as far as the audit, it's all been audited. thank you. >> i also have a quick report that i do every year that looks at the financial statements.

as you know from the representative kpmg, they did an examination of this financial statement, comparisons between 17, 18 and 16, 17. the trust began 17-18 with a balance of $72.5 million and ended the year with $7.4 million. the $4.9 million increase is due $6.1 million decrease in the city health plan due to clean stabilization reserve. $5.6 million increase in the blue shield flex funded plan. due to excess premium in claim costs $1.2 million in use of the

claim stabilization funding totaling $4.4 million. there's $2.2 million if dental plan acquisitions. offset by claims destabilization reserve application of $2.8 million. there's a 900,000 increase in blue kaiser plan. which is based on premiums agreements for new enrollees, members eligible for medicare and members with changing contribution schedule. there's $800,000 increase in savings in the healthcare sustainability fund. $200,000 increase in flexible spending account account

employee contributions for claim reimbursement to participants and $.8 million increase in the net position for income performance guaranteed. the obligations and reserves against that fund balance total $43.4 million this consist of $23 million in contingency reserves, $18.3 million in stabilization reserves, $900,000 for the healthcare sustainability fund. i did provide a graph that i have not provided in the past. it shows the obligations and reserves against net positions

by fiscal year. you can see that there is a consistent decrease in the obligations and reserves. this is due to use of the stabilization reserve. there's a change in the net position which is expected. other information that we present at this time, at the end of calendar year 2017 combined total $14.4 million within the stabilization reserve city plan delta dental. total $5.9 million was used for the 2019 rate. balance for the future is $8.8 million for delta dental. the dental rates were billed that we will start drawing down on that, that balance.

in comparison of investment earnings performance guarantees and forfeitures is presented in the report. total decrease from $1.12 million to $824,000 in 18-19. in terms of performance guarantees, in 17-18, total of $107,000 in performance guarantee penalties is $25,000 less than what was received in 16-17. other things in terms of the adoption assistance program, the total amount reimbursed to members since inception of the program in january 2017 is $186,000 for eight adoptions. we continue do -- to get

applications and scrutinize the paperwork. in terms of the next steps, the financial statement were issued february 5th. hard copies are available at s.f. h.h.s. office. soft copies are online in the report section. i believe that is new rebranded in terms of what the name of the website is. i apologize if i didn't get that. the comprehensive annual financial report, which is citywide, will be issued i in te near future. any questions. i like to thank in terms of financial statements elizabeth

salazar, alan yantz. they worked on the closing year and the financials. which is very large. as i mentioned, marina coleridge, and mitchell's group was essential to enter some of the financial statements. >> president breslin: i have question on this. on the third page. medical benefits during the fiscal year provided to members of the systems, three-plan choices. i don't see united healthcare on there. >> this is --

>> president breslin: we have four choices. >> thank you. >> president breslin: i saw somewhere in else. >> i appreciate your dedication to reviewing this. >> president breslin: it stood out at me. obviously we have another client. that would need to be corrected. >> i will definitely get that right next year. >> president breslin: are there any other comments? this is an action item. did you have something further? okay, thank you. thank you very much. we need an action item on this.

that will be to accept the audit and financial statement with corrections as mentioned. any public comment on this item? no public comment. all those in favor say aye. any opposed? it's unanimous. it's passed. we're getting near that time where people like it take a break. we will be on break for five minutes. [break]

>> president breslin: we're back in session. item number 15 plaza. >> item 15, demographics report presented by marina coleridge, the enterprise system analytics manager. >> marina coleridge enterprise analytics manager. here to deliver to you 2019 demographics report for our membership.

this report is 40 pages. there's no expectation that will go into detail today. you can find it at s.f. h.h.s..org. go about us section and underneath there is a report.

looking at page 3, we've made refinements over the previous years. the bigger change that we implemented this year is doing lot more breakouts of our nonmedicare retirees in previous years, lot of that population was just lumped in with retirees. we're trying it give them little bit more visibility. we continue to grow in terms of the medically enrolled lives that we support up another 2164 on the table there on page 3. we have 122,547 covered lives.

we've get about 5959 additional members that waived coverage. we're up to 128,506. pretty significant. you'll see the breakout i was talking about. >> president breslin: excuse me, 128,000? >> yes. you don't see it here. i just know these things. it takes 122,000 plus. what you're seeing here, there's a new line in here for kaiser permanente advantage. when we look across our plans, we know access plus and trio are

for nonmedicare population. you know it the united healthcare advantage p.p.o. are medicare population. we we looked at kaiser, that was asking where the divide was for making things more comparative. moven omovingen toingen to sli o slide 4. dental enrollment is upward trend. we increased lives there. another 1861.

we only administered dental for the city and county. the sphere yor -- superior courd our retirees. flexible spend, we do that for the city and county of san francisco. that continues as well. that upward trend, 7135 different enrollments between the healthcare. some people enroll one or other. some people enroll in both. on page 5 is a quick snapshot of the voluntary benefits. we had instituted those couple of years back now. interestingly enough, the biggest growth this year was short-term disability with

27.33% increase. legal shield almost 24% increase in enrollment. and the accident insurance about 24% increase in enrollment. the other benefit that was introduced last year, you'll see in the graph on the bottom part that's our v.s.p. vision premier. this current plan year, we had an increase 4585 members enrolled in that. 14,742 taking advantage of that benefit. that graphic down there just breaks it out across our various employers. all right, we're now just high-level comments here. on page 7, what looks different here, little maps that breaks

out visually how many are employees, how much are dependents. bottom restrict there with the little orange components. that's now break out of the nonmedicare retirees. we used to have them lumped together with the other retirees. the ratio of employees to dependents that stayed the same. about 25% of medicare retiree have dependents enrolled. we've get an increase in 651 lives in that population over previous year. page 8, just calling out that graphicking is there -- graphic there on the left looks different. we've taken the kaiser h.m.o. for our active population.

you're seeing all the kaiser plans together all of the blue shield plans together. kaiser continues to be the plan with the highest percentage of our lives enrolled. i think it's trending up almost 60%. we have got the breakout by down of where our people live on page 9. major in san francisco county at 38%. lives in all the counties increased except for napa and riverside. we saw slight decreases in our population in those counties. everywhere else we're growing. looking on page 10, just calling

out here the lives by medical plan that you see, kaiser permanente senior advantage. this is a 5-year trend. [please stand by]

on slide 12 is a view of our enroll ment by the retiree members, not dependents, just members. here we have done a better job of giving you average age by medicare and non-medicare. you can see the further breakout on the charts on page 13. many of those are pretty static, however, again, majority of our enrollments are living here in

san francisco county and high 90 plus percentages in th the 8 bay area counties when we look at our members. it is hard to read. might be time for a new pair of glasses. >> this is very clear and wonderful. i wonder if you will comment. something to go back to when we have questions or concerns how this can be used because you have a lot of detail here. we do 10 county reviews for, you know, rates. how do you envision we can take this and not refine it to more detail, but use it in terms of our own deliberations? >> that is a good question. sometimes over the years questions are not in here maybe disability retirement what are we talking about with the

retiree population? we don't have that in here. knowing a lot of our decisions are based where the hmos are available the breakout who is in the county, who is in other countries makes sense. we have had considerable conversations that talked at times about especially leading up to diva and domestic partners anspouses, who was that population. you know the majority of domestic partners are opposite sex and not same sex. it dispels some beliefs we have. it is a good reminder, too, because we tend to have a bias or i have observed that to exist for thinking through the lens of city and county of san francisco our most dominant group. we administrator benefits for

four employers. who is our average age. who is the benefit. who is taking on like if you look at usd, they will hire percentage of their population are taking kaiser, and they are the ones that tend to be more of an e only or older age by employertends to come from city college. what does that mean if we talk about age and gender and implications to risk scores? those are some of the things we consider. right now, i have had this question. we tend to really just align our rates by our ee only or e plus one or retire reonly or retire replus one. one of the rating out there and i will refer to mike, might look

at where the first dependent is just the adult dependent versus a child dependent. it is worthwhile to consider changes to look at that with the distribution there. we definitely tend to be static. if you look at the percentages year over year, yo you don't see huge swings, where they are living, distribution of male to female, the average age is slightly dipping. is that meaningful in terms of stability of population against the backdrop of other changes. i think that is meaningful. i would love the day when i could keep this more dynamic and update this more regularly to act for enrollment changes as the year moves on. it is heavy to get this one out we are not there yet. >> it is great. i like you divided up the

medicare tir -- retirees. >> at the board meetings with the recognition of the decisions you might weigh. what needs to be in the report to help you as you go to the next year? >> i recall discussion last month about looking at new districts for healthcare costs. encourage everyone to move to riverside county where the health costs are very low. you can see our demographics and how that does impact or bottom line in terms of the programs we offer, plans we offer. this is useful. not just pretty pictures. >> we do like the pretty pictures. >> pretty pictures, too. >> any other comments on this?

>> all right. moving on. i won't take up too much of your time on this. let's focus on page 18 on the employee members and their dependents. here again, i had alluded to the fact on page 19 where we see the breakout of the age that our average age is slightly dipping. what we know is th the age of dependents is increasing, age of member is slightly decreasing. you can see distribution of members and dependents in our plans. you will notice it is more members on the lower number on dependents. in terms of the ratio of that contract there. moving on on page 20.

again, same thing. with or without dependents. san francisco's most populated county. we hear about migration out of families, san francisco is expensive. those are all considerations as you think about employees and access and engagement of healthcare. of all employees that do not have dependents. 54.62% of those are in san francisco. that is a 2% drop. looking at all employees with dependents, 38.37% live in san francisco. 97% of our employees live in the top area counties on page 20. again page 21 is a lot of data. if you look at the trend lines, ratio of employees to depen

debts 49 to 51 is the same year-over-year. enrollment by coverage level same year-over-year except for slight rounding, close to the same numbers. not a lot of changes. we are increasing in our population. for our retiree members, and we saw this for all of the lives, but our enrollment in city plan did increase. retiree lives on the whole increased. we see some of that as we moved forward in the pages here. i will say as you know as we look at the retiree population, and move on page 24 here. in these little circles on the bottom left graphic there. you can take a look at members to dependents to our children dependents that are in those plans, and members, of course,

for blue shield are smaller against the kaiser and united ud healthcare. if you take all of the employees it is 10% in blue shield. bump it up against the comparison looking at non-medicare retirees 41% are in blue shield. again, san francisco being the more dominant county, there are enrollment on page 26. 93% of the retirees are in california. the next highest number is in the distribution. we have a number of individuals who live out of the country. 93% in the state. 90% of those in bay area.

36% of those in san francisco. the influences of what happens here and the northern california market have a huge impact on our retiree population. we are not disbursed widely. we have people everywhere, but not in huge numbers. >> we can wrap this up. >> distribution on page 27. retiree members versus dependents stays the same. five year trend is the same for the last six years. page 28 here is where you see the statistic on survivors, bottom row of the table. if you want to know where the surviving spouses are and the kinds of numbers for the population and their children that is where you find that. 891 surviving spouses are

enrolled in our retiree plan. dental. page 30 for the retirees. this was quite popular for the 2019 plan year. again, maybe it was the benefit changes with the orthodontic lifetime increase. 1246 lives increase which is over the previous two years. definitely an increase there in the dental. final section of the report looks at the same metrics. it looks by employer. aggregating the active and retired population from that particular employee. both of their active and retired populations. no surprise. city and county largest proportion 81.26% followed by unified school district 14.07. 3.48 city college. court 1.1%.

looking at page 32 on the graphics there. i just give you the percentages. if you are curious you can look at the top left to see the total numbers of lives that we have that are coming from the different employers and you can see on the bottom left there the average age based on those all lives from our employers and a breakout by plan. we are getting a little pretty there. interestingly enough, we have got city and county of san francisco increasing year-over-year on the five years. look at the dental enrollment on the bottom part of the table. a lot of that increase is coming there were as super-your court is seeing a decrease in employment enrollment and dental

plans the numbers are dipping slightly. you will find that information and more in your 2019 membership demographic report. conversation earlier today look at page 34. it doesn't show who is paying what premiums. if you are curious about the number of employees in city plan, you can find that by looking at the employer breakdown for city and county here. you can see on page 34 towards the bottom uhc city plan you will see the numbers. 963 city employees are sitting there and 599 are in e only. that will help you as you move forward. sometimes and we have talked about this as we look forward with our strategic plan and initiatives around other factors. there will continue to most

likely be changes in the demographic report where you might get inside by contribution or by unions or by language and ethnicity information. looking to bring more information to you. i am going to essentially leave it there, i think, so i don't take too much more of your time. any particular questions? i am trying to get my head around this. we know the health care cost toward the end of life go way up. i am curious about the number of enrollees who live out of the state. do we have a way to access how many moved back to the family homestead in north carolina or florida or texas toward the end of their life? if we look at how we counsel

people and services we see that are being provided, this is happening. people are moving outside our major health plan areas. we might want to look into that. i was looking at the data to try to come up with some initiatives. >> we don't know if the childhood home or where they are going. that i cannot capture. what we have access to are the previous addresses in the system. you know, with zip codes we can do analysis about the cost of living in various zip codes. we can show that kind of movement of folks. we have 93% of the retirees in california. we assume where they are going are places less expensive than the bay area counties. some may be surevay data to

people who don't live, we can identify who is not here and ask them what factors did they use in deciding where they went. >> any public comment? >> dennis kruger, active retired firefighters, spouses and dependents. i just want to comment on the number of years i have been coming here. this is probably the most detailed demographics report i have ever viewed. normally, these go in a file i have somewhere in the back of my home. this report will it is in my briefcase in the very front because there is so much information to be used for the next year in this report. i just want to commend the people that put this together. it is excellent, excellent.

>> any other public comment? seeing none. item 16, please. >> item 16. approval of the san francisco health services annual report. the report will be presented by the executive director. >> i am going to walk through the highlights of the annual report. i can't take credit for it. they did a marvelous job, and with that being said, i do want to just kind of zip through a couple of pages. page 4 is a fun page. you need your reading glasses with a lot of highlights from the various reports the team puts out as well as finance.

the trust fund contributions are over $900 million now. we have reached that mark. that is to be so noted going forward. as you know we are in addition to the board, there are five divisions within hsf. finance, member services, enterprise system, communications and well-being. the report does have the demographic highlights you just heard. i need not repeat those. the board had 11 regular meetings, one special meeting and a number of committee meetings in 2018 and approved the strategic plan and actuarial contract. what we are looking forward to is online and in person education for the board. we are about to review and

approve the governance documents that have been revised. we are looking forward to the member seat elections and hope to -- the board will receive monitoring reports on the strategic plan, a quarterly report starting this spring. the finance group in addition to a lot of the work that you had presented to you today has their arms around 41 contracts, work order relationships with 33 departments, thousands of payments processed and had a clean audit. go! our compiling the r.f.p. for the medical plans. we referenced that several times today. i did want to point out the reason it did get delayed to give us adequate time to prepare

for the proposal and put out a proposal to give us clear choices going forward. if you think back on the timing, i started here almost a year ago this week, and we immediately completed the proposal process for the aquarial project and moved to the process in june an approved in october. when we sat down to do the proposal for the medical plan we thought we would undertake it for the 2020 plan year, but when we mapped out the timeline, it was not going to work so we are committed to issuing that proposal in may of this year. moving forward, members some of the highlights i spoke from are on page 12 in the report.

in addition, we all know wever successfully completed the diva process with earnings and savings to the system. i don't know if you have all been to hss to see the new lobby developed. it allows a nice area for us to greet members and provide education and manage the large numbers in open enrollment. call volume is high, over 63,000 calls this year outside of open roamment. we are doing some things in member services. i will give you what we are looking towards this year. one of th the things i believe i mentioned is adopting a quality improvement process called lean six. we have completed the first

pilot project with controller's office and engaged two staff members in looking at a very complicated process that needed attention, and they were not only diligent in completing the process but enthusiastic and did the presentation to the all staff meeting. we have two volunteer staff members coming forward for the next pilot phase. the leadership team will engage in training over the next several months. that is all aimed to improving work flow between and within divisions and enhancing member services overall. the enterprise system is the success of the self-service initiative that occurred in open enrollment, keen attention to

cyber security that we pay careful attention to and launch of the website. going forward this builds on the questions about the demographic report to have an understanding of population health and look at the social health. we have the unique opportunity as the folks that stay long-term of looking at co-hearts of the population and understanding how we may be able to help influence their health over time since they are with us for a lifetime very so far ten. we are very much looking forward to having self-service e benefits for all going forward. that will mark a new day for the health service system when we converted to pretty much e benefits to all. there will be exceptions to those who can't cross the digital divide, if you will. it will be a new way of doing

benefits going forward. communications on page 14. they talk about the volumes of communication services that are provided, fixed benefit guides go to 75,000 folks that receive enrollment packets. there was a terrific project where we took photographs of our members. we have our members. we still have staff photograph agree but most of it is us. we put together a couple videos. we are in the video age where many folks, my children learn by watching videos. they read books, but they know a lot of stuff from watching the videos. we are there. the well-being program continues to flourish. there is the employee assistance program part of well-being.

they serve over 6,000 people through direct services or trainings. well-being at work is a concept alive and well. i would invite each of you and you will receive an official invitation to attend the celebration on march 15th. that would be terrific if any or all of you can come. they completed almost 5,000flu shots. next year we are looking at campaigns to look at retiree well-being since we completed the assessment and survey. we have a rich partnership with rec and park. we are looking to do better with giomapping where the employees and can we design and produce programming that is more engag

engaging of employees. the director phil ginsburg is creative and interested. they do a terrific job of providing services. we have been meeting on a regular basis to strengthen that relationship and partnership. last but not least, it is noted the average monthly contribution of members is $173. keeping our plan sustainable going forward is paramount to what we do. that completes my highlights of the annual report unless you have any questions. >> any questions or comments? >> yes, i don't know how we include it someone's you get something -- once you get something printed. if i recall correctly this board engaged in a lot of activity to hire a new executive director, you. that needs to be noted as part of the work of governance or

accountability. we took renewal of the actuair re. i put those two points out there to ask they in some way make the way into the content of the report. >> so noted. page 6 we will make those adjustments. >> i would like to state the obvious. the size of the contributions relative to the budget is impressive. we get a lot of bank from our -- bang from our staff for the responsibilities. i am impressed with that. this highlights once again how efficient you all are and the innovations to try to improve efficiency while we manage such a large trust fund. it is amazing to me.

>> i have a question. i notice something about our well-being needed a new person or something at park and rec. >> i think you saw in one of the budgets. >> yes because our relationship has become so robust, we need to look at an add on to the budget in the budget process the cost of administrative personnel for rec and park to provide and build out the services. it makes sense to us because of the hiring and scheduling that goes with all of the classes that are serving our members. this is not for recand park to continue to serve the residents of san francisco but this is specifically for us. we have actually pushed them to develop some classes our members want they didn't have.

they had to do job descriptions and create new classes. they have just kind of -- they are hitting the wall how much they can do without additional personnel. >> these classes are only for our members not the public? >> prettyh. >> if it is public they should pay for it in their budget. >> right. >> we need a motion? with the two edits that i have referenced i move approval of the annual report. >> second. >> any public comment on this item? seeing none. all those in favor. any opposed? >> it is unanimous in favor. >> now we are on item number 17. >> 17 cataracts surgery white paper and update presented