that was mentioned it would help. >> thank you, director. >> i look forward to working with director ram and i want to thank the commissioners because i worked with you during this process and will is the community along with cpmc. the department of course has the development agreement and we have the responsibility to provide this overall health in our city for example with the ebola response we worked very closely with the hospital and made site visits to make sure they were prepared. we are obligated to ensure that when we hear things like diabetes and cultural competency i think we can work closely with cpmc and a stronger way to ensure that they are culturally competent. i don't see why i can't work with them closely to ensuring them. also the mso issue in the tenderloin, i think we can

solve that. we tried to work very closely with the clinic consortium and there is an mso within that group and that is an example. so there is i think a possibility of that. we also want to work closely to ensure that the new hospital does provide and i'm talking about the cathedral hill or the sand hill that it does have a structural response to medi-cal patients. we believe that's important, that's why it was in the beginning of our process and we'll continue to work with cpmc to ensure that and we'll begin our process to and i think we put a lot of effort into this and we still have a lot of work to do and we can improve those areas for at least the development agreement on the health side. i want to thank all of you and thank the cpmc for the work that they have done. >> thank you, commissioners

are there any further comments during our joint session here? >> one question. i tried to look for the language around the tdm that it says 223 5 years for implementation. i couldn't find it. if someone can sent me that language on the agreement specifically that would be really helpful because i think that's where some of the disagreement comes from also. >> i did have one further comment as we were talking about what elements should be put into the potential letter not only the issue of diabetes but because we are talking specifically what might be the necessary services of saint lukes and not get into business plan of the cpmc enterprise, to really discuss

what the community, what part of services community did need and i think the diabetes issue is important, but i think it maybe only a harboring of what the underlying issue which is how do we meet the needs of the current residents of the mission as well as what would be an expanded need as the city continues to expand. i think that is the underlying concern whether it be just simply a diabetes clinic or should be a gestational program or women's program or what not. so i think there should be not to subvert an overall master plan but understanding how one meets those community needs at the same time as it meets the larger needs of the world center that it is building. and i would suggest that it be part of it along with that cultural

competency again is not just simply on the issue of diabetes but that would cross all of the other programs that cpmc has. i into -- know they have some wonderful programs and that's another area that director garcia pointed out that once again the health commission does have that responsibility to see that we are getting the best health for our residents and so looking beyond just the saint lukes issue and we've had issues around renal care and how we deliver that care is there a better way than just the translator that you call by phone because that meets the minimum, but isn't it better that we have somebody who could be culturally competent and be able to take care of that and are those possible settings because this is going to be a wonderful

system we set up and we need to have what we are trying to do the very same thing within our very own city structure we are trying to see that the other hospital systems would be also looking at a better way than just meeting the minimal requirements as for cultural competency. i would hope those would be part of the emphasis within our letter that is being developed by the directors. so sorry, i took all that time. so we are back to i motion therefore for an adjournment is in order. is there a second? >> i think we can say it jointly. okay. with the president's permission. all those in favor of adjournment please say aye. >> aye.

>> all those opposed. thank you. we stand adjourned. >> for the commission's hearing at noon will begin at 1:15.

. >> okay regular board of health service board it in order january '88 please stand for the pledge and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. >> roll call please. sxholt expected

commissioner wilson's supervisor jane kim commissioner keane we have quorum. >> first item please. item one action item approval that possible modifications of the minute regular meeting of november 15, 2014 are. >> my correction to the minutes seeing none do we have a motion. >> i move to approve the minutes to the meeting of the november 13th 2014. >> second any public comment on this item? no public comment all in favor, say i. of approving the minute say i opposed? unanimous okay item 2 please and item 2 discussion item general public comment on matters within the

board's jurisdiction not appearing on today's agenda. >> any public comment please come forward. >> my name is diane i want to give something to the board i want them to consider including in the benefits package i have sleep american people necessary i use a appliance kaiser paid for the oral appliance for the first year, however, not the follow-up treatment i h have had before the board the guidelines from the academy the american academy of sleep medication they recommend that anyone who wears an oral appliance e lines should be seen once a year to have their appliance connected checked to make sure it's not effecting their jaws or teeth

i've talked to my sleep doctor he recommends doing that but the insurance wouldn't pay for it is caught between the dental and medical the dental say it's a medical thing i'm not sure which one but something that insurance should cover and so does the american academy of sleep medication this is their guidelines for the treatment of sleep apnea what an oral alliance the follow-up recommends that you be seen once or twice a year a check up i think our insurance should pay for it i want to present this to the board and ask that they look at this to see it gets covered who do they recommend you say. >> the sleep dentist once you

have the approval you go to a sleeping dentist they make the appliance and makes sure it fit our mouth and you go back to see it fits my sleep dentist she send me to kaiser to do a take-home sleep test to make sure it is still working but won't pay for the dental to get the appliance checked. >> somebody will look at that and get back item 3 oh we can't do item 3 the president is not here we'll pass that item until i arrives also i believe we should pass item four until i

arrives item 5. >> item 5 discussion item director's report director date of birth. >> thank you commissioner breslin the director's report is longer than usually we haven't met but done a lot in the past few months personnel wise a gentleman was appointed a chief executive officer and here today mitchell and metabolismal has been with us for over two years and over 3 year sorry thank you and before he came to us he worked with the i s w he has lots it experience and known to vendors and departments and hit the nail on the head and still doing his old job we've filled

we still a a benefit textbook on i hope to fill it soon the new positions that were in the budget to begin in january including one posted a government principle programmer analyst for the awe logics department and posted as well as a program manager for well in-laws those interviews are occurring now we're setting up interviews for the finance contract staff and trying to fourth what to do with the assistant manager the list is so old every time you call someone their have a job i'm going to let finance present

under the finance topic under vendor contracts we've been working closely with ann daily if not multiple times a day i toured kaiser substance abuse we met after the increase from the police and fire it was very impressive a state of the art in the tenderloin on more than 12 hours a day they've really, really good success statistics we were successful in meeting with the mta to look at the substance dawes bases from both

major providers and really got in touch in terms of of the mta who they need to call it 3 that information has been shared with police and fire we spent long hours devising and redevising the "x" sister tax in terms of of the transparent is resolution i've met with the 3 major vendors and blue shield was limited in the amount of data the hospitals were willing to make transparent i sent a letter asking for a transparency and pivoting we have an database the only hospital i heard back from was sutter they don't do tearing

and they would really prefer a global cap rather than giving us claims data they've been operating for years in kaiser by the way weenter have to work with them to get the data so sutter's answer was not exactly the right one i will forward those answers see into the wrvrdz who passed a resolution i was fortunate enough to tour the kaiser innovation center with the folks w the garfield where is health care going to be in 20 years and it happens to be during the time they were training people in front of the center the infection techniques what's unusual throughout the country it is academic centers

that are designated as ebola centers in the bay area kaiser actually got an ebola treatment designation that's unusual but it is fascinating to watch the training we reviewed carefully the united health care contracting guidelines and we actually asked them to do this a couple of years ago this is exciting they'll be steering people to providers that have a specific outcome measurement november calm visits were average usually in an open enforcement after people get a confirmation letters the calls go up and newly letter you have in your packet the calls were

lower this year in terms of that confusion you however we make up for that this last monday when we hit seven hundred and 12 calls usually, we're looking at one hundred and one hundred and 20 seven hundred was a lot about the skipped pay period those retirees know we're moving first page a pay in advance to a pay as you go that information was if the on enrollment in the guide and in the section is it fair to say on our voicemail system that went out if the e news and printed in the letter but people were still spriept they are more money in their checks than normal there feeling were a lot of calls they got the information off the voicemail system i'm going to ask we met with ann

to plan the sutter rate audit you'll recall the land use limited the calls that sutter could make we're in the process of doing that and we worked with finance on the e e rp summary you'll take action on today when we - i also met with kaiser research along with stephanie you'll hear about that in terms of communications i already mentioned the confirmation notices but when you imagine 63 thousand letters going out in spitting despite of a large amount of work if i payment through the managers deck she's had a very very about his busy

two months so i'm going to kind of skip through all of that and i'll call on the divisions in a moment after i kind of say that i we met with the mayor's office after the initial excise tax analysis and posted for the december meeting and reviewed the "x" sister tax in terms of general numbers we've been meeting with the h.r. as we did last year the state protective committee and the mayor we asked to make transparent a priority and asked the blending of the medi-cal excise tax be a regulatory federal level issue and that at the federal level we oppose increasing the age of

medi-cal which is in the republican house budget to increase their age for eligibility to 67 it will be a hardship for the general public and financial hardship for the city and county arrest city college district had a choppy on enrollment and when we finally print the books we had to print them without rates we finally got them to agree to last year's rates we took out the subsidies and published them and then their mind was changed again we had in mile-an-hour confirmation letter we had to say that is not the rate with on enforcement if you want to make changes i can we had no changes but it created

a second on xrorment when was complex and culp so many i was honored by chuck cowgirl with the ymca with my wellness when i worked in the mayor's office oh, so many years ago, i attended the webinar and trained that was a national webinar this was available to the board but no one could attend i'm now the new chair the national committee for social security and medi-cal and attend their board meeting which i had them schedule the board meetings on the we understand only gone one day for travel signs e.r. since i'm the chair i can have

them meet on this weekend much to the members dismay we i attended the pb h choosing wisely i want them to make a presentation it's a specialist organizations combined to do a whole consumer education program through the consumer reports it's really, really well craft to help people to make decisions and not immediately need an mri or an x ray or whatever so i'd like to ask them to come o to present and perhaps in the next contract ask our vendors to participate in choosing widely campaign the mta had a diabetes

conference we met with the diabetes foundation person yesterday to see what is available they have a lot of materials it stephanie will roll out through wellness and i put in what the anticipated changes to medicaid are and to see president obama's budget before although the senate voted them down they're likely to be in the house republican and they'll have to push obama to look at that this includes the surcharge on the charge for consumers it didn't say effect our members but anyone that is paying for medicine gas it increases the part c and d premiums their

taken out of your social security check that's for everyone it increases the b co-pays for home health to $100 per episode and s. it increases the guilty to 67 that has a significant impact on our excise extension that's the section where our premiums are the highest i'd like to briefly call on operations and then david wellness to update things so operations how did we do? >> mitchell chief executive officer of the health care system i wanted to briefly talk about operations as far as our end is concerned on the third page of the deck after the director's

report second slide it says year-end enrollment we've received 26 thousand calls a decrease in 2013 and member services animal a little bit over 13 thousand with the 2014 a 21 percent increase from 2013 just a little bit about on enrollment 2015 flexible spending accounts we have 34 hundred about the same or 33 hundred and the tenant care 985 increased in 2014 on the no objection page i want to bring to your attention the plan enrollment tb on enrollment as you can see the top line is defenseless 2014 the second line is january 2015 so by

december 1st, 2014 we had done our just of late enrollments and that type of things blue shield did well, for family coverage at one hundred and 24 it's the first time it's increased in 3 years that shows a lot about the work that agents have define to get the enrollment important stabilized the other thing to bring to the boards attendance the on enrollment is one hundred and 65 separate tabs that you know have to complete for on enrollment and i wanted to just add to the point that we had a 21 percent increase in person assistance that has implications to p