us >> i'm wondering if i can get my colleague to respond. >> it gets to a high-level just generally what is it about and what kind of report do you expect from it and when - >> my answer is going to be vague because i don't have the information. >> - >> speak into the microphone. >> we receive that information but we didn't realize they sent us one for active employees and retirees so we submitted one and it was really trying to get at some that demographic areas and

around the different plans and premiums so it's a relatively brief survey and as to how it's you - that information is being utilized i'm not able to answer that. >> thank you. >> thank you. >> any public comment on this item? seeing none. madam secretary item 4 >> item 4 discussion item for fiscal year 2014, and 13, pamela levin and a good afternoon pamela levin chief financial officer. at the on that ground meeting greg went over the preliminary year for the trust fund my as the acting director mentioned

auditors have come to our officer for fieldwork so i don't have any update and they're still doing our closing enterprises. so when i look at how early it was in the year i didn't think it would be a good idea to talk about the information so i thought i'd like to update you in terms of our general budget that was approved by the board of supervisors. i provided a detailed analysis for you in the presentation you have in our binders but i want to make maya few comments. i think you probably know i've been here for 7 days so i want to make this brief and to the

point. with the help of the mayor's office and the board of supervisors we have an approved budget that's similar to the request with a couple expectation or so. the start date for a couple of positions was changed to become later in the fiscal year to conform with the rules that the city has and to give an estimation of the budget analysis to more accurately match the time it takes a higher positions. the rent was increased to reflect the actual lease that was negotiated by the real estate office including the wellness center and for moving the department up to the third floor. we need and are going to monitor those expenditures very closely

to make sure they don't exceed the funding level. the other change in the budget was the professional services were increased primarily for the wellness center. the second point i want to make is we request approval for a carrier forward from the 2012, 2013 budget to cover professional services, materials and supplies and a capital. the balances have primarily going to be used to hear fund the ti work and continue the implementation of the affordable care act. we're pretty confident that the request will be approved. it was well received and finally since this is a two year budget the new pentagon's that were

added will be for next year and that will serve the basis of the discussions for the fourteen, 15 budget at the next meeting we'll go back to the previous formality we'll talk about the audit and give you a general administrative budget. i'm happy to take any questions >> commissioner scott. >> just a question. how much was the carry forward request approximately >> it was approximately 2 hundred thousand and a okay. thank you. >> commissioner limb. >> i don't have is a question i want to welcome pamela i worked with her three or four years i

think i want to welcome you. >> any public comment on this item? thank you pamela. no public comment item 4 - 5 >> item 5 discussion item carvings negotiations update with opportunity from input rephrase the question members. >> lisa combot from the this is the first of the presentations on the kaiser new york city updates to the board and membership so welcome input in terms of and effective. we've had 4 meetings and the

conversations have long been very good we've had strong attentions from the kairsz team and we're doing a lot of level setting getting us on the same package with regards to knowledge from what sf knows what's to be true and we've spent some time talking about the structure and goals of the negotiation and i wanted to take a minute to kind of review those and see if there are any questions they're open the first page. we'll have meeting through december lasting an hour one half. the vendors will be available to answer the questions from members during this session and

those negotiations we expect to be completed by 1231 and presented to the board here for the january meeting. we're also expecting to complete and sign the commitments regarding the 2014 renewal where we had significant discussions around wellness and performance guarantee changes we explicit expect to have that completed and october 1st. in terms of the goal of the negotiations we're funding different structures like flex funding as we know it with the blue shield world risk adjustment premiums we're evaluating aefltsz with the care

management charges and evaluating proving perform guarantees that guarantee all comboogsz of sf. we're evaluating how to prove car cost and fee changes over time to the fee schedule flexibility. we've outlined this for this effort and i'd like to pause to so if there's any questions from the board or membership >> dr. slayed. >> yeah. thank you chair >> i can't hear i. >> score the microphone is on.

thank you to the chair. i think in that negotiating this touching arrangement you know there's so many details and nuisance and a lot of butterfly effects where the small thing caused the big thing so i'll kind of raise my hand as someone in the physician understanding the mechanics of the - i mean it's in the health care system if you want to include me to let me weigh in i've been be spending a lot of time on incentives and how do you move the needle we think money is the right incentive and it's not so to frame everybody brown around

spend to the extent i was in and out out in the world i was all day at princeton talking about how do we flip the clinic and that means right now you have to come to a place and talk to somebody in person and how do you did don't that with education i go home and watch videos at home. so there's a lot of things going on in health care where people is made of to explore difference ways to do thing. we've got kaiser but we really need to think about benefit design change. how do we pay doctors. now kaiser is one big payment and they pay their doctors but

blue healed they get paid on a different basis. fully for serve. historically it doesn't work you get paid to do things so the incentive noting not to do things people want to put patches on service then hmos came up if you're get paid $10 per month and you see nobody during the day i still get paid so not to see people you're still paid. the new obamacare is really the hmo with a little bit of

trainers so that gives us some insight but the model i think and i'll say it out loud i read a post on that in the morning is the concept of paying for engagement. how do the doctor's get paid if they do what they're supposed to do if you penalty e penalize the doctor and they have no insight that the patient participated in the program your telling them if they get their there's a penalty or bulls. those are new digital tools and

tool kits it enable services. as part of those negotiations i've been knee-deep in incentives of what drives people and drs. doctors are losing the joy of practicing medicine is going like that. and who wants to show up for work and not want to. go into medicine to help people. the borrowing of health care is which kind of kind of chewing up drs. doctors so they have to find the balance of where to find the joy. there's a check and balance the the money flows with prarpths. that's something i'm dreaming up

and i think we can weave that into some of those conversations >> if i could just comment. up until now we've spent a lot of time with the underwriters and we've now about to start the discussion with the practitioners. so it's timely thank you >> great. >> any other comments? any public comment outreaching i don't think we're on public comment. director or you finished >> you know there's a lot of details about what we talk about i wasn't going to necessarily going to go into every meeting but i'm happy to if there's a

appetite for that. >> i was participating in the meetings on the one on the 23rd. i know the intent and the objectives of the meetings have indeed caused kaiser to think ahead of the process and that's part of the review we did last year and after the fact discussions about renewal rates and what have you. as we ignored there is room and time not a lot for additional thinking around this so to the degree that members of the plan and i mean all the members of the plan have an opportunity to

raise questions to the commissioners directly you should be doing so. i said this last month and i want to reiterate we can't wait until next spring to discover oh, it's all over. so i hope that members will euville them both active and retired to come and speak up at this phase of the process >> any other xhishthsz comments? this the item you i'd like to hear public comment from the members. this is particle a part of the resolution he we would like to get input from the unions and retiree and all members >> good afternoon larry bradshaw. on behalf of the labor we want to welcome this opportunity for

those monthly briefing on h reports. we're hearing a lot of - i'm sacrificing our members have taken a rate decreases and we're being hit with increased health care and co-pays so our members are asking us to look at this and see how we can influence that. thank you so much for the report. i have a question about the report does h f s require the defects in plans as a paramedic there was one person who was

discharged from the emergency room and is going back both the hospital but does h s think they have a profit cap or things like full transparence on the rates. i know you've had preliminary conversation and the documents you as a you're going to be evaluating that but what is you're thinking >> director. actually, i think those are both good points but i want to make sure i want to say you've made a recommendation to us to make sure when we're discussing with kaiser i want to make sure i captured it completely reporting on the defects or - oh, the pa

cs. thank you. i think we at the may 9th meeting provided the guidance what we think is reasonable in terms of profit. but if you have further thoughts, please this is the forum >> any other public comment? >> hi i'm a retiree. well, in this report i hoped they would spell out all the acronyms. i posted an article on the facebook is between the hospitalizations and my wife was in the hospital in the sprirment because kaiser gave her the

wrong medicine but she was getting the same care and the only reason was in the payment and they said one is hospitalization and one is observation and the doctors are the ones who enter the billing code. there's an interesting story on m pr that i posted additional it does effect people on medicare so maybe you, ask kaiser what is it and report on the difference between hospitalization and observation because it makes a difference if a person in home care has to go back to the

hospital. she had to go back to the hospital and had to pay 9 thousand because it wasn't codified. can you get a opinion from kaiser on that. thank you >> commissioner frazer. >> so the issue of hospitalization and observation that's a medicare issue so if you ask kaiser to do it you should ask every other medicare plan to do it you may be convincing the two. >> any other public comment. oh, please come forward >> i'm here on behavior. >> can't hear you. >> is that better?

>> thank you. >> hello, i'm here on behalf of the local 21 we're. >> i still can't hear you, you have to speak a little bit closer. >> okay. we're here to say we appreciate the board supporting this particle as - particularly harassing as it relates to kaiser. >> and representing pr b i have a written statement to read but before that with the statements of richard brought that actually providers are doing to screw with the medicare payments their

probable for their own payments and it's a question to be asked of the providers and not medicare. medicare is falling the payment and it's being screwed with so medicare is not picking up the cost. po b times me to read this statement and one thing we'd like you to know when we talk about development costs from kaiser we're hoping those are not increases that are passed on to our members because they've been developing better facilities but those construction costs shouldn't be passed on. on behalf of the po b thank you for allowing retirees in the

negotiations rewarding rates. we appreciate you're willingness to listen to us. po b believes the hospital board and staff works diligently to insure the best possible rates. further we firmly believe it's defense attorneys the jurisdiction of the health board to negotiate on rates and benefits for the members of the system. san francisco taxpayers will save more than 52.6 million over the next year's by pursuant decisions. while the resolution was well meaning the tack of upholding the benefits hostage was irresponsible that tactic and delay caused do you get and fear

among other retirees who rely on kaiser doctors. they're not a political health chip over half 55 thousands of those lives are enrolled in kaiser. we believe that special interests will continue to insert themselves into this process and it undermines the charter and competition betwe betweentions providers we support the rates and the board of supervisors in their desire for transparency. as you negotiate please beermentd that po b supports the lower costs of care. costs is vital to argue roasts -

i'm almost done. we hope you'll harness data to analyze the data and it can be tapped to help the beneficiaries of the health service system. there's a great need for that type of information to help transfer the data not harmful for the negotiations and health passage. we also i will add support adding dr. to this passage. thank you for indulging me >> i want to say if we account give a time leeway on the speakers. >> hello, i'm sal i didn't i'm speaking on the 10 to one.

i wanted to just pickup on something that larry bradshaw said and ask an additional question maybe it's a comment maybe our thinking about quality bajsz of based on performance guarantees report on provider profitable and attach performance guarantees that are related to specific and 34ush8 reductions just a question about whether that's an anticipated part of our negotiations >> absolutely and even with more vigor now that i hear this is how important but hearing our

voices today knowing that's something you want to pursue we'll continue to work towards that. >> any other public comment on this item? any comment from the commissioners? no comment public utilities seeing none, item number 6 >> discussion item and presentation of dashboard. >> data manager for the system. >> dr. with the a and hewitt. >> today, we're going to bring

the cost and the utilization blue shield and it talks about the cost trends for the plan. highlighted in this particular report is the impact of the implementation of the h co and the cost trends. to put it into prospective. and the implementation of flex funded has also given us an opportunity to singeing the dashboard such as rate setting and risk assessments that we perform. this has been our opportunity to again focus on merging trends as