>> good afternoon. i now call the regular meeting of the health service board for april 11, 2024 to order. i like to have you all please stand as we recite 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 go to roll call. >> thank you president scott. call to order is 106 p.m. president scott, present. vice president hoa is on her way. commissioner breslin, present. commissioner canning, present. supervisor dorsey, present. commissioner follasbee, present. commissioner zvanski is absent. >> item 3. >> item 3 is general public comment. a opportunity to comment on any item within the board jurisdiction not on the agenda.

all read our instructions aloud. remote viewing is available on sfgovtv and online using webex. the board welcomes public participation. there will be opportunity for the public at beginning of the meeting and a opportunity to comment on each item on the agenda. in person will be first and virtual. for anyone waiting in person you are welcome to approach the podium now. each speaker is allowed 3 minutes to comment unless the board president deems time limits. all public comments are made concerning the item presented. a caller may ask questions of the body. the health service bord will hear up to 30 minutes public comment for each item. remote public comment for those who received accommodation will not count towards the 30 minute limit. members attending the meeting can call by dialing 415-655-0001 and enter access

code 266046 i'll repeat that, 26604469747. press pound and 1145 and press star 3 and you will the prompt you have raised your hand. please wait to speak until i call on you. when the system message says your line is unmuted this is your time to speak. you are muted when your time expired. for those watching on webex, click on raise hand icon. the raise hand will appear next to your name. when you are unmuted in the system request to unmute will appear on the screen. select unmute to speak. once i welcome you on the call you begin speaking. when your time is expired you will be muted, click on raise hand icon to lower your hand. members of the public are encouraged to state name clearly but may remain

anonymous. i'll thank you for your comment and placed on mute. thank you to sf govern and media service. we'll begin with in person public comment. no one approached the podium. our moderator will notify of callers in the public comment queue as we move to remote public comment. >> board secretary, we have one caller on the phone line, zero callers entering the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. we'll move to item 4. >> thank you. item 4 is approval with possible modifications of the minutes of the meetings set forth below which were the march 5, 2024 health service board meeting minutes and march 14, 2024 health service board regular meeting minutes. >> i am ready to entertain a motion. >> president scott, i dont think your microphone is on. >> can you hear me out there?

>> now i can. >> alright. i got a little- >> closer probably. >> i got something going on with my throat and don't know what it is. all i can say. i am ready to entertain a motion for the two sets of minutes for the meeting of the governance committee and regular board meeting held in march. >> mr. president i move we approve both sets of minutes. >> it is properly seconded that we approve as distributed the march 5 governance committee minutes and the may 14 regular board minutes. any changes or adjustments or additions? >> march 5 and march 14. >> march 5- >> and march 14. >> and march 14. >> i thought i heard you say may. >> no.

did i? >> now i can hear you. [laughter] >> these are march minutes. are there any additions or edits or changes? >> vice president hoa submitted edits to both. >> those are incorporated? >> they have not been incorporated yet, but i do have them. grammar formatting. >> there are some edits, miner edits to the board meeting minutes of march 14. any further questions or comments from board members? hearing none, we'll go to public comment. >> thank you president scott. [providing instructions for public comment which are scrolling across the screen]

no one approached the podium. we'll move to remote public comment. the moderator will notify of callers. >> we have one caller on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. we'll have roll call vote. >> roll call vote starting with president scott, aye. commissioner breslin, aye. commissioner canning, aye. supervisor dorsey, aye. commissioner follasbee, aye. >> the motion carries unanimously. item 5. >> thank you president scott. item 5 is president's report. this is discussion item and presented by president scott. >> it is a bit of a sad duty today to do what i'm about to do, because of the outstanding

service of one member of this commission. i have before me a resolution that i'm going to call for approval by this board. whereas, chris canning was elected by the health service to the board in 2019 and served 5 year term until 2024, and whereas, commissioner canning has provided exceptional leadership to the health service board and helt service system assuming the role of vice president from 2020 to 2022, and whereas, commissioner canning served as responsible fiduciary of the health service trust fund and worked to propose affordable rates for employers and members and whereas, commissioner canning diligently supported the mental health and wellbeing of members throughout the covid pandemic

and post-pandemic recovery periods, and whereas, commissioner canning continually advocated for member education, insuring members understood the breath of their benefits and whereas, commissioner canning regularly advised to provide data driven recommendations to enhance member benefits and whereas, commissioner canning maintained collaborative and cordial working relationship with his fellow commissioners and, whereas, commissioner chris canning served the city and county of san francisco as a san francisco police officer since 2007 in the mission, tenderloin, southern police, and richmond districts promoted to lieutenant in 2017 and promoted to captain in 2021 and now resides as commanding

officer for the richmond station, just a footnote. career success comes with serving on the health system board. [laughter] the health service board extend profound thank you and appreciation for chris canning dediligence and commitment to the health service system and members and be resolved health service board along with the staff of health service system wish chris canning every success and much happiness in his future endeavors. this will be signed by myself as president of the board and certified by the board secretary. we also made a request i believe for a board of supervisors resolution, supervisor dorsey. when that comes up, i hope you'll vote for it. [laughter] >> i hope i have a role in authoring it. >> good.

with that, i like to at this time call on commissioner canning for any comments he might make. >> mr. president, thank you and fellow colleague, commissioners, staff, representatives and members, it is with a heavy heart i sit here. i'm at a loss for words with which might surprise some of you, but i know i am [indiscernible] many gracious acts of service and support and it has been my honor to work alongside my colleagues, executive director yant and her team with focusing specifically on how we can improve benefits for our members and i am very optimistic if all commissions and governing boards in san francisco work like the health serveest system and health service board. we are in a good place and going in the right direction. thank you for your patience with me and again, it has been

my honor to serve so thank you mr. president. >> thank you commissioner. i will now call on any other- [applause] call on any other members of the board for comment. >> could i-i would say for me in my career, in just a few short years there have been three professional capacities that i have benefited from, the mentorship and friendship and professionalism of captain canning. as a member of the police department command staff and the role of communications director, i had the opportunity to work with you and as a member of the board of supervisors i had the opportunity to work with you. i looked to commissioner canning for his mentorship on this role and i hope you know that you're not off the hook and got your cell phone number, so i'll continue to depend on you for the insights you bring and i just appreciate your public service and thank you for the service you continue to bring.

>> thank you supervisor. >> any other comments from commissioners? >> i would just like to echo all the accolades. sounds like you are all most dead, but you are not. you have a long life and that's the problem. i think that i want to echo the comments that the board evaluation every year, a question is do we come prepared and we can tell from your other professional duties that you have a lot of responsibilities and you always came prepared and always came ready to act and deliberate on the very important issues that we considered. that i think is really quite wonderful and makes the board successful, so we share in the success that you offered to us and i want to thank you very much for your contribution. >> thank you very much. >> any other comments from board members? commissioner hoa. >> yes. i will miss you.

we will miss you and i want to thank you for the perspective that you brought to our deliberation. i think what folks out here don't fully appreciate is that, commissioner canning always gave us a point of view during closed session when we were stuck in some sticky conversations about decisions we had to make, and his-they were always very enlightened and i really appreciate the perspective that you gave to all of us so thank you. >> thank you. >> hearing no other comments, we'll now call for public comment. or no, call for a motion to the adoption of the resolution. >> i move we adopt the resolution as eloquently stated. >> thank you. second? >> second. >> properly moved and seconded that we adopt the resolution as presented. we'll call for any other board comment at this point. hearing none, we'll now have public comment. >> thank you president scott.

[providing instructions for public comment displayed on the screen] no one approached the podium and move to remote public comment and the moderator will notify of commenters in the queue at this time. >> board secretary, there are zero callers on the phone line and zero in the public comment queue. >> thank you moderator. hearing no further callers, public comment is closed. >> thank you. we'll have a roll call vote. >> starting with president scott, aye. hoa, aye. breslin, aye. canning, aye. dorsey, aye. follasbee, aye. >> passes unanimously. like to give a standing--

[applause] with that, we'll move to the director's report. item 6. >> thank you president scott. item 6, director's report. this is discussion iletm item and presented by executive director abbey yant. >> thank you. good afternoon commissioners and congratulations captain canning. we will miss you, but i do have you on speed dial. [laughter ]. i know who to call and still waiting for the blue bloods dinner. thank you so much. just to go quickly through the director's report, this month to remind the board that we are still in a black out notice period through june of 2024 and

so that's not that far away. the medicare rfp is going along swimmingly as planned and we are looking forward to presenting our recommendation at the may 9 health service board meeting. i think everyone is aware that we are in the process of the health service board election that will take place during the month of may, and also the member services has adopted i think at this point because i think this is the third time, we have done a internal-second time done internally of the diva audit looking at dependent eligibility and so it is it good that we are well on our way having it be part of the standard practice of the organization, but it takes a

village and the whole team is involved in doing that, so it can not be too disruptive to the daily business of member services and esa. >> executive director yant, would you please give me the spelled out acronym for diva? >> dependent eligible verification audit. >> i just want that to go across the air ways and record in this meeting. that means that periodically we are absolutely looking at eligible and ineligible dependents in the health plan enrolled in the health groups and doing internally as a matter of fiduciary responsibility as well as good practice in terms of cost effective operation. we are not singling out or targeting anyone, but it is process we are committed to do

and we ask those of you who are subject to the audit that you take it in that spirit as we go forward. thank you. >> thank you. i mentioned last month that we were pursuing a lease agreement with the landlord at 1145 market street where we reside. that is continuing the lease that we are attached to i believe coming before the board of supervisors budget finance committee next week. we do not at this point anticipate issues with that, and so that will be good to have that taken care of. it is a significant cost savings to the city, not just for us, but for many other city departments that will be tenants in the building. that's moving along. [indiscernible] has as usual

put together a list of the equity inclusion types of events going on throughout the world and so noted that april 4 is world health day. that speaks about healthcare as a right and i know that is the sentiment of this board. it talked about climate action and we are learning more and more about the impact of climate change on our health and wellbeing, and that also the national minority health month is the month of april. the state california state healthcare affordability board and advisory committee i sit on the advisory committee, things are heating up quite a bit because the target must be approved by the board in june, and they have set the threshold at 3 percent and the industry i would say in general would like

it to be a lot more. but the base year for the target is 2025, so that total cost of care for 2025 and 26 should not--the target if the industry providers go beyond the 3 percent, assuming that is the approved target and that is a big assumption, but then there may be penalties involved. there are also will be a opportunity for the industry providers to explain the increase that is over the target. we can all imagine what that might be with the pharmaceuticals and glp drugs and other things that come up from time to time and do increase the cost of healthcare. the implementation of this will be challenging.

it will be pushed back-there is already push-back at both advisory committee and the board so that will be heating up over the next few weeks, but it does according to state law must be approved in june. >> i think this is really important and i thank you for the update. again, sounds conflict of interest, but i'm retired. where the penalties seem to inxh come is provider base and part of the 5 goals is enhance primary care so i'm hoping in the midst of 3 percent talking about pharmaceuticals and hospital costs and all that, that the providers don't get penalized because they have been penalized i think through many health plans so i advocate for them as i am sure you do having been a provider yourself in other job descriptions, but it is critical we keep an eye

on that as part of the strategic plan as a board. >> it is part of the healthcare advisory board work is primary care advancement of primary care practice, integration of behavioral health and efficiencies that provider groups and health systems can do to contain the cost of healthcare. it is a very robust piece of legislation. there is a related piece of legislation that looks at all the workforce issues because they are across the board. there is workforce issues everywhere, so it is a far reaching piece of legislation that we are in the midst of implementing and time will tell how-what impact it truly has at the end of the day. then i just wanted to highlight, we have a couple new staff members here today. i think they are here in the room if you wouldn't mind

standing. stephanie and john trautman. part of the member service team. thank you for being here. [applause] >> [indiscernible] please remain standing just for a moment. we like to thank you for being willing to commitment a portion of your career in the service of the health service system and welcome you to your new assignment and hope you find not only a opportunity for professional growth, but public service as well, so thank you and welcome. >> thank you. we will be presenting later in the agenda the annual report for the department, but i will call out in the monthly director 's report, we do put forward many of the goals and the improvements ongoing throughout the year, and so i would just call your attention to be able to look at that. i know there is a question from

time to time about how we measure our performance and it is both in the annual report, you will see the summary roll up and also please note it is attached to the director's report each month and the team does a really good job and member services is all most hundred percent staffed. two more positions, which is a long way from where we were a year ago. that in itself is of just hiring all those people is a accomplishment to be celebrated. so, the last thing i wanted to highlight because we did have a opportunity [indiscernible] myself were able to present at the mayor's department head meeting giving a preview of the campaign that we'll have throughout the may for mental health awareness month and there is a couple of cool videos that feature a lot of department heads.

we have videos specific to public safety and general city working population, so we look forward to it. it is a very well received and it is really just such a change to be able to speak to an audience that supports the concept of talking about our mental health and not their mental health, but our mental health. it is very refreshing. i think we made significant changes in the system. the delivery systems are still challenged by the shortage workforce shortage in mental health, but there is a lot of work underway and at the state level they are looking creating new type of job classifications that may expand the team that provides services to take care of people with emotional instabilities or mental health issues. it is really great. i think that's all i got for the director's report. >> are there questions or

comments on the director's report? i understand holly has a update on the election process. >> yes are, thank you president scott. as the coordinator for the 2024 health service board election, the calendar states that nominees were required to submit all paperwork to both the ethic commission and to the department of elections today by noon and they were able to confirm the nominees who are now confirmed as candidates. there are three confirmed candidates. we will proceed with the election. the three candidates include john cremens who is retiree with the firefighter department. art howard, who is active employee with the san francisco police department. and kelly mccray, active employee with the san francisco airport. >> thank you. so, we have two vacancies, that correct? >> correct. >> so two out of the three will be elected we hope with due process and sworn in by june of

this year i believe. >> yes. and from here on out, the department of elections and ethics committee will be undergoing all the processes for the election, which are stated on the website with the schedule. >> alright. thank you. >> who does [indiscernible] >> kelly mccray is active employee with the sfo airport. >> thank you. any other comments on the director's or questions for the director's report from the board? hearing none, we'll now have public comment. >> thank you president scott. [providing instructions for public comment. instructions are displayed on the screen]

we'll begin with in person public comment. no one approached the podium. we'll move to our remote public comment and our moderator will notify of callers in the queue at this time. >> board secretary, we have one caller on the line, zero callers entered the queue at this time. >> thank you moderator. public comment is now closed. >> thank you. we'll go to item 7. >> thank you president scott. item 7 is sfhss financial report as of february 29, 2024. this is discussion item and will be presented by iftikhar hussain, sfhss chief financial officer. >> happy to report the trust balance improved a little from projection for the year by a couple million. the result now is expecting a net decrease of $16 million, 15

of which is due to the stabilization that we had planned and reduced our rates so that caused the fund to drop. we have that consistent pattern of the medical claims higher and dental claims lower, but the dental claims utilization improved. over prior years doing well on pharmacy rebates and the general fund we project that to be [indiscernible] half million. a portion of the, 218 is what we promised the mayor as part of midyear budget cuts. so we are better then that. and, i do want--we changed graphs and changed the detailed report and i want to take maybe a couple minutes to walk you through the changes if that's okay. >> please.

>> okay. so, you used to get the monthly graphs and they are now

replaced in the memo with net activity for the month and the net activity is made up of revenues that we collect through pay roll reduction and employers payments every month. then the expenses are claims expenses. the first page illustration is basically a sum of all medical plans and you can see on the top graph the net change by month and the top graph net change and bottom graph shows the change made of changes in revenues, which are collections from pay roll and employers based on pay roll cycle so you see on the orange line, the monthly swings are caused by the pay periods in the month and the other change would be at the good beginning of the calendar year the rates are reset so you see a change there. in the expenses are claims coming through, which is the blue line at the bottom. so, this is a newer graph,

which shows all medical-all flex funded medical plans, which includes the access trio and the ppo plans. >> thank you very much. i appreciate this. it is useful. >> great. >> start to see a trend, so that's good. >> the other thing you see here is the next graph is the same information with dental plans. the net change as well as revenues and expenses. you can see actually the trend shows that the deficit did go down in the month of january, and february as the new rates were reset, which is something that i mentioned last time. happy to answer any questions on the new format of financial's or the numbers themselves. >> i like to have one basic question addressed. why did you decide to move from the prior type of reporting to

this? >> the prior reporting had a cumulative presentation, so when you looked at month to month it was a cumulative result for the month and the scale ended up being so tight that you couldn't really see the monthly trends. >> thank you. not challenging you, just wanted a explanation as to why. >> the other benefit is we are now showing both revenues and expenses in addition to the net change. >> thank you. >> i think our packet did have the cumulative as well. i think-was that presented to us as well in the packet of your report? this is just a summary of what we saw, i think. am i wrong? >> in the packet, i replaced the monthly trends with cumulative graphs, correct. >> yeah. >> thank you. any other questions or comments

on the reporting? i notice the audit is underway. >> yeah. >> all is well? >> yes, hard to believe it is that time. they started and we are working with them. >> alright. thank you. are there other question or comments from the board? >> i just wanted to clarify with dr. follasbee that the old presentation is not in the current report and will not be going forward. >> alright. hearing no other comments from the board, we'll take public comment on the report. >> thank you president scott. [providing instructions for public comment which are displayed on the screen]

no one approached the podium, we'll move to remote public comment and our moderator will notify of any callers in the queue. >> board secretary, we have one caller on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. we'll go to item number 8. >> thank you president scott. item 8 is review and approve sfhss annual report for 2023. this is action item and presented by executive director yant. >> thank you. different perspective. good afternoon. here to talk about the annual report that is in your materials and i will do a brief

presentation, but first and foremost this is cheater moment where the executive director i get to creditt for the work done by the team. i really want to acknowledge ryan close and jessica she who did an amazing amount of work pulling this together. i did one of those things you are not supposed to do where i said no, we have to do it a different way at the last minute. much appreciated. we got a terrific product here and really shows off the tremendous work that our team has continued to do through all the trials of the turnover of staff and pandemic and personal stuff and, it's just been a wild couple years i'm sure for all of us and to be able to stay on track and continue to improve is just phenomenal. it is very much appreciated and i really just want to highlight

the alignment we have with the strategic plan has been a ongoing conscious effort to really try to zero in on those things that move our strategy forward, and it just continues to work. i am one of these believers in planning that the planning process itself is a change agent and then the staying attending to it over time, things seem unachievable when you first string these up and put in a strategic plan actually can happen. we are continuing to do that, and in--as a overview, we have a lot of focus on optimizing service. i know you heard from rey and olga and the team how we are doing that, starting with the commitment to hiring, which has been a big challenge, but we

formed a excellent partnership with human resources. we funded staff to help us recruit and hire and we were able to find really well qualified individuals to join the team. we will continue to have turnover. that is the nature of the beast. we do have in that band of classifications job opportunities promotional opportunities throughout the city, and so we do get great people that come in and help us and then they leave either on our team or through hr, et cetera, and that is just the nature of personnel management. i think we are getting better at that as well as better bringing people on board and orient them, standardize the practice that occur, so that is a acceptance i think of real world and how we manage employee turnover. we certainly do not want to have the experience we had

during the pandemic and the great resignation ever again. that should be a rarity, but we will have-because of the nature of the type of work, some regular turnover and i think we got good systems in place for being able to aggressively hire those positions as they come open. the call volume, we had lots of issues. we did bring in an outside service to help us. that was a huge learning curve as well, but definitely had merit on being able to help with these unusual peaks in service we must be able to demands in service we must be able to meet, because it does move us forward. we are considering retaining that service through a personal service contract that we may able to use for special times when we do particular high

enrollment activities where there may be changes in plans and there may be high enrollment activities. we'll need to bring services into support the team and do work that really keeps our doors open, our phones answered, not trying not to re-create the voicemail box that no one likes to leave a voicemail and it is a challenge to pick it up and find somebody that called you. so, we had a great experience, we learned a lot and may be able to continue to work with that company or others to support the team. the other challenge that i don't have to tell you about, we just referred to it is the significantly rising cost of healthcare. we are seeing this across the board. this is what's going on, why

the state has a healthcare affordability board. i think we are just--a period of time where people are recovering still from the pandemic. there is tremendous workforce shortage everywhere and the cost of labor has gone up quite a bit, because of the negotiation labor does with the employers, and so there a number of these cost drivers that continue to impact the rising cost of healthcare, so we have to pay attention to ways healthcare can be more efficient. integrating the services in a more meaningful way that produces healthier members, but also reduces the cost. there is still a tremendous amount of fragmentation in healthcare. how many times do you have to

give your history when you are entering the fragmented healthcare system? i think there is definitely, and this has been a clear message at the state level, there is lots of knowledge out there about what can be done to make healthcare service more effective and efficient, but they are not necessarily being done. so, that we need to continue to require where we can. so, we will see more about that in the future meetings. the next slide just is a highlight of all the way that we by the numbers, the activity by the numbers and it's pretty high. i know when i started here i never--i joked with the staff i did ntd n't want to be around when we were talking about it billion dollar club but we are here now. that is the trust fund, it has

that much money that flows through, so that is a pretty significant responsibility that we carry together in order to pay for the healthcare services that our members are able to enjoy. so, there are many statistics that are here that talk about the various programs that the staff does. the call volume was very high. the enrollments, the e-benefits continues to be a very very strong asset to our members and to our services to be able to have many-the number of people able to access benefits and sign up and enroll and et cetera electronically. all these activities are supported by the various divisions within the health service system and we really appreciate the leadership of the entire management team that

makes this happen with their staff on a daily basis. i'm just very pleased that we are able to continue and i hope that you are able to take the time to really read through the annual report, because there are a number of really nuggets of interesting information and what it takes to run the health service system today. it's a pretty big responsibility that we have to manage this billion dollars that flows through the fund. we are able-iftikhar has been effective negotiating the staffing with the mayor's budget office in the very tight budget year. they do understand our commitment to service and we have many mandates. some of this stuff we dont make up. there is a lot of complains

mandates and other things that we cannot slip on, so it the team is very attentive and able to prioritize, but that workload is significant, so we are pleased the mayor budget office is at this point keeping our budget in tact as approved by this board, and that includes the 1 $1 increase in the sustainability fund so that is good we are at this point in time. so, with that, again, i just want to say that it's my pleasure to speak on behalf of the entire management team at health service system and the entire staff. we are having a second annual all staff all site retreat on april 18 and we are looking forward to it. i think most of us know that those types of retreats can be very effective for doing

customer service training. i previewed some of the materials that they asked us to preview yesterday and learned a lot. there is always something new. a clever idea how to better serve our members, so i think the staff will bring their voice and their experience and be able to practice and how to manage difficult situations over the phone and get the training and support that they benefit from and therefore our members. thank you. i'll take any questions. >> any questions or comments? yes, commissioner follasbee. >> yeah, i want to thank you and your staff. i love the report. both in the scope and depth was really impressive and very clear. i really reaffirm the scope of what you felt was important to cover. i have a question about slide 4. if we can go back. i didn't notice this, so i don't know quite if we can go back to slide 4.

had to do with the aging-the main healthcare cost drivers. the aging workforce and worsening health of the workforce. are you talking about the healthcare workforce- >> talking about our members. >> okay. jush want to make sure. i saw that in the report. >> the aging workforce is just generally true, and for san francisco it's a little bit of-there is data in there because of the great resignation. for a period of time we had lot of people leave both retirement age and just active people. that kind of ebbs and flows but generally government employers have a older population, san francisco has a older population, just by a few years but that can mean a lot dollar

wise. we see earlier chronic conditions and earlier onset of multiple chronic conditions and that is where a lot of healthcare dollars are going today. >> you said this isn't only hss but other employers across california. is that generalized? >> government. >> not in the government. government has the tendance to employ a older population. >> thank you. >> other questions or comments? >> my compliments executive director to you and your team. as always, a lay person who might not have technical expertise as colleagues, this is very easy to digest. tremendous work the team does and the progress that the

health service team has made under your leadership so compliments to you and your team that make the last minute changes. i have been on the receiving end as well so thank you. >> it will take me a while to earn my credibility back. [laughter] >> alright. commissioner hoa. >> i do want to commend you and the hss staff for the your commitment to continuous improvement. i think the numbers in terms of when you on slide 5 when you showed the year by the numbers, they are pretty impressive given the staffing challenges and the volume the staff handled and the way you are responsive to the members remained impressive so thank you and the team for your hard work. >> i would call the board's attention to the closing statement on behalf of the

board, which is found in more detailed report on page 24. i took the presumption of requesting that we would incorporate into the document and then communicate to others as needed that closing statement. when you approve this report today and accept it, you are committing yourself not only to continue to support what the staff under the leadership of the director has done, but also reaffirming the strategic plan and goals as we go forward. if you want to decent, this is the time to do so. but i wanted to be sure that didn't slip under the radar as we discuss this item. are there any other questions or comments? if not, we'll now have public comment on this item.

>> thank you president scott. [providing instructions for public comment. instructions are displayed on the screen] >> excuse me, i didn't ask for a motion. i like to call for a motion and a second that we approve the sfhss annual report for the year 2023. >> i move that we approve the sfhss annual report for 2023. >> second. properly moved and seconded that we approve the annual report summary as presented. is there any other board comment? hearing none, we will have public comment. >> thank you president scott. [providing instructions for public comment] no one

approached the podium and move to remote public comment and the moderator will notify of any callers in the queue at this time. >> board secretary, we have one caller on the phone line, zero caller entered the queue at this time. >> thank you moderator. public comment is now closed. >> i call for roll call vote. >> roll call vote starting with president scott, aye. vice president hoa, aye. breslin, aye. canning, aye. dorsey, aye. follasbee, aye. >> the motion passes unanimously. thank you. we'll move to the committee as a whole. rates and benefits. with item number 9. >> thank you president scott.

item 9 presentation of 2024 rates and benefits calendar for plan year 2025. this is discussion item and presented by abbie yant, sfhss executive director. >> good afternoon commissioners. the rates and benefits calendar is going to change somewhat in that, we anticipate being able to bring before you the recommendation of the rfp on the medicare advantage plan. at the first scheduled meeting in may that would be may 9. we will be considering if we need to adjust any of the plan other plan rates and benefits approvals accordingly. we do have a regularly

scheduled meeting on may 23 that would accommodate any overflow that may need to get bumped from the may 9th meeting, so i think our approach would be to put a few of the plans on with the medicare discussion, and then if the discussion is robust and we need to bump those, there is room to bump those on to may 23 meeting. that's why just for the record, about 3 or 4 years ago we set two meetings during rates and benefits season so that if we had meaty discussions we could do this. i'm stating that because it does not constitute a special meeting. it is a regularly scheduled meeting. those other second meetings in the month of rates and benefits season as you recall, we each month would consider whether we needed that second meeting and we were able to cancel them.

we will not be canceling the may 23 meeting, it will be a full agenda. >> i like to reinforce that. we will be here twice during the month of may and the item we'll lead with we hope will be the result of the medicare rfp. so, i say that again publicly to reinforce and invite those who have interest in that area to come and be a part that discussion on that day. any other comments? on the rates and benefit calendar? if not, we'll have public comment on this item. >> thank you president scott. [providing instructions for public comment which are displayed on the screen]

we'll begin with inperson public comment. no one approached the podium and move to the remote public comment and the moderator will notify of caller ins the queue. >> there are zero callers on the phone line, zero callers in the public comment queue. >> thank you moderator. hearing no further callers, public comment is now close d. >> thank you. we'll move to item 10. >> thank you president scott. item 10, review and approve self-funded and flex funded health plans 2025 stabilization reserve actions. this is action item andprinted by mike clarke with aon. >> good afternoon mike. >> good afternoon commissioners. >> delighted to have you here at this time of year on this topic. >> yes, indeed. everybody loves to talk reserves.

before i commence commissioner canning on behalf of aon my colleagues and health plan we appreciate your partnership over your service on the health service board and like everybody else stated, wish you great success, which you already have, but it has been a pleasure to work with you during your tenure. >> thank you mr. clarke, likewise to you and the team. >> let me introduce my colleague grace wu supporting with slides today part of the aon team supporting the rates and benefit work you will see today and through the coming meetings. >> grace, we welcome you to this activity we call the health service system, and you and your team have done terrific work over the years, aon and others, mike as we had a lot of issues that we wanted to research and reviewed.

i recognize that you may not be here at every meeting, but our questions do have reasons behind them, believe me. we appreciated the active support that you and your team have provided. >> happy to be here today. >> thank you. >> so, i'll present the self-funded flex funded health plan 2025 stabilization reserve action that will fold into the rate cards you will see presented in may. i'll start with the background on health plan reserves. walk through the rate stabilization recommended actions for each plan you see here on the agenda page. leaving out to the recommendations to today. i will not go through the appendix but for reference there is prior history on all of these plans representing today the rate stabilization actions. so, the recommendations that i'll walk through today, first for the self-funded flex funded

medical plans and stabilization fund policy to approve the use of 1/3 of the december 31, 2023 stabilization fund balances in plan year 2025 as you see below for each of the plans that we'll discuss today. there is a deficit on the blue shield hmo access plus and trio and split family plans and united healthcare epo plans. we are flipping to surplus in the non medicare ppo plan so good news based on favorable experience i presented last month and health net hmo plan runs well so continue a surplus. page 4, i will request that we amend the health service board approved self-funded plans stabilization policy on one time basis for delta dental ppo plan to approve 2/3 of the

stabilization surplus applied towards rates so i'll explain that going through the presentation. just a quick refresher on page 6, this is one of three reserve policies for the health service board. we presented earlier meetings this year on the incurred but not reported and the contingency reserves so today focused on number 3, the rates stabilization. those original on page 7, contingency reserves approved in january and recall last meeting to try to apply some thinking towards how we could reduce overall budget for sfhss and following plan year and beyond. sought your approval which approved, the modified contingeany reserve that lowered the deficit or increase surplus for 2025 and beyond that you'll see today. the policy itself requires

annual determination of financial gain or loss over the calendar year for self-funded and flex funded plans per policy amortized over a 3 year rating period. this-what you'll see today is is a function how 2023 experience compared to what was originally estimated in the spring of 2022 and then added to any surplus or deficit balances carried forward from the prior calculations. with all that, page 10 i'll start with blue shield hmo, which is primary access plus and trio. when you think of this plan that is what everybody thinks about. if you recall starting of 2023, united healthcare became the administrator of these plans for individuals who are in split family circumstances. if there is one or more family member medicare in the united healthcare medicare advantsage plan and one or more family

member non medicare, united healthcare administers those plans for those individuals. the vast majority are administered by blue shield as access plus and trio. 98 percent of total lives across these plans, but we can't forget about the split family members and we incorporate them into the experience. page 11, there was a carry forward balance after the rate stabilization calculations last year of about $6.7 million. 2023 plan year as we reviewed previously plan experience did significantly exceed amounts. it lead to higher incraes for especially access plus and 2024, but these calculations focus on 2023 experience relative to those expectations, so there was a $29.4 million rating shortfall for 2023 plan

year for these plans, so if you look at the next page, you'll see that on number 6 to the right side under the actual column, as we work through all the claim information, administrative expense and i want to thank [indiscernible] from the financial team who supports me strongly with the information that you see in the presentation, so i just want to make sure yuri is recognized for his great work. there was expected to be a shortfall of $6.6 million and it was $29.4 million. with the actions taken last month, the reserve decreases which helped reduce the overall short-fall for the plan year so when you compare to the expected revenue shortfall it is little over $20 million. on page 13, what you see is the

stabilization balance prior carry forward, $6.7 million. we add $20.363 million into that, so it a little over $27 million as a deficit balance as of december 31, 2023 and per policy we apply 9 million 27 thousand into the stabilization buy up for the 2025 rate process. flipping to the blue shield and united healthcare non medicare ppo plan, just like i discussed earlier, there are two administrators and again, united healthcare for those split family non medicare members, so most of these lives became administered by blue shield at the start of 2022 coming out of the last rfp that occurred and united healthcare retained ppo administration for the non medicare split family members. there was a carry forward

deficit blansh after last year cal cushion of 1 million, 492 thousand, but as we explained last month, there was favorable experience in this plan for 2023 relative to those expectations. so, that was about a $5.5 million favorability where we actually saw higher enrollment in 2023 primarily from the active employee population in the plan so that helped increase plan contributions. that produces a flip you see here from deficit to surplus in total when you combine that with the contingency reserve reduction as a result of last month recommendations, 7 million 553 thousand surplus carries forward into the rating for 2025. on page 18 what you see is the stabilization deficit that

existed from the prior carry for ward of 1 million, 192 thousand, then flips to surplus. the net surplus is 6 million 061 and 1/3 per policy is 2 million, o20 that is recommended to carry into buy down of rates for the ppo plan in 2025. health net canopy care hmo, a new plan as of 1-22. last year was the first time we had any rate stabilization calculation because it was the first time with plan experience. this is the second. it carried a surplus last year with a much lower enrollment that is enrolled today and as we reviewed on page 21 last month again favorability in the claim experience is leading to

a increase in the surplus, so when you look at page 22, don't be alarmed because of expected and actual because of september 2022 we still had relatively low starting enrollment in the plan which grew steadily through 2023 so that is why the dollar figures are higher on the right side of page 22. the bottom line there was a surplus from 2023 experience of $761 thousand that carried forward into stabilization calculation. so on page 23, you add that surplus to the carry forward balance. it is all $23, you add that surplus to the carry forward balance. it is all most one million as of the end of 2023 and $332 thousand carries forward in the rates for 20 25. with delta dental active ppo plan. we had a fairly large stabilization balance on this plan for a number of years and if you flip to page 26, you see the history that stabilization

balance built-up, and the fact starting in 2020, really reflective at that point in time of much lower utilization due to the pandemic that there was a shift to exempt the policy or amend the policy on one time basis and amortize more then 2/3 oof the policy. that is in place every year either 1/2 or 2/3 since 2020. the goal here is to try to eventually get to a point to return to per policy. that has always been what we tried to achieve on this plan. thankfully we are starting to see higher level of utilization of preventive care, which is outstanding. we were more peep in the plan accessing preventive dental service and it also means with that claims go up a little bit. my hope is this becomes the last year where i come to you requesting an amendment one time of the policy in order to do anything other then the 1/3

per policy amortization. when you look at the experience then if we go forward to page 28, partly because of the contingency reserve modification approved last month and partially favorability of experience relative to the original forecasts, there is a surplus build up from 2023 experience of about $5.3 million so what you see on page 29 is the carry forward of $3.7 million added to the $5.3 million for figure of 9 million, o18 and again requesting recommending the 2/3 be applied towards stabilization leaving still $3 million to carry forward as a stabilization balance after 2025. so, i realize i went through that quickly and happy to

entertain questions, but i'll close on pages 31 and 32 with the recommendations for health service board action today. page 31 contains recommendation for the self-funded and flex-funded medical plans with the stabilization fund policy approved the use of 1/3 of the december 31, 2023 stabilization fund balances in plan year 2025, plan rates to apply proportionally between active employees. first for blue shield hmo apply deficit amount of 9 million, 27 thousand or 1/3 of 27 million, 81 thousand towards buy out of rates across all rating tiers for plan year 2025. for the blue shield and united healthcare non medicare ppo plan applying a surplus amount of 2 million, 020 or 1/3 of 6 million, 61 thousand towards buy down of rates across all rating tiers for plan year 2025.

and health net canopy care hmo plan apply surplus amount of 332 thousand, 1/3 of $196 thousand across all rating tiers for plan year 2025. those are the recommended actions on medical. and then page 32, close with the self-funded dental ppo plan. recommendation and health service board approved self-funded plan stabilization policy on one time basis for delta dental ppo plan and approve use of 2/3 of december 31, 2023 stabilization reserve

surplus or 6 million, 12 thousand which is 2/3 of 9 million 18 thousand to be applied towards buy down across all rating tiers for delta dental active employee ppo plan for plan year 2025. president scott. >> thank you very much. you heard the recommendations and the report provide d. are there questions or comments from members of the board? nothing. it must be abundantly clear or we are all confused. >> i suggest we are abundantly clear. i still find it sobering in termoffs the deficit in the first recommendation. as we move to the-think about the following year and cost of healthcare. but i thank you for your detail. can i make a motion that we approve items 1, 2 and 3 in the medical plans and in the dental that we amend the approved self-funded stabilization policy on one time basis for a surplus buy down of 2/3 as

recommended. >> second that. >> properly moved and seconded. if we accept the recommendation provided by the actuary. any questions or comments from members of the board? we'll take public comment. >> they think president scott. [providing instructions for public comment which are displayed on the screen] we'll begin with in person public comment and no one approached the podium and move to remote and the moderator will notify of callers in the queue at this time. >> board secretary, we have zero callers on the phone line and zero callers in the queue. >> thank you. hearing no callers, public comment is now closed.

>> thank you. we'll take roll call vote. >> roll call vote, scott, aye. hoa, aye. breslin, aye. canning, aye. dorsey, aye. follasbee, aye. >> the motion carries unanimously. we'll move to item number 11. >> thank you president scott. item number 11, review and approve active employee 2025 dental plans rates self-funded delta plan ppo plan, fully insured deltacare usa and united healthcare hmo plan. this is action item and presented by mike clarke aon. >> there are three plans we'll discuss for the active employee 2025 dental plan rates self-funded delta dental ppo and two fully insured hmo plans from deltacare usa and united healthcare. i will not review the appendix.

just reminder, there are three different funding strategies on page 4 for various plans, and today these plans encompass two. self-funded for the delta dental ppo were the claims flow through the trust and administrative fee to have delta dental administer the plans and full insurance for the two hmo. and then, the rate setting process essentially involves looking at 2025 projected plan costs divided by what is in place today for 24 rates and enrollment to determine the needed rate change factor. the renewal summary just as reminder, the plans again, the funding i went through on page 7, when we look at page 8, the

reminder about how these plans are offered for coverage. the city countsy county of san francisco employees, municipal executive employees of these organizations have access to these plans. for most employees, the contributions are set by mou at $5 for employee only $10 employee plus 1 and $15 for more. this is why i ask for total cost rates but not employee contributions so total cost rate approval. there are few populations that does not pay contributions as you see and for the hmo no contributions. as reminder, san francisco unified school district and city college of employees do not elect to offer dental

coverage through sfhss. you see the rate recommendations on page 9. for the active employee dental ppo plan, the 6 percent increase proposed is primarily a function of the change of the rate stabilization amount from last cycle to this cycle. i'll talk through that shortly. then insured plans you will see the recommendation per the plan rates is to keep the rates in place from 2024 to 2025. last presentation i reviewed page 10, so just not to belabor it, but again, last year there was $7.4 million applied towards rate buy down in the ppo rates. this year $6 million, so there is buy down but less then last year, which is part of why you have 6 percent increase in the total rate. so, the recommendations that

i'll go through on page 11 just documenting there is a nominal increase in the administrative fee for the delta dental plan and 6 percent increase in the total cost rates with no change for insured rates for hmo plans. page 13, for the administrative fees, what you'll see is, there was a three year agreement put in place with between sfhss and delta dental starting with 2024 plan year where there is a nominal increase in the administrative fee for 2024 and then again for 2025, so that will stay in place two years at $4.82 per employee per month. on page 14, just looking at the distribution of enrolled population in the ppo plan, across the employee only and plus 1 or more tiers,

self-funded rates project to be before stabilization, but you still have a very appreciateable benefit to the claim stabilization buy down so even though it wasn't as much last year at 7.4 it is 6 million. it creates 6 percent increase in cost rates that flow through the trust and those employee contributions remain the same based on mou. and then for the hmo plans you'll see no change in rates, so page 17, the plan rates for each of the two plans remain at 2024 levels going to 2025. with that, i'll close on page 19 with today's recommendations on the active employee 2025 dental plan rates. staff recommends to the health service board approval of the following:2025 active employee

dental plan rating administrative fee action with specific information on each recommended action provided earlier in the document. first approve the following recommended delta dental ppo rating actions nominal increase in the per employee month administrative fee, which is 12 cents per employee per month so total $4.82 per employee per month and 6 percent increase in self-funded total cost rates from 2024 to 25. approve for deltacare usa fully insured hmo plan, no change in rates from 2024 to 2025 and for the united healthcare insured hmo plan, no change in rates from 24 to 25. president scott. >> thank you. are there questions or comments? >> this is again complicated. can you maybe explain why two

hmo plan there is no change in rates but the ppo plan there is 6 percent? you think employee cost supplies and all that go up in all plans. why is it the case? >> sure. i know so for the delta dental hmo plan, we established a 3 year agreement with delta dental into the 2024 plan so next year is the second year. hold rates flat for 3 years so that was the commitment on the delta dental hmo plan. for united healthcare it is a annual renewal but it is consistently flat rate for quite a while. i don't think you had a increase in that plan for many years and some is the nature it is more managed dental plan as a hmo, a much smaller network of providers and so i think they are able to keep costs

down relative to broader network ppo plan like most emplyees are in. we reviewed the plan experience last month for the delta dental ppo plan and if i remember correctly, there was about 1.7 percent actual claim increase per employee per month, so that was all attributed to preventive care so the good news we are not necessarily seeing higher increases from a pricing standpoint, but we were seeing advancements in preventive care utilization which i would say is the best spend you can have for a dental plan, and so if we didn't have the rate stabilization concept i would be presenting with a 1.7 percent renewal on the ppo. with the stabilization, there is the recognition we had high stabilization balances for a long time and we've tried to

apply more stabilization in rates in the last couple years and it helped. also keep in mind that that $9 million total amount of which we are taking $6 million 2/3, 2 million was generated by contingency reserve action to convert the contingency reserve to zero on dental last month, so i feel on go forward basis, the goal in underwriting is try to match what we think will happen at the end of the period that is what happened, so for instance, if our 2024 calculations were spot on, i'll present to you next year request to apply $1 million in stabilization out of the $3 million balance. so, that is our ultimate goal. >> thank you. >> alright. are there other questions?

hearing none, i am ready to accept a motion. >> mr. president, i move we approve the recommendations specifically approving the delta dental active employee rating actions, which include the increases noted and then approve for the deltacare fully funded hmo and united healthcare insured hmo, no change in insured rates for 24-25. >> second. >> been moved and seconded we accept the recommendation as described in the presentation. any questions from board members? seeing none, we'll go to public comment. >> thank you president scott. [providing instructions for public comment displayed on the screen] we'll begin with in

person public comment. no one approached the podium. we'll move to remote public comment and the moderator will notify of callers in the queue at this time. >> board secretary, there are zero callers on the phone line and zero in the queue. >> thank you moderator. public comment is now closed. >> thank you. we'll have roll call vote. >> roll call vote starting with scott, aye. hoa, aye. breslin, aye. canning, aye. dorsey, aye. follasbee, aye. >> carries unanimously. we'll now move to number 12. >> thank you president scott. item 12, review and approve

retiree fully insured 2025 dental plan rates and contributions delta dental ppo plan, deltacare usa hmo plan, united helt care hmo plan. this is presented by mike clarke. >> mike clarke, aon presenting on the retiree dental 2025 plan rates and contributions and just to note, there was appendix i will not walk through, but fairly extensive information just describing background on dental insurance, retiree network details similar provided on the active employee ppo in march as well as those dental plans. they are there for reference. as recommendation for summary today is to approve the rates as i will present in the document and then we also have information on cost utilization information for the delta

retiree ppo plan. it is by far the highest enrolled in the 3, but aappreciateable enrollment none the less the two hmo's. for the overall recommendations on page 4 delta dental retiree ppo, rate increase of 2 percent from 2024 to 2025 as part of a second year renewal rating commitment by dental denta for annual 2 percent increase through the 2026 plan year. for deltacare usa hmo, the rates stay the same from 24 to 25 as part of the second year of the three year rating commitment and united helt care, the rates remain the same from 24 to 25. i will skip through the rates setting reference as i presented on that. the bottom line, these are all fully insured plans and on page 8, what you'll see are the premium rates and retiree contributions for the current

year. keeping in mind that the retiree dental plans are available to all sfhss retirees, even though of the school district and city college, so unlike the fact they are not getting dental they can purchase dental through sfhss retirees and you can see the rates below the retirees pay the full amount of the insured plan rates for these coverages. again, 2024 on page 9 was first of 3 year rating commitment for delta dental on their two plans. uhc rates are quoted annually. so, going to page 11, just little more information on the retiree ppo plan. the experience we saw 1 percent increase in the overall number or percentage of covered lives who had at least one dental

cleaning so a favorable move here in the overall rate of preventive care. which is especially important here given retirees pay full cost of the plan so you hope they are able to utilize the services. again, that shift produced a higher percentage then year's past of the distribution of service attributable to diagnosis and preventive, things like cleaning and x reys so great to see. page 12, we heard it in prior meetings, concerned about what may be transpiring in the networks and we did see and observe increase in the overall percent age of services in 2023 going to out of network or non contracted dentist relative to those in each of the two networks, ppo and premier, so that's something obviously we continue to focus on in the dialogue with delta dental and

county by county information there is a slide in the appendix that you probably want to reference because there are certain counties where you see a higher percentage of care then this going non contracted. good news, we talk a lot about smile way. this is the platform by which certain individuals who are identified with i believe up to 9 chronic conditions can receive additional services during the course of the year, so thinks like a third cleaning, a paradontal service, things that really help to promote great dental health for those who have chronic conditions that might otherwise be exacerbated if someone had poordantal health. the good news through connectivity to share information on a secure basis about diagnosis to increase

percentage of individuals, the number of people who are enrolled in the smile way benefit program, and about 2/3 or close to 70 percent of the members identify with smile way are using the plan in some way so that is good to see. the premium rates for the retiree ppo renewal you see on page 14. this represents a 2 percent increase in the rates and you see the associated plan enrollments across retiree only plus 1 and plus 2 or more. for page 15, deltacare usa renewal, you see enrollments by tier with rates remaining the same as part of the three year rating commitment. these remain the same for 2026. page 18, the united healthcare retiree hmo where the rates remain the same as well. so, close on page 20. it is recommended that the health service board approve

the following 2025 plan retiree dental plan rate actions based oen the specific information provided in the document. for each of the plans you see how those rates will change or not from 2024 to 2025 along with the per retiree per month difference in premiums for the delta dental ppo plan correlating to the 2 percent increase. >> thank you. are there questions? >> i have a comment. >> yes, commissioner breslin. >> as you know, [indiscernible] when you look at these costs, they went up another 2 percent with no increase in your benefits, so a person is paying-a single person is paying $615 a year for $1250

maximum so $600 a year is what you make with the plan no matter what you do. for a plus 2, it is like $19 thousand a year annually, so and then as you know in the past we had many reports from members where their dentists are no longer taking delta dental because of the reimbursement rate so that has not changed. i know this is kind of like people what they keep, but it is just not a good plan. we had a lot of problems with delta dental and complaints from members on and on and nothing really changed. one member mentioned a bunch of other plans, but i dont know that much about them. net life, cigna, etna, [indiscernible] it seem zs like as a director it seems delta

dental seems to have a monopoly on this and i don't know fwt the other plans at all. how many dentists take them and how good they are. >> as we know in the fall of every year we consider what rfp may be useful to conduct, and we have looked at doing the considering a dental rfp twice within the last several years. the concern is while there are many other plans out there, they have very small networks, and so the disruption to our membership would be tremendous. delta has done two adjustments to payments in the provider. they are providing quarterly reports by county showing the

number of dentist leaving and being added. as people age out or choose to not have delta as one of the providers so they turn in and out of the plans but they agreed recently to work with us because i had the idea that we have similar primary care where it is hard to find a primary care physician that will not only accept your insurance, knut but have an appointment to you. i mentioned in the last meeting we have to adjust thinking in appointment in two weeks to 6 months. it is the same with delta, so we reached an agreement to explore ways that we can help members find a dentist, because that is where the pain point comes from when a dentist you are seeing chooses to leave delta and you are on your own to figure what to do next.

we are talking to delta exploring ways to support our members finding another dentist or finding the first dentist. we have active employee as well as retirees that have dental insurance and don't go to the dentist at all. we are exploring that idea of supporting them. we did have a-i had a similar conversation one of the physician groups about primary care and how they can help our members, because it is enormously frustrating to do that. i think it is a customer service of the day that we really need to support our members in finding the right dentist for them so we'll explore doing that in san francisco and consider moving into other counties if we find a successful customer service outreach to help people find that right dentist. dental insurance i keep saying doesn't feel like the right word, because we are acustoms

to use insurance like the medical plan, fwut but the struck ture of the plans is very different so that is something we talked about over the years and jessica and the team looked how we work with delta educating members on the available benefits, but if you look what the total amount is you can get but there is also-i think it is particularly valuable to retirees dist counted on the most significant service of implants and root canals and those type of procedures that do become more common as we age. part of it is setting the expectation with our members, industry is in great flux, cms is talking including dental as a benefit, so that will increase demand on the dentists we have, so i think if we can

get a little ahead of the game i think we will be better off. doing an rfp to find a service less expensive we will get less for it and we'll get less dentists enrolled so we have chosen not to do that at this point in time. >> i agree--[indiscernible] 1250 is maximum but it excludes cost of services for diagnoseic and preventive. if i get a cleaning it doesants accumulate towards the 1250. $1250. just services like dentures, implants, fillings, things like that, root canal accumulate towards $1250 but diagnostic and preventive do not. >> you mentioned [indiscernible] >> could you repeat that karen please? >> mentioned delta dental will look for another dentist for members? >> we are in conversation about

creating a customer service that would do that. >> i dont know i frust trust them to look for another dentist for me since they are not covering it. >> i can't comment. >> president scott. >> this is really important conversation. i think we do need to move away from thinking of as dental insurance t. is dental benefit which is stratifyed based on the level of which one enrolls whether hmo or ppo. i think had personal experience to realize i wasn't paying attention to when i had one dentist who was over-coding the procedure that i had and i just didn't pay attention to this. i was paying out of pocket over and above the benefit. until someone alluded me in the practice they were over coding so as consumers i think we have a responsibility to pay more

attention because this healthcare is really structured differently then what we are used to in our other plans. i think it does require more action on the part of each of us as consumers. i know my own benefit plan changed for 2024 from one provider to another and i went online to the service to see if my current dental practice was in-it wasn't listed so i called them and they said of course we are. again, it takes a lot more proactive to call the dentist office and find out, because they all suffer from this sort of plague of inappropriate or incomplete provider information and they are online websites. >> other comments?

>> i actually just from a glass half full, when you think about the cost of personnel and inflation and products, the fact that again, these hmo products for retirees are zero increase and only a 2 percent and even though there are no increased benefits, in the midst of everything else we are hearing about, this is pretty incredible that it is such a small percentage based on what we are used to in terms of the grocery store and gas station and the rest of it. rents and everything for these providers. >> other comments from the board? hearing none, i'm ready to entertain a motion. >> president scott, i move that we approve the recommended 2025 plan year retiree dental plan rate actions as described by mike clarke. >> is there a second? >> second. >> properly moved and seconded

we approve retiree 2025 dental plan rates and contributions as described by the actuarial. any comment from the board? hearing none, we'll 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. >> i like to ask that the chart be taken down so we can see the person in the room who is making public comment. >> you can leave it up. >> no, we want you full on. >> good afternoon commissioners.

director yant. dennis krueger, active and retired firefighters and spouses. about 7 years ago, i set before the board and said,dantal care should be part of healthcare. it should be included in our insurance because people know how poor healthcare is directly connected to poor health. we were able to do a couple things. we had them take out the cleaning separate from the $1250 or $1200 max which gave the members a $1400 max benefit. as with the vision, another thing we tried to do and was accomplished, we set up a 2 tier system for vision. you have a primary and then you have a secondary higher.

i'm hoping next year delta might be able to come before here and offer the retirees the same benefit. i know we are self-funded, i know a lot of people cant afford dental. even the dental plan we have that is only increased by 2 percent, but it is just another option to offer members who can afford it. probably make a subsidy that is added to it that goes into adding to reducing the cost of healthcare our the dental care just like we have for our healthcare. there is additional premium put on that. again, with the active or healthcare, it is all most everybody's part of it. with the delta you are forced-dantal care you are forcing people into it, so it is not-it is a idea, but you

can't force people into this. i would also hope that the benefit gets raised to a higher level again. like i said, we were able to move it up by taking the cleanings out of the overall benefit, but i know from just personal experience, my dentist no longer takes delta. they help me by submitting claims back to them and i get money back. but one procedure, depletes the nund fund for a year and i just hope those things are takenen to consideration for next year. >> thank you for your comment. is there other inperson comment? hearing and seeing none- >> we can move to remote public comment. our moderator will notify of callers in the queue at this

time. >> board secretary, there are zero callers on the phone line and zero entered the queue. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. we'll have a roll call vote. >> roll call, scott, aye. hoa, aye. breslin, no. canning, aye. dorsey, aye. follasbee, aye. >> majority vote. at this time, according to my clock, it is now 5 minutes to 3. we will take a 10 minute recess and resume at 305. thank you. [10 minute recess]

>> good afternoon again. we ready to reconvene our meeting and we'll start with roll call vote. >> thank you president scott. roll call, scott, present. hoa, present. breslin, present. canning, present. dorsey, present. follasbee, present. >> thank you. we have quorum. and now ready to move to item 13. >> thank you prez sident scott. item 3 review 2024 plan year health value initiative hvi benchmarking study. this is discussion and item and presented by mike clarke with aon. >> mike clarke, aon. this is our annual review of

the active employee health plan what we call health value initiative study. page 2, you see a robust data base to compare the active employee medical prescription drug plans to, looking at the cost information, population information et cetera for comparison to 6 million health plan employees across 857 employer organizations that represent over 2500 health plans and a staggering $88 billion in healthcare expenditures. compared to $87 billion more. this captures active only. dental and vision are not measured and retirees not measured in the study. like we have done in prior years, when we have done the study, the active employee

health plans have a effective score that remains among the best in the study and i'll explain going through the presentation. what a higher efficiency score means is that there is a higher level of value for every dollar spent in healthcare then most participating in the study and that is gauged normalizing the plan cost differences caused by plan design differences, demographic differences and geographic differences among populations. page 4, the medical prescription drug plan is higher for us. you see that in the study even though the efficiency is greater which is driven by three key factor s. first, the higher average population age. i know executive director yant touched on that earlier during the annual report. the population is about 3 years older on average then the

overall average of the employers in the study. 857 employ oars. the average age is similar to the public sector so keep that in mind. there was higher healthcare cost in the bay area which we've had the opportunity to discuss over the last couple years and then the higher percentage of allowed cost paid by the sfhss plans versus the other benchmarks when you look at the plan design elements and again, we talked about this during our education session last fall. from the employee perspective, what would an employee look at as a result of the benchmarking, the employee pay slightly less for out of pay check contribution amount. what rolls through to the employee and rate cards, but employees average pay substantially less then other benchmark organizations for

member plan design, cost sharing things like deductible, copayment and coinsurance. with that, is a summary background just to get if to a few of the statistics that we generate from the study. what you'll see is sfhss compared to 5 benchmarks. the public sector is [indiscernible] 65 different organizations. our largest set of organizations, 25 thousand or more employees that represent 52 different organizations. the fortune 500 subset so comparing to large corporate employers, 58. labor market where most participants in the study have people where sfhss members are including the vast majority in northern california and then the entire data base of 857

organizations. what you see on page 7 is a look at how the total health plan cost ultimately segments into the average employee contribution. average employee design out of pocket amount and what flows through the to employer where you see on the left side of the chart and each of the 5 dt data bases including total study. the employer pay 85 percent of the healthcare respond think of the discounted health plan cost before deductibles and coinsurance applied and copayments compared to arrange of 69 percent to 74 percent for benchmark averages, and as i mentioned primarily the dif ferential is in the plan design, deductible, copayment, coinsurance. on page 8, i mentioned

purchasing efficiency when we normalize for differences in geographic variations of plan costs, the demographic difference in population three years older. you expect the cost to be higher for a population of 3 years older then the ooverage in the database and plan design differences. at the end of the day what we try to measure here is what value is sfhss getting for the spend and this is really reflective of the partnership with the health plans, the work that sfhss does with aon support to identify the optimum cost health plans and what it says is spend is from pure value stand point, 14.7 percent greater or more efficient which is a positive relative to the overall data base.

pages 9 and 10 close the report looking at information about the various subset, of the employer baselines from a pure active employee total health plan spend about $800 million for sfhss relative to $88.2 billion over all. the employer portion is about $700 million for sfhss. you see average age line, this is employee age so not including dependents, the average rate is 46.6 relative to 43.8. slightly average family size. similar nationally to female male split but different then what we see in the public sector database and to close on page 10, you see the per

employee health plan cost both on total and employer basis. the financial index and then what the employees pay on average for contribution. recognizing it could be zero and could be much higher then $2475 a year, but on average the employee is paying $2475 a year in contribution and about $500 per year in out of pocket expense. once again, positive results. president scott, turn to you for any questions. >> are there questions? comments? >> i did have a question about your public sector. is it nation wide do you know where they are concentrated or-- >> it is primarily outside california. we have a couple of public sector organizations within

california and one thing we talked about in our november education session was the nature of health plan coverage in california, the actual values tend to be higher for public sector in california relative to what we observe for public sector in other parts of the country. this is primarily a public sector view of mostly the rest of the u.s. outside california, versus what we reference said in november when we did specific analysis around 10 county employers and their benefit programs where sfhss is much more similar in the plan designs to other 10 county employers in california. >> okay, thank you. >> other questions, comments? we'll take public comment. >> thank you prez sident scott.

[providing instructions for public comment displayed on the screen] we'll begin with inperson public comment and no one approached the podium and move to remote and the moderator will notify of commenters in the queue. >> board secretary, there is zero callers on the phone line and zero in the queue. >> thank you moderator. public comment is now closed. >> thank you very much. now move to item 15. >> thank you president scott. agenda item 15, we may want to go to the kaiser permanente, item 14. >> sorry, yes, thank you.

>> item 14, review kaiser permanenty hmo plan 2023 experience. presented by mike clarke with aon. >> mike clarke. my final item for the day is review the kaiser hmo experience for 2023. there is a appendix with a couple very detailed slides i will not go through but if you want to see month by month plan experience based on roll up for 23 versus 22 that is in the appendix. this is looking at calendar career 2023 for hmo plans and this relates to covered active employees and early retirees. this experience will largely be the basis of the renewal. there is a slightly different timeframe because kaiser will have early 2024 experience available for the renewal, but this give as flavor of most of

the experience that will factor into renewal that i will review with you all on may 23. the key observations overall go through to give a frame of reference. the total premiums for the kaiser hmo plan for non medicare plan members was $444 million. then additional $51 million for medicare members which represents 46 percent so all most half of everything we review is within with the kaiser hmo world. turning to page 7, this highlights the bottom line observed based on kaiser reporting for per member per month claims for 2023 in the active employee segment which is the left side of the chart that you'll see and the early

retirees which is the right side of the chart that you will see. we also have the medical and prescription drug data for each of the populations as well as the sum of those two together. what you'll observe on active employee side is very little change in the total enrollment but a 5 percent increase in the per member claim experience for medical and 7 percent for drug. when you average, 5.2 percent on the early retiree side you see a similar total increase of 4.8 percent, but very different in terms how it played out between medical and prescription drug. the highest percentage of the slide is the prescription drug experience for the early retirees and we'll talk about that in a bit. page 8 in terms of for the active employees what were some of the highest spend diagnosis in both medical on the left

side and prescription drug on the right side. for the active employees cancer, circulatory, so heart conditions and so forth, injury poisoning-those were the top 5 identified medical spend conditions in 2023. then on the prescription drug side, the antiinfective drug class the highest spend fallowed by end ocrin so largely diabetic medication where everybody certainly talks about increase in that category. dermtulogical is a significant contributor as well as anti-cancer and anti-inflammatory. >> can i ask a question? >> yes, please. >> i found this interesting in that, the highest rx spend was

antiinfective but none of the categories for medical, expense are infection so assume this is hiv in terms of the cost of hiv drugs, and that antiinflammatory covers mus cural skeletal. mental and behave y none of the rx categories include antimental health drugs. antipsychotics and antidepressants which are increasingly costly since there are so many out there. i find it interesting in terms how these categories overlap but not completely. >> i think you find the mental behavioral would not have been top 10 in prior years and it is more demand and kaiser building up their capacity to serve member mental behavioral health

needs. >> thank you. >> flipping to early retiree page 9, cancer is the dominant category on the medical side and perhaps you see that as number 2 category on prescription drug side on the right. mus cural skeletal high, circulatory high. similar in the active information, infectious and parasidic category and symptoms and signs is more a function of preventive care will fall into that category or other sorts of encounters that are not necessarily linked to a diagnostic category, but are something that a early retiree member is seeking. and then to round out the spend categories on the pharmacy, besides antiinfective, anticancer, endo crin, diabetic high, antiinflammatory and start to see central nervous

prescriptions as well but more a distant 5 relative to the other 4. >> thank you for trying to clarify the symptoms and signs. those are not diagnosis so it is a-jumped out. what is that? is that evaluation for chest pain that turned out not related to reflux so that would be gastrointestinal? confused because that isn't really diagnautic category. >> we have a number kaiser representatives in the audience i think can answer the question. who wants to take this one, shawn?

[no audio] >> somewhat summarized roll ups for these terms and diagnostic. a number of different areas. looking at inpatient admission for the active population early retiree on the bottom. what you see here is how

inpatient service is is playing out for medical admissions, surgical admissions, muturnty admissions, mental health, substance ause and skilled nursing facility, so when you look at things in aggregate for e acve population there was small increase in the inpatient utilization rate and these numbers are the number of inpatient admissions per 1,000 covered lives in the plan, so that's when you see that admit per thousand is what that means. on the medical active side we saw the highest rate of change was on medical admissions and little on the skilled nursing facility decline on the early retiree population in admission per thousand. the next couple pages look at outpatient visits per thousand covered lives starting with active employees on page 11 where the services you see the

predominant increase are outpatient mental health and the non-kaiser emergency room utilization. but i will say overall the vast majority of emergency room utilization do happen in kaiser facilities and you hope for that. the members enroll in kaiser. overall a drop in the number of outpatient visits by 9 percent for the active employees. for early retirees, a small increase, 2.7 percent. again, lead no surprise by outpatient mental health as capacity grows the ability to serve member needs grows. page 13 shows information on telehealth visits per thousand members for each of the months. for 2023 with active population, at it top of the chart in the early retiree

population at the bottom and the conclusion you can draw is both phone and video visits remain very popular with these populations. video i would say much more popular relative to phone for the active employee population for the early retiree population, a little more use of video versus phone, but strong use of both modalities. and then just looking to close the health status immunization preventive care rates by population for the active employees and early retirees together, what you see here is the first couple columns, the first represents the active employee population and second the early retiree population and all relative to the kp regional average which groups all non medicare members together so there isn't a specific benchmark separate for

active or early retirees but you see it together. generally speaking when you look at this preventive care screening rates are higher generally for sfh is rks s employees early retirees then the kp regional average. health risk indicator metrix are favorable relative to the benchmarks so when you compare rates of obesity, though 3, 4 percent you can say high for both active and early retirees, but lower then 38 and half percent obesity rate for kaiser average. another area that especially in the active side you see lower rates of blood pressure, undesirable smoking status lower for both populations then the kp regional average. blood sugar, poor control so inverse that is in control. better rates of blood sugar

control for the sfhss population. you certainly expect early retiree population higher rates of chronic conditions, but on active slide slightly lower. say the really good news here is generally speaking up and down. higher rates for utilization in the sfhss population versus what you see in the kaiser book of business. on average, it is good to see the higher rates of preventative care, which should hopefully lead to somewhat more favorable health risk indicators for the sfhss population. again, the appendix detailed information but i will end here and turn over to president scott. >> thank you. are there questions or comments beyond those that have been asked regarding this presentation? hearing none, we'll have public

comment on this item. >> thank you president scott. [providing instructions for public comment which are displayed on the screen] we'll begin with in person public comment and no one approached the podium to move to remote public comment and the moderator will notify of callers in the queue at this time. >> board secretary, there are zero callers on the line and zero in the queue. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. thank you mike. you have done yeoman work this afternoon. >> thank you and see you may 9. >> okay. now we'll move to item 15, which are reports and updates from contracted representatives.

i like all of the contracted representatives in the audience to please stand. just for a moment. it is good to see all of you. thank you for your continued partnership and diligent work with our staff. thank you again for coming today. alright. i understand that out of the group that stood up, we have one person who has an update or contractor comment. please. >> good afternoon. denise rodriguez with kaiser permanenty and i want share a exciting new partnership kaiser is embarking on to launch a program called habitat health. the intention of this new stand alone i guess i call it a company is to provide low income members with

comprehensive care and that really focuses on social health as well. now, this really supports part of our mission statement, which is to improve the health of the communities we serve as well as our members so this would be that community part. we are not doing this alone. is a joint venture with an organization called, town hall ventures and they are a healthcare company focused on transforming care for low income eligible people in our community. habitat health will open up and i have to read slowly because it is a tunk twister. a program of all inclusive care for elderly often referred to as pace. if you heard that. that's a cms program. essentially, they will be opening centers and begin first in california. there is one in sacramento that kaiser will be participating in and one in los angeles.

so, in addition to providing healthcare, lowing low income residents to stay in their homes, they will provide social services like personal care in their home, so helping with some of those things that are hard for someone who has some challenges putting their medications together for them and things like that. they will also provide respite care for caregivers, and when you go into one of the habitat health centers it will be a social environment. so members can go into these places and engage and have a social connection with their community. there are some qualifications that have to be met but these are kaiser permanente physicians supporting their healthcare. you don't have to be a kaiser member but you do have to sign up for pace and you get all your services through pace.

it is actually a really good program. my mom was part that and it helped us out a lot. i think it is a great program we are participating in. again, there are qualifications that must be met at a high level, there might be others but giving you a high level. so, the most participants in pace are eligible for medicare and medicaid. low income. they also must enroll in a pace and have to be 55 or older and live in a pace area service area, so for example, when we have facility will be in sacramento and los angeles, so these people will be eligible. they need to be certified by their state for being eligible for home health service and the ability to stay safely in their home. again, this is a really nice program for the communities we serve. not sure how many of your members qualify, but the message we want to leave is we

are not just a provider of healthcare to enroll members, but really focus on keeping the communities around you all of us healthy as well and support that. that's it. any questions? had >> are there questions? had >> yeah. i like to ask a question. because i know there is a program similar to this opening up in the cochela valley and long beach and sacramento and los angeles already and it does require medicare and medicaid eligibility. do you have a prediction for what percentage of enrollees in this program that kaiser is partnering with might be kaiser members in addition and i would urge that there are probably we have probably some health plan members who's parents qualify, and so this could be a very important program for our members because they may have other family members who-this

would be a relief in terms of their burden to have these programs available. a question is about, what percent will have kaiser? won't be on medicaid if they have kaiser as well. unless they got medicaid through kaiser. >> because this is a brand new program we are embarking on and haven't broken ground on the facility, i don't know at this time we know the volume, because we don'ts just serve kaiser members it is anybody enthe community. if they sign up for pace they are no longer kaiser members. they are part of the pace program, so it is hard to say right now. i can come back when we have more information but i think you are right. those taking care of parents, this is great program. i hadn't thought in those terms so it is a good program. >> other questions? thank you for sharing this new

information with us and as appropriate, please keep us updated. >> i will. i wanted to give you one more notification. our wonderful executive account manager, debbie--as you know who has been working on the account three years now, five, my gosh. times five! right? she has decided to move on. fortunately she is staying with kaiser but relocating to our southern california team. we haven't filled the position, we are actively recruiting now and it will be a very long transition, so i just want to let you know-i'll still be here to provide consistency and continuity, but we are actively recruiting. >> thank you very much for the wonderful work and partnership that you provided during your service. we wish you all the best in the

next phase of your career. any other questions or comments from plan representatives? hearing none, we'll move to- >> can i make one-i want to follow up on the comment you made about the fact all the plan representatives are here. we have so many here and we heard a report about the health value initiative and clearly we feel we are getting value from the services we provide and always working. i know sometimes it seems intense for each of you, the questions and the demands we make, but the fact you are all here to me just reaffirms the value that we are getting and expect and i thank you all as well as speaking for the board in that regard. >> thank you. alright. we are now ready to move to

item 16. any public comment on the plan representative? >> i open up for public comment and those instructions are displayed on the screen. in person public comment will be first falloweded by remote public comment. those on the line press star 3 to be added to the queue. click on raise hand icon to be placed in the queue to speak. we'll begin with in person public comment and 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, there are zero callers on the phone line and zero callers in the public comment queue. >> thank you moderator. hearing no further callers, public comment is now closed chblt >> thank you. we now move to item 16. >> thank you prez sident scott.

item 16 vote on whether to hold closed session to review and approve the 2023 annual employee performance evaluation rorlt. this is action iletm and presented by chair hoa. >> thank you. we have the opportunity to review and comment on the performance of the director so i like a motion please to move us into closed session to do so. >> madam chair, i would move that we move into closed session. >> second. >> properly moved and seconded. may we have public comment please? >> thank you vice president hoa. [providing instructions for public comment]. >> there isn't any public comment in the room. like the end of the school day. [laughter] ring the bell.

>> the public comment instructions are displayed on the screen. [providing instructions for public comment] we'll begin with in person public comment and 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, there are zero callers on the phone line and zero in the queue. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. so, we'll--roll call vote. i never want to vote. roll call vote. [laughter ] >> scott, aye. hoa, aye. breslin, aye. canning, aye. dorsey, aye.

follasbee, aye. >> thank you. we'll now move into closed session. thank you everybody for attending. [closed session]

[meeting reconvened]

>> i will state the item passed. we voted not to disclose any discussion held in closed session. it passed unanimously. that was an action item 18. we are now moving to item 20. >> [indiscernible] >> yes, thank you jennifer, city attorney is reminding us to repeat the announcement city hall internet is down now, which prevents from take remote public comment on the remaining agenda item after we came out of closed session, so we move to agenda item 18, there is possible public comment for in person and there was no public comment for item 18. we are on item 19. >> we are at item 19, and we wont be having electronic public comment. we call for any public comment in the room?

hearing none, we are now ready to vote. >> thank you president scott. roll call vote, scott, aye. hoa, aye. breslin, aye. canning, aye. dorsey, aye. follasbee, aye. >> with that, the april meeting is of the health service board is adjourned. >> thank you president scott. adjournment at 4:19 p.m. [meeting adjourned]

>> my name is nary shay assistant fire marshal. assigned at fire pro investigation. i was born in hong kong age 8 me and my family- (indiscernible) i grew up in sunset area and all employment jaibs are with the sitdy of san francisco. when i was growing up my

parents were traditional chinese parents. they emphasized school. they didt want us to join or play sports because they said school is the only thing that is important and want us to get a college education. i envisioned myself maybe being a doctor. after high school i went to uc berkeley and major in bio chem. after college what i did happen is-what happened was i landed a job at ucsf and was a research associate there. one day me and my co worker were talking and don't know how it came about, they talked about fire department and someone mentioned i would be good for the fire department. even though i didn't play much sports i was still athletic. fire department, what will i do in the fire department because i didn't know there were women on the engines and trucks and

didn't know the difference between engine and truck. the same night i was watching tv and there was a commercial of the fire department recruiting women firefighter and there was a woman all dressed and tolds to go to division of training and 27 and a half year later i'm erhoo. when there is more presence of asian person, asian community it educates the population and helps people understand our community rchl ism i think people hate because they don't understand. i will tell the young women that definitely consider you know, a career in the fire service. don't just think it is just for men, because the fire service is not just suppression. suppression is one portion of it it. there are different parts of it. there is

ems portion, the medical portion, the fire prevention portion, and there is also the fire investigative portion. all of the departments needs to work together to keep the city of safe, not just the citizens safe, also the first responders. i thinks the career in the fire department is great. i start #d as a firefighter, i had the opportunity to also become a paramedic and then i landed in fire prevention. i'm very happy at fire prevention because not only am i able to enforce the code and make changes to help the citizen of san francisco be safe in their homes or place of business, but i think my work also make sure that my fellow firefighters and first respond ers, when they respond to a fire, the building is also safe for them.

>> [music] you are watching golden gate inventions with michael. this is episode exploring the excelsior. >> hi i'm michael you are watching golden gate inventions highlighting urban out doors we are in the excelsior. pickleball. let's play pickleball! pickleball is an incredited low popular sport growing nationwide. pickleball combines tennis, bad mitton and ping pong. playod a bad mitton sized court with paddle and i plasticic ball. starting out is easy. you can pick up paddle and balls

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have a huge respect for disk ball player its is difficult but fun. thank you for joining me in the excelsior this is goldenate adventures.