involved people each day. released from the county jail, state parol, on pre-trial diversion, local probation and federal probation. we also fund career development and other supportive services for justice involved adults. i want to turn it over to victoria who will talk about the drug treatment services. >> thank you, steve. hi, i am victoria westbrook reentry policy planner for adult probation. formerly incarcerated and struggled with methamphetamine addiction for over 20 years. we had a work order with department of public health for 2012. i will focus on the last three fiscal years.

we fund residential treatment beds. this was provided by the department of public health as well as 360 and harbor life. in 18-19 there were 432 referrals for drug treatment. of these 129 enrolleds in treatment and 34 completed. 47 days from the referral to get the client into treatment. 1920. there were 273 referrals leading to 140 treatment enrollments and 49 completions. for this fiscal year the averaging number of days in treatment was 41. current year 161 referrals and 88 enrollments and 15 completions. this has taken 49 days to get someone in treatment on average. there may be outliers for the days to enter treatment because some clients are in custody

prior to entering treatment. i do not believe the repersonrals are from people in custody. 40 days to get clients in treatment beds we fund is too long. i am in the middle every ferals for treatment by the staff and i was able to get clients in to treatment the same day through phone calls. including clients that were in custody. prop t said between one to 8 days to get into residential treatment. i don't see how this is possible. if it takes 40 days to get clients into beds we fund not funded by drug and medi-cal. we have only two options right now. 360 and harbor life. if the client is unwilling for the six month program. that leaves one option. we have had many complaints about the treatment service at health right 360. nowhere to get away from drug

use. it is challenging to say the least to stop using drugs. it is more challenging to stop using when people in the same facility are high on marijuana and pain medications. we don't have a good sense what is being required of our clients to complete treatment. what does completion mean? it seems to be based on 90 day treatment stay. rather than drug free. there is no longitude amtraking of post treatment in san francisco. it no secret drugs are a problem in san francisco. you need to incentivize clients for treatment. you heards the housing programs we fund. a couple years ago we header over and over again why should i go to treatment.

i will have nowhere to live after i complete. we consider this to be a valid concern. to meet the needs in 2008 we created recovery pathway initiative. it provides two years of free transitional housing to any client who completes 90 days of residential treatment. many clients this has supported the journey through recovery. in 2018 we hosted san francisco recovery summit. soon after we launched the working group. it met over a two-year period. developed recovery matrix and launched a survey. the data with the information gathered from the focus groups led to the recommendations. in an effort to tackle the drug crisis and improve outcomes for

those struggling with addiction. in october 2020 these recommendations were unanimously supported by the reentry council, which includes public defender's office. in february of this year supervisor stefani called a hearing for a forum for the department of public health to hear from recovering addicts. to include the san francisco response to addiction we need to expand treatment options. city needs an all hands on deck approach. it is a major crisis. we need a safe site to harm reduction to management and abstinence based programs. >> i guess the question comes

down to is san francisco currently meeting the treatment on demand needs? the answer is clearly no. it comes down to values question with the department of public health. i am often shocked to hear what medical doctors say. it is interesting. if they were shooting dope and in the tenderloin if they had the same answers to the question. i don't get it. people in san francisco are not getting well. the people that are in thetren whichs doing the word. glide, felton, aids, they are saving lives every day. for those that want to escape that after their lives are saved, there is no outlet. it is one lane. you cannot put somebody who does

not want to be around opiates in a place where people are on pain management. i heard the psychiatrist say that. i will tell you how often my clients say, please, i cannot be clean. all i want to do is shoot dope. we heard a medical professional tell us that they mix all of these modalities to one program. it makes no sense. how are we going to meet the needs of justice involved people? simple. we need to expand treatment options. that means on one ends of the spectrum we need safe consumption sites, harm reduction strategy. we should invest as much money from harm reduction as the people on the front line tell you they need. once they are saving lives and for those off drugs completely

we need a place where they can go and be away from drugs? what does that mean. the city funds 486 treatment beds for people on methamphetamine. what if i don't want to be in that treatment center? we can have a longs discussion. the role of the department of public health should be to fund providers to save live in the community. i don't find it to be the role of the department of public health to help people be loaded. it is the role of the department of public health to help people change their lives. to save them so they can regain their place in the community. it is astonishing the things i hear. again, you fund programs now doing incredible work in the community. people are like blaming them for

overdose deaths. they are not to blame. the problem there is no escape for people. they are stuck out there. i want to talk about what we are doing to support the ongoing needs of justice involved people. first, we do fund residential treatment and detox beds. not 30, 60, 90 days. ics months treatment. i was on the phone with the director of the treatment program this morning. they are on six months and want to stay longer. no problem. it doesn't matter the medical necessity. it was what the client wanted. clean, treatment, wants to stay, should be able to stay. next thing we connect clients to medication. at reentry center we provide clinical case management. we have been doing contingency

management since before it was popular. city-wide to manage reentry. we have been working for clean drug tests. we don't test at the department. it is a tool to help clients stay clean. we are medication manager on site with nurse. outpatients drug treatment program on site. clinical therapy through department of health. the star program. i heard the doctor mention salvation army. i do think the department of public health does not fund that directly. i think those funds are from the board of state and community corrections. the star programming and prior to that lead does a good job of connecting people to treatment and case management. holelisicty across the board for department of public health i

have concerned about their values and addiction. another way that we help justice involved people meet ongoing needs. we developed community support networks through positive directions, circle, solutions for women, men's movement and black is beautiful. we have housing programs. we prioritize clients from treatment into housing. there is some concern earlier supervisor safai mentioned about how quickly people leave treatment. it was told to me they leave within seven or eight days because of bad assessment. i don't think so. you should go to those programs. it is culture. you don't feel like you belong. i have been in recovery and treatment. i was in the treatment program

for five years. the day i went to that program i wanted to leave. the only reason i didn't leave because everybody in the program was just like me. i had never felt at home like i felt there when i entered lansing street. it was a place where people understood me. the community has been telling elected officials what they need. elected officials and the department of public health are not listening. you will hear from a leader in the community momentarily. my advice listen to what he is telling you and take notes and figure a way to implement what he is asking for. i know supervisor safai and morris are working diligently to get the recommendations over the finish line. we are so grateful for supervisor stefani for the

hearing in february to recognize that the community should have a voice and needs a voice. last question how are we expanding access to treatment? we are trying to use it as alternative to incarceration. people don't need jail or prison. people need to get lives together. not using jail or prison as the only means to address the consequence. we need to use treatment. we do extensive outreach for clients with behavioral health needs. the star program, we are investing in programs that meet the needs of clients. last as i mentioned over and over again is really important. listen to the community. it is just so important. i don't see it happening across the board in san francisco. i will turn it over to west side

community services and positive directions and hope that he can fill you in on the needs he is seeing every day. >> thank you, steve. good afternoon everyone. as this death toll from this opioid crisis continues to mount. i see families in obituaries about loved ones who passed away from overdosing. i especially want to acknowledge someone who passed away yesterday. she was in a struggle. as supervisor has started this with the moment of silence for the people in san jose. i would like to take a moment of silence for the people who have overdosed.

thank you. i had a lot of things to say. after herring this today. it is really in a way depressing. in a way i can understand how people who are witnessing what we see will need therapy to director this is no disrespect to you or the department of public health. i have to say this. they talk about law enforcement and the police killing african-american community. i have to say the department of public health is as bad as the police because they are killing us. the reason i say they are killing us is because we are sitting here having a conversation. what has been out of everyone's mouth from the department of public health is not what we

see. this is spoken by quite a few people. this is not what we see on a day-to-day basis. me working in the field for 25 years witnessing how the system works. it doesn't work on behalf of african-americans or people of color. first the department of public health is not keeping us safe at all. we feel harmed every day by seeing needles walking children to school. people loaded in fronted of the school, not protected at all, no, heeducation about it at all, families when loved ones die, nowhere for families to go to process the emotions, thoughts or feelings. they project them on the children or community or on each other, which results in them doing exact same thing what they are grieving about. what we had to do as an agency like you were talking about

having beds available. we had to purchase showing you how the department of health failed us. we put people to treatment or detox, never could do it. we had to go perform the beds in detox. five beds but place a person there to work to assist our five people to assist the beds with detox to put people in there immediately when the person comes to ask for help. we have influx of population in bayview asian and latino community. we have so many latino people that we had to create a house for them alone because they have access to no treatment. women don't have a place to go to access treatment. this is what i mean when i say

the department of public health is failing us. not assisting us. we are doing this not with support from department of public health and city of san francisco but through san francisco adult probation department funding beds to do it. we are doing it through churches which insist houses in the community that allow us to use houses. sometimes don't charge us anything for it. it is still a cost to be able to run a house on a day-to-day basis. what i am asking for is increased funding for treatment for wraparound services, all substance abuse disorders. stop separating and pitting substance abuse separate because it is an issue. the other thing is -- i have to say this. right now it is almost like

wartime. the way this was treated today is like we are not in wartime. i understand the name for bandaids on situations, narcan and all of that. what is wrong with telling the person not to do it today? i don't see the problem with that. that is not encouraging at all. especially in a community suffering from so many other ills. additionally i recommend that we need culturally competent substance abuse disorder services and treatment programs with an anti-racist framework. because i truly believe like how the department of public health is killing us. the framework is on a racist theme. it no way to be able to fulfill needs to help the people of color. in the african-american culture what we depend on is in a

personal relationship. same i was seeing you talk about on here that everybody talked about working together, but we need that in treatment also. what happens is like someone was talking about earlier. when medi-cal came in they spend more time on documentation than talking to the person. in our what we have to do is turn it around and just put our energy and our money into the individual and not in the paperwork. also, we need more emotional support groups and classes to deal with the loss of loved ones and loved ones currently using. i get calls every way where can i go to handle this and talk about this? what we have to do? spontaneous create that. another thing we need is the

faith-based communities to be involved in service and treatment. the collaborative efforts. black and latinos, the church is key for support and spiritual leadership. most programs in san francisco you cannot talk about that or you lose your funding. if you are going to tell people what else they can do and can't do, you can tell them they can use drugs, it is cool. makes no sense to me. also, we need to involve the whole community in this. diverse community partnerships. i truly believe in community partnerships and working with police, probation, department of public health, working with everyone that is involved with the individual that is in their lives that we really truly have to work together.

it can't be just conversation. it means sitting down with differences with one another work those out to help an individual. one of the most important things is that when we do that, when we exclude people, we create enemies. if you have an enemy, that means we ain't working together. i strongly support the adult probation in san francisco because a lot of times people say we can't have criminal justice system involved in helping people. if you excludes the criminal justice system, what are they going to do? police are killing our community. people are going to be indifferent. they are part of the process also. you have to include them. you can't exclude anyone. they say so with this also. i support the san francisco adult probation.

i thank them for allowing them for letting us on this call. i give you credit. you had to sit here for three or four hours. if you do this on a day-to-day basis i commend you for your work and thank everybody for allowing me to be on it. >> thank you so much for the presentation. are you guys done? >> we are done. if there are questions, we will answer them. >> feel free. >> thank you so much. this is a good follow up to the hearing that supervisor stefani held back in february on the recovery of the working group recommendations. thank you.

supervisor mandelman. >> yes, i want to thank director ad a.m.i. and his westbrook and akbar for the presentation. for the work they do. i think they have highlighted the disconnect between what we are seeing in terms of these prop d reports and the experience of the people trying to get treatment for folks. i think as we look at updating prop t and working with dph to do that, adult probation and providers like west side community services are an important part to figure out what information more particularly than in the prop t legislation will help pullout the information that is relevant like the fact that wait times are not days, it is 41 days that

is horrific. that is not just the pandemic. that several years. there is work to be dub. i thank them for, particularly in akbar, demanding the system not give up on people. recognize that there are people who are going to struggle for a long, long time. we have to take care of those people. we don't want them to die. also recognize that while we take care of those folks to keep them alive we shouldn't abandon anybody, particularly african-american people. there is supervisor stefani. >> i can wait until you are done. >> i am done. go ahead.

>> thank you. i just wanted to extend my thanks as well. i think the passion is there because they themselves have found recovery and they are passionate about it. they know what it has done for their lives and they want to give that to others. that is commendable. i love working with you. i know there are a lot of things we need to look into based on what you have reported especially victoria about the number of days and discrepancy between what dph reported and you reported in terms of getting people to treatment. what do we do next in terms of you working with dph. how is that going to happen? continuing this pattern of coming back to hearing and not being heard cannot continue. i want to have dph to reach out

to all of you so we can move forward with this in a collaborative manner. you are passionate about this. you know it saved your life. i remember victoria when you said and you had people in tears. your life got bigger when you found recovery. you were in a cell. that was powerful. nobody wants anyone to sufferin' carceration. that is not the point. we want people to find what works for them in terms of dealing with any addiction that is on their back. it is an alberttros around people's necks. there is various ways to do it. recovery the ways you spoke of. medically assisted treatment, harm reduction. we have to be united and how we

go about this. we have to. look at the streets. i can't thank you three enough. i don't have questions right now. i didn't realize we had another presentation. i will stop and listen to the next presentation. thank you all. >> we will move onto our final but not least speaker laura thomas, director of harm reduction of the san francisco aid foundation on the treatment of demand coalition and after ms. thomas we will go to public comment. >> thank you. i will share my slides now.

>> thank you very much.

i am here presenting on behalf of the san francisco treatment on demand coalition. first of all, i want to thank the supervisors for holding this hearing. i want to also appreciate the department of public health presentation. i am excited about doctor k un an's arrival. i want to appreciate citied and victoria for presentation as well. you are going to hear a lot of similarities between what we are asking for and what atd is asking for. in particular, the need to listen to and include the voices of people who are most affected by substance abuse and substance abuse disorder. treatment on demand is a coalition of both neighborhood

residents and community-based organizations working to improve access and available of mental health and substance abuse across the full continuum of care. obviously, we are here because of prop t and people have gone into detail on this. the goal is to improve access and yet in many ways access to treatment has not gotten better since 1997 but has gotten worse. this is the problem and this echoes many things said. low income san franciscans face substantial barriers to accessing treatment including eligibility, lack of integration, criminalization and for many the most effective way

to access treatment is to encounter the criminal justice system. certainly everyone in the criminal justice system needs access to healthcare, treatment, dignity, respect. no one should have to get arrested to access healthcare. overall, you have heard this before. there is a lack of funding for parts of the system. in particular a lack of coordination from one program to another or one institution to another. those who actually seek treatment often cannot easily access it. that should be the overall goal for this system. this comes from the stop the reinvolving door report coordinated by the coalition on homelessness. data collected in 2019. report published pre-covid and

published last year. they were surveying unhoused and marginally housed people. i want to make it clear they found about a third of the people that they surveyed identified substance abuse as significant challenge. we know there are housed people who have substance abuse disorder and also unhoused people who do not have you stance abuse disorder. we don't want to conflate the two. look at this vulnerable population and we found for many although not all treatment did in fact help meet their goals and address their underlying issues. it is working for the people who can get into it. a third of those surveyed reported barriers for treatment. we need to do better.

access was confusing. the wait list too long. disability issues, linguistic assess issues. so what we are doing and some of this goes back to supervisor mandelman's questions at the very beginning of this hearing. we want a comprehensive needs assessment of the existing services and funding to identify where the gaps are. we need to have this information so that we can plan for the system overall. we want to see more resources or supportive housing, case management, low threshold drop in centers and treatment beds. we recognize this system of care is not just about treatment beds. it is about everything around those beds as well.

we want to make sure community voices are being represented as we create these policy solutions. >> what are we asking for? we are asking for comprehensive inventory re-evaluation of services including barriers to care. we want to make sure we are asking the right questions to understand the needs and barriers. planning for services should include people with lived experiences. we want to fix the gap in services to ensure that people are able to smoothly transition from one part of the system to another. we are very concerned about proposals to increase law enforcement of the solution to the overdose problem. in over policing and jailing can

increase overdose responsibility. we need to address the needs in the community. we want to broaden the definition of mental health support and substance abuse support. low thresholds drop in services, safe place to rest and warn meal are as important for somebody as sense of well-being as chin services or hospital care. we want to strengthen and expand harm reduction and ensure that services are culturally as inclusive as possible and address language, cultural, access to phones or computers, history of trauma, family status. we need more models in more places in more neighborhoods to

mead people's needs. in particular, i know that the previous item on this hearing covered this somewhat. we need to be prevents overdose deaths and keep people alive to access these healthcare treatment and recovery options. if we can't keep people alive all of the treatment beds in the world won't do any good. we need to step up the community harm reduction to prevent overdose deaths in all settings. i know it is a broken record. we need supervised consumption services yesterday and better address the causes of overdose vulnerable. the 72 hours after release from the jail and people are vulnerable to overdose.

we hope the board will emphasize the perspective of someone looking for treatment and not able to find it and scale up city programs to bridge these gaps so that people know what is available and how to access it. these are some of the references in here and that is it for my presentation. thank you for holding this hearing. we are ready to do what we can to ensure that we are asking the right questions in these reports. i appreciate the work of the department of public health and the work to extend services, but we need to do so much more and in particular we need to collect

the right data and ask the right questions so that we know that our efforts are going to good use. thank you. >> thank you, laura, for that presentation and for all of the important work of the treatment on demand coalition. supervisor mandelman. >> thank you, chair mar. i want to thank ms. thomas and the treatment on demand coalition. my legislative aid and i started attending the meetings shortly after i was elected. it seems like a really important thing for the city to be doing. this notion of a comprehensivegan analysis to get revisited each year to inform our annual budgeting. if we aren't able to do what we would identify through that exercise failing means we will never meet the need.

i want to thank the coalition for pushing on this. i am hoping and i want to take although we got off on a bad foot with dph today and i don't think the treatment on demand reports they have been doing are adequate in any way to meet the needs of the city now or really the intent of the legislation. i am grateful for the invitation and their openness to think about how to turn these prop t reports into something that might be part of the overall comprehensive needs assessment in san francisco. it is part of mental health sf and we can have great conversations with the coalition. i would point out that the perception of the treatment on demand coalition it takes getting arrested to have a

better shot, not great experience of accessing treatment services, but the sense that is better than for the noncriminal justice involved population is more troubling if we look at apd numbers which show terrible access for people criminal justice involved. this is going to be a robust conversation going forward that will not end with this hearing but lead to some legislative changes and new approaches at dph. that is all i have got. thank you, ms. thomas and thank you to the coalition. some folks may have called after four hours. >> supervisor stefani. >> thank you.

i just had a clarifying question. on one slide about what you are asking for the board no increase of law enforcement solution. we need alternative responses to come from the community. are you referring to adult probation in terms of the programs they provide? >> i am specifically talking about policing and the way in which aggressive policing increases overdose risk. for example, people may use their drugs more quickly because they are afraid of being seen by police or arrested by police and that may mean that they misjudged the amount of substances that they are injecting. that will increase overdose risk for them or if they are trying to hide in a place where they won't be seen, they won't be

seen if they overdose by a passerby. you know, i think it is -- i do appreciate the ways in which sfpd carry naloxone and bart officers carrying naloxone. we can increase vulnerability by overdose by using police as a response. >> you will still be working with police to make sure they have narcan and how to administer it? the numbers are high in terms of the overdose preventions that police provide because of narcan. >> i am not saying that. you still want them to do that, right? >> i want police to have naloxone on them. the numbers of overdose reversals done by sfpd pales in

comparison to those done by people using drugs. we certainly do want police to continue to have nailing ox own on them. absolutely. >> -- naloxone on them. >> thank you for clarifying that. that is all i have. >> thank you. maybe we can go to public comment now. are there callers on the line? >> thank you, mr. chair. we are working with department of technology to blink in the public comment callers in the queue. for those watching our meeting on san francisco channel 26 or sfgovtv or he wills where follow instructions on the screen by dialing 415-655-0001. id1870170254.

press pound pound and then press star followed buys 3 to enter to speak. press star 3 if you wish to speak. those on hold in the queue continue to wait until you are prompted to begin. we havics callers have raised hands for comments. first caller, please. >> this is jennifer from coalition on homelessness. i did not expect to speak first. thank you so much for having this hearing. i wanted to just add really good presentation and wanted to add some stuff specifically around our report that we did. the problem with a lot of

problem was the system not completely touched on. one of the pieces that we are finding at least with the unhoused community which by the way many of the folk have not been in treatment for the past five years. what seemed to come out of the survey there was other issues that ended up being more priority in terms of basic survival. another thing that came up a lot that the is deeply connected. we interviewed about 600 people and it was intensive survey with universities involvement. this connection to housing and people feeling like when they had been in treatment and they

had been in treatment several times and they ended up back on the streets. they were not interested in going back to treatment. they felt like it would be a waste of effort when they knew they would be worse shape when they were back on the street. the connection to housing is very significant for unhoused community members in terms of both success with treatment and even at this point trying to get folks into treatment. other things that came up that i think are really important and by the way it was about a third of the unhoused people. >> thank you very much for sharing your comments. next caller, please. >> i am with public policy and community organizing.

life expecting of tracks woman of doll. [indiscernable] if we go to the root cause it intersects with social and economic impression of marginalized lbgq communities of color and mental health and without adequate shelter. accessory cover reis not the same top, middle and bottom. the fact we have separate category for treatment on demand we are not doing enough for substance and mental health. not a criminal justice issue. true treatment on demand will be holistic,en come bus community love and not pulling up by the bootstraps if you don't have boots or the straps are broken.

>> next caller, please. >> supervisors this is the second time i have listened to this topic. what you are doing is in the middle of pandemic we have to pay attention to what you are saying. you go on and on and on. just have one are two presentations because the more presentations you have the more we have to listen to and traumatize us. we have to go to the location by 450 golden gate to see what is happening. san francisco has gone to the

hogs. the presentation we need more people of color. we are fed up listening to the whites telling us what to do. they are behind the killing going on in the community. blacks are dying. you know what? we have police who are black and mayor that are black. they don't give a damn. many of them have not been given an opportunity and they are dying. they are watching this. you are talking. [indiscernable] where are the changes happening in the san francisco general hospital? this is bull. supervisors family members who are on drugs or something, that is your problem.

don't bring that to our attention. we don't have empathy for that. [indiscernable] go to the pow-wow. >> thank you for your comments. could we request that meeting attendees not members of the committee please turnoff cameras while we take public comment. next caller, please. is there a caller on the line?

>> good afternoon, supervisors. thank you for calling this hearing and the opportunity to comment. i am policy director at comes family services resident of district 8. i want to register support for treatment on demand and holistic approach to treatment that provides access to everyone who is experiencing a need for mental health and substance abuse treatment. we are facing an extreme crisis in the streets right now. we have stepped up police presence that is not comprehensive response to the problem not making families feeling safer. we want to support harm reduction response to the crisis. we want to uplift the needs of

pregnant women who use drugs who need the treatment and stable housing paired with it. i also want to uplift the need for broader conversation about mental health in our community. i am hearing a lot about substance abuse. it is important to promote safe injection sites and pair housing with is services. it is critical to think about mental health needs of children, families and youth. we have families in shelters where children are regressing in behaviors. basically wetting the bed and having nightmares and using food to control the uncontrollable situations and lives. we are not funding adequate services for those folks for the families and we are not funding services embedded in the programs and not providing the level of housing to get them

into the stability where they wouldn't be experiencing those symptoms of traumas of homelessness. i want to uplift the need. >> thank you. next caller, please. [indiscernable] >> the issues myself. next door neighbor had severe issues. his family was distraught about not being able to get treatment

for him to get him out of jail but nothing happened. this is an issue of racism. 70% of oak land's homeless are black. we need lower levels of care instead of waiting for things to get to the advanced stage. i also feel like in the context of such need that we are talking about conservatorship the only way out. so many people have said there is no such super substitute for permanent supportive housing. 70% of san francisco homeless people. [indiscernable] they were driven out by high rent.

the city policy to encourage luxury housing. the policy would do that. so be it. thank you. >> next caller, please. >> i live in san francisco. i want to say it sounds like the people are falling for the lie that harm reduction approaches. it bizarre in terms of access services. it is jarring because we aid people with harm reduction services towards sobriety every day. i can speak for my experience.

i like to hear that they wished they had cold turkey abstinence and intervention. that can be a death sentence. the last time i overdosed in 2015. the harm reduction and accessible treatment options allowed me to be the kind of member of society that people in this call are speaking as though i need to be to be deserving of care. it didn't work for me. day in and day out for the people i serve and work with unhoused drug users and people on the call talked about front line workers and harm reduction, reducing opioid related deaths. you have to provide the funding to back these words. listen to drug users about the treatment they haven't been getting on demand and need. volunteer with harm reduction.

people say the same things over and over. they have inquired. they can't get into because of the barriers. if they were fearful of strictly programs because of stigma and control and lack of understanding that leads to death. >> thank you very much. next caller, please. >> this is david elliott lewis treatment on demand coalition. the reason i am age to do community organizing today is because of the treatment i demanded abreceived about 16 years ago when i needed it. treatment on demand works. i am an example. in 2005 i was unhoused in need of mental health treatment. it took about a year of trying

to find permanent supportive housing back then. it only took a few weeks of trying to get hooked up with the san francisco system of care by walking into a public mental health clinic, asking for help, getting assigned a therapist that i got to see on a weekly basis with a weekly 50 minute session that was helpful in me pulling myself out of the dark depression into alive that i can now function and give back to society. i know it works.we don't have i. it should be easy to get. many of the clinics lie behind unnamed, unmarked buildings. mission mental health is invisible omission street near 23rd. it is not labeled.

1380 howard is unlabeled. many in the community don't know it offers walk in treatment. again, we need labeled accessiblevis visible behavioral health treatment for mental health and substance abuse. we are close but not there yet. please take the recommendations seriously in this meeting. thank you. this is david elliott lewis, treatment on demand coalition. >> next caller, please. >> on behalf of glide. there are so many different proposals to be considered along these lines and so many other proposals that intersect with the addressing of the needs.

i want to lift everything shared we laura thomas, and the other harm reduction members of demand members. flied is a cause and -- glide is there. the more likely they are to develop acute needs. san francisco must increase funding for all behavioral health treatment to implement the competent system of treatment that acknowledges and addresses these approaches. we need to be prioritizing the trained professionals from community-based organizations with a track record of service to prove more beneficial than the opportunities when it involves engagement with the criminal legal system which is for the perpetuating trauma and contributing to further

incarceration of up house of un. >> next caller, please. >> this is bryan edwards. member of treatment on demands coalition. i want to make clear the comments are bryan edwards, private citizen. as a drug user most of my life. i have been around drugs and users, for the last 18 years i have been around people in recovery in one form or another. i will say that the last time i went into recovery it took me almost 8 weeks to get to the program i wanted. that program is the reason why i am here today. i am one of those that looks back at 2020. it was one the best years of my

life. i was able to get good work done with many people on the call or supervisors, people who presented. you i hear the language of harm reduction versus abstinence and it sidetracks us. i still use drugs today. when i hear someone said sfph is as bad as sfpd. i poured my first glass of wine today. i am not clean now. through the help and support and they played a huge role in this of the san francisco department of public health and one of the providers. i have a great life and i am able to manage the drugs don't do me. they help me get through life. a large portion not because -- this is my third time through rehab. i know that routine.

you know to be someone in san francisco who is basically i am not going to make a ton of money in my life this. is what i do is advocate for people. to watch supervisor preston and his eviction moratorium and not be -- >> thank you for your call. i understand there is one more caller. please connect us. >> hi, i would echo the calls for expansion of mental health treatment because if you have ever tried to access mental health not just specifically for drug treatment just in general. it is a nightmare regardless of what insurance you have. let's say you have ppo insurance, access the procedure is you go to the insurance

company website, figure out who is in network, call a bunch of therapists, leave numbers and hope somebody calls you back. if you have medicaid they have a special number for you to call and you leave your name with somebody and you wait for like a day or so for somebody to call you back to screen you for what sort of help you might need. then they give you a referral and you have to call these other people in hopes that they can fit you in for an appointment. then if you have an hmo like kaiser, good luck with that. i know that the public high

schools used to have drop in therapy appointments with counselors. everything is on zoom now. i don't know how that works. accessing mental health treatment in general is just a nightmare. that is not how the stigma behind it. a lot of people aren't aware it is an option. if that is not an option obviously people are going to look to things like alcohol and drug use as a way to take care of their problems. >> thank you for sharing your comments. next caller, please. >> good afternoon, supervisors. i am and destone with h.i.v. advocacy and san francisco aids foundation. i am calling to support

treatment on demand. there are a lot of barriers for low income san franciscans. i think it is crucial to expand access to services and reach people where they are with care. it is critical to address the stigma around substance abuse and those that use drugs. the more we continue to increase it and kind of continue to shame people who use drugs around substance abuse the less able they are to access treatment in a way that is helpful and this just leads to cycles every lapsing and heightened risk of overdose. i am calling in to highly support and urge the board of supervisors to support expanded

access and lowering paperriers and harm reduction framework and reduce stigma around substance abuse and people using drugs. also bringing them to the table to make sure we listen to their voices. creating systems that support and truly care for them. thank you. >> thank you for your call. next caller, please. >> hello. i am a resident of district 3. supervisor mandelman, i will say i truly appreciate your comments about the accountability issues and filing grievance. we are falling short on many fronts. i worked with the work force development specifically homeless, veterans and

individuals we all recognize that the pandemic exacerbated the key words immediate and all. allowing ever individual access to this treatment when they are at the critical point. deciding they want it is crucial. timely access contrasts with policies that emphasize

punishment. we are suffering one of the worst crisis in drug abuse and usage. expanding treatment on demand will address the addiction it helps creating safer communities for every resident in san francisco. i calm upon the elected leaders to trust in the long-term solution for residents to access for the treatment they need when they need it. i ask leadership respect the request for expanding treatment options and making treatment on demand more readily acceptable. >> next caller, please. >> yes, david grace. i live in supervisor haney's district. i am a member of sign and display union. i noticed that david mentioned

there were a couple sites that didn't have signs on them. i would be glad to petition the union for signs if needed. second thing, early about an hour ago one of the participants mentioned that medicare was a problem in payments. i hope to get more information to help with the lobbying in that. i wonder if it is an issue of anonymity or patient privacy and that medicare doesn't pay unless they get more details. finally, tracking bad batches. in traveling through the tenderloin recently there are a bunch of women obviously on some strange new drug. i am wondering if there is a tracking of new bad batches that go on. i don't like to necessarily see people arrested for things like this, but if the dealers are

introducing strange new things like bath salts and what not, if there is a way to track the dealers when bad batches show up. thank you. >> thank you for your comments, david grace. any further callers? there are no further callers mr. >> thank you, mr. clerk. thank you everyone who spoke during public comment. public comment is closed. thank you, supervisor mandelman for calling for this hearing and your leadership on one of the most urgent and challenging issues in the city. the drug addiction and overdose crisis playing out in our city. this is another long but important hearing and discussion about these issues.

highlighting how we still have a long way to go and a lot more to do to address this crisis. this is timely today as we are in the midst of the budget process right now. i think we are all committed to ensuring more investments in the budget for drug treatment programs and smarter investments and better coordination of programs. thanks. i thank the presenters for all that you do as well. supervisor mandelman. >> thank you, chair mar. i know this is a long hearing. the flight of the chair but i think this was important and i think data reporting is not

necessarily the sexiest thing. if we make smart investments to get a handle on the substance abuse crisis in san francisco, it is going to take us figuring out what we are trying to measure and getting regular reporting and then using that data to inform decisions we make. i think that is part of mental health sf. i have spoken with supervisor ronen. i would like to do the next step on this to work with cosponsors of this hearing and treatment on demand coalition and department of public health, adult probation and stakeholders to figure out how to make this reporting not the exercise that it has been for many, many years now where a document is produced

to not be used by anybody for anything but rather though fulfill the intent of prop t to have a document to help shape and improve our response to the substance abuse disorder in san francisco. i would like to take that offline and have meetings with folks to figure out some changes we can make. legislatively. i would like to leave this hearing open to the call of the chair if the committee is willing to do that in case it is useful to bring this back for additional conversation with the committee, but i think the next steps are offline conversations. i will be reaching out to all of the presenters and other folks to try to make that as useful as possible. thank you, chair mar and committee members, supervisor

stefani for being here and to supervisor haney who could not be here at the very end but i know is very committed to this problem and to solution to the challenges. thanks everybody. >> thanks, supervisor mandelman. supervisor stefani. >> thank you again, supervisor mandelman for leading the hearing. i am a huge proponent of treatment on demand. thank you presenters and those who called in. there was a comment made by someone who called in about the idea of the terms thrown out in this recovery field. i wasn't dirty before. he is absolutely right. the stigma around the disease of addiction is so unfortunate and unnecessary. it has to be dealt with as well.

i remember being at public safety hearing a while back for a liquor license hearing. the person presenting said there is a bunch of alcoholics. i said to him, you need to be careful with your words. alcoholism is a disease for many. there are people who are recovering alcoholics. that term has such a potent way of shaming people. or the term addict or whatever. back to the matter that many people i know speaking from my experience greatly suffer and their families suffered because people have been addicted to substances that they don't want to be addicted to. they have taken many strides and pains along the way. a lot of pain to try to recover. i so admire people who are in recovery. that doesn't mean i don't admire

people who are not. it is a hard thing to do or people who continue to use drugs. it is something that we have to -- any type of shaming will get no good results. it struck me when he said that i wasn't dirty before. you are absolutely right. those who suffer from the cities of addiction and substance abuse disorder are not dirty, nothing wrong with them. it is like another disease. we should be more loving and accepting and work hard with one another to understand where we are all coming from. what each of our experiences are. those who continue to use, that want to use, don't want to use. found a different way. we have to listen to each other. this problem is too great and too many people are hurting for us to put up walls to pass judgment upon each other, pass

judgment upon those who we are trying to help. thank you, caller for what you said because it is a opening. we have to be very aware of the stigma when it comes to addiction and making sure that we are helping everyone we can with everything we have. thanks again. >> thank you, really. >> i would move that we continue this item to the calm of the chair. call the roll, mr. clerk. >> motion to excuse member haney from the vote on this action. vice chair stefani. >> aye. >> member mandelman.

>> aye. >> chair mar. >> aye. >> there are three ayes on the motion to excuse. then on the motion offered by temporary member mandelman the hearing be continued to the call of the chair. vice chair stefani. >> aye. >> member mandelman. >> aye. >> chair mar. >> aye. >> three ayes. >> thank you, mr. clerk. this will be continued. any further business? >> no further business. >> we are adjourned. have a good afternoon. everyone.

>> shop and dine in the 49 promotes local businesses, and challenges residents to do their shopping within the 49 square miles of san francisco. by supporting local services in our neighborhood, we help san francisco remain unique, successful, and vibrant. so where will you shop and dine in the 49? >> i am the owner of this restaurant. we have been here in north beach over 100 years. [speaking foreign language] [♪♪♪]

[speaking foreign language] [♪♪♪] [speaking foreign language]

[speaking foreign language] [♪♪♪] [♪♪♪] is -- >> our united states constitution requires every ten years that america counts every human being in the united states, which is incredibly important for many reasons. it's important for preliminary representation because if -- political representation because if we under count california, we get less representatives in congress. it's important for san francisco because if we don't have all of the people in our city, if we don't have all of the folks in california,

california and san francisco stand to lose billions of dollars in funding. >> it's really important to the city of san francisco that the federal government gets the count right, so we've created count sf to motivate all -- sf count to motivate all citizens to participate in the census. >> for the immigrant community, a lot of people aren't sure whether they should take part,

whether this is something for u.s. citizens or whether it's something for anybody who's in the united states, and it is something for everybody. census counts the entire population. >> we've given out $2 million to over 30 community-based organizations to help people do the census in the communities where they live and work. we've also partnered with the public libraries here in the city and also the public schools to make sure there are informational materials to make sure the folks do the census at those sites, as well, and we've initiated a campaign to motivate the citizens and make sure they participate in census 2020. because of the language issues that many chinese community and families experience, there is a lot of mistrust in the federal

government and whether their private information will be kept private and confidential. >> so it's really important that communities like bayview-hunters point participate because in the past, they've been under counted, so what that means is that funding that should have gone to these communities, it wasn't enough. >> we're going to help educate people in the tenderloin, the multicultural residents of the tenderloin. you know, any one of our given blocks, there's 35 different languages spoken, so we are the original u.n. of san francisco. so it's -- our job is to educate people and be able to familiarize themselves on doing this census. >> you go on-line and do the census. it's available in 13 languages, and you don't need anything.

it's based on household. you put in your address and answer nine simple questions. how many people are in your household, do you rent, and your information. your name, your age, your race, your gender. >> everybody is $2,000 in funding for our child care, housing, food stamps, and medical care. >> all of the residents in the city and county of san francisco need to be counted in census 2020. if you're not counted, then your community is underrepresented and will be underserved.

>> president follansbee: the health services board may 13th 2121 will becalled order, if we could have the rollcall . >> agenda itemnumber two is rollcall . i'm getting mybandwidth notification so i will be turning off my camera .

... thank you for yourpatience. agenda item number two is rollcall . [rollcall] we have a quorum. >> presidentfollansbee: thank you very much, i'll call for

agenda items three . >> agenda item 3 is the approval with possible modifications of the minutes below. this is an action item. >> president follansbee: okay, so any corrections or additions to the minutes of the april eighth meeting? >> mister president. >> president follansbee: yes. >> i move the adoption of the minutes asdistributed . thisis commissioner scott . >> president follansbee: moved and seconded that we approve theminutes as in thedraft form as present . any other comments from the board members ?if not, then i'llopen this up for public discussion .>> commissioner scott: mister president, there needs to be a second . class i've seconded it.

>> commissionerscott: thank you. >> president follansbee: i heard it . >> presidentfollansbee: now i'd like to open this up for public comment . >> i'll be reading a short description. public commentswill be available for each item, each speaker will be allowed three minutes . all public comments are to be made concerning the agenda item presented and as a reminder a caller may askquestions but there is no obligation to answer or engage in dialogue . when i welcome you you are encouraged to state your name clearly and when you're three minutes have ended i will thank you for your comments and the moderator will unmute the next color. remote viewing is available on sfgov.org or sfgov tv channel 2. public comment is available by dialing the number on the

screen, 415-655-0001. again, 415-655-0001. when prompted you will use access code 187 087 3967, then pressed pound, pound. dial star 3 to be added to the public comment q. when the system indicates your mike has been unmute itwe will start yourtime to speak . wait until the system indicates you have been unmute it . sfgov tv has adelay of two minutes and we will take away that cost to allow callers to dial in . our 45 seconds will begin now . ... the 45 second pause has

ended. ourmoderator will note if there are any callers in the queue . >> if you could please transfer privilegesat this time . we have ninecallers total on the phone line . 4 callers have entered the public comment q at this time.

a reminder to all colors online, you must dial star 3 now if youwant to join public comment . i will be advancing the first caller now and you will hear a shortmoment of silence .>> president follansbee: can we remind callers we are dealing with agendaitem number three, approval of the minutes ? we will have the opportunity for other comments later in the nextagenda item . >> thank you president, that is a reminder to all colors that we will be speaking to this agenda item .

>> i have received host privileges andi am looking back at the queue . all 4 callers havelowered their hands. i will wait five seconds and we will close public comment for this item . board secretary, seeing that all hands have been lowered there are no callers in the queue at this time. >> hearing no further callers public comment is closed. >> president follansbee: having been moved and seconded to approve the minutes of the april 8 health services board meeting of 2021, i now call all those in favor signify bysaying aye . opposed? it carries unanimously, thank you very much. we can go to agenda item number four .

>> thank you president follansbee. agenda item 4 is general public comment which is the opportunity for members of the public to comment on any item in the jurisdictionor requesting the board take up the matter on a future item . >> president follansbee: while people are calling in if we turn over host privileges to president follansbee. people have sent in emails to the board and i'd like to acknowledge receipt that the subject ofthose emails will be addressed in the directors report which is item number six . so we are acknowledging receipt of several emails for general comment that will be included in this item, in the minutes of this item. it will open it up for public comment. >> thank you president before i

do that as well i did want to acknowledge that supervisor chan has joined the meeting. and noted in the minutes. >> president follansbee: thank you. >> commissioner zvanski: if those emails were sent infor public comment don't we have to read them into the record ? >> presidentfollansbee: yes, that's why i mentioned it . they will besubmitted into the record . >>commissioner zvanski: but don't we have to read them out for the meeting ? i'm just asking the cost when they do it at the retirement board for bringing up another benefits board, they do read them out into the record . so that's why i'm asking. procedurally i just don't know.

>> commissioner scott: i don't think they have to.i'll double checkbut i don't think we are required to read them and we should definitelyinclude them in the record . >> president follansbee: that was the board attorney speaking and so he will look into it further . but i would like to again reassure everyone who comments whether by email or verbally during the meeting at those items will be entered in their entirety into our record . >> when will theboard get to see these emails ? >> president follansbee: we've seen 2 already. >> i haven't. >> president follansbee: it just came through in your commissioner breslin email system. i do see it was addressed to all board members .it happened just prior to calling intothis meeting . >> commissioner breslin: we don't know theissue brought up

. >> president follansbee: if you're asking, i can address the issue so that everyone understands that it will be addressed further by the director. the issue has to do with the recent changes in federal legislation regarding use of hsa accounts in 2021, expanding the allowable amount for this calendar year, and asking the board of health services to address this opportunity for its members . it's specifically to increase the allotment through use for childcare. >> commissionerbreslin: the ssa for childcare. thank you very much . >> president follansbee, shall

i proceed? thank you public comments will be available for each item on this agenda . each beaker will have three minutes unless the president deems a different time limit during the meeting. all comments are to be made on the agenda item for the meeting. a caller may ask questions but there is noobligation toengage in dialogue with the caller . state your name clearly although your name may remain anonymous . when three minutesand it you will be placed back on mute the moderator will unmute the next caller . remote viewing is available on 30 sfgov.org and channel to read the opportunities to speak are available by dialing the number on the screen, 415-655-0001 . again, 415-655-0001. when prompted you may use access code 187 087 3967. again, 187 087 3967. then press pound, pound.

you will enter the meeting as a public comment caller and dial star 3 to be added to the queue. when the system indicates your line has been unmute it this is your chance to speak. wait until thesystem indicates you have been unmute it . sfgov tv has a 45 second delay and we will take a pauseto allow the systemto call catch-up . our 45 second pause begins now . ... the 45 second pause has

ended. our moderator willnotify us of any callers in the public you . >> thank you board secretary. i will now be checking the queuewe have 10 callers on the phone line .seven callers have specifically entered the public comment q at this time. other colors may enter the queue as public comment continues. i will indicate when there are no more callers in the queue and you will hear abrief silence as we transition between callers . advancing the first caller now.

>> caller: can you hear me? >> welcome caller. >> caller: my name is liz dyson, a local 21 member who has worked for the sf and pa for 10 years and i'm here to ask youincrease the flexible spending account limit from 5000 to $10,500 . this would authorize an american rescue plan that has yetto allow city employees to take advantage of its benefits . i am the mother of a 19 month old and pay over $30,000 a year for the nanny share that we participate i'm lucky to have a good salary myself but even so childcare costshave impacted my family's budget soit would make a difference for me and many other city employees to take advantage of this benefit . you for your consideration . >> thank you foryour comments.

moderator, unmute the next caller . >> caller: good afternoon commissioners. my name is natalie hofmeister, a professional civil engineer and a member of isp t-mobile 21. i have two youngchildren, a four-year-old boy and 19 month old girl . my husband and i work full-time and we have our children in paid childcare area as part of the american rescue plan act of 2021for tax year 2021 , the federal government is allowing for increased independent care asked flexible spending 5000 to 10,500 for married couples filingjointly . those of you that have young children in childcare know that it is very expensive in the bay area averaging around 2000 the month for children ages 5 to 0 yearsold .

i'm estimating my husband and i will spend $45,000 in child care for our two children this year which is way more than the 5000 currently allotted for dependent care flexible spending area the increase in contributionswill provide a needed tax break for working parents and their families . i encourage you to adopt this increase to allow families a well-deserved financial break . you for your time and consideration .>> moderator, you can elevate thenext caller . >> caller: good afternoon commissioners, my name is laura stone hill and i am an engineer at the sf mta . i have a baby in daycare at 4 1/2-year-old in preschool and i'm sure you're aware childcare is very expensive in the bay area allows for increased care to $10,500 for 2021 up from

$5000 but hsf has yet to allow city employees to change their amount. allowing us to raise our dependent care at the higher limitwould greatly help me and other parents working for the city . >> moderator, youcan elevate the next caller . >> caller: my name is anna herdman, i work for the sfmta. i'm asking hhs to adopt $10,000 for dependent carecontributions made possible by the american rescue plan . i have, i am a parent of a nine-month-old son and we have a wonderful loud care provider we're sending over $20,000 a year for home-based daycare. this is incredibly expensive and reflective of thehigh cost . adopting the increase for dependent care will help my

family as well as others afford childcare. thank you. >> thank youcaller. moderator, you can elevate the next caller . welcome caller. >> caller: i haven't been to public comment in a while and i'm a county employee. i wanted to circle back regarding the infertility benefits . there is a small but critical piece missing from all the time and effort the city and commissioners have put into this. there is no easily accessible public document stating what was presented back in november. it's nowhere on any of the cit sites , the micro site and i've emailed blue shield and the department on a couple of occasions seeing if there a

plan to update the language that reflects that and i haven't heardanything back . again, this is the last critical part. i was also contacted by a journalist from the new york times to share my story and experience of how the needle moved in san francisco but i could give her no documentation stating that, which is important i guess for the journalist but most important for any members so they understand what's their coverages and if they are denied they can go to a website and understand thecoverage just like they could with their mental coverage or dental coverage . i would appreciate if this could be looked into to update the language so it iseasily accessible and understandable for all members . i am also in support of the parents that called in regarding the increase for the

fsa. thank you so much. >> moderator, you can elevate thenext caller . welcome caller. >> caller: i'm president of isp local 21 and your you've heard from several of our members and other areas of the importance of raising the limit on the home healthcare childcare benefit for members to 10,500. our members are front-line workers.they help the city recover from the pandemic and the benefit that's important to them so i encourage you to follow the guidelines set the american rescue plan to increasethe benefits, thank you . >> thank you. moderator, you can elevate the

next caller . >> caller: my name is richard roffman, and a retired employee and it looks like delta general still can't get their act together in reference to this mild program. i want to thank abby and mitch for helping me so far, i've gotten two bills from delta general. user one is correct, it clearly states in our plan and in the consultants that if you're in the smile program, you do not have to pay thedeductible . and i don't know why one hand delta dental can't tell the other hand so i appreciate that helping me in that issue and wanted other retirees in the

smile program that they didn't have to pay the deductible and i think they need to do more education so for the doctors because i have a good friend who is a retiree and he can't explain it to his doctor becausehis doctor doesn't know what he's talking about . so i hope there will be more education with delta debt . in this regard. and thanks againfor your help . goodbye. >> thank you caller. moderator,you can elevate the next caller . >> all colors have been elevated at this time. areminder to callers , it looks like we still have a few callers who have hands up. i want toacknowledge all seven callers have been escalated . >> thank you moderator. moderator, shall we wait a few more moments to see if those hands to change?

>> it looks like the hands are going down the colors that have spoken. we have one morehand raised and i'm to escalate that caller just in case . >> thank youmoderator. welcome caller . welcome caller on the line. >> by the silence i'massuming it's a caller that has a hand that just wentdown . all colors have been attended to . >> hearing no further callers, public comment disclosed. >> president follansbee: thank everyone who called in and also all those who emailedwith concise, compelling statements around the issues addressed . i want to thank everyone for

their attention to these issues. we with that i will close agenda item number four and call for agendaitem number five . >> thank you president follansbee. this is an agenda item. >> president follansbee: we have a full agenda today. it's held thursday, may 27 at 1 pm for possible meeting time if wedon't get through all the agenda items today . at the end i will announce whether we can release that date and i want to remind the board members because i can't see you on the screen, if there are lots of people with a video on to keep your video off until you are ready to ask a question or make a comment that way i can acknowledge youduring this meeting . number one i want to welcome supervisor connie chan from district 1. her background is available from multiple sources

and she said healthcare engagement over many years including work withsophie maxwell involving environmental health . and not the least of her strengths in my opinion is the rubresponsibilities which she approaches with intense thoroughness . she's enjoyed crashing down on you, it's dramatic to me which i highly recommend to everyone and assuming supervisor chan does as well. i want to congratulate chris canning on his promotion to captain of the tenderloin station . board members have contract congratulated him already so just to remind those attending that from april 8 2021 board meeting, were postponed until the day we given our very busy benefits calendar, those dates

will be updated soon to reflect the pandemic related suppression of healthcare utilization overthe last several months . these items will be dealtwith later in the calendar year . i want to take this time to thank derek sawyer and their staff for their due diligence in preparing these reports and carefulattention and we look forward to an update on the measurement plans in the future . you can tell from the background of many of our videosthis is mentalhealth awareness month . we are all wearing green ribbons today . you can't see them but the daily news features mental health issues affect each day and so many ways, in so many ways the mental health awareness is an area of health service system improvement that the board andthe system are working on diligently throughout the years not just the month of may . at this meeting we will have twoadditional guests, we will

address the meeting during the benefits sections , ray gallagher will be introduced during the discussion on the health benefits and he is vice president of paul brown whose visited the board in the past . with the area vice president for blue shield getting an opportunity to reintroduce them to this board in case of paul brown and introducing ray gallagher, will have plenty of opportunities to address pacific issues around their organizations but at this point we welcome their opportunity and comments they willbe making . to remind everyone the cdc has revised again today the recommendations regarding time and place for wearing masks, indoors and out. i'd like to issue a word of caution that the state and other counties have not yet updatedtheir recommendations on this today . the covid pandemic is not over

despite the marked improvement in cases and new infections and hospitalizations and deaths. i personally will urge all of us to remain vigilant regardless of our vaccination status to continue efforts to reduce the riskof infection for us and those around us . don't throw away your facemask yet. thank you for paying attention to this busy agenda and we can open it up or publiccomments from other board members if you'd like . if any other board members want to comment. >> commissioner scott: this is god.i'd like to add my welcome to the supervisor to this board and i look forward to working with her during the course of the year. >> commissioner zvanski: i'd like to also add my welcome to

the supervisor. i've not met her before but i look forwardto meeting her one of these days in person and definitely to working with her on the board . >> commissioner hao: welcome to the board commissioner chan, this is mary hao. >> commissionerbreslin: i am chairman breslin, welcome to the board . >> president follansbee: thank you. >> commissionerscott: welcome to the board, apologies for cutting you off . >> i wanted to take a moment, it looks likesupervisor chan is on the line . i want to make sure that you can unmute yourself if you'd like to.

>> supervisor chan: i hope everyone can hear me and thank you. commissioners and commission president, i so appreciate the warm welcome and the introduction. i can't thank all ofyou enough . i wanted to let you all know this is definitely ... i want to say while i care very much about our health care system, this is a learning curve for me and i look forward to learning from all of you. i've seen all of your bios as well and know that you are quite experienced around our san francisco health services system soi look forward to working with you . thank you so much .>> president follansbee: if there are other comments? >> thank you president follansbee. following our short instruction .

public comments will be available for each item on this agenda. each eagle will be allowed three minutes unless the board president deems the time limit during the meeting. all comments may bemade during the agenda item presented . there is no obligation to answer questions or engage in dialogue. you are encouraged to state your name clearly although you mayremain anonymous . when you're threeminutes are done i will thank you for your comment . the moderator will unmute the next caller. remote viewing is available on sfgov.org . opportunities to speak are availableby dialing the number on thescreen . thenumber is 415-655-0001 . again, 415-655-0001 . when prompted you will use the access code 187 087 3967. again, 187 087 3967. then press pound, pound. you will enter the public comment callline and dial star

3 . when the system indicates your line has been unmute it this is your time to speak. please wait until the system indicates you have been on muted . sfgov tv has a 45 minute delay so we will take a 45 second pause toallow the system to catch up . our 45 second pause will begin now. ... the 45 second pause has

ended. themoderator will notify us of any colors in the public view . >> following receipt, in the meantime we do have 2 callers on the phone line. a reminder to all colors on the line, you must dial star 3 if you want to join comment for this item. we will wait five more seconds and closed public comment . board secretary, there are still no callers on on the public comment q.

>> hearing no further callers public comment is now closed. >> president follansbee: we will now move on to agenda item numbersix , directors report. >> agenda item 6directors report, this is a discussion item . >> abbie yant: can you hear me? first of all i just wanted to make a comment regarding the issue that was brought forward by the public. we were engaging in conversation starting about 24 hours ago and we had already planned to do an update at the june service board meeting to discuss both the statutory allowance for an increase in dependent care the federal level. it has not yet been picked up with the irs we are researching the details of what is allowable and we will be able

to provide you with details for arecommendation at the june meeting . the second thing i wanted to just congratulate all of us on as our excellent vaccination rate. i spoke a few minutes ago as of this morning, i was on the city policy call. residents of all ages with almost 66 percent of our population has received first dose and just over 50 percent have received seconddose . it's a remarkable accomplishment and there is much continued work to be done but we are officially hearing now that we have a supply in excess and that's official. so it's a new problem to have but it's a heck of a good one given the struggles that we have been through in receiving vaccines and getting shots in arms very rapidly in san

francisco and it's taken a huge public-private partnership that has been remarkably successful in delivering this. the last percentage as you know the regulations allow for 12 and older now and it's estimated 25,012 and older young people in san francisco, so they're starting to get there vaccinessorting tomorrow as i understand it . and then there are pockets of folks who have not received the vaccine for a variety of reasons there's many many public health strategies being considered and implemented to reach folks who have not yet been able to get the vaccine or have some hesitancy about getting the vaccine. the campaign is shifting as we speak . and to move on to other items thati've highlighted in the

directors report , mitchell and the team are doing the yet another voluntary benefit enrollment in june. often an off cycle enrollment injune of this year so we're looking forward to being able to do that . i think two years ago we were very successful to get people enrolled in the voluntary benefits that theywere interested in doing . doctor follansbee has mentioned mental health awareness month but i wanted to publicly acknowledge carry the shears and the entire team and assistant counselors, they've done a remarkable job over the last year pivoting and determining new ways to reach people who pretty much all of us have been through anxiety and stress over the last year and our ability to cope and take care of ourselves and get professional help when it's

needed has become a huge focus of the well-being team and we've done an amazing job. we did put in also in the packet and we are open to doing a more interactive presentation at a later date but there's so much talk about the uptake of telehealth throughout the pandemic i felt it useful to put it in the materials in my directors report . much of the regulation is being now considered to make some of the services imminent that were perhaps allowed under pandemic rules and rings are changing and obviously the acceptance of telehealth was quite high during the peak period of the pandemic and continues to be so in many sectors of the health deliverysystem . i also included a paragraph in our directors report this month talking about a partnership that was brought to us by the catalystof payment reform .

they're very interested in our care organizations that have been in place for many years and have partnered with professor tim brown at the uc berkeley school of public health who was interested in looking at from an evaluation point of view. we are partnering with them. they are in the final stages of gatheringinformation and we will be bringing that information forward . a publication willnot identify our organization as such . for our partner blue shield. but we expected to bring great learning to the field . doctor follansbee did mention the measurement plan which we concluded in the reports that have been standalone and we will bring that to you again later this year. we're on track for completing our evaluation guarding the need to do any kind of competitive market rfps for medicare products that we

currently have and we will bring that information and recommendation to the board in june. i reminder that we're still in a blackout period and that extends through the month of june . we have a follow-up in the directors report regarding delta general and a question about the cfd coverage so i've included thatin the packet . i would like the board to know that we continue to escalate and bring our members, our questions, your questions and the members questions before delta. we're devising measures and reports that we will use to monitor the delta services and bring those forward to the board if they get in good shape to be able to monitor the surpluses and the concerns that have been expressed by the within our divisional report i

did want to announce 2 promotions. christie want and kevin chen within health member services team. our team continues to grow and wrap up and we had a lot of support from our department personnel officer christine and mitchell and his team for the open enrollment thisyear which is a big project . mitchell has had the foresight to initiate planning for the operations of open enrollment. earlier this year because of new products, there's additional work to be done so that project, that ongoing project really, is up and running. i know there was a comment about some of the information we have about particular fertility benefits and others as well.we are taking it

under advisement on how to get thatinformation packaged up and clear for all our members to see . since we are giving the communications team very deep and has a lot of work to do in order to get their plan. i think that's all i have to say for the directors report. i reserve the time for the plan presentations but i'm happy to entertain any questions from the board at thistime . >> president follansbee: that opens it up to the board members for comments or questions at this point . ... i'm not seeing any images, because the agenda is up. you're going to have to speak up.

>> commissioner zvanski: this is commissioner zvanski and i want to commend the staff for the outstanding work that jen and her team is doing but also to congratulate the internal promotions. i think it's wonderful when employees can know they can stay within their departments and achieve promotions and opportunities likethat . so thank you to our executive director for foresight in supporting our employees and our team. >> president follansbee: any other comments or questions from members orcommissioners ? thank you for being so inclusive. i encourage people to look at

the full report. there's a lot of important detailsthere . to follow up on issues from the last few meetings also in terms of the direction of the future. with that i think i'd like to go ahead and open this up or publiccomment . color, are you making an announcement? >> each speaker will be allowe three minutes to comment .

all public comments are to be made concerning the agenda item that has been presented. a caller may ask questions of the body but there's no obligation to answer. when i welcome you on the call you are encouraged to state your nameclearly although you may remain anonymous . i will thank you for your comments and youwill be placed back on on you and the moderator will unmute the next caller . remote viewing is available on sfgov.org and sfgov tv. opportunitiesto speak are available by dialing the number on the screen . the number is415-655-0001 . when prompted you will use the access code 187 087 3967. again, 187 087 3967. then press pound, pound. you will enter the meeting on the public comment call in by dialing star 3 to get to the

public comment you.until the system says you have beenon muted . for those on hold weight until the system indicatesyou have been on muted . sfgov tv has a 45 second delay for viewers watching on our broadcast. we will take a 45 second pause forthe system to catch up and for callers to dial in . our 45 second pause begins now. ... 45 second pause hasended.

our moderator will notify us of any colors in the public you . >> wehave 3 colors on the line . a reminder to all callers on the line. you must dial star 3 now if you want to join public comment. we will wait five more seconds and then there will be no more public comment for this agenda item. board secretary, there are still no colors at this time. >> public comment is now closed. >> president follansbee: that

closes item number six three and i like to move to item number seven .>> agenda item 7 is the financial reporting as ofmarch 31, 2021 . if this is a discussion item. >> president follansbee: over to chief financial officer larry loo. >> larry loo: included in your board packet and on the website is a write up for the financials for san francisco health services through march 2021. at nine months into our fiscal period so really, everything's performing as expected. just to recap, really are two funding services by which financial health services perform and fulfill its mission. first is the employee benefits trust fund which is used to

fund the benefit for employee retirees and family members and the other fund is the general fund administrative which is primarily used to fund programs for employees and also staff. so with regard to employee benefits trust fund , this is performing well . the trust fund is an increase of 65.9 million to end with a balance of 132million , 32.6 million so this is mostly due to the performance of the self-funded lines with busines . to recap the self-funded or self-insured plan are the 2 hmo plans on the blue shield plan. as well as the ppo health and dental plan for active as you can see , the projected fiscal year we expect to have a

positive net gain to the trust fund by 16 million. that really explains why i think the trust fund will end with 16.5 million. this includes an estimated 7.3 million and expected pharmacy rebates . today we received 6.9 million. as we get closer to the end of the fiscal year that's when more reports come. another source of revenues to the employeebenefits trust fund our performance guarantees , guarantees we have our contracts with our administrators. we don't like to see large numbers in this so this is roughly where we're expected to be. we received 176,000 dollars in terms of performance guarantees. in terms of interest we are

projecting that 1.2 million dollars will be depositing to the trust fund by fiscal year end. to date we've received 638,000. one of those funds that is in the trust with the help sustainabilityfund, that fund is used for new projects , helping to reduce healthcare costs, helping communicatewith members their benefits and so on . we are projecting for the fiscal year end that that is all performing as expected. with regard to the general fund administrative budget we projectthe end to be mutual. we don't anticipate any surpluses or shortfalls . in the write up we would recognize that we had sliced solely less than expected revenuedue to the furlough . but that's been bounced off by

the previous fiscal year so really we expect no change. lastly i think there was a follow-up item from one of our commissioners who left the meeting with regard to where we are with our budget as you recall , in order to satisfy the mayor'sbudget request , the employee assistance program was submitted with the requested additional funding so we're very optimistic about having that fundingrestored . and our budgets have been submitted and will be going to the board of supervisors as part of the mayor's budget by the end of june.so with that, as i declared in my report i

will takeadditional questions if there are any . i hope i'm not onmute . >> we can hear you,just so you know . >> president follansbee, is there anything? >> president follansbee: sorry, i was talking to myself. thank you for that. i want to open this up nowfor questions and comments from the commissioners . i'd like to comment that we had a lot of discussion around suppression of costs due to less utilization because of the pandemic. it's reassuring to me to see

that pharmacy costs have not been stretched and our numbers are still getting their prescriptions as projected. and with those at least the pharmacy costs have been in line with the suppression of other costs due to the changes and delivery of healthcare and member reticence to seek healthcare.but the pharmacy is reassuring me that numbers are still managing their conditions as to diabetes, hypertension, lung disease and all that with continued pharmacy costs and refills. withthat i'd like to open it up to other comments and questions from board members . i'm seeing none.

so unless there's any other comments or questions, larry if your self or anyone else, we will move to open this up to public comment . claire. >> i'm indicating this was an excellent report and i'm hoping that our administrative budget goes through without any hiccups and thank you to larry lou for a great report. iq so much. >> president follansbee: any other comments or questions? seeing none wecan go ahead and open up public comment . >> thank you president follansbee. public comments will be available for each item on the agenda area each speaker will have three minutes . all public comments are to be

made concerning theagenda item presented . as a reminder of caller may ask questions and if there's no engagement, when i welcome you to our encouraged to remain anonymous or speak your name. the moderator willunmute the next color after three minutes . agendas are available on sfgov.org or sfgov tv public comments are available by dialing star 3. the dial-in number is 415-655-0001 . when prompted, use the access code 187087 3967 . again, 187 087 3967. then press pound, pound. you will enter the meeting as an attendee on thepublic comment call line. i'll star 3 to be added to the queue . when the system indicatesyou have been unmute it this is your time to speak. wait until the system indicates

you have been unmute it . sfgov tv as a 45 second delay. we will take a 45second part to allow the system to catch up on colors to dial in . the 45 second pause begins now. ... the 45 second pausehas

ended. our moderator will notify us of any callers in the queue . >> we have three colors on the phone line. a reminder to all callers on the line, you must dial star 3 now if you want to join comment for thisagenda item. we will wait five more seconds and close public comment for this agenda item . board secretary, there are still no callers in the public comments queue at this time. >> public comment is now close . >> we moved to agenda item number eight. >> agenda item 8is the presentation on mental health awareness, this is a discussion item .>> do you have the

slide deck? >> i'll be bringingthat in a moment . >> i'll go ahead and get started. can everybody hear me okay west and mark excellent, thank you. good afternoon, i'm terry bashir's, manager with san francisco health services system and out over the course of the last 15 months our nation has suffered loss and trauma and within this time abby alluded to earlier we shifted our focus toelevate mental health to support our members . i'd like to spend my time with you today to speak about resources that we're elevating over the course of the next several months to support mental health. i'd also like to acknowledge you for showing your support as i see many of you wearing your pins and having a virtual

background on soagain, thank you for bringing awareness. this is an incredibly important topic . next slide please .according to the cdc mental health includes our emotional, psychological and social well-being .it affects how we ask, how we feel and it helps out, it helps toidentify how we handle stress and relate to others and even the choices we make . many factors can contribute to mental health problems such as as i mentioned earlier trauma, life experiences and even family history. all of which can really affect our thinking and behavior. mental health problems are common and in fact in 2019 nearly one in five american adults experience a mental health disorder infected them at home or at work. in californiaone in six adults were diagnosed with mental illness . during the pandemic four in 10 adults reported that theyeither had symptoms of anxiety or

depressive disorder . next slide . and i probably don't have to say this, we all knowwhat's been happening not only over the past year in the past month .we've had the pandemic, we'restill living in the pandemic . we're slowly recovering. we got california fires which we are heading back into fire season. we've had civil unrest, political uncertainty, violence againstour community , attack on capitol hill and those are just a few area many of us have suffered our ownpersonal challenges in this last yearand a half . next slide . so i really want tohow we've been able to respond and some items that we have coming up . are available to all our members and our employee population so i'll discuss trainingopportunities , campaigns, webinars and classes . our resiliency groups and additional well-being support

area and online resource of credible minds and highlight a message from mayor breeze. next slide. so first i'd like to take off with training. back in february in partnership with kaiser permanente and the national council forbehavioral health we were excited to launch mental health first . it is a four hour training dedicatedspecifically for our leaders, managers and supervisors . also offering a six hour vacation workshop for our first responders, healthcareworkers and behavioral health staff additionally in april , just last month our eap team also launched a stressfirst aid workshop . it's a complement to the behavioral health mental health first aid training that we offer thisis for all city employees . it's a two-hour workshop and between both of them really what they do is help to have an

individual build skills to not only recognize maybe things they're dealing with on their own but also recognize dental health concerns with others and have been access tocare if they needit . next slide . to highlight mental health training, as of right now we scheduled 36 trainings and since february we've executed on 25 and there's been a total number of 280 leaders, managers and supervisors who participated. we have a limit on the classification just to ensure that people have an opportunity to build skills and connect with each other so that they can really be effective and we are continuing on to offer these. we've had department specific training that can reach out to us and ask for tailored training so we had nine differentdepartments who have

reached out to us . that's including fire, library, department ofhomelessness and housing , ss public works, sfmta, hsa and the public defendersoffice . you've heard us talk about mentalhealth awareness month . we are in it and our goal is to join the movement in raising awareness around mental health . things we're putting into place to measure howpeople accessing care if they'reaccessing care . looking at our call volume to our eap service . we're looking at our dissipation in our webinars an seminars offered during the month . looking at our rates not only within the resources online but for ourcredible minds resource of . and then with our first responder groups we will also be looking at the module ask and how individuals are

clicking these windows. each week during this month we are sending out a weekly communication does highlight a lot of resources but were also focusing ondifferent topics so health care, family mental health, anxiety , substance abuse and resiliency . as i mentioned we're highlighting services like our credible minds, eap, our webinarsand all of our health family sources available as well . and then i know as wementioned a few times today ,wearing our green pins . we had the opportunity to partner with a couple of departments to also distribute pins to them to ask them to join in the movement to show their support by wearing pins throughout the month. i had the pleasure to go in front of the police commissioner and their board to ask for approval to get their uniforms modified to allow for that in so along with police we have fire, dph, the mayor's

office and the mayor's office fto. then we were also able to partner with dph and a lighting of the city hall, green. it just happened a few days ago to bring more visible awarenes around mental health month . next slide. some of the future campaigns we are working on, june is pride month. we're focusing on some mental health resources specifically for our lgbt queue group and then july following that is our mental health month so we are focusing on that and soon we are looking to launch a social connectedness campaign that is going to be erected towards our recovery population . next slide. we also have webinars and classes. we started a partnership with

the black healing circle, with dph. we have a new cohort that's going to be starting up in june. we just actually last week at in preparing your pet for your return to work seminar. we've got coping with curb and beyond, self-care, resilience and action . hour of restorative yoga, two days a week for 10 minutes our team leads what we call a citywide stretch break so you get up, you stretch a little bit and on the 20th of this month we are also partnering with dph to provide a panel discussion on how covid has affected mental health. it got two individuals. we have a psychiatrist and physician that will be joining in that panel discussion. iwould like to encourage all our commissioners , there's a lot of opportunity in regards to education that are listed here on the screen in addition

to the mental health first aid training so if they're interested iencourage you to reach out to holly for more information . next slide. one of the things that are eap started to implement in covid our group sessions.it's something they already do as part of their incident response but covid is an incident response so we've been able to tailor a group focused around resiliency. so it's a virtual platform allows people to come together, talk about their experiences andlearn practical ways on how to develop resiliency . in addition this is something that can be requestedthough people justneed to reach out to us and our eap will respond . next slide . our well-being support extends beyond.

so our team just actually launched our recognition and appreciation toolkit. we strongly feel that resiliency andappreciating people is a great way to do it . we've been able to partner with dhr and they're going to start integrating this toolkit into their 24+ training.yesterday our team met with the learning and development managers within the city to get feedback and talk about how they can implement this tool and are also looking to launch a pilot for departments wanting to create a culture focuses on recognition andappreciation so a pilot will be available as well .we continue toprovide support at the command center . we have one of our staff joining are all hands weekly meeting toprovide a well-being moment .we also are able to solidify a monthly therapy so we have a dog that comes up and

walks around, allows people time to take away from the very intense work that they're doing. then we also recentlycreated an active , physically active area within the command center for those who are interested and we are also working right now on some tools and resources around transitioning and returning back to work. our team has also been able to join our own operations weekly staff meetings. it's been fun to provide ongoing well-being activities by request all departments can ask our team to join to provide activities should they be interested. i mentioned cortical already so aside from our weekly pushes in may we continue to elevate pushing notifications out to be ask to engage members to use all the great tools that are within that wellness. next slide please.

and then i mentioned a few times credibleminds . i wanted to elevate this and encouraged everybody to take advantage of this great resource hall. we just launched this back in december. and it's got many many different types of resources and it's really delivered and how you want toget your resources . so if you really enjoy ask it will give you suggestions on those based on a particular subject. you can go in, all the information there is all evidence-based vetted by experts and it's got lots of different topics you can search information. if you're interested, we do have a website link on the page i will just read it for those who arecalling in . you would want to go to

sfhfs/credibleminds. next slide please. and then one of our really amazing partnerships has been with the mayor. we were able to ask the mayor to find a video to really elevate mental health, particularly for this month and although we are unable to play it today, i would like to read off the website that anybody who's interested can go to. and listen to the message, it's a short message but it's powerful and encouraging peopl to get help . webpages, that's

sfhfs.org/were-here-for-you. again, that's sfhfs.org/were-herefor-you area next slide . that includes my presentation. i'dlike to open it up for questions or comments . >> president follansbee: any comments or questions from board members. >> commissionerhao: this is commissioner hao and i can't tell you how impressed iam with all the work you put into this . with all the struggles , there have been mental health concerns. with lack of contact and just all the other protocols that have gone into creating our new normal, i think it's jarred us in a lot of ways to express my appreciation for all the fullness and you really taken time to care for the employee population .

>> thank you. >> president follansbee: any additional comments or questions? >> supervisor chan: this is connie chan and thank you for all the work you'redoing as well i'm a little bit curious about the pilot that you mentioned . what that would actually look like and where does it go to, to city departments? is it by request from the city departments or do you identify those that are prioritizing need of the pilots? >> we have a network of champions that isapproximately 200 city employees . additionally we have about 48 key players which typically are managers and supervisors within the city will also support well-being area our team does regular trainingswith these groups .one of our recent trainings were to talk through

the actual recognition toolkit and then sometimes we will shoulder tasks depending on what we know or where a department might be asked but in this case we really do feel in order for recognition and appreciation to be built into the culture, it really does require our department to be prepared and ready to engage in the journey because it's something that we want to make sure it's getting momentum so what we would do is we have a few departments that have reached out to us that are interested in what we would do is we would create a timeline and my team would work specifically with that department in regards to implementation strategy, looking at data metrics and then look at how we can iterate or what changes we might need to do to tailor a particular item area to give you an

example right now, we have a pilot call set up and go. the tools are available to all city departments but our pilot is really specifically working at a department that has a higher worker's comp. claim specifically for their office workers . so we sat down and we've indicated atimeline , we've done an employee survey . we've got management very committed in making sure that their elevating that particular resource provided in the toolkit so we are working with them on that that's to give you an example of how we would address the pilot area does thatanswer your question ? >> supervisor chan:i think you do need a city department to buy in .

i want to commend you and your team to. i had a chanceto visit the center and it was just so great to see the wellness area . and to see that there are considerations forpeople working there on this very stressful environment . i do hope to see that continue in virtually all our city departments and work environments area we would love to see just getting an area for people. i think in the past in city hall we had that in south like court so that people can do yoga and just having a little break so i look forward to seeing that resume in city hall and also i look forward to seeing that expand in the city departments. and definitely for our first responders. i hope that there is an effort to create a space for our first responders in firehouses and police stations and hospital

areas that really allow them to have the wellness area. so let us know how we can provide thatsupport . >> president follansbee, like togo back and i'm sure, be able to answer this . can you give me what that means? >> it's black indigenous people of color. >> thank you. i thought that mightbe true but iwasn't sure . >> thanks for asking .>> presidentfollansbee: i wanted to follow up with a question . a lot of times in the midst of the stressful situation for firstresponders , mental health professionals themselves of the firedepartment, police etc. , programs that require

additional attendance or time or setting aside for yoga or medication or's stretching don't seem to necessarily penetrate into the moment so can you maybe highlight, i don't know whether your mental health first aid programs you've targeted several departments are addressing these issues about how they can respond and create their own programs so there's not a cookbook that goes out. can you maybe comment on that briefly ? >> sure, posted our first responder groups have a peers support program so that includes fire, sheriff, police and dem so within their peers support group actually a lot of them do their own debriefing for certain incidents. they do call in our eap haswell. our eap does teach small mindful moments in the event of

a stressful situation to allow people to kind of take a step away and regroup if they need to but most of the work that we are doing is really encouraging a department to have a conversation. so allowing space for it to be made. allowing people to engage in activities. we are looking at actually sense covid shifting how long our offerings are because we know in a virtual world people get virtually built outwhen you're on the screen all day long . they're looking at reducing how long offerings are to be able to pop in and pop out should they needthem . >> presidentfollansbee: any other comments of any other board members ? we'dlike to open this up to public comment .

>> i'll call up our slides wit instructions . ... >> president follansbee: are youon muted ?

>> i'm pulling up our slide. i'll stop there so we can proceed. thank you, so public comment will be available for each item on the agenda and each beaker will be allowed three minutes unless the board members opt to extend public comment. all comments may bemade on agenda item that has been posted . there is no obligation to answer questions from the callers. you are encouragedto state your name clearly although he may remain anonymous . you will be placed back on mute and the moderator will

acknowledge the next caller. remote viewing is available on sfgov.org area opportunities to speak are available by dialing the number on the screen, 415-655-0001. when prompted use access code 187 087 3967. again, 187 087 3967. then press pound and pound again. you will enter on the public comment call line. dial star 3. when the system indicates your line has been on muted it is your time to speak. please continueto wait until the message indicates you have been on muted . sfgov tv has a 45 second delay so wewill take a pause to allow callers to dial . our pause begins now.

... our 45 second pausehas ended . >> thank you board secretary. we havethree callers on the line .

a reminder to all colors on the line, you must dial star 3 if you want to join publiccomment for this agenda item. we will wait five more seconds and close public comment for this agenda item . board secretary, there are still nostill no colors . >> .no further callers public comment is ended. >> president follansbee: thank you carrie. in light of your comprehensive presentation i'd like to now open the recent benefits section of our agenda to those of you who want to break. i'm hoping we can get through at least a couple of these items may take a break a little before 3:00 so if we can moveto

item number nine . >> agenda item 9 is the presentation and benefit calendar for 2022. >> abbie yant: the rates benefit calendar is in your packet and it serves as a record of what's been done and what is to be done. so we are currently far along in the rates benefit calendar and assuming we pass everything today we will have a few remaining items to be approved, two very important items. the medicare plan and maintenance and that's really all i have to say. >> president follansbee: any questions or comments from the board members ? questions orcomments from the board members ?

seeing none, i'd like to go aheadand open this up for public comment . >> public comment is available for each item on the agenda and each speaker will be allowed three minutes unless the president deems the time be extended. all comments must be made concerning the agenda item on the docket. there is no obligation to engage in questions with the caller. when i welcome you state your name clearly although you may remain anonymous. when you're three minutes have endedi will put you on mute and the moderator will unmute the next caller . remote viewing is available on sfgov.org and channel 2. the dial in number is415-655-0001 . again, 415-655-0001 . when prompted, use access code 187 0873967 . again, 187 087 3967.

then press pound, pound. you will then enter as an attendee onpublic comment call in. dial star 3 to the added to the queue . when the system indicates your line has been on muted this is your time to speak. please wait until the system indicates you have been on muted . sfgov tv has a 45 second delay. we will take a 45 second pause to allow the system to dial up and allow callers to dial in. our 45 seconds begins now. ... the 45 second pause has.

the moderatorwill notify us of any colors on the queue . >> we have three callers on the phone line. a reminder to all colors on the line, you must dial star 3 now if you want to join for this specificagenda item. we will wait five more seconds and close public comment for this agenda item .

board secretary, there are still nocolors in the queue at this time . >> hearing no further callers, publiccomment is now closed . >> president follansbee: discloses agenda item number nine . the discussion moves to the nextitem, number 10 . also a discussion item. >> agenda item 10 plan your 2022 ratesummary , earlyhelp retirement . >> mike clarke: i'll be starting with a summary of the active employee early retirement health plan rate from 2022 before going into each specifichealth plan later in the agenda . so if i may havesharing privileges please .

i'll summarize in this presentation what will be presented later today for approval for each specific health plan for thenon-medicare plans , medical and prescription drugoffered to active employees and retirees . we focused on mostly understanding how the 2022 projections are guided by recent plan experience, including the reflection of claim experience that was discussed earlier during cfo loo's presentation and president follansbee salute me

noted that while we did not see any noticeable suppression on prescription drugs, there was some suppression and medical claim experience so that was taken into consideration in the projection of the rates that you see below. you'll see today is largely a very positive message with respect to the projected rating actions for each of the health plans. for instance for blue shield access plus and treo, and active rate stabilization adjustment for plans to percent or less, canopy care is a new plan that will be on the sfhs platform and we will hear from a representative shortly. kaiser hmo plan even though it may be the highest percentage you see on the stage at 4.96 percent is still below national

trend levels which were approximately six percent and as will see in a few pages still the lowest cost and lowest rated plan offered in the environment. and then the pco which is transitioning from administration for united healthcare in 2021 two administration by blue shield of california with accolades in 2022 is projecting at a 2.7 percent rate increase after stabilization adjustments. this not only pays but we will talk in more detail about each of the plans. for theblue shield hmos , favorable claim experience even after adjusting for pandemic related suppression is also aided by our savings in the administrative fees and prescription drug rebate sharing that was discussed in the february health service

board meeting. the health canopy careprogram , the rates are based on financial figures that we received from health canopy care during the request for proposal process. and the rates as you will see later will be positioned between the blue shield hmo rights and the blue shield access plus rates. for the kaiser plan after a 5.8 percent increase for 2021 it is a lower increase then 2022 area this is reflective as will discuss during the kaiser presentation later today of the requested level of premium revenue to suspend the plan for 2022. and the blue shield of california ppl accolade plan as a much lower increase for 2022 versus 2021 which was nine percent, caused by a lower level of claim cost even after pandemic suppressionadjustment

. also rfp related savings and projected claim costs for the move of the administration and the network to blue shield of california and a shift in the rebate sharing and we're also seeing stabilization move from a deficit position to a surplus position as was reviewed with the service board in march. to get a sense of the distribution of active employee enrollment and early retiree enrollment in each of the plans you will see this based on information was contained in the sfhs demographic report resented to the board in march 2021. the majority of the enrollment is in the kaiser plan but you will also see a large share of enrollment inthe blue shield hmos . two point .6 percent of active

employeesare in thehealthcare pto today, a larger percentage , 15 percent of early retirees . and this is the compilation of the total plan rates at the top of the chart. the employer contribution in the middle and the member contributions at the bottom of the chart on a monthlybasis for 2022 . so we will be presenting each individual plan today for your review and approval, but ultimately what the members will see especially from a member contributions standpoint are the figures at the bottom part of the page that will essentially guide decision-making by each member into their plan of choice whether they are an active employee in the 9383 contribution approach on the left side of the page, active

employee in the 196 83 inthe middle of the page and the right side columns are the early retirees to receive the full employer contribution . what i'd like to do is now introduce the first of our 2 new health plans.mister ray gallagher, vice president of major accounts for healthnet willdiscuss the canopy care program . >> ray gallagher:this is ray gallagher, vice president for healthnet . in that role i'm responsible that for not only making sure that we follow through on the commitments made during the procurement process with sfhs, but that we also meet their requirements fromour perspective as well as meet the needs of the membership . healthnet is a managed care

organization that specializes in what we callvalue-based products , one of which is a new offering canopy care. we offer that in partnership with canopy health and to talk a little bit more about canopy health and the canopy care delivery system, i want to hand over to kate who is the vice president patient canopy healt . >> this is holly lopez, i'm going tojoin in and make sure the mutism. >> ray gallagher: rate . >> i'm calling in from canopy care in partnership with

healthnet. as ray had mentioned we have a strategic alignment with healthnet on this particular project.we are honored to have this opportunity to showcase a product that supports access to high-quality careand provides centricity that's unique in this market . a little bit about my role is that i help connect our strategy to our implementation with various initiativesthat we support across all our products . and our goal is to help improve member health and facilitate partner growth with our local collaboration of independent healthcareorganizations . and our vision is to make sure that we become the network of choice but also a national exemplar of stakeholder

vibration and also cost competitive resource centric care. my background is community health for five years. prior to that i've worked with various health plans such as healthnet and blue shield and look forward to ourtime here today . >> i'm joined on this call by tammy watts who was our executive who led the procurement process from health net's perspective as well as one of our aides who will focus on implementation ongoing. again, looking forward to supporting the environment. the canopy care product we deliver is unique from the standpoint as i mentioned that it's a value-based product but it's one that features a

leading provider whether it be the provider groups or the facilities that are available in this geography. and also has a unique delivery approach that doesn't have the same ... the same structural limitations, navigation abnormal hmos do so it's not only positioned well as an alternative product offering to the kaiser product but also removes some of the structural limitations that your traditional hmo would deliver. >> mike clarke: thank you mister gallagher and thankyou to the healthnet team. next i will introduce paul brown , area vice president for blue shield of california to

talk about the new cboaccolades . >> paul brown: good afternoon health services board members. my name is paul brown, area vice president for mere accounts at blue shield of california and i want to start by saying blue shield is honored to have been selected as the vendor to administer th self-funded pto plan in 2022 . i'd like to give a real brief high level overview of our ppo product . what's going into place in 2022. blue shield has the largest ppo provider network in california, 82,000 positions in our network. we have 391 and many other ancillary providers and so on.

for out-of-state employees and retirees or people traveling out of state we also have access to the entire blue cross blue shield provider network which is the largest ppo network in the unitedstates . in addition, recognizing that the footprints of the san francisco population is quite large in several ruralareas which some of us expect , we will be doing some targeted provider commitment to makea change from one vendor to another .inevitably there will be some providers who will be in network with one provider or another and we'd like to close those gaps whenever possible. you've done an initial evaluation of the network match and it does exceed over 90 percent, up to 95 percent and

we're going to be going deeper into the providers that may not be currently in network. there will be some special handling of members that have unique needs. for example, transitional care. they may be in treatment for health since hisbehavioral health month . treatment for his behavioral health condition, we have network providers that may potentially not be in ace lucille network and while we are in the process we provide transition of care benefits in as much as that number will get that level of benefits while we continue that course oftraining . similarly, the pharmacists benefit, there's often differences between the formularies, between different vendors as well as rules around

prior authorization and therapy for example. what we will be doing is relaxing those so focusing on what we currently have or prescription drugs for example that requires prior authorization or some sort of step therapy will not have to go through that process when they transition to blue shield. only new prescriptions for those require prior authorization or the step therapy rule to apply. finally we want to point to ou partnership with accolade . accolade is a very high touch access model where they will be providing points of service. they will beproviding the clinical programs .it's a wonderful model and we've specifically partnered with accolade a few years ago . they have health systems that

will be assigned to sfhsf members and the goal is to improve engagement for in particular high-risk membersbut all members . and do that through designated facilities. there has been an external study done that suggests that there is an approximately five point reduction in trend in year one and about 3 and a half percent reduction in trends in year 2 after moving to the accolade models. i'm really excited to work with accolade to deliverthose kinds of results . with that i'll turnit back to mike . >> mike clarke: thank you very much and with that that concludes the presentation. president follansbee, i'llturn it over to you . >> presidentfollansbee: thank you, let me turn my video on . thatit's down to questions and

comments . board members, just as a reminder this is an overview of questions about specific plans that will be addressed under the action items on the agenda. this is more of a general. i'd like to start maybe with a question for mister gallagher. it's a little confusing the different hmo programs and groups in the bay area. i'm looking at the kind of umbrella that some of us are familiar with, the dignity groups and various others but also there are several new ones but also the question that members will have is there positions are associated with those particular groups that

will automatically become members of canopy. there positions are automatically admitted to canopy and groups that may be part of saint brown that's not on this list, unless they belong to another group will be part of canopy. just in a general way can you explain the sort of force. >> ray gallagher: i'm glad jason is here,can you respond to the doctor's question ? >> it would start with the attribution of the members. let's say if a member is attributed to healthnet canopy care, that member and that pcp would work on a referral

pattern that would send that patient to the appropriate facility. so let's take the example of marine health. it might be a hill position, it might be a meritage position which is more common in certain counties and they would refer that patient to the hospital, take them there, have surgery. do whatever services are neede inpatient or outpatient and it would flow through the medical group .so if the member was not a canopy care member and that physician happens to work with other hospitals that are not part of the alliance, that's part of the utilization review and the normal processes that a position goes through t make sure the appropriate hospital is elected . >> president follansbee: that's helpful because that's one

component of how members make a decision about changing plans or whatever or administration of the plan. a question as well, if a member knows there participant in dignity, can they be assured that there already part of canopy? or will there be some sort of, not 100 percent merging of the groups? >> ray gallagher: let's take hill if a member is with hill through blue shield today , then they would remain with hill and with blueshield . if they elect instead to come with the canopy care value proposition and the products that we offer , then that would

follow. so the member would get a new id card,a new welcome packet . they would get an on boarding experience that's much like blue shield andkaiser and everyone else . the member would be on boarded to the canopy care way if you will. so starting 1, 1 they would know which primarycare physicianthere forwarded to . they can keep the same physician . they can keep their same primary position they would essentially get re-batched as canopy care. >> president follansbee: that was the question. the first question i ask is my primary care physician, part of this network we need to have easy access in finding that out. not sort of the bottom or the small print, it'sthe big print . so that's the question that everybody asks because frankly

in my own experience kaiser was a different matter but sometimes as mrs. didn't even know the web of networks that they belonged to through these variousacquisitions and the acquisitions and all that so members need to know . >> mike clarke: yes, i think that's one of the differentiators ofcanopy health is we are for the network . where anintegrated network on several levels, financially . carepatterns , so who's in the hospital in our network, we know i think the integration the provider level through provider education, that's done with the medical group participation and leadership. they are aware that they are in

the canopy health network and the benefits that affords them aboveand beyond are different from other network options . >> president follansbee: i think commissionerzvanski has a question . >> commissioner zvanski: i just want double assurance here. i'm trying to follow the conversation with regard to whether or not the member would keep the same physician and maybe access to the same hospital because their physicians have biggest issue is that continuation of care through their primary so they're having to work out a newprimary, not applying for someone they don't know . and i don't understand what's going on with this.that was not immediately clear but i think do we understand now that

that member for example that we were using through hill would get, he says instead of field? there would be no change in position and maybe their treatment and what goes forward because i think that's the most important question our member staff. thank you. >> mike clarke: you can follow up onthat point . >> thank you clairefor that clarity . the intent is for the position and the patient to maintain that relationship. keep your doctorif you will and

make sure that any treatment protocols, anything that overlaps between november, december, january and . i'd say in addition to that, the patient will then be notified that they have broader access to more specialists so should the patient want a second opinion for example, we have a program called a reliance referral program which is one of the key features of canopy health that enables them let's say to go to meritage or to go to any of our groups for a second opinion . that broadens the appeal for the board members. >> commissioner zvanski: can you tell me again what the name of that was? >> ray gallagher: second opinion isits own program . the referral process is alliance referral program. >> commissioner zvanski: thank you again doctor follansbee.

>> president follansbee: any other general questions regarding the overview for the board membersor any participants online today ? if not, let's go ahead and open thisup for public comment . >> thank you president follansbee. i'llopen our slide for instruction . public comment will be available for each item on the agenda. each will be allowed three minutes unless the board president extends the time. as a reminder a caller they have questions of the body but there is no obligation to answer or engage in dialogue. when i welcome you you are

averaged to clearly although you mayremain anonymous. when you're three minutes have that you will be placed at the moderator you the next caller . remote calling is available on sfgov.org. opportunity to speak are available by dialing thenumber on yourscreen. the dial in number is 415-655-0001 . again, 415-655-0001 . when prompted, use access code [inaudible] . again, 187 087 3967. then press pound and pound again. you will enter the meeting and dial star 3. when the system messages your line has been muted, this is your time to speak. continue to wait until the systemindicates you have been on muted . sfgov tv has a 45 second delay for viewers but we will take a 45 second pause to allow the system to catch up. our 45 second pause against now. ... [please stand by] callers .

zero callers have specifically entered the public queue at this time. you must dial *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 queue at this time. >> thank you, moderator. hearing no further callers, public comment is closed. >> great. so now we will close agenda item no. 10. i think it's been two hours. what i'd like to do, we're about 20 minutes behind schedule, by my calculation, but with that i think we still need to have a stretch break and so i'm going to give a five minute break to stretch and handle other needs at this point and we'll reconvene in exactly five minutes. >> seven. >> seven minutes, okay. i accept the amendment. seven minutes.

>> thank you. >> i'd like to repeat the roll call. >> thank you, president. roll call. president. >> present. >> vice-president. >> present. >> commissioner -- >> here. [roll call]. >> we have quorum. >> call for agenda item no. 11. >> agenda couple no. 11 is review and approve blue shield of california non-medicated hmo plans 2022 rates and contributions.

this is an action item. >> i will screen share the presentation. this presentation is the blue shield of california -- plans. you'll see the content. i will go through the opening items very quickly. i'll be happy to entertain commissioner questions at the end of this presentation on this information. you'll see consistently outlined information in the rest of the presentations today, just outlining the different funding methods, which particular plan applies the funding, how we do

the rate setting process. this slide you saw earlier in the opening presentations that i made today with the increases proposed for each plan. you'll see a page in each presentation, how that orchestrates into the total cost rates proposed for 2022, and then some commentary about how the employer contributions worked first for active employees and then for early retirees based on city charter formulas. again, in the interests of time i won't go through those in detail, but i am happy to answer any commissioner questions you may have on these slides at the end of today's -- at the end of this presentation. as i mentioned earlier, fairly nominal increases for each of the plans. these are the staff recommendations that i'll come back to at the end of the presentation. and we have commentary

regarding -- active employee rate cards that are shown in the presentation are for the two most common employer contribution strategies, the 93, 93, 83 share and the other share noting the multiple contribution strategies across all employees of the health service system, so individual employees may have different contribution strategies than these two. and then the early retiree rate cards are shown for early retirees and own the full city contribution level based on length of hire and length of service with employer contributions determined by the city charter formulas. so you'll see here in this presentation are for access plus 30 plans. no plan design changes are being planned. you see the increases for each plan, which in total combined to

1.2%, and you'll see listed at the bottom of this page all the elements that are included in the figures, the monthly wage that you'll see in the card shortly. and some commentary on these favorable increases, first the overall plan expenses for the blue shield hmos only increased 2% as i reviewed with you in the march meeting. medical claims actually decreased -- reimbursements in part because of plan suppression. prescription drug claims increased 10%, did not show evidence -- suppression, and both of these increases are well below what we're seeing for national cost trends at approximately 6%. favorability in these increases is helped by an increase in the stabilization buy-down that will take effect for 2021 ratings relative to 2021, approximately

double what it was for this plan year. so without these shifts in stabilization, increases would be 0.7% higher, and also as we reviewed in february, impacts, favorable impacts from the rfp, also helped maintain these increases to be relatively low increases. and the 1.2% overall increase for the two plans combined compares to 4.4% of the 2021 increase. here you will see the fixed cost comparison on a per-employee, per-month basis. most notably the decrease in the blue shield administration cost, and again we thank blue shield for that decrease resulting from the r.f.p. process. we're also seeing a lower increase in the large plan folding rate than we've seen in the past. there was an 18% increase in that rate for to 21 based on large claim activity in the

prior plan year. now we're seeing an increase of only 5%, and the large claim pooling fee. and just to note, the california managed care organization pack that sunseted effective june 2019, that it has now returned based on action by the california legislature. so with that, we'll review the change in contributions and rates from one year to the next. you will see most notably decreases in the monthly retiree contributions for the retiree-only and retiree plus one tiers for early retirees because the increase for the plans is less than the percentage increase in the county amal, and so as a result it will mean a lower contribution required for retirees, and the retiree only and retiree plus one tier for the access plus plan in 2022.

and you'll see the 0.8% that i talked about earlier across all of the active employee rate changes. and the same is true when we look at the 196-83 strategy. so these are the rate cards that will ask you to approve shortly for access plus, 93, 93, 83 and 100, 96, 83 and again with the favorable increase, 2% for tria. we will see a reduction in the monthly retiree -- for the retiree only tier for trio for 2022. and the rate cards for trio. so with that, staff recommends that the health service board approve number one that blue shield access plus plan renewal proposal for 0.8% rate increase for 21 to 22. second, the blue shield trio plan renewal proposal for 2%

rate increase from 2021 to 2022, and approval of the rate card contained in this presentation for the blue shield access plus and trio hmo plans. president, i'll turn it to you. >> thank you. these are really spectacular presentations for me in particular, because they are very clear. i want to thank you again for all this information, all of which is critical. i didn't mean to shortchange you, but i think this is really helpful. with that i'd like to open this up for comments or questions from board commissioners. >> i have one question. the reduction in the administration fee you said was part of the r.f.p. how long is that reduction? how long will that last? >> the administrative fee is guaranteed for three years by blue shield, so it will last

through the end of 2024. >> okay, thank you. >> thank you. other questions or comments? commissioner scott? >> yes. this is a question across, again, the general presentation. i know that we've been talking about premium suppression and utilization and so forth and so on. is there any forward-leaning indicator at this point as to how this might change and how people are thinking about this from both the plan provider standpoint as well as actuaries? are you guys getting any closer to a sense of how things might move in the coming months or trend in the next year? >> yeah, sure, commissioner scott. so what we've generally seen across our client business, and this is true at the -- from the first calendar quarter of 2021 is still a continuation of lower

medical claims expense than we may have expected with our underwriting early last year. we are starting to see some higher levels of medical claims in april, so that will likely present into cfo's presentation to the board on financials next month. at this point, we haven't seen a large surge increase in plan utilization. we are having many conversations within our aeon lead actuary team with lead actuaries from all of the national health plans to gauge what they are observing in changing of utilization based on what they are tracking for their books of business. and so there was still a belief that we may see higher levels of plan utilization for medical care later in 2021, especially if you have members who perhaps

have not been able to see a physician to address early signs of, let's say, a presenting issue, a chronic risk issue. however, we do strongly believe that telehealth has benefited members greatly to be able to engage their physicians in conversations about any health issues that could be presenting in lieu of members perhaps not being quite comfortable yet seeing their physicians in person. >> i would note that -- excuse me, i'm sorry. just to follow up to that, i recognize that, you know, we get through the rates and benefits cycle and we then move to open enrolment and we all go, foof, they were all enrolled and so forth, and so i would like to request that we get some sort of

periodic review of this over the next quarter or whatever would make sense. because what i am hoping doesn't happen, i think we are all holding our breath, is this looks great. these are moderating numbers. we know that there are some factors, some key factors that are driving these, but i don't want us to be hit in the next benefit cycle with a -- you know, an astounding wave, if you will, either pent-up demand or whatever, however it's attributable, as we go into the next cycle. so we need to monitor, have some mechanism to monitor this and report that in a very high level or summary fashion to us, just to keep our eye on this ball, around what your expectations are so that we -- as we go into next february and march, you

know, we -- if that is starting to happen, then we're kind of prepared for it and know that that will have an impact on premiums. so i would request that just as a generic issue for this board to be aware of. >> absolutely. fully noted. i'll be working very closely with cfo lou and his team as we track claim expense month to month. absolutely report back to the board on what we're observing. i will say for the presentations you'll see today, particularly on the blue shield hmo plan and particularly on the blue shield accolades plan, two things are helping the rate increases be relatively lower than perhaps you've seen in the past. one is the r.f.p. -- the benefit of the r.f.p. financially, and the second is because of the rate stabilization mechanism, that helps capture some of the favorability in claims relative to forecast, and so that is

benefiting the rates for 2022. >> abbey, did you want to maybe add a comment about how the measurement plan is generated and how responsive it is to these trends that commissioner scott is kind of alluding to, i think? >> yes. we meet yearly regarding utilization with all of the plans, and what we have been working towards is some uniformity amongst the particulars of those utilization reports so that it tells a clearer story about the population as a whole. and you know, it is very feasible. i don't have the schedule in front of me of when we get those reports, but we can look back -- we can look at that going forward and see what the best timing is to provide that report. mike did mention and i'll be working with larry lu, and you

will perhaps take a look back at your financial report where we do look at these month by month of revenue or expenses and are reported in the financial report, but as far as utilization reports, we would -- we'll consider what this timing -- you know, when we receive those reports and what the timing would be to bring them to the board. >> great. other comments or questions from commissioners? commissioner how, did you have your -- yes, go ahead, commissioner howe. >> thank you, mike, for that very thorough presentation. i just have some questions. i think it's your slide 13 where you note that the 2022 rate cards include the following cost components. the first two items projected 2022 medical and pharmacy claim costs and projected 2022 captation charges, can you tell us how those breakdowns were or

what those projections were? >> yeah, absolutely. so for overall medical expense for blue shield plans, approximately one third of projected medical expense is captation with the remaining two thirds being for services like hospital care and other services that are primarily not delivered by physicians but are other costs within the system. now as a preview for health net, actually most of the medical costs is capitated in that platform, and then pharmacy is pure claim as incurred based on member prescriptions, but then the rebates that slow to -- hss from the pharmacy purchasing become an offset to those claim costs to come degree for

pharmacies. and so, you know, overall approximate percentage distribution is medical about 80% between claims of capitation and pharmacies is approximately 20%. >> thank you. >> any other questions or comments from commissioners? seeing none, i think we'll go ahead and open this up for public comment. >> thank you, president. yes, i'll bring up our slide of instructions. so 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 -- [reading slide]. >> holly, can i interrupt for a second? this is an action item, so i

think i need a motion and a second regarding this item before we open it up. >> this is commissioner hao. i move that we accept the recommendation to increase the blue shield plans as noted on the slide that is up before us. >> second. >> okay, so move and seconded that we accept the staff recommendations for these two plans. any additional discussion? then i would like to go ahead and open -- now open this up for public discussion. i'm sorry about the timing of this. >> thank you, president. i'll pull up our slide.

so public comment will be available for each item on this agenda. [reading from slide]. when i welcome you on the call, you encourage you to state your name clearly although you can remain anonymous. remote viewing is available on sf gov tv.org and channel 2. opportunities to speak are in the public comment period are available by dialing the number on the screen. the dial-in number is 415-665-0001. when prompted use access code 187-087-3967. then press pound and pound

again. you will then enter the meeting as an attendee on the public comment calling and dial *3 to be added to the queue. when the message says "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. sf gov tv has a standing 40 to 45 second dlie for those viewers watching our broadcast live online. we will take a pause to allow viewers to catch up and allow callers to dial in. our 45-second pause begins now.

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

public comment is now closed. >> thank you very much. so moved and seconded that we approve the staff recommendations for rate increases for the blue shield, the california access plus and trio plans and corresponding -- >> [indiscernible]. >> corresponding rate -- [indiscernible]. i'm getting some feedback. anyway, rate plans. all those in favor, please signify by saying aye. >> aye. >> aye. >> aye. >> any opposition? thank you. it carries unanimously. so we now can move to agenda item no. 12. >> thank you, president. agenda item no. 12, review and approve health net canopy care medical rx flex funded non-medicare hmo plan 2022 rates and contributions.

this is an action item. >> mark clarke from am. i will share the presentation. presenting the health net canopy care for the rates and contributions for initial year 2022. much of the background is the same as what i walked through before. of note, health net canopy care, like the blue shield hmos just presented is a flex funded plan. and you'll see here where the rates will ultimately compare to blue shield access plus trio and

the kaiser plan. the total rates will fall between trio and access plus for 2022. so our recommendation today is that the health service board approve the 2022 rate cards as i will present in this material. and similar information to what i reviewed in the blue shield, hmo about the information and the rate cards. from a rating summary standpoint, we received financial information from health net canopy care as part of their r.f.p. submission that is used to determine the 2022 monthly total cost rates that you'll see in this material. the plan designs for canopycare -- mirror the designs for the blue shield plans, and the rate cards include the medical and pharmacy costs, the capitation charges, administrative fees, as well as other elements of the rate cards

that were presented in the other plans. of note, this plan will be eligible for rate stabilization into the future, but because it is a new plan for 2022 and does not yet exist, there have not been that opportunity to have rate stabilization present to this point, and so you will see zeros for the rate stabilization line in the rate cards. the per-member per-month projections were provided, as well as the other financial elements, and so i worked with an actuary to utilize this information in comparison to the blue shield access plus and trio plans to develop the total cost rates, and also worked with the health net canopycare actuary to review those projections. similar to the hmo blue shield plans on a flex funded basis, it does have a maximum liability

financial target which does mean that if costs were to exceed 125% of expectation, which would be extremely rare, that would create a maximum exposure for us [indiscernible]. one notable difference in the flex funding approach for health net canopycare versus blue shield is there is no large claim pooling for this plan versus the 1 million large claim pooling in the other blue shield hmo plans. and so with that the rate cards are presented, and we use mathematical relationships at the rates across each dependence here and across active employees and early retirees to be the same as what exists for the blue shield hmo plans. so as i mentioned before, you see in the stabilization, no entry there, but the medical figures along with the division and sustainability fee are

present in the rate cards that you see for the 93, 93, 83 and the 100, 93 -- on the right side of the page. so with that staff recommends that the health service board approve this plan rate cards as presented in this material. >> i'll see if i can try and support you from the -- >> sorry about that. i forgot to unmute myself. so again, thank you very much for this presentation. comprehensive but succinct, and

so i'm going to open this up to board members. i would like to start with a question, and that is you noted that we're used to the large claim pooling, yeah, the $1 million, and that the liability for the financial target of 125% would be a rare event. can you give us some background in terms of blue shield if you were to take out the large claim claims that occurred in the last few years, what -- how big an impact does that have on the overall financial liability in at least blue shield? i know you can't really extrapolate to this, but maybe give us some sense of our risk. >> sure, we have six years of funding claim data with blue shield as flex funding started in 2013. in six out of those eight

years -- has paid a higher level of large claim pooling fee than the total amounts that were reimbursed back to the plan, and in two years there was claim experience that was reimbursed back to sfhss and the trust that was greater than the large claim pooling fees paid. now generally speaking, you know, a large claim pooling fee is an insurance mechanism, and so you would expect over the course of time that the fees paid for large claim pooling would exceed the reimbursements, which have happened over the eight-year period with blue shield. so i don't expect this to be a concern with health net canopycare, that there is no individual large claim pooling requirement in their flex funding mechanism relative to the 1 million that blue shield does have as part of their insured filing for their flex funded plan.

>> thank you. that's very helpful. so other commissioners have questions or comments? seeing none, i'll entertain a motion to -- regarding the staff recommendation for the health net canopycare hmo 2022. >> this is randy scott. i move that we accept the staff recommendation and the rate cards that are contained in the presentation. >> this is commissioner hao. i second. >> having been moved and seconded, any further discussion? if not, then we'll open this up for public comment. hearing none, we'll go ahead and open this up for public comment, holly. thank you. >> thank you, president.

public comment will be available on each item on this agenda. each speak will be allowed three minutes to comment in length until time limits in the meeting. all public comments to be ahead concerning the agenda item that has been presented. as a reminder, questions of the policy body but no obligation to answer or engage in dialogue with the caller. you can remain anonymous. when your three minutes have ended i will thank you for your comment. you will be placed back on mute. remote viewing is available on sf gov tv.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 415-665-0001. when prompted, use access code 187-087-3967. again, 187-087-3967 then press pound and pound again. you will enter the meeting as ab

attendee on the public comment call line and dial *3 to be added to the public comment queue. when the system says your line has been unmuted, this is your time to speak. sf gov tv has a standing 40 to 45-second delay for viewers watching our live broadcast online. we will take a 45-second pause to allow the system to catch up and the callers to dial in. our 45-second pause begins now.

45-second pause has ended. our moderator will notify us of any callers in the queue. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *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. >> thank you, moderator. hearing no further callers, public comment is now closed.

>> thank you. so it's been moved and seconded that we approve the 2022 health net canopycare hmo plan rate cards as presented and all those in favor please signify by saying aye. >> aye. >> aye. >> aye. >> any opposition? it carries unanimously. we move to agenda item no. 13. >> thank you, president. agenda item no. 13, review and approve blue shield of california ppo al co-laid plan medical rf non-funded 2022 rates and contributions. this is an action item. >> mike clarke, i will share the

presentation. so presenting the blue shield of california ppo rates and contributions for the 2022 plan year, highlighting very quickly in the process this is a self-funded plan, so all claims flow through the trust along with plan administrative fees to manage the plan. and i will outline those administrative fees during this presentation. so staff recommends the health service board approve blue shield of california ppo accolade and choice not available 2022 plan year monthly rate cards as presented in this material. and the resulting aggregate overall rate increase from the 2021 plan to the accolade plan

is 2.7%. of note, in the active employee rate card is the fact that the m.o.u. for employees specifies the employer contributions for the highest cost plan offered through sfhss, which is the blue shield of california ppo accolade plan, are set to equal the employer contributions for the second-highest cost plan which remains blue shield hmo access plus. so this guides how the employer contributions are set for the ppo plan in the active rate card that you will see in this presentation. for the employee-only tier, in the 196-83 strategy, employees pay no contributions for any hss plan, including the ppo plan.

the recommended rate increases are base on 2020 claims experience, 2022, along with the administrative fees, for the proposed -- the new administrator, blue shield of california accolade. the previously approved changes and rate stabilization that occurred in the march 2021 meeting. the medical claim experience that was utilized in the projection has been adjusted to reflect my best estimate for the normalization of ppo claims claim suppression that occurred during the pandemic. if you refer to the march 2021 experience presentation for this plan, you'll note while prescription drug did inflate at expected levels, there was a lower level of medical claims in 2020 versus 2019 due to pandemic influence reasons. no plan design changes are

proposed for the ppo plan in the 2022 plan year, and we're moving from a -- where we have a buydown of the rate stabilization, that should actually be versus a 744,000 buyup in 2022. so rate stabilization is moving from deficit to surplus in this plan, which is helping to lower the rate increase. and again, you can see detail on the plan experience referencing the difference in the experience going back to our presentation in march. specifically for administrative fees, you'll see that the base administrative fee moving from the united health care to blue shield is lower, but in part due to the introduction of accolade as well, and so there is an accolade core fee as well as fees for a couple programs that

we'll talk about in the next several pages, as well as a one-time accolade implementation fee of $88,000, so the $3.93 is the representation of that on a per-employee per-month basis. you will also have shared savings fees as part of this program. similar to the united health care ppo plan today, and then so in total there will be a higher level of pepm expense, but in part because of added services that are being delivered through blue shield and accolade as part of this program, and then also just in consideration we expect a lower level of claims due to improved discounts from blue shield in this ppo program. so specifically in the fees that you saw on the prior page, i won't read them all off, but you'll see these additional services that will be provided

by blue shield as part of their administration of the ppo in 2022, and then on page 17 you'll see two added accolade programs beyond their base fee. one very much in line with mental health awareness month, a mental health integrated care program via an organization gender which will provide support to improve employee well-being and reduce health care costs through an integrated solution that is aimed to reduce depression and physical pain, improve overall quality of life, and deliver a return on investment, and this will include on-demand behavioral health coaches, therapists and psychiatrists. and also there is a cost-of-supplier program through accolade that will give members access to a program which will

provide digital support of musculoskeletal needs through live video consultations and video exercises. so two features of the accolade addition into the ppo that we anticipate will benefit members greatly in the area of mental health and musculoskeletal health. and just a refresher on the choice not available concept, participants who were assigned to the blue shield ppo accolade choice not available plan are those who live in a zip code where it may be the only available plan, the ppo, or not all other plans are available, you know, via kaiser or blue shield access plus. and so you'll see that most active employees in the p.p.o. plan do have access to all plans, but there are 142 that do not, so 142 will have choice not

available rating as in prior years, and you'll see for early retirees it's about a half-and-half split between those two live in the bay area and have access to the kaiser permanente and access plus plans in addition to the p.p.o. versus those who will be choice not available pricing for their early retiree rates. and the contribution for choice not available for active employees is particularly in the moccasin areas and early retirees who live outside of the bay area of northern california. so we'll see the choice not available for active employees are the same total rates, including all rate card elements as the blue shield access plus program offer early retirees same rates as the p.p.o., but they lead to lower retiree contributions based on how the city charter employer contribution formulas are

determined. so with that we'll show the rate cards, again with the recognition hah for the p.p.o. accolade plan the employer contributions for the m.o.u. are set to the second-highest cost plan, access plus. you'll see the percentage increases in total rates at the bottom of the page, employer contributions in the middle, and the resulting impact to the employee contributions on the left side for the 93/93/83 strategy, and for early retirees on the right side of the page, and then here for the 100/96/83 contribution strategy for employees. and these are the resulting rate cards for the blue shield p.p.o. accolade, and this is for the 100/96/83 card, and then for the choice not available, you'll see the rating impact based on the alignment of rating to the

access plus plan for the -- in here for the 100/96/83 employees as well as the early retirees, and the resulting rate cards. so with that, staff recommends the health service board approve the accolade plan and p.p.o. accolade choice not available 2022 plan year monthly rate card as presented in this material, which results in an overall rate increase of 2.7%. president? >> thank you very much for, again, a very complicated but concise presentation. so i'm going to open this up for comments and questions from board members. it looks on first blush, to me, i'll start, it seems like the blue shield accolade plan uses lots of vendors to help sort of upgrade or maximize areas of concern that we have had as

concern for quite a while. for those of us who participated in all-day off-site strategic planning when we listened to some vendors talk about -- and there's the whole expanding universe of them, particularly for those members who are in the choice not available, who may not have access to sort of the face-to-face providers in a lot of these areas. it seems like this is sort of a real upgrade. am i reading this right? i mean, it seems like it's a fairly modest increase in cost across the board but has a really high impact, and certain groups, including those who geographically are somewhat isolated and have, as you say, choice not available? >> yeah, i could agree. if i could ask the executive director yantz to speak to the process of considering these sorts of add-ons, because they are optional that the sfhss team has thought through very carefully the consideration of what accolade can bring through

partners like ginger and hinge health. >> thank you for the opportunity to speak to this, doctor, and thank you for recalling the innovation data we had to kick off the strategic planning process where we were introduced to a very few of the point-of-care start-ups that were -- are in the marketplace today, and i know at one point there was as many as 200,000 of these new start-ups a day in the u.s., and it was rather intimidating to think about how if we did subscribe to any of these how we would sort and monitor and we have the experience with one particular vendor that we found problematic in our ability to monitor and make changes. so it was a strategic recommendation at that time that should we consider these point-of-care solutions that would be best to allow the plans to do that because they are in a much better position to do that. and so with this offering

through the r.f.p. process, with this partnership of blue shield and accolade, that vision that we had several years ago has actually -- the opportunity has presented itself, and it does just make total sense, as mike has explained, within this p.p.o. population which has many unique characteristics, and we anticipate that these services with the decisions of accolade of helping connect the folks who need the services to the services will have a significant satisfaction and benefit to the health and well-being of those members. >> thank you. other questions and comments from board members? >> i'm very pleased that -- just very quickly, i'm very pleased to see that this has come full circle as well during this particular benefit cycle, so

it's been -- i know a lot of work, the staff and you going through the whole process to get us here, and i thank you for that, to you and your team. >> thank you. >> i'd like to add on to what the commissioner said and especially on behalf of our -- folks that have been struggling for so long and when i first got on the board many years ago, the first thing i had to do was take a trip up there and face that population and talk about their lack of options for affordable health care, and it looks like we're heading down a different path these days. so thank you very much. i think it's also very interesting to see the additional vendors that are being involved and the

additional services that are coming forward, and i'm hoping that what that means is better care and lower rates across the board for all of us. and i would also suggest to my colleagues on the board, one of the areas that i look at is the out-of-pocket for both the active as well as the early retirees, because one of the things that we often hear from early retirees is, oh, my god, what happened? it's like your contract doesn't cover you anymore. there's a whole new set of rates available for you to keep your health plan and your health coverage, and it can be shocking when people first retire, and until they reach that medicare age, they are at a significant out-of-pocket rate, so thank

you. all these rates so far look a lot more accommodating than we've had in the past, and i hope that that trend continues. so thank you. >> other comments from commissioners? if not, i'll entertain a motion. >> yeah, mr. president, this is christianing, and i move that we prove the presentation as was discussed with the slide in front of us, to approve the blue shield p.p.o. accolade plan as presented. >> i second the motion. >> it's been moved and seconded that we -- as outlined above that we approve the accolade planned and plan choice not available as well as the rate cards. so with that i would like to open this up for public comment.

>> thank you, president. i'll pulling up my slide momentarily. [reading slide].

>> board secretary, we have three callers on the phone line. two callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five 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. >> thank you, moderator. public comment is now closed. >> okay. so it's been moved and seconded that we approve the blue shield p.p.o. accolade plan and choice not available. all those in favor please signify by saying aye. >> aye. >> aye. >> aye. >> any opposition? hearing none, the motion passes unanimously. we can move to agenda item no. 14. >> agenda item no. 14, review and approve kaiser permanente california fully insured non-medical care non-rf 2022 rates and contributions. this is an action item. >> mike clarke, i will share the

presentation. so presenting the kaiser permanente fully insured -- and prescription drug rates and contributions for 2022. and just to note the all kaiser hmo plans are fully insured with rates determined by the kaiser organization but with close scrutiny by myself as the plan -- as the actuary and the sfhss team. with -- as i mentioned earlier, a 4.96% increase, but as you also see on this page, it is still the lowest rate from a dollar perspective. any total premium rate on the

sfhss active employee and early retiree plan platform. so the recommendation today is a 4.96% insurance plan premium increase from 2021-22 for active employees and early retirees in california and -- kaiser permanente hmo plan based on the plan rates proposed by kaiser and the resulting rate cards that are presented in this presentation for active employees and early retirees. and similar to before, we present rate cards for the majority of active employees with the two plan sharing 93, 93, 83, 100, 96, 83, as well as the early retirees based on formulas from the city charter. the status quo plan design, so

no plan design changes proposed by kaiser for the 2022 plan year. the increase is 4.96% following a 5.86% rate increase that occurred for the 2021 plan year. the development that we've talked about with the other presentations is challenged by the pandemic-caused medical claim suppression, primarily in the march to june 2020 time frame as you saw in the presentation last month on kaiser hmo plan experience. the increase represents kaiser's best estimate for the proposed plan experience, plus associated administrative costs, and there is an appendix exhibit that shows the base of the rate increase. it is a group model plan, meaning that kaiser operates the health system and the health plan for numbers. the utilization was lower in 2020 than 2019, but if you consider all of kaiser's

business expenses to operate their health system in aggregate, they came close to expectations in 2020 but just as expense requirements shifted to the kaiser organization due to the pandemic. expenses related to the delivery of care were generally lower than expected given reductions in plan utilization by members. however, there were additional expenses related to addressing the unique needs of the pandemic for kaiser and the health system, including the direct costs of providing covid-19 testing and patient care as well as staffing costs needed to support the surges that occurred with the pandemic with intensive care needs of patients. this is publicly available information for kaiser for financial results for both 2019 and 2020, and you can see that overall the kp enterprise

expenses growth was slightly higher than revenue growth. part of the revenue growth was an increase in membership of approximately 1%. that took place in 2019-2020, but due to the expense needs brought by the pandemic for the kaiser permanente enterprise organization, the operating income was less in 2020 than it was in 2019, so all told, this leads to kaiser forecasting typical increases in revenue. in other words, the insured premium rates for their customers from the 2021 to 2022 plan year. and so we built in all of the various elements into the rate cards, including the -- basic vision plan premiums and the sustainability fee. so when you look at the comparison of contributions for members at the top of the page, the employer contributions and the tota