friend, and i had a great time working with you, and your temperament on this commission. and i look forward to working with the commissioners as long as i am on this commission, but you are not going anywhere, so i will continue to work while i have you. >> we look forward to your service on the arts commission. [laughter] >> thank you very much. i see no other commissioners. thank you very much. could you call the next item? >> item 15, public comment on item 16. public comment in all matters pertaining to item 16 and below including public comment on whether to hold item 16 b. and c. in closed session. >> this is a closed session on personal matters. is there any public comment on going into closed session? seeing none, public comment is closed. do i have a motion to go into closed session class.

>> so moved.

>> san francisco health services systems board will come to order. please stand for the pledge of allegiance. i pledge of allegiance, to the i ted states of america and to the republic for which stands, one nation under god, indivisible, with liberty and justice for all. roll call please. [roll call]

>> item number -- >> item four is an action ti its of the minutes set forth below. >> are there any corrections to the minutes? >> i move minutes be adopted as distributed. >> second. >> is there any public comment on this matter? seeing none. all those in favor. >> aye >> any opposed? it's unanimous. item number five. >> discussion item. general public comment on matters within the jurisdiction.

>> i received a letter from united healthcare. if you haven't gotten it, you probably will get it. it will confuse the hell out of you. i gotten calls from our members. i'm sure clare has. saying that we can change our health plan from january to march. we can change our prescription drug plan. it's open enrollment is octobe october 15th to december 7th. all these different thing that don't affect our members. there needs to be another letter sent out by united healthcare telling our members to relax or -- i don't know who else to say other than that. it's very confusing better. i'm sure the health board will be hearing from a lot of members. >> have you seen that? >> i have not. thank you for bringing that to

our attention. >> i would ask, is there a member of united healthcare here, plan representative? maybe they can shed some additional light. >> i did sent an email the other day. it was my understanding there was 94 letters that went out to hhs member. it could be little bit more than that. ly take that back to my team. the purpose of the letter was that medicare changed some guidelines for materials effective 1/1/19. some letters went out october and december 31st that did not have the language on it. the letter that members received was that language. we agree it doesn't apply to group coverage, unfortunately. it is a confusing letter. ly take that feedback. >> i would like to request that

we follow the recommendation, that's been put forward by the prior speaker and if you know who the 94 are, that you just go ahead and send a letter to them suggesting it was sent in error and they should ignore it. if they have additional questions they can call you rather than wait until the noise rises. >> l >> i will let hhs know if there's any concerns doing that. >> thank you. >> i have a question about the dental program. i called delta dental last week to enroll my husband and me. i was told i can opt in but i was told my husband could not. i asked them why, i was psalming

that dependents were covered. the person i spoke to delta dental, said call the agency you get your insurance from. i called hhs and spoke to a benefits analyst. he said, oh, we assume dependents were covered. i'll have to check with delta dental and get back to you. no one gotten back to you. i want to know if dependents covered? >> anyone from delta dental can answer that? >> she wasn't able to be here today? >> does anyone on your staff know? >> i assumed the same thing actually. >> it is affirmed that dependents are eligible. i did hear about this from the staff. we've been getting other

question about that. we confirmed with delta dental at that time. [indiscernible] >> thank you. >> i name is gale ow. i'm a retired teacher. i got the flier regarding kaiser's support with the hmo providing fitness membership and health extras. it's not a problem that it's actually listed for ccsf california. it came to my house. the entry is wrong, diane said to me that she could not get to the web opening by entering this address. my concern is that i clicked

around to see what kind of wellness classes that were being offered. in san francisco, there are 115 classes and seminars, etcetera. which is a really wonderful kind of thing. however, sacramento offers 146 classes. they offer classes that san francisco doesn't offer on things like fibromyalgia, shoulder, hiv, anti-body testing, varicose vain treatment and the resting metabolic rate testing and individual counseling. that's an important thing when you trying to manage your blood pressure. they have a class on starting

insulin. in san francisco they offer cpr for children. also, they offer a class called cocaine anonymous. i'm wondering how this works? thank you. >> are you talking to classes that are kaiser classes? >> yes. sacramento has 146, all those that i read out they have those and we don't. >> somebody here follow through on this with kaiser? >> we will. any other public comment? come up please. >> july brady kaiser permanente

representative. ly take that question back. i'm not sure how facility determines which classes are available. >> thank you. any other public comment? seeing none. item number six. >> discussion item. president's report, report by president breslin. >> president breslin: i have nothing to report other than to say that this is a start of the rates in benefits. i like to remind everyone of our fiduciary duties. i was looking at some old information i had. it said trustees can put the general good entire population as their highest priority. they must act for the sole benefit of the beneficiaries. just a reminder, we are trustees

and fiduciaries which means we must work for the sole benefit of our members. any public comment on this item? seeing none. number seven please. >> clerk: discussion item. director's report. report given by abbie yant. >> good afternoon commissioners. as highlighted in the director's report and reemphasizing president breslin's report is our staff is gearing up for the rates and benefit season and have a full calendar meeting ahead of us. our blackout period began in november. it continues through rates and benefit cycle. we'll be going over the calendar later in the meeting. the strategic plan is continuing to be rolled out and implemented and we have purchased a tool

that's turned out to be pretty fantastic called cascade that does just that. it takes strategic plan and helps you cascade down to lower level to try to track and report on activities. our team with brian rodriguez are helping us populate that tool and we're looking forward to being able to share some of the reports out with board in the future as we learn to use it and get a report. we're happy about that. i wanted to -- we have a couple of reports that we will make from the podium as part of the director's report today. one will be the close out on the diva second, there's two items that actually will be later in

the agenda one being the rates and benefits cycle and other being the implements about -- highlighting the key steps in the board election. also, in the director's report we'll have d ma -- marina will speak to the express dashboard. i wanted to call out that la latisha was able to attend one of the calpers hearing. where they approved redistricting of the calpers region. they went from five to three. we included the materials in the director's report. i found it fascinating how the discipline with which they made the decisions and some of the information is not new to us about the high cost of healthcare in northern california. i felt that was important

information for our board to be aware of. latisha is here should you have any questions about that. on the other matters that we track is the things that come up here at the board. i'm working city risk management to develop a risk management policy which will address some of the questions we had around audits. we're still exploring the home services with kaiser. michael made some comments from the madd report after we closed this agenda item. we're still researching with assistance of our medical experts on the cataract surgery question. we are in process working through a new partnership with workers comp. i'll let pamela speak to any the

audits still in progress. i would appreciate if mitchell would come to the podium and then marina will speak as well. >> good afternoon president breslin and commissioners and board members. chief operating officer of the health services system. the dependent how -- audit report is behind the director's report. as you recall starting around the end of 2016 and 2017, we began a discussion on doing the first full denverificatio depent verification audit.

however, looking at not only your fiduciary responsibility but the system fiduciary responsibility doing a complete audit. which is typical in industry standards and benefits and administration as well as the public sector. i wanted to present some of these results for you. >> president breslin: do you want to pull the slides up? >> on the first slide, reminder our audit began in april 2018. it included just over 26,000 employees and retiree who have enrolled legal spouse or domestic partner. the audit was performed by a benefits administration company that we contracted with by the name of life solutions. the division of their dependent verification centre. we chose this route because hhs not only have the staff to

handle 26,000 pieces of mailing that needed to be monitored or they needed a second mailing and review that documentation, we close to go this route as a start. we had to start somewhere doing this route was one we decided. the audit consist of the following mailings that i have least listed here. it began on april 10, 2018 with the first alert notice. there was a period that members could opt out themselves. there were several mailings throughout. the final moats sent july 28, 2018. anyone who did not respond or provide information to confirm the eligibility their dependent

eligibility was terminated end of july. we did little bit more due diligent realizing some didn't receive the mailing. lastly, the timing of this audit was so that we can be complete as we possibly could by october 1st when open enrollment went out. it indicates you and your enrollment and dependents enrolled. we felt like this was a final notice of all the dependents we had enrolled in 2019. it was important for us to have as mump as we could a wrapped up by october 1st. on the next slide, here's some

numbers that we have as of today. the total audits dependent were 26,319. you have that amount there were 24,796 spouses and 623 domestic partners. dependents verified angel kept on was 25,511. when the verification was complete the dependents not verified and moving forward, they did not have eligibility it was about 808. that was 3% of the total that were audited. when we looked at this in the beginning, it was between two and five percent.

we're pretty much in the middle. there's some decent results and not abnormal type of way. the total annual savings, this is just looking at the amount of premiums for 2018. it's almost $3 million. that's based on 2018 rates. you have to think that each year, we have 6 to 8 percent increase in premiums. you can think about the save it'ses over the next several years. it does not include claims that we pay and other utilization costs that 808 members may incur on the health service system. just some of the other information that i think is good to know so you can know that it takes to do something like this. they received about 65,000 documents to review for that membership of 26,000.

hhs managed to come to conservative amount, about 1800. when they wrapped up the audit end of july, hhs kind of took over. we had people that found out they weren't eligible. we are continuing looking at the eligibility even after end of july. that's when the work started coming in for hhs. they received phone calls, the administrator that began this cut was about 12,517. hhs took 3000 calls during that audit period and end of the audit as well. the number we could count as far as face to face, people coming in to member services, talking about the audit, asking for more information or bringing their documents in themselves, physically into the department

it was 641. >> excuse me. did you anticipate this type of workload for the staff or the hhs staff when project began? >> yes. we did. we knew that it would be more workload than we used to. that's w. the -- that's the reason we wanted to wrap it up before the work started open enrollment. one thing we didn't predict how many phone calls we got after october 1st. luckily our open enrollment we didn't have lot of plan changeses. we were able to absorb those extra calls. it was important that we were done and had that information on the open enrollment letter so members can see that the dependents were there.

>> vice president follansbee: tg that on. thank you. >> president breslin: what about the 800 left that? what happens to that? >> they are currently not eligible. those dependent spouse or domestic partners -- again, not only did they receive open enrollment letter, they received a confirmation letter in november confirming their benefits which include their dependents. more than likely, the ones that aren't eligible and don't meet the criteria listed in the mailing, we don't hear from them. they're not going to -- most of them know they're not eligible, just let them drop. >> vice president follansbee: at the end of the day the dependents are not verified because the ones that haven't responded, the total would be

higher is what you're saying. the savings amount were identify identified. >> 808 included people that did not respond. there's a very small number in there. >> commissioner lim: the 808 not verified the dependents were dropped? >> that's correct. as of writing this report, that's the number dependent spouses were dropped. >> commissioner lim: did we hear anything back from the 808? >> we could. there could be some calls or appeals in works now of those. there's not a large number.

after open enrollment we managed 10 or 20 appeals. most of those were able to provide documentation so they wouldn't be include included int 808. right now, that's a pretty accurate number at least beginning of january. >> commissioner lim: thank you. >> i got couple of questions. we had a little problem with a vendor and communication issues. maybe you can comment on future steps, how we might avoid some of the vendor concerns and what are you considering for future. when you look at your next steps, you talk about future audits. the question will be what frequency? this is first audit in many years. yomaybe some lessons that you

learned around communication. we talked about that in terms of ways and improvements in phone services. >> that's included in here. we certainly will be going over that. i also wanted to highlight. report. the distribution over the health plans on the dependents who weren't able to be verified. as you can see, lot of our members are in kaiser. lot of familie families are in . it's a bit affordable. i don't think there's any lesson there. i did not include those. that's why we're stopping about 70 or 75 net total. to dr. follansbee's point.

some challenges that we have determined not only during audit process but afterwards. some of the challenges, we've heard some of this in public comment. we got it at hhs too with the communication. that can be looked at in several ways. having a third party -- doing this audit and va having third party administrator is new. there's lessons learned in the communications. we discussed it internally. we discussed with the auditors

themselves on what we can do. we volum have some ideas. some of that's practices we can do internally. let's say the next steps were that we did use third party to handle a future audit. the biggest thing we heard back from the communications besides some others that's not clear. benefits is never 100% clear. the membership didn't realize it didn't look like something that came from the health services system. having a different entity, answer phone calls where you call into an organization that isn't hhs, it's something new for the membership. it was new to us too how to warm transfer if we needed a type of

thing. another lessons learn end and the challenges especially if we go forward, is how do we prepare member services. again, educating our own depending if we do the audit in-house. what is appropriate documentation and get that nailed down in black and white. as far as preparedness, if we do decide to do in-house, that's something we have to think about. we have to think about the infrastructure to do that. regardless of the size of the mailing, our benefits administration system we have now doesn't typically handle a mailing that has responses. you have to track those responses and send out track of that. we do some smaller mailings like that. it would need to be done electronically and automated. which we don't currently have.

the timing of the audit is some of the challenges too. there were lot of questions coming from all the entities i mentioned earlier. whether it was the hr entities of the employers or members themselves, why did we do the audit when we did versus open enrollment or some other time. that was a challenge to explain. you have to get into how much staff you have, trying to explain people that open enrollment is a very heavy lift for us as it is. again, explaining earlier that we did this audit to hopefully get it wrapped up enough so that open enrollment mailing was

accurate for 2019. with all that considered and mentioning -- we have not done to my recollection, any record thaek find -- that i can find an actual audit of dependents of members. this is standard operation procedure. it is the fiduciary responsibility. we do not want to pay for member who are not eligible, we don't want to have member who are eligible. we do want to provide benefits to those who are eligible. it's important that we're not trying to delete members, we are working with membership and helping them facilitate their claims if needed, provide excellent customer service and good explanations talking about member services. it's important that we are trying to provide members eligibility enrollment to member who aren't eligible.

in future audits, we wanted to do one of every one to start off with. we've known there were lot of dependents who are not eligible on our membership. we find that out and someone gets remarried and they realize they have ex-spouse on for years. and ex-spouse is not eligible for benefits. we flew we needed to do this type of audit. we started off ground deeper and did a complete audit. we have to look at what's next. it's important to keep this audit going. you have to realize optics of that, we are auditing and it would help membership not keep on all ineligible dependent. we are working with other collaborators in the public sector one of them is calpers as

well as active employee association called hr. we have contact information. we'll be working with them to see how they put together this audit and the system they use and the communications they use as well as own lessons learned. typically it's de done every the years. it's a section of the membership every year. in other words, member wouldn't be audited any more or any less than every third year. i mentioned frequency we audited. really big question is how do perform this audit before doing a third or fifth however we'll

do it. do we do this internally at hhs. do we look to have some type of contract with another organization to do it. the city that performs audits, there are several options we're looking at to do this and keep the momentum going. that's all the details i have that the moment. are there any additional questions. >> president breslin: if someone gets divorced and the court order has the spouse covering it, if that spouse decided they want to keep them on the plan because the court order says so, can they do that and pay the

full price? >> no. any time the divorce is final, they are not eligible dependent on health services unless there's a court order for the husband or wife to provide coverage. >> president breslin: they order them to provide coverage, they still can't be in this plan? >> in terms of the results of this, mitchell, incident to commend you and the staff that worked on this. i know that there have been lot of ins and outs around communication. i didn't get the mailing. we've heard all those things as a result of this activity. first of all, i endorse the fact

that we've done this. leave it to you and the rest of the leadership team to determine what did we do full blown or one third issue. i would strongly suggest best practices to have external entity to support this activity rather than trying to do it with internal resources. that was my experience with the university of california system. it brings level of distance to the process. i think we need to be very closely tied into it. you can certainly do all kinds of things around communication.

we would delegate that to you operationally. going to a third party to actually go through the mechanics and support and have that accountability managed by you is the right way to do this. i think structures were right. my hope is that we can do the best practice and keep this as

an active activity, externally support and managed by ural office on behalf of the board. >> i like to add my congratulations actually. i think the learning curve for our members, for us, for the staff, i've never done this before. >> president breslin: any other comments. thank you for a very thorough

report. i know that -- i was reading calpers, they stagger on people's birthdays or something. any public comment on this matter? seeing none. we have number eight please. >> clerk: we're still within the director's report. >> i do have one question, i should have raised before the dependent audit, it's back on page two of the report. it's the last bullet point, express dashboard q3. lastly we report an issue

underreporting script per thousand for the kaiser medicare population -- >> president breslin: are you on a different subject? >> this is in the director's report. page two of the director's report. what's the what's the cost implication? >> let me ask marina address that during her presentation. >> thank you. >> number one, i'm interested -- the cash cade, -- cascade some

of the strategic plans affect us have access to this? in terms of generating reports or responsibilities or is this something we would request from your director -- what's the thinking how the board will interact with cascade? >> my thinking we'll bring reports to the board from cascade. our leadership team hasn't been introduced to the robust nature of the product itself. >> i have two more questions. the second one has to do with maybe update on the status of the seventh member of the board. we're still waiting. >> that was -- i was going to

raise that. >> i did communicate the mayor's staff person on the commission yesterday. he has two names that he is looking at. he didn't respond to my inquiry yesterday. they're getting to us. >> last question has to do with calpers report. which is fascinating to look at calpers attempt to redefine some of the cost issues and the final determination based on a number of calpers members affected. redefining by setting up a slightly different distribution. seems like it's the first step. if affects the bay area because no matter what model they use, we were number one in cost. lay would like to see if you have thoughts about where this

will go. some of the report didn't look at causality. number two, when you do things like that the issue becomes what are we going to do about it. issues that calpers faces issue that we face around the high cost of medical care. >> yeah. i can ask latisha about that. i'll allow you dome up and respond to that question. what i can say in many of the conversations that i have been in, everyone is sort of in -- we've got two more years before we can have discussions about changes in healthcare. there's some hope that governor newsom with enact some things. he'll be limited by anything that has the word waiver in it will stop in washington.

it is of concern to see virtually all of the systems. it is the university, it is dignity. it's everybody doing these vertical integrations and consolidating costs and it's only going up. >> should we have a statewide referendum about dividing the state into a more state. anyone in the bay area should take pause on that issue. now our healthcare costs won't be averaged into the rest of the state. >> yeah. >> last portion of the report one of the next step called out and online and in person was that regional factor decision in terms of creating the range. that doesn't discussed in-depth.

it was next step that excitement meeting. one thing that we talked about was avoiding extremely factor and creating consistency. the upper and lower levels of today limits would be calculated as part of the rate development process for 2020. that was very much the next step, the outcome of this and where it's headed for the future. >> thank you. >> i do want to comment, she's helping us spearhead with mitchem and rest the team and development of our new website. which we hope to go live in february. if you want to make a few comment about that, it will lead

into dashboard. >> we've been working better part of last year on getting our website upgraded to a new platform that's going to do lot of things as we try to make information more accessible to our membership including being mobilely responsive, which means when you're on your ipads or phone or whatever sites you're using to interact with the

information we have, it will adjust to your screen. it's much easier for to you consume. the search dramatically improved because we're moving to newer technology. what we're using on our website is incredibly old. there's only one person in the department that knows what's going on and keep it going. the other real excitement about where we're going with the new website is how accessible it makes it for our own people internally to publish content. that will help us be more dynamic and current and making sure information is out there and available and accessible.

i'm here to present to you our 3rd quarter dashboard out of the the all payer claims database. just a few notes on that, this dashboard is actually looking at incurred from july 2017 to june 2018. as paid through september. in areas where we look at risk scoring and based on diagnostic cost groups. that's looking at the 2017 risk score for the population.

the message is health characteristic in our population has remain consistent. if you look at the metrics or cost utilization or what episodes of care that we have and what sorts of services peopleaç are look to. there's really no surprises anywhere in this report. moving on to the second page -- >> president breslin: question here, this is on page 2, medicare. you have city plan, which is not city plan it should be uhpmd. >> we're rolling in a few changes to the dashboard as you know. we've been wanting to try to get

some benchmarks in there that aren't just western norm but that are more focused to our experience here. also some of the the benchmarks that come out are based on p.p.o. data. we're looking at how to get to those benchmarks. we'll roll all that work in. as you know, you seen the earlier version what our dashboard look like and what improvements we can bring. that's a key one. we're looking at our nonmedicare

dashboard. both active employees as well as nonmedicare retirees. we've looked at combined and the group is rated as a combined group. that's in terms where the drivers from a nonmedicare population. on our third page of the report, just the total allowed amount.

you look at that a year ago and when you average over the total per employee, per year. that's up few hundred dollars but not dramatically so. in the area we see increases are aren't surprising. your outpatient slightly increasing, your drugs are increasing. those are the areas where you see dollars driving up. quick notes on page 4 of the dashboard, here we've got lot of cost and utilization trends in the top area.

in your plan performance, all those are pretty static. ratio to the average just takes look at average performance looking across all plans and how do each plan take into account risk factors, how are they performing and those numbers mean they're performing slightly worse and kaiser .9 are performing slightly better. all those are static what we've been reporting to the board in previous periods. no changes there. looking at page 5, our chronic condition problem. this is key for us in terms of where we want to go for strategic plan and how we want to try to keep our healthcare affordable, quality care over time. we look here on page 5 what are our quality markers and some of

what we look at there would with admission rates. on slide 6 she's got preventive screening rates. these aren't the heated screening rates. this is just using a look at really who would be -- based on every two years -- ready to receive one of these screenings.

what it does for us, if you get numbers from the plans, they might report higher numbers using the methodology. we're saying, how we seeing the trends of that. >> this does concern me little bit. i need to understand it better. the column to the far right is u.s. total, i guess in terms of this. presuming they're using the same criteria. if you look at most of these -- some of these measures certainly cervical, cancer screening are below u.s. average. i don't understand why. it seems kind of sad if we're

not doing more cervical charges screening in this population in high-cost medical care community. >> part of it, correct me if i'm wrong, these populations are not managed as a population. it's not population health management. these are managed by individual practitioners. there's a play i flaw in the wat the data can be collected. >> i guess, having been practice both in services and kaiser, i sort of got reminders from health plans regarding how i was doing with breast cancer screening and cervical cancer and vaccinations and blood pressure control. if i got a number saying that i was doing 27% of the eligible population, it was sort of red

flag. i'm still little confused. i think health plans probably do more than just wait for the doctor or nurse practitioner to voluntarily do it. >> they are learning how to do it. i mentioned earlier today, i was at a meeting earlier, with a lot of independent practitioners having systems that can report data. it's not that this stuff isn't necessarily being done, it's whether how it's reported and is it coming in from outpatient. there's all these variations. it's worth continuing the conversation to try to get the data better. it may or may not true that the levels are that low. >> this is ones that we're publishing for the public. if it's not true, we either need to put asterisk say why this is

not verified or something. it doesn't look like we're doing good job monitoring the quality of screening. >> right. >> unless i'm misunderstanding. i could be. maybe i'm not getting it. >> that's a great question. i know we have notes about the screening rates are doing. we'll take that back. i'm also excited -- there's only two other municipalities