funding in the general fund wellness. the second instruction is departments are maintained the current level of budgeted and funded f.t.e. accounts, f.t.e. lessee attrition. funding is provided for the anticipated cost of living increases for most employees, in line with the c.p.i. the third is departments should consider long-term savings and cost avoidance initiatives. fourth, align with the following vision areas outlined in the citywide strategic plan. they are resident and families that thrive, clean, safe and livable communities, diverse equitable and inclusive city. excellent city services. and a city and region prepared for the future. most of what our department does

is related to city services, if we can attract and retain employees, of which our benefits are part of, we don't need that, strategic principle. the other instructions are participate in the city's talent development programs. foster community engagement in the budget development process. consider independent reviews and audits when developing the budget submissions. and the next steps are on february 8th, we will be presenting the proposed 18-19, and 19-20 budget for your approval. the key of the date is that by charter we have to turn in our budget on february 21st, and therefore, without having a special meeting in february to go over the budget we will

present the budget. my plan is that we will present the budget to the mayor's office and with the caveat that the executive director has not had a chance to spend a lot of time with our department, in fact, i believe you said the starting date was on the -- >> 12th of february. >> and as you know, we do go through a long period of time in which the budget is in the mayor's office purview, which has in the past given us some leeway to make some reorganizations within that. and then also on the 8th i'll present the health care sustainability fund. that is not approved by the board of supervisors, only approved by this board. i present it at the same time so you can see how they intermix, but that, too, can be brought up

again in another month. are there any questions? >> any questions of director levin regarding the budget, budgetary process, what we'll be going through? so, the board will hear this as a committee as a whole, in terms of the recommendations around the budget. budget process at the next meeting. and commissioner sass is chair of the finance committee will preside over that part of the meeting. that's a commitment i'm making on your behalf. >> thank you. >> is there any public comment on this? hearing and seeing no public comment, we'll now go to the next item. >> item 7, discussion item, presentation of 2018 rates and benefits calendar for plan year 2019, acting executive director griggs. >> before director griggs begins, i want to remind folks of the process. we used to have a standing

committee on rates and benefits. we no longer have that in our governance structure. this board acts as the committee of the whole as we deal with rates and benefits. and hence, we are now out of our general board meeting, and acting as the committee as a whole on rates and benefits. it's the same people, we have not changed places or positions. director griggs. >> thank you, president scott. i believe you have the calendar in front of you. at this time it's pretty standard as far as year over year. at least recent years. one addition later on i'll get to. starting in february, february 8th meeting, blackout notice will be presented. >> can you give a brief description counsel, what the blackout notice is? counsel.

>> once the blackout notice goes into effect, commissioners are not supposed to have communications with the vendors. >> existing vendors or potential vendors. >> potential vendors. >> all right. restrictions on our communications as commissioners with the vendors. >> usually are existing unless we are doing an r.f.p. >> in addition, we'll be reviewing for you and presenting the fees, and stablization reserve. a presentation on co-pay benchmarking, co-pay, deductible and compare them against other government entities and private sectors, too, i believe included. then in march, 8 early board meetings of the month.

we'll present for your approval the ten county average amount. also we'll bring you stop loss recommendation for the self-funded plans. the blue shield flex funded nonmedicare review of claims experience. as well as blue shield stablization reserve and the best doctors for renewal for your approval. april meeting, we'll have the risk scores available for your review. also do a health value initiative. this is where we take our cost, our total contributions and premiums and compare them again to the private sector and certain large employers and other public sector employer groups. we'll also take a look at the city plan nonmedicare self-insured to approve the premium contributions for 2019, so that's city plan nonmedicare. that's the first early retiree

and active employee health plan that we are approving the benefits for. also review, or you'll review for the approval of dental, vision and aetna renewal during that month. in the may meeting, kaiser permanente, and blue shield, the rest of the nonmedicare plans. reviewing their premiums for your approval. and then in june, looking at medicare advantage plans, kaiser permanente, senior advantage, for proof of rates and premium contributions for those, and this is the new item, to appear the first time on the rates and benefits calendar, we will be presenting the multi-region, kaiser multi-region, early retiree and medicare eligible plans for rate renewal. again, that was another popular well received addition for 2018. just as reminder, the reason we have the calendars and the

reasons we have to stay on schedule is that we have to present these, have to be presented initially to the board of supervisors, rates and benefits committee and then to the full board of supervisors in july, we don't have the dates yet, but they will be forth coming. >> are there questions of director griggs? regarding the rates and benefits calendar? it has a very familiar ring. i thought we just did this. >> time flies when you are having fun. >> ok. all right. any public comment? hearing and seeing none, we'll go to the next item. >> item 8 discussion item. review fund status for the incurred but not reported ibnr reserve for u.h.c. and blue shield. >> i have been sitting here about an hour and a half, and the mind can only endure what the end can support.

so, i would like to declare a five-minute recess. let me do that, all right? >> thank our colleagues for their patience and indulgence of my personal proclivity of not sitting in one place for an hour and a half. please identify yourself and we'll proceed with this discussion item. >> thank you. mike clark with aon. good afternoon. the first of the presentations on reserving will talk about the incurred but not reported reserve that each plan that is self-funded or flex-funded has within the system's programs. so incurred but not reported ibnr reserve, estimate of unpaid claim liability for claims where services are incurred on or before a certain date, but not yet paid until after that date.

and for the plans we do our calculations on a fiscal year basis, that date is june 30th, the last date of the fiscal year. what i'll be presenting on today are calculations involving claims where services are incurred on or before june 30, 2017, but not paid until and or after july 1, 2017. so if we turn the page you will see the table of our calculations for the recommended ibnr reserve for 2017, june, self-funded or flex-funded. u.h.c. city plan, delta dental of california p.p.o. dental plan for active employee participants and the blue shield of california health plan. in particular, you will see overall a reduction in the

projected ibnr reserve of about $1.6 million. and most of that being attributable to the change in the u.h.c. city plan. all of these reserves are fully funded, and particular with the u.h.c. city plan, a key driver of the reduction, as of june 30, 2016, the reserves were required with the change over to full funding on january 1, 2017, we look at the june 30, 2017, figures, you no longer need to hold reserves on the fully funded program. so, therefore that is a key reason for the substantial reduction on the u.h.c. city plan. and we will reset these reserves again as of june 30, 2018, after the close of the current fiscal year. >> are there questions by

members of the board recording the ibnr reserve? so, why do we have to do this? >> it's required that you carry the liability to protect the ability to pay the claims that are incurred as of a certain date, but not yet paid by the plan. >> thank you. many times people see money in a savings account and say well, i guess i can spend that, too. and the case, that's not the case here. so -- we, being prudent and what we are doing, we are projecting these as estimates so we can play these claims as they are submitted to us. ok, thank you, mike. >> absolutely. >> any other questions from the board, any public comment? hearing and seeing none, we'll go to the next item. >> item 9 discussion item, review fund status for contingency reserves. mike clark, aon hewitt.

>> the second of my presentations address the contingency reserve. and that for each self-funded plan is a reserve that protects against shortfalls, potential shortfalls and funding estimates. they could occur if actual claims occur over a plan year or higher if who was projected when the premium were developed, and could cause a difference between actual expenses and revenues collected. so, this presentation will review the contingency reserve status, as of the end of the prior fiscal year, for each of the self-funded and flex-funded health plans. as you can see on the table, on page three, the u.h.c. city plan, we are recommending a contingency reserve of approximately 5.5 million. for the delta dental plan of california, active employee p.p.o. plan, about 3.1 million.

and blue shield of california, about 13.3 million. for a total of just under $22 million as of june 30, 2017. this is a reduction in our contingency reserve calculations for each of the three programs, from what we had calculated as of june 30, 2016. now, all of these reserves are again currently fully funded, and we do account for the change in contingency reserve into the calculation of plain stablization. so in the next couple months i'll discuss the reserve status with you and how the contingency reserve impacts the claim stablization reserve. in particular on the change, you'll note the u.h.c. city plan overall stayed relatively stable. we had the reduction

attributable to medical retirees, coming out of the need to be reserved for because of the change in the fully funded status effective january 1, 2017. we did have some offsetting increases in the contingency reserves for active employees and early retirees in the u.h.c. city plan, in part because of the growth of the head count of those programs. just so happens they relatively net out, but there were some change dynamics occurring between the active early retiree populations and the medicare retirees. delta dental plan of california, primarily the claim variances stablized somewhat, so in the methodology, that created a reduction in the needed contingency reserves. and then for blue shield of california, we had the elimination of the medicare retirees, that contributed to the reduction on the blue shield of california plan. so, like with the ibnr reserves,

we will reset these calculations as of june 30, 2018, at the close of the next fiscal year. >> any questions from members of the board. commissioner sass. >> i'm trying to recall the discussion around u.h.c. in 2018. i know we were basically utilizing stablization funds to main -- to offset the additional cost. i'm not sure i recall that we would be exhausting the contingency fund as well, the last sentence on that. that does not ring a bell with me. it could be my own memory. >> that's actually not the case. so, i had originally had prior discussion, that's not the case. >> not the case, not accurate. >> stablization reserves, apology. >> surprised to see that. >> so you are talking about the line that says contingency reserved for u.h.c. to be 0.

>> yes, that's not correct. >> i thought that's what we expected. >> stablization, not contingency. >> i will address the stablization reserve next month in some of the early information provided. >> just for the record, then, i'm going to suggest this slide be amended and reposted. so that we don't have that lingering out there for a month, if that sentence needs to be removed or edited in any way, we rely on you guys to give us the right wording, to amend the slide than we have it posted correctly. lani, did you have a comment? >> i was just going to say that you have the corrected version, hard copy, and it's going to be posted after the meeting, the correct version. it will be corrected on the website. >> i call the board's attention to that. we were handed, and now in my stack of papers, i can't find it, a corrected edited -- ok.

and that's the one that will be posted. >> that's correct. >> thank you. >> all right. >> so, let me ask you, too, like -- and anybody else. is this a high reserve for the blue shield flex-funded plan? are we always subsidizing the flex-funded plan? >> reserve calculations for ibnr and contingency reserves are consistent across all three of these programs. so, the -- the methodologies produce figures that again are consistent methodology, and i will address the stablization fund next month for the u.h.c. plan and additional plans. those particular funds are tracked based on those programs and i know that decisions have been made to apply certain

elements of stablization funds differently to different plans over the past year or two. i will be addressing that with the board in february and march. >> director levin, do you have something to add at this point in this query? >> yes, so, there are two different reasons why we have these reserves. so, stablization is so we can buy down and stabilize the rates and present a major migration and keep the plans so we have some competition. contingency reserve is for a catastrophic situation. so, let's say, i mean -- that's the way i understand it, simple terms. he can explain it in other terms. but let's say we had a -- the flu that's going around right now, that's started really impacting people's health.

let's say that that became a huge problem. and overwhelmed blue shield. we would want to have the contingency there for those kinds of catastrophic. so, and in doing the calculation, mike will be able to kind of go through, but in terms of the use and why we have it, it's totally different. >> all right. so, just in summary, the incurred about you not paid claims reserve is there to pay claims that we know have been incurred but have not been paid. ibnr. then we have a contingency reserve set up specifically to take care of catastrophic circumstances. >> that is correct.

and there's a statistical formula behind how we calculate contingency reserves. and it's consistently applied across all three. >> and the third bucket of money over here is the stablization fund, and applying and utilizing those funds to keep rates reasonable for our members and to manage, if you will, the overall participation in various plans. >> correct. >> and all of these are broad board policies that this board has set up and reviewed. the statements of which are, i believe, online, or certainly within our terms of governance so they are there for anybody who wants to look at them and kind of see what is this money being used for kind of thing, ok. just an educational moment, kind of a public -- thank you, sir. commissioner lim. >> required financial reporting during the audit when we do the

financial report, required with the audit, and also reviewed by aon and reviewed by independent auditor. >> ok. so, further -- certification we are using the funds properly and for the purposes intended. >> correct. so, we provide the calculations but you are correct in that is audited and i know that was reported on last month. >> ok, thank you. commissioner lim. >> ibnr for the city plan was substantially reduced 2008, because pretty much all of the city plan is fully funded now. >> for the medicare retirees. >> so it would go down, expect it to go down in 2018. >> all right. thank you. any questions, other questions from the board? any public comments? hearing and seeing none, thank you. we will now return to our

regular board meeting. we are no longer the committee of the whole on rates and benefits. have we changed? no. madam secretary. >> thank you. item 10, discussion item, update on blue shield trio hmo implementation and provider partners. jeanette moen, blue shield of california. >> hi there, thank you. jeanette moen with blue shield. i just wanted to give the board an update on the trio

implementations and some other provider relationships that have changed in the product. i always have to remind myself why we are doing this because it is herculian project and undertaking, and again it's to leverage those relationships that we have already forged with provider partners en the community who are doing an outstanding job for the city and county of san francisco delivering high quality care and reducing costs. it's to reduce costs and make the plans sustainable for h.h.s. members long-term. it's an attempt to transform health care delivery by disrupting competition nuances in our marketplace. and it's to ensure that long-term all members of actually california, part of our mission, have access to high quality affordable sustainable

health care. i just wanted to give an update to the board to amend some numbers i had provided last month, we have final numbers in. based on the january 1st trio enrollment, 14,500 members, approximately enrolled, equivalent to $13.5 million in 2018 savings. continued enrollment of that number, 2019 and 20, and beyond, will only be compounded. meaning that $13.5 million for the same cohort or of members will only increase in savings. if you add more membership, it will compound even further. so, updating this pie chart, 62% of all h.s.s. members are using trio providers, and of that 62%,

40% of those 22,500 members enrolled in trio ultimately. >> excuse me, why aren't the rest of them automatically enrolled? >> you know, so we used a logic to automatically enroll members only if every family member in a family unit was using a trio provider. >> and some have 5, 6, 10 different doctors sometimes in a family. >> right. if nine of the doctors were trooi -- trio and the tenth wasn't, they were not a candidate for auto enrolling. we did not want to prompt any relationship changes with physicians. >> ok, thank you. >> so, we have some really exciting updates. we have -- we will continue having bumps along the road and

changes. fortunately today i have mostly very positive things to report. i will get the hard message out first. with meritage, if you look at the pie chart, it does not constitute a large portion of the h.s.s. membership but what we did learn, we did auto enrollment based on people having meritage providers. that is actually divided into three divisions. marin, and two sonoma divisions. the two sonoma divisions would not be part of trio. we enrolled 32 that we should have not done, we moved them back to access plus, we want full disclosure of our learnings along the way.

any questions about that? ok. this is the interesting news. as you know, big change for h.s.s., for access plus versus trio, is that the cpmc hospitals or any center facilities are included in trio at all. and met with resistance from suter, even though they were unwilling to partner with us for trio. once the numbers were in, we had a new dialogue, and it is our hope, always keep in mind, suter is our partner as well, whether you are blue shield or h.s.s., suter is the partner as well. but it does not mean you are going to partner on everything. so, they have, they came back to the table and we have added a variety of sutter facilities to the trio network as a result. and that is effective january 1,

2018. those included the ambulatory surgical centers sutter in san francisco, i have a list here. and a list of the surgical centers in alameda, a little bit of a health care delivery desert, where 580 and 880 intersect, and one ambulatory surgical center in costa costa. we did not really have a need there, i'm not sure why we added that, but it's added. it will not hurt anyone, only an enhancement. what is very notable is alta bates, and the eden medical center are add, and that's 3, 4 hospital campuses added, also where we had from what we perceived, even though the department of managed health care found it to meet all standards of a robust network, we did not like the way the network looked in that 580-80

corridor, we filled that entirely. >> i thought sutter facilities were out, but now they are in. because a deal was made with them or a better -- >> because a deal was made with them. yes. yes. and they were open to talking to us about it. >> jeanette, if i might add, open to it after the numbers were in. ok. so, i mean -- i think that is important to realize it's also important to, when you look at the 13.5 million that we are saving next year, as well as this change, you know, this is a market change that we worked really hard on, even though i know last month we sounded a little whiny and a big open enrollment and heavy lift, but these numbers and happenings make it well worth it. >> and that was the intention of this, to really talk about market competition, and if we

were able to leverage that. dr. follansbee. >> part of the problem was sutter insisted you could not deal with each campus separately, you accept one, they all had to be part of the network and you have managed now to either carve out or whatever term you want to do, some sutter centers without forced to use all of them. >> that is correct, that is correct. 100% of sutter is access plus. 100% in the p.p.o. as well, two name brand networks we have, that is correct. this is an exception. and if we think back to my first slide, it is disrupting the marketplace, it is creating competition, and it is creating change, and at the same time, it's improving outcomes and making plans sustainable and affordable. so, there will be bumps.

this is really positive news. it's a difficult balancing act. >> i understand. thank you. >> along that line, to continue along with the provider partner update, moving on to slide five. oh, we did have our utilization management, we had a series of very in-depth meetings around claims, basically, and how the risk and the claims are performing. and i wanted to go over a couple highlights. the meetings are actually two hours long, and i pulled out one slide to share. so, it's really important for everyone to understand that the risk has increased and that means it's a higher risk to finance. it's costing more to finance, and that's because a term called dxcg, commonly used term in health care risk assessment, and

basically what it does, describes a value of risk to a patient, and we all are born with a one, or we are all introduced into a plan with a one, and then based on claims and combined with demographics, our risk score alters. and so the medicare was really notable is h.s.s. has a very, very, very high risk score, and they continue to get higher. and this is why it is very difficult to negotiate with our partners to take down that risk. >> i would like to ask, is this profile similar to other employers in your book of business? unique to us? i find it hard to believe to be unique to us. >> well that, is exactly what the slide will tell you. so, if you see the dark blue line, and you see it creep up,

that represents blue shield's book of business. so the highest risk employer is at the top of that blue line at the 100% and the lowest risk employer at the 0%. the nonmedicare retiree risk is the golden diamonds. the gold diamond. almost at the 100% level. so, i think there are 3 or 4 other accounts that are higher risk. >> than we are. >> than h.s.s. for early, for nonmedicare retirees. >> that's early retirees. >> correct. compared to other early retirees. the average age of early retirees for h.s.s. is 60 versus 48 for other employer groups. the other notable score is your active score, which continues to deteriorate and part of the result of slight, and it's been

very well managed and this is not uncommon, especially municipal accounts, but the shift of membership out of a network h.m.o. into kaiser, it continues to deteriorate the risk score and we saw that, we saw reduction in membership, a slight, and also saw a slight reduction or worsening of the risk score. this is another reason of, for doing trio. we need to partner with the providers to get the cohort healthier and cared for. so, you can see where h.s.s. active employees compare. and you can see that it slightly, went from 1.47 to 1.59. >> say to director griggs, publicly and to incoming director, each time i've ever seen a slide like this it is a prelude to increased premium

rates in the ensuing year. and so i understand you are just giving us the facts today. >> actually i think you will be happy about this. trio has a cap on this. >> i understand. but each time, the precursor of what's to come. hold on to your wallet, saving money in medicare. so as we look at this, and there will be ample time for discussion, so -- >> i actually did it because i wanted to talk to you about your results as far as costs. and i would -- yes, so, let's talk about while your risk is where it is, let's talk about where your claims dollars are, relative to the prior year period. so, moving on to the next slide, h.s.s. medical trend, 1.3%, i'm going to use rough numbers here, but national trend is 7.5. so, somehow with the worsening

risk score, we are at 1.3. >> i'm sorry, i'm confused. what does the medical trend refer to, what is that? >> medical trend is the inflation for medical delivery. so, it's not just your rents going up here in san francisco, for cpmc, it's improvements in medicine technology, cost of health care, higher litigation rates, the list just goes on. there is so much pressure on this particular sector of the industry. so, medical trend always outdoes inflation. >> why is ours so low? >> because we are doing good things. >> because we are doing really good things is right. that's exactly what it is. it is unbelievable that we are getting these trends. and i'll finish it out, for prescription, it was 3.5%. for active, negative 1.7 for

early retirees, and the national r.x. trend roughly at 12%. so testament to the partnerships. i really did show you that prior slide for this. i did not -- it was not a prelude to opening your wallet. >> ok. >> i'm sorry, just to make sure i'm clear. so, what interval is this trend, is it a monitoring, is it a month, two months, a year, trio -- >> year over year. calendar year over calendar year. >> 1.3% is what, calendar year -- >> 2016 over 15 -- i don't think it's -- no, goodness. i did not bring the snapshot of the time frame. it must be 7/1 to 6/1, 17 over

16. we can't produce these until we have three months of runouts and then present on them. so probably mid year to mid year, 17 over 16. >> really nothing to do with trio, but all the rest of the things happening in terms of looking at services and accountability. >> a.c.o. >> well, you are correct, it does not have to do with the labelling trio but what is trio. 62% of your members are using trio today, and have been now we are refining that and focussing on the partnerships and calling it a product, trio. so, it is trio. and that's produced, just those trends alone, 22 million in savings. >> all right. commissioner lim. >> so, assuming the rest call for early retirees, way higher, but as far as medical trend and

drug prescription which means our early retirees are more healthier probably because we didn't have that much medical claims and prescription claims. >> well, i will say that the risk trend for the early retirees went down slightly. it went from 2.84 to 2.74. it's still that golden diamond at the top of that 100% curve. and i always like to point out when i see fabulous numbers, i don't care if they are fabulous. you -- you already overcharged me x amount and given me 1.3 discount, it's meaningless to me. i want you to charge me the right amount. we know we are being charged the right amount because we exercise so much due diligence partnering with the providers that we look at everything and we have

carrots and sticks that they do charge the right amount. what it is saying, director lim, is that it's being held at bay. those trends are completely counter intuitive to the risk and counterintuitive to national and bay area trends. >> maybe i could say this, part of that probably is attributable to our wellness program. >> i cannot say it would be attributable to the wellness program. and i'm happy, we have an opportunity next month to talk about prescription, and you can see all the various stealth prescription programs in play to manage the high cost drugs. >> at risk, have some created for the wellness program. on the page five presentation, early retirees 60, versus 48.

how did you arrive at 48? that's too -- for the whole -- you could not have early retirees most employers nationwide or book of business. workers retire at age 48, that early, i could not -- i could see for 60 for the city employees, because of the incentives when you become 60 you have more -- the present age of your retirement is going higher. but 48 for early retirees? >> i asked the same question at the meeting, i think it's driven by dependents. so, when you are an early retiree, we take into account the dependents as well. so, other groups are having more dependents who are bringing down that age in that early retiree category. >> accounting for dependents for the city, it cannot just be 60, it could be lower.

most of the city employees retire at age 60 but the dependents are way, way younger and i can't believe it's 60 then, if you accounting for dependents. >> i would ask, rather than trying to unravel this, we come back to this point. if you are talking about the age of early retirees, i don't know what their dependents would have to do with it. i would like to have a little broader explanation about your methodology for arriving at that number. you only become an early retiree when you are, it's nothing to do with the fact my grandmother i'm taking care of or my two stepchildren. >> h.s.s. transmits early retirees along with their dependents and we have to bucket them all in the same bucket together. so we do take into account the ages of the dependents and the more children that are in there,

thousands, it will mix up the ages. >> i understand you're explaining what you do. i'm asking a broader question. why do you do it that way and that would mean that you would have to get into explaining your methodology a little bit more as to why you do it that way. it's not intuitive to me, if i'm counting early retirees, those are belly buttons. that's an early retiree, it has nothing to do with the fact, you know, where they come from and how many kids they have. but -- i would like to have a clearer explanation of your methodology at a later point. >> later point, yes, of course. >> i have one comment and then a question. because the city offers a defined benefit pension plan that doubles in service value when you reach age 60, there's a tendency for public employees to stay until they are 60 years old. i think many other employers don't offer a defined benefit plan at all, they have a 401k or

some other deferred compensation plans. there is no benefit to waiting until a particular time. if you have a, the ability to retire, let's say you know, you can sell your house for million dollars for less than that you bought it for, and look at the overall financial package and the money in your 401ks, then you make a decision based upon your assets and your forecast. for city employees, age 60 is a critical date for just about everyone. my question is, are we the only employer group in trio right now? how many employer groups are there, and is it -- >> pers is not in it right now, they are in a similar version of their own and have been for some time. i can get back to you with the exact numbers. we have had a significant uptick january 1st. >> it was hard for me to imagine

any sutter facility coming back to the table if the only employer group were us. >> it's you. >> even in the east bay, we have that big impact on some of the providers in the east bay? >> i will say that ulta bates facilities are not heavily used by h.s.s. and access plus. those were added in. i was not involved in the negotiations, but they were added in. >> right. >> so you are correct. there is not a huge use there. but they were added in. >> okay. thank you. >> thank you. >> any other questions? any public comment on this item? thank you very much, we look forward to your next update. >> thank you. >> next item. >> item 11, discussion item, update on best doctors, second opinion vendor, best doctors representative.

>> hi, good afternoon. my name is nancy oh, i'm with best doctors. nice to be here. >> what is your responsibility with best doctors, please? >> account executive to health service systems. >> and you have been with us for how long? >> i have been with h.s.s. since may of last year. >> all right. thank you. >> so, what i'm here to do today is, i'm sorry, struggling to get this down near my face. what i'm here to do today is to provide an update in terms of utilization. so, the first time in may when best doctors representative john fisher, vice president of development was here, he went through two months of utilization and it was very premature and today what we'll be doing is looking at the actual closed activity, so the

actual closed cases for three full quarters. one of the things i wanted to cover before we dived into your actual utilization was i wanted to address a very common question that we are getting, i'm sure you have seen the news, best doctors and teledoc is one organization and one of the questions i'm frequently hearing from a lot of clients is basically what kind of enhancements are you providing for members, do you have any technological developments. so i wanted to address that. because best doctors is offered to all of your population, i wanted to make sure to be very clear to say all of our communications that are going directly to all the members speak specifically and only to best doctors because we don't want to confuse any membership. teledoc is a service that is offered, it's the telemedicine through video and phone visits that you can access, if you are

a blue shield of california enrollee. it's one of the benefits that are included inside the blue shield of california plans. so, blue shield of california is driving all of the communications about teledoc access, but the nice thing is that on the back end of behind the scenes, we have been able to turn on a seamless member experience. so, a member who is enrolled in blue shield of california health plans get communications about accessing teledoc, the telemedicine service, and when they download the app or register on the web portal, then they can access all of the teledoc services offered through blue shield of california that in addition to that, they'll be able to initiate a second opinion service through best doctors. so, it's one stop shopping and that's from the teledoc side. so you can see here a snapshot

of a general overview of your activity for the first three-quarters, again going all the way back to january of last year. right here we can see the total number of member contacts and that can be in the form of a phone call, an email, a member portal inquiry. so that's total. and from that, we were able to open 509 cases and at the time that we closed this report, we had a total of 413 cases. in terms of the difference between 509 open cases and 413 cases that were closed, it could be that they were still in progress at the time that we had pulled the report. again, this is just for closed cases we are trying to show you. of those 413 closed cases, you can see that there were 44% of the cases that had an adjustment and diagnosis, and of those 413

closed cases, 87 had exhibited a change in treatment plan. at the bottom of this slide, you can see that we usually like to gather data from the members asking them how they had heard about the best doctor services and we typically only collect the top three or top four ways that members collectively state how they heard of the benefit, so you can here the mailers, we had actually sent out several mailers, so we sent out two mailers this year, in addition to the letter with the magnet, and you can see what an impact that has. we have also been very fortunate to be able to piggy back on one of the e newsletters available, so another avenue to get in front of members. on this slide you can see how your 731 contacts flowed over into the different service

lines. so, from contacts you can see that you had 299 closed cases for find the best doctor services. i'll go over a very quick recap of all the service lines just to refresh everyone's memory. find the best doctor is a physician search and match program. so, say for example someone is looking for a specialist and they want to see the type of best doctors that are available in their area. so, that's one of the service lines that we have available to h.s.s. members. then you can see here, we had a total of two, ask the expert cases that were closed. and ask the expert is basically a compilation of evidence-based data, providing answers to member's questions. so, the member provides some detail about their background, there's no medical records collection, and then we provide some information in the form of a report. it's sort of like doing a google search except you are not doing

a million or 6 million hits of data. you are asking a physician to provide the report to you. the next one is the interconsultation. that is our brand name for what is the virtual second opinion service and you can see that we had actually hit what best doctors had identified as a target, so we had targeted 102 closed cases for quarter three, and we had just hit that number, so that's spectacular. and the last one is medical records e summary. basically that service is collecting a person's medical records, it goes back between 2 to 5 years. we want to make sure that everything is current. we put all of the data into a secure flash drive and then fedex it to the members. that way if they are travelling overseas, or if they are travelling across state lines, o if they are looking for a new physician, all of their current and relevant medical records are in one place.

this slide is basically showing you how exactly we are getting contacted by members. so you can see a lot of the interconsultations, that's the virtual second opinion is initiated through the phone, and i think that that's very usual because there's a lot of questions that typically people want to share, you know, how is your visit, did your doctor say anything specifically or you know, did you have another visit in between the last time we spoke. so, a lot of those cases are typically opened through the phone. again, here is a deeper dive into the second opinion service, interconsultations. in order to provide a good explanation of what the service is, i'll just run through the steps of what happens when a member initiates a service. they authorize best doctors to collect medical records. once we collect all the medical records, we then reach out to a

best doctors in our database to review all of the clinical notes, the pathology, see if we need to retest the blood, and then see if we have missed or omitted or skipped over any medical records. they might be missing. and then we have the expert review everything and write out a report with their findings. they would clearly state whether or not they are confirming the diagnosis, or if there's an adjustment, and the same applies to the treatment as well. expert does the review, writes out a report and the report is shared confidentially only with the member unless the member specifies otherwise. >> all right. i would like to pause, i think some of the slides here are self-explanatory about how you have engaged the population, and that sort of thing. i would like for you to go to the section of presentation that talks about clinical integration for just a moment. >> sure.

that would be slide 14. >> yes. >> whatever you were going to tell us about that aspect. >> sure. so on slide number 14, you can see that we capture the inbound to best doctors and out bound to your benefit partners. so, what we do is we capture each time that we refer out a member to, for example, the h.s.s. wellness team, if a member has any questions about did you know that you have this program available, and the member says no, i didn't know we had that. and then we would provide the information to the member. we also offer to do a warm transfer, because we do realize that if you sometimes just hand it to the member, they are not going to follow through. so we make sure to offer to do the warm transfer for them.

and the same thing holds true with any of the other vendor programs that you have. we don't have everything displayed here, for example. one of the things that we are not displaying on this slide is any of the tobacco cessation programs than could be we didn't do outbound programs. they don't have a case that related to the smoking cessation or referrals. so these are in bound to best doctors or out bound to one of the benefit partners. i'm sure that sometimes it might be a little surprising to see that we have a little bit of lower numbers from particular vendor partners or even from the h.s.s. wellness team, and one of the great things we do is integrative projects or discussions and that we revisit

any opportunities for referral and integration. and so that's ongoing right now. >> i have a question. >> commissioner breslin. >> you have blue shield of california referred to best doctors 0, referred to benefit partners. are you saying that, what are you saying? they didn't refer anybody? >> correct. >> blue shield wouldn't refer anybody, right? >> at the time that we had only just the regular access plus h.m.o. plan, there was not a capability for blue shield to refer to best doctors. however, we are in -- we are having a discussion and process to speak to any opportunities with trio for best, for blue shield to refer members to best doctors. so previously there was not an opportunity for blue shield to do so. but it sounds as if we are looking into opportunities going forward. >> so, it wouldn't be the doctor

that's making the referral, it would be blue shield. >> yes. it's when blue shield is speaking to the member. >> at what point would that happen? usually if you call blue shield, you call -- they call h.s.s. or might call, you know -- >> sure. it could be any number of folks. for example, typically when members are talking to clinical staff about their care or they are trying to get some guidance in terms of the direction of their care or next steps, and it's typically when registered nurse or another clinical staff member from blue shield of california is speaking to the member that you would be able to ask them did you know you have the service through h.s.s. that is free and confidential, typically how the referrals work. >> wouldn't be the doctor, obviously. >> no, it would not be the doctor. >> as i'm reading this chart, at this point, we have blue shield,

kaiser, and u.h.c. as major benefit plan partners with us. so, there has not been an active program to look at provider referrals to you, is that what i'm hearing, or you are just beginning to do that? >> we have done outreach in order to kick start conversations to look at opportunities for referrals and as you can see here, the only provider that was effective in terms of carrying out a referral program was united health care. >> all right. >> then united -- refer best doctors, and then you say referred to benefit partners. so, what does that mean, the seven people went back to u.h.c.? >> no, these are all unique users. so, if we are taking a look -- >> benefit partners. >> looking at the second line, the u.h.c., the first column show