BILL ANALYSIS
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THIRD READING
Bill No: ACR 62
Author: Galgiani (D)
Amended: As introduced
Vote: 21
SENATE HEALTH COMMITTEE : 11-0, 7/8/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Maldonado, Negrete McLeod, Pavley, Wolk
ASSEMBLY FLOOR : 76-0, 5/28/09 (Consent) - See last page
for vote
SUBJECT : Chronic obstructive pulmonary disease awareness
SOURCE : Boehringer Ingelheim Pharmaceuticals, Inc
DIGEST : This resolution Designates Chronic Obstructive
Pulmonary Awareness Day and Month, and makes legislative
findings about the prevalence of the disease. Commends the
Department of Health Care Services for implementing a pilot
program for COPD Medi-Cal beneficiaries.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal program, administered by the
State Department of Health Care Services (DHCS), under
which basic health care services are provided to
qualified low-income persons.
CONTINUED
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2. Requires DHCS to apply for a waiver of federal law to
test the efficacy of a disease management program to
specified Medi-Cal beneficiaries. The program is to
include use of evidence-based practice guidelines,
supporting adherence to care plans, and providing
patient education, monitoring, and healthy lifestyle
changes.
3. States that this waiver for disease management is to be
implemented only to the extent that federal financial
participation is available.
This resolution:
1. States findings related to the prevalence of Chronic
Obstructive Pulmonary Disease (COPD).
2. Commends the DHCS for implementing a pilot program in
August of 2006 to provide for the chronic disease
management of COPD.
3. Designates November 2009, as COPD Awareness Month and
November 18, 2009, as COPD Awareness Day.
4. Encourages, but does not require, DHCS to provide
interim updates to the Legislature on the COPD pilot
program, and prepare a report of findings and
recommendations in order to evaluate the effectiveness
of the program in reducing Medi-Cal costs and in
providing improved health and well-being for affected
patients.
Background
COPD is a lung disease process characterized by difficulty
breathing, wheezing, and a chronic cough. It generally
refers to chronic bronchitis and emphysema, a pair of two
commonly co-existing diseases of the lungs in which the
airways become narrowed. This leads to a limitation of the
flow of air to and from the lungs causing shortness of
breath. It is caused by noxious particles or gases, most
commonly from smoking, which trigger an abnormal
inflammatory response in the lungs. Risk factors also
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include exposure to industrial dusts and chemicals,
second-hand smoke, history of childhood respiratory
infections, and heredity. In contrast to asthma, the
limitation of airflow is poorly reversible and usually gets
progressively worse over time. The natural course of COPD
is characterized by occasional sudden worsenings of
symptoms called acute exacerbations, most of which are
caused by infections or air pollution. Complications
include bronchitis, pneumonia and lung cancer.
Disease management programs . Disease management is not
well-defined, but generally refers to a system of
coordinated health care interventions and communications
designed to improve patient health outcomes for a
particular disease. The types of interventions can vary
from specialists at a local hospital hiring a nurse to
educate patients about preventive care, to large-scale
programs reaching thousands of patients. Disease
management programs can be offered telephonically, and/or
require an extended series of interactions between the
patient and health professionals. Disease management
emphasizes prevention of exacerbations and complications
utilizing evidence-based practice guidelines and patient
empowerment strategies, and evaluates clinical, humanistic,
and economic outcomes on an on-going basis with the goal of
improving overall health. Patients are expected to play an
active role in managing their diseases.
Some programs may be better than others, but there has not
been enough research to properly assess which ones are the
most effective or what characteristics are associated with
more successful programs. Health insurance plans and
employers nationally in 2005 spent about $1.2 billion on
disease management programs, with 96 percent of the top 150
U.S. health insurance companies offering some form of
disease management service.
A 2007 RAND health study reviewed all past research on
disease management programs, and found consistent evidence
that these programs can improve health care quality,
improve disease control, and in some cases reduce hospital
admission rates. However there was little evidence about
whether these programs improve health outcomes over the
long term, and no conclusive evidence that they can save
money.
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FISCAL EFFECT : Fiscal Com.: Yes
SUPPORT : (Verified 8/19/09)
Boehringer Ingelheim Pharmaceuticals, Inc. (source)
American Lung Association
GlaxoSmithKline
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Emmerson, Eng, Feuer, Fletcher, Fong, Fuentes,
Fuller, Furutani, Gaines, Galgiani, Garrick, Gilmore,
Hagman, Hall, Harkey, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Knight, Krekorian, Lieu, Logue,
Bonnie Lowenthal, Ma, Miller, Monning, Nava, Niello,
Nielsen, John A. Perez, V. Manuel Perez, Portantino,
Price, Ruskin, Salas, Saldana, Silva, Skinner, Smyth,
Solorio, Audra Strickland, Swanson, Torlakson, Torres,
Torrico, Tran, Villines, Yamada, Bass
NO VOTE RECORDED: Duvall, Evans, Mendoza, Nestande
JJA:do 8/19/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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