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america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. >> roll call commissioner president scott commissioner lim sfgovtv.org supervisor farrell commissioner ferrigno we have quorum oh, commissioner shlain is excused we have quorum thank you secretary now have action item

one. >> thank you i had to turn on the microphone it item one approve the minutes so on and so forth below regular meeting of march 12 special closed session appeal on april 2, 2015. >> i would ask the board any amendments or edits or changes to the minutes as distributed. >> i hopeful to approve is interest a second. >> second. >> public comment? we're ready to proceed to the vote all opposed by the same sign opposed? and so ordered a we're now ready for action item number two. >> two. >> item two discussion item

general public comment not appearing on today is agenda is there must be comment. >> good afternoon, commissioners excuse my voice it's allergy we know know this is an item stone the agenda having to with the ma pd plan i've been getting calls and i'm ford the president i've been getting calls and concerns about this i'm hoping you will thoroughly vet the presentation many, many unanswered questions about ancillary chiropractic and ac purchase and want to point out in the exhibit the last couple of pages while it's really wonderful to have a comparison chart if it's not readable i used magnifying glasses do do the best i could i

even toom took off my glasses to read better i'm sure i, figure out but it is illegal we need another charley chart to be able to checkout but we're most concerned the plans my members center been call me they're concerned about how this differs if this is particularly to have both choitz and the answer i've given them is if you currently have is a network provider in all likely hood that's your provider that person is in the u ac network but out of network and the pharmacy there is comments about some the formula changes and pharmacy issues that are coming down for everyone in the ma

medicare challenges. >> thank you for a those comments as we come to that portion of the agenda we will trying try to be rigorous i have no doubt if we miss a beat if in regard we'll undoubtedly have members of the public that will raise the questions and we'll take the time to deal with them this is a new option if needs a thorough review and discussion we intend to have that here today yes. >> my name is a dining. >> could you bend the microphone it wouldn't bite awe you i'm diane several months ago i presented a question about having the dental man cover the appointment for the sleep apnea

i was told someone would get back to me i've not harder this is part of the dental coverage if not why since it is the protocol of the professional organization that regulates sleep dentistry i don't know if you need another copy. >> we'll be happy to take the copy if you wish to leave it it to the secretary i'll ask the executive director to take this under advisement and provide a response at the next board meeting any other public comment yes, please come. >> hi commissioners my name is it charging a lot i work for the puc in the 1244 classification i'm here today on my own on behalf of not a representative r

etch i've been working for the city a year despite the fact i work in an h.r. capacity i was unaware of significant increases that would be faced in the city ppo plan namely for the local 21 it went from one dollars 8 if to january $2,015,189 that increase from $4 to $400 is approximately 10 thousand percent increase i did the math semester over 10 thousand percentage inflicting increase i understand it is necessary for the sfoifks i did want to go ahead and put a face to that decision someone like myself that doesn't open an enrollment package i thought

everything was fine and never a reason to word otherwise i was shocked when it hit hi paycheck it forced me to seek additional employment that has to occur outside of my working for the city i come to you today is it fair to say nothing to be done i understand i put many a po we read about working families drive out of city and county of san francisco one e-mail could have solved interest problem less than 10 percent on the ppo plan or the most recent numbers indicate one e-mail having could have stopped this in m in class 1244 clarification i ask you

consider a notification outside of the some pact that is sent to any home address especially in this day and age it appropriate thank you for your time. >> thank you for bringing this to our attention i'll try to active consider whether we can take an action any other public comment? we'll now move to action item 3 we're now entering a period in our agenda where this board is arching as a committee as a whole we can have a wide decision, if you will, on this particular topic that rates and benefits that board hass acts audios a committee as a whole around those matters and our governance policies terms and

conditions you'll entertain later in the agenda officially brings this into we're now in the rates and benefits not the regular meeting but the regular benefits committee meeting i recognize there be other issues people want to dlofl into if wear deal with other issues i'll have to rule those out of order until the appropriate space so are we oriented with that we'll go >> item 3 action item blue shield hmo 2014 for the primary retirees and updates. >> good afternoon. i'm your acting actuary and today i'll present the results of our analysis on what we recommend as the 2016 rate renewable increase for the active and early retiree

rates under blue shield before i share my information i want to recognize or let you know prosecute aco people are here they are a big parcel and reason our experience has approved because with couple of years ago we implemented several times on the impact of the aco to the experience and utilization. >> if you would stop for a moment put on the record what aco. >> accountable fair organization. >> i'll go a little bit further it's where we have medical groups talking about and structuring relationships with the facilities and providing cares on a based where before they worked in silos now we're an integrated care orientation and we accountable for the organization.

>> i believe you're getting ready to introduce the representatives of blue shield. >> i'd like to have the blue shield representatives stand as he calls your name we can clearly identify who you are. >> i know several of the names but can you stand and electro yours. >> that's wholly inadequate to identify who the folks are so. >> if you'd repeat your names. >> (inaudible). >> all right. would you repeat that. >> christen strategic vice president for partnerships for blue shield. >> could a i interrupt kirsten bust the ac those three years ago what is one of the people

that helped make that happen. >> excellent. thank you. >> and would you repeat that. >> dr. stewart levine chief financial officer for blue shield. >> welcome. >> now we'll hear this is terry hill from hill physician group i think he's the motorcyclist and lead for the aco administrator. >> and we'll have richard who's the brown and to tell la half of the population from the ah o from brown and i've been terribly alone and forgotten in manhattan >> welcome back. >> ann marie director of clinical services i'm very happy to have them. >> thank you all for taking time out of our busy schedules

to be here undoubtedly there will be questions during the presentation that needs our expertise and response as we go forward to thank you for taking the time to come. >> as part of the presentation i will share my analysis then we'll have the two representatives terry hill and richard answer what we've old as questions and we'll go back and make a recommendation and close the presentation. >> that's correct. >> page 2 - okay. i don't know but we have the document on page 2 what we're doing is projecting the costs and establishing the recommended renewable for 2016 for the flex funded program before we give you our answer let's remember when we went into 2013 from 2012 when was a short planned year we raised the rates

3 and a half percent in r68 2014 we didn't raise the rent in 2015 we did not raise the rates but made a decision when it was recommend for a 4 percent increase we subsidized the rates why did we do that we wanted to keep the access of that plan viable and wanted to make sure we stabilize the enrollment immigration they've helped to make this a sustainable plan when i look at want data we've had minimal and no increases for two years i look at the data and the results of my analysis of the data is that the program now notes a rate increase what's the core rate increase we need we need approximately 9 point did percent increase from 2015 rates which are 9 approximately 9

displayed on page 3 i'll not go line by line we need that now last time i presented to the board we had excess costs over a premium on the flexion premium for 2014 the required amortization is $4.4 million we need to put into the 16 rates for our claim stabilization policy that makes the rates go up 2.1 percentage rate we're looking at approximately if - 11.5 percent for 2016 over 15 rates i want to digress this trust is the best trust when it comes to be responsible for paying for this in a pragmatic way if you have over ages we're going to put

them into rates we're environmentalists we don't make that better combuld moo blue shield is blue shield and kaiser and kaiser and city plan is city plan by a policy established before i was on board by the previous actuary put a wall it is essential for long term stability of it trust and makes each of program be viable in and of itself to you don't say this is do great we want those rated to what their cost there needs to be an 11 and a half percent increase i'll stop here are there any questions about the overall increase? >> can you tell me what we i might have experienced had we

innovating not had a nc o board overall costs. >> actually, sir we shared that if we hadn't rated this anna premature basis we had $55 million more money would have been spent over two years it's for the record that's an incredibly large amount of maintain e.r. money i'm prey very impressed the board accepted the aco and accepted the flex funding the aco allowed us to save the flexion fund we said they can do what we believe they can do we can save this money and it's happened it is already done. >> other questions from other people up to this point okay

precede and on the other page what does this mean for me we do this unfortunately, we used to give the full rate card we were in the process of being timentd termed terminated we figured out what this maples on the premiums that are applicable to the r x cottage an individual sees a $5 plus rate increase this is a 10 there's increase and the family rate goes up $38 plus that is actually not this is fantastic why is this fantastic no one you

know what do you mean it is the 93, 83 contribution the premium before we had kaiser permanente and anything that happened to blue shield all the dollars are the contribution now, it's a portion of the premium so i want to put on the record the actions taken by h ss and with the controller's office and all interested parties to change this contribution formula makes this from the employee prospective not a awful situation i don't know if that's correct grammar but i'm one hundred percent - any questions i want to make one more statement and introduce our aco. >> if you have 11 and 45 percent increasenext year what is

next year. >> what do i - i have to be conservatively it's been 3 and a half zero, zero to raids it to catch i would say to you based on the actions by the aco and the management of health care i would expect it increase not to be greater than than middle range that is math rates. >> market trend means. >> 5 to 7 and a half percent on the record. >> thank you. i want to make sure mid-market i could be thinking 3 to 5 i want to be. >> you got me if you don't mind i want to introduce the people that manage the health care costs we have 5 questions i'm going to read them

quick and have the gentleman come up and they'll say how are we're going to get that 5 percent or better. >> thank you. >> i want to read the question. >> please do. >> those are pretty good questions pertinent to this exercise that we're not entering a time what are the primary benefits realized that may not have been k450u6d that the aco not been in place they can say clearly from their prospect what changed and then the question that is always asked from utilization have they impacted the quality experience you know people are going to say working out we're all made aware

last month that the pharmacy costs of speciality drugs specific to the period went up 21 percent in the record what are you going to do that pharmacy costs and fourth your long term strategy and fifth the big take away how commented are we with those 5 questions i'd like to call up to the podium mr. richard fist. >> as they approach the podium were those questions shared in advance. >> we're one hundred percent transparent and rigorous. >> thank you good afternoon. i'm richard thanks for having me do you want me to hit all 5? >> do your thing. >> how committed a