[inaudible] >> these are all city policies that, you know -- the problem isn't going to -- the problem has to be pulled apart piece by piece, and it's not going to happen in just one street. i do support the task force, by the way. thanks. >> supervisor mandelman: thank you. next speaker. >> hi. my name is michael, and i am

the clubhouse director of the boys and girls club of san francisco tenderloin clubhouse. for over the past 20 years, we've been in the tenderloin district, and now for generations, we've had families who have lived with open air drug dealing, open air drug use, and all the problems that go with it. we live among four sites that are disconnected. what that means is every day, our staff, with their families have to navigate all the traumas that has happened in

this tenderloin district. we have kids who we ask more and more recently to reflect on their time in the tenderloin and their boys and girls club. and they don't even mention it anymore. they've normalized it, something that should not be normal. and what has ended up happening is we go through your essays to get in college, they don't even mention it no more. this is a very beautiful, tune time for us to really make some changes. i look forward to seeing what we do next because there's a lot of energy, a lot of argueses, a lot of people that are ready to do something great here. what we're looking for is to have a system changing procedure, to allow changes in

practices to really occur. this task force is definitely a step in the right direction, and i can't wait to see what happens next. thank you. >> supervisor mandelman: thank you. next speaker. >> my name is felicia smith. i'm the tenant organizer at the hotel at hyde and geary, half a block away from where a major drug organization is at. i moved there five years ago, and i noticed when i first moved there, there were all these 13 and 14-year-olds out there, and i knew what they were doing. and i wondered, why aren't they in school? and now, it's the same guys out there, and they have become more aggressive. i walk out my door, and within

15 feet, i've got them saying, do you want something, mama? do you want something? it got to the point where i finally screamed, i don't do drugs. they're getting more aggressive, they're getting meaner. i would like to say one thing, that we've had a lot of negativity here. i've been in san francisco 39 years. this is my fourth time around in the tenderloin. it is the best time. it's a community now. i can walk down the street and have people say hi, felicia. how you doing? or give me a hug, come across the street. the three times before, i didn't know anybody. it is a community now. now we just need to get rid of

the drug stuff. thank you. >> supervisor mandelman: thank you. next speaker. >> good afternoon. my name is eric arguella ao an work at the glide community justice center as a community organizer. i think to have a long-term sustainable out come that has sustainable communities, it's best to learn what are the issues. it is history of trauma, drug use, and poverty will play a role. we all know criminalization, incarceration, war on drugs has not worked. it only creates a system of punishing then taking a holistic healing approach long-term. this needs to be addressed by

bringing members of the local community who are the experts, who understand the del indicate balance between surviving and thriving, people of color who understand experienced profiling on a day-to-day basis, individuals in recovery and such. the outcomes will be truly informed, well thought out, and in a harm rubbieduction approan a long-term approach. thank you. >> supervisor mandelman: thank you. next speaker. >> good afternoon, honorable supervisors. my name is riannon baylard, and i am the executive director of operations at u.c. hastings law. thank you for addressing this epidemic that is overrunning the tenderloin.

i oversee policing and security for hastings and this is an issue that we deal with on a daily basis. our staff are scared to come to work. our students, if they choose to come, many who come to the neighborhood decide not to attend hastings because of what they see here. those who do choose to come are scared to go-between buildings, and yet these are individuals that have a choice. they can choose to go to school or work elsewhere. as has been said, there are many in the tenderloin who do not have another option, including many seniors and children as has been mentioned multiple times. so i see an opportunity here for us to come together, to reject that the tenderloin has and continues to be a dumping ground for drug activity and activities that more affluent neighborhoods push out of their neighborhood and into the

tenderloin. i don't know what the solutions are. there have been a lot of good suggestions that have been provided to today, but i believe if you are all commit today convening this multidisciplinary task force and also commit to recommendations that come from the task force, it will be a step in the right direction, and hastings stands ready to partner with you in these efforts. thank you. >> supervisor mandelman: thank you very much. next speaker. >> hi there. i'm a resident, and i work in the tenderloin. listening to all of these people talk, i realized something. you know, i'm not smart enough, nor am i -- well, we'll just leave it at that. i'm not smart enough to figure out what will work on this task force. but i do know for sure what won't work. i think it was in 1914 was the first several mandated markets laws was -- narcotics laws was

established. now, i don't know what is right, but i know a path to follow, and that is what we have done in the past. so you've got to be thinking outside of the box because buying -- hiring more police may seem like that's a thing to do but that's the worst thing because that's all we've not done in the past. so all i can say it i don't know what you can do differently, but please, let's think outside the box and let's be a task force that can do something for a positive change and not just be the same old, well, we did this last year so let's do it this year because it's too difficult to come up with something. really meaningful, and have it

work. thank you. >> supervisor mandelman: thank you. next speaker. >> my name is tony page. i'm a resident in -- off the -- off of 6th street. i'm also a volunteer at glide. the reason why i've come, you know, we're talking about open air drug dealing. thing is, where i live, i see it all the time. and most of the people i see doing it truthfully are kids. i'm seeing, like, 13, 14, 15, 16-year-old kids doing it, and they're the ones that aren't making that much money off of it. it's the people that send them that's really making the money. a lot of these kids are doing it just for survival. i think it would be a good idea to come off of this task force so we're not criminalizing them. some of them are doing it because they don't see any

other opportunity. we need new ideas, you know, to help bring this solution to a close, you know? and we also need a way to diverse the interests of these kids so that they don't think that drug dealing is the only way to go, you know? maybe more education or where to find more hobbies or common interests or something, just something, you know? because these kits -- kids are our future. that's all. >> supervisor mandelman: thank you. next speaker. >> my name is fione o'shea. i'm a resident of 9th street. i.v. drug users that come down to the alleys after they

purchase, if they're not in their cars because people do come in their cars to purchase in my neighborhood, too. most of the drug dealers in my neighborhood come on b.a.r.t. [please stand by].

>> -- that their police department is interested in increasing that foot patrol, maintaining what they installed on the streets. i think there's a lot of people we see every day in the neighborhood, and whether it's street sweepers, the neighbors that live in the building or

the neighbors that live a block away from us, one of the things we'd like to see on our blocks are guys and girls in uniform. >> thank you. >> supervisor mandelman: thank you. next speaker. >> hi. my name's john hui. s.f. native, born and lived here all my life. we've heard the stories of other people. mine is nothing special, but i want to share it any way. growing up, i experienced things that people of color experienced. when my mother and i would go to chinatown on the weekends, she was harassed by this female police officer. because she didn't speak english, she didn't know what to do. my god father told us about issues he had to deal with growing up just because he's

black. i was allowed to graduate from s.f. state with a criminal biology degree, but i wanted to get a degree in criminal justice. i'm back to school, trying to finish that up. i have a cousin that, you know, i've known him since he was two years old, since he moved here. great child, bubbly. he moved out to the tenderloin, and growing up, he's just been distant. he got to hanging around the wrong people. he doesn't listen to anyone. it's heartbreaking to see these things. i, yeah, just wants to put that out there and share that. thanks. >> supervisor mandelman: thank you. next speaker. >> hi. my name is michael nolte. i want to thank you for having this hearing but i also want to

thank you for having the hearing yesterday on the same thing, particularly, having a hearing on the assets and what does the city pay for? i think if a lot of these people could understand what is being paid for and not being paid for and how to improve it, that's part of the issue we need to address. business owners in the area are concerned about property damage. they're also concerned about -- as a resident, i'm concerned about how to keep the items in the stores that's affordable. when that damage gets passed along to the consumer. i'm also a moderator of many message boards in the neighborhood. obviously, the elected officials are not necessarily moderating -- monitoring what's

going on on those message board. they'd see the complications we have and maybe would do a -- find some solution just by what's being posted on the message boards. also, those who have been arrested in the past, there needs to be some skills be offered them so they don't recause problems. i think that's a major problem in being rehabilitated so they can move on with their lives. in the past, we've had in san francisco, the guardian angels, and the guardian angels, they made a difference and can maybe do something that can fill in some of the gaps. thank you. >> supervisor mandelman: thank you. next speaker.

>> officer krupke. is it a problem of excessive crimes? is it a problem of excessive crime control? the problem is both. so let's have another committee. we'll fill it with the staffers of all the n.g.o.s. it -- it occurred to me that this district, this neighborhood is -- because of the redistricting and the nature of redistricting, it's being threatened to being put into three separate districts. and also under jane kim, under her leadership, tens of thousands of people in the tenderloin line in district three, outside this district. this is what has allowed this community to come this far, which is pretty amazing. don't you dare, don't you dare

put someone on that redistricting commission that has not served on a single government board like what happened last time. >> supervisor mandelman: thank you. next speaker. >> i just wanted to say -- -- to hiv and then more recently, things like mrsa and other antibiotic resistant diseases. we fight these things with the drugs that are sold out there. people don't talk about that there. part of what kept that down there is opium, and what it does to the immune system. for people to shutdown that

open air market which makes or streets safer for something we have to have as a consistent issue in manhattan, that's a scary thing. it's just something to be aware of. thank you. >> okay. >> supervisor mandelman: thank you. next speaker. >> good afternoon, supervisors. my name is wendy, and these are some of my thoughts. you can't solve open air drug dealing without reducing demand. reducing demands means treatment for substance use and mental health issues. but please consider this. the city spends $7 million per training class of the police department of about 50 people with an average of 35 that comes out of each graduating

class. they come out, and they make $93,000 a year. no student loan debt, okay? first, is training for those of us in the helping profession, whether it's social workers and the like. people who work in these professions, they take training on their own, come out with lots of student loan debt, and they make about 40 to $45,000 a year. just food for thought. >> supervisor mandelman: thank you. are there any other members of the public who would like to speak on this item before i close public comment? public comment is now closed.

[gavel]. >> supervisor mandelman: supervisor haney? >> supervisor haney: well, first of all, thank you, chair mandelman. you're going to think twice before you're going to -- let me see your agenda before i bring items to your committee again, but i hope it was a worthwhile experience. this obviously is something that really, you know, most directly impacts the neighborhood that i represent but it's important to our entire city and to all of our residents. supervisor mandelman has put forward actually a task force that relates specifically to meth. as i heard all the calls for creating a task force around this issue, i think it would be great to talk to you about what you've learned already from that process and what it would look like. so i just want to thank you and supervisor stefani and supervisor walton for letting

us be a part of it. i want to thank everybody who's still here. i think it shows how committed we are to finding solutions around this. i really want to apologize, and i hope you'll extend apologies to folks who wanted to share but who couldn't stay. there are people working on safe passage every day. i just want to say i appreciate them. this was a department heavy hearing, but i think it was an important thing for us to do. it really showed us what is happening, it showed us ways we can take as we pursue paths forward as a committeunity. i'm committed to having further conversations in the community about what those next steps will be, and we can have

further conversation with a lot more opportunity for more comment out in our district. that'll be the next step. i also want to say i am incredibly impressed by comments of the members of the community today. it was also really hopeful to me that there was such unanimous and strong support of a task force. to be clear, that's not what i was calling this hearing to do, and i think it's all that much more powerful that there's a mandate to do that because the community came and said this is what we want. that did not come from me, that came from the district. i am a resident of the tenderloin, i live on hyde street. i think if there's a community that can come up with the solutions and do this the right way and deal with the complexities and have empathy and understand all sides of it,

it's our community in district six, not just in the tenderloin but in midmarket and soma, as well, and throughout our district. so there will be next steps. i learned a lot. i have a lot to process, as we all do, but this is not the end of it, this is -- we are going to continue this with urgency. the intention is not to refer it to some committee and you don't hear anything for a couple years. we're going to have to think about what we want that task force to do, what the timeline will be, and what the immediate short-term changes and prosecute priorities ne priorities need to be right now. we have budget changes coming up, so i need to know what to move forward for for some long-term changes. thank you, supervisors, and to everyone who came out. sorry for the length of this, but more than anything, thank you for your commitment. i also want to let you know, a number of the departments did

stay for the entire piece. oewd, the captain, the district attorney's office. so we appreciate that, as well -- our b.l.a., as well. thank you all for being here, and next steps coming very soon. appreciate it. >> supervisor mandelman: thank you, supervisor haney. this was a very long hearing. i think it's longer than you anticipated. it's longer than i anticipated. i know that i and some other colleagues had to rearrange some previous engagements. i guess for supervisor walton and stefani, i pledge to do a better job in the future of figuring out how long things are going to be taking and limiting our staff presenters to a shorter period of time. i was thinking somewhere around hour two that if there's any neighborhood that is deserve of

a little extra attention at city hall, it's -- you know, it's probably the tenderloin, and so i do think this was four hours well spent. i also think that as you say, the issues that came up here touch on larger issues that affect our criminal justice response, our response to substance use, our response to issues that are not neighborhood specific but do go across the city. given the interest of the board and the mayor and all of san francisco and more effectively tackling these problems, i think it was also a useful hearing in that regard. as you say, there are a lot of task forces and efforts going on, the meth treatment folks are working. i thought it might make some sense to have some sort of blue ribbon around mental health and substance abuse, but there's some critical call for

attention on the tenderloin. any way, i won't go on too terribly much longer, except to say that supervisor haney, you're okay with having this heard and filed -- you have two options. you can have this continued to the call of the chair, in which case, it would sit in this committee. if you wanted a further hearing, you could just pull it. i think i would prefer to have it heard and filed. >> supervisor haney: you don't want to do this again? yeah. heard and file. if we move forward in the task force, it would be the introduction of a task force. you can close and file this e one. >> supervisor mandelman: excellent. so i will have this heard and filed with no objection. mr. clerk, are there any more items before us today? >> clerk: that completes the agenda for us today. >> supervisor mandelman: mr.

clerk, thank you so much for your patience and help today, and with that, we are adjourned.

>> the health service board will now come to order. please stand for the pledge of allegiance. i pledge allegiance to the flagt ates of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. . >> madam secretary, roll call, please. (roll call).

we have a quorum. >> item number 4 please. >> item number 4. approval with possible modifications of the minutes of the meeting set forth below. regular meeting minutes from march 14, 2019. >> are there any corrections to the minutes? no corrections. i could entertain a motion. >> i move the regular meeting from march 14, 2019 be approved. >> second. >> any public comment? all in favor. opposed. it is unanimous in favor. >> all right. moving right along here on to number 5. general public comment on matters within the board's jurisdiction. >> is there any public comment within the board's jurisdiction?

seeing none, we move to item 6. >> item 6 is presidents report. >> i want to thank mitchell gregs who has gone above and beyond duty for customer service. i have had a couple casings okayses this month that were okayses this month were complicated. he exemplifs aphis e execs emfi. item number 7, please. >> the director's report. this is given by the executive director of the health service system abbie yant. >> good afternoon. the highlights from the

director's report. we have completed our election. we had five candidates, three dropped out, two remained. that allows us to seat those two candidates, one of which is our president and the other is mr. chris canning, who is a lieu department in the active duty police department. he will be able to sit with the board at the june meeting. we also have news that we -- the mayor's office appointed their member, marry howe -- mary howe. many understand her work in human resources. she is employed in in marincou. she is a resident in san francisco. we are not sure if she will be here for the may meeting but

defendant for june. we will have a complete board in june, which is great. i did want to just highlight we have been following some of the taxes at the federal and state level. at the federal level, the ex ice tax. there -- exise tax it will be applied for the 2020 year. the managed care tax in california is also in play, and that may very well apply next year. we weren't sure -- the state wasn't sure how to read the feds on this one, but apparently in michigan they have a similar tax and got approved very recently

by the federal government. it is likely that california will apply again. those two taxes are going to be -- we will give you the breakdown on the cost as we move forward. i want to highlight that we did have the well-being at work celebration in march, and it was great to not only see all of the participation from many different departments. we had a commander from the police department, assistant hospital administrator and the wellness manager from m.t.a. all spoke in great detail with a lot of commitment and passion about the well-being programs and how they were implemented in the various facilities, which in this case all three are 24/7 departments. it is an awesome responsibility. it was impressive to see how much thought they have given to

those programs. we did respond to questions in the director's report that have come up. marina was able to pull together the migration analysis that you requested that we look at and pay attention to. folks moving in and out. we will continue to monitor that. we expect to see more out-migration. time will tell what actually happens. the other on the data from the screening that we had some questions in the data marina presented. she is working through the data questions with kaiser data people so it will be able to better answer the screening question itself once we are certain of the data. i have come to the conclusion we have an ongoing longer list of

items that we are looking at each of the plans and how they perform opioids, fertility benefits and co-pays. we met this week to develop a more robust process for how we do some better analysis and presentation back to the board about those questions because they are getting more and more complicated. we want to take the time to give a well researched response to the board. that is under kay. on the personnel side i see vanessa price cooper is here for the contracts unit. welcome. some of you may know lisa campo. she has been with the well-being for some time and has been

promoted to coordinator. malica is assuming some of the 1209 benefits technician. there is movement there. there are fewer positions under recruitment activities. there are six there, and we are getting excellent service from the human resource department and hope to have those positions felled at that point. we have got fun projects going on that we engaged the services of the controller's audit unit online services which is an excellent way to due process improvement. mitchell has been working with them to look at call volume in member services. what are the calls?

what can we do to reduce the need for the calls. we have had leadership and staff training. we did a pilot project. engaged in a project we are under taking. we will get to a certain point to stop and suspend open enrollment. it is a great partnership with the controller's office and we are looking forward to a disciplined approach within the department. i think that concludes my highlights for today. >> any public comment on this item? any questions from the board? no public comment. item number 8, please. 8. financial report as of

february 28, 2019. presentation by pamela levin, chief financial officer. >> pamela levin chief financial officer health services system. to clarify the cadillac tax, it is 2022 when it might possibly come up. the report presented to you summarizes the revenues and expenses of the budget through february 28, 2019 as well as the projection for the year ending june 30, 2019. in terms of the trust, the balance on june 30, 2018 was $77.4 million. based on the activity through the endhe of february, it is

projected to be $83.9 million which is an increase of $6.5 million. we are seeing unfavorable claims experienced for the uhcppo and blue shield access plus plan. for blue shield trio and delta dental self funded the claims experience is favorable. we received $300,000 in pharmacy rebates and the year-to-date amount is $2.1 million. the projected year end as of june 30, 24019ne is $6.9 millio. the healthcare sustainability is projected to have a year end balance of $1.3 million. a total of $500,000 in performance guarantee payment have been received as of

february 28th. as of today $105,000 has been paid out this year for the adoption andsure gas see plan. we t updated it today. the totald expended since first offered is $178,000. the amount of forfeitures for unused flexible spending will not be known until june 2019. we continue with the graph. the goal of setting the rates is for the actual cumulative expenses to be equal to the total revenues including stabilization reserve up or down but the buyout was down over the course much the year. in summarizing where w we are te

cumulative expenses are high or for the health plan. it is lower for blue shield access and trio and delta dent dental. in termsnthe of general fund administration budget. through february 28th we were projecting year end balance around $300,000. that is due to salary savings associated with delays in hiring. that is the conclusionentation. are there any questions? any comments or questions? >> any public comment on this item? seeing none, we will move onto our rates benefit section now. first item is number nine

please. >> item nine rates and benefits for the plan year 2020 presented by the executive director. >> i have the calendars in your packet. once again, we are at the point where things are moving along very smoothly and we can make the decision to not have the april 25th meeting. we held that in a that in abaya. >> any public comment on this item? >> item number 10, please. review delta dental active employee ppo, experience and approve rate stabilization reserve recommendation presented

by mike clark am. >> good afternoon. i am here today to talk through the delta dental active ppo plan experience and suggest our recommendation for the rate stabilization handling into 2020 rates. if you look at page one, just bottom line on top we will recommend today that one half of the available reserve be applied. i will walk you through the rationale for that recommendation. as you see in the first paragraph there has been a continued pattern of lower actual claims and fees relative to premiums that is a consistent theme within pamela's financial report. thus we are recommending a higher level of rate stabilization reserve buy down be applied than what would be typical as the per policy through allocation.

we view this as fiscally responsible approach to reduce what you will see as a rate stabilization balance on this plan that is built-up substantially over the last five years. you will see our recommendation to apply one-half of that available stabilization reserve or $7.16 million which will preserve the other half with rounding 7 million and 15,000 for use in 2021 beyond rating. for comparison if you are curious. it will be at the bottom of page one. page 2 provides general background on stabilization policy itself. noting that it is important to recognize that we talk about the dental plan, we talk about

active employee ppo only because every other dental plan offered by us to active employees and all retirees are fully insured. this is the only self funded plan out there so that is why we talk about the claims for this plan rate stabilization reserve because every other dental plan including all retiree plans are fully insured. so page 3. you will see the experience for this plan over the last six years in the table at the bottom of the page. for this particular year, the claim and fee costs were 5% lower than the actual premium in the plan. as you will see in my call out boxes to the right, the actual experiences represented by the grey bars and it is averaged pretty close to $120 per

employee per month for each of the last six years. we have not seen cost inflation in this plan. it has been pretty consistent in terms of the actual cost of the plan and i will talk through reasons for that in just a bit. we also focus on loss ratio. in actureterm. that is taking the total claim and fee dollars divided by the premiums so anytime you have a loss ratio that is less than 100% that means you have lower claims and fees than the premiums in the plan, and as you can see with the bars representing the actual claims and fees, the line presenting the premiums, you can see why we have loss ratios below 100% each of the six years. so on page 4, i list three key

reasons why we had ongoing favorable experience in this active dental ppo plan. one is the experience. it has been constant claims and fees on employee per month basis. we have an underlying issue on the plan which is under utilization of preventative care. we would like to see more members tap the coverage and use preventative care benefits. out of every person employee or dependent enrolled in this plan and keep in mind every employee in this plan is paying some contribution to be in the plan, one out of three aren't seeking preventative services. that is a concern of ours and something we continue to brainstorm ideas with delta dental to encourage members to seek preventative cleanings and preventative services within the

framework of the dental plan. third, from a premium calculation standpoint, we have been using a higher annual claim increase factor in the past years. you may not recall last year we suggested using a lower trend factor in the 2019 rating. we will start to see that play out in the 2019 experience versus premium calculation difference, but that doesn't reflect in this data because this takes us through the end of 2018. as i note in the paragraph below the three items, we do expect claims and fees close to premiums as a result of some of the changes for 2019. >> excuse me. if you are encouraging preventative cleanings and so forth, would that, is there some sense if that were to spike and

people acted on what you are recommending, would that have impact here? >> yes, terrific question. i expect if we start to see a significant increase in the preventative care utilization, i could see a short term increase in claims. presumably some of those individuals shoe have not been seeking periling ventive services could be diagnosed with cavities and gum disease, as an example, so that does have potential to create what i might see a short term spike in claims, although still again preventing much more serious procedures that might have to occur just by nature of being in so much pain you finally are compelled to see a dentist. >> thank you. >> just an observation here. an employee pays $5 per month.

>> for single coverage, that's correct. >> employee plus one pays about $9 per month. i can see where it isn't significant. they think i am paying a lot for is this. i didn't know it until i looked how much the premium was the delta dental. you know, definitely it is kind of surprising only one of three have cleaning. that is not a good thing at all. if the premiums are consistently more than the cost, then why don't you reduce premiums? are you doing that? >> the overall cost of the plan is much more than just the employee contributions. you are correct. single employee pays $5 and

employee plus 1:15 the total -- 15 the total rates are much more than those figures. >> i know that. >> can i follow up on commissioner scott's question. when you look back. you have analyzed for 2018. we have been sort of under utilizing it for several years, and is that the case? do we have preventative screening ratings back to 2013? >> i have seen the data going back a couple years. i personally have not seen it back to 2013. we could work with delta dental to gather that experience over the last six years. the average of one out of three not using the plan is consistent. >> i think i assume we all believe in preventative dental care, number one, the reason is that the one doesn't when you start to have symptoms and need

care, you will not only be in pain but also reach -- this plan as a cap, does it not? >> there is a $2,500 annual maximum for each person in this plan. >> do we have any idea what the trend is in that in terms of are we seeing more and more of the lag? this can happen not much on an annual basis but over years we might see the few people reaching the cap. i am curious to know if we can demonstrate the consequences of this under utilization of prevention. >> we are happy to pull together a summary of six years of information on utilization to have available for you. i will do that as a take away to work with delta dental to affirm that. >> your challenge to the health

service system is appropriate. we have responsibility to make sure these kinds of services are being utilized. in addition to healthy diet and exercise and get out of the chair 30 minutes. we need to focus on this. it looks good because we save money. it is not good. >> i want to say especially here. you the ppo dentist get the preventative services, paid by the plan, and every member represented here is paying something out of their paycheck in the contribution to be in this plan. >> aside would the well-being program or any of that cover dental or recommend people get dental when you discuss it? >> it is very much part of the discussions we have been having with delta dental. i understand it is not a typical to have a third of the

population that doesn't go to the dentist for a variety of reasons. i think we need to find out why our population is choosing not to go to the dentist and really go out on it for the obvious reasons. oral health is a huge indicator. we put in place the smile away benefit to help those can chronic disease. we do need to step it up to find a way to help the membership make use of dental services so we work with them to create a better campaign, work with well-being, but it is a struggle to get people to go to the dentist that choose not to go. >> flyers come out in the mail. >> yeah, yeah, there is a lot of information out there. i know in general in health

information education doesn't change behavior. we have to figure out and we we will look at partners to find best practices to change behavior. i don't think it is that people don't know to go to the dentist. there are other things. i have a spouse who won't go to a dentist that won't anesthetize him. he has to pay extra. his wife makes sure he goes. i am sure there are many stories that occur. we will have to dig into the issue to understand what will change behavior. >> thank you. page 5. now, i want to talk specifically about the rate stabilization reserve and provide background on our ultimate recommendation for today. the delta dental rate

stabilization reserve started in 2014, and over the course of time because of the favorable experience you have seen in the prior exhibit we have seen significant surpluses build-up to the point where we have about $14 million as of december 31, 2018. noted at the bottom of the page you can see how much the rating benefited through the buy down year-over-year and how that has grown from 2.8% in 2016 up to 8.4% for 2019. we made some changes in our forecasting and our rating method but we also are looking for, you know, ways to spend that $14 million greater than policy. page 6. very detailed page. bottom line shows approximately $5.6 million was the adjustment to stabilization carried

forward. the amount by which the plan kind of exceeded or was better than forecast from an actual cost perspective versus expectation. that leads to the chart on page 7. when we do the math of starting point, stabilization balances at the end of 2017. look at the offset in 2019 rating. add back increase based on 2018 experience, you can see the $14 million calculation. we are recommending that we use half. you may ask why do i suggest half? the policy is one heard. i want to make sure that there is adequate reserve present for future years so let's say if we do encourage and a lot of people start using the plan beyond today and we start to see

upticks in experience. there is a contingency reserve on this plan. we don't talk about it here. the rate stabilization is a third line every serve after the i.b.m. p and contingency reserve. i feel that still having $7 million available for use in 2021 and beyond is adequate but also feel the fiscally responsible action to take is to apply for than one-third per policy. that gets to my recommendation on slide 8. what i would ask you to consider today two approval actions. number one, suspend self underred stabilization reserve on one time bases for del deltal and approve $7 million to be applied