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 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.

>> she is here, right? >> but she is coming. >> >> good afternoon, ladies and gentlemen, let me please call this meeting of the san francisco public utilities commission to order at 1:35 p.m.

will you please read the roll. >>ny here. >> caen. >> here. >> and moran is excused and torres is expected shortly. >> the first item is approval of the meeting minutes of july, 22, 2014, is there a motion. >> move to approved. >> it has been moved. >> can i second to be at the meeting. >> i will second. >> and it has been seconded, is there any further discussion, commissioners? is there any public comment on the meeting minutes of july 22, 2014? seeing none, public comment is now closed, i will call for a vote, all of those in favor, signify by saying aye. >> aye. >> and opposed the ayes have it and the motion carries, next item. >> no cards. >> item 4, is general public comment. >> members of the public can

address the commission on matters that are within the commission's jurisdiction, and are not on today's agenda, is there any public comment? >> seeing none, public comment is now closed. item five, is communications. >> commissioners? >> i have no comment >> no comment on communications from vice president caen. >> seeing none, is there any public comment on any communications in the formal record, before this body? >> seeing none, public comment is now closed. madam secretary, next item. >> other commission business? >> commissioners? none. >> no commission business, there are items coming before us quickly, would i note for the record, specifically the installation of the panels on top of our own city hall, and