>> he seems to be unmuted. >> there were problems. >> commissioner scott are you

unmuted >> thank you everyone for being patient. we'll cap up with our technology. >> can you hear me now? >> yes. >> i heard everyone in test mode. steven, can you hear me? >> yes. thank you very much. as the board is aware we annually engage in a

self-evaluation for the board of directors and also an annual evaluation of the executive director. the governance committee met a week ago to review both documents as well as a time line for both processes. as you know, we initiate the self-evaluation first and then follow that four weeks later or so with the executive director's evaluation once we received the executive director's self-evaluation. in reviewing both documents, we did not make any changes in the executive director document. we did modify in the board self-evaluation document a couple of questions. we eliminated one question and we modified the wording on another. so those changes are contained

in the attachments sent out in preparation for this meeting. i would remind board members that if these surveys and the time lines are adopted, you are pledging to complete the process in in the recognized time line. we know this year we'll have consultative support coming from the department of human resources. therefore our board secretary will be the action officer if you will, number one initiating to the board members and sending reminders and compiling respective reports. we had some discussion on this

item on november 5 and everyone was supportive and she'll be getting consultation from the department of human resources as we go along in terms of pili piling -- compiling the report but the majority of the work done by the board secretary. with that i'd remember to entertain a motion for this item. >> commissioner scott, this is mary howell. i have a question. last year we noted in certain circumstances the board was not able to observe or experience certain interactions or whatever and thought we should another rating of unable to observe. has that been add?

>> we discussed that at this meeting and felt it applied to only one item and around orientation process. there be be a change on that one item but the others we felt board members can comment on. >> all right. >> any other questions? >> commissioner scott may i make the motion to approve -- >> yes, please. >> i move to approve the self-evaluation survey and the survey with the executive director. >> and time line. >> sorry, i was about to add and the time line as presented.

>> thank you, is there a second? >> properly moved and second we had a prove the annual board self-evaluation and the executive director surveys as distribute and the time lines attached to each. is there any further board comment? if not we will go to public comment. >> thank you. i'll be reading instructions allowed. public comment will be available on each item on the agenda. each speaker will be allowed three minutes to comment. both channel 26 and sf gov tv are streaming. opportunities to speak during the public comment are available via phone by calling

415-655-0001. entering the access code, 1466684910. press pound and found again and then enter as an attendee. before beginning public comment we'll take a pause to allow callers to time to dial in. after the pause if you dial in and wish to speak on the agenda item dial star 3 and it's your time to speak for on hold.

moderator, let us know if there's callers who wish to comment on the agenda. >> thank you. there are presently seven callers. a reminder to all callers on the line. you must dial star 3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for the agenda item. there are still no callers at this time. >> public comment is now closed. >> commissioner: thank you, we're now ready to vote on the motion as offered.

all in favor signify by saying aye. on the? -- those opposed? the item passes unanimously with no opposition. we'll go to item 7. >> medical plan competive plans. it's a discussion item and presented by executive director abien. >> if i could before you begin, direct we had a robust discussion regarding the rfp process and how the commission could indeed be more familiar

with the process as well as it's role in terms of oversight and having some competence in the preparation of the r.f.p., the administration of the r.f.p., the implement of the r.f.p., responses, etcetera. we convened a meeting november 5 and the direct brought to us in great detail how the process is unfolding, what is being done and what will be done going forwa forwa forward before the board is parent with a recommend in february.

i believe commissioner breslin stated we're satisfied with the process as well as the calendar and activities brought to us by the director. as a report out today it's a high level review of what we reviewed and with that i'll ask the director to begin. >> can get the slooidz -- slides up, please. >> one moment. >> to compliment what commissioner scott said what about to present to you is high level process both a look back and forward on the r.f.p. for

the medical plan. the key dates with the assessment and the first assessment was in july 2019. que announced the decision we would not release the r.f.p. for plan year '21. we the medical plan would be through the competitive bid and that release has since occurred. there's two sections of the r.f.p. and i know you all know at this point that that document

is available and robust almost 100 pages on the hhs website and there's legalese you may not enjoy reading the two sections and provided the to the commissioners as well as is section 1 with the overview of the system. we talk about our interest in value-based payment and talk about the health plan market assessment. we talk about the results of the focus group that we did and presented the findings in i think it was november of 2019. the strategic plan has been a backbone to the entire process. the concept of even to

consideration of doing competitive bids through the strategic plan and then we updated the health market assessment. and we are always looking risk scores and we don't have the healthiest population and that is of concern. and we'll be bringing them before the board on special determinates and be before the governance committee earlier this year. so the other section of the r.f.p. that i would direct us to

and the presenters if you would take us to what is labelled slide 3 in the presentation to be on the same page. and the scope of the work of the contract go -- >> may i interrupt. can you tell us what slides you're able to see right now. >> i can see agenda. >> this speaks to the scope of work and what i want to draw everyone's attention to is this reads like a health service board agenda. all of the items that we list on

the board were topics and a deep dive in the discussions over the last two years. everything from care management to primary care medical homes, interoperability, several things on second opinion and care management and complex care management. as well as our own audit policy that we put into effect since last year and extensive training around rate methodology, a very complex subject of which hike -- mike clark helped produce four webinars on that because that's at the heart of the matter when we negotiate rate. culminating with the utilization

and quality dashboard we present to the health service board on a regular basis, all these inform the r.f.p. and as you review it you can see the work the health service board has done and how it informed the r.f.p. so that brings me to the time line. as you know we issued the r.f.p. on september 14th. we had our required proproposal conference calls. we receive the notices of intent to bid. we provide the responses all by september 30th. we have everyone involved and having a continued interest in the process have signed the disclosure statement and the proposal submission date is now

behind us. we have now received all the proposals that we will be able to receive during this process. going forward we're in what we call the an lit -- analytical phase where we're organizing the materials and responses and running the financials and disruption analysis and highly technical work and very complex given the volume of information that we've requested and have received. the materials will be prepared for the panel list who will receive them beginning first of december and have the month to complete their review with the scoring rubric that has already been prepared. oral interviews will be taking place starting after the january 1 holiday.

in order to develop our recommendation that we will bring back in a robust way to this board for a february 11 meeting. understanding -- >> director, there you go. i was trying to get us on the right slide. >> thank you very much. >> it's a little different than what i have on the agenda. so the time line is we are wrapping things up now and we are preparing for the written interview. the health service board will receive its information february 11th.

we expect that to be a very robust dialogue with the board and we'll be well prepared for that and should the board have more questions than we can answer at that time and we request for the decision to be made at a later meeting, we have secured a second meeting date in february for that purpose. >> that will be february 25, if i recall correctly. >> february 18. >> is that right? >> a week later? >> yeah. >> okay. that would be another board meeting open to the public for further discussion if necessary. >> that's correct. >> okay. thank you. >> director, thank you for the overview. i'll ask the board members if

they have question the time line or the process at this point. >> dr. collins, you're right. the second meeting date is on february 25. >> all right. that is a thursday. so two weeks after the regular board meeting. we would have, if needed, an approval meeting of the medical plan selection if we are not able to accomplish that on february 11. so just for the record, it's february 25. >> the 18th we've wiped out? >> yes, the 18th is an error on

the slide. it should be february 25. are there any other clarifying questions or other other items described in the process and as outlined by director yant from the commission or board? >> this is president follansbee, i'd like to say this process as you already stated, chairman scott, has been well outlined and described i think to the governance committee as well. i think it's consistent with the involvement of the commission board all along as i'm quite pleased having read the r.f.p. in large portions and read the comments that came in during the

comment period and question period. i really want to compliment all the staff for both thoroughness and completement and in particular -- completeness and particular thoroughness for the strategic plan for 2021. i want to thank everyone for that. >> all right. any other comments from members of the board? >> this is mary howe. i have a quick question. who will comprise the panel for the panel review? >> director, yant, would you speak to that? >> we will putting together a panel on subject matter experts including side employees and representatives from other county and entities. the identity of those particular individuals is confidential in order to protect them from undue

influence. and staff support and other support as well. >> thank you. and once we get the staff recommendation and the evaluation at the february meeting, a lot of the currently confidential information surrounding this process will be made available to the board and public unless as the proprietary information the health plans don't want divulged but the process and submission and all of that will be available to us at that time. >> and my understanding is that includes the members of the panel reviewing all the aspects of the r.f.p. formulating the

recommendation. >> that's correct. >> thank you. >> we took a formal process to selecting the panelists as i've described to others as if you were recruiting members for the governance board where you look first for the qualifications of individuals to have a rich diversity and subject matter experts. the health plan world is quite complex whether it's someone with pharmacy, expertise or government contracting expertise. we started with that list of qualifications and then a small group of us that brain stormed and used our networks to qualify people that were willing to commit a significant amount of time to this process. >> i just have a question. >> yes, commissioner breslin. >> so how do you -- you

described how you pick a panelist but who pick the panelist? who is involved in that? >> our office, myself and mike vincente our lead contact in management. >> okay. as for the city employees, that's a different group than those who have expertise, right? >> city employees have various expertise as well. >> okay. >> all right. before we go into public comment i wanted to the great deal of admiration i have for director and staff and mr. vissente and i had this responsibility before

and i know the amount of time and effort that it takes to staff support to a process like this and i wanted to call that out publicly and thank them for what they have done to date. >> at this point we'll go to public comment. >> i have a comment as well. i mentioned i'm attending a meeting and it was a strong recommendation that every plan review and re-issue r.f.p.s every three years. the appropriate and the timing of this -- appropriateness and timing of this and we are clearly in a very appropriate maybe slightly delayed time frame to review this. i'm not suggesting we do this

every three years but the recommendation by an expert outside of the city of san francisco. >> i'd thank the advice and we on the board would be better to do a broader time frame if we were to do this in three years i don't know abby, michael or any of the other team members want to go through that that soon just as a matter of work flow. >> i agree. >> president follansbee, if i may jump in for the record and apologies i've been able to listen and view and have seen the entire proceedings but with technical problems and i was just able to join with the ability for you to see me during the presentation and i wanted to

state that for the record i'm now able to participate fully. >> thank you very much. >> thank you, supervisor, welcome back. >> thank you. we'll now go to public comment, please. >> thank you, commissioner scott, i'll reading instructions. public comment is available for each item on the agenda. each speaker is allowed three minutes to comment. channel 26 and sf gov tv is available and you can dial in by dialing 1-415-655-0001 and entering the access code

1466684910 we'll allow a pause for members to press 3. dial star 3 to be added to the queue when the message reads it's your time to speak, for those on hold please wait until the system indicates you have been unmuted. when i welcome you on the call you're encouraged to state your name clearly though you can remain anonymous. moderator, i'll pass you host privileges and let me know if there's callers who wish to comment on the agenda. >> madame secretary, a reminder

to all callers on the line. must dial star 3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item. madame secretary, there are no callers at this time. >> public comment is now closed. >> with that, president follansbee i'll turn the chair

back to you, sir. >> we'll move on now to item 8. >> agenda item 8, director's report. this is a discussion item. >> good afternoon, commissioners. i have a brief director's report for you but very important in that we had a very successful open enrollment in the virtual environment in our strange pandemic world. and that is a loaded statement. i can't tell you how impressed i am with mitchell and the teams for doing the heavy lifting to

make this a good experience for our members. we didn't need to add to anybody's anxiety this year and think we did an excellent job of keeping things very manageable for our team as well as all of our members. i was crunching the numbers and we'll give you the color detail at the december meeting with lots of firsts we've accomplished with terrific support with our other department of technology and other support outside of hhs. folks who have recognized the value and importance of doing this work in a virtual world. we were well supported. our communications team took a whole new -- took it up a notch or more quote, emeril, to make

the information we had available with webinars and ongoing enhancements so the we have pages being able to monitor what information needed to be presented somewhat differently. and did an excellent job of keeping up with the face of the enrollment activity and so member services and the truth of coming through on the back end of this is that the clean up for the processing of the open enrollment transactions which is usually forcing us to be in a high operating mode for a number of weeks following the closure of the enrollment itself came to a halt pretty quickly as well which is another huge indicator of how smoothly the transactions did occur.

looking forward to seeing the all the numbers and my hats offer to the entire operations team for doing such an beautiful job on open enrollment this year under the current circumstances. >> director, before you proceed, it may just be me but your screen is flashing your image. either i have a seizure disorder maybe we can just see your name. it may save medical emergencies for the rest of your presentations if that's okay with you. >> that's pretty darn funny. that's a first. >> as the more like nausea. >> we don't need that. okay. >> just checking in too. i had noticed that as well and

it's likely a low bandwidth issue. >> thank you, all. >> reminder, i think it goes without being said we are very much impressed with the piece of the vendor blackout period is still in play. our well being services has done an amazing job this year of adapting and transforming the service board and their being able to pivot and support the workforce through a virtual world and with a huge focus and concentration on mental health and well being of our workforce it's been remarkable. and continues to grow by leaps and bounds. i'll let carry report out to you in more detail next month but we had the opportunity to observe a

champion event last week where we had over 200 champions across city departments that support well being in a very robust way and we had three key note speakers telling them how wonderful they were. it was very heart warming and well deserved because they've been our web of support for city workers throughout also well being has taken it upon themselves to pivot. [please stand by] .

>> they are leading that effort jointly and doing a marvelous job and we will be doing some more education with our staff in december as well. that combined with our focus on the social determinants of

health we will bring to you in a joint presentation in december and in january to help understand what these terms mean to us as a health service board and how we can have influence addressing some of the inequities our members experience. we do have reports in my director's report, unless there's questions i won't go over them in detail, but the plans we are concerned we are at another period of time where we may see another uptick in our jurisdictions and certainly it is true across the u.s. it is good that the health plans are concurrently monitoring this and reporting to us.

our concerns mirror what the doctor said. in addition, we have concerns about testing available, which although it continues to be much more than it once was, we're concerned if we hit a high demand period with an outbreak and/or with schools resuming, that we will be again having to triage to get these resources. that's what we experienced at the beginning of the pandemic, the testing resources were limited to those with symptoms. now things are wider than that and people without symptoms can get tested for a variety of reasons. if there is a huge demand, that may be pulled back as well and we need to stay on top of that.

we have followed up with requests for how to submit public comment. we have made the clarification and that is available on our website. also, we have compiled a board e-mail report and the board is aware of the e-mails and the resolution of the activities. so we have included that in this month's report. lastly, i would just like to say that we have -- as expected this time of year, there are issues that come up with the administration of the vaccine. there were a couple of questions that came up last week that

kaiser had a response to on behalf of one of our members that wrote about it and experienced -- i think in the pfizer roll out where there was not available the high-dose flu vaccine. to pfizer has offered an explanation. we can comment on that as well. so i will stop there. if the board has any questions, and dine you want to speak to the flu vaccine matter as well. >> if it's okay, i would like to speak to the flu vaccine issue. i was glad to see this issue brought up with distribution and

availabili availability. the high dose is recommended by the center of diseases control for anyone over 65. it's the same vaccine component as the regular vaccine which is available from multiple manufacturers. the high dose comes from one manufacturer. it's the same components, but the levels of the components are four times higher. as one can imagine does lead to a more robust antibody protection in those over 65. the vaccine was first approved based on antibody levels and not on any clinical efforts of increased efficacy or usefulness. that evidence is evolving, but it is clear that it prevents

hospitalizations by about 24%. it's not four times more effective in preventing disease, but 24% more effective in preventing disease. that is significant, but what that says is the routine vaccine, if available is also very protective and very appropriate. the question arises, will they take the regular dose or a high dose? historically there are studies that show that administration of a second dose of the vaccine is not as robust. so i can't tell you that taking the vaccine a second time does you any good and might just cause more side effects than benefit. i did check with the california department of public health on flu statistics from around the

state. from early september there is one reported death from influenza and reports from sentinel laboratories suggest it is a low level. the occurrence at this point seems to be the low, the average over the last several years. that doesn't mean it will always be this way. what it does mean is there is ample opportunity at the present time to receive the vaccine if it hasn't been administered yet and expect a benefit because we do expect to see some influenza activity. we still have opportunity. i urge everyone to get the flu vaccine if, indeed, they haven't received it and if it looks like the availability of the high

dose may be delayed or hard to predict and if one wants to take advantage of the high dose, i would urge that as well. i want to make a brief comment about the covid-19 pandemic because, director yee, you provided a detailed and remarkable account of what our health plans are doing, what's happening to our health service members. and i want to applaud everyone for their work at keeping this pandemic to a minimum in our area as best we can. these measures do work. as part of this conference i'm attending, there was a lot of discussion of benefits vis-à-vis covid. it's amazing to me the number of respondents attending this reporting a whole host of benefits or lack of benefits. the consistency with which we're

seeing in each of our vendors is impressive and it's something that we need to acknowledge and applaud that everyone has stepped-up to the plate. this is not the case around the country, despite directives and even legal sort of recommendations, et cetera. some plans are getting bills for members that went outside free-standing testing sites, bills that go up to as high as $1,200 per test. i would urge all of us and our members, if one wants a test, start with your provider and the system. number one, it can help interpret what that test may mean in your situation, whether you're worried about exposure

recently, worried about symptoms, it should be interpreted in the way for each person. again, i urge everyone to go through their medical provider. does anyone have any questions or comments? i don't see any raised hands.

>> thank you. i just wanted to indicate one of our retirees said a bill of $60 or $70 was sent to kaiser on her behalf when she got a flu shot at one of the local pharmacies and she got that straightened out. but when you mentioned the bills going in for testing, i think it's because in the community when we have these other options and they're more convenient for a number of our members and we have people going to cbvs and walgreens.

we need to consult on this. >> thank you. commissioner, do you have a comment or question? >> i do. it's regarding director yant's report about the e-mail. it said only nine people sent e-mails from september and october. would that be correct? >> yes. >> how can that be, nine people in an open enrolment? >> what? >> only nine people sent e-mails in? >> i'm sorry, what page are you on? >> i don't have any of that in front of me. when i looked through, i think it was -- >> i think what the nine e-mails represent are nine e-mails that may have been brought to the board's attention. it wasn't about open enrolment.

the e-mail report is -- sometimes we have e-mails sent as to the secretary addressed to the board of directors of the system. that's the ones i think are contained in this report being referenced. >> yeah we're not offering a report on the number of e-mails we receive sine die. >> so you're offering a report on the e-mails directed to the board? >> that's correct. >> thank you. >> commissioner bresman, did you have a question about the influenza vaccine? >> i absolutely do, but i was going to do that when item 11, contract and health representatives, because

regarding the health plans, what are they doing. >> okay. if we have to, we'll defer that until that item. any other questions or comments from the commissioners? seeing none, i think we'll go ahead and open this up for public comment. >> clerk: thank you, president. i'll be reading instructions. the public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment. the dial-in number is being streamed across the screen. opportunities to speak during the public comment period are available by phone by calling 415-655-0001 entering access

code 146 668 4901 and then pressing pound and pound again. you will enter the meeting as an attendee. before we begin public comment, we will take a 30-second pause to allow time for callers to dial in using information on the screen. after the pause if you dial in and wish to speak on this agenda item, dial star three to be added to the public comment queue. for those already on hold, please wait for the system to tell you, you are unmuted. operator, can you please let us know if there are any callers wishing to comment on this agenda item. >> operator: we have eight

callers on the phone line. zero callers have entered the public comment queue at this time. a reminder to all callers at the time, you must dial star 3 now if you want to join public comment for this item. we will wait five seconds and then close public comment for this agenda item. board secretary, there are still no callers in the queue at this time. >> clerk: thank you, moderator. public comment is now closed. >> chair: thank you, director yant, and your whole staff for an incredible level of activity in the last few months. before i call item 8, i would like to take recess for 10 minutes. it means that we will reconvene on my calendar by 2:28. we're going to have a very

robust discussion on medicare market updates that's quite detailed. and i want us all to be fresh and pay attention to this as well because this is a fas mating topic for us to keep abreast of. break for 10 minutes. >> thank you so much, commissioner.

[ roll call ].

>> chair: we'll go ahead and call item 9 which is a discussion item. >> clerk: agenda item 9, presentation of medicare market update. this is a discussion item. i just wanted to make a note that on our agenda it does have a representative, jon grosso from aon presenting, but mike clark will also be here. i wanted to make sure that jon is on the line and we can hear him. jon, are you able to hear us? >> yes, i can hear you.

can you hear me? >> clerk: yes, that's great. >> super. thank you. >> hi, this is mike clark with aon. my colleague will be presenting the market update. we encourage this to be an interactive dialog on the topics we'll present today. i fully encourage questions as we review the slides during the presentation. with background, there are two plans available to retirees. one is the p.p.o. plan to all medicare retirees. and then certain medicare

retirees have a local medicare advantage h.m.o. as well. for about 70 medicare retirees there is also a kthmo medicare advantage in washington state, the northwest, which is the portland, oregon area. the purpose of today's discussion is to initiate planning as it pertains to the possibility of a request for proposal that could occur for the medicare health plans into the sfhsf plan. there are some questions we will be going through as we discuss

the present state of the medicare market. the first is how has the need for medicare evolved in their offerings. what are some of the national and california public sector employer trends that can be used to inform. and as we initiate this conversation today leading to a likely decision by june to determine whether to pursue a request for proposal for medicare plans for the 2023 plan year. what are those steps that hshsf will take. how do we assess if the plans today are meeting the needs of measures and are there any

significant gaps that need to be thought through to think of solutions going forward to think of a possible r.f.p. with that, these are the agenda topics we'll discuss today. first leading with the medicare alignment. an overview of the healthcare market that includes coverage types. a national statistical view as well as a county view looking at the offerings provided by the 10 counties that are part of the 10 county survey. and also other bay area counties that are not in the 10-county survey. we'll look at information for those counties. we'll hone in on a medicare advantage point. we'll close our discussion

interactively with you to discuss next steps in the medicare future evaluation. we are not going to specifically review the appendix items today, but there are three robust appendices for this document. one is background of medicare programs, including the core medicare a, b, c, and d programs. more information that we'll review in the main portion of the document. and then also because healthcare is always fraught with many acronyms, there is a glossary of terms to help educate on the various terms that won't be discussed today in this presentation. with that, i'll launch into a review of how medicare plans fit in the strategic goals for

sfhsf. when we thin how the member plans play out, we need to think about copayment and say insurance. we need to think about how sfhss benefits the retirees. i can't emphasize enough the importance of the quality aspect of this by providing comprehensive and integrated healthcare. from an engage and support standpoint, the plans should work with the vendor partners to

provide literacy and address racial equity and other negative social determinants of health. before i talk through the next strategic considerations, any questions or comments about how we think about the medicare plans integration into these specific strategic goals? >> none from me. >> michael, just before you go on, in terms of the affordable and sustainable, when you talk about contributions and plan designs, you're covering copayments and all those other deductibles, et cetera, et cetera, correct? >> correct, that is [indiscernible] -- >> thank you.

i just wanted to be sure that was embedded in that and we may want to clarify that in future presentations. >> thank you for that suggestion. >> for the other two strategic goals, we realize the sfhss should think about the needs of members and provide a meaningful opportunity certainly from the healthcare plan itself and the vendor partner, the plan design element that we just spoke about, the copayment, the co-insurance, the affordability of member costs for services. and then in the provider network and health system that are embedded within the networks of the medicare plan.

and then the last strategic goal recognizes the plans to be provided by vorpeds who will support the ongoing well-being of activities and shifting sick care to health in healthcare and reduce barriers to care. in other words, addressing in a very targeted fashion the negative social determinants of health aspects. so we think about the potential to consider on r.f.p. for 2023. this is how we're thinking about the integration of goals into the sfhss strategic goal platform. >> excuse me, i have a question.

in the prior slide. what does negative h.o.s. mean? >> i'm going to go to the prior slide as it's more spelled out. negative social determinants of health are those social determinants of health that may create a barrier to health or healthcare that may be a negative influencer to someone with the ability to access care to find the opportunity to sustain health. for example, you may hear the word food desert. someone's inability to eat healthy foods in their neighborhood to be viewed as a negative social determinants of health. low income impacting someone's

ability to pay for services, for healthcare services, could be viewed as a negative social determinant of health. >> well, everyone has the same opportunity and choices in san francisco. if you work for the city and you're a member of the plan, so i'm not quite sure how this is clear. there are cultural differences of what people eat and how they exerci exercise. that depends on cultures and ways of life, a little bit more than food desert in san francisco. >> yeah, i know that you've obviously been leading the charge with sfhss. i'd love to hear your commentary. >> it might sound good and goes with the program, but to me it doesn't make sense.

>> we will be doing a robust presentation at the next two board meetings about racial equity and social determinants of health. one is on social isolation. we have a significant number of seniors in medicare that live alone and that is a risk factor as high as smoking is. there are others that do affect some of our members quite severely. we'll be highlighting that in the reports that are forthcoming. >> i would add that even though all of us may have access to the same spectrum of services, issues like skin color make a difference in the ability of contractors we've designated to diagnose certain conditions. we have some responsibility to make sure that our vendors are

assuring us that the vendors are well trained in certain issues such as skin color, this is just an example, on diagnosis of skin cancers. this goes beyond simply what was available in terms of services and also responsibility of vendors to guarantee equitable care as well. >> i would think any doctor would know that. >> i don't want to belabor the point because we're going to have a presentation from the american economy of dermatology talking about the challenges of knowing that their newly trained dermatologists are well trained

across the country. i think any doctor is probably too broad a voice of confidence. >> and i'll reserve my comments to the presentation that we'll be having in the ensuing board meetings. this is not only about care availability, but not only the cultural accessibilities and food and diet, but also pre-existing conditions in certain populations that are also present in our membership. so it's a much broader construct than some of the items we've talked about. and i think we need to be informed by those presentations.

>> thank you, commissioner. i'll shift gears to introduce the current medicare healthcare market. these are the available plan types on medical coverage. so the left side of this page starts with what we call traditionally original medicare. these are the programs that when medicare was first passed through the federal legislation in the mid-1960s, these are the programs that were introduced, part a for hospital coverage and part b for medical coverage. each provides a level of coverage, but with deductible and copayments and for part b coinsurance. it is funded primarily by the federal government with part a being earned with 40 quarters of

employment over the course of a working career. part b requires a member premium except for low-income employees. this is the levels of coverage, not in a network, but it requires that physicians and providers accept medicare. the middle two are indemnity type coverages without reference to a network other than the provider is accepting medicare. a medical supplement is commonly known as medigap. this may fill in, say, the hospital deductible, other parts of the copayment structure.

it could fill in the part b medical deductible and some or all of the 20% coinsurance that typically comes with the traditional medicare member. there is an additional premium that would increase as the fill-ins increase. with most states, there are 10 different approved benefit designs that vary based on the amount of fill-ins. a fulfill-in is a coordination of benefits, that's the third column. fully filled in those levels of medicare that would have the highest premium of any supplement coverage. then the right side is the medicare advantage plan, otherwise known as part b or

m.a. it provides coverage for both medical and prescription drug services, unlike the other three that are medical only. they usually have benefits for services. if someone is enrolled in medicare service, that plan becomes the coverage. it can be possible to obtain plans that are as low as zero-dollar premiums as long as the member is eligible for both parts a and b. a distinction of member cost is found in the fact that you can have individual market plans that any medicare retirees could source via the market place or what is commonly known as group plans, group insurance, such as those sponsored by sfhss. the individual market plans tend

to have lower market premiums, but higher copayments for doctor visits, description drugs, et cetera, at time of service. group plans may have higher premiums, but typically much lower copayments for members. some additional items related to the medical coverage. you see the additional potential member benefits are not there for original medicare, but supplemental medicare advantage plans may offer potentially benefits such as dental and hearing. more commonly and we'll talk about the prevalence of these shortly, some plans include added member benefits such as meal delivery and transportation coverage such as the sfhss and they plan to do today.

a very important distinction in these coverages are the quality measures. there are no quality measures or original supplement c.o.b. coverage. we'll talk at length about those star ratings coming up later in this presentation. also the care coordination, there is none for the original medicare supplement and c.o.b. plans, whereas there is care coordination for member advanta advantage. this page covers the descriptions in the prescription drug coverage. the base level is available through the medicare platform. it was introduced through the

medicare modernization plan in 2003 and part b went live for medicare retirees in 2006. there are four levels of coverage, based on how much prescription drug expense a member has incurred. at any point in the year it starts with a deductible. the first goes to insurance, the second layer goes to the donut hole. once a staff member achieves the donut hole there is approximately 95% of coverage for the member at that point. several thousands of dollars of expenses. the premium is paid by the plan members, but there is no automatic offering of this like

the hospital part a and the standard part b do have the lowest premiums on the prescription plans simply because they have the highest level is at the time you purchase. there are no benefits. and there is no member care coordination. the middle column of the prescription drug plan, think of that as medicare part b plans with enhanced levels of benefits. so, for instance, they may create a greater level of fill-ins or greater level of member co-insurance along the way. certainly a higher premium. it's common when any medicare beneficiary is purchasing a medigap plan or a coordination of benefits plan for medical on the open market, they're also

typically purchasing some form of prescription drug plan, or p.d.p., as well to provide those prescription drug benefits. on the right side, medicare advantage, we talked on the prior slide how medicare advantage is integrated in the prescription drug plan. so the prescription drug coverage comes with medicare advantage. there is no requirement or need to purchase a separate p.d.p. star ratings will talk about that shortly with respect to the medicare plans and the member coordinations. any questions about these compare and contrast tables with respect to the variety of medicare plans available in the market place?

>> none by me. >> i neglected to add a slide here, but there is also the ability to be covered by medicare under certain conditions of having end stage renal disease. of all these medicare eligible individuals, approximately two-thirds are enrolled in some form of original medicare and may only be parts a and b. individuals could also purchase, like we talked about, medigap or

other supplement plan and about 50 million medicare individuals do purchase some form of individual medigap plan supplements. the original medicare hospital benefits. we also know about 21 million medicare individuals purchase a part b prescription drug plan. as you can imagine, many people are among the 15 and the 21 million who purchase both. those are individual counts, but there could be the same individual in both of those counts. then about two-thirds of individuals are enrolled in medicare advantage plans. 19 million are in the plan. about five million in group-sponsored medicare plans. you tend to find more in medicare market place plans

because some employers have discontinued any form of medicare on a group basis. so sfhss is like other employers predominantly public sector, perhaps employers with significant retiree populatios.s there are groups who work for smaller employers such as retail or hospitality who do not offer employer-sponsored medicare plans. those individuals would be the type of individuals to purchase medicare advantage plans via the individual market place. this could be h.m.o.-based or

p.t.o.-based within that network of benefits. it can be local and regional. the last bullet we can glean from that statement is in california specifically, relative to the rest of the u.s., there is a higher proportion of medicare-eligible individuals who enroll in an m.m.a. plan versus a flash supplement plan. that gives a sense of how populations distribute per employer. there are generally two approaches. you can see those in kind of the lighter-shaded blue ovals on either side of the page here. we say modified group strategy.

these are group insurance plans guided by the employer working with health plans to offer these plans to retirees. some of the evolution of these approaches happens through a combination of how healthcare reform has shaped the retiree market as well as employer objectives, like strategic goals that we discussed at the outset of the discussion. on the other side you'll see the strategies where employers have eliminated their group-based plans and gone to sponsoring and offering the individual medicare plans, whether they're supplements, d.o.b., medicare

advantage, purchasing those plans in an individual market pla place. and some things in each of these strategies, for group base, typically medicare advantages can include coordination of plans, also medicare part b prescription drug pl prescription drug plans and medicare advantage, region and local as well as national plans. then from an individual plarkt-bas plarkt-bas plarkt-basmarket-based needs, is are providing any funding or contributions, the individual market-based plans are through a health reimbursement which

provides tax advantages to both the retiree and the employer. these are typically amounts that fund into the health reimbursement accounts that are earned over the course of time, typically some form of age and service-based build-up of account accounts. some of the key issues, perhaps opportunities or challenges that are going to guide where the medicare plan market evolves from here, first certainly what impact the elections that transpired last week could have in the evolution of medicare plans. so we'll get a sense of how the federal government may look to evolve medicare plans. the outlook for medicare

funding. the centers for medicare and medicaid is the agency of the department of human health and service sincere that orchestrates the medicare program and essentially determines the underlying funding that goes towards various medicare plans. the medicare access and children's health insurance plan reauthorization plan is legislation that passed a number of years ago that is guiding the future of reimbursement methodologies for providers. looking at how that needs to evolve over time as well as broader u.s. social welfare progr program. concepts we talked about earlier and long-term outlooks for the group. knowing that for employers

sponsoring medicare advantage plans, it's very important to think especially about a national p.p.o. to provide the plan to retirees regardless of where they live across the u.s. medicare supplement plans are inefficient. they're filling in some of the gaps for parts a and b, but they're not necessarily providing any form of care

coordination or any aspect that can be provided. medicare standard plans that were first allowed in legislation that started in 1999, the big advantage is they provide them in tons of quality focus not seen in other types of medicare plans and have facilitate facilitates cost allocations. there are examples here of what are embedded in the sfhss plans today. i'm not going to go through this in detail. this is the information on how original medicare compares to the medicare advantage across a number of different aspects of

looking at the plans. the original medicare, a member can see any provider that accepts medicare, where non-complying providers must collect directly from the patient. or the h.m.o. models typically only provide in that work providers certainly with provision for emergency care that may be thought of at work and p.p.o. models can accept any medicare. the mavast majority of these listed do accept payment. as part of preparing for today's presentation, we know that retiree

retirees have information on what other categories they offer. so we scanned both bay area counties as well as the remaining california counties that participate in the annual sfhss 10 county survey to understand what they offer to their medicare retirees. highlighted in red is all offer one medicare advantage plan, some directly and some through an individual plan market place. when you look at the market place platform, you'll see some are using the calper plan.

those employers may be providing some employer contribution for retirees to be covered. so four of these counties you'll see leveraged calperes some way as the exclusive approach or for certain retirees that received covera coverage. again, you'll see kpsa predominant throughout these next few pages, as a typical bay area planned sponsor offering in southern california as well, but you'll also see that for group m.a. plans, you'll see others like your u.h.c. plans being offered to retirees.

there are some counties offering other group plans like supplements or c.o.b. but i will note in san mateo county, to go along with their plans, they are adding a third medicare advantage plan in 2021 from blue shield california and eliminating the coordination of benefits plan after 2020 to replace it with the medicare advantage plan, which will be much more streamlined costs for san mateo county as well as the plan members. for the remaining countries, three of the counties are represented in the bay area. these are the remaining seven. you'll see one m.a. plan is sponsored by each of these

countries. kpsa in all instances spans a southern california specific plan that is not available in northern california, but see is prominently offered in l.a. and orange counties. you will see some other plans that are offered and some of these other counties. and then some are available for retirees in riverside county. as i indicated before there is additional information contained in the appendix to this act. there are each of the 15

counties represented on these two pages. it would be helpful for me to know if there's any additional information that might be helpful for us to collect. so thinking about our 10-county survey, we only do it for the purposes of determining the 10-county amount and it does contain information on costs and plan designs. we could also start to seek information for each of these county counties or retiree benefits if that's something board members would be interested in seeing. >> i'll defer to my colleague who has her hand raised, but i would like to comment on this afterwards. >> thank you very much.

my concern is that while our issue issues including the surrounding area workers. when those folks retire, they send to remain in those areas because a lot of them have been living in those areas for many, many years. some are employed in those areas because they were already living there. so while it doesn't pertain to the financial analysis that we do for the 10-county supplement, i think it's information i'd like to see for retirees in that area. and what i've also noticed over the years is that a good number of active employees from the bay area like to retire to areas that are around like senora and

the twaleme area. it would be good to know what's offered to those employees. thank you, mike. >> absolutely. we can do that research. i think calpers may be the preferred conduit. we will absolutely do the research and funnel up with that information in a future board meeting. >> i was just going to say that as we're collecting data or starting to think through plan design changes and so forth, i think it would be useful to try to find what benefit designs are

present in some of these -- at least the 10 counties that we have traditionally compared to. i can't think of a particular feature, but certainly co-payments, there might be any fo formulary issue. we should think about that going forward, particularly framing the r.f.p. >> absolutely. and for starters, we can partner with kaiser to help us understand how the current plans compa

compare. and then supplement that with additional research. >> i have a comment too. nobody can see my hand i guess. hello? can you hear me? >> yes. go ahead, commissioner. >> so most of the counties or all the counties have the medicare advantage, but most of them have a p.p.o. and most of them have more choices than we do, especially for the medicare group. i never did like segregating our population. i think there should be one p.p.o. that's open to both actives and retirees, which of course made it affordable at that time. so they have the medicare advantage, but also p.p.o.s in

the mix. so they have more choices than we do. >> thank you. and you'll see that through these pages of exhibits that many of the counties offer multiple plans, more than just two. >> i have another follow up. may i go ahead? >> yes, please go ahead. >> thank you. one of my concerns was that previously when we had r.f.p.s going out, it wasn't split as it is today with the medicare part being separate. we actually looked at having presenters that offered both medicare benefits for retirees as well astivities and if they didn't have both, we didn't have them in the system. that was some years ago. my concern is primarily with

blue shield are anybody who will respond to our r.f.p.s. blue shield went out of the medicare business a number of years ago. kaiser stayed in and are consistent with their offerings. blue sheet, a lot of their contract providers didn't like the reimbursement, and basically we ended up with the c.o.b. because they didn't want to be keeling with medicare. my concern is going forward as i see here, it's a new day, blue shield is marketing to medicare and it's back in business. well, that back in business might have to do with medicare reimbursements and other issues with regard to what goes on in washington, d.c. i wonder if we have any sense of

the reliability of a vendor such as blue shield to stay in and provide the services for no less than our contract. going forward it's difficult to change plans. a lot of our retirees are living in areas that are limited to start with. if they have a plan, it gives the best bang for their buck. changing plans in the future can be very devastating especially as we get older. i'm putting that out there and wondering can we trust among any of the other vendors, like blue shield, to be consistent in their promise to stay in the business and they're not going

to drop out if they don't find it beneficial. >> thank you for the comment. i'll make a brief statement, but if i could ask paul brown from blue shield to follow me and provide a brief statement on your medicare offerings. i know in my discussions in preparation for today, that an example of the blue shield commitment was the coordination of the benefits platform to the blue shield benefit plan for 2021 that is available on a national basis. paul, if you're available to provide more on this. >> paul brown from blue shield california.

thank you for your question, commissioner. we never exited the medicare market. we have always had c.o.b. plans or medicare coordination plans i should say in the group market. we have had in the group medicare advantage h.m.o. area, the coverage in the past has been somewhat spotty because of our limited ability to get contractors to give the right rate to strike the balance between the medicare reimbursement and the rates. since then and to my point, we have added a medicare advantage p.p.o. to our portfolio. it will be offered to san mateo county starting january 1.

there is some benefits about coverage. those employees in the remote areas really do benefit from the medicare advantage p.p.o. so it spans coverage far beyond a county level. it's really a national plan and it can accommodate those employees or retirees who like to travel, which is not always easy to get coverage outside the area. >> if i could just chime in. again, we don't have an r.f.p. for medicare. i think the point of this presentation is not necessarily to add for responses for certain provincial vendors should we issue an r.f.p., but i think it's incredibly important and it

was in the r.f.p. for the non-medicare plans. if we can focus on the potential respondees in the future, we can get through all the comments. anyone else have any questions for mike clark at this point? otherwise, i'll ask him to proceed. i think you can go ahead and proceed, mike. >> thank you. on the market update, i mentioned earlier that approximately one-third of all retirees are [indiscernible] --

also there are numerous additional benefits in the various medicare advantage pl s plans. think about how director yant

spoke about the caregiver support could be the next generation of people supported. from a plan landscape, we talked about h.m.o.s that are in that work only. p.p.o. plans in and out of network. the predominant style of plans are the p.p.o. we're seeing local and regional p.p.o.s take hold. this slide shows the predominance of the types of plans and carriers that are offering medicare advantage plans. united healthcare has the largest at the moment. you'll see two formations. kaiser is fourth on the overall

list. the bottom chart is the total m.m.a. membership that is group based. so you'll see that you're aligned today with two of the predominant m.m.a. carriers in the market place. >> mike, can you clarify, what is a pffs? >> privacy for service plan. >> thank you. >> and i talked earlier about star ratings and these are the foundation of quality measures that the federal government through the c.m.s. entity uses to determine how a medicare advantage plan is performing. so for m.a. plans, there are up to 45 different quality-based categories that culminate in a

rating that can vary from one star, which is the worst rating, to five stars, which is the best. they can include categories including how plans help members stay healthy through a bunch of screening tests. how members manage their conditions, plan responsiveness and care protocols. also an aspects of operational performance. how many member complaints may be coming through. members repeating services and customer service. many of this feeds into the comprehensive star ratings that are produced by the federal government and they're also

determined by c.m.s. for the prescription drug plans, up to 14 measures for those stand-alone plans. again, the good news for sfhss is if you're offering two plans that have high star ratings, over 600 member advantage plans excluding d.d.p.s were filed in 2020. of those, about two-thirds were rated. the national star ratings is 4.17. the goal is to at least make sure you have a plan four stars or higher. the satisfaction of the quality performance as well as the funding from the federal government, the higher the star rating, the higher the funding.

kpsa is one of only 20 contracts. only 20 or 5% of those contracts received a five-star rating for 2020 and that includes kpsa. national p.p.o. plans have a more difficult time achieving a five-star rating just because of the national nature of the program and the need for information on member health and conditions to be known, which it doesn't always happen if members don't either see a physician in a year or in the case of the u.s.c. plan get a house call. any questions about quality

measures for medicare advantage? >> did i understand you to say that the reimbursement from the federal government to the h.m.o. plans is somewhat improved by the higher the star for the same diagnosis or diagnostic group, they may get reimbursed a little better, you have five stars, as opposed to three stars? >> that is correct. the higher the star rating, the more there is the membership. the goal is to maximize what portion of that revenue is being generated through the federal p.m.f. subsidies. the remainder is when i present

to you on the premiums, that is after the federal subsidies from applied. >> since a high-level government official just accused the medical profession of fraud in their building, are these plans all subjected to the same anti-fraud activities to make sure that indeed the data they provide that generates the five-star information is, in fact, valid? >> one of the deep dives we plan to do is into the quality because when we talk about value-based payments, that is what we're talking about, the whole shift of payment mechanisms is shifted away from

fee for service outcome and the instruments are important on that. certainly the federal government has a very large compliance division that looks very carefully across the board on all c.m.s. charges that come in. >> thank you. >> i have a question about that. >> just go ahead. >> if the doctors have a plan to get reimbursed by the government, as you're saying, does that mean the doctors get more for their services? because part of the problem as i see it is, yeah, they offer all these coordination of cares, but now there's a shortage of primary care doctors because they're getting paid so poorly. >> and i think we're at an

inflection point where that is starting to change, where physician practices to local i.p.a.s are very much working in the direction and we're building that into some of our contracts is their ability to perform by quality measures, some of which c.m.s. is asking and some of which are the institute for healthcare association and -- in california, this is a heavy lift to move the needle to go in this direction. c.m.s. has taken the lead to determine what those quality metrics are and determining their ability to comply and over time this trickles down the system.

>> i have an example and when i saw what they got reimbursed, it was sorry. i don't even know why they would take the plan. it was 24-hour care and people right there all the time. and to see how little they were reimbursed was kind of shocking to me. we have to be careful and this can be part of the discussion. all the federal government can do is reimburse those using electronic billing better. but the federal government can't monitor quality from individual providers.

the reimburse for these providers and e.r.s and all of that is something that is negotiated not directly with the federal government but with the various health plans or insurance companies. is that fair to say? >> yes, i would like to ask my colleague if he can comment. >> sure, mike. can you hear me? >> yes, we can. >> so the general rule, the health plans, the medicare advantage plans, are going to reimburse the providers something close to what traditional medicare would pay the providers directly. so those reimbursements from a medicare advantage plan can be

below medicare, at medicare, or above medicare, but they tend to hover around the fee schedule and not deviate too significantly from the base line that is accepted by the provider community. >> well, what i have seen in my personal doctors and physical therapists, which is a big deal for me is that they will accept medicare and not medicare advantage because medicare advantage is reimbursed so poorly. i've seen this, where the

doctors will not accept medicare advantage for that reason. >> that's not surprising here. there are different specialties that can be reimbursed differently for various reasons by different health plans. i think what you're saying is not surprising. we would absolutely agree that that happens. by and large if this plan is used as the base line, and they may pay a little bit below or above. and there will be chances for bonus reimbursements for data sharing, for certain positive outcomes as determined by the medicare advantage plan and as governed by c.m.s. this can be a complicated area, but we're not surprised there will be anecdotes out there.

>> this is the reason most won't take an h.m.o., the well-qualified ones. that's the way it is. >> maybe, mike, you can continue with your presentation so we can stay on schedule a little bit. >> commissioner scott, did you have a question or a clarification? >> no, nothing at all. go right ahead. >> thank you. i will proceed. this chart highlights different types of medicare advantage plans. we discussed them, a combination of local, regional, national

pp.o.s so you can see the distinction on these plans from the spectrum of low to high on the left side to the level of care management and restrictions which are highest for h.m.o.s and juxtaposed with cost management opportunity, which is higher in terms of an overall opportunity on the national p.p.o p.p.o.s. just some further information on these programs. building provider relationship and improving member help. plan sponsors who commit to this

advantage should consider this approach. what we often find is those competitive business can result in 20% to 50% savings relative to let's say if current plans are supplements or c.o.b. type of plans for these reasons listed in this chart. >> [indiscernible]. >> we have one page on covid-19 impacts. the revenue for 2021 came in slightly lower than expectations, just unrelated to covid. the health insurance tax

relieved some of the pressure. we saw that under u.m.c. renewal. what is expected going forward is in the short term there may be a lowering of premiums versus what they otherwise may have been and we've seen that in the u.h.c. renewal, a decrease for 2021, a very small increase for 2022. the importance here is how the riskers are sustained. we'll be keeping an eye on the

covid impacts as we see how future c.m.s. forecast may affect 202 and beyond rates. so where i want to close is talking you through considerations in the 2023 plan year. that's where we started and certainly welcome any feedback, based on what we talked through here today and any early commissioner thoughts on this concept, engaging an r.f.p. next year for the 2023 plan year. today we want to accomplish a review for the medicare offering. we want to discuss general medicare offerings and provide key information on the different counties.

we want to talk on expected covid-19-related pandemic impacts. for my final slide, just reinforcing that today's discussion will guide the consideration coming up from now to the main june time frame of next year. thank you for your interactions and your comments throughout. i'll turn it over to you, president. >> chair: thank you very much. i see there is a question or a comment. in the interest of time, i want to make sure that the questions or comments deal with the broader issues and a particular vendor or something.

>> my question is do we have any sense of how the hearing before the supreme court with regard to the a.c.a. will impact any of the presentations that we've had so far? can we speculate or not? >> i prefer not to at this time. i'm not really prepared to make those remarks. >> i think there are a lot of questions about the age or eligibility for healthcare may drop to 60. i think we should leave these questions to see what happens on the political agenda side, but the issues that are important will have to be built into our fees how they adapt to the change in the national political scene on the medicare question.

but that is an important question, but it needs to be deferred. >> thank you. >> chair: any other questions or comments? hearing none, we would like to go ahead and open this up for public comment. again, this is an information item. >> thank you, president. i'll be giving instructions for public comment. public comment is available for each item on the vend. each speaker will be allowed three minutes to comment. the dial-in number is streaming across the screen. public comment is available by

dialling 415-655-0001 and entering access code 146 668 4901. again, 146 668 4901. and pressing pound and pound again. you will then enter the meeting as an attendee on the public comment. before we begin, we will take a 30-second pause to allow callers to dial in using the information that is on the screen. after the pause, callers, if you've dialled in and wish to speak on these items specifically, please dial star 3 now to be added to the queue. when the system says you've been unmuted, this is your time to speak. for those already on hold, please wait until the commission says you have been unmuted. when the commissioner says "welcome caller," you may speak. moderator, i will pass you the

host privileges. please let me know if there are any callers who wish to comment on this item. >> operator: thank you, board secretary. we have nine callers on the phone at this time and zero callers have entered the queue. a reminder to callers, you must dial star 3 now if you want to join for this specific agenda item. we will wait for a few second and then close public comment for this agenda item. >> clerk: public comment is now closed, seeing no callers in the queue. >> chair: i want to thank you for your presentation. still lots of unanswered

questions. i want to thank everyone who is listening in on this to continue their own education about this market, that you are an important component to these reflections as we move forward. so i want to thank all of you for listening in on that. with that, i would like to call the next agenda item. >> clerk: thank you. agenda item number 10, report on blue shield infertility and pharmacy benefits process improvement. this is a discussion item. this will be presented by shawn lovering, and i will pass over presenting privileges now. >> thank you.

is -- good afternoon, commissioners. i'm shawn lovering and i have responsibilities for the services account at blue shield of california. i'm here to provide you an update on the infertility processes that were presented on in june. so as we talked about back in june, through our research we discovered we had several operational gaps around benefit interpretation and the authorization process. effective 11-1-2020, we streamlined the process. we removed the authorization and requirement of a diagnosis of infertility. we felt this would greatly

improve access to services, remove administrative barriers for members and physicians, and allow members to access services according to their cycle and timeline, not ours. so by removing all these barriers, members will enjoy a much more streamlined process and not having to have the headaches of prior authorization and getting their services in the given time that the authorization is effective, and be able to have a much more streamlined process. we also engaged our provider partners to ensure accurate benefit interpretation and compliance. we've ensured that the benefits and services related to fertility are culturally compassionate and are in alignment with the health services goals. we've created access to an internal subject matter expert.

we continue through our concierge services to continue navigating and advocating for patients. we've also processed all claims of telephonic outreach to members who had their claims erroneously denied. on the medication part, the infertility access issue, when we looked at this and found the medications were covered under the medical benefit that caused a limited access to a select number of providers and patients had to either pay the full cost up front then bill blue shield of california. they were sometimes offered a lower price if they paid cash, so there was inconsistent pricing and they had difficulties getting their medication. what we did to alleviate the

concerns is we moved the infertility medications and they are now covered under the pharmacy benefit. this helped the patients obtain them at any pharmacy. we now have stable pricing with greatly improved discounts and we removed the prior authorization requirement for medications related to infertility, again to help streamline the process, make sure that members have access to the medications that they need at the times that they need them and don't have to wait any longer for their medications and they know up front what they're going to pay.

when we looked at the drug cost shares, what this means is infertility medications are still covered as a 50% coverage, simply because that is what the infertility meds are designed to be paid at according to the infertility underwriter currently in place. these medications now have access to a.w.p. pricing through c.b.s. specialty pharmacy, which greatly improved member access and cost share. we've done a soft transition to the pharmacy benefit coverage, beginning 11-1, and we have anticipated retirement of medical benefit coverage in 2021. so we'll now have -- members will have a greater stass, they'll have greater discount on their medications. and thoseaccess,

they'll have greater discount on their medications. and those with greater benefits through freedom pharmacy and the limited other areas they could obtain those locations will now be grandfathered over to the pharmacy benefit effective 1-1-2021. for those members not currently in a -- accessing their drugs through the medical plan, effective 11-1, they can now access those through the pharmacy plan. so we are very excited that we were able to work out this deal with c.b.s. specialty and provide additional access for members in this area. now i would like to answer any questions you may have. >> yes, commissioner. >> my question is when you

indicate that you reprocessed all denied claims, how far back did you go in terms of benefit [indiscernible] -- >> we went back to 1-1-2018 when the enhanced rider went into place. >> thank you very much. >> any other raised hands? >> this is commissioner scot. i would like to thank blue shield for taking what i think was a transformative step based upon member concerns, the issues raised. we had to go back and look at our board policy in this area. i thank you for your partnership and diligence over the last several months that has brought us to this place.

>> thank you, commissioner sc t scott. >> chair: if there are any other questions or comments -- that was a clear presentation and i also commend you because i think it takes people to respond to this in each of our health plans. and i think you were key in this. i think the whole health service system appreciates the responsiveness of key individuals. thank you. any other questions or comments? >> shawn has been a key person in creating organizational change. we all know how hard that is to do. >> thank you very much. thank you for adding that comment. >> chair: with that, i would like to open this up for public

comment because it is an information session as well. >> i will read out the instruction for public comment. public comment is available for each item on this agenda. each speaker will be allowed three minutes to comment. you need to dial 415-655-0001, again 415-655-0001, enter access code 146 668 4901. again, 146 668 4901. then press pound and pound again. you will then enter the meeting

on the public comment call line. before we begin public comment, we will take a 30-second pause to allow callers to dial in. if you wish to dial in and speak to these items, please remember to dial star 3 to be added to the public comment queue. when the system says your line has been unmuted, this is your chance to speak. please wait until the system indicates you've been unmuted. moderator, could you please let us know if there are any callers who wish to comment on this item. >> operator: we have seven callers on the line and one caller has entered the public comment queue at this time. other call irs may enter the

queue. i will elevate the first caller now. welcome, caller. >> good afternoon, commissioners. my name is erica may down and i come as a humble employee. i brought an attention an [indiscernible] -- of looking into and understanding the issue. while i think we were all thinking this experience was isolated, it became clear that this was experienced by a subset of members. it was also clear in addition to supporting members, that the policy change required in order to ensure equitable access.

i'm truly grateful for the work and dedication of director yants, the staff, and you, commissioners. this is true when i was relentless in my advocacy. to all the commissioners, this is priceless in terms of getting the policy closer to the finish line. for me, this has always been about the policy and the moral obligation of equity. i want you to know the decisions made on the policy have measurable impact and for some it will mean a difference between having a family or growing a family or not. this last july i welcomed a daughter and will share this as part of her story. i am proud of the commission and

our city, that you will continue to work to ensure employees have equal access to benefits. i was unable to determine the new costs [indiscernible] but i also think it's important for you to know the impact of your work on this decision. last year i spent $6,500 on meds alone and this was 100% an out-of-pocket cost. overcoming infertility is not a sense of [indiscernible], but you need to know that the

changes you're supporting will save members thousands of dollars and for some it will mean fulfilling the dream of having a family. my most humble thanks to you, commissioners, for hearing me out, prioritizing, and for not giving up until the issue was addressed. thank you so much. >> chair: thank you for that summary. thank you also to the rest of the commission to articulate the issues at every step. we didn't go too many times into the blind allies. you really helped address this issue for yourself and all health system members.

thank you for that. are there any other comments in the queue? clanchts we have seven callers on the call line and no additional callers have entered the queue. we will wait a few more seconds and officially close public comment for this item.

>> the hon. london breed: good afternoon, everyone. thank you so much for joining us here today. we're here with dr. grant colfax of the department of public health to provide a very important update around what's happening in san francisco as it relates to covid-19. as of today, the total number of cases in san francisco are 13,139. the total number of hospitalizations are 36. sadly, the total number of deaths has reached 151, and we are seeing 5,000, almost 6,000 tests per day. our positivity rate has went from a record low to now 1.28%,

and what does all this mean? we are seeing an uptick. two weeks ago, we put a pause on our reopening efforts, and we made it clear to the people of san francisco that we are seeing the number of cases increase, and we should be concerned. we had plans. we had plans not only to continue our reopening efforts, but we had planned to really expand so many services, so many businesses, and a number of other i think thisethings, o weeks ago, we knew we were probably headed in this direction, and sadly, what we're seeing today has put us in a situation where we have to take a moment and to recognize that there is a problem. the upticks that we have seen

are really a cause for concern, and it's put us in a situation where we have had to make yet another hard choice. san francisco has been praised over the past couple months around the number of cases, our testing capacity and positivity rate and having one of the lowest number of cases in the country, but that's only because many of have been very cooperative and have supported the efforts that we put forward. and unfortunately, you know, we've been in this for a long time now, and people are tired, and so people have gotten complacent, and as a result, because of behavior, we're seeing an uptick. and as a result of that uptick, it has forced our city to make some very, very hard decisions,

and not just pause the reopening efforts, but to, in fact, roll back some of the gains that we have made. so sadly, beginning the end of the day friday, we will need to eliminate indoor dining, we will need to reduce capacity as gyms and movie theaters. we will be putting a pause on opening additional high schools, and so there are a number of things that, unfortunately, we will now need to do as a result of this. and dr. colfax will talk a little bit more about what that entails why we are in a place of doing something that i wish we didn't have to do, because i

understand, especially as the weather gets colder and it's the holiday season, and people are starting to hire back their employees and purchase food and get prepared, that this is having a tremendous impact on so many businesses and, in particular, the restaurant industry in san francisco. i understand that, you know, we're not making any roll backs on any elementary or any middle schools because what we know about high schools is, unfortunately, the transmission rate is similar to adults, so we need to put a pause on opening high schools, but it doesn't mean we shouldn't move forward and get our elementary and middle schools open as soon as possible.

in fact, we know that the board of education has plans to vote on a resolution to get our schools back open sooner rather than later. we are committed as a city to work with them to do just that. this concern around this uptick does not mean that we cannot still move in a direction to get our schools open sooner rather than later. we also know that, again, some of our cibusinesses are struggling, and we can't do it alone. just recently, we put out some information around providing some additional support for our restaurants. $2.5 million in fee and tax waivers, $1 million in grants to restaurants to support

outdoor dining, and we're redirecting the $3,500,000 interest s.f. help loans towards low and moderate income residents. we know that help is needed, we can't do it alone. this is why i wholeheartedly support the restaurant act, h.r. 107, which will support investing $20 billion in restaurants in this country. we need to do more, but the fact is the virus is spreading, and we have to make the hard decisions. the good news is that we have a new president and a new vice president, and we just heard the good news yesterday that we made progress on the vaccine, but those things aren't going to help us today with what we're seeing. they're going to help us for the future, but for now, we have to make sure that we're protecting and saving lives

here in the city right now. it's a very hard thing to think about just what impact this is going to have on the people of san francisco. when making these decisions, we don't take them lightly. we look at the science, we look at the data. we think about every single restaurant and every single school and every single business that has not collected any revenue whatsoever since this pandemic began. we understand cthat challenges exist, and it's why we've continued to recavamp our jobs now program to pay for employees, and deferred and even waived city fees, and we will continue to work to do as much as we can, and like i said, we're not going to do it alone. we're going to count on the decisions made in washington to

provide some additional support that could help put us in a better place. but for now, we have to do what's necessary to protect the people of san francisco. and so when there are people who are out, not wearing their masks and not following the public health orders and doing things that, sadly, spread the virus, then it causes us additional delays on our reopening efforts. when i think about, you know, what's been happening as it relates to the virus, we know that in the past, we talk about the disproportional impacts with particularly the latino community. we made a record $28 million investment to try and curb that, and the good news is we're seeing the numbers change slightly. so we are seeing is more impact

by the virus. we're seeing people hanging out at the bars and some of the places, and we're seeing masks coming off and people who are getting comfortable and complacent. this virus definitely reacts to behavior that does not follow the suggested public health guidelines around mask wearing and social distancing, and so we know that we're going to have to change our behavior as we come possible the holiday season. we know that people are going to want to get together, families and friends, and it's a little bit colder outside, so people are going to want to be -- they're going to want to be indoors, and so we're going to have to think about how that's going to impact this virus and its ability to move around. the hard choices that we make now will help make things better in the future.

it will get our city open, it will get our businesses open, it will get our kids back in school faster, so we have to continue to make the hard choices. i know that the people of this city are tired of me asking so much of you. time and time again, i've come out here and have asked you things that make it very, very difficult for you in your life, whether it's taking care of your children, your elderly parent, or even going to work, but we need everyone's cooperation, we need everyone's support. we know this has not been easy. we know it's not been easy for so many people for so long, and we didn't think we'd be in the midst of a pandemic as long as we are. we're seeing places like europe, where they've had to roll back their reopening efforts. we've seen upticks all over the country, not just san francisco.

and the reason why -- and so many of you have been understanding, and you've cooperated. so i want to thank you for doing that, but we are asking for a lot more, i know. and as we approach the holiday season, we need everyone to be mindful as to what is at stake. making a decision to support opening a business and then asking that business to close, it is heartbreaking. it is very, very unfortunate, but it is necessary, and the way that we make sure that this does not continue to happen is if we realize that the possibility of rolling back even more could happen if we don't change our behavior. so sadly, we are at a different

place. i'm hopeful that we are going to have a president and vice president that is already working on a covid response and a national response around wearing masks and doing what's necessary in order to get this country through this because even if san francisco is doing well, it means nothing if everyone else isn't. think about this holiday season and people traveling and moving around more. that could potentially spread the virus, so we're asking people not to do unnecessary traveling at this time because we really want to get this undercontrol under control so next year, we're able to do exactly what we want, and that's celebrate with one another. we're asking you to sacrifice so we can get back to life as we know it. this is hard, yes, but it's

necessary. i want to thank you again for your cooperation and understanding. this is really tough to put a pause and to hold back some of the things. i know how hard this is to do, especially with reopening businesses and things that people were preparing for, and the cost of that preparation. we're going to do everything-- continue to do everything we can as a city to make sure we support our communities and our businesses and our schools and our families. it is a hard, long road, but we're going to get through this. a vaccine is inevitable, but

it's not here yet. so at this time, to provide clarity around the data and what it means and to provide specifically detail around what will open and what will be paused right now, the director of the department of public health, dr. grant colfax.

>> good afternoon. dr. grant colfax, director of public health for the city and county of san francisco, and thank you, mayor breed. as always, we are fortunate as a city to have your leadership and tenacity. today, we are unfortunately taking a step back. we are taking a step back to ensure that we can move forward in the future. if we take these steps today, we can mitigate the spread of the virus and, in the long run, we will be safer and stronger. but this is difficult, and this is a sacrifice.

we are halting indoor dining, pausing on in-person learning at additional high schools, and reducing the capacity of some indoor activities. this is because the spread of the virus is aggressive and threatening. let me do a deep dive to show you where we are, and where we could be headed if we do not take these aggressive steps. our cases in san francisco have been increasing dramatically over the last month. we have seen cases increase, as shown in this slide, by 250% since early october, and, in the past two weeks, from october 21 through november 5, our rate has increased from 3.7 per 100,000 people to 9 per

100,000 residents. we are averaging nearly 80 new cases a day now, up from just 32 new cases at the end of october, and this is consistent, unfortunately, with what we are seeing across california and across the bay area region. in fact, while california still remains in much better shape in terms of case increases compared to the rest of the nation, california has seen a 29% increase in cases in the past two weeks. so where may we be headed if we do not reverse this trend? let's go to the next slide. this shows how cases are increasing, and the projection

for those cases. so you can see on this slide that we're in a position where cases have increased dramatically. our reproductive rate of the virus, that rate which the virus spread through the community, has increased above 1, meaning cases will continue to increase dramatically in the future. as you can see, we will go up to over 300 cases a day by late december if this increase continues, a sharp, rapid increase in cases. reproductive rate above 1, remember, that means that the virus is rapidly spreading through our community. let's go to the next slide. so our current level of increase is greater than the

last surge. this suggests much greater transmission and has the potential to be explosive. the orange line here shows what happened this summer, when we had that summer surge of the virus. we peaked in our cases on july 19, but again, as this slide indicates, we are on track to exceed the surge in the summer as our current cases show -- are shown here in blue. so that blue line indicates since july 25. that summer surge is imposed on the orange line, at the beginning of that summer surge, june 15 to june 30. the point is not only this increase that we're having now

in this fall surge commensurate with this increase. this means if we do not turn this around, our fall surge will exceed our summer surge. if we stay on our current course of activities, if we do not pause, and we do not reverse, it is entirely plausible that we will face a situation where our health care system could become overwhelmed and reverse the community progress that we've made all these many months. therefore -- next slide -- our action today will limit indoor activities. we will close indoor dining and

bars serving food 11:59 fridfridap.m. friday -- this friday. we will also close -- we will also limit -- can i have the next slide, please? i think there's a next slide here. yes. we will also pause the opening of more high schools and restaurants and movie theaters. schoo high schools already open wi high schools that are open at this time will be allowed to stay open, and elementary and middle schools will be allowed to continue open, but high

schools that are not open at this time will be paused as we determine our next steps in possible reopening or even a further restriction of activities. i also wanted to discuss the holiday season, which is quickly approaching, and we need to remember that the virus is not only still with us, but there is more around than ever before. the virus, unfortunately, has no boundaries, no limit, and unfortunately, it certainly does not have a holiday schedule. today's announcement goes a long way in making sure that we will have a much healthier holiday season. as we move into these holiday months, we are maintaining our focus on our hospital capacity and ensuring san franciscans can receive the care that they need during this holiday

season. and we want to do everything we can to avoid reinstating a shelter in place order that would unfortunately shut our city down for the holidays. and even if we beat back the rapid and aggressive spread of covid-19 that is currently racing through our city, we must continue to act with caution and diligence during this holiday season. this means following the principles and guidelines that i have been sharing with all of you since the beginning of the covid-19 response. and i know that these messages continue to remain demeaning, but we have to continue to beat

back the virus. for the holidays, our guidance includes the following. traveling outside the bay area increases your chance of getting the virus and spreading it upon your return. nonessential travel, including holiday travel, is not recommended. additional precautions must be taken when hosting and interacting with people who are traveling to the bay area, especially from other communities with widespread covid-19. wear face masks and stay 6 feet away from people outside your immediate household, and that includes family members who are not in your immediate household. eating and drinking together is higher risk because people must takeoff their masks to eat and drink. restaurants are often relaxed

around social distancing, while eating and drinking create more respirato respiratory droplets. please, have that holiday meal in person only with the ones you live with. join your family over the holidays on zoom, on teams, on the phone. this is not the year to pull together a big holiday table with multiple households, multiple members of your family indoors, potentially spreading the virus to your loved ones. if you do have a holiday dinner or gathering, please, it must be outside. people must say 6 feet apart and wear masks, and please, use caution when actively eating or drinking. now, i know this is not how we imagine -- this is not how i

imagine this holiday season, but unfortunately it is the holiday season we need to have this year top truly show the people that we care and to protect the people we love how to keep ourselves, our families, our friends, our communities safe. we need to protect our aging parents or grandparents, and this can only happen with caution and diligence that includes that masking and that social distancing and limiting interactions. but everyone needs to do this part, and do it with caution and care. we will get through this together, and i continue to thank all of you in san francisco for doing your part.

thank you. >> operator: at this time, we have a few health related questions for you when you are ready. the first set of questions are from alex bareireira. are the numbers today from business openings attributed to these activities? >> so we are taking a break from reopening based on the science, data, and facts on the most risky. we know that the virus is likely to be transmitted indoors where people take their

masks off, so the decision -- the difficult decision that we made today is based on the data that we know how the virus is spread, and that those activities increase the risk. we also know that the virus is more likely to be transmitted in large groups or gatherings, which is another reason why we've reduced the limit on gatherings today. >> operator: thank you. the next question comes from gerald chin, san francisco bay. does the city expect the state to put the san francisco back in strict [inaudible]. >> so what we're responding to is the local date on that we have, and as -- data, that we have, and as you saw, i just showed the recent data, you saw the slides. we are going to continue to watch the state, we expect the

state will shift us to another tier, but we need to move fast here. we need to look at our local information, and that's why we're responding so quickly right here. you saw that that rate of increase. that increase is very concerning, particularly the fact that it exceeds the rate of increase that we saw at that summer surge, so we need to act to turn the tide now on this fall surge. >> operator: there are no further questions, and this concludes the press conference. thank you, mayor breed, and dr. colfax.

?oo hi, i'm holly lee. i love cooking and you are watching quick bites. san francisco is a foodie town. we san franciscoans love our food and desserts are no exceptions. there are places that specialize in any and every dessert your heart desires, from hand made ice cream to organic cakes, artisan chocolate and cupcakes galore, the options are endless. anyone out there with a sweet tooth? then i have a great stop for you. i've been searching high and low for some great cookies and the buzz around town that anthony's are those cookies. with rave reviews like this i have to experience these cookies for myself and see what

the fuss was all about. so let's see. while attending san francisco state university as an accountinging major, anthony's friend jokingly suggested he make cookies to make ends make. with no formal culinary training he opened his own bakery and is now the no. 1 producer of gourmet cookies in the biarea and thank you for joining us on quick bites. how do you feel? >> i feel great. >> so i want to get to the bottom of some very burning questions. why cookies? >> it was a recommendation from a friend. hard to believe that's how it all started. >> why not pies and cakes? what do you have against pies

and cakes, anthony. >> i have nothing against pies and cakes. however, that was the recommendation. >> you were on the road to be an account apblt. >> actually, an engineer. >> even better. and it led to making cookies. >> in delicious ways. >> delicious ways. >> this is where the magic goes down and we're going to be getting to the truth behind cookies and cream. >> this is what is behind cookies and cream. >> where were you when the idea came to your mind. >> i was in my apartment

eating ice cream, cookies and cream ice cream. how much fun, cookies and cream cookies. their cookies and cream is not even -- it took a lot of time, a lot of fun. >> a lot of butter. >> a lot, a lot, a lot. but it was one of those things. all right, now behold. you know what that is? >> what is that? >> cookies and cream. >> oh, they are beautiful. >> yes, so we got to get --. >> all right, all right. we treat the cookies like wine tasting. i don't ever want anybody to bite into a cookie and not get what they want to

get. we're training staff because they can look at the cookie and tell if it's wrong. >> oh, here we go. >> you smell it and then you taste it, clean the plat palate with the milk. >> i could be a professional painter because i know how to do this. >> i can tell that it's a really nice shell, that nice crunch. >> but inside. >> oh, my god. so you are going to -- cheat a little bit. i had to give you a heads up on that. >> what's happening tomorrow? these cookies, there's a lot of love in these cookies. i don't know how else to say it. it really just makes me so happy. man, you bake a mean cookie, anthony. >> i know. people really know

if they are getting something made with love. >> aww >> you know, you can't fool people. they know if you are taking shortcuts here and there. they can eat something and tell the care that went into it. they get what they expect. >> uh-huh. >> system development and things like that. >> sounds so technical. >> i'm an engineer. >> that's right, that's right. cookies are so good, drove all other thoughts out of my head. thank you for taking time out it talk to us about what you do and the love with which you do it. we appreciate your time here on quick bites.

i hope you've enjoyed our delicious tale of defendant 93 and dessert. as for me, my search is over. those reviews did not lie. in fact, i'm thinking of one of my very own. some things you just have it experience for yourself. to learn more about anthony's cookies, visit him on the web at anthoniescookies.com. if you want to watch some of our other episodes at sfquickbites/tumbler.com. see >> announcer: you're watching "coping with covid-19." today's special guest is dr. steven getnick. >> hi, i'm chris man us and you're watching "coping with

covid-19." today my guest is the director of the behavior therapy center of san francisco and professor emeritus in counseling psychology at the university of san francisco. doctor, welcome to the show. >> thank you. >> let's talk about managing anxieties during this pandemic. what types of issues are people facing at the moment? >> there are a number of issues and i really want to point out that this is affecting everyone and has come on very quickly. so it is normal. if you are not experiencing some anxiety, something is a touch off because this affects us all. i think some of the main ones are our health and worried about getting the virus and our developing serious complications. i think for a lot of people who are single, living alone, in

isolation, has been very difficult. i think being in close quarters with people who we normally have some space from now are together 24/7. that's produced a lot of stress and anxiety. that loss of connection with others. we already addressed. and having kids home. for a lot of people. >> yes, absolutely. what are the other problems that they might have? >> i think without that dynamic, the good things are not a problem. it is the difficulties we have. and when we're together 24/7, again it's like hooking everything up to an amplifier. >> so, what kind of problems could be created from working home from home, perhaps for the first time in your career? >> a lot of people are not used to working at home and a working at home just isn't the

same. for one thing, there is a lack of social interaction. some people find that that affects them greatly. some people are actually finding they're getting more work done at home without distractions from work. the lack of structure is probably the most common. we see it here with work at the office. people are kind of watching. we know that our schedule is, suddenly you're at home and you are on your own. >> absolutely. if those are some of the issues people are facing, what are some of the techniques people can use to overcome their anxiety? >> caller: i think there are many. one of the first is how managing and keeping track of your thinking, we think and talk to ourselves a lot. that's normal. we have a dialogue with ourselves often and we need to monitor that a bit. people tend to ruminate versus problem-solve.

that is they tend to worry about all the things that might go wrong. and what i suggest is, look, there are things that can go wrong, but ruminating about the worst-case scenario is not going to be very productive. sit down, figure out what the things are that you have to deal with and try to problem-solve. i think any of the self-control techniques for anxiety can be helpful. and there are dozens of them. the common ones are meditation, relaxation techniques, yoga, for example and another is diaphragmattic breathing. if you google that, you can learn diaphragmattic breathing in about 10 minutes online. it's incredibly simple and it is a really nice way to reduce

anxiety in the moment. self-control procedures, exercise. whether if you're fortunate enough to have equipment at home, that's great. if you're not, get outside and go for a walk, keep your safe distance, of course. but you need to be active. that's helpful. >> i think people marry be dealing with information overload at the moment. how do you suggest people manage that? >> i was just going to say that. i think it is really important to kind of limit the information you get. not in terms of accuracy. i think in terms of accuracy, you want to identify a few sites where people are coming with evidence-based information and scientific information so you can form yourself well. once you've informed yourself, you need to not be watching all day long. i've talked to people who are mesmerized from the tv and a it

keeps that anxiety going so you need to limit your viewing for sure. this can be stress for people who have economic concerns and worried about their family and friends and loved ones who are essential workers. what would you suggest they do to help manage anxiety and stress? >> there is a number of things. one of major ones for depression is behavioral activation. simply, it really means that people will tend to not be depressed as a number of reinforcing activities to engage in. whether it is hobbies, you read, you listen to music, you crochet, you -- whatever. these kinds of things are very important so you want to make sure that you're engaging in activities that literally make you feel better as opposed to sitting around ruminating, worrying about the worst-case

scenarios that might happen. >> what about trying to do some self-development? >> yeah. it's a very interesting time. i've talked to a couple of my own clients who are finding, in a very positive way, that this isolation, while at first can generate a lot of anxiety, particularly if you're just not good at living alone. for a number of people, it's giving them a chance to sit back and really think about what is important in their lives, what are the priorities. i think that maybe if there is any silver lining in this epidemic, it's really forcing all of us to kind of rethink what's really important. >> indeed. you know, though, at the same time, there are people who are feeling very lonely at home. how would you encourage them to overcome that? >> you get online. facetime, skype, zoom, like what we're doing right now. you can stay connected.

it's very possible. most connections are important. we are social critters and we need that connection. i think for people who don't have those options, pull up photos, take a look at pictures of family. you need to stay connected. and it's very important. >> and finally, do you have any suggestions that are specifically for families? >> yeah. well, again, i think one of the interesting things that's come about from all of this, is i talked to families on video is they're obviously spending more time together. while it's a bit awkward, particularly for parents who are in the house working a lot. it's a chance to really deepen relationships and spend more good, quality time together. i think parents really need to step back and kind of plan their day a little bit. not micro manage it, but have some ideas. can the family play games together?

a lot of people i talked to, they're even together as a family for the first time. so i think there are a number of things that people can do. i think it is qulaouzful for the families to take five, 10 minutes and say how did the day go? i talked to someone in the phone book before we started who said they noticed what time of day all their anxiety kind of comes together and they start sniping at each other. now they're taking a few minutes at tend of the day to say, ok, how are we doing? >> i think they need modeling good behavior, something you can do within the family, too, to try to -- >> that's right. i think that's relevant. very relevant to how children are going to do. most of the research from crises, particularly things we can't control showed that

children do as well as their parents do. so i think it is important for parents to think about how they're react aing and they stay calm because whatever they do is modeling, coping for their children. so, that can be very useful. it can also be problematic. >> when we talked earlier, you mentioned that acknowledging that your kids are afraid is important. >> yes. i think that ties to your last question. i think modeling -- you know, it's not incompatible with saying, yeah, you know, mom or dad is a little nervous, too. it means a lot of stuff is going on, but we're going to be ok. we're going to stay together. we have our time together. we're going to be safe. we'll -- fill in the blank. so you can do both. you can re-assure but in a realistic way that once the

kids know it's normal to be anxious in these times. >> thank you for coming ton show, doctor. i really appreciate the time you've given us. >> you're welcome. thank you for having me. >> and that is it for this episode. we'll be back with more covid-19 related information shortly. you have been "coping with covid-19." thank you for watching. >> how i really started my advocacy was through my own personal experiences with discrimination as a trans person. and when i came out as trans, you know, i experienced discrimination in the workplace. they refused to let me use the women's bathroom and fired me. there were so many barriers that other trans folks had in the workplace. and so when i finished college, i moved out to san francisco in the hopes of finding a safer

community. >> and also, i want to recognize our amazing trans advisory committee who advises our office as well as the mayor, so our transadvisory community members, if they could raise their hands and you could give a little love to them. [applause] >> thank you so much for your help. my leadership here at the office is engaging the mayor and leadership with our lgbt community. we also get to support, like, local policy and make sure that that is implemented, from

all-gender bathrooms to making sure that there's lgbt data collection across the city. get to do a lot of great events in trans awareness month. >> transgender people really need representation in politics of all kinds, and i'm so grateful for clair farley because she represents us so intelligently. >> i would like to take a moment of silence to honor all those folks that nicky mentioned that we've lost this year. >> i came out when i was 18 as trans and grew up as gay in missoula, montana. so as you can imagine, it wasn't the safest environment for lgbt folks. i had a pretty supportive

family. i have an identical twin, and so we really were able to support each other. once i moved away from home and started college, i was really able to recognize my own value and what i had to offer, and i think that for me was one of the biggest challenges is kind of facing so many barriers, even with all the privilege and access that i had. it was how can i make sure that i transform those challenges into really helping other people. we're celebrating transgender awareness month, and within that, we recognize transgender day of remembrance, which is a memorial of those that we have lost due to transgender violence, which within the last year, 2019, we've lost 22 transgender folks. think all but one are transgender women of color who have been murdered across the

country. i think it's important because we get to lift up their stories, and bring attention to the attacks and violence that are still taking place. we push back against washington. that kind of impact is starting to impact trans black folks, so it's important for our office to advocate and recognize, and come together and really remember our strength and resilience. as the only acting director of a city department in the country, i feel like there's a lot of pressure, but working through my own challenges and barriers and even my own self-doubt, i think i've been try to remember that the action

is about helping our community, whether that's making sure the community is housed, making sure they have access to health care, and using kind of my access and privilege to make change. >> i would like to say something about clair farley. she has really inspired me. i was a nurse and became disabled. before i transitioned and after i transitioned, i didn't know what i wanted to do. i'm back at college, and clair farley has really impressed on me to have a voice and to have agency, you have to have an education. >> mayor breed has led this effort. she made a $2.3 million investment into trans homes, and she spear headed this effort in partnership with my office and tony, and we're so proud to have a mayor who continues to commit and really make sure that everyone in this city can thrive.

>> our community has the most resources, and i'm very happy to be here and to have a place finally to call home. thank you. [applause] >> one, two, three. [applause] >> even in those moments when i do feel kind of alone or unseen or doubt myself, i take a look at the community and the power of the supportive allies that are at the table that really help me to push past that. being yourself, it's the word of wisdom i would give anyone. surely be patient with yourself and your dream. knowing that love, you may not always feel that from your family around you, but you can

[♪] [♪] >> so i grew up in cambridge, massachusetts and i was very fortunate to meet my future wife, now my wife while we were both attending graduate school at m.i.t., studying urban planning. so this is her hometown. so, we fell in love and moved to her city. [♪]

[♪] >> i was introduced to this part of town while working on a campaign for gavin, who is running for mayor. i was one of the organizers out here and i met the people and i fell in love with them in the neighborhood. so it also was a place in the city that at the time that i could afford to buy a home and i wanted to own my own home. this is where we laid down our roots like many people in this neighborhood and we started our family and this is where we are going to be. i mean we are the part of san francisco. it's the two neighborhoods with the most children under the age of 18. everybody likes to talk about how san francisco is not family-friendly, there are not a lot of children and families. we have predominately single family homes. as i said, people move here to

buy their first home, maybe with multiple family members or multiple families in the same home and they laid down their roots. [♪] >> it's different because again, we have little small storefronts. we don't have light industrial space or space where you can build high-rises or large office buildings. so the tech boom will never hit our neighborhood in that way when it comes to jobs. >> turkey, cheddar, avocado, lettuce and mayo, and little bit of mustard. that's my usual. >> mike is the owner, born and bred in the neighborhood. he worked in the drugstore

forever. he saved his money and opened up his own spot. we're always going to support home grown businesses and he spent generations living in this part of town, focusing on the family, and the vibe is great and people feel at home. it's like a little community gathering spot. >> this is the part of the city with a small town feel. a lot of mom and pop businesses, a lot of family run businesses. there is a conversation on whether starbucks would come in. i think there are some people that would embrace that. i think there are others that would prefer that not to be. i think we moved beyond that conversation. i think where we are now, we really want to enhance and embrace and encourage the businesses and small businesses that we have here. in fact, it's more of a mom and

pop style business. i think at the end of the day, what we're really trying to do is encourage and embrace the diversity and enhance that diversity of businesses we already have. we're the only supervisor in the city that has a permanent district office. a lot of folks use cafes or use offices or different places, but i want out and was able to raise money and open up a spot that we could pay for. i'm very fortunate to have that. >> hi, good to see you. just wanted to say hi, hi to the owner, see how he's doing. everything okay? >> yeah. >> good. >> we spend the entire day in the district so we can talk to constituents and talk to small businesses. we put money in the budget so

you guys could be out here. this is like a commercial corridor, so they focus on cleaning the streets and it made a significant impact as you can see. what an improvement it has made to have you guys out here. >> for sure. >> we have a significantly diverse neighborhood and population. so i think that's the richness of the mission and it always has been. it's what made me fall in love with this neighborhood and why i love it so much.

and supervisor walton, our clerk is john carroll and i, of course, want to thank the folks at sfg tv for staffing this meeting, as well as board of supervisors operations it for their hard work. mr. clerk, do you have any announcements? >> yes, thank you very much, mr. chair. in order to protect the public, board members and city employees during the covid-19 health emergency, the room is closed. this is taken pursuant to all various local and state federal orders, declarations and directives. committee members will attend this meeting through video conference and participate in the meeting to the same extent as if they were physically