sfhss and then how that plays into your underwriting. >> but aren't we cross checking that with our all-claims database, when we get the plans, we're reviewing it and comparing what our interpretation with theirs as we're getting into this risk adjustment discussion? >> well, so i would say this. through the all pair claim database, we understand how the health risk is, let's say, different, between the individuals who are enrolled in each of the two plans. and so that helps inform us on when we get to renewal time, if we see changes year over year in the aggregation of the health risk. that will be inform ative to me

as the actuary then evaluating the renewal positions of both united health care and kaiser permanente. >> so since there is some way of us knowing or having another interpretation beyond just what the plan is telling us is the only point i was making. >> president breslin: right. >> we're in a place now to gather that data, analyze it, and help as we approach the discussion with it. >> i know marina tends to present on the risk scores around the march time frame. i am a sponge of that information when it then comes to evaluating the renewal positions based on those risk scoring changes from one year to the next. >> president breslin: i was just going to say one of t -- >> i was going to say one of the things that i'm exploring

with aon is our risk coding procedures because i know that audits are quite complicates and require particular expertise, and i don't know with this sitting that that's a roll that h.s. -- that health service system could or should provide. but it's certainly, you know, a part of what goes on in the industry at various levels. so the whole audit question and whose responsibility is that and how do we do that -- i know that c.m.s. does an intense amount of auditing themselves. they have a huge fraud and abuse division. and you know, and the provider side certainly witnesses audits on an ongoing basis. so i think we can, at some point later in the year, provide more information on what the audit procedures are that we can and should do and those that are done by others, so there's certainly clarity about whose responsibility it is to do these types of audits. >> thank you. >> thank you.

any other questions while we're going through this? any -- no? >> so on page 14, so on one last comment before i dive into sfhss specifics on the plans, i do reference a specific study of m.a. plans. very interesting read. i just capture a couple of key highlights here around the m.a. plan, focus on preventative services and observations about quality of care delivered to m.a. plan members versus other medicare beneficiaries. so i reference the -- the study at the bottom, and certainly, it's an interesting read. so let's talk specifically about the sfhss plans that are in place on slide 15. so for those in northern california, which are about 90%

of where sfhss retirees reside, there is the chase of kaiser permanent then say senior advantage, and the mappo, and then, the p.p.o. is also beneficial to the remaining 10% that live outside of california as the national plan offering. and just as a reminder, we talk maybe about rates, but also just a reminder of what the retiree ultimately pays for the benefit is set per the city charter formulas. the medicare retiree only coverage in both plans have no retiree contributions because the total cost rates for both of these programs are well below the ten-county amount. medicare retirees who cover one or more dependents do have some level of contribution which varies by plan.

so some of the cost of the coverage is borne by the retiree if they're covering dependents, and then, the rest is borne by the employers. page 16 shows some key dates of the milestones of the last decades. so you know kind of up through the early 2010s there were three medicare plans. kpsa through northern california, the h.m.o. in northern california, which also -- for those retirees outside of that geography where the h.m.o. was offered were offered a supplement plan through blue shield. and then, the u.h.c. city plan, which was also a supplement plan. so these supplement plans are

essentially providing wrap-around coverage to medicare, kind of like a medigap style plan that i talked about earlier. in early 2013, i think you'll remember that the ability to adopt what was called the employer group waiver plan approach on the u.h.c. plan did generate savings for sfhss, and for cast to be about 4.3 annually at the time, so that was a provide that was able to be provided that enabled greater federal funding into the u.h.c. plan. 2016, the uhc-mappo was added as a fourth plan to expand the footprint for sfhss, and then

20 2018 was the last major year of change. t the two primary changes were cost savings and focus member care delivery. so again, today is really to as we close the plan of the two-year approach, what are we seeing in terms of achievement towards these goals? is another kind of refresher on the changes that happened in 2017, the supplement plan allowed for the rate stablization reserve amounts that had built up overtime primarily through the medicare

plan. that allowed those moneys to be retained within the city plan but be applied towards helping stablize the rates towards active city employees and retirees. so the moneys were the-- monie were there -- >> so excuse me, that was for that year, right? i mean, after that, now, we're in a big problem. we don't know what to do with the city plan because it was only one period of time. >> correct. >> because, you know, back in

2013, the medicare retirees in that plan were doing very well. like, the loss ratio was 72%. they were talking about reducing the deductible. >> correct. >> and so -- i mean, they kept us afloat. so that was -- looks pretty on here after the year, but it didn't do anything after the fact, so now, we're in a situation where we don't know what to do. >> yes. and if i could turn to the next page, so on slide 18, you recall that i referenced earlier that there was a 2.3 million annual savings projection when the approach was implemented in 2013. what this slide shows is my estimate looking at the actual renewals for 2017 because in 2017, we actually knew what the

rates would have been because we were still working with both scenarios. and the decision to fully impleme implement uhc-mappo wasn't made until the last meeting in june 2016. so the 2017 numbers are ak rate based on the enrollments at the time did -- are accurate based on the enrollments at the time. if you go back to the meetings in may and june of 206, we projected 2.3 million in savings. and then, as you look over a three-year summary, if i apply similar trending scenarios to 2019 based on actual knowledge now of the renewals for 2018 and 2019, i'm calculating that there's been over 30 million in savings during the three-year

period for the implementation of the uhc-mappo plan. >> that's savings for the city, right? >> sola savings for the city prime year primarily, but also savings for dependents that are paying something for coverage. through either of these na scenarios, the medicare employee would have always been zero contribution. and then, beyond the cost, you know, the rationale for these decisions in 2017, there was design improvements relative to the programs. the additional programs

tailored to employees, and also the fact that u.h.c. is a national p.p.o. partner has strong geographic availability and in fact has the greatest market share of any national m.a. plan in the country. and so strong for northern california, but also strong for any retiree living outside of northern california. and you can see a chart here of how provider access works. similar to some of the things that i explained earlier. by its nature, kpsa guides member care through really what i called patient centered home care through the kpsa provide

channel. and then, the mappo is relying on these innovative touch points given the nature of how the p.p.o. is setup. >> the next several pages are comparisons between how the two plans work, is that correct? >> exactly. so there's simply just some education on the kpsa model. really quickly, emphasis on telehealth within the kpsa model, for instance, that you'll see on slide 22. a lot of emphasis on helping members what to expect if they're already enrolled in the kpsa on slide 23. slide 24 from a uhc-mappo perspective, again because there's not the requirement to have a family care physician, you don't have patients that

are a medical care home. you do have these various touch points in the u.h.c. approach. and then, what i was to specifically focus on starting on page 26, because i know there's been some cast commentary raised in past h.s.b. meetings is the raise program to try to enhance the care experience for the member, trying to deliver annual visits from a nurse practitioner, to a member to help better understand what health needs are. you can see those benefits on the right of page 26, just trying to help increase collaboration with the member working with their primary care physician, identify gaps in care. and nearly 50% of the visits in this program do result in some

sort of a program referral. you can see on slide 27, you can see, from a peer standpoint, based on a couple of studies that the rand institute has performed. the whole idea here is to try to improve the health of the member through decreasing hospital admissions, increasing physician hospital visits, decreasing emergency room visits, and most importantly, increase the detection rates. so president breslin, to your point earlier, how u.h.c. try today do more to understand the risk of the member, certainly, this program helps the member to, i guess be more aware of the health risk and perhaps greater -- you know, greater

incentive to work directly with primary care physician with the health risks. but the more that's known with the member, that does help to increase the star rating, and i'll talk about that more in a bit and ultimately can lead to higher reimbursement from the federal government that can then help to manage down the rate of the uhcppo for us. we saw a decrease in the rate from 2018 to 2019. and on 28, i refer to the star rating. these are ratings through the center of medicaid and medicare services that helped to impact the amount of federal government bonus funding that a plan receives, so the higher the funding, the lower the premium needs to be.

you can see here key criteria that are measured by c.m.s. so then deliver what the star rating for the given plan is. that includes helping members stay healthy, managing their conditions and so forth, and obviously, deliver outstanding customer service as part of that. you know, what i'm happy to report on on page 29 is that the fact that there's a range of star ratings across the country from various plans, but you align with two partners, one has the maximum star rating in kpsa, and one with a very height rating, especially for a national p.p.o. program, with u.h.c. so both are delivering high star ratings, which then helps to maximize that reimbursement from the federal government and in teurn helps to manage the premiums that are passed onto

sfhss. so where i'll close on 30 and 31 and then happy to open up for additional questions, the important to think about how medicare advantage plans fit into the strategic plan and the five goals of the strategic plan, i mean, i'll certainly right off the bat, you want to keep these programs affordable for members, and the m.a. plans really do offer the greatest ability to deliver on that. y you know, trying to reduce the complexity and fragmentation for members. these plans are really about guiding members, whether their patient advocate is their

patient care physician. all of the other programs offered like kpsa. they're really there to encourage preventive care and to seek appropriate care alternatives when those needs come up. -- and ways to bring additional innovations to members. and then, on 31, choice in flexibility. you know, very important to offer members an array of choice. in northern california, where

90% of your retirees, but outside, knowing you're partnering with a very strong partner. and then, the whole person health and well-being. it's not just about sick care being delivered in the m.a. programs. so much of the emphasis is on preventative care and supporting needs through the entire, you know, care spectrum for the member. >> any comments? any questions? >> well, in retroexpect -- retroexpective view, i know this board struggled around this consolidation motion, and whether we were doing the right thing. in retroexpect, based on this two-year experience, yes, we got the cost savings, but we also created an unintended consequence with one of our existing programs that we're

now trying to solve. so i guess on balance, it was the right decision. it's just a matter now of trying to fix the remaining piece that's out there with the city plan, so that would be my comment. >> i just had an article from kiplinger magazine saying that now doctors partner with third party organizations. i guess not everybody's in favor of advantage plans, just to -- not to rain on your parade here. >> a very fair statement, and there are a plethora of opinions on medicare advantage plans out there, no question. >> right. right. >> yeah. i think what's also true is

the -- from the c.m.s., this is where they're investing their innovation, and so the opportunity -- that's where the opportunities are, and as we well know, you know, the innovations that they create there are often -- you know, the science that they use is really sound, you know, and it takes them a while to approve certain things into your plan, but that's because they're looking for significant findings that these things really work. so in that respect, i think this board was very forward thinking in looking at medicare advantage and where it is today, especially given the politics that we're living through right now, the innovation center continues to innovate at c.m.s., so that part of it is good news, where we're seeing, you know, this expansion of services into the community to -- and all of these are aimed to drive down

costs because of the ballooning number of persons that are in the system are just not sustainable any other way. >> okay. onto the next item. oh -- >> public comment? >> oh, public comment. sorry. >> dennis krueger, active retired firefighter and spouses. i was on vacation -- permanently, but i was on vacation, thinking about some things, and i have a couple questions. with the united health care's plan, with your ability to go see any doctor who accepts medicare, also stated here by aon, that you don't even need a primary care physician, who

correlates all your medical records? is it medicare? who, with the primary physician, you need this test. you go get the test. the results come back to your primary physician. he tells you, you need to do this now or everything's okay. seems like under this system, you decide if you need a test, you go get your test, where do the results go? back to you? how do you interpret them? how do you understand what you got back and what got done to you? it seems to me that not having someone who is the center to control your medical health outside of united health care, and so my question, which i'm stating twice now, who correlates all this information? and if it's united health care, do you just get a phone call from somebody, saying you got

this test back, these results are there. you now need to go see somebody else. it seems it's a nice system that you can go see anybody you like, but it's a system that lacks interpreting what you've done and being able to then guide you on the next steps. and maybe united health care can answer that question, but it's been something that's in my mind. and if you do designate someone that's your primary care physician, do they get something on a monthly basis or is it just when you go see that doctor even though you consider that doctor to be your primary physician. thank you. >> you know, dennis, if i just go see a specialist, the specialist has the records. they have everything. they're the person you talk to after you see them, not your primary care doctor. >> normally, any specialist

sends whatever results you've had back to a doctor, who now, you can sit down and have those results interpreted, and so i'm just -- do you go back and see the specialist a second time? sorry to go over your time. >> no. the specialist would then confer with you about the results. just like the ordering doctor would. >> the ordering physician is responsible for that. you can't have a test done on the band. you have to have a physician order it. we can talk later, dennis. >> yes. you know, you can go see any physician. so does that mean you ever ae got to go back to that same physician the second time for the results? just questions about the plan. thank you. >> thank you. any other public comment? seeing no other public comment, we can move onto -- >> i thank aon for just

providing this overview. i think it'll be a helpful reference as we continue to go through the discussions with city plan and the advantage plans as we get further into the renewal cycle, so thank you. >> so would everyone like a break at this point? we don't -- we don't have many items left, but it actually might take a while. >> i'm always in favor of recesse jinks, but don't ask me. >> okay. we'll be on break. five minutes.

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>> president breslin: all right, we're back in session. madam secretary. what item are we on here? >> clerk: item 12. >> number 12. >> president breslin: agenda item 12, the presentation of the retiree survey by stephanie fisher and carrie beshears. >> stephanie, could you pull your mike down a bit? i'm just saying that we want to hear every word. >> it's true, it's okay. well, today's presentation has a

few things to consider as we start to look at taking care of retiree well-being on a larger scale. i was very fortunate when i came here five years ago that a needs assessment had been done in advance and a lot of conversations and a lot of focus groups and a lot of data collection happened to make it possible to hit the ground running when i got here. so hopefully in the past five years i have collected a few of those data points for those to come, and today i have a few of them for you. so today's presentation is taking you through the retiree check-in survey, talks about how we're going to communicate the results and share some resources and talks about an upcoming campaign which are just a few of the ways that we're trying to address retirees while being with a little more regularity. and we'll end the presentation with the very important in-person retiree activities

that claire alluded to earlier in her comments. so getting started with the check-in survey, it was last may that we sent it out. and it took a team to make the survey possible. so i partnered with mitchell chief operating officer who was the benefit expert. it's something that we realized early on is that -- to help retirees we have to do it through our benefits which you have heard a lot of in mike's presentation. and we had extensive literature that honed in on the right questions to ask in the survey and we didn't have to ask because the literature is there for it. and we called on kaiser and united health care and the dental and the v.i.p. to craft the survey because there were questions in the survey about the health plan and the survey was different depending on which

you were in so you could ask -- so you could answer questions specific to your health plan. we hired an external communications consultant, rise and shine to proofroad the survey but honestly really to help us to draft how to present the results. and the booklet, and also the follow-up communications. we wanted to be careful to not just do a survey and disappear for a year but instead to really make sure that we had a plan to communicate those results right away. and so rise and shine was really critical in helping us with that. we called on our retired members, some of our friends and some of our colleagues, to help us to do some user testing with the survey and also to give us feedback on the questions. and during the process the director came on board and she gave us some really nice external public health social determinants of health perspective that we hadn't had previously and other staff

members within h.s.s. and finally, our printing and mail house center helped us to craft how to mail out to homes and get that data back quickly and easily. so a huge team, a huge undertaking. and it all came down to this little postcard. so we sent a postcard home to all of our retired members and the postcard invited them to go online and take the survey or to tear off half of the postcard or mail it back. if they mailed it back a paper copy of the survey was mailed to their home. so we were trying to reduce our carbon footprint by not mailing the long survey home to everyone. but also making sure that those who wanted to had it on paper had that opportunity and it was easily available to them. and tear it off and throw it in the mail and it was done and there was no postage required. it was good that we did that because although 80% of the people who took the survey took it online, 20% that didn't helped to even out our

demographic. so if you looked at just the online results they were a little bit younger and a little less likely to be on medicare. but after you added in the paper surveys it balanced out to look a lot more like our typical retiree demographic. so you can see that on slide seven that we had just over 2,700 respondents which is 10% of our retirees. what i have shown you here is the percentage of the people that were various demographics as they compared to the demographics report of 2017. so you can get a sense -- it was a it is underrepresentative of those in medicare but only by 2%. we had a little bit more blue shield population and less kaiser, and so it gives you a sense -- in all honesty, we're within five percentage points of every demographic in the demographics report. so hopefully we got a really nice representative sample of our retirees.

and then we wanted to know what they wanted to know about because the whole idea is helping them with where they are and when they're interested in. so what you have on slide eight is some of the top topics. if you cut it by medicare and by health plan, there ends up being six. and they are healthy eating, brain activity, breathing and stretching, sleep, and weight. so regardless of how you cut it those six are of interest to everybody. and then we wanted to know how they wanted to be communicated with because we're hoping to help them and to reach them. so if you look at those non-medicare population, their top two ways to be communicated with were electronically, either through email or the e-news. for our medicare population, still a very strong interest in using email, but a very strong interest as well within that

population. so it's important to look at the data and it's also important to cut it by our different demographics. so how are we going to share the results? we're going to do a combination of print and email because that's what we have heard our members want and need. and the resources that we'll share with them will be a combination of print and online resources so they can access information in the way that they're most interested in doing. so in early january we anticipate sending an email to our members who are on our e-news or our retired members for whom we have email address addresses. which i want to say is just over 10,000, which out of our 27,000 members is pretty good. although it would be nice to have all of them. that email communication will encourage them to check their mail towards the end of the month, early february, for a booklet that will have those

results in it. so in early february they'll get a booklet that is about half a page, that includes both the results, not but not just, hey, this is what you told us, this is what you told us and here's our resources to help to you take action on some of the topics that were most interesting to you. and the booklet will be timed to drive them back to the website. so it will have information in it, but it will also drive them back to the website which will be launching hopefully in early february. it will have a section within well-being that is just for retirees. so really carving out information. though some is relevant to everybody, carving it out and saying that there's a section just for you, retirees. and then we're suggesting the home mailing in late spring, about the health and well-being value of being social. so on slide 12, you can see some of the results. there's some of the results.

there's a lot more results to dig into and that will be my gift next if they can dig through those. on slide 13 you have a sense of how these results compare to some nationally representative data of retired folks. some areas we were a little bit more physically active than the comparison data, but we sleep a little bit less. so you can look at that as well. on slide 14 here this is a copy of the booklet. so this is a page within the booklet. it covers six topic it's -- physical activity and healthy eating and emotional well-being and stress management and routine and preventative care and advanced directives. each pan page has a result frome survey and it talks about the importance of taking care of that aspect of your well-being. it poses a question to get folks

thinking about how they address that. and it gives them ideas to get started and encourages them to check out the various resources through their health plan. and then it asks them to set a goal. so if they never go online or do more with this, the booklet itself really helps them to reflect on what is important to them when it comes to well-being and to make goals associated with that. if they choose to go online afterwards they'll be greeted by our new website and the section just for retirees. and you have screen shots of the proposed layout on page 15. so they can dig into these topics in a little bit more depth. this is, of course, an area that will grow over time. and there will be content there to begin. and then something that we were researching both in the literature but also that we found in the data is the importance for retirees to be social. so the last slide that is slide 16 and it talks about the

importance of people being social. it isn't just a feel good thing, it's also a monetary thing. it's also a health thing. so it shows recent research from aarp, with recepers ou researchs showing that they are more isolated. and if you're social, you are being active or working on your brain health or eating with them. so all of the other topics that the retirees are interested in tie into the value of being social. which is why we wanted to start there. so that campaign and that message to retirees is slated for next spring. so those are some of the things that we learned. there's a lot of data -- you might want to peek at it. we did ask a lot of questions about what is your health plan currently offering, are you interested in that? are there other things that you're interested in.

so we have additional resources as we get into these conversation busy how to change our benefits or expand our benefits straight from our retirees. so hopefully it's a survey that will continue to give you interesting input for future conversations. i'm going to turn it over to carrie to talk about the in-person activities with retirees and before i go a special thank you to claire for her feedback on the survey and her feedback in general and for keeping the retirees top of mind for me for the last five years. >> carrie beshares.: carr i had the opportunity to work with claire and with the staff and the food clinic and bringing those on-site activities that

she had mentioned. it's been a ton of fun for me and we wanted to thank you, claire, for bringing those activities to the meetings and putting well-being at the froar front in the newsletters. one of the things they wanted to highlight this year was the food clinic. so we had 90 retirees engage in getting a flu shot at the clinic. and then among the 23 clinics that we did across the city we gave 246 high-dose flu shots. that actually represented about 6% of all of our individuals that got a shot this year. so definitely from a flu shot perspective we're getting some good traction there. and one of the ways that we also connect with our retiree population is through our wellness center. and what you see in front of you is a picture of dotty. dotty is 91 years old and she's a retired teacher. she's been a retired teacher for almost 30 years. i actually spoke with her the other day to let her know that

we were sharing her message and sharing her picture and if you ever meet dotty she has an amazing energy. and one of the things that -- to talk or highlight the social piece that stephanie had mentioned is that she said that the things that we offer, it gets her out of the house. they get her engaged and moving. otherwise, if she didn't have those things she'd be sitting at home. so we look forward to continue to provide these types of things to all of our members but including our retirees and we hope that these will continue to draw folks together to engage in their well-being. any questions? >> president breslin: any comments? >> thank you, and, stephanie, thank you, and we thought before you came that well-being of one of the benefits that they have

been asking for unions and with you coming on board and availing of this program, thank you for your leadership. almost everybody in the city is going to be missing you for this. >> thank you, commissioner. >> president breslin: any other comments? any public comment on this item? none. thank you very much. all right. item number 13. >> clerk: agenda item 13, reports and updates from contracted health plan representatives. >> president breslin: anything from kaiser especially?

>> thank you, anne thompson as well as mike clarke. we just -- well, some of you may already be aware as we worked through the proper channels of notification that we want to let the board know that we've had a team change and that juan anderson has chosen to leave for a new opportunity. and we wish her the best. we just wanted to make that notification publicly. >> thank you. >> hi, kate, from kaiser. i wanted to let you know and you have probably seen this on the news that we have a strike going on with nuhw, the national union of health care workers. we were notified a couple weeks ago and knew that strike would begin at 6:00 a.m. on monday morning and it concludes at 6:00 a.m. on saturday morning. in addition there's a sympathy strike going on with c.n.a. and

the union of operation engineers local 39 as well. they do some of the facility maintenance and engineers within our facility. the important part of this is that all facilities are open, all care is moving forward. there are some routine surgeries and routine visits that may be rescheduled but we did have kaiser permanente individuals call personally to those affected by that. anybody who needs care or they handle our mental health workers and anybody who needs care is still able to get care. we have outside contracted mental health workers, therapists, that are able to take care of any demands that we needed this week and we also have traveling nurses working to assist with any nursing care that we needed. so all has continued this week. as usual and in providing care and everything, it will remain open. any questions?

>> president breslin: any public comment on this item? public comment? item number 14. >> clerk: agenda item 14, opportunity for the public to comment on matters within the board's jurisdiction. >> president breslin: last chance, any public comment? here we come. >> sorry, i was almost asleep back there, not quite. i wanted to wish everyone on the board very happy holidays and a happy new year on behalf of recess and the west bay retirees and we're hoping that 2019 will be a better year and we look forward to some changes with regard to our benefits and some additional improvements like laser surgery for cataracts and

a few other things that maybe will cost us all less. but happy holidays and happy new year from all of us. >> herbert meyer, h.s.c. patients. what i would like to be considered next year are the fees with the lab test with united health. like you have to pay $25 sometimes for some of these tests. and if you have a serious illness these costs really add up. i'm very grateful for the lower fees and for seeing a specialist which is $15 and contrast to the $25 before. but those lab tests can really add up. and i think that this should be really be taken into consideration with benefits. otherwise, i'm pleased with united health and i've had your service from them and i wish everyone on the board a healthy

holidays and a very nice new year. and let's cure all of the sickness with the health service system and all of the health care in this country. i can think of one person who really is the help that i won't mention here. >> president breslin: any other public comments? all right. we're almost there. >> commissioner yee: agenda 15, opportunity to place items within the board's jurisdiction on future agendas. >> president breslin: anybody have anything for the agenda? we'll go into our rates and benefits in january basically. >> the pace will pick up. >> president breslin: yeah, definitely will be more meetings. so take advantage of these. but i'd like to focus on preventative health, very strongly next year, more so than we have. any public comment on this item?

and i'd like to also wish everybody a happy holidays and a healthy new year. so now we are at the end of the meeting and any objection to an adjournment? this meeting is adjourned. it.

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china in our chinatown you don't have to go far. >> small business is important to our neighborhood because if we really make a lot of people lives better more people get a job here not just a big firm. >> you don't have to go anywhere else we have pocketed of great neighborhoods haul have all have their own uniqueness. >> san francisco has to all bayview. >> a lot discussion how residents in san francisco are displaced how businesses are displaced and there's not as much discussion how many nonprofits are displaced i think a general concern in the arts community is the testimony loss of performance spaces and

venues no renderings for establishes when our lease is up you have to deal with what the market bears in terms of of rent. >> nonprofits can't afford to operate here. >> my name is bill henry the executive director of aids passage l lp provides services for people with hispanics and aids and 9 advertising that fight for the clients in housing insurance and migration in the last two years we negotiated a lease that saw 0 rent more than doubled. >> my name is ross the executive directors of current pulls for the last 10 years at 9 and mission we were known for the projection of sfwrath with taking art and moving both a experiment art our lease expired our rent went from 5 thousand

dollars to $10,000 a most. >> and chad of the arts project pursue. >> the evolution of the orientation the focus on art education between children and patrol officer artist we offer a full range of rhythms and dance and theatre music theatre about in the last few years it is more and more difficult to find space for the program that we run. >> i'm the nonprofit manager for the mayor's office of economic workforce development one of the reasons why the mayor has invested in nonprofit displacement is because of the challenge and because nonprofits often commute technical assistance to understand the negotiate for a commercial lease. >> snooechlz is rob the executive director and co-founder of