providers who are not in the ppo network should somebody have a direct need to see a provider we will try to recruit them number two as a fall back, they will have coverageage they don't have today. >> questions? >> there are a lot of things not covered under network. specifically preventive care there say whole list of them >> yes that say a good point >> what do you do all of that out of network none of those would be covered >> correct to the degree they will could covered by medicare they would have coverage there we as a blue shield policy ppo plans do not cover preventive care with nonparticipating providers >> that is no different than today is that correct? >> well today we don't cover

anything for non-- >> just for a point of education i'm trying cocompare and contract >> that care would not covered. >> it would not be covered at all >> correct. >> is the mills peninsula group in paloalto a part of this group. >> yes they are >> mills peninsula. >> pal low alto >> yes they're in our ppo >> those are the two not covered before for the seniors >> correct >> they will be now >> yes >> how many are there? do you have any idea >> providers? >> members down there? >> boy i don't know. i don't know if i know that. >> we will refer to director sh dodd to do research on that we can continue. >> part of the disruption we

should be able to part of that information, and we also did geo access by county you can see how many people by each county >> these people turn 65 now and they're not being able to go to their doctors as of now >> correct >> if they went into this doctor they would be able to stay there >> that has been another point of noise within our plan an existing member active member early retiree goes into their medicare advantage network they don't have the same access network they have today. >> so i don't have the exact blue shield numbers but i will tell you that san francisco has in terms of the retiree memberses has 12,221 san ma matao has 689 members --

>> i was inqueering about that group the mills pen anyone la and paloalto group there are ones coming in all the time -- >> it's 2012 >> people are turning 65 it's a constant problem. that's okay -- >> if you listen to our chief operating officer that sun one of the chief complaints that blue shield members make >> i know. it's been a problem. >> and this would be a corrective to that. >> might be one of the positives. >> yeah santa clara we don't have it completely rolled up >> but they would all be covered >> they're all in the network yes. this is of course our population 95 people in sanmateo county and it looks like about the same in

santa clara county. which is where palo alto -- >> we have another 135 right now that will not be in the network a new 135 that will not be -- >> right. >> where are these people? they're obviously in california probably right? >> yeah. pltalo alto -- >> they're virtually in the bay area they're further out today. >> you are pretty sure you can accommodate all of these people in some way? >> to the medicare pp o.? yes. again it's ape ls and oranges it's one large ppo network. >> please continue.

that was the highlight of the advantages and disadvantages of both plans, in the appendix we provided a sample of the id cards making the point that general medicare is primary they would have to show their medicare id card as well as blue shield card and they would following that particular slide have a separate prescription drug card so it is different from a service experience level today different id cards it's not a delegated model the payment isn't today like it is today the $25 koe payment at the point of service they will get a pill this is not a bill from

blue shield so that is different today. >> also on page one of this here in-network services under out-of-pocket maximum the new in network would be 6005 and the new one is 2,000. that is quite a jump. >> yes it is the jump. >> i thought it would be the opposite for blue shield 65 +. that's a huge jump. >> yes. >> >> $4,000 >> with work with our product people why there is such a high

maximum. >> please identify yourself >> chris parerrez blue shield account manager i think your question is you are asking about the annual out-of-pocket maximum >> yeah, the access now is only 2,000 for an individual 4,000 for a family and new ppo it would be $6,350 for an individual and 12,700 for a family. >> that is correct. so the majority of your folks today are covered under the gmapd which is the 65 + plan out of about the 7,000 people that we cover currently about 5300 aren't in this plan so we modelled the national ppo plan we wanted to model it out of the current hmo plan that is offered

to the majority of your people. if you notice that that third column where it says shield 65 + annual out-of-pocket maximum is 6,000 per individual >> i was looking at the access i don't know how many people are in the access >> 15 to 1700 >> out of area >> they're out of the gopd 65 + service area so in actuality the new national ppo plan we're offering has a lower annual out-of-pocket maximum than the current 65 + plan. >> i see that one. >> all right is there more clarification on this point? i think i see someone to wrour right paul >> my name is charles lee with the medicare product organization to piggy back on what chris is mentioning about

might be roring the 6700 for the gmpd program for 65 + the reason it's set at that level is initially when we modelled the benefits was the fact that the benefits overall for ccsf is so rich that getting to that 6700 number oftentimes you know actually would be beneficial if we left it at that figure it would help actuarily to lower those the rates so the folks due to the generous plan design to get to the 6700 there wouldn't be as many folks to get there. so as a result of that logic then the 6700 was left there to reduce the overall rates to the city and county. >> it's about risk at the end of

the day >> just one more reminder the national ppo plan that we're offering as far as -- there is no deductible all of the copays mirror the existing shield 65 + plan. so the likelihood of hitting this out-of-pocket maximum is probably very slim. >> all right. thank you. continue >> following the xiktexhibits that concludes my portion of the presentation >> all right. are there further fe from the board >> i have a question i'm concerned about here. where are the pluses the minuses are here.

>> i would like to raise one issue you identified this i think correctly. and it is in your disadvantages around this particular program without clinical management. and i want to say to our actuary and to the director that should we adopt this plan this will be an area of continued monitoring concern during the year. i think it's something we will have to pay attention to. we try to talk about large community based disease management programs and so port we haven't done an expert job at that even though we have at other plans the fact that we're acknowledging it's not there that gate or whatever it is that threshold is not there is a concern for me it is one of the thingses we will have to actively monitor closely at the end of the day it will inmruns

our rates the risk of this group it's something we have to pay attention to. i don't know if your plan designs in a larger context with all of the wellness things medicare and others have been talking about if that is not a point of emphasis you want to consider to be a future feature of this plan you know what the comment ailments are for this population hert disease diabetes that would be something you want to incorporate into your design going forward >> it's a good point i would add that when they're paying 80% of the bill doing disease management when actually cms ends up getting the benefit of

that work it's not cost effective for us with the active population in the aco work we do that doesn't apply here we have seen really good work er emissions down and length of stays down to the point it's bleeding over to the plan we're getting the benefit of medicare reimbursement which is the lowest reimbursement payer they're the lowest cost payer we know or virtually the lowest if the units go up that's where the intersection will be in the future >> it's a point to be monitored i want to put a pin on it

director dodd? >> that is sort of my question this could definitely change the rates in the future and the rates you presently have now are just a little bit under what your present mapd rate is in our past history has not been good with this field the only time you brought your rates down with rfp and the next time they went up double digits this could be lower with the intention of next year skyrocketing that say big concern with me. i think it should be everybody here you don't have the long memory i have on the board. so we have a lot of ups and downs with the blue shield and double digits with pressure i don't see how that's going to change. which brings me to the point will there be more transparency

in this >> director dodd? >> i will add this will greatly increase transparency because we won't be trying to eek out information suter will have to accept what medicare pays right now suter gets more than what medicare pays, that is one of the places we will see our costs remain lower because we're not paying the high hospital costs and we will also get the bill and diagnosis that is something that is completely unavailable to us now it will increase transparency because we will be paying the bills >> that is a big plus for me otherwise i don't see anything with your history really going up high next year. >> yeah a couple of points. i think our initial renewal

which is double dujts was a status quo renewal was us looking at again within the medicare advantage plan there is different revenue streams there is medicare star ratings revenue risk adjustment revenue egg whip revenue all of that is subject to change from any given year there is less transparency than simply saying the paid claims data with the medicare cob program for the record when we went from our initial to revised renewal for the status quo option there is some -- there was contract negotiations which i'm not as liberty to share to get us to the lowest point we can cut our rate by 17%. so i just want to make that clear we take it back to the

drawing board and back to the providers and look for an alternative arrangement >> this board will continue as you know to monitor premium rate increases formally and informally by you folks we took a very public position as you were undergoing your negotiations with suter you were kind enough to come and explain your positions to us we were more than sympathetic i'm not talking about quid pro quo but i'm saying the fact that premium rates continue to be triple what the rate of medical inflation is is a worry som issues as commissioner breslin pointed out during my tenure here that that has happened we're not expecting that return of state of affairs >> yeah i speak frequently with

aon hewitt we understand the ongoing rates and the liability we understand that is critically important >> thank you. >> one more thing i wanted to mention. with the same situation i brought up with unitedhealthcare. to do diligence we should have an rfp to see what else is really out there of course then your rates would really come down that is my thought again. >> i thought we addressed last meeting that would be activity considered in the next cycle >> yes. >> all right. are there any more questions from the board? >> thank you. >> is there any public comment? oh, yes. all right. as you approach to make public comment we ask that you identify

yourself and then confine yourself to the time a lotted which is three minutes. yes? >> good afternoon my name is stephanie moman the vice president of contracting care with brown and toll physicians here in san francisco 3800 of the san francisco medicare eligible retirees are enrolled in the blue shield 65 medicare program each of these retirees has a relationship with a brown and toll doctor as a primary care physician the options presented to you all have advantages and disadvantages as you have seen. i would like to highlight one of the important advantages of remaining status quo with the current plan specifically the shield 65 option the slide

pointed this out as care management delegated to the medical group this is a coordinated care to the activities of brown and toll medical group our care of social workers medical director and staff come together with one goal in mind to prent the right care at the right time to the patients we serve we believe in the value of providing coordination among all health care provisors doctors hospitals others health care providers in the city to make sure the patients gets right care at the right time. at the center is the physician who understand's his or her patient's needs and gets what he or she needs being referred to the right specialist. being enrolled in the right brown and toll management

support this primary care doctor's role is to not only take care of the illness to help with medical errors drug interactions unnecessary tes tests and hospitalization when everybody works together like brown and toll hospitalized and improved quality of life with those with serious chronic conditions we urge the health service board to consider how losing this care coordination will effect your retirees brown and toll physicians will still care for your enrollees through the alternative plans that were presents it's important to know that none of these care options have allows us to do what we have been doing for eligible care members so our doctors can

receive the support that he need to continue to do what they do best for the medical care for their patients thank you. >> thank you. >> how many people did you were in your -- >> over 3800 >> thank you. >> dennis kkruger active and retired firefighters i'm dismaid that a caveat of this plan there are no further plans to go to san mateo for medical care for blue shield if you take this plan you can use the other system but if you stay with the old plan we don't plan to go down there and do any more work. seeing how there is a number of people that live on the peninsula i find that discouraging second of all they're dealing with the same population the few people i talk to the first question that is

asked is will i still be able to keep my silver sneakers with this plan even though it's the same population in the same area pretty much in the same demographics that portion is not provided for in this new plan. i think that would be one thing that would be an advantage to the plan if they did offer that. if we go that way. but i'm still sad if we don't go that way they're not going to go any further into san mateo county seeking better care down there >> thank you very much for your comment is there other public comment? yes? >> hello good afternoon my name is fiona wilson a physician. and chained at usc f primary

care physician my current role is a chief medical information at brown and toll and three patient medical home here in san francisco california i posted a question what was the city of san francisco want? three things a healthy retiree population you want to spent less taxpayer doctors and better outcomes for the patients and member i suggest getting those outcomes does not include letters from hmo to ppo in order to leverage the services that are built and serving your retirees well the model of coordinated and dedicated care to support better patient outcomes does provide affordability provider over site

and infrastructure social work tools for assisten physicians for the health care doctor which is it's from ancillary pricing and choice to genetic care and alternative all of these help serve the patient better in the community senior patients obviously there is a great range what it means to be a senior patient many have complex clinical issues and coordinates planning for complex patients with a seemless hand off back to the primary care discharge -- this contributes to the length of stay and less bed days that you all are paying for i urge the health care board to consider to promote the blue shield 65 + program because it

provides for a wide number of seniors and health care providers thank you. >> thank you very much for your comment is there other public comment? >> carin representing rccsf in looking at all of the materials it's difficult to make decisions i appreciate the questions brought up by commissioner breslin and commissioner scott if you look at plane dollars and cents it looks like this is the way to look when you look at what is lost here the case management and prevention services i dismaid to hear that basically the comment was it's sort of -- what was it? it's not cost effective to not provide case management that is clearly a business decision and

somehow it's cost effective for kaiser and it's clearly cost epektive for uhc to offer that in their plans i'm dismaid,this is why blue shield lost their nonprofit status because they're looking at the bottom line that is a slam at blue shield my apologies these are the ill things that irk a lot of us i think we have to look at what is best for the members overall i like the idea that it's an expansive network i think a lot of our retirees do to allow for opportunity to access providers to move out of the basic service areas i they that say plus if you look at the bigger picture of what the services are ib colluding the loss of something like silver sneaker it sounds like a little thing but it impacts a lot of people. i think maybe this say little

premature and look at it perhaps if blue shield will go back with their blue pencils and refigure this and think about what they want to come back with down the road there is a way we can see it for the fufrpture now we have the disadvantages outweighs the seemingly obvious advantages it's right on the fine line it's a difficult decisions our members, he -- we will cope with it either way and the others have the same deal if you are talking about competition. thank you very much >> thank for your comment is there other public comment? >> i'm herbert winer i'm thoroughly confused by all of this i'm well med by it i think

i will have to run out and see my primary physician after that one thing i do like if i'm correct i can cross over to any physician in the city like say if i have a primary care concern if i'm with brown and tollen right now i can see my former physician with the hill medical group i can see him i have that portability that say good thing i will state that one problem with primary physicians is they do have their own networks they have their own networks of preferred physicians some of them don't work out as well i have had that experience with my recent problem of nerve pain hi to go through so many physicians to localize what was wrong with me. there are those advantages and disadvantages i like the idea of

preventive care and i think that's very important because that is cost-effective all across the board. you don't want to have to wind up in surgery for something that could have been prevented early in the game i think that is extremely important i like the idea with brown and tollen right now i get a free medical exam a year where they can identify the problem that is all to the good of everyone including brown and tollin they won't have to make an extraordinary surgical expense. if i'm correct right now i have enough portability where i can see any physician as long as they cake medicare that is throughout the country that works to my advantage the only disadvantage is i better go to the social security and get my