california. where the accountability happens is at the local level. all of these non profit hospitals are creating a health needs assessment and that determines what are the needs of the community and then simultaneously, they prepare an annual benefit report. hopefully the community is looking at the report on what the hospital did verses what the community needs and hopefully those match up. but that's where that comparison needs to happen is at the local level. thank you. >> thanks very much. mr. smith. we're going to have comment -- public comment in a minute. at this point i'll ask kaiser to come up and thank you for being here and for your continuing to work with the city of san francisco in our service system. >> thank you very much farrel and mar. it's a privilege to be here. we're here to today

to lend our support and to affirm our commitment to quality transparency and to price transparency. i am -- i'm the manager here in san francisco for kaiser foundation hospital and health plan and i'm accountable for the care delivered to a little of over $192,000 people. 3,000 healthy san francisco 192,000 people. 3,000 healthy san francisco healthy participant and $3,000 health members and for kaiser california we serve 55,000 city and county employees and a little over 2,000 in san francisco. we value our partner and our relationship with the city and county. and we look forward to collaborating on this effort. for many years, kaiser has been involved in sharing successful

clinical practices, quality transparency. we know that by doing that, we get the best clinical outcomes for our patients. for example, if you're a kaiser member in northern california, you have a 30 percent lower risk of dying from heart disease as compared to someone who is not. we have outcomes like that and we know that's not enough. we know we have more work to do. we also acknowledge that while we've been the lowest priced health plan for the city and county since 2008, we know that doesn't necessarily mean affordable to people. we know we have to do better and so i want to reaffirm our commitment to tell you that we will continue to collaborate. we support the principals of

quality transparency as well as price transparency and i've asked my colleague, our senior vice president for sales and account management in california, peter andraty to talk about this issue of transparency. >> thanks. hello supervisors and good to see you again. i'm sure you'll have questions later. i work with lisa and the hsf staff on our contract and how we deliver services here and i'm responsible for working with 8,000 large groups in california including public sector accounts and 80,000 small businesses so i work with the group market. we at kaiser agree that the rising cost of health care is a challenge to you, it's a challenge to the citizens here in this city and it's the biggest challenge we

face in america and in fact costs and affordability is really what triggered health care reform. that was the issue. both insurance carriers and health care providers need to pick up this challenge and be sure that people like you that pay the bills, people like you guys who pay the bills, you can afford the insurance and it has to be high quality. i'm going to talk about how it has to be cost and quality. our purpose is provide the highest quality care that's affordable and insure the community. chris spends a lot of time, our organization spends a lot of time in the community. it's around the community health and population health management and not just our members. we want to improve the health of the community. you have to told me that we have high quality and so you've said, i've got it. you have high

quality. it's the cost. it's almost back to bill clinton, the economy is stupid. it's the cost. we hear you. our whole company hears you. our new ceo made public statements that health -- health care insurance is unaffordable. and we have physicians that are doing things everyday to drive down the cost of health insurance and health care while improving quality. we're also encouraged that there's a number of studies out there and you know them already. there's accounting and consulting firm that says kaiser is the most sufficient health care in california. that's not good enough. it doesn't mean we're affordable but it says we're more efficient than the others. we're deeply committed and i was with lisa today for over an hour, so i want to reemphasize

that we're committed to the city and county and your employees and your union to give you the best value for your health care dollar and we intend to lead the way to make things better regarding both the cost and the transparency. so it's a little strange. we talked about transparency. i go throughout the state and talk to customers and transparency means a lot to a lot of different people. it can mean unit costs, it can mean quality. it can mean inappropriate care which we hear. it could mean your margins. it could mean why does your ceo makes so much money. we actually believe it is about access to data and cost and the prices that's being charged vment --. we heard about that. we believe that groups like you and the

average first on should have better data to them. we believe that sharing data on quality cost and sufficient -- you can hold doctors and hospitals accountable for what they're doing. we believe the industry needs to focus on prevention and outcomes and create new metrics that measure quality and cost. it's cost, quality, outcomes and access. we don't have a lot up here, but you go down to south california and they have these narrow networks, we need to look at the qualities of those, who is in and out and access how long did it take to see a specialist. that's not the on plan list. it doesn't say that you have to wait six weeks to see a specialist. i'm trying to give you advice, access is a

big deal. >> can i ask a question. >> sure. >> in talking with all the insurance providers and our health service members and the union members, an easy thing to grab on is what is the data set we want. we talk about utilization as a big thing. quality, that's a gray area and i wonder in your experience, do people even begin to -- i think even on the same field in terms of agree to what quality or how to measure quality? >> we would love to work with the staff and you. i think there's lots of well known quality metric out there. leap frog, we heard. what is disappointing of it is the average consumer doesn't seem to care so what can we do

together to take and key this metric and turn that into something that the average group and the average person can understand and then say here's the quality scores, here's the cost and what's the best value accident so we would love to work with you and translating that into something simple. >> great. >> a couple of more remarks and i'll go on. >> we have tough times in this room or at least i've had tough times in this room a few months ago, so i appreciate that we're here and we're enthusiastic about working with lisa and the hsf staff and the entire board on our next renewal and on transparency and data reporting. ultimately this comes down to how can we make health care for affordable. there isn't one simple example. we're looking at care

transformation which is changing how we deliver care and we're looking to be more efficient and we're looking at the cost of things we get. so we have to buy drugs and contract with ambulances so we're try to go do that as best as possible because those costs get passed onto you of course. we recognize you want to look at your data for the same reason we want to look at the data. we have the same vision and goals, better care, better health and lower cost. thank you and i'll entertain all questions including about the integrated care management fee. >> supervisor mar. >> thank you for your work with the health service board and the system staff, but coming to the board of supervisors and explaining how we're moving forward with transparency and the acknowledgement that our

community needs. i love that thrive. it's prominent throughout the city and the tremendous support to the community based programs is really valuable to me. i'm touring the french campus. i think it's on friday which is in my district and i appreciate this transparency as we move forward. >> i was born at that hospital too. any other questions in supervisor avalos. >> i got stitched up many times at kaiser hospital. my son was born there. >> thank you for being here. >> excuse me. thank you, sir. we'll have public comment in a minute. i want to thank anyone who did come. those speakers, i think, we'll have concluding comments, but we'll open up to

public comment. everyone will have two minutes. i have a few speaker cards and there's more. larry brad shau and brook. please, anyone want to speak in public comment and everyone will have two minutes to speak. >> is this working? >> sir, sir, the podium will work, go ahead. >> this is -- [inaudible]. stand still is a body. stop it at a good point where it needs to be stem too. [inaudible]. laws and competitions and unless there's market making and market up and down and competitions. point number

two, price structure. difficulties allies for price paid for construction. third point, the way and rules for spending in terms of choices. all mutual benefits [inaudible]. one day of opening or one day of closing. one day of promoting and one way of cutting short. one day of live and one day of killing. one way of discussion and one way [inaudible]. this can be summarized. terms of contracts. wholesalers and sellers. [inaudible]. that matters, thank you. >> thank you very much. next speaker. >> good afternoon supervisor.

i want to first thank you so much for all work that the city staff has done for your leadership on this. this is such an important issue and i'm the vice president the politics for 1021. and the same thing has been happening in san francisco throughout the northern california and i wanted to make comments about why it's important that we attack these issues about cost, transparency and quality. as you know california premiums have stored 170 percent in 2002. and the health care rises, family incomes become very difficult to manage and cannot keep pace of inflation. the insurance cost rise on profit. for example, kaiser profits are $8 billion a year. and high prices, net revenues

for california homes increased 11 percent and discharges only increases by 4 percent. the cost are passed onto us in next year's premium. if we don't reform our health care market by having transparency, health insurance will equal 120 percent. we have a chance to address these problems and not shift them to families and i thank you for your leadership. >> next speaker. i want to take a second to recognize the health service board members that have joined us today. thank you all. mr. bradshaw. >> mr. bradshaw. i'm a long time paramedic for the city and county. i pick up one diabetic patient every shift. as a study, i don't no if this would

project, but in a study that was done, it shows 30 percent of our -- of what we spend on care for diabetics is wasted on outcomes that were preventable. infections and outcomes and rehospitalization. that's similar. when i get a diabetic patient that ask me, what hospital would you go to, particularly in the regular hospital is on diversion, i can get a feeling of what hospital they can go. i don't know if my dee diabetic patient has a leg ulcer. where should they go for the best care. i don't that have data and hsf don't have that data. their own medical doctor don't have that

data. kaiser has that data and they track that for the avoidable data. they didn't share the data and that's what we need to drive quality health care. i hope if we move forward, that the board will make data required. >> next speaker accident please. >> good afternoon supervisor. my name is rebecca and i'm a registered nurse and a member of sci 1021. larry talked about the data and we need it not just on pricing but outcomes. patients wants that data and we don't know what to tell them. we have ads are with the best guesses. that's not how we do things in medicine. i'm better off buying a used car in san francisco than i am trying to

figure out which provider, which facility provides better karat a reasonable cost. when i buy a used car, they give me a car fax and it says that car has been involved in five collisions or that car was a rental. i have the data. it gives me the information to make the best decision. right now you have the power to look at regulation, to look at legislation, to promote transparency because secrecy is never a good thing. thank you. >> thank you very much. next speaker, please. >> i wanted to answer your question, supervisor. last year the commute hospital of san francisco sent $179 million dollar on health care. >> next speaker. if anybody wants to speak in public comment, come forward. >> i want to congratulate you

for pronouncing my name right. i'm going to make a short comment. i think this is a wonderful hearing that we're having today and i thank the supervisors and the speakers forgiving this presentation. i've had a long term interest in health care and why it's so ex pen -- expensive and why they can't provide the same amount of care. it's instrumental in making this possible, patly behind the scenes and i know they said theft is very interested in the same topic. if us, as ten to one members, we represent many of the people who are in the lower income level would are really impacted when the price of health care goes up, so we really look forward to continuing to work with all of the parties, the critical role we play is helping to mobilize

the public. it's not enough just to have discussions, you have to also have the power to bring the negotiations about that will lower the cost of health care. so thanks everybody, again. >> thank you. >> next speaker, please. >> excuse me, sir. everyone has two minutes to speak. sorry, sir. you've already spoken in public comment. thank you very much. >> next speaker, please. >> hi, good afternoon supervisors. following on the hearings that were held with the kaiser rate renewal over the summer and we're hearing today, there have been general statements made about transparency and the willingness to be more transparent. that's a shared go, et cetera. i'm wondering if we can get something a little bit more specific because what we're talking about in terms of transparency is transparency in cost, transparency in pricing and

outcomes also, rate quality, metric. i'm wondering if the kaiser representative can commit to anything as far as transparency such as acute and chronic conditions and how those compare across the bay area, kaiser facilities, something like that. >> thank you very much. are there any members of the public who wish to comment on this item? >> mr. daily. supervisor, welcome back. >> i'll go once. thank you mr. chairman, first. let me thank you and this committee for your work on health transparency and for the follow through and for -- we thank the health service system as well and their professional staff for a thorough presentation and to follow through with what's happening. but following up on jeffrey's comment, i was going to speak on the next item, but

i'll take this opportunity to say, you know, look, our union, this city, our state senator in sacramento had a bill for some of this very same purpose, sb 747, passed. with barely a whistle was vetoed by jerry brown. there was little in the veto message, so why we appreciate the talk about the transparency from council and kaiser, it's clear that the hastings is what we need to get the transparency we need. i won't speak on that next item when that comes up, but thank

you for your work and pursuing this and you have a partner in the house of labor to make sure this happens, thank you. >> thank you very much. are there any other members the public who wish to comment on items one or two. we call them both together. okay. seeing none. public comment is closed. i would like to wrap up here by thanking everyone who came today and especially those who put in the hard work, like lisa and the union workers and all the speakers that came and many flew from out of town and i want to thank our state hospital council and i want to thank kaiser for being here. we are uniformly in agreement that transparency is something that we need to pursue as a city. there's no disputing the facts about rising health care cost. i think some of the most

stark slides that we've seen today are in rising health care prices verses income and it's eating up our family's income in san francisco and across our country. it's an issue that as an employer. i want to thank anyone who came together but has been working on this issue since the summer. we have legislation that's in draft form that we'll be working on together to be introduced in the relatively near term to really make sure that san francisco is a leader here and we can be an example and do it right in san francisco and to lower cost outcome. i want to thank anyone involved and look forward to working -- continuing to work on this topic not only today but in the future and making a difference

in our city. supervisor mar. >> i want to thank farrel on this and he's got the health service staff. i wanted to be added as a cosponsor of item 2. despite the health service boards members, i feel we're benefiting the public in what we're doing here and it's our role as the board of supervisor when we want more information and we demand that transparency and i hope we work together at the state level. i don't think we would have had this discussion without a strong voice from the community and the labor saying let's have a dialogue with this with mutual respect. i'm glad that kaiser and i saw rose here earlier, but really the hospital rep working with communities to make our on health system work better with equity focus as

well. thank you. >> thank you supervisor mar. so if there are no other comments, colleagues, items 1 and 2, so i'm going to continue 1 to the college of the hearing. we can do that without objection. item 2 is the motion in resolution supporting transparency and thank you supervisor mar for your cosponsor ship and we can move that forward. thank you everyone. >> mr. clerk, we're going to move onto the rest of the agenda. call item number 3. >> item number 3 ordinance appropriating $13,786,681 of parking garage revenue and expenditures to the municipal transportation agency consisting of $8,513,825 for the 5th and mission parking garage and $5,272,856 for the ellis-o'farrell parking garage in order to support the department's projected revenue and expenditure increases.

>> item number 3 ordinance appropriating $13,786,681 of parking garage revenue and expenditures to the municipal transportation agency consisting of $8,513,825 for the 5th and mission parking garage and $5,272,856 for the ellis-o'farrell parking garage in order to support the department's projected revenue and expenditure increases. >> okay. thank you very much. i had some knowledge from the mta speaker, i don't necessity if anyone else from the mta -- i'm sorry. i saw you earlier. thank you for being here. >> good afternoon supervisor. steve lee. the $13.8 million garage revenue and expenditures supplemental appropriation before you, $8.5 million for the garage and 5.3 for the farrel garage. it's a result of the sfmta refinancing the debt owed by the corporations that ran those two garages. in july of 2012, the mta refunded $6 million for the 5th and mission garage and $2.5 million for the garage. the mta terminated its lease with the

two garage corporations. so historically the garages were run in a way that the corporations collected all of the gross revenue and paid all the expenditures and at the end of the fiscal year gave the mta the net income, so within the mta budget, the only budget line area was the reflection of the net income. now that the mta is running the garage directly, we need to have an expend tour so we can run them. we recommend that you approve this. >> thank you very much. colleagues, any questions? could we go to our budget analyst report, please. >> good afternoon, chair farrel and members of the committee. campbell from budget

legislative office. we recommend adjustments to the ordinance with locating the correct amount of money of the ordinance which the department agreed with. otherwise we recommend the approval of the ordinance is amended. >> okay. thank you very much. any questions, colleagues for the budget analyst? we'll move onto public comment. are there any members of the public who wish to comment on item number 3. seeing none. public comment is closed. colleagues, we have proposed recommendations. we have a motion to approve those. we can do to without opposition and the underlining item as amended, can we make that amended for approval. thank you very much. item number 4, mr. clerk, can you please call item number 4. >> item number 4 resolution extending an agreement between the city and county of san francisco and s & s trucking corporation from december 20, 2013, through december 19, 2015, and increasing the estimated cumulative contract amount from $9,000,000 to $13,500,000 for hauling biosolids sludgee and grit,

pursuant to charter, section 9.118 bb. public utilities commissionn. >> item number 4 resolution extending an agreement between the city and county of san francisco and s & s trucking corporation from december 20, 2013, through december 19, 2015, and increasing the estimated cumulative contract amount from $9,000,000 to $13,500,000 for hauling biosolids sludgee and grit, pursuant to charter, section 9.118 bb. public utilities commissionn. >> i know we have agreement that this item will be continued for one week until our next meeting. so unless -- is there anyone from the pc that wish to comment? we don't need it. we're all in agreement. we'll skip the budget analyst report. we have to open up to public comment. anyone wish to comment. seeing none, public comment is closed. colleagues can we have a motion to continue in one week. we can do so without opposition. clerk, please call item number 5. >> item number 5 resolution retroactively authorizing the sheriff's department to amend the existing contract with global tel*link for inmate telephone services, which will result in an anticipated commission to the inmate welfare fund of more than $10,000,000 over a four-year period from june 1, 2010, through may 31, 2014, with a one-year >> item number 5 resolution