adjourned. >> shop & dine in the 49 promotes local businesses and challenges residents to do their shop & dine in the 49 with within the 49 square miles of san francisco by supporting local services within the neighborhood we help san francisco remain unique successful and vibrant so where will you shop & dine in the 49 my name is jim woods i'm the founder of woods beer company and the proprietor of woods copy k open 2 henry adams what makes us unique is that we're reintegrated brooeg the beer and serving that cross the table people are sitting next to the xurpz drinking alongside we're having a lot of ingredient that get there's a lot to do the

district of retail shop having that really close connection with the consumer allows us to do exciting things we decided to come to treasure island because we saw it as an amazing opportunity can't be beat the views and real estate that great county starting to develop on treasure island like minded business owners with last week products and want to get on the ground floor a no-brainer for us when you you, you buying local goods made locally our supporting small business those are not created an, an sprinkle scale with all the machines and one person procreating them people are making them by hand as a result more interesting and can't get that of minor or anywhere else and san francisco a hot bed for local manufacturing in support that is what keeps your city vibrant

we'll make a compelling place to live and visit i think that local business is the lifeblood of san francisco and a vibrant community >> self-planning works to preserve and enhance the city what kind hispanic the environment in a variety of ways overhead plans to fwied other departments to open space and land use an urban design and a variety of other matters related to the physical urban environment planning projects include implementing code change or designing plaza or parks projects can be broad as proipd on overhead neighborhood

planning effort typically include public involvement depending on the subject a new lot or effect or be active in the final process lots of people are troubled by they're moving loss of they're of what we preserve to be they're moving mid block or rear yard open space. >> one way to be involved attend a meeting to go it gives us and the neighbors to learn and participate dribble in future improvements meetings often take the form of open houses or focus groups or other stinks that allows you or your neighbors to provide feedback and ask questions the best way to insure you'll be alerted the community meetings sign up for the notification on the website by signing up using

you'll receive the notifications of existing request the specific neighborhood or project type if you're language is a disability accomodation please call us 72 hours before the event over the events staff will receive the input and publish the results on the website the notifications bans feedback from the public for example, the feedback you provide may change how a street corridors looks at or the web policy the get started in planning for our neighborhood or learner more mr. the upcoming visit the plans and programs package of our we are talking about with our feedback and participation that is important to us not everyone takes this so be proud of taking ann a.

>> a lot of water heater in san francisco look like this may be yours doesn't too do you know it is the post earthquake problems we'll show you to brace our water heater hi, everybody i'm patrick director of quarter safety for the city and county of san francisco welcome to another episode of stay safe today, we'll talk about bracing water heaters water heater failure is a leading problem with earthquake fires you have a a single source you'll have in our home. >> how are you. >> so what are we looking here. >> this is a water heater 3

weighs from 200 to nine hundred pound during an earthquake that weight will try to move sideways we need to secure is. >> we'll brace the water heater our model home in south of market we'll use a simple kit interest the hardware stores from $20 it the the clean up itself single thing to do what necessary look like. >> this is what you'll find in our kit a inch and a half wide strap to attach to the wall around the water heater and so you want to compare this in some garages around the city and state which is called plumbers tape innovate as strong and we need to brace the water heater

if you find this you'll want to replace it with a streetscaping kit. >> we've put blocking so that way we streetscape the water heater a nice fit it is important and important probation officer mention you need to move our water heater to strap is it talk about to a license plumber they'll come out with a firm once we streetscape those obviously we want to follow the manufactures instructions. >> typically the instructions will require the strap one strap be installed to fit the top third of the water heater and the bottom on the bottom 1/3rd away from the controls if it is above a certain size 50 gallons a third train e streetscape in the middle of the water heater. >> a lot of time i see older

water heaters on the ground obviously explain why this is required and the mr. chairman is required if you pa a water are hereto in the garage gas fumes can accommodate and the pilot light will ignite the fumes so you want to above the grouped level. >> so why not go ahead and he get started with the bracing. >> we're joined with peter from construction he'll help us

>> there you have it for not a lot of 340e7b in a short time we were able to reduce the risks as you can see secure and even in a big rumble bell not going to come losses thank you for watching we'll give is one more big push as you can see with

>> ♪ ♪ we are definitely pioneers in airport concession world a world of nationally if not entirely or internationally >> everybody is cop us right now. >> the people that were in charge of the retail this is where that began. >> i didn't think we would have a location at the airport. >> we've set the bar higher with the customer commerce. >> telling me about the operator and how you go about finding them and they get from being in the city to being in the airport. >> so first, we actually find a table and once we know what we want a sit-down we go to the neighborhoods in san francisco

and other people seminary of the retail let us know about the rain water and are excited to have the local operators in the airport. >> we have to go going through the conceive selective process and they award a lease to the restaurant. >> they are planning on extending. >> we that you could out the china and the length evens and the travel serve and fourth your minds and it's all good. >> how long for a vendor to move through the process. >> i would say it could take 80 up to a year from the time we go out to bid until they actually open a restaurant. >> i don't know what we signed up for but the airport is happy to have us here.

and, you know, even taking out the track simple things there's a learning curve >> with once we're here they are helpful. >> it's an award-winning program. >> we're prude of your awards we have won 11 awards the latest for the best overall food address beverage program and . >> like the oscars (laughter). >> the professional world. >> tell me about the future food. >> all the sb national leases are xooirz and we're hoping to bring newer concepts out in san francisco and what your passengers want. >> well, i look forward to the future (laughter) air are we look fofofofofofofofo

>> san francisco health services system board is now in order. please stand for the pledge of allegian allegiance. i pledge allegiance to the flag of the united states of america, and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all. madame secretary, roll call, please. president here. vice president here. mary hao is expected. scott present. canning present.

we have a quorum. >> president breslin: item number 4. approval with possible modifications of the minutes of the meetings set foorth blow. the regular meeting minutes from may 9, 2019. >> president breslin: any corrections to the minutes? any corrections? no corrections. all right. is there any public comment on this item? seeing none, all those in favor of moving the minutes? opposed? it's unanimous. all right. item 5. >> general public comment on matters within the board's jurisdiction. discussion item.

>> hello, i'm gail. united educators, retired division. and i want to say how much i love this. it is so wonderful, this guide for the retirees and well-being. it's excellent. i have a couple of things that came up in the last month since the last time i've come here. and i'm a longtime san franciscan, so you know, my dad worked in the controller office and i have family members who use the medical system. and our medical workers as well. so i came to have the experience using the new sutter cpmc on van ness avenue. it was quite an interesting experience. first of all, i came in on van

ness and geary. there were no signage. i wanted to find the emergency room. i couldn't find it. and when i tried to leave the building, there were no signs of this door is x-ray, or that door is here and no signage. i had the experience of riding with four different emt people and they said they still can't find their way throughout the building and some of the signs are wrong. they think the signs might have come on before -- i don't know, but that's the situation. and the situation with the emt was interesting. as we were moving my mother back to assisted-living, she stepped

on human feces. and she was quite upset. so you know, it's a very, very tough job there. okay, that's so that. the second thing happened when i talked to my cousin and he has the opportunity to use the kaiser in south of market. and his doctor told him, please, don't make any appointments to see me during any game days, you won't get in, you won't get out. so i hope there is some kind of, you know, busing situation, carpool. i know there is talk of some kind of a ferry service, but it may -- i think it's something to think about and not forget. thank you so much. >> president breslin: thank you. >> my name is connie levi, i'm a

member of the uesf retired and member of united health care. my concern is the recent hospital ratings. my doctor is affiliated with mission bernal which got a d-rating and i'm concerned, i don't have to go to the hospital before that is improved. only two hospitals in san francisco got an "a". and most of them have a lot of room for improvement. i hope there is something that can be done to -- so we can prevent botched surgeries and hospital infections and all of the other issues. thank you. >> president breslin: thank you. any other public comment? seeing none, item number 6. >> item 6, president's report. the report given by president breslin. >> president breslin: i am pleased to introduce our new board member, chris canning.

commissioner canning is a lieutenant for the san francisco police department where he has served for 12 years. he has also served on the board of directors of the supervisor police officers association. he has quite a good background. welcome, chris, i hope you enjoy being on the board. >> commissioner canning: thank you, i look forward to it. >> i would like to make an observation. this is the first time this board has been at full strength in more than two years. very pleased with my fellow commissioners, that they have joined am me in this labor. >> president breslin: any other comments? and i also wanted to say that our july 11 meeting will not be cancelled this year. we'll have a special meeting and our director will elaborate more on that in her report coming up.

that's all i have to say for my report. item -- oh, is there any public comment on my report? seeing none. item number 7. >> item 7, election of the health service board officers both president and vice president for the fiscal year 2019-20 presented by president breslin. >> i currently am serving as chair of the governance committee so i assume the responsibility on behalf of the president to make the recommendation for the president and vice president for the ensuing year. and that the board approve the reelection of karen breslin as president and dr. stephen

follansbee as vice president. >> any other nominations? none, all those -- oh, you. sorry. [laughter]. >> i'm ready to a motion to that effect if someone wants to offer or accept the recommendation? >> you don't really need a motion, you can just -- >> i move that we accept the recommendation. >> all right, moved. >> i'll second. >> properly moved and seconded that the recommendation be accepted. is there any discussion? any public comment? all those in favor signify by saying aye. those opposed? it's carried unanimously. i'll turn the chair back to the president. >> president breslin: thank you. item number 8. >> item 8 is the director report. the report is given by abbie yant, the executive director. >> thank you.

good afternoon, commissioners. the directors' report i'll draw out highlights. yes, we are holding a special meeting of the health service board on july 11, as i mentioned in our last meeting, we thought it was useful and necessary to take sort of a timeout and bring in subject matter experts to really help us understand the current information about the rapidly evolving health care marketplace. we intend to cover market consolidation, emerging integrated delivery systems, changes in physicians practices, health plan integration with pharmacy benefit managers and other partnerships. and understanding of these changes will help us understand the different models that benefit packages that hsa should be considering. once we have educated ourselves and designed possible models,

we'll have multiple stakeholder sessions facilitated by our staff to solicit discussion and feedback on what we're learning. and we'll report back to the hsa board by the end of this calendar year, the conclusions. there are announcements on the table. they'll be up on the website today. as we get things -- get our facilitators secured and get a plan for our outreach and meetings, that information will be heavily promoted and through our usual mechanisms, and in addition, if anyone in the audience or listening to this, wishes to be on a particular mailing list for this purpose, let us know and we'll design our outreach to meet what i hope to be a rich discussion that will take place over the next several

months. next i'd like to let folks know that our blackout period officially ends today. because all of the rates have been negotiated and presented and i'm presuming approved at the board today. so that will end the blackout period. the -- i did want to mention that mitchell in conjunction with our work tara partner, offered a special mid year -- special enrollment for voluntary benefits and very much exceeded our expectations. we had a total of 1153 enrollments, 221 critical illness benefit accidental insurance 146, supplemental term life 477. short-term disability 124. legal shield 111. life lock 29. pet insurance 45.

so our members clearly are interested in some of these volunteer benefits. it was a test to see how we could manage that in offcycle while outside of open enrollment and i think it was successful. so congratulations to mitchell and the team for doing that. and since they're doing such a great job in operations, they've asked us to create a more standardized office operations. we've had for some time now a practice where we closed the office for member services every other thursday that coincides with when the system is down, due to payroll. but trying to communicate an every other week schedule is extraordinarily difficult. so we are -- we are going through a lot of changes in training in the member services, so we've determined that it's best to open the office to

member services at 10:00 on every thursday. so that i think will be more consistent and easier for members to figure out. it's often i come in on every other thursday and i see people waiting to get into the area. that's not the best way to operate. that is effective august 1. we have a robust communications plan in development and we'll let people know, but i expect actually it will result in increased member satisfaction, because they'll arrive when we're actually open. also, in your packet today, there was a quick look at some of the tolls that are available through the cascade product that helps us monitor the strategic planning. we have on the list to do a robust presentation to this group at a later time when with we can take a look at that together. also, in operations, we have partnered with the controllers'

office to develop our expertise in doing process improvement, using lien methodology. we've partnered with the member services and finance team in looking at one of the top drivers of calls into member services has do with delinquent payments when staff are on leave. it's quite a complex process. and is a really excellent place to start. we're really learning with the help of the controllers' office on learning the process, but really with the help of the staff, learning how to improve that procedure and process and at the end of the day we hope that things will be much improved for our members. we are at the table with the unified school district talking about how we'll administer their dental plans. that conversation is continuing. we heard at our last board meeting some concerns about how we make information available on our website, about how to reach

the health service board. you have on the table in front of you a sample of one of the several web pages that natalie and carole from our communications division have taken to be sure that contact information is found in multiple places on the website. and much more visible to you on the -- so you don't have to go looking for it. it kind of pops when you open it open. thanks, natalie and carole, for that. we did have a good discussion about the hpv vaccine and did research into how that can be administered. pharmacists are licensed to provide vaccines. there are regulations in your pact. and the -- packet. and the question around minor's consent, the minors can consent for the vaccination and the law is written in there. delta dental was responsive in

providing information about accreditation, and there is quite a bit of information in your packet today. there is a representative from delta dental that can answer any questions you might have. the other highlights would be that you've heard us talk about the new telephone system that is coming. we're making major progress on moving that along. our intent is to have that up and running before open enrollment. and at this point, we're on track to do that. and open enrollment plans are continuing to evolve and our ability to have the self-service enrollment is going to expand greatly is this year. so that project continues to move along nicely. i did want to introduce to you today a new operations executive assistant to our team. lily lang is here. lily, do you want to step up?

and thank you and welcome to the team. i know mitchell is thrilled to have a new executive assistant. and lily comes with a lot of city experience and that always is a huge plus, that you don't have to learn the city system. and she has got a good technology background and will be a great asset to the team. thank you. i think that's it. >> thank you. that's a very robust report. i want to thank you for the follow-up on the delta dental ppo accreditation and the vaccine issue, which is a major issue around the consent of minors for things like hpv. i wanted to encourage everyone to come to the july 11, or 12, or whatever the date is, special meeting. we're starting to see advertising from vendors now on

television for some of these services. and i know we're being inundated with this. for mental illness, diabetes and all of that. and the enact we're seeing -- fact that we're seeing them on tv, all members should be interested and aware that we are looking at these and what the role may or may not be. vis-a-vis the health plans. i want to congratulate mitchell on opening up voluntary benefit enrollment. that's a kudo and shows the flexibility of the system you're attempting to achieve in the future. that is really exciting. one question. lean. what is it and does it replace another accountability mechanism in the city? these things kind of roll out pretty often. i don't understand it. >> no, no, it's not a accountability method at all. the lean methodology, you probably heard stigma and other

methodologies for doing process improvement. the lean team from the controller office has themselves as they've developed their skillset in others learn lean, have spent a lot of time in the hospital. and most hospitals have quality improvement programs. so the lean methodology was developed in toyota in japan in the 80s. they've taken this and kind of stream lined it for government purposes, taken out the jargon, made it rather straight forward. and really what they do, they come in and help you identify a process that needs improvement in our area of concentration and work side-by-side to help develop different communication methods. then they bring in teams to help you really map the process, find

the pain points, and it's built on the principle that the line staff knows the work best. so it's teaching staff, really different communication styles and facilitation in order to encourage that staff input to come and redesign the process and then they own it and the process is sustainable over time. versus kind of the older management style, topdown, telling people what to do, and the people that are telling what to do don't really know the work. and so it never actually goes the way you plan it. so it's a very reverse kind of engineering principle. and thus far, it's been extraordinarily well received by our staff. i came into work and we sort of collided with different initiatives we have going on. we have ergonomic coming in and upgrading the work stations and when you were supposed to be doing the morning huddle, so

they switched that to the break room. people were engaged and anxious and talking about how they've all got great ideas on how to fix this pretty major problem. >> commissioner follansbee: thank you. >> president breslin: any public comment on this item? no public comment. item number 9. >> item 9, financial report as of april 30, 2019, presented by pamela levin, chief financial officer. >> pamela levin, chief financial officer, health service system. i'll summarize the report in front of you. we're looking in terms of the trust at a year-end balance of $86.8 million which is increase of $7.2 million. and that the primary reasons are

that we're seeing unfavorable claims, but for trio, delta dental, and the claims experience continues to be favorable. we received $1.8 million in pharmacy rebates from blue shield in march and $263,000 from uhc. the total received in pharmacy rebates year-to-date is $5.8 million and the year-end projection is $6.9 million. the health care sustainability fund protection remains the same, $1.4 million. and that is within the trust. then we, as of april 30, we received a total of $500,000 in performance guarantee payments. as of today, we've received

$105,000 -- not received, we've paid out $105,000 this fiscal year for the adoption of the plan, and that is $200,000 since we first started in january 2017. we still don't know the amount of the forfeiture for the flexible benefit balances until late this month, early next month. in your packet, we continue to provide graphs. i hope that they are useful. what we're looking at is the cumulative expenses compared to the budgeted premium. and the cumulative expenses are tracking higher than revenues for uhcpp program and the expenses are tracking lower for blue shield access plus and trio.

and in terms of the general fund budget, we are still looking at about $334,000 balance at the end of the year due to salary savings associated with the delays in hiring. usually this time of year, i give you a quick update on the budget for next year. and where we are right now, our first budget hearing is tomorrow. they're asking very good questions. it's very interesting. and we haven't gotten the list of cuts that they're going to recommend, however, i got a verbal agreement. i don't know if it's a gentleman's agreement when you're talking on the phone, but not to do a dance that we usually do on back and forth, and we offered cuts that really will have a nominal effect on us.

the second budget hearing is next week, so by the end of the month we'll know what we're looking at for next year. any questions? >> i just want to make a comment. you know, i want to acknowledge the staff. you know, working, the $334,000, whatever it was, surplus, because of hiring, you know, the time to hiring puts a burden on everyone who is here. and we don't have a lot of excess staff i don't think. so i want to acknowledge, this is not a budget concept that we applaud. is to delay hiring. we want to acknowledge -- i want to acknowledge the work of the staff to make up for this and to continue the work of the health service system in the midst of that. >> so i -- we're projecting and estimating that by the end of august, we will be fully staffed

for all the staff that -- we'll have still one of the strategic planning positions will be still outstanding and possibly, two, but it's going -- everything is catching up. we're spending a lot of time interviewing. there is kind of a fight for the conference room to have the interviews, which is a good thing. thank you. >> president breslin: other comments. >> yes, as pam is returning, i would like to thank her for her continued work and effort and her team in going through the budget process and pleased to hear that we're not going through tkabuki dance that we have in the past. thank you. >> president breslin: any public comment on this item? seeing none. item number 10.

>> item 10, infertility benefit, report on utilization 2017-2018, current practice and future consideration. presented by -- that is incorrect. sorry, should say aon. ann thompson. >> in front of you is a pretty brief presentation that we wanted to come back to the board with information on some research that we've done recently and then on kind of the next to last page we'll tell you about the next steps. just to preface we are getting to the next steps. on page 1, of the introduction, we worked together -- i'm using the royal we i guess for hsfsa staff, and looking at clinical research to ensure that the coverage supports best practices, approaching for the

membership. coverage of the infertility benefits today is based on several different things here that you can see in detail. focusing on clinical evidence, stewardship of resources, relevancy to all families, recognition of the definitions of infertility as a disease, and assisted reproductive technology as a treatment. looking at state laws, which we need to comply with, and then as well as alignment with strategic goals that we've set last year. on page 2, this is a reminder that in 2017 we did make benefit changes to the infertility benefits with the health plans. these were pretty progressive enhancements at the time and include all the items you can see here. just a couple of examples, we increased to two cycles of ivf.

we increased the coverage for egg and embryo storage to 12 months. and lastly we added adoption and surrogacy assistant plans. really tried to create a really robust program in terms of the benefits coverage. on page 3, just a reminder, well, first, as a second attachment, there is a side-by-side comparison of several of the key infertility related services and how they're covered under the three health plans. mostly, covered at a 50% cost share. this is the current listing of the program. you may recall in the may board meeting we did make a change to kaiser where there were some services covered at $20 co-pay,

that was moved to 50% to be in line with all three programs. a reminder of the appeals process. that is always available to any member, not only on this topic, but any topic. on page 4, we included some sample pricing. i'll use truly sample, because there is a wide range of costs associated with infertility diagnoses and treatment. you can see here, san francisco being the first listed and generally at the upper end of costs for the metropolitan areas listed here. so at a 50% benefit in this sample pricing, that is about $12,000 coverage for an average of the $25,000 cost. again, this is a same.