systemic errors, actually three systemic errors, two of the systemic errors involved the same cause and the systemic error has been corrected. we ran an impact report across the population and found they were under paying on the same issue. $3069 and they have been reimbursed. that systemic issue had to do with benefits and that's been corrected. the impact report for that issue and we identified both claims in the population. $2538, they have an been reimbursed correctly.

$5061 for adjustment and recovery and are pending reimbursement. >> is any of this provided to us in writing? >> >> yes. it's included in ann hewitt's report. >> it's not in the analysis what you told us in terms of how many claims and the dollar values. is that included somewhere in >> it is. it's included in the last column in the tables pages 11-12 estimated group financial impact. >> it's the column. and the na is because you have

determined it's annoy a systemic error. >> that's right. it's an error that we did not agree with or an error due to process or which was not systemic repeatable. >> i just want to make clear if you disagreed you did not do a financial analysis even though our auditors continue to disagree with you. you just said is we don't agree and we are not going to show you the numbers. >> correct. if we did not agree, we did not run a corrective analysis. >> we appreciate your opinion on the matter and would like to see the numbers on this. for future we would like to see them, totally we understand reasonable minds candice agree, but if reasonable minds can -- disagree, we should have that information so we can assess

whether we need to go further and revolve the difference. so for the non-systemic errors you make no extrapolating. >> so basically if an error is agreed due to adjudication or keying error it's review and feedback with a responsible process or and keyer and or the dedicated team. to our own internal control we monitor manual adjudication errors to look for trends. >> my suggestion is and this is to the staff when audits are done that they do a corrective action plan in writing so they actually write down what they did so we can see if these errors are in fact occurring year to year. my other question is is are there performance guaranty

because i will note the error rate is unsatisfactory 2 out of 3. >> as part of the external process does write a report in response to ann hewitt and it goes step by step each error identified by an hewitt so we have that information available if you would like to look at it. >> i think it would be great to include it in the packet. >> i believe we got it last month and i believe the board got it last month. you had a report as well as the deck last month. >> an hewitt came and presented preliminary findings and they wrote a corrective action based on preliminary findings but the corrective action was just from a

preliminary. it would logically flow at least for me but i won't be here but you can do it at a different way that it will come at the end so people like me don't say, where is that? >> any other questions or comments? >> you would need to hold that in the financial report. >> i understand what hut has what they consider for accuracy, financial accuracy and payment accuracy. what are your standards? >> united health care standards? >> >> in these three categories? >> sure based on paid dollars is 99 percent. payment accuracy is is 97 percent and overall accuracy is 95 percent. >> let me ask, i'm sure you won't have this at the tip of

your tongue, with that type of accuracy level what's the consequence to united health care with those kinds of targets in place. does that impact you in anyway if you are paying claims or claims are not accurate to the level that you just described, does it have an impact in your operation? >> if the group has a performance guaranty united health care reports a monthly statistical audit report on the results and if they fall below performance guaranty then there are penalties on unit health care. >> you said there are standard levels for accuracy, when the

performance is not met what do you do? >> >> we take these standards very carefully. we have quality management and we do have intense training for our claims processors and we constantly are updating our training documents to ensure that the most current information and it does change a lot is made available. processers go through an intense training class when they come to united health care and those trainings continue tullius -- throughout the year and web basing applications as well as classroom training if needed side by side process or training and we have an -- array of different quality controls to make sure they are processing correctly. one of

our enhancements is smart audit rule which takes scenarios that are known to be problematic and after the claim is is processed but before the payment is released, the claim is actually held in a cue where another individual has to take a look at that claim and double check to make sure it was paid appropriately. >> all right, thank you. what i would ask from an hewitt when you have satisfactory, that's based on what. how did you pick this point to say this is excellent performance, this is good performance and this is satisfactory. >> this is an fulton with an hewitt. we do hundreds of audits a year. we constantly evaluate what are reasonable objectives based on what we

have seen in the industry. we have had these objectives since 2008, prior though that we had financial for payment and 95 for overall accuracy. in 2008 we determined the bar keeps on raising, the administrators are doing better and better and what is acceptable and to us based on hundreds of audits a year across all major administrators even third party administrators, we have determined that 99.3 financial is acceptable and 95 acceptable for payments and the good and excellent looking at what are we seeing in the industry like the bell curve, there is not going to be many but we've had 100 percent accuracy with the administrators. it's from years and years of auditing

experience, we felt like these are appropriate, and many of the administrators achieve and exceed these objectives. they are very reasonable objectives so we feel like we should hold all the administrators to these objectives and consistently across all of our audits. we don't change the objectives from one at straer -- administrator to another. >> thank you, we just wanted to get that into record, there is a variation and we don't know the total impact and there needs to be some articulation and if we go forward to talk about performance guarantees with the administrator, this should be noted. >> any other comments by commissioners? >> seeing none, is there any public comment on this item? >> yes?

>> >> to close out the audit we had final recommendations to go over on page 13. these are going over the last meeting. >> great and we have received them if they have not changed. is that right? >> we did add one recommendation regarding a second review for claim denials over $10,000. we had one audit error over $200,000 denied in error. we are recommending a denial audit put in place. >> that was my recommendation. >> i can see why we would do that because someone was very unhappy that it was denied in error. so this is where the process is. so uhc, i'm sorry i have forgotten your name, i apologize, does your report

of the last time address this finding? >> >> rené marcus, united health care. i do have an update on this, i don't have it in writing as of yet. >> okay. why don't you give it to us orally and provide it later. >> so additional research investigation was conducted and i am happy to report that united health care does have an internal control in place for billed charges currently right now the threshold is $25,000 in claims and greater. if it goes 0 , it goes through a second review to ensure it was denied correctly. the recommendation that the threshold be lower to billed charges from $10,000 and that recommendation is being considered. >> okay, we'll look forward

to hearing from you the final answer on uhc on that one and thing you for accepting the staff and an hewitt's recommendation. any more questions? >> any public comment? >> great. thank you very much. i very much appreciate your work on this. next item. cl eric clerk item 12. approval of all payer claims data base vendor. marina cole ridge. >> given the lateness of the hour i'm going to ask that you start with the presentation since we seem to be having trouble with some of this.

david flores. health contractor management system. >> we are seeking your approval. i will call this apcd. over the past 10 years there have been apcd all payer claim data base to gather the data and cost and quality and utilization of health care. an acpb is a large scale data base that systematically collects medical claims, pharmaceutical claims, other data. currently we have health care policy fellowship, we

have organizations, employer organizations such as the pacific business group on health, consumer advocacy all advocating apcd on cost containment. in that avenue, the comprehensive system on the market remised s -- released to 13 vendors. i'm not going to read all of these quotes on here about the suffice it to say it's been long time coming which dates back to 2009 on reporting and information. we have been able to view our data on fore costing and trends and simply improve our care and reduce our cost by incorporating

that claims district -- data. so long time mission. and to that end we've also had delays and the intent and delays have been reported over the years to this board. in september of 2012, we had started to pick up traction and that was related to committee on health and wellness on accountability and transparency we had a few milestones come out of it. we had released a joint statement in support of accountability and transparency in may of last year that was signed by the mayor. it was signed by the controller, by the department of hr, health services and aciu and they wanted us to establish a

multi-clarity base and there was a transparency resolution passed by the board of supervisors and that claims be moved to all payer's claims data base and in june the health service board approved the wellness plan and a key component of that wellness strategy of the wellness plan is the database. some of the work we've been doing in items now coming in together. as we look at our milestones, i have already just called out some of the first few ones dating back in 2012 to 2013 and really we have spent all this year trying to realize that goal out of those resolutions, to that end we did in january of this year bring to the board our recommendation on the 205 budget which included the claims data base. in

february of this year we included the blackout notice for the rfp and did release that in march. in june the wellness plan which is an integral part for our going forward strategy and also in june the rfp process wrapped up and we noted our notice of intent and we have spent direction negotiations with our vendor with being ready to bring that to you today. just an overview, what we are proposing here in our apcd overview is that our data sources we bring in will be our medical claims, pharmaceutical claims, from all three of our health plans we'll be including the well being assessment data and the benchmark data. the characteristics and i cannot stress this enough is that all

data will be identified. we will not be seeing any employee level data of identifying any employee at all. it will be confidential. and the well being assessment data annually. as far as the robust analytics we'll be able to do our analysis on the wellness of the diseases and programs and certainly not only cost and utilization importance to us but the quality of care our members receive is very important to us and we'll be able to use database guidelines for those gaps of care and we'll be using our ad hoc analyses for audits and clinical procedures for ncqa and we'll be able to

integrate our plans to provide those integrated dash boards. at this point i would like to turn the presentation to my colleague david flores. >> i get the short part of this presentation and i'm very very pleased about that. president fraser, commissioners, we've given you the background for our clearance data base and now we are at the nuts and bolts of where we are and extensive period of negotiations we believe we can present to you at this time what we consider to be a fair and equitable deal on this department on the contract. i want to point out through our negotiations we were able to bring to year one cost under budget by $15-20,000 from what we

originally forecast and our analyzed cost which is approximately a three 1/2 year contract achieved savings there as well. it's a testament to the commitment of truth analytics and our team that we were able to get to this point where we are proud to bring this recommendation to you. as marina has indicated m march of 2014, we did complete a comprehensive review, comprehensive rvm for this service and 13 vendors were invited to participate. at the end of that process which was about four 4 months the only one left standing was analytics. we ask you to approve to enter into a contract with analytics to june 2018. the purpose again of the contract is to

develop, implement and maintain an all payers claim data base and to train staff to operate it. upon your approval, staff will continue to procurement process to bring the contract to full execution under city standards. outline slides following some scope of particulars related to this contract. i will be very very appreciative of your time and not read them to you. if you want us to call out any of them, we have a representative, the accounting director, lisa sanchez who can answer any questions you might have about the execution of the services under this contract. i want to bring to your attention the breakdown in cost. these are two phases where the actual data base is implemented and

developed and the second part is services and maintenance related to the end product. the cost for the implementation or the development implementation of the data base is $85,000 which is well below budget we had forecast and service fees and license fees the remaining balance for the three 1/2 year term beginning on february 15 th and ending on june 30th, '18. if you have any questions, we are willing to answer any questions you might have. >> thank you very much. any questions? >> >> is this coming out of trust? >> >> it's a combination of sources. i believe the majority is coming from the trust because it is appropriate according to one of the services covered there.

>> it's oit of the 205 which is part of the trust. >> why only part in >> because the trust only has $92 million in it. >> the $2.05 is the only eligible that makes the fund in the trust. >> it comes out of the $2.05 cents and you approved it at the january meeting. >> how much is in it now? >> >> i can't tell you. there she is. >> pamela levin, deputy director. we have about approximately over $1 million

that is already received and not expended and then we have an on going amount that will come in each fiscal year and honestly i'm sorry, but i don't remember exactly those numbers. so we have a the easiest way to say is we have built up a balance that we are spending down that balance and making sure that the on going activities that we are doing in communication, wellness, analytics, are all covered on an on going basis. so what this does is it fits within

exactly, the amount that we have in the bank if you will and the on going cost of this contract are built into going cost, i mean the on going revenues that we are getting for the 205. so we are not exceeding. >> i'm going to ask you to pause and see if you have answered the question. >> all i need to know is this money coming out of the trust, out of that money of the 205. >> it is coming out of the 205, correct. >> the total amount? >> it's completely out of the trust. okay. >> any other questions? >> i have some process questions and i recognize this board took action on a budget and we've had monthly

reporting on the analytics regarding the various stages that you have gone through to get to this point, however unless i missed it, i was never made aware of the criteria that we are going to be used either publically or privately to select the vendor. so now that the process is concluded i am requesting that those criteria be incorporated as an addendum to this meeting. i know you don't have them with you today, so we can have them fully on the record what were the criteria for you to select among these 14 vendors to come through. i would also like to have as a part of this record a bit about the company history, who they are, where they come from, are they an american company, is it's subsidy of somebody overseas.

i would like to know more about them, the type of experiences they have had with working with large employers, etc, and then lastly i would like to know who served on the panel who selected. i'm sure we have a full team of confident intellectuals who would have brought this process. that would provide a futsdz context to this recommendation. >> i have got a process question, are you requesting that this item be deferred to receive that information or are you requesting that information be provided to the board subsequent to the meeting? >> >> it can be provided subsequent to the meeting. i know these guys have work very hard but in the future any

future time of project in this scope of importance, those thing should be a part of what you are bringing to us to make a final record. >> what happened if you are talking after we approve or after -- >> i don't want to make a recommendation, someone else can. >> to which point my question what happens if we disapprove with the process or we have a public that didn't agree. >> we just need to be clear. it is not my experience that when contracts are brute to -- brought to the city information that all the information in the rfp process is included. this is a change in process. so what i'm hearing you say and i want to say it out loud to make it clear that when there are

contracts of this magnitude you would like the board to consider that the full information is provided. >> that is specifically the type of information that i would like to have it per my request to have it. >> are any of the commissioners requesting this item be postponed pending this information? >> no. >> pamela levin, chief financial officer. this is the first time that we come with such a big contract. there are things that we can provide to the public and there are things that we can't provide to the public based on the process that occurred, the process set by the city and county of san francisco.