you have a very large stabilization reserve and a up substantial contingency reserve and an i b r reserve you don't need to fund a premium for stop-loss at the present time and the majority of the costs are in the medicare portion we seldom see large excess claims this is our opinion and that was what we would like to - is that an action item. >> no stop-loss is required from the actualy. >> so for clarification what's the dollars threshold for the stop-loss. >> the dollars threshold. >> the stop-loss. >> you could go really high we go one million dollars. >> you can buy down to lower

monuments in you feel it's in our best interest depends upon the size of the claims i recommend the stop-loss. >> i move we accept the recommendation of the actualries no stop-loss. >> second that. >> any public comment? hearing none those in favor >> i. >> opposed motion carries next item. >> regular board meeting matters item 9 president report supervisor jane kim. >> the president can't be here i don't have a report public comment. >> next. >> 10 director's report director bohe. >> thank you commissioner lim i

want to direct your attention to a couple of items the first is that we are again partnering with the department of public health for shape up walking challenge in each and every one of you can join the challenge we have an sf team i encourage the vendors to join the shape up walk this is a citywide challenge think not only an employee and i encourage the employees to have a shape up walking challenge team claire. >> she's not hearing me anyway, the shape up is more and more successful we literally walk the coast of california and walk all the way across the country and around the world we would like to be the best and you don't have to walk you can get

decreeing credit for 20 minutes of other experience we've decided what our name is we don't have a team name yet okay. the next one is the municipal executive associations and the department of human resources has created a leadership twice a year doing a working group and two of the management team numbers were selected to participate i spoke at the first one and it is a very, very valuable training program i'm sure you're aware of we're taking middle managers without a lot of other experience and persian them up as retire into the leadership position and i'm proud we have 23 out of our staff accepted to that program i joined supervisor farrell's staff and the mayor's staff and

sparking directly to senator hernandez staff on sb 26 and 125 sb 26 is the transparency bill that was introduced last year and didn't move so it will likely be a 2 year bill this year but a data transparency bill and sb 425 requires the vendor to post every week updates on the providers and whether or not the providers is accepting patients we're urging that they add to that posting whether or not they have urgent care and the number so we'll get it one way or another of we have to pass state legislation

other items are that we commissioner breslin is participated twice with u h c they called together leaders how to find out the problem of where the health care is there's a variety of follow-up items their assembling a list of urgent care facilities in the bay area and those will go out open a postcard ultimately fix the nurse line or the website or if the state legislation passes that will solve that so thanks to commissioner breslin and communication manager rosemary and the last couple of things in our packet it the gadsby report from the controller's office every two years we're required to as a

public entity to assess our government accounting standards board liability which is how much unfunded liability the city has in retiree health contributed is tremor amount the good news and the second two page cover memo is that this unfunded liability decreases to $470 million since the last assessment and you may recall on the last assessment is decreased and that count was given to h ss it was from lower medical inflation for the cost containment efforts by the city so in the a jewel in our crown and an expensive one but decreasing the gas reliability

by 10 percent is significant and the last thing i want to say something about i might ask the city attorney to comment on the current supreme court decision or the supreme court arguments that are occurring open the affordable health care. >> do you want to. >> i prefer to do it at the next board meeting. >> i'll say this about that and then see if there's news you can just want it as you've read or heard in the news there are 4 words in the affordable health care act that are the words are established two the state so the supreme court it ruling whether or not those 4 words will sierra club eliminate subsidies for 237 states

i'm sure you're aware of only 17 states implemented their own health insurance exchange and california is one of them i read today that oregon just de23u7kd but nevertheless the federal government stepped in and established the exchanges in the other states the subsidies that come from the federal government have been or are supposed to be going to go the states but the language says in exchanges established by the state not established by the federal government so this will actually leave out subsidize for some of the poor states in the country and that's what the supreme court is deciding what's the intent of the law it was before this accident by nancy pelosi she said if she able arresting it wherever you pass legislation

you have to look at the continental budget office an analysis for the desires country not only for the state by state it is one of the argument there many arguments forced the intent we're paying the hit tax and the transitional fees to help those states and help establish the subsidies and get the exchanges going so we don't see the cost shift from our population and looking at over 14 million people insured to date this is patio very, very important interpretation decision in terms of where health care form goes in the future i want to end my report on that note thanks. >> i have - i'd like an update it was in the people will the

hiv specialist drugs and how expensive they talked about kaiser permanente but they said that the other health plans have not been resolved as far as of tier in the hiv drugs. >> kaiser permanente actually - do you want to address this. >> kaiser resolved theirs they went back and corrected their tiers i'm not aware of issues with blue shield or united health care but we can ask the vendor and kate investing so for kaiser we resolved that and did those drugs are not parrot of the third tier that was resolved completely i do not comment on the other health care. >> blue shield have you included this applies only to the individual market not our

members blue shield is not aware that's an issue united health care and unit health care is not aware it's an issue. >> directly from the can't believe what you read in the paper. >> really? so just so highlighted where the director is saying a lot of us don't know so that's sb 45 is a financial levy how much the city will cost the city to cost the premiums on a study i believe most likely in the next thirty years will the city update just to highlight based on in part that the board has approved we've saved $437 million that's

a chunk of money we're talking about thousands but $147 million we've saved the city just to highlight the demand >> any public comment? on this item dennis kruger retire and actually firefighters through the chair to katherine i think i got lost are we addressing to the director's report could you speak a little bit about your what went on before you and v s p with our sessions you had and secondly if you can k30u7bd on the

meeting with hd r the see controllers and the mayor's office or was that pretty much what ou were talking about >> on the front page off your report the vendor contracts i actually can't 0 comment on the r s p because we have a person in the field. >> i hope that 2 level vision plan is in there if possible. >> thank you and in terms of the meeting with the mayor and we - the excise tax presentations you 3r0eb8g have in our files at home it was made in january of this year we packed u walked through the x size tax with the mayors staffs and others to look at what that

means as we approach 2018 and the excise tax is implemented this is less than two years we have work to do. >> any other public comment hearing none next item. >> item 11 discussion h ss reporting as of january 1st, 2015. >> director bohe. >> unfortunately, our chief financial officer couldn't be here in changes in the finance report that is before you it is just has a year most more of expenses and income and plus there's no substantive changes to present. >> so when we had that change in payment where this was a month no contributions how did that effect the trust or show

up. >> that was january but and i don't have the answer to that i don't think i saw that. >> but i will we'll have that at the next meeting. >> thank you. >> any public comment? hearing none next item >> item 12 discussion and possible action regarding the medicaid plan and director bohe and the h s representative. >> we've been invited u h s to present for a funding mechanism for our medicaid e medi-cal

retirees and we'll go ahead and present next month what this will look like the board will be able to choose where they want to substitute or where they want to do nothing or add a new option for retirees i want the board to hear about what that option will be we've invited them and harvey can introduce forest and nicole. >> thank you director bohe and commissioners for having us nicole with unit health care our account exclusive. the city plan retiree pagers and similar sound-producing electronic devices are prohibited at this meeting. program i'm pleased to have my peers here they'll walk through the presentation and welcome a q and a around this possible new plan

>> good afternoon nicole united health care i'm the accounting exclusive i work in managing our partner plan good afternoon. i'm forest burke the chief financial officer for the united care solution our medi-cal business and director bohe and decorators thanks for your time today we've got a presentation probably a little bit longer you want i'll step through that quickly about how the program works and how it might be different than things in the past so nicole you got the - you can run the slides move to the first slide the subsidies slide. >> there you go. >> so a medi-cal advantage plan takes the part organization

benefits that are medi-cal part ab part a a hospitalization and skilled nursing worker and b is outpatient and physician services in the case we'll be proposing a medi-cal m ap d the benefits of the pharmacy plan and combines them into one completely clinically initiative plan as a result the member experiences that the chair a single card that covers everything; right? including narrowing drug coverage and the additional benefits are beyond the other benefits we use a unique bp o structure you'll step you through it if we jump to the next slide nicole you'll see just in terms of how medi-cal advantage is funded so obviously employer payroll taxes the individual pays a part b

premier about $104 a month typically can be uphold from a social security check from the beneficiary fund from the federal government those are funneled to the center for medi-cal and medicaid services they then pay a premium to a private service in this case you united health care to manager the risk and in addition in a group plan such as the one proposing here there is employer paid additional premiums one of the things that's important i'll get to this the amount that comes from cns 129 insure is depends on the risk adjustment factors the most notable so if you're able to accurately capture and encode the part of the population c.m.s. and others

government adjusts the premium to reflect the fact are you have an illnesses burden this is adjusted to the premium you pay an additional a stars quality bonus and the government also contributed an additional amount to waiver plans employee group above did plan it ceases a great funding source in total if we perform wall well, to have a richer better coverage experience dr. maybe you had a question. >> no, no. >> if we move to the next slide. >> can i ask you a question you have something about a star

something what is that. >> the c n ms a stars rating program and for the medicaid business over 95 percent of our members are on a four-star plan that qualified's for a bonus if you're on a plan 3 and a half stars or less that's basically 3 percent of the revenues so it's $30 a month i'll get deeper into that commissioner breslin. >> what do have you have to do to get the star. >> it the a quality business to capture and close gaps in care that is the principle test there are a series of manufacturer that are focused on some of those are manufacturer and

others are medication adherence gaps so it is really taking how well are you tracking the care at a level and did standards that are identified and applied by c.m.s. they pay you an additional for a dividend our generating with that, let's jump to the next slide nicole this is a at some point of our medicaid national p po plan that is a history i'll directing your attention to the blue column so the enclose geographic availability is the leading national medicaid p po network the network has no steering it is number one differential benefits in and out of in effect

the way it works we have a single largest over half a million providers but in addition a full benefit level any provider for medi-cal we pay them fees rates for medi-cal they'll bill unit care dribble we pay them 3 times as fast as the government and most provider practices and hospital organizations prefer the access is broad if you have retirees that live in the bay area but travel to seattle to visit grandchildren and their children had he have a health fended no issue in assessing any provider that accepts medicare in that community and they could go to the cleveland they're in our p po network if they have an issue

so any place really in the 50 states and territorys we have contract network plus a will provider to see those retirees whether they're at home or traveling really anywhere in the country the value that translates the different kind of revenue source we're reduce the cost of benefits that the employer sponsor level so nicole the city and county of san francisco this would translate into mooefrn gadsby liability reduction and real kind of a savings in the trust fund. we've quoted in working with drod it will improve the deductible we took to zero and

no out of liability for those madam clerk, any other business before this committee? members >> so you u how can you have a out of network liability. >> as long as the provider accepts they have to accept the fee reimbursement for the medicare provider so if you have non-provider subject to a contract today the best example a hospital based on physician so the member i'll take my own example i needed a total knee replacement last december if a member is scheduled that surgery knew knew the surgeon and didn't know the ann gift or the radiology group non-par.

>> non-par. >> not contracted with our network i'm sorry but not part of the network they have the ability to balance bill that member but as long as they'll not be an information group that doesn't accept mechanic so all they'll do with the medicare advantage plan is foil for and receive one hundred percent of fee reimbursement as i understand it a thirty percent differential 85 to plus so that potential endorse is eradicated there's a great member list but i did same token we manage the overall cost of the care beechld in fee for service medicare you have a member today that has

medicare prime didn't it explicit matter who the coordinator medicare does nothing to manager care in the fee program nights i that's the lions share of the cost when up coordinate and pay the benefits that wrap up around our carry whether blue shield or united health care was able to step in and make a difference in terms of the sort of trajectory, if you will, has been established our late to the party in terms of making an impact we get to manage it from the get-go the claims come directly to the door a. >> so medicare will not be primary. >> your medicare plan becomes

primary so 0 a comprehensive plan that includes the drug coverage is their primary but the city and county of san francisco plan. >> there are a number of doctors and physical authoritative that don't takes hmos so like the plan now so how would that work now i went to the same - and there's a difference between the individual plans you're referencing most medicare are individual or local plans either a local hmo those are only contracted next time you have to be in the network they'll not go to any provider you'll have providers not president to be in the plan but continue to accept the fee medicare so the

providers the member goes they say i have a group member a national p po that pays the service you get from any other medicare provider and they'll receive the claim and pay you a third of the time with the federal government we sometimes have a provider that says i'm not i want to accept the plan we have a service group that do outreach i have a slide a few we can jump to over 99 percent of provider nationally will accept the plan or whether their contracted or not i think slide 9 we're able to pull that up nicole. >> it would be the members the member goes to the doctor gets the bill and submits the bill to

you. >> the physician will just send us the bill and we'll pay it directly 99.9 percent of the time our data shows we're serving roughly a third of the numbers we're able to educate the provider open their financial benefit of the speed of payment and it takes the member out of the middle. >> they just bill medicare and medicare reimburses them the reason they don't take hmos you set the fee not medicare who is setting the fee you or medicare. >> we'll arrested on 0 rate based if we don't we pate them one hundred percent medicare. >> you'll pay medicare's fee. >> absolutely that's why they