is supporting open enrollment event support at all the locations and we are actually adding a new partner to this and that is dignity. so they will also be attending some of these events and we think that's exciting and a good opportunity. we have the benefit information meetings on the 10th and 18th of october and then welcome to medications we going out in january. in addition, begin with open enrollment our show concierge will be contacting all of those members were being automatically enrolled. again, we're looking at doing three phone calls total. only living one message though because people get sensitive about having multiple messages left. >> is that the end of your report? >> it is. any questions he was any questions from the board? commissioner follansbee >> sorry i sound like a broken

record but i want to be assured when you list the positive services available at dignity and ucsf but members that are consider not know the only obstetrical services in the city and county of san francisco are ucsf. and i want to make sure that is clear to everyone. that they won't-the only other option to stay within the dignity system would be to go down to the peninsula. do you have a chart that deals with that, or, how you communicate that? >> right. we did not single out a upstart chicle services. we did single out that brown and tolan members will be admitted to ucsf and dignity. we did not single out particular services by each provider. what we have is putting together an ob flyer for the event showing who the brown and tolan ob/gyn are and

showing illustrating the referral pattern to ucsf versus cpmc. >> yes. again i want to make sure i am clear that, the difference here for most people is actually not to provider because you think 70% of them may already have what will be in the trio providers. the differences where they can get services and there is a difference. there's not a difference in orthopedic care or cardiac care or whatever they all provide, all the above but there's a difference in obstetrical care. so i do think they need to know that if they stick with their trio obstetrician that the trio obstetrician who will only be able to admit them for inpatient delivery, assuming that's what they want, to ucsf. that means that if they are electing-if they plan to elect

voluntary tubal ligation, for example, that would only happen at ucsf. they would not even have the option to go down to the peninsula to a dignity hospital. so i just think these-it's not so much important all the services are duplicated as the services not advocated by their current understanding of what they might get at is sutter hospital, as opposed to the new panel. so i think it's important to make sure that's in the materials when they are selecting not in generative when they're selecting during open enrollment. >> so i want to make sure i understand first, i want to acknowledge what you are saying has been a lot of thought put towards transition of care. obie falls into that category. so anyone who is my think, beginning their second trimester, which means about 13 weeks, 12-13 weeks into pregnancy and it's been

established all of those will go through the standard direction they would've gone prior to january direction they would've gone prior to january 1. there is no issue there for those people and again anyone who's in the course of any form of treatment they would continue on with that form of treatment given the panel that existed into 2017. so we can be rest assured there will be surprises for them. we are we want to be sure people understand that in the event they are using brown and tolan will be that they are delivery would indeed a curry at ucsf were, in the event someone is using a brown and tolan primary care physician and they became very ill, that their services would be rendered at ucsf and the non-sutter outpatient facilities in san francisco is where in the medication letters and shield concierge line, we spelled out the hospitals and cpmc is not on that list. so,

we are doing coaching on the shield concierge line as well for the people we get a hold of. but i do hear what you're saying about there being an opportunity to communicate that further and i will take that away, and we are planning on incorporating that somewhat into the oe events with actress people walk by our table and get that education. >> if i could add, too, is it possible to have it as part of the outreach and training of the providers that are going to be like brown and tolan.. as much work as i know you're doing with brown and tolan on the change, that may be part of that on boarding for the medical group?>> part of the on boarding. so, director griggs, can you elaborate on that? i do not quite understand it. he was the differences between the services they could be getting at ucsf versus [inaudible]

because now brown and tolan is not going to be admitting or referring to cpmc facilities, so if they are doing that and they are guiding patient to their healthcare needs and to a facility, could that be part of the education process? >> absolutely. dr. laos who's been here in the house, she has been spearheading the effort the trio transition for members and they have gone through the exact same transition. as i mentioned, for another carrier. as well as calpers calpers does the same thing. so they actually hired hardcoded into the system where certain services should be directed. so that education is there. she is also identified obs with a certain referral pattern and she had suggested that we actually use some of those as highlighting during our oe meetings. does that make sense?

>> yes. >> all right. thank you. any other questions. commissioner lim >> on your last like communication tylan, and the third point it says [inaudible] would it be more targeted to be [inaudible] i mean, where is-because it's the non-members we need most of the- lot more extra nation why they need to move to a [inaudible] pcp >> you know, we are not--we are not trying to recruit. we are suggesting trio to members who are already using trio. the intent of these phone calls is to make sure they understand it what trio is which of the same plan as [inaudible] in most likely cost less but if there brown and tolan member they

need to know about cpmc or if they arehill number or any other medical group, there is no change for them but we still want them to feel comfortable with it. the same time we also want them to know the value of trio and that's really what those calls are about. it's not a recruiting-it's not a attempt to get people to switch. that's not the intent of those calls. >> what if i want brown and tolan [inaudible] member. not the trio member, but not the brown and tolan, not trio. how do i know i need to switch the- >> i do not understand the question. can you say it again? >> so if you are on the health axis >> yes. >> you need to know during open enrollment your still a member, and you want them to switch to being a trio member,

right? >> you're saying if someone wants to switch become a trio member? >> yes. >> if they become a trio member the be getting a phone call once they elect trio. so they will be included in all the communications, the following year,, in 2018. but, we are not reaching out to those people >> they still remain in that system? >> they are and access plus. there using non-trio primary care physicians. we want everyone to be exactly where they should be and we are not pushing that's not the intent >> okay. >> all right. other questions from commissioners? commissioner follansbee >> i think that's a good plan because people going to complain back to hss are the people who are automatically transferred to trio because all of the providers for their family and dependents and spouses are already trio. so those people can be hit with a surprise that

they there has been a change to a lower premium good but limited access to facilities, bad. so that is the right plan because they are being-they need to opt out of that automatic change and the only time to do that is during open enrollment. they got a month to opt out. those the people need to be targeted first. i think, before you start advertising this to people who might think it it's a good investment to go just to trio but would not have automatically been transferred. i applaud that >> yes. it's like any other plan. hss is showing all plants equally disclaim them all equally. it's a not it's an additional planets gang the same limelight as the other plans, but for the auto enrollment we want to target them and just a reminder, there are only some of the auto enrolls will see a change in these facilities. while many will not but we are still calling all of them. >> the estimated number? >> 20,000 >> 20,000

>> 20,000 have been identified as auto enroll families. recently don't ask the committee to remain in there. >> all right. thanked at any other questions? commissioner breslin >> mitchell,you had said this earlier on. if a member does have to sign up for the wrong thing, no problem,, or, if they decide to change the plan they can do that? >> absolutely. >> right. but i read in the minutes and it said,, the minutes eight hss will review each case. >> so during the month of october anyone who we would typically set up to auto enroll into trio, they can notify us through the open enrollment application form that they want to remain in access plus or change plans or whatever they want to do. so that is not a case-by-case basis. so what happens so what happens after

october 31, there are some scenarios where somehow even all this communication we are doing it doesn't reach someone. and there in the middle of care or some type of care continuity or treatment continuity that were looking for. were, need. somehow they didn't either understand the message or didn't receive the communication. so we would review those types of cases case-by-case after october 31. >> my understanding was if they came in they could just switch back to the other plan. you do not have to review for any particular thing. that was their option. >> is there option during october. >> the rest of the year they can do this? >> well, it's february which is after october 31, if it's february and they are going for some type of treatment that they have been receiving prior to january 1 those are the cases that we would review and

for the purpose of continuity of care we would allow them to stay in access plus. >> so you are telling me they can't just change from one plan to the other? during the year? you have to review the case. >> this only certain circumstances that we allow that under the health service system roles >> i was not clear i would not have voted for this because that was what you had said, i thought. that's not going to be a problem because they could switch back if they want to. in fact, the way the plan is set up now they can switch from ucsf back to two different groups they have now. >> so now they can change their aco. if there under brown and tolan they can move two hills. they can still do that during the plan year but brown and tolan now, if you are in trio will refer to ucsf and dignity

facilities and the others in trio but if there and access plus, they would either more than likely, refer to facilities in cpmc. talking up ron and tolan. you can change pcps now >> no. i'm talking about between trio and access plus. it's my understanding you would be able to do that. >> no. >> that was one of my questions i thought will no big deal, then. but i would not have voted for that. >> yes. trio is a plan just like- >> i know that but that was what i understood >> that would--so the reason why there's an open enrollment period in every plan has this >> i know all that but this was just- >> right. >> that's what i understood this to be. somebody realizes

it's what it really is and they don't want to be in it, they can just go back to the other plan. >> not after enrollment>> right. you can change plans after open enrollment >> they can go back the next open enrollment >> right. they can go back next open enrollment but what we were talking about during the meetings trio the fact that there are some people that do not get their direct communication, or, there in the middle of treatment. >> is probably can be [inaudible / off mic] >> they probably will be. >> those of the circumstances will be reviewed and case-by-case. >> right. >> okay. any other questions for members of the board on this topic? any public comment? please standby because you may be called back. public comment you can relinquish the microphone. thank you. >> thank you. i want to get

back to what dr. follansbee mentioned. i think something in the open enrollment materials in the benefits booklet needs to indicate that not all services will be available through dignity. that might've been of able otherwise. may be specifically indicate thaat obstetrical services, but this also i think i guess part of my question is, will this impact retirees, because among early retirees, but also even our medicare retirees, we have split families where there will still be independent who might be under blue shield and if they have the option than to opt into trio while they are still in that split situation, this does impact us and believe it or not, obstetrical services do impact retirees, especially early retirees. these are issues that concern us. i think there needs to be

something indicated in the material so that people understand, or, they can ask the questions about what kinds of services may not be available through dignity. we are very very sensitive to that and that primarily is that since we have some splits that retirees are in fact impacted as well. because, this is going in my newsletter and i will start getting calls, emails, the system will get the calls and emails because people want to know what this means for them and especially certain services will be available. thank you very much. >> thank you for the public comments. duly noted. any other public comments? thank you for your presentation aan update and will look forward to seeing you again post open enrollment. >> thank you >> okay. 90. we are now ready to move to action item 10.

>> item 10, action item, vote on whether to cancel october 12, 2017 regular health service board meeting due to open enrollment. acting director griggs >> every year we ask the board to consider-canceling the regular meeting during october because of the amount of work and a lot of meetings we are going to in the preparation they usually takes regular meeting so that the action item that's recommended >> you for the recommendation. i'm ready to entertain a motion >> i move we approve cancellation of the regular october meeting >> second. >> is been properly moved and seconded that we cancel the regular health service board meeting scheduled for scheduled for october 12, 2017. are there questions for discussion of the board? i will only make one observation. that even if this motion passes, i do not want the board members to take this day off

your calendar. i wiill explain why in a moment. so, is there any public comment.. hearing and see none will ready to vote. all those in favor say, aye. [chorus of ayes.] all those in favor say, aye. [chorus of ayes.] opposed, nay. the motion passes unanimously. >> [gavel] >> so the regular board meeting will be canceled but i am requesting that,, through our search form, that we hold that date for possible interviews with candidates for executive director. we will know more as we go forward. so, please, do not take the time off your calendar. all right. next action item. number 11. >> item 11, action item, vote on whether to cancel november 9, 2017 regular health service board meeting and instead hold an educational forum. acting

director griggs >> so i believe it's in the been in the past two years we've use november since as part again looking at our strategies for next plan year which would be 2019 for this year and you and education forum. the things we've gathered over the years that we want to make sure the board is informed about or learn about as far as benefits administration were other things and things in the future with healthcare etc. so we recommendation that the board have the educational forum in november. cancel the regular meeting. >> you for the recommendation. i'm ready to entertain a motion. >> i move that we cancel the november meeting and hold an educational form. >> is there a second >> second. >> it's been properly moved and seconded we cancel the regular november meeting and hold an educational forum. that would be on november 9, topics to be determined, and, again, if there are topics that the

general public, members of the system, feel we need to explore in depth from providers, or policy issues and so forth, this is the time for us to take those up. we don't try to boil the ocean but we do try to stay focused on some prime topics. the opioid issue being one of them, for instance. any comments or questions from members of the board? public comment? hearing and see none we are ready to vote. all those in favor say, aye. [chorus of ayes.] all those in favor say, aye. [chorus of ayes.] opposed, nay. the motion carries. >> [gavel] >> discussion item 12 >> item 12, discussion item, report on network and health plan issues if any. >> right. are there any network or plan health plan issues? this is the opportunity for any of our partners to speak. commissioner

breslin. >> is there any way from united healthcare? >> united healthcare? no representative >> no represented from united healthcare? >> it seems like everyone is looking around or ducking under their seats. >> really, she left. recently, i'm just going to put this out there so members notice. recently i received a letter as other members have been offering this home call visit as part of your plan. so, now i've been getting like harassment i received five calls i get calls from other people i know. why am i consul in getting these calls from united healthcare about this home care service? i mean, this is a nice offer but why are you doing that? why are they calling so many times? it's unbelievable. they stay a long time trying to talk you into it. so, my question is, why. this kind of operation doesn't happen for the benefit

of the members. >> right. was director griggs to follow up with united healthcare and see if we can get a response as to the marketing approach is what i would characterize it as >> it's like robo calls >> find out why the number are doing and so forth and so on. thank you. any other item on network and health plan issues? item 13. opportunity to place items on future agendas. any public comment on that? director griggs >> so last board meeting is brought to our attention that a letter from t dph was written and sent to blue shield in regards to zuckerberg

reimbursement by blue shield of their trauma and er services. there had not been a response. i believe the original letter and out in may and there had been a response. so, we've asked blue shield to go back and first of all respond and send us a copy of that letter. so just prior to the agenda being issued received a copy of that response. that response from blue shield stated it felt like it was pain with usual and customary and talked about the collaboration of trying to be able to contract,, have a commercial contract with zuckerberg and the difficulties that currently entailed and that negotiations were currently at a stall but could be ongoing. so with this particular time it will be up to the board how we want to further move forward and either

create agenda for this item in the future board meetings, come up with a policy statement or resolution on this issue. >> well, i am going to ask us to step back and figure out if we have a dog in this fight at this point. i was not here at the tail end of the meeting where this got discussed, but i think that is kind of where we are at this point. it also points outto my fellow board members when of the items a policy, or, communications amongst ourselves and to the general public that's found in our communication policy in terms of reference. so i am asking on a going forward basis, as you may have items or issues they want the rest of the board to be notified about and you send them to me but they also be sent to me and that i will confer with our counsel to be sure we are not

sort of getting out ahead of ourselves in terms of more than two members, or three movers talk about a given item. so i will play the bad guy. laney will keep me advised if she's in receipt-tthis is just fyi information on health plan policy or whatever and asking that you send it to her but also send it-cc me. i'll confer with eric to make sure were keeping in compliance with the medication policy and other requirements for meetings and communications. so masking your assistance on that going forward. all right. anything else on this topic? >> so what we can do about this? >> nothing. that's what i'm proposing at this point because it's an issue that was addressed by the department of public health. >> so i think it was part of the [inaudible] at that time and

there was a comment from the public. [inaudible] last time we started to [inaudible] blue shield respond because the letter was addressed to health service board. since there was a letter that was response to that comments. a letter from the public [inaudible] as far as this board is concerned i think we have fulfilled our responsibility up to this point in time.. i don't think there's anything anymore for this board to take it up on a matter. >> is a letter of response didn't say they were going to pay the bill, right? >> but i think it's up to public health and also to discuss [inaudible] with this is outside of our fiduciary responsibility >> [inaudible/cross-talking] >> i agree with alfredo. the balls back in the department of public health court and i'm certainly will fully capable responding to that letter.

>> thank you. all right. counsel, any information? >> yes. i would reiterate dph will take the lead on this and when you figure out what they want to do, if they want additional assistance, or, input from hss is expected to reach out to director griggs. >> right. thank you. we've got enough on her plate at this point. the core issue might be one for the new executive director takes up as part of a broader strategy but that's a whole other kettle of fish at this point. all right. we are now onto discussion item number 14. >> item 14 discussion item, opportunity for the public comment on any matters within the board's jurisdiction. >> is there any public comment on anything that this board is responsible for? hearing and see none, we are now ready for action item of 15. >> item 15, action item, vote

on whether to hold a close session for member appeals, pres. scott >> i'm willing to entertain a motion to the effect we hold a closed session and hear a member appeal. as is customary items with dealing with individual members are held in close session due to their nature. >> i will behold a close session >> is there a seconds >> second. >> properly moved and seconded. any questions from the board? public comments? hearing and see none, we are now ready to vote. all those in favor say, aye. [chorus of ayes.] opposed, nay. carries unanimous appeared speak all >> all those in favor say, aye. [chorus of ayes.] opposed, nay. >> [gavel] >> >> we do say whether to disclose >> we are in open session at this time >> okay. >> i see >> open session for us. so we wrap up >> okay. >> now we move not to disclose

>> if i call for that action action item 17. >> so action item 16 actually. wait a minute. i think you are right. you are absolutely right. i am so sorry >> action item 17 vote to elect whether to disclose any or all discussion held in close session. >> i'm ready for a motion >> i move we don't disclose was held in close session >> second. >> probably moved and seconded not to disclose any or all discussion held in close session. under the appropriate administrative code provision any further discussion? hearing and seeing none, we are now ready to vote. all those in favor say, aye. [chorus of ayes.] opposed, nay. the motion carried unanimously seeing none, >> [gavel] >> item 18 action item possible disclosure close session >> probably moved and

seconded we not report on the actions taken during close session under the appropriate government code section san francisco administrative code. any discussion by members of the board? hearing and seeing and were ready to vote. speak all those in favor say, aye. [chorus of ayes.] opposed, nay. >> [gavel] >> the motion carried unanimously. with that, this regular meeting of the san francisco health service system board is adjourned. >> [gavel] >> [adjournment] >> >> >>

>> thank you all for being here today, and thank you, particularly, to mercay for catering the event. let's give them a big hand. [applause] >> we look forward to the start of their cafe soon. let's have a call for the order. >> this is the november 15, 2017, treasure island authority board special meeting. item one call to order. director sun. >> here. >> director richardson. >> here. >> director sa