>>

>> good afternoon everyone. i wish to call the regular meeting of the health service board to order. would you be jointly in the pledge of allegiance? >>[pleage of allegiance]

>> thank you i will call on her secretary to call the roll call >> president scott present lim present harris-dawson here supervisor farrell excused ferrigno expected to involve the present sass present we have a quorum >> thank you. we will now move to action item [inaudible] as the president of our retiree association enters the room lightning, thunder and static

all the same time. >>[laughing] again, we will now move to action item number one secretary >> >> item number one approval with possible modifications the minutes set for forth below regular meeting of january 12, 2017. >> i call for this time for any additions, edits, to the minutes of the last regular meeting of this board? m. sass >> yes. i think it's on item 7, the third bullet there's a reference to governance code section 53 600 i think the california code g3 600. >> thank you you are correct. >> all right. any other edits or corrections were additions? if not i'm ready to entertain a motion for adoption. >> moved to approve >> moved and seconded up the

meeting of regular meeting of january 12, 2017. any discussion on the board? any public comment? hearing none, and seeing none, we are now ready to vote. all those in favor say, aye. [chorus of ayes.] opposed, say nay. it passes unanimously the edits. item number two >> item 2 discussion item general public comment on matters within the board's jurisdiction not appearing on today's agenda. >> we are now calling for any item or public comment for any items that do not appear on today's agenda. is there any public comment? hearing none, and seeing none, no public comment we will now move to our next item which is the rights and benefits committee. again this is for those of us were not

always playing inside baseball. we used to have a standing committee[static] we used to have a standing committee of the board on rates and benefits. that committee was dissolved when he amended our terms of governance a few years ago. now the board handles matters of rates and benefits as a committee as a whole. so that is what we are doing at this time. we are addressing items that would come before the rates and benefits responsibilities of this board. the first one is action item number three and are secretary will call that out in just a moment. we try to find out with the static is. be on my talking in the room. >> i'm sorry >> no problem item 3 rates and benefits >> thank you item 3 action item

initiation of blackout period for all hss vendors for duration of 20 teammates and benefits process. director john >> director dodd >> each year we agree to the blackout period. you have it in your packets. other questions? this means you don't have conversations with the vendors that we are negotiating with. are there questions? >> that means, just as a point of clarification, any contact.. we really should not be engaging the vendors directly as members of this board even when we are not in a blackout period because sometimes those matters will come before this board to be voted on in that member may apply themselves conflicted as a result of having having had a

conversation get this is particularly true when were in a bidding process. so there are specific guidelines for me to follow. if there's any questions, i would ask that you direct them to the board secretary or to our counsel. so that we all clear about what we are doing. is there any board comment on this action item i'm willing to entertain a motion for its adoption? >> i move that we approve the blackout period during 2018 rates and benefits process peer >> is there a second? >> second. spews is been probably moved and seconded that we adopt the guidance in the blackout period. any board comment? regarding public comment? hearing none, and seeing none, no public comment, we are now ready to go. all those in favor say, aye. [chorus of ayes.] opposed, say nay. the motion carries. >>[gavel] >> action item for >> item 4 action item approved city plans administrative fees for 20 team plan year into it >> we now bring to the podium and gentlemen that's going to be with us through the rates and benefits process. estes english ashbury from a on. and

i think that we are is that going to come up on the screen? the presentation? >> okay. thank you good afternoon. actuary. duly noted as your distinguished actuary. so thank you ray much. i looked up my colleague from unc over here because we have two benefits that we are adding into this exercise for the administrative fees for the united healthcare city plan, [inaudible] for active in early retirees. you have before you the deck that outlines with the fees were. i ask you to turn to page 3 of this deck. right now, we're being 49 dollars and $.95 for a set of services that heather can outline in more detail if you ask any questions. the proposed increase for 2018 is $43.04 and

i would like to let you know that this includes $.44 great benefits known as reproductive resource services. so i won't say anything about that benefit but that benefit is included there. so the overall increase is 2.6% initially we got a higher number and renegotiated with my colleague at this, united healthcare. they added the $.44 in and reduced the cost. so starting from where we are to where we are now like to highlight the fact that they were flexible in giving us a very good renewal and we want to acknowledge that publicly at this time. so i will continue with the overall set of numbers and then i will ask-also

included in this is a real appeal but that's acclaimed based program so was not part of the administrative services. it is a program that's going to be offered but it generates a claim. so it's a service that they can now have. before i go forth i like to say in addition, under the united healthcare structure, there are various components of how they do business where if you go to out-of-network provider they negotiate a lower savings than what you would have gotten and eight you share the difference in the savings. so some of these numbers are basically the first to the shared savings in the reasonable and customary are allocations to the administrative fee because you will get a charge for those dollars. you will see the net fee and then you will be paying united healthcare. they keep 35% of the savings. so with that being said these are revised numbers value-based pricing is that they negotiate with contractors to do something analogous to our hcl and you've heard about claims targets before. so this is an allocation to fund any incentive payment and so we

left it at the last year's allocation and with all that being said, i would like to say that we have good news. we've added our fee is that we put in our sustainability fee for what is paid to hhs. we priced and our shared savings. we've added the $.44 were buried in the renewal. we have a new program. and we are recommending that you accept these fees which means the overall cost impact is [inaudible] what is not presently in the rates at $49.49 to $51 and 61 something if you do not mind, i would like to stop here and let heather outlined the two programs and then we can go back to business >> that would be fine. please, give your name full name and your responsibilities >> thank you good heather shen l united healthcare on your accountant executive for city plan. active in early retiree >> thank you

>> you are welcome reproductive resource services i know they provided a flyer. this program we recommended the city is looking to enhance and does have a nice rich set of benefits around the fertility services that they provide for your members were doing with that. when we use the reproductive resource services this gives a clinical nurse case manager to those families that are doing with the reproductive infertility issues and helps them both understand everything that's available to them, help them find centers of excellence that about i success and are highly rated with her providers and really got them through that process for all the resources that are available. so this would be a program that is built in and would be available for anyone that has the need to use or want to use the program giving him a clinical support. >> if you would just cause there. dir. dodd is this consistent with the other health plan providers are doing similar? >> it is similar but it is actually more than the other health plans are doing. >> all right., thank you. >> okay. the real appeal program is something we are

excited about. aion and hss vastness was united healthcare doing to help control diabetes and other chronic conditions and so real appeal is a fantastic interactive program that would be available. as i mentioned there's not a cost for this program because it's a clinical weight loss management health management program. so it's available for anyone that would have a bmi of 23-29 or 30 and above and potentially comorbidity condition did so they potentially have diabetes, heart disease hypertension, and so what is done is that members who i can we do a full rollout implementation of this plan so your members are aware of it and then the members actually have a clinical intake. so that is done with someone to

understand all of their needs should once they are essentially approved and enrolled into the program than a claim is built like a medical blanket we have a network within our system or these clinical providers would go a claim. it is great because it's not where the six-week eight weeks work and help you. this is a full year. its 52-week program. ongoing they will have coaches that they will meet with virtual imaging they work with. you have seen the materials potentially does a wonderful kit that literally is shipped to each member. this has workout dvds. has a blender. as a weight scale. it has all the tools and resources for healthy eating. this no cost to the member to get this. once they have that they will work with her coach to the great thing about this program is we do not build a claim unless a member is being successful and they are on target. so if they continue to work with her coaches and have their meetings and meet their weight loss goals as they have those coaching sessions that additional claims are billed through the system. so it's great support tool. not just for weight loss management but for chronic conditions as well. >> thank you, thank you very much. that's quite a feature.

are there questions from members of the board? >> yes. i like to ask a couple of questions. what about on real appeal. take up positions order? >> no. >> okay. you mentioned to bmi ranges. is the 23-29 with a cold morbid and then anyone 30 and above regardless of what they have >> regardless >> okay. >> we can even talk about that and has some flexibility in there to make sure meeting the requirements of the population that we want some get some axis did so part of the intimidation will be ensuring that we are doing a good job getting to anyone who'd benefit from that program. >> so there's no prescribing of diet or anything? there's no physician component professional component you are doing is the-is the dietitian interestingness? >> yes. the clinical coach with as a background that's working with them. yes. >> okay. commissioner harris-dawson >> in calpers in their letter

they start january 1 all calpers health plans are required to offer diabetes prevention programs and they must meet the center for disease control's innards. at no cost to a notable members. do your standards me back the center for disease control? >> for the real appeal program >> right. >> yes. we can get additional information. we can even have some someone from the real appeal program, at a future meeting if you want to know what the clinical components of that. but, yes >> all right. never calling joining please identify yourself >> i michelle-of your vice president sales and account management for the sector >> i manage a toddler's account as well in real appeal program is what we rolled out to meet those needs so they're

actually- >> so the working with the center for disease control? >> correct. >> as part of this program they rolled out? so yours is basically the same >> exactly. the program we rolled out for calpers to meet those records is the same program we been going out to city and county. >> all right. so we got something on a par with or better than the largest plan in the state. thank you. any other comments? any of the questions from the board? >> how much extra is this costing us? be so it does not cost you in the form of an administrative fee from us. the member that's participating, it will be billed just like a medical claim so the initial assessment is $103 claim. if we paid at your benefit level. that number doesn't have any cost out of pocket pocket for that and it's going to be dependent on the member's

participation. because of you have 52-week soda numbers extremely engaged the total maximum cost is $691 but what we are seeing is the average cost the amount of times they are meeting with coaches and having them is about $300 per member for the 52-week program. the return on investment the are like they're showing as always 221 getting them under control with a loss management and healthy eating and everything headed in the right direction. >> this article said one in three people have free diabetes. i do not realize it was that high good one answered iron 50% of the people in california are prediabetic or diabetic but i did not realize one in three have are also prediabetic. that's scary. >> no. i think people who have the program and i've seen--i was able to attend a meeting good people had not lost a significant on weight and started controlling their chronic conditions. it seems like there's a lot of support this and really interactive components to it where they use

different professional athletes movie stars superstars etc. get involved in their cooking shows and things to really engage those members make them want to be a part of the program. >> how about individual nutrition counseling? are these broke programs or individual? >> so the initial assessment is individual. their ongoing coaching will be with the same coach but there will be a group of people that are working so the people who pick on the same timeframe same allotment when they want to do will be an on those same sessions with him from a virtual standpoint you got a virtual coach. it all out in like a classroom typesetting but it's individual coaching for that person with the coach. >> all right. yes director dodd >> some of their new was we've requested different vendors include nutrition counseling as an availability. >> okay. thank you. it's thank you very much for your comments and clarifications. so oh when will you come back, please? >> with all the questions being answered and i thought very well done presentation of the two benefits, i would like

for us to turn to the final page of this, and my recommendation is that you accept the administration fees as presented which means an overall increase of 3.4% and included in this is acceptance of us going forward with a real appeal program rreproductive services program. so that is my recommendation at this point >> right. you for the recommendation. are there any questions or comments from the board? >> i may be reading this wrong but i see the percent change is 4.3%. is it 4.3 or-i'm not sure where i am leading it quick i see 4.3% >> we revise this document and hope you had the >> you sent the wrong one out and i got it up properly- >> there's a document on the web and i mentioned-i'm very sorry about that, sir but this is the corrected document >> okay. >> the correct number is quick >> overall 3.4%.

>> is that what everyone has greet >> that's what i love my handout as me. >> it was me. >> the revised document and the one on the website has that number. the was 3.4 so everybody is clear on that. >> any questions for members of the board? all right. ready to entertain a motion. >> i moved that we approve this city plan administrative fee for 2018 and year >> is there a second? >> second. >> is been probably moved and seconded up the recommend rendition from actually two approve the administrator free from united healthcare. and the benefits as described in the-thank you. other comments from the board? is there public comment?

>> i just want clarification >> you are, sir? >> i'm herbert weiner >> very good and you reside here in san francisco? >> i certainly do. beautiful for us and unaffordable >> rur tyree of the health services system? >> disulfiram >> we are delighted to have you are this afternoon the was thank you very much for the reciprocity on a rainy gloomy day. anyway, i don't know if i'm out of place with this and please, let me know if i am. i've concern about the benefits from you hc on the ppo. now is this relevant to make comments at this time? >> well, when not knowing where your comments are, and if we past the agenda item for any item that may not be on our agenda for today >> okay. >> let me finish. i'm going to indulge you but i would ask that you please be brief given

a factor we have a close session for an appeal that we must cover and we need to be out of here by 4:30 pm ps yes i have to be out of here because my [inaudible] is all messed up so i will be brief. i wish to practice my concerns by noting that i have shared in united health and welcome the freedom of choice and selection of physicians and the decreased co-pays. unfortunately, the plan has a booby trap. there are co-pays for procedures as ultrasound treadmills and other outpatient steps >> wait a minute are you talk with a new city plan? >> on talk about the ppo. >> the regular city plan the real city plan? >> yes. the preferred providers. >> okay. the new one is called preferred provider, too is why everyone is confused. >> i use my medicare card. okay. unfortunately, the plan

has a booby trap. there are co-pays for procedures. ultrasound treadmills and other outpatient test. i had a heart murmur. i'm a step further tests after being on a treadmill. these costs at all. under blue shield i never had to make copayments for these evaluations. united health is six on the fortune 500 with profits of $5,838,000. surely, it can cover all payments for all outpatient tests as it does with blood work and other outpatient procedures. when my quote alan? stand saying there's no free lunch. my sponsors don't be the lunch. >> all right. we thank you for the observation. and even though it was out of order in terms of the topic, we have received your comment. if you'd like to be the statement with

the secretary, we thank you for the comments. >> i won't repeat them. >> i understand. thank you very much for your comments. all right. is there any other public comment on the matter dealing with this action item? if not we are now ready to vote. hearing none, and seeing none, no other comment all those in favor say, aye. [chorus of ayes.] opposed, say nay. it is adopted unanimously >>[gavel] >> all right. we are now moving to action item number five - excuse me - discussion item number five >> item 5 discussion item review of city plans 2016 claims experience. neil kosher and in hewitt >> before you have the packet titled city plan utilization claims expense calendar year 2016 presentation. each year we provide to you a month by month array of the data for the early-the act early retirees in

the post-65 retirees for this program. this way the last time we present the post-65 because are now part of the ma medicare advantage ppo and fully insured structure going forward. we started at the beginning of this. so that data will not be presented at what will be presented as yourself funded ppo program which is constituted as a set of actives and early retirees. so with that being said, if you turn to page 3, it gives you a summary of what we are doing. it also says what are the salient statistics to give you an idea of how these theories is running. so with contract size average cost average cost the membership. so those are the items we will highlight as we go through this experience review of the data for city plan. that being said can we go through an introduction and in the introduction, it forms a transparency and communication, we want to be clear that it's understood that

in 2016 when we set the rates in 2015 four 2016 goes quite a bit of stabilization reserve and it was required by the stabilization policy to be amortized into the rate in addition to that, we added $5.4 million into the rate action so that we could lower the rate so that we could hopefully over this going into what is known as a [inaudible] wendy spends just expose we don't have enough members in the pool to sustain this on a go forward basis. so even though those actions at the time were considered relatively aggressive, we are here to report what happened as a result good this is one of the messages that we want to clearly communicate to the board. did our actions in 15 help us grow membership and get our actions in 15 hope was to not have a per subscriber cost increase possibly and hopefully a decrease? so those items

actually happened than the actions taken were prudent and from my view of the world as an actuary were prudent and the correct actions to be taken. with that, i turn you over to the active claims experience which is this weather volume set of numbers >> all right. knowing that most even us who have document in front of us this is fine print and so forget i like a little bit of orientation to what's on the page. >> i will gladly do that. what we do on this particular page is we go through the monster would look at calendar year 2016. so the far left column by the month by month statistics. from a membership, a premium and a paid claims and incurred claims based. what is the difference in pay claims? that is the customer incurred claims are adjusted for your reserve. we reported >> what is i dnr >> currents but not reported. in a given month you will have data where some of the paid claims were for service dates

before and some of them were will happen in that respect month and in this the incurred claims his assessment of what is the actual cost that's attainable to that specific month. it's an actual calculation did at some point in time when all the data come through the system weekend that of the data and vapor service dates of state x-month we go talk with the incurred claims working with that being said, that's what we present to you could redo the premium by month could do the paid claims with cash numbers that go through cfo pamela levenson books and there's incurred number should just as a representation since having your actuary we've always presented exactly the same data. so recognized you decided that we could spend the stabilization. so to look at

the bottom line say we lost a bunch of money. we set the rate knowing we would spend more than we took in. we were burning off the cash so to speak if that's an okay statement to make the public disclosure. so did we get more members? we started-if everybody i know i'm supposed to talk this way but we started with 735 in january and we ended on the way going through this exercise-you know they come on. that intermittent periods. we ended with 891 members. what does that mean? that's not each individual delete button is the term we used it subscribers. so it is he +1 and e +2. at the end of the day, we actually lost 2 million seven or $42 and 50 -limited vatican 2,000,007 or $42,250 on the paid basic si calculation. before we say a thing about it i like for us to turn over to our little set of statistics. on what does this

imply relative to 15-16. as we got more members when we decided to do this we said we want to grow the average contract size. we are doing this to bring families in, to lower-get lower-cost members into the pool. people, if we do this, on the active on these is what were talking about when people come into this pool and will this allow us to stabilize this program creates an important factor in this is did the average contract size grow period over period over period? it's a little actuarial but, yes, it did. it was from 2014 at 2.4 which means we basically had only the baby and they were sick. now we have 1.55. so we go back and we say okay, i'm going to see if i follow this. how many families did we get? that's e +2. we are sitting at if we go back to this data, 115

families. we started the year with 72 families. so you know it's a small set of data relative to the enormity of this pool but it didn't work. i'm very-that's my opinion as an actuary. it went fine. with that being said, we also want to know the motive look at these statistics. tell us what we spent her, as we cut these rates what we spent on the clean side in 15 versus 16. so if we look at the this and 16 on and incurred basis we spent $1000 and 22. in 15 we spent 1200. if we turn over and look at this on a paid basis, same kind of numbers. weights. i'm talking at the premium. my dad. sorry. i'm looking at the premium. that confused me.

thank you, suite we spent 1306 in 16 and 1400 in 15. we go to the other one, very similar numbers. so we increase the membership. the cost per member went down. we increase the contract size. so was the subsidy on of highlighting this, totally asked to come back to this board after the fact when we leave the votes and represent what happened and whether or not it's working in your opinion. depot are welcome to have opposite opinion but in my opinion it's going the right direction. is this a sustainable program going forward? well we have to see what happens first three months of this year because we did it again in 16 417 and so with this being said, is this direction we going the right way? did we grow membership? did claims per member go down? the answers, yes. okay before i go through all three and then will open to questions. okay.

given that were now going to look >> just a moment. would you go back to--i want to go back to page 5 for a moment. >> okay. yes, sir >> there is a little square red square around these columns. would you explain what that is about? >> well, these are numbers we wanted to-you mean the little thing in the bottom there? we are highlighting some points just as when we do the respective numbers with a loss ratios are and what the average contract size is, just as a way of highlighting these items. we do not say it's 1.55. his the contract size. look at the loss ratio due to the loss ratio is the ratio claims to premium. then her in our observation section behind it we highlight with that implies. 15 versus 16 so that is the point of highlighting those numbers to bring attention to these numbers which are also

discussed in our observation section >> all right. thank you for making that clear. commissioner breslin you a question? >> i'm looking at page 7. there's a loss ratio for 2015 was 119%. page 7. for 2016 it was 100 18%. so bigger loss >> that's true but we subsidize the premium substantially by more than 20% adduction. so proportionally speaking we didn't do an additional set of analysis to say, if we attempted the premiums going up at the same level as-if you can see the premium was $1482 week. the premium was three $200 and we dropped it to 1022 and we

subsidized it. so when you take the ratio of the claims to that lower premium, you of course get a higher loss ratio. so i am saying to take on number is what these band was. he was $1482 and 15 and a drop to $1304 in 16. >> with the subsidy? >> with the subsidy >> but how long are you going to have subsidies? that's the question. it's with the subsidies. >> okay. we lower the premiums. the claims line we've increased the membership that we lower the cost per members. >> which were the stated objectives for doing the subsidy >> yes. goes with the stated objectives are reporting back to the board given the stated objectives correct, sir, this is the result of the action taken. >> all right. this board has the capability as long as we have fund in that reserve to continue to subsidize premiums until a point in time going for. is that correct? >> >> that is correct., yes sir. that's absolutely correct.

>> if you could pause commissioner moon-reynolds >> wedded physically does is in 2016 we reduce the premium and in terms of being the members so we have more healthy members that's why the [inaudible] claim is going down by over 100-$178. so by reducing the premium we encourage tormentors to come in and the claims gone down from 1000 482 1000 304 in 2016. >> absolutely correct, sir. that was the intent to stabilize but we have to subsidize to stabilize and when we do that those of the two s is a natural lingo subsidize to stabilize. that's what we did. >> director dodd >> i just want to make a comment. doing a lot of reflection these days and when

i came to this job i was told by our then actuary that city planning was in a death spiral would be dead in three months. i think that this board with the instructions from our different actuary has worked very hard to stabilize city plan and this is an example of it. >> thank you. please, >> okay. so now we go to the second set of data points which is a early retiree. so did we accomplish to the same degree what we did with the actors when we subsidize-because we subsidize both activists in earlier times by the additional

$5.4 million to we were required by policy to $8,910,000. that's how much extra money we got good why did we have that money? because dr. dodd and i came on board said we are going to put in the egg whip. the with reduced medicare claims expense substantially with help us generate quite a bit of stabilization dollars. with that being said, moving on, we would be on page - excuse me - >> page 8 >> yes, sir. we go to page 8 additional information early retirees. the average contract size which is hard to do for early retirees but it did increase the loss ratios are fairly substantial. this is a reasonably prized product so when you have splits with medicare the rates are very nice for the medicare splits. we didn't want to do anything to get rid of that for these people. so this allows the medicare splits and all go into our medicare advantage ppo program the ability to use this and as we own blue shield always takes those splits. so this is a good thing. so,, give me reduce the spend by

subsidizing this pool? on a paid basis of the answer is, yes. then we dropped the premium quite a bit. you can see on that page. i incurred basis, the answer is, yes. we dropped the premium quite a bit there to keep these people available to as splits and not do anything to erode the ability for early retirees decoupled with medicare retirees. so it took all the necessary actions when we did the subsidy to make sure further direction of the board and the director from hhs to make sure we did not do anything in our work that would do something converse or negative to the early retirees could so we did that. the money went down

as far as what you are spending could so in a slightly different way, we accomplished the same goal. we get what we needed to do. i would like, if you don't want to finish this hall the questions you want. now the medicare experience. this pool ran fairly well. unfortunately, the egg whip premium requirement that we got from united healthcare went up substantially and it started to spend more money the program. we had to pay for our fixed costs for medicare, drug-the medicare drug costs plus the fee-for-service dollars at the part the medicare does not pay, it started to increase and we knew directionally it was increasing so we made a decision for 2017 when we got the renewal information to move this to the advantage program. so i could walk you through this data. this program is not part of our portfolio anymore or offering could gather program is. so what we want to know is, if we turn this over, and look at 15 versus 16, the premiums versus the spend. in

15 we were averaging $325 of spend straight off of that experience reported well the prior one could in 2016 we were spending $369. i think this is a very important number to highlight for the board. >> these are found on page- >> i'm so sorry, sir on page 12 i really want to highlight 369 versus 325. that was the trajectory of the seal be self-funded ppo program for medicare persons for city plan. so in 16 democrats was costing the trust. this isn't-this is literal money paid out the door. was costing that per retiree. our rate, if you look it up on my hs got word from our rate for the medicare advantage program for 17 is $320 to $320 but we were

spending $369. from a keep the legacy alive. the benefits going perspective, if you ever had a trajectory that said in hindsight you could save but you go forward, and that was what the charts and dr. dodd was don't wait a year to do some and put it out there as soon as we see a single in a certain direction, you are $40 and from a 15-16-7 is this chew on the other side? yes, it is true. so i highlight that. so i am saying at the end of this axis, does a lot of experience. i go through this and what i conclude is >> those conclusions conclusions are found in page 14? >> page 14. on page 14 i conclude-i know it seems like a lot of money but we got the results we needed for 16 by doing this subsidy and voting it in for 15 416. i will also

say that from a trajectory of cost for the ppo self-funded medicare program, versus the medicare advantage program, we have a 320-i don't have the exact number-but i know we have 4.5% increase cap depending on certain other aspects of the offer for next year that could and that number happens to be below kaisers medicare number, that program from being able to offer a substantial set of benefits versus what it would've cost for the trust. that program is a very good financial decision and i put it in here. you know, so i'm presenting to you the experience could experience what is what it is. i am also qualifying that through the experience that the actions taken by the board in my opinion,-is an actuarial

opinion, were correct and pragmatic imprudence and very responsible. he thank you. questions from the board members on any aspect of this presentation? commissioner sass >> yes. i can to questions maybe just looking at the actives, the chart on the actives. when the number increases in this plan i guess arguably its decrease from some other plan. is that correct? we are showing one plan only an increase in the mentorship of those numbers came from somewhere. kaiser blue shield or summer i would imagine. >> they could either the new people that signed up his family were people that migrate from an existing program. >> to the extent there's overall growth in the total population yes that is correct, sir >> whether this grade is the average total growth or is it really a migration from one plan to the other, you don't

know the answer to that for sure spirits that will be announced at the could be done but we have not done it >> my second question relates were looking at one year and we had a large stabilization transferred to make this happen but if you go back several years the city plan went to the enrollment look like say five years ago or four years ago in this plan before we-where are we voted to the longer-term view of what's happening with clinically >> okay. i cannot say this. since this is a public forum it did go down quite a bit for the actives i know that is a very general answer but it is now increasing could i also had in the conclusions we got the open in romans for 17 and the winner even more. i do not read a part of. but it's going up more. so to be go like this and i were moving up in the last six. is

improving based on the actions. the answer is, yes, we are increasing membership. i can come back to the board when i do the renewal and present the last five years with the membership was and go through and say how-then as the rate increases with this direction where it went. because when i came on board we were putting 18% renewals up for the ppo program. before. we have not done that. so with that out will be glad to present that in the correct fashion >> right. you provide the context. director dodd >> two answers. one is that if you look at page 5 you can see the changes month over month could you make him we really have an opportunity to see real migration is during open enrollment. those be numbers from november and december but you actually saw subscribers increase during that year. so new retirees who are choosing city plan. largely because the rate was competitive with the other ones. then you will hear later from marina coleridge who

prepared a demographic data in on page 22 of the demographic data there is data going back to 2013 and if you look at city plan, and i'm looking specifically just for employee numbers, it was 1145 in 2013. drop-down two 952 and 14, down to 816 and 15. backup two 1040 in 2016 and up to 1530 in 27 and so it really does tell the story of what you are your work in terms of taking the claims stabilization money subsidizing the premium.. so perfect time to ask that question >> all right. >> i guess my last question we do have-we will have some stabilization funds to work with next year but the total

dollars available are not they were a year ago or two years ago to work with good so we don't really have the same volume stabilization funds. is it also possible to use contingency dollars if necessary to stabilize rates? or sadly not available to us? beas >> i've accept the end of this that i get the first three months of data to rate the case for 18. so get the numbers until mate. >> yes. >> so at that point, the question is, can you decide to use contingency dollars if stabilization is not enough to keep these rates a certain range such that we believe we will continue this process. can i say that is a question we would have to pose to the board and you guys would have to vote whether not to do i as your actually will not say one way or the other be thank you. director dodd >> just one other learning in 2014 a contract size was 1.24. in 26 in our contact size was

1.55. overly that will result in better analysis of those first three months of this year. because we have more families clearly amongst the actives. so keep your fingers crossed. >> commissioner breslin >> so the active claims experience is 120% incurred a loss ratio four 2016. the early retirees is 166%. i mean, that doesn't look good to me. the medicare retirees was 99%. >> i think would be helpful if you clarify what it claims loss ratio with these percentages represent. >> anything under 100 is good? >> the technical answer to that is, you divide the top line

>> i'm not talking about how you got to. what do the numbers of the resulting numbers mean? >> what is the result was 128 >> yes. >> okay. that says you spent 20% more dollars than you took in. but that is 28 more dollars were 24% of a subsidized premium. we expected a loss ratio to be over 100. that's where we subsidized it. >> so it would have been larger without the subsidy. is that correct? >> i think conversely without the subsidy the premiers would've been larger than we would not have gained a membership and we still might've had-this is conjecture

>> i understand that last >> i have to qualify its conjecture. so the premium would have been hired which would've been analogous to the 15 premium. the claims could bring even greater because we would not have got the new members and so we still might've had a data loss ratio. the goal is to get the claims per member to go down the membership to go up after three months of this year given as was stated in the conclusion we are getting more members could got even more people that may be an experience is such that we don't necessarily need very large stabilization to keep this going. that was our goal for masters action >> is it accurate to compare the loss ratio between each of these programs as outlined or should we be looking at the discreetly? >> look at them discreetly. two are highly subsidized or do you lower the premiums are loss ratio for the medicare historically ran between 70-90%. we did use their stabilization without the additional subsidy and a stolen up to 100%. so that being the case you look at the medicare is medicare and the fact that there subsidized is different

than the normal state where you want to actually equal 100%. >> all right. i'm asking these questions for educational clarification be solely fine with me >> thank you good are there other questions from the board? is there any public comments on this discussion item? hearing none, and seeing none, no public comments, on this discussion item we will now move to action item 6 >> item 6 action item review and approve city plans rate stabilization reserve a on hewitt >> thank you and actuary. you have before you the standard calculation of the stabilization reconciliation and what we need to add or subtract from the existing funds for city plan. so we took it upon ourselves as a matter practiced in the last acts of director dodd to write out indeed jokes that we have these cut rations are done as a matter of time and consideration to the board and

members of the audience will not be due to all this >> thank you. >> so i would like for us- >> director dodd >> our cfo deserves credit for writing all this out >> yes. but is ignored from the distinguished actuary to the distinguished cfo-i like that part-thank you very much for what you did. okay. she's trying to give you-okay. so let's turn to page 5. when we set the rates for 16 as we have discussed, we plan to lose or spend on page 5-i want us to go to the number that says, revenue shortfall surplus. we said at the board that we want to spend $13,000,991 and that's it. 13 million 919 [inaudible] how did we do we did we spend more than that and it was-or

did we spend less? well, we ended up basically burning less money. if i can use that phrase. width don't >> okay. we ended up retracted that. we ended up-the actual experience spent less money than we projected that we would spend in order to maintain these rates and the actual resulting in that 13,000,600.. with that, we have a contingency reserve for the self-funded medicare program.. we illuminated that reserve. by policy, that reserve, the contingency reserve, has to be brought back into the stabilization reserve. so the impact of that is that you got 44-$444,000 more dollars into the stabilization bucket. i'm

going to use the word bucket. that being said, at the end of the day, given we came in as slightly better than we projected we added $444,000 of contingency money, this is-this is the way this board practices completely technically correct, by requirement, and this has been reviewed by pamela and her staff. this is their cash numbers of this money in their trust their accounting system, we are saying that 736,000 dollars needs to be added back to the contingency reserve. i mean stabilization reserve could my that. correction, stabilization. with all that being said, there's quite a bit of notes here. let's turn over to page 8. the exercise, where are we at we stand here today? we have $3,793,000 in the

reserve. we are adding back 736,000. that gives us $4,529,000. a third of that goes into the rates for 18. that is 1 million 510 thousand dollars. that's what were going to apply to the rates for actives and early retirees. that's going to turn out to be fairly nice subsidy for them because they are not that many of them compared to the retirees. so we had to allocate it by premium. this is-that's actually going to turn out to mr. sass is, and this turned out to be a nice amount of money to apply because it's for that population. so i don't to

belabor this because we talked quite a bit about the expense if that's okay with the board and i just want to recommend you accept these numbers as presented in except that we will-i recommend we do apply this amount to the 2018 rates and in may of this year i will present the rate this will be used to adjust the rates downward >> before the actuary's recommendation. are there any questions by members of the board? i'm ready to entertain a motion. >> so moved >> it's been properly moved that we set the actuary's recommendation on the rate stabilization as presented is there a second >> second. >> there is a second and probably moved and seconded any comments or observations from the board? is there any public comment? hearing none, and seeing none, no public comment were now ready to go. all those in favor say, aye. [chorus of ayes.] opposed, say nay. passes unanimously >>[gavel]'s >> we are now ready to move to action speeches discussion item seven >> item seven discussion item

presentation on co-pay benchmarking. a on hewitt. >> i'm one anderson senior consultant >> would you repeat your name? >> one anderson. >> thank you. >> is the microphone working okay? >> yes. >> great. i promise not to go through the 20 18th pages one by line. but we do several studies on behalf of hss and this is the first one of the benchmarking of the co-pays. we will do another different set of benchmarking. this one

focuses on specific plan design components. for example, things like deductible, co-pays,: insurance out-of-pocket limits. it doesn't necessarily look at the total value of the plan design we conceal you benchmark because each of the component parts >> these co-pays are against the health plans for medical dental and vision plans come correct? >> exact it within two different databases into comparative groups for your population it to look at the government and public entities and the whole national plans. if you turn to page 2, will start off with the ppo programs and you will see the number of compared of groups within each of the categories that i just mentioned your government and national. you can see there's a certain number of employers in that database and a number of plans. you will notice the number of plants are greater than the number of employers which basically means most employers offer multiple plan options which is the case for a change hss as well. if you turn to page 3, this of united

healthcare ppo plan can the city plan benefits. we are looking at just the in network portion of your ppo program and you can see starting from the left of the components where hss is today which is your current plan design. the benchmarks for a on and benefits select and that represents 2016 data. so it's off by a year. >> it benefits select is what? >> it's just a different database we have within our database >> all right. thank you >> we pulled it from multiple sources. if you look at that adoptable for the individual and family you can see the hss plan is more generous meaning lower adoptable amounts than the benchmarks across the board. the next component you can see

the out-of-pocket limits are slightly higher than what you see from a benchmark perspective. you will see the coinsurance is different. again this doesn't tell you the value of the plan design get it just compares individual components. you will see the co-pays for primary care, specialist and in hospital the hss land is all coinsurance based whereas the information in our database really has copayments. so you'll see some differences there just to give you a sense of how that equally to the: insurance for the pcp if you considered average service of $150, 15% co-pay would be like a $23 out of your pocket cost. so it's relatively comparable >> there's a footnote here that's is one on this, can you expand with that is about? >> one is on page 5 which represents united healthcare benefits that are paid after the member has the deductible >> all right. in the interest of moving forward, let's go to the hmo on page 6. >> sure. page 6 >> the layout is similar

>> very similar >> in terms of employer-so >> we will look at blue shield and kaiser >> thank you. so >> so again use can see from the doctor pulls not a pocket limit for hss. the plan is much more generous than the comparative groups. and you look at the co-pays again from most of the co-pays the plans are either comparable or more generous. >> all right. and to kaiser? spews it is worth mention on page 8, the co-pay for hss pharmacy programs are a lot more generous than the comparative. >> all right. >> you move to page 10 which of the kaiser permanente. again, each of the components i would say majority of the component pieces hss kaiser

permanente plans are much more generous than your benchmarks. >> all right. >> that we are significant population of enrollment. >> right. let's move to prescription drugs if you would. >> instead of kaiser permanente? >> yes. >> if you look on page 11 again you'll see two things. one that the plan is a lot more generous for hss and kaiser permanente has what we call to tears versus a three-tier plan with all the benchmarks. all the benchmark plans tend to have a three level of benefit coverage. so that would be generic, formative and non-formulary. >> okay. can you then move-a moving past governmental national comparisons. down to the dental >> right. dental plan same set up. if you look on page 17 you will see agents as benefits and you'll notice that the delta dental plan has three tiers could basely concentric [inaudible] got up broader

premier network have access to an out of network could the benchmarks are for the a on bench it doesn't differentiate network at a network. and then for the spec select it in network only. so if you're kind of comparing the a on bunch government column you might want to compare that to more like a tear to within the hss plan and you can see the hss plan is much more generous than a few compared to the tier 1h ss is much more generous than the benchmarks. >> all right. let's moved to delta. >> i'm sorry? haight >> yes. delta dental page 20 >> i didn't you'll see the same story. the more generous than the benchmarks >> all right. then you hc. that is on page 23 and 24.

>> same story there. hhs more generous >> all right. now on page 26. >> 27 is a plan design and here i would say it's comparable. guthrie co-pays that were benchmarking to get very similar to our database from a co-pays perspective. >> all right. so your summary conclusion is- >> hhs benefit design is a lot more generous than the benchmarks >> thank you. all right thank you very much for bringing us information. you come back as our actuary and remind us of this in several different ways during the course of the rates and benefit process so thank you for this being the first of the illustrations for the cycle. we are now ready to go to discussion item number eight.

>> item 8 discussion and presentation on united healthcare's audit. >> want anderson standing in for page who cannot make the flight out today from >> i am shocked. does it have something to do with the weather? >> exactly. same thing here, to go through the 36 pages. >> thank you >> this is the healthcare united plan medical audit why don't we obviously wanted the program to make sure the quality of the plane administration of service provided to membership >> may i ask is this our first audit with united healthcare with this configuration or? >> no. this is been something ongoing >> okay ongoing thank you >> why don't we turn to page 4 which is really the summary of the audit findings. first of all i did want to mention that this is a random stratified sample of 220 which means it statistically valid at the 95th

confidence level. so it's a valid audits. >> all right. can you pause? how many claims with united healthcare be handling? do happen to know that? >> i don't know that off the top of my head. you mean for the hs membership? >> yes. four- >> it might be in the back here. this is what happens when you stand in for someone else >> i understand >> page would have that information. >> no people that would say i'm sure it was several thousands of claims. >> thousands and thousands. yes >> so how could 220 be a representative sample? explained that >> maybe i'll have a ashtray expand the statistics >> thank you to take a moment and do that, please? he wasn't prepared to speak him i understand. you guys need-you need to come to prayer did

every meeting you never know when you're going to be called on. >> tom rex actuary with a on hewitt. i might be the last time i say here. in principle you could say the same thing about anything. or any type of survey. ideally you want to look at all the data points but there's resource constrained time constraints. so the theory would be given the size of the data set there's going to be a minimum number of observation that you need for to be statistically valid to represent the entire body. so that looks like the methodology they are applying here and it stratified about which means that the different categories is going to be a certain number of observations they want to look at it so they won't look at economic an assumption it-not reviewed it in detail-but they would not look at two and 20 primary care claims only. they look at different categories to make sure that each category of each type of claim is going to be representing actually. >> all right., thank you.

>> so to answer your question is on page 19 and the six-month period from january 1 through june 30, 2016 97,104 claims were processed with the volume -this is a medically and stop 8 g of $189 million with almost $13 million and paid amount. >> all right. thank you >> this is also identified on >> page 18. so then that will serve as background to what you are going to give us a very high level. >> exactly >> director dodd >> you will recall the last year same question came up is this a representative example in the united healthcare actuary said that it was 220 with the standard that's used for examining claims.

>> that's why i'm doing this because as we go through each of these cycles it seems like we are all supposed to remember what we did the last time and that's not true. so it's a matter of trying to educate more broadly be on this womb about how and why we get to the decisions that we are getting to. >> thanks a lot. >> >> thank you >> so the 220 claims represent just under $1 million in total benefits paid in the sample and you'll see there were some errors from a financial perspective that represented about $8400. of the 220 claims, five will recall and simple-oxley met as well-the two out of sample-were identified as errors. if you look at with the out of sample means is that errors are discovered during the course of audit with her outside of the sample so in terms of the actual calculation for the accuracy@incorporated in there. so five were in sample, three of them were benefits errors and two of them were allowable

cost errors. then, of the two out of sample errors, most and were denied charges for eligible charges. on page 5, you will see the five key metrics that we evaluated which includes financial accuracy, overall, payment accuracy, turnaround times with the metric of 14 days and 30 days. we have also categorized the actual results for 2016 at three different benchmarks to review against good so satisfactory for my yukon a baseline benchmark that we would expect claim administrators to perform at and then above that is good and excellent is best in class. so you will see for the financial actors cd was towards excellence and best in class good same thing with the overall accuracy. the payment accuracy was also on the excellent category, as well as

the turnaround time within the 14 calendar days. we did see a little bit of slipping from a turnaround perspective from the 30 day jet so they were basically six claims. one was processed between 22 days and 30 days and were five claims that were processed after 31 days. >> all right. the next series of pages of this presentation puts you wait see into a basket of other comparatives where they might with a paragraph so there. so let's move ahead through that and come down to your summary findings if you would? >> sure. >> which are to be found on page 12. >> so are recommended next steps obviously is to share the audit report with united healthcare and wait for a response in terms of the

findings and their observations. we would expect them to address the conditions for some of the performance areas and it could include things like training their processors or it was a systematic issue to identify how they actually fixed the systematic issue and we would ask for that report back. >> ohthat report is not been requested yet? bti seat >> thank you other any other general questions from the commissioners? yes? >> so this is usually a position confidence sort of a waiting on these. so it's 95% plus or minus how many percent? >> so this is a the 95th percentile and a believe this actual audit was within 3.68% of margin. >> so theoretically the one

that failed could've been good or better than the one the were satisfactory could not be good. i mean there's enough of a potentially >> yes you're plus or minus >> you're very close to these markers on each of these ratings can so it's not like we have a really low rating in some area. it's within the conference and precision level it that should be high enough to rate a satisfactory in some other ones that are red or vice versa. >> yes. but i would say that on an overall basis the results were very positive. >> they seem very positive >> yes. >> are there other questions or comments? >> ivan observation unit two fails and three excellence. like on page 5. how does that compare to the chart like that from last year? do they have the same type of problems and have they improved from last year? >> that's a good question >> [inaudible] >> i don't have the results from last year so i can compare

>> if you can't compare year-to-year you can >> could you plan on bringing that back >> yes, i think i will >> i think it's an excellent question >> any other questions from commissioners? any public comments? thank you very much. we are now ready-the mind can comprehend only with the and can endure. we are going to take me 10 min.-a 10 min. recess at this time. >>[gavel] >> >>[recess] >>

>> >>

>> thanked everyone for being co-operative. we are now ready to move into the coming-finance committee that there are some matters that need to be brought before us for today which were accomplished in an earlier financial special financial committee meeting and there were a couple of board members who attended that meeting as nonmembers but heard very complete presentation. i will now turn this over to commissioner sass who serves as our financial committee chair. >> i probably >> you will need the gavel. >> already, then. >> he is in charge >> i won't do anything with it

but i'll keep it in case things get out of control. >> thank you >>[laughing] >> so the finance committee met at 10 am this morning. there were three members of our committee ferrigno [inaudible] all three bus in addition to two additional commissioners with us so five of the six commissioners here at the meeting today, all are the same presentation of full our discussion of the mayors budget summation the department is going to be making to the mayor for the department's administrative budget. the basic instructions that the mayor has given is that all the departments are being asked to make a 3% reduction in their allocation of general fund so that to make cuts equal to 3% of the general fund for this coming year and for that year after. so 417-18 and 18-19 would be due to budget years. and those cuts general fund

cuts, would require a 97,001 or $42 reduction for next year 17-18 and another 97,000 442 thousand dollar cut 418-19. the basically-just as a very high level overview, the cuts for next-the first budget year of 17-18 we know enough about the departments operations this year and where there's opportunity to make cuts that are-well minimum impact on our department. the cuts were made to some cuts were made to contracts and nonpersonal services travel and things of that nature. those cuts were relatively for the first year. for the second year in order to

get the $97,000 reduction there are fewer opportunities to make an additional 97-$87,000 reduction so in that particular case the cuts were made to the -in the wellness area, to the - excuse me - just a second here -to again in the nonpersonal services come up but for the -i've just lost track of myself. to a portion of the wellness project for well-being. well-being services. these services consist of like a lot of coaching and classes and things where we get support from some of our vendors to provide training and coaching and other kinds of services to people in other departments, in our department as well as other city departments, as was the school district and the courts and so on. after i think a

fairly-the presentation was mike pamela levin and she certainly had to answer questions people may have, but at the end of that presentation we recommended that the full board approve the budget for 17-18 and 18-19. ministry of services, and in addition we had presentation on the healthcare sustainability fund. this is a three dollar per member per month funds >> point of order. we should just confine ourselves to the item that is identified in that was 09 which is the general administrative budget. the next item is that so we need to- >> would you be administered of budget for 1719-18 and 19 we recommend approval of the budget was approved unanimously by the finance committee and appeared to be that are two

guest members also appeared to be in favor of the approval of that item. so i think this would probably be appropriate to just to make a motion that the board approve the health system 17-18 and 18-19 general administration budget as presented by our cfo pamela levin. so i guess at this point we should probably have a motion >> i move to approve the 17-18 and 1819 general administration budget. >> is there a second? >> second. >> is been probably moved and seconded to approve the general administration budget. any comments by any the commissioners? i like a u levin to please, come to the podium at this time with her

calling. would you introduce yourself please? >> pam 11 chief financial officer. i want to present you elaine g is a principal administrative analyst and she helps me with the numbers for the budget and i would like to thank her participation and we also had other members of the team, our contract folks who are very good at taking our way of looking at things and making it into something that is more understandable. >> all right. he was there also contributed >> i want to commend you on your leadership and also think your colleague for her assistance in would you please, convey to holding on behalf of the board and specifically the finance committee, our appreciation for their hard work in bringing forward this document. it's always a labor of labor not a labor of love sometimes. a little frustrated you we all understand that but

it clearly shows a very fine results. it was very clear and well presented in the meeting. i thank you for that. >> thank you. >> any other board comments? were observations? one item that i will want to speak to just very briefly, we want to recognize that this budget also is going to respond to you transition needs of four executive leadership with director dodd stepping down good so there are going to be some statements incorporated into the budget document that is presented today to acknowledge that we will be in a period transition searching for someone and that the budget has the means to support that effort and we will do that during the course of this year. so why there any public comment on the budget? hearing none,

and seeing none, no public comment comments i think we are ready to vote. all those in favor say, aye. [chorus of ayes.] opposed, say nay. so ordered. >>[gavel] >> would will now move to action item number 10 >> item 10 action item approval health services system is clear 2017-18 and fiscal year 2018-19 budget for the healthcare sustainability fund committee chair sass >> okay this is the second item. on her agenda. the healthcare sustainable fund is a three dollar per member per month funds as i start to explain earlier that is affects premiums for all members active, retired, city, school district, core system. the proceeds of that money are available to the-to the

departments for paying for certain expenses that are such as communications expenses in particular, but a variety of expenses that are really a function of communicating and providing data to all the individuals that receive benefits, the booklets although until you get during open enrollment, things of that nature. then there are a variety of other expenses also eligible for to be funded from that. we again also heard a presentation from pamela levin, our cfo, on the planned expenditures from that fund. it really falls into two categories. its annual expenses that will be paid each year associate with help and open enrollment and other medications activities one-time expenses that we will fund things like it expenses and other things that phone

systems, things of that nature that are used for-help us with communications that one-time expenses that will be paid form funds that have accumulated there so that we utilize all those funds over the years. we reviewed a detailed chart of all the expenses that are proposed to be paid the timetable for those payments, and the amount that would remain in that fund of each year for future similar projects, and at the conclusion of the presentation the again, the three members of the finance committee and the two guests present with us all-the finance committee recommended approval of this budget and the two members with us were in agreement that it-without motion. so i think at this point but it would probably be appropriate to enter their motion for the approval of that budget. >> is there a can i have a motion? he was i moved the

2017-2018 budget for the healthcare assistant sustainability fund >> is there a second? >> second. >> is been properly moved and seconded that we approve the budget as presented discussed and edited by the finance committee and a special meeting this morning. are there any comments or observations from the board? is there any public comment? hearing none, and seeing none, no public comments we are now ready to vote. all those in favor say, aye. [chorus of ayes.] opposed, say nay. so ordered. >>[gavel] >> just for point of orientation, we are no longer dealing with finance committee matters. we are now ready to deal with the regular board meeting matters. after an hour and 40 min. finally we get to the board meeting. what else

have you been doing today? the first item is a discussion item. >> item 11 discussion on presidents report president scott >> the commissioners have before them a memorandum from me to each other them regarding the hss director search and i would like to at least read a portion of the memo and then talk about some broad next steps. as we begin our search for a new executive director, i believe it is not an overstatement to say that hss is at a crossroad. this crossroad may not be one of our choosing but here we are nonetheless. it is an awesome responsibility that we now exercise on behalf of our members. while we are in a new and may be unfamiliar territory we are not without direction. we are not desperate. we have excellent staff support among

not only provided by our board secretary, but her deputy city attorney, eric rapoport, as well as should not up-who will be working with us from the director of the dhr department of human resources of the city. we have also some well-known processes that will help to guide us to our final result which is namely selecting and recommending to this board the best executive director candidate that we can find. to accomplish this goal the most important asset we have is in our experience as commissioners and are informed judgment which will bring to bear in screening, selecting and recommending the next executive director for hss. it is my intention to call on you collectively and individually during the course of this process. i thank you in advance

for your willingness to assist and work on this task and i'm glad you are in this process with me. i then make a series of requests specifically directed to the board members. to speed us on our work, attached in the packet or memoranda are two items. commissioner breslin wasn't able to unearth an original version and copy of a job description which we asked about at the last meeting of the executive director. director dodd has advised me she also has a version of this document and we will get that out. but beyond that, there's also a draft for a request for proposal that was put together by dhr and it will invite this request of responses from six preapproved and under contract search firms with the city and county of san francisco. that

list was shared with us at the last meeting but i've also taken the liberty of including it in my memo to the board. the notion is this. i'm asking that he board members reviewed the draft rfp and review the job description and get any and all comments edits, suggestions, into scott our board secretary, by the close of business on friday, february 17. then we will spend some time putting together a document based upon the inputs of the board members and then we will circulate that during the latter part of this month, and be ready to take this item up as an action item to approve our rfp proposal as well as the broad job description at our next board meeting. so that we are very

clear, we are going to have an interim executive director. the action on that will be done at our next meeting in march and we will be making a recommendation. we will also, with namely that individual, try to make a recommendation on reasonable remuneration i.e. compensation, i.e. pay increase that will reflect what we are asking that individual to do. both in their current assignment as well as the overall matters of this board. so that will be in action item at our next board meeting. we will be asking the search firm to reach out to the various key constituencies of the hss its system. this will be a transparent process. there's no kabuki dance that's going to be done. so there'll be ample time for people to provide their input about criteria, where

they think the system is, what 20 be needed going forward but at the same time we are not going to boil the ocean. we are not going to spend and less consultation. i would active with you see the university of california system just what does uc stand for good everywhere was a unending consultation. well, that's not what we are going to do it within a dual enough outreach to be sure we have indeed talk to the key key constituencies, active as well as retirees but at the same time try to get to an endpoint so that we can get a job posted and the criteria for interview frames with the search firm and then get about the business of selecting a new leader. as you well know, catherine tenure with active tenure with his board ends on 15 march. so the interim executive director will be named effective 16 march. we don't want to lose any time over that matter. with all of

that being said, i would expect and hope that within a reasonable period of time that we would've qualified candidates in front of us for interview and ultimately selection. i'm sure there will be ample time for additional comments on this as we go forward in the process. secondly, all basket board members have questions about my memo in about what we are planning to do and how we are planning to approach this? okay. i do highlight in a memo that eric and chandra >> the question. is there anything that says with the present salary ranges for this position? >> not in this document the salary range for the position has been recommended by dhr ends in the range that the incumbent salary ranges.

>> okay. is a much more? >> the actual pay was lower not the salary range. in the original document >> 146,000 is the maximum >> no. it's a different range now. i say in a note to the board that eric and chandra will be our two guides in terms of what the protocols and where we need to stay clear of violating any ethics rules and all the rest of that and they will be alternate guide in that regard. so we will not do anything that's going to get us in trouble. i can absolutely assure you of that. following their counsel. i would solicit from board members, if you've got a question about process or procedure, that you engage me and/or rainy to get the question or directly to eric so we all can be informed if there's an issue that comes up.

i tried to make clear that i made coordinating point for the search and i don't mean to be a roadblock but a coordinating point for this to get done. i think working together and being focused on what we need to do we should be able to come out of this process with an accent successor to our current executive director. at least that is the objective. so that is the end of my report on the director search. have i missed anything? do you have any questions great >> so will be a committee? >> based on some guidance from our counsel i have spoken to some board members about being a subset committee. it turns out that if we convene ourselves as a subset we are under the same brown act requirements and everything else as if we were a full board. so we can't do that.

>> so we only use three, right? >> if you meet as three uri committee it's all the public notice and everything else. so if i call on individual board members were to board members to undertake a task that's what my solution is to individually and collectively, to do a certain task that is okay but when three or more gathered in the name of this activity we have a problem. public notice and all the rest of it. so eric did some double checking on that with the ethics folks and we know that there can be some review tasks or interview tasks that might be taken by individual members and we will do that as the go along. so that's how we have to handle it >> so will not be a committee? >> not a committee percent yes commissioner? >> the determination is made by wallboard >> absolutely. the whole board, nobody else's chart with the final adoption and interviewing and selection of the next executive director. while many may be called and we may listen to a lot, the one

that is chosen will be done by us. okay? there should not be any confusion over that. all rights. i look to counsel. is there anything more i need to add to this? >> no. i think you got a pretty good. >> pretty good, thank you >> but a good description based on colleagues experiences providing advice to similar boards there is a sense that setting up a separate committee is just creates more work. then you need to is understand the next ups are-that you're requesting the board numbers reviewed the draft rfp and job description and forward any edits two-i friday february 17. she will collect that information, call eight it and bring it back to the board at

the next board meeting so the full board to make a decision in open session. at the board meeting going forward if there's specific tasks this board can assign those tasks to one or two board members without violating the brown act and if for some reason the board decides that it's worth having a subcommittee need for a specific issue the board could do that but that would have to be unnoticed meeting and comply with the brown act. so given the administrative issues with complying with the brown act our recommendation was it's just easier to if you can, do something and then come back to the next regular scheduled board meeting especially given everyone else's schedules. >> all right. we will get there within the rules provided. >> so selecting the vendor for this or headhunter, are we just

going to get and written information from? >> that's what the rfp will do. that's why masking to look at the rfp. is there a specific services, tasks, that you think we need to highlight. but those in the notes that you give back. so that we when we send it out, the final document, all six vendors are going to be asked to respond and provide a price point for doing what were asking them to do. some will come and i had some will come in low. typically when looking for a executive at this level of these to my expense, it's not been unusual to have a fee structure that is anywhere from 25-35% of base pay be the cost of what the services are. i'm not suggesting to any these vendors that's what they need to come back and tell us but rather that's been my experience having been in hr for about four years. >> so we will have the meeting to do this as part of our general board meeting a

separate item? >> yes. >> where we will decide- >> we may want to come make a presentation and this is where we may get into having a couple of board members actually talk to, maybe a couple of these firms to be sure that they understand were asking them to do and then we make it down to maybe two of them in the two finalists come in and say here's who we are and this is how we handle this and so on. so again it will be some might be some prescreening steps that might involve one or two of you and then begin town to kind of making the final decision it's going to be in a public forum. okay? >> i know [inaudible] had an interest in being involved somehow. of course they were the ones that initiated the ballot measure provided this opportunity for us to point the director to make this an individual department. so they

have a special interest >> the special interest, the tyree's, protector of benefits, there's the executive-there's a number of labor union groups. everybody's got an interest in leo going to be assured that the search firm spends time talking to those constituencies. so protector bennetts will certainly be on the list. in terms of the actual picking and choosing of candidates in the final selection that's going to rest here in this board. so many will be consulted but the final choice will be ours. i hope to have this done before i sit down as president but god only knows. >>[laughing] okay. enough on that point. i do want to remind the commissioners come again-and this is my bad-i do not follow up as i said i would after the last meeting

but it will be for the next. we do need to have you identified -your educational interests for program attendance for various seminars in this budget year. they may go the on the budget year according to the calendar. some of the ones we have identified but i will send that note out to at least get those who are interested in attending to identify themselves so we can get the funds obligated during this fiscal year. with that, i will call for any public comment on my report? >> so excuse me our lease with the e-mail link? >> yes. the seminar you want-if you're saying yes i want to go to the trustee needing or whatever simply send that notice to her. she will collect them all and if her

over our budget she's going to come back and say no, alternative you can go could only two can go or whatever happens to be. all right. public comment on the president's report? >> claire-[inaudible] i may just sit in the job description because at one point you had indicated that constituent groups would be involved and i was hoping that perhaps rd ccsf would get a copy of the job description. we could then offer some other-some additional suggestions or just say it's fine as is but that we would somehow be involved as a constituent group in determining that just to set the record straight, dob was created so that rd ccsf 11 opportunity to put items on the ballot that would enhance for example to return health services to an independent agency and things like that. so

while pob has an interested to the rdc's f membership that's the basis of sustainability for retirees as we would like an opportunity to participate and look forward to that very much in the future. i don't think we need to look at the rfp necessarily the job description is what we are most interested in. think of them at >> thank you for your comments. other public comment? >> dennis cooper active retired firefighters widows and their dependents. my question is more about the interim director because if you plan to have a real director before you read here the interim director might be here a while. so my question is, does the interim director gets elected by the board only? this human resources come into it? last but not least i hope consideration would be from within the health services system rather than someone from inside the city is outside the

system. >> i'll be happy to respond to those questions will take him and somewhat in short order. the individually have in mind is absolutely within the current management structure of the hs ss system. rather than trying to preview that i've not had an opportunity to directly talk to this individual don't want to get involved in that point today. we have been in consultation with the department of human resources. not only talked about naming an individual but also what common station consideration requirements would be required as well. so i think that the person we are focused on is more than able, is very familiar with the operations of hss and will be able to provide the type of leadership that 20

required during this transition period. okay. any other public comment? if not we will go to the directors report. >> so you make a selection? >> no. not meet the board is going to >> the boys got brother names >> no. i said the board will make a decision as an economic next month. that's what can happen. it will be revealed at that time. the interim one more time-the interim executive director decision will be made by this board at its next meeting. okay? director-i'm sorry we are now ready to go to the directors report. discussion item 12 >> item 12 discussion i'm directors reported director dodd. >> thank you. you have my report before you could i want to point out that once again,

we have only one position open and we are hoping to that position-the new benefits technician will start in mid-february and we will have one 12-10 position this only happens a couple times a year that we have filled our positions. it was a kind of a surprise to us that the benefits analyst position which is a place where we have employees with significant tenure who are dedicated to our members, the new people we have hired our are not interested in the work as long. with that several new people hired to learn the job and then decided to leave. so there's a lot more mobility in the millennial generation then in our previous generation. soap

point data. operations when you look at the report, there was a 31% call increase over the same time last year. while we expect a high call volume in the first month of the year this was exceptional and was because of issues with blue shields 2017 -- could we are grateful blue shield was willing to keep retirees until age 65 and to the split families but unfortunately the computer programs have not worked very well could so there has been a lot of unhappy members in terms of that transition. we will also point out however, you eight seed had staff on-site so that questions can up the benefits analyst they could just do a warm transfer to eight

u hc staff person. we could look at things in terms of history for the first two weeks of january and i worked extremely well in a couple of complex member issues that you hc handled and so far things have all been satisfactory. our-the first payroll deductions for voluntary benefits were taken. it was, again, all these new things happening in january and may generate a tough year but we were successful in voluntary benefits have begun. in terms of data analytics overlapping with operations, we've now had over 800 acre boxes with our files of our members taken off-site in a hippa protected manner tested. they are being

digitized. so something i've been talking about for four years is actually happening even as we speak and it's going to enhance member services because you will be eight-you won't have to get up and go look for the file and look for the piece of paper in the file. it will be on the members digital file. i'm just kind of-i want to highlight a couple things. i think the other piece is the demographics report, which marina, will be presenting a little bit later. then lastly just recognizing the data analytics staff who have undergone that as was described herculean efforts to work through the different data

processes that had to occur for the outbound eligibility for the split families and others. you have heard from finance and contracting has moved forward. in terms of wellness, i really urge you to click on the link and look at the well-being reports. a lot of work goes into these reports and 2016 highlights include that we now have over 241 wellness champions throughout the city and other employers and whiskey about that is you don't just get appointed to be a champion could this a fair amount of care and feeding of the champions in terms of keeping him train. they come in and get retrained, give them tools, giving him different potential things they can do with the members that they interface with. so maintaining a group of

241 motivated wellness champions is no small feat. we did our first ever as you know, nutrition challenge. that was participated by 6% of the employees and people are still talking about it. we did the first ever physical activity challenge and there were 22% of our employees participated. the flu program gave more shots than we've ever given before the healthy holiday program addressed stress, relaxation and weight management for the first time. there were six and 29 participants in the maintained no gain project and interim 24 participants in the 12 days of relaxation as opposed to 12 days of christmas.

over 175 activities and seminars were held which was a 52% increase over the prior year. lastly, this speaks to the previous conversation at this board meeting is the diabetes prevention program modeled after the american diabetes association which is a joint research project with kaiser is continuing through 2017. they recruited 156 participants in a peer-reviewed project or peer approved project with human subjects approval they will be looking at what works better. people meeting together are people using an online guidance program. i personally know someone who has achieved her goal weight, reduced all harbor numbers is no longer prediabetic and i think it speaks to well for continued activities. this year we are launching a healthy start campaign. again a physical

activity challenge which the commissioners are welcome to participate in. as a summer nutrition challenge in the fall flu prevention. we will also be doing relaxation volunteering maintain no gain and a pilot programs for healthy weight series and that diabetes prevention program in the summer of 2017. so wellness is really doing well. well-being is really doing well. i have to get that correct, well-being. in terms of my reports, the periodic utilization review meetings with kaiser which chairman scott participated in, and with blue shield were actually going to try and bring to the next meeting and comparison of pharmacy costs between blue shield kaiser and

united healthcare in terms of how they've grown over the last five years and in what areas. this will be an area that you will need to continue to watch over the next-at least four years of not beyond. mayor lee held a community meeting with key participants about what the implications of the affordable care act repeal would be. clearly, it will mean a cost shift to employers and since we are the largest employer in san francisco it will mean a cost shift to us. we are working with the san francisco health network. blue shield and united healthcare to include zuckerberg san francisco general hospital in our network so employees could go there. as you know it's a world renowned

hospital and it's been going on for some time and trying to push it before i leave but it will continue to be something that we will need nurturance. i want to just publicly say that the held positions accountable care organization has produced remarkable results and in every single area. there was one graphic that just showed the line going down. they are a stellar book accountable care organizations which all other accountable care organizations, including the other accountable care organizations that we have with the city. i will-we are putting into place follow planning on the engagement survey that we did and as pamela alluded to we're beginning the budget process and have begun meeting with the mayor's budget staff. other items of note. you may recall that there was some question about whether we had overpaid with him when when was

our life and disability company and as it turned out we had overpaid them. it was very difficult to itemize it. this different records were kept in different places but with the help of our city attorney, we agreed to a settlement and $575,000 was paid to us. it will go through the controllers office and will be distributed to the different departments that maybe overpayments. it's not like it comes back to us, but it was our diligent efforts to make sure that we got it back. for those departments. in terms of a federal update, which i gave you a federal update in january. i will just say that the news today is that secretary price will be confirmed. he, as you know, has

vowed to scale back much of the federal government's role in health care because he believes in a free market built on privatization. he wants to reduce spending on medicare and medicaid and he's opposed to price negotiations terms of pharmacy benefits. i anticipate that that vote will occur either today or tomorrow. that's right they don't work on fridays. monday tuesday. they don't work on mondays at either. in terms of pharma as you probably saw in the paper pres. trump promised to address for missy costs and he had and then he met with, and said maybe we won't to all the things we talked about during the campaign but he has said and in the cures act that was passed at the end of december, the regulations are being pulled back from the fta and

dr.-he and i had a conversation, the whole idea trying new drug and determining whether it's good or not by the reports of adverse reactions i get sent in is the kind of monitoring that is being proposed. i anticipate from a cost will continue to make up the single fastest growing part of our costs. in terms of repeal and replace, they are not talk about the pugh and repair although today the white house press secretary said that the repeal would begin with the reconciliation act of 2017 and the 2018 tax reform legislation would finish it off if you will. the other thing that significant thing that happened in terms of san francisco, a

place where we were and continue to be a leader is gender treatment and a court ruled that that particular regulation those part of the affordable care act does not need to be implemented. so employers can choose whether or not to provide gender-benefits. i will say united healthcare put out immediately that they would continue to provide their benefits if employers are choosing them. home on that topic, we will have-we are currently comparing the gender benefits between blue shield kaiser and united healthcare and we will bring the comparison to next months meeting much the way we did the infertility benefits. in terms of mergers and acquisitions, today the great merger that's

been in the works between cigna and anthem fizzled. the court will do against it but what we are going to continue to see our mergers and acquisitions based on capabilities. so we are not going to see big companies that do the same thing birch and acquire each other but we're going to see companies acquire other smaller companies and one of the examples that's been given is uht purchased surgical care affiliates. so it's not you wait see is an insurer and they purchased a smaller company that had a specific capability, or, like care provider collaboration like sutter health plus. you have a list of things that we can-that

are predicted. the value based reimbursement i think is really important and i'm pleased that it was part of the united healthcare proposal certainly part of the way, blue shield and kaiser do business. there was bipartisan support on that in the congress last year when it was passed through macro. i had a presentation yesterday by the united states department of health and human services cms regional administrator for region nine who went through the medicare.gov star system and talked about what different providers health plans hospitals medical groups and physicians had to do to get those stars and it really-it's the voice of the consumer. the consumer has a voice in whether or not quality care is provided. so awfully that will get repealed. i think those are kind of the major issues that i

had highlighted. are there any questions? >> questions of director dodd and her report squeak any public comment we? i think you for particularly the federal highlights. it seems to be a changing landscape by the hour and we are still waiting upon the appellate court decision that might be released later today or tomorrow. we are not sure regarding some of the other actions the current administration and their impact. so, with that is there any public comment? >> claire-we are concerned about the split families issue. for those transitioning into you wait see and so having families with blue shield and we would like to know a little bit more about what's going on because we are hearing-i know

that it has been an initial problem in january but is he getting resolved and is it going to be resolved so those families will be able to utilize those plans? thank you >> yes. i believe it's been resolved. he met daily and weekly in january could generally we met daily.we narrowed down to a specific number of families and reached out to them. >> yes. if you would please identify yourself thank you >> i'm jeanette loan with blue shield of california and as a result of the medicare split contracts with the medicare subscriber would orate event would be united healthcare and a non-medicare subscriber defendant would be with blue shield there was a lot of

programming that had to be done between the city and blue shield of california for the first few days of january. it was an oversight where the non-medicare subscribers not deposited in the correct divisions therefore they were prescriptions and/or prescription eligibility that i could not be elevate validated that was manually corrected around the fifth or six of the month and then ccsf in the due diligence decided to have us do a full 100% audit of those files which was conducted for the duration of january and that was conclusively at 100%. >> all right. thank you for a much for that update. any other questions were public comment on the directors report? hearing none, we will now move to discussion item 13 b item 13 discussion i'm hhs financial reporting as of december 31,

2016. pamela levin. >> director lebanon going to ask you be as brief as you can be. and this will also apply to the next discussion item in this is to be sure we have sufficient time to deliberate in closed session on the member appeal. so take the time you feel is necessary to be clear >> pamela levin chief financial officer. right now the projected fund balance in the trust is by the end of this fiscal year 630 17 that were projecting 54.3 million. that is 7.4 million more than we reported in january that that swing is due to a couple of different items. one is that we have in underestimation of the impact of the illumination of the [inaudible] tax in 2017

which significant lowers the blue shield administrative cost of this was factored into the rates when they were established but we were pleasantly surprised to see that it significantly reduces the administrative rates >> so the actual fact that, just to be very clear, is the city as an employer has had its cost lowered as well. is that not true? >> correct. >> to the tune of what? >> $12 million >> $12 million. >> is that right speed mike >> $12 million. to the city and cost avoidance. we've reduced by 12 noon dollars. the reason why i'm repeating that is because this is to be material for the very budget that we have passed and the discussions were you will be having as we move forward. these millions of dollars, $150 million commitment memory serves, over the past five years the city and county of

san francisco does your in and year out on acknowledged and unheralded unless we bring it up. i intend to do that mightily as we go through the budget process this year. please, director lebanon >> second is there been improvements in the blue shield and self self-insured plan claim experience and we also did a wee projection of the healthcare sustainability fund based on our review of the development the budget that was on the agenda today. we have no additional pharmacy rebates received in december and the year and projections remains unchanged. no applications had been received for the surrogates adoption benefits and we are projecting the general fund that we will and on budget before it's expanded

>> all right. thank you. any questions from any members of the board regarding the financial report for this month? any public comment? hearing none, and seeing none, no public comments, den director lebanon we would like to thank you for your continued hard work for you and your team day in and day out to achieve these kinds of results. on behalf of the board i thank you. we are ready to go to item 14 >> item 14 discussion item presentation of 2017 demographics reena coleridge. spears marina court eight analytics manager health system. thank your president scott and commissions. we have a presentation. that stuff up

with the my colleagues [inaudible] and helped pull a lot of the state of the presentation to get this is the annual demographic report that is a snapshot in time of our membership at the beginning of the plan here. so this is data we extracted out of january 1. the format of the report is consistent with what you have seen in previous years in efforts we take a look at our all of our lives in the health service system in romans when we take a look at just a retiree employee numbers and we look at employees and their dependents and retirees and their dependents and we do a little deep job but each of the various employer groups. as we look at the report today and go ahead --as we look at the report today

the to significant driver of the changes that we are going to see is really as results of the illumination of the blue shield and the care plan and also the funding change with the city planner medicare plan. so we have the migration into the new city plan which also has implications in other areas but we are concerning a trend of increasing rn rolled lives. we now have one heard 17,000 people enrolled which is eight 2088 percent increase over 2016. likewise on the next page, are dental in moment is also increasing we saw 2006 and 75 more people in rolled in dental good i like to copy off that every year because i recognized it to do a lot of work but for just people enrolled in benefits but also people who leave benefits also get various outreach touch points from our department, that accounts for another 6000 people.

>> dir. dodd >> i just want the commissioners to appreciate that increase of 2088 enrolled people. when you're out and about talking to people because that's like for very large businesses. the we assumed and not increase our staffing. we are serving-when i started it 207,000 members. so we have increased by over 1000 or 2000 every single year without buffering our operations. it's a tribute to all of our staff. i just wanted to bring our john

>> we commend you could forgive the point is we also know technology has been a support tool 12, keep up with the growth. at the same time our overall administrative costs are substantially lower for plan administration that a lot of our bond vendor partners. the company side of that also. these, continue >> thank you. look at slides for this is new to the demographic report because as you know sin to approved it we did roll out of voluntary benefits to all employees of the city and county of san francisco and also the superior court so this was presented in a previous board meeting but now in our demographic report just showing you over the seven different voluntary benefits and what the enrollment in those berries benefits were all told it was more than 5000 in rolled in those benefits. looking-i know we are moving for just a couple highlights as i start around the rest of the reports but to some comments on our enrolled lots on page 5. he continued to see that

seven-year trend of kaiser increasing their enrollment portion only a 1% kaiser now has 55% were covered lives. additionally i would like to call out the city plan did gain 490 employee lives. that was the conversation point earlier with commissioner sass when we're talking about the stabilization reserves and is a deeper dive on that on page 22. also i would like to talk about a percent of overpopulation that's in san francisco. some of you may have seen a january 21 new york times article was titled, where are all the children going to look nationally and some of the big cities and for example as a percent of population new york had 21% of children under 18 years of age and i think chicago's 23% in san francisco

was really on the low end of the spectrum at 13%. when we look at our own lives rashly doing a little better than that i am pleased to say. look at both employee and retiree lives we've got 21% of those that have children living in san francisco. when we just entire when we just look at our employee lives but it's over 31%. so within our own population we are bending the trends of the larger city and county of san francisco. moving on to page seven, of course they change you are seeing here in the graphic is the migration over to new city plan as result of the planned changes that were made this a good hourly alluded to the 55% for kaiser which months to 64,000+ lives. i will have 14,672 lives in the new city plan. over 11,000 those were members in the remaining our dependence but the impact of this is that are blue shield-that graphic on the

bottom right-blue shield doesn't have that retiree plan anymore so the average age and a plan is significantly lower than what you see in previous years. i would like to-because i'm forever honest about these things-also call out a couple of mistakes. on page 8 the trendline on the top left graphic about retiree lives in medicare and will get an updated one post on the website-but the average age is not 61. we inversely included [inaudible] and we look at this from a medically enrolled perspectives of virtually 53.77 is the average age and of course you see impacts on the bottom left there in our average age across plans. that was because we had our membership moving around. then i will just skip ahead to page 11 and a leg know for those that do consume these reports

year in and year out that as we were looking at what changes we saw by each band in 2017 we were noticing quite a spike in the 25-34 age group when we research what was going on without we realize that in 2016 there was a transpose arrow in the head data in the wrong columns suite restated 2016 for you as well. you can see that. in our year-over-year were not seen significant change. that's also true in terms of the percentage of our retiree to our employee percentage were our subscribers to our dependence. we stayed pretty flat in terms of our-how we look at those things. slide 15 this is a new addition to the demographic report that we know as the go through the many many questions come up in this report is sometimes looked to to try to quickly get some answers and so we do look at where are our employee and early retirees who we tend to have under the same active

groups. where are they distributed by plan and by county certainly in previous time periods as we've had to look at various reports looking at displacement. we thought that would be helpful going forward. >> on the [inaudible] what is that sliver? >> you are on page 15 >> yes. what color is that great >> what color is [inaudible] green >> i'm sorry among the wrong-i'm on the wrong page >> a little bit of blue and orange. >> that of course because of the that hetch hetchy so we

have them enrolled in city plan and make it the edge of cheesesteak and that's what you see there could of course they tend to be number only, two. small number of those have a dependent. i think unless there's any particular questions from the board, i know you need to move on with other agenda topics. i party explained away out of the report in terms of how it sequences through the various groups of employees and retirees and told him on the employee level. i will leave it there and take any questions. >> just a general one. as you look at things over time, other any broad themes or trends that you could talk about regarding health plan coverage from the demographics of our employees? 30,000- >> well, when i think about our risk scoring and looking at her

age gender we are continuing to see these repeats some things are previous year that the average age for invoices dipping. it's very slight but it's dipping as the state continues to more hiring. another-we tend to be pretty consistent with our splits by gender. i will say though, that traditionally it's been court and usc that had a higher percentage of female enrollment in this year ccd shifted up in that a little bit. but, yes, -then of course we are seeing some of the differences with overall age but again that was impacted by taking over retirees significant portion of guitarist and lead them over to the new city plan. otherwise, we do remain consistent year in and year out. >> okay. i just make a note for our vendor partners as we

start to look at age factors and assumptions if you will around actuarial outcomes and impact on premiums and so forth. just a passing comment. thank you. any other questions from members of the board on the demographic report? this is one that i would hope that gets [inaudible] but the one that will be coming back to us as we start to look at rates and other issues. county comparisons and on and on sort like a baseline report for this year and again thank you and your colleagues for all of your hard work on this. i know it takes a lot to put it together. any comments from the commissioners? any public comment on the report? >> claire-i think this one of the most fantastic items that gets produced every year and arena does a phenomenal job. i think it's very telling about

who we are serving and where in i noticed that this year-and i am assuming it's going to be early retirees that we have plaster county in yellow included because there's more outreach and i look at that for a minute i was stunned when i saw early retirees as part of that category. i'm assuming that our reach with eu hc plan and members really not having to live within certain service areas that we are now acknowledging a lease in northern california that we have members in other counties that we have not traditionally had them or least not covered by -not covered by us as much. they were plan one i don't know where they were. it's interesting to see these new counties being added that members are being served farther out in the think we have to bear that in mind because i think these are trends . this more telecommunication

both with changes how we work as a city and county but where retirees cut. so i just want to acknowledge the staff work on this and think them very much. to me this is one of our bibles i think it's just fantastic and should give us a lot of information that will help us understand, benefits and where we go from here. thank you so much. >> thank you for your comments. any other public comment? hearing none, we will now move to discussion item 15 >> item 15 discussion item report on their work and health plan issues if any. >> good afternoon could michelle-united healthcare is wanting this opportunity to let new member from our team introduce herself for the board. she joined our team in support of ccsf probably about two months ago. i would give it >> she knows everything.

>> yes. >> okay. very good welcome >> thank you my name is christina lord and the field account manager for the city and county of san francisco the commercial active and early retiree plan. so i'll be supporting the members of the plan and hsa and wellness and open enrollment and benefits support all that good stuff. >> all right. well thank you very much for taking the time to be here today. welcome. >> account manager for medicare retirees of united healthcare. i have two items today. the first one is i had to take away from the january meeting to confirm when members see a specialist when a self referred to see a specialist who is responsible to get those medical records over to their primary care physician and i believe that mitchell didn't report out at a retired

firefighters meeting but i also want to bring it back here to the member does have to requested that of the specialist so they can get those records over to the primary care physician. >> is there any work plan going forward? is this where you are going to stick or are you thinking through other alternatives or options to that? >> we don't have a medical record account management system or a coordinated one because as a national window be very difficult to do. >> all right. director dodd >> our best doctors would put your medical records on a thumb drive. if you just wanted your most recent x-rays and lab work and positions notes they would get him on a thumb drive to you and you could take them to your specialist. so we have a workaround for that. >> okay. any other-other

comments? >> so i one more item to bring to the board today. united healthcare retirees solutions is conducting some voice of the member focus sessions over the next couple of months and we have received approval from hss to include the city and county medicare retirees and those focus groups. the purpose of those are to gather feedback directly from the retirees have attended one of the retiree educational meetings in the fall to get their feedback on how those meetings went, what worked well, some of the charities for improvement so that we can improve those meetings for future. there will be two meetings and based on where the biggest attendance was, we are targeting probably san francisco for both of those meetings. the 90 min. in length . we will be reaching out to

six retirees randomly for each of those sessions and then it will be a third party that actually conducting a meeting with those retirees and they will bring feedback back to us and i can share that with the board on how those once. there's also an opportunity to have some questions that hss would like to have them there if that something that would be of interest. so you could get the retiree feedback on those questions as well. >> i hope you're going to feed those that come to the meeting? >> yes. >> food, not snacks. a new. a healthy meal. commissioner breslin >> i some questions but my hearing is impaired so i don't want to have to wonder what the end was left ask it about this but it's really important that you do more outreach to doctors and members that were in the city plan and blue shield plan because-that seems to be the

complaint. they go and say, no, we don't won't take you and then there's more confusion because it's called the new city plan because some of the doctors think it's the same plan. it is not those of the whole thing is-it's been a very confusing. but next time around-but it seems like at cmpc homage outreach has been to all those doctors there to get them into your network? with people go and they say, welfare not in our where work so we have-we won't take use they have to go to all the process. >> right. we need to do the our reach again if you're not in our network it is up to the doctor whether or not they want to bill united healthcare and continue- >> but if our reach wants to can you they want to keep

coming to your network? >> we sent him a packet of information >> how many doctors have by cmpc >> how we are reached to? i don't have a number of the top of my head >> there's a lot of them, right? >> yes. >> over there on webster street >> i would encourage retirees if they have those issues to get in contact with united healthcare. they can call the number >> but there in the office may find out then and they need to see the doctor. these people are not young people. >> we are continuing our outreach efforts as we become aware of member potential member disruption. we are outreaching to those providers. >> i thought you presented with that discrepancy was that you had surveyed providers to see how many are already in the network and you were doing active outreach to those. i

don't remember the exact numbers. maybe you could remind us what they were but i thought they were at least in terms of the primary care was a fairly small number. >> about was the blue shield disruption and was a very small number. >> right. i guess i'm not sure whether >>[inaudible/off mic] >> i don't know it seems like cmpc a lot of them are not. >> center doctors are in our network and i know sutter is affiliated with cmpc so there should not be disruption if there are sutter dr. i think what we are seeing the issues would've [inaudible] and were having to outreach to them. >> so they can be both the networks? [inaudible] >> all right. any other questions or comments? >>: is the medical group. uh c

is the insurer. so the positions in brown and toland can be individually in uht network. >> all right. they can participate in both networks. is what you are saying >> they can participate and they don't have to be a part of our network in order to accept the plan but sometimes we do need to outreach educate them on how to build united healthcare and have to accept the plan >> okay. that's so not to process >> is ongoing. outgoing with calpers and ongoing as we bring on additional >> all right., thank you. other planned representatives issues? of the comments in this area? >> addenda screwed up active with our voters widows and

their dependents. as your starting the rates and benefits when the things that i go up every year and talk about is the two-tier vision plan. somewhere in the back of my head >> it used to be [inaudible] the dental >> no. the two-tiered vision plan i love it two-tiered ( >> it used to be that that the plan reference. okay. we fixed that one so please, proceed >> well, you have not fixed it. you've done the best you could to read the was the kind of exit >> as far as the two-tiered vision plan summer in the back my head under what somewhat out there floating around and i hope this year will be considered again. the wonderful benefits for people who wear glasses. if it's possible to fit into this year's rates and benefits i'm sure a number of members would appreciate so thank you >> all right. we will make due note of that. dir. dodd

>> it will be part of the presentation. >> it will be part of the presentation geared all right. stay tuned. future events. all right. any other public comment? item 16 >> item 16 discussion item opportunity to place items on future addenda. >> any of the comments? item 17 >> item 17 discussion item opportunity for the public comment on any matters within the board's jurisdiction. >> does anyone have anything to say that might be within their jurisdiction of this board? catherine, may i ask do you introduce the new member of your team? >> thank you. >> i looked over >> i apologize i should've during my report a new medication management pamela, would you come-pamela johnson, we have a-to the microphone

pamela johnson's come to us from mpa. before that she had her own pr firm. she is a fiction writer and has lots of ideas to bring us into the social media space and make information much more available to our members. do you want to say anything? >> also i worked at public works as a public information officer in the fs mta. i'm looking forward to my new role as medications manager with hss and have lots of ideas so we should see some really exciting stuff from the team. glad to be here >> on behalf of this board we welcome you to this staff and we look for to working with you during the course of this year. >> thank you >> thank you again for choosing to spend this portion of your career with us. >> thank you >> thank you. any other thing

that might be part of the jurisdiction of the board, public, dramatically i don't see any. we are now moved to action item 18 >> item 18 action item vote on whether to hold closed session for member appeals follow-up president scott >> i'm willing to entertain a motion that we hold a closed session for member appeals. >> so moved. >> second. spews is been properly moved and second on whether to go into closed session. is there any question by the board? any public comment? hearing none, and seeing none, we are not ready to vote. all those in favor say, aye. [chorus of ayes.] opposed, say nay. >>[gavel] >> >>[closed session]

>> the with if they moved that

we not disclose. the celebrations are closed session and with that we stand adjourned. >>[gavel] >>[adjournment] >> >> >> . >> (clapping.) >> in 2013 san francisco legislators newsom agreed to allow the reciprocate of our soft story buildings te