meeting to a close. [ gavel ]

>> health services board will now come to order. please stand for the pledge of allegiance. [pledge of allegiance] >> madam secretary, roll call. >>clerk: roll call. [roll call] >> action item number one,

please. >> action item number one, approval with possible modifications of the minutes of the meeting set forth, regular meeting of september 13, 2018. >> are there any corrections to the minutes? >> i would like to offer one or two. i would strongly recommend that we put page numbers on the minutes in the future and with that in mind, i'm going to refer to what i believe would be page 3, at the top of the page, above your first bullet. there are two audits in process with k.m.p. -- kpmg that will be reported at the december 2018, i presume, meeting, and an update on the gatsby.

it's general accounting standards board. so meeting and correction on s gasb, along with page numbers. >> thank you. any other corrections? i submitted some corrections earlier that will be reflected in future minutes. is there a motion? >> i move we adopt the september 13 minutes as edited. >> i move. >> second. >> all right. any public comment on this item? no public comment. all right. all those in favor? [voting] >> opposed? all right. item number two, please. >>clerk: item number two, discussion item, public comment on matters within the board's jurisdiction not appearing on

today's agenda. >> my name's richard rothman. i've been in health services since i started with the city in 1983, and i've just run across some things that are quite disturbing, but first, i want to thank kaiser for saving my wife's life. she's still in the system, but i oh, a big gratitude for them. but the not so good part. i just got an e-mail yesterday, kaiser listing their standards of service, and that they're supposed to answer telephone calls within ten minutes. well, the two times that i've called the resource center, it's been over ten minutes, and once i got them, they're very nice. and the other is the durable

equipment, and my doctor ordered some for me. i waited two weeks, i left a voice message, called. so the first time, i decided to wait on the phone. i waited 45 minutes, and when i got a human being, they didn't even open my doctor's e-mail for the equipment that i wanted. they didn't have the right one, but still -- and then, when i called the second time for my wife, it was about 25 minutes. and i've complained, but i think if it came from you, i think we're still the second largest group in kaiser that you could make some changes. and i did call, and the first person i called told me that mitchell wasn't there. he didn't know who he was, but i'm going to talk to him tomorrow about it. but the other thing is i put in a sunshine request and never got

an answer to the e-mails or phone calls. i guess they're working on it after i have to call the sunshine task force. so i would recommend maybe the staff and the commissioners get a briefing on -- about the sunshine ordinance and how to implement it. and thank you. >> diane ehrlich, retired uesf division. in the book that we got for open enrollment, it said about that smile away open dental plan, see pages 25 and 26, but there's nothing on it, no explanation of what you have to do. and i was told by my friend that i need to get a letter from the

doctor, the dentist, take it to delta dental. i just wanted to verify that that was the correct procedure. >> is that -- can anybody answer that right now? mitchell, delta dental, would you like to come up quickly? >> good afternoon. i'm iliana desoto with delta dental. basically, they just need to log into the system, indicate what conditions they have. there's a set of five different conditions, and once they indicate that, they won't -- you'll need to indicate on there your physician information -- name, telephone number -- but after that, you're enrolled in the smile away program. >> so you do this on-line?

>> correct, it's all -- [inaudible] >> may i have, diane, would you come back to the microphone so that everybody can hear you? thanks. >> if you don't have kaiser, you don't -- most people don't have a phone number for your physician because you just get the call center. >> right, and that's -- that's perfectly fine. you can certainly just put on there that your physician's name -- >> can you come forward to the microphone? >> yeah, so you don't need to -- if you don't have their phone number, that's fine. you can use kaiser's just toll free number, as long as you indicate the physician's name on-line. if you don't have access to the on-line, you can contact our customer service line, and they can do the enrollment for you. >> okay. this has been said here today. my concern would be how do we communicate this more broadly to others that are going to be

dealing with this in open enrollment? >> yeah. we'll take this back and add some information to our processes. >> thank you. >> i'm a temporary helping out sharon who's your account manager, so i'll make sure she knows and she can reach out to the appropriate people. >> thank you very much. >> thank you. >> okay. >> good afternoon, commissioners, claire zavonsky, retired workers of the city and county, zcsf. i just wanted to thank lisa o'campo and all of the staff that really worked hard at helping us put together a really incredible fair yesterday at the scottish rite rcsf. i actually saw a few active employees coming in because they were in the appropriate uniforms

of their positions. so i don't know how many flu shots we gave out, but i think that just about everybody got them. and it was really a well put together and very well organized health fair, and i just want to thank the health service staff, mitchell, abby, lisa, and everybody from well-being that participated yesterday. it was wonderful, and we even got some exercises in. so it was a perfect day, and we thank you all very much and look forward to next year, doing even better. thanks. >> okay. any public -- public comment? public comment closed. item number three, please. >> item three, discussion item. president's report, president breslin. >> i have nothing to report. is there any public comment on this item? all right. item number four, please. >> item four, discussion item, director's report, executive director jand.

>> good afternoon. it is open enrollment month, and i am informed as of today, we've had 3,757 calls, 1,068 applications have been received. over 400 of those are already processed. we had good news, too, early on, about the self-service. folks were using it, and that seems to be going very well. haven't had any major glitches with the self-service, so that's very promising, and we'll keep you posted on that. we will, today, be talking about the strategic plans and i'll skip over that. and what i would like to jump to, though, however, is the november education forum. we did receive feedback from -- on a survey that we sent tot board members about what topics would be of interest to this

board, and about 70 to 100% of the ratings vary from interested to extremely interested in. one is under the rubrick of care navigation, health care navigation. the second is primary care medical homes is the second topic, and the third is pavement reform, so we're working on getting subject matter experts to help us with our presentations on november 8th. and so that's -- and the other subjects, there really wasn't a -- they were all pretty tight across the board. so we have many other topics to learn, and we'll look for ways to integrate that into future board meetings throughout the year. t the -- and also in your packet was the list of all the farirs

and the outreach that the department is doing. there's events daily throughout the month, so the staff is super busy, and i have to say that they seem like they're enjoying it, and i stopped by. our beautiful lobby is quite full very often these days, so -- and we've got some of the newer staff that are on board or acting as receptionists, and we've gotten some really great comments about their ability to make people feel welcome and comfortable even though they come in and do the math and figure out how long they're going to need to wait, they seem very satisfied about what's going on there. so we're still wrapping up the dependant eligibility verification audit, and we did bring that in house, and are working on the -- on the final

appeals process that we're in sort of a second appeal stage. we are also considering how -- what we do with the folks that have not responded to the audit. we have had concerns about people who have found out about it very late or found out about the fact that their dependent has been dropped after getting a bill and used services. that's always unpleasant and disconcerting, so we're taking all that into consideration and intend on providing a full report to this board in december on the whole process and the lessons learned and what our recommendations will be to address this concern on a going-forward basis. and i think that's it for the director's report for today. any questions? >> any questions?

>> yes. so the report in december will also include the resolution -- how those issues were resolved, when people missed the deadline for including the dependent and got bills and all that, so there'll be a full report on that, as well? >> yeah. and to date, correct me if i am wrong, mitchell, but when those things have been brought to our attention and we've been able to receive adequate verification documentation, there have been reinstated back to the july 28 date. >> good. >> all right. any public comment on this item? this is the director's report. come forward. >> yes. i thought that was a very good report. i thought it was really good to have a chance to talk to -- >> could you identify yourself? >> my name is mike delaine. retired fireman, fireman for 36

years, wife kicked off the health care. i also want to give credit to mr. riggs. those are the only two living people to contact me. now, i understand, there's a problem in trying to get the people who have done bad on health care to try to weed them out, but the people who have done good, myself being one for 36 years, i think it's a tragedy, even if you affect one person out. hundreds of thousands of people -- out of the hundreds of thousands of people that are affected by health care. you guys have a member statement that say we are committed to members, we treat members with respect. we are responsible for our work. i'd like to know who was responsible, but i really like the last bullet point, where it says we have fun and we maintain our sense of humor. it's not fun for me to maintain my sense of humor when my wife it taken off the health care.

abby, i know you have a tough job, but if you affect 100,000 of the people doing something wrong, that's something. i've run into eight people in the last month who have been kicked off of health care. not trying to find them. as she mentioned earlier, one of them was a person that broke their hand, wife didn't know she was kicked off until he received a bill. so please take a look at this, hopefully, this won't happen in the future. thank you for having the patience to listen to my pain in the butt self. thank you. >> thank you. next public comment? >> nice new cell phone. this is my week. found a laptop yesterday, and a credit card, and a cell phone today, hey, hey, hey. got a new job. i just want to -- claire zonsky.

i just wanted to mention that one of the problems that i had when i was on the board was a lot of times, members don't open their packets, and they don't open their mail, even when it comes -- says it comes from health service. we send out those notices,

letters, and it's clearly identified from us, but people put it aside. they'll get to it later, and later is when they get the bill for services. but the reason i really came up here was that little brain farther here, i forgot to also -- brain fart here, i forgot to also say for all the vendors that were there yesterday, we had u.h.c. and kaiser, we had both health service open enrollment, and well-being, we had delta dental, v.s.p. best doctors showed up, and that's always interesting. then, we always have something with regard to retirement. all the vendors, everybody had a very full day, and i just want to thank everyone for coming to our open enrollment, and also remind us that whatever it takes, i don't know. we've made the envelopes flashier, we've put notices onto open immediately. i think health service has done all it could to attract attention of our members to open those envelopes when they arrive, and we'll just keep on doing what we do, but thank you all. i know it's difficult and trying for the staff, as well, but we appreciate all the efforts. thank you. >> all right. item number five, please. >> item number five, action item. san francisco health service systems strategic plan, plan years 2020, 20 -- technically 2022, my typo, executive director yant. >> good afternoon, again, commissioners. thank you for having us here today and meeting in october. i know this is not usual, and appreciate your attention, and allowing us to come forward with final recommendations for our strategic plan for the next several years. this has been a -- a really terrific process that we have gone through, and we acknowledge in the front of the report that, you know, it's really taken a village and really helped us out kicking off with the blue sky date back in june when our heads were filled on subject matter experts, all the new innovations that are taking place on health care. we -- also, then, we took that and our leadership term at sfhss met many times over the ensuing months to consider all of that information and the work that we

had before so that we could design this strategic plan. and then, also, towards the end of the process, we also took the time to have all staff meetings on the strategic plan to ensure their input and that staff can see their role in the input plan and also did a number of stakeholder sessions with some of our members to get their input. and that is very informative and very well received, that people were being invited in to talk about what is important to them. so the process has been very comprehensive and has taken a bit of time, but i think it always yields a stronger product when we all work together, so i do appreciate the board helping us kick that off last june. and so we'll -- i'll just walk-through the plan. there's -- that we changed the format rather dramatically since you last saw this, but the content is essentially the same with some edits here and there, so i'll just walk-through it at

a high level and give you the highlights. and then, subsequent to me talking, laticia here at our side will talk a little bit about the work that we've taken this into sort of the next phase of implementation and developed a work plan with our team on how we'll carry out the developments in the strategic plan, and then, also, subsequent to our presentation, you will also hear from pamela on revisions to our sustainability fund budget midyear that we are -- and this was very much a surprise to me. i come from a rather austere environments where i'm used to doing strategic plans without a budget, so it was really sweet as we got through this to realize we had some funds that we could reallocate and use it to realize some other objectives in the plan, and i look forward

to hearing about that, as well. so in the plan, we did restate the mission vision and values that -- the mission and vision is a restated from prior strategic plans, and then, we revisited or values and restated them as the way we're feeling them today. respect value, inclusivity, and collaboration. if you go to page four of the strategic plan, we have our -- our graphic design has been very helpful to sort of take a snapshot of how we take the strategic plan, the mission cores being in the center, peace, the strategic goals in very short form read affordable and sustainable, reduce fragmentity and collaboration, our membership, recognizing that choice and flexibility is very important and really taking a look at the whole person in

health and well-being. this is a big shift in the way that we do our work of looking at people solely when they're ill or injured. we look at them across their life course. as the health system really takes care of people from early days of active employment and well into their senior years. it's very important to take that life course consideration 'cause our needs change over time. and then, we've wrapped -- we wrapped around all of us the organizational excellence of the health service system staff itself, that we're very committed to carrying out the objectives and stepping up the game and already well -- very well run operation that was just -- i consider myself blessed every day that it's as strong as it is, and i hope to just continue to strengthen the organization as we move forward. one of the areas that i -- we did spend quite a bit of time on developing that may seem like a

lot of words on a page, but i think this, again, is where process is very important is these guiding principles on page six. this is the type of document that i think that we will find ours referring to as we develop designs and plans and recommendations to bring to the board because we want to operate within these guardrails, and so we've had a lot of discussion internally about what those guardrails are in each of these categories, and i won't read them to you again, but when we come back, and we start wandering, you know, i think we need to hold each other in check that we're -- really, in order to get through the strategic plan, we're going to try to stay within the guardrails that we've designed here, because it's very easy to lose focus in this complex world that we live in with all the external pressures, so i think the guard rails will be very helpful in that regard. page seven of the plan, again, takes that life cycle, that health cycle view of things.

i think all of us can see where we fit in this. one place one day and another place another day, quite frankly, so it's important that we recognize that, you know, we're living, changing organisms for sure, and the way that we interact with health delivery needs to reflect that, as well. and then, just again, we go through the goals at -- on pages 8 -- 8 through 12, really taking this -- this hard look at retaining affordable and sustainable health care and some of the educational areas that we mentioned are going to be important for us to really look at how we pay for health care, so payment reform is very alive and well. that whole discussion will be important for us to all understand what options are out

there and being developed, and how health care is being paid for in different arenas, and what's working and not working. much of this is experimental, but c.m.s. is making a lot of exchanges, and what c.m.s. does eventually rolls down in the commercial world, so we need to be staying on top of that game. reducing complexity and flamt -- fragmentation is also important to the health care system and getting through the right place at the right time. the educational topic that we'll be doing around care coordination is important. there's a lot of pilot programs that are going on, trying to determine, really, what is -- what is best ways to do this, and there certainly is not going to be a silver bullet of any one way. it goes back to the fact that we

are all so different at different points in our lives and what is the best way to keep us engaged in our health care and in getting the right kind of support. which folds nicely into the next strategic goal on engagement and support and learning different ways of doing that. and we've talked here today already about different ways, traditional ways that we've engaged our members, whether it's mailing an e-mail, etc. [please stand by]

-- and perhaps even a shorter life. so i think it's really important, an important value, that we learn how to do that and

the city and county is certainly not a single employer. we have many different departments and many jobs and there's no one way to do that either. moving into the initiatives that we have in the plan year, we've condensed them on a couple of pitches here. what we'll be looking here in the very near future, i wanted to draw to your attention that, you will not be seeing here today the request for proposal for our medical plans. we considered bringing that forward at this point in time but have had to recognize that that is such a volumeness job to do that we can do a better job if we postpone it until the spring. so we will be doing that. and so it will not -- if we -- depending on the comprehensiveness of that

initiative will not affect 2020 year but will affect 2021. that does put the pressure on us to address the city plan issue. we know that. we recognize that. and so that's part of our near future initiatives, addressing the city plan now and perhaps a larger r.f.p. for the 2021 year. what we will be doing shortly, and i will let michael talk to this more specifically, we will do an r.f.i. to look at the different tools in the marketplace that we will learn by doing an r.f.i., getting more comprehensive information and have a better idea about how, when and where to vet, embed, select, purchase the whole slough of choices that are out there. you got a taste of some of those at the blue sky meeting, but we need a process for how we'll consider those. the medical plans are doing something similar, so it's

helpful to -- for us to get really smart about what's out there and determine the best approach. so that is the highlights of the -- that i would like to speak to on the strategic plan. i want to pause here -- before i do, excuse me, on page 15, we do have what our success outcomes look like in the organizational work plan. as i said, this is where we hold our team accountable for creating high standards and organizational excellence. we do have a lot of regulations that we do abide by and need to have a comprehensive audit strategy, so that we are doing audits on a very regular basis of several different kinds, not the least would be hippa, and

there are others as well. we really wish to design these optimal plans and really look at the payment reform strategies and how we can look at the ramp-up time to get those types of things. the multimodal engagement strategy, we have a lot of efforts working with our communications and engagement. we don't have a comprehensive plan on how to do that. i think it's really important that we take a step back on how best to do that in today's age. and then the other two are really talking about evidence-based, standardized planning with metrics. so we're data-rich. and yet we have not fully optimized doing the analysis in a way that drives change in our department, so we'll be embracing that and are embracing

that now. we can talk more specifically about some of the things that we have under way to actualize this work plan. but i wanted to pause before i hand the microphone over to leticia and see if there are any questions or comments on the strategic plan at this point. >> vice president follansbee: i want to compliment everybody involved in this. each draft, how it's been added and how it's enhanced the understanding and clarity. i want to point out one thing, which i brought up individually. we tend to use the word concierge. it appears in the stay well, needs care, and is a patient.

and i think on page 14 under engage and support. i want to point out, it's not defined in the glossary. the glossary helps extensively in terms of what is being said. but from the medical provider standpoint, i don't think is what we're talking about. just to remind members of board and the audience that from a medical professional standpoint there are concierge services out there. and individuals pay anywhere from $800 to $1,000 a year over and above their health premium up to as high as $15 how to to you -- $15,000 to $20,000. that's not the way we're using it. if people understand it in that sense, it's the wrong expectation. maybe we need to define it

better or come up with a different term such as individualized or something that doesn't quite have the same impa impact, than that we're going to provide $15,000 individual supplements. >> thanks for bringing that up. i know a number of people that practice concierge medicine and that's not what we're talking about. we're talking about personalized, individualized care required for certain individuals where they need something hyper-specialized. so let us go back and correct that. it may be that we just remove the term. i don't think we can fight the marketplace. in san francisco, concierge medicine is alive and well. any other questions? >> a question on page 13 and

thank you for including in this year's business plan some attention to the plan and the verbal references to it. what i'm trying to understand, you have various, bolded items, some of which say action, and i understand that. some say pilot, i think i have a notion as to what that might mean. and then it says discovery. that's where i lost myself. i could understand that maybe the actions we were going to take during this year's business plan and come up with some initiative. we might test it out, so on and so on. others, i'm expecting you and your team and others will bring something to us over time and we'll adopt it. discovery, i'm not clear with what you intend there. >> it was a little arbitrary when we went through this in

great detail with president breslin and follansbee. some things were fairly clear what we could do now. other things, like the city plan, weigh really need to do some deep dive and discovery into what those options might be for that matter. so that's where the term came from. >> commissioner scott: so the intent is it will be exploratory -- >> at least initially. >> commissioner scott: thank you. secondly, i'm struggling with the graphics on a couple of -- i think -- i would echo strongly the comments by commissioner follansbee about how you have worked to massage this to make it readable. it's understandable. i think it has a good flow and so forth, but then after i got

the logos tied to the strategic goals, i said, they all make sense, but then started to look at the pictures and said, how does that connect to the concept? i'm with you on the complexity on page 9 and that particular graph, that picture. the one that says engagement and support with someone sitting on the telephone, i was struggling with that. i think the notion is, wore trying to engage the membership and support our members and -- >> and this is one of our member services persons taking -- we're proud of that photography. >> commissioner scott: i understand and i appreciate that. >> both a member and member service person, so want to acknowledge that. >> commissioner scott: i get it. i think something that would be more illustrative of the concept is what i'm suggesting.

and similarly on page 11, the same thing. i understand the circle and the faces, but i don't understand the hole in the middle. and the idea is choice and flexibility. and, again, the graphic doesn't seem to quite support the notion. those are minor things compared to the overall tone and communicative depth of the document. it's very well done. >> thank you. i will take this pause and allow leticia to talk about the initiatives that the staff is doing with the work plan and then i guess we can act on this agenda item.

>> good afternoon, everyone. i'm leticia pagan, senior health program planner. i'm here to discuss how we translate the strategic plan into work plan implementation. calling your attention to the screen here at the top portion, i'd like to start off by emphasizing that sfhss prioritizes two important strategies. the first is using key performance indicators. in addition to checking items off of the work plan list in terms of completion, we're striving to quantify each and every initiative using metrics, whether that be the time it takes to do that, the number of people that were trained, for example, percentage increase, decrease, etc. to more effectively track and measure from a measurement and evaluation standpoint. the next important strategy is referencing evidence-based benchmarks. in addition to relying on

internal knowledge and experience as an organization, we're comparing our organizational bench lines against benchmarks in the field to guide continuous quality and improvement. i'd like to move to the bottom portion of the screen to highlight a couple of examples of initiatives in the work plan. this is by no means an exhaustive list but gives an indication of the products explored and the corresponding focus areas the first focus area being member services. we're exploring the adoption of a network promoter score. this will help sfhss gauge how satisfied the customers are, to what extent they would recommend an intersection with support services. it helps us to quantify our membership from the standpoint of, who are the passives? those that we engage within their action, not necessarily the most satisfied as much as they could be, our detractors,

that wouldn't necessary recommend an interaction with us, and those that are promote others, knowing we're a go-to for answers. this is our effort to employ a methodology for gauging and quantifying our service delivery from a membership standpoint. it affords us an opportunity to survey our membership on a more frequent basis, so we can understand the unique customer service needs. the second focused area is communication. the first touch point is open enrollment preparedness benchmark. it's a measure we're exploring to help us gauge our readiness in relation to being a benefit administrator and open enrollment activities that come along with that. in management, design, analysis and even evaluation. open enrollment drives so much of the work that we do that we're striving to improve continuously not only for the event itself but for the project

and work involved leading up to that event the next focus is multimodal communication plan. that was discussed. we're aiming to outline step by step our comprehensive and ongoing strategies to boost awareness and encourage use of the available plans and services. we're using various mediums, individualing 0 raffy, photography, website redesign and doing that for membership preferences and that our population absorbs information in different ways the final point is enhancement of the customization of our knowledge base. one way to do it is to better integrate the c.r.m. with the sales force. enhancement to the membership services scripts. to unify our response to the

members. our member services is our frontline. in order for them to do their work to the best of their abilities, we need to enhance this knowledge base as the primary tools they use. in doing so, be able to better understand why our members call in the first place. what the informational needs are. the next focus area is analytics. beneath that, we're hoping to increase the analytic payability of our claims database to identify high risk and high cost conditions that affect our membership. whether it's enhancement to software, modules, data pool for specific measure, again, striving to support enterprise systems and analytics in the modernization and optimization. next, staff support. enhancing staff support in benefit education, plan design, well-being. our staff are pooling their resources and time to do the work to the best of their abilities. as we build up priorities to the

adoption of the strategic plan, we'll need to evaluate how to support the areas to keep the work moving forward in terms of staff support. the final area, organization alex lens -- organizational excellence. with all the data collected, the lens shifts to the synthesis of the data. from there, we can refine our efforts and prioritize resources, time, and staff most efficient efficiently. the work plan aims to adopt quantifiable strategies. this is evident as we look at composite scores, because they helped us to quantify the working done and to establish baselines from which we can work

forward over the next several years. as we adopt the enhancements we discussed today that align with our work, we can be better prepared to measure the impact of the changes being implemented. and hopefully come back and present findings, using the most disciplined approach. thank you for your time. i'd like to pause to see if you have any questions. >> i just want to be clear. if we say we have an initiative like city plan, okay, in the 2020 initiative, will this work plan implementation framework, will you then say, okay, at member services we'll do this around this initiative, we'll be doing communication, analytics. i'm trying to figure out how

this ties back to a specific initiative within the business plan. >> if we look at the work plan on page 15 where we talk about what success looks like for the team that we call out, optimal plan design and payment strategy, we have not flushed that out as a particular project. we're working on just reorganizing, restructuring how we work together and lay out that plan. and we -- last year, i think, last year, last rates and benefits cycle it was pointed out at one point that we needed to have some clear criteria about design change. we initiated that. we'll be taking that and have other rubericks for decision making. while it's not outlined here today for you, it's very much part of how we're shifting our work, being very clear from the

onset of what the process is going to be and what the timeline and what the outcomes need to be. so, you know, having -- my clerk and i both having our first experience with rates and benefits last year have talked quite a bit about how we could consider changing the process to make it crisper, cleaner, and we see our job as to provide the right information to you to make those decisions. that's where we're working on those areas. >> commissioner scott: i'm just trying to tie this back to the document, where i'm trying to make that link. >> that's why it's still in the discovery bucket, because it's not clear. it is not clear at this moment how we'll do that. >> commissioner scott: i with just suggest. rather than say "pause it, "like

i said last month, i would suggest that as you outline the details of any of the details, that you come up with a framework that will have some of these elements and some detail around budget or staff resources or whatever they happen to be so any time we're looking at that initiative, we're seeing kind of progress along the way using that same framework. >> i'm totally with you. i'm familiar with that process, having used it in prior jobs and i find it quite helpful to keep us organized and on target. >> unless i'm hallucinating, in one version of the draft, there was an attempt to begin to address that. there were strategic goals for years and how each of those, you know, got ticked off into the

five strategic goals. i thought there was a big chart that we saw that had some crossed all five elements and some didn't. so i think that that -- it then disappeared. >> there's a chart similar to what you are describing in the found -- finance or budget report. we tried to make sure that all of the budget items that we were requesting had a relationship to one of the goals. to make sure you are not outside your guardrails. >> vice president follansbee: i think it's the same vein. i wasn't hallucinating. thank you for clarifying. >> any other questions or comments? >> president breslin: thank you. this is an action item. any public comment on this item?

i can make that after the action item. >> we need a motion. >> i move that we accept the strategic plan as outlined and discussed today with some additional maybe considerations that i consider minimal modifications to move forward. >> i second. >> president breslin: any public comment on this item? seeing none. all those in favor, signify saying aye. opposed? it's unanimous. all right. >> i'd like to add to the motion or add another, if i may. >> commissioner scott: this is a supplemental motion on the strategic plan.

i move that a letter of approval and endorsement by the h.s.s. board of directors be drafted for inclusion in the publication and communication of strategic plan and the placement of that letter would come after the introductory letter of the executive director the letter should include citations of the role and commitment of the h.h.s. board to work with h.s.s. staff and leadership in the assessment, design, development, implementation of all phases of the strategic plan on behalf of the members of h.s.s. and can i clarify what i'm talking about. >> president breslin: does anybody need clarification? >> commissioner scott: there might be. just 30 seconds. sometimes we assume that everybody reads our minutes and knows what the board is thinking

and this plan, if i envision it properly, as it's been put together, will real i will be a communications tool that goes beyond just this board and just the administrative staff folk and other folk that may or may not be within the confines of "city government," with whom we relate. to that end, it should be very clear that this is not just the staff speaking on behalf of the system. the staff and the board are conjoined in this effort and it's not going to be occasionally brought back to us and here's the next thing we need to do or think about. but that we're going to have an engagement process with the board, the leadership, to followthrough on the implementation of the plan. this has been a great deal of work and effort to kind of frame our future for the next few years and this board needs to publicly say that we're going to

be on board with that, leading where we can, supporting where we must, to get this done so the letter, as chair of the governance committee, i will volunteer to draft it. give it to the president. and anybody else that wants to see it, including our secretary, who doesn't have a copy of this motion, but i will give it to you. and then we can go on to incorporate that so we're very clear it's a unified effort as we go forward. >> vice president follansbee: i would like to speak in support of this as well. i appreciate the fact that the role of the health service board was noted in the acknowledgement in front of the table of contents. but i think that such a letter will endorse that the board is taking an active role, not overwhelm in the implementation,

but also in the design and follow-up to this and part of the issue around action refers to us. part of the issue about pilot refers to what we expect. and so i think it enhances the fact that the board isn't just willing it look at this and put it on a shelf, but that this is an active document that we help design and are engaged in and it will be engaged in over the next three years on a regular basis. >> president breslin: motion moved and seconded. any public comment on this item? all right. all those in favor, say aye. any opposed? it's unanimous. all right. item number 6. >> clerk: item 6, action item, approval of san francisco health

service system budget revision for fiscal year 2018/2019, healthcare sustainability fund. presentation of the budget, pamela levin. >> good afternoon. pamela levin, chief financial services officer. in february, 2018, health services board approved the health service system budget, the $3 budget. in the intervening time, we

developed the plan that you just approved. now we're looking at aligning the budget with the strategic plan and the goals outlined in the plan. based on the '17/'18 fiscal year close, there is sufficient funding to support this realignment. i will first speak to the revenues, followed by the expenditures, and conclude with a review of a table that is actually projected, but i realize it's impossible to see. it summarizes the revised budget. the table that is projected is in your ipad. so you will be able to see it a little better. >> is that on pages -- >> page 5. >> page 5 of the document? >> very fine. >> yes. >> okay. >> but i will first start and

give some context on how we got to where we are. in '17/'18 the revenues in the carry-forward amount were greater than projected in the budget. in the aggregate, the revenues exceeded the budget ex-pepped tour by $976,000. furthermore, the and well and one-time expenditures were $2 million less than the budget expeditures due to staffing shortages and city's required procurement process. as a result, the additional revenues combined with the lower expeditures resulted in a $3.4 million carry-forward into '18/'19. this is $357,000 more than what was assumed in the '18/'19 budget. in addition, we project a $50,000 growth in annual

revenues for '18/'19 based on the '17/'18 actuals. this is where we get the money to pay for the revised budget and items that we are requesting to be funded. during the budget negotiations, in order to prevent cuts in the well-being budget, sfhss agreed to provide a one-time transfer of $100,000 to the sfhss general fund administration budget to support on site, well-being activities for sfhss members. sfhss is responsible for the programming of the activity and, therefore, has sole discretion for the use of the funding. these activities are provided under the direction of sfhss and pay for recreation parks