san francisco, 911, what's the emergency? >> san francisco 911, police, fire and medical. >> the tenderloin. suspect with a six inch knife. >> he was trying to get into his car and was hit by a car. >> san francisco 911 what's the exact location of your emergency? >> welcome to the san francisco department of emergency management. my name is shannon bond and i'm the lead instructor for our dispatch add -- academy. i want to tell you about what we do here. >> this is san francisco 911.

do you need police, fire or medical? >> san francisco police, dispatcher 82, how can i help you? >> you're helping people in their -- what may be their most vulnerable moment ever in life. so be able to provide them immediate help right then and there, it's really rewarding. >> our agency is a very combined agency. we answer emergency and non-emergency calls and we also do dispatching for fire, for medical and we also do dispatching for police. >> we staff multiple call taking positions. as well as positions for police and fire dispatch. >> we have a priority 221. >> i wanted to become a dispatcher so i could help people. i really like people. i enjoy talking to people. this is a way that i thought that i could be involved with people every day. >> as a 911 dispatcher i am the first first responder. even though i never go on seen --

scene i'm the first one answering the phone call to calm the victim down and give them instruction. the information allows us to coordinate a response. police officers, firefighters, ambulances or any other agency. it is a great feeling when everyone gets to go home safely at the end of the day knowing that you've also saved a citizen's life. >> our department operates 24 hours a day, 7 days a week, 365 days a year. >> this is shift work. that means we work nights, weekends and holidays and can involve over time and sometimes that's mandatory. >> this is a high stress career so it's important to have a good balance between work and life. >> we have resources available like wellness and peer support groups. our dispatchers of the month are recognized for their outstanding performance and unique and ever changing circumstances. >> i received an accommodation and then i received dispatcher of the month, which was really

nice because i was just released from the phones. so for them to, you know, recognize me for that i appreciated it. i was surprised to even get it. at the end of the day i was just doing my job. >> a typical dispatch shift includes call taking and dispatching. it takes a large dedicated group of fifrst responders to make ths department run and in turn keep the city safe. >> when you work here you don't work alone, you work as part of a team. you may start off as initial phone call or contact but everyone around you participating in the whole process. >> i was born and raised in san francisco so it's really rewarding to me to be able to help the community and know that i have a part in -- you know, even if it's behind the scenes kind of helping the city flow and helping people out that live here. >> the training program begins with our seven-week academy followed by on the job training. this means you're actually taking calls or dispatching

responders. >> you can walk in with a high school diploma, you don't need to have a college degree. we will train you and we will teach you how to do this job. >> we just need you to come with an open mind that we can train you and make you a good dispatcher. >> if it's too dangerous to see and you think that you can get away and call us from somewhere safe. >> good. that's right. >> from the start of the academy to being released as a solo dispatcher can take nine months to a year. >> training is a little over a year and may change in time. the training is intense. very intense. >> what's the number one thing that kills people in this country? so we're going to assume that it's a heart attack, right? don't forget that. >> as a new hire we require you to be flexible. you will be required to work all shifts that include midnights, some call graveyard, days and

swings. >> you have to be willing to work at different times, work during the holidays, you have to work during the weekends, midnight, 6:00 in the morning, 3:00 in the afternoon. that's like the toughest part of this job. >> we need every person that's in here and when it comes down to it, we can come together and we make a really great team and do our best to keep the city flowing and safe. >> this is a big job and an honorable career. we appreciate your interest in joining our team. >> we hope you decide to join us here as the first first responders to the city and county of san francisco. for more information on the job and how to apply follow the links below.

sustainability mission, even though the bikes are very minimal energy use. it still matters where the energy comes from and also part of the mission in sustainability is how we run everything, run our business. so having the lights come on with clean energy is important to us as well. we heard about cleanpowersf and learned they had commercial rates and signed up for that. it was super easy to sign up. our bookkeeper signed up online, it was like 15 minutes. nothing has changed, except now we have cleaner energy. it's an easy way to align your environmental proclivities and goals around climate change and it's so easy that it's hard to not want to do it, and it doesn't really add anything to

>> 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