Legislature(2011 - 2012)CAPITOL 106
02/15/2011 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): Commissioner, Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 15, 2011
3:06 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Sharon Cissna (via teleconference)
Representative Charisse Millett
MEMBERS ABSENT
Representative Bob Miller
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Commissioner, Department of Health and Social Services
William Streur - Juneau
- CONFIRMATION(S) ADVANCED
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
WILLIAM STREUR, Acting Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified as appointed commissioner of
Department of Health and Social Services.
ACTION NARRATIVE
3:06:15 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:06 p.m.
Representatives Keller, Dick, Herron, and Millett were present
at the call to order. Representatives Seaton and Cissna (via
teleconference) arrived as the meeting was in progress.
^CONFIRMATION HEARING(S): Commissioner, Department of Health
and Social Services
CONFIRMATION HEARING(S): Commissioner, Department of Health and
Social Services
3:06:35 PM
CHAIR KELLER announced that the committee would consider the
confirmation of the appointment of William Streur as
commissioner of the Department of Health and Social Services.
3:07:26 PM
WILLIAM STREUR, Acting Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), said that he
had been involved in health care for 33 years, 30 years of which
were in the private sector. He pointed out that he had worked
extensively with Medicaid. He stated that he moved to Alaska in
2003 and had been with the Department of Health and Social
Services since 2007.
3:10:36 PM
ACTING COMMISSIONER STREUR offered to answer each of the written
questions which the committee had presented to him. [Included
in members' packets] He read the first question [original
punctuation provided]:
A lot of focus over the years has been on the supply
side of health care, cutting costs through reductions
in reimbursements and/or services, requiring prior
authorizations, etc. what is being done on the demand
side to keep our beneficiaries healthy?
He said that the demand side kept beneficiaries healthy and made
sure that they had "the proper care at the right time, the right
place, delivered to them." He commented that although it was a
big part, prevention was not the only answer. He pointed out
that the Division of Public Assistance provided services to help
achieve its mission of protecting and promoting the health of
the public. He listed six core public health priorities from
the demand side: infectious disease and epidemic prevention and
control; injury prevention, control, and emergency medical
services; chronic disease prevention and control; access to
early preventive services and quality health care; public health
emergency preparedness and response; and protection to human
health from environmental hazards.
He read the second question [original punctuation provided]:
Wellness and prevention programs have shown reductions
in health care costs and other improvements of around
$3 per every dollar spent, have we looked into these,
and what are we doing in this area?
ACTING COMMISSIONER STREUR, referencing the $3 for every $1
spent, advised that "the jury is largely out on this." He
stated the necessity of determining which of the prevention
programs actually worked. He directed attention to the success
in curbing the adult smoking rates, resulting in 8000 fewer
tobacco related deaths, and $300 million in averted health care
costs. He noted that public health employees actively worked
with communities and organizations to build sustainability in
health systems and ensure access to quality health services. He
established that the Division of Public Health engaged in
activities to ensure emergency medical service personnel were
qualified and properly trained, and provided medical and legal
investigative work related to unanticipated sudden or violent
deaths. He declared that the division worked with a variety of
organizations and individuals to develop and implement health
promotion strategies and community action plans for prevention
and reduction of chronic diseases. He confirmed the
effectiveness for reducing health risks and injuries by the
promotion of healthy behaviors through education and community
support. He endorsed the outreach programs to the high risk and
disadvantaged people in need of services. He opined that the
continuing efforts with "self inflicted health care issues,"
such as obesity and smoking, would reap rewards. He announced
that these issues currently cost Alaska $600 million each year
in health care, and an additional $1.9 billion in lost
productivity. He explained his struggle to balance the demands
for care, the growing budget, the increasing number of
enrollees, and the funding for prevention activities. He
suggested a slow movement toward prevention activity and away
from treatment activity to showcase any success.
3:15:00 PM
ACTING COMMISSIONER STREUR reported that professional staff
within the Division of Public Health monitored and assessed
health status through the collection and analysis of vital
statistics, behavioral risk factors, disease and injury data,
and forensic data from post-mortem exams. This information was
used to improve the program services, develop healthy
recommendations, and inform future public decisions.
3:16:05 PM
ACTING COMMISSIONER STREUR read the third question [original
punctuation provided]:
Do we have data on the prevalence of various
preventable chronic diseases in our Medicaid
population, such as cardiac disease, type 2 diabetes
and obesity?
If we do, what disease/conditions are they?
Are we doing anything to address them?
He stated that in FY 2010, Medicaid covered 120,879 Alaskans
with total payments of $1.172 billion for health care. He
declared that respondents with chronic conditions represented
49.7 percent of active Medicaid recipients, with 86.5 percent of
Medicaid payments.
3:17:13 PM
CHAIR KELLER asked for a breakdown of the chronic diseases, by
expense and prevalence.
3:17:46 PM
ACTING COMMISSIONER STREUR replied that, in FY 2010, there were
5217 Alaskans with diabetes on Medicaid, with payments of
$12,553,951; 1318 Alaskans with congestive heart failure, with
payment of $5,687,000; and 6669 Alaskans with asthma, with
payment of $5,521,000. He explained that Alaska had a case
management contract to ensure that these individuals kept
appointments and took medications. He reported that this case
management contract saved Alaska $673,636, about 5 percent, for
patients with diabetes; saved $591,300, about 10 percent, for
individuals with congestive heart failure; and saved $427,000,
about 7 percent, for asthmatic patients. He added that case
management was now an electronic process, also resulting in
savings. He opined that the Alaska Medical Home Program would
also save money.
3:20:25 PM
CHAIR KELLER asked if the community health centers would be a
solution.
ACTING COMMISSIONER STREUR offered his belief that a community
health center pilot program, as well as a private health
facility, could contract with the Alaska Medical Home Program,
for "a gentle form of managed care." He opined that there would
be a "steep learning curve to implement [Alaska] Medical Home,
but I believe it works."
3:22:08 PM
ACTING COMMISSIONER STREUR moved on to the next question
[original punctuation provided]:
What have you done to define Medical Necessary?
He stated that Department of Health and Social Services and
Department of Law had worked together to address this and
determine a practical approach for Alaska. He stated that only
a medical professional could determine "medical necessity." He
agreed that the issues were complex and that analysis was not
yet complete. He noted that other states were confronting a
similar dilemma.
3:23:51 PM
REPRESENTATIVE MILLETT asked for a time line to the Department
of Law recommendation. She pointed to a current request to
increase the federal poverty level designated for qualification
to Denali KidCare.
ACTING COMMISSIONER STREUR replied that he wanted a decision as
soon as possible, possibly by March 15. He stressed the need
for a solution to the expansion of Denali KidCare.
3:24:57 PM
ACTING COMMISSIONER STREUR read the next question [original
punctuation provided]:
Could you also share your thoughts of how the
department will ensure equitable service to the people
who are most difficult to reach (I'm referring to
those in the bush) and who may need the help the most?
He offered his belief that Alaska had risen above all the other
states for the range of services provided, and the ability to
develop community health aides, dental health aides, and
behavioral health aides, ensuring that services were available.
He pointed out that the Alaska Native Tribal Health Consortium
and telemedicine had connected with [rural] clinics and health
aides. He referenced a DHSS program for a broad delivery of
behavioral health service in rural areas. He stated that "to do
good, we have to do well." He announced that the state had to
work with its health partners to ensure the ability to provide
services to the communities. He opined that Alaska would not
have "a social worker in every village" but he emphasized that
access to services needed to be developed.
3:28:13 PM
ACTING COMMISSIONER STREUR stated that DHSS had been working to
add Medicaid coverage for behavioral health aids.
3:29:19 PM
ACTING COMMISSIONER STREUR read the next question [original
punctuation provided]:
What is the benefit of having Therapeutic Courts
compared to regular courts? In regards to the
recidivism rate.
He stated that, in 2007, the Alaska Judicial Council had
conducted a recidivism study of the felony therapeutic courts in
Alaska compared to the non-therapeutic court participants with
similar characteristics. He shared its findings: only 13
percent of the graduates of therapeutic courts were re-arrested
in the first year, about one third that of the comparison group.
He noted that only 6 percent of the therapeutic group was
convicted of a new offense in the first year, about 25 percent
that of the non-therapeutic group. He stated that therapeutic
courts significantly lowered the recidivism rates, and he
emphasized that the cost for a therapeutic court candidate was
10 percent that of an incarcerated person.
3:30:42 PM
REPRESENTATIVE MILLETT asked if the tracking for therapeutic
court recidivism extended beyond one year.
3:31:08 PM
ACTING COMMISSIONER STREUR replied that there was tracking for
multiple years, but that this data was only year to year. He
offered to supply the additional longer term data.
ACTING COMMISSIONER STREUR compared that the four year re-arrest
rate for drug court participants was 29 percent and 17 percent
for drug court graduates, compared to 41 percent for similar
drug offenders who did not participate in drug court. He
pointed to a similar study for DUI [Driving Under the Influence]
court participants, who were also found to be "substantially
less likely than comparable DUI offenders sentenced to probation
to be arrested for a new DUI offense or any criminal offense
within two years of entering the program." He stated that the
longer term effect of drug court in Portland was a 30 percent
reduction over five years.
3:32:33 PM
ACTING COMMISSIONER STREUR read the next question [original
punctuation provided]:
With over $4 million dollars spent on suicide
prevention our numbers are still the worst in the
nation. Can you tell us of your plans for turning
this around that's different from what's been tried in
the past?
He reflected on the [Alaska Statewide] Suicide Prevention Summit
in 2010, and noted the priority by the Suicide Prevention
Council to strengthen the communication partnerships between the
stakeholders and the systems. He discussed the partnership
between the Alaska Mental Health Board, the Suicide Prevention
Council, DHSS, and the Alaska Mental Health Trust to design and
launch the interactive web portal, stopsuicidesalaska.org, which
would help individuals connect with community groups engaged in
suicide prevention. He stated that this would address the gap
of ongoing communication, which had been addressed at the
summit. He directed attention to a comprehensive toolkit for
community training and response which had been developed by the
Suicide Prevention Council, DHSS, and the Alaska Native Tribal
Health Consortium. He shared that the Suicide Prevention
Council had worked to expand access to suicide prevention and
intervention training, as well as mental health first aid
training. He pointed to a need for continuous engagement with
community members, as suicide was epidemic not episodic,
observing that social media was an effective tool. He described
the Iron Dog poster and the baseball card campaigns, and pointed
out that each included the Suicide Prevention hotline phone
number. He attributed the campaign successes to the inclusion
of role models, as opposed to scare tactics.
3:37:57 PM
CHAIR KELLER reminded the committee that its role was to
determine whether to forward this nomination.
3:38:36 PM
REPRESENTATIVE SEATON, describing the high percentage of full
mouth reconstructions for children in rural Alaska, asked about
targeting for rural dental problems.
3:40:18 PM
ACTING COMMISSIONER STREUR confirmed his frustration for the
inadequate use of the Early Periodic Screening, Diagnosis, and
Treatment Program, the [Medicaid] dental program targeting
children. He pointed to a lack of available dental
professionals to ensure good dental care, stating that community
dental health aides could expand and improve this service. He
also emphasized the need for a change to the trend for sugared
drinks in rural stores. He suggested a school meal program in
conjunction with Department of Education and Early Development.
He reflected that dental care was the most difficult care to
access in rural Alaska.
3:42:27 PM
REPRESENTATIVE SEATON, offering his support for the dental
health aides, declared a need to ensure early preventative
dental programs. He opined that dental problems could lead to
other health problems, including depression.
3:44:31 PM
ACTING COMMISSIONER STREUR offered to report back to the
committee.
3:44:55 PM
CHAIR KELLER agreed that committee time would be dedicated to
that report.
3:45:11 PM
REPRESENTATIVE CISSNA reflected that state government had a role
in health issues for the 300 communities around Alaska. She
asked for a list of health needs per community, and, from this
list, she suggested formation of a "community mentorship."
3:47:13 PM
ACTING COMMISSIONER STREUR agreed that a health check on the
communities would be an admirable undertaking.
3:47:46 PM
REPRESENTATIVE CISSNA asked if the current state technology
could allow for statewide hearings "to get people throughout the
state working on it and actually have it be something that the
people help build."
3:48:28 PM
ACTING COMMISSIONER STREUR replied that he would speak with Dr.
Hurlburt for possible options.
3:49:15 PM
REPRESENTATIVE HERRON asked if Acting Commissioner Streur had a
plan or a timeline for strategies on Medicaid managed care or
cost containment.
ACTING COMMISSIONER STREUR replied that he had "bits and pieces
in place to roll out." He expressed his desire to have the
Medical Home program ready by early summer, and that the
Enhanced Care Management Program was already in place. He spoke
about care management, ensuring that patients receive the proper
care, and case management, directing patients to the proper
place. He pointed to some of the challenges of the Medicaid
budget, surmising that there was "a whole lot to do." He
emphasized the importance for getting the proper technology in
place, but that it would not be accomplished until early 2012.
He offered his belief that the data for detailed reports
determining the exact care provided would be available soon.
REPRESENTATIVE HERRON requested to be included in the Medicaid
decision making process.
CHAIR KELLER agreed, stating that House Health and Social
Services Standing Committee had a huge responsibility.
3:53:48 PM
REPRESENTATIVE MILLETT offered accolades to Acting Commissioner
Streur from her senior constituency that both he and OCS were
attentive to their needs.
3:55:19 PM
CHAIR KELLER closed testimony.
3:56:00 PM
REPRESENTATIVE DICK moved to forward the confirmation of William
Streur to joint session for consideration as commissioner of
Department of Health and Social Services. There being no
objection, it was so ordered.
3:56:35 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 3:56 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Commissioner HSS - Streur#2.pdf |
HHSS 2/15/2011 3:00:00 PM |