Legislature(2015 - 2016)HOUSE FINANCE 519

02/25/2015 01:30 PM House FINANCE

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01:32:16 PM Start
01:33:25 PM HB39
02:17:54 PM Recidivism Reduction Discussion: the Pew Charitable Trust
03:17:10 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
+ "Recidivism Reduction Discussion: The Pew TELECONFERENCED
Charitable Trust" by Gary VanLandingham,
Director, Pew-MacArthur Results First Initiative
& Stanford Turner, Associate, The Pew Charitable
+ Bills Previously Heard/Scheduled TELECONFERENCED
CS FOR HOUSE BILL NO. 39(HSS)                                                                                                 
     "An Act establishing the Advisory Committee on                                                                             
     Wellness; and relating to the administration of state                                                                      
     group health insurance policies."                                                                                          
1:33:25 PM                                                                                                                    
REPRESENTATIVE  PAUL  SEATON, testified  on  HB  39; a  bill                                                                    
establishing   the  Advisory   Committee  on   Wellness.  He                                                                    
reported  that the  intent  of  the bill  was  to create  an                                                                    
advisory  wellness   committee  within  the   Department  of                                                                    
Administration  (DOA).  The   legislation  required  DOA  to                                                                    
implement procedures  to decrease  the incidence  of disease                                                                    
in Alaska  in an attempt  to hold healthcare inflation  to 2                                                                    
percent  per  year  for state  health  insurance  plans.  He                                                                    
purported  that  the  bill  added   weight  to  the  current                                                                    
wellness  committee through  establishing  the committee  in                                                                    
statute,  expanding the  membership,  and  requiring DOA  to                                                                    
respond  to its  recommendations within  6 months.  The bill                                                                    
further mandated the  department to provide a  report to the                                                                    
legislature   on   DOA's   response   to   the   committee's                                                                    
recommendations.  He  detailed  that the  wellness  advisory                                                                    
committee was  modeled after the Citizen's  Review Panel for                                                                    
the Office of Children  Services (OCS) [Department of Health                                                                    
and  Social   Services  (DHSS)].  The  Office   of  Children                                                                    
Services   was   required   to  respond   to   the   panel's                                                                    
recommendations,   which  proved   effective  at   improving                                                                    
children's   services.   He   expounded  that   by   holding                                                                    
healthcare inflation to 2 percent  on the state's active and                                                                    
retiree healthcare  costs the state would  reduce the Public                                                                    
Employees'   Retirement   System    (PERS)   and   Teacher's                                                                    
Retirement System (TRS) unfunded  liability by  $3.8 billion                                                                    
dollars. He  added that  healthcare inflation  was currently                                                                    
at 5  percent but  was estimated at  2 percent  for payments                                                                    
made  to  the  PERS/TRS  system  which  contributed  to  the                                                                    
unfunded  liability.  He  related  that  HB  39  focused  on                                                                    
curbing   state  worker's   healthcare  costs   because  the                                                                    
contractual    relationship    between   the    state    and                                                                    
employees/retirees   could  be   manipulated  to   influence                                                                    
behavior. For  instance, the  state could  employ incentives                                                                    
through  co-pay  or  deductible changes  to  reach  specific                                                                    
health goals.                                                                                                                   
Representative  Seaton   drew  attention   to  a   study  on                                                                    
depression titled,  "Vitamin D and Depression:  A Systematic                                                                    
Review and Meta-Analysis Comparing  Studies with and without                                                                    
Biological  Flaws" (copy  on file).  He  read the  following                                                                    
from page 14:                                                                                                                   
     The   effect  size   for   Vitamin   D  in   depression                                                                    
     demonstrated in  this meta-analysis is  comparable with                                                                    
     the effect  of anti-depressant medication,  an accepted                                                                    
     treatment  for  depression.  Should  these  results  be                                                                    
     verified by  future research,  these findings  may have                                                                    
    important clinical and public health implications.                                                                          
Representative Seaton  communicated that many of  the social                                                                    
problems in the  Alaska populace was due  to depression. The                                                                    
state's prison  population had  deficient vitamin  D levels.                                                                    
Vitamin  D  levels  also contributed  to  a  healthy  immune                                                                    
system.  He surmised  that maintaining  wellness within  the                                                                    
correctional system  through vitamin  D use was  one example                                                                    
of  how  the  wellness  committee could  work  to  influence                                                                    
better health through DOA.                                                                                                      
Co-Chair  Thompson referred  to  page 2,  [line  23] of  the                                                                    
legislation and cited the  language, "legally and reasonably                                                                    
practicable."  He  asked  what the  legally  and  reasonably                                                                    
practicable  standard was.  Representative Seaton  responded                                                                    
that the language  was included as a way  for the department                                                                    
to  evaluate  the  advisory committee's  recommendations.  A                                                                    
recommendation  might be  unlawful or  violate HIPPA  rules,                                                                    
therefore the  administration was not required  to implement                                                                    
the recommendation.  The recommendation  would also  have to                                                                    
meet  a  standard  of  practicality.   He  voiced  that  the                                                                    
language  granted  the  department  flexibility  within  its                                                                    
required review of the recommendations.                                                                                         
1:41:30 PM                                                                                                                    
Vice-Chair Saddler  asked about  why the  advisory committee                                                                    
was  part of  DOA and  not housed  within the  Department of                                                                    
Health  and Social  Services  (DHSS). Representative  Seaton                                                                    
replied that state only had  a contractual relationship with                                                                    
state  employees,  retirees,  and  their  dependents,  which                                                                    
provided   a  "mechanism"   to  incentivize   outcomes.  The                                                                    
Department of  Administration was  the only  department that                                                                    
reviewed  the health  policies of  the  state employees  and                                                                    
Representative Kawasaki  referred to  Section 2 of  the bill                                                                    
and noted that  the focus was on healthcare  costs. He asked                                                                    
whether it was the intent  of the legislation to examine the                                                                    
state's   health   care   insurance  costs   and   coverage.                                                                    
Representative  Seaton responded  that  the  purpose of  the                                                                    
bill  was  to  create  a  healthier  workforce  and  improve                                                                    
retirees'  health.  He  explained  that  the  bill  was  not                                                                    
attempting to change the health  care plans' provisions. The                                                                    
bill  focused  on  prevention  as  a  way  to  help  control                                                                    
healthcare costs.                                                                                                               
Representative Gara  relayed that the Citizens  Review Panel                                                                    
had a  difficult time  obtaining requested  information from                                                                    
OCS. He  wanted to ensure  HB 39 was  written in a  way that                                                                    
made it  easy for  the advisory  committee to  get necessary                                                                    
information from  DOA. Representative Seaton  responded that                                                                    
there  was  a difference  in  the  mission between  the  two                                                                    
advisory entities. The panel  reviewed state operations, the                                                                    
wellness  committee was  finding  ways  to improve  worker's                                                                    
health, which did not require DOA to supply information.                                                                        
1:45:36 PM                                                                                                                    
Co-Chair Neuman  cited page 2,  Section 2 [lines  15 through                                                                    
21] of the bill and read the following:                                                                                         
     (13)  To the  greatest  extent  legally and  reasonably                                                                    
     practicable,  the  Department of  Administration  shall                                                                    
     work to  hold the  escalation of  health care  costs to                                                                    
     less  than   two  percent  annually   by  administering                                                                    
     policies of 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                                                                    
     that facilitates implementation  of the recommendations                                                                    
     of  the  Advisory  Committee  on  Wellness  established                                                                    
     under 21 AS 39.30.093.                                                                                                     
Co-Chair  Neuman  asked  whether  the  department  would  be                                                                    
required to  implement the  recommendations of  the advisory                                                                    
committee  in its  plans policies  in order  to achieve  a 2                                                                    
percent reduction.                                                                                                              
Representative  Seaton  responded  that the  intent  of  the                                                                    
legislation  did not  mandate  the  department to  implement                                                                    
policies.  The bill  required the  department to  review the                                                                    
recommendations  and respond  to each  recommendation via  a                                                                    
report. Each  recommendation would  be held to  the standard                                                                    
of legally  and reasonably  practicable. He  summarized that                                                                    
HB 39  did not  mandate implementation  of policies  only to                                                                    
review recommendations.                                                                                                         
Co-Chair Neuman asked  about Section 3 [on page  2, lines 23                                                                    
through 28] and read the following:                                                                                             
     (b)  To  the  greatest extent  legally  and  reasonably                                                                    
     practicable,  the  Department of  Administration  shall                                                                    
     work to  hold the  escalation of  health care  costs to                                                                    
     less  than   two  percent  annually   by  administering                                                                    
     policies of group health  insurance obtained under this                                                                    
     section  in  a manner  that  is  likely to  reduce  the                                                                    
     incidence  of disease  in  the  state's population  and                                                                    
     that facilitates implementation  of the recommendations                                                                    
     of  the  Advisory  Committee  on  Wellness  established                                                                    
     under AS 39.30.093.                                                                                                        
Co-Chair  Neuman understood  that  DOA  was already  working                                                                    
hard to  contain healthcare  costs for  the state.  He asked                                                                    
whether Section 3 guaranteed that  if the department adopted                                                                    
the recommendations  of the  advisory committee  costs would                                                                    
come down.  Representative Seaton  answered that  a wellness                                                                    
committee  was in  place but  met infrequently  and did  not                                                                    
carry  much  weight  because its  recommendations  were  not                                                                    
required  to   be  addressed.  The  bill   facilitated  that                                                                    
recommendations  would be  addressed  and  those with  merit                                                                    
should be considered for implementation.                                                                                        
Co-Chair Neuman  remarked that the  bill packet  contained a                                                                    
lot  of information  about  the benefits  of  vitamin D.  He                                                                    
asked whether it was the  sponsor's intent for all Alaskan's                                                                    
to  take vitamin  D at  the recommendation  of the  wellness                                                                    
committee to  reduce the cost of  healthcare. Representative                                                                    
Seaton suggested the information  was included as an example                                                                    
of  something that  the wellness  committee might  recommend                                                                    
based on  sound scientific  information. He  emphasized that                                                                    
HB  39 only  addressed  people who  the  state maintained  a                                                                    
contractual  relationship with  in order  to provide  health                                                                    
insurance   for;  state   employees,  retirees,   and  their                                                                    
dependents. The  contractual relationship enabled  the state                                                                    
to  provide incentives  for better  health outcomes  through                                                                    
preventive care.                                                                                                                
1:51:12 PM                                                                                                                    
Representative  Wilson  expressed  concern  that  healthcare                                                                    
costs over 2  percent would be transferred  to the retirees.                                                                    
She  wondered  whether  the  commissioner  of  DOA  had  the                                                                    
medical expertise  to implement  programs that  would reduce                                                                    
the  incidence of  disease. Representative  Seaton responded                                                                    
that the legislation could not  change the cost structure of                                                                    
negotiated   contracts.  He   reiterated  that   a  wellness                                                                    
committee already  existed in DOA  but lacked  a requirement                                                                    
to  review the  committee's  recommendations and  facilitate                                                                    
implementation. He  commented that the bill  expanded on the                                                                    
work the  department currently undertook; to  administer the                                                                    
state's  health insurance.  He informed  the committee  that                                                                    
the department previously testified in favor of the bill.                                                                       
Representative  Wilson  voiced   that  the  state  insurance                                                                    
already   sent   recipients   an   abundance   of   wellness                                                                    
information.  She   was  bothered  by  the   possibility  of                                                                    
mandates  in  order to  reduce  healthcare  costs to  the  2                                                                    
percent inflationary  level. She  felt that  the information                                                                    
that was  already available was  enough to  induce wellness.                                                                    
She felt  that the legislation  was "heading down  the wrong                                                                    
path" by  creating mandates. Representative  Seaton remarked                                                                    
that the  bill was  attempting to  reduce $3.8  billion from                                                                    
the unfunded  liability by  prompting the  state's employees                                                                    
and retirees towards improved health.                                                                                           
1:55:05 PM                                                                                                                    
Representative  Munoz wondered  about the  contract for  the                                                                    
administration  of the  state's health  insurance plans  and                                                                    
thought that they were currently  under review. She wondered                                                                    
how the committee  would work with DOA  to implement changes                                                                    
while    contract    negotiations   were    taking    place.                                                                    
Representative Seaton  thought that  the committee  would be                                                                    
fully integrated  with the department.  He pointed  out that                                                                    
currently the  wellness committee did  offer recommendations                                                                    
but they were  never reviewed or acted on.  He restated that                                                                    
the bill  was just  "adding weight"  to create  an effective                                                                    
wellness committee.                                                                                                             
Representative  Munoz   mentioned  that  the   previous  DOA                                                                    
administration  implemented a  wellness  program. She  asked                                                                    
whether  the program  helped to  change  outcomes and  lower                                                                    
costs  under  the  current contract.  Representative  Seaton                                                                    
responded that he  did not know the  statistical outcomes of                                                                    
the department's  efforts to entice  people to  quit smoking                                                                    
or  provide state  employees  free vitamin  D  tests at  the                                                                    
state's health fair.                                                                                                            
Representative Guttenberg  mentioned that the  state already                                                                    
had a  wellness committee  and a healthcare  commission full                                                                    
of healthcare professionals  and administrators. He inquired                                                                    
whether  the  sponsor   considered  "rolling"  the  wellness                                                                    
committee  into  the healthcare  commission.  Representative                                                                    
Seaton  answered  in the  negative.  He  explained that  the                                                                    
wellness committee consisted of  state employees and "people                                                                    
on  the  ground" that  viewed  things  differently than  the                                                                    
medical  establishment.  He  reiterated  that  the  wellness                                                                    
committee  existed  in  DOA and  not  DHSS  to  specifically                                                                    
address  how to  lower  healthcare costs  for employees  and                                                                    
retirees  and  not to  examine  the  general health  of  all                                                                    
2:00:04 PM                                                                                                                    
Vice-Chair  Saddler asked  whether  HB 39  would sunset  the                                                                    
existing  committee  and  replace  it with  a  new  wellness                                                                    
committee.   Representative   Seaton   answered   that   the                                                                    
legislation  expanded the  existing  committee  and did  not                                                                    
incur costs.  The members participated  online and  on their                                                                    
own time.  Representative Seaton, in response  to a question                                                                    
by  Representative Saddler,  indicated  that  the bill  only                                                                    
dealt  with the  Advisory Committee  on Wellness  within the                                                                    
DOA and had no connection to the healthcare commission.                                                                         
Vice-Chair Saddler commented that  the language in the bill,                                                                    
"greatest extent legally  and reasonably practicable" seemed                                                                    
"firm"  and  he needed  to  ponder  how much  authority  the                                                                    
committee would actually have.                                                                                                  
Representative Gattis  requested clarity about  the advisory                                                                    
committee.  Representative Seaton  reiterated that  the bill                                                                    
only  dealt   with  the   Advisory  Committee   on  Wellness                                                                    
established within DOA and had  nothing to do with any other                                                                    
commission on  healthcare. He  reiterated the  proposed role                                                                    
of the committee.                                                                                                               
Representative  Gattis  reminded   the  committee  that  the                                                                    
state's employee  healthcare was  a benefit  paid for  by an                                                                    
employer. She  opined that  the bill's  provision was  not a                                                                    
"liberty issue."  The growing cost  of health  care dictated                                                                    
that  the state  implement  measures to  control costs.  She                                                                    
opined   that   if   the   state   offered   incentives   or                                                                    
disincentives to  accomplish cost control, the  employee had                                                                    
the choice to  accept the benefit or not.  She asked whether                                                                    
the sponsor  agreed with her  point of  view. Representative                                                                    
Seaton answered in the affirmative.                                                                                             
Representative Edgmon supported the  concept of the bill. He                                                                    
believed  the intent  was reformist  and would  achieve cost                                                                    
savings  and   raise  awareness  over  time   to  produce  a                                                                    
healthier working  populace of  state workers. He  felt that                                                                    
the  objective of  the committee  to help  reduce healthcare                                                                    
inflation to 2  percent was ambitious. He  expected that the                                                                    
committee would be  very active and engaged  to achieve such                                                                    
an  ambitious goal.  He  wondered  about its  administrative                                                                    
costs.  Representative Seaton  indicated that  the committee                                                                    
was  voluntary and  met  "electronically"  and consisted  of                                                                    
employees  who  cared  about improved  health  outcomes.  He                                                                    
surmised   that   by   providing    more   "heft"   to   the                                                                    
recommendations made by the committee,  the members would be                                                                    
actively involved.                                                                                                              
2:07:57 PM                                                                                                                    
Representative  Edgmon  referred to  page  3,  [line 8]  and                                                                    
     (d) The committee shall meet at the call of the chair                                                                      
     or at the request of a majority of its members.                                                                            
Representative Edgmon suggested that  the provision could be                                                                    
strengthened by  requiring that the  committee met  three or                                                                    
four times  each year to  achieve its goal. He  thought that                                                                    
achieving the  cost savings  was an  arduous task  to burden                                                                    
the committee with.                                                                                                             
Representative Seaton pointed to page 3, line 11 and read:                                                                      
     (e) At intervals of six months, the committee shall                                                                        
     make recommendations…                                                                                                      
Representative Seaton  noted that  the committee  was tasked                                                                    
with   continuously   examining    healthcare   and   making                                                                    
recommendations  every  six  months. He  detailed  that  the                                                                    
department had  to respond to  the recommendations  no later                                                                    
than six  months and once  a year DOA  had to report  to the                                                                    
legislature sometime during the legislative session.                                                                            
Representative  Edgmon referred  to the  Alaska Health  Care                                                                    
Commission with an  annual budget of $300  thousand who also                                                                    
made recommendations  to the legislature that  weren't acted                                                                    
on.  He  wondered  how  a  volunteer  committee  held  to  a                                                                    
difficult cost savings task could accomplish its mission.                                                                       
Representative   Kawasaki  asked   what  the   current  cost                                                                    
escalation   of   healthcare  was.   Representative   Seaton                                                                    
responded  that it  was in  the 4.5  percent to  5.5 percent                                                                    
range. Representative Kawasaki commented  on the boldness of                                                                    
the 2  percent goal  and that  a difference  existed between                                                                    
healthcare outcomes and  actual costs. Representative Seaton                                                                    
responded  that if  diseases could  be prevented  costs went                                                                    
down dramatically. He explained that  the 2 percent goal was                                                                    
a target to achieve a  $3.8 billion saving in the retirement                                                                    
system's unfunded liability.                                                                                                    
Vice-Chair Saddler referred  to page 2, line 8  and read the                                                                    
     It  is   the  intent   of  the  legislature   that,  by                                                                    
     establishing   a   wellness  committee   and   wellness                                                                    
     initiatives  that  create  incentives  and  methods  to                                                                    
     decrease the frequency and severity of disease…                                                                            
Vice-Chair  Saddler  wanted  to  know if  a  scenario  could                                                                    
develop  that  required  employee  compliance  in  order  to                                                                    
maintain employment.                                                                                                            
Representative Seaton responded in  the negative and did not                                                                    
see the bill as punitive.                                                                                                       
2:13:36 PM                                                                                                                    
Co-Chair Thompson noted that the  fiscal note (FN 1 ADM) was                                                                    
zero.  He referred  to analysis  on  page two  and read  the                                                                    
     The costs  of specific  initiatives recommended  by the                                                                    
     advisory committee on wellness,  some of which could be                                                                    
     substantial,   cannot  be   estimated  at   this  time.                                                                    
     Therefore, the department submits a zero fiscal note.                                                                      
Co-Chair  Thompson  requested   some  specific  examples  of                                                                    
initiatives that could lead to substantial costs.                                                                               
MICHELE   MICHAUD,  CHIEF   HEALTH   OFFICER,  DIVISION   OF                                                                    
RETIREMENT  AND  BENEFITS,   explained  that  currently  the                                                                    
department  had a  wellness committee  and coordinator  that                                                                    
were  only  focused on  the  AlaskaCare  employee plan  with                                                                    
approximately  6,700 recipients.  The department  contracted                                                                    
with its third party  administrator to provide lifestyle and                                                                    
disease  management  services  to  AlaskaCare  members.  She                                                                    
furthered that  the bill expanded  the services  to retirees                                                                    
which  added  approximately   67,000  more  recipients.  She                                                                    
stated that  any initiative that  was not covered  under the                                                                    
plan would increase costs.                                                                                                      
Co-Chair  Thompson  asked  whether  the  department  had  to                                                                    
implement  the  committee's   recommendations.  Ms.  Michaud                                                                    
answered in the negative.                                                                                                       
Representative Gara  asked whether  it was  the department's                                                                    
intention   to   take    the   committee's   recommendations                                                                    
seriously.   Ms.   Michaud   answered   affirmatively.   She                                                                    
communicated that the  department's goal was also  to have a                                                                    
healthier workforce  and retirees  because it was  proven to                                                                    
reduce costs  and DOA was  interested in innovative  ways to                                                                    
accomplish savings.  She added  that the challenge  would be                                                                    
to implement recommendations without additional costs.                                                                          
Representative Wilson  asked whether  the current  2 percent                                                                    
target was  met within  the AlaskaCare program.  Ms. Michaud                                                                    
answered in the negative.  She explained that the department                                                                    
did not specify a monetary savings target for AlaskaCare.                                                                       
Representative Wilson  asked for a breakdown  of the current                                                                    
costs for the AlaskaCare wellness program.                                                                                      
HB  38  was   HEARD  and  HELD  in   committee  for  further                                                                    
^RECIDIVISM REDUCTION DISCUSSION: THE PEW CHARITABLE TRUST                                                                    
2:17:54 PM                                                                                                                    
Co-Chair  Neuman  recounted  that the  presentation  was  in                                                                    
response   to  strategies   developed   by  the   recidivism                                                                    
workgroup created  under intent language  in 2014 in  HB 266                                                                    
[Approp:   Operating   Budget/Loans/Funds].   One   of   the                                                                    
workgroup's strategies  was to work with  the Pew Charitable                                                                    
Trust to develop a recidivism reduction plan.                                                                                   
SUSANNE  DIPIETRO,   EXECUTIVE  DIRECTOR,   ALASKA  JUDICIAL                                                                    
COUNCIL, ALASKA COURT SYSTEM, explained  that SB 64 [Omnibus                                                                    
Crime/Corrections/Recidivism  Bill]   was  adopted   by  the                                                                    
legislature in 2014 and created  the Alaska Criminal Justice                                                                    
Commission within  the Alaska Judicial Council.  The council                                                                    
was exploring ways  to obtain resources to  support the work                                                                    
of  the  criminal justice  system  and  discovered the  Pew-                                                                    
Macarthur  Foundations  and  the technical  assistance  they                                                                    
GARY  VANLANDINGHAM, DIRECTOR,  PEW-MACARTHUR RESULTS  FIRST                                                                    
INITIATIVE, explained that the  Results First Initiative was                                                                    
a  partnership between  the Pew  Charitable  Trusts and  the                                                                    
MacArthur  Foundation, which  helped  state's identify  what                                                                    
evidence based  results a program would  offer a policymaker                                                                    
wanting to implement change. The  initiative was born out of                                                                    
the  "great   recession"  in   recognition  of   the  fiscal                                                                    
difficulties  states   found  themselves   experiencing.  He                                                                    
shared  that   he  previously  worked  as   the  legislative                                                                    
research   director  for   the  state   of  Florida,   which                                                                    
experienced  a 30  percent decrease  in  general funds  when                                                                    
emerging from  the great  recession due  to the  downturn in                                                                    
the real estate market. He  voiced that Florida was expected                                                                    
to  financially  recover  to its  pre-recession  2006  level                                                                    
sometime in  2016. He stated  that other states  were facing                                                                    
the  same challenges.  He detailed  that Florida  engaged in                                                                    
broad  budget  cuts  due to  lack  of  information  enabling                                                                    
better "strategic"  choices. He  thought that  states needed                                                                    
better tools to make more  informed "tough" choices and that                                                                    
more  evidence  based  information was  currently  available                                                                    
about the best programs that  would deliver the best results                                                                    
for the dollars spent.                                                                                                          
Mr. VanLandingham turned to slide 2:                                                                                            
     "The Policy Change."                                                                                                       
     •Though policymakers want to make strategic choices,                                                                       
     the process often relies on inertia and anecdote                                                                           
     •Limited data on:                                                                                                          
     -What programs are funded                                                                                                  
     -What each costs                                                                                                           
     -What programs accomplish                                                                                                  
     -How they compare                                                                                                          
     •Solution: bring systematic evidence into the system                                                                       
Mr. VanLandingham  delineated that much  systematic evidence                                                                    
currently  existed to  determine  the value  and outcome  of                                                                    
programs  and  needed  to   be  "packaged."  Throughout  the                                                                    
country, thousands  of studies  and "rigorous"  research had                                                                    
been  carried  out  over many  years  on  various  programs.                                                                    
Collectively  a lot  was known  about "what  works" and  the                                                                    
challenge  was  how  to  find it  quickly.  The  benefit  of                                                                    
collective   knowledge  could   be  incorporated   into  the                                                                    
legislative   process.  He   noted  that   the  process   of                                                                    
interjecting the  collective knowledge into  the legislative                                                                    
decision-making   process    was   called,   "Evidence-Based                                                                    
2:25:05 PM                                                                                                                    
Mr. VanLandingham advanced to Slide 3:                                                                                          
     "Evidence-Based Policymaking."                                                                                             
     •Focuses on "What Works" - target funds to programs                                                                        
     shown to be effective by rigorous research                                                                                 
     -Uses lists of 'proven' and 'promising' programs                                                                           
     identified by clearinghouses                                                                                               
     •Outcome-oriented approach                                                                                                 
     •Asks whether programs' benefits justify their costs                                                                       
Mr.  VanLandingham  shared  that the  professional  baseball                                                                    
team, the Oakland A's employed  the same method to develop a                                                                    
winning  team  that  was  25   percent  less  expensive.  He                                                                    
believed the  same approach worked for  government; identify                                                                    
what programs  delivered the best  results on a  "dollar for                                                                    
dollar" basis" for the citizens  of Alaska. He surmised that                                                                    
the  evidence  based  approach asked  whether  there  was  a                                                                    
better option  that produced better, more  effective results                                                                    
for  the money  that was  expended into  the system  without                                                                    
spending additional money.                                                                                                      
Mr. VanLandingham continued to slide 4:                                                                                         
     "The Results First Approach."                                                                                              
     Compare current programs to evidence                                                                                       
     Target funds to evidence-based programs                                                                                    
     Conduct cost-benefit analysis to compare returns on                                                                        
     Goal: Achieve dramatic improvements without increased                                                                      
Mr. VanLandingham explained that  the initiative asked basic                                                                    
questions  about what  programs the  state was  operating in                                                                    
the  specific policy  domain and  what was  known about  the                                                                    
program and  its effectiveness. The  initiative subsequently                                                                    
performed  a   thorough  analysis  of  programs   that  were                                                                    
identified  to  have  good   evidenced  based  outcomes  and                                                                    
subject  the  programs to  a  "cost-benefit  analysis" on  a                                                                    
portfolio basis in order to compare programs.                                                                                   
Mr. VanLandingham  turned to slide 5:  "Inventory Programs."                                                                    
He elaborated that  the initiative identified a  list of the                                                                    
state's  programs  that  included the  programs'  costs  and                                                                    
percent of budget.                                                                                                              
Mr. VanLandingham  discussed slide 6: "Compare  Inventory to                                                                    
Database  of  Evidence-based  Programs." He  indicated  that                                                                    
subsequently,  the  list of  programs  were  subjected to  a                                                                    
comparison of evidenced-based programs  from a database. The                                                                    
color-coded  assessment  identified  whether  programs  were                                                                    
well-supported, promising, effective, or not effective.                                                                         
Mr.  VanLandingham scrolled  to  slide 7:  "Assess Level  of                                                                    
Funding   for  Evidence-Based   Programs."  The   initiative                                                                    
evaluated the  information and ranked programs  according to                                                                    
their  effectiveness. Often,  states operated  programs that                                                                    
lacked any  evaluative information about them.  He suggested                                                                    
auditing programs that did not  have evidence-based data for                                                                    
comparison  against the  national data  base. He  emphasized                                                                    
the importance  of discovering  the effectiveness  and value                                                                    
of programs the state funded and  were high risk in terms of                                                                    
investment under the cost benefit analysis approach.                                                                            
2:30:00 PM                                                                                                                    
Mr. VanLandingham turned  to slide 8: (no  title just bullet                                                                    
     Results First provides a national database of evidence                                                                     
     on program effectiveness.                                                                                                  
     The state adds and analyzes their own state-specific                                                                       
     population and cost data.                                                                                                  
     The model calculates long-term costs and benefits for                                                                      
     each program.                                                                                                              
     The model ranks programs according to their return on                                                                      
     Policymakers consider the information during the                                                                           
     budget process.                                                                                                            
Mr.  VanLandingham explained  that the  initiative used  the                                                                    
national  research   database  and  applied  it   to  Alaska                                                                    
specific data.  He exemplified that if  a successful program                                                                    
in Georgia that reduced  recidivism was identified the model                                                                    
would apply  it to  Alaska specific  data to  determine what                                                                    
the program could accomplish in Alaska.                                                                                         
Mr. VanLandingham discussed the  example graphed in slide 9:                                                                    
"Example:  Meta-analysis of  Functional Family  Therapy." He                                                                    
indicated that  typically when  children were  "getting into                                                                    
serious trouble"  they were sent to  a residential facility,                                                                    
where  the state  provided treatment  and various  intensive                                                                    
services  in   order  to   rehabilitate  the   children.  He                                                                    
elaborated  that the  programs were  very expensive  costing                                                                    
anywhere from  $60 thousand  to $100  thousand per  year per                                                                    
individual and  many children  were not  rehabilitated after                                                                    
release.  He cited  Washington  state  recidivism data  that                                                                    
revealed  that 50  percent of  the children  re-offended and                                                                    
were back in  the system within 6 months post  release. As a                                                                    
result,  Washington   state  instituted  a   program  called                                                                    
"Functional   Family  Therapy"   which  provided   intensive                                                                    
services but kept the child  at home in a community setting.                                                                    
The state also provided services  to the family, in order to                                                                    
address the  dysfunction that  caused the  child to  act out                                                                    
and  instruct the  parents on  better parenting  techniques.                                                                    
Recidivism  rates  were reduced  by  22  percent. The  model                                                                    
would also  determine the costs  to achieving  the reduction                                                                    
and whether  it was  worthwhile for  the state  to implement                                                                    
the program.                                                                                                                    
Mr.  VanLandingham  discussed   slide  10:  "Community-Based                                                                    
Functional  Family  Therapy."  He reported  that  Washington                                                                    
State  discerned that  the 22  percent reduction  equated to                                                                    
over $29  thousand in benefits  by avoiding tax  payer costs                                                                    
to  prosecute and  intern  the  offending children,  lowered                                                                    
victimization, victim  costs, and  created a  safer society.                                                                    
He  noted that  the model  provided  a dollar  value to  the                                                                    
societal  benefits of  avoiding specific  crimes by  knowing                                                                    
the  costs associated  with various  crimes.  He added  that                                                                    
over $9.5 thousand  was saved in societal  costs by enabling                                                                    
more  of the  children to  graduate high  school and  obtain                                                                    
employment and health care  costs were additionally reduced.                                                                    
The  total value  of benefits  of the  therapy was  over $37                                                                    
thousand  dollars at  a  cost of  $3.3  thousand per  family                                                                    
which amounted  to $11.28  in benefits  for every  dollar of                                                                    
2:35:03 PM                                                                                                                    
Mr.  VanLandingham discussed  slide 11:  "Compare Return  on                                                                    
Investment of Programs - Consumer  Reports." He related that                                                                    
the model was  more "powerful" to examine the  approach as a                                                                    
portfolio  of  investment  opportunities  for  a  state.  He                                                                    
explained that  by looking  at programs as  part of  a whole                                                                    
the cost-benefit ratio could  identify "best buys;" programs                                                                    
that dollar  for dollar delivered  strong returns  and would                                                                    
receive  higher  priority  for  funding  considerations.  He                                                                    
reported  that  in  Washington State,  cognitive  behavioral                                                                    
therapy    programs    were   inexpensive    and    produced                                                                    
approximately  $25  for  every dollar  invested.  Electronic                                                                    
monitoring produced  approximately $22 per  dollar invested,                                                                    
which was not  as good as cognitive therapy  but much better                                                                    
than  others.  He  added that  regarding  juvenile  programs                                                                    
Washington  State  discovered  that  aggression  replacement                                                                    
training had a high return  on investment dollars at $37 for                                                                    
every  dollar spent.  However,  the  program called  "Scared                                                                    
Straight" which  was very inexpensive  at $66 per  child was                                                                    
very   ineffective   and   actually  increased   crime   and                                                                    
demystified  prison.  He  revealed  that  domestic  violence                                                                    
treatment was  found to  be ineffective  in many  states and                                                                    
when  replaced with  a cognitive  therapy  type of  program,                                                                    
yielded much  better results. He  summarized that  the model                                                                    
allowed a  state to use  national research but tailor  it to                                                                    
state  specific   information  to  measure   results  versus                                                                    
investment.   Failed  programs   could  be   identified  and                                                                    
Mr. VanLandingham  advanced to  slide 13:  "Participation in                                                                    
Results  First."  The  map identified  the  16  states  that                                                                    
participated   in  Results   First.  He   voiced  that   the                                                                    
initiative  began  four  years  ago. He  observed  that  the                                                                    
initiative operated in both  conservative and liberal states                                                                    
because bipartisan consensus supported investing money in                                                                       
things that work.                                                                                                               
Mr. VanLandingham turned to slide 14:                                                                                           
     Developed comprehensive  inventory of  all correctional                                                                    
     programs at state institutions                                                                                             
     •Eliminating   and   replacing    programs   in   adult                                                                    
     •Implementing   data-driven   efforts  to   standardize                                                                    
    enhance, and increase accountability in drug courts                                                                         
     •Passed legislation that:                                                                                                  
     -Requires  data  reporting  by  local  courts  and  law                                                                    
     enforcement agencies                                                                                                       
     -Requires  comprehensive   program  inventories   in  4                                                                    
     -Defines evidence-based, research  based, and promising                                                                    
Mr. VanLandingham reported that the state of Mississippi                                                                        
utilized the program for the past two years.                                                                                    
2:40:02 PM                                                                                                                    
Mr. VanLandingham reported on slide 15:                                                                                         
     "New Mexico"                                                                                                               
     Implemented in all available policy areas                                                                                  
     •Produced Innovative Reports including  a report on the                                                                    
     impact of state budget cuts and                                                                                            
     -"Cost of Doing Nothing"  report: offenders released in                                                                    
     2011 will  cost state additional  $360 M over  15 years                                                                    
     under current policies and programs                                                                                        
     •Used  Results  First  approach   to  target  $57M  for                                                                    
     evidence-based  programming in  early education,  child                                                                    
     welfare, and criminal justice                                                                                              
Mr.  VanLandingham indicated  that  New  Mexico adopted  the                                                                    
model with  the help of  Results First three years  ago. The                                                                    
state was  "fairly poor"  and had  big social  problems. The                                                                    
legislature  realized   it  needed   to  invest   in  highly                                                                    
effective programs.                                                                                                             
Mr. VanLandingham advanced to slide 17:                                                                                         
     "Complimentary Initiatives."                                                                                               
     Results First                                                                                                              
     Informs the budgetary  process and increases investment                                                                    
    in evidence-based programs across many policy areas                                                                         
     •Not  designed  to   address  sentencing  policies  and                                                                    
     Justice Reinvestment                                                                                                       
     Generates  policy  recommendations to  promote  system-                                                                    
     wide reform in criminal justice                                                                                            
     Identifies  policy  options  to manage  the  growth  in                                                                    
     corrections costs and increase public safety                                                                               
     The Initiatives  have worked  together in  states -both                                                                    
     consecutively    and     concurrently-    to    achieve                                                                    
     complementary and successful outcomes                                                                                      
Mr.  VanLandingham reported  that  the Justice  Reinvestment                                                                    
project examined what was driving  the costs of the criminal                                                                    
justice system  in a particular state.  The program explored                                                                    
ways to reinvest  any savings achieved by  reductions in the                                                                    
growth of  the prison population, back  into proven programs                                                                    
in the  criminal justice system  to create a  virtuous cycle                                                                    
of  recidivism reductions  while holding  people accountable                                                                    
and  improving  public  safety. He  continued  that  Results                                                                    
First  was  more  of an  investments  advisory  service  and                                                                    
examined programs for maximum effectiveness and not policy.                                                                     
Both programs had parallel processes but were distinct.                                                                         
Mr.  VanLandingham  communicated  how to  become  a  Results                                                                    
First state. He discussed slide 19:                                                                                             
     "State Selection Criteria"                                                                                                 
     1) Commitment to evidence-based decision making                                                                            
     2) Ability to provide necessary data                                                                                       
     3) Willingness to dedicate resources                                                                                       
Mr.  VanLandingham shared  that Results  First looked  for a                                                                    
letter of invitation from the  legislature and the governor.                                                                    
He  added  that  the  initiative  needed  a  commitment  for                                                                    
sufficient  bandwidth and  staff resources  by the  state to                                                                    
implement the program.                                                                                                          
2:45:06 PM                                                                                                                    
Mr. VanLandingham advance to slide 20:                                                                                          
     "The Role of Partner States."                                                                                              
     Secure leadership support                                                                                                  
     Appoint a policy work group                                                                                                
     Establish a staff work group with project manager                                                                          
     Collaborate with Results First to strengthen the model                                                                     
     and build a learning community of states                                                                                   
Mr. VanLandingham  believed that the Judicial  Council would                                                                    
be  the  proper policy  work  group.  The work  group  would                                                                    
communicate  and  provide  directives to  the  agencies.  In                                                                    
addition,   the  University   of  Alaska,   Anchorage  (UAA)                                                                    
volunteered to chair a staff work group.                                                                                        
Mr. VanLandingham moved to slide 21:                                                                                            
     Services Provided by Results First                                                                                         
     Provide software                                                                                                           
     Train staff in the approach                                                                                                
     Provide ongoing technical assistance                                                                                       
     Help interpret results for policymakers                                                                                    
     Compile and share lessons learned with other                                                                               
     participating states                                                                                                       
     Expand and update model                                                                                                    
Mr.  VanLandingham  articulated  that   Pew's  goal  was  to                                                                    
capture  the  knowledge  of  what  works  and  to  make  the                                                                    
information available  to states and expand  into many other                                                                    
policy  areas  and major  budget  drivers.  He informed  the                                                                    
committee  that  the  choices   the  state  made  under  the                                                                    
initiative  were theirs.  The  initiative  only enabled  the                                                                    
process  and  would  never lobby  for  a  particular  policy                                                                    
Co-Chair  Neuman  remarked  that   he  helped  organize  the                                                                    
recidivism   reduction   workgroup   that   had   previously                                                                    
testified  in committee.  He  asked what  the  costs to  the                                                                    
state  would   be  to  partner  with   the  initiative.  Mr.                                                                    
VanLandingham answered  that the  commitment from  the state                                                                    
would  require one  FTE (full  time  equivalent) spread  out                                                                    
over  parts of  existing positions  and no  new funding  was                                                                    
Co-Chair Neuman asked for clarity.                                                                                              
Ms.  Dipietro stated  that one  designated full-time  person                                                                    
was  not needed  and felt  that wasn't  a "good  option" for                                                                    
Alaska. She  delineated that UAA  could absorb  the workload                                                                    
with existing agency staff for  the initial work of building                                                                    
the  model. An  attorney from  Department of  Law (DOL)  had                                                                    
access to  the data needed  to develop the model  that would                                                                    
be shared  with UAA. She  added that other staff  from other                                                                    
agencies  might  be  called  upon  to  answer  questions  or                                                                    
provide information for the model.                                                                                              
2:51:49 PM                                                                                                                    
Co-Chair Neuman  reiterated what  was needed from  the state                                                                    
to implement  the initiative. He  wondered what  the success                                                                    
rate was  in other states. Mr.  VanLandingham responded that                                                                    
in order  for the  model to work,  strong "buy-in"  from the                                                                    
legislative  and  executive   branches  were  necessary.  He                                                                    
relayed  that in  the initial  states  a breakdown  occurred                                                                    
after the  initial analysis  was accumulated.  He discovered                                                                    
that  where the  program was  "housed" was  critical to  its                                                                    
success. Currently,  in New Mexico the  program was "housed"                                                                    
in the legislative Finance Committee  and partnered with the                                                                    
appropriate agencies  to build the components  of the model.                                                                    
Additionally, the  information was  easily available  to the                                                                    
legislators   and  built   into  the   bill  analysis.   The                                                                    
information  had driven  reforms  in  New Mexico's  criminal                                                                    
justice  system   and  other  policy  areas   as  well.  The                                                                    
initiative had  adopted the same  approach to work  with new                                                                    
partner states  and other states adopted  its own innovative                                                                    
process.  He surmised  that states  that were  operating the                                                                    
model correctly were successful.                                                                                                
Vice-Chair  Saddler  asked   what  the  interaction  between                                                                    
Results  First and  states that  already employed  evidenced                                                                    
base  analysis  approach  was. Mr.  VanLandingham  responded                                                                    
that the approach would be  "complimentary" and fed directly                                                                    
into the model.  The model identified what  things should be                                                                    
measured by  the agencies  and reported  to the  agencies on                                                                    
program   areas  instead   of   the   agency  defining   the                                                                    
parameters.  The tool  assisted the  process and  integrated                                                                    
traditional legislative policy processes.                                                                                       
Vice-Chair Saddler  wondered about the data  base on program                                                                    
effectiveness.  He   asked  how  many  different   types  of                                                                    
programs were in the data  base. Mr. VanLandingham responded                                                                    
that  there were  approximately  100 programs  in the  crime                                                                    
component of the  model and 150 programs  on substance abuse                                                                    
and mental health  and was building into  other policy areas                                                                    
as  well.    All  total  the  cost  benefit  analysis  model                                                                    
contained  250  programs.    He added  that  the  model  was                                                                    
supplemented   by   the  National   Research   Clearinghouse                                                                    
database,  which contained  approximately 900  programs. The                                                                    
clearinghouse  focused on  criminal justice,  child welfare,                                                                    
substance  abuse, mental  health,  education, and  Medicaid.                                                                    
The initiative started  with social policy because  a lot of                                                                    
evaluative information existed.                                                                                                 
Representative Edgmon  stated his support and  believed that                                                                    
it was  a foregone conclusion  that the approach  worked. He                                                                    
asked   whether  crime   started  as   minor  offences   and                                                                    
snowballed into  major crimes. He wondered  whether that was                                                                    
the  "subtext"  for  why  a  "measurable  impact"  could  be                                                                    
achieved on  the front end. Mr.  VanLandingham reported that                                                                    
research  pointed to  certain approaches  having a  positive                                                                    
impact. He  expounded that a  "swift and sure"  response was                                                                    
better than  the length and  severity of  penalty. Cognitive                                                                    
approaches were effective as well  as choosing good programs                                                                    
and  targeting  them  to  the right  people.  Doing  a  good                                                                    
program badly was useless. He  deduced that dramatic impacts                                                                    
could be  achieved by "disciplining  the whole  system" into                                                                    
choosing what works.                                                                                                            
3:02:10 PM                                                                                                                    
Representative Edgmon  reported that  in the  last 10  to 12                                                                    
years  in Alaska  the percentage  of violent  to non-violent                                                                    
offenders  rose from  48  percent in  2002  to presently  64                                                                    
percent of non-violent inmates due  to alcohol and substance                                                                    
abuse.  He  asked whether  that  was  a typical  ratio.  Mr.                                                                    
VanLandingham  responded that  although he  didn't have  the                                                                    
actual  information  available  he believed  the  ratio  was                                                                    
generally correct.  Laws like  three strikes,  which metered                                                                    
out  long  sentences   and  employing  criminal  prosecution                                                                    
instead of treatment for drug  use violations contributed to                                                                    
the increase.                                                                                                                   
Representative Edgmon expressed  the geographical uniqueness                                                                    
of  Alaska.  He supported  the  approach  but expressed  his                                                                    
skepticism that  the program  would work in  the state.   He                                                                    
believed it  would take  an incredible  monetary commitment.                                                                    
Mr.  VanLandingham reported  that  the information  informed                                                                    
the process in a "new and  powerful way." He voiced that the                                                                    
"tough  choices" would  remain  and  that legislatures  made                                                                    
value  choices   that  weren't  always  based   on  monetary                                                                    
Representative   Gara   mentioned   that  there   were   two                                                                    
components to avoid building the  next prison. He referenced                                                                    
the proliferation of longer  jail sentencing for non-violent                                                                    
offences.  He   wondered  whether  the   "recalibration"  of                                                                    
sentencing  could be  established  more  quickly than  other                                                                    
measures.  In   addition,  he  asked   whether  coordination                                                                    
existed  between the  initiative  and  the Criminal  Justice                                                                    
Commission that  was doing  similar work.  Mr. VanLandingham                                                                    
responded  affirmatively.  Results  First  colleges,  Public                                                                    
Safety Performance  Project would  initially, work  with the                                                                    
state for a year to determine  the drivers of the system and                                                                    
provide options.  The state  would choose  a set  of reforms                                                                    
for  adoption  by the  legislature  to  avoid building  more                                                                    
prison  facilities. Results  First  provided more  long-term                                                                    
options to decrease recidivism.                                                                                                 
Ms. Dipietro responded that  the Criminal Justice Commission                                                                    
was  staff for  the Judicial  Council and  was working  both                                                                    
with  Results First  and the  Justice Reinvestment  Project.                                                                    
She  mentioned that  the commission  was looking  forward to                                                                    
employing  the data  from  the Results  First  model if  the                                                                    
state  chose to  participate.  She provided  the example  of                                                                    
possibly   predicting   increased    savings   by   reducing                                                                    
sentencing as  a way the  commission could benefit  from the                                                                    
Representative  Gara  asked  about  the  concept  of  "swift                                                                    
justice."  He  inquired whether  it  was  more effective  in                                                                    
reducing  long  sentences.  Mr. VanLandingham  replied  that                                                                    
national  research "consistently"  proved the  effectiveness                                                                    
of  swift  justice.  He  exemplified  the  Hope  Program  in                                                                    
Hawaii, which  dealt with immediate  response to  an offense                                                                    
and was more effective than traditional sentencing.                                                                             
3:10:43 PM                                                                                                                    
Vice-Chair Saddler referred to  "smart justice". He wondered                                                                    
whether  Texas had  signed onto  the Results  First program.                                                                    
Mr. VanLandingham  indicated that Texas had  recently signed                                                                    
on but it was too early  in the program to quantify results.                                                                    
Vice-Chair  Saddler asked  whether any  of the  results were                                                                    
available to  the public domain. Mr.  VanLandingham reported                                                                    
that  the  clearinghouse  research   was  available  on  the                                                                    
Results First  website in addition to  states' case studies.                                                                    
The initiative's goal was for transparency.                                                                                     
Representative  Guttenberg asked  about  the consistency  of                                                                    
evidence  and  results coming  out  of  programs already  in                                                                    
place.  Mr. VanLandingham  responded  that the  same set  of                                                                    
highly  effective  of  programs were  "generally  consistent                                                                    
with  some interesting  variations."  Some  states had  been                                                                    
able  to do  more with  research than  others. The  state of                                                                    
Washington had  instituted a robust risk  assessment process                                                                    
in its  criminal justice system  that informed  its spending                                                                    
choices.  Some programs  were a  better  investment in  some                                                                    
states than others  because of the variables in  the cost of                                                                    
delivering the program.                                                                                                         
Representative  Gattis  was  intrigued that  the  university                                                                    
would  be involved  in implementing  the process  in Alaska.                                                                    
She  asked how  the process  happened in  other states.  Mr.                                                                    
VanLandingham responded that it  varied in different states.                                                                    
He indicated  that it was  critical that it would  be placed                                                                    
somewhere with  easy access during the  legislative session.                                                                    
Currently, in most  states it was placed  in the legislative                                                                    
finance office, governor's budget  office, or university. He                                                                    
found that placing  it in an agency was  not very effective.                                                                    
The software  platform was changed  to a web  application so                                                                    
many of the state's entities could access the database.