Legislature(2015 - 2016)Anch LIO Auditorium
05/13/2015 03:00 PM House LEGISLATIVE BUDGET & AUDIT
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| Audio | Topic |
|---|---|
| Start | |
| Public Testimony: Department of Health and Social Services Performance Review | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
LEGISLATIVE BUDGET AND AUDIT COMMITTEE
Anchorage, Alaska
May 13, 2015
3:07 p.m.
MEMBERS PRESENT
Representative Mike Hawker, Chair
Representative Kurt Olson
Representative Lance Pruitt
Representative Steve Thompson
Representative Sam Kito
MEMBERS ABSENT
Senator Anna MacKinnon, Vice Chair
Senator Lyman Hoffman
Senator Cathy Giessel
Senator Bert Stedman
Senator Click Bishop
Senator Pete Kelly (alternate)
Representative Mark Neuman (alternate)
OTHER LEGISLATORS PRESENT
Representative Liz Vazquez
Representative Paul Seaton
Representative Cathy Munoz
Representative Tammie Wilson
COMMITTEE CALENDAR
PUBLIC TESTIMONY: DEPARTMENT OF HEALTH AND SOCIAL SERVICES
PERFORMANCE REVIEW
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
MARY SHIELDS, Chair
Alaska Commission on Aging
Anchorage, Alaska
POSITION STATEMENT: Testified during the public review of the
Department of Health and Social Services.
BRETT GLIDDEN
Homer, Alaska
POSITION STATEMENT: Testified during the public review of the
Department of Health and Social Services.
DAVID MORGAN, Director
Alaskan Center for Sustainable Health Care Spending and Policy
Anchorage, Alaska
POSITION STATEMENT: Testified during the public review of the
Department of Health and Social Services.
ELIZABETH VAZQUEZ
Anchorage, Alaska
POSITION STATEMENT: Testified during the public review of the
Department of Health and Social Services.
REPRESENTATIVE PAUL SEATON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the public review of the
Department of Health and Social Services.
JIM WALDINGER
Public Consulting Group
Boston, Massachusetts
POSITION STATEMENT: Shared background information explaining
their involvement with the Department of Health and Social
Services performance review.
JENNY WALL
Public Works
Austin, Texas
POSITION STATEMENT: Shared background information explaining
their involvement with the Department of Health and Social
Services performance review.
ACTION NARRATIVE
3:07:39 PM
CHAIR MIKE HAWKER called the Legislative Budget and Audit
Committee meeting to order at 3:07 p.m. Representatives Hawker,
Kito, Pruitt, and Olson were present at the call to order.
Representative Thompson arrived as the meeting was in progress.
Also in attendance were Representatives Vazquez, Munoz, Wilson,
and Seaton.
^Public Testimony: Department of Health and Social Services
Performance Review
Public Testimony: Department of Health and Social Services
Performance Review
3:07:58 PM
CHAIR HAWKER announced that the only order of business would be
public testimony on the performance review of the Department of
Health and Social Services (DHSS) conducted in accordance with
House Bill 30, the statutory requirement that every State of
Alaska agency be reviewed for its ongoing performance every ten
years. He reported that the DHSS process had begun at the
beginning of 2015, with anticipation of a final report by the
end of the year. He explained that the Legislative Audit
Division had hired consulting groups to work alongside the
division on this report, and that these contractors were also
listening and available on-line.
3:10:13 PM
CHAIR HAWKER said that the Department of Health and Social
Services was the largest agency at the State of Alaska and, due
to its size and its scope, the performance review would be
focused on three critical components of the department:
behavioral health, long term care, and the overall
organizational administrative structure of the department. He
stated that the purpose of these hearings, as required by
statute, was to give the contractors for the performance review
the opportunity to hear any public comments. He reported that,
although the meeting was being held in Anchorage, it was being
teleconferenced statewide, providing the opportunity for anyone
to participate. He reiterated that the purpose of this meeting
was to provide public feedback to the consultants, not for any
individual committee action, and was focused on the performance
operations and interaction of the DHSS with the community. He
stated that this meeting was not to debate any issues
specifically related to budget items. He clarified that this
would provide information for the contractors to review the DHSS
organizational structure and its implementation and whether this
promoted or inhibited the efficiency and effectiveness of the
department in achievement of its mission. He pointed out that
anyone wishing to submit written testimony could do so.
3:13:54 PM
CHAIR HAWKER opened public testimony.
3:14:43 PM
MARY SHIELDS, Chair, Alaska Commission on Aging, paraphrased
from a prepared statement, which read:
My name is Mary Shields. I currently serve as Chair
of the Alaska Commission on Aging.
The Commission on Aging is a Governor-appointed board
under the Department of Health and Social Services
with the mission to ensure the dignity and
independence of all older Alaskans, and to assist them
in leading useful and meaningful lives through
planning, advocacy, education, and interagency
cooperation. The Commission was established in 1982.
The Commission consists of 11 members, seven of whom
are public members mostly of senior age appointed by
the Governor to serve four-year terms based on their
knowledge and demonstrated interest in the concerns of
older Alaskans.
The Commission also has four designated seats
including one seat for the Department of Health and
Social Services. Duane Mayes, Director of the
Division of Senior and Disabilities Services, serves
in that position and keeps ACoA informed of the
Department's programs and services for Alaska seniors.
The Department is an important partner to the
Commission on Aging. As Alaska's State Unit on Aging
designated by the Governor, the Department works
closely with the Division of Senior and Disabilities
Services and the Commission on Aging to carry-out
these responsibilities which include administration of
funds for senior programs, development of the Alaska
State Plan for Senior Services, advocacy for policies
that affect Alaska seniors, outreach, and educational
activities. Currently, the Commission is working in
close partnership with several of the Department's
divisions within the Department of Health and Social
Services, including Senior and Disabilities Services,
the Division of Public Health, the Division of
Behavioral Health, and others to finalize the Alaska
State Plan for Senior Services, FY2016-2019. Division
staff who contributed to the Plan were responsive,
honest, and hard-working in their efforts to forecast
the needs of seniors for the next 4 years. This Plan
satisfies a federal mandate for all states to receive
funding through the Older Americans Act for programs
serving people age 60+.
The Alaska Commission on Aging, with support from the
Alaska Mental Health Trust Authority, Alzheimer's
Resource of Alaska, and the Department of Health and
Social Services collaborated to develop Alaska's
Roadmap to Address Alzheimer's Disease and Related
Dementia that was published this year. As the result
of our fast-growing senior population, Alzheimer's is
one of the most pressing health care challenges we
face in Alaska today. Several divisions within the
Department were represented in the Roadmap's Steering
Committee and will continue to be involved in the
Roadmap's implementation.
Based on my observations, the Department is working
successfully to provide much needed programs for
seniors in a timely and fair manner. They work hard
to address current issues with providers through face-
to-face meetings, teleconferences, and email E-Alerts.
The Department is a leader in adopting the Results-
Based Accountability management framework. The RBA
framework enables the Department to deliver quality
services while making the best use of public resources
and measuring its impact on the health and well-being
of Alaskan individuals, families, and communities.
Using the RBA framework, the Department has developed
strategies to work across divisions in order to
leverage resources and build more cost effective
programs.
During this very difficult fiscal time in Alaska, the
Department will need to be innovative and make some
very difficult funding decisions. We believe that the
current leadership of the department well qualified to
take on this very difficult task.
3:19:26 PM
CHAIR HAWKER relayed that it was good to hear when things were
"working right and well" within an agency. He said that there
had not been a lot of response generated for this public
testimony.
3:20:04 PM
BRETT GLIDDEN said that she had worked for several agencies
delivering behavioral health services, and that, as she was a
certified chemical dependency counselor in Alaska, she was
testifying both as a citizen and as a service provider. She
reported that she had seen remarkable programs funded by DHSS.
Recently, she had been working with a local coalition reviewing
community access to behavioral health and other related human
services, and she had been researching specific grant funding
for substance abuse. She reported that she had been working
closely with the Department of Health and Social Services to
outline the current funding and its use with current
programming. She relayed that she had "hit a couple of walls as
a community member that have made it difficult." She declared
that it was specifically difficult to find out what was
happening with funding in administration versus programming.
She stated that her approach was not from an audit point of
view, but as a concerned community member with experience in
non-profits and an understanding of fiscal responsibility. She
stated that she had often been frustrated with a lack of
transparency for understanding the amount of money allocated for
her region. She pointed to the difficulty of interfacing
between the general community and the department for finding out
anything but general public figures. She noted that her last
request had not been responded to for more than a month. She
asked for a more user friendly approach to the interface with
Department of Health and Social Services. She offered her
belief that she should not have to work so hard for answers from
public agencies.
3:25:25 PM
DAVID MORGAN, Director, shared his background in healthcare and
healthcare finance, which included service on the Alaska Health
Care Commission, and Chair of the Municipality of Anchorage
Health Care Commission. He added that he was also a fellow of
the national Healthcare Financial Management Association. He
stated that he wanted to discuss the management overview and
philosophy of the Department of Health and Social Services. He
declared that the real question was for the quality of what we
were getting for our dollars. He relayed that the actual amount
paid by the state on health care for employee insurance and
Medicaid payments was about $2.6 billion. He added on the
Indian Health System payments of $800 million, the community
health center payment of $40 million, and the aggregate total
became $7.6 billion. He declared that he was not asking for
money, but instead he shared the need for discussion of the
overall management philosophy. He pointed to the legislative
audit of Department of Health and Social Services which revealed
confusion with no clear metric or goal. He stated that many
individuals in the department were not even aware of the key
performance indicators report. He reported that his discussions
with John Boucher, author of the report, had found
inconsistencies of cost and operational data that conflicted
with presentations on projections given to the legislature. He
offered his belief that there should not be a reorganization of
the organization or the payment structure, but that it was
necessary to transform what was being done, and to develop a
system that met the needs of those people receiving the
services. He advocated the Nuka System of Care, a style and
philosophy of care that could drop costs between 30 - 40
percent. He suggested that the legislative leadership meet for
discussions regarding this system of health care, as the goal
was to give people the health care they need and want, and to
use best evidence medicine. This would improve the quality and
lower the cost by improving health.
MR. MORGAN, in response to Chair Hawker, explained that Nuka was
a [Alaska] native word meaning health, that it was a concept and
philosophy of care management, and that it was the development
of systems that would allow people to avail themselves of
activities that would make people healthier. He offered an
example of diabetes management, which included a health
nutrition education program that taught people how to check
blood, review diet, and learn to cook, among other things, which
would improve health, reduce dependency, and result in fewer
emergency room (ER) visits. He declared that although this was
hard work for health professionals, it paid off with healthier
populations and lower costs. He said that a reshaping of the
delivery system to focus on health care would take a few years,
but was better than throwing more money at the current system as
this just created more problems. He recommended an evaluation
based on the existing key performance indicators, and work with
the Nuka Institute, to develop these programs for Medicaid and
public health. He declared that state and retired employees
would ask for it once it became successful. He suggested using
the $2.6 billion to work through health professionals in the
Department of Health and Social Services, as the remainder of
the other programs were administrative, for a change in the
philosophy to one of integrating a program of better health. He
acknowledged that this was a lofty goal.
3:37:26 PM
The committee took a brief at-ease.
3:38:39 PM
ELIZABETH VAZQUEZ stated that she was testifying as a citizen,
not as a legislator, and she shared her educational and work
background that reflected her "passion for health care."
CHAIR HAWKER reminded her that this was a performance review.
MS. VAZQUEZ suggested that the consultants look more closely at
prevention, as there was a lot of research that low levels of
Vitamin D contributed to depression, cancer, and other diseases.
She stated that there were also extensive studies on the effects
from low levels of Vitamin B12 and other B vitamins. She asked
that the consultants find a way to make the healthcare system
sustainable, as Alaska has been able to fund many programs that
other states cannot provide. She offered her belief that it was
critical to know how Alaska was doing in comparison to other
states. She acknowledged that, as seniors were the fastest
growing segment of the population, there were problems including
dementia, the rate for which increased with age. She declared
that the Medicaid budget was not sustainable, and she asked to
look into means of more prevention. She stated that the cost of
nursing homes was disconcerting, and she asked what could be
done to make them more affordable.
REPRESENTATIVE PRUITT asked if there were any other areas that
would benefit from a review committee analysis. He asked if
some of the departments were not working at the highest
efficiency.
MS. VAZQUEZ said that she would send in some suggestions from
her legislative office.
3:45:00 PM
REPRESENTATIVE PAUL SEATON, Alaska State Legislature, suggested
that the review committee look at the lack of follow through by
the Department of Health and Social Services for House
Concurrent Resolution 5, passed unanimously by the Alaska House
of Representatives and Senate in 2011, which called for
prevention of disease as the primary model for health care in
Alaska. He declared that the previous administration had done
little or nothing to advance this prevention of disease model in
Alaska. He pointed out that, although the legislature had
spoken strongly, this had been ignored by DHSS in the past, and
that this should be reviewed again. He suggested that the
current administration also be reviewed to ensure that they were
being more pro-active with moving in the direction called for by
the aforementioned resolution. He offered his belief that there
had not been much action toward prevention or Vitamin D use from
the previous DHSS commissioner. He expressed his concern that
the standards of care for Alaska in the public health system
were not being based on comparisons of the best available data,
or science. He stated that a high standard was being placed on
a change from the status quo even though there was little
evidence to justify the current levels, especially with regard
to nutrition.
3:49:49 PM
JIM WALDINGER, Public Consulting Group, offered an update,
stating that the performance review team had been collecting
information and data while talking with state staff and
providers in Alaska over the past few months. He pointed out
that there were two teams, one team was leading the behavioral
health performance review and the other team was leading the
long term care performance review. He declared that everyone
they had met with had been very accommodating, helpful, and
open. He stated that the review team will likely release some
of its findings during the summer.
CHAIR HAWKER clarified that the performance reviews were
actually conducted by the state's legislative auditor, although
there were contractors engaged to provide additional "mission
specific knowledge on the agencies." He pointed out that the
final reports would come from the Legislative Audit Division.
3:52:54 PM
JENNY WALL, Public Works, reported that her company had assisted
state and local governments, as well as individual agencies, in
more than 12 states with performance reviews. She noted that
her group was specifically working on the organizational and
administrative portions of this performance review. She shared
that the field work, which included extensive interviews with
staff at all levels, as well as comparative and best practices
research for comparable agencies, was being completed.
3:54:36 PM
ADJOURNMENT
There being no further business before the committee, the
Legislative Budget and Audit Committee meeting was adjourned at
3:54 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Agenda_LBA_13May15_ANC DHSS Testimony.pdf |
JBUD 5/13/2015 3:00:00 PM |