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? >> pretty much. >> 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