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 we move forward and are reporting to the board. please note that each of the per thousand metrics are represented as an annual listed member. the content for our report will

include the utilization for surgical and maternity services. utilization for the anti patient office visit, lab and urgent care and surgical procedures from pharmacy to utilization and the impact of the high cost provided by blue will shield as matter of our annual litigants part of our report. so at this point i'm going go to turn to over to my colleague. i want to first drawing our attention to some of the changes in the dashboard assault of combrooin the services. you'll notice in our graft we've

highlighted you may need for comparison purposes and it helps when you've made a decision how that's made an impact going forward so it gave us a prospective historically of how positive the actions that the board has taken has been for the members. i'd like to note on the grafts that you can see in the june or july of 2011 is when the ac o started i mean technically in june but july of 2011 and you'll notice there's on a stabilization, if you will, in 2012 and 2013 as the member. i want to draw our attention to offer this 3 year period you'll notice that the membership has aged by 1.4 years.

that means 91 if you assumed that 2010 was the baseline or one that there are 3 or about 3.3 percent higher risk this is based on demographic risks. any questions before i go on? okay. what you will notice based on our finding first of all, your subsidy has had a impact and the age of the population is increasing and with the age increasing you have a increased scores. moving to page 34. one of the things you should notice in the red circle of 3 carriers that below cross went down and the other 3 went up

sorry blue shield went down by 1.5 percent and that's going down with the aim and risk increase. and we do consider this reduction to year after year it maybe the impact of the ac o because this might be the first year >> moving onto the page 5. >> sorry. >> you have to push. >> sorry. you brought theble blue shield risk and decrease in price their risk went up and - i'm sorry the average age is lower i don't know if the risk score went down

>> off the top of my head i don't know if kaisers risk score went down. >> but if age is a metric e metric then the risk score is lower for kaiser and the cost went up. >> that's a correct analogy correct. any other questions? director godfrey >> i want to point out those are claims not guilty premium price so it's important to distinguish. i think if we had the same kind of prigdz from kaiser, you know, if it was based on claims we might have seen a reduction as well but the claims - just pointing out. moving onto page 57. we want to talk about this 3

year period that the total costs remain stabilize with only a 1.9 percent increase over the past year. one of the things to benchmark this is for the industry period was 8.5 to 10 percent and one would assume that due to the efforts of the ac o the the inpatient costs represent only 25 percent of the claim dollar. first is the 27 percent that was in the prior years. the cost of inpatient is a major impact to your budget is going down >> moving to page 6. so what i want to do and note that you'll notice it says

percent for inpatient facility. in the a medical cost not to include pharmacy that was included in the pie chart is not in the medical costs that's why there's a difference in the cost from one payment to the next. one of the things you'll notice is the change relative to inpatient is a 12 percent decrease and this is the efforts of the ac o plaintiff's and the increase in the capitation are still less than the industry. so again, this is representing very good work on the part of the blue shield and h f. this is for the thousand members

first of all, you'll notice that the emits increase was driven by the medical admits so they went up to 21 from a low of about 16. in the second quarter of 2012 and again one of the things be we've seen is this january was one of the busiest months that the local hospitals has seen in years and this was carried across the nation as well. so i will talk about and you'll see the impact of the acs review there were more admits during this timeframe but you'll notice that didn't resolve in great days they were able to get them in and out.

so in looking at the next slide page 8 inpatient per thousand members has decreased and again, it's that bar that runs up and down the chart that went from a high, if you will, if i look at down to the average of 169 it's a significant decrease. one of the things we find somewhat paradoxal the maternity permits are going up and we think that's now that people are willing to have children again. looking at the average length of stay you'll notice the average electricity of stay for the inpatient invests overall has

remained flat, however, you'll also note increases a decrease in the medical average lethal of stay remember arthritis where the admits went up but the medication went down and that is the decrease in inpatient days. 4r50sh9 your inpatient cost per day it increased and this increase was really you driven, if you will, by the medical costs as you know in the hospital the short the stay the more intense of the services that are used in the days that are there but we want to insure that that is happening. the other thing we wanted to note is we would have expected due to the changing democrat graphics for blue shield you'd have higher costs we didn't see

if you remember from page 3. now - any questions before i move on to out patient? looking at outpatient services we see that outpatient procedures have increased 7.7 percent over the past year. one of the reasons is the increase in colin procedures. and we have other increasing go in the musculoskeletal diseases is our top reason for seeking care and overall one of the things is the urgent care is one-hundred and 56 visits power thousands and the c e os are

experiencing higher visits. moving on the cost of outpatient services one of the things a that's nice to see is the the surgical procedure costs reduced. and overall you'll notice that united states outpatient costs has gone down 9.7 percent and the main driving drivers are the surgical costs and this $313 decreases translates to approximately $1.4 million for the trust fund. we then look at are our services being used. we're looking at the

professional procedures per thousand if you want to divide this but 1 thousand but the trends you see about 1.2 office visits per person per year that your overall contact with the system meaning our lab x rays so you're seeing not way you sauce u saw in the hmo as the doctor awe let you to earlier there's a decrease in folks being seen and there's a decrease in the procedure per thousand we're trying to understand meaning surgical procedures that might

not be being done we're report on that in a later meeting >> 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 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