>> commissioner frazier. >> can we look for one moment at lab services. >> sure. >> they've had a decline it is quite wisdom. >> if you remember in the outpatient the encounters are billed quickly, however, when your cap tatted lab and services that are part of the captation there being a recorded as an energy for about a quarter to four months. that's why we're going to be following this to make sure that lag is the cause of the drop not some other reason >> if i'm understanding the charter the drop started

january 2012. >> sure. >> we agree in partnership with blue shield that number is lower than we expect to see we don't understand the sever decreases in that so we're undergoing an investigation right now we have not completed that but we intended to bring that back to the board. >> thank you. it's just a hypothesis but we have several services that went and coordinated with the medical group. if it's real it's incredible but we're not having as much duplication because there are other facilities that maybe

involved but it maybe premature but the hypothesis is that the other systems that l have long been integrated >> yeah. a bit of history maybe work out discussing for a moment when i you were i was an intern in the hospital we checked labs on everyone everyday we didn't care about costs and over time if somebody was the the hospital you reorder those labs and you don't think about them everyday. so i move if everybody is normal i don't need to check it everyday. so i know that working between unsaturate and uc f if i send

someone a blue shield patient to say a specialist they what to redo the sample because they trust their lab. i think the majority of the tests is if you really sat down and talked to a doctor and i guarantee we have patterns so when someone says they need to change their behavior it's hard to get out of our patterns. i believe that doctors are being said if you're checking someone every quarter could you do it every 6 months because it's not goes to move the needle in any

major way. so there's an element of the doctors looking at their lab patterns and understanding what they're doing now that i'm obeying being on the dollar amount. in addition to this epic thing is repeating real this duplication if you're getting dinged for duplication you've got to look at the labs they're all good. i'm hopeful that it's real. i think we order labs at 50 percent too much so patients maybe want them but the frequency is too much. i want to ask a silly question

on the gesturing drugs graft. if i didn't have any educates numbers and i saw that q one, 2 and 3 this 12 q one and q one 13 it looks like this grateful is thirty percent bigger and wow, it look like a big number how did you pick under no circumstances to be your access of the graft it cuffs if you made this from 1 hundred to - >> point well-taken i was trying to say we were trying to make the graft legible. >> well, the drug showed us

graphs and it looks like it's 80 percent better but that's by the says of the bars and you can see that's really a small change even though it looks like a big change. >> put well-taken and a going back to the previous page on the decreases professional procedures. >> uh-huh. >> on top of laboratory could you looked at that because it went down 40 percent and you surgical and lab okay. >> thank you. any other questions? since we've been segued by dr. last thing we want to first of all, give you a prospective of a

benchmark for every time we do this blue shield estimates a doctor so the gesturing dispensing rate between quarter one 2011 and 2013 increased by 7 percent so that's a significant impact on our pharmacies spent. in future they expect the increase will continue due to the efforts of the cf os. the active population is 87 is a benchmark for the country and that's the reason we'll pulled it out that's the gold standard to move towards something. so let's see costs per script and member. the cost per script has

decreasesed. the cost percent month has driver's side 8.8 percent but has gone to go back up at the rate of 3.5 percent. industry trends is between four and five percent so your clearly demonstrating a reduction and your judicial notice dispensing rate has gone down >> you will notice that comparing your prior period to this period there's been a doctor's about 15.3 percent and really what you'll notice there hasn't been a change in the

number of patient i mean 506 but you'll see there's been a significant decreases in the number of complainants 53 vertigos 678 is rejected in the 53 decrease in the per member per month. again from the earlier intervention. i'd like to turn it back over to marina to summarize our finding >> thank you page. our metrics show the overall utilization to the actually costs have long been increased and a going forward h f f is

positive that will continue and the number of claims has ridiculous. expectations is in the next 24 most the costs will be utilized. it continues to be a complete intervention and that will be continued to be monitored on sticking to that some of the incentives by the cos are going live with a nurse lifeline so they have access to the patients record and it helps with the records so some cases where the member was diverted from going through the other lifeline so we're seeing some positive activity there. another initiative is an after

hours clinic so we have 3 clinics in the city and their seeing about 50 members a month and it will have to increase occupy 2 to 3 thousand to have an impact and we'll continue to monitor that. the risk scores for the blue shield population does continue to trend up and may result in higher claims and it ask a challenge to skews. we'll be exploring the cap tatd services and we're working with blue shields to understand the recent decreases in level as going back to page 15 on the the descriptions cost per script

you're saying the cost of script has dliendz 53 percent >> yes. >> instead of the decreases. >> at this time i'd see the majority would be related to genetic. >> understood thank you. >> thank you. any other comment? thank you. any public comment on this item? come forward

>> larry bradshaw. seems like is a lot of good news coming out of h f o. does h f f have the ability to drill down to see what kinds of services that could have long been avoided if better care would have long been provided. this dramatically reduced their numbers which has a positive effect on care and costs? director >> thank you very good question. i think as you probably can see from the reporting we've done on the ac os in the last year and a half there's been a lot of focus on reducing the unnecessary utilization of

measures. we're talking about the quality over the next 2014 in terms of goals and we'll be bringing the suggestions to the table guarantees from our c os and reporting as well >> any other public comment? no other public comment. ma'am, secretary item 7 >> item 7 presentation of confidence and rosemary and a sf communication manager. >> thank you for the opportunity to speak with you about member qualifications. we think it's important to

evaluate our currency practices. we brought in an outside affirm to get a prospective on our services. ben's conversations is is san francisco company that benefits in the communications and they work for electric greetings and jennifer ben's the lead at that firm is involved in pb j h and is involved with other employees to increase fully engagement in their wellness programs. the goal was to have them evaluate h f communications with best practices and identify the practices where we have opportunity to grow and improve.

they have a basically program that's high quality were we identified the world of communications and health care is changing where we can pursue some new directions and use some new tools to engage our members. in particularly we're leaking healed to online engrossment what's the timeframe that is 2015. it's going to be a self-serve system they'll go only line and enroll so we want to use this opportunity to prepare for and we can equip people to be in a

more is it serve mode. it comes down to 3 things and we ask are we serving one of those options. the first is awareness then adopt activity and resiliency. when it comes to awareness i use myself ann as an example i knew a lot about consumptions but not a health care expert not a medical professional but i feel i've gone through an education process and i'm more for the record about health benefits and my goal would be to take the minutes through a similar process so they can have a good layperson's understanding of the health care system.

at the same time we're going to be asking people to do more because the world of health care is getting more complicated with the federal health care and other things offered by the state. we need our members to have a higher involvement and awareness in the ongoing flow of information that's going to be delivered from a lot of other sources. so in order to do that i think we need to a develop some more tools and get more strategic about our communications calendar so we're targeting messages to different populations. we're having videos and online course war and coordinate with our vendors so work on common

campaigns that are hitting with the same frequency throughout the year and you need to have a feedback group. we need to start protein to at this point, the opportunities we can billed into our online tools and this way we can move past simple words and pictures to flunking behavior. the second i think it's called adopt activity. we're in the means of the federal government is coordinating with health care at the same time the providers are all pursuing different types of innovation so we need to adopt and h f can help facility this

by building more feedback groups back to our members. one example of this is the mathematical is you may see a sign on market street that every time a bicyclists goes by the sign it reflects that. we need to build that into our cultivation so our members are influenced to make better choices and join the community of folks who are making better choices. we need to develop aligns to take part that the physician people are going to be involved in. we talked about the clinic that roshd johnson is putting forward and uc f has a health program

where they're creating with regard to cardio yack conditions and we want to be a part of that and make our members feel it's a positive and good thing. there's going to be a barrier and what does that mean i'm feeding information back to my decrease into a wristband and what does that mean. we need to make sure we report on our wellness incentives to get member feedback and identify the types of programs that are going to be interested. and we can make the members part

of the innovation and design process to increase the engagement. finally resiliency is something we need to build. we have thirty thousand erngz coming out san francisco dedicated their lives in protecting this city there are thirty thousand retirees but how connected are they to the destroy of the city and highway connected do they feel to each other. this is an important element we can help foster more community among our workers and retirees so that we can facilitate stabilize and an joishl work environment and maintain high levels of productivity without the stress. people need to be given the

opportunity so the behaviors can become the no more in our workshops. from the prospective of h f f means we can do more outreach to our member pomgsz and more with that seminars be son for people to ask questions were we can help our members celebrate life events such as a their work anniversary or engrossment of they're new family members to educate about health enrollments. also, we need to provide better supportive to members who have catastrophic illnesses. they can get the most from their

benefits. that includes coordinating with retirement and other agencies. and as we go into our wellness incentives we need to get members to motivate each other to take the next step on the wellness journey. i lived say we, do better to increase our collaboration and so that we're all working together on those common initiatives. this is the fun part. we did the brain storming and strategies we were coming up with a bunch of potentially great ideas so the in essence step is come back with a line

item that budget but lisa wanted to give you an idea of what we're working on and hopefully, your in agreement with our direction >> any questions? any questions? no >> thank you. >> thank you very good. oh, commissioner limb >> oh. okay page 8. >> sorry on your package 8 commissioner. >> okay. >> you have a lot of the channels and the impact time and costs with dollar signs. >>right. >> are those included in the

next year's budget. >> some of those. >> - >> those are new under the influence p incentives and given i giving us low-cost high impacts we don't have a line item budget by the first step we've disguise do what's called on r f q to get a pool of qualified vendors then we'll go to that pool and get bids and say wheelchairs here's what the various items cost. we'll go to the online pool and we'll have to come up with what we feel has the best o i but

probably we'll do something in between >> thank you. >> thank you. i wanted to voice my preshths for the work that rosemary led on this effort. i find this work so inspirational in terms of giving us in terms of how we're have you found. we very much want to hear from the board in terms of how this strategy feels to you and whether you feel it's the right strategy and we will be working towards on rfp to help fulfill some of those and very much appreciate people's feedback in how this looks to you and a

commissioner >> rose mary applaud you i think it's great. all of this is to complicated for our employees. and i'm really interested in the wellness piece. i'm sure you meet with other directors but citywide there's a pie that happy people save us money because they don't get sick >> commissioner scott. >> i hope as your beginning to work with our outside firms you'll bring in advanced pieces so we can get some reaction from both the board as well as from our members and the general public. i don't know if you're going to

be testing things out before you put them on the website in a more form way but i'll put that to you as part of our planning. >> i want to thank you for bringing that up. feeling in fact, i went to a meeting and they have some team members from the standing for the record d school and their whole philosophy is about that protein tipping and getting feedback from our audience while it's in development before you compliment the dollars to the project. and it's exactly as you described. >> any public comment on this

item? seeing none, no public comment. item number 8. it's an action item. >> oh, i'm sorry this is an action item. i'll need a motion to approve the strategy plan >> motion to approve. >> second. >> okay. it's been move forward and approved to approve the statistic plan. any public comment. all those in favor that is. all opposed? it's unanimous and a action item vote on whether to school the october meeting because of the open enrollment