have to manage the care better than the another providers in the marketplace. >> any other questions yes can you pull your mike down. >> the community is in the sutter network. >> it is unfortunately, we don't have physicians in mirpd but your sonoma physicians a can refer to nevada that is closer to the broader. >> how do they do that. >> excuse me. >> the brand new hospital in sanity ross but for those who live in the southern part find couldn't sutter can admit to nevada. >> okay. >> so what's the pleasure of the board on this item. >> well, i will ask we had

difficulty getting as you heard in the dashboard data from sutter this is a major investment on the part of the city and county of san francisco and the health e health service board we get data if kaiser permanente it is a fully integrated system you you know if we precede can we count on getting data feeds so with, look at data cost vendor. >> director dodd excuse me. >> have - >> the ceo would like to answer that question. >> please identify ufdz. >> steve commissioner breed executive director for sutter plus it was started as a primary strategy for sutter health three years ago to address what is recognized as a incredibly

changing environment at all levels i was interested as a group united states daunting challenges you have in front of you that require you to do things i've not done likewise this changed the game for us a bringing the health plan with reinvent the way sutter looking at the community one plus years as part of community but you have to adopt we have to adapt in that context that is where the health plan formed yes. the we are to your question yes? the way to get access to to the data we working closely with interest in open books and sharing that kind of information to get to

the right outcomes we have a shared responsibility to change the way people receive health care we'll not do to perfectly but we - yes, that's the answer. >> where you have instituted this plan with other place of residence have you had shared risks arranges or incentives performance measures those types of things that are part of what you do. >> yes. surely we're very flexible you have to create an accountability with the tasks of delivering on the promises sometimes require that accountability. >> yes. >> just to just to be clear this is a a nonprofit health plan. >> what's the pleasure the board the staff represents to direct the staff to pursue the

calculations for consideration for the 2017 plan year. >> this is a discussion. >> one additional question along overseeing lines with 32 to 35 thousand members growing and doubling at what point is the membership significantly large enough to make new valid statistical forecast of the health care how you know what might impact you know kind of the cost of service it seems to me a a relatively small population it seems small you know i've seen plans they've had difficulty inform managing their costs not a day or significant you know one thousand dollars or $2,000 admissions can have an

impact on the costs that's a good question but a different answer this is a solely supported health black man by absurdity health unlike we it is a doesn't have a third party status we work dribble with the costs - >> that's the nature narrower network are forming up this is a

sutter product and a sutter health facility and we close that gap all right. thank you and any other questions for commissioners any public comment? there was no mention of a - my friends would be disappointed i expect if you consider macro new changes look to plans that have

our full membership and the process has an rfp adding any other planned to the network so one of the things i'm occurs about is if sutter has been deliverability maintaining high costs to other plans like blufld and nickel and dimed health care to low ball the market with their own plan

>> thank you for your comment any other comments. >> good afternoon. i'm a representative for i f p local 21 we represent the employees in san francisco and santa clara and, of course, our members who work here in san francisco oftentimes live in you know the bay area county so you know more and more we're seeing our members in the community in potential you know health care plan is very important to us to look at alcohol so as your commissioner vice president moran whether or not to move forward in the health care i on a couple of comments first, i echo the previous commenters you know questions around the current high costs of sutter

health care and whether the promises ring try those costs will maechlg drop and mr. staff mentions in a previous comment after looking at the report then we see pharmacy costs and you know after all the other graphs we are shown it leads to a conclusion the reason that blue shield rose significantly this past year was due to the prices from our hospitals and physicians going up and similarly in december of 2013 the 90th had a first page article of their costs a single cinch may be one thodz and charging over so i hope 9 board is careful in reviewing the

information that sutter has present i hate for our members your union members to be presented with a plan that begins allow and drauchl increases and transparent in pricing i think the board is well aware of the lawsuits that is currently moving forward against sutter around transparent in their pricing and you know, i would hope that that would be take into consideration before we agree to sign on to a new health care plan with a cooperation that has long had allegations against it of lack of transparent in providing. >> thank you for your comment any other comment? >> dense kruger active and association. >> i just want to remind the

board before we start that process what we went through last year of almost everybody in the entire bay area having the possibility of changing doctors because of absurdities fight with blue shield if we do go into an argument with sutter we have long them into that agreement for a number of years i feel that sutter getting in and once in changing the order in which they do business based on they're past where'd record and those are things i want the board to consider when revealing their system and look forward to the rates and benefits process so we can see maybe inside of sutter and get a better idea of when they're

proposing. >> and happy new year. >> happy new year to you sir, any public comment? hearing none i'm going to an on behalf of this board request the director under take the work to about consideration of this health plan as part of our rates and benefits process not an objection will the board members we'll certainly will be spending significant monuments getting the questions and issues that might arise from the consideration present vetted and then make the type of informed decision it is part of progress that is what i direct on behalf of the board at this time any objection as mr. vice president i agree i will say i agree with the gentleman's comments and perhaps unavailable but as this

is a first step in the long process but of grave concern so i hope this is something we look forward to as well. >> all right. we'll now move to the discussion item 11. >> item 11 discussion and possible action of blue shield database if the 2015 i have this chief financial officer what me today. >> your other colleague who presented is not with you. >> she's here in the audience. >> thank you. >> would you giving me her

name for the record. >> jane. >> so i'll take a few minutes and help to beat you are timeline and provide answers to our questions one of the things that i think we didn't get across was the benefit to the members and i am going to use. >> antidote i have a 16-year-old son with autism and a slate of medications and if he shows up in an emergency department without one of his parents he will be treat by a physician unable to assessed his conditions and medications and what is going on so he comes in their wonder is a head injury why is he combative one of the journalist if in my son or

someone with a similar condition shows up the physician can log in to that and see what is going on with this patient and be able to make the treatment that have a different outcome without that information i'm also a member of blue cross blue shield my data is in cal so i share private concerns with everyone else so that's another aspect of it we weighed when we went into this i don't want some perspective employer looking at my information and seeing you know am i going to make a decision based on the clinic information i was able to get so we saturday out with those types of thing in mind the objective to - we're trying to drive quality and

affordability through the sharing of clinic information it is spotty we saw an example earlier, you looked at kaiser permanente number of prescriptions versus the network health system blufld the number of prescriptions slightly hive advertised due to the fact that the communication and the information between physicians is not exchanged so someone is not will know in a primary care what their physician is prescribing we're trying to leverage the technology to be able to bring that information together and that infrastructure for health care search mass not been in place we also really want to take advantage of the benefits of the technology so we've got a large camtc of developers here in california

down the corridor that are eager to be able to within a really controlled environment with privacy concerns people get access to information an boost patient to make dignities or an advance and do pass, consent on the phone when my son shows up he has an iphone can give it to the treating physician so that was the genesis those types of objectives when we went into this all the thing we released early on blue shield we represent square somewhere between with within and 5 of a panel not enough of physicians not enough for blue shield members our mission doesn't say blue shield members of all of california we want to make sure

what we are dying is assessable for everyone in california thus cal index recommending california so we partnered up with ann enthusiasm to create cal ethics one of the things i want to stress from the conversation lass last night we are that particular in the guardrails an cal index to stay true to the intent we were aiming for a few of the things a not for profit and controlled by the board of directors not controlled by blue shield not controlled by any independent board of directors to make the decisions but the founding members had to insure that cal index remains secure to the

mission the other thing financial data show not be a tool for any provider organization or any payer organizations to try to ledge a competitive scenario where while i provide different cost care but to provide a higher quality of care no a cost strategy advantage if for any party we went through and codified the objectives of cal we codified the iefbldz to address health and care and quality and codified to facilitate the efficiency and improve the public health and the research data were very tight we were concerned about the same types of things as the

doctor was concerned with that would be leveraged for some company trying to sell to physicians or someone we didn't want that to happen but not create a dictate with 40 millions californians not assessable to a scientist at ucsf trying to do analysis and research in cancer in alzheimer's and some other disease with the treatment a so on and so forth so that's what we do did we set out to do we launched it in august of 2014 and cal index became an official organizations in september of 2014 i believe we've provided some answers to some of the questions you should last night for the minutes before and i wanted to make sure that we had an opportunity to both