okay it's after. >> it's after the kaiser wellness research study section that's in the directors materials. >> so it's just before the blue page. >> thank you and in the interest of brief it i won't read all the material but we had 7 key areas used in our elevation criteria the panelist i've listed them with their backgrounds i'd like to certainly raise taken into consideration attention we felt we had qualified commitments this gentleman has served in

american people advisor capacitate with our agency for health care research and quality and so provided a number of key insight and before county in terms of having that public employer went will the challenges we're facing and administering the benefits and that gap doesn't help decision makers move forward there's in sight i'll a leave it there unless additional questions. >> thank you marina for providing this information for one it heights my degree of confidence knowing that truman is a company that acquired metro staff and they were an excellent vendor in the olden form this is

an o from any prospective i think we'll find a good product from them and it achieves the kind of long term results we're looking for so this to me pass been more than illuminating and for any project of this scope and scale that is kind of what we want to put on the record we did a due diligence not just about the money and the approval and the direction from the board of supervisors to we're doing it and did indeed spend time and get expertise in making the selection so thank you for doing this. >> thank you very much commissioner. >> and i should do a shout out to relinquishing in the finance department worked overtime quite literally often the community

college rates and accommodate an unusual employer question. >> just for the record you can't can you remind me is there a fee. >> yes. tests not enough (laughter). >> we charge them both the school district and the xhuj per member per year and it's probably something we should re-evaluate and that money becomes part of our administration budget. >> okay. >> lastly i'd like to call up stephanie to give us the exciting data on the being the assessment we were confusing when we first met i want to point out in the deck her report got put together the kaiser research east actually goes

under tab it begins on slide 5 it is under tab 15 she's only going to talk about wellness and well-being. >> i'll remind you of that stephanie with the health services system the bullets in the director's report are both from the december and january meeting they give you the early status on the va and the final status but just wanted to give you the final on the flu shots clinic we had $3,000 one hundred 74 shots andes news information about obviously there's been drift in the stream they're concerned about the vaccine

focusness aforementioned the additional importance of any general washing your hands and staying home when our sick so since we last met we launched the rewards contest and finalized the w b.a. we ended up with 3 percent participation in the san francisco unified school district and 33 percent in city college and participation in the san francisco ethics commission as you can see the employers it comes down to the extent of initiative he leadership we're looking forward to applying the lessons where we had a robust roll out looking to see how we can apply that i'm currently working on a 2014 report that you will have more information than you need you'll see that at

a future board meeting that includes the issues of wellness it's the first robust year of wellness there's a lot to reflect and learn from we just started the interviews for our newest is position we'll hopefully add a 7th member for the next board meeting i'll be letting you know who that is those are the major highlights over the last month's are there questions we'll talk about the wellness in the next meeting. >> comments from the board i xhund commend you on a good start and look forward to the fulsome report of all the activities of year come back to us soon thanks again for all you're doing.

>> all of those what are employees can participate in the wellness caudal the what and daily champ. >> but the daily champ is available to you i think my daily challenge was to go like this ten times you get it on your eye phone it remind you to do something healthy so we'll give you that website to have a well-being challenge. >> thank you stephanie that that concludes my report. i've asked vice chair scott as some people know there's been a change in the blue shield with sutter hospital and given that change was so substantial i asked blue shield to send a

couple of high-level people to bring a presentation they'll be coming at some point but i feel confident that blue shield is doing everything they can to communicate and make sure there's no gap in service to for members we'll will have to ask them the questions. >> thank you katherine i ask you to be on alert i don't know the people by site you probably do i will claim the privilege of the chair when by the e they arrive one has another appointment immediately following this average we'll interrupt the flow of the agenda that has vendor participation at any time end item 14 or something like that we'll call upon them tattoo bring their perspectives to us i want to claim the privilege of chair to

go back to the president report i had an issue i can be at the board at 1:30 this was my error this is specifically from high prospective to focus on the work and contribution of jan who severed as the president of this board for a much too brief tenures u you are during this past year i invited her to come she was unable to because of another commitment she indicated in november she wanted to make some parting comments to the board in discharging her responsibility they are e she was unable to do that i hope if she has an continuing interest

she'll know from my own standpoint i wanted to recognize her board service i felt as a confirmation in my brief time working with her, she was thorough and diligent and stealing candid and probing in terms of her questions and objections and concerns about the matters of the judiciaries jurisdiction of f this board i hope i can learn from here example again jean if you're listening or hear about it i took the occasion to publicly thank you and wish you will in our future endeavors and invite board members at this time to make comments regarding her ore the executive director regarding jean's service to the board.

>> well, i'll say i knew jean since the beginning of the san francisco health plan they brought us the best medi-cal managed care in the staifshgs she came to the board with a lot of experience observe from her contributions she's a bicyclists enthuse i thought we have a sign that says enjoy the journey we'll sendoff to her. >> thank you commissioners that i if your listening out there i don't think you are they moment i wanted to note so and so she was an incredibly thoughtful person with a lot of expertise with prior board that illuminated my thinking on how

to be a commissioner as well thank you for that. >> i echo all the commissioners comments thank you jean you provide insight and thorough knowledge especially, when we discussed the rates and benefits and really provided good questions and gave insights to the board thank you for your service. >> i agree with all our comments. >> thank you very much for your service you gave a lot to the commission. >> thank you all for our comments i'll ask any public comment on the president report. >> good afternoon claire speaking as a former member of the health service board jean served as a representative from the city attorney's office it

that had a position on the board in those days so she asked asked probing questions she was representing the city attorney as a commissioner so i think she still gained quite a bit of her expertise as serving this city in her capacity on our board then when she went off to run the other plans extended that and brought back a lot of knowledge and expertise that is probably very unique because she already had a prospective of how we were and how we worked so it was interesting when she came back as a confirmation in a very different capacity that she was able 0 bring much more to the board i think that enhanced our

ability to move ahead in a number of areas just as a prior commissioner, i said want to add my thanks to her and the displeasure she presented i wish her well in her future endeavors. >> any other public comment it's been brought to my attention the representatives from blue shield are here i'm clearing claiming the privilege of the chair i'll move to agenda 14 i believe it is - >> 17. >> i was corrected by my board secretary comments from the vendor i want to invite the representative of blurld please come to the podium i find as i got the call from katherine it's a shocking call and with an that

i guess in my worse moments wished that that he that wouldn't be where we are today, i happen to have health care expertise in the industry and been with the public education program had to deal with this same health program or vendor, if you will, contractor in this case, i say without question i've been amazed at the outcome of both the strategic and operational think they bring to theory their efforts i want to have the representatives identify themselves and make whatever public comment they wish to make and prior to that, i want to ask katherine to identify the employee impact, if

you will how many members do we have participating in blue shield that might be impacted the service area that type of thing and hear from the representatives. >> i'm not sure if you brought additional numbers with you i handed out to the confirmations i had our director tell you you have this how many members are in each north bay county and if our handouts materials from the blue shield their website that gifts outer information so the largest you madam clerk, any other business before this committee? members are 11 thousand in san francisco and 5 thousand in san mateo but we have 22 thousand - 22 hundred in alameda and 2 thousand in kontd cost at least

in san francisco and alameda county in terms of the medical groups the brown you recall we have a acu with brown and tom listen their innovate effected because their national affiliated with sutter so people will be able to keep their doctor and in the east bay a subsidiary they're able to keep their physicians it's the hospital network that is effected and alameda county is probably the most bare hospital at work you have the numbers in front of you, we also have john in costa mesa county is 2 satisfactory.

>> yes. thank you very much introduce users. >> thank you members of the board director dodd. >> i'm tom the vice president of the public affairs that blue shield of california i'm joined by mr. best graffiti watch volunteer award he'll provide the details on the impact of the members i'll talk about the negotiation with sutter and first of all, i want to say we're seller regretting the uncertainty it is caused we negotiated with sutter in several months and plan to do so we're doing so in hopes we can resolve this before members are you mean entangled but the reason we don't have an agreement is two-fold were

trying to keep the care affordable to our and our members by trying to avoid having to psa pay high costs to medi-cal we don't want to deny services if they want to challenge the practices of that particular provider in open court occupy anti trust grounds there's a lawsuit that's doing that now we don't want to see that restrained in the document i believe i have the power point we you know i'm not going to walk through each slide it demonstrates the dominance the sutter health chain in the markets in california and their strategy of medical facility acquisition and consolidation has occurred and basically resulted in higher rates as you can see from the power

point that hospital rates, etc. at the facilities are thirty percent higher than other northern california hospitals and their physician expense has risen 3 times as fast as the other physicians in the last 4 years statewide as you can see they've been accommodating a fairly substantial profit margins in double digits most of the time in addition it to that situation we're trying to address and keep health care affordable they're trying to limit the access to the court there's a pending class-action lawsuit that was filed by the u e b t trust affiliated that the oc w they've challenged the practices of sutter health

certain aspects their lack of transparent they're tying hospitals together and so forth it in the suit they see one the first round no court and sutter is appealing so sutter basically came to us with a new provision they've never asked for all lawsuits for all customers and trusts and so forth will have to be arrest traded and not permitted to go to open court we thought it was not acceptable and binding our customers 2, 3, 4 a way we didn't think was appropriate so we're pushing back against that we you know we are happy to answer more questions you might have about this and look forward to try to resolve this issue before anyone loses their coverage. >> now paul will speak on the

specifics of the impacts on members. >> good afternoon paul brown i'm the area vice president for premier accounts i'm to take a few minutes and talk about the potential impact to your membership i believe we've identified about 57 hundred or about one hundred and 12 percent of our membership that are directly impacted meaning they'll have to have a new primary care physician a non-sutter physician i want to back up with our last negotiation. >> excuse me. paul step closer to the mike. >> in our last negotiation with sutter health which was also very contentious we purchasing e purposing negotiated in a transitional period to take the

customer out of the middle so this you go time around we've gone to negotiation we answer or enter into a transitional period members can get care from sutter does have this change their prim care physician until april 1st part of it is rigid requirement we're required to stickle with wrpd to the regulators in sacramento the d mc requires we give the members who must change the primary physician because of a dispute with a group give them 60 days notice we tipped on real estate the letters on approximately january 15th or 16 in another week or so that the

transition to a new primary care should we not reach american people agreement is effective april 1st so it's a bitter for favorable this time around because of the transitional period we're now in but should we not reach on agreement with sutter we will be dropping those letters and we are fully prepared from a customer service center prospective to answer those letters and direct them to other providers in their area should they not contact us we'll automatically assign them to another physician if they don't like that physician we'll direction them to another provider in their area i'll pause do you have questions.

>> one question for mr. unat the scene is sutter asking for language for the right to not have the city sue them. >> yes. yes they want to bind the people who receive health coverage from us from suing in open court on the anti trust ground the sutter. >> the second thing a point out of clarification there's a lot of stiff being said about doctors and hospitals being a physician who is unable to join brown back in 1997 they were investigated by the federal trade and they were not allowed to take doctors i was not allowed to join when i finished any residecy as a trained doctor so if you're a brown and tom

nolan's doctor that takes blue shield and he e you happened to have our office on webster street that's right being next to 0 sutter hospital you as the doctor has specialists at that hospital that you use all the time and their your relationships on how to manage our patience so patients do exist in a volume they have to deal with lots of people especially with a lot of problems if you're a blue shield patient that sees a doctor that used the sutter familiarity and the doctor can't use the sutter facility to get paid your blue shield patient at brown and tom nolan doctor has to go to a non-sutter facility i'm a sutter

doctor and if i send you over to the hospital i'm basically saying i don't know anybody and hope they call me back it's a k345ishg9d endeavor to increase score it's trickier you have your doctor and don't worry you can use my facility you hope the one hundred works just as they did with the specialists i have the cell phones and i know the staff this matters when our taking care of a person there's lots of nuance or so here my big question and now a clarifying statement you can clarify it if you time for those who have who don't know certifying civil right is about to announce or announces they're to indemnify

themselves as i look at this i know they've negotiated with blue cross it is something in here to try to boot you out to launch their thing is that - am i wrong is that kind of right. i know maybe i can't comment i smell something funny here is my comment. >> yeah. i won't want to speculate on that in the current negotiations that is we don't believe that's a factor at all we are norwalk with sutter like we've also negotiated with sutter it's difficult they're good negotiators but i we really don't put into this e situation it's really, really small image

in the sacramento region to your first point i want to talk about brown and tom man but i want to go back to my original comment those 4rg thousand members they'll have to change their primary physician and larger group in the range of 2 to 25 thousand of our members that have a nonsutter physician such brown and 80 lane they admit to a sutter facility those members are going to get a different letter they'll be told they can keep their primary physician but the facilities will not be forwarded or part of the blue shield network so our example of specialist care we definitely recognize it health care didn't occur in a volume and many multi discipline factors that go into

the care of very complex patient with respect to brown and tom lane and other in the east bay they'll continue to refer to their colleagues within in their medical group when they require any type of outpatient or in patient care not going to a sutter facility and there's persistent with us right now in the covered california market sutter is not in our network so c p n m is not in there and tom man refers to other non-sutter hospitals in the city and can i as which ones. >> i don't know. >> st. mariah's and t