                               
policies  of  the  group health  insurance  obtained  under  this                                                               
subsection in a manner that is  likely to reduce the incidence of                                                               
disease in the state's  population and facilitates implementation                                                               
of  the recommendations  of the  Advisory  Committee on  Wellness                                                               
established  under   this  bill."     He  emphasized   that  this                                                               
represented a  "total change  in the direction  in which  we view                                                               
health care."   He stressed that it was necessary  for a new tack                                                               
if  we were  going  to  address the  unfunded  liability and  the                                                               
impending big budget  deficits.  He said  that the aforementioned                                                               
Advisory  Committee  on  Wellness  was modeled  on  the  Citizens                                                               
Review Panel  for the Office  of Children's  Services [Department                                                               
of Health and  Social Services].  It would comprise  of a minimum                                                               
of  seven  appointed  members,  with at  least  one  health  care                                                               
provider.     Similar   to  the   Citizens   Review  Panel,   the                                                               
administration would  be required  to address the  issues brought                                                               
forward by  the panel.   He declared  that this could  change the                                                               
course of  escalating health  care costs  and the  large unfunded                                                               
REPRESENTATIVE  TARR  asked  whether there  were  expansions  for                                                               
preventative  care  and  additional covered  services  under  the                                                               
Affordable  Care and  Patient Protection  Act, and  were these  a                                                               
complement for long term cost savings to the proposed bill.                                                                     
REPRESENTATIVE SEATON  replied that this proposal  was a paradigm                                                               
shift,  whereas the  Affordable Care  and Patient  Protection Act                                                               
was  directed more  toward affordable  insurance  and paying  for                                                               
sick care.  He relayed that  its only prevention means were early                                                               
detection screenings.                                                                                                           
REPRESENTATIVE  SEATON read  a  list of  the  study titles  which                                                               
included   Senior  Health   Issues,  Vitamin   D  Supplementation                                                               
programs, and  Low Serum Vitamin  D concentration  in Alzheimer's                                                               
REPRESENTATIVE  SEATON,   in  response  to  Vice   Chair  Keller,                                                               
explained  that the  proposed bill  requested that  Department of                                                               
Administration (DOA)  focus on disease  prevention in  its health                                                               
coverage policy.  He suggested an  incentive of a lower co-pay if                                                               
people agree to  increase their Vitamin D level  to between 40-60                                                               
ng/ml.   He  suggested  that DOA  construct  an incentive  system                                                               
during  negotiation with  the union  health care  contracts.   He                                                               
pointed to the  potential health care tradeoffs  with health care                                                               
accounts.   He noted that this  could spread to include  not only                                                               
the  health insurance  programs in  the state,  but also  include                                                               
Medicaid.    He declared  that  many  chronic diseases  could  be                                                               
avoided  at a  fraction  of cost,  noting  the huge  cost/benefit                                                               
ratio.    He   reminded  the  committee  that,   in  2011,  House                                                               
Concurrent Resolution 5 was passed,  which called on the governor                                                               
to declare prevention of disease  as the primary model for health                                                               
care, and  that this  resolution had not  been implemented.   The                                                               
current proposed bill, HB 356,  would be another reminder for the                                                               
administration to  implement the policy,  and, as it would  be in                                                               
statute, it  was a priority.   He declared  that the crux  of the                                                               
proposed  bill was  to prioritize  this paradigm  shift to  lower                                                               
health care cost by avoiding disease.   He allowed that there had                                                               
been a voluntary  wellness committee in Department  of Health and                                                               
Social Services,  although it  had never been  set in  statute or                                                               
required the  DOA to  respond.   He offered  his belief  that the                                                               
focus had always been to pay for  the sick care, and not to focus                                                               
on keeping people  well.  Lifestyle changes were hard  and had to                                                               
be voluntary.   He  declared that the  intention of  the proposed                                                               
bill was for  the Alaska State Legislature to set  a policy for a                                                               
healthy Alaskan workforce and retiree  base, and lower the health                                                               
care  cost.    He  opined  that this  would  help  alleviate  the                                                               
upcoming fiscal constraints.                                                                                                    
VICE CHAIR KELLER summarized that  the proposed bill was a change                                                               
in  the DOA  mission  statement, and  that  performance would  be                                                               
measured    on    the    successful   implementation    of    the                                                               
REPRESENTATIVE SEATON  replied that the language  of the proposed                                                               
bill allowed a lot of latitude.   He said that the millions saved                                                               
would make a huge difference.                                                                                                   
REPRESENTATIVE  TARR said  that she  supported the  idea and  any                                                               
efforts at prevention.   She suggested a  need for clarifications                                                               
of the criteria for the seven volunteer committee memberships.                                                                  
REPRESENTATIVE SEATON explained that  the proposed bill suggested                                                               
at least seven  committee members, though there could  be more to                                                               
even better create a geographical  representation.  He emphasized                                                               
the necessity for a clear intent from the legislature.                                                                          
4:47:37 PM                                                                                                                    
MIKE BARNHILL,  Deputy Commissioner, Office of  the Commissioner,                                                               
Department  of Administration  (DOA), expressed  his appreciation                                                               
to the  sponsor, and  stated that DOA  shared the  enthusiasm for                                                               
wellness initiatives and the idea  to trend medical costs down to                                                               
2 percent.   He questioned whether this  was achievable, however.                                                               
He offered to share past  DOA programs, which included a wellness                                                               
committee for  the 2012 state  employee health plan.   There were                                                               
over  90  applications  for  the 12  positions  on  the  wellness                                                               
committee.   He explained the  "first dollar preventive  care" in                                                               
the  state  employee  health  plan,   which  meant  that  certain                                                               
preventive care services were not  subject to the deductible.  He                                                               
opined that  it was too early  to measure the efficacy  of any of                                                               
these measures;  although some of these  initiatives were popular                                                               
with certain constituencies, there  was also an equally prominent                                                               
constituency that  was skeptical of government  telling them what                                                               
to do and  how to live their  lives.  He offered  his belief that                                                               
this  was the  larger segment,  and he  questioned how  to engage                                                               
with this population for an effective wellness campaign.                                                                        
MR.  BARNHILL said  that a  variety of  issues drive  health care                                                               
costs.  He  stated that end-of-life care was  very expensive, and                                                               
there were many expensive behavioral  issues, as well.  He stated                                                               
that many people  will not change the way they  live their lives.                                                               
He  opined  that, although  the  benefits  of  Vitamin D  was  an                                                               
interesting proposal,  there were  health costs driven  by issues                                                               
not addressed  by Vitamin D,  noting especially the high  cost of                                                               
orthopedic fractures.   He reported that AETNA  was developing "a                                                               
more   robust   network   particularly   for   specialists,"   as                                                               
controlling these costs was very important.                                                                                     
4:54:37 PM                                                                                                                    
REPRESENTATIVE TARR asked about  the suggested wellness committee                                                               
approach in the proposed bill.                                                                                                  
MR.  BARNHILL replied  that  there were  discounts  for State  of                                                               
Alaska employees at  gyms, recreation clubs, etc.  and that there                                                               
were intermittent  programs, competitions,  and initiatives.   He                                                               
expressed  his understanding  that this  would only  appeal to  a                                                               
certain percentage of the workforce.                                                                                            
MR.  BARNHILL,  in response  to  Representative  Tarr, said  that                                                               
there  was   a  strategic  health  initiatives   coordinator  who                                                               
coordinated these program discounts.                                                                                            
VICE CHAIR  KELLER asked for  details about the  current wellness                                                               
MR. BARNHILL replied that the 12 members met monthly.                                                                           
VICE CHAIR KELLER  asked if the committee had  considered the use                                                               
of Vitamin D.                                                                                                                   
MR. BARNHILL replied that he did not know.                                                                                      
REPRESENTATIVE SEATON  said that  the wellness committee  had not                                                               
met "since AETNA  came on-line."  He referred to  the New Zealand                                                               
report  which advocated  for  Vitamin D,  noting  that usage  had                                                               
jumped  from  15  percent  to  74  percent,  with  a  32  percent                                                               
reduction in  aged residential care  in the  emergency department                                                               
from falls and fractures.  He  expressed the need to reach out to                                                               
residential senior  facilities across  Alaska, and his  desire to                                                               
give the  administration a tool  for use in  contract negotiation                                                               
for  prevention  programs.   He  suggested  that the  legislature                                                               
adopt a policy for healthy Alaskans.                                                                                            
5:00:10 PM                                                                                                                    
VICE  CHAIR KELLER  asked that  the DOA  discuss its  support and                                                               
report back to the committee.  [HB 356 was held over.]                                                                          

Document Name Date/Time Subjects
HB0319A.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Sponsor Statement.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Sectional Analysis.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB319-DCCED-DOI-03-14-14.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Documents Natural Estrogens.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Documents Estriol.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Documents - Harris.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document Insurance nightmare - FAI Daily News Miner.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Thurman.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Statues and Regulations - Pharmacies.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - What is compounding.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Quality Control.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - introduction.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Compounding Resources.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Compounding & Pharmacists.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Alternative Medication Forms.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Jordan.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - IACP Introduction.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - IACP Frequently Asked Questions.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - IACP - What is compounding.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Gherman.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Calmes.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB0356A.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 356 sponsor statement.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB356-DOA-DRB-03-14-14.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB356 Support KPBSD.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 356 Mayo Clinic vitamin D for health a global perspective.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 319 DOA DRB FAQ 3 20 2014.PDF HHSS 3/20/2014 3:00:00 PM
HB 319
HB319-DCCED-CBPL-03-14-2014.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 356 Background Materials.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 356 Wellness Presentation.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356