Legislature(2009 - 2010)BELTZ 105 (TSBldg)
03/10/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES
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* first hearing in first committee of referral
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SB 172-ALASKA HEALTH CARE COMMISSION 2:26:28 PM CHAIR DAVIS announced consideration of SB 172. It was heard previously. SENATOR DONALD OLSON, sponsor of SB 172 said the bill relates to the authorization of the Alaska Health Care Commission. This will be a permanent commission to address health care issues and rising health care costs. He noted that a proposed committee substitute (CS) was distributed to members. CHAIR DAVIS asked Mr. Obermeyer to review the changes represented in the proposed CS. 2:28:17 PM TOM OBERMEYER, staff to Senator Davis, said the only substantive difference between the proposed CS and the original bill is on page 3, line 6, relating to the composition and membership of the commission under Sec. 18.09.020. Version S designates that there will be 12 commission members; nine voting members will be appointed by the governor, including the state medical director as chair, and three nonvoting members will be ex officio members from the House, the Senate, and Office of the Governor. The original bill designated a 10 member commission. 2:30:51 PM SENATOR PASKVAN moved to adopt the work draft CS for SB 172, labeled 26-LS0790\S, as the working document. There being no objection, version S was before the committee. CHAIR DAVIS pointed out that the CS designates the medical examiner as chair but it doesn't identify who will fill the other seats. A separate handout proposes the organizations or groups they might represent, but the designations will be made following committee discussion and public testimony. She noted that the commissioner of the Department of Health and Social Services (DHSS) wrote to ask that the commission remain small and to suggest that if the membership is increased that the new members should represent [primary care physicians and the behavioral health provider community.] It was the sponsor who recommended adding two members for a total of 12, she said. SENATOR DYSON observed that this seems to be a good way to handle it. 2:34:28 PM JAMES J. JORDAN, Executive Director, Alaska State Medical Association, said ASMA represents physicians statewide and they support creating the Alaska Health Care Commission in statute. However, they would like the committee to consider physician representation on this commission, both general practitioners and general surgeons. He opined that physicians need to be at the table helping develop Alaska's comprehensive statewide health care policy and helping the commission fulfill its duties in developing the strategies necessary to improve the health of all Alaskans. SENATOR DYSON asked if one of the voting members should have significant experience in rural Alaska or does he believe that the physician representation he suggested would adequately represent the medical delivery teams in rural Alaska. MR. JORDAN said he believes that the general practitioner could represent the health care professionals that are part of the healthcare delivery team, particularly with telemedicine. 2:38:02 PM SENATOR PASKVAN observed that the proposed position number 8 designates a primary care physician who is licensed to practice in the state and is board certified. He asked if board certification is a meaningful requirement and if ASMA has a position on that. MR. JORDAN replied it's becoming uncommon to find primary care physicians who are not board certified in Alaska. He described the requirement as forward looking in light of the movement to require board certification and continuing renewals in licensures and certifications of competence. CHAIR DAVIS said she'd like the administration to speak to that because it was their recommendation. 2:40:10 PM DEBORAH ERICKSON, Executive Director, Alaska Health Care Commission (AHCC), said she works within the Department of Health and Social Services (DHSS) and she is speaking today on behalf of both DHSS and AHCC. She confirmed that DHSS suggested the language related to the additional seat for a primary care physician who practices family medicine, primary care internal medicine, or pediatric medicine in the state. Because it's very rare now for somebody to be practicing and licensed without having board certification in any of these fields, DHSS would have no objection to adding clarifying language that the individual practicing would also be required to have board certification in that particular field. 2:42:02 PM SENATOR PASKVAN asked if she said the department wouldn't mind if the board certification requirement were removed. MS. ERICKSON replied DHSS doesn't have a concern with either adding or leaving out the provision requiring board certification. CHAIR DAVIS said the committee needs to discuss and make a decision on that matter. She asked if she's seen the list the committee is considering. MS. ERICKSON answered no. CHAIR DAVIS said it was her intention to take testimony on the proposed list of commission members before making a decision about what to put in the final CS. MS. ERICKSON said she'd like to first speak to the AHCC recommendation about the size of the commission. The AHCC January report included a recommendation for a permanent commission established in statute and responsible for comprehensive, sustained, accountable, and transparent health system improvement planning for the state. They specifically recommended that the commission remain the same size as the existing commission, which is seven voting and three ex officio members. AHCC made that recommendation with the specific understanding that there was some support for a larger body. The concern is that a larger commission would not facilitate communication and decision making and that it might in fact function more as an advocacy body. Thus, for reasons of efficiency and the function of the group, AHCC wanted to state on the record that the existing body worked well. 2:45:30 PM MS. ERICKSON said the Department of Health and Social Services also believes that the commission should maintain a relatively small size, but the two additional seats would be acceptable. If these are added, DHSS recommends that they be designated for a primary care physician and a representative from the behavioral health provider community. Although they're somewhat different than DHSS suggested, she believes that the department would find the descriptions for the primary care physician and the behavioral health provider acceptable. 2:46:57 PM JEFF JESSEE, CEO, Alaska Mental Health Trust Authority (AMHTA), said AMHTA wants a seat at the table too. He is familiar with the struggle to keep a group small enough to be functional and still represent all of the necessary aspects adequately so decisions are fully informed and representative of the issues that need to be considered. While he's pleased that there is interest in adding behavioral health representation to the commission, he believes that it's critical to have someone who has a system wide perspective. He confirmed this with Commissioner Hogan and he expected the DHSS representative to convey that the department would support the behavioral health representative being a representative of AMHTA. That representative might be a provider or an administrator of an organization but they would be able to represent the interests of the behavioral health system and have a systemic view of this issue. This would bring the type of expertise and information that would be most helpful to the commission, he concluded. SENATOR DYSON asked if the mental health community would include people who deal with substance abuse. MR. JESSEE answered yes; the term behavioral health is universally used to denote both mental health and substance abuse. 2:51:01 PM WAYNE STEVENS, President and CEO, Alaska State Chamber of Commerce (ASCC), related that he has served as a member of the Health Care Commission for the past year. This temporary commission expires this year and while it began to address many relevant issues, it doesn't have time to address them to the degree required. Alaska's health care system needs adjustment in order to provide cost effective, quality access to residents and the best first step to address these issues is to establish in statute the Alaska Health Care Commission. Experts and representatives of key stakeholders appointed to this body will form a plan to realign the system. The Alaska State Chamber of Commerce supports a permanent commission that will provide recommendations to the governor and Legislature that will result in a health care system that provides quality and affordable access to all Alaskans. The ASCC also supports including seats on the commission for the state chamber and for primary care. 2:53:29 PM SENATOR DYSON asked if he has a specific member to recommend. MR. STEVENS replied he isn't seeking a seat for himself and he doesn't have a specific recommendation, but he does believe that the business community needs representation because it is a significant contributor to the health care system. He added that he has an interest in the health care community and served on the Kodiak hospital board for about 14 years. And as a representative of the business community he has an interest and understanding of how to control and contain costs. According to testimony the commission received, there are four basic parts to the cost equation in the drivers of health care: 50 percent is personal responsibility; 20 percent is the environment in which you live; 20 percent is genetics; and 10 percent is the cost of access to health care. When you're not addressing the largest part of the problem it's not productive to argue about the smallest part of the problem, he concluded. 2:56:51 PM SHELLY HUGHES, Alaska Primary Care Association (APCA), thanked the committee for adding a primary care position to the bill. She echoed Mr. Jessee's statement that a representative with a system perspective would benefit the commission more than say a solo practice physician who is focused on patient care. APCA could provide this perspective for medical, basic dental, behavior health, and the many primary care provider type positions. While the position could be filled by a physician, administrators sometimes have a better overall sense of what works in the overall system, she said. Because primary care is so key to costs and prevention, it's important to have someone with this system approach, she concluded. CHAIR DAVIS said she would take direction from the members and the sponsor with respect to the proposed list of representatives before she had a new CS drafted. 2:59:05 PM SENATOR OLSON said he agrees that a large commission could be unwieldy, but busy schedules can make it difficult to get enough people to a meeting to get a fair cross section, particularly with health care providers. Referencing the earlier discussion about board certification, he said he doesn't support that idea. Another concern relates to the governor making the appointments because it vests too much power in that office. He asked the committee to consider the alternatives. CHAIR DAVIS said she and the committee would take that into consideration, but the governor wouldn't have full control because people would submit their application and the governor would have to select from the list. 3:03:12 PM DENISE LICCIOLI, Staff to Senator Olson, referenced an earlier statement that the sponsor asked for the commission representatives listed on the handout and said that's correct for the first seven positions but not eight and nine. The sponsor clarified that he doesn't support the requirement for board certification for position eight and for position nine the sponsor requested a member from the Alaska Mental Health Trust Authority. CHAIR DAVIS held SB 172 in committee.