>> item 9, action item, approval of section 125 cafeteria plan updates, lisa ghotbi. >> so, the changes for the cafeteria plan document are in some way consistent with the changes to the rules, the first one being on page b4, and discussing the update to the fsa healthcare and the fsa carry forward. and so i think that that one, does go because it has that entire section on the forfeit turf the unused balances and i think that it does cover that issue from the rules, and in more detail, but just wanted to see if there were any questions? >> so i would like to make a motion to amend this to make it clear that the minimum of $10 means anything under $10 is forfeited. and if you happen to have language, eric? >> if you don't that is fine.

>> the language, and that actually sounds good what you are saying. >> i second the motion. >> all right. >> and we will not vote on that separately, but we will call that and add that when we look at the time item in its entirety, any other questions on this one? >> good. >> all right. next one. >> the next one is on page d3 and this is where we have listed the flex credit values, for the different groups that have flex credit as part of their benefits and so the changes for 2015, are listed and you will see that the changes this year, for the city and county, are slightly different than we have had in the past and then that there is a different amount of flex credit depending on and for the family coverage depending on the health plan that you select. and so this is a different application, of the flex credit benefits and i wanted to make sure that you are aware of that and approving it. >> any questions on this one? >> all right. and the last one is just

updating, right? >> right. >> the last change is just to update the groups on the etna plan. so with that. >> any other questions from commissioners? >> all right, so you have moved this in its entirety. >> yes, i move the adoption of item nine, with the appropriate amendment regarding the less than the $10 amount that it be adopted. >> second. >> any public comment on this item? >> seeing none we will call the question, all of those if favor, aye. >> opposition? any abstaining? >> great, wonderful, thank you. >> and i just wanted to say lisa by the way the summary is very helpful and i appreciate that. >> all right, next item. >> item ten, discussion item, report on the vendors on after hours care.

hss vendors. >> yes, so i think that the correction, while we have been fine. >> that is okay. >> and to explain to those on television or anyone else in listening, you have a powerpoint, which we have and which i believe that people attending also have a copy of? >> yes, i can get a copy of, it is just not going to up on the screen. >> heather with united healthcare and thanks for having us today and so i have some information on urgent care resources for the united healthcare members and how they can best ease to reach and yous multiple options for people to use. and so to the second page and we are talking about the tools that are available. and so number one our website for people who are using that,

the my, uhc.com and i will go through that and we have a couple of apps for the smart phone users and a lot of people like to use tho and hope for me and doc gps and the people who want to know that they can call the customer service center, and those customer service representatives will help them and then lastly just so that the people that do have the tools and helping the people decide if it is an urgent care issue and an emergency issue and after care and then those are materials that can be placed on the member website so that they have additional tools. and first of all, the my uhc.com, and so the folks can search for the physicians or facility and this works for the urgent care as well as doctors and the important thing for the members is that they know, what network they choose, because that will drive the results that they get. so first it says, choose the network for the city and county which is our choice first network and the on the right side, it is hard to see and they will type in what the

network is and search what they are looking for and there is also the quick links and of course, the urgent care center ss one of those links and they can search for that center. >> what network with you talking about? >> all united healthcare members, have choice plus network, and so when you go to my uhc.com and you are attempting to do a search it is going to ask you what network because we have networks by different names. >> we wanted to put that there because that is an important tool as you always will look under the choice plus network. >> how would they know that? >> well, you know, that is something to think about is that the member, i mean, certainly if you call or use the apps you are going to have that, but on the my uhc dot web site, let's take a peek. >> if there is a member id card on here. >> it is not. >> it is not on the member id card. >> it is in the member guide. >> it is in your member guide? >> and so, on the member guide, they are aware of that. >> yeah. >> but the issue that came to

us that triggered this report, was a gentleman, and i forget where he lives and i was been out of the city and but the retiree, and he basically did call the number and then, it went sideways and that is why you are here today. >> so they don't know what network. >> if the threshold question is that before you call in to find out what urgent care center is, you got to know what network you are in. that is a fundamental piece of information that needs to be just as clear, as where you are putting the telephone number. >> yeah. >> otherwise people are going to say, i am signed up for, >> united healthcare. >> and keep saying that. >> and over and over >> right, if the customer service person is helping them correctly and the member has their id card and give them the card and name, they will know that they are on the choice plus network because they are going to see it that is the one way that the customer service as soon as they look them up and identify them as an employee they will know the

network and be able to help them. >> that seems to be the missing element >> yeah. >> the card. >> it is on the card. thank you. >> the bottom right-hand corner. >> i have not looked at that. >> united healthcare choice plus. >> yeah that is all that they need to say is choice plus. and so, that is the piece, but they are not going to know, you are right, it is on there. >> but i see this here, and i am going to say that is like blue advantage. >> yeah. >> it is a line there, and it does not tell me that this is the key word, to cause you to get into our system. >> yeah. so we need to at least, you know, try to highlight that somehow, in the member guide, or something, that you need to know that we here in san francisco are in this network. >> yeah. >> any time that you are facing with the customer service. >> because that looks like it is the title of what united healthcare is verses, that tells me what network that i am in. >> right. >> maybe we can put it?

the, when you send the confirm nation back. >> and in the enrollment. >> and the instructions to members. >> why don't we ask you to think about a way and there are ways that it can be the city health plan-what is it call again? >> choice plus network or something like that. we will leave it to your discretion. >> okay. >> and it is good timing because we are signing off on all of these guides and member tools and make sure that is on there and i can see how that will be the hard part. >> if you contact them and a urgent care center, you want to know if they are in the choice plan network. >> yes, basically, if you are searching by the correct network, the only things that are going to show up are in the network facility to go to and like he said that is the key piece. >> if you make that phone call. >> urgent care center. >> yeah, and so that is really how this works so if you are looking for an urgent care center you go on next and you can put in a zip code range and a that i want to know 50 or 100 miles, what are my options and

actually what comes up is that a pdf directory that you can print real time and that is a nice tool once they found that and if they want to they can printout that information and the other thing that you can do once you have found that care center and picked it is that you can map the directions so that it will work like a map quest it will give you the directions to get to that location. >> the printout, is that where you got it from the site? >> yes. >> yes. right from my uhp.com and you search you can printout the directory and in your zip code range. >> so you can call or you can go to the computer. >> absolutely. >> and we have a lot of like i said, elderly people, right. >> and plan. >> and they want to use the website, you are right. they can call the customer service and if they look up them and so we will make sure that that tool is available. >> and i noticed that i did a little checking on these places over here. and some of them opened 7:00 to

7:00. and one on, and they are, and closed on sunday, and i mean, if they are going to be urgent care it seems to me that these places should be opened differents hours than this. >> i think that you going to find out that they will be open and that is where some of the tools of what kind of care do i need can come into play because it is after hours or on a sunday, then you have to make a determination if it can wait for a regular hours or needs to be addressed at emergency. and we try to avoid the emergency, when it is appropriate, we want folks there. but we do want people to use the urgent care centers. s and so, yeah, that is the one option, if it is, and every carrier is that way, if it is not urgent, they have to choose, whether to use the emergency, and there are other tools and things like the nurse line can help to determine, if it is necessary, to go to er. and those resources are also on my uhc.com. because they can actually talk for a nurse, 24/7 and tell them

what the symptoms are. >> and then, in another one, the pediatric medical, that is not a urgent care center. >> this just a sample, this was for the urgent care. >> i want specifically urgent care on here. >> yeah. >> i am not interested in the emergency room. >> right. >> okay. >> so these two are not, urgent cares? >> i don't know, is uc on here? >> this is just a sample that we pulled. and this is just a sample. >> well,... >> this goes, all the way as i can see to wvw, san francisco as only a few. but, and what i can tell, that it and when they call, and i personally called, the number. >> okay. >> so that i gave her and she wanted my zip code and i gave it to her and the closest that she could find was south, san francisco. and that and i gave her another zip code and the closest one to that was berkeley and i gave her another zip code and the

closest was south san francisco. and so, that is not really working well at all as far as a call in. if they can't find, you know, the person on the phone does not know where to find these places and you call in and it is not working. >> right. >> i know that south san francisco is not the closest place, can you tell me if the university of california is part of that, their emergency room? >> not without doing the search i couldn't tell you without that. >> how would i know that? >> stow, by using, if you used the... and so you called and gave them. >> and they didn't have it. >> right. >> but she did not have any. >> if we did the zip code search by urgent care, i could tell you, but i have not done the specific search to know if that is in network. >> how are people going to find this stuff? if i had all of this problem, you can sure that someone else was. i thought that we are trying to save money from the people going to the emergency rooms that is the objective here. >> right. >> and the people would rather go to a closure intelligent

care place than sit in afacility. >> and the one at usc has been there for a long time but it does not show up and then, i know that there is another one, over and the golden gate urgent care. and they are also, and the hours were better there too and they are actually opened saturday and sunday. >> but, i would like to know, and be able to find out, since the person on the phone did not know anything about this, as far as anything that was in san francisco. >> may i suggest that you provide to us a list of all urgent care facilities that you know are urgent care facilitis in san francisco? >> right. >> yeah. >> and we would like to see that. >> yeah, and i will take a look because i know that we pulled a sample here and so i don't know, and she did 100 miles from 94103 as the attachment. >> that is what i am suggesting for the future meeting. >> i think that the issue which will be and i know the answers, and i looked ahead on the test.

the issue is that, we have been trying, for example, to put together our member guide, and the vendor services staff called over and over again and said what is one number that i can call when i am sick? if i don't feel like going to the computer and, what is number that i can call and be told where i can go and get the urgent care uhc is not unique in not having one number but the message is that we want one place that our members can go, to find out where to go, otherwise they are just going to go to the emergency department. >> right. >> it does not help for us to... sure. >> for us to have a list. >> and whoever you call on the phone needs. >> and the members should be able to call the number for customer service on their ip. >> yeah. >> and that is the problem, but it is not working to look at that. >> and there is another one on here, smile and that is not

urgent care either.. and then they are lists in the facilities yeah. and i mean there is some way to get the message to the members so that it is not hard for them, that is the whole point of this. so they don't have to search and sit on the phone to get urgent care and i got cut off the first time. >> yeah. >> and i have not used the app. and i am not sure. >> here is what i am going to suggest. >> yeah. that you come back again, after doing a little bit more investigation. and as though you were a member, calling. to which i think is what part of what commissioner is pointing out that may be the way that most people are going to be looking for this. if i may, i am on-line and on the uhc website and i put in the zip code in san francisco and i typed in the urgent care

and, it came up with urgent, united healthcare, choice plus, urgent care centers located less than ten miles away, and then it has pediatric resource medical group, i know them, and they are, and they are golden gate urgent care, which is the workers comp for the most part. and you know, i think that it is one thing to have the names and lists and numbers and another thing about quality and these are closed and these are practices that unless you are a patient of them, you can't get in, i know that the owners of these practices and they are full. and so, they do do urgent care for their patients. but if you are a new patient, and not of that practice, you can't get in. because they don't know who you are and so you basically a new patient, and you are not an urgent existing patient they are not truly urgent care, they are pediatric practices. >> what is happening is that those providers have told us that they do urgent care, it

does not mean for the general public, they are listed as urgent care. >> and i think that the one qualifier, i used to run a care clinic is if you are saying the urgent care, it has to be for the new patient and for the existing patients because, a lot of people that are doing the urgent care, they tried to get in to their doctor, and they can't, they are looking for someone that is going to hold their door and has a welcome door or welcome wagon, you know, sign. i just think that nuance makes all of the difference in the world in clarifying what matters to people. >> sure. >> i am at home fixing christmas dinner, a cut my finger, do you want me to go... and i know that i am going to need stitches. do you want me to go to the emergency room, or can you tell me that i can go down to golden gate urgent care center, west portal and they can take me right now, and give me the stitches that i need, that is

the question. >> it is that simple. >> and yes, impart of the choice network. >> and that the pediatric resource, i call both of those numbers and they said that they are not an urgent care center. >> we are trying to find the urgent care. >> and they are going to tell me the criteria is that the provider indicates in their contract that they are accepting urgent care, they end up in our director, and i can't change that. it is a big animal. but i think that the important thing like you said is just a tool and a phone number to insure for this area, and a listing and making sure that is clear. and so that the directory and for the people to be able to get into a center. >> may i ask this of you? you are not the network manager. ; is that correct?? >> correct. >> and you don't do network management? >> correct. >> what function are you? >> i am your account executive

on medical benefits. >> all right. i am going to request that you, as our account executive in rendering the follow up report that we have requested and that at any future time that we come back to talk about this topic, that someone that you, take the accountability to bring someone with you from network management. the genesis of this issue is that genuinely it felt experience of the member and the representative, or a retiree, who spent in two and a half hours, trying to get through the very thing that we talked about today. and so, if it is a network management, issue, you should not be taking the heat for it. we need to be talking to those guys. >> sure. >> and i recognize that you know you are doing your function and that is fine. but they need to be here, as your colleague, if you guys are really serious about customer service. >> so, somebody who can do something about it. at least, to be able to say that i will take it under

advisement with my network management colleagues and it will be a better public answer, rather than saying, there is nothing that can be done and it is a big system. >> yeah, i did not mean that there is nothing that can be done, i know that there is criteria and that is why you are seeing that there are others and we can get, and those are ones that are available. >> and you know, there are really not that many in that area, i don't see why it is a big deal to be able to find them. >> yes. >> and another thing, some people will call their doctor's office. >> and the doctors don't know where the urgent care places are. and you would think that the doctors should have that information too. >> that is going to be more difficult, because they don't know the networks of the various, and many patientses of many, many different networks. >> (inaudible). >> so why don't we ask that you come back, on this issue and we appreciate the efforts that you

have made so far. >> and so that they get to hear it. >> no problem. >> right. >> no problem. >> i think that we have it kaiser up next >> good morning, is it morning, got up and flew, it has been a long day, good afternoon, cindy and i believe that you have two slides and i am going to go through thoughs fairly quickly to to allow for phone calls so as you guys. >> i think that you mean questions. >> did i say phone calls? >> really long day. >> good afternoon. we will start with slide one. >> okay. >> as you guys mentioned in the june board meeting when this came up is that kaiser is sort of a different model and a different beast, so that the way that we go about, funneling

the way for the members to find is that we have a number. there are a number of numbers, that they all go to the same place, and so some people are more comfortable with the san francisco prefix and the 800 number and all go to the same place and it is what we call, our aacc, our appointment and advice call center. and it functions, it is like a super appointment center, and nurse advice line and it does a number of things and it is really the place where you triage the member who is calling in for services and it is opened, 24 hours a day, and 7 days a week and all year long and it does not close for holidays and etc.. and it really, and the first slide, really defects, whether it triages you to a virtual visit or you triages you to an inperson visit and it depends on why you are calling and when you are calling, so the virtual visit is that it could be the rn advice as simple as i have a

fever and what should i do, it could move to a physician phone visit, and there is different levels of triage, and it could have an immediate specialist phone call and there is a number of triage protocols that they go through. and or, it could lead to, a pc, p, appointment if you call at 5:00, there are appointment that is that are available until 7:00 that night and on the weekends on saturday and sunday, around nine to one and the time frame and so you very well could be led into appoint. and our objective is to actually get you into an appointment slot, virtually in person, rather than having to go one place and waiting in a waiting room and you will see on the bottom right-hand corner, we will start to funnel some of these phone calls to the emergency rooms and they call call in and having chest pains and call 911, and we have

listed that one and a half phone calls lead to an emergency triage and we have provided the statistics, for you on the right just the average speed to answer the phone is 35 seconds. and there is number of metrics and then, we are fielding roughly, 46,000 calls a day now. and that is for all members in northern california. and regardless of where they are located and then on the second page, to just give you that snapshot, and i should mention the phone number it actually is not on the slide when i looked this morning, it is on the back of their membership card. and if they called our other 800 number, which is more about benefit and eligibilities and things like that, there is a prompt for you, if you are calling for, you know, advice and you push that button and it brings you to the right place, and so pretty much any number that they call they will get the hands on and they will get the application and on the second page we took a snapshot

and we have the charts for east of the area. >> let me just ask you one question. >> so your urgent care would be probably housed in the same place your emergency room would be? >> that is right. where there are urgent care locations if there is a distinction between the urgent care and emergency, they are in that and there is not a stand alone, urgent care only. >> good. >> and we have moved away from having urgent care everywhere, it is more about triaging you into the right location, but there are still a future urgent care locations and they are in the same place. >> i think that it is clearer now what you are doing and i understand this. >> great. and then page 2, just gives you a snapshot. of this area, that the broader bay area, and number of eobs and number of offices that we see in a year to give you a sense of the distribution at that location. >> thank you. >> anything that i did share that you were hoping to hear?

>> does anyone have any questions? >> that would be great. >> thank you. >> thank you. >> all right. >> next? >> blue shield? >> my question here first is don't you have a list of any urgent care places >> we didn't provide it. >> or did you miss my message last time >> this is what i was asking for. >> i am sorry, we were not clear that we were supposed to bring it to the meeting. we did provide a separate listing. i don't know a fau dies ago and it is not included in here. and we just made the presentation based on what we would tell a member or how we would advise them to find an urgent care center. >> this is not adequate, i would like to see where they are. because i have had three or four people do this phone call,

and not satisfaction. and i am not a blue shield member i could not do that myself. but the person that did show up at the prior meeting i believe that he was blue shield. and one person called on a saturday or a sunday, and they did not get any place in san francisco, it was an out lying areas, and it was not an emergency room situation. but, the person on the phone could not give them anything in this area, nothing in san francisco. and the other person that i called, gave them cpmc, which was the emergency room. and not the urgent care facility. and another person i can't remember what else, but it was just a real run around all of the time. and the person on the phone does not know, and so this phone number really means nothing in what you have here means nothing because everyone has this information, already.

we are looking and where are your, and where are the places that you will pay for that are urgent cares? >> so, and you will have to come back and bring more. >> okay. >> we will be sure to provide it in the next month's meeting. now for right now, do you want us to kind of go through what we... >> what is there to go through? >> these are the forms that are people already and i have had them call and unsatisfaction results. >> i do want to make one comment, chris perez, and gaib from blue shield, we are aware of the member that came and complained. and he did point out some items that we could do better on. and as a result of his complaint, from one of these board meetings we are trying to improve some of our on-line resources. >> it is not all on-line, the

phone. >> and the phone as well. >> nobody knows where these facilities are, and could not find anything near me and they are there. >> that is ridiculous. and i don't know how long we have been talking about saving money on emergency rooms, and we are still at this point. >> okay. >> we will be sure to include the complete listing in next month's meeting. >> and if someone would look them over first to make sure that they are actually urgent care facilities. >> the listing that we did, which was an ad hoc reporting we are not able to just you know, go through our find a provider site to get that, because, changes can happen at any time. additions or deleting but they made sure that they are just urgent care centered where they will be charged the urgent care co-pay and not the emergency co-pay. >> but, if i may, are you

saying almost like your colleagues, not kaiser but the colleagues prior, that if indeed, i get an urgent care center, it could be for pediatrics but they take the urgent care patients. i just cut my finger, and now, i have come to an address, and pediatric urgent care facility, is there some distinction in the system for the type of urgent care services that are provided at that location? and the interest here was not special, and not more specialized urgent care, but general, urgent care and i got a condition and i am not feeling well and i have fallen and sprained my hand and that type of thing and the normal, reflex is that i will go to the emergency room and sit and somebody will take care of me. we are talking ou