discharges from the hospital setting in terms of the emergency room. you know, that -- i think it's more the integration through the electronic medical record and the notification to the primary care doctor, to follow up with the pry imary care doctor. one of the opportunities for us is in the geriatric population and that's where we see a lot of, you know, the management opportunities for these more complex patients. not just that one narrow specific disease for the whole person. >> commissioner follansbee: i guess i still hear a gap. and i think that we would be interested in hearing how that gap is being looked at. in terms of, i know as a specialist in the hospital, i would often say to the hospital and the house staff team, have you called the primary doctor? do they know the patient is here

and what is happening to them? a small fraction of them, i would bet, 5% of them make rounds in the hospital, on their own time to see their patients during hospitalization, by may be brief of longer. i understand the model, butt system -- but the system doesn't really encourage that and all of a sudden, the primary sort of gets handed a patient on discharge and sometimes the hospitals, they institute a program where the hospital called the patient a week later to see how they're doing, but after that, the hospital was out of the picture. assumption was the primary care, but they have, as in every health care system, not just kaiser, they have their hands fall just dealing with walk-ins that don't have insurance that day [laughter]. >> i want to make sure and i think this is your understanding, that the presentation wasn't about complex care management just in the ob-gyn setting.

>> i know that, yeah. >> it's across all areas. i know in the discussions we've had in working on all of this, there has been a great deal of attention making sure that when members are discharged from the hospital, that there is that connection. so while i know that is not your area of specialty, we can certainly get somebody in here who can talk about that. i know in all of the prep work we've done that is a major focus. so maybe it's a discussion about what has changed possibly. because it is my understanding that is happening. >> yeah, and the other thing i would say, we don't have to the apm model you're describing exactly, but we have brought back some elements of that. over the past years we've worked to strengthen our medical assistant and physician partnerships. i was at lunch with three assistants who were talking about every day, every friday, they talk about their patients

that they're outreaching to. they share patient stories. the shared the story of a gentleman through their care team they were able to bring down his home globen from 1 down to 5. not a nurse, but the m.a. is also helping with the care management for the physician and we've brought behavioral health back into the primary care sort of team. >> this has been a focus over the past several years, making sure that is happening. but i didn't mean to say this was only for ob-gyn. >> commissioner follansbee: i understood that. i only hyded because i know that -- highlighted that because i know that department in san

francisco is the platinum standard for management of problems of any level of severity and complexity. i guess that, again, some of this is my prejudice from my own training, is that the nurse is the one in the complex chronic who can answer the phone, deal with any kind of problem, yes, you need to call an ambulance, yes, i can help you get in to see your kidney specialist, yes, i can help with the durable medical group. i will tell you, unless things have changed, the medical assistants, the behavioralist, all those people great at what they do, can't respond to the complex chronic patients urgent and semi-urgent requests and i guess i would like to hear nursing that been reinvigorated into this role.

maybe i'm too vague. >> i appreciate that. i know we use nurses quite a bit in helping with that. i think that the fact is that the other piece of it is the e-mail. for better or worse, that is an easy access point and a way for it to come through the primary care doctor and for the doctor to decide how to disseminate that and connect the patients with what they need. whereas more traditionally, it was a call to a nurse. but what about members who don't have access to e-mail? >> commissioner follansbee: i'm sorry. one more thing. it's a bugaboo. one is that i get a call, if i'm not picking up my most expensive medication from a pharmacist in their time frame. because it's so expensive. they want to make sure i'm adhering to it, i appreciate

that. but all the other blood work asked for on a routine basis, because i'm not following a chronic condition, i've been ordered by my heart specialist, i get no reminders. i have no way to go into my medical record and find out what was due. and so i know that i had lab that was due at three months and i made the decision, because i remembered that, to wait six months, because i didn't think i needed it that often. so i went in when i thought i was ready. that's great for me as a retired physician, but particularly for the chronic complex patient, the medical record doesn't support their self-management. gee, maybe it's time you check out the peak flows. we haven't seen documentation of that. see what i'm saying. >> i guess also i would say also we need to do a better job of

advertising. my patients just joined k.p. because they moved to california so i'm able to have proxy access, see when they refilled medication, see when they're due for screenings. the app is one we did for just that. the my k.p. meds app tells you when you refilled medications, when it's coming due. that's the other tool that we created to address that gap. i don't know if that -- >> commissioner follansbee: it does. just to point out that your list of manage the health care, misses -- i can see when the last hemoglobin was, but i can't see if i have one on order. and when that was due. and so that's what i'm trying to sort of bring in. that in order to get the results that you want, and want the member to be kind of in charge or his or her caretaker or

spouse or whatever. it would be nice if there was a little more enhancement in that regard. that's the only thing. >> that is good feedback and it is constantly being enhanced and changing. >> absolutely, hopefully this will help to continue the discussion. i know there is still follow-up. and we're happy to talk about complex care management as long as we need to. so director, we can follow up and see what other discussions we have, but i'm glad the doctor could come and share some of the information. >> any other questions? >> thank you. >> thank you very much. >> president breslin: is there any public comment on this item?

>> richard again, retiree. i've been a kaiser member for more years than i care to remember. the kaiser doctors are great. i know two instances when a doctor came in on sunday night and operated and another instance, the doctor operated at 3:00 in the morning and saved the person's life. the integrated system is fine, but there is one flaw. it's the home health care. kaiser contracts out with staffing nursing. and these staffing nurses are great, but they can't communicate with electronically with kaiser. they don't have access to kaiser's date database. they can't send e-mail to the doctor like a photo or send an e-mail or communicate with the doctor. you know, either the kaiser patient has to do it or they have to send -- you know, do it over the telephone. and i think this is a serious

flaw. you know, what upsets me is that kaiser wants to give a lot of money to the warriors and to the sharks, but they need to fix their infill system. their doctors are great, but like this nursing issue. this really bothers me. because it's happening with my wife. and you know, the nurses are great, but they should be able to communicate with kaiser doctors. i don't see why can't they do that. and other things, about the shingles shot. i've been waiting over a year and kaiser hasn't communicated. they said come in. apparently now they have a weighting system, but why didn't they send out an e-mail about it. i have to hear -- the only reason i heard about it, because my friends not in kaiser got them. so i started asking, you know, just by chance, my doctor told me to come when he got it to see him. and they didn't have any.

then i found out there is a waiting list. i don't know how long the waiting list is. and you know, there are other things. try calling durable equipment sometime and waiting on the phone for 45 minutes or a half hour. the other thing, my doctor i've seen for 30 years is cutting back. and the only reason i knew, because i was in to see him, but when you go online to make an appointment, you don't get him, you get -- apparently he's training the new doctor -- why doesn't kaiser send out an e-mail saying he is retiring and you can see this other doctor, instead of looking online. if i went online, would have started calling up and saying why can't i see my doctor i've seen for 30 years? you know, kaiser needs to get down in the weeds and fix some of the issues before they start spending money on the warriors and the sharks. thank you. >> president breslin: thank you.

any other public comment? seeing none. now we'll go back to number 8. >> back to the regular scheduled agenda. item # is the finance reporting as of june 30, 2019, and as of september 30, 2019. this is presented by pamela levin, the chief financial officer. >> pamela levin, chief financial officer. i'm going over the report for fy2018-19. the report in front of you i know is dense and long. this typically would be given at the same time as the audit results. those are still delayed we think, as i understood from yesterday, that -- i thought they were going to be out in the

middle of december, or next week, and i think they're still going to be delayed. but all the data that i'm presenting is exactly the data that will come out in the financial report. they just haven't finished all the work. so the trust ended fy18-19 with balance of 91.2 million, this is increase of 4.7 million from the 17.74 balance as of june 30, 2018. i'll discuss the increases against this $92.1 million fund balance. the 4.7 million increases because of 3.6 million decrease in the trust fund associated with united health care ppo plan, resulting from subsidizing the 18-19 -- the 2018 and the 2019 rates from the

stabilization reserve. and unfavorable claims experience. particlely upsets -- partially upsets. unfavorable claims experience is offset by the pharmacy rebates and the $3.6 million decrease in the trust fund. for blue shield access plus, there is a $7.1 million increase. this is several different factors are contributing to this. the first one is that we had a buy-up in the rates to cover the 2016 and 2017 deficits that blue shield had. there are pharmacy rebates and favorable claim experiences. these are offset, these positive balances are offset by incent to

payment to brown and toland for the 2018 year, plan year performance. for blue shield trio, there is a $5.5 million increase in the trust fund balance. it's resulting from the buy-up in the rates to cover 2016 and 2017 deficits. there is also pharmacy rebates and favorable claims experience. for delta dental self-funded plan, there is a $1.2 million increase in the trust fund balance. resulting from favorable claims experience. which is offset by the use of the stabilization reserve to subsidize the 2018 and 2019 rates. we have a $800,000 increase in the trust fund associated with kaiser due to three factors. the first is the impact of the

pay calendars through the school district and college district. when you have fiscal year ending and there is still a contribution coming from the entities. and that's the -- it's just a timing factor. there is contractual provision governing the timing of the premium payments and also members are moving from active to retiree and from non-medicare to medicare status. there is $100,000 decrease in the trust fund balance associated with claims payments for flexible spending accounts exceeding the payroll deductions as a result of the timing and the reductions. it's the same sort of thing. when the fiscal year ends, there is -- it doesn't necessarily mean that -- that all the payroll deductions are actually done. there is some timing issues.

we've always had that. there is $400,000 increase in the trust fund balance due to forfeitures for flexible spending accounts. as we discussed before, the irs allows forfeitures to be used to fund the administration of the flex spending accounts. the forfeitures reside in the trust fund and the expenses for the administration reside in the general fund. so a transfer is required at the end of the fiscal year. so on the chart that you have, at the beginning of the report, you'll see a forfeiture is up $400,000 and then negative transfer for forfeiture, fsa administration. i want to note that we keep this transfer to the minimum required to fulfill our obligations in terms of our budget. and we don't transfer any more than what is actually brought in from the forfeitures.

there is $500,000 increase in the trust fund associated with the health care sustainability fund. the table that is in there shows budget versus actual, but at the end we have increase of $500,000. there is a $2.9 million increase in the trust fund associated with investment earnings. this is considerably better than what we had several years ago. i think we can all remember those years. and there is $400,000 increase in the trust fund balance for performance guarantees which is net of the $100,000 dollars paid in 18-19 under the adoption and surrogacy plan. there was $8.1 million in pharmacy rebates received in

fy-18-19. the end of the year, 92.1 and for the fund balance, but there are obligations and reserves against that. so i'm going to go through those. there is $44.7 million in future obligations against the $92.1 million. trust fund balance, they consist of $23.5 million in contingency reserves, $16.1 million in stabilization reserves. $3.9 million for the health care sustainability fund. $1.2 million in performance guarantees for the adoption surrogacy benefit. and after that, the total is $44.7 million in future obligations. once that is netted out of the 92.1, the fund balance is 47.4.

i provided a chart to look at where we are in terms of, you know, the fund balance and then the future obligations. and over the last five years -- and you'll be able to see that the value of the future obligations and reserves has remained relatively stable since 2016-17. turing now to the general fund administrative budget. there was a balance of $698,000 at the end of the fiscal year due to delays in hiring. after we carried forward $195,000 into this year, a balance of $504,000 remained. we went to the controllers office and mayor's office and requested manual carry forwards. these are up to the discretion of the -- it requires approval by the controller's office and

the mayor's office. they have to be justified and we had 130,000 carried over into 19-20 for professional services, materials, and supplies and work orders. you can't carry over surpluses or balances in salaries and fringes. so is there any questions on this report? i'd like to take that before i go onto the next. the report for this fiscal year. okay. all right. i turn to this fiscal year. so we're giving a report that summarizes through september 30, 2019, and then a projection for the year end being june 30,

2020. in terms of the trust fund, as i just reported, we're starting with a balance of $92.1 million based on the activities through september. the fund balance is projected to be $89.1 million, which is a decrease of $3 million. we're projecting no change in the fund balance for the ppo plan. for access plus, the fund balance is projected to increase $11.2 million primarily due to pharmacy rebates and favorable claims experience. and i just like to put a caveat on all of this, this is only three months, july, august and september. so you know, the crystal ball is not fully developed until about may when we can tell you what we'll end up in june. for the trio plan, we're projecting $8.9 million decrease in the fund balance primarily

due to large claims incurred in july, august and september. we have -- we're working with aon and blue shield to dig deeper into this -- the large claims. we're projecting $3.4 million decrease in the fund balance fort delta dental self-funded plan. and that is a result of subsidizing the rates and -- and when you look at this, it's greater than the favorable claims experience. for the health care sustainability fund, we're projecting a year-end balance of $1.8 million. this -- when you look at the projection in the chart, that is

provided in here, budget versus actual, and the projection, we're projecting 14.5 -- 14,000 left at the end of the year when you just look at the annual expenses and the annual revenues. which obviously indicates that the expenditures, annual expenditures, ongoing expenditures are cripesing at fast -- increasing at faster rates than the revenues and we'll have to do something about that. in terms of investment earnings, we're projecting $1 million. there are no performance guarantee payments received as of september 30. we paid out a total of $45,000 under the adoption surrogacy assistant plan through september. and we are projecting that we will use $200,000 for

reimbursements this fiscal year based on prior experience in what we're seeing right now. just to right size this, when you went to approve the servicing adoption plan, we set aside a maximum of $300,000 would be distributed in a year. so we're still staying well below, as far as i'm concerned, well below $300,000. the ammana forfeitures or unused spending account balances, which i described coming to the trust, that won't be known until july 2020 after the run-out. and as previously described in terms of use of the forfeitures for the administration of the flexible spending accounts, currently there is a budget of

$600,000, but as i mentioned before, we'll only transfer forfeitures up to the amount that the forfeitures come in and no more. so at the maximum, it would be $600,000, but as you can see from this year, it was $400,000. and in prior years we haven't transferred anything at all. i have tried very hard to be fiscally responsible for the forfeitur forfeitures. no pharmacy rebates have been received this fiscal year, but we are projecting an $8 million balance based on prior years' experience. the plan showing the expenses compared to the budget of premiums. the cumulative expenses are

tracking higher than revenues for the uhc ma ppo plan and the expenses are tracking lower for access plus and delta dental. again, three months into the fiscal year, we'll continue to work on that and see how that flows out and continue to monitor it. and then in terms of the general fund right now, we're projecting that we'll end the year on budget. is there any questions? >> commissioner follansbee: can you go back to page 4, the blue shield trio flex funded. you said there was during this period, $12 million decrease in fund balance due to unfavorable claim experience, what kind of claims are those, do you have any idea? >> so in trio, let me make sure i have the right report. we're talking about through september? >> yes. >> yes.

so in the last three months, we've seen a peak in high cost claims. those are claims over a million dollars. what happens with trio is that the -- correct me if i'm wrong, mike -- but in trio, the risk on the claims is born by blue shield. so while this is alarming, there -- it still doesn't present a really super -- i believe that at the end of the year, this will wash out. but we are -- we have a meeting with blue shield tomorrow. we're planning to ask questions. we're seeing their utilization where mike has been in contact along with me with aon.

with the account management team for blue shield. and we're really monitoring this carefully. >> all right. >> mike clark, aon. when we started to see the uptick in the claim experience overall for the trio plan, july, august, september, we did reach out to blue shield, because my inclination is always to focus on large claims first. there is a reason why claims may be spiking one month to the next. but also we put a general ask, what are you soo eking in the data -- what are you seeing in the data? they're saying it's isolated. we're seeing one high cost chronic kidney disease claim that just rolled onto medicare, because that's one of the qualifying events, but it takes

29 months for that to happen. highly unusual cerebral vascular events. but when we look at it over the course of the year, and look at where the claims have come in on trio, it's really unusual to see the spike for july, august, september, that we frankly hadn't seen earlier in the year. pamela commented on the favorability of trio through june 30 where we didn't see spiked large claim experience, but we did see it for july, august, september. we've had ongoing conversations, just in general discussions around large case management with blue shield and how the partners are working with patients who are incurring large claims, so those discussions continue from a care management for those patients standpoint. but i'll also say that sometimes you just see peaks and valleys

and incidents of large claims. we have gotten early advance preview of, okay, what portrayed for october and november as well. obviously not verified yet, but very early reporting, where we did continue to see a little bit of large claim activity in october. and to pamela's point, too, anything over a million does roll into blue shield responsibility because there is million dollars per individual for a calendar year on large claim in both the trio and the access plus plans. so part of what also happens, is when a claimant goes over a million, it will still play into the data that pamela has through a given period. and it may take a month or two then for the stop loss reimbursement, to vend that out in the experience. i think that's also happened when you look at data through september, versus some of the

early information we've now seen through november. >> thank you. >> we're on it. any other questions? thank you. >> president breslin: any public comment on this item? seeing none. would anybody be interested in a break? we'll be on a >> president breslin: in session. madame secretary, item number 10. >> item 10, open enrollment report. summary of the open enrollment key statistics and the member plan migration. this is presented by mitchell griggs. >> mitchell, you survived.

>> we did. mitchell griggs, it's that time of year again where we're coming to report out about october. as i like to call it, our really big show. it takes a lot of work. up to it and during that 30 days -- 31 days, whatever it's going to be of open enrollment, and then after, it's a lot of work, too. i always get fussed at by the members services staff when i say open enrollment is over october 31, because as you see it continues to go throughout the year. this is my 8th open enrollment and i do consider this one as one of the most successful and we'll get into why i feel that way. just as a reminder, back in september i mentioned the size of open enrollment. we mailed out 76,000 packets

this year. we brought in the county and court commissioners into self-service this year. so that was a total of 36,000 people. we did do a pilot for self-service for the school district which i believe was about 337 people. and we added more retirees for a total of about 6,000 there. 7,000. so last year we only had 8,000 actives and 4800 retirees. all in all, we had 42,000 people in self-service. so we were anxious and excited to see how the adherence was. i'm going to talk about that, but putting off, because i'm going to talk about that later. and talk a little more about member assistance. this year, the phone calls, we

received 11,000 calls. that's down 8.5%. last year, it was 12,000. we met all the custom service metrics. that was good, people waited average of 8 seconds for analyst to answer the phone. and in-person assistance, this is when people come in during the month of october, and the number there says 2158. that is last year's number. it didn't get updated. it was 2900 this year. that was increase of 26%. that's what we want. we want to be able to provide this assistance to people face-to-face when they come in. we also go offsite. this year, we got 1800 members we spoke to. we have a lot of people who ask a quick question, grab a

benefits guide. we don't necessarily count them, but i went to several of them and is looked like attendance had decreased a bit. this is not necessarily a bad thing. in the years where we don't have huge plan changes, some of that will decrease like the phone calls. but all in all, you know, it's good to have that many offsite events. i did notice in looking at all the statistics, it was the lowest call volume in three years. three years ago we implemented trio, which caused a lot of calls. and then in the last year, we're still trying to figure out why we got so many calls. it's the way the planets were aligned. i think there was still after effect of trio. but this year, pretty steady. on slide 3, still about member assistance, we had upgraded and improved our website this year, earlier this year, i believe it

was march. so for open enrollment, we looked through october and we had 27,000 individual users go in and check it out. as typical, though i wanted to look at this, everyone looks at it on october 1 and then everyone looks october 30 and 31st. there are few things in between. some peaks in between that corresponds with our e-mails, our mass e-mails we send out to people. and some of them are actually, after the offsite events, people must go home and look at things. on the slide 4, speaking about our website, it appears that 25%, a quarter of the people actually access it through their smart phone, mobile phone. which is good news for us, because we know there are employees out there who don't necessarily sit at a desk, not at a computer all day at work, but we do believe that most of them have a smart phone.

so we're glad that people are looking at it through their mobile device. and on the right-hand side of this particular page, this is the top 10 pages that were accessed. we had 16 -- 116,000 sessions. so if i were to go to the website three separate times day, that's three different sessions. that's a lot of people accessing the website. and 40,000 of the top 10 pages were accessed and you'll see number 2, the second highest, of course, the home page is always going to be the highest. that's the first page everyone goes to, but the most visited outside the home pages were pages for ebenefits. again, that's what we wanted. we wanted people to learn and use e-benefits.

on page 5, how many paper applications did we receive versus people putting their changes through self-service. last year we got about 12,000 pieces of paper. when you do that, we have to manually review it. someone has to manually enter it, check it. so it's a lot of repetitive work, computer work for the benefit analyst. so people use self-service, that helps us a lot. so this year we received 5,000 applications. that was a decrease by 55%. which is the less paper that received since i've been there and certainly a lot less than last year. then we received electronic changes and we received 8710. so the vast majority, 66% of all the changes, went in through self-service and that was one of the success points that i was

talking about earlier. we were hoping and thinking the unreachable goal would be 50% of changes. so getting that 66% is massive. and there was some reasons why, which we'll get into. but i just wanted to demonstrate here in this chart below those numbers is how many people submitted by e-benefits, broken down by employer, how many forms did we receive from the employers. so it kind of helps us see where we need to do work. the bar graph on the bottom is percentage of people who have access to self-service. if you see on the first line, for example, the court, 68% of people that had access to self-service didn't submit any change. 24% of the people that had access to self-service actually submitted a change.

7% that had access to self-service decided to send us a piece of paper instead. so not too bad. last year, when our pilot, when we did about -- those numbers i mentioned earlier -- about 12,000 or so, when our first rollout. i think adherence was about 20%. compared to today's 24%. so on slide 6, i think some of the things that helped us have success and the lower number of phone calls as well as e benefits is our outreach. back in september, i told you we did improvements to our communication and i think it showed based on the feedback i got from the staff that speak to the members enough, that they were understanding our guides better. we did a lot of work on the inside improving on the graphic look, making it easier to read.

in many cases, it worked on the copy without changing top of the actual meaning. i think this was a success too. it's the first time we were able to demonstrate that our communications improved the open enrollment experience. on the next page, continuing with outreach, just to go over the specific numbers of our direct member engagement. these are the offsites. you can see the numbers here. a lot more people show up to these things and we actually spend time with this, so those numbers are actually bigger. but i want to look at air here. that's airport. sfo. about 200 people. that was 11 to 2 or 10 to 1, two to three hours we were there in the morning. we also did a second shift, marina and i, went out from from

10 p.m. to midnight to speak to a lot of the staff that are starting the third shift. so marina did her advising on ebenefits and i tried to help everyone with the benefits, but it was a great experience and we saw at least 200 people from that time, 10:00 p.m. to midnight. a lot of good feedback. a lot of these offsites were health fairs where we included flu shot clinics and i didn't want to mention for carrie here, that we did increase the number of flu shots to 3.1% increase from last year. so total of 4,482 flu shots this year, 204 being high dose. and that's just about 18 -- but the goal was 4500, so they missed it just by 18. that's good to hear, it's

increasing 3.1% over the year. on page 8, i want to talk about the outreach. again, this is one of the reasons that i think we had such good success with e-benefits is part of the outreach. and a lot of that has to do with the fact that some marina, including marina went to the offsites and promoted e benefits. the benefits analyst had on blue shirts that san francisco health service system and what i called the geek squad, had a note on there, saying ask me about e benefits. so i think that did a lot to promote e-benefits. we also had a how-to video on the website along with the regular open enrollment video which was nice. we had codes. we pass these out, so it's easy

to access e-benefits are their smart phone. so i want to step into another category on page 9. talking about the planned enrollment. in is looking at the migration of what happened, this is results of the open enrollment as far as plan changes are concerned. this is preliminary. there is a lot of work that takes into getting these numbers exact and looking at the reasons and that's why we present the demographic report in february. so there may be some more additional information, but just a few things. comparing to 2019, and those orange columns, this is the variants. and some things that are a given, city plan pretty much decreased the most, with 14 employee-only moving out of the

plan. 12 employee plus one and five families moving out of that plan. but another thing i've noticed is that employee-only and kaiser and blue shield trio, both decreased. now there could be a few reasons for that, which we're looking into, and this takes a lot of time, we're working with peoplesoft. these could be employees only moving to family coverage or adding a dependent and staying with the same plan. i want to do a little more research, are they staying in the same plan, or migrating to a different plan. we have to keep in mind that diva happened in 2018 and some are putting spouses back on, because we only allowed them to perfect their claim for the dependent eligibility through september. so and then during open enrollment, they were allowed to put them back on for 2020 if

they provided documentation. there was some of that going on, too. also noticed that 85 people left waive, that means having no benefit and moved into some of these plans. again, i'd like to see where they went and get a little more information about that. but that in general shows you overall, there was an increase in employ plus one of family coverage. so definitely some interesting things here that i think is worthy of us looking into and maybe having an addendum to this in february with the demographics report. on page 10, quickly, as many of you know, we have the split family situations for families that have one medicare member. they can be in united health care, ma, ppo and then have one in city plan, they could be in blue shield.

so we just look at a little bit of that migration, kind of the same thing. with a little bit more leaving trio this year. on page 11, this is our dental plans. i see a good number of people here to the far right, the variants, leaving what we all our dental hmos and moving into delta dental. i don't think that's too uncommon as those plans seem to continually be more unpopular. then there are benefits we've added this year to delta and the rates have pretty much stayed the same. then on slide 12, vsp, this plan is extremely popular. this is our premier plan, if you're enrolled in a medical

plan, you're enrolled in basic, but you can double your benefit. you get glasses every year. frames, allowance, $300, et cetera. so again, there is significant increases in here. we went from 15,000 to almost 18,000 for 20. and just for -- if you remember, when we first started this plan for the plan year, well plan year 2018, the enrollment was 10,801. that was the first year. as you can see, we've increased significantly. on page 13, we've also significantly increased, thanks to two open enrollments, of voluntary benefits that we initiated for all city and county a couple of years ago. you can see here that we increased by 1900 from november. and just so you know, or recall,

we had a mid year open enrollment for these voluntary benefits around july. so we went up from july of 9,274 to 11,000. our initial enrollment prior to july was just 5600. so quite a significant increase in voluntary benefits. i think the word is getting out and people are like can the benefits -- liking the benefits. just a couple of comments on page 14. this is a snapshot of enrollment, these pages that i just went over. so you know, from january 1 to november, when we started looking at this. there is plenty of retirement. there are people who leave the city and new hires. so those change throughout the year. so this is looking at november. whereas the demographics report will go from january to january. and that will be showing january

1st. i think that's about all i wanted to say, except for the fact, something new we did this year, we provided two surveys. one was to our own staff and member services asking them about their thoughts on their preparedness for handling open enrollment. and then we did a follow-up survey with the staff after that. we also surveyed the entire membership asking for their feedback on open enrollment. and we received almost a thousand responses on the membership survey. so i was going to add a little bit of that in this report. but i got so interested in it, that i wanted to provide a little more information in january on the results of that survey and follow-up items we'll be doing. but thanks to marina and her staff. she pretty much directed the whole plan of getting self-service up on the past two plan years. working not only with the department of technology, or not only the controllers office, but the department of technology and

getting that going. and if you see three departments in the city working together that well, it's unusual. i think it has a lot to do with her and her personality and to get everyone working together. like i said, huge successful e-benefits rollout for the entire city. and again, the staff. the member services staff for taking all the phone calls and talking to those people and perfecting those enrollments and that type of thing. our communications department that did all of the hard work. care and ryan on improving those materials. and also finance. if we didn't have finance, we wouldn't be able to print those rates and talk about those rates correctly. again, everyone really stepped up and did a fabulous job. it was a very good open enrollment. any questions? >> president breslin: just want to thank you for your dedication. did i hear you went to the airport at 10:00 at night? >> yes, we did two offsite

events at the airport. health fairs. we sat there and discussed -- >> president breslin: that's great. >> and they weren't flying out that night either. >> taking a flight after? >> yeah, it was tempting. [laughter] open enrollment wasn't quite over yet. >> commissioner follansbee: on behalf of the members and this board, i know every year this is a herculean effort for you and your team, you're to be commended and i thank you for your diligence, each and every one of you. >> thank you, appreciate that. >> i would concur. this is spectacular in terms of the migration to e-benefits. it's something that makes sense in this era. i have a couple of questions. one has to do with the people who show up in the lobby on the third floor. number one, do you have a sense about what their encounter time is? how long are they there to get

their questions asked and answered. as awalked through, there are several terminals, i think. so are members able to complete their e-benefits there? is there staff to help them so they can actually use the equipment in the reception area? i was impressed with the number of terminals and the possibility that could facilitate the learning curve and next year, you might have fewer face-to-face encounters. >> absolutely. we have some idea of the wait times in the lobby. it is right now -- the system that we're using the sales force, the people log in when they come in and the timer starts there. and the timer changes time whenever they're called in and then it changes time again when they leave. it rounds off to like an hour. so it's very inaccurate. and we're looking at more ways of gathering that information.

but we do notice it. and it also depends on the problems, but the staff is really good of keeping an eye on -- because they can see through the sales force, how many people are waiting -- and most of the offices, you can see how many people are waiting outside. did you want to say something about wait times? okay. so what we did this year, we have staffed our reception desk in the lobby when you come in. there is always one that has been there for a while. we staffed reception desk and put some footprints on the floor there to guide people on how to sign it. because it does get a lot of traffic. and footprints leading people to the terminals. the terminals are functional for them to look at the website, the health plan and access self-service. that individual that was sitting at the reception desk is the desk top support specialist for

those people. encourage them to try ebenefits on the kiosks. that's why they're there. and when we start new hires, hopefully, by the first or second quarter of next year, the new hires come in, that will be there, using those kiosks. >> it reminds me to give accolade to the receptionist. i came in to pick up the ipad, so i didn't sign in, but she was right on it. can i help you? she went looking for the right person. and i was not dressed -- i was dressed in street clothes. i didn't look like i was really important, although i think she did ultimately recognize me. but she was very personable and i think that really makes a big difference, because the visit starts as soon as you get off the elevator.

and that really makes a big difference. >> i think it does, too. and we have lots of other times, other than october, there are times we have a lot of retirements or sometimes there is new hires, a lot of new hires at once for the larger departments, so it's good to have the reception there and face-to-face contact. it really does help a lot. >> so, mitchell, it's amazing you went out to the airport at 10:00 at night. are there other strategies for the 24-7 operations for other locations? >> this was our first one. going outside of our typical business hours. with the exception of school district, we do go there until 8:00 at night, because a lot of the teachers are at many different schools throughout the city, and we're at a spot with the school district benefits

team, so we stay until 8:00. right now for the 24-7 we don't have any. we tried this. and like i said it was very successful. and we got a lot of positive feedback from the airport administration. so we do want to look and do that more often. because it showed me, marina and i there just there for two hours, and talking to 200 people, it showed the need, they definitely need member engagement. >> president breslin: thank you. any public comment on this item? seeing none. we'll move onto item number 11. >> item 11, market assessment part 2. sfhss member engagement presence. this will be done by both -- are you presenting -- by both heather imboden, principal

communities in collaboration as well as shah nay hawkins. >> i'd like to focus this on the board meeting that delivered in-depth content of the rapidly evolving market place. that covered the impact of industry activities at a national and local level, defined the major players and opportunities in today's health care ecosystem. outlined a spectrum of health care design, explored factors driving health plan market assessments today and models for the san francisco health service system. the opportunity to hear directly from members allowed them to give voice to their health

benefit experiences. this process was an additional step in informing the health care market assessment. following that in july, we announced plans with support from communities in collaboration, specializing in inclusive strategic planning, research and evaluation. we shared a comprehensive outreach plan with the health service board targeting diverse members, and adult dependents who could speak to health care priorities for our member groups. they coordinated nine focus groups in san francisco, san matteo, alameda, including the san francisco police department, the san francisco international airport, the public libraries, office of transgender initiatives, oakland public library, moccasin folks and