>> president follansbee: this is house services board meeting for the public awareness follansbee was connected and is having technical issues and call the meeting to order. we will await his arrival. madam secretary, please call roll. [roll call]

>> vice president canning, you have a quorum. >> vice president canning: pleas e call the next item on the agenda. my apologies, given the fact that we are virtual, if you would please review the details for the public's awareness for participating in our virtual meeting. >> due to covid-19 health emergency and to protect our board members city employees and the public, the board of supervisors legislative chamber and community room are closed. however members will be participating in the meeting remotely. this precaution is taken

prestudent to the local state and federal orders. community members will attend the meeting through video conference and participate in the meeting. we have a few courtesy reminders. you can see on the screen now. all public comment will be three minutes in length unless the board or the chair of the board deems new public comment time limits during the board meeting. it is your right to address the commission about agenda items on the public section of the meeting. public comments are to be made concerning the agenda item that just has been presented. my public comment made by a member of the public that is outside the current agenda presentation will be asked to hold their comments for the appropriate agenda item called.

providing your name and other identifying information is optional. you can choose to remain anonymous. to review our public comment procedure, it will be veil on the agenda. both sfgov tv are streaming the meeting. each speaker will be allowed three minutes to speak. comments during the public comment video are via phone by dialing 408-418-9388. you will enter the meeting as an

attend attendee. you will hear a beep. stop and listen, wait for the public comment to be announced. when the president or myself call for public comment, dial star 3 to be added to the speaker line. you will hear, you have raised your hand to ask a question. please wait to speak until the host calls on you. callers will hear silence when waiting for your turn to speak. be sure to be in a quiet location before you speak. mute the sound of your equipment including television, computers or radios it is especially important that you mute your computer if you're watching via web link. please speak slowly and clearly. when the system message says

your line has been unmuted, this is your time to speak. when the commission secretary, myself, states welcome caller, you are encouraged to state your name clearly. as soon as you speak, you have three minutes to provide the comment. once your three minutes expired you will be moved out of the speaker line and back as a participant. you will hear your line has been muted. participants who wish to speak on the other public comments can stay on the meeting line and listen for public comment opportunity. vice president canning, we can now move on. >> vice president canning: pleas e call the next item on the agenda. >> agenda number three. [agenda item read]. >> vice president canning: thank you so much. fellow commissioners, the meeting and minutes for june 11,

2020 meeting was distributed. are there any modifications any commissioner wishes to make to the june 11, 2020 meeting minutes? >> commissioner scott: i move that the minutes be approved as distributed. >> commissioner breslin: second. >> vice president canning: there 's a motion that has been properly seconded. we will go ahead and vote on the item all in favor please say aye. >> mr. president. there needs to be an opportunity for public comment. >> vice president canning: thank you very much. there has been a motion that has been seconded. is there any public comment on the item?

>> general reminder, the opportunity to speak is now by dialing 408-418-9388. before we begin the public comment, let wait about 30 seconds for a pause to allow those callers to start dialing in.

waiting for the moderator. >> no callers in the queue at this time. >> thank you. seeing there's no public comment, vice president canning, public comment is closed. >> vice president canning: thank you so much.

motion has been seconded. i'll entertain a vote. >> aye. >> vice president canning: it's unanimous. please call the next item on the agenda. >> [agenda item read] >> that might be dr. follansbee calling in. >> vice president canning if we can pause for a second.

>> can i confirm the call in number that's on the invite? >> yes. >> 408-418-9388. >> he lost his internet.

>> vice president canning, shall we move on to item 4? >> vice president canning: yes, please. [agenda item read] >> thank you for being patient while we're waiting for callers to call in.

any callers at this moment? >> there are no callers in the queue at this time. >> thank you. vice president canning, hearing no callers, public comment is now closed. >> vice president canning: thank you so much. may we pause momentarily to get a status check on president follansbee. next couple of items deal with matters most appropriate for him to handle if he's available.

>> i have given him the numbers. i confirmed it. he's trying to dial in. i'll check in with him and let you know what i hear. >> vice president canning: while we're doing that, may i also just check mr. city attorney, if it's appropriate continue to have issues with president follansbee connecting if we items of the agenda out of order? particularly moving item 7, director's report to be handled next. is that something that requires a motion or commission vote. can we modify those agenda items

that are not actionable without a vote of the commission? >> commissioner scott is the muted. >> commissioner scott, can you hear us now?

>> commissioner scott: presiding officer, you can take items out of order if so choose. calling for the director's report at this time will be appropriate unless there's an objection by a member of the board. >> vice president canning: i understand the technical difficulty. thank you commissioner scott for your help. with that in mind, we're continuing to wait for president follansbee to connect. i would propose that we take item 7 off on the agenda, which is executive director yant's report. unless there's any objection by my fellow commissioners. thank you so much. if we may note for the record, i see commissioner zvanksi has joined us. if we can note that for the record please.

please call item 7 on the agenda madam secretary. [agenda item read] >> good afternoon commissioners, i will tell on a technical level, president follansbee is on his way over. we will connect in person. i will be walking out front to answer the door.

>> vice president canning: it will cause more confusion if it's appropriate to call a brief recess while we reconvene. probably be the most appropriate. i don't know if there's a way to maneuver the screen. >> i can start now. >> vice president canning: very good. >> i'm going to share my screen.

are you seeing my screen now? >> yes, we can see the screen. >> thank you very much. i wanted to talk about the director's report that's in the packet for everyone and it's posted online. obviously we are in virtual environment, which is far from perfect. our staff continues to be really remarkable in adjusting to this world. i want to remind the commissioners and the public at large that we're all in this together and our staff has been

really remarkable in learning how to work online in a virtual environment. it is working. also, the next item on the director's report, reiterate what we talked about numerous times over the last two years, competitive bid or the r.f.p.s. we are in the final days of preparing this bid to go public in september. as a reminder, this is a competitive bid as medical plan for the active employees and early retirees. the goal of the r.f.p. is really to support the strategic goals that have been in our strategic

plan. that's a heavy lift for the department to conduct an r.f.p. hats off to our contract manager who's leading us through the many myriads doing competitive bids in a public environment. we have many rules to abide by in order to do this properly. he's keeping up from project management, on target as well as adequately informed about the process and how we must abide by it. in relation to that as a reminder to the board, there's a blackout period that continues. the notice is in the packet on page 41 of the director's report

as a reminder. many of you aware that racial equity planning is under way through the office of racial equity, we to respond to requirements they have issued that were aligned with our budget submission. our budget submission to the board of supervisors today did include comments about our alignment of our budget with the racial equity initiatives that are mandated through the office of racial equity. we do have an internal advisory committee has than really looking at how we want to approach -- i'm going to pause. i hope that's director follansbee at the door. you can mute me please. thank you.

okay, here we are. thank you. welcome president follansbee. >> president follansbee: my internet went down. >> i was going through the director's report and speaking to the racial equity thing we've been doing. we've done a good staff assessment of people's knowledge around racial equity issues to determine what our occasional plan needs to be going forward. we've initiated that staff bidding to begin this

conversation around race. we are putting together a more in-depth and longer plan for addressing the educational need. at the same time, we're considering what structural things initiatives we can undertake to improve or reduce structural racism that we maybe contributing to in our construct. more to come on that. it's very deep and difficult work and very important -- our staff is very engaged. which is terrific. commissioner scott was able to speak with our staff earlier this week. i don't know if you wanted to add any comments at this time commissioner scott? >> commissioner scott: just briefly, i did have an opportunity to visit with abbie

and members of her staff regarding this initiative. it seems as if we are in a leading position based on the work that has been done to date. while this first -- what i understand to be the first phase is more of an internal look at this issue and how we are trying to meet this from a policy standpoint and staffing and that sort of thing, within our staff and the department that certainly as we look at other aspects of this, i call it the phase two step once this is done, all of the issues that we've been looking at as a board under the social determinants of health. should come in play as we deal with our health plan partners as we go through the r.f.p. process and so forth.

i think that we are very well positioned to begin to address this issue in an ongoing way as we've been doing thus far through some of our reviews and educational forums around social determinants of health and longer term strategy that we've laid out. >> thank you for taking the time to talk with our staff. very dedicated to work on this issue. we're looking at the construct of that working group and how we can appropriately involve others over time. i want to move into the operational report. we did have an additional retirement, elizabeth salazar retired after working in hhs for a number of years.

she will be sorely missed. we are in the process of replacing her and that announcement should be coming shortly. we have several other positions open that we are aggressively recruiting for. the operations manager board member services is a key position that we struggled with finding qualified candidates for this position. we are in the process of engaging our recruiting firm to help us find qualified candidates. we have several senior benefit analysts that we're recruiting for. as you know, we continue to work in a virtual environment. i'm going highlight some more things as we go forward.

the finance report, i will highlight as we go forward. there are a number of initiatives that have had great impacts on our ability to serve our members in this virtual environment. we've also been able to bring online enrollment to new employees and to employees that have life qualifying events throughout the year. that's been a big leap for us to go forward in that way and to be able to have that accomplished with our partner agencies in san francisco. it's been really great. we are rolling out new electronic health records software for our staff who is

very busy as well as looking at some additional resources for mental health through a company called credible mind. i will scroll through this quickly, i want to highlight this particular slide where we looked at the uptick of the loading of software for public safety. i want to point out that in these departments on the left hand side of the slide you can see the size of the department, the size of the towers as you go across the page, they are all -- we're a little bit comparing apples and oranges here. the police department has the highest uptick because they have the highest number of folks. all in all, we're very pleased

with the fact that enterprise distribution of this application or individuals have uploaded it. we know it's out there. we're now in the stage of figuring out what the cadence is for encouraging interaction with the app. end game here is that folks that may be on a trajectory to requiring mental health services have ready access to those services through an application that they're familiar with. that's been a great effort on the part of our workforce and our partnership with all four public safety departments. well being has really done a great job of adapting from primarily on site kind of services that they've provided to doing a lot more virtually

and supporting new enterprise in the city which is the covid command center. our city converted from all emergency operation center model to a very specific command center. we all realize that this pandemic is going to be with us for some time. they needed to put a structure in place. it's still highly dependent on city workers to staff it. our staff continues to contribute to the staffing needs of the covid command center. we're all required to be available for such enterprises in this one being so big and so long-term, it's really taxing. but it's working for now. well-being at work just continue to adapt and look at different ways and department continue to

contribute best practices in this environment and trying to figure out how we reach each other to do healthy behaviors where the stress is being in this environment is mounting. we need to continue to support the workforce and continue to go through these various stages of the pandemic. i included in the director's report, some detailed information to questions that were raised about the dental benefit and some of the procedural issues that dr. follansbee brought up. he adequately addressed those clinical questions.

there were questions raised about the ppe. it's our understanding in-network providers are not passing on the cost of ppe to the member, rather they are reimbursed by the carrier. for folks who are out of network, there's -- charging range from $10 to $25 per visit for that ppe. we also had discussed several months ago -- heads up on this concern. i think it was in england where there was some concerns about some of the products that have

been contaminated with other substance. apparently this has hit some of the u.s. market as well. all of our carriers have been very diligent in identifying their memberses that are on any of these drugs and being certain they have adequate notice to transition off those drugs. that's what our members have been advised of. we have counts on the members that are included in this. they are very small. i think each carrier only identified like three to five individuals. they're in pretty good shape as it comes to addressing this

particular move. the financial report is included in the packet. we do continue to see the trust fund balance increasing at this point. it is up to $112 million. which is on the high end for a trust fund. there are details in the report as to what is contributing to that. we did see some utilization decrease. therefore, the number of claims that came in april and may. we are seeing -- everything is indicating utilization is coming

up again. we don't know what the new normal will be. we are watching this very carefully. >> vice president canning: uhc on the slide said projected increase, that's confusing to me. usual in favorable, we see decrease. is it increase due to favorable increase because of utilization? is it decrease due to favorable claims? [indiscernible] >> pamela or larry, you want to address that? i'll go ahead. we had this discussion earlier.

>> we have two different situations. with u.h.c., we have -- can you go to that page?

actually, this is stated wrong. essentially, we have increased -- we have favorable claims experiments -- it means that we don't have as many claims and they are not as great as we set and expect when we did the rates. there is an increase. that is over the decrease if fund balance. you are correct, that should say an increase in fund balance. >> thank you. is that favorable? >> yes. some of it is the rate and some of the experience. lot of that is due to the

pharmacy rebate that we get at the end of the year. that's why we, at this point, are projecting $1 million. as director yant explained, we report on a fiscal year basis about the fund balance because that is what we're audited at. however, when we -- if we end the year at $111 million fund balance, i really think that as we go through the next month, people -- we're seeing people starting to go back and claim starting to occur. i think that that fund balance will be decreased in another six months or something.

there was a question on blue shield. remember several years ago, i believe it was 2014, we had very high losses in the blue shield plan. the stabilization reserve was at a negative balance. in order to get that stabilization reserve propped up because of the losses, we have been increasing rates a tiny bit each year to make up for those losses. it was a buy-up as opposed to a

buy-down. with blue shield, we have an increase in the revenues because we're getting more revenue because the rates are higher than we would have had otherwise. plus we had a large amount, 1.9 in pharmacy rebates. when we have unfavorable claim experience, that means the claims are really high. we had a lot of claims in the last couple of months for trio -- actually we had a big problem at the beginning of the year. it's still is a problem. that uses fund balance.

you have to spend more. that shows it is a decrease because the decrease -- using of the fund balance is greater than what we're adding to the fund balance. i know this is very strange and there's a big difference between u.h.c. and blue shield where we were in the hole in stabilization reserve. we're going to try to rewrite this report so it's a little clear. this will be more easily understood from non-financial basis. >> that helps. thank you. >> i apologize for the

confusion. >> i think that concludes my director's report. additional information is in the report about the many pieces of legislation that are out there. there's one issue that i know commissioner zvanksi brought to my attention on the balance building issue. i believe we talked about this at prior board meeting. i couldn't find anything that articulated what the impact or may not have been with our membership. larry has assisted in writing this. larry can you comen and say hello to folks?

i like to introduce you formally to the commission. >> sure. thank you, good afternoon commissioners. thank you director yant. nice to meet everyone. >> welcome. i do think he did a great job of explaining the balance billing matters that are still unresolved at a federal level certainly for our membership, it is not an issue that has come up too often. at least we will look back several times to see if any of this is going on. it only affects the p.p.o. plan

to get their emergency bills paid and things like that. if there's any questions, we can take those now as well. >> commissioner scott: director yant, i don't have a question on the balance billing, i have a question on the r.f.p. i wanted to raise my hand earlier, but you rolled right past it. i apologize. >> president follansbee: let me speak here. thank you vice president canning for stepping in when i went off the internet. i couldn't call in and i got disconnect. -- disconnected. we don't have the hand raising

sign. the board members would have to speak up. >> commissioner scott: this is randy scott. >> president follansbee: we have that. i'm sitting next to director yant in her home in order to attend the meeting. please go ahead with your question again about the r.f.p. >> commissioner scott: thank you. i wanted to just clarify and affirm regarding the scope of this r.f.p. that this is for active and early retirees only and we will not be adding to it. retiree plans at this point in time. is that correct? >> that is correct. >> commissioner scott: that might be the next phase of an r.f.p. process? >> yes. what we talked about is doing

some education and deeper dive into the medicare world. there's a lot of concern about what may happen with the election in november. i have been -- it's a heavy lift to do this medical plan. we haven't done one in some time. the regulations have gotten quite extensive as to the contracting process. we're undertaking that now. we'll learn a lot. should we then dive into the medicare products that we have available for our members to determine that we want to look at those in a different way or have a bidding process, then we will be better prepared to do that since we done a thorough job this time.

we have the bandwidth to do it. one of the things that i think -- one of the terms that i've learned in this job is disruption. any change in the medical plans will be a huge disruption to some segment of our population. for member services to manage that is really prudent that we segment that population as much as reasonably possible. otherwise it won't serve the greater good to have planned disruption for the entire population. it does make sense to go about doing it in a logical order. >> commissioner scott: thank you very much for that clarificati clarification. >> president follansbee: i will call on commissioner breslin and commissioner zvanksi after commissioner breslin.

>> commissioner breslin: my question, when will the board see the draft of the r.f.p.? i have a quite few other concerns about the r.f.p. also. what i see is that we really need competition. the cost for the early retirees with dependents is becoming unaffordable. $16,000 a year. that's a lot. especially for early retirees which i'm sure there are going to be a lot more of those. therefore, this could be a large percentage of their income. unless we have some competition for blue shield -- [indiscernible] we need another h.m.o. in addition to them. we should have two h.m.o.s,

beside kaiser. $16,000, that's a huge amount. i'm also concerned about this being a level playing field. blue shield has had a very horrible backing in the past. mayor office interfered and blue shield got the job. i noticed governor newsom is using blue shield for his task force, covid-19. it is important that we try to get a level playing field. i don't know how that's going to happen. in the long run, our members lose and basically the city does too. you're paying more than you should be paying. but the lack of choice -- i hear members ask for it all the time. that is a big concern of mine.

i don't know who's involved on the negotiating team when this comes up and how that actually works. there was a time when the board members actually were involved in these negotiations. not to say i think that's a good deal or not. also, prior to 2017, we did not separate our members. the city plan at that time was doing quite well. there was about 5000 or 6000 medicare members in that plan. [please stand by]

>> we have a subject matter at

hand and the vers -- >> why are you not able to see the draft? i'm not clear on that? >> it's because it's not seen by the public or any of the -- the board doesn't review our rfps and it's my understanding that that's not our practice. >> could t it could change. >> this is the general and the communications policy make it clear and it's on paragraph 26 on page 7. it says the board recognizes it's not effective nor efficient to be involved in the and the

board will approve the awarding of final contracts for the following primary service including the health insurance carriers. those are the governance policies the board adopted. the board adopted those policies after consulting with an expert and you hired experts to -- you rely on expert all the negotiating contracts and doing everything that hss does and whn you make decisions about healthcare policies and you always relied on your expert to develop these governance policies and so, consistent with that and hhs' best practice,

since i've been your general council since 2005, the hss has developed these rfps and you ask on the panel in the past, commissioners have participated in the panel and that deper and to have a commissioner participate on the panel but based on the governance policies at this board adopted nns just moved proved with drafting the rfp and. >> i know part of the rules and i read them many times and we're not involved in this selection but i didn't see any reason in that those rules that you

couldn't be involved? looking at the draft involved in approving it so i'm just, you know, i just am not sure it's reason enough we won't see the draft. you are the lawyer so -- >> i'm not saying, i'm just saying that my understanding of that fast practice is the hss has gone a lot and i see clear shaking her head and i'm not going to -- it may be, i don't know, clear. >> why don't you go a mead. >> not to divide and anyway, i think the policy change during bart done can's director ship and some of those were cranky

about that because we sat as a full board and reviewed all of the -- and blue shield was not allowed to offer retiree benefits. they wanted out of the medicare business but prior to that every vendor we have whether it was foundation and blue shield, whether it was regardless of who it was, they all had to offer retiree benefits and most of the

building problems came from (inaudible) people and i think mitchell is aware of that. that's my comments, thank you. >> i apologize for that new title. so, i think what i would like to do is maybe, since commissioner scott is the chair of governance and has a commissioner scott looks at this with his committee and discuss this further and and back with decisions with ways to rectify this and commissioner scott or someone to sit in on the deliberations or something and there are several options and this is not the forum to us go over the history completely

and to change what is currently our policy so, if i can go to the chair of that committee it will be the next step. >> for the covid test, can our members go to their health provide and he is request a test and have it done? >> can we come back to that we're doing a presentation on that. i just wanted to add the time constraint we're under. we have to get this done quickly and we are issuing this rfp in september before the next board meeting in order to meet the time lines that are followed at.

>> >> to the other point that was just made and i would be happy -- when you have voted on the governance committees and mr. president, i'll be happy to take up this question and with the committee and we have to call a quick meeting. i would be happy to do that in a very short order. >> thank you, very much. >> the calprs rates went down, including blue shield.

>> what was that? >> my understanding -- >> it's not in the appropriate context of this discussion. so if we can move on to any other questions or comments from the board regarding the director's report. >> i also want to make a comment about on item number 9, health plan representatives and. >> yeah, well, unless it has to do with the topic that was presented in the report. can you defer that until the plan representative?

>> >> number nine? >> yes. >> yes. >> i will have that and is delta dental present today? >> a representative? >> we'll have to check and see. >> ok. >> yes. >> so, yes. i'm on the call virtual meeting. >> great, thank you, very much. expect to be called upon on item number 9. >> ok. >> great, thank you. >> sorry there any other comments or questions for the director? >> >> thank you, very much. since i came in late, i'm not sure -- do we go back now to we've gone through items 1-4 and we're on item number 5, is that correct? >> yeah, president fond and this is commissioner and that's right

we have skipped items we'll proceed outside item number four and i'm sorry, number five. i circulated essentially a list of. >> mr. president, just for continuity and i would ask you called the board secretary to call the item and title so that it's clear in our virtual environment. >> h. >> it's a good suggestion. i'll call upon the board secretary at this point. >> >> thank you, president. and just to check, is my volume coming in better than before? >> go louder. >> louder is working better?

>> it's still low. i'm going to read this item low and i will work on it. we are on agenda item number 5. president's report. discussion item. >> thank you, very much. thank you for the item. so number one, i want to welcome larry lou and holly lopez to the health service system and we are interacting in the last few days and weeks and it's been weeks d partnership for all of us. it deals with the issue that has already come up several times and it makes it a little bit the further asking on the pandemic and that is to remind the board and reminder the members we take both medical care very seriously, even during times of pandemic. and the links link top cancer

prevention, dental care, pediatrics, including vaccination schedules and some other issues that we urge our members to not interrupts as much as possible and their own preventative health care strategies with their def providers and i reinforce the issue about pediatric vaccinations, et cetera. and this is i would like to make sure that our members check on the sf.gov website which has extensive recommendations for interventions with the health-care system including an extensive session on testing options both for individuals who work within the city but also those who reside in the steed and hour health service members as well. there are suggestion and guidelines and comments there and they're updated frequently

to help members navigate the confusion over the testing options. this is a moving target i would say. and i would say only from my own experience that for example, some of the commercial lay outs i've had fema essentially take back testing equipment to redistribute to other sections of the country and so please, be patient with your healthcare providers in the systems and as they're trying to do the best they can to meet the demand for testing. i will just point out that as we go through this statistics, a lot of the testing numbers are not based on unique individuals or unique medical record numbers and some people are getting tested out of anxiety and concern multiple times. so it's probably a good idea for all of us, including our members, to evaluate why they're being tested at this point so we

don't overload the system with the worried well when there are people who are desperately in need of testing because of the exposures, the first responders in this group at the top that are critical to our health and safety. just point that out and please, look at the links and please, look at sf.gov website for further discussion on that. and that concludes my president's report. so open it up, i guess, to public comment. >> we can't hear you. >> much better? >> yeah. >> thank you.

we are going to have a 30 second delay to have callers join the line. >> the opportunity to speak on public comment is available at

408-48-9388. and entering your access code 146-139-5983. >> no callers have entered the queue at this time. >> if there's no one in the queue so that ends the discussion on this item. >> can i have you call. >> clerk: governance committee for fiscal year 2020-2021. this is an action item. >> so a little bit confusing. this is a list of the discussion items in the agenda but an action on the slide.

how many have been distributed to the you are all willing to join these committees. i think that this is an action item but everyone has agreed the assignments and chairs as listed. can you post that -- thank you. >> >> is there any discussion from the board members? >> i would like to offer suggestions that we accept the recommendations that have been made as proposed. >> second. >> moved and seconds.

we'll open it up for public comment. open it up for public comment, holly. go ahead and open it up for public comment. >> there are no callers. >> we've changed the protocol can i have the board secretary

please read the motion as it's been seconded. holly, would you please read the motion. >> clerk: the motion is -- >> i'm going to need help. be be to accept the board president assignments to the finance budget committee and the government's committee. >> thank you, very much. all in favor say aye. >> aye. any opposition? it carries unanimously, thank you, very much. >> item number 8. >> yes. thank you. agenda item number 8, covid-19 general updates.

discussion items. >> anne thompson presenting. >> that's great. >> let me just pull up the presentation. again, this is anne thompson and i will be joined my my colleague on a couple of these slides as well. when we get to that point. >> it was revised yesterday as the president mentioned earlier. this is a moving target on data a count as more information comes in and so we did our best to try to update with information as of yesterday. that is the -- on the table of

contents. i don't have my camera on either. we'll take a look at some national and california data, some sfhsf specific data, we have updates from the health plan and we have some comments on testing to get to commissioner's question as well as the current status of any benefit change and related to covid-19 and at the end we have a couple of slides on emotional support resources and some links to some very important services

for those out there who are looking for some help. looking at this first slide, in the united states and we'll start off large and bring it down so as of 8/12, there's 163,651 deaths in the u.s. due to covid-19 and you can see in this snapshot, this is the confirmed cases by 100,000 in population and the darker the color, the higher the amount. you can see over in california, i don't know if you can see my cursor, here, and the darker colors that means you are over 35.82 per 100,000 population and it's the higher level of confirmed cases.

>> new cases have hit a second peak of hospitalizations and if you expanded these two charts out further to the left, you would see a prior kind of increase before and a dip and an increase again. for california, you can see some good information here. you can see that there are, as of 8/11, there were 597,056 cases of covid-19 with 10,648 deaths. you can see how many were in the icu, almost 2,000 and there was no data for the few items in the middle currently and as mentioned rapidly moving target

as well. and in terms of, again, this is a california view, what this slide is showing you in the darker the later blue and in the gray numbers are the total patient count and across the bottom you can see the timeline and you can see when different things occurred in terms of california guidance and shelter in place march 17th when it started and what happened since then with july 17th on the california watch list. the yellow stars indicate bay-area specific, san francisco county actions that happen in terms of opening during this

different stages and what initially happened there was that decline as things close and that as things are opening up we can see things going back up again. this is at the bay area snapshot looking at the counties here. these are confirmed population cases per 100,000 in population and similar to that u.s. map we looked at earlier, this is the bay area specifically and you are all in darker marine color indicating you are at the higher level of cases. with some data we received from san francisco, on cases reported, deaths, good information here on again da

distribution and as well as test collected, this is through august 9th this data and down below, we have on the left a seven-day test of 3,122 and this was as of july 30th and this is meeting a target for the different target levels that were identified for average new cases per day per 100,000 residents worth 10.6 which is putting us in the level four high alert. so more information to come as we track this data. this is what executive director yant referred to so this is available through the city and we received data as of june 20th. it had done 5,389 tests for city employees and they broke that down by carrier here h just for

your reference. because each carrier collects the data in slightly different ways, we did our best to align the information across the table here and we will dive in a little bit more specifically into each of the carriers on the next few slides so you can see, for example, the cases are the top sections and the test results are the bottom and you can see the testing 1,201 for blue shield and kaiser 7533 and i think earlier it was mentioned many of those tests are not unique to people. this could be the same person getting multiple tests and they would be here multiple times.

so for march 1 through june 30th, blue shield has paid out $198,000 in claims and over 1,873 claims encloud tests and hospitalizations and you can see how that line has increased overtime as it has been cumulative. for cares kaiser, this is all re and we can see how many members were hospitalize and how many members were in the icu so currently we have six members and hospitalized and none of which are currently in icu. for united healthcare non medicare, they paid $20,000 in claims for testing and $167,000 in claims for treatment.

they provided a breakdown by three age grouping so you can see where the counts are and the majority in this rather large be it category of (inaudible). or medicare data as of july 19th, you can see the demographics of individuals with covid-19 related services and for covid related services, we're including testing and treatment and so i can h you can see it in the blue slight and the dark blue the population so we can see in this 7 75 or older group, higher -- i'm sorry, aiding above and lower member

count but higher claims and that could be expected. and on the right, we have the accumulate individualaccumulatef we can go over this that would be great. >> i'm going to talk about the claims suppression and impacts and noting the earlier discussion during the director's report i have more information to share about what we've observed.

>> you are not muted but we cannot hear you. >> maybe i can hop in his place if he joins that would be wonderful so go easy on me and as shelte shelter in place, we e lower levels of claim activities. this is referred to as claims depression and there's several factors that are causing the claims suppression as noted including but not limited to healthcare practitioners having temporary close your and deferral of elective procedures and certain care avoided and sports injuries and happening

and provider practices are opening up it's still other early to tell how much this will impact the health plans as we see claims come in for the second half we'll learn more. on this side, i'll just try to orient you here. each is for each carrier so kaiser, versus blue shield versus uhc, dentsal and vision and the medical and the pharmacy is separated out for the medicae shield. united healthcare numbers are combined. this is looking at the percentage of typical claims that we would receive each month so for january and february,

before the shut down coined of,l claims were rolling in as expected and services were happening as expected. what we see happening as the march close your came in march 17th, we can see pretty good decline in those services and leveling off there for a couple of months and as things open back up, we can see the increases here into june and this is data through june so this is trying to represent what is happening in terms of claims suppression of what we typically versus what we see so 100% would be what we typically see. >> if i can just jump in here. this is very instructive and validated that we look at kaiser hmo province x it's anxiety in the member of our members that their medications will be

interrupted so an increase request for 100 days surprise, et cetera. and as we stock up on durable goods and things like that through other sources. people are interrupting their case and it may have adverse impact on claims as well so this is a good snapshot and i believe them but they're hard to interpret for the future without essentially encouraging our members to continue to try to get their routine care and follow-up care for established diagnosis as much as they can. >> can you hear me now. >> yes,.

>> ok. paul from technical issue. yes, so we're anticipating -- our estimate has been half of deferred care during this period may return in the second half of the year and july data is extracting and how things look for the second half of the year. what this gravel straits mos grt of all are plans that have lower risk populations. think about risk correlation for the risk report and for instance, it's not surprising to see kaiser medical suppression happen more quickly and that goal line into april and may and compare that to the united healthcare program where we

experience some suppression more in the may timeframe but we saw increases in june and it was related to host cost plans and great observation on the pharmacy. you will see that there was to exceed lip tal levels and where you see the deepest valley is the dental and vision plans for this time period but we're starting to see some escalation but far from return to 100% expected levels. >> so looking at the next slide, we put together a summary of health plan benefit information and this is as of august 10th, 2020.

where some of the copays are waved for certain telemedicine visits and some relate to covid-19 and tele behavioral health co pays waved or not and you can see all the details here. at the bottom, because it says dynamic we included links to each of the carrier's website and it's a great place to find some of the most up-to-date information on the benefit components. the screenings are provided and there are several methods of it

if it's a good candidate for testing and going to your urgent care center and the best way is for members to call their primary care provider or physician group to help find a testing center to go receive tests. or kaiser, they've internalized nearly all of their testing. they have built a new lab to accommodate these tests. they are using testing equipment in regions for multiple vendors to troy to keep the flow moving very quickly and to get the testing out and they're monitoring the testing criteria and volumes to prioritize patients with the greatest need. if you feel you need a test they're recommending that you call the appointment and advice call center and you will be screened -- go through a specific screening protocol to assess the need and then direct it to a test site.

there's some information here at the bottom with the link for more information. and related to kaiser, as well, while they have many tests for members, there's a shortage nation wide and so to increase testing access, members can get tested outside of a kaiser permanente provider facility and submit the claim for reimbursement. there are requirements here noted at the bottom to be eligible to submit the claim and so you can -- i wouldn't read these to you you can see them here and there's a link to learn more. this is for medicare and non medicare members, they are looking to expand access to care, support and resources during this time and they have a test location and only the

earlier slide so you can go on there. >> i'm talk through these and take a pause and if he wants to add anything to this. so, the city health plans will provide priority testing for first responders and health care workers insured with the three carriers under sfhss and if you are displaying symptoms, you will be prio prioritized for te. so if you are experiencing symptoms and you are a kaiser member all the advice member and if you are blue shield or united healthcare, call your primary care physician. self-identify as a city and

county of san francisco first responders and healthcare worke and explain your system and if testing is necessary that will be determined by the provider and they will district you to any testing facility. >> additional resources and this is also on the sf website and the covid-19 page and it's great resources her and triages are available here and there's a local 800 numbering and theand e and fire are available to assist with their employees. >> the services are overwhelmed and they are asking for assistance in helping stick to

the priorities they've identified from a public-health perspective and they're clearly stated here for city employees and most of us should be getting, should we be symptomatic should get our tests through our provider and they are the ones that will care for us so it's really important that we retain that relationship with our provider and city tests is a stand up operation and orders for -- it's a assumed if you qualify for a city test that you have an order from a public-health officer. they're not your physician record, however. so, just keep that in mind. we also have come to realize there are folks who are using the city test sf to do tests that may not be the most pro pro at so we encourage people to be wise about the use of this very pre anxious public resource permission testing to see if you

are ok to go visit someone. it's really not helpful and the verse is true if you've gone on a trip and it's important the tests are taking care of people who have been sick, symptomatic or had some kind of an ex pose you're and many of our city workers are fellow members and they do have exposure risk in their everyday line of duty so we ask that we reserve this test for them and then public-health and well they have had more impact. so that is -- >> if i can just reiterate this.

there are a couple of really important progress. one there's the drop-in testing. i think this is part of a dialogue with the public-health system or your providers or both to figure out, a, if it's appropriately tested and b where to get tested. there were a number of tests given emergency approval by the food and drug administration. many have not stood the test of time and so, it's important for the provider to have some accountability for where the test is performed and so there are mixed results and a negative this morning and a positive this afternoon or voice verse a and one can begin to track. we need to alert our members to they're getting unsolicited phone calls from people saying i'm calling to tell you that you have been exposed to covid. i can't tell you who because

that would be a violation of can if den shality but wconfidentiao is provide a credit card to see where this is going. please, don't responded to unsolicit it and saying that you have been exposed and need to be tested. this can contact tracing, at this point, is in difficult strength and every community, including san francisco is under a lot of constraints over personnel and just the numbers of people. if you are contacted, then you need to identify who the person is who is contacting you and to decided further course of action. it may not be able to tell you who but they should geoff you credential and appropriate

follow-up but no credit card, please, or other financial release in the process. >> be aware there are scams out there. >> this is scott on this point. also,. >> that would be part of that same function. >> that's a good point. >> thank you for that. you covered my slide and as well 25 and it's that reminder of taking covid tests to be

specific and for the population. the personal protective equipment so there was a question about when dental providers can charge for ppe and they put together this chart as executive director yant mentioned earlier for non network providers under the delta dental active or retiree ppe plan, those providers may charge you for ppe. wore hearing it's $10 to $25 and that is payable by the member. if you go in that work to a ppo or premiere provider they may not charge you. same for delta dental care and the hmo in network only plans and those providers may not charge. just awe couple slides i'll go

over these quickly and employee systems programs are and great program and additional information on the sfhs website and a link here. there are some great well-being resources outlined as well and again on the sfhs.org website and by information there, we put together a couple slides with some phone numbers so we have the eap here on the left and some national resources as well for substance use and domestic violence, suicide prevention, national parent hotline, sexual assault hotline, center for victims of crimes, and safe call now which is for public safety and police. and this deck is on the website with all these phone numbers. we can't stop talking about covid without talking about masks. just a little graphic about

masks and how airborn transmission happens without a mask. and that is my presentation today. >> thank you, very much. i would like to open up to questions from the board members. >> i' i'll make a couple commen. there was a study published by investigators at duke university showing that all masks are not created equal and so i was in the hab e habit of using the nee or and it kept any neck warm in our cold san francisco environment on the great highway but it does not work and as a matter of fact, it may enhance droplets transmission so,

please, resource your mask. masks that have vents in them, they seem like a good idea, but you will see some places of business that will not let you in if your mask has a vent because they're not effective. not all masks are created equal. the other comment is there an end in sight to this? and the question i probably get almost more frequently than anything else, is when will the vaccine be available? just point out, this morning there was a nice summary in "the washington post" if you have access to that, there are 200 vaccines in development and most of them are what we call pre clinical and they have not gone to human beings and there are only throw or four in phase 3

clinical trials. there's at least one and the bay area and by understanding is it's opened up to people under the age of 85 which i think is a plus and they will be prioritized along people with chronic medical conditions and this placebo control so people won't know when they get the real vaccine but these are steps in the right direction and if you have friends living in russia you try to access a russian vaccine on your own at this point and it appears from the lack of information, it's been disseminated there are no phase 3 trials and the fact that putin's daughter may or may not have taken the real vaccine is not reassuring to me at this point. this is an area that i have great interest and we'll meet to follow but at this point for all t. i guess it's back to my point about accessing medical care and

routine follow up and there is no end in sight for us and we cannot say that by september 15, or december 1st or january 1st that things will be improved so we need to find our own rhythm, which includes our healthcare. is healthcare maintenance and dental care and vaccinations for your children and grandchildren and that kind of summarizes my own sort of position on all of this at the present time. if there are no comments from the board we can open it up to public comment.

>> anne was saying some of these items are on the sec sight which website do you mean? >> >> hopefully you can hear me. on the website. this presentation that i just walked us through is under the board calender and many of those web sites were taken from the either eap sub sight or from the well-being sub sight we will. >> thank you i just wanted to clarify because we'll reccsf i'll make sure that the e-mail is sent out to members so they know where to get the additional information. thank you, very much. >> i've been informed by our

moderator that there are no callers in the cue and seeing there are no callers, we can end public comment. >> i couldn't hear you again. >> am i coming louder now? >> i've been informed in the moderator there are no public callers for comments and so public comment is now closed. >> thank you, very much. this was a discussion item only and so we're able to move on to the next agenda item and it's been two hours and so we have at least with the board members several items of importance left and so if we can board's consent take a 10-minute recess and reconvene in 10 minutes, i'm not sure the time exactly so at

3:06. if i may make a request that we limit our break to five minutes if possible. >> >> any objections to a five-minute break? >> we'll reconvene at 3:01. thank >> commissioner karen breslin. >> here. >> [roll call]

>> we have a your um. >> next item, please. >> thank you, president. agenda item 9, reports and updates from contracted health representatives. it's a discussion item. >> this is debbie with kaiser can i go ahead. >> yes, we don't seem to have a list in front of us so please start with kaiser. >> ok, thank you. can you hear me ok? >> yes. >> great. so good afternoon, this is debbie with kaiser. we wanted to provide you with a few brief updates. the first one is good news related to the addition of the wheelchair gurney van for the transportation benefit. we did confirm that we will have the capability of adding this

enhancement as of september 1st, 2020 so ahead of schedule. we will be working with director yant and her team on the implementation and roll out of this addition. so that is good news. the next couple of updates are related to our work around contact tracing and our support to address systemic racism and kaiser has committed to grant funding to the public-health institute and and hired from within communities that have been disproportionately effected by covid-19 and such as the black and latino communities and will support the work of local public-health departments. it will help facilitate opening for businesses and schools.

additionally, kaiser is providing investments and grant funding to address the systemic racism and lack of economic opportunities that have per sited and prevented communities of color from achieving total health. as the next step towards supporting these communities, we will provide support to more than 2,000 businesses owned by plaque and under representative people across the country. we will designate additional grants to build upon or work to address adverse childhood evidence for aces and trauma to support efforts to end systemic racism. and finally, kaiser is also stepping up to our commitment to workplace inclusiveness and supplier diversity by committing to suppose sort women lgbtq plus

veteran, individuals of color and individuals with disability-owned enterprises so that's my update. >> thank you, very much. any questions from the board members representatives? >> this is randy scott, commissioner scott, i'd like to thank you, debbie, for following through on this particular issue regarding wheelchair accessibility on your vans. the fact you were able to get that done early on prior to renewal and so fourth, you are to be commended and i thank you for your responsiveness. >> thank you. we're just happy we're able to provide it ahead of schedule so thank you. >> >> other questions? >> >> thank you, very much. and i've seen you with the

questions we can move on and with the next. >> we have someone from united healthcare and delta vental available? >> >> they have been contacted and aware but if they're not speaking up right now, it's my understanding there's no updates. >> there was an update from delta dental. >> hi, yeah, i was just waiting to see if there was anyone else from the medical providers that would provide an update. and my apologies, i do not capture commissioner breslin's question regarding delta dental in the director's report when we were going over that content. >> i'm going to give it tomorrow. >> go ahead and ask a question.

>> right. ok, this is where i'm being the personal protective equipment and i saw your memo that you provided. you pay $10 for cdt? what does that mean. >> california dental terminology codes. >> so only certain saying you pay for is what you say? >> there are specific codes that we have identified that will be most relevant for individuals that are returning to seek preventative care and so we've listed out did 10 codes and the dentist will receive an extra $10. >> so due to the nature of this dental work, they have to take extra precautions and i don't think there's a choice here.

i realized the extra things that they had to do and they have not been getting the income because they haven't they have been seeing patients on an urgent basis and delta dental has received all the premiums, as far as i'm concerned, it's coming out of my check, and i don't see where your revenue has dropped there. yes, some of our members say they have and dropped in their income. for a single person this is not bad but someone with children you have to pay $25 a child for a business and it's costly and it seems that delta dental should step up and pay for what they consider a reasonable charge for this ppe equipment because this is costing the dental plans and you have been continuing to get your premiums as far as i can see and you

haven't had reduction in your care and as the dentist have so i think that is what you should do. of course you have would have to establish what's a reasonable charge for this. i wouldn't want to see our members not have care because they want to avoid this cost. >> do you want to respond to this? >> >> we have been in conversation with our delta and this profession of businesses has experienced and will be presenting the information to the board and at the next impact on on rates. we have time. >> what does it mean and.

>> do you want me to and sharon of dental california the account manager. we are providing our contracted dentist both the ppo and premiere dentist a $10 reimbursement. if you seek services and as a member to seek an out of network dentist, then that ppe cost is not covered. we have been providing for the delta care those providers are a basis so they've been receiving salary per se and during this time period so we pay our delta

care dentist because they're on a cap tated contract so they're not out any money actually. other than not being able to provide care during those two months where it was totally shut down and so that would be if they were providing a service that had a co pai copay attachet but under the environment there are many procedures that have no copay the delta care dentist have remained whole in their salary and income and then as abby alluded to, we do have a program for our dentists aside from the loan program that we've established. we've established $300 million in loans for our dentists and our contracted dentists ppo

premiere and they can apply for those with a no-interest loan and it's over a two-year period of time. we've had about 90,000 loan dollars put back into the dentist's hands to compensate for their lack of salary. >> there's such a small number of members in the hmos but i wasn't even thinking of that. >> there were 20,000 in the dhmo. >> just to be clear for everybody, if you are in the dhmo o.p.p. o programs there's no po kay requested or allowed from your delta dental provider and it's only if you are going out of network.

and again, if you are concerned about the finances of your dentist, you can discuss this with him or her but it's reassuring to know that the hmo dentist are getting the reimbursement because it's a contracted number based on the number of members who signed up with them and the ppe may be able to discuss with you further, you know, their own stresses but it's reassure to go know that our members should not be expected to pay the additional cost of these protective mechanisms which are pretty universally been applied to the american dental association come out with strong recommendations for the safe provision of dental care under these circumstances both to the staff and also to the dental patients so i thank you for your char indication on that. >> you are welcome. >> well the last i looked, our

members were in the the ppo plan. as i recall and we went over that before. >> if we want to discuss the dentist's financing if they're not in the ppo plan they should initiate that but it's noise to hear they have provided a zero interest loan to those providers and who are part of their preferred network. >> any comments for the den ta dental representatives and if not thank you very much. >> you are welcome. >> i believe there are no other plan representatives available for updates, is that the case? >> yes. i don't see any others waiting

to speak. >> can we open this up for public comment, please. >> yes, we'll give a 30 second pause for callers to get on the line. >> no callers have entered the cue at this time. >> >> thank you, very much. it's a discussion item that is closed and if we could move on to item number 10. >> yes, president, item number 10 on the agenda opportunity for the public to comment on matters within the board's jurisdiction.

>> open up the discussion to the public on this agenda item. >> >> thank you, we'll have a 30 second pause waiting for callers to call in. >> no callers have entered the queue at this time. >> thank you, very much. so this general item number 10 is closed we can move on to number 11. >> >> agenda 11. to place items within the board's jurisdiction on future agendas. discussion item. >> >> go ahead and hope this up for public comment. >> i have a question here or a

process about anything else to the board and i know there have been e-mails that we haven't gotten and i want to do this up in a follow-up meeting but, the process is -- like follow-up e-mails i tried to e-mail you last year and we didn't get it and so i want to make sure we're getting the e-mails and they know they're going to the board and we assume they're going to the board and not sure of the process and does it go to our board secretary and on to us? >> and then i don't see that we have been seeing any of the response either and it's important and especially important now since they have a hard time getting in contact and this is question for abby. >> i'll turn it over to the director yant for her response.

>> i want to discuss several times the the e-mail come on the board and she does want to see if they are containing private and health information of which we do not accepted them to the board and we have an obligation to protect that information and the board members private e-mails are not secured and so we do that review and just to note we get very few e-mails for the board maybe one or two a month at the most and we do take them under advisement and troy to correct the problems. i'm happy to provide report on this at a upcoming board meeting and to try to have concerns and information not coming into the board. >> i would.

because,. >> i'd like to stop echo abby's point this is an agenda item to place on the future items so it's a valid and useful topic and we really just should put it on the first board agenda maybe part of the director's report. >> ok. >> so noted. we'll add that to the next board director's report for the next board meeting. >> are there any callers on this item number 11? no callers in the queue at this time. >> thank you, moderator. >> so thank you very much. so, item number 11 is now closed. so if you call item number 12. >> yes. thank you.

item number 12 vote on whether to hold closed session for member appeal. action item. >> this item is open. i'll entertain a motion. >> i move we have closed session. >> this is commissioner scott i second. >> thank you, very much. i don't see that there's room for public comment on this item. i will go ahead and if you read the motion? >> president, the there does need to be a public comment for this portion although it's not listed and so we will need to take that 30 second pause to open up the lines. >> i didn't see it on the agenda so go ahead and let's open this up for public comment an.

>> beef not seen callers enter the cue so look to the instructions to the screen. there are callers on the call line. press press star 3. no callers have activated the lifting of their hands at this time. i want today give a final reminder. >> there are no callers for this agenda item 12 and i will call the discussion closed on this and we'll go for the vote and have the motion reread. >> the motion to hold closed session for member appeal.

moved and seconded, all in favor please say aye. >> aye. >> any opposed? it carries unanimously. thank you, very much. >> thank you, president. at this time, we will be making sure that attend attendee have n removed off and into private session. i would give us 30 second to a minute to make that process happen and we will then enter into closed session. please stay on the line.

tech support is coming through. thank you for your patience.

>> our presentation is delayed. it looks like it's coming on now. that's wonderful. ready to resume. agenda item number 13, vote on to elect to disclose any or all caution held in closed session. >> i'd like to ask for roll call police and we'll move to agenda item 13 as listed. >> thank you. my apologies. roll call. [roll call]

>> we have a quorum. >> thank you, very much. moving to agenda item 13 i'll entertain a motion regarding disclosing any or all discussion held and closed session. >> this is commissioner scott, i move that we not disclose any portion or call of our discussion held in closed session. >> second. >> any discussion? >> i'm going to go ahead and ask for a vote on this. the motion is clear and i don't need to have it repeated. >> there needs to be public comment. >> open it up for public

comment. the moderator will open up the line for public comments. >> that concludes public comment. >> all in favor say aye. >> aye. >> opposed. pass unanimously. we can move to agenda item 14. >> agenda item number 14, possible report on action taken in closed session. >> this is commissioner scott, i move that we not report on actions taken in closed session. >> i second.

>> any discussion from the board? >> public comment. >> a slight pause for the moderator to let us know if there are any callers. >> thank you, moderator. that concludes public comment. >> i don't think we need to have the motion reread, all in favor please signify by saying aye. >> aye. >> opposed. passed unanimously. i now adjourn this meeting of the healin health service boardr august 13th, 2020. >> thank you. >> thank you. >> thank you.