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secretary are they ready yes. >> we're ready they're ready. >> i now call the regular meeting of the health service board for the date of thursday january the 14, 2016 to order will you please revise and recites the pledge of allegiance and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all happy new year everyone and we welcome the members of the general public comment who might be viewing this as we under take your work for 72016

madam secretary roll call supervisor mcnamara commissioner lim excused commissioner wilson supervisor farrell connected commissioner follansbee expected and commissioner commissioner sass we have quorum. >> thank you we will now move to the first action item. >> item one action item approval with the possibility modifications for the minutes regular meeting of december 10, 2015. >> are there additions or edits to the minutes. >> under the financial reporting page 15 number 3 bullet number 6 insert his after president skwoolt there is something there i don't have any minutes up here.

>> okay. thank you. >> that needs to be a history. >> okay. thank you. >> i'd like to go to page 4 regarding the public comment public comment i'll put on the record again, today this board will be guided by i at that particular timey guidance by itself council i want to be sure we are clear about that i thank the person for their comment at the time and do so again, today we'll be guided in the proceedings of this board so i'd like to have to noted. >> yes. thank you. >> thank you you thank you. any other comments or edits to the minutes? any public comment? hearing no public comment we're

ready for the action all in favor of approving the minutes with the prior meeting and yes, i did i > opposed? no. >> so ordered a item two general public comment on matters within the board's jurisdiction not appearing on today's agenda. >> any general public comment on any item seeing none, we preceded to 3. >> destruction item president's report. >> my president's report to call the the public's attention in the new era of the work processes of this board we've been equipped with machinery that makes us amazing brilliant and provides insight and easy to our deliberations namely an ipod, pad excuse me.

(laughter) and it is to that point that i want to thank bryan jay rodriguez an information system specialist sitting to my left and the audience right he'll be attending a few of the meeting to high blood pressure help us maneuver through this technology and keep us on point i cause to reflect upon cesar chavez item perfected action 5 sequence one miranda says oh, w0ur7bd how many goodly creates and oh, brave new world with such people in that if, if you go back to the original she or he and look up the word brave she's not talking about courageous or beautiful exceptional people and i--i don't know if i'll find the counter with this new technology to be that or not

and so if we are stumping a little bit today, we ask your patience we'll find the places to scroll through or find the appropriate file in the system some people like dennis the buena vista publisher you think i'll old that's not true i buy every new guys month it comes out and plays with that until i understand how it works and give it away in this case it is a city property we'll not being able to give the items away but return them, no bryan's department it is a different day and intensely enhance you are work and provide us ready assessed to things that were on paper and hope to inform our activities as we try to render services tote city and county of san francisco and the members of

the health service board so i thank the leadership of our executive director in this area for moving us somewhat into the 21st century i hope we're all prepared to respond so thank you yes. >> katherine dodd director i wanted to comment that elaine and i went through the packet it is one and 44 page packet if we photograph copied that for all of you is is realms and realms of paper not to mention 25 copies required for the fabulous we're saving money and saving the environment and but it will be stressfully (laughter). >> i thank you for conceding that point we'll precede as i said bryan to my left and will be available to us during e duration of the meeting if you think 72 hours huddled over us for a reason this is true we'll need his help and we'll getting

get through that we'll move to item number three or four. >> item 40 destruction item director's report director dodd. >> thank you very much you have my report somewhere in front of you i will directing your attention to a couple of highlights first, the governs committee has requested and has had significant discussion about an employee engage salutation if you turnaa totion if you turn to item number 38 you at this 38 you media from your staff pamela in particular so you get out the

department of the home sharing and the department of public works we're doing the employee engagement surveys to try to determine if one of them is appropriate for us the dph is a a survey in response to health care restroom because it has a lot of questions about patient satisfaction and patient and family engagement it was also extremely expensive and was not exactly what we were looking for in contrast the department the home sharing has a contract with enter grow be talent system and d h.r. is piloting this department willing we actually that think that that particular survey would be perfect for us it includes project planning and survey design and includes data

analysis and executive presentation data and action plan a 90 day follow-up with the coaching for the managers so we - it is also much less expensive and within our budget if we move around work order and can get an initial survey this year and put it in our budget a new edition for next year to without objection from the board we'll go forward. >> let's pause for comments or observations from the members. >> have i have a question sounds like a general way to go sounds like every department is different some questions been generic across departments and some specific to dhs s does talent have an experience with

the similar kinds of department or its own management have to come up with the questions specific to our department. >> they very experience with other employers but we will be able to sfert our own specific questions. >> okay. >> i'm sure thaim they'll make recommendations but the advantage is that the work that d h.r. does with the progressing of the employees is similar to what we do we do a lot more of it. >> commissioner breslin. >> so we'll be taking this up under the gefrns or governance committee and look at it more and other samples i sent out i'd like to see what a these questions would be what this will entail. >> one of the issues as i understood and call on council to you be sure i'm stating we're

bringing resources to the board we might looter use and recuse ourselves in the consideration of an rfp; is that correct. >> i don't. >> a vendor for instance, we - if i went out and found vendor and we're getting ready to recommend. >> it would be probable be better if usual gouge to do an rfp that the individual board members do have contracts before the rfp process stats. >> these were actually those are referral from d h.r. companies that i had seen before and i've seen the actual questions so it is not as though i'm including overseeing companies. >> i understand. >> we're not viewing the main thing with the rfp is there is a prospective a level the playing field.

>> as i said, i think that the issue at hand would you restate our question executive director dodd. >> my question we add onto the department of h.r. engagement contract they're doing the pilot now and we could do that if we move smifl we have money 90 in the budget and the work order we can use d h.r. there are no went through a process and a i'm hearing an objection with moving. >> we have no idea of the questions. >> in terms of the business of running the department if this is actually a policy area for the board to pick the questions. >> well, the governs committee

is the ones that took feel up to begin with. >> as you recall correctly we explore the idea and look at the options of having an employee engagement survey i don't recall any participation in my discussion we'll review the questions but talk about directing it get done that's my recollection. >> anything it okay with you without looking at. >> i did not say i said if we directed the director to look at options i think that over the course of doing or following our requests she inquired with the department of home sharing and with the other department of public health and said we'll find one that is in line with the intent felt discussions were in governance and this board and

in the report we've done to the public if indeed we have the option of united airlines ourselves with something that is cost effective it needs to be instructed the executive director to do i did not intended to sit or spent 7, 8, 9 reviewing the questions i think that is in the hands of the staff and the department of h.r. we're encountered to look at the result and report back to the director. >> i can't remember when the details but details how we will handle questions they will not initiate director dodd wanted to come back to her we said no, maybe to - >> if i recall that aspect. >> it is written down. >> yes. part of this aspect it was around the actual input or

survey the staff if we were making direct inquires about performances either the directors performs or within the department beyond director dodd herself she would like to have privy. >> i recall we didn't have a procedure but i'll have to look at it. >> elaine and i look at the notes under the governor committee and the board and the instruction was to come back with recommendations and i know that but prior to that what we will do with the climate survey as far as calculating the results who will they go to that was initially we talked about. >> that was true initially but then we agreed we will ask the director to look at survey options that were being utilized

in the city she's brought back to us two options one of which is an expensive option and has a lot of consulting work as well that drives up the expense and the other more of in alignment with the dissolutions she's suggesting today to consent she proceeded to work through the process with the department home sharing this is what is being asked. >> you at some point want to see the survey we'll not be able to see the survey? >> no, i've not seen the survey. >> i know but we should be able to see the survey. >> is that a request. >> sure. >> well, the first step we authorize to proceed if you like her to share what she's found

once she's involved that the governance committee make that in the form of a motion. >> i think it will be more valuable to if you just look at the brief summary the action plan that was developed is developed specific goals for the management team and i think the action plan is in responded to the data that is collected the action plan we should be held accountable and this is more valuable to the board than looking at the survey questions a if you don't know what the questions asked that makes a big difference. >> didn't bother me if you want to see the questions it is not a policy issue. >> fine line there. >> yes. >> doctor coming down the pike

from my own understanding my understanding this is not like a one hit process. >> our goal to keep it in the budget. >> year over year. >> as to roles out it is appropriate that we understand what the scope is of the survey and that it covers and the feedback in terms of - i'm personally word smith question it is a process that will continue budgeted that will make it went to make sure in our world it is accomplishing you know what we think it should be as the board. >> otherwise it is like 20 thousand for nothing. >> not a one shot thing. >> okay. so it there. >> i'd like to compare to the wellness assessment we spent hundreds of thousands of dollars on and the board didn't review

the questions they reviewed the results of the assessment and what the plans were for responding to how healther our population are so i will do whatever commissioner breslin wants. >> i think this is the sense of the board that unless i'm misstating to the contrary we're asking you to proceed to work through the pilot process with the department of the home sharing that we would like to be informed once the survey document is near finalization and put that into the governance committee as a step 40 in the process that would be welcomed any other comments on that aspect of the director's report? please proceed >> okay i have to go back to my book

mark in terms of operations i want to point out that we had a volume increase and it is because we through the work of communications sent out over 65 thousand confirmation letters and the questions hit about the errors in them the calls come rapid the ac a requirement for offering minimal essential coverage is one of the things going to cause us a lot of phone calls in the future but because it is a legal regulatory requirement i'd like to ask mitchell the c o organization to explain what the people will be receiving in the mail from the federal government this is in

your book under report if you hit the little at the bottom on the report of minimal essential covera coverage. >> page one. >> of the director's report after the letter. >> i'm sorry we're engaged in a technology moment here. >> telling me what you're ready. >> director briggs precede. >> i think that is useful to point out as we've tried to several other times the affordable health care act carries with that a lot more things than health coverage we've will find later today various fees and assessments we pay and all employers are required to pay them to help opportunity the implementation of the act there is a lot of

reporting requirement and communication reminded that are embedded in the act that employers have to act on and we as an arm having those benefits providing those benefits to our members have to be diligent in our middle classes and communication with the members and i know that sometimes, the stuff may look like another thing from h c sf and throw it in the trash can myself as an employer and i'm sure director briggs feels the same way is anyone out there does anybody care that's not the option those are requirements so from time to time we need to stop and pause to say that it is not about health coverage by communicate clearly to the members of the

requirement so - >> mitchell greg's and president is correct i thank you for that introduction the next compliance landmark for the affordable health care act the ac a used abbreviated an employer requirement to report the minimal coverage we call the m e.c. the coverage provides the essential coverage every time we talk about reporting on that it is clear we have 3 i'll not be saying the letters any longer than to an your presentation here on the first bullet the ac a requires two forms for inclines with the requirement when reporting submitting the information food for thought irs about the employer to provide even though health coverage to

full-time employee 1094 c an electronic form it is programming in a form electronic file we'll upload to the irs the other report includes submitting form 1095 c to all full-time employees for all employers we'll be including individual that retired or trermd during the year or coverage for a partial of the year or one day and furniture a copy to the employee by january 21st, 2016, the original role, however, they expanded it to march 31st, 2016 so this is the the paper form we'll be mailing to each individual person that is eligible for i coverage and considered full-time under the city and county of san francisco so lastly on the front page we'll file electronically with the irs by march 31st that is

also in april or i can't went the date maybe march tlith to electronically up load with the system of the irs all 1095 forms. >> would you pause for a moment the information that is uploaded to the irs so on every single individual and our plan the value benefits is not. >> it is the value of the benefit. >> by value of the benefits it means the view the amount of dollars it benefit quiz; is that correct. >> correct. >> just went there some people think that is a precurve for something else it is saying we're reporting to the irs everyone is required to do it the value of the benefit that every member is receiving. >> so also on the san jose

second page of our presentation we're not providing but the members will be getting a 1095 b if hmo coverage you'll receive those from the insure and this will list the independent for employers that sponsors we will be providing this information on the original 1095 form so if they have an hmo coverage they'll receive a 1095 from kaiser permanente and then if it is city plan we were required to provide that information and specifically is the coverage for the independent. >> this is a huge effort like the first bullet we reviewed hundreds of pages of requirements talked with consultant and rereviewing the study a lot of the work went

into the area in our i s area also talking to the employers because we're given to all employers the selection for the school district and the city college and he superior court working with them and talking with them and making sure their information is correct in their system and understand what they consider full-time employees we garter the information and do the list through the controller's office with the division of the controller's office so this functionality didn't exist this is a homegrown effort not only by h ss but the controller's office the payroll department for working with us and getting us in compliance within the deadline so i'll skip to the last page just to tell you our next steps

we're currently a in testing we're looking at the scenarios you know that can happen in an employee's year of coverage for 2015 and you know a lot of that is whether they're new hires or terminated or retired or change their coverage within the year so western be looking those and testing them and also file testing with the irs we're going testing testing to make sure their compliant electronically and generating a letter trying to explain what 42 hours form is what they need to do with it and so we're sending the list and form and doing additional communications e-mail blasts with the employees given to certain department flyers in the break rooms to help them figure out what this form means they'll be interested to know the codes

and stuff so we'll be adolescent in explaining that to them so we are sending out about 50 thousand forms we want to communicate to etch hopefully, we won't get 50 thousand calls maybe 40 thousand so we are conducting test with the mail house because some of them will not be mailed if their active in the city and county of san francisco departments will pick up them from our office and guarantee more deliver in the u.s. mail in certain neighborhood like i said we're planning to get them out in the first few days of february. >> due have a sense of cost the total cost so for. >> the cost will be specifically the postage and haven't really devised.

>> how about staff time meetings and that sort of thing don't spend a lot of time but if you could get a rough estimate i would think that is informative for us and everyone. >> we certainly include customer services. >> yeah. all those things the technology and every employer is undergoing the same thing so i would be interested at some point if you could get an estimate. >> absolutely probable in march. >> director dodd. >> i think if you look at my report one of the things if so impressive impressive we began this process last april and came back to this point if you remember kwavp health policy news over the holiday the irs agreed to extend the deadline to march 29 now we'll have our out westbound the deadline we

originally set january 31st a testament to mitchell and the team who engaged i mean several part of our department engaged to the emerge folks had to pull data a in a new format a major undertaking under the timeline sat i read an article today that said what about people that want to file their income contamination before march 29 and it said they should send in a copy of their medical card or a copy of their payroll receipt they have major premiums deducted which is not as thorough as the former and the information on the 1095 so the idea the irs is going to match

up copies of medical cards with the electronic information that the vendor sends the electronic information that the employer send so figure out who's covered so they can charge them a penalty for not having health insurance for one month or 12 months will be a bureaucratic nightmare in washington we have to fill our robot and want that in the record should we ever be audited. >> right so that's the question more curiosity so 1095 c is actually individualized to each employee. >> that's the social security and the value of their benefit and they will get a hardcopy of this in the mail are distributed through their employer at sometime a lot of them will be

going to lose or ignore is it available to them electronically. >> not more this year but a plan for 2017. >> the second in question in a sense this is 2011 an employee that we employer is also submitted an electronically the 1095 c so this is sort of a copy of what they've submitted; is that correct. >> but the employee with his or her income tax filing also have to send in a copy to make sure it matches the electronic one that's our understanding. >> right the 1095 c will go to with their tax return the same process as the w-2. >> that's the same as the employer filed electronically and who's going to field the phone calls who are the

employees who say what happened to in my 1095 c i never got it. >> you're looking at him (laughter). >> so that's going to be the issue they're trying to give everyone a head up that's why we're taking the time this is coming an important papering just like a w-2 your expected to have this other document when you do your filing we know that people will lose them or the dog ate may homework or whatever else but at the end of the day the calls come to this department. >> we're expecting a large volume. >> this ann is an annual. >> yes. until we're told otherwise. >> oh, brave new world. >> are there any other questions from the commissioners? okay director dodd >> so i'm going to move on to

to data analytics i want to say we have completed the initiative to convert the papered hundreds of thousands of paper records into oh, i'm sure the distribution and digital for materials and we experiencing that even as we talk we completed all the calendar and we have a part in payroll and w 20s we have to 0 go through every single one of the calculated income to payroll to be included in the w two forms that are distributed and to marinas credit we completed every single one of our department staff have taken and security awareness training

that was actually kind of fun and so we are secured data wise in terms of communication i want to point out in calendar year 2014 a 7 percent increase over 2014 through our website nearly all the visits were on devices other than a desktop computer as mentioned we mailed out confirmation letters and will be mailing out take into consideration forms when not delivered by hand that is coming out of 2005 budget and it is an inanticipated expense in terms of 6 wellness you have a in our packet well put together we had a very successful flu shot with 26 flu shots gained over 3

thousand plus flu shots thank you to kaiser permanente for fascist that in 19 different locations that kind of roach outreach is very labor intensive and the data collection revealed is retiree engagement in flu shots represented 5 percent of our total flu shots and this is the first year we did outreach to the restored e.r. retiree with their flu shots i'll not go through the specifics we'll have several mergers with blue shield was of the data issue approximately 25 hundred of our members did not get lowest into the blue shield eligibility the call volume of january was 6

hundred everyday that was higher than the engrossment harding park back to the usc cards our meeting are blufld everyone will be manually entered and reconciled with questions but it has been not just inconvenience but people have not been able to get care going forward everyone is in the system so beyond that president's report. >> are they're questions. >> i have a comment i've heard a couple of members say even though they as i said up for united health care and one signed up for blue shield and never got the blue shield card. >> that's been the issue but the united health care i'm hoping he calls the number

he said a blue shield also as other comments yes. >> one other question i want to talk about the flu shot whether we through those clinics give flu shots unless a capillary member at a kaiser permanente clinic that means the uploading of the medical record the believe potential quality measure we should be as the service should be cognizant of how is that information unless a member says i got the flu at walgreens or. >> that's the blue shield the united health care they have no way of tracking the flu shot kaiser permanente side. >> the vaccinations are a liability quality of measure. >> any public comment on the

director's report?quality of me >> any public comment on the director's report? >> happy new year claire with the city and county of san francisco first of all, thank you and kaiser permanente for the flu shot clinic it was successful this year at the annual health fair and a fair number of spouses and independents attend and we're trying to promote more of that thank you for the fact that margaret regularly attends and has made good strides in terms of members activity and wings that is a positive for retirees thank you have you very, very much for that the concern i have is that when your discussing the 1094 and reporting to the irs no mention

i believe the ac a is requiring everyone to have coverage no mention of early retirees on medicare and what happens with the retirees on medicare another irs forms that concludes my report we will get we need to submit with our no objection tax filings with regard to satisfying that same requirement to the environmental impact reports there was no mention of that i'm very concerned about that and the last thing i want to say that commissioner breslin and director dodd when you guys speak your voices trail off and it is hard to hear so i'll it if you get closer to the microphone. >> to that question director dodd's do you have a response or mitchell. >> do you want to we are that director briggs. >> mitchell deputy director of

the health services we'll be sending information to 95 c to medicare if they have city plans. >> right we're since tha that part is self-insured. >> all right. >> okay. i think that is responsive. >> we are probable over reporting to be safe ash early retirees will receive they're ten 95 c from the h.r. >> thank you for clarification and the comment from the public my other questions on the director's report comments objections if not we'll move to discussion on item number 5. >> item 5 discussion for november 30th pamela levin. >> pamela liv even driver's

seat health services cfo our report in front of you hopefully and i just want to point out. >> give assurance the answer to that is, yes. >> i want to point out a couple of things the trust balance as of june 30th, 2015, was $81.5 million right now promissory note out of june 30th, 2016, has a balance of $77 million the decrease in the fund balance is $4.5 million and it is the result of several different items i'm not going to glow each of the ambulances to summarize pharmacy rebates succumbed raised and utilization in terms of the dental

self-insured dental plan there's an increase in the fund balance we also have interest going up for the turns a decrease in fund balance with the general fund and increase in the performance guarantees i addressed commissioners question own the self-insured dental plan yes, this is expected at this point it is interesting we looked back as of november 2014 and we were at the same projection the trick on the projections is that we plan and set the rates and benefits on a calendar year but report on a fiscal year and the way they match up makes it difficult to to do projection we

recorded on the t o 5 for commissioner breslin and called that outthink the summary page of the trust and right now, we're projecting bans the current distribution models to have a balance of $42,000 in terms of the what i mentioned on the contribution models as you may know a lot of the models 93, 83 in some cases a hundred and zero to be pled employed to the majority of premium that people pay of the 205 is based on the employer didn't hit the employee in terms of the pharmacy rebate fiscal year to date is 9 hundred and 19 thousands and we have a projection of $3.4 million this

is handled through a reduced reduction in the amount of claimed we pay to the vendor the forfeitures that 2 thousand 15 forfeitures amounts will not be available until after march because of the run out period and also a time we do the actual skiethsz and 14 the general fund administrative budget including the concept the enterprise content management system is budgeted for this fiscal year we are projecting that we will have a balance of one and $50,000 by year-end for savings in salaries and non-he personal services that concludes my report. >> thank you. please stand by any questions from commission as i have one question

last year about the forfeitures to the general fund that they have to go back to the general fund. >> no what happens is that simply or several years ago the general fund was having issues and difficulty in funding h ss we agreed to have a portion of forfeitures to transfers of review to the general fund to cover the administrative costs of offering the independent care and health care benefits so we as in past years will continue to work with the controller's office to not transfer any more than absolutely required and but all the forfeitures come into the trust and they stay in

the trust until they interest or have to be transferred to the general fund. >> you have 0.5 with the general fund here but then on the other hand, other enough money to cover the administration if not enough money why return money to the general fund is that a different year. >> no what i was trying to state and i forgive me if i wasn't clear the cost associated with the administration of the benefits for independent and health care exceeds the amount of the revenues that can be you know budgeted to the transferred if the under expenditures in the

general fund budget we don't have to transfer as many forfeitures to the general fund in order to make the general fund whole. >> i don't really understand that but that's okay. >> it might be useful at some future point not today to get into an explanation better late than never about if you are terrors forfeitures i believe you're saying general fund the cost the h ss cost the general fund cost; is that correct not the general fund of the san francisco ethics commission. >> but i think that is a bit of language that needs to be careful about too. >> all right. but that is for a future day. >> and one additional question

i'm looking at 9 projection on the summary sheets the fist page how is it so i can understand how is it the projected loss lutherans $11 million in a forecast the blufld is $2.8 million lost and projects to surplus at the end of june i'm curious how those forecasts are made and those numbers are kind of odd is that dpiengs four times the loss of city plan and you return a sound-producing electronic devices are prohibited at this meeting. plus. >> so we do our projections based on a straight line for an x amount of months this explains the city plan we've seen that we

will continue to have - obviously have to subsidize the rates in the two years and then we are projecting to continue to have unfavorable experience so it is based on what 5 months so i need to look at the flex think plan and core relate the numbers every year. >> it would be nice to see maybe if it might be interesting to see how the forecast is done for the major component it played into where we think we'll be at the end of the year with of the trust fund even a straight line 3 and a half by 12 is not 11.4 and an

administration line didn't produce the surplus a different way i'll be tdr in a sense of how we do that. >> all right. any 0 other questions or comments from the board any public comment? if not we'll proceeded to discussion item 7. >> 6 discussion item 6? >> i'm sorry 6 yes. >> item 67 discussion item health services 42016-2017 and 2017, 2018. >> we have gotten the news from the mayor's office on our altercated our reduction target from 2030 and 20152018 i'll be discussing that and why we're in

the general fund has been the predicate they're in and just to remind you will we'll be bringing back the budget to you a totality for your action on february 11th and that will also include the two year budget for the health care fund the 205. >> and a meeting of finance committee prior to the next board meeting? >> i need to follow up with brian about this. >> okay. that would be a step i'll trust will happen between now and the next board meeting the finance committee will sit with you and walk through though the process to make sure they understand and inform us from the prospective of what needs to trans pier. >> the mayors and the

controller's office and the boards budget analyst have projecting a deficit of $98.99800000 in 2016-2017 and one and $44 million in 5 m and 5 to 6 based the current operations and staffing and revenues the primary there are two primary issues that are contributing to the deficit has to do with with retirement there are increases in the employer retirement contribution due to employee benefits or pensions to offset the lower than expected returned in the pension system for 2014-2015 there are updated mortality

assumes that is we're living longer and there was a legal challenge to a portion of the 2011 prop c that reformed the independent and health care benefits in related to the supplemental cost of living adjustment and the city lost that lawsuit and therefore the cost of two departments has risen and the city has to make up for that. >> those are retroactive amounts drawing your attention of the legal dispute and, yes the city owes and you have to pay them? all right. >> and then there are voter approved propositioned set side increases in retirement be

contributions are required some voter is the mta baseline well, that's the primary one the projections generously include the impacts obviously the labor noeshthdz from 2015-2016 and state and federal budget impacts and changes in the economy such the recession the budget resurrects are more complex this year not only do we have to summit two year budget which is similar to all departments in the city we have to summit what is called a fixed two year budget that means that when you develop the 2016-2017 and the 2017, 2018 budget we can't - we can't

really do the 2017, 2018 budget next year in terms of we'll go on a two year fixed budget and not have the repeat we reopen the full year and rebuttal this makes it more complex we have to make sure that everything we do we check and double check because we'll be held to those numbers. >> may i interrupt this a substantial change in process i would ask this is permanent been delivered to us not something we can go back and raise a question; is that correct. >> i'm not sure if they detailed the meeting a meeting scheduled earlier this month

with the finance committee and the board of supervisors to make the final decisions on whether we'll be subject to this there were questions that the budget analyst asked and singularly they want to have the option of reviewing the budgets each year and asking for compelling department to take cuts i fully expect we will be required to do the fixed year budget we can make changes in the second year but they have to be supplemental requests again open them up. >> i understand i'm trying to get at a process decision discussion maybe the director will respond we're delivered with guidance i see something like if we are a selected department that suggests an

option an opportunity for discussion and so i'm trying to figure out how is that happening or has it already happened or will it happen. >> we got notified by the mayor's office we were going to be in one of the 38 departments that are moving if the typical budget process into the fixed budget process about two days before it initially went to the first reading of the budget and finance committee the budget and finance committee didn't hear it for a while the mayor - the board budget analyst made recommendations meetings were cancelled, and what is going to happen the finance committee if it hadn't already met will then read it in

as a formal action to the board of supervisors. >> and do we know what that is going to happen? >> i will look for it but i don't have it in front of me. >> i guess what i'll getting at the finance committee needs to be engaged in the process with you to the degree they can be and that this board needs to informed we've glutton this sort of thing over the last during my 10 year on the board of broad guidance and then some level of negotiation and then some sort of informed changes to a point more recently, there is a broad guidance and market-rate changes we're getting into a more constrained environment you're putting on the table in a field that

explicit necessary travel at the same rate of inflation that everyone else does and presuming are r have a level need to have levels of flexibility and decide we have to shift for one reason or another staff operations whatever systems we got to go back and rejuvenate another two year time so this cabaret confining and disadvantageous to the members we're trying to service i understand a process you know some things are immovable but some level of discussion we're not part of it i think we ought to be so i ask the director if you have any maybe nobody's on the board is concerned but i am like the train is boarded and it is not

leaving the station we're in a whole new world 0 beyond how we got there. >> it is not as tight as it appears to be because we can go to the board of supervisors and do what is called a supplemental request that does ask for under certain circumstances additional funding i understand where you're coming from and we will notify you latter today what the schedule is. >> i'm not trying to resuspends an okay. but moves from elements to concrete to cement to concrete quickly we're in the submit stage already and going to concrete stage it is not going to change happens like

the bat of an eye i'm concerned and stating that pubically and asking the director and you to inform us how to get engaged do begin on the front end raise questions about process that's what i'm talking about process not able to maybe change at outcome. >> i told the mayor budget director when i called her after i heard about this is the reaction of our commission and also in terms of my reaction was this is very difficult it was okay for an enterprise department did you it gets to be more difficult for a department like this. >> so director dodd any. >> i appreciate your support we'll find out when the finance committee is doing a one and a

half percent cuts across the board and making it concrete is certainly a challenge especially, when you look at the increase of administrative costs because the affordable health care and you'll note our membership is up over one hundred 13 thousand people so in please, fire the population of san francisco is growing muni has set aside we have to other people our work is increasing not decreasing i appreciate your support. >> and chairman liam the vice president liam the chair of the finance committee i know that supervisor farrell greg and greg is on the finance committee i'm asking to get an informed conversation before our next meeting around those issues to see how they might be addressed from the finance committee or this board or myself needs to go

to a forum to talk to people i'm more than willing to do that. >> just a couple of observations we over 90 percent of our revenue comes from work order recovery from other departments they're not subject to the same kind of freezing of the second year a significant amount of revenue in the administration active budget are subject to changes that will influence our ability to basically, we have to come to zero at the end of the year with the budget and our general fund and the work order recovery we pay 15 percent of our expenses to 09 departments once again what those work cost united states as a result of those go changes in these 0 department effects our ability to balance the budget we too tithe tied to the other departments and some

were enterprise and some not subject to the two year fixed budget it seems to me unless all those numbers sh9 favorable compared to the budget we've required to submit an appropriation to get through those are the good reasons for the supplemental i hope in their not denied but exposes us to the budget analyst who is looking phone call for other cuts that exposes us different from the typical process. >> so i question the mayor's budget budget analyst and the director about how our recoveries will be impacted by the two year budget process and we were told that they will justify the other departments for once our budget is established they will adjust this other departments like thank adjust us in terms of our

requests. >> on that pot point this is almost presuspending an outcome and telling me how you'll be doing something i might need rather than looking at the need and responding to it i accept the representation and the intent of our confusion conversation but in the the fundamental process that's allo conversation but in the the fundamental process that's anfu conversation but in the the fundamental process that's afus conversation but in the the fundamental process that's allu conversation but in the the ental process that's asion conversation but in the the fundamental process that's aion conversation but in the the fundamental process that's aon conversation but in the the fundamental process that's an cn but in the the fundamental process that's a conversation

but in the the fundamental process that's allconversation but in the the fundamental process that's aonversation but in the the fundamental process that's allconversation but in the the fundamental process that's all m saying as we go forward again like a done deal okay. that's all i'm asking. >> so i'll mofb move on to the proposed reductions the budget instructions include that all departments are to submit reductions with river reductions or revenues one and a half percent of their general fund support those are ongoing reduction matt haney that the 2017, 2018 in 2030 make a cut of $48,000 plus that is ongoing so then in 5 m, 5 to 6 make an additional 48 thousand these cuts are are recommendations we have to summit the budget with these recommendations they've we've been told by the mayor's office not all the recommendations will be accepted and therefore we have to summit a balanced budget but can do it

win caveat of these are the things that we object to. >> okay. >> can i. >> blood cell director dodd. >> once the mayor's office is finished remember the board of supervisors budget analyst taps us further. >> right that's why i'm saying is it the concept of this in a fixed mission bay anything that says foiktd to me ♪ environment or in terms of trying to you interpret and support our operations question i have a profound question with so that's why i keep harding park during the courts >> i have worked on a two year budget not easy and something i

prefer. >> okay. all right. anything more in your report please. any other questions or things from the board the budget instructions any public comment seeing none, we'll precede then to our next item. >> item 7 destruction with the presentation of 2016 rates aid benefits calendar for 2017 director dodd. >> you have 200 in your packet the calendar you remember this is not set in concrete use the met for and we know one thing is certain we have to have the rates done by june so that and your actuary says so the changes in governs governs we

don't have a rates and benefits committee this board acts as a rates and benefits committee at this point, i'm pub appealing to the members of the public it is critically to have our attendance to act on the matters in a timely way corresponding to the calendar any question from the board members or public comment. we'll proceeded to the next discussion item which is item 8. >> item 8 discussion item educational presentation underwriting hedge funds 101 ann hewitt. >> i'll be more quiet as we precede but we have hope a hard stop to go into closed session

around 4 o'clock this afternoon we'll try to get there with everyone's coordination we'll be doing pregnancy by actuary. >> nice to see you commissioner scott glad to be here why are representing underwriting 101 here on the first month ending in june we finally lists the rates aid benefits from 0 one and 14 thousand people to do that director dodd suggested and i go through a quick time con rat review how we do underwriting we present the themes and what we expect and your go taking the risk it is underrated but each of the things we'll discuss are the building blocks of the rate and what is a the job of our

independent actuary and sharp able to reduce the numbers as those, etc. those are represent numbers and good as presented initially with that, i say let's go through this i'll. >> the only thing i'll request a certification as the actuaries at the end of the presentation. >> yeah. we'll qualify. >> oh, absolutely you'll now have your initials actuary certification to the board of training. >> thank you so what is underwriting looking at the historical experience and projecting by trend assumptions what it will cost in the future and the purpose of underwriting to rate the plan we look at the data and alexander add the - any

fees required by h ss and this is basically, we do that for you or the plans do that this is what is done in health insurance in a group basis so all the experienced over a given experience period in the pot on a unit basis we add that and figure out what it should be in the future and say that is what the rate increase will be the good news we have not yielded increased the rates all that much over the last couple of years experience is good or programs by director dodd and the board like the h ss or kaiser permanente keeps us lower low for the an extended period of time we are actually, i'm interjecting we're bucking the trend so with that said, what are the

rate consultant there are 3 the component of the paid claims not recorded but adjusted we report those every february those are your reserves for the self-opportunity plan what a an idea for the audience and everyone the public the reserve is the not recorded liquidated you pay claims if you stop the program you'll have to pay the claim informs for that period of time it is on the balance sheet in the 5 years you're well retired under policies and under retired on the conditioncy and so then we take the information we put it on a per head basis and have administrative expenses we pay them to pay the claims to service whatever and

unfortunately, they create a health care reform from a spin prospective whether our pro or against it i say they cost a lot of money we have good news when we built this report we're not going to see the it as long as we thought they've rolled back things i'll get to welcoming i'm trying to move along quickly i hope you'll bear with me and look at the things we look at it and when we look at this we look at network if we changes a network we're broad or big in certain cases can we narrow the network if we do it and specifically will we lane i and then the hospitals to possibility do this more efficient so for us the plan designed do we want to change a co-pay a couple years ago we

changed it such not changed benefits have we changed the network in your case those are pieces it change the answer but in your case not many changes but things we put in the pot when we do the calculations and pharmacy rebates are they something you activity get and the answer is yes you get a lot of money as we more often and go through those educational pieces the one that is worthy of discussion page 7 is the component of trend so i won't belabor this but it goes through the various pieces what is going on one of the reasons we take the claimed and raise them because the population as the population aged they spend more dollars on medical services and technology

costs more money and erosion and utilization. >> pause what do you mean by cost erosion. >> it is explained here 15 percent due to fixed dollars features like co-pay per the definition i'll correlate it as you have a fixed benefit design more dollars you hold the co-pay flat and therefore more dollars are spent above that amount of money it makes it go up quicker so cost shifting is when the money gets shifted for people that don't have services to the people that have services and less with the affordable health care act intelligence is a new procedure you know techniques the utilization people use more

medical and the utilization is with pharmacy costs you've seen prescriptions go up it used to be when i first started 3 script now 8 to 10 and blue shield population you'll see 11 scrips and maybe others on average with that said, does that answer your question okay all right. so with that being the case we take all the numbers take into consideration and then we have some taxed we've recorded and requested by director dodd we've presented to the board the standard taxed saying we need to add or the core the transitional insurance tax and the excise tax tax we were worried about at the last meeting we recorded the excise

tax during this cycle every time question did the rates how did it impact the excise tax the board look at it so we'll look at that with h ss that was for excise tax in 2018 per the new budget it is rolled back to 2020 i'll stop and suggest we'll not predict the excise tax in this cycle. >> let's get the slides for the public's information caught up to where you are on page 10. >> yeah. >> you're putting to the board it is something we need to consider that we don't have to pay an excise tax not in 2018 but 2020. >> i would suggest that just because we have a few more years

added would we've taken an haven't look those matter in 2014 we were doing modeling and thinking and recognizing that was not going going to happen until 2018 we may not spend as much time in calculation efforts around doing this we need to be informed about something that is 4 years away is in many ways we are at least thinking about it and figuring out how to do that on a going forward basis. >> i concur in terms of every time your printed we're going to present american people excise tax. >> we may not be going into that level but conscious. >> i'm asking our permission working with director dodd to go back and report what the status of the overall impact versus the

topics. >> it make sense. >> that's an idea so since we've talked about this several times i want to say - >> were you mentioning the others tax and many times the patient after research the korea fee is a small amount of money and he did research into competitive medical treatments and take that and put that into the rate everyone pace that and we go into the transitional insurance fee an page 12 explains what it is and then we have the hid tax which we pay an an insured it is the health insurance is states what it is and that's it right here and then so they take and chop off

in 2017, $14 billion and appropriate it across the united states and say that will afternoon 2 and a half percent of rates and if our estimate spin for 2016 which we are in $16 million our minimum premium plan and for our kaiser permanente plan we pay more than $8 million for the hid tax when we do the tax add $8 million to it guess what the answer is for 2017 they repealed it 2017 and we go go the rates and benefits depending on who the carrier will be we continue no one is going to have the hid taxed in the rates for 2017 so when we look at the overall $700 million budget it will be

down $16 million for one year we said to point out that. >> okay with all that being said time is of the essence i apologize for going too fast it is basically goes through the math is a as we come back to you, we present 23450i7b9d health care city plan plan and blue shield we'll tell you we we review kaiser permanente this is how a rate is built i'll leave it to you to review and possible bring questions and then it says how do they come up with the rate increase they've looked at the information and done the projections and the print assessment and the rate changes 3 percent or whatever the case i want to take the rate and do the county and the differences this is what you're paying and the

other pays the rate changes our job to review that and assist you in this that and hopefully you know for the sake of getting our mind thinking in terms we'll be doing a lot of this the next come up of meetings in order to get to the june timeframe of a rates for the 2017 which my suggestion is that those are the rates and serve the people as well as they can additional the great work you, you do and it is a great honor to be your actuary and assist i'm done. >> are they're questions from the board. >> i just have a question about it. >> yes, ma'am. >> the tax is the multi employer are they using the threshold for all families the

benefits. >> for the excise tax. >> yes. >> the multi employer plans louded to. >> entitled to use the family threshold to all participants. >> can you cite i did reference. >> yeah. the tag is saying november. >> 2015. >> 2014. >> page thirty. >> okay. i'll look it up and let you know. >> what is the wheeze e china's repealed. >> i'll check it out i have a responsibility to answer correctly. >> to make sure i'm clear in terms of how are the they clawed we're spending a lot of time with the pharmacy cost is that

come under you know projections around or adjustment like the pharmacy cost. >> we'll build it into the trend the specialist is throwing a larger percentage so our actuaries look at that and have begins from the collective actual body and from hewitt and the vendor and use all that information in the next plan year. >> the demographics is the pharmacy. >> some is benefits and some cost acceleration with the specific categories we'll review all that that and the plans are are responsibly with the data we do the best job possible any other questions. >> this is an observation that through all of this. >> yes, sir. >> through all of this after you've done all the work one beautiful thing is true the

rates are higher or the same as they were the prior years just like rust it is always with us and the trend is not flailing flat out those figures collectively push the health care costs upward we talk about the rate of increase but it seems the increases we need to understand that as foundational to the american health care system. >> that's an observation i've heard in earnest your observation many times. >> any other questions from the commissioners or public comment? okay >> claire rcc sf this was informative i recently attended a town hall meeting with

assembly member it's on the tip of my tongue and one of the things that came up was the governs tax for medicaid and looking at those issued i'm not sure where that fits under taxed and fees this was one of the concerns about the impacting our rate and then hitting the 2018 excise tax is now been moved i think we still have to follow was going on with the state budget and the governor is requesting as an increase in hi budget that ultimately impacts that's my question thank you very much. >> thank you. >> do you have a response to that. >> as we build the rates we all the federal government taxes and as far as all statements premium takes they will always

be built we didn't itemize we'll have in them in did calculations director dodd. >> on that note i've accelerate the mayor's legislative committee there the governors included in the managed care tax we are watching it we're not packing a taking a position at this time and i actually think it is helpful if members 0 who are well-versed in this like claire she talked to assemblyman it's on the tip of my tongue and said do you release this tax will increase the costs i can't lobby until the city and county of san francisco takes a position this money of course is being set aside to cover the shortfall in the medical projects that

increase in a year, if any, which means your taxed will increase every year there are two ballot propositioned one of them fund medi-cal for hotz this is the tax own people that make over 200 and $30,000 a year this will be proposition on the november ballot does nothing to the health care tax this is where a member is opposing the managed care are the chambers, etc. for the things that were said when you increase the tax it gets passed on to the employer and employees so this is the legislative position. >> all right. thank you for that. >> any other public comment? any other board member inquiry in not i'd like to thank you for this educational moment and you

have changes to come back and reinforce as we get to the taxes we'll proceeded to item 9 i'm sorry - >> i would like to just follow-up on the concern that you have on us moving to a fixed budget it is at the to the call of the chair of the finance committee i believe is supervisor farrell and it there's no meeting scheduled for the rest of this month that makes it go on to february. >> all right. >> i don't know that is an observation. >> yes. >> that's one of the questions. >> in an earlier item we remember talking about the prospect supervisor farrell

about the prospect of this dependent on a two year fixed budget it has gives me heart burn and other commissioners you don't have to answer today, we're encouraging our finance committee at this board you're a member work with the chief financial officer and the decoration to be sure we have a complete dialogue about the process and the implications to our work so. >> so commissioner scott and to colleagues up here and director dodd i think that unclear whether or not those items will go through with the board of supervisors the genesis of there are a number of city departments that receive at the end of the day somewhat minimal and could be argued with the board of supervisors resulting in a number of things that director dodd and i have been

advocating for $10,000 in the h ss budget in the grand scheme of things enters the overall 4 point it becomes you know a challenging discussion at times at the board of supervisors and so the discussion was around whether it is really a good use of time for certain departments that are not truly political or as consumer surfacing as others to residents noting notwithstanding h ss function with the city employees and retirees whether a better use of time from a strategic mr. haney structure not to have the cfos and department to come before at wants an arbitrary process with the board of supervisors that staff time is not better spent doing other types of future planning rules within an

organization so that discussion is continuing i don't at this point have a clear thought whether or not that will happen that's the background and quite frankly as i i've said leave the departments of actually having to go through the process that the board of supervisors budget every year when ultimately you know there are potentially moving around under one percent of the budget whether that make sense from is a staff time from the constituents we serve those department will be better served with the staff doing outlet things. >> thank you for that clarifying and intent would rely on the process with the finance committee being engaged in substantial decisions in case you think we're off topic this was an educational moment in

item 8 back to an earlier agenda we'll now freed to item number 9. >> item 9 discussion health plan dashed to 2015 ann hewitt and h ss. >> can you introduce this we need a drum roll it is our first all database report. >> oh. >> congratulations. >> (laughter). >> marina data analytic manager. >> aon hewitt. >> just a few reintroduction comments you mean 9 health service is involved in the dashboard reporting and as well as our capacities and we wanted to improve the data collection

and our presentation make that dashboard more flexible and informative and incorporate the benchmarks we've merged that with our strategy with the database as one of the tools to inform policy marking benefit design and other activities and got to the information about the cost effectiveness and health care delivery now our pair database if you'll go through with me is host by the ann olympians and released into paroling production in 2014 joining us here today, our account director alicia sanchez any questions about the ap c i'm unable to answer them we have resources in the room

but to our ap cd not our tool set with any newborn with the infancy of our competence so our critical second is knowing the data and in the last 3 months we've released this emersed our data aligns with the database so its opinion a been an effort and with the partnership of our health plans thank you to all of them for putting us in touch with the resources as we went into down this path and go our partners were present in helping us in this work i'd like to specifically recognize charmane in the room here today and a member of my team and she fairly

conducted the mass majority of this analysis when we get here representing the high-level information legally you missed a lot of what happened behind the scenes so humor me on i know we're short on time but share some of the activities to insure when we can stand by the numbers we're presenting so as examples we had to obtain comboubl and in parish with the metrics on the athletic system we're using and we have identified that different constituents are using different g rp so we had to approve the differences and what they cause and the path to understand a lot of the logics

into building things based on claims and the admission level report and the service category and understand nuances sometimes definition it get used to the reporting but not the financial reporting does it is quietly quite an undertaking thus far i'm pleased to say we have the go forward policy better. >> so the report we will be present to you is the transition of the health care from the vendor report to our all pare database this report will detail the thinking patient ate outpatient blue shield and kaiser permanente and city plan for our active population

through q-22015 this is the dashed we're presenting and of such the comparisons are gone in a total level a side note not adjusted side values that's our next step with the database so some notes on page 3 that are some of the data you're seeing in this report is still source for more under reports about the immigration paw the blue shield have a source from vendor report the financials on the system are not provided ♪ 9 ap cd and our ap cd went through angle investigation and our threshold was less than a 3 percent variance as the criteria with that, i'm going to turn it

over to page >> everywhere. >> did the fact we don't center the claims from surety make a difference in the accuracy. >> we did the work around that we used the vendor report from blufd for some of the data not undermining our all pare database just not the finances. >> thank you. >> any other questions before i begin? >> well, i'd like to review the clinical very quickly first, let's looking at demographics he get this every year for the open enrollment that are 43 plus members in kaiser permanente as of the

second quarter if 2015 i want to call out 25 percent are under 20 and 35 are in the age rage of 4 g to 64 it is something i'll highlight in a little bit on page 5 looking at blue shield you'll see their membership at the same time is 32 thousand plus they're under 20 population is 24 percent, however, their 45 inform 64 population which again is when chronic illness begins my doctor said 41 the goals over the last couple codify years move families back to go blue shield while we've been successful no moving one and 24 families from kaiser permanente to blue shield unfortunately, it

made no difference as you can see in the overall population distribution within blue shield now the one i really want to highlight because it plays a significant factor in the way we report is that city plan currently has 8 hundred and 76 members so they don't center a report out over a thousand on all - every admission that the city plan has is worth 14 percent more impact whereas for kaiser permanente it is 2 housing unit 2 percent of the whole and for blue shield is 3 percent but city is not only it is muscled by 14 percent more because of the small numbers the second thing 45 percent of the

city plan is ages 45 to 64 again stressing that network chronic illnesses and this demonstrates this population is seeking positions and care that may not be available through either blue shield or kaiser permanente so they're going two physicians that may not be as well-managed although again, the plan a managed but clearly the different types of reviews that lets is kaiser permanente puts on their physicians. >> so moving on let's look at the total costs on page 7 you've heard city plan continues to be the most expensive at running 1348 per member and capillary is a 415 and blue shield is at 560

you'll notice that blue shield has increased by 16 percent, kaiser permanente only 6.5 percent again city plan small numbers where one you know person who is spending a lot of money cost case has significant impact on their overall experience has changed 44 percent in the two years we're reviewing here again what you've seen in city plan back to the demographics dropped by 2 had had members each member has greater and greater influence on the cost looking at the dopey want to draw out if you look at capillary and blue shield their pharmacy costs again relating back to the question rafrd special medications has

increased 17 and 18 percent respectfully and highlighting that genericish company are fewer and fewer with mergers that allows them 0 the opportunity to increase their cost they have less and less competition i want to appoint open kaiser permanente 19 percent over they're other that is where you see the icm and o ms the 09 medical groups you'll not see pould pulled out because of the structure of blue shield and city plan 19 percent of their overall premium it is as they go down and able to reallocate and properly label those expenses. >> so some degree aren't those costs part of the administrative

costs where blufld and the city plan exists but don't show up on the you know you're using the premium i'm having trouble with the category from kaiser permanente that makes - on this particular pie chart makes the percentages smaller than apples to apples to apples to apples and pie chart your comment about pharmacy 7 and 18 percent no data to show no line graph showing the increase in pharmacy costs the pie charts don't really give us the information your drawing a conclusion from on this slide. >> unfortunately, your a little bit earlier on early on the cutting-edge segue we have the costs in the next few slides but as far as the first

observation about the other services where you see those services in blue cross and city plan how the physician groups are putt together and what costs absorbed as they're paid through the decapitate television station and some for disease management arrest case management you'll find in the administrative costs of blue shield not a total cost that will be born in the same way by blue shield that will be distributed downward towards the aco or the physician groups. >> where's the physician ♪ patient or outpatient >> in patient. >> you'll see for blue shield they have 41 versus 36 percent so it is not quite distributed

but we're hoping over time with our new coding system we'll be able to reduce the other costs so they're more comparable if we do this pie charts in the future. >> all right. >> dpkz. >> okay again. >> 42 percent outpatient for the the city plan seems like that would more in patient cost. >> their older but remember that outpatient cost is the out surgery and the radiation and infusion therapies on a outpatient city plan if you look at page 9 for beds per thousand i want to make sure it is light

colored green colored telethon they have 15 in the mix and of that population so it really didn't have that great of an impact unless again, they're not a thousand enrollees each has a greater value you're seeing actually is that they're using more outpatient serviced they're less expensive in the long run okay? >> having some sensitivity of time remember those slides are grand letter they give us the costs and so forth. >> so number are to the point you're making even this slides the very first one. >> i'll focus on 3 other slides and be done the first one is slide 10 why i

wanted to point out is that the afternoon length of stay for the city plan and for blue shield is a half a day less mri more excuse me. than kaiser permanente roughly and each half day represents almost $4,000 that is an additional costs based their cost per day and looking at at 40 plus submission it adds up quibble you'll see the difference even though capillary is per day in the hospital is more because of so fewer admissions and the length of stay is controlled their costs are quite within reason going on to i want to go to an pharmacy page 15

going back to commissioner sass question as you can see the costs are trending up quite significantly and what i said to point out is that if you noticed the cost per member per month is 51 force capillary and city plan is 200 and 67 the rebate that kaiser permanente and blue cross is different not their prescriptions are different because because the members within blue shield is getting almost 5 more prescriptions per year that addresses $40 to members per month to the overall pharmacy costs then as far as city plan what the 267 represents is the fact that the patient that are in city plan

going back to my earlier comment they're seeking positions and medications that are more expensive because are their chronic illnesses you're seeing the types of drugs not necessarily that the city plan pharmacy is not as effective as the other two then i on the other panel i'd like to go to say the conclusion as far as the next steps the considerations i'm sorry i'm going go to page 18 the costs of industry is adding to the trend of pharmacy an unexpected i know that california has legislation pending trying to get 24 under control we've seen in january we've had drugs that have been stable for the last two years

all of a sudden everyone is increased somewhere between 14 and 40 percent i can provide additional literature everybody is calling for investigations into pharmacy companies they're afraid of the future it some compliment city plan and blue shield during the two year period they've reduced the lbe length of stay by a half a day that's a big deal we will encourage blue shield to work on reducing their number of admits in this case reduce the gap between what kaiser permanente and where they are is 7 percent reduce the 7 percent by 3 quarter of an admission that is

a great movement and again looking to make sure that earlier intervention on people where ill in essence and post discharge services will have an impact on the number of admissions and length of stay with thatwith that - >> next page a couple of quick next steps to say i already mentioned? the next upgrade and looking to talk about the bookkeepers we've turned our effort to the residencies and going introduce the same analytic validation of the data but i'm pleased to say we provide quarterly dashboard i know historically getting that information to you and loading the blue shield historical data

and shins or since the other categories came up commissioner sass in our next load we're starting the kaiser permanente data as well. >> well, this has been a big effort and quite frankly at the beginning i was probable more than a skeptical tick we'd get to the day and our staff and leadership is proufrnd to be commend? powerful stuff we're probable ahead of loot employers by being able to interpret and translate with some meaning in comparison factors that are influencing what we're doing here my great hope is that based on this we'll have a more informed understanding as actuaries are are coming to say those are the rates and trend we'll in about in a position to

raise those questions as well as the health plan where he wants stand before us to make their cases to why and what they're doing thank you for other information and look forward to you future reports. >> maybe we can ask - i'm really quite impressed first place associated with one of the health plans one of the logical questions b around hospital stays since there's a difference in demographics by age and you point out actually, the problems are looking at city plan because of the small numbers if you look at the 45 to 64 group and in terms of hospital days and maybe that's part of risk adjustment to sort of say it is that big of a difference between kaiser permanente and blue shield there's a difference of 35 versus 41 in that age groups

maybe longer than and the other questions you've referred to this i'm curious in terms of city plan you the implication i've understood the members are looking at trying to find physicians that maybe be able to treat specialist diagnoses or provide medications i suspect the blue shield and sairp neglects actually provide the expertise and medications and hiech change in that health plan the city plan people are people that have been involved you know the city employees for 3 decades and they're not they don't want to look at changing their providers over the change in demographics etc. are - anyone knew is there as

many coming out kaiser permanente and blue shield their diagnoses and the familiar outlet of who the providers are and where they're related to >> first of all, it is the city plan does provide coverage for other service areas for active like hetch hetchy employees and allows people that have had similar behavior over time for figures they've been choosing to do that without interference there has not been congregate in the city plan as the costs are quite different and so really haven't seen the younger population coming out will offset the high cost of, if you will, the middle age population are chronic illnesses. >> any other questions.

>> just must show may be one question one of the things i've questions i've asked in several meetings specifically relates to the blue shield plan why the cost of this plan has exceeded our projections as exceeded the amount of revenues in the employers and employees and transfers in order to get larger and larger amounts in order to pay the costs of insurance plan it is helpful it shows that the age distribution alters blue shield has not changed over the years you can't society that with higher costs with the age and number 2 the high rate of pharmacy costs didn't explain that and number 3 the average admissions per thousand didn't prepare to explain the increase in costs based on maybe some

small component on length of stay but not significantly over the period of measuring is leaves me with the impression the only factor is mustache our expenses up is the price of the service that is flowing through our flex plan for the surfs we're providing and that means that that is the whether this is associated with the negotiation between blue shield and cpmc and usf and others to get them computed in the as available for admission whether in their negotiation or state up price increases occurring at the hospitals it appears to be the cause of large increase i'm looking for i'd like to see something that takes all the strategic data and relate it in some way to the costs and sort

of derives of the consistent if for the associated with volume it is associated with price i think that pricing issue in the long run is really going to injure us faster more significantly than anything else in terms of volume. >> thank you. >> is there any public comment on this year any other commission comments. >> again commend you and your team for your great work on this effort. >> all right. we're going to my internal clock says take a break but if we do we'll not make our the fact of the matter take a deep breath and pay attention as we move to item

number ten. >> item ten presentations of possible new health plan sutter represent

>> scoff taken that break. >> we should have taken that bacteria at your suggestion i'm going to suggest a 4 minute because of 5 minute pause it is now 7 minutes after 3 we'll reconvene at 5 minutes after that 312.

>> we're now moving back from the recess we'll begin with the discussion item number ten. >> yes. >> rob sutter health plus good afternoon members of the board thank you very much for louse 80 us to introduce our organization to the city and county of san francisco and in northern california we look forward to talking to the employers but the option in the play with me is steve nolte the cfo of the health plan he's been with us since the inception and structural in 9 expansion and the day to day operations we have in santa monica, california i believe the board is familiar about sutter health we've been part of the community

for a long time well recognized and brand with the california pacific medical center and locally and certainly across the bay and in the post ata environment we recognized the need to bring what is most people are looking towards in a health plan quality and affordability and we believe we've built that in the providers sponsored health plan by building a vertically plan and bring that affordability to various employers in and out 0 northern california a little bit of history we got our license in 2013 by january one of 2014 up and running be with the first member in the county of sacramento the overall goal to expand it into the same foot so

after a year of being into business we've extended into sonoma county because of a new hospital in the heart of santa rose and we launched and wanted to make sure we expanded in the bay area by the end of 2015 so we expanded into san francisco carbon dioxides and alameda and parts of santa clara county just to give the board of an idea what partners we've encourage work with today, we have a bay area network of 16 hospitals with 168 hundred providers and medical providers are familiar to the broadwell recognized glanced or brands with the east bay and a acholic beverage relationship we current

have with brown and shall address their comments to the commission as a whole and neither the police commission nor the physicians in the bay area moving to the valley the valley was really the first 8 county we expanded into stockton and the surrounding area and moving into that enernex neck of the woods 2 thousand providers 8 county and again revokable members are users with the sutter independent and medical foundation so to continue to give the board a visible what we coffer simply a map of the same service area i've provided in the birnt orange and in the service area we are authorized in the department of management care and this is the zip code but aizing the hospital we utilize

and the most recognizable about, about cpmc and health debates but anothers thought the peninsula and the east bay we currently utility again, the same snapshot in terms of what where we are we operate in but all kinds of absurdity facilities and partners as well some of some of the milestones the early doctors to two years in business in northern california and the mumentsz and school districts we're able to solve the unique needs collaborate with them in bringing quality health care

to 9 delivery system we now as i mentioned before we have stand expand in the bay area and looking for other employers to do the same thing in this next e neck of the woods after this two years 33 thousand members now 35 members growing we feel we have o the foundation as we explore the counties in the bay area one of the metrics that are really important to sutter the system is we know in the short term we'll expand that of the 35 thousand plus members we have the 66 percent are brand new to sutter health it is a mission we have to do we begin to accomplish at the end of the day you know affordable health care act is assuming a lot of

employers are looking at for and this board takes the next step in the process with sutter to go down f that road to looking at the health care provider for the city of san francisco in the future thank you. >> thank you for your presentation and i should say your advisement at the end of the day a business relationship that you're seeking out of that process as it is we formally request that the board allow us ann hewitt to pursue the rates of benefits for the city and county of san francisco. >> thank you for your clarification. >> questions or comments. >> 66 percent of our members 19 are due to sutter health how do you define new. >> the sutter system when we enroll with sutter health plus

no relationship with brown tom nolan or physicians in the placing last two years. >> the other question i have that many of your physician organizations are foundation of the sutter foundation of positions does the health plan that is incredible with sutter hospitals and physicians; is that correct. >> that's correct. >> are there 09 questions from the board director dodd. >> when you expand into sonoma we have a fair amount of retirees and a handful of complaints and letters that came to them they can no longer see their regular doctor had to switch to a sutter doctor i mean i was surprised i saw the

letters i, i have surprised not a transition plan when you have been seeing a physician ear a retiree and seeing the physician and all of a sudden have to go to a new cardiac lost or whatever was there any thought given to what that meant to people. >> director dodd i assume you're talking about a sutter physician or a patient that had to be transferred to a different physician. >> ; correct i'm not sure i'm thinking of two not hospital patient but they were our patient in blue shield who were told you can no longer - the medical groups reformatted not everyone went into the sutter go uper u grourp group they were required to move. >> i don't know anything about

that but i can find out for you. >> so what the pleasure of board. >> i'm assuming this next time is small. >> it is a sutter network being areas like we partner that brown and toland. >> why would this be more affordable. >> at the end of the day, we are a if he environment the a cortex o we're to the right we share the governance and share financial responsibility but we put that within the network we 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 state why question did this and make sure you have an finding and answer any of the questions remaining from the information if may not

have been provided or if you have additional questions. >> so if there are questions i have questions i'm sure other commissioners do as well. >> you made a argument for universal health record i'm clear that is a universal health record you answered a lot of the questions i have two one is it appears that anyone who is data is forwarded to cal index can request a health plan or provider forward to them the information but does cal index because our getting a summary from all the provider presumably on any single enrollee so a member can review and then the process they have the members go

back to the provider that provides the information to dispute is it there a little bit of confusion clarify that. >> we prefer that i'll let the officer answer thank you. >> part of the reason at this point some say stated by law under hip at blue shield and the provider are covered entities so part of that going back and saying blue shield could you you, please provide me we call it a patient record can you provide me the designated or the longitudinal patient record in cal index becomes legally that is the way that that hipa works with that said, we're looking for the future to come up with something won we can you know

authenticate people and get the information from cal index to the individual we're not there today i don't want to have a situation you come to me i don't have enough data to authentic you in a way that blue shield are the way your physician is and i end up giving someone else your daughter to me as a provider it is cumbersome to you know expect this process to be very effective if i can't look at a record as part of who misdiagnosed my patient with dooefshz and all of a sudden and found out that they have diabetes bans a data. >> the clinical data within the longitudinal reported it

records it will say diabetes diagnoses or a-1 c tested open this date. >> the patient can't get that nonetheless he or she knows the provider. >> they can get the longitudinal record from any. >> the whole record. >> you can go to our doctor's office i want to see my longitudinal record the physician can have it and print that record there right there for the individual just like call up blue shield and ask for the longitudinal record as well. >> my related question then i'm done i've been involved in you know databases before hiv was difficult to get physicians to find or their staff it find

time to fill out a chart form that included we thought useful for a large database and so how are the physicians are their offices reimbursed for the time it takes to submit f this information and if someone comes in and ask them to print out the paper and 9 time it takes the staff how is the figures reimbursed. >> they're not reimbursed. >> it is a volunteer. >> they participate from cal index they keep in mind they get not only the information they put in but the information that the physicians put in an example would be i go to my physician and i my primary care i have an elevate a-1 c end up go to a specialist and they'll be able to see my lp r and if one of the

medications i was taking was cac indicated the idea to produce better care the records we download the reported from the office and i'm a lawyer now a technology expert but what they can - they dloofld and at sometime we hope there will be a blending. >> sorry so let's say a non-partnering physician described the indicated medication so it was a non-partnering physician but city council. rightone: doesn't have access because it is was a non-xrarpt physician.

>> well, it depends on so they won't have access is from the physician him or herself us u but from the claim is paid to blue shield we can get the request pb m through blue shield. >> the claim. >> is uploaded and what we are doing we're 12kr5k9 the claiming data. >> are other questions. >> well or comments. >> the claim and clinical information i was under the three combrefgs. >> it is the criminal information from the source we is one of the claim on a financial information complaining but physician site of service and type of service meds and those types of information we took a different view the data and the health

plan typically does what a itself relevant information and put that two the cal. rightone: and try to fill in those. >> i have two questions will patient have access to change their data if it is incorrect. >> under that they can get a longitudinal records they can go back and we'll work with the provider to change the - >> how will they - >> our notice of persists you have the right to ask our provider for an amendment their notice of privacy it will be a acholic beverage effort and the other question is this is from a couple of years you have acknowledged you intend to use it for research although last time that was not one of the

source of revenue to continue to fund it how can we be sure in 3 years when in is not working the way we want you don't sell to some other organization i mean is going there - there's no agreement between cal health and other services that protects my members from having their data sold in 10 years. >> we can't legally sell it we can only get the data under the perimeter that are participation agreement and allows us we are an under hipa a covered entity a health plan and the provider and there is vendor that is what we are vendor like ourselves are business associates did you law only allows us to. >> any patient with the extent

of that contract figure we sell it outside the scope with the notice of privacy practice we would be in violation of the law. >> it could change your va. >> not without consent of the provider and the health plans we're doing business with and selling information under hipa is contemplated the intent to use only the identified data for research to benefit the public good. >> i think it would be quite difficult franklin to change the va a. >> it would be a public database. >> researched will not have access to the data directly what they'll do like any other they'll submit a research proposal we have not yielded engaged in any research

activities of at this point we but- we will have they'll submit the research proposal we will create and work with an index rb to review the research proposal and with the index rb and with our board make the decision to whether this is research we want to participate in we're not going to participate in any research activities until the protocol is vetted. >> lastly you said that of members opt out their data is there are it won't be assessable to different emergency departments so you would potentially continue the research on this daughter we are prohibited the data is completely blocked we are that prohibited from looking at the data you know for research or

any other partnership that is so forth in the privacy policy as well as our contract. >> just a few comments i thank you for your responsiveness in providing the information we asked i still have a foundational and i want to be very clear a fundamental concern the way this is deny did you not have enough faith in the membership you serve the members you service e serve you couldn't have gone to them and asked him if they wanted to be part of the process rather than be a part of whether or not i still don't understand the business decision to do is that way. >> and even after reading all this and your privacy notice it

means each individual has to make the effort not to be part of it i'm stuck on that point beyond that i just don't i understand the charting perimeter to establish with our board this board is independent at the end of the day even the con stwrant they operate not a controlling interest you gave that up when the elected the board i understand the intent and the benefit of an with integrated medical record what is has a affordable health care act been talk about and the other health care reform i get the message i'm stuck thank you point of requiring our members to participate in this without

informed consent i recognize i don't see is that way. >> to be clear the members are not required to operate one an content they have the opportunity to opt out i understand we are using the same words different my point i joined blue shield and i didn't have my information shared in the third party forum i didn't come to blue shield with that expectation not a member last year or the year before you've told me i'm not anita lee now part of this. >> we had the opportunity - i understand the position this is a rich date that is happening over the country's. >> yeah. >> we looked at and spent a lot of time going through this and how this is approached and looked at it this successes and

failures across the country the liability of a critical mass the whole gamut of that and there is a rich debate across the country asia folks who are you know very much on one side and others on the other side and frankly i'll suggest not a really solid consensus. >> i'm not asking about contention i'm talking about a volunteer act my me as a member asking to participate at some point in the begriming is guard had a maybe medical useful but at the end of the day i have no control unless i opt out any benefit to me is denied once i do that it is like a choice at the end of the day i have a problem with it and the other

piece is the level of employer, letter vendor partnership relationship communication every time this board meets on a monthly basis we have an open agenda item of anything that might be a future there are of any interest under the scope of duties and precious little notice this was d being down or done i find that problematic we have a clear working relationship with blue shield and nothing and to my working knowledge i've been here have been discussed with this board formally we're under thanking that's a good question this is reason and so forth so that's why but find me more resistant at the end of the day it

violates the functional promise of a vendor partnership so i am stuck and i don't know know if i'll get you think stuck underlining unless we go on record recommending our members opt out so we missed the opportunity to come in front of the the board and communicate this we had discussions with the the president and some formal communication but absolutely missed the opportunity to come in front of the board i ielgs. >> any other questions or comments. >> one just out of custer i frnlt to our addendum opt out form to see if i can fill it out try superintendant guerrero our date of birth it assumes in january of 2016 in order to get

your 40 years old you have to psychologically through 8 hundred plus members to find january of 1975 it takes two minutes when you tap over. >> i'll talk with our technology people immediately that is not what i've been informed and definitely that shouldn't be. >> what were you doing it an, an ipad. >> on a pc to the website a required field the only month is january 2016 you have to scroll back. >> this takes you have you tried it. >> no, i haven't. >> that's the defect. >> we'll take care of that. >> we have another question

any other comments or observations. >> i want to clarify i'm a chronological or chronology your contract requires blue shield to clear any communications and beginning back in october of 2014 the first letter came out and we were stunned and but told we couldn't change that - i just

wanted to information has gone to the members but information from i guess from blue shield but it is about cal index. >> i understand all right. we thank you for your presentation and follow-up today thank you. >> thank you. >> you're welcome. >> is there any public comment? claire representing all 71 retirees and commissioner scott i support your comments and your

prospective i share that and i'm greatly concerned for the members that are urban ware their data is collected and used and they were not properly informed and my own report to retirees will reflect the information that we got not only from the last meeting but today, there are concerned in the retiree community it is good it have shared medical data i understand that and many of the members that blink under the capillary system appreciate that about this system this was done without consent and i know your point that members should have the opportunity to opt in and not the opt out because the opt outburst kinds of options while they may meet the legal

standards the individuals get things they don't realize the u.n. intended conventions are not explained this is problematic and the concepts seem fine the whole process in terms of how this was done the issues with the department not vetting those letters interest the process and not having lowell u allowing members the opportunity to opt into that a program is very problematic and i'm hoping that in the future something can be done about this i think your members need to be told that they need to be informed their data is lierltd this way and despite the protections of high blood pressure ca a there is serious concerns >> thank you for your comment is there any additional public comment? >> hello, again members of the board i want to echo the comments we represent the it

workers here in the city and county of san francisco and so we you know have intricate living of data to what the city and the work you do but our membership you know see offhand the dangers when information is private and given away to private entities or nonprofit that don't have the level of security we are seriously considering sending a letter to our members to opt out until they look at this program and encourage the board to send a letter to all members encouraging them to opt out until they view the information from the fault your opted in you're in the program people

will change that and i think this is concerning i saw the letters that were sent out to the members of the blue shield it is something that pefrm if i thought in blue shield i might have easily thrown that away e.r. understand the level of you know level of seriousness of this issue and you know i'm concerned we have had members that have no idea their information was shared to that stent and how it is being used and while the privacy policies seem nice you know, i on the members asking them to opt out instead of opting in it sdinz i encourage us to send out information around the program and encourage the members to opt out pd if at the do the research

and want to be part of the program to on the back in and - you know. >> thank you. >> other public comment? and dennis kruger active of firefighters and widow those as one of the people that opted out when i got the letter what was not discussed in the letter if i opt out my information will remain until and they can for whatever reason have access to it internally of i've heard shaurps that's not true i'll propose to this woeshgs the opt out information is deleted otherwise why are you opting out

>> thank you for your comment. >> may proposed action?. on that this item from board members >> well, you know, i do support the universal medical record i've not heard assurance about the privacy i appreciate and no, i rb for example, at this point but it abort me about the process i've been involved with other opt out process in terms of prescribing the information physicians don't understand how to opt out i'll recommend we ask the staff to look at drafting a letter reminding our blue shield enroll resolution this is an issue and look at the program this is as

potential consequences without going introduce the issues ourselves. >> consent around that? directing that a letter be drafted by the executive director for review by the board regarding the cal index program to be directed to blue shield members who are part of our system? >> i hear no objection all right. we'll precede once the letter is drafted we'll take into account it. >> all right. at this - >> is that an action. >> i'm sorry that was a recommendation is there a second. >> i'll second it. >> thank you very much commissioner breslin. >> i still kind of caught up where i'm at on the topic (laughter) so is there any discussion by

the board members on the motion. >> i'll say one thing an option to include that as an item for the regular newsletters from h ss that include the items of wellness and the category for the blue shield members. >> are you adding that as an amendment. >> i got the letter it was intended but that is an electronic communication. >> in addition to that. >> potential the communication can be part of electronic communication. >> i'll strongly endorse that. >> i apologize when i am reading this information it says it didn't increase the health information protected by the federal or state privacy provisions and that includes physio therapy and personal information and records relate to personed refs services for

the state disability and the state test results i guess my question if you have a child with very well disabilities you are likely to get enrolled in a regional center would that will in the record to the emergency depended knows. >> we'll suspend action for one moment hopefully to expound. >> those exclusions that require specific through the law consensus that i'll allow doctor smith are jones to see my record and it is couldn't be done so if

someone yes, we have to 0 exclude there's a law called lp s that requires. >> the example that was given was specifically about the development all if thai receive any state - >> we're back to objection axes on the motion. > all in favor, say i. > any public discussion there is public discussion on the motion. >> denls kruger active and retired fir for widows i think that should be boulevard responsible to pay for the letter that blue shield shared the mailing list to send the letters out that everyone is in

unless you opt out they should send the letter out without the expense. >> thank you for your public comment any other public comment. >> that should be part of motion. >> it is part of motion we make a request that blue shield pay for the costs of mailing. >> of the letter once it is drafted and once it included did amended provisions discussed. >> can i comment i hope there were refusal to pay will not delay the h ss communication in any form electronic or by letter i feel that is something we have a responsibility to do. >> duly not any other comment from the board in favor significant by i opposed? so order

all right. you the penalty of being a chair we have a discussion item and possible action, an sergiocy we have an action item on the annual report or two that we had indicated to our member we would be ready around 4 o'clock to go into closed session out of consideration we will do so so i'm going to suspend the portions of the action items at this time and request a motion as to whether we should hold the closed session for a member of appeal. >> motion. >> second. >> it's authenticating we suspend our regular meeting agenda at this time to have a

closed session for a member appeal is there any public comment? hearing no public comment we're ready to take the motion >> questions. >> i think we're back in live session. >> i think we are too. >> thank you, madam secretary and having concluded our business for the regular meeting we are officially adjourned

>> hello, i am with the recreation and parks department. we are featuring the romantic park location in your backyard. this is your chance to find your heart in santa and cisco with someone special. -- san francisco with someone special. our first look out is here at buena vista park, a favorite

with couples and dog walkers. both have a significant force. a refreshing retreat from urban life. the romantic past that meander up and down the park under pines and eucalyptus. hang out in this environment and you might see butterflies it, fennel, and then the lines. -- dandelions. is ada accessible. public transit is plentiful. we have conquered the steps, we have watched the dogs, and we have enjoyed a beautiful view. this is a place to take someone special on a romantic stroll and enjoyed a beautiful look out.

welcome to corona heights located in the heart of this district. it offers a view of the downtown skyline, the bay bridge, and the east bay. it is one of the best kept secrets in the city. it is hardly ever crowded. on any given day, you will run into a few locals. , bought a 37 bus to get there without any parking worries. for legged friends can run freely. there is also a patch of grass for the small box. >> it is a great place. it is a wonderful place to have these kinds of parks. that dog owners appreciate it. >> take time to notice of the wildfires that are on the grassland and keep your head out on the lookout for hawks and other bird life. be sure to take your camera and be prepared to take a view of

the city will not forget. it has a beautiful red rock formations. you could watch the sunrise over the bay. this is another one of our great lookouts. we are at mount davidson. 928 feet. this is the place for you to bring someone special. to not forget that dogs and enjoy all of the pathways and greenery that surrounds you. it provides a peaceful oasis of open space and great hiking trails. the spectacular view offers a perfect place to watch the sunrise or sunset with someone you love. >> it is a good place to get away from the hectic life of the city.

come up here and listen to nature, i get some fresh air. that view is fantastic. >> where sturdy shoes. hikers get the feeling of being in a rain forest. mount davidson is also a great place to escape the noise and the bustle of the city. take the 36 bus and it will drop you at the entrance. it is quite a hike to the top but the view is worth every step. this is the place to bring that someone special. golden gate park's largest body of water is an enchanting place. is a popular spot for paddling around in boats, which can