>> the san francisco health system service board is now in order. please stand for the pledge of allegiance. [ pledge of allegiance ] we have a new secretary. natalie? madam secretary, will you

please call the roll. >> good afternoon. president karen breslin. >> president breslin: here. >> vice president steven follansbee. >> vice pres. s. follansbee: present. >> wilfredo lim. >> commissioner w. lim: present. >> commissioner randy scott expected to be here. >> i am here. >> approval with possible modifications of the minutes set forth below. regular meeting of august 9th, 2018. are there any corrections to the meet sng >> yes, in the roll call i share many things with you, madam president, but not your name. so i would like to have it

corrected to read randy scott, not randy breslin. [laughter] >> oh, i missed that too. [laughter] >> any other corrections? no? seeing none. >> i move the adoption of the minutes as edited. >> second. >> okay. any public comment on this item? all those in favor signify by saying aye. all those opposed, no? it's unanimous. item number 2. discussion item. >> item 2, discussion item. general public comment within the board's jurisdiction, not appearing on today's agenda.

please come forward. >> my name is mike delane. i want to start by saying thank you for all you do. i received a letter from kaiser hospital telling me my wife had been taken off my health care. i'm kind of like, what's going on? i got a letter dated the 28th of july telling me to call this number. i called the number. they tell me they are doing an audit. i said fantastic, we need audits. they said you haven't contacted us with the last two letters we sent to you, so we are taking your wife off your health care. i said if you haven't contacted me, why would you do that? they said, well i'm sorry, this is what you are going to have to do. they told me all the steps to do a tap dance to get her back on my health care, which i find outrageous. let me just read you this.

terry lynch delane, ph.d., has been executive director of life learning academy since the inception of 1998 as principle and executive director for the last 20 years. she has provided a community for thousands of young people. primarily youth of color from low-income families living in neighborhoods where violence and instability are commonplace. propeling them into a productive adulthood. dr. delane credits delancy street foundation for saving her life in the early 70's and teaching how to create a healthy community. dr. delane has over 30 years working with substance abuse, convicts, prisons and community programs in 1997 she started a highly successful substance abuse program, choices which still operates in jails in san

mateo, she has a masters from the golden gate university, licensed psychologist and holds ph.d. clinical psychology from the wright institute in berkeley, california. myself, i spent 33 years retired as a captain, san francisco fire department. and i find this outrageous that the people that do the right thing can have people taken off their health care. please do something about it. >> president breslin: would someone like to address this? director? >> i'm abbey, the executive director of the health system and i appreciate you coming forward with this information. we have audited over 25,000 members on whether they are dependents are currently eligible and we have found a number of folks who are not and it is a part of our doing

business, as usual. i know mitchell rigs is sitting behind you, our chief operating officer and hopefully has spoke to you or will speak to you about the particulars of your case, because we would like to understand exactly where the system may have failed you and we would like to correct that. so i appreciate you coming forward. >> thank you for hearing me. i love that thing where people go into military or service in san francisco where i was for 33 years and they say thank you for your service. you know what, we don't really need thanks. what we need is to make sure you take care of us. thank you. >> thank you. >> president breslin: any other public comment? seeing none, we will go onto item number 3, please. >> clerk: item 3, discussion item. president's report. president breslin?

>> president breslin: well, i would like to introduce our new secretary, natalie eckbert, she has been working diligently to get up to speed and had everything ready for today, i'm impressed. i look forward to working with you. i'm sure all the other board members are up to it. thank you. that's all i have to report. public comment on this item? no public comment. item number 4, please. >> clerk: item 4. discussion item. director's report, executive director. >> we have acknowledged and welcomed natalie to the family and also want to acknowledge the heroic job anthony did

substituting while we didn't have a full-time secretary, we appreciated, i'm sure he is glad to not have to be here today. so that was great. i did want to insert, i meant to put this in the written report but we didn't include a financial report today and i wanted to comment on that. first of all, we are at the fiscal year-end close of fiscal year-end '18. that information is not final and will be and will be presented to you in november. the first quarter finances report will also be given in november for fiscal year '19. and then we have two audits under way with kpmg and that will be reported out in december and then the gasb audit will be finalized and presented in december as well. there's a lot of activity going on in finance. but we do not have any reports to include in the public report today.

i will speak to the strategic plan as we introduce that item next. and we will be also commenting during the strategic plan that we wish to have a meeting in october, which i understand is unusual. i have promised mitchell and his team that we will not burden them with the agenda items in the october meeting because they will be very involved in the open enrollment. once we hear the strategic plan presentation, your questions and comments, we will be able to go back and finish those documents and bring them for approval in october. that is the plan we will present later today. we are also putting together the november forum agenda for you. we will be following the lead of the strategic plan in doing

that, as long as we have a laundry list of other items that have come up over the last year to consider how we offer that education to this board. i also wanted to welcome the new members of our team. we have had a lot of activity with our human resource department. we have already welcomed natalie. we have two new benefit technicians. matthew pabry and geraldine la pez. we are creating lists for senior benefit analyst. carrie bashirs has been promoted. i'm not sure if carrie came today. and we also have in well-being a couple of interns who are always a glue to that

department, spencer gillespie and -- >> director, could you pause for a moment. if any of these staff members are in the room, i would like them to stand at this time. >> there we go. >> vice pres. s. follansbee: good afternoon, and i'm sure on this board, i'm not the president, president breslin is, but we are delighted you have come to be with us for a portion of your career. so thank you. >> i also did want to call out in the report and the gentleman who just testified is highlighting the challenges that we have with the dependent eligibility verification audit. we have gotten through 24,467 dependents who have been verified. and we continue to work through an appeals process in trying to reach with those who are

challenged by the decisions not to accept their dependents. so we are working diligently with our consultant and our member services team have stepped in to also aid in bringing this project to a close. and we are particularly concerned about those folks who did not respond, whether this gentleman's case is one we aren't sure but we have a number of folks who have not responded. it's been a challenge for us. we have done multiple mailings, as you see in the director's report. we are now doing phone calls to a lot of these members to try to track them down. so we are really working diligently to try to bring this to a close because those that did not respond were deemed ineligible, did have their dependent dropped as of july 28th. we are able to reinstate them but it's cumbersome at this point and it does take some time.

i do appreciate what he has said and this is exactly what we are trying to avoid is where we have dependents who are truly eligible, they should have no disruption in service, but if we can't reach them, it's very hard to make that determination. so we are very focused on that and trying to close it out before the open enrollment on october 1st. so that's where we are on that. that concludes my director's report. >> any public comment on this item? >> just on the audit itself. and it may be in your report but do you have some quantification of the numbers you were just referring to. you said a number of people who had dependents dropped. is that in the report somewhere or have i missed it? >> what's in the report, these numbers are very fluid and changing everyday.

we have the 550 that are in that appeals process. most of those are getting through but some of them are -- not problematic but challenging for folks to produce the proper documentation so we are working hard with those folks to do that. so those are the numbers right now. >> commissioner w. lim: thank you. >> the number drops daily as we are able to make phone calls. >> president breslin: i noticed there was also a report in the health care value initiative report of who they did cover because there were questions last month about what were they comparing to. >> right. >> president breslin: i would think in the future that these

reports should be more relevant to our population. >> yeah, we have been discussing that and how to do that. we actually had some preliminary discussions on what the feasibility was. the ten county survey in some way. so we are just beginning to explore it because we recognized that disconnect that occurred during that presentation. so we are taking a look at what other ways we might have of providing a more comparable benchmark. >> again back to the eligibility audit. are you collecting data for example on the non responders to find out why they didn't respond. is the database up-to-date in terms of addresses and phone numbers? our members have a responsibility to provide accurate information within 30 days of a change of status.

whether it's residency or whatever. and so it will be interesting at some point when are you able to close it out, where it failed. is there a problem in the way we tried to ask or the questions we asked or whatever? >> i appreciate that. and certainly there are always issues with people remembering to tell us if they changed their address. so we are working on that. and we have multiple addresses on people, we have mailing addresses and we have home addresses which is an interesting challenge that we have. but as a matter of course, we will, at the conclusion of this process have a very thorough debriefing with our partners at the comptrollers office who made it clear they want to be our partner on this on an ongoing basis going forward. we hope we will be able to codify all the lessons learned

and build it in a process that is not a surprise to folks. i did review the member guide that we put out and it's mentioned no less than three times in the member guide but people don't necessarily read every page in that member guide. so we can do a better job, i think keeping people on notice we will do these eligibility audits on a more regular basis. >> just one concern, how do we check for those non-responders. if there are policies with claims or have seen a doctor between july 1st until now? because that's what concerns me most. if the dependents have seen the doctor but the member has not responded, then all of the sudden they will come to us for members appeals and i have

20,000 bills that need to be paid but my spouse was dropped july 1st but my spouse went to the doctor sometime around july or august. >> exactly. and we have a couple of those cases we were notified through one of our unions of someone's dependent had an emergency and received a hefty bill and that was brought to our attention and we were able to correct it but it's the scenario we were concerned about. they either didn't open the mail, they acknowledged they weren't sure whether they received it or whether they just didn't open that mail. and then this brought it to their attention and we were able to correct it. i'm not sure if the claims come in that fast, that we would be able to look and see if people are actually using services on that non-responded list but we will take that back as something we can take a look

at, because that might be another piece of the puzzle we can add to this final push that we are doing as we close the audit period. >> commissioner w. lim: thank you. >> president breslin: i noticed in the latest pers magazine, public employee retirement system, they do it every three years. >> yeah. and i think they do it on a rolling basis where they do like a-g one year h-m and n-z the next year. >> president breslin: any public comment? seeing none. >> i have one other comment. during the course of the director's report you said we wouldn't have a financial report. but i would like to at least have the record reflect we are still financially solvent. [laughter] or affirmed. >> we are.

pamela keeps a good eye on things. >> thank you. >> president breslin: madam secretary, item number 5, please. >> item 5, discussion item, hfhss strategic plan 2020-2023 aon. >> hello, ms. anderson, excuse my voice. abbey, do you want to start with an opening comment or have me jump in? >> the board has been very supportive of hss and aon developing a strategic plan since i've been here and we have made significant progress and i would like to thank commissioners breslin and follansbee for spending two and a half hours with us in great detail and providing subsequent feedback on the plan in its current state.

we are bringing before you a pretty high level overview of the plan to be certain you have an understanding of where we are going and can give us any questions or suggestions on the strategic direction we are taking with the plan. there is a lot of detail behind this that we did not include in the presentation today. although one of the spreadsheets we had delivered to your home, i knew you wouldn't be able to read it on a screen, we hope you had a chance to look at and certainly, we will take comments, subsequent to today as well. we will be flushing out the plan in that greater detail. particularly in the form of a work plan our staff is anxious to have flushed out so we can be certain we are getting the work done because some of the plan does call for immediate action that we will need to do to ramp up to have, in effect for plan year 2020.

so when you look at the plan, it's written from a plan year perspective. the run up to that plan year will be as important as the plan year itself. but we will be working internally on all of that documentation and we will be sharing with you a more flushed out narrative form of the plan that won't just be the powerpoint presentation you see here today. i also wanted to let you know that we had the opportunity to have an all-staff session on the strategic plan. i challenged dr. follansbee, you could ask anyone of them if they knew what the strategic plan was and hopefully they can all say yes. it was a great session, letitia pagan is an excellent facilitator and helped us put together that workshop with the staff and also just this week have done three stakeholder input sessions with members at

large and again we have facilitated discussions and got a lot of useful feedback from our stakeholders and that was a wide range of folks who chose to participate from various departments and both active and retirees. so i think commissioner scott, you had challenged me at one point to see how we could involve actives and we've got quite a few. so it's been very informative. so with that, i will turn it back over to juana unless there's questions at this point. today is really a discussion item. we purposely kept the agenda light so we could have a discussion today on this. and we are hopeful our plan is to come back in october for the approval of the plan itself. >> great, thank you.

as abbey mentioned, board members, leadership staff, stakeholders and outside experts have helped shape this deliverable with their insights and feedback. we also considered some of the macro-external environmental issues we talk through in our june innovation day in terms of really understanding the changing demographic, the unhealthy aging workforce, the escalating cost, fragmentations in the health care system and really the fact while we spend lots of dollars on health care, we're not at the quality and outcomes we desire. we try to take those considerations into play as we thought about how we wanted to define our strategic goals and objectives for the next three years, as you recognize solving these problems is very complex and it will require a multilevel, multi-layered, many times creative thinking and

maybe even leading the way in some of your solutions and approaches. this plan is really intended to also demonstrate some of the near-term issues that we need to solve for as well as the position to address future changes as they emerge in the future related to health care. so as abbey mentioned, the intent of this document is really to provide a high level overview of the mission values and goals of the plan. we will do a much deeper dive in october of the objectives, the actual action items. we have an entire measurement strategy around this strategic plan as well as an operational plan that will bring the strategic plan to life. if we start on page -- if we

look at, i want to kind of define some of the words on the right side of the page. you will see in our vision, the world whole person and you will see that from the document. we wanted to make sure we articulated the whole person, we know as individuals we aren't one particular disease state, we are a person with life and families and health care issues etc.. you will see that word throughout our document. the other word you will see pretty consistently is really supportive programs. we are in a situation where we know that just giving information to our members is not going to create the actions that we would like, so we need to provide supportive programs and services to guide the experience for those members. the mission statement here is the same as it was in the last

strategic plan, so no changes there and we have outlined key core values. and letitia will come up in a few to outline some stakeholder feedback. so i will stop there and see if the board has any questions on this page. >> i'm struggling with the vision statement a little bit and the mission statement. and they might be more editorial than anything else. but in the mission, when we say we want dedicated improving quality health benefits and enhancing the well-being, i would like to insert the word of our members and their families.

>> is that it? >> yep. >> thank you. any other comments or questions? if we move onto page four, this is a high level framework for the strategic plan. as you can see at the center which is anchoring all we do, the vision mission core values. surrounding that are five categories of key goals that we have defined. and you will see in the further document that within each of these over arching goals we have 1-2 specific goals. and you will see we do a deeper dive with those specific goals into specific objectives and then business plans to support those objectives. underlining the plan is the organizational strategy to execute on this plan over the course of the next several

years. i will go into each of the strategic goals in a little more detail. so any questions before i move to the next page? >> having looked at this several times, i think this is a powerful diagram. the icons reflect the category and each icon really tells the story of what our mission and values are. but also that it's all surrounded by organizational excellence. it's easy to read this and think about our responsibilities of all the stakeholders and our members and all that. but it's really the organization of the health service system that actually is going to make this work. so i like the placement of that around it and i think we need to keep that in mind as we go through all this. sometimes we lose the forest through the trees and this is the forest. >> yes, i agree.

the devil is in the details for sure. so the next page, just in terms of format is the strategic goals. and we do make an aspirational statement within each of the strategic goals. and then we have a very specific goal we are targeting within that broad category. so the first one is affordable and sustainable and we are making an aspirational statement to ultimately transform health care purchasing and care delivery to provide quality, affordable and sustainable health care for our current and future members. through value driven programs decisions systems, you will hear the word value quite a bit. and it really is about worth, usefulness and importance. you will hear other words like value-based payments. payment reform and that's really trying to get around reforming the reimbursement system today which is based on fee-for-service.

so you are rewarding for volume versus value. value is a broad description but you will see that theme throughout the document. the specific goal in that category is to design a transparent health equi system that results in higher quality better outcomes and eliminates wastes and inefficiencies in the system. the second is reducing complexity and fragmentation. our aspirational statement is moving toward an integrated delivery system focusing on primary care and prevention and targeting and personalizing care. again you will hear the themes of primary care which is very important. we think the best practices are around team-based and collaboration, where we are having the patient in the center with coordinated integrated care around them.

two specific goals are ensuring we have programs that address the entire health cycle. we are talking a little different lingo, we talk about spectrum and we are kind of used to the linear health. we have kind of modified that to a cycle. you could be well at one time and you could be sick or you could have chronic condition you could have a chronic condition but come back to a well state so we are kind of defining that as a cycle. we want to ensure whatever programs are available address all of the different categories of your health status which is being well, at risk, maybe you need episodic care or chronic care. in order to help really bridge the complexity and the fragmentation we think it's important that a goal is around really operations and processes and procedures to help thread together the fragmentation in the system.

you will hear us talk about how do we help guide and close the gap of those fragmentations. the third goal is around engaging and supporting. and again, we want to ensure it addresses the entire health cycle. we want to ensure that members gain knowledge and confidence in using the health care system and ensuring they actually optimize all of the great programs that are offered today and in the future. we think there are two key goals in that category. one is really, it's partnering with the members. it's not saying you go do, it's in partnership and collaboration with the members and stakeholders to enhance the health literacy of the membership in terms of health benefits. and then of course, we are going to need to provide resources and tools and services to help them make informed choices and decisions and actions.

we know from consumer research in the space of health that members really do want help and they seek help from their plan sponsors in this area. i will stop there before i turn to the next page to see if you have any comments, questions, thoughts? considerations. >> i'm on page five and i'm looking at the engagement and support. and again, i recognize this might be more editorial but it's also aspirational. i think we want to do something more than want something to happen as we are starting that statement and we are asserting certain things under these other strategic goals, we are aspiring, saying we believe in. i would pause it with you we aim to ensure programs services and resources address the entire health cycle and when we are talking about partnering with our members and

collaborating to advance health literacy, i hope that we activate rather than enhance engagement and that's been kind of the bug a boo if you will for a long time. we want people to get involved and we hope they will do the right thing and all the rest of it but we have to kind of nail down some of the best practices if you will, that cause people to act on their concerns in the health cycle, i would suggest. >> excellent. moving onto page six. i was saying aim is similar. >> it's more than expressing a

desire. >> page 6. ensuring we collaborate with appropriate organizations to deliver on the whole person perspective. here the two specific goals are around tailored individualized personalized health choices and experiences that meets the needs of the population and understanding they have different values, preferences and needs and then the second piece is really creating an inclusive environment that values diversity and really respects the broadness of the demographics which include things like generational differences, gender, ethnicity, culture, income and life stage characteristics. because everyone has different values in terms of where they are in their life stage what

types of benefits they need and what types of support they need. the last one is whole person health and well-being. and again here is an aspirational statement about valuing and supporting members and their families' lives holistically and fostering a climate of well-being that will have happier, healthier more engaged population. ensuring we have the programs around the whole person and then cultivating and fostering collaboration with stakeholders to advance positive organizational culture and environment. the second item was really trying to get at meeting the partnership because not all of those items are within the purview of this board when we start talking about some of the environmental well-being and maybe even well-being at the home for kind of a whole person perspective. i will pause there again.

>> i worry about word smithing and trying to get through the document. but maybe we should insert under broad demographics including geographic so we don't lose sight of that challenge. >> thank you. if there's no other questions or comments, i will invite letitia pagan for feedback on these particular areas we just covered. >> good afternoon, everyone. as mentioned my name is letitia pagan, i have been on five

weeks now and i was welcomed on the august 9th meeting which was also my birthday so thank you for that gift. i mentioned alongside abbey i was responsible for design and facilitation of the staff and stakeholder engagement efforts related to the strategic plan. we were challenged by the v.p. follansbee to explore to what extent sfhss employees felt included and involved. we made it our goal to change the lens of the traditional outlook, yes strategic planning is taking place in the board room with the leadership staff, kind of away from all of the staff and membership being reflected. we held an all-staff meeting to explore that idea and increase engagement. we also held three stakeholder sessions. as abbey mentioned we had quite a diverse representation, to name a few, representatives from the city office, courts,

library, firefighters, roofers and water plumber proofers union and actives and retirees. we completed a survey. we had it open about a week after the engagement session with staff, we have some of that data to share with you. and open through next week for data to be shared later as well. one thing we focused on was values and assets segment. the themes are respect, excellence, stewardship, inclusivity and collaboration as a reminder for everyone in the room. we talked about values in relation to how they guide our behavior, personally and professionally. for our stakeholders we talked about how values influence how we pursue health, which dependents we decide to cover. we talked about values how it

influences our motivation, for staff, how and why we do the work we do everyday and for our stakeholders which procedures and appointments we choose to pursue. sometimes the value can out weigh the cost of a procedure. lastly we talked about how it influence our well-being. if the groups respect the values we appreciate it makes a difference in the work we do everyday as staff. and also if my benefits reflect what i value, i'm more likely to pursue them. one of the questions we asked is for them to elect amongst of the five values which resonated the most. they shared experiences as staff members, certain values rose to the top amongst ones they valued among others. for staff members pretty much neck in neck between stewardship and collaboration and for stakeholder stewardship also rose to the forefront but another value trust was very forefront in discussions we had

with the stakeholder groups and discussed how it was incorporated in the stewardship value of entrusting the care of one's health in someone else's hands. the second exercise we did related to the strategic goals, for the staff we really zeroed in on organizational excellence in relation to the strategic goals. as a reminder, affordable and sustainable, reduce complexity and fragmentation, engage and support, choice and flexibility and whole person health and well-being. building a solid foundation in helping members navigate their health it's critical for staff to be reflected in the organizational strategic goals because organizational excellence begins with us. with the stakeholders, we discussed from a member's perspective how sfhhs can work toward each strategic goal. we talked about the criticalness of having the stakeholders reflected in the plan because it was designed

for them, was a resonating theme. some key findings from our staff now, like i mentioned when we had the stakeholder percentages we would be happy to share that after the feedback survey is closed. this is the extent to which our staff strongly agreed or agreed on these different measures. the meeting enhanced my understanding of the process. 59% agreed or strongly agreed. input was welcome. 82%. i felt supported in discussing both positive and challenging aspects openly and honestly, 83%. strategic planning values reflected sfhss as an organization, 83% and the final measure, strategic planning values represented me as a person, 91% of our staff agreed or strongly agreed. when it came to both the

all-staff planning sessions one resounding theme was your voice matters. wanting to put it forefront your experience matters, your role matters, we want you to feel a part of the plan and its creation and the business and everything we are doing moving forward, seeing yourself as a part of that process. for the size of the stakeholder sessions, interestingly enough, we did two sessions at noon and one at 5:00 to afford a little flexibility in the day, we had both larger sessions that filled our conference room and with smaller sessions people afforded an opportunity to disclose more intimate matters about their personal membership experiences that were both positive and challenging at the same time. that size of group afforded that level of intimacy that might not have happened in the larger group. we were glad to see that variation. large group share outs and small group discussions to create those same atmospheres for disclosure.

our charge is really forward for maintaining our commitment to that level of engagement for the future and moving forward involving our partners, our staff and our stakeholders and we would like to extend our sincerest appreciation to everyone who participated to our staff and i see stakeholders here that were just with us yesterday, so we thank you for your participation as well. >> president breslin: thank you. >> may i inquire about the staff. all staff, managers, front line folks as well? >> that's correct. we have about 50 staff members. 10 helped facilitated and at least 50% contributed to the survey so we saw some really good numbers. >> thank you. >> great. lauren anderson.

we are back on page 7. we have a list of guiding principles, intended to be guardrails and guidance how we solve for issues of today and tomorrow. we have identified in just alpha order the guiding principle listed below. there are a few comments that i would like to make on the guiding principles versus reading them. on collaboration broadly in terms of with members and with city departments and health providers and partners in general is required and needed in many of the things that we are looking to accomplish in the future. on the data driven insights it's extremely important but i think you know, what we heard consistently over our conversation the last couple months is relevancy to hss so that's in the forefront of our mind as we think about solutions and programs and services. the other piece that you will

see throughout the document in more detail you will hear us talk about social determinants of health. conditions which people are born, grow, live, work and age. really the socioeconomic factors neighborhood zip code race ethnicity gender income education, housing, food security, etc. and there is a fair amount of research out there that articulates 50% of health outcomes are determined by social determinants. you have yant who could talk hours, she is a deep expert in the area. coming to the forefront health despairities.

abbey did you want to add anything there? >> we recognize this is an area that will require education. we just received an article yesterday or the day before that mike clark forwarded from the actuarial society where they have taken on this matter as well looking at health equity from an employer benefit perspective and we are scheduled to hear from kaiser tomorrow. about their work of integrating the work they have done on social determinants through their community benefit arm into the integrated delivery system. there's a few systems across the u.s. that have really stepped into this, montessori, guysinger. there's a lot we know and solid

understanding we have to solve for some of these problems or we won't get to the root cause. >> social determinants and cultural. >> cultural is part of it. economics have a big part in it. age. where you live. they affect our health seriously and we don't even assess for that. when we don't really know how to assess for that. i was just reading an article about work that's been done in oregon, trying to build in assessments and it's really challenging. it's a cutting-edge kind of thinking but it's a nice merge

that's always been kind of separate. >> san francisco has a diverse population, more so than other areas. >> we need to ask our self hard questions is the delivery of our health services equitable. another article i was reading earlier today about maternity care and health outcomes across different ethnicities and races are quite variable and we need to address that. >> moving onto page 8. before we go into more detail this is a framework from a member perspective, the health cycle and we are trying to make the goals and objectives we just discussed a little more concrete and how we envision those goals and objectives to materialize and benefits programs and services are outlined on this page. so if i could walk you through

this page, the member is at the center. and the member at some point could be well, at some point could need care. at some point could be receiving serious care or have a chronic condition. surrounding each category are types of services, programs, benefit design that are there to support the member in those categories of health. and how they experience health care within those particular areas. the services and programs that would be available to say a member who is well. there would be a lot of things around well being, stress management, a lot of the more preventive care and you will see if you look at the member

who is a patient there are more around condition management, specialty care for some of the complex care. so this is just really an illustration to put it to paper in terms of the concepts we are talking about. >> i like this slide. i think it captures everything in one page. it nails everything down so you don't have to read the whole book so i really like that. >> i like it as well, it's a matter of how it's illustrated and i would like to come back with a few suggestions to you. >> please. for now, or later? >> for later. i'm sorry. i said i would like to come back to you. later.

with some suggestions prior to the next meeting, i will send an email. >> wonderful. i would like to orient you to the rest of the deck. we won't go through that in detail but i want you to, starting on page 11, so what we have done in these sections are to take each of those strategic goals, identify strategies within each of the goals. each strategic goal has anywhere between 3-5 objectives. and then if you move to the right side of the page for each objective we have a business plan initiative of the actions that we are going to take to ensure that we fulfill the objectives. if you move to page 12.

initiatives reflected in the plan year we anticipate taking some action, evaluation discovery. you will see them noted by year 2020-2021-2022. i would like to provide definition for some of the bold cap words on page 12. you will see words like action, pilot and discovery. and it was a way for us to basically indicate action. there's a good amount of knowledge in this particular business initiative so we are taking action to review the options associated with each of the business initiatives. on the categories categorizing as pilot more that make sense and seem to align with our

objective, we need to do a much deeper dive and take a more measured approach to implementing those programs, it's the complexity of that particular action or that we just need to have a much deeper understanding so that's the pilot. and then in discovery, i would take that as more as emerging solutions and so we want to take, again, a much deeper dive and understanding what it is, the relevance it has for your population before we take action to implement a program service or what not. so those are the words there. and you will see each of the strategic goals have these two pages on the following pages. >> the team with president breslin, this is much more filled in than what we dealt with in our two and a half

hours. again, these are not the ten commandments written in stone. this is a framework to think of strategic plans over the next three years. i think the goal is the strategic plan offers not only the specifics but also the flexibility and the focus. so i agree, again the focus on the well-being of the member in all stages. we have to keep coming back, these categories may move and we may be moving quickly from pilot to action or whatever. i hope we don't get locked into thinking this is a time frame, this is too soon, strategic plan says not until 2022. we may have to. i want to remind people to not get too anxious, remind me not to get too anxious about the plan. >> thank you for that clarification and i'm yearning

to ask one question behind all this. where is it, or under what category will be address the sustainability and the future of the city plan. >> i knew you were going there. can i take us back to that 11 x 17? >> yes. >> okay. so the actions we have outlined or the business initiative we have outlined for plan year 2020 are really focused on addressing some of the key issues today. one is the city plan. two is around mental health and behavioral health. the third is really around optimizing the current services and programs that you have. this is just my discussion wanting to ensure we were thinking about what we need

today do for 2020. >> i'm trying to figure out where the strategic goal area this is coming under. >> yes. >> is my question. >> yes. so to answer your question specifically, they are in a couple different places, but for example one area we will look is around actions we are taking with the r.f.p. and the piece that we will look at in terms of alternative ways of looking at your risk pool and looking at different financing mechanisms to address the issue of the inability and debt spiral within the city. they are captured here so that is definitely on the forefront