supervisor stefani and supervisor ronen's conversation, but it reads as follows. page 2, lines 1-7 -- domestic violence cases are incidents presented or cases charged consistent with the definition of domestic violence set forth herein, including but not limited to cases charged under penal code section 273.5 and 243e1. so, this morning, i did have an opportunity to speak with supervisor ronen. she explained to me what some of supervisor stefani's concerns were and in an effort to accommodate supervisor stefani and take her recommendations into account -- and i did send these recommendations to supervisor stefani's office as supervisor stefani indicated -- i have been working closely with her legislative aide dominica,

so the following amendments are reflected as such and i will circulate this to all committee members as well. but on page 2, line 23, it would be read the number of domestic violence cases that the police department must report that fall under the definitions provided by penal code sections 273.5 and 243e1 as well as cases referred to special victims unit then presented to the district attorney for investigation and/or prosecution in the prior quarter and of those cases, the number in which the child or children were present and/or a firearm or firearms were present. so, essentially, what this would do is require the police department to report on the cases that supervisor stefani has in her original legislation, but it would also expand those

cases that are referred to the special victims unit as well. for police officers as well, when they arrive on the scene, they're able to evaluate the relationship between the individuals, even if a physical touching has not occurred. for instance, like i stated earlier, a violation of a domestic restraining order is still a domestic violence case. but the original legislation doesn't take that into account, so we're expanding the reporting requirements in that -- in that respect. further, on page 2, lines 3-5, we have changed it so that it states the number of domestic violence cases that the district attorney charged in the prior quarter, including cases defined under penal code section 273.5 and 243e1 as well as cases referred to the district attorney's domestic violence unit. so similarly, what we changed above in terms of the police

department's reporting requirements, we're doing the same below. so we will circulate these amendments to you as well. finally, the second amendment we proposed will require the district attorney to provide data on how the offices victims services unit is serving survivors of domestic violence, specifically the amendment asks the d.a. to report on how many victims the unit contacted or attempted to contact to provide victim services. this amendment can be found on page 3, lines 9-13. and states the number of crime victims to whom in the prior quarter the district attorney has provided or made documented efforts to provide victim services, including but not limited to assistance applying for protective orders, guidance in navigating the criminal justice system, referrals to local resources and services and

support at court hearings. finally, committee members, supervisor ronen added a section allowing the district attorney the opportunity to provide additional information for disposition and victim services where the raw data may not provide adequate information. this amendment can be found at page 4, lines 1-4. and it states, in any report required under subsection a or b above, the district attorney may in its discretion and to the extent consistent with applicable law provide information regarding the domestic violence cases and victim services reported. any such supplemental information shall not include personal identifying information. so we're asking for this specific data because, this data will provide information that will be useful during the budget process and in terms of making policy decisions on how to

divide funds and services between the community and victim services unit of the d.a.'s office. for example, penal code section 273.5 will cause deportation proceedings to commence against individuals, even if they have lawful immigration status. the penal code, i believe it's specifically section 1016.3 requires both parties, the public defenders office as well as the district attorney to consider immigration consequences in every single case. therefore, both public defenders and district attorneys often negotiate a plea agreement that holds an individual responsible for domestic violence, but it won't lead to deportation and immediate banishment from their family and community. we need to make sure that the survivors in our city are properly represented and provided with the services they

need. given that these amendments are substantive, they will have to be continued to the next meeting, but it's my understanding that supervisor ronen is asking to adopt these amendments today and especially in light of the first deadline for reporting requirements that is coming up at the end of this month, i believe, december 31st if i'm not mistaken. supervisor ronen is happy to continue working on the language in between now and then and can discuss any further amendments, but she is asking this morning that the committee members adopt the amendments and continue the amended duplicated file to the next meeting of the public safety and neighborhood services committee. thank you. >> chair mar: thank you for the overview of the proposed amendments and thanks to you and supervisor ronen for your work on trying to strengthen this really important legislation. supervisor stefani? >> member stefani: yes, thank

you, chair mar, and thank you for the explanation to those very complex amendments. and i just want to add that, you know, this is a very important piece of legislation. supervisor ronen and i are working together on it. i think it's audacious to ask people to accept amendments that are this complex and this substantive without -- without having the police department even look at them, which is going to require them to report differently than they have been, require them to report differently than what is in prior legislation authorized by supervisor mar. i would like to ask diana, from the police department, whether or not she's seen these amendments and has any concerns or she would like some time to consider them and get back to the original author of the legislation? so, diana? >> thank you, supervisor stefani. chair mar, if that's okay with you, i'm happy to respond. thank you.

good afternoon, again, i'm the director of policy and public affairs or the san francisco police department. i, too, want to thank supervisor ronen for elevating this issue of domestic violence. i think it's really important. it's critical. we need not to forget the issues of domestic. for the san francisco police department it's incredibly important to help victims, especially of domestic violence. however, what i will say, we worked with supervisor stefani to go back and forth about what we're capable of doing given limitations to staffing. this is the first time we hear of this, nikita, so it would be really beneficial for us, given that we're going to be the department that actually institutes and reports on a quarterly basis, that we review and we agree and we dialogue with supervisor ronen's office and supervisor stefani to be able to decide on any

substantive amendments. it's difficult for us to expand the definition given that we would need to report. we're looking at earlier in this hearing on another item, we have such limited amount of capacity given union square, homicide in the mission district, homicides in bayview western addition, looking at increase around robbery, looking at increase with the issues going on with policing and limited amount of staffing. we want do what is best for the city, but we cannot agree on additional capacity for the department if we don't have the staff. i think for us it's critical if we're going to discuss an amendment, with etalk about -- we talk about that ahead of time. we spent three and a half months discussing back and forth with supervisor stefani's office. we're hoping the same courtesy. we worked in the past with supervisor ronen around other

amendments and we've gone back and forth to come up with a good compromise but also an important piece of legislation on other public safety topics that benefit the city. as of today, it's really sort of unfair for our department to step in and just hear the amendments today. because i have not received anything at all. neither has the chief. neither has s.v.u. or any of the staff. i apologize to throw that out there. we want to be supportive and make sure we're clear, but i hope you understand, we do need to be able to talk openly about what we're capable and not capable of doing. i would encourage us to read what is already out there when it comes to the quarterly requirements. we have a quarterly report already that is instituted that talks about certain specific fields around victims. i do think that, you know, supervisor stefani's legislation will actually make our reporting requirements more robust and it will be more specific with domestic violence, but we need to be all on the same page,

right? so i want to encourage just for the committee to really rethink about involving our department when it comes to some of these amendments. >> thank you, diana. i just want to say, too, i agree with supervisor ronen on needing more information and thank you for being thoughtful about this. and i think what we're getting at here is to have a proper framework upon which to pull out the data. and for me starting that framework within 273.5 and the 243e1 which is the fame work on which the san francisco police department is operating and the cases they give over to the district attorney's office, it is then within the purview of the d.a. to provide as much information as he wants. if he provides the information on those that are sent over, but if he can also provide information about other cases that come to him that he believes fall under the family code definition of domestic violence. so this is something, supervisor

ronen and i have agreed to work out. but to adopt amendments that nobody has really looked at, i think it's really irresponsible and i am not going to do it. and i would like the courtesy to just continue this item to the next meeting and continue to work with supervisor ronen's office in the process. and i'd like to make that motion, again. >> mr. chair, before any motions are made, i would like to make a clarification about the procedures. because this is a duplicated ordinance and has not been amended from the original version, the original version will go into effect on december 25. at this time, the duplicated ordinance will no longer be valid because it will be codifieding language. if we want to continue this, i would say that some minor amendment be continued, because

you will not be able to continue it if there is no -- >> thank you for that clarification. the next meeting of this committee is not until january 13th. >> understood. >> is there any part of these amendments that you would be willing to adopt today, supervisor stefani? maybe the amendments regarding what defines abuse? >> member stefani: let's see. i would have to have a minute. because i don't want to change the definition in a way that is going to make it very confusing for the police department to report out. based on, of course, what you heard diana say. so whatever we change, it's going to have to be something that doesn't affect the framework of the reporting and the structure that i have worked out and have worked on for quite some time.

so, i don't know, chair mar, if you want to do a five-minute recess so i can figure that out? i think to figure that out on the fly is -- >> chair mar: okay yeah. i hear you. we can certainly take a brief recess. i just want to see deputy city attorney pearson, were you going to weigh in? >> thank you, chair mar. as you are reviewing the amendments to see which if any you're prepared to make today, i wanted to make clear that our office prepared and approved as to form a set of amendments that i believe were circulated to the committee yesterday. there were additional records that were -- amendments that were read into the record today that we have not approved as to form yet. so the ones that i think you should be looking at are those that were circulated yesterday. thank you. >> chair mar, in the ones that were circulated yesterday, i only have the ones that i just got. very last minute regarding

allowing the d.a. to submit supplemental information. that would be okay. dominica, can you give me the old amendments? so under the old amendments, from yesterday, page 4, 1 -- lines 1 through 4, it says any report required, the district attorney may in discretion provide supplemental information regarding the domestic violence cases and victim services reported. any such supplemental information shall not include personal identifying information. i would be fine to accept that amendment. >> chair mar: okay. that's good. >> so, committee members, i

would ask you to adopt that specific amendment for now and if we could continue the -- the amended duplicated file to the next meet ongoing of the public safety -- meeting of the public safety and neighborhood services committee, that would be our request this morning. >> chair mar: sounds good. does that sound good to you, supervisor stefani? >> member stefani: yes, that's fine. >> chair mar: do you want to make that motion and then we can go to public comment. >> sure, i move that the duplicated file be amended to include on page 4, lines 1 through 4, the lines that i just read. i don't think i need to read them again. >> chair mar: all right. thank you. can we go to public comment? are there any callers on the line? >> yes, mr. chair. we're checking to see if there

are callers in the queue. for those who wish to speak on this item, please call 1-415-655-0001. enter the meeting i.d., 2486 673 7933 # #. when connected, press star 3 to enter the queue to speak. system prompt will indicate you've raised your hand. we do not have any callers in the queue, mr. chair. >> chair mar: great. public comment is closed. i would just move that we continue this item to the next meeting at the public safety and neighborhood services committee. which i believe is january 13th. >> and i'm sorry, just a quick question, would that specific amendment be adopted so we can still be working on it? >> chair mar: oh. >> we have to adopt that, right? >> chair mar: yeah.

why don't we do that? >> on the first motion to accept the amendment to item number 3 on page 4, lines 1 through 5, which is subsection f, vice chair stefani? >> member stefani: aye. >> member haney: aye. >> chair mar: aye. >> would you like me to call the roll on the continuation of the ordinance as amended? >> chair mar: yes, please. >> >> member stefani: aye. >> member haney: aye. >> chair mar: aye. >> clerk: there are three ayes. >> chair mar: okay. so we will come back to that on january 13th. thanks, everyone. >> thank you so much. madame clerk, is there any further business? >> that concludes our business for today. >> chair mar: all right, we are adjourned. thanks.

on for general public comment. we know it is important. >> agenda item 5. president's report. discussion item. >> no written report. i want to mention a couple things. as everyone is aware in 2022 health service board will look at strategic plan and i have been participating as an

observer in a number of webinars. a couple of issues resonate with me as we look to the future of the health service system and our responsibilities. first actually is a quote. it is anonymous from a cardiologist a friend of the moderator of a webinar i listened to this morning on the future of the healthcare profession in 2030. change is bad even change for the better is bad. that message actually resonates with me at times. i think probably with all of us. either ourselves, our friends, colleagues. the people in the community. change is difficult. we face this every day. we face this in a lot of arenas. we face this in the midst of

covid pandemic. part of our responsibility as it was clear from a number of the presentations our responsibility as board members of the health service board is not only to address this information which to be clear was in many avenues to make sure that we are addressing the issues or confusion that actual information that is being put out there. for example. some of the news agencies are picking up rumors that one vaccine may be better than the other. there are no head to head comparisons. yes, there are rumors. why would a news agency do that? part is to fuel confusion. what is confusion? fuels distrust. part of our responsibility is to

help deal with uncertainty. the uncertainties of the pandemic are daily. information changes from day-to-day, week to week. even information that is quite accurate. for example, israel is recommending a booster at five months. we recommend the federal government cdc recommends at six months. differences of a month fuels anxiety, uncertainty, distrust. who do we trust? part of our responsibility is to recognize uncertainty is part of the game. this is something that we have addressed in many areas over and over again. we need to continue to not shy away from the uncertainty but to educate ourselves, our family members, friends, health plan members, community about how

uncertainty is part of our life today. how to deal with that. the other issue i wanted to address briefly was a call by david brooks in the "new york times" by november 24th called the age of the creative minority. i won't repeat the column except to say that david brooks is trying to deal with many of the political issues that are facing our country and population. his solution is integration without as simulation. why does this resonate with me as physician, president of the board, board member, as we look at health it is not just enough to provide the same benefits

across the board. what we have to make sure is those benefits acknowledge that individuals have a right to their cultural, racial, ethnic structures history. we are not trying to fix all of our health plan members into one box, one manner of care. the themes that are emerging in the future of healthcare is that healthcare is going more and more to the health plan or patient, not trying to bring the patient into the health plan. in other words, that we make sure our services reach out. that means healthcare without walls. the way we function and what we are comfortable with are the

walls. come to us as health plan providers, participants and we will try to deal with it. that is not the future of healthcare. again, remind us that change is bad. even change for the good is bad. we have to address that. the change for the good still feels bad. it is our responsibility to help make it feel good for everyone, including ourselves. that will conclude my remarks. any comments from board members? go ahead, supervisor. >> i so appreciate that especially the comment about not to ask our members to the plan but bring the plan to meet our members' needs. i appreciate your leadership and

your comment today. thank you very much for your remarks. >> thank you. any other comments? we will open up for public comment. >> thank you, president follansbee. our support team is helping from the back end project our visual instructions. i will be reading those another aloud. i thank you for sending notices about public comment. we want that to be accessible to all public attendees. >> we had to postpone agenda

item 4 to address the public comment of each agenda item maybe be suspended. i will ask everyone until we get notification that public comment is suspended on that agenda item is to allow that we can open public comment members or listeners to call in to comment about any agenda item that is before us. i think that would mean this item we would postpone public comment until a later time when members call in. it is not an action item. i can do that without impacting the legality of moving on the agenda. if that is okay to board members and to our attorney, i would suggest we suspend public

comment until we have people calling in. any comment from our board members or attorney? >> good idea. >> it is a prudent strategy. >> i concur and ask eric to also give his verbal consent if he chooses to. >> can you repeat the question? >> we are having technical problems. the call in line is not functioning. >> i think on discussion items you can put the public comment off until the end. you have general public comment at the end. i will try to figure out what to do on the action item. go through the discussion items.

>> i will give item to action item 7. we will carry it over. we will address that when we get to number 7 as well. thank you. we will move to agenda item 6. >> thank you. we will move to agenda item 6. i am getting updates minute by minute. the progress is being made. i will check at the end of the next agenda item with public comment be accessibility. 6 is director report. it is a discussion item. presented by executive director abbie yant. >> good afternoon,

commissioners. may i take this opportunity to wish you all well during this holiday season. i hope you had a pleasant thanksgiving give the key word was that it was a quiet thanksgiving. if that is what you desire for christmas and new years and holidays to celebrate, i wish you well. as to my report today. it will be nice when we can stop talking about covid. we are about to end year three. the number was covid 19. we are at the stage in the pandemic where we are starting to appreciate the benefits of the efforts that have gone underway particularly in the bay area. we are grateful and blessed we live in the area that is

progressive in receiving the medical treatments and prevention measures that are available. we knew in our last meeting boosters were having a lukewarm recommendation from experts. that has changed dramatically. the demand on boosters is off the chart. i have to say i am so impressed with and you know i have worked in public and private health in san francisco for over 40 years. the collaborative around the around vaccinethe remarkable toe demands that have occurred. this booster demand occurred while many children were getting the first vaccine and many were getting eligible for the second vaccine time the booster demand

went up as healthy reaction to the identification of the new variant. also, i think again in the bay area people are compliant with the recommendations. we realize how safe it kept us through in pandemic. i hear stories about people struggling to get the booster. advice i give everybody go get one. i am not hearing stories of people being turned away. there are struggles for appointments. if there is an urgency you may have almost every site will take walk ins. i do suggest everyone do that. our staff has done that. reported in november we are back in the office and learning how to be in an office together. it has all of the benefits and

uncertainties that comes with doing something, another change, as president follansbee said. we are weary of change and we are trying to find our way through this transition period. also, in the report today for board members who are newer may not be aware of the process that this agency under went several years ago where we did audits of persons identified as dependents in the system. this is a sound business practice for agencies such as ourselves. we did find quite a significant number of people who were not eligible as dependents and were removed. we used outside resources to help with the audit a couple years ago. it hasn't been done in many years and we needed help with it. since that time our team,

capable team put together a plan to not only do thursday selfs but -- do this ourselves but in a way that is ongoing. audit one-third of the population each year to give a cycle every person will be audited every three years. we are very pleased to do this. it is good practice. i think just by doing it in this way we will reduce the number of persons who attempt to pull the system and have a dependent covered that is not eligible. we are in the contracting stages with the vendor to help with programming and other things that we need to do to institutionalize this practice. we are aiming for beginning of april. it is not date certain at this point. don't hold me to that date. that is our north star at this

point. you will hear much of everything else i have in the director's report. you will be hearing directly from our team today. that includes the racial equity planning and we do have a really stellar team to report out on the open enrollment activities that occurred. it was really a cool team effort this year. not that it is not every year, but they were new energy and ways of communicating. we were able to take care of that. i think we will speak to their activities with the flu clinic and then last but not least, of course, busy contracting unit that did have i will let the

team speak for themselves. you will hear from our leaders today. thank you very much. i will entertain any questions. >> open up for questions from the board. thank you very much for that. director this is a process question. we need to say a third of the population. i presume that is by random selection of some kind. >> yes. i am not sure what we are cooking up. it will be a method that can be built upon. i don't know the exact rules yet. >> thank you. >> any other comments or

questions from board members? i think it is did to get this issue about the confirmation of dependents on the agenda in advance. it created a fewerrow the last time. it -- furor the last time. with the work of your staff, people did understand that it was a benefit to them to make sure that their health plan was subsidizing people who were truly eligible. i applaud the efforts to do it in a structured way. any other questions or comments? holly. what is the status of public comment? >> we are getting reports it has been fully restored. i check the website and our

e-mail. it does look like people are able to enter in and we can identify callers in the queue as of now. thank you every one for being patient. >> i realize it is frustrating. if we could ask caller to first of all, stay on the line if you want to speak on this agenda item or any previous ones. because of the confusion we will take in the order they called in not try. we can't tell from our end who is calling about which agenda item. apologies to director yant we will open the calls. some may deal with earlier agenda items. with that we open up the call line. >> thank you. we will display the instructions and i will read them. public comments will be available on each item on the

agenda. each speaker is allowed three minutes unless there are new time limits. comments are concerning the agenda item presented. the caller may ask questions. there is no obligation to answer or even gauge in dialogue with the caller. state your name clearly. when your three minutes ended, you will be on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv. opportunities to speak are available by dialing the number on the screen. 415-655-0001. when prompted use access code 24861164844.

then press pound and pound again. enter the meeting as attendee and dial star 3 to be added the queue. when the message says you are unmuted that is your time to speak. if you are on hold wait until the message indicates you are unmuted. sfgovtv has a standing 40 to 45 second delay for viewers watching online. we will take a 45 second pause to allow the system to call in and viewers to dial in. the 45 second pause begins now.

>> we have four callers on the line. reminder to all callers, you must dial star 3 if you want to join public comment for this agenda item. you will hear a moment of silence. escalating first caller now.

>> we have a three minute time limit. >> welcome, caller. >> good afternoon, i recently retired from the fire department after 30 years i am part of the peer support and critical incident support for the san francisco fire department 1700 uniform personnel. the behavioral unit has two units for those in crisis. they are responsible for current members of the fire department, families, retirees and their families. they face over 100 incidents each month due to a crisis. the safety wellness team says the position office and firefighters recognize the need for mental health for members. resources are available for

members. employee assistance, future care program and fire chaplains. i would like to discuss the specific treatment dedicated to firefighters. international association of firefighters for behavioral health treatment and recovery is one of a kind specializing in ptsd for professional members struggling with trauma, substance abuse and addiction. it is currently located in maryland, outside of washington, d.c. they will add another facility in california in 2022. it treated more than 2000 firefighters and dispatchers for every state in the u.s. for last five years. most of san francisco insurance options do not permit members to access this care unlike firefighters in other parts of the state. i would like to give our members the opportunity to have an option to attend this facility to receive specialized treatment

for behavioral health issues. we can contract for care and payment as many other health plans have done. this would be an in network option for members. the treatment at coe is no more expensive potentially less than other treatment programs in california. they have high return work rates and low readd mission rates. 46% every lapse for treatment compared to 6.5 for the center of excellence. this is the best case situation for san francisco for employee investment. keeping the firefighter on the job rather than trains a new one. it assures not paying claims multiple times. this is a priority for the san francisco firefighters 798. i would be placed on the january agenda to open discussion directly with the center for excellence for employees. i e-mailed contact information

and would like to set up a meeting with staff for further discussion. thank you for your time and attention. >> thank you, caller. we will elevate the next caller. >> one other caller in the queue at this time. >> welcome, caller. >> good afternoon, commissioners. i am with the national union of healthcare workers. we have about 4,000 members who are mental health commission who work for kaiser. i want to thank commissioner co n nie for doing the letter of inquiry with health service system and current tore for filling that out and attending the hearing in the oversight committee to look at access issues for health plans and

specifically the keysser health plan for the health service system of san francisco. what was really incredible about the hearing was the difference between what kaiser was saying, what the access issues are for receiving treatment for behavioral healthcare and what the clinicians were saying. kaiser was saying their data which is self-reported meets the timeframes that required for access. in fact, they report that information is inaccurate and that the clinicians are only able to provide when the next available pointment is. this is a critical recommendation when it is not. treatment doesn't begin until several months after the first and second intake call. this was revealed in the

hearing. kaiser officials were not able to defend that very accurately. it begged an important point that is clear that we need to make sure our health plans provide the access that kaiser says they will provide. for the 55,000 people enrolled in the san francisco health plan, this is the significant issue. we committed to the commission a summary of the hearing and some recommendations about how to proceed into the future especially when it comes to negotiating a new health plan with kaiser is that we add language that stresses receiving accurate information around the access for timely care and treatment that we inform the plan that we are negotiating the

new legislation that requires the access into effect next july s b-22 1 with metrics that can be tracked, followed, held accountable and to make sure the oversight body for the state of california receives accurate information from kaiser about what timely access is. the department of managed healthcare. we hope that -- >> thank you, caller. next caller. >> thank you for announcing time limits on public comment. we have one hand raised. someone who has already spoken. reminder to please dial star 3 one more time so you can lower the hand so we know which callers have been attended to. i have a new caller that entered

the public comment now. >> welcome, caller. >> hi. can you hear me? >> yes, you are loud and clear. >> good morning. i am a therapist at kaiser call center in san leandro which serves northern california. i am member of the uhw union. on october 21st the board of supervisors held a hearing about the difficulty sfhsf members have accessing behavioral health services by kaiser. the director reported back. i was a presenter at that meeting. they only had access to self-reported data from the department of managed

healthcare. on you presentation we were able to correct this misleading information and state that patients routinely face longer wait times on average of three months for ongoing treatment for mental healthcare which harms progress and has impacts on the city. kaiser confirmed that the data only referred to initial appointments. then claimed the 84% for treatments within ongoing treatment fall within the therapist recommended timeframe. that is manipulated data. kaiser's appointment system is designed to force the therapist to choose the time that is happening in the system, not what is recommended but the template says recommended. so many of us are new to kaiser and want to keep our jobs and

be? good standing with the manager. to many of us misrepresent the data in charting balls our managers tell us to even when we is say i would rather the patient be seen sooner. three months is inappropriate. my experience is that kaiser patients suffer from the long wait times which are way beyond what is clinically recommended. we shared the information with the board. we presented and asked that the board consider it to strengthen the data collection and asks that hsf take accountability measures in future contract with kaiser to make sure the patients get the care they deserve. we hope you take this information seriously and set aside time on the agenda to work

towards these accountable measures. i would be glad to answer questions as i was a presenter in the initial meeting. thank you. >> feel free to check if there are more callers in the public comment cue. >> reminder to dial star 3 if you have spoken to indicate your land is lowered and your call is attended to. we will wait five more seconds for any other callers to enter the public comment queue at this time. >> from are no more callers in the public comment queue at this time. >> thank you. no further callers, public comment is now closed. >> thank you very much for the

callers. thank you for your patience in terms of holding the comments until we got the technology up and running. we appreciate both e-mails and very balcomments today. with that i will close item 6. we will move to item 7. >> dr. follansbee, could i comment on the last public comment. >> of course. >> i would like to ask supervisor chan. it is only fair that you do the same analysis on blue shield and united healthcare instead of just kaiser. it seems unfair to just do one plan like that when i am sure there are issues in all plans. is there a plan to do that in the near future? >> absolutely. in fact, the item at the city

government and oversight was continued to the call of the chair. we definitely intend on the board of supervisors committee to actually exam further about mental health services provided across board. we were glad there is public comment made today. i wanted to urge this commission and this board to really direct our staff to think about how to really have not just kaiser but contract serving our members all across to make sure there are timely mental health services provided. not just those who sign up with kaiser. what can we do as this board to ensure quality and timely services being delivered for all members. i want to add to the this as

well. it is to respond the first public comment made by our retired firefighter. i also want to reference back to president follansbee remarks to think how we do we taylor our services to meet our members. in the case of firefighters think about their needs not the same as other members that we serve when it comes to firefighters and first responders. the ptsd they suffer may be related to mental health and other needs could different and the services should meet them and their needs. thank you. >> thank you. we will get a report on blue shield and the other plans that we use. >> thank you. >> thank you very much.

moving to agenda item 7. >> 7. black-out period notification. this is an action item to be presented by abbieiant. >> this was presented fully discussed with public discussion. unless director yant wants to extend beyond original notification. i would like to go ahead and pick up where we left off. that was, in fact, the vote. currenttor yant do you want to modify in notification. >> i do not. >> i am going to use the president's prerogative to calm for a vote on this item fully

addressed at our november 18th meeting. unless there is objection from anyone else on the board. with that all those in favor of the black-out notification presented november 18 and restated in this agenda state aye. >> opposed. thank you very much. it passes unanimously. agenda item 8. >> health service system financial report as of october 31, 2021. this is a discussion item to be presented by the chief financial officer larry loo. >> thank you. good afternoon, commissioners. this is the chief financial officer of health services to

read through the highlights of the financial report for the health services system through october 31, 2021. it is available online. some highlights from that write up. as of four months of reporting, we are one-third of the way through the fiscal year. just to remind commissioners we have two sources of funding. one employee trust fund and one through the general fund administrative budget which is through the mayor's office. with regard to the trust we are to have a year increase. $3.8 million. to end with net positive balance $129.7 million.

a good source of the increase in the trust fund is through our plans. we have $6.1 million increase in the funds. large part of that is due to the expected pharmacy rebates we are typically receiving. we have receive $1 million in terms of the rebate. another source that increases are trust fund specifically is the performance guarantees. this is an area where we expect not a lot of administrators are doing a fine job. they are not requiring to pay penalties or guarantees. year-to-date this is going to change from the previous report of receiving $21,000.

another source of funds is through the interest we receive from the pooled investments of the city. year-to-date we have not receive any posting of interest from that. within the trust is healthcare sustainability fund used for the members. overall well-being programs and initiatives we may embark on to reduce cost of care. [please stand by]

questions for mr. loo. >> i have a question about the trio plan. i noticed the expenses were 1.6 million greater than revenues. i think the last couple of reports, it was true that the expenses were more -- am i correct about that? when we first introduced trio, we were at a loss for quite a few years anyway. it didn't appear it was doing very well and then levelled off.

>> there was a trend of expenses going over revenue. a lot of the costs are cases that are appropriate. they are catastrophic. we work with blue shield to monitor and make sure everything is appropriate. at the present time, it is hard to say. it is only four months in. over time, if it's a non reoccurring cost it should be fine in the long run. >> i have the same question for the united healthcare ppo.

i was wondering if some of these catastrophic cases could be tied into the pandemic, people were hesitate to get regular care, follow up and we're seeing catastrophic complications of underutilization of care during the sort of height of first and second waves. i don't think it's a question you can necessarily answer but throwing that out there as well. >> we do an annual utilization report to this board. mike clark is on the call and can probably tell you better than i can about when we do that. i think larry's comments about being premature to talk about this is quite true. your questions are valid and we'll address those during the review. >> thank you. any other questions or comments from board members? thank you again. the format of this is useful, to

me, i'm assuming other board members and our public as well. i appreciate your attention to that. any other comments or questions? if not, i'll open up for public comment. >> thank you president follansbee. i'll read the instructions and visual instructions in a moment. public comment is available for each item on the agenda. each speaker is allowed three minutes to speak. all public comments made on the item presented. there's no obligation for the board to engage or answer the caller. you are encouraged to state your name clearly but may remain anonymous. you will be placed back on mute and then the next caller will be

unmuted. the number is 415-655-0001. when prompted, use access code, 2484 116 4844. then pound and then star 3 to be added to the public comment queue. for those already on hold, please continue to wait until the system indicates you have been unmuted. there's a standing 40-45 second delay for viewers watching online. we will take a 45 second pause to allow the system to catch up

and callers to dial in. it will start now.

our moderator will notify us of any callers in the public comment queue. >> thank you board secretary. we have five callers on the phone line. one caller has specifically entered the queue at this time. a reminder to callers that have spoken in previous rounds, your hand will remain raised unless you press star 3 again. the hand has been lowered and no other callers in the queue at this time.

a discussion item to presented by sfhss staff. i'll change presenter privileges.

thank you for your patience. i wanted to announce that this agenda item will be presented by olga stavanskaya-velasquez, our operations manager at sfhss, rin coleridge, analytics director, jessica shih and carrie beshears. >> thank you. good afternoon president follansbee and commissioners. my name is olga stavanskaya-velasquez, i'm the operations manager with member services. the member services staff are responsible for determining eligibility of our members and their dependents. they review the members cases, guide them on steps in the

enrollment project and support deescalating member issues. the member services staff process a variety of reports both internal and external from our plans to be sure member eligibility and information is accurate. this year's open enrollment was virtual and ran from october 1st through october 29th. member services did not provide face to face counseling to members. instead the focus was by providing support through phone and virtual one-on-one consultations with microsoft teams. the consultations began in june of 2021 for retirees and by september, extended to include newly hired employees and employees with changes in their circumstances. the consultations continued through open enrollment for members to schedule

consultations on their own time. in preparation for the increase in the call volume and increase in virtual consultations during open enrollment, member services staff started working in the office three days a week to be sure there was limited disruption due to technical or connectivity issues. member services staff went through training on the newly offered care plan on services, on the blue shield plan and internal business processing system. the planned trainings occurred multiple times starting in august to allow for member services staff to absorb the new information and provide feedback on the types of questions members have on the plan. the second training on both plans occurred closer to open enrollment, preparing staff to support members based on feedback we received. now i will turn to statistical

data to illustrate the success of this year's open enrollment. we saw a slight decrease in the number of phone calls this open enrollment compared to last year, however, this is the fifth consecutive open enrollment for which call volume has dropped. i want to highlight the significance as it comes as a time that a new plan was introduced to our members and typically lead to an increase in calls. members are still learning the self service portal and face to face counseling was not offered. our speed of answer did increase this year, meaning the hold times were longer for our members, attributing that to support who requested a walk-through of the service portal. the average call duration was under seven minutes but there

were quite a few calls that lasted significantly longer and we again attribute that to the walk-through support members requested with the self service portal. jumping down to paper applications received, we saw a decrease of 34% in the number of paper applications submitted by members and an increase of 25% in the number of self service submissions. these changes and the method of submitting open enrollment elections led us to believe the membership is getting more comfortable with the use of the self service portal and we are encouraged that next year we'll continue to see the increase in the use of self service as members build familiarity with it. i do want to mention that although we are seeing a decrease in the phone calls and paper applications submitted, member services staff are still responsible for processing the paper applications we do

receive, finalizing self service submissions and cleaning up exception report data, generated before members receive confirmation letters and before member information can be sent to the plan. this slide illustrates the flows we saw with the paper applications we received throughout the month. it is quite typical of open enrollment with the increase happening toward the end of the month. in looking at the data on the previous slide and on paper applications and here with e-benefit submissions, we see some correlation between when members submitted elections for open enrollment and e-mails released by the hss

communications team. this leads us to believe the call to action in the e-mails and information in the webinars drove members to make their election. are there any questions on the member services sections before i pass the presentation over to my colleague, rin coleridge with enterprise systems and analytics? >> yeah questions or comments at this point? >> i applaud the whole staff for a process that seems to be smooth, at least from my standpoint at this point. >> and this is commissioner hao, i want to commend you for the excellent customer service you

continue to deliver to health service members. >> thank you commissioner. >> any other board comments or questions? otherwise we'll turn it over to rin coleridge. >> just wanted to say that i thought a very smooth process this year. and i think you're right, members are getting used to doing this electronically and it is going better. kudos to the staff for the improvements and ease of use. thank you so much. >> thank you for the feedback. >> okay. rin coleridge, director enterprise systems and analytics. next slide, please. commissioners, we do a lot of systems work, but we do a lot of other support, too to help ensure a smooth open enrollment and there was a significant

effort around communication to try to simplify for our members this year. we started a long time ago with automated change of address, we do right before creating the mailing letter data files, well over 76,000 letters that go out that we're making the records be ready to go. we did a few specific things this year to really assist our members for a smooth transition and to various new plans. so for example, we identified the members who were going to be impacted by the new administrator, the ppo to blue shield to do targeted mailing and we provided enrollment data ahead of when our normal system files go out to get a jump on their communications and ensure that those new plan members had an opportunity to select their pcp in time for id cards and alike and they were very thankful to us and communicated

to us how smooth the onboarding was working with hhs. we went through early test files to help assure that and we got data over to blue shield and assisting in the transition. those are extra items we did. we also do other things like assisted with internal training and producing the webinars from a technical perspective and helping to set up bookings for the member consultations that member services did. next slide please. so yeah, the big focus is continuing to advance the adoption of e-benefits. this year we finally on boarded the community college of san francisco, the final employer we have now on self service. we also handle like password resets for retirees, writing

audit queries so we could make sure events were being processed. on the right, let's look at the numbers. so 10,539 submissions came in online. you can see the distribution by our various employer groups. of course the largest there being one of our larger employers. and then the comparison to paper. let's take a look next slide please. here's the five year trend line. we have in blue is paper, in orange is the benefits and as you can see, that is continuing to trend up. two years ago that was around 63% i believe and then last year we got to somewhere around 84% and this year, extremely successful, well over almost

92%. that is just extraordinary. it is really right there an indication of the success we were able to achieve and all the work done to really help with the system and communications and materials so our members had the ease and option of going online. next slide please. here's a preliminary look at medical enrollment. i'm not going to go through all this. in february, we'll bring different graphic report to you that will give you greater detail. just a note on what you're reading here. first off, it looked like we gained 720 enrolled members over the previous period and for us here, previous period is looking directly just a month ago and we're doing that because we really are trying to ascertain what happened as a result of open enrollment versus the course of the year, we have

retirements and new hires being brought on, family status changes. so we try to eliminate all that noise and focus on what did people do with open enrollment elections. next slide please. the column is enrolled in 2021 and now for 2022. if we look at that first number there, 49 means the 49 subscribers into health net for 2022 were in blue shield access plus in 2021. so that's how you read that slide. next slide please. also, i know it is important for us to keep track of this special

population we have. this is our split carrier. this is the highly specialized administration we're doing for members that we have that are mixed medicare families but we have their benefits across two different carriers, between united healthcare and blue shield. fewer people that meet this scenario for 2022. some of that as a result of people aging into medicare and no need to do this split solution we have. next slide please. here's a look at preliminary enrollment and, again, it looks like variants, positive increasing enrollment in our dental plans for 2022.

next slide. here we're rounding out with looks at vision. this really continues to be a very popular benefit that we're providing to our membership. you can see the total variants there. 1555 new prescribers for the 2022 plan year and a quick look at the voluntary benefits that we offer and keep in mind that voluntary benefits are only offered to employees of the city and county of san francisco and superior court. i think that brings me to the end of my slides. so before we move into the next section, are there any questions or comments about this portion of the presentation?

a member -- not medicare member partner, can they choose canopy or does it have to be blue shield? >> it has to be blue shield and not only it has to be blue shield, it has to be trio or access plus. >> why? >> we do not have the arrangement set up with healthnet or blue shield ppo at this time. >> i think in the future it should be allowed. >> i just wanted to thank you. i always look forward to your

analytics when i break it down. my little brain appreciates that, to see how our membership fares throughout the process. so thank you. >> thank you commissioner hao. and with that, i'll pass this along to jessica shih. >> thank you. good afternoon commissioners. i'm the communications director here at hss. and i have the pleasure of walking you through the communications goals, strategies and tactics we used to achieve the great results this past open enrollment. next slide please. our objective is to educate our members about the new benefit options and changes to existing benefits so they can make an informed decision to help them elect the benefits that best meet their needs.

we really wanted to reduce unnecessary calls to member services, increase benefit elections through our self service portal and decrease paper applications and this year, we wanted to address member concerns over our ppo administrator change. next slide please. so for the communications strategy, we wanted to be intentional with our communications and move our members on this path of creating awareness to driving members to make their elections using e-benefits. you can see in this little chart here that we started them -- creating awareness mailing their packets and sent out e-mails two weeks in advance of open enrollment and then directed members to learn more about open enrollment through the booklet, open enrollment webinars and

comprehensive web pages. as we received feedback from members, whether they called member services or we're getting the feedback from what members are clicking on in the e-mails or website, we would modify our communications based on that feedback. we would encourage our members to get help through health plan office hours. our vender and open enrollment webinars and of course through member services so they can eventually make their elections online. next slide please. so our tactics to reduce unnecessary calls to member services was we did a couple of things. one, if you remember, we had that open enrollment video. in the past we would do almost every communications was a summary of open enrollment. this year we were very

intentional, just asking members to open the open enrollment packet and review the packet. the view was cute and we used our own member's children and it received 1300 views. then we distributed a series of six e-mails and we sent that e-mail intentionally on monday every single week. leading up to open enrollment and throughout open enrollment. you can see for active employees, we had over 29,000 members and for retirees, over 16,000 members. for those e-mails, they were always sent on monday's because we wanted people to know what are the upcoming webinars and things we're doing to support them and open enrollment choices and options to pencil our webinars into their schedule. and monday, i'll share this

later, it was e-benefits monday. we always had the webinar on monday's. the e-mails were meant to drive our members to our open enrollment landing page, which received over 18,000 views during the month of october and we were driving members to make their election on e-benefits and we had over 4500 views on our e-benefit's page. we developed alternate avenues to get help, asking all our health plans to offer one-on-one counseling for our members and partnered with venders very closely on micro sites and the webinars and our comprehensive open enrollment web pages. next slide please. and then the tactics we used to

really increase election using self service and reduce paper applications, as you saw the numbers earlier, we decreased by 34% over last year and increased e-benefits and self service use by 25% this year. that is a big jump for one year. and what we did, we had 23 hss sponsored webinars and some were for navigating and using the account and registering for the account. i want to thank my partner who supported us in our webinars. it really took a village to pull this off. this was also the first year we did not mail members paper applications, which is why you heard earlier there were a lot of calls to member services helping members walk them through using e-benefits for the first time. and we gave incentives to

webinar attendants with an open enrollment raffle giveaway for attending. and it ranged from 20-200 per webinar with an average attendance of 94 per webinar. next slide please. what we did to address that blue shield was going to be the new administrator for the ppo plan, first, we e-mailed all of our existing ppo members, over 1200 of them, a postcard to let them know about the change. we were very intentional to give them just enough information to make them aware to move to the next step. then we followed with an e-mail to all impacted members informing about the change and

letting them know where to go to get more information. by then, blue shield had built up the micro site that had information for members to be able to see if they want to check if their doctor is in network. finally, i think it's about another two weeks after that, blue shield and their customer service telephone all of our members and left voicemail messages if they couldn't reach them to let them know about the change and answer questions they had. from those communications, the feedback including it was difficult for members to figure out if their doctor was in network if outside of california and because it is called blue shield of california, a lot of our members who live outside of california were concerned that their doctors weren't in network. we worked with blue shield to address that on their micro site and finding out to make it

easier. we wanted them to have an alternate source to get information. we developed a new calendar for our webinars. in the calendar, once the webinar happened, we would post the video up and members who couldn't attend could watch at their leisure. we also use this heat map tracking tool, which is the images you see to the left of the screen here. that showed us and told us what members are clicking on. we knew -- as you can see at the bottom, a lot of members from csf were clicking on to see what their benefits were. the other thing we did, we created a smaller banner. this was feedback we received

one-on-one feedback from our members last year when we were trying to get feedback about our website, with the large banner, members didn't know there was still content below it. we created a smaller banner so they could see oh, there's content there and we added the left hand navigation to help members navigate to the information they are looking for quicker. and we gave placement for health plan office hours. we put it towards the top. we wanted to drive members to ask about the plan benefits and what the differences are so they can learn about the different choices they have. next slide please. and this is a first this year. we had a new health plan and we really wanted to promote and let members know, there's a new

benefit we have and we want them to consider it if it is a good option for them and their needs. we supported creating awareness about new health plan and featured stories about health net. they were featured in our weekly open enrollment e-mails and did three webinars called is canopy care right for you. we asked different departments if they were interested in having a canopy care table at their on site flu clinic and three were really interested and invited them to participate. and we had e-mails, website promoted them, the different webinars and of course the vender materials all encouraged members to schedule office hours and appointments. and a placement of a full page color ad in all of our open

enrollment mailers. we invited all of our health plans to share what makes their health plan different and unique. and we let them run this color ad. we had ads for all of our health plans in our mailers. next slide please. and this is a result of the total packets that were mailed. as you can see, this year we had a slight increase over last year by a couple hundred. this is really my summary for what we did to ensure successful open enrollment this year. do you have questions? >> if i could just -- i'll start. one thing, i think probably is my provider in the plan is very stressful for members. you eluded to the fact there's some sort of questions coming from people out of state.

were those successfully dealt with, did you get further feedback on the process. and the second question, was there a target for what the enrollment in canopy care would be for the year? was it a successful launch? how does the system -- how does staff see the enrollment in that regard? >> thank you dr. follansbee. for your first question regarding finding out if your primary care physician is in network, most of those questions were reporting the new ppo plan, the blue shield of california plan. we did work closely with blue shield to make it easier for members to find out and so some members called our member services and others we found out because blue shield was proactively calling all of our members and that was the number one concern, while on the phone with blue shield, blue shield

helped them check to see if their providers were in network. also, blue shield offered members one-on-one office hours and members took the opportunity to reach out using that avenue as well to check if their current pcp was in that network. there were several ways to identify that information. for those technically savvy, they were able to go online and we worked with blue shield to make it easier to find that. it was a little challenging. there was blue shield of california and this is part of the national network access they had. and for canopy care, we didn't start with a goal.

we tried to create awareness to let everyone know about the new plan and benefits. ultimately it is the member's decision to make that decision on what is best for them and their family. >> thank you. other questions and comments from board members? >> can you clarify, when you talk about putting that canopy information in all packets, that didn't go to retirees, right? >> it actually did go to retirees. many of our early retirees do have access to the plan. >> medicare advantage. >> that is not a medicare advantage plan, correct. >> so it's not quite true it went in all packets. just being picky.

sorry. >> thank you for that distinction. >> this is useful information i want to go back with rin coleridge on her details, too. this is very useful for us who want to see the numbers and watch to see how many of our members do what and also that we're moving away from a lot of paper into more electronic access and activity. i think you're to be complimented on that. thank you very much. >> thank you commissioner zvanski. >> i wanted to comment on this field trip video. it was good. these children seem like professionals the way they got up there and said stuff.

i thought it was one of the cuter videos i have seen. thank you for that. >> thank you commissioner breslin. we're already brainstorming ideas for next year to up the cuteness level and sfucs has offered to use one of their facilities. >> i think the board members are cute as well and you could use us. >> i may take you up on that offer. >> i wanted to talk about the open enrollment, particularly around communications. there's been a remarkable steady progress over the last three to four years in improving the outcomes of open enrollment, the clarity of the communications that when you started a few years ago the logo of faces of

open enrollment and so forth, the whole process has become more and more and more friendly, user friendly, member friendly, as a result. and i would like to commend each of you on your work leading up to today as well as the results that have been achieved. and your staff's. >> it really does take a village. thank you commissioner scott. >> we can move on to the next part of the presentation, a brief update on the flu shot clinics? >> good afternoon commissioners, i'm carrie beshears, the wellbeing manager. i'm going to spend a few minutes talking about the success of the work site flu clinics this year. we hosted 23 clinics at 22

sites. of those, seven were open. we identified open clinics as locations where employees and retirees and spouses and domestic partners of retirees are eligible to get their flu vaccine. we had 16 of the locations were restricted or department specific where there might be some guidances or rules and regulations the get access into the building. we added four new clinics this year. i wouldn't say they are new to our clinics we have offered in the past but we did not offer these clinics last year due to some of the safety guidelines and those are at the port, city hall, library and that is a great sentiment to the changes we have seen over the last two years with obviously covid and the opportunity to allow for

opening up of other work site locations. we provided 57 high dose flu shots as well. we did have a couple of new things happen this year for us. we did start earlier. we had a couple of clinics that began at the end of september versus october like the previous years. and our team provided the full 100% administrative duties at all of the clinics. we have been at the clinics providing support but we were able to step up and help with all administrative responsibilities. and since we're here in year two of these things happening and covid, we developed best

practices that we were able to pull over this year. one is we have planning logistics. we meet with our provider and all of our locations and our site contacts prior to the event and work out all of the logistics, safety issues or concern, which had some changed a lot from last year. there were a lot of things lifted and then floor plans that help in the sense of ensuring that we had safety and everyone felt comfortable obtaining their vaccine this year. so that concludes the flu report and i'll open it up for questions. >> was this an overall increase in the number of shots given year over year? >> it actually decreased this year which was slightly interesting for us. there was about a 13% decrease. right now we don't have all of the data from the health plan since we are technically in the

flu vaccination season still. so we'll be able to get a better perspective if we see a jump at the health plan locations but we do feel going from last year to this year, a lot of people are more comfortable with understanding what their options are on where they can get vaccinated. i also know that kaiser opened up some facilities at their local pharmacies for people to go. making it easier for individuals. i know personally, i did the drive-thru with my family last year and this year. >> i would also think a number of covid sites were offering flu shots as well. >> right. we do feel offering this at the work site is convenient for

those going in and very much a success. >> i would agree. >> i would also agree and say again, it is part of our mandate to see that the care comes to the patient rather than demanding the patient come to the care site. this is really a step in that direction. does the flu vaccine get forwarded to kaiser and blue shield, etc cetera for their health plan. >> we use kaiser and have for a number of years to help facilitate the vaccine. on the informed consent, they're asked to implement the kaiser number so that will be placed into their medical record. for non kaiser members, what we

have worked out is to encourage those who want proof to be able to take -- in the last two years, an image. we used to have a carbon copy handout to show their physicians or primary care physician. it was up to the member. >> i eluded to influence of vaccine has -- is that interface between our own individual care and also that of the community.

so those -- that information should be a quality measure that we look at with each of our health plans. thank you for encouraging that. questions or comments from board members? >> this is commissioner zvanski. bringing them to the work site is i think significant. when i first started working for the city, we were required to live in the city and easier to access services here. now a significant number of our active employees live outside of the city of san francisco. and as a result, might find it more challenging to either make appointments to get the flu shot or the covid shot or just have

other difficulties because of the need to commute and having these opportunities available at the work site, i think is really significant and it's probably what has contributed to us having a very high vaccination rate as city employees, i think we have one of the highest vaccination rates of any employer around. i would credit the fact that these clinics and the shots were available closer to work sites as being responsible for that. i think it's a brilliant move. thank you very much. >> thank you. anymore comments or questions? if not, i'll open it up -- >> i was just going to say, a lot of us love the drive-thru. thank you kaiser for the drive-thru. >> if not -- >> i just want to note for the record, i arrived and i'm happy to be here.

thank you. >> we'll open up for public comment. >> thank you president follansbee. i'll read the instructions out loud and present them visually in a moment. public comment will be available for each item on the agenda, each allowed three minutes to comment unless the board president deems new time limits. all public comments for the agenda item presented. there's no obligation for the board to answer or engage with the caller. when your three minutes have

ended, i'll thank you for your comments. remote viewing is available on sfgov tv. opportunities to speak during the public comment period are available dialling the number on the screen. the number is 415-655-0001. when prompted, use access code, 415-655-0001. then press pound and pound again. you will enter as an attendee and dial star 3 to be added to the queue. when system message says this line has been unmuted, it is time to speak. for those on hold, please continue to wait until the system indicates you have been unmuted. there's a standing 40-45 second delay for viewers watching online. we will take a 45 second pause

for callers to dial in. it will start now. our moderator will notify us of any callers in the queue. >> we have three callers on the

phone line. zero callers have entered the public comment queue at this time. a reminder to all callers on the line, you must press star 3 to join public comment for this specific agenda item. we'll wait five more seconds and then close public comment. there's still no callers in the queue at this time. >> public comment is now closed. >> thank you. this concludes agenda item number 9. i think it's a good time for a break. we have a very full agenda. i want everyone awake, attentive and stretched for each of the items. and we're about 15 minutes behind schedule. i remind all of us moving into the second part of the meeting

this afternoon, but right now we'll have a 10 minute break and resume with a roll call in 10 minutes. thank you very much.

thank you, president. roll call. [roll call]

>> secretary: thank you. with that. we have quorum. >> president: great. we'll move to agenda item number ten, which is discussion. >> secretary: thank you. agenda item number ten, review findings for medical market plans. this is a discussion item and will be presented by ann thompson and with h.s.s. contracts manager michael viscante.

>> thank you. my colleague is going to bring up the presentation right now hopefully we can get that screen up there. perfect. let's go on to the next page. today's goal is to inform the h.s.b. of the conclusions of the r.f.i. process we just completed. we have a section on financial perspective and then we will get to the conclusion of the market advantage plans for a new process i've just wanted to

take a look at what we're doing to enensure and that goes on year after year we do review the plans and make sure they're performing the way we want. we've done some marketing in the past and most recently the active or early to that kind of wholistic perspective. with that market update, we put

the goals together for an r.f.p. in june 2021. we've reviewed the process in office. we've reviewed the final time so just to get to the bottom line first, we'll go to the slides and come back to it. sfhsf is staffed with the current plan leaderses. so as such, this report will close out the will close out the market process. so we will go into the next slide with a little bit of

background on the process and timing and the contracts manage. >> as we have gone over on previous meetings, the r.f.i. process was a very straight forward one over the last few months. we began with the august 12th, 2021, meeting sharing the decision with the r.f.p. prior to doing and to allow

responsibilities namely, we are allowed to bring a wide number of our internal personnel. and our senior health program planner leticia pegan. we were also able to bring in our team members again, the r.f.i. process culminating with this meeting and this discussion here. again, we posted the r.f.i. back on september 27th, 2021, and we received a response from a number of our parties. kaiser admitted health care as well as responses from blueshield and health net as

well as aetna. to discuss the responses from proposals on november 8th, 9th, and 16th, and, again, as mentioned, we had additional members of the team. we had dr. lioness lane. the as well as a retiry medical specialist. the team met as a group and discussed in-depth all of the r.f.i. responses and with a company by and supported by ann thompson and mike clark, our team and consulting team as well as the contracts team represented by myself. i will now hand these back over to ann thompson to go over kind of the details of the r.f.i.

process in what we found in the learnings we obtained from these robust discussions. >> thank you, michael. so the two slides that we found during the process. so things like the use of predictive modelling to identify individuals who are likely in need of intensive health care services is standard industry practice. many if not all added or offered value added programs so those are things like meal delivery, transportation, dental, exercise, fitness. we found that was a common practice. which are the encumbent plans. our star rating of 5.0 and there were the only two in

compliance for 2022. about the cms star rating and kind of what goes into that which is a lot around quality and satisfaction. so having a 5.orating is significant. as for kaiser, they leveraged in-patient hospitalization data to implement a modelling tool to implement hospital safety. u.h.c. looking at zip codes of where your current retiree population is. for the respondents. kaiser offers if they transition from premedicare to medicare. and health net partners which we're familiar with on the

active side to provide plans and primary care. we can go on to the next. management programs that stratify programs. it's standard industry practice. we saw some industry leading programs which we're familiar with. healthy at home and point of care assist which is looking to help members transition from hospital to home and point of care puts more data on the provider on the patient so that they can provide real time care. so things like prescriptions and formulary. our national carriers are leveraging robust open access p.p.o. networks. so providing access to any medicare provider nationwide. and so we have talked earlier about split families. most proposed utilizing a third

party vendor to support the administration of the population. it was notable that u.h.c. did offer a $300,000 fund to help with programming fees to make this process a little bit easier over the next few years. and another note is on kaiser. so we currently over them in california, hawaii, pacific northwest, and washington. and colorado and the mid atlantic region in georgia. carriers identify and collect information through a variety of programs listed here. several are carrier sited participation through their individual plans versus group which is what we have. but the participation and disease based on insurance design model. most carriers are still in the

data phase and have not expanded these programs nationally. so we're going to keep an eye on those. most offer incentives to encourage appropriate wellness care and specific carrier call-outs. that's the support in transitions from hospital to home. looks at readmission risk. also a determinence of health. and their members successfully completed wellness of medicare. so in conclusion, hsf is set aside with the current medicare plans as industry leaders in support -- and update support polls and objectives. most notably kaiser with their five star rating with their robust transition program. again, you can see what the five-star plan indicating high quality care member

satisfaction, robust care program, value added programs, ongoing innovation and pilots across the u.s. and the most robust network covering all counties in which they currently live. we'll go on to the next. i will ask my clerk to join me to talk about the financial perspectives. >> good afternoon, commissioners. mike clark with aon. just a brief reminder that the r.f.i. process described by michael and ann is not designed to capture rate quotations, but as you'll see in this chart, when we look at the program insured rates for the kaiser, h.m.o. in california as well as the national p.p.o. plan, there is confidence that h.s.f. is quoted best in market by your two encumbent organizations.

every year, we go through a thorough review of those rate quotations and the underwriting elements behind those quotations including how prior cost experience and changes with funding would impact you to your rate quotations. and as you'll see in this chart, the rates are 2022 for both plans are actually lower than the rates in 2020. and, in addition, during the pandemic, the height of the pandemic suppression in mid 2020, u.h.c. did provide a premium refund due to covid pandemic suppression. in the spirit of partnership, that should be considered in addition to review of these insured monthly premium per individual rates for 2020, 2021 and what's coming up in 2022. and in the final bottom of the

page, we would not expect the pattern of rate reductions year to year in the long run, consider that both kaiser and u.h.c. are well-positioned to continue best in market rates to the medicare population since both now have that 5.0 cms star rating. kaiser's possessed that rating for many years. u.s.c. have been at a 4-star and so we expect that to help sustain the rates going forward as we look at 2022-2023 and beyond. >>. >> thank you, mike. with the completion of this r.f.i. and the financial review, a market evaluation in

the next three to five years. and i believe there's one more slide. so just to bring us here to the end, the conclusions that we stated earlier and then as part of the due diligence process, we will incorporate learnings from the r.f.i. into the plan renewal process with the current encumbent centers that will be continuing on to engage them and incorporate learning into the current plans. and provide market updates to the h.s.b. as needed. that concludes the presentation. dr. follansbee, i know commissioner scott and commissioner zvanski would like to speak. >> president: yeah. i will open it up now.

it may have looked so simple and the timeline and the amount of information you received and you made it all look so simple and straight forward. so, with that, i would like to maybe open it up to commissioners zvanski and scott for initial comment to the board. >> commissioner: thank you. this is commissioner zvanski. it was an intense process and actually i was very impressed with how it went and what we learned i felt was a really good opportunity is their various plans and offering to look at the differences between what we have and what remains out there and whether or not we were giving the maximum benefit

and opportunity to our members, to our medicare advantage members and to give them everything we could or was there something else out there that would work better that would be easier administration that would give them more offerings it's easier to deal with the structure of an r.f.p. that's much more confining. so it really was a rather fascinating process and what we've learned was that we're already sort of sitting in the cat bird seat with a couple of the best options around and also because kaiser -- we're now offering more expanded kaiser coverage as it goes to hawaii and southern california and the other opportunities to

remain in the kaiser system if they move out of the area and that was something a member of my colleagues had asked me about some years ago as we were all retiring whether or not kaiser would ever be available in these other states and it is and i think that that has helped greatly. but this was a fascinating process. it was done very well. i want to compliment michael visconti who was very helpful. because at least for me when i looked at the packet of materials, i was a bit overwhelmed as first and thought oh, my gosh, this is going to be a difficult decision, but in the end, when they organized it and it's the

way that both the staff and mr. visconti organized this plus the input we received from larry lou and abby, it was very helpful to be able to break down the significant elements and do good comparisons so that we could readily see what our options were and to have the kind of discussions that i think we need today have to determine if it would be worth it to go forward with an r.f.p. and i'm comfortable that the decision we made was the best one for now and down the road, we can look because there's always a lot of advertising. there's members calling us and asking about it. there's other things out there in the marketplace. from what i can tell, at least from all the information we had, we have the best opportunity for our members and

there's nothing more that would enhance it. it would just add to more administrative work that i don't think we need and it wouldn't help our members at all. so i was very grateful for the process and thought it was useful. we should consider doing things like this in the future if we have that opportunity because it's very enlightening. >> president: thank you very much. commissioner scott. >> commissioner: i'm sorry. i was on mute. i absolutely concur with everything commissioner zvanski has said. both from michael, as well as abby and the other management team members who participated.

one of them was a point of discovery for me and the reason i think it is behind recommendation of three to five years before we go back to the market, we were able to discover there were a number of health plans out there that are really getting started in the medicare advantage space or are returning to it. and some of the scriptors of what they're currently doing as i said in the meeting was a little bit thin in terms of where they are and what specific plans they have and so forth and the couple looking at the four-star rating now, but our long term goals to get to

five and four and a half and any of that from a marketplace standpoint and there's also a merger and consolidation going on in some of these plans as well. that's going to take a bit of time to mature and i think that some of the respondents were looking at the health care systems as a way to kind of, you know, take a leapfrog in terms of their marketplace position and that came through in terms of some of the thinness and proposals of what they wanted to do. so the market is expanding and i think that we'll as ann from aon has pointed out. we look at this stuff every year, so we won't be missing anything and then it's a matter of saying, okay. a few years down the road, have

these other options matured enough from a quality standpoint and a service standpoint, benefits array standpoint to compare to where kaiser and u.h.c. are today and they -- you know, it was very clear there was a distinction between where we are and what we're getting versus where the marketplace is right now. so i'm very comfortable with the outcome and i appreciate it, are the opportunity to be apart of the process. >> president: thank you. other comments or questions from -- yes. go ahead, supervisor chan. >> supervisor chan: thank you so much. i could not thank you enough for taking your time

commissioner zvanski and commissioner scott to do this and report back. i really appreciate your knowledge and time. i would like to understand a little bit better that both about just the from this point and on looking at, i can totally understand to come back and to really formalize a process for an r.f.p. three to five years from now. but i think commissioner scott has briefly mentioned, i just want to confirm that we are on an annual basis that looks like or sounds like on on annual basis, we are thinking of an r.f.i. process because it's intense and thank you for your time and effort that it is a better way to evaluate before we go off on a formal r.f.p. is that correct? yeah. that is true. and the point is if you recall from the active r.f.p., we kind of broadcast the fact that

we're going to go to the marketplace almost a plan year in advance before we did. and i would make the assumption that this would be the same thing that if we were ready to go to the medicare advantage marketplace because we saw either emerging strength in some of these programs operating questions that were not given in the r.f.i. process, but we would certainly drill down on those for an r.f.p. here are some of the

things we're going to ask. to this. >> supervisor chan: go to the marketplace for an r.f.p. in 2023. is that correct? >> that's right, but i would just caution that if we see emerging trends or advantage, i would again rely on our staff

as we do our annual benefits rejew to alert us to that and where they are today, i can't imagine they're going to somehow be able to kind of gather comparability to what we have in a two year period. for instance, in 2023 or 2024 because, you know, the performance of a health plan and service and quality measures take time to develop. and so they've got to make investments internally or and we've set a threshold so it

sounds like a bit of a time away, but it isn't. >> and i just want to add that was a very significant consideration. we're going to stay there and do well of our own benefits plan where a major provider did not stay in the medicare business and that created great problems and we will not hit that wall again and so that was

one of the major considerations. we want to see performance, we want to see proof that they achief a certain profficiency levels and and it's definitely not worth it for our memberships, so commissioner scott, that's very well on that. that's one of the major reasons we said 3-5 years. you have to give them time. and there are different plans that are considering merging. there will be changes and fluctuation in the marketplace that we see based on the information that we had that we see coming down the roads for the next year or two and so it's not the time to make a leap or any other commitments.

we have to and the other physician was also extremely helpful based on his experience. we've been very fortunate in this whole process. >> president: thank you very much. any other questions or comments from board members? >> supervisor chan: i think that i do have a last comment that is my sentiment just in general about city contracts and city services and programming. to look at the best quality of

service. i think at times that when there are service providers. at the same time, i think to always give them competitiveness so they increase quality of care for our members. so i look to staff and director ins to continue to provide us guideness and how to so thank you for all your hard work. >> president: thank you. if there's no other comments or questions, we'll go to public comment. >> commissioner: i just want to echo what others have said.

as far as r.f.p., from my understanding it's common to do this every 3 -- i don't know what the number of years was but i've heard many times. i thought it was less than five. i thought it was like three. so it's something that we're as i understand was everything including the reaction of all of our providers. >> president: from my understanding the purpose was the last r.f.p. was -- so the purpose of the r.f.p. was to investigate this moment. i don't think we have our by laws or direction to actually mandate an r.f.p. on any schedule for our plans. >> commissioner: i don't think

it's mandateded, but it seemed to be understood for all providers. >> it's a city practice and michael visconti can clarify this for us, but it was but i believe the cycle for contract. i think michael visconti can clarify that for us. >> thank you, commissioner.

this is michael visconti contracts commissioner. it the city requirement is so i think that that is what we discovered because where we may have more latitude on defining and interpreting to how plans work for our active employees, it's a very different game with the medicare as you now know that's so highly regulated by the federal government. there's not a lot of influence

that we have and once that's in place, then the commercial plan follows for our employees. so it did make sense that the active employee consideration and in this case this last year, we did the r.f.p. and learned a lot through that process and that informed what we now have finished with the medicare product. you know, they're linked or not linked, but it is prudent business to take a look at these on some kind of a regular basis as people have said. i didn't really inherit any kind of pattern. so we did decide to develop our own. so that's what we currently have in place and just to reassure the board, the contracts there is a renewal process that we go through

every year. we keep track of all of our forward thinking ideas or theories that we've had some bumps in the road and we build that all into our renewal process. so it's not a rollover, an automatic roll over from year to year. it's a well orchestrated process by both parties. >> thank you very much. any other questions or comments from the board before we open this up for public comment. okay. go ahead and open this up for public comment. >> secretary: thank you. i'll be reading the instructions out loud and displaying them. those instructions will come up

momentarily. public comment will be available for each item on this agenda. each speaker will be allowed three minutes in length. all public comments are going to be made during the agenda item that has been presented. there's no obligation to answer or engage with dialog with the caller. when i welcome you on the call, you may state your name. you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org. opportunities to speak during the public comment period available by dialling the

number on the screen and i'll make sure that screen is correct. the dial number is (415) 655-0001. and meeting id, 24861164844 then press pound and pound again. you will then enter the meeting as an attendee on the public comment call 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. sfgov tv has a standing 40 to 45 second standard delay. for viewers watching our live broadcast online. we will take a 45-second pause to allow the system to catch up. our 45-second pause will begin now.

the 45-second pause has ended. >> board secretary, we have four callers on the phone line. 0 callers have entered the queue at this time. a reminder to all callers on the line, you must dial star three now if you want to join

public comment for this specific agenda item. we will wait five more seconds and close this public comment segment for this agenda item. board secretary, there are still no callers in the queue at this time. >> secretary: hearing no further callers, public comment is closed. >> president: thank you very much. this concludes item number eleven. we are now one half hour behind schedule in this meeting and i'm hoping the speakers can be focused on their comments and not necessarily repeat the information that was already submitted to us to review before the meeting so we can focus on the most important issues. so with that, we'll go to agenda item number 11.

>> secretary: thank you. agenda item number eleven racial equity action plan annual update. this is a discussion item and will be presented by s.f.h.s.s. senior health planner leticia harris and also our lead racial equity action plan lead for sfhss. i'll be presenting transitioning presenter privileges momentarily.

>> thank you board. as a reminder, a year ago the prove fully endorsed. the assessment and valuation of initiatives advanced racial equity. this included the acknowledgement that race and the social determinents of health. the presentation is the first annual update reflecting on sfhss's initial year. next slide, please. this slide provides a brief overview of our agenda today. i'll begin with a quick review that require the city wide racial action plan. we'll review how the frame work is broken down into two phases. cover the departmental goals. review a time line of activities for the past year.

spotlight data driven insights, lessons learned all with the collaborative input from our board. next slide, please. back in july of 2019, ordnance 118 arrived. the administrative code that stems from this ordinance was approved and signed by the mayor requiring every department in the city to create a racial action equity plan. next slide, please. on the screen now is a quick recap of our racial equity plan. every department needs to create a plan, submit the plan to the office of racial equity, mayor's office, board of supervisors, publicly present to their commissioners and an julily report starting in 2022. to supplement our department has chosen to provide annual progress reporting to our board

as well next slide, please. i mentioned the frame work. as we move forward, i do want to point out an important distinction between the two facets of the mandated frame work. phase one was released in the summer 2020. including our racial equity climate survey. qualitative results from the survey are used to build focuses on external services and programs to support vulnerable populations. i just wanted to chime in that our department's charge is external. but today's phase one presentation communicating how we've invested in our most

valuable assets, our staff. beginning from the inside out, changing our programs and policies, our thinking and quality of interactions among the members of our department. with the understanding that the way we treat each other first and foremost is how we treat and empower our members next slide, please. sfhss has three core focus areas the first focus area builds organizational culture, normalizing train, education and equity and inclusion. insights around staff needs drives every action. specifically from our departmental survey which including opening the questions from our department at the time, we had a participation rate of 76%.

we received over 400 open-ended responses. our staff had a lot to say and their world view. mentioning their family structures, immigration histories, religion, lived experiences our goal is to make this racial equity plan accessible. so we created a website that's had over 700 views. including the anonymous survey results. we've realized our members in our work place have not had a chance and we will make that

accessible in the new year staff recruitment this goal seeks to empower staff at all phases including building a diversified work force. one of the ways we're doing this so that anyone that's part of the department will understand more about recruitment scene to identify, attract and invest, developing internal policies and budget lines. outlining clear protocols for how to attend conferences one example of this is our racial equity advisory. so that we can bring the most innovative ideas about this

work back to our department and commission about compassion and separation which our managers and supervisors will participate. the goal to infuse equity from the time they arrive to their departure. our final goal is equitable at all levels. this includes a race advisory. and as a reflection of all that we've learned this year. we're creating a formal charter to set forth our purpose and connection to the ordinance. we've invited our commissioners from our board to participate alongside and manage explicit bias training and it will also be repeated to make them accessible this is just one of

the entire suite of trainings that we and other topics we will pursue in the future including transgender 101. information about how to access that is included in the report. next slide, please. to recap. a lot has happened in the past year with respect to racial equity work. since the board endorsed our plan and our web page went live, 50 city worldwide champions were being trained and diversity, equity and inclusion consideration to boost employee moral. our ceremony and we celebrated our disaster service workers.

this month, we're representing our update and in the new year, we'll do another pulse survey with trainings repeated. next slide, please. as we round out this presentation i want to reiterate that everything we do is surrounding by our data. our inaugural climate survey is to be more aware of their feelings, their attitudes and behaviors around racial equity and how that can impact your thoughts and behaviors. on the screen now is the anonymous valuation data from that training that shows strong agreement and the building and

awareness of strategy and apply these learnings in the work place to make it more inclusive for everyone. because racial equity helps us to learn about ourselves, our peers and our pork place. the same presentation was shared. it was paired with a growth mind set. through this activity, we reflected on the challenging and inspiring aspects of discussing equity in the work place and before our first ever training, 53% of staff said they knew little to nothing about the lived experiences with their co-workers and after that training, 87% said they knew something if not a lot about the people that they work

with. the tree represents the work that we've done to provide the roots and foundation that allow us to grow. we're growing individually and as a team with the understanding that growth today is an investment for tomorrow. final slide, please. in the first year, we've developed teams. we've seen firsthand the positive effect that this work has had on our organizational culture and in support of our staff. we've raised our personal and communal awareness checking our biases and embodying the and i invite everyone to visit the office of racial equity to see

a lineup of all 63 departmental plans. on how this work is being implemented citywide and to conclude with a question, why are we doing this? year complying of course with the mandate, the office of racial equity, the mayor's office, the board of supervisors, but more in depth and most notable and what's been drawn from our racial equity survey is that 100% of our staff responded with great awareness to this statement that people of all races play a role in addressing racial equity. 83% of our staff reported feeling comfortable talking about their backgrounds. they said that race and culture are an important facet of their identity. mentioning family structure, religion. we're doing this because it's important to our staff. and enforces strategic plan values. i'd like to acknowledge all staff, our leadership, our

advisory and commissioners for the highest level of engagement and thank you all for your time. >> president: thank you very much. you know, your presentation really highlights the importance of this. and all times and i'm wondering if you see the covid pandemic coming back to in person and the office highlighted or enhanced or made more difficult some of these issues around racial equity and how you see each other? can you maybe comment on that? >> absolutely. i think that was most exemplified in one of the partnerships between the racial equity and well being division. we understand with the covid pandemic, a training was designed to employ employee

resiliency through recognition and this was done by tapping into national leaders in this field with the understanding that we need to boost employee morale and we need to prioritize coping mechanisms and resiliency in relation to covid-19 and racial equity considerations. that's but one of the activities we've done in addition to acknowledging our disaster service workers who've stepped up and took precedence in these trying times. >> president: thank you very much. other questions or comments from board members. >> yeah. president, if i may add. congratulations for a wonderful presentation. the director of leadership. it exemplified the importance and values of these trainings. these are difficult conversations and very challenging but i think some of the information you shared particularly with the surveys that you received back from staff and the team there certainly demonstrates the

amount of quality of care and concern that has gone into rolling these trainings out and incorporating them into your daily work on them. i value the work you've done and commend the team for that. creating an environment where people are comfortable to share those things is critical in order to have a single foundation delivered to our members so thank you for that. >> thank you both. >> president: other questions or comments. >> yes. i'd like to make a comment i really have been very impressed with your leadership and the rest of the team that you're

working with but also laying a clear is my understanding was that some of the city you were all in the process and i think you've handled it in a professional way and i think it has and will continue to yield very strong internal staff work, if you will and respect for 1 another as a team working to serve the members of h.s.s.. so thank you for all you've done today and this is not

misplaced effort. it's not over the top sentimentality but real focus and work turns into human interactions apart of peoples lives as we have tried to articulate that to not only your staff, but also as we are beginning to interact with our health plans regarding the social determinence of health and i thank you for your presentation today. >> i just wanted to add the two sentiments. i'm sorry, commissioner zvanski. very quickly, i am very grateful for the work that you and your team is undertaking. this is hard work. this is continuous work and i appreciate how you are engaging with all members of the department and allowing them to be kind of where they are, but

also continue to move forward. so i think to start this conversation, and to continue the conversation, it can get really uncomfortable. but kudos for you and everyone engaging. thank you. >> i just want to add to that and i just want to point out that when i started working for the city back in 1973, it was my colleagues, it was a very different demographic and i've watched it change over the years and it's very exciting to see the leadership that you have put into this and the program that has been created here. that is very inclusive. a lot of us focused our work through our union participation because that's where we had the ability to work with colleagues that were more diverse and push

for changes within our employer and to get those changes manifested. but the work that we do at health services unless we are truly sensitive to the great diversity and until we understand really what a diverse population means and how health care in some cases is very specific and we need to be sensitive to that and aware at all times and this program is just really fantastic and so i look forward to more expansion and changes as time moves on and thank you very much for your leadership and involvement in this. it's really exciting. >> president: great. any other questions or comments from board members. if not i'd like to open this up

for public comment. >> secretary: thank you. i'll be reading the instructions aloud verbally and displaying them momentarily. public comment will be available for each item on the agenda. all public comments are to be made concerning the agenda item that has been presented. of as a reminder, the caller may ask questions of the policy body. when i welcome you on the call, you're encouraged to state your name clearly. when your three minutes have ended. i will thank you for your comment, you will be placed back on mute and our moderator will unmute the next caller. opportunities to speak during

the public comment period are available by dialling the number on the screen. the dial in number is (415) 655-0001. when prompteded, use access code 24861164844. then press pound and pound again. you will then enter the meeting as an attendee on the public call-in 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. sfgov tv has a standing 40 to 45-second delay for viewers watching our broadcast online. we will take a 45 second pause.

our 45-second pause will begin now. our 45-second pause just ended. i will now check the public comment queue for any callers waiting to share.

we have four callers on the phone line. one caller has entered the queue at this time. i will indicate when there are more callers in the queue and you will hear a brief silence as we transition between callers. i'll now elevate the first caller. welcome, caller. >> caller: my name is francisco de costa and i've been listening intently to the presentation and also to the remarks made by those on this commission or committee. if you do some research, and you google san francisco with a plus sign, racial equity

action. or you google critical racial theory, you will in your readings come to an understanding how racist the san francisco city is and by default san francisco the city and county of san francisco and city hall. now, ya'll may not know it and it has not been mentioned, but it's good to mention that we have about 35,000 city

employees working. it's a far cry when you are about 23,000 or 22,000 from five years ago. and if you who are on this board or this committee pay attention to all the hearings that we've had prepandemic when mostly blacks come and state how they're discriminated. nothing much has changed. so it's very easy to say like, you know, somebody has done the heavy lifting. it's very easy to say, let's get together and do this and do that.

we need to have an action plan when quarterly or. >> secretary: caller, you have 30 seconds remaining. >> caller: what did you say? >> secretary: you have 30 seconds remaining. >> caller: thank you. so at this quarterly report, the good actions that move towards what ya'll have in mind. thank you very much. >> secretary: thank you, caller. i'll now check the queue to see if there are any further callers in the queue. there are still no callers in the public comment queue at this time. i'll give a 5-second pause. there are still no callers in the public queue at this time. i'll give a 5-second pause.

board commissioners, there are no callers in the public comment queue. public comment is now closed. president follansbee. just want to make sure we're hearing your murder in the second. >> president: sorry. i was muted. thank you for the presentation. we do look forward to followup. i'm going to close agenda item number 11. agenda item number 13 involves some individuals from outside or health service system. so i'm going to move to agenda

item 13 and we'll take that into consideration at the end of agenda item number 13. so we're going to call for agenda item number 13. >> secretary: thank you. you called the agenda item number 13. is that correct? >> president: yes. to get us back on schedule with outside presenters. >> secretary: so board education which is the health insurance portability and accountability act. >> president: i'm sorry. that's agenda item number 12. i'm sorry. i'm confused. i want to go to the board education of the u.c. bank of

americaley thank you. it got switched on the time sheet. >> secretary: okay. so agenda item number 12 is board education u.c. bank of america berkeley. it will be presented by timothy t. brown. emily hague, and alicia newman. >> i'll be brief commissioners. i'm very pleased we have this item to present today. as you know, this is a partnership for payment and catalyst reform and funded by the peterson foundation and i'm just going to let the show go on because i think it's a very interesting study and i'll hand it over to the team:

>> secretary: and i believe presenter privileges have been passed over to emily hague. >> thank you for the opportunity to present our work. i'm tim brown. i'm a health economist. i'm a faculty at school public health at u.c. berkeley. i'll let my colleagues introduce themselves when they speak. from the peterson health care. these results will be followed up with more detail the question is a high performance

hmo and this is blue shield trio. let's define our terms. high performance we referred to a health plan with a select narrow network of positions and hospitals combined with a comprehensive patient navigation and support system. this is blueshield trio. an a.c.o. or accountable care organization is to foster efficient and collaborative care for patients with providers being accountable for cost of care and quality of care. next slide. an hmo or health maintenance organization is paid a fixed payment per patient and responsible to cover all care for that fixed patient. the key characteristic of an hmo is it has a closed provider network primarily funded by cap

tated payments. by improve, we mean improve lower cost and higher quality. i should note that the trio has lower premiums. next slide. the question has important implications for san francisco you want to understand the impacts of the high performance hmo and more importantly you want to learn whether this lower cost health plan continues to achieve and more broadly, this study will inform the design of health plan options and other organizations and we want to publish this study. it's actually just about ready

to go out to full review to a journal and we want to contribute to the body of knowledge regarding how to improve health care values. important caveat was that this research was only commissioned to compare two health plans. blueshield trio. so we did not make comparisons across all health plans available in the san francisco health care system about how the two plans we perform compared to the nonsan francisco health care plans. so the idea is try to isolate which we were able to do because, one, the benefit design which includes medical services and mental health services was the same between the two plans, two of the overall administrative services and systems run by blueshield

were fundamentally the same. so the primary differences were the comprehensive patient navigation. this is what we call a mixed message evaluation to avoid being biased by any one source. this is a type of try angulation. we conducted interviews and we conducted a member survey. next slide. in terms of interviews, we interviewed 13 leaders from the following groups, the health insurer, provider organizations, and the san francisco health system. to identify successful practices and opportunities to improve care delivery and provide context for conducting and interpreting our quantitative analysis which i'll turn to the next slide. in terms of medical enrollment

data, we included 24,555 continuously enrolled members and we required continuous enrollment to make sure we could attribute any changes to health care or rather to another plan and we analyze the causal effects in switching access on risk scores, utilization, expenditures, and access. next slide. finally, we conducted a survey of trio and access plus members. we surveyed 512 members of trio and access plus. we waited them to reflect the overall population and in the survey, we asked questions about satisfaction, access, care coordination, medication reconciliation, care for chronic conditions and mental behavioral health care. next slide. this slide presents the

unadjusted raw data. the dark blue bars. now, there was only access in the preperiod, that's 2016 to 2017 period right there. and the light blue represents members who had switched to trio. clearly people on each plan are different and take that into account. next slide. we performed a quasi experimental analysis has a treatment group. this is the chain we're trying to look at and a comparison group, that's access plus, but people are not randomized in each group. now this accounts for all baseline differences between the two groups at an individual level. so we can isolate the causal

effect switching from access plus into trio on each outcome measure so our findings were that there were no difference between the health care higher. there were no differences in access to care. this one refers to medical services. we'll get into the mental health services a little bit later. next slide. there's no difference in the cost for patients who received any amount of medical care. so this is for patients who went to see the doctor. but there was a 15 percentage point. and we attribute this to the comprehensive patient gav nation and customer suspect system many questions answered without having to go to the doctor. so it eliminates redundant and low value care when it is not needed. then, we explored the relative quality between the two plans

more broadly in our survey and i'll now turn the presentation over to emily to present the survey results. >> thanks, dr. brown. my name is emily hague and i'm a student at u.c. berkeley. so dr. brown spoke about our claims for the high performance health plan. as we mentioned at the beginning, value isn't just about cost, it's about quality and member experience and that's what i will address. we'll talk about some of the findings for the access plus and trio health plans from the members survey that was conducted earlier this year. i'll start by highlighting that findings were largely positive across those plans. and just as a reminder here, i'll be showing a lot of statistics throughout this portion of the talks that are representative of our broader findings, but there's a lot more detailed findings that will be included in a report to

be shared with sfhss leadership and this board at a later date. you can see here survey responsibilities accessed care in a timely manner. that feedback was 70% positive and responsibilities stated they had good conversation with their primary care provider. access was even better for specialty care and to get an appointment in a timely manner and there was no significant difference between the two plans. while feedback was positive overall for both plans we did find a difference between the two their health plan 7.2 out of 10 points on average while

high performance members reported an average score of 7.5 out of 10. and as dr. brown noted, the benefit design is identical between those two plans we wanted to look specifically at access to care. we found that the network did not include access to specialty care and members of that plan were less likely than the broader network despite some common related complaints which may feel like a counter intuitive findings.

we attribute this to the patient navigation that's called the trio concierge. there were a few other areas where the high performance trio plans worked better than access plus on measures of patient experience especially around medication. for example, we found that high pandemic answer was we were told about side effects for medications. members also rated that care higher than members of the broad network plan as you can see here. compared with 5.1 for the broad number access plan. you may recall this was

compared to 7.5 and 7.2 for the health plan overall indicating there may be opportunity to improve satisfaction with mental health care across both plans. [please stand by] trrz

>> i do want to reiterate, there are big challenges. these things are not unique to the two plans we are talking about today. by saying that, this was a very exciting project for us. we always want to deliver good news. satisfaction was high for members of both health plans and efforts to manage costs across those plans to ensure sustainability seem to have been effective. and we see this even more for the high-performance plans,

which appears to perform as good as the broad network plan or even better while being a lower cost. lastly, we want to thank the wonderful teams who have all been working with us for months to coordinate this and to gather the data and compile everything. thank you for your attention. at this time we would like to invite your questions. >> thank you very much. this is a fascinating report and article looking at some of the questions that we all ask. i really appreciate that. in part because we will have to defer the hip the discussion until next meeting. can you review how members were recruited for interviews? was it random? how was it observed, and what was the failure to respond

numbers? how many members refused to reply to requests to be interviewed in that portion of the study? >> the interview portion of the study did not cover this. the survey portion did. the interviews were with high-level leaders of the various plans so we could understand the way that the plan works. do you want to take the question about the survey? >> for the survey, it went out to active employee members of s.f. plus and trio with the help of paul brown and blue shield and others people. we got a 17% response rate mac of about 4,000 people that received the e-mail. >> how did you interpret 17%, and send it out?

did it go through a review board? was it scent out by you, was it scent out by blue shield? just so we understand what the members might have been expecting and maybe questions that they might have raised. >> go ahead, emily. >> it did come from a position from an academic study coming from uc berkeley. it did get cleared by our institutional review board. we didn't collect any identifying information from members and they had very explicit consent which was often the first question of the survey. seventeen%, i think we were very happy with that response rate. typically will see 10% to 15% without incentive, which this did not have. >> we did wait for the responses

to reflect the overall population. we tried to minimize the bias. >> thank you very much. any questions or comments from board members? >> i just have a comment. i know this is a problem that only 70% would see the primary care dr. i know this is a big problem. personally, even when i was going to change primary doctors it was difficult. i don't know how that is going to be changed in the future since they don't reimburse primary care doctors as well as one might think. my understanding is that not many people are going in to be a primary care doctor as a specialty. any thoughts on that? >> emily, what was the survey

about the primary care doctor? >> that was, in particular, a slide being referenced that was related to getting a primary care appointment as soon needed. i agree that that is reflective of access to primary care in general. >> i would agree. i not part of it, and sometimes it is a problem for me. >> is there anything going on nationally or anywhere to remedy this reimbursement level for primary care doctors so we can get more primary care doctors? >> it is a continuing issue, and the relative pay differential is quite large. i think you put your finger right on it. there is work going on to try and solve it. we don't have any permanent solutions at this time.

>> i think the survey helps to highlight the problem. i don't think it was out looking for solutions. believe me, this issue worked for us at all levels. both primary care, especially mental health care, is a huge issue from all of the webinars that i have been going to and the articles. i don't expect the study to be able to answer that but it does add to the body of information about the concern. other questions or comments? >> i do have one. in terms of this report and kind of what are the next steps, we will get it reviewed and so forth when it is published. and then the question is, so what? what will we do with it. what are our plans, et cetera?

>> i have a question for the board. >> do you want to respond to this? >> i'm also looking for someone inside to also respond. first, great information. what do we do with it now that we have it? are we going back to the root cause with a more focused approach? i want to find out where the endgame is. >> blue shield representatives are on this call and watching this presentation. they are very well aware of this. i think this is just symptomatic today for problems across health plans. these are predicted to be problematic or wildly successful. they were trying to compare issues around a sense of

high-performance. with that -- we can't expect the universe to open up. i will turn this over to abbey. >> i would say, you know, a little bit of what i was noticing was that the care coordination programs that shield has put in place, three of the programs had an impact. i have to say, you know, when i first came into this role and i saw the plans were expanding care coordination, i was baffled. i'm coming from a provider role. now i have been proven wrong. it works. so that is a conversation that we will have. we also, you know, as far as some of these access issues, yes, we continue to work on them. these will be some of the questions that arise from the findings of the study and that will inform some of the

direction that we take with the strategic plan. some of them are very large and, you know, may go beyond our scope, but we can discuss that. i think it will also be interesting, since we have suzanne from catalyst here and blue shield, and they are ready to make plans. this is very new information. i don't expect any of us to have a plan mapped out about what we want to do with the information. it would be wise to discern and put it in context with everything else. i don't know. i found it very beneficial to have this kind of partnership. it has been a really excellent opportunity and it worked really well. i think it would be useful to do other projects in the future.

>> abbey, it is suzanne. i will speak briefly. our interest in supporting this study is there has been almost no research projects done on how effective these are and how organizations are in the commercial sector. so this is really an important contribution. we are so grateful to the san francisco health service system and blue shield and all the other partners who took part, as well as the team at uc berkeley for doing this work. it will shed light on, you know, seems to be effective, what kind of practices we would like to see more widespread. especially because as the researchers share, it is nice to have positive results in the study with healthcare. it doesn't happen so often. i think, you know, our goal would be to share what was

published about it broadly with other employers and purchasers and health plans and spread the word about what we have learned here. >> thank you. >> this is probably -- paul brown from blue shield. a quick comment, i would like to say we welcome the opportunity to participate in the study and part -- in partnership with uc berkeley. dozens of blue shield employees contributed to the work, both in terms of resources and data sharing, and candidly, we are very pleased to see third-party validation with the work that we have been doing now in partnership with them for over eight years, and we have 70 of these collaborations around the state. what we are doing in all of these communities across the state is we haven't had any external validation and this contributes to that.

from a blue shield perspective, there are definitely lessons learned and we will engage some of the key stakeholders and the medical perks to tackle some of the issues we know. behavioral health is an issue. assistance for chronic patients was a new one for us -- us. we are engaging our internal clinical teams as well to see what we can do, as well as our care gap that seems to exist. a few key takeaways that we can learn from and act on. more importantly, just validation that our partnership over the last few years is actually seeing a benefit to the members. >> thank you. any other questions or comments from board members? or other people participating in this agenda item?

this is really fascinating. again, i applaud everyone's effort in this regard and point out the successes and the challenges as we go into our own. with that, i will close discussion and open it up for public comment. holly? >> thank you. i will be presenting, displaying the instructions visually and reading them aloud. public comment will be available for each agenda item. speakers will be allowed remember -- three minutes unless the board president puts limits. public comments are to be made concerning the agenda item.

as a reminder, callers may ask questions of the policy body but there's no obligation to engage or answer with the collar. what i welcome you on the call you are encouraged to state your name clearly, although you may remain anonymous. the moderator will then announce the next collar. remarked -- remote viewing is available online. opportunities to speak during the public comment period are available by dialling the number on the screen. i making sure the screen is presentable for everyone. the number is (415)655-0001. one prompted, use access code 2-486-116-4844. press pound and pound again.

dial start three to be added to the public comment to. for those already on hold, continue to wait. there is a standing 452nd delay for viewers watching the live broadcast online. we will take a 452nd pause. our 452nd pause begins right now.

the 452nd pause has ended. the moderator will let us know if there are any public callers. >> there is one person on the phone line. there is no one in the queue at this time. a reminder to all callers, you must dial start three now if you want to join public comment for this agenda item. we will wait five more seconds and then close public comment for this agenda item. there are still no callers in the queue at this time. >> thank you. hearing no further callers, public comment is closed. >> great. thank you again to letitia and others.

thank you for your engagement in the study. we look forward to the publication, which i will read carefully. i would like to move to agenda item number 14 with -- which is an action item. >> thank you. agenda item 14, approval of revisions from the health services membership rules and section 125 cafeteria plan. this is an action item and will be presented by mitchell rigs, the chief operating officer. >> thank you. can you let me share, please? >> yes. that will come over momentarily.

>> great. here we go. good afternoon. i'm the chief operating officer of the san francisco health services system. we do this every year. i ask for you to review our rules and section 125 cafeteria plan. and the reason we do this every year is because the san francisco charter requires that the health service board make rules and regulations for the administration of the health service system. we also do this in the public forum so members are notified in a public forum that we are changing the rules. this year we are not making any substantial changes to the rules. they are mostly clerical and slightly operational. i presenting the memo here, which you were provided, too, in your boardman -- board materials. for the plan year 2022, the only

thing that we changed, which we update every year is a list of the benefit coverage periods. coverage periods are based on payroll dates, biweekly, semimonthly, monthly, et cetera. we always put that in so it reflects operational policy. the other document for your approval is cafeteria plan documents for plan year 2022. just basic clerical changes. the first event of the change is section d5, claims deadline. and review of the documents we still have some lingering there about the flex credits and the benefit for a couple of unions. prior to that, you actually had to claim any flex benefits that

you didn't use to buy pretax benefits. since that language is no longer applicable, i removed it. and just to update based on this, the group term life insurance for that particular union was raised from 100,000 to 150,000. we updated some of our voluntary benefits. we are employee, not employer paid benefits, that we give the city access to purchase. we just updated some of the benefits that we were offering and made some improvements this year. we wanted to make sure the document was updated. this is a section of the cafeteria plan benefit that we

are required to have based on the internal revenue code that helps us keep our tax benefits. those are the changes. like i said, there is no absolute changes. it is just operational and rhetorical. if you have any questions, i can answer them now. >> we will open it up to board members for questions and comments. >> mr. president, i move we adopt the changes as presented and distributed to us and that we incorporate the a corp -- they appropriate documents in terms of governance for the board. >> i second that motion. >> it has been moved and seconded when we as we adopt the

recommended changes and outline and add that we put the benefits into our governance documents as well. any further discussion? if not, we will open this up for public comment. thank you. >> thank you. i will be reading the instructions out loud and display them. >> public comment will be available on each item in the agenda. all public comments are to be made concerning the agenda item. there's no obligation to answer or engage. what i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when you three minutes have ended, i will thank you for your comments.

remote viewing is available online. opportunity to speak during the public comment period are available by dialling the number on your screen. when prompted use the access code. we will take a 45 second pause now.

>> the 45 second pause has ended. are there any public callers in the queue? >> we have one collar on the phone line. zero callers have entered the public comment queue at this time. reminder to all callers on the line, you must dial start three

now if you want to join public comment for this item. we will wait five more seconds and then close public comment. there are still no callers in the queue at this time. >> public comment is closed. >> it has been moved and seconded that we approve the revisions to the rules and regulations cafeteria plan updates. all those in favor these signify by saying i. >> i. >> opposed? thank you. it carries unanimously. this item is closed. we will move to agenda item 15. >> i will be updating that screen.

agenda item 13, reports and updates from contracted health representatives. this is a discussion item. >> are there anyone -- are there any member still in the meeting to make comments or updates? speak now or hold your peace for the holidays. hearing none, i'm not sure i need to open this up for public comment if there is no report. does anyone have any guidance on this?

>> we will now close the agenda item. sorry. >> mr. president, before we adjourn, i would remind the board members that if they have not done so, to complete the self-evaluation, which is due tomorrow. i know we did not do item 14 -- 13, which is about hippa training. we have all been signed up for it in the learning portal for the city. i think those are supposed to be done before the end of the year. i would ask everyone to check and see which courses you have been enrolled in. i'm sure holly will be following up as well. >> thank you very much. i want to apologize publicly for what looks to be a very comprehensive report. something that, as you can see from other the -- from the other

agenda items, is not only important today, but will be important into the future as we explore contracting with other vendors our own discussions and our members need to understand completely. we will put that on the agenda for sure for january as well. with that, i would like to wish you all a happy holidays and adjourned the meeting. >> thank you. happy holidays, everyone. >> happy holidays to everyone. be safe, be well, and enjoy yourself. >> thank you very much, everyone. >> bye-bye. >> by. >> thank you.

francisco. >> my name is fwlend hope i would say on at large-scale what all passionate about is peace in the world. >> it never outdoor 0