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 of some consideration, i think it would

be most helpful to our membership. >> absolutely. and do apologize for the miscommunication during open enrollment. it was our intent, we had started conversations with january to try to get ahead of this, and it was slow to respond once they notified us of building their own network. >> commissioner follansbee: one point and request for the future. one point, how does brown and toland update their open panel list of primary care? is it updated every day? every month? and how do members access that? >> so brown and toland update the health plans weekly with changes as in terms if a physician based on the policy qualifies to close their panel, then they notify us and we notify the health plan of that

change within a week. so we send it out every week depending on when they send us notification. the lag would be about two weeks. and then the burden is on the health plans when they load it. we can also -- there is a phone number there for member services and that is updated realtime, so a member can call member services and we know realtime, if a physician is open or closed. >> commissioner follansbee: can we ask for maybe an update on this, maybe in february, how many -- if we identified 49 i believe, and how many of them either left and went to access plus and how many were successfully able to within a window find a new primary, so we have sense about the process for future? because this will happen again. we know this. >> i think that's a great idea. i know it's a constant juggle for everyone to know who is on what plan on what day of the week. i think the other thing, i would enjoy working with brown and toland and the other physician groups on, not just are they

open to new patients, but are they truly available. because that's -- especially when there is diminishing number of primary care, we are very interested in supporting primary care practices, because it's the core. so we'd love to continue to work with brown and toland and other groups on that matter. >> happy to come back. >> president breslin: thank you. >> i'm going to defer anything else because we have a guest here from kaiser, so i want to respect the time. ets up -- it's up to the president, would it be okay to defer the financial report for the kaiser conference care? >> president breslin: yes. are you finished with the

director's report? >> yeah, i'm finished. i have one follow-up matter but we can take it later. >> president breslin: okay. so we're going to the item number 9 now. right? >> yes. >> out of order, item 9, complex care management presentation presented by dawn ogawa. >> hi, kate kesler, area vice president for kaiser permanente. wanted to thank you all for having us back to discuss complex care management. we have one of our physicians here. i'll let her introduce herself to you all. and dawn ogawa. >> thank you so much for inviting me and to those in the audience as well. my name is dawn ogawa.

i'm an ob-gyn physician and the assistant chief overseeing health promotion. we wanted to continue the conversation we started in the last board meeting and based on questions about complex care management. so i wanted to start with the focus on the broader approach to managing the care of our members with more complex cases. and i wanted to touch briefly on how complex care management is core to what we do as an organization and how we have invested in tools to support this work, like the electronic medical record. i'd also like to focus on the experience of our kaiser permanente members with more complex conditions in the outpatient and inpatient setting

and what we're able to achieve through this care. what can our members and family members expect if they have a complex or catastrophic condition? you see here on the next slide, a general overview. we placed the patient purposely in the center here with the support system around them. our members have the benefit of award-winning disease management programs that give them comprehensive range of integrated tools, resources, and services. so what makes kaiser permanente's approach different and successful? first of all, it's proactive. we use clinical data drawn from our electronic medical record. the second and very importantly, it's team-based and physician-led. our physician-led care teams are individualized and assembled according to to the member's care needs. the care is comprehensive. so we have a wide range of preventive care and

self-management tools to motivate members to effectively manage their conditions and to make that as easy as possible to do. it's also system-wide, because our industry-leading electron medical record links every member, caregiver, hospital, physician office, pharmacy and lab in realtime, helping ensure accuracy and consistency of care. it's also data driven. disease care registries help track outcome and determine effectiveness, enabling continuous improvement. finally, and probably most importantly, it's really patient centred. members and care teams work together to determine the most appropriate clinical, social and educational interventions to meet their health goals. for example, i bring up the example of my patient who tested positive for diabetes in pregnancy. all of my patients get testing for this. if the patient has elevated

blood sugar, she'll be called right way by a specialized nurse who answers her question, and refers her to one of our dieticians. she has a number to call directly to a specialized nurse and i work closely with the nurse and the patient care team to ensure her blood sugars are well controlled. this reduces her risk of complication related c-sections, low blood sugar for baby and making sure she is kept safe. my patient and her health care team knows to recommend screening for diabetes yearly given the increased risk of this. that's because it's front and center in the electronic medical record. so we all know that lack of coordination can be a major barrier to providing safe care, particularly between the hospital and outpatient setting.

at k.p. we focus on collaboration. this leads to better outcomes. k.p. health connect is our leading electronic health record that identifies and eliminates gap in care while ensuring patient safety, every member, every time. all of the staff share this one medical record and the member's care team can pull the entire medical history, labs, test results and prescriptions up. for example, going back to the prenatal patient with diabetes in pregnancy, she'll now get reminders to do her diabetes screening along with breast cancer and cervical cancer screening when due. this eliminates care ga gaps and increases quality of care. so for our members with multi-chronic conditions who need complex care, k.p.'s model is set up to reduce

fragmentation. we're able to provide the right care at the right time. for example, i might see a patient in the office. i was seeing many this morning for abdominal pain or pelvic pain. when i see her, i can search her health record for emergency room visits. this improves parity safety by avoiding unnecessary testing. for example, a ct scan that would expose her to radiation that she might have had done a couple of weeks ago, or the overuse of antibiotics. in an outpatient care setting as a primary care doctor, we're the quarterback for the members with complex care needs. we help them navigate through their care journey. our case management is a focused high level care program for our sickest members with significant medical problems. that is there to assist the patients along with primary care

doctors. case management involves a process consisting of identifying high risk members, offering comprehensive assessments of their needs, providing assistance and setting treatment goals and coordinating care by a team of physicians and other health care professionals. you can see on the slide, all of the different people that are involved, whether it's a dietician, a health coach, a health educator, you know, my medical assistant or program assistant. members with chronic or catastrophic conditions are automatically enrolled in these programs and there is no sign up required, no homework they need to do. we want to make the right thing easy to do for members and families particularly when they have a chronic or catastrophic condition. another key feature of our program, it isn't outsourced, so our physicians deliver and manage the care. we are the patient's quarterback and best advocate. i'm proud we're able to do this quickly and compassionately because of our integration.

i had a patient i diagnosed with uterine cancer and when i provided the results, i was able to hand off to oncology. she had an appointment within a day and her life-saving surgery were quickly scheduled. being able to provide this type of care is the reason i do my job, the reason i enjoy doing my job. five years later, i continue to see her regularly for her follow-up and she's doing well. we also provide robust discharge support for patients. during the hospital stay, my hospital-based physician colleagues partner with nurse patient care coordinators to develop a post discharge plan that leverages our integrated system. in this case, for patients who are hospitalized, it is the p.c.c. who acts as the quarterback.

they help navigate them through the care in the inpatient care setting. closer to discharge, transition care pharmacists review medications with the patients. additionally for complex patients at high risk of re-admission, they follow up after discharge to ensure that they're supported during the transition to home. because of our comprehensive electron medical record, the entire outpatient care team, including myself, their primary care physician, specialists and disease specific care managers can view the entire course of treatment in the hospital. i'm notified realtime if patients are admitted and discharged and what follow-up might be needed for them, all thanks to this integrated system. my team has access to discuss care and transitions. this is true for our patients discharged from both the hospital and the emergency room. in addition, all patients are

provided clear written discharge instruction, including the 24-7 phone number to call. in our internal and contracted home health agencies a multidisciplinary team provides care. depending on the needs, nurses, social workers, therapists work to develop a care plan. we have nurse coordinators to provide oversight to them. the other area that we have the same system is our skilled nursing facilities. skilled nursing facilities based p.c.c.s help with similar transitions to the outpatient setting. so kaiser permanente strives to reduce the rate of admissions in various ways. effective discharge summaries and patient instructions,

including post-discharge follow skraup and coordination -- follow-up and coordination with primary care. i know that was a lot of information about how we manage our care for our members with complex needs. but i think the proof is in the outcome. how does this impact members and what is their experience? i wanted to share this last -- these last two slides. this one is the performance for diabetes and heart disease management where we receive the highest level at five stars. next slide. the result of the prevention and control has led to kaiser permanente outpacing the nation in reducing death from heart attack and strokes. if your family member is cared for at kaiser permanente, we know they have reduced risks of these outcomes. this is why kaiser permanente are focused on management and making sure members with complex needs are at the center of our approach to managing care. i'd be happy to take questions.

>> commissioner follansbee: i was a kaiser physician, so i've seen a lot of transition during my 16 years. i want to compliment you. the department of obstetrics and gynecology, their ability to track residents is one of the outstanding ones on the west coast. i would encourage you to include the education part as one of your -- one of our circles, because i think it really does. >> absolutely. >> commissioner follansbee: a lot of what you referred to really does reinforce the impression about ob-gyn. a lot of your data in terms of blood pressure control and glucose is great, but the majority don't have complex conditions. they're being followed for one of two conditions and they're ambulatory and certainly able to be monitored and engaged. so we're looking at a narrower

window. you mentioned home health care. from my standpoint, and i think i would suspect from our standpoint, is not a problem because it is totally integrated system. usually the primary care provider transitions out. >> yeah and they have a new primary care provider. >>nd the system works because they're homebound. >> right. >> commissioner follansbee: it was a relief to me to see some of the patients transition to that because i knew they were getting superb care at that stage. nursing homes i have to say was a bigger problem. because most the nursing homes are not kaiser facilities, so what goes on, the primary care provider you refer to see the center of this, is completely out of the loop until somebody gets a discharge summary from -- so i guess of the questions, i have is could you focus on

complex care management? we had a member stand up and say she and her husband were in the emergency rooms several times and never gotten a follow-up call from the emergency room. i know there is attempts to improve the liaisons, but i got the impression from earlier presentations there is an institutional-specific and maybe don't translate across all kaiser facilities. and maybe department-specific. and i think that is kind of, from my standpoint, what we're interested in. how that smaller group of people really get managed and handled. i'll just say one thing. that is when i joined kaiser in '98, the adult primary care model was rolling out. i think it was before your time. >> a little bit. >> commissioner follansbee: in medicine, we had a nurse on our module, we had behavioralist,

all kinds of personnel in various stages of support and it was a team. and over the time of 16 years, i saw that nurse, we often used in a complex case for the department of medicine, transition out. and a lot of these nurses are now program -- not the same nurses, but if i developed heart failure, i have no doubt there is a heart failure nurse, but he or she is not necessarily dealing with kidney failure, hip fracture or my stroke and all that. so again, do you have information maybe on how those patients who are really complex and chronic get handled maybe outside the department of ob-gyn? >> only what i shared with you in terms of primary care from the hospital. i think from the emergency room, the calls, those 24-hour calls and pcps, that's are from

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 the health service and at the

wellness center here at the health services. at the end, we -- at the end of the day we had 117 individuals participate in the focal groups, representing 34 of the unique departments across the city. with that, i'd like to turn the mic over to heather and shenay to talk about the presentation of the core findings from this endeavor. thank you. >> thank you. hi, commissioners, it's nice to be here with you today. i'm heather imboden, i'm with communities in collaboration. we're an oakland based consultant. we also do program evaluation. i'm here with my colleague, shenay hawkins who also supported this project. i'm going to breeze through the beginning of this presentation because abbie so thoroughly

covered a lot of the introduction, so we're going to talk to you about the work we did. we're going to focus on what we heard from members who participated in this process, both through the focus groups and also through an online survey that was made available for members who are not able to join us. and then we'll talk about the implications for hss and some of the things that hss is already doing to address the needs that were heard. so abbie covered the purpose of the engagement. i'll recap. it was to hear the experiences of members and understand their priorities, but also to test those health care models presented to the commission earlier in the year. and understand what the questions and ideas that members had about those models might be. we targeted active members and retirees who are not yet

eligible for medicare, primarily because those models were focused on non-retiree, non-medicare -- backing up -- on members who are active and who are not yet eligible for medicare. medicare eligible members have a different set of plans as you know. so we did not folk our efforts on those members, but we did have a number of medicare eligible retirees who participated and their input was certainly taken into account. as i mentioned, abbie went over the process, so i won't go into that here. we did hear from a great group of people. we wanted to hear from a really diverse group of members and so as we were receiving our demographic surveys from participants, we kept an eye on that throughout the process to

make sure that we were hearing from different departments, different locations, people with different -- enrolled in different plans and other demographic factors. so we did additional outreach throughout the process to make sure we were really hearing from the broad diversity of members. so the meat of it. i want to talk to you about what we heard from the participants. and this is reflective of their personal experiences with their health benefits. so we tried to put this from their perspective as much as we could. i want to say at the outset that we asked a lot of questions about a lot of different kinds of care. and most participants were quite positive about their experiences. so i'm going to talk about some of the things we heard lots of good things about and then i'll go into areas where we heard consistent messages about room for improvement.

as far as primary care choice and access were really key for our members, as well as being able to stay with a provider that they trusted. one participant told us i would walk through fire for my primary care provider. that is a particularly emphatic statement, but when someone is happy with their provider they're very happy. access to specialists. members really appreciated being able to get to a specialist quickly. and being -- having access to high quality specialists. being able to be referred out of network when that was called for was also appreciated and making sure there was good communication between specialist and primary care providers. we asked about urgent care. and there were many members who felt very positive about urgent care because it was more accessible to them and they felt that the quality was very high.

so that convenience of being able to access urgent care outside of regular business hours was really valuable to members and they felt like they were getting good care when using those services. we also heard a lot of positive feedback about apps and digital records, which are being used more and more by members. again, there was the convenience factor that was very important to members. and knowing that their providers could see their records as well was very appreciated. one member said you can make appointments, e-mail your doctor, lots of things through the app, it's very easy. going to skip and talk to medicine, because we heard something similar about telemedicine for members who appreciated not having to leaf the comfort of their office or home to access care. sometimes it was easier to get an appointment over phone or video. and they felt that quality of

care was there for those services, so that is something we heard they're looking forward to using more in the future. and then dental care, again, really appreciating the ability to stay with a provider over the long-term. and trusting their providers and having friendly relationships with those providers was very much appreciated. one member actually told us they liked their providers because the provider laughed at their jokes. it's the little things, right? so there were three areas where we consistently heard messages of -- room for improvement. where members felt like there was opportunity and needs that weren't being met. one of them was in mental health and behavioral health. we already spoke about that a little bit earlier today.

they felt that they had a very hard time finding providers who were covered within their networks. even if they had a list of providers who were technically within network, they might not be able to find one who is actually accepting patients at that time. they wanted more robust coverage particularly for care before it's an emergency. we heard from members who had crisis, mental health crisis within their families, they had good coverage and care when the crisis happened, but they felt if there were more robust coverage leading up to the crisis, the crisis might have been averted. we also heard that some members had trouble finding providers that met their needs as far as being a match and understanding their background. and the more diverse providers, so that was another area members were seeking more support.

another area where members were seeking more support was in wellness services. and they talked about that as far as fitness, as far as nutrition counseling and weight loss support -- and being able to access those things in some cases just being aware of the benefits that were available to them, they didn't realize were available to them. and if they were available, being able to access them outside of regular 9:00 to 5:00 working hours. we heard from some people with non-traditional working schedules who said, there is exercise at my office, but it's from noon to one. if i'm a shift worker, that doesn't work for me. they were looking for more robust services outside of those traditional 9:00 to 5:00 hours. then the last area where we heard pretty consistently a

desire for support was in alternative medicine. primarily chiropractic care and acupuncture. again, finding providers who specialize in those areas was difficult. for members to find covered providers. and so members often were paying -- reported paying out of pocket or using their fsa funds to access those services with providers that they felt met their needs. and actually we heard that around mental health as well. there were members who had mental health care providers that they wanted to stay with and ended up using their own funds or fsa funds to stay with the providers because they were not covered in their networks. and with that, i'm going to turn it over to shenay who will talk to you about the feedback we received on the models. >> good afternoon. as part of the engagement

process, we presented five models of potential or possible health care model options are or options that are hypothetical options that members were -- could potentially look for in the future. the first model -- during this presentation, members were able to share questions -- ask and share questions about the models, look at the models in detail to figure out what things were appealing and then also talk amongst themselves. really to determine what models were appealing, what questions they had and what were priorities as they select future health care benefits. the proposed models, there were five selected. the first one was the current plan offering. i won't go into too much detail about that. the second model that was presented was the plan offering third party navigation and

advocacy support. for this model, support is considered to be any -- third party service provider that is not at h.s.f. that is not the member's employer and not the health care provider or insurer that advocates for the members and supports them throughout navigation process of health care. the third proposed plan was a consolidated plan that included kaiser as well as one other insurance company. and that one insurance company provided -- will provide both an hmo and ppo. the fourth model that was offered was a system competition model. that model offered kaiser as well as three other fully integrated health care providers and another ppo. the fifth model was the private exchange model and this was described to members as the cover california model.

so you have a variety of insurance providers that offer multiple and various insurance plans at different price points and different services. that is created to offer a little bit of flexibility and choice around offerings, as well as price point for members. one thing that i should note, kaiser was available in each of those proposed models. i'll give you a little bit of feedback from each the models, the model one was the current offerings, i so won't go into detail. model 2 is the current plan offerings with third party support. when we think about or analyze the data, one of the key takeaways we got from the model, was there was mixed feedback around what third party support services were. when they asked question, it was

really around trust. can you trust the third party support provider? what is their level of expertise in the health care profession and medical needs? are they going to -- this third party provider held accountable to the same hipaa standards and laws in the medical field. this was about trust and wondering the fidelity of the provider. one of the key questions that came from that was how third party support impact complicate the overall experience of care. so while members were fairly interested in this, they had a lot of questions about trust fidelity and the bureaucracy that might come, or the complication that might come with the third party support providers. model 3 was the consolidated plans. that provides two options. the key takeaways around that

was how does having three options for health care benefits impact choice? is it going to minimize the way that i'm able to select a provider? is it going to minimize my selection for doctors? will i lose different options around that? and similar with coverage. if we only have three health care options, how does that impact the way that i receive coverage? and the last one was around cost. some people thought that having only three insurance options would either drive up costs, because with only three, that limits the competition. and others thought because more people might be under each plan, that could drive down costs. that was a big question around costs and there were varying sides of that. the fourth model is a system

competition model. this included kaiser as well as three other fully integrated health care insurance providers as well as another ppo. for those of you who aren't clear about what an integrated health care system is, it is all of the care provided under unumbrella. they're provider, insurance company, et cetera. one of the questions was how will integrated systems impact ability to receive coverage outside of network? so by integrated systems having -- housing all of their services in-house, how would that impact members in seeing specialists or getting second opinions. that was a big concern. and finally, the private exchange model, t this model rad

a number of concerns. some of the biggest questions were around how might the plan options and choices affect equity, quality and accessibility in relation to care. a lot of the insurance providers will provide different services at different price points and a lot of members wondered if i select a lower price point for my health insurance plan will that mean that i'm selecting a lower quality of care. so there were a lot of questions around there. there were things that came up around all of them.

third party support services were offered in three of the five models. and they wondered if third party support, could that be offered in all of models? and another thing that came up again as i mentioned was the level of quality and accountability that the third party provider would have. as we explore different, or as members explore the different

options, everyone is worried about coverage, or a lot of people questioned how their coverage is impacted once they retire as they travel or for members independence who live out of the country and out of the bay area. >> i'm going to talk about the major themes of the asks that members had. we asked them if there were any other services they were looking for when they think of what hss provides to members. and some of these are going to be overlapping with what shenay said about the models. a key theme we heard was around service standards and

accountability. what can hss do to extend more support for members to make sure that standards are met and make sure that patients are being served particularly around can we make sure that there are mental health providers available to us. can we make sure that if the benefits say they cover alternative medicine, that the providers are there within network? and could we think about the third party support? because having support in the navigation and advocacy were something members were interested in if they believed it was going to be a high quality benefit they could trust. members also, a lot of issues around communication. again, support around the advocacy and problem solving, communicating in general about benefits. i know that hss does a lot of communicating, but there was still a lot of things we heard about from people, where members just weren't aware that the

service was available to them. so there was -- they were looking for better communication. and another area where they were looking for communication was around the transition to retirement. would say in every single focus group we held, this question came up, either from people who are approaching retirement, people who recently retired, questions around what is this going to do to my benefits? how can i plan for this? what are the implications for me and my family? there were many, many questions that people had about that transition. then the last theme that arose was meeting population-based needs. i know that abbie mentioned we had some focus groups specific to particular populations we know have specific needs. some of those are first responders. some are lgbtq members or members who live outside of the bay area. and there is work to be done to engage those subgroups and

really make sure that we're meeting the needs of those people. i want to note that there are some things that hss is already doing around those areas. that these acs are -- actions are under way. one is around the service standards and accountability. as h.s.s. enters the renewal period, this is an opportunity to deepen the conversations. abbie mentioned they were having conversations about access to providers, particularly mental health providers. as far as enhanced communication, there is an open position for a communications director. there is a search going on and when that person is brought on board, it is hoped they can

promote hss advocacy services that do exist and make sure members are aware of when it's appropriate to call hss. we heard mitchell talking about people calling during open enrollment, but one of the things we heard in the focus group, members didn't actually think to call the health service system when they had issues that arose. we might hear about challenges in finding providers, but very few of them called hss for the support that could have been provided. and lastly, around meeting population-based needs, hss is working to develop strategies to monitor and enhance services to meet the needs of these groups and that is actually something that is part of the strategic plan. i want to talk a minute about just how the things we heard and the things that hss have opportunities to take action align with the strategic goals

that have been outlined in the strategic plan. one of the things that members asked for was that hss continue to negotiate really hard for affordable comprehensive and high quality care. we heard a lot of appreciation that hss was doing that work and they want to see it continue. another of your goals is reducing complexity and fragmentation. and one way in which hss can do that is supporting that transition to retirement. and also encouraging improved communication among providers. we heard from some members who felt like there was just a breakdown in the mune indication of their -- communication of their network and perhaps hss could advocate for better support around that. engage and support. we heard from members who wanted more variety and more frequent communication around the plan

materials. people access different -- access their information in a lot of different ways, so making sure it's available to them early and in a variety of formats was asked for. we heard from a number of members who asked for greater translation services and support. for both support for open enrollment, but in other areas as well. there are lots of languages spoken by hss members. and, again, just increasing the awareness of the services that are offered by hss would be beneficial to members. choice in flexibility. advocating for improved and expanded access to providers, particularly those mental health providers, alternative medicine and the primary care. and as far as whole person health and well-being, ensuring the wellness programs are accessible to all, including shift workers. we also heard a request that maybe hss had a role to play in

providing members with checklist of questions they could ask of their providers, or insurers to help them be better prepared for their own advocating. and we heard a lot of positive things about eap services and members were looking to have those continued and expanded. so i just want to go over big picture summary of what we heard, our key takeaways. number one, the work we did, when we do this kind of conversation with community members, sometimes you hear big surprises. that wasn't the case. what we heard really affirmed a lot of things that staff is already aware of, both the positive and the negative, which is really valuable information to have. it raises some really important questions for hss around what

are the barriers to prevent members from calling hss when they could? and how can this organization strengthen communications with members about plans and benefits? how can we better support members through the transition to retirement? what are additional ways hss can hold providers and insurers accountable for excellent care? and are there targeted approaches to improving outcomes for populations with specific needs. as i mentioned in many of these challenges are already being addressed in actions taken by the organization right now. with that, we're happy to take questions. >> president breslin: any questions? >> commissioner follansbee: i have a couple of questions. one, it's impressive and i like the summary about this enhances a lot of the themes that we've

already been discussing and helps us feel tuned into what the members are. are you happy with the sample size? was that -- what was your target? and number two, i was kind of curious about the response to the urgent care issue. because urgent care has a broad -- we've been dealing with this to some extent over other issues. they have a broad -- it has to do with availability, location, shift workers, all sorts of things. and also without integrated care model, which we support some nonintegrated, urgent care has the specter of actually not bringing communication. so i'm just curious to know if you have enhanced -- first the question about the numbers and then about the urgent care issues and if you have a sense of what members thought that meant and what they wanted. >> so the first question, i

think we were aiming for more. and i will also say we were happy with the turnout we got. primarily because the representation was so diverse. we looked at so many different measures for where people worked, where they lived, what their educational background, languages, race, ethnicity, all these factors and plans. and we felt like we were hearing from the spectrum of members. i think we were aiming for more like 200 and in the end we got 117 focus group participants. and then additional close to 50 who provided surveys. so we got close to our number. and as i said, i felt like the representation was good. i also felt that there was a lot of consistency in what we heard which is useful to hear. you know, the things that people

were happy with, the things that people were frustrated with, and the questions they had around the models. when you start hearing repeats of the themes again and again, then you know you're hitting a lot of what you want to hit. the question around urgent care. i should mention that there is a report that we're finishing that has a lot more detail on all of these aspects, so you'll be able to look at that when that's complete. but i would say it's interesting that you bring up that point of the connection and coordination between urgent care and other care. because one thing that people did say was that they liked urgent care particularly when it was available in association with the hospital, so not free standing urgent care clinic, but the urgent care aspect of their own network, because then they knew that the information would be communicated and if there was

a problem that urgent care couldn't take care of, it could be escalated to an emergency room in their network. that said, there was a lot of appreciation for the free standing urgent care clinics. especially those who can't make it to a doctor during the regular office hours. >> i would be interested, now that we've had this foray in terms of getting feedback from the director. and we've made a larger decision to defer, going out to the market, how we're going to sort of keep this fresh to align with that action. >> nice queue up for my closing remarks on this. thank you very much. i didn't even pay him to do it [laughter]. i want to say that the recommendations concludes our findings are in alignment with goals. while there are areas identified

as opportunities for improvements, the findings reflect a positive experience interacting with health care providers. these findings are really qualitative in nature and confirm that the benefit design serves members through quality, sustainability and well-being, core facets of the mission of hss. and we are staying abreast of the health care market place in an ongoing way. as we begin this renewal process for plan year 20-21, we will in parallel continue the ongoing market assessment to determine what the right time to advance one of the new models for the health plans and restart the procurement process. so this is kind of a moving train which we, i think, have on reflection have really -- it's been of great value thinking

deeply about what it is we're trying to accomplish and getting this input from experts and members that is complimentary. so i think that will all inform us. i've asked my team to help put together what that parallel process would look like to sort of double-team an annual renewal process, while we fully prepare for a new procurement process. just because of the length of time that it will take to do the full procurement process, we will have to do it in parallel. and i believe we'll be able to do that this year. the market is the market. the sutter decision i think will be very informative. the rollout of the canopy product that you see is going full force. so there are some major shifts occurring in the market. anthem is making a play in town.

so there is quite a bit happening that we're tuning into and paying attention that -- that is the rationale behind why we delayed in this last year. so it seems as though it were the right decision looking back on it. but it is something we have to look at in parallel with our responsibilities to have a solid renewal for the 21 year. >> i just want to thank the consultants because i think that the report shows number one, understanding of the issues that we are concerned about, and also from the responses that i heard, that the respondents who participated also were willing to respond in depth. and did not respond in a superficial or casual way. that's something we should thank you and all the respondents who

did participate by questionnaire or in person. i want to thank everyone. >> president breslin: any public comment on this item? seeing none. item number 12. >> if i may, i would just like to add one thank you to natalie and letisha on the team that led the effort to engage our members. and it is a herculean effort. it's an area of growth that we have and the reason we're bringing in a communications director, because we don't have the best way, clearly, yet, to communicate around these types of issues. the open enrollment messages are get through well, but we perhaps can learn from that and continue down that path to more readily engage members on as-needed basis. item 12. reports and updates from contracted health plan representatives.

>> good afternoon, denise rodriguez with kaiser permanente. last time, i stood before you and you had many questions about the transportation benefit we're adding january 1. i wanted to come back with more information. we were remiss in not providing an upsooner. so a -- update sooner than now. so my apologies. what i would do is start with defining the benefit. commissioner scott asked what are we paying for. i want to explain the exclusions and what caused the exclusion of a particular benefit and what our plan is moving forward. the benefit -- and i also want to emphasize that the rates that you're charged for the benefit does not include the excluded benefit. i'll walk through that. so the benefit, if we cover up to 24 one-way trips -- i just woke up with a scratchy throat,

so i'm sorry if i'm not clear. we cover up to 24 one-way trips, 50 miles per trip per calendar year. it's for nonmedical transportation. there is a few conditions that need to be met. need to be going to a appointment for a covered benefit in the evidence of coverage of course. they have to use the vendor that we contract with. so pretty basic stuff in terms of that. this cost that a member would pay for the transportation is zero co-pay. so that's covered at 100%. there are nonmedical transportation exclusions. i think the one that was particularly of interest last time is transportation for members who require a gurney wheelchair van. that is excluded and i want to explain why. let me emphasize though, if somebody is in the wheelchair and can make it to the curb, then the driver will assist them

getting into the vehicle, store the wheelchair and get them out. and getting them in the wheelchair again on the way to the appointment. so when we rolled out and offered the benefit, it was with the idea it wasn't going to be fully implemented, that we were going to roll it out with what we could provide in a short time frame we had. we started discussing the benefit in may and june. many of you commented, and from i think the audience as well, last time, there are many vendors that pride that service. that -- provide that service. that is correct. the challenge is we have to go through a regulatory process to contract with them and cms has requirements that we have to meet. and we have to get system changes done to track it internally. and that takes about a year. and so what we try to do to get this to go to market for january, was to look at what is a vendor that we're already approved to use. and that's the vendor we use for

the medi-cal population. they don't have the same requirements for the gurney, we're able to access other services to provide that benefit to the medi-cal population, but because of cms requirements, we're not able to that now until we contract with the new vendor. so that's the challenge that we're faced with right now. i also want to emphasize that in no way are we trying to exclude anybody. that is certainly not our intention. our intention was to try to meet the needs of what we heard from the medicare population with san francisco health services system to provide a benefit that would benefit the majority of the population initially. i do also want to say this is the benefit that we're only offering to san francisco effective january 1. so it's kind of special in that

way we're the only one we're doing this with because you had so much passion around this. as we continue to fully implement the benefit, we expect to add the benefit going forward. i can't give you a time frame. if it's going to happen 2021. but what i am committed to doing is having more check ins with you all. you can decide how frequent that can happen. i need to stay close to mitchell and abbie -- executive director yant, around how the implementation is going because this is a new benefit. and we want to make sure that any bumps in the road get addressed quickly and effectively and efficiently. so i will stop there and see if you have any questions or comments. >> well, thank you for answering my preliminary questions. and from what you said, where you are at the beginning of january will not necessarily be

where you are maybe mid year in terms of trying to contract with wheelchair services or get the appropriate clearances? and i think i heard you say you're trying to work that through to do that. >> so we're starting that process. it takes about a year. we've been focused on trying to get this up and running since january 1. now that we're there, they're starting the process to add the benefit. they're working with the current vendor to see if they could add it. that would be an easy fix, but we also have to get the systems up to speed to meet the requirements of cms. so to answer your question, i don't know. we're working on it. i will answer to say we're committed and working on it. i can't give you a time frame. but i will know more as the year goes on and will be happy to provide an update. >> i would be interested in at least a quarterly update in the area to track your progress.

i recognize that licensing and vendor contracting in your organization, like in most large organizations, takes a bit of time. so, some kind of status would be helpful. >> okay, then i plan to come back again in march, unless sooner. >> i appreciate the update. i think it's quite -- i understand what the issues are and the hurdles that have to be met. listen, in my own mind, i was distinguishing wheelchair to gurneys. gurneys are a much bigger deal. i was not focused on people who need to be in a gurney. that is a bigger hurdle. i guess the question i do have, though, one question, one point, does the -- say someone is in a wheelchair and needs an attendant to help them get to the appointment, you know, a spouse, partner, whatever. are those people transported as

well, or do they need to then help their dependent into the van and then leave and come by a separate route? because that would make a difference to me about the comfort level, about access. >> okay. i'm going to pause and ask one of my colleagues if they know that. if not, we'll have to come back. my gut tells me they're included. so, yes, they can ride in the car with them. >> commissioner follansbee: good, because i'm much more comfortable with that. when we do revisit this, if he could have a sense of how many didn't qualify. so we have a sense of the volume. because none of us want to make a big deal over an issue that really is, you know, can be handled another way. if we had some data on your access. >> and i think that's why the quarterly check kinz will be

good. we have communication plan we're working with abbie on right now to roll it out. the first month is going to be slow. the second month it will build. and the third month we'll see more. so we'll keep you apprised of what is going on through regular check ins. >> commissioner follansbee: one more question. so it covers the san francisco facilities, mission bay and then the geary and french campuses, but doesn't cover south san francisco or oakland or -- i'm a little confuse about the limitation? >> it's a benefit for your entire population, so depending on where they live, it would cover them up to 50 miles per trip. >> commissioner follansbee: thank you. that claver -- clarifies it. >> thank you. >> i'm going to give denise's

voice break and make our second couple of announcements here. so we do have a strike notice from nuhw, the national union of health care workers is that will begin the 16th of december and will last through the 21st of december. these are nonphysician behavioral health professionals. and so they will be going on strike. we do -- we are prepared for this. all facilities will remain open. routine appointments may be rescheduled, but anyone who needs care will get care and we're prepared for that. we also have received notice of a sympathy strike through the operating engineers local 39. and those are engineers for the facilities in northern california. so i wanted to make sure is that you were aware of that strike notice. the second announcement that i have is that we have chosen a new c.e.o.

and this was -- many people have commented this was very quick. i think this speaks to the fact that we've done a lot of succession planning and gregory adams has been named the c.e.o. of kaiser permanente. more than 30 years of appearance in the health care industry. a longtime kaiser permanente employee and really has worked closely with bernard overtime, so we're exciteed as an organization to have a new c.e.o. and i wanted to share that with you. >> president breslin: any public comment? >> actually, not a public comment on that. another vendor update. >> go ahead. >> i'm with aon, i'm not a health plan, but i do have update at the request of executive director yants over the medical.

i did reach out to them and had a conversation. i wanted to give you an update on what the conversation was. so i pulled off -- at the top, i've included the link that i looked at, which is the one medical website under faqs. so the link is there. it's in regard to the annual membership fee we heard some membership complaints around to access their provider. and what i highlighted at the bottom of the first page is that payment of that annual membership fee is not a prerequisite for receiving medical care in one medical office. >> president breslin: what does that fee give you? >> the way one medical described it to me. they think about it in two pieces. they provide the care in the

office and then they have technology. so their app, making appointments online, virtual visits, senior electronic medical record online through the app, kind of that concierge piece. if you wanted to see a provider, dr. smith at one medical, you can pick up the phone. you can call. you can make an appointment. you can see the provider, have the appointment. it will go through your insurance. and that's the end of it. there is no problem with that. if you want these additional technology services, you would pay that fee. in addition, at the bottom of this, it says for more information click here. one medical does have financial assistance and so if members wanted to call in to see if they are eligible for financial

assistance, they can do that as well for the annual membership fee. it does appear they would potentially help with some of their out-of-pocket costs, no co-pays, but the other out-of-pocket costs. if we want more information, we should invite one medical back to speak with you. does that help? >> president breslin: yes. that's makes it more clear. first you say they can't charge a fee. and then you say they can charge a fee, but -- so thinks the reason they can -- this is the reason they can charge the fee for extra technology. that makes sense. >> correct. >> commissioner follansbee: i'm not sure i need to hear more from one medical. i do think that it does raise again the issue of the question i asked of our outreach survey about urgent care and all that, because obviously you know, to

buy membership in one medical would be think being getting ongoing care. i mean, like, urgent care. in their own sense. and i don't think that our own networks, through any of our providers, actually, they belong to any of those networks. i think that would be something -- >> one medical? >> one medical. >> they do. >> commissioner follansbee: they do? they are? >> yeah, they kind of -- i don't know for certain who all they're connected with but i think it's pretty much everybody. >> commissioner follansbee: maybe we do have them back, because the member who is a hill physician patient is seen there, is the lab and the encounter automatically transferred to some medical record? so there is continuity of care that we heard the members want? there are pieces about all of

this that i still am a little bit confused. i can understand the ease of making an appointment online if you're getting your physician care at one medical, because they're all over the city and i assume outside the city limits, but i don't know. again, these are issues that we would need -- would want to know in terms of how to direct members in terms of -- what members want and need. this is not really a substitute if it doesn't meet certain criteria. >> they came on the market 15 years ago? and they've been around a while and they were cutting edge when they came on market with all the technology. and they've stayed focused on primary care and they have expanded. i'm not aware that they do urgent care. >> no, not in the office, but they would have virtual urgent care. >> yeah, so during regular business hours, that type of things, but they don't run any

of the urgent care clinics that i'm aware of. >> commissioner follansbee: the question is, can people walk in and get care? >> yes. >> i know they don't have 24-7 coverage. i have former colleagues who joined one medical as physicians and so there is nothing in my mind about the quality of care they deliver or the technology or anything, that's not the issue. the issue is really this wholistic approach to the delivery of health care, which i think is something that we as a board, we as a health service system, are really interested in promoting. >> maybe we should ask them to come. >> president breslin: any public comment on the item? thank you very much. no public comment. moving on. item 13. >> item 13, opportunity for the public to comment on matters within the board's jurisdiction. >> president breslin: public comment? clare?

>> good afternoon, commissioners. i'm representing dennis kruger and firefighters. dennis couldn't find parking. found the garage overfilled. and so he sent me a text. he was very frustrated and he left. >> so they're following up. they want to wish everybody happy holidays. by the way, we loved abbie's,

director yant's message, it was nice to see. and that was pointed out at our retiree meeting yesterday when we had the party. so we are here to wish everyone happy holidays and also -- sorry, always to thank the staff. we have the best staff in the world. i'm sorry, i get broken up about it. health services workers, our staff is the best in the city and i've worked in a lot of different departments. i won't tell you stories, okay? but we have the best. they work hard for us all year. open enrollment is a killer. and they make it easy for all of us. and all the services that they provide, you just need to know that all the retirees are grateful. and all of the associations, whether it's retired fire or vpoa, or retirees, all of us are

extremely grateful. happy holidays and happy new year and see you next year. >> president breslin: any other public comment? seeing none. item number 14. >> item 14, opportunity to place items within the board's jurisdiction on future agendas? >> president breslin: i think we have our work cut out for us. any public comment? we're going to closed session and have to be closing the doors. >> item 15, vote whether to hold a closed session for the public employee evaluation for hss executive director. this is presented by president. >> i need a motion -- >> i move that we vote to hold a closed session for the public employee performance evaluation. >> i'll se