recommendations >> thank you, mr. rose any comments? >> yeah. thank you very much for your time. >> okay. thank you. colleagues can i have a motion to accept those amendments without omission. okay. up next why don't we have i see the folks from the health service system. just for the members of the audience we're going to take a break from 1 to 2 clock and so we'll start with the health system.

>> good afternoon a chairman and supervisors i'm the acting director here on behalf of our director doctor dodd. she's been engage in the process she's on medical leave and she thanks you in advance of your attention. i'm joined with greg and he'll be making the presentation. we'll both be available for questions.

>> good afternoon supervisors i'm am servicing as the interim ceo some of you may remind me when i was with the department of health. i want to say that first, i think the significant achievements of the department in saving the health care costs. the health plan has been impressive and they've done a lot with the city plan and generating some significant savings to the city and really keeping the cost of the members thank you minimum. the second observation is that

really it's how significant the staffing constraints have been. that every year the workload increases and as we're making changes in the blue shield contracts the increases in workload have been dramatic and the department manages to get the work done. the material you'll be looking at on the slides really we'll see there's a significant staffing increase in the budget with respect to that i do want to express the mayor's office and the controllers office have been supportive to help us going

get to the - greg let's move to the next slide. oh, you have it over here? i don't think i have control here >> okay. we're going to be talking about over the next few minutes to talk about the mission statements. i want to split the budget into the administrators budget and then i want to take a separate look at the e pa program and finally we do have a response on the competency issues. moving into the statement it's the department is dedicated to help and enhance the benefits of

the employees. looking at major responsibilities the department does negotiates all the rates for our health programs it's worth over $6,004,080,000,000 a year it covers the city college and court system. there are other contracts for flexible he expense and come back bra benefits we also manage that have a cost of $20 million a year. there's regulatory cinnamons issues we need to be in compliance with particle as we go into full implementation of health care reform.

there's the member enrollment and i can tell you as a retired rethe newsletters i get regular will i as well as the information on their website it's been excellent. the whole process was really helpful for me. there are within the area of benefits and wellness there's a whole range of consumptions associated with that and finally the department really manages the agenda and the material for our health service board and that's another responsibility. i want to take a minute and comment on something that was in the exclusive summary of the mayors report.

the city will save more than $62.2 million as a result of the h f s. it is involved in the cost containment and implementation. it's not only to the city but to all the members who are having the co- pays taken out of their checks. the next chart shows you how we did that. the orange line see tracking the rate of increase in the health care2013.

so that's actually a chart we like to show. i'm not going to spend time on

this next chart it's intended to be a snapshot where you see the judge a high-level breakdown of the 28 vendor plans and health plans and down below we're broken the department down where you can see the staffing along with a few metrics. you can look at this and kind of or certainly help you if you have any questions. i do want to spend a little bit of time on this organization chart. this is everyone in the health service system. it includes two people who are paid 1 hundred percent by the employee trust fund and on the

right there's a communication manager both of them who have no general fund cost whatsoever. you'll seeing the new positions and they're in the doted line places. we're going to take our 3 person wellness and faeg people in over the course of this year and in place by the second year of the budget. the next column we're adding an administrative manager. you see the commission secretary and this person wears 3 hats of the department and the solution to that was to divide those

responsibilities so that person is doing one job predominantly\and we have more sports in the department >> i just wanted to ask about that doubling of the wellness e ap and doubling the staff is that because of the health care act. >> i've got additional information it might be better if when we get to that. but it is not because of the affordable care act it's really what we see is the larger needs of the city to have one person there is not sufficient to respond to the city's needs and potentially the courts and city

college we need a more robust program that's going to be effective and the goal be obviously so to bring down a little bit - >> i'm for wellness and improving healthy employment. >> i have some metrics i'll be showing you these but those are the 12 contracts and meeting and

we're way behind open getting contracts final listed. and we have little time to do everything so we're going to add a data manager and another analyst so we can complete the

work we need to do. and so those are the key position that are on the chart. we can come back to this later >> what the next slide is this is not the entire department. as i've said before the first component is everything expect wellness i did want to spend separate time. the first thing is as i can see one of our positions the communication manager is 1 hundred percent fund with funding from the trust fund so we have 33 individuals increasing to 42 and next to 43.3 in our operations and finance area.

that's where the growth is. the other second important thing to note is a very large portion of our budget is from non-general fund sources. we recovery significant funding from the school district and the courts and the city college. so any increase in our expenses only 50 percent is general fund and you can see at the bottom 46 percent is from non-general fund uses. so given that the significant growth here is really in the personnel area i wanted to show you a couple of metrics. the first is not a criticism of fema but a recollection of what

happens in a post implementation stage there are additional things to be done. the daily events we're processing prior were 2 hundred and 54 a day. it's increased by a for about of 4 to 5 to 6 in the months following. so the same must be are requiring a tremendous much higher level of interactions. that's temp costs this year and it's something we hope to address in the additional positions there. you can see the increased call volumes and it is significant in

2013. this is the enabling complexity of health care. the changes in pharmacy benefits and to the members as they become medicaid eligible. almost 75 thousand for the year and this is the budget for temp services. so what happens with us, you know, again, just an indication of how important our staff is we immediately back them with temp services or use the open enrollment to meet the deadlines.

we think all of that is a good indicator. and fbl a few other items that certainly effect our costs health care reform will be an additional responsibility. we've qualified for grants on early retire

56, 54 is relatively a small budget of which more than have of it is coming from general fund >> a few comments since i pulled a mrurp from an evaluation from the boards budget analyst from 2008 they performed an evaluation and they recommended in their remedies the city employment promotion

programs should be coordinated. and i would add that our boil so not only to do the work ourselves we can engage the health plans in addition to bring support to us in the wellness activity like kaiser and blue shield. we're ideally positions to do that. our focus to date with our one person has been focused on weight management and diabetes education and resiliency training. so certainly behavior health and our employee assistance programs

work. some statistics to be aware have to report to the department of labor on a workplace wellness they have 2 hundred armor employees report some kind of wellness programming so this is very widespread and it's something that needs to happen. and just have a healthier workplace. this is a sum of two slides there's no new information on here. it gives the overall information. and finally to move away from the budget and it up on the competency issue. we're not required because the

city employees are expected to have an english competencecy we're not required to have a foreign language program we have people who speak russian and cantonese and other foreign language skills we do respond to. we look forward to the future clearly as argue retire population continues to imagine a and the angle is over 70 but that as people live long-range we want to make sure we can reduce the hearing loss and we understand that. so that concludes the slides it's about 2 more than 10.

colleagues any questions for the gentleman. >> welcome back. >> hey, thanks and it's great to have you here. >> i'm here mainly to help katherine out katherine dodd she's staying very involved pretty much on a daily basis. >> just a question regarding and hopefully, this is the right place

. now we're working directly with the providers and the community both brown and sutter hospital and ucf we're working directly with them. we're trying to get to the

someplace with kaiser. it's hard to get them to understand the needs of all the employers in the bay area. i think we're very confident when we're asking from something from kaiser other folks are asking the same things. we're very clear we have costs in health care that's not was it expected to be we put a plan in place whether it's employee wellness or if we have other issues we can get the cost under control. eave had trouble getting kaiser to the table on that regard. we had to show the health board

that all our data indicates we should have had a reduction in the last few years and as we dug into the presentation it was not argue - it was quite frustrating especially with we're trying to do wellness and get people healthier they expect to see that >> are the lielgsz. we have actual would have had a negative trend on blue shield because of the romper taxes we came in at zero. our rates in blue shield as

declined and with kaiser we're not p there. a united voice from the supervisors and the mayor's office and our unions all saying the same expectation of kaiser is we have to know what we're paying for. so we appreciate i'm happy to brief you more. we were frustrated with having to accept the it .5 increase from kaiser but we have 2.5 million people who are getting services from kaiser. kaiser will come to the table and there will be a better solution to our pricing >> and to add to that comment i'm very much part of the

conversations and echo how frustrating it is but there are - we passed a resolution about a month or two ago we'll be discussing and a number of other measures in terms of open data and transparency are going to happen not only with kaiser but blue shield. we see we're ben with the health certify we're driving down the affordable care act. and so it's a big deal but why i voted again to despite a lot of strong words to support the

kaiser rate plan was the open enrollment and those folks who would be exposed it would have been a wrong move not to support that >> we will be perjure other costs for kaiser in case negotiations don't go well. >> so the board has approved the rates. >> colleagues any other questions? staff. i understand there's no agreement yet; right? >> no, not yet. i think we can come to an agreement certainly by our next meeting and we understand the items they're proposing we