>> good afternoon. i call the december meeting of the health service board to order. would you please join me in saying the pledge of allegiance? >> i pledge allegiance to the flag of the united states of america, and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all.

>> we'll now have item 2, roll call. >> thank you president scott. our roll coloradoed to order is 103 p.m. and roll call starting with president scott, present. vice president hao and breslin and canning is excused. dorsey, present. commissioner follansbee, present. with that, we have a quorum. >> can we go to item number 3? [multiple speakers] >> it wasn't his fault. >> thank you president scott. item 3 is general public comment. a opportunity for members of the public to comment on any matters within the board's jurisdiction that is fot on the

agenda. remote viewing is available on sfgovtv and online using webex. welcomes public participation. there is a opportunity for the public to comment at the beginning of the meeting and each item. in person comment is first and then virtual. each speaker is allowed 3 minutes to comment. all public comments are made concerning the agenda item presented. a caller may ask questions of the body but no obligation to answer or engage in dialogue. will hear up to 30 minutes of remote public comment total for each item. remote public comment for those who receive a [indiscernible] call in by dialing 415-655-0001. enter access code 26607621309 and pound.

you will be prompted to enter the webinar password, 1145 and pound. press star 3 to be added to the queue and you will hear the prompt, you have raised your hand to ask a question. when the message says your line is unmuted this is your time to speak. for those watching on webex, click on raise hand to be placed in the queue to speak. a raise hand will appear next to your name. when you are unmuted request to unmute will appear on your screen. select unmute to speak. once you hear me say, welcome caller, you can begin speaking. when your time expires you will be muted. members of the public encouraged to state name clearly, but may remine main anoninous. anonymous. we thank sfgovtv and media service for sharing with the public. we'll begin with in person

public comment. no one approached the podium. we'll move to our remote public comment before going to written submitted public comment. moderator e will notify of callers in the queue at this time. >> board secretary, we have one caller on the phone line. zero callers [audio cutting out] >> thank you moderator. i'll move to our remote or written public comment. we had one submission for written public comment. the first comment was submitted by tim lee with sfmta regarding delta dental ppo. my childs dentist decided to leave the network. trying to find a new pediatric dentist there are not many in network. searching on the web there is similar result of dentist leaves delta dental ppo. is there something the board

can shed on the information or search i other carriers in the next open enrollment? end of submission. >> thank you and we thank the member for the written public comment. i would ask that the executive director do review as well in terms of talking with delta dental regarding this particular comment. thank you. >> moving to item 4. approval with possible modifications of the minutes set forth below from the november 9, 2023. will be presented by president scott. >> are there any edits, changes or additions to the meeting of

november? hearing none, i'm ready to entertain a motion. >> move approval of the minutes of the regular health service board meeting of november 2023. >> second. >> properly moved and seconded. is there any board comment? hearing none, we'll go to public comment on the minutes of the november meeting. >> thank you president scott. i'll begin with a short intro. public comment is open. instructions are displayed on the vene can for those watching on sfgovtv and webex. [providing instructions for public comment] no one approached the podium and move to remote public comment and the moderator will notify of callers in the queue at this time. >> board secretary, we have one caller on the phone line, zero callers in the queue.

>> moderator, i believe you said zero callers, so with that, public comment is closed. >> thank you. we are ready to vote and have roll call vote. >> scott, aye. dorsey, aye. follansbee, aye. zvanski, aye. >> motion carries. item 5. >> item 5, president report presented by president scott. >> there is a continuing question that has arisen since the board of supervisors made a change in their public comment process. as we all know, we had all in-person public comment prior to the covid pandemic. with that, when the pandemic hit we went to do it in online

or in person or combination of both and we have maintained that until the most recent incident with the board of supervisors having what i would call hate speech time comments being made during public comment and they made a decision to discontinue the online or virtual public comment process. that again sent further ripples to the rest of the 165 commissions that we have in the city or 130 boards and commissions as to what we should do, and during the past several weeks the board secretarys of the commissions and boards that are present in the city have met around this issue. i understand the city attorney's office has been

involved and the current state is that apparently i have the authority as the president of this board to discontinue virtual public comment. i'm not going to do that. i rather going to request that this board make a decision about whether we discontinue or modify public comment going forward and in the process is going to be as follows:i requesting the executive director to review the usage and cost for virtual public comment for the last 6 months. i think i have a sense of how many people we had online during each of the past 6 meetings, but i like to have that in some type of written report. i'm requesting the board

secretary gather additional information from the other board secretarys regarding what other commissions and boards are doing. by now i'm sure there has been kind of iterative process. i was watching the planning committee, planning commission deal with this question a few weeks ago and they are going through the same process. their council had a bit of guidance for them. the secretary of their board and said well, let's hold off make ing a decision at this meeting and do it later. that is what i like the board secretary to do. requesting of the council that she provide the residing officer, whoever it happens to be with written guidance what to do if we have hate speech or that type of kind of situation come up during a board meeting and it would be disrupted by it.

i think i know what i would do under my own natural instincts as a presiding officer, but i like to have legal counsel give me guidance, because i don't want to breach the free speech rights of members or callers or those who might be listening into these proceedings. i like to have some written guidance from that. and then lastly, the board will have this as a action item for its february meeting. we'll hear the results of these requests and then take action on how we will proceed to have virtual public comment going forward. so, with that, i'm willing to entertain any questions or concerns the board may have or any of the offices that i have requested these items of.

yes, commissioner zvanski. >> thank you commissioner scott. this is a very serious issue as far as i'm concerned, because i'm very actively involved with retired city employees, and our members live all over the city, all over the peninsula, all over the state, all over the nation and all over the world, and our meetings are specific to their benefits, their issues and to this unique or select population, and i believe that it is essential that we maintain under those circumstances and with consideration of our specific and unique population or constituency i should say, that

we maintain having remote and virtual public comment available at any and all meetings that we hold. it is a matter of respect for our members, it is matter of consideration and i believe it is a essential benefit that we need to provide because we have this unique constituency. >> thank you for your comment. are there other comments? >> i guess the only comment i would add-- >> mr. follansbee. >> thank you very much president scott. i think we had situations in the past where public comment either in person or online has been out of order. it is addressing other agenda items or items that have to do with the sort of goals and mandate of this commission, but i think we need clarity when the board secretary or the president or acting president

can rule something out of order. if it doesn't fall within the-and we need clarification on that so that kind of speech if there is a method to rule on that can be done fairly to all participants. >> alright. thank you commissioner follansbee. >> just to add from the perspective of the board of supervisors, one thing that really plays out i think uniquely at the san francisco board of supervisors is that public comment is something that plays out on national television sometimes. you may have seen last week tonight--there is-it has a national audience and i think because of that there's people who were calling in directing hate speech in ways that were disrupted and we don't want to give a platform to, so there were unique situations that the board of supervisors faces as a high profile kind of government

body that other i think disservice to the people we serve and in bodies like this. if that isn't the problem it may not be something we have to address. the other thing i think legal counsel can address better then i, we also have to make accommodations. we have to do that. i know when this came up before my committee, one concern i had because initially we considered this and decided to allow continuing public comment, it is little acward to ask people to identify themselves as having a disability or needing accommodation. there was-we didn't have comfort level of doing that. only because circumstances kind of forced our hand that we didn'tant to give a platform to something that was disruptive -for the good of open government and accessibility if

we can avide that i think it will be better. >> thank you supervisor. any other comment? hearing none-- >> i want to thank you for your comment supervisor, because i think it makes it very clear the board had no intention of this policy being extrapolated to other commissions or committees. this was in fact referring to the board of supervisors meeting and not a general recommendation or declaration to anyone else and i think that helps clarify that and thank you for that. >> alright. there is no further board comment. is there public comment on this item? >> thank you president scott. we'll open public comment. the instructions will be displayed on the screen for those watching on sfgovtv and webex. [providing instructions for public comment]

no one approached the podium. we'll move to remote public comment and our moderator will notify of callers in the queue at this time. >> board secretary, we have one caller on the phone line, zero callers entered the public comment queue at this time. >> thank you modraert. hearing no further callers, public comment is closed. >> thank you. we'll go to item 6. director's report. >> thank you president scott. item 6, director's report. this is discussion item and presented by executive director abbie yant. >> thank you. good afternoon commissioners. i would like to start by director's report welcoming a staff member, member service jolene rousseau who is in the room. >> please stand. welcome, we are delighted to have you with us and congratulations to planning to spend this portion of your

career with us. >> thank you. i also want to recognize in the room is carrie brusheers and her coordinator lisa not in the room but may be watching. she is pretty busy. they pulled off incredible event for the wellbeing awards event a few weeks ago and it was very well attended and they gave out lots of awards to many different city departments. i was privileged to moderate a panel of department leaders to speak to how they viewed wellbeing. t thapanel included the jada jurden from the department of public works. she was quite inspirational to listen to. kelly dearman, department director within the health

service agency and as well as city attorney david chui, so it was a nice mix of folks and they were really very passionate about the wellbeing program and it's just i think a testament to the work carrie and her team have done. a small team, but they have broad reach and it was very satisfying to see them being recognized as well. the-i had the opportunity to testify before the board of supervisors budget finance committee november 15, where supervisor chan had as the chair of that committee had requested that we come and do some explaining about the rate increases in the environment we are currently in with the cost of healthcare. as a precursor to when we come before the board for the rates

and benefits in july, we are under extreme time constraints and everyone appreciates that, so i do respect her forward thinking about laying the ground for what they may see in the coming year. i don't know if supervisor dorsey you were able to attend and did you have comments? okay. appreciate you participating in that. we also continue to pressure any way we can the relationship between the united healthcare and ucsf medical group. we were notified yesterday by united healthcare that they are resuming negotiations with that medical group. they had been stalled, so that was encouraging to hear. so, we'll keep everyone informed, but to date we are not aware of problems that have

aprison because of this so while we understand the medical group has concerns about the situation, they haven't made any practice changes that we are aware of and i would appreciate if they do make that decision any decisions along these lines that they keep us informed preferably in writing, but we have n't seen that yet. >> i appreciate the fact this item correctly identifies what the issue is. there a lot of misinformation out there and my next door neighbor or neighborhood [indiscernible] ucsf dropped by united healthcare and i didn't bother to read it and don't want to get in conversation with neighbors across the city over misinformation. clearly for whatever reason people are rather anxious about this and so i appreciate your efforts and efforts of your staff to make sure that a, the issue is clear, it is not ucsf

medical center, it is medical group that practices at ucsf, and that you are monitoring any problems that might arise because of access both for primary and specialty care. i want to applaud your efforts in this regard. >> i appreciate it. we get an occasional call or e-mail and there are people worried that something may go awry, but to our understanding, we haven't identified a case that there is a problem. i do recognize the anxiety and like it clarified so hope fully will come to resolution on this. i want to remind the board the black out period notice issued november 9 and expect to go through june 24. if you have questions about that or are approached by

anyone, please let us know and we'll walk you through the process. also, cal prla, a hr professional organization has a annual conference in monterey. we did a presentation on the healthcare affordability and we have been able to do about it and i do appreciate iftikhar and mike's efforts in helping put this together and it was well receivedism . it was friday morning the last day of conference so a packed room. >> commissioner hao presided at a meeting? >> she was the moderator and she encouraged us to apply, so very helpful. there were several people from our department of human resources, carol izen,

[indiscernible] arden. labor relations person. it was a excellent conference and pretty big event. we also i are wrote in here about a data breach weef were notified from blue shield. i will tell you that yes, there have been others. there was a big problem with the data warehouse called move it a couple months ago that seems to have touched tons of organizations and but we are finding that our--it is third, forth degrees breaches. not from hsf, or providers it is more downstream so that is good and not good. what we are in the process of doing is working with [indiscernible] to create a web page where the information we have about data breaches would be available so if people are concerned they have a place to

look it up easily, because sometimes we get these random phone calls about a breach that may or may not effect our membership, so that is in the works and we'll see something first quarter next year. also starting in january, we will kick off the health service board election process. we have two member service positions that term out in 24. captain chris canning and karen breslin and so we will need to replace those individuals and holly will help us understand the process and presentation that we will do at the january health service board meeting. the unified school district problems continue. they are grappling with what to do. they are considering yet another vendor so we just have to exercise extreme patience

because there problems are many and each time they uncover one, it is another bolis of members we have to work with and problem solve and hats to member service team being so diligent and patient with both the members and school district. it is very troublesome, but we do get through it. latisha harris is invited to speak in a actuarial conference talking about health and equity action planning and i think a number of things. one, it is wonderful we were invited to present, but also a very hallmark who has been working on the social

determinant issue, it is amazing to see this in main stream and talked about and understanding how social determinants and various equity issues effect our membership. we are learning our way through this with everyone and think the conference will be very helpful and good that we have some experience in this area and can speak to that. i have talked here before about some of the external committees i participate in and boards. the integrated healthcare association is a 40 plus member board that has representation from pretty much all major health systems and medical provider groups in the state and they really work on consensus to improve the delivery systems and healthcare. we are working on a number of things, not the least of which

would be advanced primary care,b the equity issues, the cost issues, data issues et cetera, but it is a very rich group of people that are really forward thinking and there is a lot of compromise that happens there, which is quite impressive. they are very interested in and watching carefully the healthcare advisory board and its advisory committee that i sit on because they are charged with the legislation that governor newsom sponsored on the health affordability of healthcare. we are getting closer to definitions of total cost of healthcare and what the targets will be and those decisions will be made in 2024, so there is a cap in site, but not been clearly identified and it will

be several years before it actually goes into effect. latisha monthly writes very informative messages but health, equity diversity inclusion opportunities. much appreciation and deep understanding how we are working in these areas. the divisional reports you'll see throughout each division, i just want to comment on the contracts division lead by [indiscernible] with supportive patrick young and william and lots of folks from aon. we have a great medicare consultant working with us and they were able to successfully release the medicare rfp yesterday, wednesday, so that is a huge accomplishment. much more work to be done.

there was a real team effort in getting it launched, so much appreciation to the entire team for that effort. i think that's all i have unless you have questions. >> i want to go back to the united healthcare ucsf medical care group medical situation and this board gave you full authorization abbie to pursue, prod, prompt, promote and encourage the parties to come to a resolution on that and i am very pleased you have exercised your prerogative where possible and i encourage you to continue to do so. are there other comments ? >> i want to applaud all your efforts once again for the department. you and the department on the health equity diversity inclusion. i think you are leading the way. there are misconceptions that sort of quality of benefits

equals equity and it does fot. equity is outcomes and we know outcomes for vaccinations and screening for cancer and dental care and all these things are different from a variety of social factors and so equity is the right word and at this board as well as hss been very interested from all the vendors how they address equity issues, outcomes, not just benefits, but how equity--the benefits translate to equity in all these areas so i want to again applaud you and the department for the work on these ish areas. this is very popular, but still misunderstood. the feeling, if everybody has the same employer and same access to benefits then what is the question here and there is a big question. the board recognizes that and affirm the work you and your department is doing. thank you.

>> are there other board comments on the director's report? hearing none, we'll now take public comment. >> thank you president scott. [providing instructions for public comment which is displayed on the screen] we'll begin with in person public comment and no one approached the podium. we'll move to remote public comment and our moderator will notify of any callers in the queue at this time. >> board secretary, we have three callers on the line, zero callers enter the queue at this time. >> thank you moderator. hearing no further callers, public comment is now closed. >> thank you. we'll go to item 7.

>> item 7, sfhss financial report as of october 31, 2023. this is discussion item and presented by iftikhar hussain, sfhss chief financial officer. >> happy to report our trust fund balance is stable. the results are similar what we had mentioned that year and this is after a year we had high claims and expenses, so we see the numbers stabilizing. the trust fund balance we ropro-ject for end of it had year is $93 million. it is decrease, $11.5 million, but that is due to stabilization and reduction in rates funded by the sutter settlement we got last year so we have to buy the rates down which causes the ending balance to drop. the net climes are running close to what we expected. we did receive pharmacy rebates in october, we are at $5.8 million this year through

october. we expect that to be $15 million by the end of the year, and interested consistent. last year the sustainability fund we expect a net use of $1.2 million. by the end of the year. in the general fund we are running ahead of plan. [indiscernible] and lastly, on the audit, the external audit is complete, and the benefit trust audit is ongoing. >> are there questions from the board regarding the financial report? >> i would just commissioner follansbee, i urge everyone to look at your excellent graphics that are included in the full packet, because to me the net claims item to me is still very

concerning. a, the fact that claims for dental care remain consistently low is not reassuring to me, because i do believe dental care is important and if this back-fires and no doubt that poor dentition contributes to other issues. screening for certain cancers for example, heart disease and gum disease are related, and so the fact that we net claims are zero out, because members are not utilizing dental is not a good sign to me. likewise,b the fact our medical claims still exceed the revenues, still points to the ongoing and future problems and so everyone should be really familiar with these graphs and the fact the trends are not really changing to my mind at least to my review and maybe you can correct if i'm wrong, but the trends still seem to be in both areas in concerning

directions. >> the medical claim [indiscernible] but it is for the running higher then what we expected, but the dental claim is pretty consistent trend. >> are there other questions or comments from the board? of the cheer financial officer? he survived the audit in good shape. [laughter] if nothing else from the board , we'll take public comment on the financial report. >> thank you president scott. [providing instructions for public comment which is streaming on the screen] we will begin with in person public comment and no one approached the podium.

we'll move to online. >> board secretary, there are three callers on the line, zero callers enter the queue at this time. >> thank you moderator. hearing no callers, public comment is closed. >> thank you. we'll move to item 8. >> thank you president scott. item 8, report of open enrollment activities for plan year 2024. this is discussion item. presented by rey guillen, sfhss chief operations officer, jessica shih, communications director, olga stavinskaya-velasquez, operations manager and carrie beshears, well-being manager. >> i would like to welcome the chief operating officer and his team back. they are still standing. they look well after open enrollment. no harm for all of the hard work that i know that he and his team have done during this past month to notp only get a report ready to do all the stuff you are going to outline

today. it is very very intensive process and i marveled at the way you transitioned in this role. >> thank you prez accident scott and commissioners. again, rey guillen. over the next several minutes, members of the management team and i will provide you with a summary of the activities from the just completed open enrollment period for plan year 2024. during our presentation, we will review the purpose of open enrollment, the specific objectives set for this year, reminder of the population we serve. highlights from this year's experience and project plan, communication efforts and the work performed specifically by our enterprise system analytic team. we will also provide a

report-out of member service results, the result of some key initiatives, the success of our health fairs and flu clinics and preview some of the early enrollment results with you. as a reminder, the reason we hold open enrollment every year is to keep our planning and compliance with section 125 of internal revenue code. the cafeteria plan is what allows us to have active members pay for their health benefit premiums on pretax basis. however, the specific timing of open enrollment is set to allow our staff enough time to process all the plan changes submitted. this year we scheduled open enrollment for run for 4 week period from october 2 through october 27. again, just as reminder, open enrollment is one time each year that members can enroll

in, change or wave coverage and add or drop dependents without a qualifying life event. as this board is aware, certain portions of our retiree populations will experience significant premium increases beginning january 1, 2024. in addition to insuring we are clearly communicated impacts to our members, and also being prepared to handle a possible increase in volume of calls that may result, we set important goals this year. first, we wanted to improve accuracy and fortunately during the last open enrollment period there were a few errors in the communications that required us to send correction letters to some of our members. this year we want to strive to avoid the cost and effort required by such corrections. given the large membership and limited staff rfx we want to drive our members to our

website and to other communication channels to get questions answered and hopefully eliminate necessitate them to call member services. we always have the goal to reduce cost. communicating to our membership and providing the assistance is huge undertaking. membership exceeds 79 thousand subcribes and broken over 4 employer group, the city, the courts, the school district and the community college district as well as all the retirees. adding to complexity of it job is a variety of union agreements, pay status and pay roll frequencies. we just want to highlight before we get into details some of the outcomes and things that

we were able to accomplish this year. one of the major accomplishments we are able to do is to reopen our office to in-person support and so we had a variety of our members join us in the office and we were happy to provide them in-person support. one of our overarching goals is always meet the members where they are, so we are aware that some of our members are not comfortable reaching out over the phone. sometimes they have communication limitations, other times they just want to get something resolved face to face with our staff and so we happily reopened our office for the first time since the pandemic. due to continued challenges

with hiring, we did bring in the support with off-site call center to help answer member calls. in addition, we were still able to support number of in-person activities including 10 healthcare and 24 flu shot clinics. answered over 6500 calls from our member jz also supported long-term viability of health net canopy care plan by helping increase the membership by 82 percent and we'll go into more details for each of the items in later slides. as this board knows, planning for open enrollment requires year-round planning. we also take into account a very detailed project plan to make sure nothing falls through the cracks. brian rodriguez, our project planner was not able to be here today, but we do rely on brian to make sure that we are staying on track and make sure

everything goes off without a hitch. this year's project plan included over 280 with every division involved. we generally meet once a week to insure we keep on track and resolving potential issues as soon as possible. next i like to introduce jessica shih our capable communication director to walk through this year's open enrollment communication with you. >> thank you rey. good afternoon commissioners. >> jessica. >> yes? >> could you bring the microphone just a little lower? there you are. it all most looks like you are trying to eat it. >> good afternoon commissioners. jessica shih, communication director at health service system and going to walk through our communication for open enrollment this year. i would say the best-if i had to choose one word to describe our communication it is really, transformative year for us.

i think under our new leadership, rey guillen our chief operating officer observed inconsistency in our material, so we actually my colleague and i actually worked together to completely overhaul the communications. we rewrote the member guides. you will probably see completely different looking rate sheets this year. we have new envelopes and we combined guides because we realized the information from mea superior courts and csf were essentially the same, so we combined to one guide to streamline our information and we didn't actually increase the pages in the guide, because we were able to reduce some of the information. we looked at member call data and call drivers and made sure that we added clarity where it was needed to our guide and we reduced superilous information. i want to thank my colleague

ryan klaus our graphic designer. did an amazing job and inspired by digital access ability and inclusion mandate so brought a lot of icons into design elements of the guide and you will see throughout the guide. visually people will understand this is a vision page and this is dental page, so we hope you were able to see the materials mailed to you. and as rey mentioned, we worked hard to improve accuracy in our print material and it seems a little counter intuitive, but we were able to accomplish this by increasing the number of letter templates we created. last year we had like 22, which was already a lot of different letter templates for us to manage, this year we had 87 and what we did is we hard coated the rates on the back of each of the open enrollment letters. this way we didn't have to have more data provided through

printers which cause errors. we didn't have to issue any correction letters this year. i'm thrilled. and as always, i think we learned a lot during the pandemic and that we always want to meet our members where they are at. during the pandemic you remember we started doing webinars and offering health plan office hours and we continue that even though-and of course now we are offering in-person health fairs and flu clinics and we like offering all the different avenues of support for members to provide education so they understand the benefits and make those elections. and as always our goal, we are all stewards for the environment so we wanted to reduce paper waste and print costs so this year we consulted with our city attorney and

determined what was really necessary to be in the mailers and for active employees they didn't receive booklets. instead we drove them to our online web pages to have more comprehensive resource and information for everyone to--and also we want to make sure they knew about the events happening and so what we learned is we didn't receive many requests for members saying i want my benefit guide. it seems the online resources was enough information for them to participate and learn about their benefits, so we might pilot it next year with our retirees. >> would you repeat that? >> we are considering carefully contemplating removing the booklets and retiree mailers and now you have to remember, every member still has a right to ask for a printed guide and they are always welcome to call us and we'll mail one to them.

>> thank you. having been-am a retiree of a very large organization in the state, i wish you every success in making that transition. [laughter] >> thank you. we will do our best to make sure that our retirees get the information they need to make the decisions they are best for them. now i like to hand-- >> can i follow up on that? i realize i'm unique recipient of all these materials, because i have never been a employee or retiree of the city or any of our employers. i never-i don't find option to opt out of mailings so i get appropriate mailings and i was quite impressed with them, but i like to be able to let you know i like to opt out in the future and just get it online. was there a box i missed to opt

out or was that something might help facilitate transition as you include new groups such as retirees? >> no, that's something that we have been discussing internally is how we create a system that has a lot of information on the open enrollment letters is private data so how we create a secure system for people to access information. we are still working on that. but that's a great question. >> the follow-up is-- >> no, you haven't missed anything. there is no opt out option. >> do the employees who are not getting the printed--all of them use the sfgov e-mail address? is that the way you guarantee confidentiality through internal system, whereas retirees don't have access to that? is that part of the complication? my account through a different

server may not be secure as what sfgov provides? >> sfgov isn't all employee e-mail addresses, there is usd which we don't have access to, puc, superior court. there are a lot of e-mail addresses we don't have access to and when 80 consulted the city attorney there was legal documents we have to guarantee sort of that members receive and one way to do that is to send it to them via u.s. mail. >> okay. thank you. >> thank you. >> commissioner zvanski has a question i believe or comment. >> thank you. yes, i are like to know how you are going to inform especially our retiree group with regard to the fact that they won't be receiving the booklet? >> she didn't say won't be. i want to correct that. i want her to repeat what she said and would you repeat it again? >> we are considering piloting it. >> i understand that and i like

to know how you anticipate communicating with this specific membership group with regard to that if you make that decision, because we have a lot of members who do not have e-mail. they do not have wifi. they don't have a cell phone, and especially we have a number of retirees who are quite elderly, but many who are not technically savvy and i have great concern about this because i get a lot of those calls on a regular basis and when i go and meet with these various retiree groups i hear about it and so i'm very concerned that we have a good communication--they get the opportunity to at least let you know how they feel about it or how they would get that

information in advance if they don't have other options for electronic-for getting materials electronically. >> thank you so much commissioner zvanski. that is certainly something we'll take into consideration and for those members we'll most likely continue to mail them the materials. or they can always call us and request a full printed guide, in which case it will have more comprehensive information. >> thank you. >> are there any other comments or questions for communications? thank you for all that you have done. >> thank you. i like to turn it back to chief operating officer, rey guillen. >> thank you jessica. rey guillen, chief operating officer for health service system. just to be clear, all members did receive a mailer in sent to them via u.s. mail. they receive a comprehensive open enrollment statement that shows what their current

elections are and what the premium cost for those current elections would be as well as the other options available to them for the next year. what we did remove from the active mailer for active employee was the shortened enrollment booklet which highlighted changes for the next year. what are seeing with the booklets number one, they are very expensive to produce as we try to keep up with the city mandates for use of recycled papers and things of nature. we found the vast majority of members want the current information of the benefits, what they cost now and in the future and don't rely on the booklets much at all. in addition in the mailers we also include what jessica was referring to is legally mandated notices we send to each and every member, so still a pretty comprehensive guide and booklet, just does not include the printed summary

booklet we historically included but continued over the years to shorten, so now we have two printed materials, member booklet, which is summary and our full member guide which has all the information. we do feel that at some point a employee or retiree is making consideration to make a change they should refer to the full member booklet with all the relevant information in there so we are trying to point employees both active and retirees to the booklet as the single source for what their benefit options are in future years so we'll take that into account when we consider possible changes for the future. going to back to esa, our enterprise system analytics efforts, unfortunately [indiscernible] our esa director is not able to be here today. she is performing her civic duty and on a jury the next two

months so we are doing watt we can to continue on in her absence and giving her staff additional responsibility to build up the strength of her team. esa is responsible for basically all the technology that goinize to making open enrollment run and it is a huge lift every year. each year the esa team needs to update all our systems to account for rate changes and any changes in the administrative processes. speaking of rates, there is over 3900 different rate calculations that need to be calculated every year and this is again due to the large number of employer groups we have as well as a variety of union agreements. most of those rates in the past have needed to be calculated manually. later in the presentation we are talking about exciting new initiative to automate that task, so stay tuned for that.

in addition, esa worked diligently to work through both the technical connections necessary and both the data security protections that need to be put in place for our new off-site call center we utilized this year. speaking oof the esa rate calculations, we are really excited to kick off a new project working hand in hand with our finance team to develop a new premium rate calculator using sequel server rin developed the data requirements to provide to the selected contractor to build a comprehensive computer program to hopefully calculate those 3900 premium rates each year. once completed, we are hoping that there will be several benefits automating this manually intensive process

allowing us to get the premium rates calculated earlier to aid in our communication efforts and probably most importantly decreases the chance of error. this year the contractor developed a program while our team calculated the rates manually. hopefully to provide the side by side comparison to see where continued work needs to be done. now i will turn it over to olga to go over our member service results. >> good afternoon president scott, commissioners, olga, stavinskaya-velasquez health service system honored to discuss accomplishments and challenges member service division encountered during open enrollment. before we delve into details, let's begin with a quick summary of the member activities for plan year 2024.

as we can see, we had a slight increase in members enrolling dependents to medical and dental plans. appreciately 4 percent of members made adjustments to next year medical coverage and 3 percent made changes to dental and vision plans. we see constant with fsa enrollment with slight increase from plan year 2023. member service staff play a vital role in supporting our members. they determine member and dependent eligibility, process paper applications over 900 during open enrollment period, validate thousands online transactions and provide support and plan selection to our members. during this plan open enrollment, member service managed 6571 calls with support of our off-site call center.

they supported 291 members through virtual consultation which includes consultation for retirees that were looking to retire towards the end of the calendar year, provided virtical consultations for members looking for support on e-benefits and that platform for enrolling during open enrollment. participated in multiple health fairs and assisted 470 members in person in the lobby. this was a change from last year and it was a welcome change as staff saw as a "back to normal". open enrollment related calls accounted for all most 30 percent of our total call volume with other call drivers remaining consistent from month to month. we were concerned with potential of increase in phone calls during open enrollment with the perspective premium cost increases, however, this

concern did not get realized. in fact, we saw slight decrease in calls related to open enrollment overall from last year's open enrollment. 2023 was a challenging year for member services. we experienced sig nificant loss in staff starting winter 2022 through september of this year and even though we are all most fully staffed by october, the new staff were not yet trained on all of the support that they would be providing to our members during open enrollment. to insure we are able to handle increase in call volume that happens during open enrollment we went through the civil service commission seeking approval to contract with a as-needed off-site call center. the idea is establish agents able to resolve simple open enrollment inquiries while the member service team tend today

complex calls, support members in person and focus on work streams that are necessary for timely ly enrollmt. we contracted with off-site call center vendor, vsa. the vsa call center supported members with inquiries around documents received, request for document mailings and general eligibility and enrollment questions. also supported with scheduling virtual consultation. as you see from the data, a significant number of calls during open enrollment were for inquiries that did not require processing with 4277 calls of our 6571 being routed to our off-site call center. the vsa support during open enrollment ramped up fast.

did cause challenges especially during the first weeks of open enrollment. however because we were in constant contact with vsa and able to review call data performance we made changes quickly. there is however a area where we were not able to create a resolution during open enrollment. one technical issue that still exists is the call center system integration which resulted in members on hold for significantly long time and then the calls disconnected. this was a major issue and did cause strain to the members and leading cause of unanswered calls we attempted to address it in several ways. multiple mitigation strategies. identified the calls and are they were-the team was able to call the members in those situation back within one hour to be able to reconnect and

support them with their inquiry. the second strategy was for hss to reserve back two major queues, one for retirees and one for active enrollment so we reduce the number of calls. this did increase our total number of voice mails received but vsa was able to support in that as well by calling back. the goal is connect with the members kecking with us even though their first experience was not fully completed. the third strategy in resolving the issue is a shared use agreement which put vsa and h is rks s on the same at&t platform with understanding it eliminate the technical challenge. the solution has not been implemented, there are complexities with contractual review. we are still pursuing it. we will however be pausing our

contract with vsa starting january 1 as is per our contract. but we want to attempt to resolve the issue before the contract end in the evend event we reengage vsa in the future. as we proceed to2024, our commitment continues to focus on process improvements with emphasis on customer service excellence and creating lasting impact on operational efficiency and satisfaction with service. i will pass on the presentation to carrie beshears. >> before you do that, in case the are questions from the board. >> absolutely. >> i have a couple questions. how were calls diverted between hss staff and vsa? after hours went to vsa so 24/7, accessibility or what was the mechanism?

>> great question. vsa supported during our regular business hours and so the way that we divvied the calls, we identified three different queues that would be transitioned over to vsa. we identified queues that did not require processing while the hss team held to the queues that required more complex review of cases and actual processes of work. vsa basically supported us with inquiries where members self-selected they were looking to confirm receipt of documents or they were requesting us to mail documents to them and general eligibility questions that otherwise would be answers would be of teams through the website or the member role. hss we retain queues targeted towards making payments and access to care questions that

members may have. so members have a opportunity to self-select a queue. we also have divided into active and retire members to track volume from each. >> can i follow-up? the slide that looks at the amount of time on the call with the two options, a couple minutes longer on call time. we suggest that maybe either they were not complexity was more then anticipated, took longer or the vsa staff had not been quite [indiscernible] to deal with thought to be simple questions or the members when they called didn't quite understand where their calls were going to go or had multiple ish sues.

sometimes you are asked to make a selection and have 3 issues. were they misdirected? this is a complicated issue and appreciate your delving into it and hope for success in the future. the last question i have is, did members know who they were talking to? they were talking to hss or vsa staff? >> members didn't know. we tried to make a seemless process for them so they knew they were contacting us because the trust is in h is rks s. we provided as much training as able to do for our off-site call center for vsa and they were always in contact with me should any additional questions come up that they may not have-may have missed training on, but it was a very integrated process in our communication and we supplied quite a bit of training for them so it is a seemless process from the member

perspective. >> okay. not sure how i feel about that. i think it is a tough question dealing with vendors outside hss, not always knowing who won is speaking to or visiting the house. are employees of the company visiting the house or vendors who don't have the same ownership to the issue so not sure how i feel about that, but i'll leave that for staff to address in terms of transparency to make sure that all members get equal access to hss staff when appropriate. >> absolutely. we did have a process to be able to do that. should there have been a situation like you identified where members were calling about a issue that had multi items,b vsa transferred over to escalations to supervisor team or transfers to our team to be able to address.

they had the opportunity or vsa team had the opportunity to triage and get them to the appropriate party. >> thank you. commissioner zvanski. >> thank you. i agree with commissioner follansbee and the concerns. what i notice is there are-should i ask, did you track calls that were lost? >> we did track the calls lost. we had vsa call back the folks that were lost. often times what happens when we are looking to reach out to them they are no longer available and we absolutely understand that was a challenge during open enrollment. >> did you have in some cases where you couldn't call back because you couldn't access their numbers? a lot of times people have their phone numbers blocked. >> understandable. yes, that could have happened, yes. >> do you know how many? >> i don't know how many were

not called back? >> i appreciate when we do this in the future that we include some of that as well. it is good to know and it might give more options what else we might be able to do to get to those members. thank you. >> lastly, i just have a general question. this is the first time we used "outside vendor" to support this aspect. do you think that it met minimally or maximally or kind of okay or no, we won't do this again or need to do further work? how would you assess the result overall? >> what i can say is we would not have been able to meet our members needs if we did not have this contract. >> alright. >> because of the low staffing at the time.

even though it might not have been the excellent experience that we are expecting to have for our members, we were at least able to connect with them and provide them with a level of support, so we would not have been able to do that without the vsa contract. >> alright. thank you. so, there is more work to be done and you are saying that you wouldn't have been able to do what you were able to accomplish during this open enrollment period without this vendor. okay. yes, director. >> i want to commend the team for putting the solution together because it was a big challenge to put it together and it was a great effort. we had a lot of support from the department of technology. igist spoke with linda yesterday who is retiring from it department of technology, but she was very impressed with how this all came together in a rather short period of time and

it did provide a service that was quite remarkable. in addition, there are many unintended benefits from that relationship and i think olga and her team have come together on understanding-i liken to running a er. you got to be able to flex, got to be able to triage and get people the right place and right time and that way of thinking and doing business is now embedded in member service in a new way, so i think it has been a fabulous relationship. it did was not perfect, but the effort that went into it real time live, ongoing learning and put into place new procedures was remarkable, so i would really like to commend the group for being able to pull this off in a very effective way and i are just congratulations to the team. >> thank you and the team for

all that you have done during this season. >> thank you. >> carrie, please come forward. >> good afternoon. carrie brusheers beshears to talk about flu and health benefit fairs. first i want to acknowledge on my team, [indiscernible] she is the one individual that really spearheads up all these events. naturally she has support from our team as well. i will highlight some things she did this season with our vendors, with our partners and some of the hours she put in herself to make this happen. so, i will start with highlighting that she manages about 16 vendors. we have 10 health benefit fairs and we have our flu clinics and there is partnership between many of those.

managing 16 vendors can be challenging but she pulled it off excellent this year. there was 35 communication materials that were developed just for these events which we partner closely with jessica and her team on. and then it is about 9 months of planning. we talk about open enrollment starting in january and not stopping and it does for us and also with flu and health fairs it is a very strong 9 month period in which jalisa tried to quantify her hours but at least over 1400 hours dedicated to making these events happen so i wanted to highlight that. i'll start by focusing on open enrollment events. sorry, health fair events. total of 10 this year. maintain the same number year over year and continue to offer 2 clinics at the airport. one is a evening clinic that targets different population

which we found very successful year over year. we also-it isn't in the highlights here, we do also continue to offer benefit fair over at hetch hetchy. we find this very valuable and partner with the flu clinic and this we brought in vendors on site which we know is very helpful for that population. some of the main focus areas in how we target is look where we are going to pull in the massing or pull in the people who naturally are on the ground not always in an office setting so often times we target those different maintenance yards or like hetch hetchy to gather in a lot of folks for these fairs so they get the information that they need. one of it best practices we started two years ago when we first started doing the benefit fairs was doing a pre-planning call with all our vendors. it allows jalisa and our vendors to pget on page of what are the expectations, where they need to go, who are the

site contacts so we continue to offer. this year we also invited some of our other partners to attend the events. particularly we invited our external eap--who as you may know or heard have expanded service to first responder departments but continue to serve our entire employee population. we also brought lighthouse, the first responder wellness app we transitioned from a different vendor and also had some of our mhn partners specifically through health net attend these more specifically for the first responder locations as well. and last, we had a partnertion with credible mind. sure you may have heard us speak about it. it is online tool that provides a lot of resources around mental health and emotional wellbeing and they came on site to a lot of our locations. i'll shift to the flu clinic.

we hosted 24 locations-24 clinics at 23 location. we do two at department of emergency management to target early morning folks. 10 open clinics which anyone has the opportunity to join. no access issues. generally open to the public but anybody can get in as long as they are a member. 14 restricted locations. we had one location we did not offer last year due to low participation. we have minimums we need to meet for our clinics so every year we assess are we meeting those, how far are we not meeting those so we brought back the puc sunol clinic. there was a lot of interest because they are further out and not so close to the city. we administered just over 2 thousand vaccines this year. i wanted to note, that is 10 and a half percent lower then last year. i wish i could say because we

didn't offer the same number of clinics, the one clinic we didn't offer had very low participation so don't have a lot of data showing us why that might have happened. we know what we are hearing, which is really all over the map. could be anything from people in hybrid schedule, not in the office that day. we have heard a lot of messaging around vaccination fatigue, so again we don't know exactly why but every year the goal is go up, up, up. this year we did not go that route. >> sure among other factor is the fact there are more vaccines available in more venues then 3 to 4 years ago. go to the drugstore, the supermarket, what have you, so people where we used to be health plan provider or employer based as a primary source of vaccinations there are many more sites out there

now and so that too may be impacting what you are seeing. >> right. which is a good thing. >> yes. that may be the reason as well. >> very much so. >> if i comment as well. there is a lot of public service messaging around flu season, but the [indiscernible] rsv and covid frankly is sometimes confusing to the public because you can only offer flu when people are somehow tuned into rsv because a vaccine is available for certain subgroups, adults for rsv and pediatric vaccine was short supply. this is very confusing to people, so i think some of is the low participation may just be not only vaccine fatigue and vaccination overload like how to prioritize this. i applaud all your efforts

regardless. >> thank you. thank you. the good news we are getting people vaccinated either way so that is great. some of the best practice we do continue to offer clinics to mid-november. we closed a little earlier isthe year and that was because it made more sense. we also continue to partner with kaiser permanente who over the last 2 years, now the third year utilized the third party vendor, albertson's/safeway. a few new things is dr. wilson our medical director officer for the city attended a couple of our events. she found this to be successful in some of the covid pop-ups they were doing that it is like a ask the doctor and a lot of people were approaching her, asking her questions. we were not able to do covid vaccines this year with the flu so is it allowed her to answer any questions that could arise

for both vaccines. a new change this year which generally impacted just our kaiser members is self-reporting. generally in the past anybody who was a kaiser member, their flu vaccine information would be directly put into the medical record, anyone else has to take a image. this year all the participants who engaged wouldn't need to take a image in order to put that information into their own medical record. and that concludes--open enrollment benefit. questions? >> are there questions for carrie? commissioner zvanski. >> thank you. because i know there have been a lot of shots available of both types in the communities that san francisco has been very active and in the peninsula, east bay, where we have a lot of active members living as well, but a lot of

retirees and i see it because i have been involved with some of those. i'm wondering-- what am i wondering? i'm wondering if we have been-health service has been involved with any of those community options or if we know those are pretty much run by the communities and the pharmacies, because i think private pharmacies are still giving shots as well and having the shopping centers like albertson's and safeway available present many options for people as well. have we been involved with others? >> now, we do not do direct partnership with community locations. we do provide information through our materials and online for where someone can get vaccinated outside our work site flu clinics. >> it is self-reporting if that goes? >> correct.

>> okay. thank you. but i just wanted to mention that i think there has been at least in the immediate bay area great expansion of options available to get these shots and still ongoing and a lot of education going along with it, so thank you. >> thank you very much carrie for all you have done during this period and your team. >> thank you. i'll turn it back over to rey. >> rey, guillen. knowing we are presenting with much of the following information in our demographic and annual reports in the coming months, i just briefly want to share with you some information that we learned after processing our open enrollment transactions. first, open enrollment applications submitted electronically still remain very high, so currently at 88 percent all open enrollment application submitted through

e-benefits or online benefit system. we'll never to 100 percent because some transactions will not process through the system due to overlap in transactions, so for new hires for example, if they have a new hire event sitting out there, they cannot have a second open enrollment event open at the same time, so for those members we have to collect paper applications. also for members transitioning from active to retirees status, similar situation where we will need to collect the applications via paper. we'll never get to hundred percent, but we always strive to increase the number because it does reduce the complexity on staff processing those applications. when we look at the medical plan enrollment for our active employees, there were not major shifts with distribution between the different plans. the one notable exception again

was with our health net canopy care plan. this year again we increased membership in that plan by 50 percent. again, this is leading to more sustainable plan as long as they get that base enrollment up. again, no significant enrollment. we do see increase in enrollment from last year the this year primarily driven by increase of employees during the reporting period. again, for the pre-open enrollment data that information is based on the data we pulled for open enrollment letters late august and so the post-open enrollment data we are looking at is after we process the open enrollment application which is mid-to late november and therefore we just had a number of new hires in the workforce during that period of time so increase is not indicative of anything other then the increase in the

overall membership. if we look at the next slide it helps if we look at early retirees and medicare retirees. so, the one thing we wanted to keep an eye on was knowing there were significant increases in premiums for some of our early retiree members. we want to see if there was potential shift in enrollment due to that fact, however as olga alluded earlier, that did not come to fruition. enrollment stayed pretty stable for our early retiree base coming out of open enrollment. again, similar to that--back to that previous slide. similar to the issue we saw with active employees, where we saw new hires, we do see overall decrease in the number

of non medicare retirees, but again this is primarily due to the shift between the date we pull the data and for the pre-open enrollment data and post-open enrollment datea. we have number early retirees aging into medicare over that portion of time and so again, the decrease in enrollment that you are seeing is primarily due to that issue. enrollment stayed very similar. when we look at the medicare retirees, just opposite. you see we increased the medicare members, but again it is primarily due to those early retirees aging into medicare over that 3 month period of time. enrollment in the plan even though we were fearful of potential decrease in enrollment due in the united healthcare medicare advantage ppo, again, that enrollment did stay relatively stable.

here you see the positive enrollment in our health net canopy care hmo plan. we did see significant increase in lives for both when we look at it from a total subcriber base and total live basis and also subcribers or enrollee basis. we see significant increase in enrollment in that plan, again, after we experienced pretty much the same last year so very happy to see that in order to maintain the viability of that plan. when we look at dental, again you will see same thing as with the medical and increase in the accounts active. attributed to the increase in employment during that period of time. the one thing that we are seeing when we look at both the data for active and retireees

is a small shift from hmo plans to ppo plans. it is noted we have not had a chance to look into that for reasons, for that but we wanted to point that out. next slide. similar with vision, again enrollment stayed pretty stable and we do apologize, it looks like there is overlap in the data, but we did see when we look at the vision data, we do see a also a migration from the vsp basic plan to the vsp premier plan and again, the difference between the two is, there is no copayment for lens on the premier plan asual as there is a benefit allowance for things like frames and contacts every year versus every other year but we see members moving to the premier

plan from the vsp basic. when whee look at retirees similar story. enrollment pretty stable but see a slight move from the hmo to ppo dental plan. and again, similar enrollment change for the vsp plan for retirees, just members moving from that basic plan to the premier plan. so, with that, that concludes our presentation and we are here to answer any other questions you might have. >> are there additional question from the board? again, rey, on behalf of the board, we thank you and each of the teams in your department for the hard work and diligence that you displayed again this year in carrying out this process. >> i do thank you for that. it is truly a team effort.

every person in our department plays a very critical role towards the success of open enrollment from the planning on and so, i just thank the entire team for being team players through the entire process. thank you. >> thank you. if there are no further comments from the board, we'll take public comment on this item. >> thank you president scott. [providing instructions for public comment which is displayed on the screen] >> board secretary, we have three callers on the line, zero callers entered the queue at this time.

>> thank you moderator. hearing no callers, public comment is closed. >> thank you. at this point, we are going to take a recess of 10 minutes. i often said, the mind can comprehend only what the end will ender, so we'll take a 10 minute recess at this time. thank you. [recess]

>> we are ready. >> thank you. we are going to have roll call. >> thank you president scott. roll call starting with president scott, present. follansbee, present. zvanski, present. >> now we move to item 9, which is board education. >> thank you president scott. item 9.

. board education: opportunities for future consideration: (discussion) presented by anne thompson, senior account executive, aon, and mike clarke, lead actuary, aon. >> good afternoon. >> we'll be presenting today. just as reminder, before we start just for background, this has been a ongoing education process throughout the lete summer and fall months and just reminder of what those 2023 requested topics were and how a lot of what we'll talk about today brings the last three discussions into focus for the future. and that is the title of our discussion today. opportunities for future consideration. we'll go through the just brief overview of the overall board education modules that commenced in august and conclude today as well as the key take-aways from the august, september and november discussions.

the strategic goals are embedded throughout the duration of the discussion today, including conversation about driving high value in healthcare ann will go through, opportunities for future consideration that both ann and i will discuss and then anne closing with concluding thoughts on take-aways from today's discussion and preview of health service board education discussions that will occur in early 2024. reminder of the modules commenced in august with broad review of the health ecosystem, and just preview of what transpired from september to december. september focusing on market and health system invasion, november on benefit design benchmarks and plan design on plan use behavior and taking all that information talking through opportunities for future consideration today.

page 5 reviews some of the key take aways from those prior three modules. from a health ecosystem overview standpoint, certainly the complexity and everything that we see in healthcare and how those complexities drive up spend and how that spend increases with age and advancing needs for those with chronic conditions. that underlies a lot of what we see in our environment. labor shortage in the healthcare environment, wage and supply cost, what is happening with specialty pharmacy and deteriorating physical and mental health. we pivoted in september to review market health consideration. involving dynamic vendor ecosystem. focus on unmet needs including

navigation, wellbeing equity and affordability and a lot of [indiscernible] care delivery. for instance, the alignment blue shield will have starting in 2025 with the cost plus drug organization. the alignment of amazon with one medical delivering primary care as well as virtual care. and then last month we spent our time talking through benefit design benchmarking. assessing plan des zines what we see in the broad employer marth place across the country and specifically in california public sector and how that influences behavior. copay based plan increase spend as prices increased significantly. there are differentials within the plan designs between the kaiser copayments which are generally lower then other

plans. research has not shown significant impact on behavior with increase point of care copays and coinsurance to some extent there. the member design features within the plans again align well with other california public sector entities, but richer then national public entities and how utilization is continued to increase as the population ages and those chronic care needs of members increase. >> so, as we think about the future, what kind of went into my mind is we want to drive high value healthcare and we chose those words very carefully. with we are not look frg the cheapest, we want the quality, which generally is the less expensive, but that's what is driving this at the end of the day, so we see there are 3

different components so the first on the left side improving health outcomes which we spoke earlier. dr. follansbee you talked about health ucwety and driving outcomes. this combines closely with the middle item reduzing member utilization and we want to do that through better health outcomes. the healthier the less you use the system or use the system when needed and that gets to making sure when care when needed is efficient and effective in the care delivery setting. how do be do that? on the next page we like i said combined improving health outcomes and reduce utilization and there are several areas we wanted to call out as key areas to address as we think about the future and so preventative care. we screen vaccinations which we

have spoken several times about vaccinations today. chronic condition management, wellness and wellbeing. heard from carrie and her team all the work hss is doing and looking at pharmacy and medical device management. i don't think we have talked about pharmacy recently. maybe last year, but we know there's a lot happening in that space so we want to really make sure we keep an eye on what is happening in that space and so again the ultimate goal is health improvement for better quality of life and utilization production. when you look at efficient and effective care delivery, again key areas primary virtical care, which we heard a lot from executive director yants and organizations that she participating with on primary care. [indiscernible] making sure that the right level of care is

being sought. something that can be done at your primary care, that happen s at primary care urgent care versus emergent care. this is ideal situation. we want to look at insuring the right side of care happening. we heard a lot 2 mupths about technology advance and invasion, so keeping an eye on that and how those things can teach us or initiatives we want to be involved in or engage in. navigation. accountability care organizations which you had in place for several years now and then fraud waste and abuse keeping active eye on that. those are the key areas in the effective care delivery. as we think about the future, and we will then look at future opportunities.

>> leveraging high value healthcare, as we look at the future considerations certainly promoting use of high quality and low cost care is a big component and we'll go through little of information relate d to the current plans today. addressing affordsability and sustainability. my passion as your actuary and anne will lead through ideas supporting member health and wellbeing and those with chronic conditions. on page 10 we do a lot to look at rates and cost and in our rate benefit presentations in may and june do side by side among the plans, but thes is interesting graphic and credit to anne coming up with this to look at the picture from a standpoint of both network size and level of care management where if you look at this, these are the plans available

to active employ eoos and early retirees. the dollars you see are active employee only monthly total cost rates for 2024 and the size of the circle corresponds to the member enrollment size for the active employees within each plan. so, that success we see around delivering high quality low cost care comes from encouraging members or incentivize through a combination perhaps plan design variation, certainly member contributions to enroll in well managed plans. we look at kaiser permanente at the lower left, not the lowest cost in 2024, but historically they have been the lowest cost plan it just so happens in 2024 it is health net canopy care but that is largest population size and correlates to probably highest level of care management among the plans

within hss and the smaller network simply because it is leveraged through the kaiser permanente medical group. you also see health net and trio plans fit that mode of high levels of care management. within networks that are more focused on the providers that in this case health net through the canopy care platform trio through their selected network and blue shield environment are able to deliver the numbers. access plus still delivering high degree of care management but the larger network size and ppo is there for individuals who want to select the ppo and certainly early retirees who live outside the bay area. it is its own plan, but you have a less degree of care management and certainly largest network available.

>> commissioner follansbee. >> when i saw the slide and materials i was confused by it, and the level of care management was very clear. the network size confused me a bit. do we actually know the number of providers that are member c in health net verso trio versus access plus versus kp? kaiser has a much more limited provider base and so the other plans sky is the limit of the ppo. when you look who our members are accessing, i'm wondering if this is accurate. do our members in the ppo paying so much more access that many more providers then for example kp offers? can you maybe elaborate?

>> absolutely. starting with kp, not all care goes within the kaiser permanente medical group. vast majority does but some care goes outside the network for complex care needs maybe kaiser isn't equip to handle and certainly members have the choice to go out of kp for emergency care. thankfully and we do get this information on a quarterly basis from kp, i think well over 90 percent of emergency room visits are happening within the kp environment and from personal experience that isn't true for other california clients. with health net, the canopy platform or primary providers, so thinking health physicians, john muir, mare taj, the partners within health net, blue shield actually shares with us on a quarterly basis robust list of the percentage of members aligned with various

physician groups in their network, so brown and tollnd and hill physicians are the dominant physician groups for your members within the trio environment. i think they account for probably 80-85 percent of the membership. john muir is also prominent within that trio environment. when we look at--this was part of the discussion we had around the rate increases going into 2024 between access plus and trio were access plus had the higher rate increase, trio, nominal increase. is there opportunity for access plus members to consider enrolling in trio? we saw from the team information earlier we didants see a lot of movement, but about 60 percent of access plus members leverage an ipa independent practice association so in other words a physician group, that is also

available within trio. now, the access plus also has i say about 1/3 of members affiliated with a sutter health or palo alto medical foundation physician where those physician groups are only available within the blue shield plans within access plus or the ppo but not available within trio. does that help? >> it does help, but i think it begs the question about where our members are getting their care and are they getting their care with basically three times more providers then access plus then adjusted for the number of enrollees compared to kp. my gut feeling is part of the problem is that we may have more providers in the ppo-go to the ppo. but when you look at only one

or two or three providers per member and so when you talk about care management and trying to get messaging out, this is little misleading. ppo, someone say look at the ppo network size is huge. i will spend the extra money, but where members get the care may not be that huge a denominator. that is what i was trying to get at. >> i think i totally agree. part of the ppo network is hetch hetchy and sonora accessing care in out of state localities. i think within the bay area itself there isn't a great difference in the provider composition in the ppo for blue shield versus access plus. there will be then when you go access plus to trio.

>> alright. please continue. >> certainly a big focus the executive director yants and team is looking at alternative payment models and certainly as it relates to primary care and advanced primary care. those alternative payment models are to look to shift away from just a pure fee for service. pay for number of services to models that provide those financial incentives for equitable high quality cost efficient carement we see it today, especially within blue shield and health net environments through capitation, physician capitation for blue shield plans, capitation for all most all services in the health net canopy plan and value based payments with aco partners, hill physicians and brown and

tolland. we look at future trying to link the payment models more to quality. they have been historically with brown and tolland but that is in the blue shield environment. the investment in those advance primary care initiatives and hss talking often to the blue shield team about how that is progressing within their key aco partnerships. payment transparency. the data collection aspect. looking at these variables which are fairly i guess new to the thinking of integrating them into the data process, and then integrating information on more real time actionable basis to support population health management. >> on this issue of payment transparency, there is a larger effort i think with center of

medicare services around actually having hospitals and other i guess larger providers post their details of what things cost on a national website. is that still moving forward to your knowledge? >> yeah, so there are two cms initiatives around data transparency. initially it started with hospitals and then broadened and it this week there was actually a piece of legislation that passed the house around more advanced data transparency and we'll see what happens as the senate considers. the history we are seeing in general is it data set is so large, unwieldy, while you may get compliance it may be more technical compliance but not necessarily with a mind to-say

a system putting the information out there in a clear concise usable way, so there is definitely efforts underway by data organizations to i guess advance the technologies that allow us to have better insights from the data that has been released. >> okay. it is still a project ongoing just hasn't-- >> yeah. it is good we have these regulations in place and it is continual work in progress to get to a point where we have more useability with the information that is required. >> okay. thank you. >> from affordability and sustainability. last february we talked through some of the mitigation strategies that may be part of recommendations going into this rates and benefit cycle. these strategies, we think of them as ongoing and certainly

in collaboration with the health plans that support the advancement of these aims and most recently we spoke in november about how those periodic plan design feature reviews is recommended to support the overall plan affordability and sustainability. just a example, page 13 is a slide we shared with you last month just looking at the levels of annualized increase in certain services especially on in-patient hospital side, out-patient surgery side and brand prescription drugs. these are elements that require the least amount of cost-sharing for copayments. just to give you a sense, this is what actuarys do, if we look at alternative plan design,

looking at elements of the plan design today across various plans so you see the plans across the top and you'll see examples of particular plan design elements down the side of the page. just what if. what would it look like if we were to consider a particular increment and plan design feature for each of the given plans so that is what this is meant to do is show what that possibility is. for some it is a modest amount. for some it could be significant. not saying all these are recommended and all brought forth to you, but just as a example, if all these increments were applied close to $18 million. there may be elements of this that we bring to you over the course of the winter and spring months. >> could you pause. are you on page- >> page 14.

>> that needs-- >> there you go. >> that needs to catch up. >> page 14. to give a sense too, you see at the bottom of it page, if you look what transpired over time and hypothetically if you look to periodically index the copayment growth to something, think of medical cpi, a national measure of increase in medical cost, it has grown 50 percent since 2009, so granted,ter is 14 year period here, but it would mean that a $10 copay in 2009 needs to be $15 for instance in 2023 to keep pace with inflation. and then again a recent slide to show examples of recommendations that i made to

the board just looking at kaiser recommendations for both the 2021 and 2024 plan years. again, just to get a sense what the financial impact would have been under those particular recommendations. >> can i maybe make a comment? i appreciate--a lot of this is rehashing the dat a we have seen and think it is very important. i guess that again, the concern i have in terms of our messaging is, when we talk about one of the early slides i bristled at the balloon that said, reducing medical utilization. i think that probably could be better worded. maybe something like, optimizing healthcare utilization or something, because i think that this idea

of minimizing medical utilization, the sort of concern is by minimizing early utilization we are increasing conditions that end up only managed by brand drugs or inpatient hospitalization or surgeries, and i guess where data transparency is important is can we really effect these three items by your later slide talked about, optmizeing preventive strategy and healthcare utilization early and this is where we see this gap. it looks terrible because in red, rx brand, they start cutting-asking to pay a lot more for my rx brand and that isn't--from my position on the board is to try to increase the screening and utilization early on so fewer people need the

brand drug for the conditions that are so advanced that there are not many options or treatment may be much simplified rather then needed heroic drugs for the last 30 days of a person's life. i think this is a complicated area and appreciate you attempting to clarify, but don'ts want people to take away we increase copays for high cost as the only solution. it may be a solution in part, but there are other solutions we need to focus on in terms of early optimal healthcare utilization. >> thanks for the comment. >> i'm preaching. sorry about that. >> i think we struggle-- >> [indiscernible] we understand and you have to get that message across. >> it is is great point and certainly not our intention and we struggled with the wording so wish you would have been in the room when we were doing that slide. certainly it is not to reduce

utilization because of needed care, it is to get up-stream on the preventative care which we talked about earlier, the health and wellbeing. those actions to ultimately reduce utilization but not in a punitive-- >> commissioner zvanski. >> thank you. dr. follansbee, i heard my father's voice ringing through with this, because he would look at his employer plan and also as he went into retirement and said, the goal is to really cut back so that we-to get to the point we use fewer service and less and less expensive and the point we are try ing to make, if there is early utilization and preventive looking more at the preventive options, the end result is the

savings on the other end, but again, how we present it, the minute i saw that phrase i went--my god, he's coming back to haunt me. it sends a different message and i think what we want to say here is we want our members to be more prudent in their use of the benefits they have, because we know we have very good benefits, better then most, and we want to encourage our members to properly utilize those benefits so that they won't need as much going down the road and that we can keep our benefits cost effective as well, because we are locked into formulas that are pre-set. there is only so much negotiation because charter languages says this is what you pay and what you pay and that is what you pay and we are

stuck with that and i think what we want is to optimize the opportunities for the best care and save us some money in the long run. we'll have to work on our vocabulary a little bit. thank you, because when you say opportunities, affordability and sustainability, those are key phrases, key words that we want to see and we want to present that to our members. >> thank you. >> the last thing, the change recommendations when i look at opportunities on page 15, i think what we are trying to do is not have to make those changes, because the more we make those changes, the more it limits someone's access one way or another. we may not be aware of it. especially with retirees and those that are older and have

low retirement benefits. they may not be able to afford going for from $35 to hundred dollars and may skip some of the preventive opportunities. thank you. >> thank you commissioner zvanski. let us continue. >> on 16 and 17, we talk about the health and wellbeing program hss host and puts on with carrie and her team and i say will not read this to you, the key opportunity here is increase awareness and engagement. there is tons of great programs and we have great utilization, but let's get more in these amazing programs to really get at that upstream care. on page 18, i'll jump to that. not to-want to acknowledge vendor programs. just listed out a couple for each of these. some could be quite long lists, but there are lots of programs

within your health plan to also support health and well being so creating awareness and engagement in these programs. page 19, getting to the chronic condition management. in support of those, we see three main avenues. navigation, advocacy conditions specific support and value driven network. some of the opportunities here we talked about i think in september was kind of digital care, integrated care, support navigation advocacy, continuing to [indiscernible] aco population you have focus on advance primary care, driving care to high quality providers and then last but not least, data [indiscernible] just because you send data doesn't mean the person get tg can use it. if you want to refresh on that, there is presentation from i believe august 2020.

2019. it was in person. in conclusion, a few take aways from today and really want to put this out there to establish the baseline of the great thing s we are doing and want to grow and development and if gauge further some of these initiatives and you may hear some of these as we move into read benefits in future years. again, promoting use of high quality low cost care. we won't say reduce utilization. address affordsability and sustainability. health and wellbeing, getting upstream and supporting those with chronic conditions. that concludes the education part of our presentation. i will note on the next page sessions that we'll be hosting. training in january with chris sears and february employer budget position that we'll hear

from at that time. >> just to clarify in the february session, we sent letters to the 4 employer entities this board serves and we asked those representatives to come and talk about the budgetary impacts of rising healthcare costs in terms of their operations, so that's the school district, the community college district, the superior court, as well as city and county of san francisco represented by its controller, and in the case of the controller, i took a point of personal privilege, because i understand he's leaving in february. i wanted him to also provide the board with council and guidance, lessens learns if you will, coming from his experience over the past several years with this issue and how it impacted overall the

budget of the city and county of san francisco. we'll see how that goes, but it isn't just about their budget positions, but it is talking about the impact of increasing healthcare costs on their total operations. alright. thank you for your leadership in terms of this particular--getting to mike in a moment. your leadership in terms of these sessions and also mike, your expertise in supporting the effort of reviewing these topics over the past several months. it is called board education but my hope is it laid a public foundation with what we are grappling with as a board as we go through the benefit cycle each year so thank you again. any other comments from the board? >> i just want to reiterate what you said and just again,

where the rubber hits the road when you look at the high cost areas, you talk about vaccination decreases absenteeism good for the employer and are decrease secondary pneumonia from flu or rsv or covid and hospitalizations and complicated sometimes very long hospitalizations and rehab that goes into that. the prenatal care, we spent a lot of money on very few cases, very complicated pregnancy and yet prenatal care can minimize that risk. substance use, we spend a lot of time worrying and asking our patners to talk about substance use because we know uncontrolled substance use translatess to hospitalizations, complicated surgeries for drug users who end up having heart transplants or liver transplants and all that as well as high cost

medications. these all factor into the same issues, which is early optimal utilization of these services whether it is substance use, vaccination, pregnancy et cetera. again i want to highlight that we are all driving towards the same point. not just trying to balance copays for those who are hospitalized. they don't want to be hospitalized we should have prevented that and we could have in some cases so thank you. >> alright. no further comments from the board, we'll now take public comment on this item. >> thank you president scott. [providing instructions for public comment which are streaming on the screen]

>> board secretary, there are two callers on the phone line, no callers entered the queue. >> thank you moderator. hearing no callers, public comment is closed. >> thank you. we'll move on to item 10. >> item 10, .health service board annual self-evaluation and employee performance of sfhss executive director evaluation and timelines for plan year 2023: (action) presented by governance committee chair hao. this is action item. >> thank you very much. i hope i have this right

because i got notes here so thank you very much board secretary for preparing this as well. the governance committee had a meeting and reviewed-took a look at the materials for both the board self-evaluation and the evaluation for the executive director and made some recommendations accordingly and we set up a calendar with regard to when these activities are going to take place. monday december 18 the board secretary will send the executive director performance evaluation survey to the health service board with director yants self-evaluation attached

and there will be 4 weeks to complete the evaluation, and i just want to make sure--it is the same with regard to the coo and cfo and that's again 4 weeks to complete the evaluations and then reminder we'll go from the board secretary to the board and the c orks o and cfo in december 27 and we'll be looking at that basically january 5. the responses will be due and there will be a draft that will be prepared for the governance committee to meet and take a look at those in january at some point, a date to be determined and the governance committee meets february 15, maybe. it is a proposed date with

regard to the final recommendations and the report going forward. not until march 14 that those items will come to the board in a closed session for our review. there is a number of steps that will be going forward with regard to these things. also, with regard to our self-evaluation, there have been a number of changes the governance committee proposed. for example, they took out number 3, item 16, a term was removed from the policy that was stated. item 24 and number 27, number 34. those were removed and language

changed in item 38 so instead of comment about the board engages in effective management succession planning, it would be where feasible the board may make recommendations because we looked at how the process works and what the board actually does. there were a number of modifications that were put forward in the governance committee meeting and those will go forward in the materials presented on those dates i listed. and i think-are there any questions with regard to what the governance committee- >> i like to move we accept the recommendations of it governance subcommittee visa vithe employee performance evaluation, the health service board self-eal evaluation and timeline, all three i move we accept these recommendation. >> thank you commissioner. >> is there a second?

it is properly moved and seconded that we accept the report coming from the governance committee on the executive director performance evaluation, the board self-evaluation and the related timelines. >> and thank you commissioner follansbee for adding the timelines, which i didn't mention. >> any other questions from the board? hearing none, thank you we appreciate her work on this project as well. with that, no further board comments, is there any public comment? >> thank you president scott. [providing instructions for public comment displayed on the screen]

>> not hearing response from our moderator. give one more second while i also support in the number of callers in the queue at this time. there two callers in the queue. no callers raised their hands so public comment is closed. >> thank you. we'll move to item--we need a roll call vote on the item.

>> scott, aye. dorsey, aye. follansbee, aye. zvanski, aye. >> passes unanimously and we'll move to the next agenda item. >> thank you president scott. item 11, reports and updates from contracted health plan representatives. this is discussion item and plan represents can move to the podium. >> are there any health plan representatives who want to make information comments or recommendations, edits, amendments? anything at all? would the health plan represents here please stand? i like to say to you and your colleague we look forward to a very happy new year and we wish you a very happy holiday season. thank you for coming today.

alright. with that-- >> no discussion- >> any discussion? there was no comment so no discussion and no need for public comment. >> correct. >> i think i can aggregate it the process. the last item on the agenda is? >> i'm sorry- >> yes. >> i want to go back just a moment to a previous item and add a couple recommendations for future education for the board. >> i think we can do that in the solicitation of the board survey, which will be part of the board self-evaluation. >> okay. that's fine. thank you. >> that way we'll address at that time. the item i see before me is the adjournment of this meeting. hearing no objections, the meeting is adjourned.

[meeting adjourned]

community. >> my outlet sherene the executive director of homeless and congratulate sfgovtv for thirty years of the service to the community. um, this is a real testament to 70 to transparent and the accessibility and in government and want to say i had a chance with work with 70 for many years because of commissions i worked with and also, because of things i've done directly with sfgovtv and have been impressed with the professionalism of the station and all the staff that work there and just really great we provide a little bit of service >> flyshaker pool was a public

pool located on sloat boulevard near great highway. it operated from 1925 to 1971 and was one of the largest pools in the world. after decades of use, less people visited. the pool deteriorated and was demolished in 2000. built by herbert flyshaker, pumps from the pacific ocean that were filtered and heated filled the pool. aside from the recreational activities, many schools held swim meets there. the delia flyshaker memorial building was on the west side of the pool. it had locker rooms with a sun room and mini hospital. in 1995, a storm damaged one of

the pipes that flowed to the ocean. maintenance was not met, and the pool had to close. in 1999, the pool was filled with sand and gravel. in 2000, the space became a spot for the san francisco zoo. these are some memories that many families remember swimming at flyshaker pool.

>> san francisco is a positive impact on my chinese business. >> i'm the founder of joe-joe. i'm a san francisco based chinese artist. i grew up in the bayview district. i am from china i started at an early age i started at age of 10

my grandfather my biggest inspiration. and i have followed with my traditional art teacher in china:i host educational workshops at the museum and local library. and i also provide chinese writing in public middle school and that way i hold more people fall in love with the beautiful of our chinese calligraphy. it is a part of our heritage. and so we need to keep this culture alive. hand writing is necessary field that needs to be preserved generation toieneration. this art form is fading away. but since covid i have been very dedicated to this art and i hope

that my passions and serving this art form. there are many stores and shopping centers and companies that are interested in chinese cal iing ravi. i feel motivated to my passion for chinese calligraphy in today's world. so people can always enjoy the beauty of chinese calligraphy, from time to time i have a choice to traditional chinese calligraphy to make it more interesting. we do calligraphy on paper. i can do calligraphy different low. >> my inspiration is from nature and provide calligraphy that was

popular style of persons time. i will invite to you check out my website or instagram. and there is some events and updated upcoming events that you can participate.

♪ [ music ] ♪ ♪ >> the two largest bridges in the road, symbolizing pioneer and courage in the conquest of

space and time. between these two great bridges, in historic san francisco bay, here's tribute to the achievements of our time. he's a dream come true, golden gate international exposition on manmade treasure island. >> the 402 acre artificial island was build by engineers from 1936 to 1937 on the neighboring buena island. 300,000 tons of rock was used to build a seawall around an existing sand ball then followed by filling the interior with dredge material from the bay which was consistent of modern sand. the federal government paid for construction ask three permanent buildings which would serve as a potential future airport. treasure island was constructed at the same time as the bay bridge and it was a project of works progress

administration to construct this island, which was initially used to host the golden gate international exposition. >> carnival gone big. it was busy. >> it was going to become an airport after the exposition but it was turned over to the navy and turned over to a military base for the next 50 years. >> 1941, the united states army moved to treasure island as america prepared for world war ii. the island was a major training and education center with 4.5 million personnel shipped overseas from triangle. after the war ended in 1945, treasure island was slalthed to be an airport -- slated to be an airport but aviation changed and the clipper were no longer in regular service, and the island was never developed as an airport. the navy continued their presence on treasure island. during the cold war years, the island was a myth

training center and for military efforts throughout the pacific and asia. personnel trained on and shipped from treasure island and supported military activities in korea, vietnam and the persian gulf. >> the base was listed for closure by the navy in 1993 and the city began a process in 1994 under the redevelopment agency, forming a citizens reuse committee to look at potentially plans for the island, island's future. after the base closed in 1997, the treasure island development authority was created to develop and implement a reuse plan. >> the navy has completed their environmental cleanup in that area and last week, the california department of public health issued a radiology unrestricted recommendation for that portion of side 12. it's a big milestone for the project.

>> the treasure island development facility was setup to implement the master plan that was adopted by the board of supervisors in 2011. >> given the importance of housing in the city, both the affordable component and the market rate housing, we felt that it was important to review what the housing plan is at treasure island. >> the development facility and (indiscernible) that oversees the implementation of the master plan to make sure that the master plan, which was adopted by the board of supervisors and adopted by the city and after meeting, that's plan that the city approved. the members of the board was appointed by the mayor and the board of supervisors. [multiple voices] >> the (indiscernible) is very

detailed plan. looking at the ecological aspects of the island, looking at the geotechnical aspects of the island, but also making sure that there is an ongoing of development that's in keeping with what the original plan was, which is that we have up to 8,000 rooms of housing and there's retail and hotels. but also that there is open space that's created so it's an overall plan that guides the whole development of treasure island and the buena island. >> materials used during the construction of treasure island severely compromises the integrity to build structures. in today's geotechnical engineers standing, treasure island soil is being readdressed for soil stabilization for future development. a mechanical stabilization process is being

used to consolidate the liquid fashion of the mud and sandy soil. >> because treasure island is a manmade island, we have to do a significant amount of soil improvement before we can build new infrastructure and new buildings on the island. in the foreground, you see here, it's a process called surcharging we we import additional topsoil to simulate the dead weight of the future buildings to be constructed at that site. so this is causing bay mud that underlies island to consolidate over time and we can monitor that and as that consolidation primarily consolidation is complete, then this soil will be removed to the intended finished floor elevation of the new structures. ♪ [ music ] ♪ ♪ >> in the 1989 loma earthquake, the ground level of this island dropped by four inches. pretty much uniform across the island.

loose sand material used to build the island, whether it gets hit by a seismic forces, the sand moves and consolidated. >> one of the processes to further stabilize the loose granular ground, a dynamic rate is used to densify the soil by high frequency mechanical vibrations. >> the rig in the background has four h-piles that goes down through the upper 50 feet of sandy material and as they vibrate, they vibrate causing that san material to consolidate and settle so as we do that process, we observe about 18 inches in settlement so the ground level around that equipment will drop by 18 inches, so this causes that same type of event to happen through mechanical means rather than through a seismic event. >> the dynamic vibrant compaction rate vibrates the

soil every four square meters and moved along to the next section. to further assure stability, tamping is followed around the site, compassion takes approximately three to four months to complete 12 acres. once the compassion and tapping is done, it's settled ask using laser alignments to assure a level service to build on. >> i think that every city when they have the opportunity to do something that is as large as treasure island because treasure island is five hundred acres and it depends on their needs at that time and in 2011 to now, the most important are thing for the city is housing. there's two aspects to that master plan. one, was the new district for

san francisco. 8,000 units of housing, which is all levels of stability. the other (indiscernible) is 300 acres of open space and parks. and actually, it's the largest addition to the park system in san francisco since (indiscernible) 300 acres and this is a tremendous gift to the public, both the housing, which we desperately need in san francisco as well as an open space and park system which really is going to be worm class and it will attract people in san francisco but attract people locally as well as internationally. >> cmg architecture was brought to the project once they award the agreement between the city of san francisco and the united states navy. cmg has earned

national recognition and numerous awards for merits and design, social impact and environmental stewardship. >> we were a part of the project in the beginning when the developer initially was awarded the exclusive negotiation agreement or the ena with the city and they partnered with the planning and architecture group and we joined that team to work with the developer around the city and community to come up with a plan for treasure island. >> so there's quite a lot of open space in the master plan and there's a couple of reasons for that that's pragmatic. one is that the amount of area that could be converted for private use on treasure island was very limited, actually it wasn't allowed at all because treasure island was previously public open waters and protected by the tidal and trust act to be redevelop for public use. but there was a land swap that was allowed and approved by the

governor of california, governor schwarzenegger to be put on a public trust for a one to one swap to be taken out of the trust to be developed for private use such as residential and that amount of land was 89 acres which leaves a bunch more space that can't have housing on it and the question was, what to do with all of that space? there could be other public uses that allowed such as conference centers or museums or universities or things of that nature but what made the most sense for this location was to have more parks in a really robust parks and open space plan and that's what led us to the plan we have now. >> planting strategies for treasure island and buena island are to maximize habitat value in the park areas wherever appropriate and where we can to create comfortable at the pedestrian scale. there are these diagonal lines that go across the plan that you'll see. those are wind row trees like

you see in agricultural landscapes where they are tall tree that's buffer the winds to create a more calm areas down at the pedestrian scale. so of course, we do have some areas where we have play fields and surfaces where kids need to run around on and those will be either lawns or like you see in norm at sports field. >> related to where the housing is on the island and its convenience to the walk to the transit hub, i mentioned we're trying to create high-quality pedestrian -- and the innovations of treasure island is called the shared public way and it's a road that runs down the middle of the neighborhoods. it's a curbless street, cars are allowed to drive on it but pedestrian can walk down the middle of the street and the cars are to yield the right-of-way for pedestrian and it's intended for streets where there's a low traffic volumes and the traffic speeds are low so while car was allowed, there's not a lot of reasons for

cars to go on that street but it's to create a social street that's much more pedestrian-friendly and prioritizes pedestrians and bikes. one of the interesting things is working with all architects that have been designing buildings in the first phase to encourage them, to create architecture that welcomes people to sit on it. it's wlm like sticking its toe out and asking someone to sit on its toe so buildings integrate public seating and places for people to hang out at their base, which is really, the opposite of what you see often times in this city where there's defensive architecture that's trying to keep people off it. this is architecture that's trying to invite people to come and inhabit it at its base. >> incorporated in the landscape architect of treasure island are wetlands, which are designed to factor in coastal erosion control from incoming sea level rise and natural animal habitation and stormwater runoff

treatment. >> there's different kinds ever wetlands planned for treasure island and they have different purposes. they are stormwater wetlands that's treating the runoff from the island and filtering that water before it's released to the bay to improve the water quality in the bay and the ocean and the first phase of the large wetland infrastructure is built on buena island to treat the storm water from buena island. we might see that when we go out there. there are tidal wetlands plan for the northern side of the island where the sea level rise adaptation and flood protect for future sea level rise is held back away from the edge of the island to allow sea level rise to come onto the island to create future tidal wetland which is helpful for the bay in the future as we see sea level wise flood out existing wetlands and there are some natural vernal pool in the wetland that's captured

rainwater and capturing certain habitat so there's three purposes of the wetland primarily around water filtration and habitat creation. >> consumable sustainability was incorporated in the redesigning of treasure island. innovative urban farming is included in the plans to foster economic viability, conservation of water, and to promote ecological sustainability. >> the urban farm is 20 island. and it's a commercial farm to produce food. it's not community where the volunteers and neighbors grow their own, it's commercially run to maximize the food production and that food will be distributed on the island. and interestingly, the urban farm is tied into the on island wastewater treatment plan which creates recycle use for water on the island so water used to grow the island will be a sustainable force and we're trying to close the loop of water, food, and create a new

model for sustainability. >> part of the design for sustainable landscape was incorporate natural form water garden filtering systems, the first of three natural stormwater gardens is here on buena island. and a total of ten will be on treasure island. water from storms, street runoffs from neighborhoods has the possibility to collect toxic materials as it makes its way back into the surrounding bay. this garden has been a model for future, natural filtering systems through out the bay area. >> whenever a storm comes through, all of the water, you know, it lands on the streets, it lands on the top of the buildings, and at times it often collects a lot of heavy metals and greases and it needs to be cleaned and before sent back into the back. it goes into the pipes and stormwater drainage and put into our stormwater

basin and then all of the plants and soil you're seeing in there, they are acting as a filter for all those oils and heavy metals and greases and all things that's coming off the roadways, coming off the development and so it's treated here in the storm water basin and then it's sent out into the bay as a clearer product and cleaner water which increases our water quality here and throughout the bay area. so the structure in the center of each basin is what we call the for bay. that's the point at which the stormwater exits out of the storm drainage system and into the stormwater basin itself. so the for bay is shaped as almost a gate to kind of push all water out through the pipes, all of those rocks help to disburse it before it's sent into the stormwater basin itself. the storm water basin was designed to fill up to the height of the berm of the side you're seeing here. so this is

juncus and these are well-known fresh water grasses found in any place around the bay area that you find standing water or in a drainage channel, you're going to find a lot of these junket species. this is a leave a lifter in the bio treatment. it soaks up a lot of water, to soak up the contaminants and heavy metals, so it's kind of our backbone species. this one is called douglas siana and the common name is mug war. it's a beautiful plant but doing the heavy lift and pulling, those contaminants out of the storm water and pulling oil to help treat the water before its sent back into the system and back into the bay. this plant is known as salvia or hummingbird sage. it has a lot of habitat value in that it's a strong pollinator plant. obviously, you can see the pink and purple flowers which come up in the

springtime and attracts a lot of hummingbirds, a lot of bees which help to pollinate the other species within the garden and throughout the rest of the island and all of those native plants. all of these plants are designed to be able to take a heavily inundation of water over a several day per like standing water for a long time. all of the plants can withstand that and honestly, thrive in that condition. so all of these were selected based on the ecological and habitat value but also their treatment and functional value for stormwater. >> this is super tiny. >> it's very much a big part of our design and master plan for the development of the island. it was a navy base and a lot of navy housing on this island specifically for around 80 years and during that time, a lot of innovative species were introduced on the island, eucalyptus, a lot of different

european and algerians plants were on the island. we wanted to bring in the native eye college here on the island before the navy started to redevelop it and introduce some of those invasive species so the species you're seeing in this stormwater garden in the basin and the upland area was a part of those types of ecology s that's trying to be returned to this side of the island but different other spaces through out the islands development. so whenever we started this process, we identified a number of species of native plants that seem applicable to the ecology that we're trying to grow. there's 45 species, so a -- there's 15 species so they are hard to find in the nursery trade so we needed to grow it ourselves to

achieve the biodiversity that's in the design here. as a part that have process, we brought on a nonprofit group called ledge, l-e-g- which is literacy for environmental justice. they grew those plants and put together the plant palates you see. >> most of landscape was inundated with invasive plant species eradicating species and having the plan on buena island and treasure island. literacy for environmental justice, a community volunteer educational program involved with restoring local habitats and preserving san francisco's unique bio tie varsity, teamed up with the redevelopment group to grow the 50,000 native plants to -- to

repopulate treasure island. >> the city of san francisco set up meetings between leg and they came in with high expertise and urban design, and architecture, and green infrastructure, but they really hadn't worked with flytive plants -- worked with native plants at scale and they were also kind of scratching their heads, like how are we going to grow 50,000 native plants from remnant native plant populations. it was a unique partnership of figuring out what plants can grow, what plants will function in stormwater gardens. not all native plants are ascetically pleasing to landscape architect, so we kind of worked around what plants are going to be pleasant for people, what plants are going to provide habitat, what plants are going to actually be able to sequester carbon, deal with erosion, preserve the island biodiversity

as well as be able to manage all of these stormwater treatment on the island. >> there's about 33 naturally occurring native plant species that survived the last one hundred years on yorba buena island. we were able to go in and get the seed and salvage plants in some cases, some of the development work that occurred was actually going to destroy native plant habitat and we went in before the bulldozers and before the roads were build and the new water tanks were installed and dig them up, divide them, hold them, of the 50,000 plants we grew 40,000 of them in-house and the other ten, we had to rely on our partners to do it. with the 50,000 plants we did, we did 100 species and 95 of them are from the county

of san francisco. about the other five are from the state of california. but the other 95 species really are the native plants that have been here for thousands of years. we used collection sites such as angel island, the presidio had genetics for the projects in san francisco. we used remnant plant habitats at hunters point and we used a lot of genetics from san bruno mountain. just to collect and process all of the genetics was a two-year process. and then it was about a two or three year process to grow all the species. >> this is the infamous -- it's a low, growing sprawling native herb and it's in the mint family and i'm rubbing my hands on this

and it's extremely aromatic. it feels like a flush of peppermint just came across my face. it's edible. you can make tea out of it. it's a great digestive plant for settling your stomach. it has been cool to introduce yerba buena to yerba buena. this plant is called dutchman's pipe. when in bloom, the flower looks like a dutchman's pipe. and another thing that's unique about this plant is, it's the whole specific plant for the pipeline swallow tail butterfly. so some butterflies are able to adapt to other species and can use larva and food from different species.

in the county of san francisco, there's only about three or four healthy populations of this plant. these particular plants were going to be destroyed because of the green infrastructure project needed to put pipes in and needed to demolish all water tanks and build new water tanks for the island, so we were able to go in, dig them up, cultivate them, extrapolate dozens of plants into hund hundreds of plants and restore it through the restoration process. one day one of my nursery managers was down here and she found the pipeline butterfly have flown over from yerba buena island and came to our nursery on treasure island and was breeding on this plant. and successfully did its life cycle inside of our nursery. so, it? how that butterfly knows

it's out there and find it, this is one of those unique things that we can't explain why butterflies can find this species but if we grow it and put it in the right location, they will return. so the plants we're looking at here is faranosa known as just dedlia or live forever. the construction is it work happen nothing that area, it's likely to be destroyed. a unique thing about this plant and the unique succulents we have in california and the live forever plant can live to be 150 years old. recently, the state of california just did special legislation to protect this plant. i think in its intact population on the island, there's less than 50 of them, so to be able to grow several hundred of them and have them be a part of the plant palate of the stormwater gardens that was

installed recently is an increase of biodiversity and a step forward towards protecting the natural legacy of the island. >> i moved to treasure island in 1999. i believe i was one of the first residents on the island. i have seen how the island has been destroyed and reconstruct since its beginning to restore the island to its native form is extremely important to me because that will help all the animals come back to the island and make this place even a better place to live. >> i want to be here because these are people i know, so that was my first thing is just, like, i wanted to come here to help out and be with (indiscernible) and to actually put my hands in dirt. i feel

like we as people don't work in army -- we don't see the benefits of plants, like, but i just learned about a plant that if you rub it enough, it turns into soap. that's cool. and we need those things. we need to know about those things. >> one really unique thing about this project is the scale. to use 50,000 native plants over 7 acres is a scale we have never seen. it really is trailblazing when we think about the 350 or 400 acres of open space that is planned for treasure island, it sets the stage for what is possible. there's a way to use nature-based solutions at scale to meet the needs of climate change, sea level rise, the crisis of local extinction and

create natural environment. the first phase of the project sets a stage for what is possible and i just feel really blessed to have been a part of it. >> one of the main focus on triangle is keeping vehicle traffic to a minimum. for residents and visitors, public transportation is highly encouraged and will be the center point of keeping the island pedestrian-friendly, retaining an open space sent and providing an eco system that reducing carbon emission >> we need the transit to be successful because if we had 8,000 homes here and everybody was trying to use their car to access the bay bridge every month, it will overwhelm the system. new on and off-ramp are being constructed but all over the focus of the development is to be very transit oriented.

triangle itself is very flat and very bikeable and walkable as a result and so there's a focus on using both bus and ferry service to get from the island to san francisco in the east bay. there will be a number of transit demand management tools that will be employed of the two new ramps to and from the -- to the island and allowing a limited number of cars to access the bridge and there will be a management toll to encourage the use of transit. >> all the market rate housing on the island, the price for residential unit whether that's a rental apartment or a for sale condo, the price of the unit is decoupled from the price of the parking spot. so people can buy a condominium without paying for a parking spot. they choose to have a parking spot, they would pay an additional price. market rate residents are required to purchase take transit pass each

month through their hoa fees or through their rent so the residents will begin the decision of driving or taking transit with a transit pass in hand each month. that transit pass will function as a muni fast pass allowing people to take muni and transfer within the muni network and function as an ac transit allowing people to take ac transit to the east bay and transfer within the ac transit system and it will also provide unlimited access to the treasure island ferry. >> treasure island is going to take decades to be fully build out. it's going to take some time for it to reach the envelope that was passed by the board of supervisors and maybe there will be changes to it as well. we don't know what is going to happen in 50 years but

i'm confident by the fact that the plan that was adopted was fully, fully thinking even for its time and the building the island to a way it's sustainable, it addresses sea level rise, but also gives the public the open space and parts that are so necessary to fill treasure island. there's economic, certainly, challenges and whether we're going to be able to build out all of what was desired in the master plan, it will -- time will tell, but i think that the last ten years, we've been coming to this point. we are seeing incredible progress and the infrastructure is being finished by the island. market rate housing is being finished. affordable housing is

being finished. and so, we feel within the next five years, substantial part of what we had envisioned is going to come to fruition.

>> i think a lot of times we get in adult lives we are afraid to follow our passions and think life can't be that easy. but i truly do believe i followed my heart this time in my journal in city government i did not know that is where my passion lied. i kept following it and ltd. to great opportunity to serve the city. [music] >> i'm katy tang the executive director of the office of small

business. >> small business contributes to san francisco's economy. they provide the bulk of employment in the city and employing a million people in san francisco. and roughly 90% of the businesses are defined as small businesses. so, they contribute to the economy but also just the quality of life. small businesses are more then and there a place of transaction it is a community center. a play where people gather. know each other and form memories about the city. >> at the office of mall business i run a team this helps report all mall businesses in san francisco whether they are looking to stfrt a new business or expand or perhaps they are feeling with issues. our office is here as a point of information for anyone with a business that has 100 or nower

employees. >> i was growing up i had many ideas of when i wanted to do. i wanted to being an olympic swimmer. and i wanted to men be an architect, you name it i had many ideas for what i wanted do when i grew up. and i never anticipated entering in politics. this opportunity came along wh started working for former supervisor carmen chu and she became the district 4 sunset district supervisor. that was my firstent row in politics and government in a different level. and so when i was finishing up my time working for legislative aid i thought, i will go off and do something else. may be explore opportunity outside of city government what was then approached by this opportunity to also serve as a district 4 supervisor.

if not the traditional route that many people think of when you enter in politics. a lot know that is manage than i want to do and run for office. that was not part of my culture and upbringing with manage my parents were wondering why i wanted to go in that role this legislation and important because so many women when have it return to work after having a child feel embarrassed or don't feel comfortable asking their supervisor for will any lactation accommodations. i saw it as an opportunity you could use the position where you have tools creating legislation and pass laws and where people listen to to you help the community and pass cause catharsis important to the city and individuals. my family immigrated to the united states from taiwan. and they came here in pronl

probably late 20's almost 30. and so, they came also in the knowing english limp barely read or write but had to quickly understand english to i can't haveigate services and find a job in america. i grew up in the san francisco sunset district i spent most of my childed hoo up until i went off to college. so when i started working in city government, i think i had mixed reactions about my involvement working government because for some of our parents generation, there is i bit of distrust in government. i think there are questions about why i was entering in this field of work. i think you know when i went in city government i thought about my parents like so many other who is have to navigate city services and resources english first language and help the

individuals both navigate, intercept that is on an application approximate signage. it is fulfilling to mow to help people like my parent and feel like government is there to support them and not to harm them. my parents are happy that i retired early from politics and being a district 4 supervisor i could have continued on for a couple more years approximate decided to leave early. i think that over all they were able to see some of my work appear in the chinese newspaper. through that they were able to see i was able to help communities in a tangible way. >> the member of the board of supervisors. >> transportation authority. for the city and county of san francisco. congratulations. >> i think about one importance when i was worn in as district 4 supervisor. years ago, and someone actually came up to me during the swear

nothing ceremony and said, wow, i'm traveling here from canada, and i just i could not believe i saw an asian female worn in in this role a leadership role this meant so much that someone would say that and felt they were inspired by the scene. so -- i hope that as more people see people that look like them and more women coming in positions of leadership than i feel they can doing the same. person this inpyred me is carmen chu who is our city add administrator but also was district 4 supervisor when i worked with her as a legislative aid. at this point, i too, was skeptical of going in politics. i saw someone who had herself never seen herself in politics. got thrown into it and put her heart and soul and dedication to serve people.

and it gave me the confidence to pursue that same job and i honestly would not have either chosen or accepted or considered serving on the board of supervisors were not for carmen. >> if you want to make your business accessible. >> in my role in city government where i have seen the most challenge is people who don't know you and you are here to serve and help them that they classify you as our city government and here to hurt you. so, people will talk to you and -- and just you know treat you disrespectfully. and sometimes i noticed that they might do more to me as a female compared to my male colleagues. but you know i try to be empathetic. one of the most significant barriers to female empowerment we feel like we have to be 100% meeting all of the qualifications before we think

that we are qualified to do a job. if we look at a job description or an opportunity to come your way well is self doubt about whether you can fulfill the obligations of that role. i think that the confidence is huge and sometimes i think we make up for it by trying to gain more experience. more and more and more in whatever we can put under our belts we'll feel better. that may not be the case. we might be qualified with when we have already accomplished. i started rock climbing indoors a couple years ago as an activity to try to spends time with my husband and also to try something new and i finds that rock climbing there are so many parallels to life. you know when i'm on the wall i'm concentrating and trying to

make it to the next piece without falling. there are daying you think i'm not making progress. you come back and wow, i hit another level. and so i feel like in our daily lives and w we think we are not making enough of i change in the city. and sometimes we have to take out time to reflect every day as long as you try and give it your all and you look back you will have made a significant contribution there is no limit to where you go in terms of rock climbing. i want to reminds myself of that in terms of daily life. >> follow what it is you are interested in, what makes you feel excited about wake up every day. you never know and be open to all the possibilities and opportunity.

[music] please welcome to the stage, michael froman, president of the council on foreign relations. and dr. condoleezza rice, the 66th us secretary of state and current director of the hoover institution at stanford university.