>> we'll start by having a roll call. >> prescott. >> present. >> vice president lin. >> present. >> commissioner breslin. >> here. >> commission. >> present. >> supervisor sheehy. >> we have a quorum. >> thank you. action item number 1. >> item 1 action item public employee appointment hiring hss executive district or position vote on whether to hold closed session for update discussion and possible action regarding board selection of h.s.s. executive director prescott. >> i'm now ready to entertain a motion to hold closed session for the purposes outlined in action item 1. >> i move we have closed session >> is there a second. >> second. >> properly moved and seconded that we have a closed session

for the purposes outlined in action item 1. are there any questions or comments from the board? any public discussion hearing and seeing none we're now ready to vote. all those in favor signify

>> let's move to action item 3. >> item 3 action item whether to disclose discussion held in closed ask. president scott. >> i'm ready to entertain a motion whether we will disclose our discussion held in closed sex. >> i move we do not discuss the discussion. >> it's moved and is there a second? >> second. >> and properly moved and second s that we not disclose any or all discussion held in closed session and any public comments? no public comment we're now

ready to vote. all those in favor signify by saying aye. >> aye. >> all those opposed. the ayes have it. action item 4. >> item 4 action item, possible report on action taken in closed session. president scott. >> i'm ready to entertain a motion on possible reporting on actions taken in closed session. >> i move we do not disclose the action taken -- report. >> yes. >> that we not report on the action taken in closed session is there a second. >> second. >> it's been properly moved and seconds we do not report on any actions taken during the closed session. is there any public comment? hearing and seeing no public comment we're now ready to vote. all those in favor saying aye. >> aye. >> all those opposed. without further business, we will now adjourn formally the

closed session. we are now ready to take up our regular meeting. >> i'll invite everyone in. >> invite them all to come in.

>> i call this meeting in order and i ask you to remain for the pledge of allegiance and stand and ok knowledge the passing of our mayor edwin lee. i pledge allegiance to the flag of the united states of america and to the republic for which it stands one nation, under god, in divisible with liberty and justice for all. join me in a note of silence for the mayor and his family. thank you. well now i have roll call.

>> prescott. >> present. >> vis president lin. >> commissioner follow. >> sheehy, we have a quorum. >> thank you. >> we're ready for action item 1 >> clerk: item 1 action item approval with modifications of the minutes of the meetings set fourth below and regular meeting of september 14th, 2017. special closed session of september 22nd, 2017. special meeting of october 12th, 2017, special meeting of november 9th, 2017. special closed session of november 16th, 2017. >> the documents have been provided and i'm seeking a motion foray approval or any etiquettes that anyone would provide to the minutes distributed. >> i move we approve the minutes as stated. >> it's been properly moved that the minutes of the pre seeding

meetings of this board as outlined in this action item be accepted. is there a second. >> second. >> it's been properly moved and seconds we accept the minutes as outlined and distribute it. is there any public comment? hearing and seeing no public comment we're now ready to vote. all those in favor signify by saying aye. >> all those opposed. it is carried. item 2. >> clerk: discussion item general public comment on manners within the board's jurisdiction, not appearing on today's agenda. >> is there any public comment on any matter that's within the board's jurisdiction that is not on the agenda today? hearing and seeing none we will now go to item 3. >> clerk: item 3 discussion item

president's report. >> i wish to remind the board members that in the current climate it is critical that if you have not completed your sexual harassment prevention training, that you do so by the 31st of this month. it is a requirement to continue to sit on this commission and we all must do it even though there aren't points of pause in the course or book marks in the course but we're asking everyone to complete that. we have been working very diligently with the search firm and with the board and our meetings to move forward with the selection of an executive director and we think that we are within arm's reach to do that so it would be my hope at the ensueing meeting in january we would be in a position to make a public announcement about

the results of those efforts and that is all of my report for today on that topic. is there any public comment? any comment from the board? no. we'll proceed to discussion item 4. >> clerk: director's report acting executive director griggs >> thank you president scott and members of the board and i want today give the board today that will be concise and we have some really great presentations and i just want you to know i've spoken to every presenter and we've be efficient with time since we're starting late and it encompasses open enrollment and september and november so we've had a lot of work to do and to say the least and i was just watching last year's meeting where we presented an open enrollment and catherine dodd said it was the busyest open

enrollment ever and that was last year and this year i want to say that this is definitely the busyest open enrollment and it's good and it was complex and it was a heavy list but we made it through and we'll present a little bit later a summary of the metrics just to show you the volume of that work. before we get in to that i just want to talk about some open positions and positions we filled and are about to fill. we have filled a 1209 benefits technician position by jesse franklin who is in the audience with us today. >> would you please say the name again. >> jesse franklin. >> jesse franklin would you please stand up so we'll know exactly who you are. on behalf of the board we welcome you and hope that this stop will be a major contribute or to your career growth and development. thank you for joining us. >> he definitely was a big contributeer to open enrollment

and he took off running and we're appreciate of that and we've selected a candidate for the 5320 graphic designer and we're waiting for h.r. to do their veting and we'll write an offer. we filled the 1649 accounting intern position with todd cell who is also in the audience today. >> where are you? >> thank you for standing and welcome to the health services system we'rely delighted you joined us. >> so i'm going to continue with the report before the presentation but as operational ly for open enrollment this year the technology that we have put in place really helped if we didn't have that technology like the enterprise content management system which takes all of our paper and puts an electric form and our data base to the specific members we would still be doing data entry and filing copies of enrollment forms so all of that have is complete and

that was a huge help this year. and a lot of that was due to the add add minute services team and they took the forms that members were bringing them and scanning them and linking them in data base so i want to mention them on the report and their involve ment this year administratively. they did the set ups for all of our events and side events so everyone comes in and we have a little area that members can come in and speak to analists directly up and we have a vender week where our vendors come in and they're responsible for setting up and breaking that down and another big task they do is they keep inventory and keep supplies of all of our new planned materials ready for members when they come in that it's right there for us to access so they're always a big help so the manager of that division. i also want to mention

enterprise service system anna anna -- an a lit ticks and they do the plan year which say huge accomplishment and they also are responsible for implementing technology i mentioned earlier and they're also responsible for bringing the data in so when i give you numbers in a minute about the enrollment, they're the ones that were responsible for doing that and last but not least, brian rodriguez and marina coolridge is our project manager who has done an ex ex exemplary job. we have 35 of these left remaining to be tested and so we're still that and this is for our when the report was written they've gotten through a few more by now but january 1st when

we start sending files out, we have to have those, most of those complete. another important thing that marina and her team accomplished here is we had a self-service pilot so 165 members participated in that and everyone really enjoyed it and they enjoyed providing feedback and we're taking a survey they completed and when we start developing it more for a bigger roll out we'll use all those responses. even though we were really busy we had to get that in and it was well worth it. i do want to go back up a little bit to operations and talk about some of the outcomes of the enrollment. we had several big things that happened this year one of them as you know, the implementation of blue shield trio and we'll get in to more details in the next presentation after the direct report with blue shield but again as we knew that would be a big task and that was a big

enrollment movement. that was a big set up in july, august and september and in october when open enrollment is live and people make changes and as we move on after october and in to the first of the year, that is also a big -- a lot of work for us. any time we make plan changes and any time is expected we'll save money next year for it and it's going to cause work and so it's well worth that work. we have some occurrences back in august and september where we felt perhaps our abilities and communicating our plan choices appropriately and we took some pre-emptive and proactive action with them and along with erik the city attorney's office we sent a letter to them making sure they knew that any communications to our members

about our open enrollment or our board's decision could be run by us and it's a good thing we did they showed their hand they had prepared a communication that would have seriously confused members and especially if it got outside of the members they were referring to. that started a dialogue between me, them and the mayor's office as well because i contacted the mayor's office about our request not to communicate to these members so we were all to collaborate on the communication that where 80% ok with so we did mitigate some damage there. other than blue shield trio we'll get more in to it in just a bit i want to mention some of the other enrollment results we did we implemented the kaiser multi region plan so we offered kaiser in hawaii in the northwest, oregon and washington so we had a total of 38 subscribers enrolled and it's

good and that is not the total so i don't have those numbers yet. that message out got out there and i'm sure in the following years we will continue to get good membership with that. outside of trio, non medicare and blue shield decrease about 127 subscribers so they did lose some membership. kaiser active enrollment increases 406 subscribers and it tripled that number so that was a good addition for them and city plan members increased by about 31 subscribers. healthcare, medicine' care, vantage, ppo increases by 171 subscribers and cruger senior advantage 150 were gained. so i just wanted to give you those numbers and just so you know how our communications work and what type of migration and

activity is going on out there and there's just a -- i'll finish up here. vision premiere plan which was another very popular addition that we did this year we have many, many, many compliments from membership thanking us and the board forayeding this. we enrolled 10,123 members. that's huge. and 9,000 dependants so 19 lives all together. last year we introduced voluntary benefits, these are your pet insurance, supplemental life, accident insurance, those types of things. we put those out there foreign rollment again this year and we received another 1100 enrollment s were total of about 5,000 for the supplemental benefits. a move on to finance and

accounting, so when we wrapped up open enrollment now it's budget time so we are preparing for the fiscal year 2018-2019 of this year and 19-20 budget season in january there will be a presentation on the budget and the budget instructions that were passed down from the mayor 's office just a week or so go. we have executed service agreement with a partner in our web design so we're looking forward to -- i'm certain by open enrollment but hopefully earlier have a brand new website so we're really looking forward to that work. finance and accounting always help us out a lot during open enrollment and sometimes we don't give them enough credit for that and they help us a lot with their rates calculating our rates and going to the m.o.u.s and looking at the things and the differences between the m.o. u.s and how the employer

contribution comes out and then when we get all that information and we start developing and writing our materials, they're key in reviewing those materials and make sure they're accuracy. so we have great participation in that from finance and accounting and communications always plays a big role. again i want to do a shout out to carole karimi who is our new communications manager she came in and got the materials all drafted and so she helped us get them together and she was a huge help and she really dug in and what this is especially now with our communications going out with our confirmation letter she was key in that process as well. we did have a large website present as you can see, 58,000 website it's in october and 2017 and again responsible for

producing all the member materials and just recently we created 75,000 confirmation letters mailed and most of those have been received by membership according to our call volume which goes up when we mail something. well-being will be presenting later the review of the well-being program, data and successes soy just want to mention that again we did 26 clinics, flu shot clinics in october and some in november as well and that is one of our big out reach during october the flu shot clinics along with providing either a help fair and open enrollment all at the same time and it's really bringing in members and we're there to answer questions so it's been definitely. it's a bit fanatic and we might want to work on that next year but we did the same as we did last year with 4,131 flu shots between october and november. speaking of off sites, we are geting and i know shavon will

mention this a bigger percentage of participation so we go to department of human resources and the p.u.c. building, we come to city hall, and those types of things and we saw about a 22% increase in participation this year and some of those i enjoy going that is ruccsf and we have a health fair with a flu shot and it's great talking to the retirees and they have great questions and i learn a lot as far as customer services and things that they rely on us on and then got an opportunity to say a few words at the beginning of that. kind of going over what is going to be new for 2018. one of my other favorite off site events is going up to mock sin and talk to the hedge employees up there and it's my third year going up there and it's great because i lose cellphone coverage before i a arrive so they have cellphone coverage but not my carrier and it's nice and it's a nice little

break talking to them again they have a lot of questions and they're very appreciative of us coming up there and going through these changes and answer ing their questions but there's a distance and a separation there. i also want to note too that we had opioid follow-up questions that i have included in the report. if you have any questions i can ask them and we're also going to do an opioid update in february which all this information will be include inside in part of the presentation including commissioner press lynn -- breslin regarding job classes and what types of jobs are accessing or needing opioids and a few other questions that were clinical which came from dr. follansbee and do they have

any non opioid pain management policies or in development and what type of provider training and dr. follansbee you saw the printed answers coming from the carrier. >> yes, i thought the responses were quite appropriate and encouraging. >> and we have had a couple utilization meetings just this week from two of the plans and looking at some of the pharmacy utilization you can see the results from their opioid management plans that we went over last month. so at this time, if you continue through and look i can leave this after page 13, it's right behind the director's report you will see the operations management reports. it starts off with calls and person assistance in october 2017. the top.

>> that's page 13. >> yes. >> ok. all right so i'm go to ask sha von conner our operations manager to come up and give a review of open enrollment metrics. >> can i ask questions about the director's report or do you want to wait for the presentations. >> is it something that's been covered? >> it's something that's been covered. >> please. >> flu vaccinations close to my heart so i appreciate it and i'm curious to know does the department see it mostly as a way to draw people in to get the flu vaccine but also to hear about other programs enrollments so that's really the sort of card to get them in not because our employees think they don't have access through their health plans or other means? >> right. >> and stephanie, so one of the things when stephanie first started with h.s.s. and my

discussions with her s. what can we do during open enrollment as far as not only increasing the participation in flu shots received but also it's open enrollment this is the time to have the plans to ask questions and time to have h.s.s. there to ask questions. so i think the combination of those things has really added to the value of the flu shot, it's encouraged more flu shot like i said there's 22% increase and that's just the people that are coming to us and asking questions and we're tallying those so every year we're doing this and including the flu shot it's i believe it's benefitting both divisions and stephanie would agree. >> questions of the board? >> i'm sorry to follow-up question. are the recipients given a card that they've gotten the vaccine and what the vaccine was and the lot and all that stuff in case there's a recall problem or something that the department is now responsible for in terms of

administration or something? >> we partner with kaiser who provides those flu shots and i'm not sure what they give. >> i can tell you. >> ok, good. >> sorry. >> they give you a piece of paper but they don't give the details information. >> it's more like what the flu, i don't think they give you the lot and batch number and if it's a recall it says a basic vaccine and who type of adverse reactions you may have. >> the fact they partner with a provider actually solves that problem. i think no member would want this with the lot and wait for f.d.a. announcements so that answers the questions and i think it's perfect. >> great. >> all right. >> so any other questions? if not please. >> shavon o'conner will go over our customer service metrics for

open enrollment. >> how are you? >> i'm very good, thank you. how are you? >> just fine. health services system and we have slides. i can't see them but i wrote a script. first i want to say i'm honored to be in service employees and retirees in the city of county of san francisco. it's a privilege to ensure they have benefits, this service orientation is the north star by which member services does everything. to that point, open enrollment 2017 for a plan year 2018 was exceptional in every regard. most notably as you can see we took 14% more calls, and then in 2016, we provided 13% more third floor in-person consultations and 22% more off site consultations and mostly at the largest benefit fares you will see in a later slide. we provided 19.5 more first-

floor in-person consultations and we received and processed 24% more applications than last year which was the largest year in the history of h.s.s. we did 24% more this year. we also had roughly 10% fewer staff hours and this year instead of having 20 days of active open enrollment we had 21 days which is part of the underlying foundation for the bigger numbers.

>> so 2017 member services benefited from the longer open enrollment in october so we had 5% fewer calls and because we process open enrollment in the beginning of november we allocated the staff almost exclusively to processing with a few people answering phones and it worked out really well and we processed in a timely fashion and we were only officer vis level by one second which i consider -- i pulled together a slide that shows you plan year 2015 over 2016 over 2017 so if you take the long view from 2015 to 2017 call volume is up by 32% in-person consultation is up by 54% and applications received is up 35% so the demand is rising

at health service system. you can see the increased call volume hit the service level and speed of answer was over a minute which is not the best and it's an expected impact with this kind of call volume. the next slide. slide 6. i also did a day by day comparison of 2016 over 2017 we took 1400 more calls in 2017 than we did in 2016 part of it was due to the extra day of open enrollment in 2017 we took 962 calls. also, there was a higher call generated by the new plans and

answering those calls took a little bit longer because we wanted to make sure that people understood what the v.s.p. premiere was and what trio was. the next slide. to me the real game-changeer this year was technology and enabled for open enrollment and the the past few years the staff ing is flat but this year the member services team was really apt and fluent in the electric content management system deployed at health service last year and instead of handleing application on paper by hand we scanned them all in to the e.c. m. and process them out of the e.c.m. and counted them and it allowed us -- it probably saved us at least 333 hours and that's a conservative estimate it's probably more like 400 to 500 hours which helped us close the delta between the

staff hours we had last year and what we had this year and still gave us a little bit more. next slide. our in-person contacts have increased and our in-person contracts have been on the first flor because brian rodriguez who mitchell mentioned earlier came up with a idea of having these little mini scanners at each station so instead of xeroxing applications and gives them back to members for the records we scan the application in on the spot and it linked in to the system and we gave the original back to the members so it was not only efficient it was green because we probably on the first floor alone scanned five or six thousand applications and that's five or six thousand pieces of paper we didn't have to replication -- replicate. the largest off site fairs were busyer. city hall was dish sent three

staff members to the city hall off site benefits fair and they didn't get a break they were talking all daylong and people had tons of questions and it was similar and some of the fairs were flat and one of the p.u.c. fairs but the bigger fairs we had that are more around the civic center are much bigger this year and unified school district had a benefits at john owe owe owe -- we didn't get an accurate count because it was so many people that just like helped them as fast as can you. the next slide. the impact of o.e., the demand of o.e. impacted the abandonment rate and when the abandonment rate goes up because people don't want to wait anymore the call volume goes up because

they're going to have to call back and they have questions that need answers so for we were stretched thin because we were out across the city and our calls lasted a little bit longer delinquency and termination volume for october and november had what i consider to be year over year the normal fluctuation it's higher this year but i won't go through the slides unless you request. >> we have the material in front of us. thank you. >> i feel open enrollment is like christmas to me and it's my favorite time of year. it's also a very challenging time of year and this year was more so and it takes h.s.s. village to pull this off it takes everybody on our team to finance teresa's team, marina's team to pull it will off and member services is more front and center and i consider everybody at h.s.s. to be a hero

when we're doing a really good job, no one knows we're there when someone needs us we step forward to help out and it took many hours of evenings and start as every year during open enrollment to process 14,000 applications and so i want to recognize out of the hero some particular people who were there literally every night until 7:00 every saturday veteran's day and they are florence lamb, yak chow , marine chan, ruby diaz and jesse. our newest member. each one of these people every hour of open enrollment whether on straight time or overtime so thank you to them but i wanted to list every person on the members services team and that was edited so thank you member services team i much appreciate it and i also really want to thank anthony who is blazing fast at work and he has a very

complicated demanding job and already, he processed over a thousand open enrollment applications to help support the members services team and i want to acknowledge our noble leader who is the calm force in the storm and it's very helpful to have someone just kind of say, slow your roll, focus on forward and keep going so thank you. all said this year's open enrollment was epic and spectacular and i appreciate the opportunity for getting this experience. more importantly i really appreciate the team that i get to work with. thank you. >> thank you, are there questions from members of the board? >> i just have one question, you point out it was a wonderful report and i think also want to add congratulations to the team for all the work and it was spectacular and as you alluded to, call abandonment escalates

particularly members anxiety, anger, hostility, and so do you have some idea about how long a member was on the phone before they were abandoned. >> interview: i think the average time before people abandon was about 65 seconds, i can look that up and provide it to the board. >> it looks to me like if i were called i would go back to the slide and maybe you had an average answering time and i think it was -- >> it was 73 seconds which is a minute and 13 seconds. >> abandonment time is 65 is actually longer than the answer ing time i mean, again if there are ways where they look forward. >> i can look it up. >> just look forward to how you can message when the calls come in and are there better times to call? not better days. avoid monday and friday but better times to call so members who are thinking about abandon ing their call because they just can't wait might have

-- it would be left with a message how to maybe not be so angry and call at a better time? >> we did message that call volume was increased and it would -- we expected a longer hold time and i don't think that we put up messaging if you call first thing in the morning or between 4:00 and 5:00 and you have a better chance of getting through right away and one of the things about i.v. r.s and they're frustrating as well and so when people finally get through pushing the buttons and listening to the message they're already like grrr so i think everybody on the team knows that during open enrollment people are going to be frustrated and you just kind of have this practical mentality of like bring this person down and let them know there's no problem that we can't fix and that is the truth there's hardly any problems that we can't solve one way or the other. they may take time but part of this thing is delivering that

message because if someone escalated but they know fundamentally we'll get them where they need to be and they calm down pretty fast. there are a few people that don't and that's just their nature so as customer service professionals and benefits professionals we have to deal with that. >> the comments were addressed to maybe not be fixed at the moment and fixed for future and look at some of these metrics and thank you for the wonderful report. >> you are welcome. >> are there questions or comments? >> commission commission lin. >> thank you to all the staff that helped during open enrollment and for your leadership during this hard times when we didn't have our director so thank you for all your hard work. >> thank you so much we appreciate it. >> any other comments from the board? well, on behalf of those who are silent and those who have spoken i want to say thank you directly

and to the individual members of all the teams that you cited that what you have done here particularly this year with the new tools and new complexity that we the board and our decision-making delivered to you and you executed on it very well and an outstanding manner and we're profoundly in your debt and so are the members of the system so thank you. >> thank you so much. are there any click -- public comments? >> good afternoon, claire, i just wanted to add that retirees were grateful for mitchell and the team that came out and we were also very greatful to the kaiser nurses who put up with a

lot of chaos, we had people who received shots and they weren't prepared and we weren't prepared for the response we got and it increased a lot of these off site visits are very, very important and they're important for retirees because it's one of the few places where we gather as a group and i also spoke to some potential fire department retiree and i also speak to all the potential police department retirees and we talked to them about the fact that we do these clinics and that there's more special attention given to them during open enrollment and we can't thank the staff enough and we can't thank the leadership enough for all of what gets done for us during open enrollment and yes, it was that piece of paper thank you supervisor, i was about to say that, so just a big thank you and we hope that there will be -- we're waiting for electronic complete

electronic open enrollment everybody has been calling for that since before i retired but one of these days we'll get there. the scanning idea was brilliant, it saved a lot of trees and we want to reiterate that we as retirees are extremely grateful for the service we get, especially during open enrollment. >> thank you, any other public comment? >> we thank you the plans for being present as well. thank you. director griggs. >> i'm also just wanting to mention and i was going to do this at the beginning but, this was a particular tough week for h.s.s. with the passing of mayor lee and a lot of us worked closely with him and his office so it impacted our office and

our staff as well and i want i wanted to thank the employee assistance program, we were training messaging 5:30 that morning and her team had already prepared a communication to give to all the city on the employees and those department that's were more directly impacted like the mayor's office controller office and memorial and i was able to deliver that to our emergency department head meeting that morning and i delivered that message to the director of the d.h.r. and the mayor's office directly. >> thank you. >> do we provide e.a.p. to the retirees and the message is this is available to them because the woman that trained me had been a city manager for a while and our

department and she was quite upset. she knew mayor lee quite well and believed value over the decades. >> unfortunately we did not provide it as a retiree? >> >> i'd also have you take note of several articles that are contained in the director's report both for your education and he had they're not pinpoint ing any particular provider or health system but they are of interest of our working relationships with some of these entities so i would call that to your attention and also i believe buried in the report maybe it's coming up in the finance report and i'll be corrected by you is a highlight we're working on r.f.p.s? >> working for something in particular? >> yes.

>> well -- >> it was not in my report. >> it's not in your report, it must be elsewhere. >> so with that are there any other questions? any public comments on the director's report if not we'll move onto the next item. >> update on blue shield trio h. m.o. implication, janette moan blue shield of california. >> welcome. >> thank you. >> now that we have crossed the bridge together -- [laughter] we are now entering new territory and we expect to see you here frequently in the next month or two. >> i really appreciate you, i think we've crossed a bridge. >> ok. >> um -- i'm janette and i'm

with blue shield of california thank you for having me and i wanted to do a recap and some lessons learned from our open enrollment. we have a presentation that was submitted in advance and i want to let you know -- >> some of us here at our level, it's not public, but all of the screens are flickering now up here so we'll be an uninformed group for a while. >> there is goes. >> now it stopped now that i said something about it. now it's going again and don't worry as long as it's clear on the screen we'll proceed. so please. >> thank you. >> we have a presentation. >> thank you. >> thank you. >> i want to let you know in advance of going through this presentation that the numbers here were losely based on ex pecked enrollment based on employee who enrolled so some of

the numbers are soft and we indicated with special equal signs that they are i just wanted to review the objective of trio in the first place and number one, was to make an affordable high-quality health plan available to the h.s.s. members. the current access plus h.m.o. is very well run and it has a cost trajectory that could be perceived as non sustainable as a non kaiser alternative so the intent is to provide something to our members that is sustainably for our future. in addition to that the trio product leverages all the good work that h.s.s. and blue shield have done with our deep partnerships bringing that to the next level. we want to create more competition in the work in the healthcare delivery system which will also lead to more

affordable prices and also higher clinical outcomes for our patients. we intend to transform healthcare delivery and of course the bottom line is ensure high-quality care for everyone. part of the plan was to do a three-year rate guarantee for starters, trio is 10% lower than the access plus pricing and that trickles down to the members there's a trio 2019 rate cap of 5.9% and a 2020 rate cap of 8.5% the provider partners including dignity, ucff, are making investments in the product and financial investments as well as operational investments. and in addition to that they're also investing in clinical innovations that are providing higher levels of care and

hospice in patient counseling, et cetera. blue shield is invest north this trio offering as a broader bay area strategy to ensure high-quality cost effective healthcare plans in the bay area long run. and this pi chart i want to re illustrate of the 38,000 blue shield h.s.s. members, 62% were already using the trio product and when i say the product i mean the network, the same providers in the end we got 40% of those 62% to remain enrolled which actually would be great to be 62% but we learned a lot along the way there are provider nuances and it's a great start.

we wereen rolling auto members in to trio for january 1st and that again was based on their providers their primary care physicians being in the trio network as well. we had to reduce that number for auto enrollment by 3,000 members and those 3,000 members were because within brown and toll around who generously stepped up and creed to create a custom trio network just for s.s.f. it was discovered later that sutter objected to some of their primary care physicians being included in trio and those were the sutter foundation primary care physicians, if you think about it, healthcare delivery is a business and sutter is not part of trio so our foundation p.c.p.s should not be part of trio either so we removed 2800

to 3,000 members who were originally thought to have been on the docket for auto enrollment and we took them off. because we did not want any disruptions to primary care physician relationships. in the end we auto enrolled 22,000 of which 14,500 remains. trio enrollment savings for 2018 alone is not 15 million it's actually 12.6 million based on 14,500 membersen rolling and my numbers are slightly different because again i updated it. since we found out the actual enrollment. is everyone following so far? and so it's 12.6 for 2018 and 2019 and 2020 should be more significant and the missed opportunity are those several thousand members who did not

remain auto enrolled and who went back to access plus and they are constituted $2.7 million in savings. and that again. >> i wanted to just to talk about the imitation a little bit and the lessons learned. they had interesting nuances mentioned in the sutter primary case physicians which we responded to immediately and there was confusions about specialists who are also employed by sutter. so that work is continuing and identifying those in determining whether they impact anyone and everyone enrolled as of january 1st or enrolled at any point in the plan is eligible

for continuity of care so any treatments they have in progress they get to continue on with those providers for those treatments. so we're not concerned about patient disruption but it was a lesson that we learned along the way in creating this custom network for h.s.s. we got a lot of feedback from members being happy that now they had ak stows ucsf so that was something positive that we learned that we had not anticipated, even though we know ucsf is a world-renowned medical institution in the united states we didn't know our members knew that as well. we did have some sutter interference with the enrollment and there was a lot at stake for sutter and it was a lot of revenue to be lost should they lose thousands of patients and not having them fill their hospitals and this is a normal reaction they did want to do a communication campaign and

fortunately city and county of san francisco took a proactive approach and approached them directly through the city attorney office asked them if they were and then collaborateed in the communications and it above been ideal had they not done anything because they were confusing and created noise but they worked in h.s.s. as far as an outsideer could see. there was an additional robocall that did cause further confusion and the noise hit the target, there was definitely confusion and reaction to the letters as well as the robo calling and dis enrollment during this period from the trio plan. at the same time, we need to recognize that sutter is a partner as well, just not in the trio product at this time and we

appreciate what they provide on the access plus. we do have some lessons around communications and our letters really predominantly focused on primary care physicians and they could have focused for the hill and all the other trio providers , it was going to be the same. we really focused on p.c.p. because that was the logic to develop the letter list so that's a lesson learned for next year. as a result of that, not identifying that we did lose 800 members that there's no reason that they would be in access plus because there's no difference between what access plus and trio for them and as far as network the only difference is that they have a look contribution out of the paycheck but they elected access plus still so that's an opportunity for the future and it would have been nice to have

better control over sutter it was amazing control over sutter but the city was able to perform and perhaps we should talk to them earlier next year. we need to better understand in the future the complex relationships our provider partners have with other partners and that could -- there could be more that we haven't thought of so i just wanted to be honest about that and we don't think there is but we didn't think these were coming up. i just want to be honest and transparent and where we would like to continue this to be very flexible and collaborative and working with the provider partners and h.s.s. in the event something ups and another observation is do we do auto enrollment again for those people for which the only difference would be a lower contribution so it's just a thought. >> it's a