>> sorry. i also want to thank all the participants for the great progress that is being made over these several years. and a number of us have been sitting here and it is better to be really looking at the fact that the major component parts are moving forward. and where we are now is where our comments have been made regarding how we can actually enhance where we are going to go so that the health care facilities that are being built here will serve the entire population and the public. and that includes clearly the residents who are around the new cathedral and the residents of saint luke's and the greater

city, we aren't that large that we don't really have [inaudible] of san francisco. and clearly a number of steps have been taken, but they do appear to take an awful long time to get there. even if we ignore the fact that this is a 2015 report because we did get an update on the current priorities and -- in 2016, we're hoping to hear better information, but the fact that after all the discussion, that saint luke's is just an example. it has taken almost three years in order to bring about -- one additional bilingual staff member. and was apparently some question that there is community input. so i believe that from at least

the health standpoint, we certainly are on point with most of the agreement. i do think that -- i'm somewhat concerned from director dod's first comment that we didn't have the fee assessment within time, but we had agreed to have an assessment and i would ask staff that those points that are in compliance or within the compliance, but clearly if we're behind in that, then the issue of the cost of our health care for city employees may in fact be overstated, if in fact the study shows that there were problems. so i think that needs to move forward. it's a small point, but so many are on our city plan. i would think that -- i don't have all the details on how that audit was supposed to work, but if it's

supposed to be sure that the rates are appropriate, then we need to be sure about that a lot earlier or perhaps it's within the time schedule. i'm not sure. but i do think we need to understand that a little better. i think the other broader things that i would also like to echo is that i think that going beyond the letter of the agreement is the spirit. and the spirit does say that we involve those who actually are in need of the care from our communities and may be able to benefit and even better, to be able to enhance the services that may well be provided and our commissioner spoke about other organizations within each of the communities that may well be a synergy to the work owe open advisory board comes up about how formal and how informal, but to have

the community input. it's what we do at the department of public health. we actually hold all these hearings and involve -- we must have three, four dozen advisory boards so that we understand what the communities -- what our target populations need and therefore we can also have them as partners as we move forward to the goals that we have for our own organizations and i would say that where -- you have two campuses in two great areas to make that impact on our communities, working with the communities really is going to make an even better agreement and a better health care system for all of us. so i would encourage that, and lastly, i would encourage we not only look at the letter of whether

or not we are meeting cultural competence, but it's really an issue of are we actually creating a better environment for health care decision making, which is what it's all about. so it's not merely complying with the very pretty picture of 15 standards and where we have all the people in place to do it. that's a progress and a process, but that we understand the outcomes. you have that on your interpreters but i encourage as we look at this and the class standards, and they're not there to be checked off, but to be there to be sure and it's not easy. we have made a difference by having appropriate class standards and not just the numbers that we have. from our standpoint, i commend our own department staff for the work they have done in responding to this.

thank you for cpmc for filling out all these forms and >> thank you to the health commission and thank you to city staff. this is a ton of work and especially to the coalition that have been a driving force in get this agreement done and implementing it. so that's all. do you want -- >> indeed it is. i believe the commission will break before our regular hearing for 30 minutes. >> yes, if you're here for the 12:00 planning commission hearing, we're going to take a break. we're finishing up our 10:00 meeting and we'll be back here at 12:45. thank you.

>> 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 >> 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