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 about an intermediate step ta will be

clearly communicated to the members of a plan. and that if you have non-emergency care, that you are seeking, general practice, or if you need some specialized help you are somehow clarifying that in your literature and the identification of these facilities is that going on? >> we do have some clarification, and it needs to be better. it does. i can say that we are in much further ahead than our colleagues were in regards to that if you go into the urgent care and you go to the website and you hit the button for the urgent care it is going to give you a list of anybody listed. >> but we do have the disscripters in there, but you have to be paying attention to this, if you were the hurry, you would grab the first one yes, you will show up at the pediatric center >> thank you. >> okay. so i think that this will be return item for the next agenda and we appreciate the effort

put into this. >> thank you. >> any public comment on this item? >> oh,, and may i make the same request, of blue shield? are you guys in network management? >> medicare operations? >> account management. >> and i am going to request of you, that when you return here, that you please bring with you someone who and not someone who can just provide information, someone who has accountability for network management. and it might be a senior, management, and manager and we are taking and saying the same thing to united healthcare, someone who makes these decisions about urgent care centers in your network. so we are not talking to a division head, that has to, you know, kind of, i know that you are a big company, and everybody has to coordinate, but someone who is in the decision-making capacity about these matters. around the network management

and communication. >> okay. and i am saying the same thing to united healthcare, thank you. >> thank you very much. >> thank you. >> public comment? >> good afternoon, vonsky, again and i want to remind you all, that hetch hetchy we had a member of active employees, and retirees up in those areas, and a lot of them have been families and urgent care is what they really need. not the emergency care because most of the kids have cuts or whatever, and they might need something urgent, but not emergency. so, could i request that we add that to in the area, to the list of the samples that people bring back so that we know what those care facilities are up there, and it saves those

families lots of money, and it also gives them an opportunity to get the kind of good care that they need. because they have to travel long distances often to get any type of care up in those areas and it is very remote and we also have a lot of retirries, in more remote areas who can also benefit and even though they are in the out lying areas of the bay area when you see the map that was provided in here, that if they are a urgent care facility, that are within, 100 miles of san francisco that covers a great deal of the retiree membership as well and so i would like to request that we take a look at a broader scope and that we don't also forget our folks up in the hetch hetchy and the people down in the area that are out of the range of the hmos but do need urgent care, thank you. >> thank you. >> any other public comment?

>> all right, seeing none, next item please? >> item 11, discussion item, report on vendors on medical loss ratio refunds, if any, hss vendors. >> good afternoon, heather united healthcare, we did go through this with the team on the plan and we did check against it, there is no rebate from united healthcare that is relative to this. and we provieed them with the number that they can call and also, william, from your team found a great tool where you can check the website to indicate, so we did confirm that there was no refund from united healthcare. >> all right. >> all right. >> good afternoon. cindy, from kaiser.

so, on our june first, medical loss ratio calculation it was above the established thresholds for both the large group which is 85 percent, and the small group, and most of the individuals, so the small and individuals at 80 percent. over all we operated above those thresholds for about 99 percent of our 9 million members and we did have one finding in the individual market and that it is a small portion of the individual market which is under our insurance projects so it is the pos and ppo portion and so it is about 46,000 members. and they were below that 80 percent, threshold and so they were given the refunds which were roughly, between 30 and 31 dollars. and those were mailed out for the august first, so there was not a finding for the large group or the small and there was a small finding for the individual. and any questions? >> any questions from commissioners? >> great.

>> thank you. >> good afternoon, bob, from blue shield of california. in respect to the mlr, rebates, or requirement due to the aca of the minimum threshold of 85 percent, blue shield met, actually exceeded that threshold for the calendar year, 2013, for all segments applicable segments for the ruling. so, the filing on june first, is public filing can be found on hhs's website, and we will report that that was exceeded. >> great. thank you. >> any questions? >> no. >> thank you. >> appreciate it. >> and any public comment on this item? >> seeing none. next item. >> item 12, action item, vote on whether to cancel regular

health service board meeting on october 9, 2014 in hold forum on statins instead, director dodd. commissioner shlain who had to leave wanted to do a forum on the college of cardology recommendations. and we were looking for times and places, and since this room is routinely reserved, i said why don't we just do it at our routine time and place. and we will be asking the vendors to identify experts in the area of cardology, to come and present, on whether or not they intend to adopt those guidelines. or how they treat cardio vascular disease and whether or not they are, and i am sure that there will be discussion at particularly from dr. shlain's introduction of this

issue. and i appreciate president frasier's question of is this more work in the middle of open enrollment and i will be working and get the letters out to the vendors and dr. shlain is inviting a special guest who has done a lot of work on this area. so that will be the october meeting in lieu of our health service board meeting. >> because we traditionally cancel the october meeting because it is open enrollment, which is a difficult time for staff. well it is a great time for staff, but it is a lot of hard work. >> and so, the motion is to cancel the october 9, 2014, the idea is to cancel the regular meeting on october 9th and instead hold the forum on statins. >> i move to cancel the october 9th meeting and hold the forum on statins. >> second. >> and i have a question. >> i know that i brought this you before, and i thought that in order just to have this meeting on statins it would

important to have something on (inaudible) because a lot of people will be attending this and if you are looking of some way of getting to this point where you need the statins it seems that diet and exercise fit into this. >> how long do you think that this meeting will be. >> how long do you think this meeting will be. >> i am hoping that it will not be more than two hours. and relatively confident that the experts will talk about diet and exercise in the context of cardio vascular disease prevention and i did mention a idea of doing a separate forum on exercise to the president frasier and she said let's wait at this point. and so, >> okay. >> if it is agreeable you, we could see what they present, and because it is not all going to be on pharmacology, i don't think. and they may cover diet and exercise, in that context,. >> okay.

>> just seems like it should be together. >> you know, because... of what it is. >> any way. okay. >> a motion. >> and is there any public comment on this item? >> seeing none. all of those in favor signify by aye. >> aye. >> and okay, no opposition. >> and okay, next item. >> item 13, discussion item report on network and health plan issues if any. >> good afternoon. i will be very quick, i wanted to formally introduce a team member, she is really been engaging with hss, for eight or nine years, but we, and eight or nine months, but we have not formally introduced her here and so i wanted to take the opportunity. and cindy green is the senior executive account manager that is or holds the liaison role between the city and county of san francisco, and kaiser and

will be regularly attending, and i will continue to do so, as long as my schedule allows, but i wanted to formally introduce her to the board. she has been with us for over 16 years. and is hit the ground running about 8 months ago and has not stopped. keeps looking at me, but does not stop. >> great. welcome. >> thank you. >> anything else? >> any other reports? >> any public comment? >> >> all right. next item? >> item 14, discussion item, opportunity to place items on future agendas. >> yes, i meant to bring this up on item four and there is a resolution in the director's report, on healthcare quality, and cost transparency, requirement. and this is right up there, and i will turn to the attorney, eric, this is right up there with my previous inquiry and i

are recognized that things go on, beyond the boundaries of this board. but they seem to again, and again, come back to requirements of things that we ought to be doing. and i know that given the way that city politics and things are structured, that is not always possible, to talk about integrating efforts. but, in this particular case, i don't think that there has been any point in or during my service and it has been brief, where we have not either advocated, pushed, controlled and brow beat, health plans in trying to be transparent about what they do. we are a very much in support of this. but, to again, to have a requirement set down that we have to report back specifically on this topic, in 2016, but it, and again, it sort of crosses the line. and i don't know why, these things continue to happen. and they seem to.

and in another, we negotiate, and we come to agreements and we are deliberate with the requirement. and i have not a clue, from the director's standpoint, what the costs of this is going to be, to comply with this effort, beyond what we are currently doing, but if there is some extraordinary initiative that we have to undertake to demonstrate that we have indeed, advocated for, sought, and pressured, and persuaded, tried to influence, this particular issue. and i feel compelled as a member just to raise again, my hand to say, why do we continue to do this kind of thing? and nobody in the room has an answer. and i recognize that, commissioner or that director dodd was part, of the process, for crafting this, and i recognize, that as we got into the union negotiations, which would put another requirement on us, that we would cult consult it. >> but at the end of the day, the board is required to do

something. i would like to add this to the other item if you will in terms of you giving us interpretive guidance as to how we will comply. >> i would be happy to talk to you about that. for now, i just note that it does not say requirement, but recommend. >> i understand, but here a recommendation will get translated into a requirement. and you and i know it. we will say it here today, and six months from now, or a year from now, when we are moving along through the renewal process or whatever, this will take on that message. and we need to be realistic about that and it is what it is and we are here but it is a requirement. this board of supervisors, took an action, and they are expecting a report. and even though that it is a recommendation, they are expecting a report. that sounds like a requirement. and it has got a date in it. >> just to be clear, >> yeah. >> what is required is that the

health services system will report back to the board of supervisors on the status of negotiations. >> yes. >> and it is a requirement. >> it is a requirement to report on the status of the negotiations. >> you are right. >> the health service system ultimately is a agency of the city and county. >> right. >> and so, all right. and any public comment on that one? >> seeing none, i believe that we are adjourned. thank you. >> thank you..

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you don't have to be 7 feet tall or be super faster but you do need skwil. once you teach kids how to have control over the tennis courts they'll master. please invest >> good morning, everyone. welcome to the san francisco board of supervisors budget and finance subcommittee meeting for wednesday, july 23rd, 2014. my name is mark farrell. i will be chairing this committee. i am joined by supervisor eric mar. want to thank the clerk of the committee ms. linda wong as well the members of sfgtv covering this meeting jonathan gomwalk and jennifer low. madam clerk, do