follansbee. we went through agenda item number one and will be going through item number two which is roll call. and roll call. [roll call] vice president chris canning will be arriving around 1:30. [roll call] >> president follansbee: great. if we can have then -- we have a quorum and move on to item number three. >> commissioner: could i ask just one question? has anybody appointed the supervisor to our board yet?

>> president follansbee: no. not yet. >> commissioner: okay. thank you. >> clerk: okay. agenda item three is the approval with possible modifications of the meetings set forth below. this is an action item. >> president follansbee: so i'd like to open up the discussion to commissioners for modifications, corrections, submissions to the meetingen minutes which we've seen draft form march 11, 2021. >> commissioner: i think i sent a typo. that was the only thing i found. >> president follansbee: thank you. >> commissioner: i move that the minutes be adopted with any edits that have been forwarded. >> commissioner: second. >> commissioner: second. >> president follansbee: so moved and seconded. i'd like to open this up to public comment. >> clerk: thank you, president follansbee. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems new public

comment time limits during the meeting. all public comments are to be made on the agenda item that has been presented. as a reminder, the caller may ask of the policy body but there's no engagement for the commissioners to answer. when your three minutes have ended. you'll be placed back on mute and the moderator will move to the next caller. opportunities to speak during the public comment period are available by dialling the number on the screen. the dial-in number is (415) 655-0001. when prompted, you'll use access code 1872965890. 1872965890. then press pound and pound again. you will enter the meeting as an attendee on the public call line. when the system message reads your line has been unmuted,

this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sfgov tv has a standing forty-second delay. we will take a forty-second pause to allow assistants to catch up and callers to dial in. our 40 seconds begins now.

our 40 seconds has ended. our moderator will now let us know if there are any callers in the queue. >> we have six callers on the phone line. zero callers have specifically entered the public comment queue at this time. to remind all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda item. secretary, if you can pass me privileges, we will wait 5 more seconds and close public comment on this agenda item.

board secretary, there are still no callers in the public comment queue at this time. >> secretary: thank you, moderator. hearing no more callers. public comment is now closed. >> president follansbee: thank you very much. i now would like to call for a vote on approval of the minutes of the march 11th, 2021, health service board meeting with modifications as listed. all those in favor say aye. >> commissioner: aye. >> commissioner: aye. >> president follansbee: opposed. thank you. it carries unanimously. i'd like to move to agenda item number four. before holly announces it, i'd like to remind the public that this is the merging of two previous agenda items. this is the third month we've now combined the opportunity for public to comment on any matter within the board's jurisdiction as well. it's requested that the board place a matter on the future

agenda. this will be done to this agenda item. thank you, holly. >> secretary: thank you, president follansbee. this is agenda item number 4. general public comment. including anything that is not on the agenda or requesting that the board place an item on the future agenda. this is a discussion item. >> president follansbee: let's go ahead and open this up for public comment then. >> secretary: thank you, president follansbee. public comment will be available for each item on this agenda. each speaker is allowed three minutes in length to comment unless the board president deems new public comment time limits during the meeting. all public comments are to be made curbing the agenda item that has been listed. callers may ask the. when i welcome you on the call, you're encouraged to state your name clearly although you may remain anonymous. when your 3 minutes have ended, i will thank you for your

comment and place you back on mute. results are available at sfgovtv.org and sfgov channel 2. opportunities to speak during the public comment period are available by dialling the number on your screen. that number is (415) 655-0001. when prompted, please use the access code 187 296 5890. once again 187 296 5890. then press pound and pound again. you'll enter the meeting as an attendee on the public call line. dial star 3 and when the system message reads, your line has been unmuted. this is your time to speak. for those on hold, please wait until the system indicates you have been unmuted. sfgov tv has a standing 45 second delay for viewers watching live. we will take that 45-second

pause to allow assistants to catch up and callers to dial in. that 45 seconds begins now.

the 45-second pause has ended and our moderator will notify us if there are any callers in the queue. >> thank you, secretary. looks like we have six callers on the phone line, zero of which have entered into the public queue. you must dial star 3 now if you want to join public comment for this specific agenda item. we will wait 5 more seconds and then close public comment for this agenda item. board secretary, there is still no callers in the public queue at this time. >> secretary: thank you, moderator. hearing no further callers. public comment is closed. >> president follansbee: thank you. so let's move on to agenda item number five. >> secretary: agenda item 5 is the president's report and this

is a discussion item. >> president follansbee: i essentially have no report. at this point, the president of the board of supervisors has not appointed the charter mandated seventh member for the health service board. so we are waiting her appointment at this time. i have really no other items to -- on my report. so i think that we can probably dispense with public comment since there's no report. if that's the case, we'll move on to agenda item number six. >> secretary: okay. agenda item number six is the director's report and this is a discussion item. >> good afternoon, commissioners. can you hear me? >> yes. >> great.

director's report this month and i will again, just give a highlight which is that the audit activities of 2020 and the plans for 2021 as you may recall when we brought this before you last year was a new function for the agency to formalize what our audit program was and we did a few audits last year and a no significant findings but did reflect on the process we had used and did some homework. it was helpful to have larry woo as our new cfo with some of the audits done by other regulatory agencies. we learned quite a bit about that and don't want to use our resources to duplicate what is done by other agencies. however, we can and will do a

more robust job of monitoring those reports as all those public reports come out from those other regulatory bodies. i think that will be informative for all of us. and then that would allow us to be more focused on our efforts and since we are bringing on a new plan, there is a preimplementation on it that we will be conducting. so it seems very timely that we have developed this and are learning from our experiences and adjusting to what's best for us at this time. and, as you know, the new health plan offering with health net canopy and blue shield is the administer p.p.o.

with the accolade. we've had a very robust kickoff meeting with various entities and our engaging in those plans and developing those new relationships as they dove tail immediately with our open enrollment planning activities that mitchell gregson is team lead for the organization. on covid-19 update, i think we're all very pleased with the fact that there's a growing number of us that are receiving vaccines. we're still in a little bit of a lull for the remainder of this month as i understand it and that the vaccine distribution quantity of the vaccine will significantly increase in may. we are at a pivotal point, however. you have seen that there some major outbreaks across the

united states, michigan being one of the hardest hit. we're fairly suppressed at this point in san francisco, but the numbers are not going down at this point. they are plateauing. they're just very small creeping upwards so we're cautiously optimistic that the vaccine administration will get ahead of the disease, but it's kind of a critical time in the city and the state with our very robust re-opening plans which have a lot of advantages and they also have worrisome risks. it's a difficult time for us, but we're remaining optimistic that we'll get ahead of the curve with the adequacy of the vaccine being available, distributed and i can't say loud enough how we all need to

encourage everyone that we have any influence over to get the vaccine. and, i also wanted to point out, i did put in the report itself a hot link, commissioner scott, i had in mind when i added this, just last week, the department of health revamped their data reporting capabilities around vaccinations and really looking at the race, age, gender, neighborhoods. it's a pretty rich tool and it's really driving a lot of the efforts and locations of where vaccinations are being provided. so that's i think very helpful for all concerned. we're nearing the end of the benefits period. as you know, we're on track this meeting to complete the

cycle with the health service board at the june meeting so the vendor black-out period continues. i will speak later in the agenda with a little more detail ant the h.s.s. measurement plan as we introduce some of the data reports that our staff will provide. we've provided a monthly race equity action plan update in the report and i think of particular note is that our team did participate in managing implicit bias program with a number of employees from the health service system and we were -- had two of our commissioners commissioner scott and commissioner hao were able to participate as well and i'm grateful for you to have

extended yourself and committed your time because it was a whole half day workshop. [inaudible] -- to getting a shared understanding on how implicit bias impacts our behavior. we do have in my director's report, there's a lot of regulation these days that we're keeping track of that relates directly to the pandemic and how it affects our various benefits, so we're keeping up with that fairly well. the medicare plan evaluation is ongoing. we are committed to being able to make our decision about whether we would need to do it and we'll be reporting that to

this board in june. there's a couple of followup items in my director's report from the health plans that were helpful in addressing concerns for fortified membership. one was questions about kaiser's practice for replacing physicians when they were on leave of absence and when the patients are not usually reassigned to another physician, but rather, the other physicians take over the responsibilities of checking on things. so but kaiser members can be reassigned to another position by contacting k.p. there was a question out there that someone found some information about a united health care silver sneaker program going away. that turned out that that particular communication directed to an individual plan.

united does have plans to replace that program, but not this year. so we'll be talking with them about that benefit when we sit down shortly to discuss the '22 contract. as far as the report separation, reports from our team, people are just super busy because we've got a lot going on. and i personally really appreciate the efforts of all of our staff as we continue to work in this telecommunication environment and are extremely productive in getting the work done and members through member services, working through the contracts, finance, budget, all the well being activities for supporting particularly the mental health during this

trying time has been really remarkable how well our team has worked together and with other departments. i think we've got all together relationships across the city with many departments since they've come to widely recognize the help that we can provide for them during trying times. it helps to know how services are. that's been a wild time. there are discussions going on at a very high level at this point about re-opening various city services. we will keep you informed as decisions are made. and, i think that wraps up my remarks on the director's report. thank you. >> president follansbee: so i'll put it up for the board members for questions and

comments. >> yes. director again, this is commissioner scott. i'd like you to expand on the medicare plan evaluation. i read what you said here and i just wanted to be sure that you highlight or underscore that this is leading to ultimately the r.f.p. and it's not just an educational process for you and your team, but it's leading to that i would trust. is that correct? >> director: it is leading to the decision to do an r.f.p. and that's why the timing of it is useful to consider. we want to do a much better job. all is clear with this board should we decide to do an r.f.p. and make that decision known in june. we would have adequate time to

clarify what the board what the contents of that r.f.p. would be. because with the medical plan for the active employees, we were i guess a little more subtle about all of the discussions that we had about points that were billed into the r.f.p. and this time we'll be much clearer about that so that it's really -- there's a common understanding of what it is we're aiming for if we do choose to do an r.f.p. >> commissioner scott: thank you for that point of emphasis. >> director: you're welcome. >> commissioner: i'd just like to make a comment about when we get back to in-person meetings again and i know that's up in the air, but after looking at the ethics trade and the brown act and sunshine rules and then

i know this member definitely contacted abby and holly about his difficulty getting in to the public comment. so, you know, by any standards, we'd probably be in the violation of brown and sunshine act at this time because of the difficulty people are having getting in. but i know there's nothing we can do about that except i hope that we do get back to regular meetings sooner than later, but there is no definite date for when city hall will be open or anything like that. >> director: no. discussions are at a very high level at this point. the thing is to keep in mind we're at a very pivotal point on whether or not we are ahead of the curve on the pandemic. and all the policies of san francisco has been very driven by science and will continue to be and it makes a lot of people

uncomfortable when we start, you know, when the governor is kind of widened everything without the science to back it up necessarily. so it's going to be a challenging time and hopefully they'll be enough of us taking the vaccine to achieve some of these goals to be more open. so we'll see. >> commissioner: some people are going in to the office, their offices now apparently from a couple people i talked to. >> director: yeah. there's always been a limited number of staff that go into various offices. it really depends on their function. we've had a few people that go into h.s.s., but it is, you know, it's not just being in the office, it's getting to the office. there's other places where it's risky and so we're not in a position to put our

[inaudible] especially when we're so highly functioning environment as a staff. >> commissioner: i have a question about the managing implicit bias training which i really wanted to take except 8:00 a.m. is like the middle of the night for me. i apologize, i don't do 8:00 a.m. well now that i'm no longer working. so i'm wondering if that is available in any other way if we can, you know, like some of the other trainings that we had from the city attorney and we were able to get them remotely on -- we're able to get them remotely. will this managing implicit bias be available remotely that we can access it and take it at a different time? >> director: there are various programs that are available remotely. this one is unique, different

in that they're in their action amongst the participants in the program. so it's not like a prerecorded, lecture style education. so, but i can also let leticia comment on what we know is available at this time. it's a continuously evolving subject, so leticia, are you comfortable making a few comments? >> yes. good afternoon everyone. this is the senior health planner with h.s.s. these management implicit bias trainings is an interactive live training on zoom. there will be subsequent dates in the coming months. i'm happy to be in contact with the commissioners and let holly know when other opportunities arise. we also do have additional trainings that are recorded

from i.s.e.b.p. that are related to race, equity, diversity, and inclusion. so we're happy to send you trainings that are prerecorded if they better suit your schedule so that you can immerse yourself in this type of education. >> commissioner: yeah, i'm just holding this maybe like 1:00 to 4:00 p.m. in the afternoon, that's my real issue. i look forward to this in the future. >> definitely. the schedule is put together by the department of human resources. it is a d.h.r. training program. so it does revolve around the trainer's ability, but i will pass along that message and thank you for the input. >> commissioner: yeah. sorry. not all of us are morning people. [ laughter ] thank you,

leticia. >> commissioner: i would just like to say, number one, having taken the training, i was given the 8:00 start time. i have to say the training was very engaging. it moved well. it was four and a half hours and part of the power of it was all 20 participants were from h.s.s. and so there were people who i have either met or known or talked with in other capacities and some people i hadn't met or known or talked with and, yet, because of the flexible small group nature of this, we broke up into small groups several times. so part of it was that this was focused on the department and therefore allows for a probably more robust thinking for the future about how each department can handle implicit bias not just as an individual, but as a department with the city and county. i would like to also just to comment and reiterate and reinforce what the director

said about the covid-nineteen update. number one, you know, i cannot reinforce more the necessity of everyone getting vaccinated as soon as feasible. [please stand by]

no vaccine is perfect. we don't know still what the durability will be and we do know that all of the vaccines seem to be pretty equally effective in reducing serious hospitalizations and death, intensive care admissions and not necessarily all infection. it does decrease the transmissibility and the predominant variant, now in the united states, is a more transmissible variant. so we still -- a majority of cases are coming from a variant that was not here at the beginning of this pandemic. now it's more easily transmitted. so it just makes it all more important that each of us, not only be vaccinated, if we haven't been, complete the vaccine series if it requires two doses, the johnson & johnson does not. and, lastly, that we urge as

many people, even casual contacts to be vaccinated and help them be educated about the safety and importance of this for themselves, their family, but the community at-large. at that point we need to think about coming back into a real meeting situation, as we were used to, prior to the onset of the pandemic. but there are some real serious obstacles that threat than timeline. so again i want to thank, abbie, for your participation, for the department's participation, for the information that we're being provided to our own members. but also what's happening in san francisco and the bay area, california and the nation, as well as the world. are there any other questions or comments for the director on this report? seeing none, i can't see everyone on the screen. but everyone else is muted.

i'm now going to open this up for public comment. >> clerk: thank you, president follansbee. public comment will be available for each item on this agenda. each speaker is allowed three minutes in comment in length to comment, unless the board president deems new public time limit during the meeting. all public comments are to be made concerning the agenda item that's been presented. as a reminder, caller may ask questions of the policy body, but no obligation to engage the caller. you're encouraged to state your name clearly and may remain anonymous. when the three minutes have ended, i will thank you for your comment and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sfgov tv channel 2. opportunities to speak during the public comment are available during the public comment time, the number is (415)655-0001. again (415)655-0001.

when prompted, you'll use access code 187 296 5890. again 187 296 5890. then press pound and pound again. you'll enter the public comment call line as an attendee. dial star 3 to be added to the queue. this is your time to speak when the line is unmuted. for those on told, please continue to wait. sfgov tv has a standing 45-second delay for viewers watching op our live broadcast channel. we will take a 45-second pause to allow the systems to catch up and the viewers to dial in. 45 seconds begins now.

>> clerk: 45-second pause has ended. our moderator will notify us if any callers are in the public comment queue. >> thank you, madam secretary. if you could please share privileges. looks like we have four callers on the phone line. they have specifically entered the public comment queue at this time. 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 this agenda item.

board secretary, still waiting host privileges. give it just a few more seconds. board secretary, there are still no callers in the public comment queue at this time. >> clerk: thank you, moderator. hearing no further callers, public comment is now closed. >> president follansbee: thank you very much. i'll know close this agenda item and move to item number 7. >> clerk: agenda item number 7 is the h.s.s. financial reporting as of february 28ers,

2020. 2020 -- 2021. this is a discussion item. >> president follansbee: i'll turn it over to larry loo, the chief financial officer. >> thank you. holly, do you have the slide up? okay. thank you. good afternoon, commissioners. this is larry loo from the health system. i'm reporting on the highlights of this month's financial reports. the financial report through eight months, as of february 28th, that's in your packet. this one slide is really summarizing some of the key highlights for this month's report. if i get into the numbers, i want to say that the overall everything is going according to plan, if not better than budget. and just a little word on how these projections work. we take the amount of expenditures and revenues through the eight months, fiscal

year eight months and, you know, divide it by eight and tremendous it out for the -- trend it out for the remaining of the year to get to a projection. one thing to note is february is a short month. january, february are the start of new benefit payouts. so the premiums are a little bit different. some of these numbers may jump around a little bit. but there are two sources of funding for -- that we oversee as san francisco health service system. the inflated benefits trust fund, which is the main purview of this body. overall, the trust fund is projected to have a fiscal year-end increase of $18.5 million. the majority of that increase in the trust fund balance is from the self-insured plans. right now we're projecting that it will increase -- have an

increase of $19.3 million. this does include the expected $7.3 million in roob rebates, primarily blue cross blue shield and united. in terms of performance guarantees, that remains pretty consistent from the last report. and that we received $174,000 in performance guarantees already. so still projecting, you know, to be a positive balance at the end of the year. the general fund administrative budget, this is what funds most of our personnel and the initiatives for employees, we are projected that this will be relatively neutral. we don't foresee any surpluses or shortfalls. currently we are showing that we will have a surplus of $143,000, over the annual budget.

but as we ramp up for activities to implement the two new health plans, we may be chipping away at that surplus a little bit. so that concludes my report out on the financials for this month. thank you. >> president follansbee: thank you very much. i would open this up for questions or comments from the board members. >> hello, mr. president. this is chris canning. i want to note for the record, i was able to log in. i apologize for my tardiness. >> president follansbee: great. thank you very much, mr. canning. so mr. loo, just before people think about ways to spend the increase in the employee benefit trust fund, can you give -- we're going to hear more about

express dashboard and some claims and utilization experience, that we've heard some already throughout the course of the year. we'll expect a lot more. and there's a lot of projections sort of a tsunami of maybe reutilization or utilization. so you have any sense about how much we can be comfortable, $18.5 million increasesome adequate for the future, after the pandemic? >> yeah. that's -- you know, mike clark, the consulting actuary and i have had conversations about this. and really at this point it's too early to tell. there's likely to be some flux in these numbers, you know, from the turn of the year temperature pipically your first quarter of the year, you know, you'll have

sort of less utilization than normally would have. there were some changes to some of the plans were late in processing claims because it's the turn of the year. and last-minute changes were made in terms of what the reimbursement schedules looked like. it's too early to tell. and, you know, i think some of -- whatever assumptions that we may have going forward into the future are encapsulated into analysis that our actuaries have put together for renewals. >> president follansbee: thank you. i would just point out that the side benefits, in the pandemic, it's a lot less influenza activity. and so i'm sure fewer admissions, critical admissions, hospitalizations for severe influenza and associated bacterial pneumonia. and also it seems like there is maybe fewer complications from surgery and all of that, because

there's fewer operations being. so some of this, you know, seems to be sort of an upside in the midst of a pretty devastating pandemic. but i appreciate the fact that it's hard to know what the future looks like across the board. commissioner zvanski? >> dr. follansbee, don't you believe that a lot of what is going on is -- i hate to call us deferred maintenance. but a lot of people have been deferring physician visits and also maybe postponing surgeries and other kind of processings, so that we may have a surge once we're sort of back to not being as restricted and that will have a surge then in claims?

>> president follansbee: i totally expect this to happen. a lot of projections about what this might look like. but i think that mr. loo's response is exactly right. we don't know for our population exactly. >> right. yeah. and he's the money guy and you're the science guy. [laughter] we have -- and i'm really grateful that the discussions have been happening. what i wondered is sometimes when we get the finance report, we also take a look at the budget issue with regard to our office. and i just wanted to know what the status is with the budget going forward and where we are in that? or did i miss -- is it somewhere else in the material? >> no. the budgeting -- the budgeting process is ongoing with the general fund budget. we are in the midst of working

with the board of supervisors analyst to go through our proposals, working with the mayor's budget analyst as well. still a little back and forth on items we've requested. so that's ongoing. and obviously there's a delicate balance between the mayor's general overall fund and our general fund request, because one of the drivers in the mayor's overall budget is the health benefits. we're right in the midst of that. so it's still ongoing. and more to follow as we get closer to june. we're scheduled to be discussing that at the -- at that committee. >> okay. quite the delicate dance. i know. >> yeah. >> thank you very much, larry. appreciate it. >> sure. sure. >> president follansbee: are there any other questions or

comments from the board commissioners? hearing none, i'll go ahead and open this up for public comment. >> all public comments are made to be made concerning the agenda item. when i welcome you on the call, you're encouraged to state your name clearly, although you remain anonymous. i will thank you for your comments and placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org or sfgov tv channel 2. opportunities to speak during the public comment period are available by dialing the number on the screen.

the dial-in number is (415)655-0001. again (415)655-0001. when prompted, use the access code 187 296 5890. again 187 296 5890. you'll then press pound and pound again. and you'll enter the meeting as an attendee on the call-in line. when the system message reads your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system message indicates that you have been unmuted. sfgov tv has a standing 45-second delay for viewers watching the live broadcast online. we'll take a 45-second pause to allow the systems to catch up and callers to dial in. the 45-second pause begins now.

>> secretary: the 45-second pause has ended. our moderator will notify us if any callers are in the public comment queue. >> board secretary, we have four callers on the phone lines. zero callers have specifically entered the public comment queue at this time. 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'll wait five more seconds and then close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> secretary: thank you, moderator. hearing no further callers, public comment is now closed. >> president follansbee: thank you very much, mr. loo, for the presentation. as we move on to agenda item number 8, which is also a discussion item. >> secretary: agenda item number 8, the presentation on the sfhss communications plan overview. this is a discussion item. >> president follansbee: and i think jessica shih, who is the communications director, will be leading this discussion. >> good afternoon,

commissioners. >> president follansbee: good afternoon. >> just waiting to get control. thank you. good afternoon. my name is jessica shih, i'm the communications director for sfhss. and i started right before the pandemic started last year. i've now had a chance to really take a look and evaluate our communications opportunities and this year we've put together a communications plan and our objective for 2021 is to proactively develop, design, and create communications that helps our members better navigate their benefits and engage in their overall health through preventative care and self-care to support the sfhss mission. so previously we were more

reactive as we were fulfilling requests and we want to really move into the proactive state, where we're anticipating and driving communications for our members. our target audience, if you see these lovely people, we've got our members. they are the heart of everything we do. they are why we exist. and they are as diverse as the city of san francisco and we know they have unique needs. in addition, we have our amazing leaders, who have a mission to fulfill and we want to support them in meeting that mission. our strategy to achieve the future states is to really anticipate and drive proactive communications, and we will do this by using the sales first data. so our benefits analysts are logging and tracking calls and why our members are calling in and we'll take that data, review that information. of course, we also have all of our meetings and information from our meetings that we can

pull from, as well as our web analytics reports and data. then we want to really closely collaborate cross functionally with all of the different teams, including well being, finance department, our enterprise systems and analytic team so we can develop proactive, strategic communication. and another thing that we want to do is really to take this design thinking approach. so we want to start with the end goal in mind. identify the target audience and really approach that from a diversity, equity and inclusion lens. and who are they, are they an active employee, are they retiree, what's their demographics. you know, what are their unique needs. once we understand that, we have to consider everything that the fact that 43.9% of san francisco residents actually speak a different language. we also have one in 10s.f.

residents who have accessibility needs. and then, of course, there's geography. think being all of our members. and then we're going to develop our outreach tactics that can be measured and track those results. as for the tactics, we really want to execute on this continuous feedback loop. and one example of how we do that is the small way program. i'm sure you guys have spoke about this before. we know, you know, the challenge right now is there's low utilization. and in the past we have done member communications. we've done the broad reaching communications to every member. and we didn't really get much of a bump or increase. so we're taking a different approach. we're going to engage our health plans to ep help us determine which members would benefit and qualify for this program. and then we'll work with delta dental to really take the lead

and do outreach to members who qualify for the program. the more targeted approach. then finally we'll take the year after the promotion and then track the utilization rates to see if there's been an increase. once we see if that's been successful or not, we can always either pivot, if we need to do something else, or we can increase our promotion efforts and see if it's been effective. and here's a list of some of our communications channels, it's actually fairly comprehensive. you've got everything from our monthly e-news and all of our mailers and then to all of the partners that we work with, like d.h.r., we work with our h.r. liaison. we have the d.h.r. newsletters. of course, we have our community partners like protect our benefits. they also communicate to members and, you know, we're looking for ways where we can partner to do

more outreach. we also have wonderful well being champions and key players, who are in the majority of the departments, within the city and county of san francisco. and they're sort of like our way in, you know, our people on the ground who know what's going on with their teams. and, of course we have something new. push notifications for first responders, which i'll talk more about later. we have things like the employee portal and, of course, i would be remiss not to mention our sfhss.org web sit, which is a huge tool to help our members do self-service. and then, finally, i think it's always really important to have that discipline and measure our results. so when i was brought on, i was told and informed that we really want to increase member engagement. so i'm looking at different things like can we increase e-benefits utilization rates. can we reduce unnecessary call volumes that are on topics that can be found through sfhss.org. you know, can we increase more

diverse participation in our well being programs. and how do we equitably member preventative care and track that information. and increasing our e.a.p. utilization, app usage for our first responders and increase awareness of our benefits program. here's just a few examples i'll walk through for the open enrollment communications. sorry. just need to check one thing. can everyone hear me? >> president follansbee: yes. >> secretary: yes, jessica. >> excellent. sorry about that. seeing a lot of pings.

so apologize. for open enrollment communications plan, we are taking this multi-channel approach. and historically we have taken this similar approach. but all the blues -- all of the squares are really where we're enhancing those programs this year. so we're going to do the traditional things that we've done before, like our mailers where we include the -- the booklets and we'll also have our printed guides. and then this year going to do custom webinars for hetch hetchy, u.s.d. and retirees. and then we're going to partner with our health plans and vendors, those are actually the blue squares on the left to do additional mailings for our members, such as custom office hours. and we're going to monitor member service calls to identify member trends and points. we discovered a lot of members were calling in about s.f.a. and so we decided to figure out, well, what are their concerns

with f.s.a. and get in front of that communication. we started communicating what change in f.s.a.s and really partnering with admin, who administers our f.s.a. programs to help educate our members. and then, of course, we want to incorporate member feedback to make our content more equitable and accessible and provide digital, educational materials to empower members to engage and enroll online. that includes more webinars. we're going to do more videos this year. i'm really excited that we have a new video vendor that's joining. and we're also starting a social media channel. and going to do more engagement through that as well. and this is our enrollment calendar. what's changed from last year to this year is that we're starting almost all of our programs earlier. you'll see videos is already starting now. you know, we've secured a new video agency. and we're going to start scripting out those new videos.

and this is a project that i'm really excited about. we want to really revamp our website sfhss.org. we want to do it in phases, because we really want to take the time to do it right. this year we are in the discovery phase. it's where we're going to assess the user experience. got this heat map tool that i'll show you in a little bit. it's going to help us understand user behavior and we want to secure member feedback, include members from hetch hetchy to include diversity and accessibility needs and then we want to capture and identify improvement opportunities. then as we go into 2022, we'll partner with e.s.a. on, you know, our development priorities, exploring new tools and resources, you know, can we create a more intuitive user experience, improve navigation and design a website to be more equitable and accessible. and then in 2023, we'll complete

all of the priorities we didn't complete in 2021, tier 1 priorities. it will be time to reiterate, you know, like reassess all of our improvements. you know see that's going to be a theme going through all of our plans. so here's where we're at this year. this is what the heat map tool actually looks like. and, you know, we want to find equitable ways to invite members to provide feedback. one of those things is to -- we're going to have these pop-up surveys. and one of the reasons for that is we're noticing for our health page, in the upper right corner, you'll see that the contact us and search buttons are in red, which means that's where our members are clicking the most. and for that reason, since you're looking at search, we want to be able to have a pop-up survey to ask questions like did you find what you were looking for. if not, what were you looking for to see if there were shortfalls in our search

capabilities. we want to increase accessibility. i know i have probably said this multiple times. i'm really excited for this tool. i've definitely been scoping out different websites like white house.gov to see how, you know, what best practices there are out there. and others have the ability for members to be able to choose to increase the font size on the page. if you think about, you know, what percentage of our members are retireesk they benefit from such a feature. that's what we really want to add. increasing contrast, increasing font size, text facing, what can we do to improve the online experience. and that is an example of what we're doing this year. then we have the cordico app. i probably heard me mention this earlier. super excited. for the work we've already done. it's a two-fold strategy to uplift and catch. the app itself was already

designed for the portion to help first responders in crisis. and we want them to be able to reach out and get the help that they need, when they're in times of extreme stress. but in order to really get more adoption, get them comfortable with using the app, we have the strategy. and that's where we make, you know, using the app a part of your regular everyday lives. we wanted to have fun, quarterly challenges and contests. i know for the p.d. and sheriffs, apparently challenge coins are a thing. and we've done treasure hunts to get people used to exploring different aspects of the app and the modules. and we're doing -- like sharing your pet photos. the fire department really picked up on that one. and that's just all to get everyone comfortable with using the app, so when, you know, there is a time of crisis, our first responders know how to reach out for help and know that

this app is there for them. and then finally this is the last example. we are going to be developing social media plan. and we really want to test out like can we engage with our members on social media. we want to see if we can help our members achieve their health and well being goals by creating a social media community for active employees and retirees, where sfhss can share benefits and well being programs and challenges, while giving members an online community to inspire others and support their journey. phase 1 developing the social media plan and securing a social media management tool. phase 2, which is the phase that we're in, is really creating editorial calendar with content that will help us grow our social media followers, by having social channels be a diverse resource for healthy living. and phase 3 will -- each phase really will be dependent on the data from the previous phase. so depending on which content

our members latch on to, we want to start creating microcommunities, with different health topics such as reversing diabetes or hetch hetchy or pet lovers. and then we move into phase 4, which i want to say is social media nirvana. we have the extensively sustaining -- self-sustaining channels. and i actually am a part of the community that's achieved this nirvana, where members share their own stories and then they provide support for each other. i don't even know who the moderator, administrator is. you about the group keeps going. of course, phase 5 is always going to be time to reassess on how can we do it better. and that is pretty much it for our social media plan. our goal is to deliver a proactive, strategic communications to help solve member needs. if you have any questions, i'm happy to answer them now. >> president follansbee: great. i'd like to open this up to

board commissioners for comments or questions. >> yes. commissioner scott. jessica, i haven't had the pleasure of meeting you personally, since you arrived here, i guess right before we began these types of meetings. but to see the scope and depth of what you're planning to do is very impressive. and i commend you for your work on this. i think that this has been a gap in many ways, between our members. there has been some interim efforts taken to try to bridge that, as we've gone the last year or two, prior to your arrival. and this to me is very exciting that you've been able to hone in, after reviewing kind of where we've been, and where we are, to outline what's going to happen in the future. so thank you very much for your work on this. >> thank you so much, commissioner scott. >> this is commissioner zvanski.

i'd like to actually follow up on what commissioner scott said. i was also very excited and pleased to see this report. and i want to thank you so much for considering our hetch hetchy people, because the two people i advocate the most people for and i see commissioner scott laughing at hetch hetchy. because they are out of sight and out of mind. and special communications to them and acknowledging them and understanding what their needs might bereally outstanding opinion and also thank you for bringing in the retiree groups. we're here, as my other hat is to be involved with the retired employees of the city and county. and we are here and anxious to collaborate with you on communications, so that people understand once they retire, they're not really gone from the city and they're not gone from

the process. a lot of them think they just sit back and collect their benefit the and don't have to worry. and then there are changes and they -- they're suddenly surprised. they say, oops, what happened. and we're all about getting that information out in advance and working with you. and so this communications plan is really exciting and wonderful and very inclusive. i want to thank you for your efforts. we're looking forward to more coming from you down the road. thank you so much. >> thank you, commissioner zvanski. we do have exciting plans. i know carry has -- carrie has a great program that we're so close and waiting to launch for our retirees. >> wonderful. >> i just have a quick question. >> president follansbee: yes. >> i was looking through the -- last year's open enrollment guide. and nowhere did i see in there anything about nutrition

counseling. we added that on a few years ago. and if it's not there, i don't think -- nothing that i can see there in that guide that comes out annually. last year was a shorter one because of the pandemic. so, i mean, even if it is on the website, it should really be in that guide as one of your benefits. so it really -- i would hope -- i don't know how you get this message to the doctors. because they're the ones that should be referring people. i'm sure a lot of people need nutrition counseling. so the doctors know that that's available through their plans. that would be very helpful, too. maybe they do know that. i don't know. but, anyway, you did have a very nice presentation. thank you. very clear and easy to follow. and i was speaking to mr. scott before the meeting a bit on here. and we were talking about

communication to the elderly people, who might be living alone. and they don't know how to navigate the system. you know, i've been seeing more of that. and it is very difficult really to navigate, even when you know something about it. especially if anybody has a language deficiency. if they have a family member or someone to help them, that's good. many people do not have that. i'm not sure how we get the communication out to them. a lot of them may not text and may not do that much on the internet either. so it would have to be by mail or some other way. i was hoping maybe the health plans -- each plan would have some way of communicating to these vulnerable populations. >> that's really good point, commissioner, breslin. i will definitely be looking at if there's space opportunities to add the nutrition benefits.

and we are actually working closely with our health plan partner, kicking off speaker series, we're exploring those opportunities to bring their expertise and presenting it in front of our members. but i do understand the continued challenge and accessibility challenge for technology for our members, especially our more elderly members and it's just something that's top of mind. we don't have a perfect solution for it yet. >> president follansbee: so -- this is commissioner follansbee. commissioner breslin brought up important points about accessibility, age and also language. i don't think it's adequate from my -- from members who are more proficient in english to help them access the information you know, most of the health plans don't accept family members as interpreters or translators in

the office, because of issues around confidentiality and sensitivity around the issues. could you outline or expand on what are our language needs, do we have some assessments of our members and language preference for information. and then how we build on that in our communications strategy. >> thank you for bringing that up. it is actually -- we are looking at language tools. we definitely explored it for everything from webinars and we've actually been meeting with our health plan partners to discuss the same issue. i believe in discussion with some of our plan partners, and i don't want to speak for them, they do have a third party who can come in and translate on behalf of the member. that's my understanding. so it's important to sort of raise those concerns in advance at the doctor's office. i also know, you know, like my own mother whose primary

language is mandarin, chinese. she would prefer a doctor that speaks chinese to help with that gap. so there's always that preference. when you're choosing your primary care provider to find a provider who speaks your native language. still an opportunity area for our communication. and i would love almost if you recall this, this lovely slide here, is, you know, if we can also have the option to translate some of our content in different languages. that would be definitely something we're exploring as we revamp our website. like is this feasible to do. and, you know, how quickly could we get something up. we've already identified some top tier languages where the majority of our members may speak. we narrowed it down to six, seven languages. >> president follansbee: thank you. that's really great. i just want to point out that i think that having interpreters available in a doctor's office visit is sort of regulated and regulation. but i don't know about t.a. --

you know, the telemedicine and where the regulations around telemedicine. and since many of our members access their information through telemedicine appointments, what are the rules, mandates and how can we help educate our members that this is a right that they have as well, not only in doctor's offices, but also in telemedicine visits. so these are all important components. >> thank you so much. that's something that we can ask our health plans to address. >> president follansbee: yes. >> very good point. thank you. >> president follansbee: so are there other questions or comments from commissioners? i see commissioner breslin still has her microphone on. do you have any other comments? >> no, not at the moment. thank you. >> president follansbee: okay. anyone else? >> jessica, this is commissioner hoa. i want to thank you for being proactive and having explicit slides that say you'll be proactive in communications. because also what i have found

that you figure out how to communicate, as a result of something that went awry. so thank you for looking ahead and anticipating. >> thank you, commissioner hao. >> president follansbee: great. if there are no other questions or comments, i'd like to open this up for public comment. >> if i may, dr. follansbee, i'd like to comment that this program that jessica has just spoken to was and her position was a direct result of the strategic plan. really understand our membership and engagement piece. you know, she does it with a small team. you know, ryan is our graphics designer, quite skilled and carol is on the team as well. but i just wanted to -- as we've often talked, it's useful to tie things back to the strategic plan and this really advances that in many ways. >> president follansbee: that's great.

congratulations to the whole team for this presentation and for the progress you're making through these phases. so if there's no other comments, now we can move to public comment. >> secretary: thank you, president follansbee. i'll put up the slide. okay. now that's on the screen. public comment will be available for each item to this edge a. each speaker will be allowed three minutes to speak. all public comments are to be made concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the policy body, but no obligation to answer, engage in dialogue with the caller. when i welcome you on the call, you're encouraged to state your name clearly, although you may

remain anonymous. i'll thank you for your comments and you'll be placed back on on mute. remote viewing is available on sfgovtv.org and channel 2. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is (415)655-0001. again (415)655-0001. when prompted, you'll use the access code 187 296 5890. again 187 296 5890. then press pound and pound again. you'll enter the meeting as an attendee on the call line, dial star 3 to be added to the queue. when the system message reads your line has been unmuted, this is your time to speak. for those on hold, please continue to wait until the system message indicates you have been unmuted. 45-second delay on sfgov tv. we've been notified for viewers

watching on the broadcast line. so we will take a 45-second pause for the system to catch up and the callers to dial in. our 45 seconds begins now. >> secretary: 45-second pause has ended. our moderator will notify us if there's any callers in the

public comment queue. >> moderator: we have five callers on the phone lines. no callers have specifically entered the public comment queue at this time. 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 this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> secretary: thank you, moderator. hearing no further callers, public comment is now closed. >> president follansbee: thank you. this concludes agenda item number 8. so we now move into the rates and benefits section of our agenda. i'd like to point out to the board, members and everyone else

on this call, the next three items are action items. and i'd like to -- we have six board members onboard until 3:00. we will be reduced to five. so if we can go ahead and start this and you -- people will get their sort of physiology comfort break at some point before the afternoon goes too much further. i'd like to call for agenda item number 9. >> secretary: thank you, president follansbee. agenda item number 1 review and approve the hartford fully insured 2022 rates and contributions, which is the life insurance, accidental death and dismemberment and long-term disability plans. this is an action item. >> good afternoon, commissioners. mike clarke with aon. i'm presenting the hartford renewal that i'm about to screen-share.

let me give it to full-screen mode. we'll talk about the recommendation summary, provide a brief introduction on renewal backgrounds and then talk through the experience. and the actions for each of the plans that are offered under the hartford lifespan plans. then we have an overall renewal summary, rotate the recommendations and actions. i will not review the ray -- appendix, but material regarding the value-added service for participants of these plans. today we recommend the health service board accept the renewal of fully insured, accidental death and long-term premium

rates. the premium rates for 2022 will remain the same as they are in 2020 for each of these programs, as 2022 represents the third year of a three-year rate agreement. that started january 1st, 2020. the programs that i'll talk about today are offered to certain active employees in the superior court and the municipal executives' associations. including basic life insurance, which is paid by the employers, long-term disability or l.t.d. insurance paid by the employers. and member-paid coverages, supplemental life for employees and dependents. they are not offered to retirees of sfhss. or are they offered sfhss, through the city college of san francisco. those particular employers have separate coverages for these insurances.

just some renewal background. there was a priority rate guarantee under aetna, which became the hartford, when the hartford expired. the aetna life insurance. there was a new three-year rate guarantee enter into for 2020 through 2022. and at that time, in the june 2019 meeting, rates were proposed that would save employees $119,000 annually and the employers a little over $1 million annually. although there was a substantial increase in the basic life insurance rate during that period. so the next renewal, so for at this time last year for 2021, the hartford agreed to reduce the basic life insurance rate from the 2020 level. so it's still not quite as low as it was in 2019. but we did secure almost an 8% reduction in the basic life insurance rate. at this time last year for the 2021 plan year, which generated

annual employer savings of $135,000. so with today being the third year of the three-year original agreement, as you see in red text here, the current 2021 insurance rates will maintain for 2022. and we show rates on this document by lines of coverage. for basic life insurance, it's 100% employer paid. there are four different levels of insurance, depending on the type of employee. i present a web page here for anybody's reference on details of the basic life insurance amounts, by type of employee. as you see from this chart, most employees have coverage at the $50,000 level. this is a chart that the hartford provides, that examines the premiums for the plan paid each year from 2016 to 2020, compared to the incurred claims

for the plan. as you would hope for life insurance, the plan is running well, which means thankfully less staff experience than perhaps predicted by the rates. and the loss ratios have improved substantially as you go across the timeframe here, where they were higher in 2016 and 2017. and have now lowered for 2018 through 2020. loss ratio is the comparison of the incurred claims for the plan, divided by the premium. for long-term disability insurance, favorable loss ratios continue as well. with all of the information presented here, where the focus was here at the bottom of the page, with the loss ratios for the coverage, coming up to 50% over the course of a nearly five-year period from 2016

through september 2020. and so you can see here over this past three-year period, the life insurance rates, that was in place in 2020, it has been reduced for 2021. the 10.5 cents per month per 1,000 of coverage will continue for 2022. and then for long-term disability, you can see there are two different plans. the majority of employees are in the 60% of coverage plans. and you can see the rates will maintain for the 2022 plan year. for the employee supplemental coverage, favorable loss ratios as well, implying less death experience in these programs versus the premiums. and there are almost 1500 employees enrolled in employee supplemental life as of january 2021. for dependent supplemental life insurance, again favorable loss

ratios, 36% since the start of 2017. although we did see an increase in the loss ratio at 78% for 2020 experience. and you can see there are 725 adult dependents and 520 children enrolled in supplemental life. experience has also been very favorable. so you will see here the rates for supplemental employee and dependent life. they vary both by age and by smoking status. the rates will maintain from 2021 to 2022. and so will the supplemental child rates at the bottom life, supplementationmental a.d.d. rates at the lower right. so in aggregate we expect $8.6 million in total premium paid to the plan, that is the premium in place, the annualized premium as of january 2021.

so assuming insurance volumes maintain, because there's no change in the rates, we'll expect that there's about $7.8 million in total employer spend, between the basic life and long-term disability, both for 2021 and 2022. and employees are paying $776,000 in premiums for their supplemental insurances. so with that, i will state recommendation that the health service board accept the renewal of all life insurance and accidental insurance and long-term disability, included in this presentation for the 2022 plan year, recognizing this is the third year of a three-year agreement, that commenced on january 1st, 2020. president follansbee. >> president follansbee: thank you very much. very clear presentation. i'd like to open this up for questions and comments from the board members. do you have a question?

i would like to move to accept the actuarial recommendation as presented. >> i second. >> president follansbee: it's been moved and seconded that we accept the recommendations as outlined. any other questions or comments? if not, then we'll go ahead and open this up for public comment. oh, wait. karen, i'm sorry. >> no. >> president follansbee: commissioner breslin, do you have a question or comment? >> no, i didn't. >> president follansbee: okay. i'm sorry. i'm getting a little confused by mylaiout here. thank you. okay. now we can open this up for public comment, holly. >> secretary: thank you, president follansbee. i'll pull up the screen for our instructions.

public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length, unless the board president deems public comment time limits during the meeting. all public comments are to be made concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the policy body, but no obligation to answer or engage in dialogue with the caller. you're encouraged to state your name clearly, although you may remain anonymous. when the three minutes are ended, i will thank you for your comment and placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and channel 2. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is (415)655-0001. again (415)655-0001. when will prompted, please use the access code 187 296 5890. again 187 296 5890.

then press pound and pound again. you'll enter the meeting as an attendee. [ please stand by ]

>> operator: madam secretary, there are still no callers in the queue at this time. >> clerk: thank you, moderator. seeing no callers, public comment is now closed. >> okay. so i'd like to call a vote on this recommendation to approve the hartford fully insured 2022 rates and contributions as outlined. all those in favor, please signify by saying aye. any opposition? thank you. it passed unanimously. if we can go onto agenda item number 10. >> clerk: thank you, president follansbee. item 10 is review and approve vsp vision fully insured 2022 rates and contributions.

this is an action item. >> mike clarke from aon, and i will screen share once i have the sharing privileges. thank you. this year, i prevent the vsp vision fully insured 2022 rates and contribution credits, including each of the plans that you see on this -- and contributions, including each of the plans that you see on this page. rates are set by vsp vision, and what they do is they look at prior experience by trends, any sort of design changes or ad count changes, which haven't been present in these plans, adding any administrative fees,

and there are no h.s.a. cost reflects. you'll see 2020 costs divided by 2021 rates and enrollment. the plans offered to sfhss are the standard plans as well as the premier plan which was initially offered in 2018 as a buy-up to provide a higher level of benefits than the basic plans. so the members pay the contribution and the rates between the basic plan and the premier plan. and there are about 20,000 or so employees who also have access to a preventative vision care benefit through vsp. so you'll see our recommendation is to ask for approval for 2022 rates for each plan that will remain at

2021 levels. a little bit of history is effective for the 2017 plan year. sfhss entered a five-year renewal agreement, so that agreement is expiring at the end of this year, and you can see the rate change actions as part of that agreement. initial rate change, no change for two years, and then, there was a premium increase because pay-loss ratio inflated, so rated increased overall 2020-2021. it was essentially due to the addition of the premier plan in 2018 which resulted in higher ratios for all, and the full amount of that increase was passed to the premier plan. approximately 4% total premier plan increases for that plan each of the last two years. what you'll see here is

financial experience for the last several years across all plans for 2018 and 2019. you know, we saw high loss ratios, claims, and fees significantly exceeding premiums by 15% and 17%. for 2020, the loss ratio started high before the pandemic. in the first quarter, you can see the claim suppression in the second quarter was fairly substantial, but return of services not quite to the level of first quarter 2020, and then, the second half of 2020, we did see claim experience pick back up. the basic plan, it's run, you know, fairly well over the course of time. loss ratios in 2018 and 2019 below 100%, meaning the premium was able to cover the claims and fees and 2020 in the

pandemic impact. however, what you see for the premier plan, for the buy-up plan is claims and costs are exceeding premiums. the good news for the addition of the premier plan is it continues to be a very popular and growing benefit for active employees and retirees. it started in 2018, capturing 20% of the vision moment, so we clearly see the premier plan is valued by plan members. so taking us into this next five-year renewal period, v.s.p. has proposed the rate action that you see on this page for the next five years. starting with 2022, year one, where there'll be no rate changes for current basic and

premier plans. year two, there is a potential for as much as a 2% increase, depending on the loss ratio experience, and then, 2024 rates would settle to be the same as 2023. 2024, up to a 2% increase, and then for year five, in 2026, 2025 rates would continue for 2026. and throughout this five-year period, the computer vision care rates, 83 cents per employee per month would continue at the present rates for the next five years. so this illustrates specifically on the top of the page the 2022 proposed rates including the rates that i just walked through in tab year form. it also means that the member contribution rate for 2022 will remain for no change in 2021

rates. the recommendation for health service board action is to approve the 2022 rates and contribution plans, which reflect no change in premium rates and premier plan member contributions from the 2021 to the 2022 year plan. president follansbee? >> thank you very much. any questions or comments from board members? >> yes. >> yes, commissioner? >> yes. a question. you presented the outline for 2022 to 2026. do you have a recommendation for us for that at this time? >> my recommendation is to accept. these are fairly nominal increases for year two and year

four, when you account overall the loss ratio experienced for the plan for 2018 and 2019 was above 100% and was only below 100% in 2020 because of the depression in q-2. >> no, i'm talking about the overview that you presented for 2022 to -- this, do you have a recommendation -- is this part of your recommendation, as well, for today? >> so i'm recommending that this be accepted. the recommendation, you know, specifically is for 2022 rates, but with the understanding that this would be the agreed-to rates for the next five years with v.s.p. >> thank you.

[inaudible] >> so mr. president, with that clarification, i would move that we accept the actuary's recommendation as outlined on pages -- as he's presented them and on page 26 -- or page 13 of the presentation. >> i have a question. >> excuse me, commissioners. >> yeah, i think we have some

more comments and questions -- >> page 14. >> commissioner -- so commissioner breslin, did you have a question or comment? >> yes, i do. now, the premiums for the members is built in your basic health premium because i never really see this premium. >> correct. so on this page -- >> yeah, this page, it's something i never see. >> it's built into the rate plan for the medicare and non-medicare rate plan approval in june. >> okay. so we never really see this. i just went to the eye doctor for a lens change. four years ago was the last time i did that. at the end of the day, i paid $98 for a lens, and they paid

$48, so i never really delved into who -- i guess, are the members getting their best bang for their buck? i just see that a member -- well, they're not going to -- a family member paying $11.20 a month for this. but there again, if you're an out-of-network doctor, you're going to pay more with v.s.p.,

but because this has not affected me very much, i've never really paid attention to this benefit, are we really getting what we should out of this? so costco, you can still go to costco and get your frames, right? frames and your lenses? >> yeah, costco is still one of the providers. >> okay. that's great. [inaudible] in the annual rates and benefits? >> yes. so a couple points i would make here, first, on the -- the basic plan experiences generally run equivalent to claims except for just this past year because of the

pandemic. i would expect it to return back up. most of this coverage is paid for by the employers since it's set forth in the m.o.u. for active employees and retirees. and this would show that claims have exceeded premiums fairly regularly, so from that standpoint, that would save those premier plan members are getting a good deal. >> yeah, that was going to be my next question, is employer versus employee claim, and you said the employer paid most of the premium? >> yes. the vast majority of these are paid for by the employer through the m.o.u. formulas for active employees and the city

charter contribution formulas for retirees. >> so it's same for actives and retirees. >> correct. >> okay. thank you. >> and then, you'll see these as line items in the rate cards that we present next month and in june as part of those overall, you know, cost elements for medical plus the basic vision. >> okay. thank you. a lot of these things, i haven't been paying attention to. thank you. >> so mike, could you just clarify, are there v.s.p. preferred providers and out-of-network providers who are optometrists? because i don't remember us discussing that issue, you know, about who they are and how many there are, etc. i know we discussed the issue about reimbursement for frames and teased out costco as, you

know, warranting a smaller refund to the member, but we don't tease out any other providers of frames, so the member gets the same reimbursement wherever they go, except costco, where they get less. >> yeah. we can provide follow up to the board on the v.s.p. network. it is among the stronger vision networks, especially in northern california because that's the root of v.s.p. v.s.p. started many, many years ago as a california vision doctor plan in northern california, and so there is a robust network. the different in frame allowance between costco and non-costco has more to do with costco's purchasing power on the frame costs, but the

members are free to go to any v.s.p. provider. there is also out-of-network coverage, but certainly, the reimbursements are higher than with v.s.p. providers, so we'll provide that information in northern california. >> i know there was a significant impact on the impact of the cost of the benefit. the other question i had is related to what commissioner scott asked. we're being asked to vote on 2022 rates with sort of an indication of a calendar for 23, 24, 25, 26, and each year, we will then be asked to approve the rates for the

subsequent year, but we still have the agreement that it will be the intent to be divided like it was before, the rate increase will go to the premium plan if, in fact, the basic plan is still within a very acceptable, you know, loss ratio region. is that still our option down the line? >> absolutely, president follansbee. we will still go through an annual renewal cycle every one of these years with v.s.p. that is certainly a distinct

possibility. we would have the same sort of annual renewal process with v.s.p., using what you see here on page 13 as the going ahead framework for the rating actions each of the next five years. >> okay. thank you. >> yeah, and this is eric rappaport with the city attorney's office. the board has the power to revisit that, but consistent with the board's power to do an annual review and do the annual rates and benefits process, we're getting this five-year commitment, as mike just explained. >> okay. >> and isn't the -- excuse me. commissioner zvanski here. isn't page 14 really what we're voting on? page 14 has the rates that are specific, and that's what we're actually approving, is the top

part with the intent that the five-year provision is sort of a goal, but it's not cast in concrete with the exception of year one, 2022. am i correct in that? >> yeah, i would say that's accurate. i like to think of it as a little more than a goal. it's a commitment by the vendor, and, you know, subject to possible renegotiation if conditions change. >> right. i actually miss janet, and i think, commissioner breslin, it used to be janet, who is the vice president of v.s.p., and she used to come every year and give us very good deals and not raise rates for years in a row. it is, as mike clarke specified, when we do the medical rates, v.s.p. is always a separate line item and has been that way for all the years that i know i've been dealing with our medical rates. so we've seen it, and v.s.p.

has a very extensive network. people can access their ophthalmologist or optometrist through v.s.p. they can also use their ophthalmologist through their medical plans. there are very few places in the city that are not v.s.p. providers, but almost every eye provider in the bay area has access to v.s.p. there are a couple that i know that have very high priced frames, and those guys have elected to not be, even though some of us have tried to get us to join v.s.p. >> thank you very much. so if there's no other comments or discussion -- >> 14? >> yes. so it's been recommended

that -- with a modification to include the subsequent year sort of plan, not written in statement, but recommendation or commitment -- we're voting on 22 with this commitment for the subsequent four years. do i have a second? >> this is i'd like to second. >> clerk: thank you, president follansbee. let me get up the public comment slide. okay. public comment will be available for each item on this agenda. each speaker will be allowed to comment three minutes in length unless the president determines

another time to be set forth. as a reminder, member of the public may ask a question to the board but there is no obligation to call. when your three minutes have ended, i will thank you for your comment, you'll be placed back on mute, and the moderator will unmute the next caller. remote viewing is available on sfgtv.gov and cable channel 26. public comment may be made by dialing 415-655-0001 and entering the access code 187-296-5890. press pound, and pound again, and star, three to enter the public comment queue. for those on hold, please continue to wait until the system has indicated your line is unmuted.

sfgtv has a standard 40 to 45 second delay for the members of the public that are watching. we will take a 40 to 45-second break to allow members of the public that are watching to catch up. our 40 seconds begins now. 45-second pause has ended, and

our moderator will notify us if there are any callers in the queue. >> operator: madam secretary, there are three callers on the listening line, and zero callers are in the queue at this time. i am hearing feedback on the line. a reminder to all listeners and members on the line, please mute your microphone at this time. a reminder to the public, you must dial star, three now to join the queue and enter public comment for this agenda item. we will wait five more seconds to allow any public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> clerk: thank you, moderator. hearing no public comment, public comment is now closed. >> thank you very much. so i would now like to call for a vote on the recommendations to approve the 2022 v.s.p.

vision fully insured rates and contributions as well as the intended v.s.p. communications regarding subsequent years. all those in -- any questions about this item? this has been amended. all those in favor, signify by saying aye. any opposition? it passes unanimously. thank you very much. so i think we will -- this is a good time, before agenda item number 11, to take a break of ten minutes. agenda item number 11, which is also an action item, is going to be a fairly robust discussion, given the number of rates and contributions to review, so we'll come back. it's now 2:57.

we'll come back at 3:07. >> commissioner follansbee, since we're going to lose commissioner scott as 3:00, is there anything we should heard from commissioner scott prior -- i'm concerned that we would want commissioner scott's input. >> well -- [inaudible] >> if my commitment concludes within the half hour, and i believe it will -- i don't know that for sure. i'm not the chair of the group -- i will try to rejoin you during the course of that discussion as soon as that meeting concludes. >> so to make sure i'm clear, you do need to leave at 3:00. you may be able to join back in. i don't think it's appropriate to open this agenda item for one commissioner to make comment. i think we'll go

>> if we could go on head to item number 12 -- by the way, we're still on the rates and benefits section of the agenda. >> clerk: okay. so agenda item number 12 is a presentation on 2021 aon health value initiatives h.v.i. active medical plan, benchmarking study. >> mike clarke, aon, and i will bring up my presentation.

i will be presenting the report we call the health value initiative or h.v.i. active medical plan benchmarking study. the database was launched in 1986, and it's a robust data collection representing 2600 health plans and over $60 billion in health care expenditures. this benchmarking study captures the medical and prescription drug data for medical physicians only. the study itself calculates a purchasing efficiency score, and for sfhss, it remains among the best of any employer, you know, plan that is --

participates in our study. and what outstanding purchasing efficiency means is you're receiving a higher level of value in your active employee health plan purchasing for every dollar spent in health care, more so than most other employers participate in our study. and what factors in the financial efficiency includes normalizing for plan cost differences among different employer plans that are caused by plan design demographic and geographic differences across populations. you know, this particular study is not necessarily used for underwriting purposes or rate setting purposes, but really gives an indication of how plan designs and overall costs on both an unadjusted basis, just employee per year basis as well as normalizing for plan design and general design differences, how that relates to other employers and plan sponsors.

the overall medical and prescription drug spend for employer is higher for sfhss than it is for the average of the organizations we benchmark, and it's really driven by three key factors. number one, the higher average population age for sfhss employees relative to those of other benchmarks, though sfhss is very similar in average age to our public sector benchmark. number two, higher costs of health care overall in the bay area versus u.s. averages, and i know we've talked about that with the health service board in the past, and also, a higher percentage of allowed costs, you know, the discounted charges for services that employers pass through the plans that are paid by sfhss versus other benchmarks are higher because simply the member plan design elements

tend to be less on average, like deductibles and copayments, and i'll demonstrate that here shortly. from an employee perspective, from the planned cost sharing that employees pay in the sfhss plan, the employee paid amount is similar to other benchmarks for the out-of-paycheck contributions and lower than other benchmarks, in other words, more favorable to the employee for the average plan member timesharing. for sfhss, we're looking at actually 2021 premium rates for the fully insured plans and the total cost rates that are developed for the self-insured and flex funded plans for the

medical prescription drug and health care basic costs. it excludes the vision rates, the age stabilization fee and stabilization adjustments, so we wanted to get more of an apples-to-apples basis. we benchmarked organizations with similar size, knowing that that's a factor in the leverage of the purchasing that you bring. 46 other organizations have employees with 25,000 or more in their plans. subset of fortune 500 organizations, 47 participate in our database. labor mark organizations that are in the bay area, so most organizations participating in our study do have locations somewhere in the bay area, and

then, the entire database of 549 participating organizations. so when you look at this data, what you'll see is sfhss employers pay about 83% of the overall health care spend when you incorporate the combination of contributions paid by members designed out-of-pocket and deductibles and coinsurance and copayments as well as the employer cost. this is higher in the range of benchmarks from 67% to 77%. the member cost in sfhss plans is higher for employee contributions on average than the plan design features, so the average employee pays $2,238 in member contribution, and $493 a year in plan design out-of-pocket. of course, this varies for any individual employee based on

their contributions. there are some that pay zero for their plan if they're on zero coverage, for instance and there are some that pay higher if they're in the p.p.o. plan, but the design out-of-pocket generally is less for employees of sfhss than for other organizations. the contribution levels are slightly higher than average in the public sector database. member out-of-pocket tends to be lower across the board by a substantial amount compared to the other benchmarks. the financial index wraps in, as i said earlier, plan design, difference normalization as well as geographic and demographic normalization, where a financial index score is better the higher it is.

a score above 100% reflected better than average financial efficiency, and sfhss, as we portrayed to you in past years, when we presented this study, exceeds all compareators at 117%, and that means the sfhss purchasing power is significantly better than many others in our database largely because of the high proportion of employees enrolled in shfss plans. 90% of employees are enrolled in the h.m.o. plans. we have some data that shows the comparison between sfhss and the other database in terms of the population size, the total plan spend, how much attributes to the employer spend, the difference in

average age, where i talked about earlier where sfhss is older than average age study, 46.5 at sfhss versus an average study age of 44.2. on average, the sfhss employees are older. this is on a per-employee total basis cost, the very high total high index cost as well as the employee and plan design costs.

i will conclude my presentation saying that despite the higher-than-average costs for sfhss compared to some of the other baselines, when you consider the cost of health care in northern california, the slightly older age of the population, and a plan design that generally pays a higher amount of the total cost of services because of the lower design cost share for employees, that really does create a financial value plan environment for the work that sfhss does in working with these health plans, so follansbee, i'll turn it over for -- so president follansbee, i'll turn it over for any questions. >> what do we do with all of this information, other than the work of all the sfhss employees and leadership on the

work they do? >> i'd offer a couple of perspectives. first, is the -- so to me, as an actuary, this really does validate the focus on h.m.o. plans that sfhss has taken for the active employee population. historically, the blue shield plans and the kaiser h.m.o. plans and now going forward, heading the healthnet canopy plans. there is a significant part of the population that is in the p.p.o. plan. 3% of total active employees are on the p.p.o. plan. i know that derrick and rin will talk shortly about w.i.s. scores. to me, it says continue down the pathway with the plan design structures that are in

place, you know, but with noting this particular, you know, finding that members are paying a lower amount at time of service, and certainly, when you compare that to other benchmarks here, you know, that -- that's a -- kind of a feature of the plan that i think is important to recognize for the active employees and also, the retirees. even though the retirees aren't studied, the early retirees have the same plan design as the active employees. >> are there any other -- well, i guess i have one other question, and that is, in each of these other comparator groups that have equal -- san francisco h.s.s., is that the reason -- when you look at the

exceptions to the overall, in each of the groups, can you tease out, is that the only issue -- are there other issues? >> so -- you find in some of the other --

[inaudible] >> given this slide, are there any sort of long-term recommendations that you would make for us or that you would help us think through? >> certainly. i think the, perhaps -- and again, i'm just speaking this as an actuary. [please stand by] 493 number.

>> thank you. and just a quick question, i may have missed it, the 493 number design out of pocket, can you just briefly explain what that is. >> sure. so it is the expected average about that a member and also

family members are paying through deductibles, copayments. >> got it. >> any coinsurance in the program. so it's essentially what becomes the member requirement through those cost sharing elements the plan designs. >> thank you. >> i just want to say i think this is a very interesting and exciting presentation. i think we know that northern california, we have higher costs and i look to see the public sector in the labor market and see how we compare there, but i think we should be grateful for our charter language. we should be grateful for our negotiators and for the fact that so many of our members

have chosen to belong to h.m.o.s. i know as an active employee, a lot of us still were very interested in the p.p.o. plan and that was what was in the original charter language that required definitely an all choice p.p.o. plan that was set up many years ago. but we have a number of employees that have health problems and have found that for whatever reason, they are getting better service or they're getting the access to the specialized services they need through the p.p.o. plan. and so i think that always remains a concern when we have to do our rating as to how to keep it affordable and how to keep it sustainable within our system and especially, it was an issue for employees who we finally did some redesigning that opened some doors for a few more of them to get into

h.m.o.s, but when we have employees who by virtue of their remote employment which is necessary that are paying a heavier burden, i think we have to acknowledge that and continue to do what we can to keep it affordable remembering that it is our own in fact health insured plan. i thank you, mike, this is a fascinating demographic and fascinating presentation and i think it points out that we should feel very good about our plan, our benefit structure and how we take care of our employees in san francisco. thank you. >> president follansbee: thank

you. >> commissioner breslin: >> commissioner breslin: , do you have any questions or comments? the way the screen is set up i have to scroll up and down to see who's not on mute. it's a little cumbersome. >> commissioner: no thank you, mr. president. i thank mike and the team for the very informative report. >> president follansbee: great. thank you very much. i think we can open this up for public comment now. >> secretary: thank you. this will just take a moment while i screen share. great. public comment will be available for each item on this

agenda. each speaker will be allowed three minute to comment in length. all public comments are going to be made concerning the agenda item that has been presented. there is no obligation to answer and engage and dial up with the caller. you may remain anon house mouse. when your three minutes have ended, i will thank you for your comment and you will be placed back on commute. remote viewing is available on sfgovtv.org and sfgov 2. dial-in number is (415) 655-0001. when prompted to use the access code please use 187 296 5890. then press pound and pound again. you'll enter the meeting as an attendee on the public comment call line. dial 3 to be added to the

public comment queue and when the system message notifies you you will be allowed to speak. sfgov tv has a standing 40 to 45 second delay for viewers watching our broadcast online. we will take a 45-second pause for the system to catch up and the callers to call in. our 45-second pause will begin now.

the 45-second pause has ended and our moderator will notify us if there are any callers in the queue. >> board secretary. there are four callers on the line. zero in the public comment queue at this time. you must dial star 3 now if you want to join public comment for this specific agenda item. we'll wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public

comment queue sit. >> secretary: thank you, moderator. public comment is now closed. [inaudible] >> president follansbee: okay. took a few jabs at it. thank you very much. so that does conclude agenda item number twelve and we'd like to move on to item number 13, also a discussion item. >> secretary: and just to clarify, president follansbee, we overlooked agenda item number eleven, but you'd like to go over item thirteen. >> president follansbee: yes. i'm still waiting for representation of the board and i don't think commissioner scott's back online, is he?

>> let's take a moment. >> commissioner scott: yes i am. >> president follansbee: oh, he is. then actually we'll move to take this -- open discussion item -- action item number eleven. sorry about the confusion. >> secretary: it's good we checked. agenda item number eleven is review and approve retiree 2022 and dental rates for the fully insured plans. delta care plan. delta hmo popular and united health care. this is an action item. >> mike clark. i will pull up my presentation. i'll be presenting the retiry

2022 dental rates and contributions for the fully insured plans which includes the three plans you see here on the page. i will start with a short rate setting methology preface. it provides some detailed background about distinguishing elements of the retiree plan as well as review of the 2021 rating action that took place last year for this year's plans. ultimately present the recommendation for health service board action and so do you have it in the appendix. i won't be reviewing it but the entire hmo are designed. just as a reminder, we'll present the accidental plan 2022 renewal plans at the 2021 health service board meeting. this presentation focuses exclusively for the retiree dental plans. it's recommended at the conclusion of this

recommendation that the health service board approve the 2021 retiree dental plan rates presented in this document, and you'll see plain cost and individualization for the dental p.p.o. of the three dental plans offered to h.s.s. retirees as you see on this page. like the vision plan, all of these plans are fully insured meaning that the health plan develops the plan premiums. the plan sets those rates with close scrutiny from myself as the actuary. although, again, the last step is not applicable for dental as there are no added specific cost elements. background, each of these plans

are available to all retirees including from employers who do not have these coverages through active employees. but those retirees and all others are offered as retiree dental plans. they're all fully insured and the retiree members pay the full premium rates as member contributions. there are no employer contributions for any of the retiree dental plans. as you can see the chart of the existing premiums at the bottom of this page for each of the plans and the three coverage tiers. retiree elderly. retiree plus one and retiree plus 2 or more. the background is to provide protections towards the cost of dental procedures to encourage

recommended levels of preventative care including coverage levels for diagnostics particularly to cleanings and exams a year. anywhere from 50% to 80% of costs covered for basic restorative and major restorative services. this really is that financial protection element with the remainder of cost by plan numbers from stop paid by the plan. the words be coinsurance level for the member as we'll see in the design chart here in a little bit as well as an aggregate annual to help assure rate stability across the entire covered population for the dental insurance. while there are no employer contributions for the dental plans, there are certainly advantages for retirees buying their dental plans throughout h.s.s.. first, there's historically

stable ratings over time as i get to the next page. these plans are offered via a group mechanism. and, again, that includes the scrutiny by the sfhsf team and of the planning premiums written by delta dental and u.h.c.. you have member services helping to support individual issue that is could arise for more recentralized billing and payment for the coverages and the performance guarantees that sfhss is to ensure that optimal service is being delivered and achieved for the planned retiree members. as i mentioned, there have been relatively stable rates over the course of time. this chart dates back to mid year 2012 for retired p.p.o.

dental on the left, u.h.c. on the right and you'll see that the overall, you know, pattern of change here, the rates over the course of time has been relatively modest. retirees certainly have the option of researching and finding a dental plan that could be available on the individual dental plan marketplace or through other memes through the geography of the retirees would find

that buying dental plans for sfhss can provide a lower premium for the initial purchase of the plan. and so ultimately 3 key

elements drive the premium rates. first, the premiums must be adequate to cover the cost by the retirees and their dependents. given that these are insured plans. the plans are set to strike a balance between reasonable benefit coverage when services are delivered. and so sometimes we'll get questions why it's different from the active employee dental design. this is the primary reason why those benefits exist. and then delta dental has a two tiered network approach in the retiree ppo plan in the plan

that optimizes their needs. the ppo network dentists allows for the lowest out of pocket plan for types of service while the premier network being a larger network of dentists allows for a lower out of pocket cost time of service with no balanced billing versus using nonnetwork dentists and the retiree rates reflect the existing across three network distinctions. delta does contract with more dentists in northern california for its ppo than any other ppo plan provider. there's some to accept the highest service price discount levels. those are the ppo dentists. also, a lower discount level, but still being in network for delta, those are the premier dentals. so to my statement about the size of the ppo network for

delta for a total dentist standpoint relative to other plans in the marketplace, you can see this chart based on march 2021 data where you have slightly over 2,000 dentists in the plan and the premier you have an incremental almost 1500 dentists on top of that and the combination of those in the bet work. the next highest composition is just over 1,900 dentists and it drops from there the provider initiated turnover for delta does remain low relative to total provider counts. acknowledged that it was higher in 2020, delta reported 168

dentists to us and is shaded their exit from the delta dental network in 2020 higher than the numbers for 2019 and 2018 as you see here on the second bullet. this is the planned design for the retiry ppo where member costs are lowest when using a ppo dentist. for instance, there is no deductible with use of a ppo dentist. there is a deductible for use of a premier or out-of-network dentist. that excludes diagnosticic and preventive care. that excludes preventative cleanings and exams and also the smile way benefits don't accumulate for that. and generally a higher percentage for use of ppo didn'tist than you do for the others, although, keep in mind

that if you use the premier dentist, you're getting no balanced billing to the member. you could be exposed to bawl balanced billing. so i have an example of utilization across the board. certainly within the realm of possibility for a given number in the course of a year. this includes one exam cleaning and x-ray. one filling for one service, and one crown. so based on delta dental information, a noncontracted dentist could start a fee of these three services of almost 2,$000. these reflect a realistic charge base but they could vary based on a given number's actual experience, but showing here for an example purpose. so what we've done is basically

take the $1,944 starting charge and looked at the service cost, the contracted rates for these services both for dentists in the delta premier network as well as those in the delta ppo network. the discounts are highest for ppo and so therefore the total network plan allowance is lowest for the ppo dentist and this example, the 3 services combined adding up to $1,071 is a service cost $1,395. then we start with the member portions starting with the deductible and then applying the coinsurance from the design chart to get to the member paid coinsurance and this is why the

member cost are less with use of the ppo dentist in part because of higher levels of coinsurance for certain services combined with lower contracted rates. so what you'll also see here is that for use of a noncontracted dentist, you have exposure potentially to balance billing when we look at the difference between the noncontracted dentist charges and the fee amounts for premier dentists and so those also recruited to member. and so the total member-paid amount in this specific example very substantially, $305 for ppo dentist. $609 for a premier dentist. $1,068 for noncontracted. the plan is slightly less for the ppo plan and then by definition, the same for premier and noncontracted because those incrementals are being passed to the member as a

balance bill. clearly the incentive for members to consider using the delta dentist network over a noncontracted dentist and, if possible, a ppo dentist as that produces the number of pain at times of service. and so, again, delta had these two levels of network dentists with the deepist discounts in ppo. still discounts but at lower rates for premier and no discounts for those who are noncontracted. this illustrates the member utilization for s.f.h.s.s. for delta dental book of business discounts for services across each of the different types of dentists. now, you do see that most s.f.h.s.s. retiree numbers are using either a ppo or dentist.

only 6% of the services in the entire plan in 2020 went to a noncontracted dentist. where you do find a difference is lower ppo utilization among retired sfhss members. the red bar versus the 59% for delta book and business. and, as you can imagine, the reverse of that happens in the premier. a much higher use of premier than book a business. we broke it into vitality recognizing that part of what kind of produces a lower use of ppo dentists for sfhss retiry members could be where retirees live and where ppo dentists are and the availability relative to premier dentals. so for instance, as you can

imagine, the highest procedure count of all counties was for san francisco county among the retirees where total service distribution only about 32% went to ppo dentists versus 60% to premier dentists. a little bit higher percentage in san mateo. among the higher percentages in the immediate bay area counties like contra costa county with almost half going to premier dentists. you see a distinct difference betweenp ppos by counties. there's a lower use of ppo benefits versus premier can very easily be driven by local gentlemen graphy where the retiree lives. so members are encouraged to consider seeking adults of ppo

dentists. we've included a couple web links for how sfhss members can search for dentists on these various web links. so i'll shift into the renewal considerations. as a background for 2021, it was a complicated year. first, it was the third year of a three-year waiting agreement with delta dental. originally, the rates were going to be the same as 2020. and they proposed no change in rates. we had rate reductions in the end from two thousand twenty to two thousand twenty-one driven by two sources. one was the permanent elimination of federal health insurance tax. that helped to create a slight decrease in all the rates and then in september, we came to you for approval with the updated one-time reduction source applying to delta dental

plans in a rate reduction for 2021 that resulted from claim suppression during the height of the covid pandemic and office closures for dentists. so this premium reduction values were about $690,000 for the retired ppo and $20,000 for the deltacare ppo plan. and all smileway services to avoid accumulation towards the annual plan maximum and that resulted in rate decreases across the board for each of the dental plans for 2021 knowing that for the delta plans, the rate reductions were a one-year benefit to apply that claim suppression value of the premium return from delta dental. they knew that would expire at the end of 2021.

for 2022, delta's entering a new renewal cycle after the expiration of the agreement. and certainly the benefit of that reinsurance expiring will continue one-time, one-year reduced premium level is expiring. so each plan developed its 2022 renewal action based on its own evaluation of recent experience and the level of premiums needed. so you'll see and i'll go into a bit more depth here on these plans. these are the proposed rating actions for the two delta plans especially 4% increase that equates into the value of that temporary 2021 covid premium adjustment expectation. in other words, the rates for two thousand twenty-two will be what they would have been without that one-time rate relief and for united health

care. they are sending a 10% rate reduction based on their review, experience, and cost expectations for the 2022 plan year. so, again, i'll present the recommendations for each of these ratings actions for 2022 and the up coming slides. just really quickly for the delta dental retiree ppo plan, the fact that we saw a much greater percentage of covered members not have a dental cleaning in 2020 was a concern. it grew from 29% in 2019 to 42% in 2020. even with fewer overall services delivered, the distribution of services for retirees across the major categories remain the same from 2019 to 2020. so 70% of all services are diagnostic preventive in nature with the remaining 30% split

between basic and major. smileway was added several years ago to provide extra services for members who qualify for the smileway program for one of five product diseases that you see here. i know there have been questions about how much of the total premium the smileway benefit is and so i've illustrated that presently in the rates without the covid suppression relief so potentially similar to what you'll see that we present for 2022. smileway represents less than 2% of the premium for the overall retiree program. this is just a reminder of the changes that applied last year to have all smileway services avoid accumulation towards the annual retiree benefit maximum.

and so when we look at the rates and this 4.17% rating increase proposal, again, very important to keep in mind that there was rate relief in 2021 from the application of the covid-19 pandemic amount. what's being proposed for the next four years in these rates is essentially where the rates were for 2018 or 2020. just pennies less technically. so this is where we started last year as of may 2020 what was originally approved. there was then the suppression applied. but what rates would have been for 2021 without the covid suppression but exclusion. those are the rates you see here. so essentially this is what

delta dental is underwriting from to produce the 2022 renewal rates which are a no rate change renewal over rates would have been had there never been covid suppression applied to the rates for 2021. for the delta care hmo renewal, a very similar story. the rates originally reduced for the renewal of the health insurer tax. they referred a reduction through the application of the pandemic claims depression. so the renewal rates for the next two-year cycle are basically what would have been in place in 2021 before the pandemic. suppression as you see on this page. so, essentially, the rates for 2022 and 2023 are actually less than where they were for 2014 for 2020 for this plan. right on pretty much with where

they would have been before the covid suppression was applied. and that's health care on top of the 3% reduction. there's now a 10% reduction into the 2022 plan as the credit was already paid before we presented to the board in september for the delta plans, those were released through direct means in 2021. and so you see the rates here represent a 10% reduction from the 2021 rate levels. the recommendation that the health service board approves the rates as illustrated on

this page. the following 2022 claim year retiree dental monthly premium rates that are highlighted in blue shading and you can see the comparison to the actual rates for 2021 where the 2021 rates include the pandemic suppression credits for the delta plans. president follansbee, i'll turn to you. >> president follansbee: thank you very much. that's a lot of information and details have a lot of background. much appreciated. with that, i open this up for questions and comments from the board members. >> commissioner: i have a few comments. i'm hoping that everyone read this e-mail from one of the dentists, you know, enumerating

various problems with being in the ppo de s network and there were a couple of recommendations that i thought were good. one is that we should make it more clear that there is a premier category. i actually did not know i was with a premier dentist. i thought i was with an out-of-network dentist. parentally, she said it's more clear in the active information. so i was never aware of that. then she went in to tell how, you know, they, well, not the reimbursement level, of course, but, you know, how they showed up in her office unannounced, of course, and then nothing recorded and gave her advice on how she could cut costs. and, one of them was to

reducing visit times or cleaning from one hour to 30 minutes, shop for cheaper dental supplies by looking online; cheaper labs sending your cases overseas; i thought that was an interesting one. and so the point that she made that i find that i thought was really clear is bad dental care means more dental care and the only people that benefit from that of course are delta dental. so i kind of felt like this is a pitch fork delta dental ppo and i don't think that's responsible unless you explain why the ppos are less expensive

and it's because their dentists are reimbursed less. they may be using not as good materials and other reasons that they are able to do this. and the reasons the dentist talked about in here would especially make you wonder how a new dentist could possibly survive in this unless they cut corners, and unless they do procedures that they don't need to do and so in the past, i've had complaints from members about that particular one and other issues. one was a delta dental was at park kinson's and had an episode working on a patient so i informed delta dental of that. they went there and they said he did a bunch of push-ups for us and claimed he was in good health and so, you know, that's

what he appeared to be and that was that for that oversight. so there were a few other incidents like that. but that one particularly stood out. and then there was another recommendation i hope we review particularly in the website here. let's see here. oh, okay. they said that delta's one of only two insurance companies who work with that refusal allow of assignments to out of network providers. so in my opinion there's no reason for this policy by delta as it only makes it more difficult for dentists to be on network. so i would encourage the city to negotiate with delta to remove this provision as it is simply a barrier to care. has anyone tried to work with delta on that?

to remove that? to refuse to allow assignment of benefits? have you done that, mike? >> we did contact delta dental about that particular provision and much of the reason they do that is because and you saw this in the stats earlier, the vast majority of dentists are in either ppo or premier and so they have not adopted the position of assigning benefits for noncontracted dentists because of the relatively low volume of noncontracted procedures that are happening. so we can continue to have that dialog, commissioner breslin with delta dental. >> commissioner breslin: i think you should. another thing i don't think you

mentioned is other dentists are not allowed to go into the premier. delta dental should be able to ask that and i would wonder why. so that's what she said. only allowed to go into ppos. there were also some correspondence in the last year or so. this one person talked about three dentists she pulled out of delta because of these types of issues and we also had a couple more e-mails but i don't have access to those. so i think that we should be overseeing delta dental more seriously than we have been and i don't think we should pitch for them, for the members to do the ppo unless we make it very

clear of why it's cheaper and if we understand why it's cheaper, we might take a second look at it. i know how important dental work is. i've been through a lot of this myself. so i just think we've sort of let this slide a lot and business as usual. i do hope everyone took a look at that letter to see exactly what is going on and appreciate that this dentist did take the time to write this. so thank you. i wanted to mention another thing. >> commissioner: can you tell us what letter you're talking about and what e-mail you're talking about. >> commissioner breslin: oh, so you never got it. there you go. february 15th. we got it a little after that. i hope you had saw that letter. >> secretary: it was an e-mail

that holly sent on february 19th. >> yeah. and this particular dentist i spent quite a bit of time and she has not permitted us to pass her name on to delta. so it puts us in a little bit of a bind, but i certainly, we do hear your concerns and have talked very frankly with delta about these concerns as you know we have a new account team that is i believe on the call today and, you know, we're very interested in looking at rates that we can measure their performance and we'll be building that into the performance guarantees in the contract. >> commissioner breslin: thank you. i also wanted to mention retirees with families or two other dependents, the monthly fee is $135 which amounts to $1,600 a year and that added on

to their premium like say blue shield which is $16,000, this really gets very expensive and it's important that everybody has dental care and i personally would of benefited a lot more by not even belonging to this dental plan over the years and saved that money. i definitely would have been profitable for me to stay even. so i think families, i'm not sure exactly. but if they're going to end up with a ppo dentist that has is cutting a lot of corners is not going to do much good either. anyway. i think i said enough here. >> president follansbee: i would be interested in having

our staff having talked with delta, the plan responding to some of these allegations and i recognize hearing from one person doesn't paint the whole network as being the same thing and we need to be cautious in our review of that or statement of that particularly in this forum. however, i would be interested in knowing when the provider in this case delta does visit a dentist or a dentist office and so forth, what is the typically the discussion around the provision of services or the parameters that delta in guidance that delta is providing to a dentist under contract with them?

i know that there are any number of cost-saving measures that can be taken and it doesn't mean there's less quality present when that happens, but i would be interested in hearing some sort of description between delta and the dental and the dentist as a contractor in terms of what guidance in the ppo realm is provided and i'm not willing to accept that just because there was some guidance given about supplies, other types of utilization measures that may have been apart of that conversation that was somehow driving down the quality of what was being provided and that implication does not run one-to-one in my mind but it would be useful to have delta not at this meeting, but at some point talk about what kinds of interactions they have

with their providers around costs, quality, etc. >> commissioner: i would just add into that to say i think it would be important to know what the member experiences are. does delta too member patient satisfaction surveys for their members who are going to both premier dentists, to ppo dentists, number one. and, part of their survey should be does a dentist use one set of materials for their ppo patients and another set of materials for their premier or non-covered patients paying out of pocket at much higher rates. you know, i think that although i suspect most ppo dentists see patients in delta dental, but

also see patients who have other plans or don't have insurance at all and obviously you would be of note whether dentists were selecting has been suggested inferior products for one group of patients but not for another, that would not sit well i suspect with the board. >> commissioner breslin: i wasn't suggesting they were using it for one group of patients or another. i was suggesting in the ppo plan would have to cut corners in order to stay in the ppo plan. so if he has this equipment or if there are other ways he cuts costs, then he would obviously be doing that for everyone. i'm not saying he's going to use different materials for in or out of the health plan. i'm just saying in general, he would have to do this in order to survive, you know, with all the expenses that dentists

have. >> president follansbee: that is -- go ahead. i'm sorry. >> commissioner: i'm sorry. i appreciate the question, commissioner. you didn't suggest what i was asking we get some feedback on. on the other hand, dentists are credentialed and we did ask delta dental to provide information about the credentialing and how with recredentialing they check for licensing agencies and all that. and so, you know, i think that dentists have a sense of accountability and ethics to their own practice and to their own quality of service and so the implication is that for either their practice or one segment of their practice, they are looking at inferior products in order to make financial success of it and i think what you suggested, there

needs to be accountability or investigation of that. >> commissioner breslin: when delta dental suggested, why would they investigate it? they suggested to cut corners. >> commissioner: well, i think you're bringing it up as a legitimate issue and so the question should be asked, you know, i can guarantee as someone who's been a private practice as well as with kaiser that there are lots of practice advisors out there who are not based on insurance companies or as insurance providers who will come into an office and make all sorts of suggestions to how to maximize revenue and minimize cost. that's not -- this is not a suggestion that comes simply from a payor. it comes from a whole industry of consultants out there who

would suggest similar kinds of approaches i suspect under the circumstances to try to maximize revenue. >> commissioner breslin: yeah, well, this is delta dental. >> commissioner: i understand that and appreciate that. >> president follansbee: the way it is, any managed care environment is going to have some of these parameters present. the question is out of it, does it drive down quality. any managed care provider that you have is going to provide counsel that in some way is going to try to restrain cost. the question is does it or is it, in fact, equality in terms of the services that are being provided and so part of that is having at least an insight into what our normal protocols and interaction between the insurer and the provider in this

particular case. >> are there other comments from either commissioner breslin or other commissioners on this presentation and the recommendations? >> commissioner zvanksi: yes, i have some questions. i think the questions that commissioner scott brings up are very significant and i think some of those suggestions go across from dental and medical and all across the whole world that we're dealing with. one of my concerns is that delta can assure us that it has delta dentists whether they're ppo or premier in all of the areas where we have members. i recently received some

comments from a couple of retirees that indicated that their dentist was no longer going to affiliate with delta and i know i've looked at this very carefully and i think they were from sonoma county where there was some dentists that -- and they said that all the dentists and i think it was sonoma not solano, i'm pretty sure, indicated that they were no longer going to affiliate with delta and so i was wondering if delta was aware of any issues and any particular area. and the two calls that i got, i don't remember the other area, but when the calls came in from the notifications, calls came in from our retirees, they were very clear that they had gone and searched of other dentists in the area and they were told

by all of the dentists that none of them were going to deal with delta. we didn't ask whether or not they were affiliated with uhc but that was a big concern with regard to that. so i want to hear about that and the other thing is one of the other and there are a number of dental conditions that relates specifically to some very severe medical conditions and so it is in our best interest especially within our retirees to really encourage them to have good dental health and to have the insurance if that's what they want, but to definitely go and seek dental care. the last thing is that a couple of years ago, i recall a discussion about the premier

part of delta's organization and what i didn't understand or what i seem to be understanding now is it was promoted, premier was promoted so strongly at one point that i was under the impression that actually the premier dentist took a deeper discount and somehow we were encouraging more dentists to join premiedentist, you know,

charging and these figures under the noncontracted dentist balance billing are basically the differences in the total charge between these two types of dentists because this flows through to member responsibility and balance billing. >> president follansbee: and, could you also clarify because i understand you say that delta, the delta quote is for

one year only and not -- did they not want to engage in a two-year discussion? >> oh, no. so the delta quotation is for two years on both the ppo and the delta care hmo. so the rates quoted here would also hold for the two thousand twenty-three planned year for the two delta dental plans. >> president follansbee: right and u.h.c., is their quote for one year or two years? >> u.h.c. is a one-year quote. so i'll forward to the rate page. >> commissioner scott: and why would they >> that's always been a one-year quote. >> commissioner: is that page 40? >> commissioner scott: yes >> page 40 for the rate. so what you see on here for the two year delta plan for 2022

and two thousand twenty-three for united health care at the one-year renewal. and so these are both coming off of for delta a three year renewal that took place for 2019 through 2021. united health care has always been a one-year annual renewal. >> commissioner: so i want to make sure everyone's clear on the last issue, that was slide 16 because commissioner breslin is correct that the, if you use the example of the one cleaning exam and bite wing x-rays, the ppo dentist agrees to a reimbursement of $246 for that service whereas the premier dentist agrees to a $300 reimbursement and can essentially, you know, the

member makes up the difference through the contracted rates. the noncontracted dentist, the $410 was an ashtary number. there is no contract for that procedure of $410. that dentist, that's the average in the bay area. that dentist could charge $300 that dentist could charge $600 and the member using a noncontracted dentist pays the difference, whatever that office feels it needs to charge to make their revenue. so although the two first numbers, the $246 and the $300 are fixed through delta dental, the $410 is not. that is just whatever dentist and the member who walks in and says i need the following service should get an estimatal cost from that dentist that says that's fine. this is what we charge. this is what based on your delta dental contracts to date,

you will owe us because we will expect a small reimbursement from delta dental if you haven't already exhausted your benefit, your $1,500 benefit. but that $410 is not a fixed number that the noncontracting dentist have agreed upon. does that fully explain exactly what we're looking at here? >> yeah. thank you for clarifying that, president follansbee. that's absolutely correct. $410 is in the example here. let's say hypothetically it was $300. then there is no balance billing to the member. now, what there is is a member cost of $60 that represents their 20% coinsurance share of the $300 premier rate. the advantage to using a ppo dentist or diagnostic and

preventive services is those are covered in full with no member cost sharing 100% coinsurance in that amount paid to the ppo dentist based on the contracted ppo rate. >> president follansbee: right. okay. so are there further questions or comments or clarifications from board members? >> commissioner breslin: if not. i would like to say one more thing. >> president follansbee: absolutely. go ahead, please. >> commissioner breslin: in may of 2019, the board voted to increase the out-of-pocket deductible for the premium and out-of-network categories. most of our members, the majority of our members actually are in the premium more so than the ppo. so my question was how was this in the best interest of our

members? the members already pay more in these two categories, so who is benefitting from that change? the idea apparently was to push people into the ppo which i really object to doing that as long as the members know exactly what the ppo is, you know, the whole setup and why their dentist may not be up to snuff. so i would like to withdraw that $20 -- change that $20. was it a $20 increase in the out-of-pocket? i don't remember, but i thought it was. >> so the deductible formally was $50 a person, $100 per family. so it went to $175, $150 and then it resulted in these benefits formally being paid for these vendors crowns, bridges, root canals and the

ppo, that increased to picket%. so the member coinsurance decreased from 50% to forty% for these three buckets of services in the ppo. >> commissioner breslin: again, you know, who's benefitting from this except delta dental? certainly not our members. i mean, why punish our members for trying to get good dental care. especially the out-of-pocket increase when they're already paying quite a bit more. i don't know why anybody thought that was a good idea. >> commissioner: for those of us that have ppo dentists, my dentist is fantastic. she's outstanding. her father was a ppo dentist and she is and i benefit from that. so i'm looking at getting the best quality dental care i can through a ppo dentist. so, i'm sorry, i don't agree with you with regard to your view of premier and out-of-network being superior to ppo dentists.

my experience and i've had even before i went to this current dentist, i had a previous dentist who retired and he was a ppo dentist and his services were top notch. he's one of the top dentists in the bay area and he was a ppo dentist. >> commissioner breslin: well, that may have been awhile ago. it sounds to me like things may have changed a bit. >> things may have changed, but we have no data that suggests that there's been a change we have no data that says that ppo dentists provide inferior care compared to premier dentists. out-of-network dentists are not reviewed at all by delta dentists and so i think we have to be a little careful. you know, there may be examples commissioner breslin where you're absolutely right, but we

don't have data across the category to support your contention. and i think there are probably exceptions in every category. >> commissioner breslin: there may be but you have lost complaints for our members and that's important to me. >> [inaudible] >> commissioner: i don't know that i can say we have a lot of complaints that have come through member services. we've had a few and we are talking to delta about them. >> commissioner breslin: that's good. >> yeah. there's been only a few here too. >> commissioner breslin: yeah. you know, our members are vocal. it's important that we listen to them, but we also have to go back and get the context and understand and i think that's what i have learned this year in looking at this benefit and you've written some really important issues working with the account team at delta to try to get this information

reported to us on a regular basis so i think that's where we stand and that we will work to get quality indicators and measuring performance that are worth looking in to from the stories that we heard. i don't know that we have the data to say that we have an extreme problem. we have some concerns that we're investigating. >> president follansbee: but these issues are very important, commissioner breslin. you're absolutely right to bring them up. and you're absolutely right, we have a responsibility to follow up on that including patient scores and quality issues and review what those parameters are. so this is a critically important discussion, but we need data and not a handful of complaints. we need information and that's not been forth coming and i think that the team is working on that and i applaud director

yant and the team as they're investigating this with delta dental. as with any contracted provider organization. >> commissioner breslin: that's true. you know, a lot of people like i would, they would just drop the dentist and go to somebody else and never say anything. i think there would be more people that would do that than not. they wouldn't even think to write to h.s.s., they just wouldn't. and so that's the issue. a lot of people don't know where to complain or they don't want to bother and say i'll go look for a new dentist. so that's an issue. i just more and more i think there's big issues with this ppo and, commissioner zvanksi, adding the $20 didn't do you any favors. you still had zero deductible in your ppo. that never changed. >> commissioner zvanksi: i realize that, that's why i like my ppo plan.

>> commissioner breslin: yeah. it never changed. >> commissioner zvanksi: for some of us, our dentists are more significant than our gynecologists or urologists. so i don't take dentists easily or that gallant with such aplum. you know, it's like my dentist is really important: president follansbee, i'd like to make a motion that this board adopt the rates as specified on page forty of the exhibit the one that's in front of us now on the screen, yes, that's the same one i'm looking at with the understanding that the delta is a two-year rate guarantee and the u.h.c. is a one-year rate guarantee. but we adapt it as presented. >> commissioner scott: and with those clarifications, i second the motion.

this is randy scott. >> president follansbee: okay. this has been moved and seconded that we accept the recommendations for a two-year rates for delta dental and one year for u.h.c. hearing no further discussion, i'd like to open this up for public comment. >> secretary: thank you, president follansbee. i'll pull up our public comment slide. when i welcome you on the call you're encouraged to state your name clearly although you may remain anonymous. you'll be placed back on mute

and the moderator will unmute the next caller. remote viewing is available on sfgov tv.org. the dial in number is (415) 655-0001. and again, (415) 655-0001. when prompted please use the access code 187 296 5890. then press pound and pound again. you will enter the meeting as an attendee on the public comment line and dial 3 to be added to the public comment queue. this is your time to speak. for those who are already on hold, please continue to wait until the system indicates you have been unmuted. sfgov tv is a standing 40 to 45-second delay for viewers watching our live broadcast online. we will take a 45-second pause

for callers to call in. our 45-second pause will begin now. the 45-second pause has ended. and our moderator will notify us if there's any callers in the queue. >> we have four callers on the

phone line. one caller has entered the public comment queue at this time. i will indicate when there are no more callers in the queue and you will hear a brief moment of silence as we transition between callers. elevating caller one now. >> secretary: welcome, caller. >> hello. my name is herbert liner. i'm on the executive board of protect on benefits. our concern is as retired civil servants who have served the city will get the best dental plan possible because our needs increase as we grow older, we see that that is more frequently and we will after

this pandemic. so we really want to have a dental plan that has teeth so to speak. and this is extremely important to us and i'm speaking on behalf of the board and my own feeling is and speaking as an individual, if you need help in formulating a more comprehensive plan, you should consult with us. we would be glad to provide you feedback in order to improve the dental plans not only for ourselves, but for all employees of the city. thank you. >> secretary: thank you, caller. our moderator can elevate any other callers. >> elevating second caller now. >> secretary: welcome, caller. >> hi. this is fred sanchez, the

president of protect our benefits. i want to applaud the amount of information, how much i learned on the discussion on the dental coverage. i mean, the staff, holly, everybody, the trustees, i know they're in the best interest of the members. i think dr. follansbee's suggestion about finding out about the service they're getting, that should be made in a motion and seconded and passed whether it be semiannually or annually. then the members would have to actually state what they feel is beneficial, if their premiums are too low or this or that, but now you have hard data and that's what you want to get. it's a very difficult situation. i mean, as we get older, sure, yeah, our cost increase greatly

for implants and stuff and i think that's why various dentists are leaving is exactly what the doctors said as far as the contracted price is at a rate that they feel they can't even break even and so when you end up paying out of pocket more than the contracted price. i mean, this is one of those things, we know what the problem is, but the solution is far greater, but i thank you for your sincere concern about this issue. i think everybody's trying to work in the right way, but i would love to see a motion to get that survey done. thank you. >> secretary: thank you, caller. let us know if there are any future callers in the call line. >> there are no additional callers in the public comment

queue at this point. >> secretary: thank you, moderator. seeing no further callers. public comment is now closed. >> president follansbee: thank you to our callers. we have a motion that's been seconded on the table. holly, would you please read the motion as is currently presented and modified. >> secretary: yes. one moment. commissioner zvanksi motion to adopt the rates on page 40 with the understanding that the dental care rates were a two-year guarantee and the rates were a one year guarantee. >> president follansbee: okay. so call for a vote. all in favor please signify by

saying "aye": do i hear any opposition? okay. it passes unanimously. i'm going to postpone agenda items 13 and 14 to our may 13th meeting. this will allow us not to utilize the april 22nd time set aside. i'd like to move to item number 15 which would then conclude the rates and benefits section. so we will postpone items 13 and 14 until may 13th. here on item 15 today and item 16 before adjournment. so can we call item 15, please. >> secretary: yes.

president follansbee, sorry. can you -- i do think that the screen is off. are you looking for agenda item which was reviewed the kaiser permanente hmo plan 2020 which i have as number 15 on my cheat sheet. >> secretary: you're correct. the agenda on the screen is off. it will be agenda item number 15 which is kaiser permanente hmo plan 2020 claims and utilization experience which is a discussion item. >> mike clarke, aon. i will pull up the presentation.

i'll be presenting on the kaiser hmo plan including a brief introduction. there are detailed monthly claims and member account information in the appendix. for your reference, i will not be reviewing that specifically today. this captures 2020 and medical prescription drugs and quality intd indicators for the kaiser nonmedicare plans offered by s.f.h.s.s.. most of this information refers to active combe and retiree and there is some information on the medicare population. for reference, there are approximately 13,500 lives on the plan. this came from a recommendation during our kaiser rate presentation last year and this follows similar presentations

that we've done to the ppo and the blue shield hmo plans and so we have key information with data provided to us by kaiser. so we thank them for all the information you'll see in this report. the paid claim information captures full panel year of the 2020 experience with other data views representing information that were available through september 2020. for reference, about $33 million in monthly premiums is paid to the nonmedicare members and about $5 million in monthly premiums for the medi-care members so kaiser overall represents almost half of total h.s.f. health care plans. a brief note on covid-19 impacts before we launch into the experience similar to other plans, the h.m.o. for kaiser

did have substantial suppression of medical claim levels during the second calendar quarter of 2020. prescription drug experience largely remains similar to pre-pandemic levels. there are no adjustments to the recording in this presentation, but the covid-19 pandemic driven claims you expression presentation that again was largely reduced in the calendar quarter of 2020 it will be reflective of a typical times forecast. in other words, they will take the 2020 experience and trend it forward but with a higher trend assumption to reflect the fact that it will be underwritten based on 2020 experience that included claim suppression where you expect 2022 experience will not include claim suppression. and also, we'll review those details of the kaiser underwriting which we've not

yet received for the 2022 planned year. but we'll receive it shortly and present it to the board on may 13th. with planned experience, i did mention the claim suppression. you can see for 2020 versus 2019, the red figures in particular lower per member per month claims for active employee medical for 2019 to 2020. and that's all prescription active medical drugs. early retiree cost reduced by more overall 16% and when you look at the bottom bullet here for the 2020 plan year, the lost ratio of paid claims

including administrative claims was an 86% loss ratio. that translates to 340 versus 395.7 million in paid premiums for the kaiser. top diagnostic categories. pregnancy and child birth is the highest cost category with mental disorders, digestive and cancer contributing to higher levels in other categories. for the early retirees, muscular skeletal the highest. so you see some patterns of consistency between the two but also some differences, especially the higher level of

pregnancy, child birth for active employees. which you can see in the footnote is at the bottom of the page. and thirty% have at least one chronic versus 42% of spend for active employees. hyper tension, diabetes, depression and heart failure are among some of the key chronic positions in helping those patients maintain control. you can see the percentage of lives in each of the populations attribute to each of those four chronic conditions and the percentage of planned cost that stems from those covered lives with those

chronic conditions. and, it is possible any one individual can present in more than one category if they have multiple chronic conditions. kaiser was able to report 14% diabetes prevalence and 46% hypertension prevalence among the medi-care. this shows chronic disease control and how it compares first on this slide, the active employee group. the higher control percentages except for depression and heart disease or the active employee population compared to industrial and regional averages as well as being a quality indicator where 50% tile is 90th in class. on the early retiring group,

control percentages are higher for all conditions below. so indicating, you know, pretty strong adherence and support for members with these chronic conditions. and, for the medi-care retiree group, we generally find higher percentages of control for sfhss retiree for medication. we see overall 7% positive test results since testing began in march 2020 through february 2021. there's been $2.9 million of paid claims for testing and $6.8 million for treatment of employees and early retirees and what you'll find from a hospitalization standpoint is a higher level of hospitalizations that took place from november 2020 to

january 2021 as we started to see some of the surges in the bay area during those months, but starting to reduce again for february 2021. and, then for the medi-care group, similar statistics in terms of the overall percentage for slightly lower test result rates at about 5%, but, again, you see the surge of hospitalizations that occurred in november to january, that declined in february. from a preventive and proactive care standpoint for all populations, you could see this chart has active employees, retiree benefits and medi-care group. a vast majority of vendors are see seen within the last year. obtained a flu shot seeing higher rates for the early retiree group.

45% for active and a large percentage of members are getting aids and other demographic factor appropriate screenings for breast cancer, cervical cancer and colorectal cancer. medications where truvada accounts for 30% of that category. the anti-inflammatory and anti-curetic medications. so in this category 50% drug scripts and 35% drug pharmacy claims for treatment of those conditions you see in the middle of the page and anti-neo plastics and 24% of specialty

drug claims fall in this category. and that's for the active employee group rounding out with endo crin and cardiovascular. those are your top diagnostics. medication adherence, certainly, we want to see members be adherent with their medication protocols and you can see that they're very high for diabetes, high blood pressure and high cholesterol higher or similar to the k.p.e. as well as central nervous system medications and then from an adherence standpoint, again, here, very high rates of adherence across diabetes, high blood pressure, and high cholesterol for the early retiree group. and for medicare retiring that pattern especially relative to

the k.p. book of averages, a higher rate of adherence for diabetes. otherwise very similar in high weights of adherence for high blood pressure and high cholesterol medications. and then from a telehealth standpoint, telehealth did increase with the onset of the pandemic in march. a little hard to see, but i'm circling where march is on the chart and if you look at the orange bars which are phone visits and the blue bars which are video visits, you see an elevation of use of those modalities for how k.p. members interacting with their k.p. physicians and high sustained utilization of those using video visits with their kp physicians. so very positive to see even through the end of december.

so this chart represents full 2020 that members continue to be comfortable using telephonic visits and video visits to consult with their physicians. and, again, we have some detailed in the member counts in the appendix that i won't go through. president follansbee, i'll turn to you. >> president follansbee: okay. thank you very much. this is really fascinating and it actually overlaps a bit with the presentation that we're deferring with all apologies to rin because i think i had some questions relating to the dash board and this information to try and testify to some of the differences that i saw in terms of the screening rates for colon cancer, breast cancer, etc. and the question i had at least when i was in practice someone with hypertension was out of control unless they had

a physical measure of blood pressure in the office. now, i know that medicare allowed virtual visits to recode diagnosis. but in terms of trying to justify the blood pressure control, >> for me personally, i do not. if there's a k.c. representative that could very quickly answer that question, i would welcome that >> thank you, mike. what i can tell you if you go back to the blood pressure

control slide. >> president follansbee: i think it was slide 16. >> anybody that we don't have a measure for works against us. so it does -- >> president follansbee: okay. actually it wasn't 16. this is the preventative proactive services which i had a question about compared to our own dashboard. that answers that. it seems to me like our blood pressure controls from kaiser is still quite good despite the fact those that haven't come in would be in the not controlled category. >> yeah. in fact, i love reviewing these numbers compared to other customers. these numbers are always really good. even in light of covid metrics. last year's experience performing really well. >> president follansbee: yeah. okay. are there any other questions or comments? commissioner scott, do you have

a question? >> commissioner scott: yes. i do have a question. this is the claims process that will go into the rating process with kaiser and you know what i'm going to ask next and that is about persistence of membership and the membership profile >> yeah. persistence is high in this plan for patient population than the business. there tends to be 95% or more, you know, consistent in membership from one year to the next in the k.p. plan and the claim experience that i did present today will be utilized by k.p. to produce the 2022 renewal. there will be a variety of factors that go into k.p.'s preparation of that renewal. they have not been at a point where they're able to release it to us, but that will happen shortly and then we'll be

engaging in deep discussions with kaiser in coming weeks to review all the information behind the renewal and ultimately be ready to present to the health service board on may 13th, the non-medi-care renewal and the multi-region plans will get presented in the june meeting. >> commissioner scott: i just want you to continue to stress persistence. >> indeed. thank you, commissioner scott. >> commissioner breslin: i'd just like to thank mike and his team and the kaiser reps for this very comprehensive presentation and i'm going to save it for those may and june

meetings and make sure that we see some good outcomes. what i have heard over the years and watched in terms of all the years that i've monitored kaiser that the adherence in our membership is pretty consistent and has increased over the years as i think kaiser and it's division of medical care has increased over the years and i know when it comes to coronary care, some of the ratings for kaiser are rather outstanding and kaiser monitors members and tries to do everything it can. i don't know how many phone calls i get that say, you know, "you should call your doctor, you need to check on this and that." they're consistent with that and you don't have that in any other plan because of the nature of the organization. it's just the nature of the

beast. but kaiser does a very good job of monitoring their people and trying to keep them as healthy as possible in the best way possible and so this to show how we compare to others says to me our kaiser members are doing very well and benefitting greatly from membership in kaiser and i hope that this continues and take that back to kaiser. tell them they need to keep up the good work and improve it if they can. thank you. >> president follansbee: thank you. are there any other comments or questions? seeing none. we'll go ahead and open this up to public comment. >> secretary: thank you, president follansbee. i'll pull up our slide.

so public comment will be available for each item on this agenda. each speaker will be allowed three minutes to speak in length. all public comment should be made concerning the agenda item that has been presented. as a reminder, the caller may ask questions of the policy body. you may remain anonymous. when your three minutes have ended, i'll thank you for your comment and the moderator will unmute the next caller. remote viewing is available for sfgov tv.org and sfgov 2. the dial in number is (415) 655-0001. again, (415) 655-0001 and when prompted use the access code 187 296 5890 and then press

pound and pound again. you'll then enter the meeting as an attendee on the public call line. when the system message reads your line has been unmuted, this is your time to speak. for those on hold, please continue to wait until the system indicates you have been muted. the sfgov tv has a standing 40 to 45-second delay for viewers watching our broadcast live online. we will take a 45-second pause to allow the systems to catch up and the callers to dial in. our 45-second pause will begin now.

>> secretary: i did want to make a note that commissioner canning had to leave. >> one caller has specifically entered the public comment queue at this time. this caller joined us in the last round of public comment so there is a possibility that their hand is still raised by accident. i am going to elevate them just in case. >> secretary: thank you,

moderator. welcome, caller. caller? >> i have muted the caller. it appears their hand has remained raised without their knowledge. so we can move on as there are no more public callers in the queue at this time. >> secretary: public comment is now closed. >> president follansbee: great. thank you very much. so that ends the discussion on item number 15, again, with ongoing apologies to the presenters for items number 13 and 14. i'd like to end the rates and benefits section of this meeting and move to item number 16 with report from planned

reps. >> thank you, president follansbee. this is agenda item number 16. discussion item. >> good afternoon, commissioners. this is debbie mccarthy with kaiser permanente. can you hear me? >> yes. >> thank you. i'd just like to provide a brief update on the investment that kaiser permanente is making to help combat the violence and help asian and pacific islander communities. there's always been an important belief and mission at kaiser permanente. it's even more important in this environment with all the

and to support the health. kaiser has intended to commit and pro mote healing communities that have been discriminated against. predates the pandemic but has recently increased along with hate crimes and connections between covid-19 and people of asian heritage and have further fuelled anti-asian sentiments and hate crimes. the grant recipients include two organizations that advocate nationally for asian american, native hawaiian and pacific islander communities. these organizations are asian americans advancing justice and stop aapi hate. the grant funding will be used for education, advocacy and community building. addressing information and

xenophobia and targeting these communities and for strengthening infrastructure within regional community based organizations for providing racist attacks intervening and promoting healing. these grants are part of our broad commitment to improve health equity and address racism in the communities we serve. i'll stop and see if you have any questions. >> one question. kaiser san francisco used to have what was called a chinese module where all the providers from the medical assistants, nurses, physical therapies, physicians, practicioners were all tri-lingual. is that still active and do they do outreach? this ties into some of our earlier discussion around our own educational outreach?

>> yes. we still have those language modules throughout our different medical centers specifically the chinese module you're referring to is still there in san francisco. and then i'm sorry the second part of your question, president follansbee? >> president follansbee: well it just has to do again it ties into a previous agenda item where we talked about the, you know, our educational communications plan or review and incorporating other languages into what we at h.s.s. can do and also to help direct our members. >> i've been working with jessica shi and carey biershires talking about this suggest to provide different languages and promoting these different language modules to help support the efforts.

>> president follansbee: thank you. any other questions or comments? >> commissioner zvanksi: this is commissioner zvanksi. and i'd like to know you talked about these grants and it sounds very good. are these for one year or are they multi-year? can you expand a little bit on the nature of the grants? >> sure. yeah. my understanding is that it is a one-time grant to these two different organizations to help, again, related to education advocacy and helping with the prevent the racial attacks. >> commissioner zvanksi: okay. thank you. and it's good to know and good to hear. thank you so much. >> you're welcome.

>> president follansbee: any other questions for this presenter? are there any other health plan representatives who would like to -- thank you very much. any other health plan representatives or did you have anything more to say? >> no. i'm done. thank you. >> president follansbee: okay. thank you very much. any other health representatives who would like to add anything? information about their own plans? >> commissioner scott: president follansbee, i'd like to ask is there a delta dental representative at our meeting today? >> yes. hello. this is mary alpona from delta dental. >> commissioner scott: yes. i would just draw your attention since it was not part of our formal agenda to the question of customer satisfaction surveys and i've asked that executive director i

believe she made a note of it would follow up with you and see if what you are currently doing around that particular question with both your providers, your contracted doctors as well as with our members and then as we're trying to explore this whole thing about data, would that become a part of our review in the future. that's a request? >> yes. we are working with representatives and providing information. yes. of course, delta dental would be open to providing data for your analysis and i'll be working with her directly. >> commissioner scott: all right. thank you very much. >> thank you. >> president follansbee: thank you. >> commissioner: yeah. i have a question of delta also. >> president follansbee: yeah. >> commissioner: is it true that the delta dental does not allow new dentists to go into

the premier status? >> with new dentists contracting, actually, they are both premier and ppo dentists. >> commissioner: okay. great. >> yes. so we are allowing for both networks. >> commissioner: okay. so let me see what else i was going to ask. i would think if there's going to be a survey, i'd prefer that would be sent out from health services. i want to make sure it's not selective or not to say that would ever happen. >> commissioner scott: my request of her exclusively was to work with director yan in the followup area. i wasn't asking delta to do a survey. i was asking them to do a survey in conjunction with h.h.s. under the direction of

director yan just to be clear. >> if i may, i perceive this as two different issues, one is that i would like to see what the standard customer satisfaction surveys are with this organization and as well as the provider surveys and then knowing what that is then that will help inform any survey process that h.s.s. would undertake. >> president follansbee: i think that's good. we trust you to follow up on this. >> commissioner scott: thank you. >> president follansbee: thank you. okay. so if there's no other questions or comments from board members on this item, i'd like to open this up to public comment. >> secretary: thank you, president follansbee. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to speak in length. all public comment will be made

concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the body. when i welcome you on the call, you're encouraged to state your name clearly although you may remain anonymous. remote viewing is available on sfgovtv.org and sfgov channel 2. dial in the number on the screen. that dial in number is (415) 655-0001. and, when prompted, you can use the access code 187 296 5890. then pressing pound and pound again. you'll enter the meeting as an attendee on the public comment line and dial star 3. when the message -- when the system message indicates your line has been unmuted, this is your time to speak.

for those already on hold, please wait until the system indicates you have been unmuted. sfgov tv has a standing 40 to 45 second delay for viewers watching live on our broadcast. we will take a 45 second pause to allow the system to catch up and callers to dial in. our 45 second pause will begin now.

that 45 second pause has ended and our moderator will notify us if there are any callers in the public comment queue. >> madam secretary, there are three callers on the line. zero callers have entered the public comment queue at this time. a reminder to all callers on the line, you must dial star 3 now if you want to join public comment for the specific agenda item. we will wait five more seconds and then close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> secretary: public comment is now closed.

>> commissioner scott: president follansbee, you're on mute if you're talking. >> president follansbee: i was talking. thank you very much. my mouth moves, no sound comes out. again, so this item is now closed. i would like to again apologize to rin coleridge for postponing the presentation of express dashboard to the may 13th meeting. i also apologize to derrick tsoi to postpone item number 14 the plan risk scores to the may 13th meeting. i want to release the date for april 22nd. that date was held for a potential overflow meeting that we will not hold that and so i look forward to our may 13

meeting and i'll declare the meeting adjourned today. thank you very much. >> have a good evening. >> commissioner scott: be safe everyone. [roll call] mr. sanchez is

absent, correct? ms. foster? >> here. >> thank you very much. >> you're off mute. >> thank you. this is commissioner molina. i'm here also. you didn't call my name. >> okay, thank you for capturing that. section b, opening item, approval of board minutes of the march 23rd regular board meeting. i need a motion and a second. commissioners, i need a motion and a second. >> so moved. >> second. >> any corrections?