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 by

abbie yant. >> our member dennis kruger has been a great voice for cataract surgery. we have taken the time with subject matter experts and also i have consulted directly with the doctor, we have prepared a detailed document in your materials. i want to highlight what our findings are. i will start by saying we are recommending we maintain the traditional cataract surgery in our plans based on the plans from subject matter experts. i personally learned a ton, and i wanted to offer to you -- next lied. the overview of the traditional

versus laser surgery technique. there is a lot of information in here, but essentially it states and i think it was noteworthy when this new laser technique was introduced in 2009 there was a lot of expectations it would replace the traditional cat tar racket surgery. that is not the case. the numbers of cataract surgery is going down. it may have advantages to folks electing to have vision changed through laser surgery. for those with cataract surgery the laser technique carries a higher risk of complications, takes longer surgery time and has issues. the substantial issues why medicare and other plans are not covering that surgery so that leads me to the next slide on

the rationale. as i said, the traditional cataract surgery is most common type of surgery. people who have it will continue to need glasses if they were having that before. with laser assisted surgery, you can also have lenses put into adjust your vision, but that is usually based on the fact that you don't want to wear glasses any more and it is considered a cosmetic improvement. there are certain medical conditions where those types of lenses can be covered by your insurance for certain types of medical conditions. they can be implanted using traditional cataract surgery methods. that is a preferred option for doing that when there is a

medical condition. there is as i said earlier, there has been no evidence of improved patient out comes with the laser surgery and indeed has a higher risk of complications. it does continue to be the most cost-effective and we are recommending that we stay with the traditional cataract surgery. are there any questions? any comments? >> just want to thank the director for doing the research and the time for responding to the member comments. thank you. >> i just have one thought. if the lens where you can see distance and close up so you wouldn't have to buy glasses wouldn't that save money for everybody in the long run?

>> not necessarily. those types of procedures where they have where they do one can to see distance and one eye that can see close. some patients can coller rate that. -- tolerate that. many choose not to. >> there is a lens, not two different eyes, the lens itself? >> no. there is a bifocal lens. it is much more closely. my understanding from colleagues. this is not my area of medical expertise. the lens has fixed refraction. the user eyes change it is temporary. there are new licenses being developed to be modified and they are very experimental. there is someone at ucsf to

change that so if the eye changes with special treatment the lens can be changed. , the shape. for the most part if it is successful, there is no guarantee it will be successful for the lifetime of the recipient. >> my sister had that five years ago and she never had to wear glasses. thank you for the research. i appreciate it. any public comment on this item? >> dennis crewder active -- kruger. today is a good day. i learned something. any day you learn something is a good day. still trying to give our members the best, if we can.

i was wondering if there is a possibility now that we removed laser surgery that we could set up or some kind of a fee schedule could be set into the policy to people who want to elect to get higher lenses where seeing how under traditional surgery they also can be inserted into your eyes, that if there is a schedule if somebody wants to spend more money to get a better lens or as abbey said the best distance lens and correct for just reading or the bifocal lens or any of these other ones if there is a possibility to put that in there as a schedule where members elect to go for that benefit it can be cost shared with the

insurance companies. thank you. >> i will let the director respond to that. >> mitchell, would you advance the slide that was on there before. >> retiree and protect our benefits member. i want to clarify something because my information may not have been accurate, but on the issue of the laser surgery, i did contact medicare, and i was informed by the individual with whom i spoke that medicare would cover 80% of laser surgery for cataracts and your secondary

policy would pick up 20%. that seems to be in conflict with what you said. >> that is in conflict with what i understand. it is not my understanding medicare will reimburse for laser surgery. we are getting different pips. >> in the -- different opinions. >> in the city plan how does it work, the same? >> yes. >> in the city plan does it pay 80% and secondary 20%? >> not the medicare plan. medicare plan is not city plan. >> there are some people in the city plan. they wouldn't have medicare anyway. >> medicare would pay for lasik.

>> since lifting information is there any information, any way to investigate that further? >> we have investigated it. this is our position that i wanted to advance the slides. let me show you the average cost of cataract surgery with no insurance is -- i took these out of order. this is the range of surgery cost. this is not quoted from our costs. this is an independent source. from $3,600 to $6,000. next slide, please. the lasik surgeons are charging these fees. these are done by individuals in

offices by physicians specializing in this service. they vary how much they will discount to the individual member. what this says to me is it makes it very difficult for the insurance companies to negotiate these prices because their price sensitivity is quite different. the number of these are just going down all of the time because the demand is less because and this is the primary reason our staff recommendation is not to go with this. increased chance of complications. i think that for us to continue to discuss doing a procedure that carries a higher risk is probably not prudent regardless of how much it costs our members.

i don't think it is a good idea for us to be recommending surgical procedure that is not recommended by the authorities, by the american college of opthunderstormology, but the subject experts. it is not that you can't have it done, but it can be done without of pocket expenses. >> one comment. there may be some semantic confusion. look at the uhc position. they pay the surgeon the same amount as if the surgeon was doing the traditional surgery. the fee schedule is identical. the surgeons need to not only cover the cost of equipment for the laser equipment and the fact it takes longer in the operating room.

they operate on expertise and volume. they can do much more than 230 years ago, -- 20 years ago, the number of cataract per day. they do fewer for laser because it takes longer. they would bill the patient. >> as i said, it was a very super-visual conversation with the representative from medicare. i intend to call and get a more extensive opinion on this. i think my concern is that when we transferred from health plan one as retirees, that we were promised that we would always be given the same coverage that if we had stayed in plan one. primarily, i want to make sure that if medicare will cover 80%

of the procedure which as i said my conversation was on a very super-official basis. i want to ensure shawe are as members of medicare advantage plan that we are still getting what was promised to us at the time we left health plan number one. i will, you know, discuss this further. there is probably a great possibility my information wasn't as accurate as to what your investigation has produced. i will bring it back before the board if that doesn't come to be true. thank you. >> thank you. i just wanted to mention, too, like the doctor said. if you are in kaiser, they only cover the traditional plan.

if you are in united healthcare they will cover the other at the same cost. in kaiser they won't be pay anything for the laser from what i am reading here. is that correct? >> yes. >> okay. very good. any other comments on this item? seeing none, item number 18, please. >> item 18 reports and updates from contracted health plan representatives. >> good afternoon. sharon, national account manager the delta dental. i am here to report on a complaint received by the board last month in regards to the smile away program. there was a discrepancy in the communication that was provided

via a phone call. one of your retirees called our contact center and wanted to enroll in the program. they were able to successfully enroll. then they wanted to enroll their spouse. at that point in time our contact center representative stated that dependent spouse would need to enroll online, go through the online portal. that was inaccurate information. the phone should have been handed over from the primary enrollee to the spouse and the spouse could have enrolled on the phone as well. there is the opportunity for spouses and all members to enroll in our online portal so by having their own online enrollment account they can go on abenroll in the program via

computer. since that conversation because we record all conversations, we have taken that as a teaching moment back to that particular representative and sent out an e-mail blast to all of our contact center representatives to let them know, a refresher how the smile away program works and to just further make sure that this does not happen in the future. a couple caveats where the primary enrollee could not enroll their spouse themself. there is phi information and as you age, meaning 18 and over, you become an adult, and you are in charge of your own health. we respect that and we respect the personal health information of every adult individual.

that is why the member. we couldn'ten legal the space based from the members communication with us. i would also like to report if there is no further questions on that piece, the enrollment for january. we have had tremendous success. 142 retirees have enrolled in the month of january. an additional 28 enrollees from the active population. that could not have been as successful without the assistance of the communications department as well as senior leadership here. it is a wonderful wellness benefit. without that promotion of the benefit we wouldn't have had the

success of this enrollment. thank you on behalf of delta dental for helping and partnering with us to present this great benefit to your population. >> was there any information to the members to explain this procedure after the original? i think we talked about sending out something additional on the smile away program. yes. >> we put it in both guides. we have nine flyers and we want to have more around the dependents. it explains the call in number, customer service number as well as the online portal. >> thank you for doing that

investigation. are there any other comments on this. thank you very much. >> any public comment on this item? >> other plan representatives. >> thank you, randy. >> ann thompson. i was asked to come up to speak to you all very briefly. we have previously spoken with the president and executive director about the go forward plan for the team. that is that i will be your account executive leading the team overall but with a focus on the nonfinancial. he is continuing in his role with all of the numbers and providing the strategic thought

to the team. we will bring forward doctor neil to promote the strategic plan. that is my brief announcement to the board. are there any questions i may answer? >> thank you so much. >> good afternoon. happy valentine's day. dennis rodriguez kaiser in northern california. at the last board meeting a member had a question about health education classes availability and difference in volume at two different medical centers and a specific question about administration of insulin classes. i want to address that today to the board.

we have health education department at every kaiser facility. we offer a variety of individual as well as group classes. the volume of classes we offer can vary by medical center. the needs vary by medical center. the types of classeses would vary because of the difference in demographics by location. maybe something in san francisco may not be offered in sacramento or san jose. insulin is in every center because it is a chronic condition. how it is communicated in the various materials we offer through the health education classes and courses could vary by medical center. i have confirmed we offer an insulin administration class in san francisco as well as

sacramento. it is diabetes basics. if a person is not able to get any kind of education around a newly identified chronic condition or having challenges we encourage them to reach out to the health education department. we are happy to provide individual training around the health education needs. we assess the needs for different classes. the dynamics can change. we take feedback from the health education department when members come in to ask for specific classes as well as a need as they see their patients. it is dynamic and it can change. we want to meet the needs of our population. i want to respond to that

inquiry. >> any questions? >> no questions. >> thank you for your time. >> thank you. >> blue shield of california. i want to give you an update on some new network expansion in san francisco that is going to help drive access for trio and access plus members. on monday, blue shield announced we signed a contract with cpmc for the members to have access to cpmc as well in the stolen group. that was for sf members only. as of 3/1. it will be for access plus. for 4/1 it is active for trio. >> are you planning to send direct information to our members? >> yes, we are.

we rolled out another new program called life spring for members seriously ill, discharged from the hope. are home bound with a low access to food. we will provide flee mail service through life spring structured around whatever health condition they have. if they are discharged and on the cardiac diet life spring will be notified and get food doo liferred up the three months for three. >> i will make the trudges there is cord -- make the assumption there is coordination with the director and chie chief operatig officer for inquiries that will come to us first. i would hope we would see the communication before it is sent

out. >> absolutely. >> we have had instances where that was not the case in the past. >> understood. we have a good understanding about communications we send out. yes we will send those over. i wanted to give you that update. >> the contract is with brown and tolling members. >> it is access members. trio effective four/one. >> i have been told that nutrition counseling, is covered. i have been told this by a nutrition assist and the center for whatever. any brown and stolen docktosh making a referral ask to be kored. i wonder how that works.

>> if a brown and stolen doctor makes a referral. >> for nutrition counseling it is covered. >> it is covered under many of our programs based on whether or not they have diabetes. >> this is not based on that. >> i can look into that. >> i would like you to. it has come up two or three times now. i was curious how it works. i thought you had brown an and tollen before. >> it is the new relationship. that had severed. as i understand they were not discussing that. now they have. your question within the blue

child family much fessitions and giving referrals for nonrelated. we have not had that conversation with shawn yet. she is brand new to the team. any questions. have a great afternoon. >> heather with united healthcare. my friend shannon is home ill. i have an update. it was brought up at the january board meeting about a mailing that had gone out to medicare members. that went out and there was confusion around that. i want to confirm it had to go out because of cms requirements. a second letter was mailed on

january 28 that will clarify why that first letter came out and confirming that members don't need to do anything. that will clarify questions about that. any questions on that? >> i guess i understand medicare has requirements and all of that. given that, is there a wet better way or lessons as to how this helps get to our members. so they understand why they are getting this letter within the context of your obligations to meet cms requirements? >> absolutely. i will follow up with shannon. she talked about better communications so though understand that. i will pass that message as well. i have a new team member where

me today. margaret kelly has been with you nighted healthcare. she is new to the team. the new senior vice president for public sector. i want to give her a minute to be introduced. >> good afternoon. hello. i am happy to be here and happy to work with you and the team. >> we look forward to the continued partnership. >> thank you. >> is there public comment on this item? >> dennis krueger active retired firefighters. i received the second letter that came out. had i not known the little that i do know, i would have been confused again. my suggestion is no matter what united healthcare or any health

provider sends our members that the director and all of the people involved see it before it goes out. >> thank you. >> any other public comment? seeing none. we are now on to item number 19. >> opportunity for the public to comment on matters within the board's jurisdiction. >> any public comment on this item? >> now, i will take my minute at the microphone. good afternoon, commissioners, representing rccf and retired siu10 to 1 members. we had a number of individuals who were confused by the last letter. i think it is more than running it by the staff. it is having health service be

involved somewhere on the distribution of the letters. our members were confused by the second letter. do we dump this in the trash as well and not pay attention because it didn't come from health service. we need to understand the impact this has on our members. i want to bring up another issue i am hearing from some of our members. this goes back to the opioid issues. there are a number of seniors who get prescribed a number of opioids to help with quality of life. with the panic with the opioid crisis fewer and fewer physicians are willing to continue those prescriptions and what we don't know is whether or not those opioids are for individuals of a certain age. we find the quality of life is

diminishing among the members who can't function any more because this is the medication i had that kept me active or going or doing various things. now, i am in so much pain because i can't get that medication or i am unable to perhaps recover from something as quickly because certain medications were not made available. i am wondering if we within our system can have some discussion or at least look at formularies and looking at the issues with regard to sustaining quality of life, especially as we get. most of the complaints were from people in the 80s and a couple in the 90s who said no longer able to get certain medications had diminished their ability to function and they were confined and finding that difficult. i hope at some point we have the opportunity to look at formularies and look at the

whole pharmaceutical issue as it comes up. thank you. >> any other comment on this item? seeing none, that is the end. now we are on to item 20, please. >> opportunity to place items within the board's jurisdiction on future agendas. >> anybody have an idea? something they want to add to the agenda. we will have plenty of items as we had today. public comment on this item? seeing none, that ends our regular meeting. regular board meeting. we will now go to our governance committee matters which our chair randy scott will. >> thank you. this might seem to be distorted. i think if you looked at the

agenda we are going to closed session. we are trying to get the general board business done before we went into closed session and took care of matters we just addressed. the first item is 21. secretary would you please read that item? >> approval of updated governance terms of reference and policies presented by the governance committee chair scott. >> you have in the board materials distributed a summary of the changes recommended by the committee in the terms of governance. we are about a year behind on doing this. this again was impacted by this board's activity around the executive director sheriff. we wanted to be sure the executive director would be fully informed and participating in the process of making the revisions. we have included in this board

packet not only the summary of changes but the red lined document that sites the specific changes in the terms of governance. unless there is specific discussion by the board or you want to look at one particular item versus another, this is an action item that will allow the secretary to encore important rate these changes in for met and edit -- format and edits to the final document reviewed by the president and myself for release and distribution at the website, we will have a downloadable version that board members can put on their ipad. we will provide hard copies for those board members who request it, like me, or others once it is finalized. that is what the action is.

and the representatio recommende governance committee. >> something i wanted to mention. i know there was a suggestion we add into this binder -- i'm trying to think. the cafeteria plan. i don't see the cafeteria plan in this binder. it has no relevance to the governance. this is about the governance and policies. >> i will defer to the secretary. >> it notes additional policies in the first section of the chart as well as cafeteria plan and the city charter. the charter i understand. the cafeteria plan has no relevance to how we operate.

that is a plan, another plan. i don't think it needs to be part of the binder. i think the charter does because it backs up a lot of what we are doing in the governance policies. that should be in there definitely. >> i understand we are not including the cafeteria plan? >> right unless there is some particular reason to do that. why would we pick that one versus all of the other plan offerings that we have? i don't know why we would do that unless there is historic precedent. >> we are willing to custommize it. if you find it is helpful we will provide them. if it is not helpful we will have a basic version. >> we put a lot of work into the

cafeteria document. >> we didn't do a thing. >> you approved it. >> we approved it. >> you spent time to work to ensure it is compliant. it is up there with the health service board rules and other operative document that governs how benefits are administered with the health service system. >> given that this will be a live document we could highlight a link to the terms of reference or to that particular plan in that document. if a board member wants a copy, we could certainly include it. >> and the rules make sense to have in there, the rules and regulations. that was on the end of it, too. that is a set will rules. i don't have that. >> health system rules?

>> right that makes sense to be in there. we have to defer back to that sometimes. >> that particularly as we go into confidential sessions dealing with member claims and so forth, the health system rules. that would be a replacement for the cafeteria document as an explicit listed item. are there other questions about the changes? i am willing to entertain a motion. >> i move we approve the red line changes made to the governance term of policies. >> second. >> it is properly moved and seconded that we approve the red line changes for the health system services board. any public comment? we are now ready to vote.

those in favor signify by aye. those opposed. it carries unanimously. we will go to item 22. >> approval of 2018sfhss board education report and reviserred 2019-2021 education plan rented by committee chair scott. >> in the board materials for this meeting we provided a summary of activities from an educational standpoint this board has undertaken during the past year. we have also laid out in another document plans for educational activities that the board will undertake in the ensuing year. we have had added over the past couple of years an educational forum, if you will, normally in the november meeting where we took up a wide diversity of

products. we relied on our able secretary and executive director to document this stuff we have done during the year. i want to commend the extra contributions and amount of time invested by the commissioner. he has 47 hours of education he undertook by attending the international employee foundation benefits conference representing this board. thank you for doing that, steven. the report is here. do you have any questions or comments? any public comment on the -- excuse me. we need a motion to accept and adopt the report. >> i move to accept approval of the 2018 san francisco health services board education report and 2019-2021 education plan.

>> is there a second. >> properly moved and seconded to accept the recommendation an approof the plan for 2018 and the report for 2018 and the plan for 2019 and beyond. is there any public comment or further board comment? any public comment? we are now ready to vote. those in favor signify by aye. those opposed. it carries unanimously. now the next item. >> item 23. approval of the evaluation report for the fiscal year 2017-2018 health service board annual selfie valuation. presented by randy scott and keith howard managing director of the department of human resources. >> kay, please come to the microphone. i want to on behalf of this

board thank you for your diligence and leadership as we have undertaken both of these required activities evaluwaiting, assessing our performance and providing the evaluation for the executive director. it is very easy to work with you, and i found it to be a lot less painful than i thought it was from the last time. thank you for helping out. >> thank you, chair scott. good afternoon, president and members of the board. kate howard managing director of the human resources department. as commissioner scott mentioned. i am here to present the annual selfie valuation. you did take a break between the last time you did this evaluation and this year because you were conducting the search for the director. i would note to you, as i noted

to the governance committee several weeks ago, i think this board is remarkable in your own efforts to evaluate your performance and improve on that. i haven't seen examples of boards or commissions taking that so seriously. as you know, this is part of your annual governance process. in january all six members of the health service board completed the selfie valuation. >> could you stop there for a moment. >> notice she said six members completed it. this commission is seven members. it has been noted that we have a vacancy, we have had a vacancy during the transition. it is my public hope and prayer this commission will be brought to full strength as quickly as possible. thank you. >> from your lips from the

mayor's office. >> i hope so. >> so all of the current members of the board completed the evaluation during the time that it was open, and the anonymous evaluation covered four key dimensions of board performance. board member intern actions and meeting, goal setting, communication and interaction with management. the board rated a series of statements on a scale of one to five indicating your level of agreement with those statements. across all four areas, the average score was 4 or 3.9. nearly 4-a cross all four categories. there is a great deal of agreement about the positive work together the board is undertaking. you have in your packet a full

copy of the report. i would highlight a few items and happy to take any questions. generally, i would note that the board appears to identify that it is working well together. in particular, members commented on the successful recruitment and selection process that you undertook together to recruit your current director which was a significant effort and one that you all appear to believe is good evidence of your work together. there are a number of areas where the scores increased somewhat including board members accepting the decisions of the board even if there was not a unanimous vote for that decision, establishing suitable goals for the investment program and providing good feet back to

the director to improve performance. a couple items the board may wish to focus on in the future to improve performance. i will mention a few of those. i would note that sometimes places where there is room for improvement can be because you have made improvement. now you have higher expectations about what is possible, and when you have new members joining your board, sometimes the orientation process can take a little while for people to get up to speed. one area for continued focus and commissioner scott you noted this in the action the board just took around the education, continuing education work, around both new member orientation and ongoing board member education around critical

issues facing the health service board. that is an area that most of you noted you would like to see strengthened. then the other item i would highlight is continuing to work on your efforts to communicate to the variety of stakeholders that we lie on the work of the health -- rely on the work of the health service board and be there is potentially room for improvement there. with that i am happy to answer any questions you have. across the categories, the scores were relatively consistent with your prior selfie valuation, and i would also note that the rating can change dramatically by one person's score. there are only six of you. each person has a significant

weight on the overall score. >> couple comments. one, some of the questions only five people responded because your percentages don't reflect six. 20, 20, 40. you say that is not six, that is five. i don't know if that is necessarily be highlighted. as you pointed out the sample is so small one person dropping out can affect a score. five respondents in one category was lower than the statements in that category that were six. i am wondering if you were very clear about encouraging us to write comments, and i guess as i recall my own responses and saw

the spread around the responses, it might be helpful if someone writes or disagree or strongly disagree score, they are encouraged to write a comment. maybe they did and the comments didn't show up in the report. a lot of the comments were interesting but relatively positive. if it was a board we would want to know why some members felt compelled to score low but didn't comment or that comment got suppressed. maybe some attention to that in the future. if you score say disagree or strong disagree a comment is strongly encouraged so we can look to see what the expectations are. >> thank you for that. that is certainly something we can focus on in the future. comments were encouraged in the survey itself and you are

correct, but there were several questions and you can tell by the percentages where one of the six of you didn't respond. that is reflected in the percentages but it may change the scores because that person didn't submit a response. >> are there comments or questions. >> additional general comments on the last page. first comment is that just taken verbatim. was it written that way? >> all of the comments noted here are verbatim from the survey. this is what one of you wrote. >> okay. i thank you for your comment about the board doing a selfie valuation. this happened quite a few years ago. we had a consultant that put all

of this together. we had none of this before. that was 2007 or 2008. maybe clair remembers. maybe 2007 or 2008. that is how we got going on this. we didn't do anything beforehand. thank you for your comments. >> any other comments or questions from the board? is there any public comment on this item? i am willing to accept this as an action item. i am willing to accept a motion. >> i approve acceptance for the employee performance evaluation. >> properly moved and seconded we accept the selfie valuation for the year 2018.

any discussion, comments, observations? public comment. we are now ready to vote. all those in favor say aye. it carries unanimously. we are now ready for the next item. >> item 24. vote on whether to hold closed session for public employee performance evaluation report for the sfhss executive director presented by committee chair scott. >> i am ready to accept a motion on whether we are to hold a closed session for public employee performance evaluation report for executive director. >> i move for the closed session. >> it is properly moved and seconded we vote to hold the closed session for public

performance evaluation. any public comment? we are now ready to vote. those in favor sick five by a -- signify by aye. motion carries.

motion carries

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