>> good morning, everyone. the meeting will come to order. welcome to the december 16th, 2019, meeting of the rules committee. i am supervisor hilary ronen, chair of the committee. seated to my right as vice chair shamann walton and to my left is gordon marr. our clerk is victor young and i would like to thank my canoe --

michael and jim at san francisco government tv for staffing this meeting. are there any announcements? >> silence also phones and electronic devices. completed speaker cards and copies of any documents to be included as part of the file should be submitted to the clerk i didn't his acted upon today will appear on the january 7th , board of supervisors agenda unless otherwise noted. >> thank you. please call item number one. >> one is a hearing to consider appointing one member indefinite term to the close juvenile hall working group. >> thank you. did you have any comments before we hear from the applicant? >> i do. thank you so much. as we know this is our final appointment to our 15 member working group for the closed year of juvenile hall. we are excited to be at this point where we can point and other young person who will be serving. i am looking forward to the committee having the first meeting this wednesday and to finalize all the members of the

working group. >> that is great news. so we have three applicants. i will call them all forward. charles peacock, danielle russ wurm and julia thompson. we don't have any of the applicants. do you have any thoughts about who you would like to see appointed, supervisor walton? >> i do. thank you so much. the first thing i want to say is i appreciate everyone who applied to serve on the working group, especially our young people who are committed to the success of the other young people. i would like to nominate for vacant seat three charles peacock who is young african-american male who lives in bayview who was formerly incarcerated as a juvenile who is now working in community and is also in college at this time. i just know that he would be

instrumental in helping come up with a plan that will lead our young folks to success versus continuance -- continuous defeat in the prison pipeline. >> fantastic. is that a motion? >> that is a motion to appoint charles peacock two-seat number three. >> we can take that without objection. that motion passes. thank you. >> did you want to take public comment? >> oh, my goodness. that motion -- do i have to make a motion to -- can you undo the motion? >> i will rescind my motion. >> without objection, that motion is rescinded. is there anyone who would like to make public comment on this item? seeing non, public comment is closed. >> i would like to move the previous motion. >> without objection, that motion passes. thank you. sorry about that. i need to wake up.

can you please read item number two. >> two is the hearing to consider appointing four members with terms ending october 19th , 2021 to the eastern neighborhood community advisory committee. there are several members have contacted me you're unable to attend today due to scheduling conflicts. >> thank you. are any of the applicants for the eastern neighborhood community advisory board here? please come up. good morning. >> good morning. i am very excited to stand before you today as a candidate for one of the positions on this community advisory group. i have served as president of the association for six years and have been involved in numerous activities in the potrero and dogpatch areas related to the increased open space and provision for better and more equitable transit and the increase in community serving facilities in our area. i know that there's change in

the group with the removal of the south of market neighborhood so i look forward to having the opportunity to serve to ensure the impact fees for the development in our neighborhoods get the most bang for their buck and serving our existing and incoming populations. thank you very much for considering my candidacy. >> thank you so much. is there any questions? we will open this up for public comment. does any member of the public wish to speak? seeing then, public comment is closed. there are four seats and four applicants. i think all applicants are qualified. does anyone want to make a motion? supervisor walton? >> definitely want to make the motion in support of the nomination of all four candidates but i want to thank jr for coming in today and being willing to serve. this is a very important committee and as we continue to deal with affordable housing and

make sure that we are responsible as we have growth in communities and voices on the intake are very important. i want to think everybody who is willing to serve ditto. thank you so much and thank you for being here today. you made a motion to move jr a blur for seat one, irma lewis for a seat two, jolene you for c3 and keith goldstein for seat four. without objection, that passes. please read item number three. >> three is a hearing to appoint one member term ending january 6 , 2024, to the small business commission. >> i see commissioner -- i see the commissioner here. would you like to come up and address the board? >> good morning, supervisors. thank you for the opportunity and your consideration.

i was born and raised in san francisco in the mission district. i have a passion. i'm a small business owner myself and just knowing the intricacies of real small businesses, especially businesses of color, minorities, we have a moral -- we have a challenge especially if english is not your language of birth. we do not get the same opportunities. having an advocate the looks like the people we serve is very important, especially as it comes to the permitting process in san francisco. during my 10 year, i was part of digitizing the san francisco business registration process, which should be something in san francisco we should be leading the way, but it wasn't. through my 10 year, i have done that. i have spee-5 spares -- personally started an initiative which will get set in 2020 where we go paperless. no more stacks of paper when we or get all the pamphlets. i'm implementing tablets. those are the little things, but my countless work, you know, i know every single business in the bayview, in the mission, i

don't know maybe as much as you, supervisor mar, but they know me when people have problems, they call my cell phone at whatever time. it takes years for commissioner to build up the relationship and understand the intricacies of how to open a business in san francisco. it has taken a very long time to get to this point where we are able to help the community navigate crazy business processes. little things like that matter in a city that they always say small business is our backbone, but people worked here because -- moved to because of the flavour of our city and our small businesses. i represent that. i am honoured for your consideration for another term as the office of small business commissioner. thank you. >> thank you so much. i wanted to thank you for all your work as the one who

recruited you to move into this rollback in my legislative age days. it has been such a pleasure to watch you shine on this commission. you truly are a commissioner of the people and are so available, not only to supervisors when we have questions, but to business owners and helping them navigate what has become a byzantine process. we have a lot of work to do to write i think what i think we have done wrong in terms of making it virtually impossible to open a small business. as you said, many business owners go broke before they ever open. that is upsurge. we are happy to change that. it is certainly something that i am looking into and that i know many of you on the small business commission, together with been blame and who is an entertainment commissioner, but also a small business owner, are looking to all the small

business owners to help small businesses and that is a phenomenal idea. i think it is way overdue and i wanted to express my gratitude to you for all of your hard work >> thank you. it means a lot. >> of course. any other comments? thank you. thank you so much. >> thank you, supervisors. >> is there any member of the public to speak -- who wishes to speak, now is your time. public comment is closed. i would be happy to do the honours of making a motion to reappoint william to seat three of the small business commission seeing no objection, that motion passes you nonthem as they -- that motion passes unanimously. >> item four is a resolution reparenting -- appointing harlan kelly junior for a four year

term ending june 30th, 2023, as the director of san francisco bay area regional water system financing authority. >> would anyone like to speak? public comment is closed. supervisor mar? >> i would move that we recommend reappointment of harlan kelly as a director of the san francisco bay area regional water system financing authority. >> without objection, that motion passes. is there any other items? >> that concludes the agenda for today. >> fastest rules committee meeting of the year. the meeting is adjourned.

>> hi. my name is carmen chiu, san francisco's aelectricitied assessor. today, i want to share with you a property tax savings programs for families called proposition 58. prop 58 was passed in 1986 and it was helped parents pass on their lower property tax base to their children. so how does this work? under california's prop 13 law, the value we use to calculate your property tax is limited to

2% growth peryear. but when ownership changes, prop 13 requires that we reassess properties to market value. if parents want to pass on their home or other property to their children, it would be considered a change in ownership. assuming the market value of your property has gone up, your children, the new owners, would pay taxes starting at that new higher level. that's where prop 58 comes in. prop 58 recognizes the transfer between parents and children so that instead of taxing your children at that new higher level, they get to keep your lower prop 13 value. remember, prop 58 only applies to transfers between parents and children. here's how the law twines an eligible child. a biological child, a step child, child adopted before the age of 18, and a son-in-law or daughter-in-law. to benefit from this tax saving

program, remember, you just have to apply. download the prop 58 form from our website and submit it to our office. now you may ask, is there a cap how much you can pass on. well, first, your principal residence can be excluded. other than that, the total tap of properties that can use this exclusion cannot exceed $1 million. this means for example if you have two other properties, each valued at $500,000, you can exclude both because they both fit under the $1 million cap. now what happens hwhen the totl value you want to pass on exceeds $1 million. let's say you have four properties. three with current taxable value of $300,000 and one at $200,000, totaling $1.1 million in value. assuming that you decide to pass on properties one, two, and three, we would apply the exclusions on a first come, first served basis. you would deduct properties

one, two, and three, and you would still have $100,000 left to pass on. what happens when you pass on the last property? this property, house four, has been existing value of 2 -- has an existing value of $200,000, and its existing property value is actually higher, $700,000. as i said, the value left in your cap is $100,000. when we first figure out your portion, we figure out the portion that can be excluded. we do that by dividing the exclusion value over the assessed value. in this case, it's 50%. this means 50% of the property will remain at its existing value. meanwhile, the rest will be reassessed at market value. so the new taxable value for this property will be 50% of the existing value, which is 200,000, equaling 100,000, plus the portion reassessed to market value, which is 50%

times $700,000, in other words, 350,000, with a total coming out to $450,000. a similar program is also available for prepping transfers fl interest r from grandparents to grandchildren. if you're interested in learning more visit our website or [♪] >> i really believe that art should be available to people for free, and it should be part of our world, you shouldn't just be something in museums, and i love that the people can just go there and it is there for everyone. [♪] >> i would say i am a

multidimensional artist. i came out of painting, but have also really enjoyed tactile properties of artwork and tile work. i always have an interest in public art. i really believe that art should be available to people for free, and it should be part of our world. you shouldn't just be something in museums. i love that people can just go there, and it is there for everyone. public art is art with a job to do. it is a place where the architecture meets the public. where the artist takes the meaning of the site, and gives a voice to its. we commission culture, murals, mosaics, black pieces, cut to mental, different types of material. it is not just downtown, or the big sculptures you see, we are in the neighborhood.

those are some of the most beloved kinds of projects that really give our libraries and recreation centers a sense of uniqueness, and being specific to that neighborhood. colette test on a number of those projects for its. one of my favorites is the oceanview library, as well as several parks, and the steps. >> mosaics are created with tile that is either broken or cut in some way, and rearranged to make a pattern. you need to use a tool, nippers, as they are called, to actually shape the tiles of it so you can get them to fit incorrectly.

i glued them to mash, and then they are taken, now usually installed by someone who is not to me, and they put cement on the wall, and they pick up the mash with the tiles attached to it, and they stick it to the wall, and then they groped it afterwards. [♪] >> we had never really seen artwork done on a stairway of the kinds that we were thinking of because our idea was very just barely pictorial, and to have a picture broken up like that, we were not sure if it would visually work. so we just took paper that size and drew what our idea was, and cut it into strips, and took it down there and taped it to the steps, and stepped back and looked around, and walked up and down and figured out how it would really work visually. [♪] >> my theme was chinese heights

because i find them very beautiful. and also because mosaic is such a heavy, dens, static medium, and i always like to try and incorporate movement into its, and i work with the theme of water a lot, with wind, with clouds, just because i like movements and lightness, so i liked the contrast of making kites out of very heavy, hard material. so one side is a dragon kite, and then there are several different kites in the sky with the clouds, and a little girl below flying it. [♪] >> there are pieces that are particularly meaningful to me.

during the time that we were working on it, my son was a disaffected, unhappy high school student. there was a day where i was on the way to take them to school, and he was looking glum, as usual, and so halfway to school, i turned around and said, how about if i tell the school you are sick and you come make tiles with us, so there is a tile that he made to. it is a little bird. the relationship with a work of art is something that develops over time, and if you have memories connected with a place from when you are a child, and you come back and you see it again with the eyes of an adult, it is a different thing, and is just part of what makes the city an exciting place. [♪] hi, i'm lawrence. we are

doing a special series about staying safe. let's look at issues of water and sewer. we are here at the san francisco urban center on mission street in san francisco and i'm joined today by marrielen from puc and talk about water and sewer issues. what are things we should be concerned about water. >> you want to be prepared for that scenario and the recommendation is to have stored 1 gallon per person per

day that you are out of water. we recommend that you have at least 3-5 days for each person and also keep in consideration storage needs for your pets and think about the size of your pets and how much water they consume. >> the storage which is using tap water which you are going to encourage. >> right. of course at the puc we recommend that you store our wonderful delicious tap water. it's free. it comes out of the tap and you can store it in any plastic container, a clean plastic container for up to 6 months. so find a container, fill it with water and label it and rotate it out. i use it to water my garden. >> of course everyone has plastic bottles which we are not really promoting but it is a common way to store it. >> yes. it's an easy way to pick up bottles to store it. just make sure you check the label. this one says june 2013. so convenient you have an end

date on it. >> and there are other places where people have water stored in their houses. >> sure. if you have a water heater or access to the water heater to your house, you can drink that water and you can also drink the water that the in the tank of your toilet. ; not the bowl but in your tank. in any case if you are not totally sure about the age of your water or if you are not sure about it being totally clean, you can treat your water at home. there is two ways that you can treat your water at home and one is to use basic household bleach. the recommendation is 8 drops of bleach for ever gallon of water. you add 8 drops of bleach into the water and it

needs to sit for 30 minutes. the other option is to boil water. you need to boil water for 5-10 minutes. after an earthquake that may not be an option as gas maybe turned off and we may not have power. the other thing is that puc will provide information as quickly as possible about recommendations about whether the water is okay to drink or need to treat it. we have a number of twice get information from the puc through twitter and facebook and our website sf water.org. >> people should not drink water from pools or spas. but they could use it to flush their toilets if their source are not broken. let's look at those issues. >> sanitation is another issue and something people don't usually or like to think about

it but it's the reality. very likely that without water you can't flush and the sewer system can be impeded or affected during an earthquake. you need to think about sanitation. the options are simple. we recommend a set up if you are able to stay in your building or house to make sure that you have heavy duty trash bags available. you can set this up within your existing toilet bowl and once it's used. you take a little bit of our bleach. we talked about it earlier from the water. you seal the bag completely. you make sure you mark the bag as human waste and set it aside and wait for instruction about how to dispose of it. be very aware of cleanliness and make

sure you have wipes so folks are able to wash up when dealing with the sanitation issue. >> thank you so much, the health service system board will now come to order. please stand for the pledge to the flag. 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. president breslin? here. vice president? present. commissioner hao is expected. commissioner scott is present.

commissioner canning is here. we have a forum. -- quorum. number 4, please. >> approval with the possible modifications of the minutes set forth blow, regular meeting minutes from november 14, 2019. action item. >> president breslin: okay. has everyone read the minutes? >> i have no corrections. i would like this comment, according to the minutes i talk too much. [laughter] so i'm going to try to be better. i keep you all here. it's terrible. but i have no corrections. >> since he has no corrections, i'll second the motion. >> president breslin: all right. any public comment on this item? seeing none, all those in favor,

aye? all those opposed. there are none opposed. it's unanimous. item number 5. >> item 5, general public comment on matters within the board's jurisdiction. this is a discussion item. please come forward. >> good afternoon, commissioners, my name is richard rothman, retired city worker. i thought after i retired i wouldn't have to come to these meetings, but i guess i do. i want to talk about the health fair. i went to the one at city hall and i found out that some of the vendors there had staff who could not answer questions. so i think when you ask the vendors to come, they should have staff who are familiar with

our health plan and can answer questions. because i think that's a good way to get answers, you know, through their bureaucracy. although, i did go back to the health fair the last week down in -- h.s.s. building there and found out from delta dental for the retirees that i think they've been miscalculating the retiree's dental benefits. that $1250 maximum should be excluded from the dental cleaning and they were -- if you reach the maximum, they were charging people for the dental cleaning, which was like my wife. and although it clearly says on the dental delta form on our web

page that part is excluded. so they're going to change it for my wife. and i think the staff needs to make sure that all other retirees get the same adjustment. that they don't have to pay for teeth cleaning and if they reach the maximum. and the smile program, too. thank you for telling me about the smile program. but i found out that the dentist, when they look in the system, don't know you're in the smile system. so you might ask delta dental to look into that issue, too, thank you. >> president breslin: any other public comment. seeing none, item number 6. >> item 6 is the president's report. this report is given by president breslin.

>> president breslin: i just want to question and bring up something that happened at the last meeting. it was the employees assistance program report when they were talking about first responders. and knowing they need specialized service, but then, when i asked about for retirees, would they be included, and they said no, they could get their counseling through the system. and, of course, this group of people, the first responders need specialized service for them to just go to the mental health program and get regular counseling would not be -- work very well. so i think -- and it said they're going out for r.f.p. does this r.f.p. include retirees. >> the r.f.p. on behalf of five city agencies are deemed first responders and it is not my

understanding that it includes retirees, but we can investigate that. we are concerned about the mental health access for all members and active members do have access to employee assistance programs and there are specialized ones for first responders. the question that you raised on whether there is specialized services for first responders in retirement is a very good question. and we're considering that. we've been talking with all of our plans about mental health services and about specialization for first responders. and so that's a conversation that is under way. and i think it's something that is obviously worth investigating, because, probably, for sure people carry these issues into retirement. and hopefully, they're able to transition their care, but as you'll hear later in our report about member focus groups

transitioning into retirement has a lot of legs, that whole issue, and we'll add to that. >> president breslin: yeah, this is really important because it may get worse in retirement, maybe not better. because in retirement, they have less to do and lack comradery testify at work, so it often gets worse. i think the suicide rate is the heightest in the police department in -- highest in the police department in the country. >> my limited understanding from talking with members of the police departments behavioral science unit, there is a gap. i think that conversation is very important to have going into retirement. at least the first five years of accumulated mental health-type issues, exposure to things and that certainly does extend to all first responders and likely other members of the health services themselves. i'm happy to hear that is something that is being considered for retirees.

>> yeah, and i think as important is looking at ways to prevent the stresses from becoming a mental health issue for officers and other first responders, our well-being program is working with various first responder agencies to get in front of some of this. so i think that's as important as treating a condition once it occurs. >> president breslin: so this, you think, will be in the r.f.p., something to do with retirees? >> i don't think we're waiting for the r.f.p. on this. i'm sorry, the r.f.p. that the first responders are doing, i can't speak to that at this moment. >> president breslin: thank you, i'd like to hear a report back on that. okay, i have nothing else to report. is there any public comment on this item? this is item number 6.

seeing none, item number 7, please. >> item 7 is director's report. this report is given by abbie yant, the executive director. >> thank you, good afternoon, commissioners and i do, before i forget, want to wish everyone a happy holiday season and stay safe and dry. kind of nice to have a wet season. so today a number of things that i spoke to in my strategic -- or my directors report will be spoken to further on the agenda. i do want to call out that we did provide an update on the progress that we've made in this first year of the strategic -- rolling out the strategic plan. it's been a very busy year and we've done a lot of discovery and investigation into all of the many -- the very long list of business initiatives that we overambitiously outlined in the report. and we have made progress on many of them.

we are as a staff, we're going to work intensively next week to really revisit those business initiatives and to be smart about what we're going to focus on in 2020. and so we're looking forward to doing that. the details are in the report and if there is any questions, we can speak to those today. we also just wanted to update, because i did get news about the sutter inn. we recently learned that the class action lawsuit settlement terms are scheduled to be released on december 13th, that's tomorrow. that's an original moveup from the original february date. we don't know if the settlement will have impact on h.s.s., but we'll report back as we learn more about it. there are a number of follow-up

items that i've addressed in this report. and one of them is working with blue shield and the brown medical group. we've had a number of conversations with both the organizations and i've invited to the brown and tollen medical groups to come join us today. can you call up their slides. they've prepared some slides that help explain the changes that are going on within brown and tollen. and i'm very appreciative they were able to be here today on rather short notice. and i think we heard the last time about the disruption we had during our open enrollment period because of these changes. and they've offered explanation and status of the organization. ryan, if you would go to the mic and introduce yourself? >> thank you.

chief strategy officer. and senior vice president of network and business development. a couple of things that we were here to address, one is just to talk a little bit about changes at brown and tollen, kind of viability, stability, high level representation of kind of where the organization is going. recognizing we make up a significant number of providers in the city. and the second, we'll speak about the evolution with sutter and the impact that has had. >> apologize for the technical difficulties. there it is. there we go.

>> so just to quickly summarize. brown and tollen, been in existence for around 26 years. we've represented and are included in seven bay area counties. we have ambitions to grow across 10 counties. we have 106 specialties represented. we have a network of over 2600 across the bay area. approximately a little less than half of that is in the city or the west bay. and over the last year and a half or so, the organization has gone a transformation to really move the organization to one that is sustainable, diversifying products. and really expanding our product set.

several hmo products as well. over the last year, we've renegotiated somewhere around 15 of our plans, both hmo and ppo. we've started to really turn the organization around in terms of physician reimbursement, implementing a 10% improvement in physician reimbursement for those in our network this year. another 7% next year. this plan, as well as addressing some of the specialist pay. we've also been able to strike additional hospital contracts.

and increase revenues by about 12% in 2019 from 2018. increased our network size, number of physicians by over 25%. and then reduced our kind of business expenses, corporate expenses by over 25% as well. so really, you know, focused on turning around the business. these five pillars on this slide represent our key -- the key elements of our strategic plan. we are now in -- well, 2020 will represent the third year of that strategic plan. and obviously, moving to the next slide there, driving -- really transformation across all of these areas. improving our care management capability, which is really wrapping around the physician, the kinds of health-related services that it really takes to provide good preventative and

intervention care. focusing on a new infrastructure, new technology in the organization, add on economical price for physicians to be able to survive and thrive. we're bringing on medicare products. we have overall eight plans? eight plans total. >> three new ones for 2020. >> could i ask you to come to the microphone so this can be recorded and i can hear. >> so we have four new plans launched in 2020 for brown and tollen, so we are growing with all of our m.a. plans with all of the national affairs. >> and you are. >> my name is teresa.

we are in some ways lengthed with fetter and we have over the years developed a complicated set of contracts with fetter and we embarked upon an initiative this year to do a lot of cleanup of those contracts. and recognizing that sutter has its own competitive ambitions, as we do we. we recognize that in the city, there were 34 primary care fashions that were part of s.p.m.f., that would be terminating. it's not really terminating, but their contract with brown and toland would be expiring at the end of the year.

and we created reciprocity agreements so that sutter could access the brown and toland network and we could access their network. that number is 34. we have in place today, a reciprocity agreement that does achieve what ultimately our new agreement is interested in also achieving in terms of reciprocity around both specialist groups, but it is quite old and outdated and we're interested in establishing something new as the current contract expires at the end of the year. we've been in negotiations with them on this for better part of the year, nearly half the year or so. we have an m.o.u., we're hoping to execute that will bridge us into next year. we hope to have the reciprocity agreements in place by the end of january. so teresa will describe about

the nature of the impact of these 34 physicians whose contract with brown and toland expires at the end of the year. >> i have a few slides. so complete what ryan was saying, late 2018, sutter, brown and toland began conversations with look at all of the agreements we have to reduce the administrative burden, to operationalize it, but this also included the physicians, hospitals, ancillary agreements and all agreements under sutter. so it was quite a large undertaking. somewhere in the summer sutter communicated to us it was going to build their own network in san francisco so began the

conversations with terminating those pcps from the brown and toland network. we began conversations with them about the specialist as well as the pcps we started to have different conferences to minimize disruption with the membership. through these conversations, sutter held strong they wanted to terminate the pcps but were open to the specialists. so we began looking at creating additional agreements that would support brown and toland specialists, sutter specialists, being able to see all of the members on either side. to solidarity date we're -- to date, we're continued those conversations and both sides want to complete this and support that access. next line. as we look at the impact to this

group, when we did this snapshot, we do hold reciprocity agreements. so to the member, it should seem seamless. we have the ability to refer and they have the ability to be seen by anyone from sutter as from a specialty care, or vice versa, if they need to see a brown and toland specialist. this is impact to us because we hold the risk for us, so it is a burden that brown and toland is bearing to make sure we have that access. members assigned to non-sutter pcps should not see a disruption in care even if seeing specialists in the sutter foundation. it turns out we have 34pcps terminating from the network. network add quays.

of those remaining, 2011 are open. we have opportunity and capacity to move anybody who wants to be moved. so we do have contact information from the brown and toland side from member services. they've all been trained and equipped to help navigate that and select a pcp that may be in their geography or based on their choices. >> president breslin: am i hearing there are only 34 that may have a problem? >> 34pcps, our roster has 34 that we are early nating from the -- terminating from the brown and toland effective 2020.

>> president breslin: they will to -- >> anyone assigned to those 34pcps will have to look at either staying with those physicians or choosing a brown and toland doctor. >> president breslin: so they'll have to choose a new doctor? >> or they can stay with the sutter pcp? >> does that put them outside the network, if they stay with a pcp that is not contracted by you. >> if they select a sutter pcp, it is a different network, and i think only one of your plans have that. they have access to brown and toland specialists through the reciprocity agreement. they don't have access to the brown and toland pcps, but they'll still see the cardiologist, et cetera. >> have these folks been notified this is happening and

how? what is being communicated. >> paul brown from blue shield. we have two plans with you. we have trio and the access plus full network. the physicians that are leaving brown and toland and going to sutter are in the access plus network. they are not in the trio network. there are approximately 1500 members that are impacted by these physicians who are moving. about 1450 are in access plus, so they do not have to change their primary care physician. they can change their medical group to sutter and retain that pcp relationship. or choose to stay with brown and toland and choose a new physician. there are 50 of your members in trio that would have to select a new primary care physician, because sutter is not in the trio network. the good news is this happened

in open enrollment, so we did member notification on november 1st. we're required by the dmhc to give 60 days notice. so we released letters to all 1500 members explaining their options around november 1st. right during open enrollment, or close to open enrollment, so if anybody wanted to change plans to align with their physician or medical group, they could do so during that open enrollment period. so really minimal disruption overall. but that's how we handled this from the health plan perspective. >> background to say i was one of the original brown toland specialists. i think i still have my certificate of ownership of stock. so the question i have basically is, if someone who was one of the 49 or 50 shows up at the

wrong office, they show up at office of somebody who now is no longer with brown toland, what will happen at the front desk? they do this february 1st. what will happen at the front desk? >> if this member has been assigned to a sutter pcp -- well, this member cannot be assigned to a pcp at trio if they're a sutter member. so they will be assigned a new one. if they go to the sutter physician, the front desk should run eligibility and say you are not assigned to this particular doctor. >> so can you assure us that the mechanism is in place that we won't get angry phone calls for people who check in -- because even though i know they've been informed and gotten letters,

mistakes happen. >> absolutely. >> commissioner follansbee: part of the problem i have, obviously, i was a physician for many years, but for members, patients, these medical groups are somewhat transparent. there is hill and this and that and there are all kinds of things, so people get very confused and may not fully appreciate. i guess the question is, can you assure us we won't be getting phone calls from the 49 who show up and is there a mechanism to deal with that? >> so the member should have a name on their membership card with an address to where to go. >> commissioner follansbee: right. >> that would be their primary care doctor. if they don't go to that location, the sutter foundation employee at the front desk -- and we're not sutter -- should be running eligibility and explaining to them, because they don't control those, i can't

assure they're going to be able to say the right thing at the right time, but the card should indicate where they need to go. best practice, when they make an appointment, that front desk should call and say you're no longer assigned to us, so they should be able to mitigate it from even coming in. >> commissioner follansbee: yeah agreed. but as you pointed out, this is very complex. and so i think that, again, appreciate these things happen, but i think we have responsibility to know that how things might be handled, mistakes happen. >> mitchell griggs, chief operating officer. i wanted to tell the board with this question, we know who the 50 members are. and we've been researching. there has been band width with us perfecting all the enrollments and we have a list

of the members and will work with them, if anyone is having problem after the first of the year. >> president breslin: so when you say work with them, could they possibly go back to access to get the doctor they want? >> yes. so some of them have for various reasons and probably because they did get this communication, and some of them have contacted us already. but we are also monitoring the others and reaching out to them as well that we have not heard from. >> president breslin: thank you. >> i think the awkwardness, i mean it is a business practice that i think is difficult for many. the awkwardness for hss and members was the lack of any advanced warning. and you know, we got official notice from blue shield on november 1st at the close of open enrollment because they weren't notified in advance. and i can understand when you're in that many contract negotiations, to be thinking

about who is doing open enrollment when, but that's what made it very difficult for us, to have to reprocess these individuals and it makes us look bad. like we didn't know what we were doing. and i think we did and it was alarming when members got the first notice we got of it, was from members who got letters from sutter. i got copies of this letter from sutter that went to our members without going through us. so it was, now e, we've down this road -- you know, we've been down this road before. i appreciate you coming here today to think through what happened and where we're at today. and i just would appreciate you look at the impact of the contract negotiations to really think about these open enrollments, because it's pretty traditional they happen in october or january around the world. so if we can be o