>> everybody ready? the health service board meeting will come to order.

all take down for the pledge. and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. roll call please. roll call. president, vice president limb. specify farrell >> supervisor phrasing. here >> inspires scott. >> we have a quorum. all right. item one >> with possible modifications of the meeting regular meeting of august 8, 2013, all the any kreksz correction to the

minutes? no corrections i will entertain a motion >> so move forward. >> second. >> okay. any public comment on this item. all in favor? it's unanimous. item number 2, please >> item two presidents report and i have nothing to report today. >> any public comment on this item? moving item 3. >> director's report lisa god from the. >> please. lisa acting director i'll to give you an update of the work of the health service tame in the month of august. very, very happy we have our new

cf o pamela has been with us in the comptrollers office and working in the public health for years. very, very experienced cf o in the city and a health care. i think the insurance health care side might be a challenge but she'll pick it up fast. we've started interviews for our wellness manager and we've got some national candidates that are looking forward to interviewing >> financial analysis position is closing and interviews have

gone and we've posted the manager positions. in terms of operation we have august was slightly lower that in terms of vacuum card to august of last year and our targets in terms of performance were all below targets. so in preparation for annual enrollment we try to clean up our easy and make sure that our addresses are valid the postage costs a little bit under 3 dollars and we send out 65 thousand paths costing 65 thousand dollars so we make sure when we're mailing the address is accurate. we've done better in terms of only have 23 addresses that were identified as incorrect by the

u.s. postal service and they spend time to track those down and we're looking at the about maybe 17 hundred that might be questionable. we should have pretty good deliver rates. we also do before an open enrollment we do on audit to determine whether or not the folks are still eligible for benefits whether or not they've obtained employment or coverage elsewhere. we had one-hundred and 26 folks identified on the list and have received response from nine hundred and 8 and other folks have other coverage so the audit

will be completed in time for the open enrollment mailing. as we've talked about in previous meetings we've had to rebuild the refluks flex credit for the units. the teams have long been working hard on u a test to make sure it's functioning correctly and i think we have completed all i have that and we're confident it's going to be a smooth enrollment for the m e a unions. in the really a fundamental step to make sure we're ready for the obama benefits in 2015. the communication team has been very busy with getting the guides and the information correct and they've all been

think sent to printers and they'll all be out on time in advance of the october 1st date. you will see later under agenda item 7 you'll see a communication strategy project that ross mary has been working on and it's a very interesting presentation on where consumption with benefits needs to go in the future and we're also starting an rfp system. our rates and a benefits are completed and the benefits are on track to be completed for the beginning open enrollment and the audit is in progress started on september 9th. rates and benefits negotiates and kaiser negotiation negotiations we started number 5 and we'll be going into that.

we've gone discussions with blue shield cost alternatives for 2015. the wellness team/have long been working hard on an enormous number of flu clinics we have 17 and including up in boston and all over the city we're going looking forward to that and i think that will go a long way to our winter costs that we'll see because of the flew. the epa staff supported our pe c during the rim fire and the traevenlg accident with our

parks and rec pr we have the city's annual performance you'll see on item 6 have had to do some building of our blue shield data and the data team heads up all the work around the projects. in terms of meetings we met that the kaiser negotiations and the school district leadership to start talking about doing some attraction moldz. as you know, we've worked with the city on contribution models and the school district is interested in similar effort. we've been joining the committees on health and wellness and participated over

the summer on payment reform that were interesting on where the marketplace is going toward bundle type of payments based on outcomes. covered california forum was hosted at mission bay i guess it was sort of a kickoff presentation on covered california. the km g kickoff and the atf we had over 1 hundred and 20 members at the seminar and to hear about the employees that might be facing early retirement and to make sure they know what their benefits are and the best practices in government epa was an interesting seminar that our staff participated in to see

whether there's opportunities to approve the employee benefits. on a more recent note the s b-46 which is a bill sponsored by senator len 0 on transparence passed for a signature and we spoke with retiree about open enrollment. in closing, i want to say not an hour of the day goes by when we don't miss our director kaefrlg todd. we're all working hard together to get through. i think it katherine is doing is good job fighting cancer and want to say how much she's

missed and thank you everyone in terms of we're having slow irons in some areas and thank you for your patience we're definitely feeling here absence >> any comments? i'd like to ask a request about s p-46. could you give a short summary of that will it make a big difference and i think we believe that this bill will be very important to all large group employers doing business in the state of california you are about to give there are essentially 3 sections of the law that are changed. the first two have to do with

transparency other than the premium payment. - plans that set their claims based on claims data so a lot of the services that are driving the trend that are driving the premium rates and also another section, section f chickens specific to i think health plans that do necessarily base their pricing on claims and it's getting into detail. we see it as something that will provide significant trainers on the the trend driving the marketplace and as a purchaser more information about what's driving our premium rate increases >> will it have any effect on the contracts for the doctor's

at hospitals. >> not directly you'll be able to see if inpatient is driving a premium you'll be able to see whether it's unit cost or utilization by you won't be able to say can i see the contract on one hospital so if itself hospital is driving the trend this law doesn't get to the level of trainers around contracts thank you. any more comments. >> i - sorry. i have to get used to hear my new - here human resources commissioner scott >> histoe oh, yes. the consensus survey director - no - she's helping over there. i'm sorry. the sense of survey employer sponsored health plan can you explain that and will the

results of that be shared with 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 effects where 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