happened to our connection. >> just don't sign out anybody. >> i couldn't get back in. don't know how i got signed out. sorry about that, okay?

present. supervisor chan is in the call. she may be coming back momentarily. >> commissioner breslin: here. >> commissioner scott: present.

>> commissioner zvanski: here. >> and commissioner hao. i apologize deeply. i'm not saying it. we have a quorum. go on to agenda item 10. agenda item 10 is a board education item. the sfhss health care cost transparency. this is a discussion item. it will be presented by suzanne del banko. >> good afternoon. i'm happy to have suzanne back in the room, if you will, with our commission as many are you familiar with her work and we've been discussing the transparency fiesh some time -- issue for some time. our go-to person is suzanne.

she's the director of the not-for-profit corporation to implement strategies that produce high-value health care and improve the functioning of market place. in addition, to her duties, suzanne serves on the advisory board of the blue cross blue shield institute, participate in the health care executives leadership network. previously, suzanne was the founding c.e.o. of the leap frog group. for those who don't know what that is, when i met suzanne, i put her in my rock-star category, because leap frog did change the public reporting around very important safety initiatives in hospitals.

suzanne holds a ph.d. in public policy from the goldman school of public policy and school of public health at u.c. berkeley. thank you for educating us today and offering your time and where we're at on health care and transparency. >> my pleasure. thank you, commissioners, for the chance to be here and speak with you about this important topic today. i'm going to share my screen. >> can you see my screen? >> president follansbee: yes, we can. >> all right, so i am going to talk about the evolution and price transparency, but i'm happy to be interrupted with questions from the health services board or staff.

so, i will work my way through it, but if there are questions for clarity, please feel free to ask me. so, abbie did a very nice job introducing catalyst for payment reform. i'll share that we are very pleased to have the san francisco health service system as a member. what i think we have in common across all of the members displayed on the screen right now are recognition of the need to change the health care system and to do that in part by changing how purchasers buy health care. and the san francisco health service system has always been a leader in this space as long as i've been familiar with it. and while there are other employers and bullet purchasers listed here that are innovative, you should know that san francisco health service system is held in high esteem by these

others. we also have a variety of members beyond the two types i mentioned, so specifically in the public purchaser arena, we have medicaid agencies. we have agencies like yours at the state level for state employees and retirees. and we also have university, we have several multi-employer union trust funds. so, we have a whole variety of purchasers who come together with this mission to try to improve value for their health care spending. and together we decide what our priorities are going to be and transparency has been a priority for quite a long time. so, you know, our goals are really to create effective payment reform, changing how we pay doctors and hospitals, effective purchasers. so educating our members and purchasers beyond our membership about ways that they can be more

effective and how they buy health care in terms of stimulating better equality, better efficiency. and we also work to make the broader health care marketplace more functional. there are many things we all would agree are broken about the health care system. and while policy intervention is needed to fix some of them, possibly, there are also market forces we can use to try to push things in the right direction. so, we do a variety of things at catalyst payment reform. i'm sharing this so you understand where we're from. 501.3c. had epping people understand what is broken and what are the opportunities for fixing things. what are models for successful programs? et cetera. we also create together a shared agenda for change. and we create purchasing tools that make it easier to implement that change as a purchaser.

whether it's questions to health plans, potential partners, or model contract provisions, ways to analyze data, things like that. and we help our members push the health care system for improvement by coordinating with each other. by all asking the same questions at the same time. or letting it be known collectively they'd like to see things improve in certain ways. we also conduct research and analysis to highlight where we need to make progress, where we have made progress. and, so, all of those things together, you know, we hope will help us act as a catalyst for a high-value health care system. and with that, i will talk about the need for transparency as part of that. so, i have spoken to this, you know, this body before about transparency. it's been quite a number of years. and i'm happy to report that we

have made some progress. but let's go back to why is it that it's important that we have insight into health care prices? as well as health care quality, i will say. you know, it's sort of a funny question to ask, because, of course, if we walk into a store, the prices are clearly displayed. and so we can take that into consideration immediately as we're looking at goods we might want to procure and make decisions about whether or not we can afford something. whether something is afford that much money to us. but when it comes to health care, just ten years ago, the access to health care prices was extremely limited. and let's just start with the end user, the health care system, who in your case are your plan members. i think we would all agree that consumers have the right to know what health care is going cost them before they receive the

care and that some who really like getting into the details might use that information before they actually seek care. others may never look at it, but they certainly have a right to know it if they want to. we've learned over the last decade that far fewer consumers look at this information than we might have expected. but, you know, when you think about the complexities of navigating the health care system, it can be extremely overwhelming. so i don't think we have reached the health care, but before it can happen, we need to have data available. health care purchasers such as the service system need to be able to see health care prices, because today prices are one of the biggest drivers in health care cost growth. there are wildly different prices across the same

marketplace from one provider to another, whether the quality differs or not. and these are things that purchasers can take into consideration when they're making decisions about health care benefit design, health care provider network. how they want to go about paying providers. and many purchasers have also asked plan members to take on more financial responsibility, so it would be hard to do that without also offering price information. in an ideal world, health care providers would have price information so they can make better referrals on behalf of patients. and policymakers also need transparency for them to understand if the health care marketplace is working. if there is any need for them to play a part in trying to correct dysfunction. they need to be able to see how prices vary.

and i would relate that as there has been more and more transparency, there has been more insistence on policymakers that can make fixes to the health care market today. and by that, i'm speaking largely to the market power that many health care providers have acquired that allows them to set prices if the market were competitive. there is ongoing reduction in the competition amongst providers in the health care system. so, i think that, you know, the need for price transparency really started again about a decade ago when some employers, including calipers, wanted to implement benefit design. so calipers wanted to set prices

for certain procedures and let their plan members know if they sought care somewhere more expensive than the price they set, that would have to pay the difference out of pocket. but to implement that, you need to have price information available. so we took stock of what health plans were doing back then to share that information. and while almost every health plan in a tool, it wasn't specific to providers or the level that a consumer could use it in making decisions. we need to have price transparency and we called on different stakeholders to take action. we have made a lot of progress since then. if you look at the chart on the right, when we surveyed health plans on what the availability of tools was in 2018, we found

that 100% offered some kind of support for cost calculator. 78% of physician choice tools had integrated costs. and 78% of plans reported that cost information providers provided to members does take into consideration their plan design and whether or not they have a co-pay and what that co-may might be. so it sounds good on paper. we wanted to really see what it was like in reality and so we did a secret shopping exercise, where we found enormous numbers of holes. so while that tool existed and it was possible to find it on the health website, once you actually looked to compare some of the hospitals at the procedure level, you would find a lot of empty cells. and it was really hard to know, is that because the sample -- or the number of that health plan

patients is too small to share information reliably? is it because there is a gag clause in place that prohibits that health plan from sharing that information? it was impossible to know why, but we know the tools don't have the information people need. where have they been turning to fill the void? there are all kinds of entrepreneurial vendors out there that have tried to create transparency tools that have more information that perhaps they're paired with or separately. vendors offer navigation support, rather than expecting a plan member to go to a website for the information, there might be a phone number one could call. and when we're think offing service, you could ask where is the best place to get this and price is part of the consideration. they're offering second-opinion services that cover all kinds of things. so, you know, employers who can

afford it are trying to, you know, fill in some of these holes, but another challenge that we're also facing is that over time health insurance companies have become more and more restrictive with data sharing. i think data has become a real asset in health care and for a variety of reasons they feel that sharing it, at least in the ways that might be useful to some of these vendors, share proprietory information they don't want to share, including their specific prices. so as a separate project we're working to help purchasers be better data stewards by putting pressure on their health plan partners about the data-sharing. so, none of these, health plan or alternative solutions, are perfect. you might wonder what is the public sector doing to ensure that people have access to health care prices? we have analyzed state laws for many years to determine whether

or not state are ensuring that their citizens have access to price information. you can see from 2013 to 2020 more states have made progress in terms of improving the information they do have available, but the vast majority of states in the country haven't stepped up. keep in mind that california's d-grade will improve once the claims database is in action, because we consider that in our grading the gold standard for how prices should be calculated as well as the total cost of care. because it can be distorting, as i mentioned before, if there is not enough cases going to particular providers that are insured by or who are paid by a certain health plan. the data can be less reliable. so, you know, california has led in certain areas. it was one of the earlier states

gag clauses that i mentioned in contracts that prohibit that sharing of information. also, i'm sure you're familiar in 2017, california implemented surprise billing protection. and set payments for out of network doctors at either 125% of the amount that medicare would pay, or at the insurer's average contracted rate, whichever is greater. we just had recent federal legislation in the surprise billing area, which helps, too, but california was earlier on that. and as you heard mentioned earlier, california has established the intent to create a database. it's now called the health care payments data program and the hope is it's in place by july 1, 2023. and that brings together data from multiple payers including medical care, medi-cal and the

san francisco health service system to help get a clearer picture on what are the amounts being paid to different providers for different services. and then another thing that has impact certainly on the bay area is the settlement in the september trust case brought against sutter. they're no longer going to be able to hide prices or interfere with benefit or provider network designs that use network information or don't. all these areas represent progress. and now we've got action coming from the federal government. in november, 2019, the medicaid services issued transparency for hospitals to make the standard charges public. and now recent expectations are that they need to also be posting payer specific negotiated charges. [please stand by] [please stand by]

-- those machine readable files could be used by the vendors that i mentioned and other parties that want to analyze that data. and so it's processed to 2022,

and the deadlines for the tools are january 1, 2023 for the first 500 services and january 1, 2024, for full compliance. in addition to this posting, good-faith estimates and advanced explanations of benefits have to be provided to insured and uninsured people by providers and facilities by january 1, 2022. though the federal government has said they do not plan to enforce this compliance right away. so the idea of the advanced explanation of benefits is novel and, you know, it has the opportunity, even by mail, to reach people with what something is likely to cost when they go in and they seek that care. and then further as of december 27th, 2020, the consolidation -- so the consolidated appropriations act ensures delivering gag prices on quality

and that is a big deal as it's federal law. and as of january 1, the directors have to be up-to-date regarding which providers are in network and out of network and if they're not, the plan member is not libel for a larger payment if they go to an out of network provider. so the cost sharing is the same as if that provider were in network. so these are additional protections and ways of ensuring that there will be transparency building on these other rules. so this is all progress forward you know, will the health plan comply at a better rate than hospitals? we don't know. we don't know how rapidly the hospitals will begin to comply with what they're required to do. so it is really important that purchasers like the san francisco health service system,

you know, they have their voices heard in terms of how important this is to them. you know, one of the things that we have to continue to work at as i mention is combating the barriers that health plans -- when it comes to data sharing across parties that all work on behalf of the purchaser. shining a light on providers that aren't complying with the federal laws, i think will be very important. you know, we have the potential here to educate plan participants about provider price variations and if that data is there. but if the data aren't there it could be hard to do that. and holding the health plans accountable. we can start doing that now in terms of their compliance with federal laws, including asking them for updates, looking for their work plans in terms of how they're planning to comply with the deadlines they have to meet and, you know, we talked mostly about price today, but,

obviously, transparency around quality is really important too because if you just have prices, you know, plan members -- or even those professionals might mistakenly think that more expensive care is better care, when, in fact, the data do not bear that out. there's virtually no correlation between price and quality. so it's important to have the da on both sides. so with that i'm done sharing what i have put together but i'm happy to answer any questions that would be helpful. >> president bernal: thank you very much, it's really a superb presentation. sometimes someone can look at california and oregon, but it occurs some much smaller gee geographic areas and particularly in communities that are maybe more rural, there may

be a diminishing number of providers. so i'm just curious to know how you see the bigger issues and these issues translating into the bigger challenge of the health care system which is actually delivery of care, period. >> yeah, i mean, i think how i see all of these things intertwined is that, you know, there's been a tremendous amount of consolidation among the health care providers, and the hospitals merging as well as acquiring the physician practices. i think that 75% of physicians now are employed by health systems or, you know, corporations of that type. and so there are fewer and fewer choices and in rural areas this is particularly a challenge because you don't necessarily need multiple providers in a rural area. and when there's a lack of

competition, that means more market power on behalf of whatever providers are left. which strengthens their ability to resist the kinds of things that make it easier for people to shop around or to be aware of what their choices are. so these gag clauses have been around for a long time. everybody points the finger at somebody else for being responsible for them, but, you know, the fact that there's now a federal law that would prohibit that i think makes a big difference. and the fact that california has had that law should make a difference. but if you're asking the question about, you know, sort of access issues -- that's -- that's a harder one. the only other thing that i'll say is that the more burdens that we place on providers, the harder the for those resources to be around. and so in some cases there could be rural providers who, you know, as these requirements just keep piling on, you know, they

feel like they just can't cut it on their own and that's part of what we, you know, the trend and acquisition. >> president bernal: other questions. >> this is randy scott. and dr. delbanco, are you there? >> i'm here. >> okay. i wanted to get your take on how your efforts are either conjoined with or parallel with the pharmacy pricing. is there some connection of work of your organization, with others? or are you taking that on as an independent effort? where are we on that? >> yes, so we are not taking that on in a large way. we're small. we have six or seven staff members right now.

so we choose to focus. we did just recently release an online course that i'm happy to make available to anyone interested that helps to educate about how the whole pharmacy system works. and, you know, from -- it's sort of a master class-style course where experts are providing lectures about different aspects of the drug industry and how the whole pharmacy system works. but beyond that, we just have, you know, to sort of drawn a line around what we can take on so i would say that the issues in the pharmacy space are very parallel. you know, the lack of transparency, and many cases the lack of competition, you know, as a result the prices rising, etc. you know, very similar issues. >> thank you.

>> and the other question that i would ask, i mean, i found myself in a situation where i was in a fee-for-service practice where i would see a patient who had essentially no health insurance. this is before the recover california, etc., and needed simple x-rays. so i would do all of the phone calls to all of the different radiology departments at various hospitals and free-standing clinics, trying to find the cause -- the price. with the interpretation. and i have to say that it was daunting. and i guess that part of the complexity now is that most people have some form of insurance with co-pays and deductibles. so what may be slightly less to have your gallbladder taken out in hospital a, when you factor in the deductibles and the co-pays and other fees that may happen, sometimes the list price

is not the true price. and the complexity has merged into what you're trying to do. >> it's a great question. so it converges in that it's sort of ala cart or fee-for-service pricing is problematic for many reasons, which i won't get into. but from a transparency perspective, it's very difficult for a consumer or a layperson to know where all of the pieces that are going to go into an episode of care. and so if you were to look at one of these, you know, tables with 500 services on it, you wouldn't know which ones to select. so there is something called

episode-based payment, that is trying to create essentially like a package price for everything that someone would need for a typical episode of care. whether it's a hip replacement or a birth or any number of things. and critical experts decide what types of services are typically included in that expert -- i'm sorry -- in that episode. and one of the things that we're lacking in this country right now are standard definitions of those episodes. and payment reform was beginning to work with another non-profit called paces that is trying to create a set of publicly available open source standard definitions of episodes, because it has implications for both payments and the ability for people to sort of price shop, as well as the simplicity and the

reduction of complexity for the provider who wants to understand what one payer is going to offer them for an episode versus another payer. and whether they should agree to that price. so it's something that i think that this country sorely needs, but until we have that standard episode definition, we may have some prices offered as episodes or bundles, but they may not be entirely apple-to-apple comparisons with prices offered on some other platforms. >> i just think that is a great response, and i appreciate that i think about the flurry of interest in lasik surgery and you see the advertising. and one never could tell from the advertising what was being covered, and whether even the assessment of whether that individual would be a good candidate somehow factored into the rather -- to the pricing. then the follow-up and all of

that. so it seems that there's a lot of education that has to go out to the general public about what bundling means. and it's not just the act of putting the lens in. or taking the liver out. but all of the care that goes around that. i think that it must seem daunting from everyone's point of view, including your's. >> well, there has been a lot of progress made on defining episodes. and we have the ability to do this. >> yeah. >> it's not something that is beyond our grasp and it's just a matter of will to converge on some shared definitions and start making all of this more sensible for all of the parties >> president bernal: great, in the interest of time do we have any more comments or questions from board members? >> i would just like to say

this, mr. president, that i have no one susan for a number of years, and i am so pleased that she and her organization have continued to fight the good fight over the last decade or more. a number of these efforts in the beginning that i worked with the specific health groups and others, it seemed like it was never going to come together in a good way. and i'm very pleased to see the progress. so thank you for your work and the presentation today. >> president bernal: yes, i think that supervisor -- >> thank you, president. and i wanted to thank you for this presentation. for me personally, like it was very educational. i just really learned a lot and so i really appreciate your expertise. it's a pleasure of learning through the presentation. thank you.

>> president bernal: we'll go ahead and open this up, and seeing no other hands raised and open this up for public comment >> clerk: thank you, president. i'll share our visual instructions. so the public comment is available for each item on this agenda. and each speaker is allowed three minutes to comment in length unless the board public has time limits during the meeting. all public items to be made, as a reminder they may ask questions but there's no obligation to answer or engage in dialogue with the caller. when your three minutes have ended i will thank you for your comment and you will be on mute and remote viewing is available on sfgov-tv, and you can speak by dialing the number on the screen.

there we go. the dial-in number is 1-(415)-655-0001. and again, 1-(415)-655-0001. whether prompted use access code 146-446-4192. and again, 146-446-4192 and hit pound and pound again. dial star 3 to be added to the queue. if the system says that your line is un-muted, this is your time to speak. those on hold wait until the system indicates that you have been un-muted. sfgov-tv has a 30-second delay for those watching our live broadcast today. we'll take a 30-second pause to allow the system to catch up and the callers to dial in. our 30-second pause begins now.

our moderator will notify us of any callers in the public comment queue. >> madam secretary, we have three callers on the phone line and one caller has entered the queue at this time. others may enter the queue as public comment continues. i will indicate when there's no more callers on the queue and you will hear a brief silence as we transition between callers. elevating first caller now. >> clerk: welcome, caller. >> caller: hi, good afternoon, commissioners. this is john oboclose. i wanted to say that i really appreciate this presentation,

and the documents provided around transparency. and, yes, it is not just looking at the transparency of cost, but it's really the transparency of the quality of services and what they say they will provide and how they'll attract consumers and how we direct our city employees to seek these plans. it's important that the accuracy of how these plans describe themselves is really clear and that is shared publicly and we can measure how the plans, you know, actually and this is important for our providers, including kaiser as well. when it comes to the costs, it's really important that we look and take into consideration that

often our health plans are penalized for providing what they say that is going to be provided and that that should be included in the overall impact on consumers. and purchasers like the city and county of san francisco. and so i appreciate you weighing in on this and i look forward on how we can work together to see greater transparency in both the cost and the quality of services in san francisco. thank you. >> clerk: thank you for your comments. moderator, if we can elevate the next comment. >> zero callers have entered the public comment queue at this time. a reminder to the remaining callers on the line, you must dial star 3 now if you want to join public comment. we will wait five seconds and

then close public comment for this agenda item. board secretary, there are still no callers in the queue at this time. >> clerk: thank you, moderator. hearing no further callers, public comment is now closed. >> president follansbee: great. i want to thank you for the presentation and also for waiting, because we delayed your presentation for quite a while and i appreciate your patience in that regard as well. so we'll move on now to agenda item number 11. >> clerk: thank you, president. the number 11 is the medicare request for advantage, our update. this is presented by michael disconti, and anne thompson with ai. >> thank you, holly. if you would give me the

documents. let me go back to the beginning of the presentation. how is that view? this might be better. >> clerk: that's full screen. >> now it's correct. excellent. all right, thank you, for your time today. and michael visconti and i will share responsibility for walking through this presentation so i'll get us started and go straight into what we'll talk about today. three kind of main categories, so just the quick review of the consolidated goals and objectives and discussing the path from rfi to rfp and rfi advantages and more details on

profits and timeline from when we last met. so on pages 2 and 3, i will not go over these -- these are exactly the same -- excuse me -- as what we looked at the the august health care service meeting. we are looking at certain colors and key objectives within the five strategic goals as outlined by san francisco health services. we can see three of those five here. and the remaining two on page 3 and, of course, underlying all of this is that we'll work within the construct of the city charter. and just a little bit of a backwards view as well on the path forward, and we adopted a

plan. and we did a review and got input on the goals and reviewed the conflict of doing the rfi process before we moved into an rfp with that i'll turn it over to michael. so let me know when you want me to move the slide ahead. >> will do, anne, thank you. michael visconti, the contracts manager. and anne introduced a moment ago our last presentation on this topic, sfhss staff decided the decision to move forward as a precursor to a possible rfp for a medicare plan year for the 2023 year. and it will educate and inform and allow for fact finding. and an expanded scope which will

ultimately lead to if deemed necessary, a more narrowly focused approach. and of equal and paramount importance is with the city procurement rules and the timeline presented by anne in this presentation, the rfi allows for an increased number of contributors and subject matter experts. mainly the members of the health service board and we extend our gratitude for offering time and expertise and experience to the health service system and our members in this rfi process. for slide six, as we have introduced previously and in august before the health service board, we have highlighted here four unique aspects of medicare and medicare plans that benefit from an rfi process. mainly, exploring other highly regulated medicare marketplace, and informing and setting clear expectations for a possible future rfp, or defining a future

rfp scope for a more focused evaluation process. and creating a medium and a more open dialogue where sfhss can express challenges that we face as well as member needs, both now and in the future. and, again, as noted on the previous page, by prefacing a possible rfp with this rfi, the health service expands the transparency into our process with both this board and our members and the public. now for slide 7, in the interest of transparencyy and to permit the health service system the broadest latitude in exploring the medicare plan and for our medicare population, this rfp is open to any carrier and any innovative approaches they have to offer. the rfi discussion by the participating members of this board, sfhss and our consultants, will be non-binding and as such this rfp is

non-exclusionary in that a failure to respond by any carrier to this rfi would in no way prevent that carrier from responding to a future rfp. and, therefore, neither advantage nor disadvantage any respondent as that rfp would be an entirely separate and distinct process. for the next slide i will hand this back to my colleague anne thompson and she'll walk us through the rfi timeline. thank you. >> so i believe that we previously may have talked very high level about timeline but we wanted to provide a few additional dates, especially now with the rfi process being added a reprecursor. so, you know, establishing the participation panel, discussions are happening now. we plan to release the rfi to the marketplace on september 24th. responses would be then due october 22nd. and the review would happen in october/november time frame and then anticipating bringing back

the results of that process to health service board. and at that point we would either affirm the need to perform an rfp or determine that it is not needed. if it is affirmed that we want to perform the rfp, we will work very quickly to release the rfp to the market in january of 2022 with the non-financial responses being due in the march time frame, financials due in april, and then we would be presenting those results to the board in the may to june time frame. at the last meeting, a question was brought up about who would be receiving the rfi, and asing myal mentioned a couple slides ago, the process is completely open to any willing provider who is interested in participating. there will be some criteria or the goal that we mentioned earlier on the first couple of slides of this presentation, in

that we will be taking into consideration, but otherwise there's nothing preventing a provider from participating. what we typically do is that we do send a notice to vendors that we are aware of operating in this space. and that it is available. so they're not invited directly or given materials. they're invited to take a look and to request access to the rfi. we have listed out some of those here. this is not a full comprehensive list, the one that we had put together as of september 3rd. so if you don't see a name, don't worry. and other carriers that are not listed on this list currently that might be interested in getting the notification in advance when that does come out can contact michael via email to request to be on that distribution list. so as far as next steps with the

rfi, we will send that out to the markets and review the results with the board if december and determine whether or not an rfp is needed at which time we'll get that moving in the january time frame, with the results reviewed with the board in the may to june time frame. and that concludes my presentation and we can take questions. (please stand by)

the terms of reference when we were undertaking the medical plan last year. it's my understanding, commissioner scott can correct me if i'm not saying it correctly, but it's my understanding it's to form the goals and objectives of the r.f.p. should we find that we want to go forward with the r.f.p., we would be bringing the goals and objectives to you, which you've already seen. we may learn what we currently have is what we need and we may not want to do an r.f.p. >> president follansbee: you presented one object outcome,

there may be r.f.p., but you presented another outcome, we won't see any more r.f.p. based -- >> we may -- yeah, it may not be warranted. >> president follansbee: the board would have to put in the goals, but not the actual decision. >> yeah. >> president follansbee: just wanted to make sure it was clear. >> we'll be very transparent about what our decision-making process was. >> president follansbee: yeah. i just wanted to make sure it was clear what will be an action item or not when the information comes back to the board after the r.f.p. or the r.f.i. process is complete. any other questions or comments from the board at this point? >> commissioner zvanski: i believe that either way, it's up

to the board. there will be a staff recommendation, but the board will have to validate that either to not go forward with an r.f.p., or to go forward. so i think it's an action item either way. >> president follansbee: abbie, do you want to comment? >> that's not my understanding. >> president follansbee: it's not my understanding either. it's not an action item. it's an information item we'll hear and have input, but it's not an action item. but if someone wants to comment. i don't know who our attorney is today. do we have an attorney present? >> he had to step away. >> sorry, i'm in my office. i don't have an official h.s.s. background, which i think i desperately need. i will take a look at this. i think generally the -- let me

talk to abbie about this and get back to you. i think generally, it probably would be a discussion item, but if the board feels strongly about it, obviously, the board has oversight. so let me talk to abbie about this and we'll get back to you. >> i think it needs to clarified. because we get into sort of a blind alley. so i appreciate you looking into it further with your colleagues and with h.s.s. thank you. that's the reason i brought it up, to make sure we're all on the same page well in advance. other comments or questions? hearing none, we'll open this up -- thank you, again for the presentation. we'll open up for public comment. >> thanks, president follansbee. visual instructions.

public comment will be available for each item on the agenda. each speaker is allowed three minutes in length. all public comments are made concerning the agenda item presented. as a reminder, they may ask a question of the body, but there is no -- opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 1-415-655-0001. again, 1-415-655-0001. when prompted, use access code,

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>> president follansbee: great. thank you very much. so just to make sure we're all clear, we will have a meeting in november, which we can hear back from the city attorney about exactly the role of the board on the agenda item that we are expecting in our december regular meeting in terms of the results of the r.f.i. so, again, i want to thank everyone for their hard work on this process. i think it's going to be really informative. so with that, we'll move on to agenda item number 12. >> secretary: thank you, president. agenda item 12 is delta dental quarterly report to the health service board. this is a discussion item and will be presented by sharon lowe with delta dental. >> thank you, holly. you can share -- presenter

privileges are coming to you, sharon. >> good afternoon, and thank you very much for allowing delta dental to provide a report to the health service board. today we'll be discussing areas of concern, the project plan that has goals and milestones. our new dashboard to track prevention, that work access and quality measurements and communication and member access. >> sharon, is there way to expand your screen? if not, that's fine. i see you're in a pdf, so i think this is the fullest it can go. go right ahead. >> okay. sorry.

so, today there are four areas that the health service board has addressed concerns and are demonstrated on the screen. the first one is preventative utilization. the next one is the smile way program. and the underutilization and low /* and low enrollment in that program. the third concern is the provider network access and the specific report from providers resigning from delta dental network and specifically in sonoma county. and then the scores with providers and members. to look at our project plan at a high level, there are three categories. one is to improve oral health.

the second is network. and the last is member satisfaction. within improving oral health, if we look at the cleanings, our goal is to reduce the number of non-users. and our benchmark is to have at or above delta dental book a business benchmark that utilization. for network, we're looking at the specific county and we're measuring that network change. maintaining voluntary terms at or below statewide benchmarks. that is our benchmark. and then to take a subject or member satisfaction transition from active to retirees, we're working to improve those communications so that as an active employee transitions to retirement, they understand the difference between the active ppo dental plan and the changes

that might occur when they transition to the retiree ppo dental plan. our new dashboard is tracking prevention. the data that is demonstrated on this page today is through q2 of 2021. and this is specific to san francisco health service system. when we look at the number of submitted cleanings, again, this is through june 30, 2021, we see that 73% of actives and 69.3% of retirees have not had a cleaning yet in 2021. however, next to the little tooth, you see a 1. and that demonstrates that 26.9% of the active population has received a cleaning and 30.5% of

retirees have received at least one cleaning. through q2 of 2021. our delta's book of business is set at 28.5%. so, the retirees have met our delta's book of business for cleanings, whereas actives are at 26.9, so to achieve that 28.5%, 1.6% would need to be increased. again, we'll be sharing this dashboard on a quarterly basis and watching these numbers as they move into greater and greater utilization. next to the right is our smileway program. what this demonstrates is out of the active enrolled members, 729 through june 30th of 2021, 509 of those 729 enrolled members have actually utilized the

smileway program. and for retirees, 852 enrolled members, 652 have utilized the benefit. the goal here is to get a 95% participation. so taking that 1581 total enrolled members and driving that participation up to 95%. or 79 more enrolled members need to utilize their smileway program to make this a success in participation goal. the number of online accounts actives are in the -- purple, 10,740. and in the grey, for 2021, 11,417. retirees have 4,096 online accounts that they've created since q2.

why this is important is delta dental continues to have electronic campaigns. and this is a way to engage members in that prevention, in the utilization of their dental plan. when we look at the last box, the utilization by type of service, actives are on the left in the blue and the retirees are on the right in salmon. when we're looking at the first set of three bars, d and p, diagnostic and preventative, which includes your exam, cleaning and x-ray, we see that in 2019, prior to covid, when we had solid utilization data for 12 months, the rate of utilization for d. and p was 74.7%. as of q2 for 2021, it's 75.3% and it's beating our benchmark

of 74.7. if we look at retirees, however, currently they're under that benchmark of 74.7. and in that middle bar in d and p, you see the percentage is 69.6%. what is really important about the utilization by type of service is the major services in retirees. that utilization where we see in the middle 8.9% of retirees utilize major dental services, whereas the book of business is at 5. so they're utilizing major services at twice the rate, one of our benchmark, but also if you look at the retiree, 4.4, compared to 8.9, again, that doubling of service. so where we want to build communications and continue to

share those communications with the retiree population is one. talking about prevention and why it's so important to detect dental decay early on. two, pre-estimates. if they're having major work done, $300 or more, get a pre-estimate so they know how much money that major service will cost them. and then they can work with their dentist to work out a payment plan. next, we're going to talk about network access and quality measuresments. so the board is probably familiar with the first three columns on this grid. the state, california. the county. and then all unique network providers as of july 31, 2021. when i reference unique network providers, that is our

contracted -- our delta dental contracted providers, our ppo and premier providers. when we start looking and spend a lot of collaboration with the sfhss executive team in providing this new provider report. and we look at sonoma in particular, we have 441ppo, premier, delta dental contracted dentists. however, when we're looking at sfhss data specifically of how many of your members are utilizing those 441 dentists in sonoma? only 273 of the providers are being utilized by your members. and when we're looking at who has remained in our network

during this same time period, we see that there has been a loss of 19 dentists. so, 273 minus the 254. for a 7% impact. the last column, though, shows that we've actually provided providers during that same time period. so we've actually netted one additional dentist in sonoma for your population. when we look even closer at sonoma county, for instance, the top shows why the providers, those 19 providers, left our network. so we see in the gold five of them, the provider moved. and in the grey, five, changed their ownership. we've got one who was a provider that had no -- did not comply with our requirements.

six reimbursement concerns. and two actually retired. now we want to look at how those 19 providers that left our network, how drastically or non-drastically did they impact hfhss membership. what with see of the impacted members, we have 18 providers that left, 13 of those providers were utilized by sfhss members, however five of those providers that left weren't even being utilized by hss members, so there was no impact to them. however, down in the bottom, we did have one provider that left our network in sonoma, and 50 of your members were utilizing that one provider. hence, maybe why there was some noise -- as we like to call it -- in that -- that the board

heard in sonoma county. however, as you can see on these slides, we've actually increased our network in sonoma county. and the majority of your members were not impacted by the dentist that left our network. looking for a new dentist is very, very easy. you go to your micro site and you can click on the dentist. if they clicked on stanford, which is a dentist, it would show what the quality rating, that four out of five-star rating. the makeup of that. if they wanted to learn more and receive a score card, they would click on the learn more about this dentist quality rating and receive that dental score card.

to talk about dental qual, it is powered by p and r dental strategies. they're a leading insight company. they've been in the business over 20 years. and they're an expert in dental analytics. they have the largest database of deidentified dental claims data. and they utilize 40 key performance measures within their database and 3.6 billion records, dental records, from over 65 dental players throughout the u.s. to determine that five-star rating of that dentist. their database represents dentists in every state and

statistically valid nearly 100% of u.s. dentists. the dentists scores are updated each month and they're based on the payers contributing to this database. to learn a little bit more about the five-star rating, delta qual wanted to make it easy for members and consumers -- and most individuals understand a star rating. how that star rating is utilized is these five criterias to the right. that treatment outcome, commitment to best practices, cost effectiveness, patient retention and treatment recommendations. a three-star rating would indicate that a dentist is average quality based on the statistical norms for that geographical area.

for communication and member access, we've done a lot of work and a lot of collaboration has gone on with the sfhss team. ways to contact delta dental, toll free number, you can view -- or visit your micro site. and if the member, or yourself, had a dental emergency, dentists are required to provide after-hour access to care for all patients. and there is a prerecorded message or an answering service to -- for patients to have instructions on how to access that care. some of the accomplishments thus far have been in member education, the redesign of your micro site. and the new link is demonstrated here. if a member were to click on the

old micro site address, it will redirect them to the new micro site address. what they'll find there are new videos on how to use the plan, your pregnancy dental benefit that is with your active ppo dental plan. so information about pregnancy dental benefits. implant flyers. one for actives as well as retirees that demonstrate how balanced billing could work, or works. and then transitional flyer which we're working on and will have loaded in october. for online accounts, worked closely with your director of communication, a newsletter article was published in your july e-news and we received additional 201 new delta dental online accounts.

smileway, delta dental, is changing their branding. it will now be support for chronic conditions. and there is a number of enhancements in promotion internally, behind the scenes, to -- within our contact center, within the communications that we are providing your members. one of the areas is in the middle of the page. the contact center item. this will be just a friendly reminder that our contact center management team will make sure that the contact center representative who are answering your member's calls know to promote smileway. and to talk about this free benefit with members. this is the old look of your delta dental micro site. and this is the new look of your

delta dental micro site. i encourage everyone to go out and look at the site and click around. watch the videos, look at some of the new enhancements in the implant benefit flyers and some of the other communication pieces that we've just discussed. with that, i'm happy to take any questions you might have. -- on any of the slides throughout this presentation. >> president follansbee: thank you very much for this report. it shows a lot of work has gone into pooling together some information. could you maybe -- maybe the i'm only one that doesn't understand, but when you refer to delta dental's book of business standard, how is that derived? what is the book of business number mean in dental care? >> so, our book of business is

our enterprise state. and those are a number of states that we're in throughout the u.s. they are -- what we're doing is gathering from each client that has, such as yourself, a ppo dental plan and we're gathering that utilization, such as cleaning. and we are looking at everyone that offers a cleaning benefit, then what is that utilization by those clients, those members within those employer groups? and then we're establishing based on that statistical -- or all of that data -- looking at what that benchmark is, so basically based on our book. so all the clients that offer delta dental to their employees have a cleaning benefit, for instance. then we're taking that data and

determining what that utilization is. so how many procedures were -- what the cost of that procedure, so forth and so on. >> president follansbee: great. so it's not a goal of excellence. it's sort of a how other populations that contract with delta dental are behaving, so we can compare our members' activity and utilization to other employer groups, but not necessarily a goal. we would like to exceed that goal, i would gather? >> correct. thank you. -- for bringing it back to really what we are focusing on with sfhss and that partnership. although i mentioned in the cleaning that 28.9% delta book of business, of course, we're trying to achieve more than that.

we're trying to get a greater within our goals for that partnership between delta dental and hss. we really want to see those numbers much greater. have that cleaning. that's the prevention. that's identifying a problem earlier rather than later. >> president follansbee: great. thank you very much. questions or comments, commissioners? >> yeah, that was -- the same question that i had. is this all we want to have is 28%? we should have at least 50%, i would think. and this is ridiculous. 28% benchmark. so and a 5% utilization? i mean, i don't know what is that, but -- so -- so you're going to be flyers around to different departments or something encouraging people to

get their cleanings, or how are you going to do that? >> so there is an actual e-mail campaign that we have to identify which identifies individuals that have not utilized their dental benefits. specifically cleanings, in the last seven months. that's what the data looks at. and then what we'll do is that campaign will specifically go out to that member and say, hey, we noticed that you haven't had a cleaning. do you need help finding a dentist? do you need help in understanding your cleaning benefit? click. then if they do go and have a cleaning, we actually reward them with another e-mail saying, congratulations, we see that you did go to the dentist. do you want to have us send a reminder e-mail to you in the future to s