you have many of the measuring companies now becoming more mainstream, if you will, as a result may be one to 3 options before you had as many as 678 that raises the costs secondly fall because of the new regulations drug shortages jen ice cream continues to balance the budget we need them to grow you have to remember they represent only thirty percent of the costs you have another 70 percent that needs to be managed if that leads me to my last slide the pharmaceutical management will be critical in the future we need to foster

competition that works not people to set prices based on with no reason we need optimal utilization by members most people fail to follow their drug regiment we need to make it a value based payment and coverage policy you are getting the best benefit for following your drugs and make sure that all the costs are transparent so people know what their bowing and increase the medication adherence and make sure we have the data so we can address the gaps in care and make sure that if a drug can be administered at a site we go to the lower site if you can take it at home or at the physician's office not going to the hospital it is 2 hundred percent higher

and in closing you also have to remember the person that is taking the speciality drugs those individuals not only are they bearing a high cost of the drugs they have that but they also represent about 25 percent of the medical so they have medical costs on top of drug costs people that are middle-income that maybe cost permissible active and right now to end with a figure estimates for the expenditures are expected by 2012 to up to $40 million it is $87 million national that is 5 years not 20 years questions >> you've brought such happy news

(laughter). >> are there questions or comments the cleft and diabetes you can cut those in half and the people taking medication for cleft it is the same things with diabetes it difficult to find a class when you have it only after when you have it why is that a prediabetic classes it hard to find it seems like things are disease management not health management we're still there such as we talk about wellness when you go to a doctor they write a prescription so there's a lot of home

remedies this is still things people use so until we get around to changing that we'll not bring this down so that's my comment. >> okay. thank you any other comments from the board are there any comments from the public on this item yes. >> please identify. >> laura provider of benefits i want to thank the lady what she said i have diabetes i took the courses but have several acquaints retired city employees they have 90 no clue higher clue how to get train this is something i believe we should work on there are so many of us have diabetes and once you understand your black and blue

goose levels i'll probably never be methd my father has followed those things his whole life we need that training. >> it's true we don't have it. >> comment we are going to be doing a research on predeceasing we'll be implementing two interventions one online two interventions that are bun successful all over the country we are going to go forward with the collaboration of kaiser and now open to active and retirees. >> any others public comment. >> you know the doctors are the gate keepers if at the don't know where to send somebody side

blue shield prediabetic classes is $400 it's ridiculous for a preapproved diabetes class and another one at st. mary's it is pretty losses not bad not enough that one is free that's one day i mean, we should be the doctors should be referring people and know where they're available and the heartache plan central thank you for those comments. >> i'm going to exercise the perspective the chair and call for a hygiene break of 10 minutes we'll stand in recess.

>> i'll take the per prerogative of the chair to make adjustments in the agenda we're just concluded the rates and benefits discussion on item pharmacy trends the next item in the that's listed as item 7 we want to defer that item to the next month to month the index will be defenders until the next meeting that's item number that and then a if you preceded in our agenda to item 13 we'll defer that by action item until the meeting i shouldn't be commenting on item 15 that's a joke.

(laughter) but that was intended to be an action item for today rather than a discussion item so it's been duly noticed i hope that all b will come and comment at the appropriate time we'll defer action until the next item and defer discussion as well it's been duly noticed a letter if the controller recommending an action and we'll take that action at the next meeting all right. so with those items for clarification we'll take that without objection. we're going to move to the governance item that is item 8 madam secretary >> action item for the terms of references and policies as approved by the governance committee splilgz.

>> you've seen the pages of the governance committee the pages i hope i have correction on page 18 item 7 c it was provide the appropriate forum to review and comment on any management letters that maybe are submitted and we will cross out finalize. >> we had agreed we want to see it before it's finalized. >> and then on page 47 we agreed to cross out item number 8 that was a input from the staff

i'm not going to go over all of this we had a lot of hours spent on the governance committee so i'll ask that this be approved by the full board do i hear a motion. >> yes. >> cross outnumber 9 on page 47. >> do you all have copies of this (inaudible). >> 47 under timing and process. >> the topic that timing and process that section on timing and process item number 8

stricken and the question is raised about item number 9. >> i think we're talking about objective criteria only number 8. >> there's been a motion to do you want the report as submitted is there a second. >> second. >> it's been improperly there is a motion and a second i'd like to commend commissioner breslin for they are per essence on this task i've been a member of the governance committee working with her on this document we started at the end of last year to bring it to this state it was an extraordinary contribution i would reference the fact that item 8 in spirit may manifest itself another way

we'll diligently look at this year in process to be implemented with the staff not saying we're going to conduct it but identify the process for a climate survey which has been done in many of the city departments here in the 80 city to get at how engaged and what things staff are concerned about and so on to try to talk about how we make this staff department one of the best places to work in the city under the leadership of our great director as we go forward we'll discuss it and as we get more detail from the department of human resources and matter to figure out what the cost and when and where to be down so forth and that's a commitment

we'll work that governance committee any comments in the board or public comment all in favor of the terms of reference for this board and it's standing committees, officers and relate entities please indicate by saying i. >> opposed? the i's have it so ordered a that was terms of references and policy. >> policies correct terms of references and policies we're not moving to the regular board meeting regular business of the board item 9. >> item 9 discussion item port authority's commissioner president scott. >> i have a brief one i'll make it very brief i know it's - first of all, i

want to thank commissioner lim for preceding at the march board meeting i also want to in that public forum thank you formerly dr. george commissioner shlain when restipend from the board i want to share an e-mail to commissioner shlain it expresses the sentiments of the board i have had the opportunity george the need for you to resign is stoipt to me i have enjoyed our council i thank you for your contributions and patience we've grappled with numerous decision in the private arena could have been resolved immediately rather than a public process it was

totally a type a person i think he'd understand we saying that the board is condominium to pursue i wish you all volunteer dmraefrz and sent by me i would like to thank you for the opportunity to welcome commissioner says and will not be at the may meeting but we welcome his presence and look forward to a replacement for commissioner shlain to operate at full strength i've participated in a wide variety of meetings including the combfrps and the telling cover-ups with the united health and with meeting a obtain hewitt open the blue shield discussion and lastly the substantive conversations my reappointment

to the board i'd like to ask the board members to take note of the fact we've been given and have returned today information on educational conference that was held national summit on price and cost transparency as we've put together those new terms for the references forbid the board the issues was education of the members of the board this conference was held few weeks and we've got to the opportunity to look at portions of it over the next 3 months and so i would innovative members of the board to look at this document and identify which particular sections of that conference they would want to be part of the webinar and the times are provided on the document as well i'd like to ask you to complete this before you

depart the chamber rather than take it home email that back we all have again intentions cooperate please that's the end of my report. >> we can go to item 10. >> item 10 director's report director dodd i'll be quick and we still have 78 vacant positions but things are moving the 0931 operation manager will close monday and finally candidates that took a while to get them into the public testimony the research assist is in the test process wellness interviews is underway a few false starts the finance and contracts we've gotten good

candidates and the emerge position we're still recruiting for terms of operation we continue to meet all our goals and are well below the industry standard our in house visits have increased we're downstairs from retirement it makes it easier to stop by and our visitors are longer so the wait times may increase we're limited by space in terms of how many people to handle contaminate i want to thank the board for their continued delegation and trying to help us utilize the emerge payroll system to input data 24/7 maybe 7 days a week they've added wednesday to us

so we're not completely down that half day on wednesday that is down on thursday i want to - in our deck you'll find a slide that document we're in full compliance with the employee mandate from the affordable health care that have we're sent out over 14 hundred letters 4 hundred employees that are signed up from the employers communication dollars a fascinating presentation who is clicking on what on our website but suffice it to say in march we have 6 thousand clicks 2 thousand went to the wellness packages and in terms of finance a little known fact we there's low income subsidy program available

through medicare and mostly we process about last month 9 million subsidy payment from blue shield and kaiser for people that have difficulty meeting their premium you can read the rest of those in terms of wellness today was a walk the work today, i noticed supervisor farrell had his walk to work bottom on and people in the audience and staffers walked to work pamela we launched the shape up team our team the h ss team spelled o o l e the teams can join us and if you don't want to be on our team be on

your own team shape up h ss we have teams outside the cry we hope you're going to join our team quarterly report placed on the website for what wellness has accomplished the highlights we had over 18 hundred visits with an average of 6 hundred and 3 per month in the wellness center monthly join in on the exercise the largest participation on the kidneys and you and how to resolve conflict series and done more that i monitoring screening to retirees and 10 were screened in 10 days and 53 percent of the members were unaware of numbers that is something that larry

spoke to earlier people don't know their numbers we had a team member watch the summit and programmed it for you to take the classes we're incomplete perplex for the all claims database you can kind of see where we are in terms of meeting presentations i will point out that sb 26 is going to be herd in the senate on the 22nd of april we have not taken a position on i'm drafting a excise tax we'll put out we hope to be able to combine from our february presentation to combine the early retirees with the

retirees and participated in the sf g h month to month on what the large employers should say most of them not to say take that away but we'll be xufk it's a burden i want to point out yesterday the state perspective committee met i abrogate forgot ab 63 by assembly member david chiu a pharmacy transparent bill and timely given the current presentation we had it requires pharmaceutical companies to file the cost of their medications with the office of the statewide health and planning development it is beginning to keep track she said none of those xoiftsdz in 2013 if he started back in 2013 we'd be looking back two years but it

is time to monitor it we had two of our new staff working and we let them stay alicia and carla technicians i have two more items i participated on the california collaborative i'm the only employer participating it is interesting that blue shield and blue cross are members of the smaller health claims and they're addressing first is the total cost of care so a lot of what was said earlier about immigration there are trying to find the best practices and share them and create. >> cafe of what can plans and employers do that will bring down the total cost of care and

then this morning i participated in the catalyst for compliment reform blue shield working group i wish the blue shield folks had heard neil sullivan their medical director does a beautiful presentation on how their integrating health care and looking at oncology where they started a year ago was doing something called a human centered evaluation they hired a firm to look at oncology care if the humans prospective and how do we organize care around the humans and in doing so how to reduce the cost of care and improve the quality of care that was very, very well-thought-out and employers and providers from all over the country on the

phone so i was expressed that that that