>> agenda item 2 is roll call. [ roll call ] >> clerk: we have quorum. >> chair: thank you very much. just a couple of housekeeping

items before i move to item number 3. the first is that we have a new transcriptionist. so i'm going to ask all the health service board members if they will please identify themselves so the transcriptist can recognize our voices when you speak. number 2 is i'm going to change the order of the agenda slightly so that the health service systems board fiduciary training that was scek scheduled as item number 9 is going to move a little later in the agenda so commissioner breslin can be here for that. with that, i will call for item

3. >> clerk: agenda item 3 is the approval with possible modifications of the minutes of the meetings set forth below, june 10, 2021. this is an action item. >> chair: are there any corrections or additions to the minutes of the regular thursday, june 10, 2021, meeting of the health services board? >> i move that the minutes being adopted as distributed. this is randy scott. >> seconded. >> chair: it is moved and seconded. any comment from any of the board members. hearing none, we will open this up for public comment. >> clerk: thank you. i just want to note for the

record that supervisor chan has joined us. >> chair: welcome. [indiscernible] -- when i welcome you on the call, you're encouraged to state your name clearly, although you may name anonymous. i will ask you to be placed back on mute after you comment. [indiscernible] opportunity to speak during the public comment period are available. the dial-in number is 415-655-0001. i.d. 187 679 7252, 187 679 7252.

dial star 3 to be added to the queue. when the system says you are unmuted, this is your time to speak. sfgov tv has a delay. our 45-second pause will begin to allow those on the line to catch up, beginning now.

the 45-second pause has ended. our moderator will alert us to any callers in the queue. >> operator: we have one callers on the phone line and zero callers have entered the queue. we will pause for another five seconds. to enter the queue at this time, you must dial star 3 now.

board secretary, there are still no callers in the public comment queue at this time. >> clerk: thank you, moderator. hearing no callers in public comment, it is now closed. >> chair: all those in favor approving of the june 10 minutes of the health service board, say aye. >> aye. >> chair: opposed? it passes unanimously. if we could move on to item 4. >> clerk: agenda item 4 is general public comment. an opportunity for members of the public to comment on any matter within the board's jurisdiction, including anything that is not on the agenda or requesting that the board place a matter on a future agenda.

this is a discussion item. >> chair: open up to public comment. >> clerk: thank you, president follansbee. public comment will be available to each item on the agenda. each speaker can comment for three minutes. all public comments are to be made concerning the agenda item presented. as a reminder, a caller may ask questions of a policy body, but there is no obligation to engage or answer. when the three minutes have ended, i will thank you for your comments. you will be placed back on mute. remote viewing is available online and on sfgov channel 1. you can dial the number on the screen, 415-655-0001, and i.d.

187 679 7252 when prompted. you will enter the meeting as an attendee on the public comment call line. when the system message says your line is unmuted, this is the time to speak. please continue to wait until the system indicates you have been unmuted. there is a 40 to 45-second delay for those watching online. we will take a 45-second pause to allow the system to catch up and viewers to call in. our pause begins now.

the 45-second pause has ended. our moderator will notify us of any callers in the queue. >> operator: thank you, board secretary. if you could please share host privileges. we have two callers on the phone lines. zero callers have entered the public queue at this time. a reminder to all callers on the line. you must dial star 3 now if you want to join public comment for this specific agenda public

comment item. we will wait five seconds and then close this item. board secretary, there are still no callers in the queue at this time. >> clerk: public comment is now closed. >> chair: we can conclude agenda item number 4 and move to agenda item number 5. >> clerk: thank you, president. agenda item number 5, president's report. this is a discussion report. >> i have no written report or no verbal report at this point. i just want to remind the board and those watching or listening to this meeting that the

consideration to move the agenda items, moving item 10 up above 9 so that commissioner breslin can attend the training portion of this agenda item today. with that, i will conclude my president's report. >> clerk: thank you, president follansbee. >> chair: i don't think we need public comment on that, do we? >> clerk: if there is one that objects to it. is there any objection? >> no, if you're making a request to make a switch, if you were deleting something, i think we would go into the process of public comment, but this is just switching an agenda item and i

don't think it's necessary. >> i think i will go ahead and close this item 5 and move to item 6. >> agenda item 6 is president assigns committee members to the finance and budget committee/governance committee for fiscal year 2021-2022. this is an action item. >> chair: do we have a slide with the assignments available? i have discussed with each of the members their willingness to serve and they have consented to do so. with that, i conclude my discussions on this. any comments from the board? >> mr. president, i move that

the committee assignments that you've identified be confirmed. >> second. >> chair: it's been moved and seconded that we confirm these assignments. >> it's an honor to participate. >> chair: thank you and you're welcome. >> clerk: each speaker will be allowed three minutes to comment in length, unless the president decides otherwise. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialog with the caller. you may state your name clearly,

but you can remain anonymous. remote viewing is available online and on our tv channel. opportunity to speak during the public comment period are available by dialling the number on the screen, which is 415-655-0001, i.d. access code 187 679 7252 then dial pound and pound again. you'll enter the meeting as an attendee. when the system 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. we have a 40 to 45-second delay for viewers watching online. we will take a pause for the systems to catch up and callers

to dial in. the pause begins now. the 45-second pause has ended. the moderator will notify us of any callers in the queue.

>> operator: we havetwo callers on the line and zero callers have entered the queue. a reminder to all panelists to remain on mute because there is background noise. a reminder to callers to enter star 3 to enter the queue. we will wait for five seconds and then close public comment for this agenda item. board secretary, there are still no callers in the queue for public comment at this time. >> clerk: public comment is now closed. >> chair: therefore, i would like to call a vote to confirm the committee assignments for the health services board for the fiscal year 2021-2022.

all those in favor say aye. >> aye. >> chair: opposed? it passes unanimously. thank you very much. now move to agenda item 7. >> clerk: thank you, president. agenda item 7 is the director's report. this is a discussion item and will be presented by executive director abbie yant. >> good afternoon. commissioners, this is abbie yant. i will be brief. on the covid-19 front, there was just a few hours ago a new health order issued for the city and county of san francisco. the essential changes in it are that vaccine verification will be required for a number of places, bars, restaurants, health clubs, lots of indoor

settings. so that new health order is effective today, as i understood, and we will be sending that out to all of you as well as going through the detailed health order now in place. thank you, supervisor, for carrying the legislation and introducing it so nicely at the budget committee meetings. we went through with no questions, which is comforting to have that cycle behind us and complete. the -- there is a note in the director's report that we are beginning to consider how we will update our strategic plan for the health services system for plan years 2023 through

2025. we are in the formative stages of determining a process. our intent is to have a new strategic plan completed by the end of this fiscal year. so it's an ambitious undertaking as always. in many ways, i think we will certainly continue the direction that we've been going in for the last several years and we'll detail that and involve the members of this board as well as finding new ways to involve members in our development of the plan. the racial equity action planning continues. i was able to forward, i believe, to all the board members the documents that have been issued in the city in the last year or so that address some of the systemic changes that are needed in the hiring and selection and disciplinary

processes for our workforce. that is very helpful because we had identified in our plan some of those same concerns. so it is much easier for sfhss to change. as we do that, we are relooking at how we have our input in our own organization and my colleague is leading us in that and we will update you as we continue down this road. the sutter lawsuits, there have been no significant updates. a court monitor has been appointed. there is consideration for how the legal fees will be assigned and once that is resolved, then

the divvying up, if you will, of the dollars for those organizations, including h.s.s. that are eligible will be determined by the monitor. there is a timeline that has been made public on this. as that information becomes available, we will update the board on that issue. the other update from the prior board meeting, i wanted to say that we have been meeting and developing a robust dashboard that we hope to be able to present in september to this body. we've learned a lot together about what data is available and how this product is serving our members. we hope to be able to present that at the september meeting.

also, in the report we mention that the kaiser permanente is advising us of accusations brought forward about different practices. kaiser is disputing these allegations at this time and does a lot of internal audits to ensure their own compliance. we will be made aware as department of justice does this investigation and lets the public know what the results of their findings are. from the operation report point of view, it's all things open enrolment. in that regard, we've actually had a new member join our team,

olga stanisayev is our new services management manager. i don't know if olga is on the call, but we are excited to have her join our team. she has extensive experience working with the city at the human services agency, where they enroll people in medical. very complex, very dynamic, always changing very intense regulatory environment. she supervised a large workforce. she has a terrific experience that she's learning the commercial insurance end of the business, but has a team of experienced benefits analysts who are quite competent. we're really happy to have olga join our team.

we also were able to retain todd creol who had been an intern. the city has a great internship program for new accountants and he did his internship at h.s.s. and then recently was able to gain a permanent civil service position in our organization. welcome, todd, as a permanent member of the team and i know the finance team is very happy to keep him here as a home-grown product. that's really great. we also have one more retirement to announce. cathy newsome who is one of our three employee assistance counselors will be retiring in the fall. she's been just a terrific asset

to our team and helping support many of the programs that we do in addition to the individual counseling that each of our counselors do. they also work on their issues of working with specific departments. she's been part of our crisis intervention team when we have unfortunate things happen with our workforce and has a real passion for working on substance use and other mental health assessment tools. she really will be missed. we're undergoing a search now for a replacement for her. we wish her well in her retirement. we also promoted to staff to analyst positions. congratulations to those two staff members and thank you for your service. additionally in the enterprise

team, the leader of that team is now promoted to the director of the team. one of her key business analysts also has been promoted from a programmer analyst to a business analyst, a well-deserved promotion for him as well. so there has been quite a bit of movement within the operations teams. that sets us up well for the fall. we have lots of webinars, live and recorded, that will help answer the questions that our members have and they'll be able to find those answers themselves and not necessarily need to call

in to the organization. finance is excited that they've gotten through the year-end flows. the contracts division continues to stay super busy and one of the big projects they're working on at this time. the contract put in place early in the pandemic has been well utilized and we've been able to work closely in tandem with some of our departments.

this has been a wonderful opportunity to do collaborative planning and service selection. it's a really great opportunity to have done that. as i mentioned, the well-being team has been our report. much of the activity that we did during the month of may, which was mental health awareness month, and that -- the need for mental health services is continuing to run quite high. we've had a very recent, within the last few weeks, uptick in calls in. there's no direct correlation to any interventions that we've done. so we suspect that it's really the ongoing and escalated anxiety that exists in our workforce at large regarding the delta variant covid-19 outbreaks that are occurring.

so we continue to update our numbers in working our way through this stage of the pandemic. so that concludes my director's report. if there are any questions, i'm happy to answer. >> chair: we extend our thanks from the rest of the board. i think the health services system considers all of the employees of the four sessions to consider the support critical for essential persons over non-essential employees. all of our employers are

essential and we're proud of the options that we provide and we really want to thank you again for your support. i think the affirmation on the board of supervisors should be noted swl /* swl as well in this regard. i want to note that in my past life, the demand for proof of vaccination is a very easy one for all of us. i have had to comply approved performance recently and they accepted a photo of my vaccination card on my smartphone. the health services will be providing, as well as the city providing, other options for how to upload that information to websites so it is readily

available. they won't need proof of a driver's license or identity card or immunity card, i would like to suggest that people not laminate one card at this point because the recommendations for booster vaccinations are in the works for certain populations initially and eventually we suspect there will be booster vaccinations for those not vaccinated with the original series. the potential to laminate that card seems to be something that might be -- get a picture of it, get it documented, put the card away because you're going to want to present it for subsequent jabs. with that, i'll turn over to

other board members for questions and comments. >> i would like to support everything you said and add congratulations to those staff members that were promoted from within. it is always wonderful to find internal promotions. i think it helps with staff attitude and the workplace environment to be supportive. and i want to congratulate those members on their promotions. i hope that means they will stay with us for a number of years and have promotion opportunities and also to thank supervisor chan for getting our budget through. that's when we hold our breath and make sure those things go

through. that's my comment. thank you. >> chair: any other comments from board members at this point? >> if i may, i wanted to say we are planning shot clinics. we have begun the clinics.

if we want to get the vaccine out there, we want to get these clinics up and running. we want everyone to get their flu shots. >> generally influenza comes late to the west coast. it shows up later. we have had covid screening and

vaccination sites and the possibility of having to reopen the city center. [indiscernible] -- there is talk about the rapid antigen test and where that sits in the scheme of things.

there is talk about reopening city test sites. the healthcare personnel are fully engaged in the pent up demand and the outbreaks with the delta variant right now. we are encouraging people to get the test. as you know and can probably state more clearly than i can, the solution is the vaccine. we do continue to have workers who don't have the vaccine, but the condition of employment will go into effect about requiring

the vaccine this week. that would be a step in the right direction for all of us for all those vaccinated. testing demands has gone up for certain. it's very he raddic. there are times when people are struggling to get an appointment in a few days and there are times you can get one now. it's pretty erratic at this point to try to meet the demand from an operations perspective. >> chair: i know that the formal

application for the f.d.a. approved was early in june and moderna was about three weeks later. so that those applications of june this year, containing a wealth of information. there was nothing hurried or premature in those applications presented really several months after the production was in broad use and collection of benefit as well as the baseline scientific studies that would add a follow up to safety and efficacy. we look forward to the future. it's been a bottleneck. at this point even recommendations for booster

shots, et cetera, really can't be acted on under this emergency use authorization at this point. the providers are not given the license to administer the vaccines. >> there are administrators in the city have a wide distribution of availability. there's been a mobile vaccine that will come to your house party for 5 to 12 guests. what we're also anxious to get is a release to the pediatric population. they are gearing up to work with children. that is ready to go when the vaccine is ready for pediatric

administration. >> chair: and to clarify for people maybe not clearly understanding, to have a mobile vaccination clinic coming to your home doesn't mean you're protected for dinner. this comes into effect 10 to 14 days after the series of the two mrna vaccinations, after the second jab. it's the johnson & johnson that only has one jab. but it is 14 days later. the protection really is robust protection, particularly against hospitalization and death. so the reports of breakthroughs are clear. the majority of those people do not put an additional strain on the healthcare system in terms of availability of hospital beds

and personnel for the routine and ongoing medical problems that occur in all of us as citizens, frankly, individuals of this party, state, community. thank you very much. any other comments or questions from the board? hearing none, we'll go ahead and open this up for public comment. >> thank you, president follansbee. >> clerk: all public comments are to be made concerning the agenda item that has been presented. as a reminder, the public may ask a question of the body, but there is no requirement to answer or engage.

when your three minutes have ended, i will thank you for your comment. remote viewing is available online and on our tv channel. you can dial the number on the screen 415-655-0001. when prompted use access code 187 679 7252 then press pound and pound again. you will then enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the queue. when the system says you are unmuted, it is your time to speak. we have a 45-second delay for viewers watching online. we will take a pause to allow the system to catch up and callers to dial in. the pause will begin now.

the pause has ended. our moderator will notify us of any callers in the public comment queue.

>> operator: if you could share host privileges. we have callers on the line, but no callers in the queue. you must dial star 3 to join public comment for this specific agenda item. we will wait five seconds and then close public comment for this item. board secretary, if you could share host privileges. thank you, board secretary. just received host privileges. i'm refreshing the system one more time.

there are still no callers in the public comment queue at this time. >> clerk: thank you, moderator. hearing no callers, public comment is closed. >> chair: so that closes agenda item 7, the true and correct director's report. >> clerk: item 8 is a financial reporting as of may 31, 2021. it will be presented by larry loo, chief financial officer. >> good afternoon, commissioners. this is larry loo, the chief financial officer. i would like to report on the financial reports of our employee trust fund as well as our general fund as of the end of may. this is the 11th month into our

fiscal year. our fiscal year is july through june, whereas our benefit period is the calendar year. so that makes for some interesting reporting. with regard to our employee trust fund, the more detailed write up is in your pack and on our website. i would like to point out some more highlights. first of all, the trust fund is projecting an increase of $16.9 million. this was an 11-month reporting. we don't expect too much to be changed in the last month, but we project that we will be ending with a fund balance of $132.9 million. the net increase, most of it is driven by the performance and

self-funded plans. just as a reminder to the board, the self-funded plans include the flex funded plans from blue shield as well as the p.p.l. plan that's administered by united healthcare and also our delta plan for active. so the self-insured plans are projected to increase to $15.9th million. roughly half of that is due to the projected and pharmacy rebates that we get back from united and blue shield. today we have received $6.2 million of that. typicallied there is a lot of activity towards the close of our fiscal year. we have received $319,000 of

performance guarantees. typically we don't want to have these too high. that means our vendor partners are not performing to the high standards that we have set so there are some fees that we have collected. interest we project that we will receive $1.1 million. to date we have received $638,000. this report typically coming in after the close of our financial fiscal year. this comes due to us from the controller's office. as a reminder, our investment funds are pooled with the city and that report typically comes out after the fiscal year closes. inside our trust fund is the health sustainability fund. the usage of this fund is for the improvement of our members'

experience, helping to reduce the cost of care, and also to really focus on improving the overall well-being of our members. we are projecting this to end -- actually, this should say $4.5 million. that's where we start in the year. what that means is our sources of revenue for the fund are roughly close to the uses of our fund. so that's the health sustainability fund. in regards to the general fund and administrative budget, we don't project there to be a shortfall or net gain. we did have a reduction in net revenue, but we also focused on keeping our expenditures in the line of that reduction. so therefore we're projecting the year to be neutral. that concludes my report and i'm

happy to take any questions. >> this is randy scott. i think i understood a comment made. could you talk a bit about where you are in the process of preparing for or engaging in the audit process? >> certainly. we typically -- typically the auditors come in after the fiscal year has ended and that's when they start the pulling of data of your fiscal environment of the documents they requested and so on. the observation we made last year was a lot of the documents include the handling of how we

handle the members' benefits, what rates we charge, how they're set up in a system, how they're paid out and how we check eligibility. last year as well as other years, we would start the process around this time. this is also the time when our staff are involved with open enrolment. it really causes a critical load on our staff so in discussions with your auditor we ask that they do it earlier. things that happened earlier are not amenable to change so we're able to shift the workload of the documents response earlier. to date we've finalized the documents request and with the auditors we will also partner with the controller's office on this. we've produced 77% of the

documents they've already requested. so we're trying to get [indiscernible] -- >> that's great. thank you very much. >> chair: any other questions or comments from board members for the officer? if not, we'll go ahead and open this up for public comment. >> clerk: thank you, president. each speaker will be allowed thee minutes to comment in length. all public comments are to be made concerning the agenda item presented. as a reminder, a caller may ask questions of the policy body, but there is no obligation to engage or answer.

when i invite you on the call, you are encouraged to state your name clearly, but you may remain anonymous. remote viewing is available online and on our tv channel. you can dial the number on the screen which is 415-655-0001. when prompted use access code 187 679 7252 then press pound and pound again. you will enter the meeting as an attendee on the public comment line. when the system 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. we have a 45-second day for viewers watching online. we will take a 45-second pause

to allow the system to catch up and viewers to call in. that pause begins now. the 45-second pause has ended. our moderator will notify us of any callers in the queue.

>> operator: we have three callers on the phone line. zero callers have entered the queue. a reminder to callers, you must dial star 3 now if you want to join public comment for this item. we will wait five seconds and close public comment for this agenda item. board secretary, there are still no callers on the line. [indiscernible] -- >> chair: thank you very much. that therefore closes this agenda item. so i'd like to now move to agenda item number 9.

again, i want to apologize to mr. christopher sears, who is legal counsel presenting from ice miller presenting the fiduciary training portion of our educational program. agenda item number 9. i think that he was alerted to the fact that we were going to adjust the agenda a little bit. so with that, i would like to call agenda item number 10. >> clerk: thank you, president fallonsee. agenda item 10 is to approve health service board resolution to have health plans urge all sfhss members to receive the covid-19 vaccination. this is an action item. >> good afternoon, commissioners.

thank you for entertaining this resolution that i put together with inputs from other city departments, including department of public health and human resources. as we discussed earlier, the way out of this pandemic is vaccinations. and the city was very cutting edge in making policy measures to make all employees vaccinated. that would become a condition of employment pursuant to the approval that was spoken of. the resolution really concludes with the conclusion of the health plans urging their providers to have consultations with our members that have not been vaccinated. that does require, of course, i

think a big challenge which is that many of the health providers and plans are addressing as we speak which is because the record-keeping of the vaccination was done by those vaccinating and not a routine provider. getting that information is no small task. but i know that everyone is working really hard to get to that place. ideally your primary care physician would know whether or not you were vaccinated and have a conversation with you so the members understand the purpose of the vaccine and the threat the disease itself poses. we do know that many who have not received the vaccine may change their behavior when hearing from an expert they respect. we know that our primary care physicians and the providers that serve our members through

our health plans are such individuals. [ please stand by ]

>> i will add that i know some systems allow members to enter the documentation of their vaccination into their medical record. i know myself when i e-mailed my dr. the documentation, my physician said here is how you do it. my doctor online. it allows important immunizations such as influenza vaccination. that is often performed elsewhere and not all the locations are automatically forwarded into the individual members' healthcare record. there are mechanisms to do that

so that this should be relatively seamless. that may be useful for members who present to emergency room for the individuals with access to medical records to the emergency room technology to see whether if the member is not able to document or answer the question has he or she been vaccinated so it is in the record because it was done elsewhere by the county or another community clinic. this is important documentation as well in order to help educate our provider to give maximal care and attention when we present with symptoms of covid that overlap many other illnesses and become part of a larger list of possibilities for

shortness of breath or fever. i urge all members to take advantage to take advantage to get medical record up-to-date as completely as possible. >> i will pull up that resolution. >> thank you. i don't think we need to read the whereas. make sure the record reflects that there are three differently solves as part of this resolution. these are broadcast to the screen. >> shall i read them? >> why don't you read them for those calling in. >> therefore be it resolved the health service board urges all eligible sfhss members as

employed by the city of san francisco unified school district, superior court and city college of san francisco and eligible retirees or dependents to receive or complete vaccine. further resolved the health service board urges the health plan in alignment with providers to conduct outreach for ongoing messaging to all eligible members, dependents, urging them to receive or complete vaccine. further resolved the health plan is in alignment provide ongoing reporting regarding the member vaccination rates of covid-19 hospitalizations and deaths. >> thank you very much. >> this is randy scott. i mover we adopt this

resolution. >> second. >> i second that. this is commissioner canning. >> moved and seconded we adopt this resolution. >> i have a question. >> open for question or comments. >> this is commissioner scott. director, can you give me a sense we are passing this today. we will assume it is adopted. what is the communication plan around it? is it going to be sent to members, providers? what happens after we adopt this is what i am asking. >> we have shared in advance these materials with providers with our health plan who see the challenges and being able to comply with this resolution. we will be in conversations with them what it will take for them to be able to comply. as i mentioned earlier we fully

recognize the challenge of having the data available and second challenge being the provider comment as i mentioned earlier. clinicians are busy taking care of sick people and pent-up demand. one could conceive this could be considered a burden. it is our intention this should not be a burden but a conversation our members have with their primary care of courseses in a timely way. we know from outreach done during especially during the availability of mass vaccination centers having outreach workers, well qualified medical assistance and health advocates have done a lot of phone calls to people. there is a very low rate every response on that. that is why we stepped it up to have a provider do that, a nurse-practitioner or physician

to have this conversation. it shows that many people that are hesitant are able to think differently once they have had individual consultation with providers that they respect. >> i guess my question, if i may, through the chair. i was wondering are we planning to communicate directly to our employees of the four agencies we have gone on record encouraging them to get vaccinated, which this does, then we are also asking health plans to report on it. i guess i am looking for a more direct communication plan to our own members. >> we have -- this message has been delivered by the hr department to employees. not necessarily that they get

this type of consultation, so i think you raise a good point we could amplify that through employers that we serve, and directly to the members themselves. we will take that under consideration. >> that is all i am asking, yes. thank you. >> any other questions or comments from board members? >> this is randy scott that could include posting this on the website stating the board has taken this action. we could do that as well. >> yes. >> again, i want to clarify. i think this is critical. the health services system not overlaps or duplicating public health department's extensive efforts looking at the safety of

all people in san francisco. this is really directed at what we are primarily responsible and that is the health and safety of our membership, which includes the people listed in the four employers including retirees and dependents as well. this is a health issue. this is why it is important, i think, to reiterate this and to support this. any other comments or questions from the board members? if not, we will open this up for public comment. >> thank you, president follansbee. i will display instructions. public comment is available for each item on the agenda. each speaker is allowed three te

minutes. all public comments to the agenda item. the caller may ask questions. when i welcome you state your name. you may remain anonymous. when your minutes are ended you will be placed on mute and the moderator will unmute the next caller. opportunities to speak are available by dialing the number on the screen. 415-655-0001. use access code (187)679-7252. press pound and pound again. you will enter as attendee. dial star 3 to be added to the

queue. when your line is unmuted this is your time to speak. if you are on hold wait until the system indicates you are unmuted. sfgovtv has a standing 45 second for viewers watching the live broadcast online. we will take a 45 second pause to allow the system to catch up and callers to dial in. the 45 second pause begins now.

our moderator will notify us of callers in the public comment queue. >> we have three callers. zero callers are on the public queue at this time. you must dial star 3 to join public comment for this agenda item. we will wait 45 seconds then close public comment for this agenda item. there are no callers in the queue at this time.

>> thank you. public comment is closed. >> they are closing the discussion on this item. all those in favor of approving the resolution to urge all health services members to receive the covid-19 vaccination signify by aye. >> opposed. it passes unanimously. >> again, i would add that we make note there will be some type of communication follow up with our members directly about the resolution. >> yes. that is a great point. that is the message that has been received. it will be acted upon. thank you very much. with that i would like to go ahead and take a 20 minute personal break.

more than you are normally allowed. 20 minute break. i am trying to give commissioner every opportunity to get back in time to hear the training discussion. what i would like to do is alert our health plan representatives i may move them up if we reconvene in 20 minutes. they would be on board at approximately 2:35 p.m. for that agenda item number 12. then at conclusion of that we will move to agenda item 9. the fiduciary trailing which i assume will occur about 10 minutes to 3:00 or so. i apologize again to our consultant who is going to lead

the training discussion. 20 minute break. then item 12. reports from health plan reps before moving on to number 9 again. thank you very much.

>> august 12 meeting of the health service call. roll call. president follansbee. >> present. >> vice president canning. >> present. >> supervisor chan. >> she is muted, but she is present. >> i see her as well. we can't hear her. >> can you hear me now? >> yes. >> present. >> we are awaiting commissioner breslin's arrival. commissioner who is excused. commissioner scott. >> present. >> commissioner zvanski. >> present. >> thank you.

president follansbee, we have a quorum. >> with apologies, we will move to agenda item 12. >> thank you. i will pull up that agenda item. reports and updateses from contracted health plan representatives. this is a discussion item. >> i move to up the agenda this afternoon. the health plan representatives to give updates? >> this is sharon from delta dental. i would like to formally introduce michelle bodey. she recently joined the delta dental team family as new director of national and special accounts. in her role as director of

national and special accounts she will lead a team of account managers such as myself and responsible for all service and retention activities for large national accounts, such as san francisco health service system. across the enterprise. she will be implementing and supporting client goals and initiatives, also, overseeing the direct support of clients delta dental benefit plans and then acting as the executive sponsor to clients. would that i would formally turn the microphone over to michelle to say, "hi." >> hello everybody. good afternoon. i am michelle bodey, director of account services at delta dental. i appreciate the opportunity to be here today. i have the pleasure of working closely with sharon your

dedicated account manager. we value our partnership with sfhsf. i look forward to getting to know you better, to work together to achieve all of our goals. i appreciate the opportunity to be here today and nice to meet all of you. >> welcome. you are not in the same room with the commissioner. >> that's right. >> welcome. >> thank you. >> we have that mirror going. that is interesting. >> the health plan representatives on the call at this point? >> mike clark. i would like to make a quick statement. >> yes. >> at the march 2020 health

service board meeting i served with you that there was a proposed acquisition by am to accelerate innovation during the course of the past 17 months there were efforts to gain regulatory approval from over 100 jurisdictions. unfortunately we decided to terminate in late july last month as a result of difficulties in gaining approval from the united states department of justice. there were requirements that were stifled. our innovation and reduce our clients serving capability. in the end the watson leadership decided not to compromise the priorities and thus announced on july 26 of 2021 the mutual decision to terminate our

business agreement. we absolutely look forward to continuing our partnership with the health service board and san francisco health service system. >> thank you very much. >> thank you for the update. >> any other health plan representatives present? is there anyone from kaiser health plan at this meeting? >> lisa davis. >> i have a question for you. kaiser members who are in the valley got a letter from the desert regional health system that kaiser was no longer going to be contracting for services with desert regional medical

center and jf kennedy hospital. the keysser is not officially told the membership what is going to happen. i think the date is october 31st. do you have any update for our members who might be residing in that area what the plans are? >> i do not at this time. i would be happy to do research and get back to you. >> that is fine. it leaves the members not knowing. there is only one other medical center in the valley. we have a number of members who go back and forth or receive care -- emergency care down there intic. i would like an update on that. >> yes. >> thank you. any other comments for the health plan status?

>> no, thank you. >> any other health plan updates then? and i apologize to moving this up the agenda. any questions for the health plans? if not we will open up for public comment. >> i see paul brown from blue shield. does paul have anything to say? >> no updates this month. >> thank you very much. with that we will open this up for public comment then. >> thank you, president follansbee. i will display instructions. public comment is available for each item.

each speaker is allowed three minutes. all comments are to be made concerning the agenda item presented. there is no obligation to answer. when i welcome you state your name. you may remain anonymous. when your three minutes end you will be on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv. dial the number on the screen. 415-655-0001. when prompted use code (187)679-7252. press pound pound. you will enter as attendee and dial star 3 to be added to the queue. when the system message says you are unmuted, it is time to

speak. wait until the system indicated you are unmuted. sfgovtv has a 45 second delay for those watching online. we will take a 45 second pause to allow the system to catch up and callers to dial in. the 45 second pause begins now.

>> the pause has ended. are there any caller in the public comment queue. >> we have two callers on the phone line. zero callers entered the public comment queue. to all callers you must dial star 3 now to join public comment for this agenda item. we will wait five seconds and then close public comment for this agenda item. there are no callers in the queue at this time. >> thank you. no further callers, public comment is now closed. >> thank you very much. i thank the health plan representatives for the updates this afternoon. with that, we are going to move

to agenda item 9. commissioner breslin is running late. we are going to go ahead and start this agenda item without her present. she will join us later. thank you very much. i apologize. >> thank you, president follansbee. 9. sfhss fiduciary training. this is a discussion item to be presented from ris sears, aye miller counsel. >> thank you very much. i apologize for the fifth time putting you on hold here. >> no worry.

hi. >> thank you, chris. we did have a short production by the executive director, abbey are you able to unmute? >> yes, good afternoon. thank you very much for being here today to hear a presentation. i know karen is with us in spirit. she has been asking for this as long as i have been with the board here. we are delighted to have chris sears with us, who works with the aye miller firm who has done work on behalf of the board in prior times. eric for our city attorney discovered chris and engaged him

for this purpose. eric cannot be here today. in no small way do we have very adequate representation from the city attorney's office. jennifer who is in the government section of the city attorney's office. she has been involved in reviewing the presentation and getting us set up. without a lot of further an do, i want to introduce chris to the group. i have had a little preview of his presentation. his style is comfortable and his command of the topic is impressive. i think that we will sit back and listen and thankfully our presentations are recorded. it is content packed. you may want to go back and listen to this again at another time. chris. >> thank you so much.

i hope i can live up to that with all of the anticipation. i am a little intimidated. i will try to share my screen. let me know if it comes up for you. this is really a heavy topic. there is a lot of information here. i think that it will be helpful to you. being fiduciary is an important role. one of the things i say is that being the fiduciary comes with

duties and liability. the individuals acting in this capacity are personally liable for their actions. while we are going to talk about indemnification and talk about sources of protection for you as fid i door re. at the end of the day you can be personally libel. when you look at cases and writings. this is one of the highest duties under the law. as a result of that it is clearly important to understand where your duties come from, what those duties are and how to execute upon those duties. that is what we want to go through today. who is a fiduciary? any person who has the authority to make discretionary decisions

with respect to the administration at least in our case, with respect to the administration of a plan. as you very well know. you are dealing with trust that holeds the funds that fund the benefits for which the board is responsible as well as the plan to provide benefits. fiduciary can be any person who is named in a plan or trust document. fiduciary can be designated as fiduciary pursuant to charter, as in this case, or through other lawful documents. at the end of the day, if you have authority to make aphid mae fiduciary act, that makes you

aphid door re. those acts are things like appointing other plan fiduciaries. selecting and monitoring investments. disposing of plan assets, determining whether or not fees, for example a third-party administrator can be paid from trust assets. interpreting plan provisions as well as making decisions over the plan such as deciding appeals under a health plan. if a member is not getting service or third-party administrator denied that service and that appeal comes to the board, that decision as to whether or not to grant that appeal is the fiduciary decision. these are the kinds of things, control of assets and add moring

the health plan. these are typical fiduciary activities. these are activities in which this board engages regularly. typical fiduciaries are plan administrators, trustees, investment committee members. again, these would be different bodies. many of these activities and duties are wrapped up within the duties of this board. you can see some of the other things. the one thing i want to point out is that last box. anybody who performs aphid doore fiduciary duty becomes the fiduciary. you all on the board are clearly the fiduciaries. what is concerns is if individuals who might not otherwise be fiduciaries are

acting as if they are fiduciaries they can become one. where this comes up sometimes is when a member of staff, for example, makes representations to a member or member of staff guides a third-party administrator and tells them what kind of decision to make under a plan. these actions can inadvertently cause one to be aphid door re. it is important to ensure that to the extent that they are drifting over. they need to go to the people with the authority to make those discretionary decisions we have been talking related to plan assets or interpretation or deciding claims or those kinds

of activities. on the other side of the coin, lets talk about who is not a fiduciary. this is confusing because many boards. you are probably in this boat. act in a couple of capacities. you are looking over the assets of the plan, monitoring those assets, how invested, where they are, making administrative decisions under the plan. you are acting in other roles as well because boards and individuals who are designing a plan, not administering but designing a plan, amending a plan or terminating a plan aren't acting in a fiduciary role. in those capacities they are acting a settler. again, the decision to start a

plan, decision to change benefits inside of a plan or decision to terminate a plan are not fiduciary decisions. once a plan has been started, once an amendment has been passed and a new benefit is administered, you become a fiduciary as you add more the plan or changes in the plan. these lines can get blurred. it is an important distinction from a liability standpoint. we can certainly talk about that a little more. you know, when we are making those decisions, you know, to amend the plan or to start a new plan, we are not really acting in fiduciary capacity at that point. other individuals who tend not

to be fiduciary unless they trip into it as i talked about before would be attorneys, accountants, actuaries advising the plan. third-party administrators and record keepers are typically not fiduciaries. again, they could become fiduciaries as the authority is delegated to them. that typically might happen when a board or plan sponsor delegates to the third-party to administer the ability to make final decisions on appeal. in some cases third-party administrator decides if the claim is covered. if they deny the claim, that appeal would go to the board. that board would then make that final decision, that fiduciary decision. it is not completely uncommon for a board or plan sponsor to

delegate final authority to the third-party administrator. at that point the third-party administrator has become a fiduciary to make that final decision about whether or not a benefit is covered under a plan. one can't say third-party administrators and entities like that aren't fiduciaries. it goes to what duties are they performing? do they have that discretion at the end of the day to make final decisions under the plan? so let's talk a little bit about where the fiduciary duties come from. what are the sources. you know these duties come from a variety of places from state or local law. they can come from federal law under certain circumstances. i will say in your days because you are a governmental plan, federal fiduciary obligations

aren't imposed upon you. in the private sector and some of the board members in other lives might have come to the private sector. private sector benefit plans are covered by employee retirement security act. it imposes fiduciary obligations on the private sector plans. it doesn't apply to government plan. those fiduciary duties don't apply in this context. i will say when we are trying to understand what the duties are, we look at federal law as a guide, not as a source that you are bound by, but as a guide to what the fiduciary duties might be. we look to the common law of trust to green what the duties

are and look to plan documents because plan documents certainly define what duties the fiduciary has with respect to that plan. of course, the board is established by the charter. the charter has a lot of information in it with respect to what the board duties are and the fiduciary obligations surrounding those duties. for example and there are a lot of words to the next several slides. i am not going to reads them all to you. you are probably familiar with the charter. i encourage you to read them. you should read the charters. for example, in charter section 12.203 it says the health system fund shall be a trust fund and that the trust fund shall be solely for the benefit of the active and retired members of

the health service system and covered dependents. those words. solely for the benefit. we refer to that as exclusive benefit rule. that is the guiding principle for the fiduciary. that is that funds in the trust for the benefit of the beneficiaries of the trust are for the exclusive benefit. that is a fiduciary. it is your obligation to administer those opportunities and the plan associated with those plans solely for the benefit of those beneficiaries. we have to be laser focused on that. we can't think about the funds in other context. they are for exclusive benefit of the beneficiaries. we have to be careful when we think about how we are using the funds and when we use the funds to pay administrative expenses for third-party administrators. how we are using the funds to

pay investment manager to invest those funds. certainly, paying third-party vendors like that is in the interest and for the benefit of the plan participants. when the fees associated with the third-party administrators or other vendors or investment managers or attorneys become excessive and you are not watching the fees, then all of a sudden you are not using the funds for the exclusive benefit of the beneficiaries. you are unjustly enriching the vendors. keep your eye on the exclusive benefit rule when it comes to plan assets and use of the plan. it is very important. also, in the charter, the health service board shall have control of the administration and investment of the health service system funds. again, it goes to the duty of

the board to monitor those funds and use them correctly. i am running through these quickly for a flavor. another provision of the charter says that the board has the responsibility to obtain information to members with regard to plan benefits. we will come back to this. one of the duties of the fiduciary is to properly and accurately communicate to the beneficiaries what the benefits are. the failure to do that can be a fiduciary breach. the charter recognizes that. it talks about the fact the board has this responsibility to obtain and disseminate the information and numbers as one of its duties. you can see there that again it is mentioned that the board has the duty of investment of the funds related to the trust. more information here from the

terms of the source of duties for the terms, reference related to the board. reference as to the duty of the board to administer the investments of the trust here goes into more detail. board has an obligation. >> this is randy scott. this is just a point on the prior slide it says the health system service board terms of reference were approved april 9 of 2015. i do not want that to stand in isolation. the terms of reference are updated, have been updated since 2015 every three years and most recently in 2019. they were all reviewed, reorganized and further updated. we are on schedule to conduct that same type of review in

2021. just to clarify that point. >> i appreciate that, commissioner scott. i was referring to the earlier versions not most haven't -- most recent. we can make the correction on the powerpoint slides so they are correct. i appreciate that. >> again, back on this slide. i mentioned the board has the obligation to approve and add don't a written investment policy -- adopt a written policy statement with the trust to ensure the qualified parties are appointed to manage assets, compliance and monitoring and ongoing review of investments and the investment policy

statement. there are many other provisions of the charter that speak to the board's duty, and i think and i encourage you strongly to go through the charter yourself if you have not done that recently to remind yourself of other duties. we will talk about more of them. i didn't want to reproduce the entire charter in this powerpoint. some of these sources are areas we would look to as a reference because some of these would not be directly applicable in terms of enforcement on the health service system board. we put them in here to give you a sense. the california has a constitutional standard for pension system. which requires that fiduciaries discharge duties with respect to the system with the care, skill,

prudence in like capacity with the common words. they have to use the care, skill, prudence and diligence under the circumstances. you see that in the investor standard. you see it finally -- we will get to the final piece. you see it in erisa, the federal standard. again, this used you have to act with care, skill, prudence and diligence. finally, directly applicable this concept has been adopted in the board terms of reference where it says that the board shall discharge duties with respect to the fund with the care, skill, that the like

character and like gains. i don't want to insult your intelligence. that sentence is the essence of the fiduciary. you will see that as we start going through now some of the more specific duties and standards relating to fiduciaries. there are sort of larger umbrella duties and sub duties within them. we will walk through them to think about. think about applying them to what you actually do on the board. the actions that you take. let's start with the duty of loyalty. the first large umbrella duty fiduciaries have to think about.

this really has four other sub duties. duties to act impartially among differing interests. we will talk about this in the slides. also the duty to act solely in the interest of beneficiaries. that is the exclusive benefit concept. third duty to act for the purpose of providing benefits or paying reasonable plan expenses. the duty to act independently without conflicts of interest. let's start with the idea of independence. fiduciary has a duty to act in the interest of all members as if there were no competing interest to protect. i think it goes without saying. one must say it. that is the fiduciary can't act for their own personal or business interest. as a result of that, a board such as this should have

conflict of interest policies, for example, where the board members would disclose any interest they have that could be contrary to the interests of the health service system trust and plans and beneficiaries of the plan. a globe option example -- a board member owns a third party administrator or investment company. one of those entities was trying to get the business of the health service system. that obviously would be a conflict of interest. that board member could not act in their own personal or business interest under those circumstances. that seems fairly obvious. one of the points that i do want to point out dealing with governmental boards is that a board member, fiduciary must set aside the interest of the party

that appoints the fiduciary. the boards like this and this board is like this. they are appointed by political officials, governor, mayor, controller or other kinds of entities or the membership. there are a number of boards whose members are appointed by the membership that is appropriate. once a board member is on the board and has been appointed and is now a fiduciary of the trust and plan. that board member doesn't represent the body or person that appointed them. they are not the governor's board member, not the membership's board member. not there to act on behalf of those entities. they are there to act on behalf of the plan and the beneficiaries of the trust. it is important to leave that at the door when you walk into a

meeting. i am not the governor or mayor's appointee. i am here as fiduciary of the plan. my job to act in their interest. that is an important point. that can be a tough point sometimes. it is a very, very important point. the fiduciary has the duty to act in the interest of the members. it requires impartial among different interests. nobody is the fiduciary of the person that appointed them, once you are appointed and you are acting on behalf of the beneficiaries of the trust, you are acting on behalf of all of them and not a sub set, not a sub set, not just retirees, not just the long-term employees, not just the dependents.

whatever group might exist, right? not just to unionize people or non-union people. as fiduciary look at all of them and do what is best for the entire group. will there be winners and losers in the decisions? yes, of course, there will. it is the duty of every member to look across the entire population and to be impartial with respect to the competing interests and come to the best conclusion for the trust of the plan itself. i mentioned plan expenses. that is in the context of the exclusive benefit rule and making sure that we are using plan assets wisely and in the interest and for the benefit of plan participants and beneficiaries. that is really a critical piece

of fiduciary duty as well. fiduciary has to discharge duties with respect to the plan and can only incur costs appropriate with respect to administering that plan. this puts on the board members the obligation to monitor plan expenses and to ensure those plan expenses are reasonable. that requires looking at other expenses of other plans or other vendors, doing benchmarking to make sure the expenses that is plan are paying are not out of line with what we look at with with other vendors or other plans. that really speaks of fee transparency of understanding how the fees work and i don't have to tell you if you have looked at various contracts. if you looked at consulting any

vendor that may be listening in. policy benefit contracts are complicated. the way those costs work can be very hard to understand. when we are looking at those contracts, it is incumbent upon the fiduciary if they don't understand how those work, understand how those fees work and the kinds of costs incurred, the obligation is to the understanding or to engage an expert who can advise the fiduciary how those things work. that is a critical duty of the fiduciary. to make sure, too, only plan expenses are paid from the trust

and not other kinds of expenses. moving to another sort of umbrella duty. the duty of prudence. it is made up of sub duties. first the duty to diversify investments. secondly, the duty to act like a prudent person in a similar situation. duty to be informed and delegate responsibilities outside of your experience. first, the duty to be informed. a fiduciary has a duty to educate themselves. they have a duty to be informed about the decisions they are required to make. that means at base you have to regulate. you have to review the materials provided to you.

i completely understand that sometimes the materials that you are provided are volumes. particularly if you get into investment information, particularly when you get into complicated contracting issues, choosing vendors. you are provided a lot of information it is incumbent upon the fiduciary to educate themselves. you have to ask questions, inform yourselves. be familiar with the governing documents. read the charter. make sure you read the health plan. you read the trust document recently. all of those things. you need to have familiarity with those documents. be familiar with the general laws applicable to the plans as well. it doesn't mean you are a lawyer and have to know about the affordable care act. you have to have familiarity

with the laws that apply to the plans and trust and as sets. you have to secure and consider the advice of expert on a reasonable basis. all of you have to exercise your own reasonable judgment. i say that and i alluded to this talking about the pgm contract. if you don't have the expertise, nobody has expertise in everything. it is important to find somebody with that expertise and to listen to them and get an understanding of the issues that you ultimately have to make decisions about because the failure to get that expert and to act in isolation and act without knowledge can certainly lead to a breach of fiduciary duty. a fiduciary is allowed to delegate responsibility. sometimes that is important.

as a board you can't be involved in every little piece of administering the plan. you can't be involved in every little investment decision or decision under the plan. you are allowed to delegate. but the process of delegation of a fiduciary duty is the duty in inand for itself. you have to make sure that delegate will act with the same fid dish reare you dense and care that would be required of you as fiduciary. you have to go through the diligence process to make sure they are going to perform those duties in a way that is consistent with the duties to be imposed upon you. when you are delegating duties,

it is important to be specific what you are delegating so there is no confusion, no over stepping by the delegate and duties aren't left on the table. you have to delegate prudently in accordance with a written plan, monitor the delegate to make sure they are performing the duties that you delegated and any costs that you pay to the delegate must be reasonable. prime example of this delegation, couple examples would be delegating authority to invest plan assets to an investment committee. maybe a subcommittee of the board is given authority to invest the assets independently without going to the full board. that would be a delegation to subset of the board. other entities might delegate

the investment to an investment manager and give the investment manager independence and discretion with respect to the investment of the assets in the context of an overall investment policy statement that the board has approved. that would be a delegation of fiduciary duty. i think i might have mentioned this. an example is delegate to third-party administrator ability to decide final appeals of a health plan claim so those plans wouldn't come to the board the third-party administrator would have power to do that. some plans do that. that is delegation of fiduciary authority. you have to have a monitoring process to ensure the delegates are performing their duty correctly.

in addition, fiduciary has the obligation to the extent they are in charge of monitoring plan assets to diversify those assets, minimize the risk of large losses unless circumstances indicate that it is not prudent to do to. it is fundamentally important to manage those as settings and to diversify those assets for the plan participants. there is a duty to monitor. we talked about this a little bit. in terms of plan assets and investment, you know, you have to adopt and review periodically the investment policy. you have to conduct regular investment reviews on those investments. this is typically done at least quarterly with your investment adviser or your investment manager. you have to compare expenses and

as set classes with respect to the assets or the investments in which the assets or investments and, finally, to determine whether certain investments should be placed on a watch list. this is part of the monitoring. if the investment is not performing the way one would think it should to keep a better eye on it, put it on a watch list to see if it on a consistent basis is not meeting the benchmark, not meeting the requirements and if that is the case then to move the assets from that investment. in addition to monitoring the investment, there is a duty to monitor other vendors. in the terms of reference, this duty is reflected when the board has to ensure that periodic reviews are done on the performance of key service

providers. they reference this duty to monitor to make sure that is done. finally, with respect to some of the specific duties, broad duties we have been talking about. follow the plan document. obviously, if you have a plan and plan document there is the obligation to follow that document and not make exceptions even when there are cases where one might work to make an exception. it is important to stay with the plan document and follow its terms. i leave this slide in here. prohibited transaction slide is not legally applicable to the board because this concept comes from federal law, but i think it does illustrate some things that fiduciary really needs to think about. i think it would be applicable through your charter or the common law.

that is you can't deal with plan assets in your own interest. that goes back to the conflict of interest idea we were talking about earlier. you can't pay unreasonable compensation for services performed. you can't make a purchase for more than adequate consideration or sale for less than adequate consideration which dealing with plan assets and managing those. you can't act on a party adverse to the plan. that goes to the idea that you are not anybody's representative on the board. you are there to serve the interest of the plan and the plan participants. finally, you can't receive anything of value in connection with transaction involving the plan assets. on this point. i am sorry in looks like the

last slide but not the last slide. on this section of the talk, you know, fiduciary responsibility is highest duty known to law. you have to act with prudent expert standard. if you don't have expertise you need to get it. that is the standard to which you will be held. good faith is not sufficient. doing your best and thinking you are doing fine is not sufficient. you need to get that expert advice if you think you don't know what -- if you are not educated about the particular issue. finally, if something isn't documented, it can't be substantiated. one of the key things about being a fiduciary is process. we will talk about this more in a minute. it is process. process means and i have seen it for the entirety of this

moaning. this is not me telling me you don't do this. it is clear you do. it is orderly meets, taking minutes. it is when you get a new vendor going through a rigorous and careful request for proposal process and documenting all of those things. one thing that you will see if you read through fiduciary cases in the courts is that you don't have to make the perfect decision, but you have got to be able to document that you tried to make a good decision. that includes educating yourself, having discussions, keeping meeting minutes, vetting vendors, going through r.f.p. processes, showing you performed those functions. at the end of the day if you got

it wrong, you probably didn't violate your fiduciary duties if you went through that process. sometimes the decision isn't perfect but the process to try to get it there is important from the fiduciary standpoint. just a couple slides on liability. as i said at the beginning. it is usually the attention getter. fiduciary are personally liable for breach of fiduciary duties. what that means is that the you breach your fiduciary duties, you can be liable to make good any losses suffered by the plan if you personally benefited improperly because of a transaction related to the plan. you have to disgorge nose prof -- those profits back to the plan. if you breach that obligation

plan assets can't be used to pay for your liability. you bleached your liability to the plan they can't pay for that breach. they can be told by the court to stop doing something or disgorge profits. not only can a fiduciary be responsible for their breach but for co-fiduciaries. as board member you can be responsible for the breach of your co-board member. that only occur ifs you knowingly participate or participate in or conceal the breach. you knew about it and helped out or concealed it. if you enabled the co-fiduciary to commit the breach or have also of the breach and fail to make reasonable efforts to remedy. these are things that the

fiduciary is committing the breach you don't want to participate in it or hide it or try not to find a way to remedy it. that would keep you from those co-fiduciary liabilities. anybody can file a lawsuit. they can go to court and file a lawsuit and say you breached the fiduciary duty. that costs money to defend the lawsuit even if you did everything right. it costs money. you might not have done anything wrong but there are costs associated with that. the california code has indemnifycation agreement. the public entity shall provide defense for that brought against

public employee in official or individual capacity or both on account of act or omission in scope of employment as employment of public entity. the law provides you protection. you are not sitting here on this board. there is protection in the law as long as you are performing your duties the way you should. now that indemnification would not exist if you intentionally breached your fiduciary duties. it provides you protection if you are doing the right thing but still get sued. looking at my clock here. i have a few more minutes. what i want to do next is go through some specific examples of fiduciary duties that arise in health plan context. just to give you some sense. we have alluded to some of these already. first of all, acceptance and

application of employee contributions and plan assets is a fiduciary duty. when members and employees pay their share of premium and those come to the trust, those are plan assets. when employers who are obligated to contribute to be health plans come to the trust, those become plan assets. as i said before, plan fiduciaries have the obligation to use those contributions solely for the benefit of those trusts. for the participants in those trusts, deepen departments, retirees and active employees. they have to be prudent with the use of the funds. they have to monitor investments related to the funds and that generally for most of the board

that don't have hard core experience here would require engagement of at least investment adviser or investment manager. the difference being an investment manager has final discretionary authorities to make investment decisions. adviser advices the fiduciary who has the final decision based on the advice how to invest those assets. that is obviously a central and critical fiduciary duty related to health plans and trusts. second one to raise here quickly is maintaining and applying claims and appeals procedures. the charter as well as health service system rules goes -- they both go through appeals

procedures. vendors, third party administrators, third-party service providers may make the decisions if the claim is covered under the plan. the members pursuant to the charter and hss rules then have the ability to appeal that decision back to the health service system. that final decision, that appeal, the decision is a fiduciary duty. it is required that group health plans under law and federal law applies. it requires you to have reasonable procedures. from fiduciary procedures you are required to have those and you do. deciding these claims and appeals is core fiduciary function. if a service is considered to be

medical necessary under the plan, whether or not a service is considered experimental or investigational. those services are generally covered. those are fiduciary decisions. when those decisions come to a board that isn't completely peopled with healthcare practitioners, that is another example where the board has to get expert advice. in my experience most people on the board that are making these decisions about whether or not something is covered under the plan don't have the expertise to know whether or not a procedure is medical necessary. or whether or not a procedure is experimental or investigational in nature. that is another example where a fiduciary would have to get outside expert advice in order to perform their fiduciary duty

of deciding the appeal. sometimes you might be delegated to third-party administrators that would still have to continue to be monitored. the appeals decisions, claims decisions have to be done within applicable law, whether that is the affordable care act, hipa, americans with disabilities act, but fiduciary has to be aware of those things when making decision. the other thing that is critical here. i have seen this happen before. you tend to see it with a single employer plan where, you know, the benefit committee knows the employee but sometimes you get those very hard cases where people are very sympathetic and you want to make exceptions

under the plan. that is a fiduciary issue because if we are making exceptions under the plans for some people because the situation seems more sympathetic but not making exceptions for other people for whatever reason, we have treated plan beneficiaries differently. that sort of goes back to following the plan documents. that is important when making these claims decisions, appeals decisions under the plan. i won't read all of those points on that slide. you are understanding the point there we are making appeals decisions. next duty that i want to hit on quickly here. i mentioned it early on in our talk. that is communicating with participants can be a fiduciary duty. when we are communicating plan

benefits to plan participants, we are really acting in fiduciary capacity. that goes to add mincetration of the plan and understanding the plan. if we misstate benefits or mislead the plan participants how the benefits work. there is an argment you violated the fiduciary duty. there is a supreme court case several years ago and this is extreme case. the fiduciary knew there were going to be plan changes coming up to the plan that were going to provide benefits not as good. the fiduciary didn't disclose that information to the plan participants and it drove the participants to join the plan which was under mined in terms of benefits. there was really, you know, a

misleading intent in this particular case. it is a little bit extreme. supreme court said that plan administrator violated fiduciary duty because they misled the plan participants. that is a little extreme case. it probably wouldn't apply to simple mistakes of fact. it probably wouldn't apply to simple mistakes of fact where there wasn't an intent to miss lead. it does really count for being careful when talking about the plan benefits to plan participants. making representations what is going to happen to the plan or things like that. you know, i found it very interesting because this is an issue that comes up. as i was going through the board communications policy, it is a policy on this that says that

the policy requires board members to exercise judgment and discretion when communicating with members. the policy says board members may communicate general information or factual information when no risk of communicating inaccurate information exists. they may not provide education advice or technical information. i thought that was a great policy in terms of making sure that individuals with fiduciary obligations don't get out with skis on intricacies of the plans that they are in charge of that they may not administrator day-to-day and might not know every little think the plan covers. this board communications policy, which i was very

interested to see, which i don't see in every boardmannual that i look at. it recognizes this issue that can arise with regard to fiduciary duty. the last duty that i want to go over specifically here is the duty that arises when you are selecting service providers or negotiating rates with network. selecting service providers. they are going to administer the plan. they are going to act on behalf of the board, the plan sponsor and plan administrator in administering the benefits of the plan. and we are going to pay them plan assets. they are going to administer the plan assets as they pay the benefits on our behalf. the choice of a plan service

provider, third-party administrator, pbm is fiduciary function. obviously, as we said before, the duty of loyalty prohibits those with connection of the plan from engaging in self-dealing with respect to the plan. that is why i know the health service system has these policies. that is why you see the rigorous r.f.p. and procurements policies when it comes to health, retirement plans and government entities to ensure outside influences or fiduciaries with other interests don't improperly influence that process. again that rigorous r.f.p. processes are really important and should provide you with a lot of comfort as fiduciary that

everything is being done above board, that no vendor in that r.f.p. process is being given any kind of preference. i have to go through rfp process all of the time with government employees across the country. we can't talk to anybody, obviously, that we are bidding on. we can't talk to anybody about the fact the r.f.p. exists. that is when they are our client and we are trying to retain the business. nobody gets a leg up. that is a rigorous process. it is important and you should feel good about that as plan fiduciaries. i think i have said a lot of things on the slide. it has been an objective process. this is how you demonstrate the duty of prudence and loyalty. this is the process that is important. you might end up picking the

wrong service provider at the end of the day and you have to deal with that when that happens. as long as you have gone through the proper process that is an important defense. you know the fiduciary has to seek independent advice when they lackness expertise to evaluate vendors. that, and i have to commend you on your terms of reference and board policy because the board policy here, selection policy says the role with respect to selection of service providers is to select policies to the providers can then award the final contract. you know, they also go on to say

that and this is interesting language and good language. the board recognizes that it is neither effective or efficient for the board to be involved in the selection of service providers. they shall be responsible for approving awarding of final contracts for certain service providers. it is my understanding staff really goes through that incredibly rigorous process of going through the r.f.p. and then presents the results to the board for final approval. that process needs to be very strictly observed. again, kudos to your documentation and process with respect to those selections. this slide talks about things you would look at in the objective process which you look at when you look at service

providers, what their fees are, financial health and experience of the service providers, quality of services, qualifications, ease of access to provideders, etc. this last point down here. i talk about department of labor quote. you are not subject to the united states department of labor. you are not subject to uresa. is it an important recognition. you don't have to choose the cheapest vendor. choosing the cheapest vendor might be a violation of your fiduciary duty. if the cheapest vendor is not a quality vendor, if they are not going to be around in a year because they don't have good financial health, if they offer bad services, they are not getting back to participants, choosing the cheapest vendor

would be a breach of fiduciary duty, probably. i don't think boards think about this. i have to choose the cheapest vendor. it is an important point to make. finally, and this is the wrap up. you will be happy to hear. we were talking about fiduciary duties. the focus is on procedural proof. going through the process. there is no one way to achieve that procedural prudence. you need to keep minutes, choose vendors, making an appeal decision plan, choosing investments or the trust assets. it is important to have that documented process and to follow that process. in following your plan documents

adopt written prudent procedures like conflict of interest. we talked about that as results of duty of loyalty. you have an charter and investments policy. i have not reviewed it. everything else seems to exist. finally, i won't go over these since we talked about them. these last two slides which you can review at your leisure really sum up the various points that we made in this talk. i think i will stop there. i am not entirely sure how to stop sharing my screen if you can steal it back from me or not. i am very happy to take questions, obviously.

>> thank you very much. that was really superb. we do have an investment policy which we update regularly. i will open this up for questions and comments from board members. >> i would like to thank you for the scope and depth of this presentation regarding our fiduciary role. i had in the lead up to this sent in input about when we breach our fiduciary duties and the consequences. i have found guilty of breached it, what are the remedies or penalties that ensue if that happens? >> i would say that obviously it

depends on the breach. if it is -- we -- i will use this example. we have done a completely slip shot effort at is choosing a vendor. we didn't go through the process. we favored a certain vendor. we didn't give people a good chance. at the end of the day that vendor messes something else. we would look at really what did the vendor do wrong. what consequences were there to the plan or the trust assets? that would be a measure of damages for which a fiduciary could be liable. another example and you can see this litigation all over the place in retirement plan contracts. what if you mismanaged the assets in the trust? you are not keeping an eye on the investments that are related

to the trust assets. you keep the assets in a terrible, terrible investment. there are processes in place to deal with this. that is an example. the delta between however far the trust tanked versus what a reasonable rate of return might have been could be a measure of damages. >> thank you. >> i would note that commissioner breslin did join us for this portion of the agenda awhile ago. just to get that on the record as well. it will be in the minutes. commissioner zvanski. >> thank you. i would like to know would you then recommend that we acquire some specific kind of insurance

on a personal level with regard to our fiduciary responsibility or are we based on the documentation that we have reviewed, are we protected by our city attorney that if there is any breach or any issues if we are suedes for violating our fiduciary responsibility the city attorney becomes our attorney? the reason i ask this is that i have some colleagues that i have worked with and known for many years on the retirement system board which is a little different than ours since it is investment-oriented. some of them have or have acquired or suggested that as fiduciaries we should have some independent insurance to protect us. i would like guidance and

response with regard to that. thank you. >> i will give an answer that sounds a little bit. i would defer a little bit to jennifer on that because they will have a much better appreciation for the california statute that provides that indemnification. my understanding with discussions from eric earlier. he wasn't able to be on this meeting. my understanding from eric, he thinks it is fairly broad and protective. i would want him to opine on that as city attorney. that said, a little extra insurance never hurt anybody. i would defer to eric on that. i apologize for not being more direct about it.

>> i want to point out you are correct our attorney eric was not here today. our city attorney jennifer is. i don't know if she would like to make a comment at this point or not. we do have an attorney here present. they do serve as an attorney to the board specifically. >> thank you. yes, i am jennifer don lynn. i am back up for eric. i would defer to eric on this matter because he has dug in. i think it would be best for him to give the answer at your next meeting. >> thank you very much. we will ask him to do that. other questions or comments from board members?

either raise your hands or turn on your video or scream at me. i want to make sure everyone has an opportunity to ask questions or make comments. >> i have an additional question. we have had at karen's behest and my own we should do this type of training. we do go through various training requirements with the city and county of san francisco annually. ethics and conflict of interest policy and all that sort of thing. my question is what type of frequency would you recommend regarding this kind of comprehensive fiduciary training?

should we wait until we have had kind of change of membership or election, appointment, that might be a time to do this or on some sort of regular schedule with every two years as refresher. might be the same content but we are going to go through this. what is your guidance on that, chris? >> i mean i would say every -- i think every three years. it depends on, i don't know what your terms are and how quickly your terms. >> five-year terms. >> i assume they are staggered so people are coming on and off all of the time. i think for many boards with which i have worked have new member orientation.

>> we do. >> i think that it is really important and maybe not 60 minutes of the gray haired guy from indianapolis coming on to talk about this. i think that staff going through some orientation with regard to fiduciary duties. it is only fair they know that walking on the board, first of all. maybe a more comprehensive one since your five-year terms you are turning over every three years. i think three years comprehensive one might make sense. that initial board orientation. something in that orientation should address it. >> thank you. >> i just have a comment. thank you for the presentation. >> i will introduce you to commissioner karen breslin.

we can identify voices with comments. >> i want to thank you for the presentation. it was very thorough. i think that we should have these type of orientations every two years because even for me it was a good refresher. the people do come in and off the board especially the appointed ones change quite frequently, a couple of them. i would suggest more like every two years. the one you get when you initially take the job the training isn't as comprehensive, i don't think, so i would prefer something of this nature since this is a very important issue. >> thank you. any other questions or comments

from board members? >> i am having trouble hearing you. your microphone is low. >> i can turn it up, yes. can you hear me now? >> yes. >> thank you very much. any other questions or comments from board members? this is a great opportunity. hearing none. i would like to open this up for public questions, comments. commissioner zvanski. you turned off your microphone. >> i think one of the more interesting and important aspects had to do with the issue of third-party delegation and

how some of those third parties are not fiduciaries but can become fiduciaries depending on what they are delegated to do. also in our system because we are contracting with vendors to provide very specific services and we are also working with other departments with regard to our fund and how those funds are invested and monitored, i think it is really essential that we understand that we still hold that fiduciary liability even when we contract that we have a responsibility to carefully monitor. we have a responsibility to question things if we are not

sure and so that we understand that we still have some liability and we need to be very careful in choosing those third-party providers. i think especially this year we went out for an r.f.p. for one set of vendors and we are now preparing to go out to an r.f.p. or request for proposal with regard to medicare advantage plans moving forward for next year. so that all of the actions we take and the decisions we make it is not a matter of passing off our fiduciary responsibility to someone else but taking on an additional concern and monitoring for fiduciary responsibility when we bring on

those third-party vendors and service providers. i think in that regard we have a very different liability and responsibility with regard to what we do here at health service versus what is done at retirement or what is now going forward at the retiree healthcare trust fund board. we are all related and the retiree healthcare trust funnedd board is more related to what is coming down the pike but direct relationship to retirement board. it is something we need to continue to monitor and i wasn't sure when karen initially said it. karen, you might be right every two years. it might be good to have an update and refresher on fiduciary responsibility and

fiduciary liability just to make sure that we are all watching what goes forward each year or every couple of years or every few years when we go forward with changes in our contracts and vendors. thank you. >> thank you. let me highlight that by saying we are all aware of the fact one of largest anaphases segments of healthcare costs is farmty benefits. you raised the issue of pharmacy benefit managers. some of the pharmacy rebates. we have some responsibility to try to unravel the complexity so we understand this as well as we can as much as anybody does. i agree with that completely. i thank you for bringing

attention to that, particularly the pbms. any other questions or comments? board members? now we will open it up for public comment and questions. >> thank you, president follansbee. >> i will be pulling up the slide for everyone watching to read our instructions. president follansbee note to the board the moderator stepped away. i will be able to elevate any callers in the public comment queue for the rest of our time together. with that i will read instructions. public comment will be available for each item on the agenda. three minutes to comment in

length unless the board gives new time limits. all public comments concerning the agenda item. there is no obligation to engage in dialogue with the caller. you are encouraged to state your name clearly. you may remain anonymous. when your three minutes ended you will be placed on mute and i will unmute the next caller. remote viewing is available for forsfgov. the number is 415-655-0001. when prompted use access code (187)679-7252. pound pound. you will enter as attendee on the public call line and star 3 to be added. when your line is unmuted this is your time to speak. for those on hold continue to

wait until the system indicates you are unmuted. sfgovtv has a standing 45 second delay on the live broadcast. we will take a pause to allow the system to catch up and callers to dial in. the 45 seconds begins now.

>> i will check to see if there are callers to comment on this item. >> we have two callers on the line. zero callers in the queue at this time. you must dial star 3 now to be added to the public comment queue for this specific agenda item. we will wait five seconds for callers to join and close public comment for this agenda item. >> there are no callers in the queue at this time. commissioners with no callers, public comment is closed. >> thank you very much. thank you very much for that detailed presentation. it might be a hornets nest of

questions. we will review this more often than every two years until the next formal update. thank you very much. >> thank you. >> that will close agenda item 9. we will move to agenda item 11. i will remind anyone participating that we have dealt with item 10. and we have dealt with item 12 reports and updates. this is item 11. >> thank you. this is item 11. sfhss medicare advantage request for proposals update. it is discussion. presented by ann thompson and mike clark. i will passing over the presenter privilege lemmings.

>> thank you. i am ann thompson joining you from aon. with me is mike clark. you may hear from him during this conversation and you may hear from others during this conversation. as we get started i will go to the next page. today we will talk about a few things. the goals are to look at consolidated view of the goals objectives, talk about the chart r.f.p. and high level line at the end of the presentation to deal with all of it. we appreciate your feedback and input as we have this conversation. with that we will go to the next

slide. you will see that what we did and this is the ask of commissioner scott from the june meeting. we outlined the specific goals. we had added four pillars and we have some key objectives outlined. what we did from the ask was try to consolidate together into one picture. you will see on the left side the five goals. then we add the pillars. there is cost, we will change to this language. quality. we will prioritize the plans for rating of 4 or higher. administration we expect the superior service.

the next page which we don't have to go to yet but underlying all of this is that we are going to comply within the city charter. you will see within each of the five goals. quality affordable and sustainable. they are not unique. they mesh together. under objectives again one modification to the language in june. that is under the second reduced complexity on the right side. minimize member disruption and what we added as well as network and the pharmacy formularies.

on the next page we are continuing on to the four pillars here. no changes to the key objective language. underlying this is working within the policy. moving to the next slide. refresh on where we have been. started to work in 2018. we did the planning process then adopt the strategic plan octobe. medicare market update presentation to the board november 2020. this past june we reviewed the goals and objectives on how to consolidate. that brings us today. after that presentation regarding the goals and objectives of the rpp staff are

recommending revising the approach to include rfi for information. let's talk more about what that means. more three letter accromins. rfi is a formal request for written information from the vendors brier to the r.f.p. it is an opportunity to educate and inform prior to r.f.p. to allow additional fact finding, more open questioning, vendors to explain the current offerings and lastly affirm the necessity to move on. outcomes of doing this process would be to develop a scope more narrowly challenged for the challenges provide streamlined questionnaire on the specific goals and objectives, identify

key vendors for focused evaluation. allows for competitive requirements for the r.f.p. to be clarified. overall the pre-work of the rfi process results in an r.f.p. process that is efficient and effective. that is the reason that we decided to move with the rfi. it is to provide nonbinding opportunity to revitalize the medicare advantage. it is dynamic marketplace. things have changed since the last presentation in 2020. we want to make sure we are up-to-date what is out there so we get the best. as part of the last r.f.p. process for the active and early

retirees we wanted to have the expectations. this approach allows us to educate and inform for this scope of work. rfi allows more open dialogue with vendors. lastly, it allows for sfhss the opportunity to include two members of the health service board to participate in the analysis phase of the rfi and provide a broader contribution to the groundwork of the formal r.f.p. with that the next step would be to prepare an rfi for the market. results will either inform or determine that the r.f.p. is not

needed. it is a decision point. staff will present to the board the option of gains for the r.f.p. for the 2023 plan year. december-january timeframe. if there is a desire at the time. at that time sfhss may retain medicare advantage plan offerings in the framework and expand potential medicare advantage or choose to come back. staff will conduct the medicare advantage plan r.f.p. for the 2022 plan in the january 22 to june 2022 timeframe. just to look at the big picture. august to september we will continue research on stakeholder

engagement, member feedback and will do a presentation of rfi summary and consolidate goals in september. in the month of september after the board meeting release rfi to the market. october-november evaluate rfi. in december bring to the board with the impact on the goals and objectives. if it is determined to be needed in january 22, the r.f.p. will be in the market. it continues in february and march. april actual assessment and in may the board discussion and evaluation and assessment of goals. we do recommend exercising the option to make sure we have time to review and discuss the decisions make and the june meeting the final recommendation to the board.

i will stop there and entertain questions. >> we would like to open this up for questions or comments from board members. this is information, not an action item. anyone have further questions for ann or mike? >> i guess the first question i will ask is that the rfi process is interesting to me. it is novel. we are familiar with the r.f.p. health services has ever done an rfi in the past as well. is this something that the two of you can comment on in terms

of experience and the further contribution beyond what you outlined? >> to my knowledge we haven't done -- this is directive director. we have not done an rfi for a medical plan. >> right. >> this notion grew out of a number of reflections and one of which was the r.f.p. that we did for medical plans last year and how tremendously complex this whole topic has become. as we were considering many things related to the medicare advantage plan decision, it became clear to us that adding this step could help clarify a number of things that would reduce the complexity of the

r.f.p. should we go forward. that is why we chose it. now michael, who i know you have met, has done rf i's on behalf of hss for other contracts. i wouldn't be surprised if he has done them in his prior roles at the airport and other places. they are very, very informative. they don't objectly gate you. they are nonbinding. they are all written. it is not -- there is no oral interview or panel interview or nothing like that. they are extremely educational in helping us understand. these medicare advantage market is quite robust at this point, intentionally so because of the wishing to develop this product.

we have our two vendors in place that we have learned quite a bit how the medicare advantage product is managed by these health plans. i think we want to know more. we have an opportunity to do it this way. >> that is great. to go out to any medicare advantage plan that might be interested and response and failure to respond. have an r.f.p. wouldn't impact ability to respond to r.f.p.? >> yes, and we will still put certain gates on the rfi because we discussed previously we will not sacrifice quality. we do have very good plans with very high-quality. that is one thing we won't

dilute that in any other. the other parameters to make sure that we are working with a field of respondents who would potentially be respondents to the r.f.p. as well. >> to be clear, we indicated that the plans would have to have at least four star or higher rating. we wouldn't be asking for responses to rfi from plans that couldn't demonstrate a four star rating or higher already? >> correct, yes. >> i want to say something. >> i am sorry. supervisor chan had her hand up first. >> thank you, president follansbee. my question is about evaluation for rfi responses october

november. it is great to see you have may be coming to the board for the conversation. i look forward to learning more about it. i wanted to understand more about what this evaluation of the rfi response looks like, who will be involved in terms of evaluating rfi responses and how would that evaluation process be disclosed? >> i am going to ask michael, our contract manager, to tell us the roles how we conduct rf i's. supervisor chan, we have a lot of rules about contracting and michael is good about keeping us in the lane. michael, are you able to respond? >> this is holly lopez. michael is in the call.

give him a moment to check his mic. >> this is michael, contracts manager. i unmuted through the portal but not with my new headset. i am learning that is different for teams. this is michael disconty, contracts manager for san francisco health system. we have for rfi process more flicks built in the number of individuals who can participate in that evaluation process. however, as with r.f.p. it is transparent in writing. we are giving ourselves enough time with our schedule to conduct that during the fall time period. i believe afternoon i am not sure if we have the next slide to address who may be involved in that process, but with sfhss we do have that ability to include additional members than the health service board.

>> great. we will make sure in your presentation in september to just really be able to include to help us understand who we will be involving with the evaluation process and identified individuals that will be tremendously helpful. thank you. >> thank you. >> i believe we are prepared to address that toed. it will be a staff function and as michael mentioned on the slide before you we have consulted with the contracts to the attorney's office and do have the opportunity to have board members involved in this part of the process. i think it is clear where we are going with this at this point.

>> i have a question. steven, you are muted. i am vague on why there is only two board members allowed to be on this panel. at what point is the panel set up? >> the number of members is limited so that we don't have a quorum and have a public meeting. >> a quorum would be four. >> i have been advised that no more than two. >> three, i think. >> i don't think that is correct. >> three triggers the certain regulations. three members. >> we can't pass anything with three. it has to be four. >> yes. in terms of disclosure of

conversations and all of that when three of us are in a conversation that becomes subject to sunshine laws. the number is three, i think. >> the material we will receive and then the two people chosen for the panel, how much more will they see? what will they be seeing that we wouldn't be seeing? >> the written response to the rfi. >> that is it? >> that is all there is. >> to clarify. from my understanding and correct me, michael or abbey, the two board members would be involved from the get go, from design and review of questions out there to make sure that the

issues that have been identified are in fact represented as well as seeing the written responses and preparing the summary report that we will be expecting to see towards later in the winter. they would be involved in every step and not excluded from the process of the rfi questionnaire, evaluation and summary in terms of the whole from the beginning to the end. am i incorrect in that? >> no what i would say to clarify is that we would appreciate two members of the board's input into the design of rfi, understanding that we each have a variety of perspectives and limitations from the contracting point of view what we can request and cannot

request. we have to work under the guidance of michael and his team. assuming that we work through that, then sitting down to look at the written responses together and having a dialogue is really where the richness of the experience occurs is not only reading the materials but having the dialogue. it is a complex subject. that would really, i think, be advantageous to members of the board working through this process and as we clearly identify the first time of doing this. i would like us to enter this as learning opportunity to determine what the board can be involved in these processes. as we heard earlier, there is a point where the contracting process does lockdown, and that is causing discomfort for the board last year.

we thought this process might aid in having a deeper understanding of how the development of an rfi works and what information we can learn at that point in the process. >> i am trying to learn here. >> i appreciate that, we all are. it is not like an easy subject to figure out. you have a ton of experience and go a lot. there are areas where it is still confusing. there is a lot to these health plan contracts. >> the two board members participate in the analysis and at the end of the day it all comes back to the full board to vote? >> no. >> i don't know that we would vote on it as the board. it informs the next phase of the competitive bid.

>> they derm whether we go to the next phase? >> that is the intention to clarify the need and also clarify some of the focus of an r.f.p. >> my understanding is that any participation from board members through the rfi would be if there was an r.f.p. to go out. this is not giving certain board members or the board any subsequent abilities to interact beyond what we already experience before. this is just, as you said, it is the process up to the point of the r.f.p. where we set what the agenda is in terms of our

quality of items. beyond that, no, we would still be the board. >> the board retains responsibility according to terms of reference to the providing that input to the goals and objectives that is exactly what we will be able to do with greater clarity at the conclusion of rfi. >> yes. >> this is ann thompson if i may interrupt. we have an additional slide that might clarify. we are pulling it up right now.

>> just checking in to see if presenter privileges are coming through clear. >> yes. >> who would be participating in this conversation. you can see here the cfo and the planner, the consultant an elected and appointed member from the commission.

>> any other questions or comments at this point? >> i would want to thank abbey and her team for coming forward with the process that will allow for broader input into the construction of r.f.p. i think this is very responsive to the concerns that were identified in the last process. i wanted to thank aon for summarizing what was confusing to look at the last time. it is a matter of trying to figure out quickly or within this reasonable timeframe who these two commissioners are going to be to serve in this role. both framing the scope of the rfi as well as participating in the analysis. this is to me very responsive

and i thank you, abbey, for doing it. you and your team. >> speaking up as president of the board to say i have spoken to all commissioners on the board both elected and appointed, and asked for input. as of my conversations this morning, commissioner scott and commissioner zvanski have had the time and willingness to participate. i would appoint them to this acting body regarding the rfi at this point. >> this is commissioner zvanski

that you and chris canning understand that i would be turning to each of you for some additional input for your opinions, for your suggestions and for your questions. as i participate in this process because it is not just me, it is i am representing all of us and i think that is the idea here that we collectively get our thoughts and ideas on to paper and look at what is reasonable to ask what we can do because one of the questions i have initially is do we need the r.f.p.? the other thing is we are holding on to contracts for many, many years. are we never reviewing them? what else are we doing.

there are many sides to this. what is in the marketplace where the changes with regard to medicare and medicare advantage plans and a lot of things. it is to me part of the all over process. just because there are two of us that and we have to be limited as to who can serve in this initial process doesn't mean it is just our ideas and just our views. i am singling out karen and chris only because the three of us are elected. that is where i would go first. i think that probably both of us would like to hear from our colleagues at some point just so we don't hit the sunshine meeting situation where three of us cannot communicate together.

it is a one-on-one where we need to be. the input is going to be invaluable in this process. we have a short timeline to get it done. i am very honored to serve in this position. i just want my colleagues to know that i expect to hear from you and i will be calling you if you don't call me. that is how i think we need to get our work done here. >> any other comments or questions? >> i would just add from the appointed members of the board that i, too, would seek input, guidance and council as we go through the process from the elected members of the board. in terms of it is not about one

commissioner. we are trying to get to a process that will absolutely be responsive to the quality, care, cost, concerns and other issues around healthcare for retired members and their dependents. >> i would suggest and urge and holly will assist that we make available to each of you all of the materials that we have put together on this subject matter for the last year. you talk about in the marketplace. we have done the analysis and had the experts in so i just want to have an easy opportunity to review what we already know. where there needs to be guardrails for areas we can or cannot go into we will provide

that guidance as well. >> supervisor chan you are patiently waiting. >> the questions i have is because i am ignorant to the process and termology of this. could you help educate me what this release to the market means? i am trying to understand the approach of getting information out there and what that looks like. it looks like it means releasing to the market to understand exactly what that looks like and what does that mean? >> the contract procurement rules for the city are very well prescribed. what it means is we put together the criteria for a competitive bid, competing businesses for a particular product, in this case medicare advantage.

they are very detailed documents that describe what has to be submitted in a written document and the r.f.p. process is interviews and special steps that are prescribed to be taken. they all must be -- what is the term? it keeps an even playing field. at all times so that the decision is made with no undue influence and may very objectively based on preestablished criteria. >> i guess what i am asking what does release to the market mean and how will vendors be notified about the rfi process? >> michael you want to talk how we do this? >> similar to the r.f.p. we

encourage every communication to be identical and simultaneous and done publicly. if we are making notification it is put on web page at the same time that we are e-mailing directly to interested parties or those that may be relevant to an rfi or r.f.p. so that everyone gets the same communication at the same time that keeps it on above board. >> thing would be qualified. we also have experts at aon to put together the list. we have done the market assessments and good idea of the players who would be applicable to this rfi and r.f.p.

>> will the board have the list or will the board get a chance to see the list of the parties noticed? >> that is something we are absolutely allowed to disclose, yes. >> i think that would be great. that will be very informative for the board to see how the rfi, who is it going to or being on the list or notified about the rfi process. thank you. >> michael, -- >> important point there are hundreds of medicare advantage plans out there. just watch tv or media. they are advertising around enrollment periods. this is important how the list is generated. it is inclusive and broad and who ever responds would need to

understand there is a certain criteria to be taken the next step but the list should be broad given the hundreds of plans out there, i think. that is an important point. >> thank you so much, president. very good point. any other questions or comments from board members. if not open it up for public comment then. >> thank you. i will display our written instructions.

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there are no callers in the queue at this time. no callers public comment is now closed. >> thank you. this ends agenda item 11. reminder we dealt with item 12 earlier in the regular meeting. remind everyone the next meeting is thursday, september 9. with that this meeting is adjourned. thank you everyone for participating.

>> van ness avenue runs from market street to bay street in san francisco. south vanness runs from south of market to cesar chavez street. originally residential after the 1906 earthquake it was used as a fire break. many car dealerships and businesses exist on vanness today with expansion of bus lanes. originally marlet street was named after james vanness, seventh mayor of san francisco from 1855 to 1856. vanness heavy are streets in santa cruz, los angeles and

fresno in his honor. in 1915 streetcars started the opening of the expo. in 1950s it was removed and replaced by a tree-lined median. it was part of the central freeway from bayshore to hayes valley. it is part of uses 101. it was damaged during the 1989 earthquake. in 1992 the elevator part of the roadway was removed. it was developed into a surface boulevard. today the vanness bus rapid transit project is to have designated bus lanes service from mission. it will display the history of the city. van ness avenue..

>> shop and dine the 49 challenges residents to do they're shopping with the 49ers of san francisco by supporting the services within the feigned we help san francisco remain unique and successful and rib rant where will you shop the shop and dine the 49 i'm e jonl i provide sweets square feet potpie and peach cobbler and i started my business this is my baby i started out of high home and he would back for friends and coworkers they'll tell you hoa you need to open up a shop at the time he move forward book to the bayview and i thinks the t line was up i need have a shop

on third street i live in bayview and i wanted to have my shop here in bayview a quality dessert shot shop in my neighborhood in any business is different everybody is in small banishes there are homemade recess pesz and ingredients from scratch we shop local because we have someone that is here in your city or your neighborhood that is provide you with is service with quality ingredients and quality products and need to be know that person the person behind the products it is not like okay. who i

>> we are right now in outer richmond in the last business area of this city. this area of merchants is in the most western part of san francisco, continue blocks down the street they're going to fall into the pacific ocean. two blocks over you're going to have golden gate park. there is japanese, chinese, hamburgers, italian, you don't have to cook. you can just walk up and down the street and you can get your cheese. i love it. but the a very multicultural place with people from everywhere. it's just a wonderful environment. i love the richmond district. >> and my wife and i own a café

we have specialty coffee drinks, your typical lattes and mochas and cappuccinos, and for lunches, sandwiches and soup and salad. made fresh to order. we have something for everybody >> my shop is in a very cool part of the city but that's one of the reasons why we provide such warm and generous treats, both physically and emotionally (♪♪) >> it's an old-fashioned general store. they have coffee. other than that what we sell is fishing equipment. go out and have a good time. >> one of my customers that has been coming here for years has always said this is my favorite store. when i get married i'm coming in your store. and then he in his wedding outfit and she in a beautiful dress came in here in between

getting married at lands end and to the reception, unbelievable. (♪♪) >> the new public health order that we're announcing will require san franciscans to remain at home with exceptions only for essential outings. >> when the pandemic first hit we kind of saw the writing on the walls that potentially the city is going to shut all businesses down. >> it was scary because it was such an unknown of how things were going to pan out. i honestly thought that this might be the end of our business. we're just a small business and

we still need daily customers. >> i think that everybody was on edge. nobody was untouched. it was very silent. >> as a business owner, you know, things don't just stop, right? you've still got your rent, and all of the overhead, it's still there. >> there's this underlying constant sense of dread and anxiety. it doesn't prevent you from going to work and doing your job, it doesn't stop you from doing your normal routine. what it does is just make you feel extra exhausted. >> so we began to reopen one year later, and we will emerge stronger, we will emerge better as a city, because we are still here and we stand in solidarity

with one another. >> this place has definitely been an anchor for us, it's home for us, and, again, we are part of this community and the community is part of us. >> one of the things that we strived for is making everyone in the community feel welcome and we have a sign that says "you're welcome." no matter who you are, no matter what your political views are, you're welcome here. and it's sort of the classic san francisco thing is that you work with folks. >> it is your duty to help everybody in san francisco.

madam secretary, will you call the role, please. >> clerk: [roll call] >> clerk: we have commissioners present. we have quorum. the department of public health and the governor mission and mayor breed have lifted restrictions on teleconferencing. this meeting is being held via teleconference. for those of you watching the