so 2014 was a year that experience did significantly exceed forecast. since then, we've had varying ranges of favorablity or unfavorablity in the plan, and you can see how that's then cascaded into the continuation of the deficit balance in the stablization reserve for this plan. >> well, they've an been unkmafshl from 2014. >> corre >> -- been unfavorable from 2014. >> perthe presentation, this is on a baseline of about 305 million in $2,017 of total expense in the blue shield program. >> a number of years ago we tried the flex funding method, too, and it didn't work.

we lost money, but it was quite a few years ago, so i don't know. at what point do you keep going? >> yeah. you know, i was actually asking some of those questions when i came in this morning. it seems to me that perhaps in addition to getting information on what other employers are being paying for indemnity insurance, maybe we should get a proposal from blue cross for an indemnity policy to compare with what we have. where we are right now, my understanding is if we move to a fully insured plan, we would -- we would have all the contingent reserves remaining, and we wouldn't need minimum, and the ib and r to handle the tail on our self-insured plans. i don't know that we'd meet all the contingency plan on the

ibnr to phase out of this, so we would have something of a credit, so we could go back to subsidize. i'm not sure it's in our interest to be taking the risk on claims if we can't predict what the cost is going to be and maintain at least a -- something of a break even. i don't think we need millions of dollars in stablization money, but i would like to see it sort of move back and forth a little bit, you know, around zero, and not necessarily be just this -- this black hole, because the black hole is really hard to dig out of once you get into it, and you have to raise premiums so much to, a, cover, you know, your cost of next year, plus fund to get back stablization money. it just becomes a more and more expensive plan which causes

migration out of blue shield and into trio. i just think this starts to argue into an indemnity plan for blue shield. >> we had that same case a few years ago, and it took a while to have -- to payoff, basically, what they were doing within the rate, so, i mean, i just think we should be thinking about it. >> at least have the book, see what it looks like. it seems like you don't really want to leave the flex plan when you've got a giant stablization deficit. i don't see how you would recover that in an indemnity policy, but we want to figure out what we want to do with this in the long run, eventually. >> i can appreciate where you run in a deficit position from where you stand today.

a couple thoughts i thought i would share. remember, plan sponsors of your size generally are not fully insured, and it's because of a couple things. there are components that are built into your felly insured rate, for example, premium tax which is about 2.5%. there's additional margin, risk selection within how the premiums are built up, so generally, you tend to have better out comes from a premium perspective when you're totally insured, because it's based on a trend of how you're projecting. i just want to be clear why we had moved from fully insured to self-insured at that point. to mike's earlier point, when you're talking about a spend of 305 million, you always want to be as accurate as possible, but always understanding it is the actual experience, the members and the plan. you can see a 1% fluctuation

and deviation is acceptable in that plan and how you project those costs forward. when that said, the bigger issue is how are we managing those claims dollars, and historically, i think the sfhss plan is really focused on some of the delivery system things like aco's and really seeing the positive impact of having aco's. there are other levers that we really need to be thinking about in terms of clinical management of those that are chronically ill as well as those that are at different stages of their health plan. and then, there's also other design levers that we should be talking about. i think if we want to bubble that up to broader, you're really concerned about the utilization and cost increases, how do we get under that, so i just want to kind of share that broader perspective, if that helps at all. >> thank you. if i could be -- i think -- in

2014, when we were still self-insured, the premium rate increases was not sustainable. and plus, we are losing members, also, so i mean, the members that we are losing, well, we cannot maintain the members, and so it was presented in 2014 or 2015, with aco coming, so we use the aco model to have more viable experience, plus, we used the 2% profit back from blue shield to buy back the premiums, and that's how we maintain and stablize the number of members. so i'm not sure really which way to go. but had we done -- that other comparison is during -- from 2014. the rate increase was way, way down. i think we maintain below 5% premium increases from 2014.

had we gone to self-insured, our rate of premium rate increases might have gone to more than five, up to 10%, so that's the other way to balance it out. >> yes, and just to note your comment on the first row of my exhibit on page eight, that 8,844,000 is that amount that you referenced from the time you were fully insured. the transition of the moneys from the 2% profit pledge, that did help to sustain the rates for the 2015 plan year. >> and we used that money to buy back the premiums, so our rate increases wouldn't be that much. but had we sustained the premium rate increases, then, we wouldn't have a positive net reserve, and the offset uses in premium increases where we would be losing members, too, and we couldn't stablize the number of members at that time. so that's what we did just to

stablize and maintain the number of members. after that, the number of members that we had for blue shield went up. >> if i also just make one comment, if you were to transition back to fully insured while the contingency moneys would no longer need to be available, theoretically, the ibnr moneys are there to help pay that one out. >> so i'm surprised, too, at the difference between -- i mean, how much active employees are than the early retirees. i would have thought it would be the other way around. that's surprising to me. i don't know how it was last year. >> yeah. and this tiis a new exhibit. we can see if we can try to figure out what that split was for 2016. >> it's quite a bit, yeah.

>> after that exhibit, they'll have more time. >> they're not as plagued with stress. >> just kidding. are there any other comments from the commissioners? there being none, i'm ready to entertain a motion. >> i move that we accept the recommendation of our actuary. >> is there a second? >> second. >> okay. so just one clarification, mike. on page five, so on recommended increase to the deficit of 5.3, that will be added to the premium or we need the premium presentation next month, right? >> correct. and th >> and then, the 3.1 will be used to buy back the presume em. >> correct. so the 3.1 would be included into our rating forecast for

2019. >> as an additional premium. >> no, as a reduction to the premium. >> it's a deficit. we're advertising a deficit. that increases the premium. >> the.3 will be used to increase the premium, but the 3.1 will be used to reduce a premium. >> this is additional money that will be included into the rates, as it has been for the last several years. >> okay. thank you. okay. any comment from any of you? >> well, just to read, i just want to make sure we're clear on this before we vote, that we added money to the premiums last year because of the deficit, and we are adding money to the premiums again this year to further address the increased deficit that -- or the deficit that we have now

because the deficit actually grew, so we're adding money to the premiums. we're not offsetting. if i'm not mistaken, we're increasing premiums by $3.1 million. >> that's correct. >> okay. fine. okay. so we have a motion and a second, right? >> yeah, that's right. we have a motion and a second to approve the rate stablization that mr. clark has presented. are there any public comments? seeing and hearing none, we're now ready to vote. those in favor, please say aye. opposed. motion carries unanimously. thank you. >> thank you. now, we are going now to our regular board meeting.

could you call item seven. >> item seven, president's report. >> so president scott is not here, and president scott, in the meeting during the last two months, president scott requested that the performance be [ inaudible ] and i think [ inaudible ]. >> thank you very much. so there is a summary that has been distributed. i won't go through it in detail. i want to thank the physicians at best doctors, as well as their staff for setting this up, and abby yant for participating in the meeting as well on the 28th. it was about an hour. most of my questions were over

acquisition of doctors, and then, the process by which claims for second opinions are handled. so without going through this in detail, i would just like to say that the -- i think that there was general agreement that the reports that we've been getting which have sort of lumped the minor, moderate and severe changes in either dying s -- diagnosis or treatment was lumped into one number. it gives us a better sense of what our experience has been over the last year when we get the year end report. i would just like to close by saying you know, i asked, what was the value of best doctors in an urban community where there's a lot of expertise in all of the health plans. i don't think we contract -- personally, i don't think we

contract with any health plans that don't have options for expertise. and so they summarized it into three categories, which i summarized in my note here. we're basically fixes to what they see as problems with the u.s. health care system, starting with the fact that there is no unified health record, and so the process of members asking for a second consultation, which is a virtual consultation, of course there's no face-to-face visit, of course is the best doctor, and works very, very hard and is very diligent in documenting and gathering the primary source documentation, including reports, and x-rays, in ways that they feel the health care system in the united states has fallen short and that many members experience difficulty

in aggregating all of their provides. the other thing is patients feel their doctors don't have adequate time in their days to give their impressions and discussions, and they really have an unlimited amount of time to talk about patients who request their services to go over their findings and reports and recommendations, and they extend that to the local physicians, so if a member requesting review, say, a cancer diagnosis, the best doctors provides the ability with the member's permission to release information for the treating phisician or local physician to talk to the overseeing doc or treating doc

in the case. if -- the names are available to our members if they want to establish an independent doctor-patient relationship, they do this on their own, not through best doctors. lastly, i think there's a general feeling between health care delivery, physicians and patients don't always know where the expertise really lies, and that for a particular problem, whether it's cardiology or gastroenterology or neuropathy, well, i liked doctor so-and-so, but i'm going to see that doctor, and that person isn't an expert in this

kind of cancer. so this really allows for the best of the best in their estimation to sort of review the case in a way that maybe patients couldn't navigate and that local doctors wouldn't be able to navigate necessarily because they wouldn't necessarily know where the best of the best lies and how to access them. so again, i think it was a useful conversation, i think i came away with a good understanding of what the services are that they're providing. and again, i think at this point, we'll see maybe more detailed reports when we reevaluate at the end of a year. >> you want to add anymore, abby, based on your meeting? >> no. i enjoyed -- thoroughly enjoyed working with my colleague in a clinical setting. i do think it will help -- this conversation will help design the reports that will provide

more meaning to us in evaluating the services that we're buying from best doctor and allow the board to get a clearer picture in where these interventions are occurring in making a difference. >> comments? >> commissioner breslin. >> oh, go ahead. >> so you -- you still think, after all this, that we are getting a good deal? >> i made no such claim, okay? i do think that this help may understand the process and the issues in the american health care that they're trying to address. i think it's up to the board, based on the reports we get, to decide how those improvements in american health kara ply to the health plans that we contract with and our own membership in this community. so i'm -- this was simply, in my mind, information gathering, and an attempt maybe to get better reports so we could understand what was being presented to us.

but i'm not rendering a personal judgment. >> well, i -- i feel that our members should have the ability to see it. get a second opinion on something serious, and if they can't, with the help of our staff, and especially with kaiser, as presented with, kaiser doesn't always offer that. i think that should be available, because there's nothing like a face-to-face, and if it isn't now, that should be part of our system. that's aside from this, but, you know, there's a lot to be said about seeing somebody f e face-to-face? >> can i respond to that? in every ruling, every health plan has a right for a second opinion or a third opinion. i was in pay for service practice for 16 years before i joined kaiser for my last 16 years, and i can tell you what the process is in both

settings. and i think what they address is that the concern that maybe -- and when i was in fee for service practice and referred people to a gastroneurologist, i referred to a gastroneurologist who was quite good, and i thought who was quite good, and they could access a third access, and i could access a third opinion if i want. there's sort of a level of escalation, because every health care is monitored by the division of corporate practices for health plans. so everyone, including kaiser. so when i was a kaiser doc, i can tell you that i referred people to university of california physicians who i thought would serve the world, the best of the best. but what we'they're saying is that's not always available to members. not that they're trying to provide second opinions when they're not available, they're trying to refine the opinions in a more select way. but everyone has -- i can tell

you -- i can guarantee plan that every health member's going to get up and say we provide second and third opinions, and a process that they want -- they want a consultation outside of our panel of providers that can be you know, listened to, adjudicated and approved. as a kaiser doc, i had several patients approved in that setting. >> commissioner? >> yeah. just looking at the clinical assessment on the first page, it describes cases being judged on a four point scale for none, mild, moderate, major. that would seem to be in a nutshell what we would want to see in terms of statistics back for them, maybe as for doctors as a whole and doctors for members. they also talk about this assessment by a team of 200 member committee. i'm trying to imagine what that must be like.

how does a 200 member committee review every thing that happens? it seems a little hard for me to -- >> in the interest of words, i actually tried to modify, to stream line is a bit. there's not a 200 person committee who review dos each and every consultation, but some of those consultants were not full-time employees of best doctors. there's a system of cardiologists, so they may ask one of the cardiologists, here's the report. do you think there's no change in diagnosis of treatment, mild, moderate, and when they said was their own internal assessment closely matches this outside assessment, so it's a check and balance system as opposed to 200 people sitting around a table adjudicating every case. i'm sorry i wasn't clear. >> do they know the assessment made by the person -- the

doctor, is it mild, moderate or major is it independent. >> this is independent, and this is not made by the consulting provider or doctor who looked at it and wrote a report. this is not this individual's assessment. my final in the report, this was no change whatsoever, this is based on best doctor's internal staff work consulting doc. >> okay. very good. >> thank you. any other comments? >> i'm skeptical of this. it adds millions of dollars to our rates. >> are there any public comment? >> oh, i wanted to thank you, by the way, for doing that. >> oh, yeah. >> good afternoon, commissioners. i don't see your reporter summary in our packets, so

you're referring to something, and we don't have it. and i would like to have a copy of that. i have members in raccsf who regularly praise the results that they have had by using best doctors consultants, and one who has just undergone some very major surgery, and her treatment was alternated as a result of this consultation and has resulted in, she believes, a much better outcome because of her specific condition. i'm sorry. i didn't introduce myself. claire chlusky. thank you very much for doing the research, and this is a benefit that a lot of members have been encouraged to apply

for, as well as the record keeping part. there's more than just the benefit of the consultation. there's a matter of establishing a -- i guess a unified record source and our members have been encouraged to utilize that benefit through best doctors, so thank you. >> so i think could we post that on their website as part of the president's support. >> yeah. >> thank you. >> i have a couple extra here. >> are there any other public comments? there being none, let's go to next item. >> item eight, discussion item, director's report, executive director yant. >> thank you. good afternoon. i'd like to begin my report by asking marina colloredge to step forward and make a repeat presentation where her team was selected as a winner for the

2017 data and innovation awards in the category of mission impossible, and mitchell and i had the opportunity to go and see marina and the team accept this award, and her presentation was outstanding, so i hope you can sit back for a moment and enjoy this. >> thank you very much. marina colerich. this is the second annual, just some back story, second annual data and innovation awards presented by the city, begun by mayor ed lee. the audience here necessarily isn't immersed in the kind of work you do here at the health service board, so some of it was trying to introduce them a little bit to who we are and why we do things, and then, the systems work since this was a data and invoe vatetionovation

>> and there's a presentation and like a lot of our presentations, there's animation with it, so i encourage you to keep an eye on the screen, if you can see it. i'm going to try and make that big screen go. all right. and what you're seeing on this first slide is just a listing of all the individuals involved in making this project happen, which involves the slick character implementation that we did for the 2017 plan year, and we work closely with the systems division of the controller's office who has overall responsibility for the peoplesoft system, and here at the health system, we are the administrator for the benefits administration module, so the team on the left is from the health service board that were involved in this project.

all right. a little bit about us, we administer benefits for four employers, and we sure over 120,000 lives, and annually we go through a rate renewal process as you're doing here today, and when the rate renewal was coming in for the 2017 plan year, we were seeing a 13% increase in the medicare population, which was going to be a 15 million increase over the previous year, and you all knew that was not sustainable from a budgetary standpoint. back to the drawing board, eliminating the blue cross blue shield plan, and negotiating better rated for our united health care. that was the good news of what had happened that year. but there were some unintended consequences, so before i get there, a little health care

101. if you would like to enroll in health coverage through the system, and you would like to add maybe your spouse or your children, if you enroll in blue shield, they're enrolled in blue shield. we don't do mixing and matching. the way it looked in our premiums here, if you are a medicare retiree, and you had a non-medicare enrollee, you were spending $373 and change. if you were in united health care, your portion of that was $457 and change. likewise, if you had two or more non-medicare dependents, you were paying $102 less in blue shield, and then, we eliminated that blue shield medicare plan. so the question became, really, with the elimination of that plan, how did we minimize the financial burden to the medicare retirees that had non-medicare dependents, and you probably all remember those

meetings back last june, but going back to the table, working with our partners at blue shield and united health care, we did the unheard of, and we went ahead and went with the split carrier offering where we are in fact now dividing members of the same family between blue shield and united health care so that mixing and matching is now on the table. then, we got to the hard part, which was how do we make that happen? so a little bit about peoplesoft, and what i -- side cars go where the drivers go, and what i mean by this is if you think of a side car and the retiree or the employee is the person driving the motorcycle, and their dependents is the person in the side car, they're going in the same direction, and we wanted to put them going in different directions. so in peoplesoft, we created two subscriber records in the system. and sometimes we want information with that second

record, and other times, we want to suppress the information in the second record, but the devil is in the details. it sounds easier than it is. this flow chart, that gives you an idea of the benefits module of peoplesoft, which is very complicated. when all is said and done, the work we had to undergo to make this actually happen in our system is to start with, we added a plan pipe. [please stand by for captioner switch]

-- considerably less than the split families being in the united health care option. >> thank you. thank you. congratulations to the team. yeah. entertaining and educational. >> i like your little side car here. >> that was great. so, moving forward with the director's report, i am, i

guess, coming up on my fourth week on the job, and enjoying it thus far and still drinking from the fire hose, the team has been fantastic and spending a lot of time orienting me and training me in the world of the health care business that i am now responsible for helping lead. mitchell has been fantastic, i really want to call out, i know he has had several jobs for several years and is, i think, enjoying one job, although he's not completely free of me yet. i do appreciate that. one of the charges that president scott and the board explained to me as i was coming on board was the need for a new strategic plan, so i am looking at how we may go about doing that in the very near future and hope to describe that process to you at the meeting next month. the -- also next month will be a

very full agenda. we will be doing a deep dive into the united health care city plan that i know you are well aware of the challenges that that continues to present to us and we are going to roll up our sleeves as a team to come to you not only as the challenges but hopefully some opportunities that will allow us to sustain those plans. as you also know that we have the actuary consulting services contract out in a request for proposal stage, and that r.f.p. was issued on february 9th. we did have a meeting where we entertained questions from the potential, from the interested parties, those who may pursue submitting a full proposal and others who may or may not. deadline for those proposals in

to us is on march 23. so, and we expect to issue a notice of intent to award by april 30th, this is a very aggressive timeline as i'm sure you are aware. and we have in the meantime worked to execute an amendment so they will be on board through september that will allow an overlap of the -- will allow a smooth transition should we be needing to change services. so, i think the contracting team has done a fine job of laying that all out in a very clear manner, the r.f.p. was very detailed and i think should bring forward some really healthy proposals that we will entertain. the staff reports regarding operations and enterprise

financer will be speaking in a few minutes. communications team also, you know, helped put together that ten-county report, so, we do have a communications team in place to staff and they are stepping up to do work as it comes. the ten-county survey was one of those products produced. they are supporting stephanie and the well-being team and are looking forward to the year's work ahead. the only other thing i would highlight in the report is there was a few other follow-up actions as a result of questions that came from the prior board meeting. the blue shield drug tier presentation, we are working with blue shield to come back to the board at a future meeting to better explain where things are

at there. we have a lot of questions that we want to work through with them prior to having that presentation here. we also did receive some information from delta dental on their approach to working on the opioid problem and we have an opportunity set up to work with them as well to get a deeper understanding of what they are able to do and how they are working with their members. but we did put in the packet some attachments on some other issues. the diabetes prevention programs, the nutritional counseling, cataract surgery and hearing aid benefits. anne helped us put together a compare and contrast of those benefits across the various carriers and so i hope that answers at least on a high level

some of the board's questions about what services are available and how they are presented by the different carriers. there's -- the one program that i know commissioner breslin has spoken to on the nutritional counseling programs, you know, both -- i have a lot of questions on that myself that i think that this is an area that we can get a better understanding of what's really available because it does seem at the surface that nutritional counseling is pretty much available on a very limited basis. and so we want to understand how that plays into -- into health and wellness for these services. let me pause there and see if there were any particular points or questions about those responses to your questions. >> i noticed on the diabetes

prevention, united health care really doesn't have any. it seems to be after you have diabetes that they have programs. but i don't see where they have any prediabetes programs. and i don't -- i know they don't have the ability to go to see a dietician. by nutrition counseling, that's what i mean, like a one-on-one to a dietician. and i know there's a difference between a dietician has a certification, and nutritionist, i don't see anything they have here, and i'm wondering why. but blue shield says they have prevention program. and another one-year for members, which looks pretty good. and yeah. so, i don't know.

yeah, just my comments. i would like to know why they don't have prediabetes programs. also in working on a plan and director, this will be for the early retirees and the actives in the city plan one, right, we are looking at what we are going to do with that plan. but i do want to make sure you refer to the charter, which is our constitution, which says quite clearly that the intent was to provide for the same health coverage to retired persons and spouses as to, as it is for actives. aside from union negotiations. so, that has to be kept in mind, because that is the intent of the charter. >> thank you.

>> and lastly, in the director's report is a worksheet that describes the co-pay and deductible benchmarking that anne put together as well that shows the variations that exist currently today. so hopefully that answers that question as well. >> thank you. are there any comments from the board? thank you, you survived your first -- are there any public comments? >> dennis krueger, active and retired firefighters and their spouses. i would like to step aside for a second and recognize the director, the two women

commissioners, all the women in the audience who do the work every day, participate here and everything else they do on this women's international day. with that, i would like to ask the commissioner, excuse me, the director on the last, second to the last page of her packet, there's a discussion about hearing aids and how you, united health care will not use costco. and i wonder if she could explain that a little more. i understand about the certificates, but at the bottom there is a -- something that says they go around it with other vendors. and so if she could answer that, and then i have one more, and i'll just finish with this. in your discussions with kaiser, if it would be possible if you could ask, excuse me, not kaiser, delta, if you could ask them if there's a possibility they could have a two-tier

retirees dental plan, which would be elective if they wanted to go to a higher level, i don't know what the top number would be, but i would like to see if it's possible that delta could put out a few proposals. thank you. >> thank you, dennis. >> i just have one question. does kaiser have a hearing aid benefit? >> yes, yes. i'm not sure if you have the same thing that i do. >> is that towards the end? >> yeah. i had it separately. do you know if this was in the -- might have arrived late. let me just say what it says. kaiser, blue shield -- this is hearing aid network and benefit.

blue shield does not have a network it allows any vendor providing hearing aids to be covered, including costco. all claims subject to the limit of a 2,500 per ear per member every 36 months for hearing aids and ance larry equipment. kaiser active and retiree, 2500 allowance for each ear toward the purchase price of the hearing aid every 36 months. more detail. and then united, contracting requirements include a provision that the provider has a medicare medicaid, and a business practice of united health, i'm sure on how they do contracting. but their benefit pays up to 2500 per ear every three years.

it's on there. >> yes, it's on there. >> ok. >> if you went to costco and you were in blue shield, how would that work? just bill blue shield? >> you know, i'm not sure. >> ok. >> anyone here knows that? >> adam gunther with blue shield, that's right, they would just bill us, $2,500 per ear per member every 36 months. >> good deal. >> good afternoon, heather chianeo and shannan huf, the diabetes, you probably all remember that real appeal is a program that united health care

is launching, it's for medicare retirees, active and early retirees, and that is the clinical weight loss management program for certain b.m.i., and also co-morbid, prediabetes, diabetes, heart disease and other. so, stephanie and the wellness team is working with our team right now and she just gave us an update that is looking to launch in march. so, that will be communications and availability to everybody in the united health care plans as a new program that does also address the prediabetic, and diabetes disease management, but you are right, that wasn't pre. so for the early and active retirees, the early appeal is at that program. and shannon can tell you about a prediabetes program that is being launched april 1st for medicare retirees. >> just for medicare? >> correct, for medicare. >> so, effective april 1st, we

will be launching a new diabetes prevention program. the goal of that program is to prevent individuals with indications of prediabetes from developing type 2 diabetes. the program will be in community and health care settings through lifestyle coaches, trained community workers or health care professionals will be the ones delivering that program. the qualifications are that you are enrolled in medicare part b, you have a b.m.i. greater than or equal to 25, or self-identified asian with greater than or equal to 23. and you also have to meet blood test requirements and not have end stage renal disease. so, more information will be coming but that is being launched april 1st. >> so you have to have certain qualification to get into that program. >> correct. you have to have your b.m.i.

qualified and your blood test, your -- >> can't just go into the program because i want to learn to eat right or prevent it? >> correct. you have to be at risk. >> we need something for everybody to just learn how to eat right. just should be open. not as though it's going to be tons of people going anyway, it's hard to get people to do this, but it should be available to everybody. >> and i would just add in addition to that, city and county of san francisco, besides the programs we have talked about, don't have a prediabetes program, but there are some that are available with united health care so we could provide more information about that. the real appeal is part of what takes care of the prediabetics as well. >> where would the facilities be, where would they be held? >> real appeal, members will call in and work with an intake provider so it's counseling done over the telephone and through coaches.

so they are going to self-identify when the b.m.i. is, weight is, predisposed conditions and be qualified into the programs and work with the coaches and then there is the kit that they can receive to help them with their weight loss goals, healthy eating goals, things like that. so, we can certainly provide full detail, but stephanie and the wellness team is working with that. >> no face-to-face. >> no, not with the real appeal program. >> can i ask one more question? about the end stage renal disease. if you get a kidney transplant, are you out of end stage renal failure then? i know they struggle with. >> after a certain point, yes. removed from end stage and you are like ok. >> i just went to a seminar, going to a seminar, metabolic syndrome and you can't fix health care until you fix diet and it has to be preventive, you can't wait until everybody has the symptoms. probably half the population does not know how to eat because

of the things going on. yeah. you really need to look at one-on-one. thank you. >> any other public comments? all right. there being none, you have anything more? ok. let's go to the next item, please. >> clerk: item 9, hss financial reporting as of december 31, 2017, pamela levin. >> pamela levin, chief financial officer, the report in front of you summarizes the actual revenues and expenses of the employee benefit trust fund and the general fund administrative budget through december 2017 as well as the fiscal year ending

projections for june 30, 2018. in terms of the trust, we always start with what the fund balance was as of june 30, 2017, and that was 72.5 million, based on six months. we are projecting a year-end balance of 71.3 million, which is about 1.7% change. we continue to see unfavorable claims experiences for the medical plans and favorable claims experience for the dental plan. we received 2.3 million in pharmacy rebates from blue shield and 300,000 from united health care, and we are projecting a savings in the $3 budget, the health care sustainability fund. no performance guarantees have been received thus far and we

have approved two additional reimbursements with the adoption surrogacy assistance plan, brings the total span since inception, $78,000. amount of -- and savings and salary and fringes. any questions, i'll be glad to answer them. >> any questions from the board? thank you, pamela. are there any public comments? >> thank you. >> there being none, almost done. item number ten. >> discussion item, report on network and health plan issues, if any. >> plan, reports.

>> shannon hof, united health care. i wanted to address the co-pay questions that came up at the last board meeting. before i start, in general, every renewal cycle you can choose to adjust benefits, either up or down. so i just wanted to make sure that you are aware of that. for the medicare advantage p.p.o. plan, the exercise we went through when we built that plan is to create actuary equivalent plan with the city plan. so when we did that, we looked at the benefits in question were acupuncture versus physical therapy. when we did that, we set the acupuncture member cost share at $15, which is the same as the

specialist co-pay. when we looked at the physical therapy, the cost share in the city plan, the co-insurance, 15% co-insurance was actually more than the $15. so, that's why there was a cost share at 25. and then the third benefit that was questioned was urgent care. and in order to encourage people to use the appropriate level of care, we set the urgent care visit in between the specialist co-pay and the emergency room. so, it's at $35 versus 15 and 65 on either end. now for this upcoming renewal cycle, we are going to price out some changes to those benefits, based on feedback we have received. so, we'll be presenting that in the coming meeting. >> so we want to encourage people to go to urgent care. that's what we all have talked about. >> we do, over the emergency

room. >> right. >> versus emergency room. so, yours is 35, and blue shield is 25, and kaiser is $20 co-pay, what i brought up before. >> we'll be looking at that. >> and equivalent to the city plan when we built the plan originally for 2016. >> city plan and went to a physical therapist, i did not pay $25 usually, by the time the medicare picked up usually it was, it was less than $25. almost all of them are less than $25. that i, all my visits i ever had, yeah. so. >> so we'll be looking at that for the renewal. a couple of benefits based on feedback. >> physical therapy is covered by medicare, the other two are not. i thought it was strange, more than acupuncture and chiropractor, not covered by medicare at all. so -- >> right. >> that's why i was -- i thought

it was kind of unusual. >> before you go, the d program for diabetes, in response to the new medicare program? >> it is. >> i wanted to be clear. any other questions? thank you. >> are there any other health plan reports? any public comments? >> herbert wiener. because i am the united health care p.p.o., i noticed a contrast between urgent care and the care i got under blue shield. it's $10 more, and under urgent care, with my brief experience, i saw a nurse practitioner and not an m.d. as i had seen.

so, what's happening, seems like a higher cost and possible diminishing quality of service, although i don't mean to trash nurse practitioners at all. i think they are very important. but you have to have parity of service and costs for all plans. that's what i would like to see. and physical therapy should be $15 if at all possible. these are the changes i would like to see under the new costs and benefits for the following year. thank you. >> dennis krueger, active and retired firefighters and their spouses. on my ongoing quest to understand cataract surgery, for every question that i've had answered, i now have 15 more questions. but one thing that comes out is that there has to be some kind of a cost sharing system between

the patient and the insurance or providers for this service. i'll give you one example. situation called a white cataract. it's a cataract that a surgeon can't see beyond the outside layer of the patient's eye, patient can't see out at all, it's all opaque. laser makes that surgery almost perfect without any exceptions for problems to appear. our insurance companies only pay for a surgeon with the scalpel. the surgeon can't see into the patient's eye so half of it is a guess. an educated guess, and a larger chance that something could possibly go wrong. i also found out that none of our providers offer laser

surgery as a general benefit. all the costs go to the patient. i understand that the board, or excuse me, the members of the actuaries and also the employees on the board are looking into this a little better. but this is something that needs to be done. the people who need the surgery the most can afford the best surgery possible. you know, it just -- i talked to my surgeon today. it breaks her heart, she tells me, to see someone come in with a problem that the laser would fix, no problem. but yet she has to use all her skills to perform this surgery with some more chance of something going wrong. so, please, look into this if you can and hopefully we can come up with something with both the insurance providers will be

happen and the patients will have a chance to get the best possible surgery they can, at least at a shared cost. thank you. >> i have a question. i saw printout where it showed united health care and blue shield, you had the option of a scalpel or laser. but now dennis, according to dennis, that option was not available to him. laser was not available even though he went to united health care. is that correct? [please stand by]