>> health services board will come to order. please stand for the pledge of allegiance. [pledge of allegiance] madam secretary. >> roll call. [roll call]

we have a quorum. >> thank you. number four please. [agenda item read] >> anyone have any corrections to the minutes? >> i move that the minutes of the january 9, 2020 meeting be approved. >> my public comment? all those in favor say aye. it's unanimous. item 5. >> [agenda item read].

>> i'm chair of the retired division united educators of san francisco. i like to get up here to publicly thank diane who has been attending these meetings regularly. she is now been replaced who will be also assistant. our new health service chairperson, she will be coming here regularly too. we want to make sure that diane get some public recognition for amazing work she's done for all of us. we are in her debt and appreciate it. we'll continue to be part of the health service committee people. thank you. >> thank you diane, i know she's

watching. my name is gail, i'm from retired teachers. there are couple of issues that have come up in the time that i've not come here. first of all, i like to know if there's a help line for people to call when they have a dental plan and they are charged something that doesn't fit our formula? that's what happened to several people. they pull you to a room and they say this is what it is, this is what you covered, sign. i like to be able to call somebody with the u.h.c. dental help line crises line, support line, something. also, for kaiser, several of my friends are diabetic and they're

on this medication called med forma, have you heard about it? it seems that it's been recalled several times because there's a direct correlation to cancer. fairly, soon too. it's like you wait 20 or 30 years. it's within five to seven years. i know two people that are on it. the third person is 92 and she got off of it but it was so expensive that the doctor, the caretaker at u.h.c. got a coupon for her so she can afford it. the waiting time was about a month for her to transition in

to the medicine and it's working quite well for her. that's my other issue. my third one is about hoping for the board to consider having this charge meal deliveries for kaiser as well. it's a wonderful thing to have for u.h.c. thank you. it seems that u.h.c. medicare p.p.p.o. are allowed 84 home delivered meals per calendar year. can kaiser provide some kind of home delivered meals for people who had post delivery and

post-operation situation? thank you. >> somebody will follow-up on the delta dental issue. >> i have a question, med forma, that's been taken off the drug list? >> no. >> all right. any other public comment? >> hi there commissioners. i'm a city employee. i want to try get through three points that i like to share with you today. the first is regarding initiative--infertility benefit. my experience was validated by data and unfortunately it was not unique or isolated. for my current understanding, the memo that was passed voted on by the commission in november, makes no measurable

impact to lesbian couples or single moms by choice. i'm hoping that i'm misunderstanding but i would love to be correct. it makes no measurable impact. i do believe the commission heard the concerns. if there's no further action is considered, i wouldn't want to waste your time or take my advocacy elsewhere. the second item i like to bring up is in regard to specialty medication that's not covered by copayment. i brought this issue up many months ago. this is my experience. if i can have the overhead turned on? specialty drugs that are not

covered under your copayment, it's 50% of the negotiated rate. it's what you pay. this was an example of prescriptions that i was given. the rate that i was given with my insurance, this was the cost, the rate the pharmacist was nice and give me if he paid 100% out of pocket, this was the cost, significantly less. i called a local pharmacy, because this pharmacy was in boston and this was the cost that's not core covered under insurance. 100% out of pocket. significantly less. by suggestion is to request negotiated rate for 75 to 100 most prescribed specialty drugs. then have 1822 or 1823 analyst or even an intern call those pharmacies that are covered under the plan and ask for the out of pocket cost.

then negotiate or demand a better rate for those drugs with the discrepancy and the cost and at minimum, it is the responsibility of the department to notify every single member that if you are prescribed any of these drugs with a list, you should ask what the out of pocket cost is and pay for it that way. third item is in regard to the paratransit contract. this might have been dealt with already. >> we already dealt with that. i think it was a misunderstanding. they take on wheelchair people but they want d -- they get then but they bring the wheelchair on. wheelchair the person right on to the truck or whatever it is. >> okay, glad that issue has

been dealt with. thank you >> can i ask one question, item 2, to make sure i'm clear, the freedom on the outer pocket expenses, is member responsibility for freedom with insurance 50%, not half of that negotiated rate. that is the negotiated rate. presumably the rate they quote was $1600 for go now. is that what you saying? >> correct. this was what i was quoted would be my cost. >> $1600 opposed to you spending $479. okay, this helps me understand. >> thank you. >> any public comment on this item? item number 6 please.

[agenda item read]. >> president breed: i want to welcome dean preston to the board. i think we all look forward to working with you. thank you. >> supervisor preston: thank you very much. >> president breslin: that's all i have on this report. [agenda item read [become. >> i want to publicly acknowledge diane's service, wish her well. and welcome gail to the position

that you're now occupying. the director's report, the first item on there is the vendor blackout reminder. we are in negotiation season with our vendors. that blackout period begins today. there's memos attached to my director's report instructing the commissioners on what that means. if you have any questions, please let us know. the board election, there's a seat open for a member, nominations are due by tomorrow. we will let folks know what is received at the end of the day tomorrow. the federal anti-trust case as you know, had a preliminary settlement and as i understand it, the final settlement

scheduled currently for februar. we won't know the details of that after that date. with the question last month, i believe commissioner lim about the blue shield cards and some folks were confused why they were getting them. marina enterprise systems and analytics team did a very thorough research of that issue. as many things in the complex system, there was no one reason for this. there were several. they are all being resolved as we speak and we're monitoring that situation. there was also question as to the references benchmarks that we were using for the

post-enrollment survey report. there's details in the director's report. i think you'll be reassured that we are using standardized benchmarks. also of note, our pamela levin has announced her retirement. i want to congratulate her on a major life decision. just restate for the record that pamela has been in public sector since 1982. she worked in various cities across the u.s. after 13 years of working with city and county, she was selected to be the chief financial officer for hhs. she was helping drive our financial and operational improvements. she's played a significant role in helping us develop our

strategic plan throughout the years and having an impact on health plan and premium cost containment. we're appreciative, she's helping us facilitate a very smooth transition. we will begin the recruitment process for her replacement officially in march. we've already secured all of the approvals and have the money in the budget and blessing of dhr to move forward with a successor that we aim to have in place long before she leaves so she or he can shadow pamela over the six months prior to her departure. on behalf of the board, and the leadership team, and all of our members we thank pamela for her

dedication. she will begin her next journey in santa fe, new mexico. she had lot of time to reflect on her 38-year career she's delighted to looking forward to retirement. i'm sure we'll be having a celebration which all will be invited. pamela, thank you for your service. [applause] a topic of discussion that we have had at several board meetings. we've undertaken an effort to put together a proposal for new general fund budget to expand our e.a.p. services due to the increasing demand. in this proposal, we are coordig with other city departments that

have e.a.p. services. as i mentioned, at this time, the fire department and several first responders agencies have prepared to request for proposals. it is not yet public. it is likely to go out in march for external e.a.p. services for the first responders. m.t.a. also has a contract for externally e.a.p. services. they're a significantly large department. we're working with workers comp regarding new law that makes post-traumatic stress disorder as a work injury for police officers and first responders for claims filed after the first of this year. worker comp claim can be filed with up to five years post-employment. that's a separate piece but

obviously closely related and we're joined at the hip with the department of human resources so these messages may get very confusing. the e.a.p. program expansion will allow us to serve more city employees and continue to advocate on behalf of our members with our contracted health plans and share the proposal with the board when it is complete. that will be relatively soon. i understand it, mayor's office will be requesting a new budget proposals during the month of march. >> president breslin: i have a question. you said there's an r.f.p. coming out our department? >> correct. >> president breslin: coming out of our department? >> no. >> president breslin: just out of the fire department?

>> yes. >> president breslin: that would coordinate with our e.a.p.? >> yes, we throughout this whole conversation that's going on for six or eight months. we've been recognizing the need to coordinate our services. we have limited resources. we can all benefit from better coordination because the workforce out there with mental health counselors is what it is. there's a workforce shortage. it's important that we understand how we're all accessing and using services so we can be advocating for the right priorities at the right time from the same page if you will. it's been a really rewarding opportunity to work so closely with the fire department and the police department and m.t.a. on

what they've done in the past and where they like to go from here. during this last year, we've worked closely with our e.a.p. team to be sure that other members, as well as first responders, should they have access issues with any of our health plans, that we have all the plans on speed dial and have a shared understanding of how we can resolve issues when they are brought to our attention. >> president breslin: anybody with an issue will go to one phone number? >> we haven't gotten to that level of detail yet. i don't imagine that will be the case. certainly as i understand it and commissioner canning can comment. the behavioral health in the police department has been in place for many years. they have very extensive peer support program and other services that in that culture, they're accustomed to accessing.

those are things to be discussed. i spent some time with the police yesterday talking about possibilities on how we could work together to better coordinate our efforts on behalf of our members. >> let me follow-up briefly to that. there are two concerns, one is the access of technicians or practitioners who can support a population and providing additional benefit to the entire population we serve with the understanding that there are particular groups that are exposed to trauma that may require some additional attention.

i was curious as this r.f.p. goes out, members of these agencies are concerned they may lose access to that pipeline they used to accessing for -- severe, not chronic -- opposite of chronic. acute, when they are suffering from a need.

>> if anything, we're wanting to support the efforts that have been so successful thus far and to ensure that they remain in place and enhance them where we're able to. >> president breslin: we brought up including retirees in this. i know that ptsd inclusion now, that was for five years after retirement. i think that's very important. i was reading this morning about access. the statistics are pretty dim.

i suspect this will be the biggest problem. i don't know what the reimbursement rate will be for h.m.o. p's. this is a problem with physical therapy and other issue. i think that's going to be a big issue is how these providers reimbursed. >> i know that was a discussion point in the development of the r.f.p. i can't speak to what's in the r.f.p. i haven't seen it and i couldn't talk about it if i had. there's also the fact that there's a market in play here. the demand for mental health counselors is up across the board. it's definitely increasing the reimbursement rate for providers. i know that kaiser has experienced and is responding

the needs of their members and their workforce. the dollars that they're setting aside for improving mental health services is certainly helping them and their members. that in turn, just following basic economics will play out for the other carriers as well in order to have the providers on their rosters, the reality is, there's a limited number of licensed mental health counselors. if you think about it, it kind of makes sense that the mental health system has been functioning as system that only really was focused on the severely mentally ill for the last four years and earlier intervention services and counseling and such was not as well utilized and demandedded for as ieddededdedfor -- demands

today. the ability to hire new counselors no matter what you pay them is really limited. there's not that many. it'sag.there really is a need fn r.n., i've experienced nursing shortages every 10 or 15 years. it seems there's often a table created to address the workforce shortage. i'm not aware of that. i know that individual companies and carriers are trying to address it. i don't know that we've had a collective effort to address that issue that i found yet. >> president breslin: [indiscern ible] >> essential it will help. any workforce shortage situation, you need to look at the pipeline. what attracts people and what

brings them in to the workforce. when i was speaking to mr. howard yesterday, he was explaining, there's a significant number of internship hours that licensed person needs to acquire in order to get their licenses. those are often unpaid internships. it's either thousand or 2000 hour. it's somewhere up there you can imagine how difficult it is for people in this city to be doing that number of hours without compensation. i know those are the types of things that workforce shortage folks are looking at. >> president breslin: thank you. >> i want to point out overlaps in housing. i know every pay grade, housing becomes an issue in the bay area and san francisco becomes

unattractive even for the people who do have licenses and would be able to practice in all of-t. this is really monumental issue. >> to the degree, it can be helpful helpful, mental health services seeing uptick in utilization. which can work for some population but not all. i did have few other things to add to the director's report, we have hired some new staff. he's joined the enterprise system analytics team. he has a background in health metrics research. we will be the one that will be

helping us on population health approach to h.h.s. so welcome. we also have two benefit technician that have been filled. welcome to the team. we've been -- we had two projects that have been regard to get to the final implementation date. one is getting our credit card service up and running and the other has been the new telephone system. i'm not sure who's going to get to the finish line first. the.just got an update today one telephone system. it is moving forward and we are projecting go live date in march. the credit card system, i'm not sure that we have a go live date

yet. it too will be very soon and that will help a lot of our members that have to make payments and make things much easier for folks. we're looking forward to those operational improvements. that concludes my report. >> vice president follansbee: ge tting back to the blue shield cards. i appreciate that we had an extensive look to see what the situation was. was everyone identified who received inappropriate card, were they proactively contacted to make sure they understood that card was not active or needed to be destroyed? member who brought it up and the supervisor lim, other members maybe confused. >> i'm not sure if we're aware if everyone has been contacted. we know who everybody is.

i know that blue shield is not here today. it's a useful practice to make folks aware. >> vice president follansbee: i would like to add my thanks to pamela levin. it's been a challenge to not appear too stupid. she's always dealt with me and my questions with calm and expertise. we have six more months to come up with a question that really is too stupid. i appreciate your expertise and ability to really handle this. i seen the changes in my tenure on the board. i appreciate your input on that. thank you. >> president breslin: any public comment on this item? sorry, one more. >> congratulations on your upcoming retirement.

pamela and i, i work -- we worked together when she was the public director at public health. thank you for your service for all the things you have done for health service. join the club in october, the retirement club. >> president breslin: public comment? >> good afternoon commissioners. congratulations pamela on your decision to retire. by the way, check out, there's lot of san francisc san francisn santa fe.

we'll see. we also look forward to getting your membership at rccsf. we send out emails. we hope that pamela will join us. i wanted to also say that, we've been very fortunate at health service through the last few budget directors to have some really exceptional people. pamela has been one of them. she's a real star. i worry about that relationship with the mayor's office and budget time and what we have to go through. i'm hoping that pamela has someone in there that will help build that relationship and keep us going forward in the future. the last thing i want to add is, the issue of the e.a.p. and mental health is significant. it was an issue for all the years i worked for the city and for the time i served on the board. i supported e.a.p. strongly and understand the needs for

specialized e.a.p. in police and fire. thank you karen for bringing up the retirees needed. that's been one of the questions we faced over the years and especially these days with people retiring and those first five years can be critical in having access to e.a.p. services is significant. thank you abby for helping us to expand this. thank you very much. >> president breslin: any other public comment? seeing none, item number 8. [agenda item read].

>> good afternoon. pamela levin chief financial officer. the report in front of you summarizes the actual revenues and expenses of the employee benefit trust fund and the general fund with actuals through november 30, 2019 and fiscal year projection through june 30, 2020. in terms of the trust fund, the balance that we reported to the auditors in june as of june 30, 2019, was $92.2 million base the on activity through november 30, 2019 the fund balance is projected to be $94.3 million which is an increase of $2.1 million. we are currently projecting a

$1.2 million decrease in the fund balance for the uacppo. for the blue shield access plus, the fund balance is projected to increase by $13.1 million primarily due to pharmacy rebates and favorable claims experience. for the trio plan, we're projecting a $5.8 million decrease in the fund balance and this is compared to the $6.7 million decrease that we had in last month's report. i promised you a little better look of the little better outlook. we're projecting a $3.3 million decrease in fund balance for delta dental self-funded plan. because the amount used to subsidize the rate continue to be higher. in terms of the healthcare sustainability fund, we're projected to have year end balance $1.9 million. we still project $1 million

increase in fund balance for investment earnings. these are only posted every quarter by the comptroller's office. so far this fiscal year, we've received $300,000 in performance guarantee payments. we have not made any reimbursements for adoption as of november. we're projected to have -- to end up having to reimbursed by $200,000 by end of this fiscal year. the amount of forfeitures spending account balances reside in the trust, won't be known until june 2020. therefore, how much we transfer over for administration for the flexible spending accounts is yet to be determined.

as i mentioned before, we only transfer the amount of the forfeitures. even though we made budget a greater number. as of november 30, 2019, $2 million in pharmacy rebates have been received. we have a year end project continues to be $8 million based on the prior years. we continue to give you the graphs that we found them very useful on our side. i hope they are useful for you. they compare the cumulative expenses to the budget premium. the cumulative expenses are tracking hootier than revenue -- tracking higher than revenue for the uhcppo plan and blue shield. they are lower for the expenses are tracking lower for the blue shield access plus and the delta

dental self-funded plan. based on the results through november 30th, we project year end balance $128,000. that ends my presentation. >> president breslin: questions or comments? thank you. any public comment on this item? seeing none, item number 9. [agenda item read]. this report will be given by marina coleridge. >> marina coleridge enterprise system health services system.

we will have a presentation. presenting to you the 2020 demographic report. this is a snapshot of the sfhss membership. i like to acknowledge the members. also, in this year's report, taking feedback we've received in previous years. we've added some additional slices of some medical plans as well as dental for the first time we got some employees

rates. that's part of broader equity issues across the city. we'll continue owork with that data. we've been able to do further segmentation with our retiree population. moving into page 3 of the report, as i go through, i'll speak to the very high level points. it's a very dense report. for those that are not able to be here with us to get a hard copy today, you can go to sfhss.org and choose reports. i encourage you to do that. i realized page 12 is the wrong version for page 12. we're going to get an updated one later today. not surprisingly, our membership continues to grow. up another 1% from previous year. we currently now have 136,483

lives enrolled or waived in our medical plans fall under the purview of sfhss. of that increase, we see 824 came from active employee population, 1047 more out of the retiree population. looking at the dental population that we see on page 4, i will step back and explain few more things for some of the new members of the board. we administered dental for just the retirees, the superior court and the city and county of san francisco employees. lower numbers there. we're looking total lives in our dental plan. which includes about 13,000 of our waived folks. those folks eligible for dental coverage. in our flexible spending account, that is a benefit that

is offered only to court and city and county employees. we continue to see enrollment in the healthcare fsas increase. total enrollment, 7928. some of our employees do enroll in both of those coverages so that's 6909 unique individuals and of the employees who could enroll, we're talking just under 21% of employees take advantage of enrollment and fha plan. quick comments on page 5. we do offer voluntary benefits and that was three years ago maybe that we enrolled to all city and county employees. you seeing on the chart, there's some significant jumps from the 2019 to 2020 number. this report is looking at year

over year enrollment from the january 1st date. we offered a mid-year special enrollment period last may. which was hugely successful. that's where a big percent of this increase in these voluntary benefits derived from. the ones that really are significant increases are critical illness and legal shield and group and life insurance. finally, on the bottom there on page 5, we're looking at vision premier enrollment. that's something we first launched in 2018. that's vo voluntary. it is available to all of our h.h.s. members. we have 17,847 individuals

enrolled taken advantage of the vision premier benefit. those are some of the highlights overall looking at page 8. here we just see some of the breakdown across our plans. proportion of our retiree lives to our employee lives is 68% to 32%. geographically on page 9, we're just looking at where our folks live. 97% of our members, this is not news to you, live in the bay area counties and 38% of those are in san francisco. we did see some slight decreases in three counties, marin, sonoma and santa clara. very slight, but still some

decrease in nose numbers there. i'm moving to slide 12. the nature of this report is, we tend to provide essentially the same information. what is our medical, dental and enrollment looking like, we're segmenting it whether we're looking at the total membership and we break it down to looking just at our employee and retiree members. then we'll look at just employees and we'll go with the further breakdowns by the employer groups. i will keep it high level, there's too much here. page 12 is the updated member. page 13, we'll look at the

graphics. average age across our employee and our retiree population is there. 46.20 is the average age on our employees. you see our medicare at 75.11 and non-medicare retiree average age 60.52. investors som -- as far as the enrollment in our plan, broken out by employee versus retired members, not surprisingly and advantage p.p.o. allure all rets over there.

we see little bit of shifting within those as we went through open enrollment. 322 employees moved from kaiser to blue shield and 240 moves from blue shield plans back to kaiser. 82 more ended up in blue shield just looking at the non-medicare population. we see some movement back and forth between access and trio. 242 people that weren't in access moved to trio. 18 more actually moved over to the trio side as we examined movement within the blue shield plan. moving to page 17, -- actually 15. there's just a breakdown in the table.

you can see when you're looking at what's the enrollment geographically, again, the migration there staying pretty static. 97% of those folks in the top bay area counties. you can see the breakout across our plans on page 14. how many people in those plans are living in those locations. page 17, just over here on the second grouping on this page. employee and retiree members by types of dependent. we've got 58% of e.e. only of all of our subscribers. 26% has a dependent and another 16% in 2020 have family coverage or more than one child. that's being consistent what we've seen in previous years.

also as far as our domestic partner enrollment goes, that has stayed relatively equal to previous years. 75% of the 1412 people who have domestic partners are opposite sex. moving to page 18 is where we start looking at the employee members and their dependents. only the employee population, looking there. here again, pretty consistent. average age employee members has been increasing slightly year over year. that average age i called that earlier was 46.20. average age of our employee dependents are 25.63 which is a very significant increase. the 97% in our bay area

counties, againing, year over year. we talked about some of the movement within blue shield and in comparison to kaiser. just looking at all of the blue shield plans suicide ou -- blued plans as our career, we've got a total of employee lives 10,565 in the blue shield plan. 20,959 in the access plus plan. that 31,524 which is a decrease there. kaiser, year over year, consistent many years. we continue to see increases happening with the kaiser population. up 1095. they now have all our employee lives, 61% of that membership. you'll see this as -- as you go

through and do your analysis by employers you can see as well by employer where the employee lives are coming from. sfusd, 80% of their employees select crisis. -- kaiser, that's a big driver in the population as you're seeing. page 20 again, that geographical outlook and here we've got it all combined, which is it note that, san francisco has majority of our employee lives. that shouldn't be surprising 41%. we know the expense living in the city. as we look at it by coverage tier across all of our employees that we have for those that do not have any dependents and enrolled in employee only coverage, 54% of those people living in san francisco.

rest are in the surrounding counties. then moving on to page 23, this tends to continue the same way out. we'll show you information by coverage tier and by plan and by location for the first time, we are starting to see a breakout that we offered you breakout some of the retiree medicare versus non-medicare. when we see our retiree members transitioning from active employee to medicare or from a non-medicare retiree to medicare retiree, members remain with the carrier they are. everybody we saw retire during the year were with kaiser and stayed with kaiser as they moved in their medicare plan. everybody we saw that that was in blue shield, went to united

healthcare financial we do not have medicare offering in blue shield. that's why you see that. we're seeing people stay with the carriers that they were with during their active employment enrollment. as far as the medicare retirees go, we see 55% of that population is with the united healthcare advantage plan. 45% are with the kaiser permanente senior advantage plan. page 24, you can take a look at the average age of our lives retiree lives and their dependents within the plans. 74.84 on the bottom right corner there and the kipsa plan, 74.1

there. looking at page 25, gets harder to read, our retirees are more spread out than the bay area. you can look at all the tables and all the data for where the retiree population is living. this has stayed consistent what we've seen in previous years in terms of top counties. going to page 26, we start looking at it by state. retirees living in albuquerque. there's 64 folks living in new mexico that we have enrolled in coverage. on page 27, where you're seeing the breakout now for both medicare and non-medicare. when we look at the enrollments.

that's an addition to the layout of the report for this year. our employer section begins on page 31. again, i already had mentioned that 80% of u.s.d. employee lives are going into kaiser. they do have the largest enrollment percentage for all of the individual employers, city and county have -- we have the largest portion of active and retiree lives, 81.42% contributed to the overall population. for the first time in six years, superior court employee lives enrolled in dental increased. that was something new that we saw. on the court page, you'll see now the layout of the dental by coverage tier that's now being

added to this report. which is not in previous year's report on page 41. for any new commissioners, this report is really good to understanding our population and how many people are coming from each of the four employers that we represent. you'll see each of the employer pages as we break it out beginning on page 33 to the end of the report. those are the highlights for the 2020 demographic report. are there any questions? >> vice president follansbee: we approved rates for kaiser in the state of washington. did you see any migration or any numbers appear? >> that looked pretty much the same from my recollection. one person moved out of the kaiser washington and understood into the u. -- into the u.h.c.

product. >> thank you for the thorough presentation and beautiful graphics. i observed that the fsa pretax accounts enrollment is really low. do you guys have a strategy to address that to market the tax benefit associated with those accounts? >> i will let our c.o.o. address any strategies. you might think that 21% is low, just having a meeting with the san francisco unified school district, they shared their numbers with us. they were considerably lower than our percentages. which surprised me as well.

>> also to set up, marina was commenting on the changing demographics of the enrollees for 2020. this annual report is a look back at 2019. so if the numbers are a little

jumbled, that may be why. i also want to acknowledge that today marks the beginning of my third year in this role. i've learned a lot and i appreciate the support of this board and the spectacular team that we have at h.s.s. we couldn't have done it without all the support we've received. i want to walk through briefly in the annual report and not take too much of your time today, but in my message, i really spoke to the strategic direction that we're collectively steering h.s.s. to. in that regard, i just wanted to kind of read a quote out of a strategic planning book that i've been referencing recently. it talks about -- the author says in my recent discussions with literally hundreds of government leaders, c.o.o.s and

senior executives of some of the world's largest employers, they are all trying to make sense of their role in an evolving environment. they must rethink their definition of health and performance. re-examine the strength of the implied contracted for health between employers and employees and reconsider their role in transforming the health ecosystem in ways that drive healthy behaviors and outcome. that rang very true to me as to what our endeavors are together with the board and the strategic plan i think supports us in moving in that direction. there are five components of this strategic plan i speak to in the director's message and just to highlight affordable and sustainable goals. we have completed two parts of a healthcare market assessment over the last year that help us define how we want to administer

benefits moving forward. those we did a market assessment looking at various healthcare models, the industry trends, the major players, and how we might define the opportunities in the healthcare ecosystem. we followed that up, helping understand from our members' perspective by doing a number of focus groups. we had good representations from over 30 city departments and really understanding what choice and flexibility meant to our members and helped inform us as to what is important and supporting the whole person and well-being of our members. we also through the engagement and support lens culminated a three-year effort to bring our efforts into the modern age of electronic enrolment with much

success this year. we've continued to receive lots of positive feedback from our members for having that way of enrolling available to them. reducing complexity and fragmentation, i think an example of that is what we've done with the employee assistance program and the health plans to look at it from the member perspective, especially focus on navigating a system that can be a barrier and an additional stressor. we have put some finishing touches this week on redefining some of the business initiatives in line with these strategic goals and we will be reporting them to the board. moving forward in the annual report, on page 4 we list our

priorities. i think those are restated as they have been in prior years. the membership enrolment on page 5, marina just highlighted some of what we're looking at in 2020, but certainly in 2019 we were continuing this rise of membership with over 122,000 covered lives and 83,000, 84,000 of those being active and 38,500 being retiree lives. so it continues to be a healthy mix of all ages in our portfolio. that challenges all of us to determine how best to deliver services to such a diverse population. >> excuse me, the demographic reports say there are 134,000 covered lives and this is 122,000. >> this is a look back to 2019

and what marina just reported on was the enrolment for 2020. >> so it says 2019, 134,000 covered lives. on hers 2019, not 2020. >> right. this is an annual report on 2019. >> right. >> right. >> hers was too as far as i could see. >> i'm sorry, i can't hear you. >> hers was too. she has 2019 and 2020. am i missing something? >> this number, mitchell is pointing out, doesn't include the waived population. >> that's it. >> thank you for that. i think in the annual report then are report outs from the various divisions in h.s.f. on page 8 is the enterprise systems, analytics, highlights of their work. living in this technological age that we are in, we are fortunate

to have a superb enterprise system and analytics team that provides the backbone for the data that we collect and analyze and report. that's a tremendous, tremendous effort, including -- i note the statistics that talks about the i.r.s. forms that we have to put o out, 53,000 of them. so there's a wide range of data services that are provided. the medical plan enrolment i won't discuss here today and the voluntary benefits and flexible spending account you heard about, those are important benefits to our members.

the voluntary benefits we did give benefits to our members who couldn't partake in open enrolment. it was heartening to see that that different strategy yielded some good results. the big highlight of the year, as we all know, on page 12 is the success with the benefits. it is now available to the active population. we have over 7,000 retirees with access to e-benefits and we'll continue to increase that number as time goes forward. it certainly will be a relatively easy transition for people that are retiring now because we know they've had some exposure to the e-benefits as an active employee. so that population will be easier. it's a little more challenging to get folks who haven't been part of that network in some time.

our communications department really does a lot of work to help us be successful in delivering all kinds of messages throughout the year, and certainly around open enrolment. we did go live with a new web page last friday and it's gone pretty darn seamlessly. there are opportunities for improvement. as users of our website, please let us know if you have challenges finding particular things or don't understand our logic, we would very much appreciate your feedback at any time. but it's certainly given us an opportunity to communicate to the -- through the internet. our well-being program on page 14 is doing quite well. we've partnered with 44 city

departments. we have well-being champions in 28 of those. we have many on-site activities. we have a large number of folks that are helped by our e.a.p. counsellors. that department continues to thrive. the finance division, i think you've acknowledged that work that pamela and her team has done. the numbers of dollars that go through the trust is rather staggering. it is an awesome responsibility to keep accurate records of the many transactions that occur and as the money flows in and out of the trust, supported by many work orders as well as contracts. as we all know, the contract process in san francisco is

quite complicated. we have an excellent contracts team who has responsibility for 29 contracts with 27 vendors. they do an excellent job of following procedure and keeping the work flowing at the same time. it's without that diligence that work can come to a halt if the contracting process does not go smoothly. i do want to end by just again acknowledging the support of our board and our -- and acknowledging the hard work of our team. it's really a remarkable honor to work with everyone to be able to deliver the services that we do and deliver this report to you today. that concludes my remarks. should you have any questions, i'm happy to entertain them. >> any questions?

comments? >> i just had one comment. did we discuss in the past maybe having this report, a statement from the board, also about how it sees its role for the year and all of that? i thought we had discussed it at some point. i'm not sure if i'm remembering wrong or we decided not to do it or whatever. but it seems like the board is integral to the system and that we should have some statement. >> you're absolutely right. we did do that in the last year. we can make an effort to add that to this report. >> i think it's a superb report. i would like to highlight the fact that the administrative costs of all of this is 0.05% of the funds that are managed. i think that that is incredible. for all of our members and the city and county of san francisco

and everyone that resides here it is wonderful. >> any other comments here? >> yeah, i just wanted to thank the director and the staff who did all the work for the annual report. very well done. >> since we highlighted flexible spending accounts and well-being in this report, that reminded me of something to add an additional response to the question about flexible spending accounts and promoting that benefit. benefits, administration, and well-being are working together to start a financial well-being program in 2010. more information about that and details later. we are going through the portfolios now, including flexible spending accounts, as we market that program. so there will be more

information and highlighted really under the banner of financial well-being. so i expect that the enrolment will probably increase. >> thank you. all right. thank you very much. so we need an action -- is this an action item? >> i move that we adopt the annual report as presented with an amendment with a board statement. >> i second that. >> all right. any public comment on this item? seeing none, all those in favor? >> aye. >> any opposed? it's unanimous. how does everyone feel? would you like a break now or do you want to go on? any preference? >> i can go on. >> okay. >> okay. we'll hav

>> our next section is the finance and budget committee matters. i will turn this over to the chair. >> thank you, president. so this morning the finance committee met and approved 2020-21 budget. some of the highlights of the budget. the mayor's office proposes 3.5 reduction in 2020-21 and that equates to $126,421.22. that's a reduction of $252,000. the mayor's office has

instructions to reduce every office's budget by 3.5%. if we could see the slide. here is the budget for 2020-21 right at the bottom, it's $126,226. just a couple of concepts, the 2020-21 budget, that's the mayor's base budget. that's the starting budget for the department to work with, cost of living adjustments, changing in the retires, benefit, and work orders. so that 126 and the composition of the $126,000, it comes from the well-being grants that are being -- that are reduced and the on-site well-being activities that are being reduced and it accounts to 31%

for the second year. other than that, there are no more increases instructed from the mayor's office. so the net effect is $126,227. for 2020-21, $254,455. the budget that will be presented to the mayor's office is for two fiscal years, 2020-21 and 2021-22. any questions from the board? >> i have not a question, but a comment. i feel compelled to make this statement p -- i've been on this board seven years. this system generates income to the city and county of san francisco in excess of -- i think in the most recent years

$5 million or more in terms of premium cost savings. we have one of the smallest staffs administering more than $1 billion of benefit payments. we have to go through this exercise each year of complying with reductions in our administrative budget. it just doesn't seem to be proportionate nor understandable. i recognize i'm whistling in the wind when i say this, but i had to get that off my chest. >> thank you, commissioner staff. for the last years, although the mayor's office has requested, we complied with the mayor's office budget sfrukss for reductions that apply to all departments. every yearinstructions for reductions that apply to all departments. every year we ask the mayor's office to fund just that. so the reductions we are putting in here for the projected

$126,000 and $252,000, once the budget is submitted to the mayor's office, we will be asking the mayor's office to do the funding for the well-being grants and well-being on-site activity activities. they're very much flexible and we usually get the requested funded that was cut. any comments upon it? pamela levin, chief financial officer. when we negotiated the budget, at the end of the mayor's phase we were back to what the base budget was. then we were successful in just small cuts from the budgeting. so they do recognize and we do communicate exactly what you're saying and we communicate very

clearly to we have trimmed around the edges as much as we can and that was done several years ago and we just can't continue to do that. >> if i can point out an addition that one of the things that i didn't remember seeing in the annual report was that the cost of healthcare for the negotiated rates, the quality that the health services delivers through its diligence and we hear questions and concerns about, for example, the cost of specialty drugs. it takes the people power from our service to really investigate those and look at the issues, not per member, but also for all the members. when the services is trimmed, then our ability even to respond to these issues in a

comprehensive way, not a point way, but a comprehensive way is really impaired. i think that the health services system really needs to be -- you know, they're successes need to be acknowledged as we move forward and the challenges that we're all looking at through our strategic plan, et cetera, to deal with the rising costs of healthcare delivery and the region and the country. i want to acknowledge these concerns of the committee. >> i would like to point out that our operating budget is less than 1% of what we handle. so we have -- in the annual report currently we have the $11.6 million and we handle $944

million in benefits. so it's minuscule. >> i'm willing to entertain a motion to approve the 2020-21 and 2021-22 annual general fund budget. >> i'd like to make a motion that we approve the proposed general fund budget as presented. >> seconded. >> it's been moved and seconded. any public comment? hearing none, those in favor say "aye." >> aye. >> opposed, "nay." motion approved. >> clerk: item 12, approval of the san francisco health service system fiscal year 2020-21 and fiscal year 2021-22 proposed healthcare sustainability fund budget, presented by committee chair lim. >> so the item before you is the healthcare sustainability fund

budget for 2021-22 and 2020-21. this is what we call the $3 per member per month as part of the premium. what's in front of you is the history of how we spent -- the annual revenues and how we spent the budget. so in the past years we always had a surplus on our sustainability fund and it's always carrying forward the following year. underneath you have the annual and one-time expenditures. so down below you have whatever balance left is the cumulative

fund balance. for 2020-21 the proposed budget for the revenue is $5,239,001. that includes from 2019-20 of $2,022,000. that's the proposed budget. so we are expecting to have a carry-forward for 2021-22 of $1,281,000. however, with the proposed list at the end of the year, we only have $120,000 left which will be carried forward in 2022-23. but we are expecting some

shortfalls in the future. there are the competitions of the budget. the annual expenditures are the personnel and other communications. down below are the well-being initiative initiatives and for transcription services. that's the annual budget that comprises the $2.9 million and $3.1 million for 2021-22. and the one-time expenditures are open enrolment communications, operations communications, well-being -- we don't have any well-being, and other communications. down below are the well-being and the additional healthcare costs. so that's the composition of the

annual and one-time expenditures. and on the annual expenditures highlights a year before we did the eligibility verification audit and we are planning -- in the budget it's being planned to do it in-house. so this is a reduction in the expenditures. then we are partnering -- we have a partnership with the tax collector on finance well-being and all of the well-being challenges. on the one-time challenges, that's the voice over internet for the customer relations management, there was programming for benefits, operations, technical process improvements, support for access to benefits, and consultants for

audits and assistance for medical services. and the highlights for the annual and one-time expenditure s. any additional comment, commissioner? >> one additional comment is i think if we were to look back at the 2019 annual report and star those improvements that came because of the $3 assessment that every member pays, we would be amazed at the improvement of access and services, information and communication, including our movement to a more paperless system. sometimes these improvements get lost in the recognition of what this budget does. i think this is quite impressive and we all need to be reminded of how integral this is to the future of the health service

system. >> any other comments? without, i'm willing to entertain a motion to approve the sustainability budget for 2021-22. >> i move to approve the healthcare sustainability fund for 2021-22. >> seconded. >> it's been moved and seconded the approved sustainability fund for 2021-22 and 2020-21. any public comment? hearing and seeing none, those in favor say "aye." >> aye. >> those opposed, say "nay." the budget is unanimously approved. thank you. returning back to the chair. >> all right. so now we're into the rates and benefits period of our agenda. so item number 13, please.

>> clerk: item 13 is a presentation of the 2020 recent benefits calendar for plan year 2021. this is presented by abbie yant, the executive director. >> good afternoon commissioners, again. your rates and benefits calendar for plan year 2021 is in your packet. may i remind you that we put holds on a second meeting for each of the months during this rates and benefits season. i would recommend that we cancel the february 27 date. i would ask that you hold the march 26 date. i'll let commissioner lim speak to this as well. we are recommending that we have a special educational meeting on march 26 with a very detailed presentation on rate-setting methodology that would inform both our newer members as well

as others that -- on the complexities that goes into rate setting. we think it would be advantageous to do it at that point in time before the rates are presented before you. we also will take advantage of the opportunity to have that recorded in this room so that persons can and we actually have ambitions to edit it so it's in three or four parts so you can watch it when you have time because it's complicated. it's very complicated. i think that you will have an interest in hearing it more than once. so we are recommending that we keep that march 26 meeting time for that special session. >> during the budget and finance committee this morning, mike did a presentation just for -- on the budget and finance

committee, but we're asking an amendment to be put on the methodology because it's a little bit more complicated. so it would be just a judicial forum for all of the board. so that's what the director wants. i'm requesting that to be put on the agenda for the march 2020 meeting too. >> i would just like to comment. i heard the presentation this morning and it was really superb. even as a provider of healthcare, i recognize -- historically as a provider of healthcare, i recognize the complexity and chaos out there in rating systems as individuals may be looking in -- looking to supplement their healthcare insurance or whatever out there in the community. the number of ads you get and the ratings systems they use are

just incredible. so this presentation i think will go very far to help us as a board look at the issues of how we rate and help select health plans for our members, but also to the general public just to look to see how their own expectations of healthcare might be met or not. i'm sure you all get questions from family members and friends about their own healthcare and the rating system and stars and all sorts of things, that this is going to be really an integral presentation i think. >> any other comments on this item? any public comment? seeing none, item number 14, please. >> clerk: item 14. review the united healthcare utilization claims experience for 2019 calendar year. this is presented by mike clarke

from aon. >> good afternoon, commissioners. mike clarke with aon here to present the plan experience that we observed for the 2019 plan year. we'll start with a previous introduction on what we're going to present, just a brief history on rate stabilization actions, but focus on the experience of the plan for 2019 for both active employees and early retirees. in this case, when we say "early retirees," we also include those non-medicare dependant retirees who are enrolled in the uhcppo plan. so we're going to outline the

decisions to provide the rate stabilization funds. and we really look at a comparison of the recently completed year, 2019, to the year before, 2018, for each portion of the population for membership, contract size, and average claim cost per employee on an incurred basis, which ties to when the services are delivered, someone visits a doctor or a hospital, et cetera, as well as a paid basis, which is when united healthcare processes the claim for release of funds by sfhcs. so we're going to talk in the next presentation more thoroughly about the plan stabilization actions for this coming cycle, but just to refresh on the past couple cycles. in an effort to promote long-term sustainability of the city plan, the health service

board has applied rate stabilization funds towards the rating for active employees and early retirees for 2019, the plan year experience that we're looking at that involved a rate buy-down of $1,161,000 in 2019 rates. as at the end of december 31, 2018, there was actually a slightly deficit of $351,000. so one-third of that deficit per policy was applied to the 2020 rates. again, we'll talk at late in the next presentation about our proposed actions for the coming cycle on rate stabilization. so getting into the conversation on page 4, what we observed in the active employee population in the uhcppo city plan, there is a lot of information on the

left side of the page. this table represents the head counts and the member counts in each of the coverage tiers. ee being employee only, ee plus being employee plus one dependant, ee plus two being employee plus two dependants. the average contract size is basically looking at the total lives and the employee plus dependants divided by the number of employees. you can see, generally speaking, about 1.6 total lives per employee throughout the year. we show the monthly premiums which are basically the head count rates against the total cost rates that we developed for the total uhcppo plan and the rate plan and the incurred rates of the plan. we highlighted in the red boxes

a loss ratio, which essentially is the comparison of actual claim experience divided by the monthly premium. that's how we calculate that percentage. what i will note in the bottom notes to this bottom is, first of all, we exclude the vision plan costs that are embedded in the overall rates for the plan, the core premium for the vision costs. also due to coding, this information does not include the active employees who are enrolled in the city plan choice not available. there is approximately 100 of those individuals. they're actually captured in the early retiree data that we're going to show here in a bit due to the coding structure setup for when this was established.

in terms of the membership count, there wasn't a big change from the end of 2018 to 2019. for purposes of this chart, we did build back in those enrolments from city plan not available just to give you a complete picture of the active population. as you can see on the footnote on the table on page 5, there are 127 active employees and 227 enrolled lives. these are employees who live in locations and do not have full plan choice because of geography location. in terms of claims per employee, we saw a 5.8% increase, which is consistent with national trend expectations. you'll see the average premium increase was a much higher

percentage at 17.4%. please keep in mind, this is because in 2018 there was a much higher buy-down amount in the overall city plan at $4.5 million total roughly. if you'll recall, $4 million of the $4.5 million was applied to active employees in 2018. so in 2019 it was a lower stabilization buy-down and it was proportional between active employees and early retirees. the 2018 number, that 1303 that you see in the table under average premium 2018 plan year was a significantly bought-down number because of how the rate stabilization reserve worked for active employees in 2018. so to me, even though that's an important number on the page, the one i would really focus on is that average incurred claim cost increase of 5.8%,

indicating the plan is generally running at an expected national trend level. the pay claim cost here is actually different, but that's because of some difference in how pay claims work. if you saw the table before, there was a significant difference in the incurred amounts for january 2019 versus the paid amount for january 2019. there is a little bit of year crossover impact that's driving the big difference. in the end we're using our incurred cost interest to do the underwriting for 2020-21. so page 7 we're going to transition to early retirees, where like the chart that we looked at a few pages ago, we looked at the headcounts across each of the dependant coverage tiers, totalling up the dependant amounts. you'll notice on this page we

have a column for non-medicare dependants of non-medicare retirees. then on the very right side, non-medicare dependants of medicare retirees. so it's important that we segment those out for purposes of underwriting. the average contract size is 1.42 when we look at just the non-medicare dependants of the non-medicare retirees. on page 8, we look at the premium of the plans for the left side of the page and then on the right side start to look at the paid claims and incurred claims across the program. again, you will see here somewhat higher loss ratios relative to the premium on the early retiree plans, in part because of claims but also in part because of the way premiums are set for this population.

that translates to the membership key observations on slide 9. the early retiree count has stayed relatively steady. we did observe some increase in total membership, some dependant counts into the uhcppo from december 2018 to 2019. in this table we exclude those active employees in city plan choice not available. and then from a premium standpoint, i point to the most number on this page which is what we see for the average incurred claim cost change. at this point 3.3%. so again, from a pure claim perspective, the plan running very favourably, not a lot of difference in the average premium one year to the next, because as i mentioned before

almost all of the stabilization buy-down occurred with the active employees, not with the early retirees. so conclusion, on slide 11, my last slide for this presentation, the membership did remain relatively similar in the city plan and we saw it in marina's data from earlier that that continued into early 2020. not a lot of change in the overall enrolment in the city plan. we are seeing reasonable increases, average claim cost for early employee and retiree and we will present in mid-may the 2020-21 city plan and choice not available active and early retiree rate recommendations. >> any questions? any questions? seeing none, thank you. any public comment on this item?

seeing none, we'll move on to item number 15, please. >> clerk: item 15, review and approve the uhc united healthcare city plan prorate stabilization reserve as of 12/31/19. this is presented by mike clarke, aon. >> mike clarke, aon. we present here the projected stabilization reserve as of december 31, 2019, and ultimately our recommendation for the reserve impact at 2020-21 rates for the uhcppo plan. on page 1, we include this prelude page, as we've done in the past. just to remind, there are three different reserve policies held by the health service board for sfhsf plans.

the first item listed in the contingency reserve is the second item presented. if you recall my colleague presented on those last month. the third and the focus of today's discussion is the rate stabilization, which is our annual determination of the financial gain or loss for the self-funded and flex-funded plans that's calculated as of december 31 each year. so i'll go to page 3 to, again, recap the rate stabilization actions in previous years. for 2019 there was a buy-down of $1,661,000 that was applied in its entirety. in 2019 rating for that number. and then for the 2020 rating, there was a small rate stabilization deficit. so one-third of that or $117,000 was provided as a rating in the

2020 rates. we do have appendix pages at the back of this material that i won't go through, but they provide more information on these most recent two years of rate stabilization actions for the uhcppo plan. on page 4 i summarize what i'll present to you today that we look at the claim experience in the prior calendar year. based on that claim experience, we look at the end state rate stabilization balance. in this case, there is a rate stabilization deficit balance of $2,233,000 that will carry into the 2020-21 plan year and beyond. today as i go through this information, at the end of my presentation i will ask the health service board to approve the use of one-third of this rate stabilization deficit of $744,000 to be applied in the

2020-21 plan year rating for this plan. and just for order of magnitude, this $744,000 rating buy-up figure will represent approximately a 2% of the early estimated 2020-21 plan year rates over and above the healthcare trend that will calculate into those rates when we present in may. so a detailed exhibit of the calculation on page 5. we compared the expected plan experience that was calculated in 2018, as we had information at that point in time to project forward to the 2019 plan year. so that's the expected column, and that's compared to the actual column which is now based on information that we now have and now know that 2019 is closed.

so at the expected column, i put a red rectangle around the $161,000 expected shortfall that represented the amount of the rate reserve that was applied to the 2019 rates. in actuality, the revenue shortfall ended up being $3,048,000 when you look at all of the items prior that we include the incurred claims, the administrative fee expense for the plan, offset prescription drug rebates, and compare to the total, both member and employer contributions that were generated for the plan in item 5. then to that we add in the change and contingency reserve that, again, was presented by my colleague last month. this was an increase to the contingency reserve. so it closed through in the

actual experience to add to the shortfall. so that creates a total deficit for the actual experience in 2019 of $3,660,000. so we subtract that figure from the $1,661,000 expected and that drives a net amount of $1,999,000 of additional deficit to add to what carried into this plan year. and then page 6, you'll see a second line is that same $1,999,000 figure added as a deficit to the deficit carried forward $351,000 from last year to create a deficit carry-forward of $2,350,000, offset by the $117,000 that was

applied in 2020 rates, to result in an estimated value of the stabilization deficit of $2,233,000 as of the end of 2020. we apply one-third of that by policy. so that one-third is $744,000. and then the remainder or $1,489,000 would carry forward after 2020-21. so bottom of page 6 is my request of the health service board today and recommends per the requirements that you approve the claim stabilization policy, that the deficit amount be amortized across all rating tiers for the city plan ppo with the remaining deficit carry-forward balance being set at $1,489,000.

>> comments? >> i have no comment. it's a classic question. this plan will continue to have a deficit going forward as far as the eye can see. is that not correct? >> yesterday we did meet with united healthcare to discuss their initial renewal that was submitted last week to us. we will come forth in the coming months perhaps with some ideas to help lower the projected cost. going into 2021, but i think your overall assessment is correct, in that with the enrolment not changing the risk profile of the individuals enrolled in this plan not changing, that the likelihood of deficit carry-forward continuing i would say is relatively high. >> i move that we accept the

recommendation of our actuary. >> second. >> any public comment on this it item? all in favour? >> aye. >> any opposed? it's unanimous. thank you. >> thank you. now i will turn this over to our governance committee chair, commissioner scott. >> thank you. we'll have the next agenda item, please. >> clerk: item 16 is the approval of the 2019 health service board education report. this is presented to you by committee chair scott. >> okay. we have -- >> clerk: the education report is first. >> the education report is

included in the agenda and it summarizes the areas that we have for the past year engaged in education and projects for future planning what we'll be doing during the year 2020. that includes also mandatory training, such sexual harassment, and so forth that we receive e-mails on as commissioners. and i know that that came as a little bit of a surprise, that we had yet another educational requirement coming from the department of human resources, but it's beyond our control is the way i'll put that. we have to do it and we're expecting everyone on this board to complete it accordingly. so the report is before you and our plans are part of the strategic goals for 2020, going into 2022.

we will be having educational sessions, such as the ones that our executive director highlighted, during the course of the year along with our educational forum and so forth. these occasions are taken to basically inform us as we are trying to discharge our fiduciary responsibilities as a board and implementing the various policies, operational and financial issues that confront us as a health system here in the city and county of san francisco. so with that, i would call for acceptance of the report. >> i move to approve the education report. >> second. >> it's been properly moved and seconded that we approve the education report for the health service board for 2019 and its recommendations for 2020. is there any further discussion?

if there's no discussion, all right, is there any public comment? hearing and seeing no public comment, we're now ready to vote. all those in favor signify by saying "aye." >> aye. >> all those opposed? it carries. >> clerk: item 17 is the approval of the report for the fiscal year 2018-2019 health service board self-evaluation. this report will be presented by julia ma, the development director of department of human resources. >> i want to call your attention to the handouts available to the public about the 2019 coronavirus. i'm sure that many of us are following this pandemic, and i

would encourage you to check the facts sheets issued by the c.d.c., the state of california, or the city of san francisco's publications. this story is changing daily, so it's very important that everyone stays abreast of what the situation is. in san francisco we're going about business as usual. the bottom line is wash your hands. if there are any particular question questions, i hope they're answered in these documents, but refer to those documents as your trusted sources of truth.

>> can i just make one comment? i appreciate everything that the center for disease control is doing in conjunction with the world health organization and our city and county and state health departments. i would just like to point out that i have been looking at the c.d.c. reports and they announced on february 11 that the name had been changed to covid-19, yet some of their documents doesn't allow for that. if you need an example of the importance of really timely updates, we're getting inundated with press coverage and all that and the c.d.c. can't keep up. there is a reason for that and it has to do with national priorities and the sense of responsibility that our federal government takes in the way they distribute moneys. this is a real issue and you can see it manifest here in terms of the anxiety and the stress that it's putting on people. i've been on airplanes the last

couple of weeks and there were people wearing masks. it's just outstanding. i don't understand it unless they're all infected and trying to protect me from their disease. i hope that's not the case, but the misinformation -- so we have a public responsibility, each of us, to kind of fill in the gaps. the information the c.d.c. is putting out is as up-to-date as they can make it, but maybe not as up-to-date as we would like to see in the daily reporting. we have a responsibility to educate our friends, neighbors, and family to try to keep the perspective. this is a real disease. this is affecting financial markets, if you don't worry about anything owner that, but you should be worried about friends and family as well. but there are -- there's real information so far, even though there are a lot of unanswered

question questions. >> have they determined if it's airborne? >> it's clearly airborne. the question is how close you need to be to someone who is coughing and sneezing and symptomatic and for what period of time. the example is the cruise ship that still remains quarantined and all the guests are quarantined to their rooms, except they're allowed an hour or so on the decks to wander around. meals are being delivered to their rooms to sort of keep them out of close proximity to each other. but when you look at the staff on those ships, they are being housed in four-person rooms in close quarters. the number of confirmed cases in the staff on that ship is incredibly high. it's not because they're kissing each other, but it's because we

don't know all the factors. we need to wait for clear definitions of cases. the last data last night from the center for disease control which they update monday, wednesday, and friday is that there are only 10 confirmed cases in the united states. they use strict criteria of confirmation of the virus. we know that it's airborne, but the question is under what circumstances. just like tuberculosis, not everyone will catch it from the air. there are other factors that go into a contagion. >> item 17 is the approval of the report for the fiscal year

2018-2019 health service board self-evaluation presented by julia ma. >> hello. my name is julia ma, the director of the workforce development department of human resources. today i'll provide you with a high-level overview of some of the results from the evaluation survey. i believe all of you have the full written report as part of your materials for today. in support of the health service board's annual administration process, we administered an electronic survey to all board members back in november and december 2019. the survey was anonymous and we were pleased that we had a 100% completion rate with all seven board members at that time completing the survey. the evaluation asked board members to self-evaluate the

board in governance, structure, policies, board member interactions and meeting activities, goal-setting and communications, and lastly, board's interactions with management. so in the executive summary of the report, i highlighted that the evaluations showed significant improvement across all four of these areas of the evaluation. as you can see in the slide, the score increases which are the global scores for each of those areas, there is an increase in three of the four areas. even with the goal-setting and communications broader category, there were several individual items in that category that showed increases compared to last year. in fact, of the 40 total statements and evaluations that board members were asked to rate, 26 out of those 40 showed increases in scores compared to last year. we didn't see any outstanding issues surfacing from this

evaluation report. it was nice to see in the 2017-18 evaluation report, there were some areas of opportunity to focus on and to improve in. when i compared those areas to the evaluation results in the 2018-19 evaluation report, i was pleased to see that the board improved in all the areas that you wanted to improve in from the previous year and that you chose to focus on. that really demonstrated board members' personal and group efforts to improve in these areas. those efforts had a positive impact overall. specifically the next two slides show some of those areas that were an area of focus for an improvement. as you can see from the scores, they did improve. in the governance structure and policies section, there was a

focus on improving the board orientation process so that the board orientation program met board members' expectations. so that showed a significant score increase. in the board member interactions and meeting activities, a second section, there were two particular statements that the board chose to focus on improving and did show growth in those areas. the board takes timely action to resolve problems when they arise and the board carefully deliberates before taking action. in the third area of goal-setsi goal-setting and communications, one area i wanted to note is the board communicates with one voice to all parties. we saw an increase in that item. lastly in the board members' interaction with management, three of the statements the board did want to focus onyshkoed improvement, which is the board provides sound advice to management, the board provides alternative points of

view to management, and the board effectively evaluates the executive director's performance. i did want to note there was one area that we wanted to note a decrease. so the decrease was for the statement the board manages the board members with policies. especially with the comments that we received for that area, it became clear to us that a number of board members indicated that they used the neutral rating score, the 3 score, because they have not observed board members who fail to act in accordance with policies. so that helped us to recognize that there is room to maybe improve the evaluation design of this tool for future years to better capture behavior not observed so that doesn't result in a decrease of score.

so in the next few slides, though there has been growth in these areas of focus, the board can continue to improve. so the board orientation is the first one i wanted to highlight. there was growth in that score, but the score is 3.7, so still room for improvement. and in sharing these evaluation results with the governance committee and discussing with management there, i'm pleased to note that already there are action steps identified to continue to strengthen the work around board orientation. so the slide shows that there's a commitment to making the board orientation materials available, not just for the new members who join the board, but also for the existing board members who maybe haven't experienced a thorough board orientation for a number of years and would benefit from viewing those materials as well. and i think that really responds

to some of the comments that we saw in the board orientation questions, in which the new board members really acknowledged. the thorough on-boarding orientation program that they received, whereas some open-ended comments, i'm assuming from more experienced board members, indicated that they had not been part of a board orientation process for quite a while. another area that was an area of growth but can continue to be an area of growth is providing continuing education for board members. and again the management team is jumping into action and identifying ways to improve in this coming area, such as presenting and planning educational forums throughout the year. it's nice to see that commissioners are asking for more and more educational opportunities and that the management team is responding. the third area for continued growth are some of the items

connected to strategic planning and goal setting. commissioners requested that there be more strategic planning opportunities made available during meetings and board discussions. the board secretary has started to do that by adding some descriptive language in the agenda items so the board members can see connection between the board discussion items and how that's tied into a larger strategic goal. so i think with those -- it's nice again to see the management responding so immediately to some of the results of this evaluation report. we've been using basically the same evaluation tool for the last three years. in the governance committee there was a recognition that the board has developed and it's time to relook at some of those questions and statements and consider modifying the

evaluation tool for maybe the next three years. so that work will begin in the summertime and the governance committee will take a close look to see how that updates the existing tools. in addition, we look at the service board progress that you all have made in the last years of evaluation. >> i would like to add to the comments a thanks to you for working with our board secretary throughout this whole process. it's been outstanding work from h.r. and you have eclipsed our expectations, at least mine, and

being diligent, timely, prompt, and interactive with us as we go through this process. thank you. with that, i'll ask if there are any questions or comments from the board. >> i would just like to add. as a new member i was not one of the folks surveyed, but just to add some appreciation for director yin, the board secretary in prepping me as a new board member, really being pro-active in outreach, he was meeting with me and answering questions. thank you for that. >> any other comments? if not, is there any public comment on this item? oh, i need a motion. i'm sorry. i'm ready to accept a motion. >> i move the report. >> second. >> properly moved and seconded that we accept the report as presented. are there any board comments?

is there any public comment? hearing and seeing no public comment, we're now ready to vote. all in favour signify by saying "aye." >> aye. >> all those opposed? motion carries unanimously. thank you. i'll now turn it back over to our president. >> all right. item number 18, please. >> clerk: item 18 is reports and updates from contracted health plan representatives. >> do we have anything from our health plan representatives? any reports? any comments? seeing none, all right. any public comment on this item? all right. item number 19, please. >> clerk: item 19, the opportunity for public to comment on matters within the board's jurisdiction. >> all right. this is your opportunity, last opportunity for public comment.

you can comment on anything on the agenda. >> during the finance and budget committee, i missed to thank pamela and her team for a job well done doing the budget and all the work you've done. i relay that thank you to you and your team. thank you. >> thank you. all right. any other public comment or comment on this. >> clerk: item 20, the opportunity to place items within the board's jurisdiction on future agendas. >> okay. anybody have anything? seeing none, public comment on this item? all right. we are on to number 21, which is adjournment. >> i move that we adjourn.

>> second? all those in favor?

>> the meeting will come to order, welcome to the february 13th meeting of the neighborhood and services committee. our clerk is john carroll and i want to thank matt ignao and