>> >>please stand by for the san francisco health service board meeting of june 9, 2022.

>> meeting of health service board of city county san francisco june 9, 2022 to order. please have the roll call. >> thank you president. call to order 103 p.m. [roll call]

>> thank you. president follansbee we have quorum. >> thank you very much. i think because we participate remotely dispense with the pledge of aliegeance for those who can't--(inaudible) we'll move to item 3. >> thank you. item 3 resolution allowing teleconference meeting under california government code 549593. this is action item. >> thank you very much. as we are aware still in the midst of the covid pandemic and city still has voluntarily mask policy so open for resolution to allow teleconferencing for the next 30 days and discussion. >> i move we adopt

resolution as presented. >> second. >> moved and second. any further discussion? hearing none we'll opening up for public comment. >> thank you. public comment will be first and virtual public comment. anyone in person you can approach the podium and just wait 1 minute. each speaker is allowed three minutes to speak unless deemed new public comment time limits. all comments made concerning the item presenter. the caller may address (inaudible) for those on the line when i welcome on the call you are encouraged to state your name but may remain anonymous. remote viewing is available on sf gov tv and

(inaudible) 415-655-0001. use access code 248 1641853. when the system message says the line is unmuted this is time to speak. for those already on hold please continue to wait until the system indicates quou unmuted. this is public comment about the resolution for teleconferenced meetings. we have one person who approached the podium. sir. this is a public comment about the resolution. >> my name is herbert winer and good (inaudible) i want to comment on mental

health and the workplace. presently there is a epidemic of- >> this item may want to wait to the next- >> this is public comment. >> this is for a resolution the board is going to vote on. the next item. >> this is public comment. >> it is a public comment for a specific item. >> no. >> yes. >> this is general comment. >> you want to make a general comment and the next one will be ready for you. >> you waiting for item number 4 herb. >> am i-i don't have my hearing aid. >> you are able to participate in public comment, it is one more item. >> yeah. it is public

comment. >> no, that is item 4. >> yeah. >> gosh. >> herb, you are on item number 3. have a seat for a minute. >> okay. i'm sorry, i'm out of order. please excuse me. >> that's fine. thank you. no one approached the podium. we'll move to virtual public comment. the moderator will notify if anyone is in the public comment queue. >> we have one caller on the phone line. (inaudible) reminder to all callers on the line, you must dial star 3 now if you are want to join public comment for the specific agenda item. we will wait 5 more seconds and close public comment for this item.

board secretary, there are still no callers in the queue at the time. >> thank you. hearing no further callers public comment closed. >> muchbed and seconded to allow. voice vote. all in favor? >> aye. >> actually need to do it by roll call. roll call vote. >> thank you president follansbee. roll call vote. [roll call] >> thank you. it issuenanimously approved. the resolution we can move to item number 4. >> thank you president follansbee. item number 4 is general public comment. an opportunity for members to comment on any matter within the board's jurisdiction not on the agenda including the board

place a matter on the future agenda. >> thank you very much. we will opening up public comment. >> i'll read instructions and one minute. >> excuse my awkwardness. now i want to make a public comment on mental health in the work place. presently there is a epidemic of shootings one at the work site of ups. last year there was a fatal shooting at the valley transit authority in santa clara county. there is not a incident in our county agency but the warnging is there. what can we do? prevention and detection of dangerous signals of violence is more important the solution of swat team. i propose the following: the employee assistance program

which serves city agencies expand and recruit graduate students in psychology, social work and counseling. resources include san francisco state university, the university of san francisco, the california institute of studies, the san francisco campus of the california school of professional psychology and other schools from the peninsula and east bay. the student could be supervisored by clinicians from the public health department. there should be city wide training and violence prevention. (inaudible) potential of violence in schools and work site. not only is prevention better then a pound of care, it saves lives. the work site that (inaudible) enhance productivity and less prone to stress. this investment yields

high reward. pardoning my awkwardness. anyway, i really encourage the board to consider it because we are at danger level. there are too many shootings that happen daily. i am willing to help any way shape and form. i have a msw and ph.d in clinical psychology. i'm unlicensed and also uninhibited . thank you. >> thank you. we'll move to our virtual public comment and i want to read allowed for anyoneening listeninging. opportunity to speak during public comment are available by dialing the number ong the screen 415-655-0001. 415-655-0001. use access code

24816418533 and press pound and pound again. enter the meeting as attendee and dial star 3. when you are unmuted this is time to speak. for those on hold continue to wait until the system indicates you are unmuted. we will wait for the moderator to let us know if there is anyone in the public comment queue via webex. >> board secretary we have one callers. zero callers have entered. you must dial star 3 now if you want to join public comment for this specific item. we will wait 5 more seconds and in the close public comment for the agenda item.

there are no callers at this time. >> thank you. public comment is now closed. >> thank you very much and thank you for the comment. close item 4 so move to item 5. >> thank you. item 5 is approval with possible modification of the minutes of meeting set forth below. action item pertain to april 28, 2022 health board strateg planning meeting and may 12, 2022. >> i open for discussion and motion? >> i move that the minutes as distributed for both meetings be accepted and approved. >> second. >> it is moved and seconded

the minutes as outlined in the agenda accepted and approved. any other discussion from health board members? hearing none open up for public comment. >> thank you president follansbee. in person is first and virtual. each speaker is allowed three comments unless deemed no time limets during the meet. all comments are made concerning the item presented. may ask question of the body but no (inaudible) state your name clearly but may remain anonymous. i will good a warning with 30 seconds remaining and 3 minutes ended i thank you for the call and placed on mute. remote viewing is available on sf gov tv. the dial in number is

415-655-0001. use access code 24816418533. press pound and pound again. star 3 to add to the queue. for those on hold please continue to wait until the system endicates you are unmuted. >> board secretary we have two callers on the phone line. zeros callers have entered the public comment queue at the time. remind you to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda aitem. >> we will 5 more seconds and close public comment for this

agenda item. board secretary, there are still no callers in the queue at this time. >> thank you moderator. hearing no further callers public comment is now closed. president follansbee. president follansbee can you hear us? i'll unmute you and make sure you can hear us. president follansbee

i'm calling to see if you can hear us. thank you everyone for your patience. i'll try to connect with president follansbee. 30 more seconds and we can see what we need to do. president follansbee checking in one more time. if you can hear us--it does look like president follansbee left the meeting for a second. i'm sure he is rejoining

so if we can wait another 30 seconds. thank you. confirm he is logging back in.

president fall follansbee we can see you reentered the meeting. >> sorry about that. i got booted off. where are we now? >> we just finished public comment. >> okay. thank you very much. so, thank you very much. move and second we approve the minutes of the meeting on the agenda. roll call vote. >> thank you president follansbee. roll call vote. [roll call]

>> thank you very, unanimously accepted we approve the minute outlined in the agenda. moving to item number 6. >> thank you president follansbee. item 6 is president's report. this is discussion item and presented by president follansbee. >> in the interest we have a busy agenda today with good educational outline i have no report so we can move to item 7. >> 7 is election of health service board officer. this is action item and presented by randy scott. >> i wish to differ to president follansbee to provide the report. >> thank you. president follansbee i'll pull up a slide you requested. >> thank you very

much. so, as a member of the governance committee i like to propose the following nominees for president and vice president of health service board for the next year. i don't see the slide. is it up in the room? >> it is coming through in the room. should be transferring shortly. >> okay. so, for president, commissioner randy scott and for vice president commissioner mary hao. is that showing up now? i can see the slide, yeah. >> i second the nominations.

>> moved and seconded. any discussion from commissioners from the health service board? >> i like to make a comment if i may. >> go ahead. >> thank you president follansbee. it has been a long standing tradition and practice that this board balance our president and vice presidential positions with appointees and actives or elected commissioners and this particular nomination in this case we have two appointees that are going to hold those seats. this in no way changes our practice or policy, it is just the way things worked out this year, if i may put it that way. and so we are making a exception to have both of our officers be appointed members, but as i said that does not

change our practice, long standing practice to balance out the governance of our commission and so with that, we are very proud to second the nomination to have randy scott as our president and commissioner hao as our vp. let's go forward with that. >> thank you. any other comment from commissioners? i like to second that and just to make clear there is precedent for the fact that the board vice president hasn't always moved up into the president seat, even during my seven year term on the board, that is not always the case, so this is not breaking that tradition either in this regard. again, i appreciate the participation of all the commissioners

on this board. any further discussion? if not, i move this to open for public discussion. public comment. >> do we have to take a vote on it? >> yeah, after public comment. >> we should take a vote first then public comment. >> i think-i assume it has been both moved and seconded so we need public comment and then take the vote is the order of business. >> i'm sorry, i'm confused. >> no problem. >> okay. in person public comment will be first and virtual public comment. anyone in person you can approach the podium. each speaker is allowed 3 minutes to speak. public comment are made concerning the item presented. a caller may ask questions but-online state your

name clearly but may remain anonymous. i will give a second warning. when 3 minutes are up i thank you for your call you are placed on mute. remote viewing is available on sfgovtv. [providing -advising how to provide public comment] we'll begin with in-person public comment is no one approached to the podium so will move to virtual

public comment. the moderator will let us know if there is anyone in the queue. >> looks like we have 4 callers on the phone line. zero callers have specifically entered the public comment queue at this time. reminder to all callers on the line, you must dial star 3 now if you want tojoin public comment for this item. we'll wait 5 more seconds and then close public comment for this item. board secretary, there is still no callers in the public comment queue at this time. >> thank you moderator. hearing no further callers public comment is now closed. >> thank you very much. so, i will call the question regarding the slate of candidates for the next year's president vice president of health service board. we'll have a roll call vote. . >> roll call vote.

[roll call] >> unanimously approved. i welcome the new officers as of the next meeting. or next year actually. i guess today. and just want to thank everyone for their support from the last 2 years of tenure as president of the board and clearly all commissioners on this board are highly qualified to be in a leadership role and thank everyone for their participation and support. historically and into the future. with that we'll move to item number 8. >> thank you president follansbee item 8 is

director's report and presented by abbie yant. we will wait to pull up a slide so everyone with can see. >> you hear me? i want to jump ahead on my director's report and recognize podium two of our long-term staff members that are going to be departing through the retirement process. first i like to introduce and think many know cathy frirson who has been with us 22 years as she is in a position as a senior benefit analyst and she'll be retiring this month. cathy started at hss in 2000 as benefit an nalsis and moved to member service team. there were only 7 people on the team. i thought that was good news. we expanded so much.

cathy helped with the member service team grow and train new benefit analyst and technician how to process member enrollment and over the years presented retire seminars to employees across the city, staffed annual health fair during open enrollment and are since 2019 cathy served as one of the leads for the san francisco unified school district which is a challenge to work with and during her tenure cathy assisted thousands of members with health and retirement benefits. cathy was born and raised in san francisco and looks forward to retiring so she can spend more time with her grandson drew and mother (inaudible) on behalf of the entire department we thank cathy for her dedication and years of service to the city county of san francisco. cathy is a treasured colleagues and supervisor who will be greatly missed. we wish a

happy healthy joyfultotomy and best in all pursuits. >> thank you all. been my pleasure. going to close this chapter and move on to the next, but it has been good. i learned a lot and taught a lot, so been great. thank you. >> thank you for your service. >> thank you. >> you have been really wonderful. a name i cherish. we hope you will join the retired employees of the city and county. >> i waiting for you to say that. >> absolutely. we are going to snag you and put you to work. >> i will. >> good. fred can help you out too. >> okay. >> thank you. welcome to a new part of your life. >> yes, thank you. >> thank you. [applause] >> don ju, please come to the podium. >> don. after more

then a decade of service to the city county of san francisco don is a benefit analyst and will be retiring from the system june 30. he started in the police department and after serving in the police department he left to start his family raising two daughters and a wife of 38 years. congratulations. and in 2008 began working hss as a analyst. don is a analyst who helped thousand members with benefits and known for willingness to go the ex strumile. when asked about his role don explains to dig deeper to make the benefits serve the members azofectively as possible. transfer today the national guard and served 129 air space unit at mof

fit before working for the city and 19900 was called to duty for operation desert storm and sever for national guard 14 years before working for the city. born in mississippi don and his family moved to san francisco when he was 8 years old and grew up in cal hollo and attended (inaudible) we like to thank don for service to city and to our country. don is is cherished member of the hss team and he will be deeply missed. we wish a happy healthy and wonderful retirement and best in all future endeavors. thank you don. [applause] >> i say thank you very much. i enjoyed my time with the city and hss. hss we have one heck of a awesome team. i hope their growth continues and continue to support city county

employees members and retires. now on my new chapter of my life. new book will start. again, thank you very much. >> we want you to also join our retired employees of city and county. you are not getting away that easily. >> yes, ma'am. >> welcome to a new part of your life and congratulations. >> thank you. >> (inaudible) >> could we--could we have the director's report slide removed while this is going on so that the general public can see this? there we are. thank you.

>> there is this great floral shop a block from the ymca where i swim in the morning and they have a big sign that says graduation leis and i said that's what i want. congratulations. thank you for being with us today. as to the rest of my director report i will be concise because we have a full agenda. we have continuing with our education that will inform the strategic plan and that is our special presentations soon to come. i do want to comment on the panel that blue shield pulled together for the conference board last month where latitia harris from the team was able

to participate in that panel and i saw the scores, they were all extremely high so the whole panel did really well speaking on the issue of health equity for a honor for latitia to be included. we appreciate blue shield asking i also appreciate everyone's continuing all of our continuing efforts to address underlying issues that produce inequity in health care. also, i wanted to call to our attention that we are celebrating juneteenth. it is a city holiday and for those who need a deeper understanding of that holiday since it is new we are happy to talk with you about it and but it is a second year federally recognized holiday with 47 states in the

district of columbia. the (inaudible) received word of the freedom. the history of these minority groups struggled for decades to overcome inequities is manifesting in social change. please join me in appreciating the works of (inaudible) lasting equity and inclusion for all. our pilot with the diva project is going very well. we are learning a lot and we will report out on the findings of that pilot at a future health service board meeting. i think with that, i'm going to draw my report to a close unless there are questions from the commissioners. >> any questions or comments from health service board commissioners? >> i want to say this ends the

black out period today assuming we pass both of the [difficulty hearing speaker] >> i do have one question. if i may--taking a look at the last page in the report on the eap it looks like i'm happy to see critical incident responses are down. i hope that means there are fewer critical incidence responses because i look from january to may, but more people are being served and there are more consultations ongoing, so are things changing and things are getting better kblrks >> we are continuing to find new ways to improve and extend services with limited staff and we work very closely with the public safety departments to be

sure we are doing that there as well. >> great. i am hoping at some point we are able to enhance our staff down the road. it has been a struggle for many many many years. >> yeah, we have two folks now because we have a vacant position we are recruiting for and the people we have are very tenure (inaudible) we recognize that last month meeting. >> all most one of the originals along with (inaudible) good. thank you very much. >> excuse me president follansbee i have one more announcement to make from staff and that is, that we need to announce that deputy city attorney eric rappaport is the last meeting with us. since 2005 he has been the counsel for san francisco health system and everyone had the pleasure and honor to work with

eric. he guided through our fiduciary duties following the brown act and health service board decision making process, hipa, cafeteria plan compliance employee assistance program to dispute resolution. i relied on eric since i started. the pre-pandemic coffee and lunch meetings gave insight into his integrity and devotion as a father husband and son down to earth still put me at ease. the thought of removing him from speed dial gives me anxiety. lucky for me and all here we get to work closely with eric as he is chief operating officer for san francisco retirement system to (inaudible) information technology and client services. please join me in congratulating eric on his new role as chief

operating officer at the san francisco employee retirement system and thanks him for 17 years of outstanding council and support for the san francisco health service system. we have been very lucky to have you and look forward having you as our new partner. we are sharing the same office building i (inaudible) eric left big shoes to fill but we have every confidence deputy city attorney jennifer donovan will provide excellent counsel and care. jennifer isn't able to join us but i programmed her into my speed dial and look forward for everyone meeting her at the next board meeting. so, we got some for you too. [laughter] >> congratulations. eric, it is not go ing to be

the same without you. [applause] >> thank you. this is president follansbee i like to add my congratulations to your new position and are also to thank you again for your constant availability and expertise. if you didn't know the answer immediately you always found the answer with your colleagues so we support appreciate the support from the city attorney's office at all times as well. look forward to meeting with assistant attorney connolly as well. thank you. >> thank you. i want to say it is a real honor to be general counsel to health service system. i remember the first day i came to the

board and been watching robert's rules of order which i have not had to refer to ever. it is just hard to believe 17 years has gone by that quickly including 21 on the labor team. i am not going far, i will be around if you have questions and feel confident deputy city attorney jennifer will take over and it is is a wonderful experience. the board changed but generally been a great board and what i really appreciated is how well everyone has gotten along. people have different opinions and maybe strong positions about the decisions it is always very am icable how the decisions are made and very important as general counsel no matter who ask the question if it is the same question i give the same answer to everybody and expect our office will continue to do that.

thank you. i'm going to very much miss this job. >> president follansbee. this is randy scott. as eric knows i call him my counsel and he has been a very (inaudible) in a number of issues that we face from a governance standpoint during my tenure on the board and i very much am going to miss your sense of humor, good will and most of all your integrity as counsel to this commission so congratulations on your new assignment and i wish you all the best. >> thank you. >> this is commissioner hao and i want to add a few words as well. our time on the board together eric has been short i think that i know eric from my previous life time with the city. he was one of my attorneys on the labor team and i think one thing about eric

you can say he a (inaudible) make great combination when you seek sound advise so thank you eric. >> this is commissioner zvanski. i think actually commissioner beslen since you i have been on the board i dont think we had a meeting where we haven't had eric as counsel so i thank you for your many years because it was-when i was an active employee and on this board you were always here and very good counsel. i look forward to listening to you at the retirement board because i monitor that as well so we'll stay in touch. congratulations. >> thank you. >> i too want to say thank you eric. i don't remember (inaudible) couldn't get a answer very soon so it

is very helpful and i think you have been there all most the whole time i have been on the board actually. thank you and good luck on your next position. >> i think all the commissioners had a chance to speak. i think i mispronounced our new board and health service attorney deputy city attorney donolan and apologize for misstating that. >> public comment will be begin with in-person first and virtual second. you with welcome to approach the podium now. each speaker is allowed to comment 3 minutes in length. (inaudible) caller may have questions of the body but no obligation to answer or engage in dialogue. the callers on the line state your

name clearly but may remain anonymous. i will give a warning when you have 30 seconds remaining. remote viewing is available on sf gov tv and online (inaudible) 415-655-0001. when prompted use access code 24856418533. and press pound and pound again. enter the meeting as attendee and dial star 3 to add to the queue. when the system says you line is unmuted this is time to speak. for those on hold please wait until the system indicates you are unmuted. we will begin with in-person public comment and no one approached the podium so will move to the moderator to let us know if there

is virtual public comment or people waiting in the queue. >> board secretary we have 5 callers on the line, zero callers have entered the queue at the time. reminder to callers on the line, dial star 3 now if you want to join public comment for this specific item. we'll wait 5 more seconds and close public comment for this agenda item. board secretary, there is still no callers in the public comment queue at this time. >> thank you. hearing no callers public comment is now closed. >> thank you. this concludes agenda item 8 and thank you for the director's report. we move to agenda item 9. >> thank you. item 9 is sfhss financial report as of april 30, 2022. this

discussion item and presented by iftikhar hussain sfhss chief financial officer. >> the detailed report is in your packet and what i present is the highlights. the results through april are pretty consistent with what you see in prior months with one exception. we did notice a large increase in pharmacy rebates in april and so we increase that projection to $11.1 million for the year. last year we had 8.6. the reason for-roughly corresponds to increase in pharmacy spend so higher the respond -spend the higher rebates. the

general decline is small define in the trust fund tied to stabilization. stabilization sp where we take the (inaudible) and so we are seeing the expected result of that. happy to answer any questions. >> questions from health service board commissioners? thank you very much. we can move to the next presentation. >> president follansbee for this item shall we take public comment? >> yeah. this is two part presentation. again, anymore questions or comments from health service board commissioners?

hearing none we will open up for public comment. >> thank you. [advising how to provide public comment]

>> begin with in-person public comment and no one approached the podium so move to virtual public comment and the moderator will let us know if there is anyone in the queue. >> we have 5 on the phone line and zero have entered the comment queue. reminder to all callers you must dial star 3 now if you want to join public comment for this specific agenda item. we'll wait 5 more seconds and then close public comment for this item. board secretary, there are

still no callers in the queue at this time. >> thank you moderator. hearing no further callers public comment is now closed. >> thank you very much for the presentation, that concludes item 9. we'll move to item 10. >> thank you president follansbee. agenda 10 is sfhss revised fy 22-23 and 23-24 proposed general funded admingstration budget. this is discussion item and presented by iftikhar hussain sfhss chief financial officer. >> so, what the budget is do is in february present the budget for approval to this committee and reviewed by the mayor and mayor makes changes. this meeting i will update on the results of those recommendations or requests to the mayor's office.

so, this page tells what we requested and what was approved and not approved. the two main-one big change that was approved is we have a health sustainability fund as special projects and temporary typically temporary in nature, because the sourcing of the funding is tied to the $3 (inaudible) limited. we had asked that two permanent positions of communication position and director position move to the general fund as a source offund is and that was approved. the second item was the updated--labor rates based on the bargaining negotiation. $200 thousand. (inaudible) the second year of the budget the lease is expiring so we got a updated estimate based

on the real estate department's renewal. work was not approved by the mayor was additional funding for the mental health program. about $440 thousand and (inaudible) you can see the last page here just to (inaudible) presented in february and the difference and (inaudible) happy to answer any questions. >> thank you very much. this is president follansbee. i'm probably joined by all the board members and disappointed by the mayor's decision not to approve the $440 thousand request for additional mental health service for the first responders. on april 28 we certainly heard the

need for mental health service and as addressed by a member of the public today, the need is not going away or decreasing, so when we get a response like this, number one, is there a rational provided and number two, maybe you or director yang can address what our options are. >> we were informed the day before the budget went public. we have been in touch with the public safety department that are impacted by this decision. each are responding in a different place. police budget is in fact. they have the model behavioral health unit and that budget is in tact as we understand it. they were going to be part of a package of services that putting together with the 400

and then we were going to pay through work orders through the different departments and so they are okay. the fire department is working to get a behavioral health unit approved through (inaudible) with board of supervisors in that they had in their m orks u for a number of years a requirement that they have a behavioral health unit like the police department, so i think they are seizing the day to get that and we offered whatever support that we can give to them in that effort. sheriff department is a little different. they do they think they have some funds they will be able to identify to do pilot programming that would set the wheels in motion for establishing a track record and program that may be fundable next year. and so we

have been in touch with them as well. disappointed, yes. i think we--the long road that we have been on has been really remarkably good for our relationship building and how we can work together and continuing to highlight the importance of these services. the mayor's office official response on this is that they put a lot offunding and this is true, they have put a tremendous amount of funding into staffing of police and fire who have had devastatingly large numbers loss of employees. there is also been some as i understand it, i dont know the details but incentives built into police and fire contractor to try to keep the 500 individuals who are eligible for retirement today to keep them on-board while they do the heavy recruitment in both departments

and academies to bring people in so there is just-don't necessarily agree but i understand the position they have currently taken and we will continue to support the efforts of the public safety departments are doing and find a way to help bring that along. that's where we are at at the moment. >> thank you. >> this is commission zvanski. is there a chance the budget will go to the board of supervisors that the board will make some changes and add some support for these departments? >> yes, as i described, the fire department is pretty confident there will be add-backfunding for the

behavioral health unit since it is stated as a requirement in their mou and they do have board of supervisor sponsor for the add-back rate. >> those would go to those department and not us? >> right. the funding mechanisms, they are fluid, there is different ways of doing this. as long we are finding the money to add the services no matter what department it is in, then we are getting there so i think it has been really helpful. i didn't highlight in my director's report though too is they- firefighters came before us for request for the addiction services and the isaa has in maryland and all three plans are working diligently to make it happen. we are down to details on the agreements now but it is looking very very positive so what is really good is public safety we are working together. there is a real

collaboration on helping them get our membersigate get what they need. >> very encouraging. thank you very much. >> this is commissioner scott. president follansbee. >> yes. >> are all of the first responders in the three departments you referenced or are there other first responder staff? >> those are three departments we focused on. we initially had department of emergency management involved as well. i think partly because they have been so on for the last 2 and a half years. they haven't been able to fully engage, but we do keep the 911 dispatchers in our thinking as we develop these and certainly they had the opportunity to use the cortico product we bought for the public safety department but it was limited but there is room to improve with that department. that is all very

transparent and very good working relationship. >> i raise that question because we know where the big departments are, but there are other agencies in the city and you referenced 2 of them that also are first responding agencies. i would hope that we would keep this request in the forefront and of the next budget cycle to provide supplemental services for the others are allocated now are seeking allocation but there may be others and we may need to be supporting them as well so i would recommend that to (inaudible) and to you director. >> thank you for that support. >> thank you. >> perhaps you know if they receive more emotional support or support in general they wouldn't leave in droves is my opinion. is there a

way to get the screens up so you can see it at home? can't really see these screens here. >> i can definitely monitor being able to see that. >> okay. thank you very much. >> for everyone to know it does switch back and forth between the room and presentation but i'll monitor when someone is presenting that it is visible for you. >> thank you. [providing instructions for

public comment] we'll begin with in-person public comment. we have one person in

line. your 3 minutes will begin now. >> this is fred sanchez with protect our benefits. >> fred you want to grab the mic there? >> i just want to thank the executive director abbie yant working with the mental health issue with (inaudible) i know to facilitate meetings with actual providers blue shield, very complex, a lot of moving parts, but without the openness to actually listen because there is very unique issues concerning-police have their behavioral units and they have very unique things as police officers as fire has very unique things that are only there with fire, so

that's very important. i thank commissioner scott for thinking of the other emergency people. that's very positive comment that you will be willing to look at the other emergency services so that speaks highly to the commissioners as well as abbie. i really applaud the willingness to try to facilitate these types of very unique issues that are very important to public safety. thank you. >> thank you caller. no one approached the podium. we will move to virtual public comment and the moderator will let us know if there is anyone in the public comment queue. >> board secretary we have 5 callers on the line, zero callers have specifically entered the queue at this time. reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific item. we will wait 5 more seconds

and close public comment for this agenda item. board secretary, there is still no callers in the public comment queue at this time. >> thank you moderator. hearing no further callers public comment is now closed. >> thank you very much. this now closes item 10. we can move to item number 11. >> thank you president follansbee. item 11 is presentation of the 2022 rates and benefit calendar for the plan year 2023. discussion item and will be presented by abbie yant executive director. >> good afternoon commissioners. the rates and benefits calendar should conclude with today's meeting. again assuming we will pass the packages before you. >> thank you. any further questions or comments from commissioners?

hearing none, we'll open up for public comment. >> thank you president follansbee. in-person first and then virtual public comment. [providing instructions for public comment] we'll

begin with in-person public comment. no one approached the podium so we'll move to the moderator to let us know if there is public comment in the queue. >> we have 5 callers on the line, zero callers entered the queue at this time. reminder to all callers, dial star 3 now if you want to join public comment for this specific agenda item. we will wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public

comment queue at this time. >> thank you moderator. hearing no further callers public comment is now closed. >> thank you very much. this concludes item number 11 so we'll move to item 12. >> thank you president follansbee. item 12 health plan 2023 rate summary. medicare retireeerks cizey multiregion retirely health plan. >> mike clarke. starting today with summary of the rates that i'll present during the course of today's meeting focused on medicare retirees and kaiser multiregion retireee health plans. what is in the materials is a summary of the rates actions that will be recommended for each of the individual presentations that will follow. the retirees

plans presented today are all fully insured plans which means the plans set the rates with scrutiny from myself and staff. the medical prescription drug plans include kaiser permanente (inaudible) but also offered in washington the northwest which is oregon and southwest washington and hawaii and national yunthed health care medicare advantage drug plan or mapd which is a ppo plan. we labeled the kaiser northwest and washington plans as multiregion hmo so as you move forward to the next page on slide 3 you see the current covered (inaudible) united health care is the largest enrollment, just over 17 thousand covered lives. fallowed by kaiser

permanente senior advantage in california be, about 17 -15 and a half thousand. and medicare is 113 and also 52 early retirees enrolled in the kaiser non medicare multiregion hmo in those geography. the rest of this particular overview we'll focus on highlight of the rate actions proposed by kaiser in california and the uhcmad plan. the linkage to the medicare plangs are covered on pages 4 and 5. really the medicare advantage plans offer really the greatest ability to support sustainability, guiding members in partnership with patient advocates to encourage preventative care and seek appropriate care

alternatives. (inaudible) allow for value added benefits beyond core health coverage and then the next page is (inaudible) for members in northern california which are most retirees. the flexibility and choice of two models. the (inaudible) and united health care model and uhc plan available nationally. very comprehensive plan. from a whole person health wellbeing standpoint designed to support members across health needs. there are several past presentations at the board. we encourage you to review the november 2020 presentation as well as information provided last year during the process for more information. from renewal standpoint what we will present in a bit here for the kaiser permanente plan is a third year in a row of rate decrease. there was a

fairly significant rate decrease in the last year for 2023 another decrease of 1.9 percent. for united health care medicare advantage plan there was a slight increase for 2022 as there was still pandemic base favorability and experience reflected in underwrighting. 23 increase of 4.7 percent and finally what you'll see from each of the individual presentations but presented here to hope comparison between the california plan and the uhcmapd national plan are the full rates for the retirees paying the full employee cont ribution. the member contribution are zero for both plans given the total plan rates are less then

the 2023 (inaudible) with that i'll pause for any questions. >> i open-thank you very much for thez the presentation. open up for questions or comments. any questions or comments from the in-person board members or commissioner breslin. >> no comment. >> hearing none we'll open up for public comment then. >> this is commissioner zvanski. a lost thought. one thing i'm reading about recently and this pertains to kaiser and uhc, are comments about the mapd plans

that are incentivized to cut service so they keep the cost lower and just as i was looking at the decreases in some of the rates while we are happy about that i dont know that we have any kind of responses from our members that they feel there are significant services being cut back, but are you monitoring that as well to find out that they are providing full services without any-- >> we do regular utilization reviews with the plans and while i have seen headlines they dont apply to our plan. if you come upon a concern or specific question a member has please refer to member services. >> thank you. very happy to hear that. thank you very much. thank you president follansbee as well.

>> i think that is a excellent question and also speak tuesday the power that we as the health service system have to monitor the plans we contract. occasionally get requests to open up for members who are living in other regions the option to sort of look for their own contracts and when these kinds of things happen we are not in a position as health service board to respond to services that might be cut to the myriad numbers of other medicare contracts out there, so again, i thank dr. (inaudible) for her response in terms of overseeing the services we do contract for and insist on being provided at the highest level so thank you very much. hearing no

other comments, open up for public comment then. >> thank you president follansbee. [providing instructions for public comment] we'll

begin with in-person public comment and no one approached the podium so will move to virtual public comment. the moderator will let us know if there is anyone in the queue. >> we have 5 callers on the phone line, zero callers entered the queue at this time. reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda item. we will wait 5 more seconds and close public comment for this agenda item.

board secretary there are still no callers in the queue at the time. >> thank you. hearing no further callers public comment is now closed. >> thank you very much. this concludes item number 12. i would like to call agenda item 13 and then promise all commissioners and other attendees we will take a break after the conclusion after agenda item 13 so i'll call for item 13. >> thank you. item 13 is review and approve kaiser permanente multiregion retireee hmo plans fully insured 2023 rates and contsbutions. this is action item and presented by mike clarke. >> mark clarke. as you see on the agend opstart with recommendation summary.

commentary on the rate proposal by kaiser. the rate cards and then closing with recommendation for board consideration. just as a introduction on page 3, these plans in this material were first introduced 2018 for retirees outside california where kaiser is available and also a number of retirees who would from these plan. called multiregion offered in washington state, northwest oregon and southwest washington and hawaii. on page 4 you see a recommendation summary to approve the rates that i will present. the total premium represented by these plans for the medicare retirees as well as early retirees is

$1.5 million projected for 2023. you see the total cover members in members for early retires and dependent and medicare retirees and dependents and see favorable rate actions proposed by kaiser. couple zeros, no change in rates. couple decreases actually. and then increases in washington for early retirees and a small increase for the norkt northwest for med kale. page 5 you see the rate actions propose d are slight decreases. early retirees 1.2 and (inaudible) kaiser determines the rates on a community rate of basis due to small population in each of the plans. obviously these rate actions are well below national health care cost increase trends. and when we look at the rate card we add the basic

vision premium approved in the april health service board meeting as well as $3 per month sustainability charge. the rate derivation is based on a early estimate before final approval offunding for 2023 is available from cms so kaiser reconciles differences between the 2023 rates and ultimate rate for 2023 that reconciliation will happen next spring to apply to the 2024 rates. (inaudible) the final rate could be higher or lower then the estimate applied but the goal of kaiser is to try to provide a estimate as close as possible to the final rates. and then just reminder that the retireee contributions reflect full employee

contribution for retireee medical coverage available to retired employees hired on or before january 9, 2009 or retired for disability and survivoring spouses or domestic partners who died in the line of duty. there is coverage available with no employee contribution to retired employees hired after 2009 (inaudible) and on page 8 you also see coverage available with partial employer contributions for certain circumstances for individuals hired on or after january 10, 2009 depending on length of service. this is rate card we ask for approval ong

washington state page 9. page 10 shows comparison of the monthly retiree contribution. impact on member contributions for early retires and medicare retirees. page 11 shows the northwest region rate card anding for approval today along with page 12 showing comparison year over year of the total rate actions and the impact to retireee and employee contribution and finally for hawaii page 13 shows the monthsly rate cart asking for approval on today for hawaii region and page 14 shows the comparison of the rating components and member and employer contribution between 2022 and 2023. with that i'll close on page 15.

staff recommends approval of the rates for multiregion hmo plan for early retirees and medicare retirees. president follansbee. >> thank you very much. very comprehensive review and proposal. particularly pleased to see the rates in hawaii are coming down. as i recall from our previous reviews of this those rates seemed to be going up quite considerbly and this is good news for our members. with that, i open up for questions or comments from other commissioners. >> could you take a motion to accept these rates as presented? >> yes, i would. yes. thank you. >> i am making that motion. >> related card? >> yes. >> i second the motion. >> moved and seconded we accept the proposal with the

related fee cards. with that, we can open up for further discussion. ask you-you alluded to national trends and how this fits in. i may have miss ed in the slide but what are the national trend in this setting? >> we are generally 6 to 7 percent for national cost trends. a lot depends on medicare plans on things like star rating and what's happening with experience in the plans and as executive director ann said we closely monitor experience with both kaiser and united health care so we say generally if rates are coming in 5 percent or less that would be less then national trends. >> i know that we will be addressing the california senior advantage age but what are the star ratings-in the presentation for the

other regions? >> my understanding unless there a-if i state inaccurately but believe it is correct, the (inaudible) plans are also 5 star rated for medicare advantage and then separately united health care is 5 star rated plan for medicare advantage ppo. >> thank you. any other questions or comments from health service board members? don't see hands or questions. if not, then open up for public comment. >> thank you president follansbee. in person public comment is first and virtual public comment. you are welcome to approach the podium now. each speaker is allowed to comment 3 minutes in length. all public comments are made

concerning the item presented. [providing directions for public comment]

we'll begin with in-person public comment. no one approached the podium so we'll move to virtual public comment. the moderator will notify of caller in the public comment queue. >> board secretary we have 5 callers on the phone line, zero callers have specifically entered the public comment queue at this time. remeender reminder to callers dial star 3 now if you want to join pub lrk comment for this item. we will wait 5 more seconds and then close public comment for this specific agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you moderator. hearing no further callers, public comment is now closed. >> thank you very much. moved and seconded that we accept the approve the kaiser

permanente multi-region hmo plan and rate cards. i call for roll call vote. >> thank you president follansbee. roll call vote. [roll call] >> thank you very much. this motion has been approved unanimously. with that, i will call for a 15 minute break so we'll resume at approximately 246 p.m. >> just to keep in time i know we usually do a 10 minute to make sure we conclude our agenda. >> yes, i understand but think we are ahead of our agenda in terms of the time piece that i have. so, i think 15 minutes is still help us get through the meeting in a timely manner. >> okay. thank you very much.

>> thank you. [15 minute recess]

>> okay. we like to call the regular meeting of the health service board with city county of san francisco on june 9, 2022 back into session. may we have a roll call,

please? >> yes, roll call. [roll call] >> president follansbee, we have quorum. >> thank you very much. move to item number 14. >> thank you president follansbee. item 14 review and approve kaiser permanente senior advantage fully insured medicare retireee twept 23 rates and contributions. action item andprinted by mike clarke. >> mike clarke aon toprint the (inaudible) with introduction commentary on the kaiser permanente rate action fallowed by the rate card and presenting recommendation to the board. staff recommend board accept the kaiser permanente

senior advatage medicare rate card in the presentation which include 1.86 premium reduction in the 2023 plan year. there are as i reviewed earlier 15.452 medicare eligible retires in the plan and since 2014 per request kaiser provided a early estimate for the year member per member per month retireee rates. last year was there a 10.83 percent decrease see on page 5 in 2022. there is a rate decrease this year again, 1.86 percent actually the third year in a row the rates decreased. what you see in the table are the primary elements that into to the 2023 rate development. these

are kaiser premiums only so at this point including the rate loads you will see later in the rate card. the early rate projection before added programs you see in the footnote number 1 is $290.35 per month. there was a small reconciliation in the 2023 rate from cms the require year rate was fairly accurate relative to cms funding. there are a number of programs you see in that footnote at the bottom including chiropractic (inaudible) post discharge mail delivery that add to $11.99 per member per month for rate. $304 per month compared to billed rate of $309.76 in place for 2022 and that leads the 1.86 percent rate

decrease for the rate into the 2023 plan year. and again, reviewed in the prior presentation, this is is a estimate based on best for ecast of cms funding but there will be a true-up next year spring with final cms funding as you saw in the prior table. we also on page 7 with the rates provide (inaudible) add basic vision plan premium to the rate card and health plan or health care sustainability fee. and i reviewed earlier i won't go through it in detail but these rate cards reflect individuals receiving full contsbution for medical coverage you see and there are depending on circumstances for individuals hired on or after january 10, 2009 potential for

no or partial employer contribution. that's reviewed on pages 8 and 9. the rate card itself that i will ask your approval is page 10 showing the premium for the kpsa plan the basic vision cost and the sustainability charge of $3 and then you can see how that compares. the 10 county amount portion is less then the actual 10 county because of the rate being less then the $780.86 so that leads to zero dollar contribution for medicare retireee only and the countbution in the final number, 2023 row for the other rate tiers. page 11 a comparison for 2022 versus 2023, the 1.8 percent decrease also vision load and

the sustainability charge as well as the kpsa premium so for most retirees or all medicare only and family tier seeing small decrease in contributions. with that on page 12 recommendation the health service board accept the kpsa rate card presented today with 1.8 percent (inaudible) >> thank you very much for that presentation. trying to get used to the word kpsa. just so i'll ask for a motion. >> i make-- >> president follansbee this is commissioner hao, i move that the health service board accept the kpsa medicare

retiree rate card which includes 1.8 percent reduction. >> second. >> thank you very much. been moved and seconded we approve the kpsa insured medicare retiree rates for 2023 and rate cards as well. and so open up for discussion. just to make sure everyone who is present recognizes this, this isn't a extraordinary request for us to request from kaiser the interim rates. this happens annually based on our agenda for the board of supervisors and kaiser's own normal procedures, so this is something we do annually and face annually and this isn't a unique situation. with that, any comments or questions from the board members? >> i would just-this is commissioner scott.

relative to this-keep raising the question and comes back again now--the utilization depression that we went through, has this in some way blend pd to what kaiser's thinking is looking toward next year recovery? >> my impression talking to the kaiser underwriters about this is the forecast is projecting a expected utilization level for 2023 commensurate to pre-pandemic times. i would say-i'm not sure how much of the prior rate decrease tie directly into pandemic suppression but sense there is a element of that-11 percent decrease from 21-22 is significant, certainly

not sustainable. i will say this rate before you for 2023 is as low as i have seen in about 10 years of tracking of rates from kaiser permanente for the california region to sfhss. certainly i would be concerned as the actuary about the potential for what future rate increases would be and that's something we are discussing with the kaiser team to try to understand how levels of utilization are expected to change. that said, i would contribute that the kaiser model of working with members working with patients integrateed care model i think does play out in the rates that you see being for instance lower then the national ppo plan where you don't have that level of management you do in

the kaiser hmo. >> are thank you. >> other questions and comments from commissioners? seeing and hearing none, i guess we'll open up for public comment. >> are thank you president follansbee. in-person is first and then virtual public comment. [providing instructions for public comment] we'll

begin with with in-person public comment. no one approached the podium so will begin virtual public comment. the moderator will notify of public commenters in the queue. >> board secretary we have 4 callers 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 star 3 now. we will wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you moderator. hearing no further callers, public comment is now closed. >> thank you very much. so, it is moved and seconded. we approve the kpsa fully insured medicare retiree 2023 rates and rate card. call for a roll call vote. >> thank you president follansbee, roll call vote. [roll call]

>> thank you very much. it has been approvered unanimously. before i call for agenda item 15 i want to follow up with a comment that commissioner scott made. in general about utilization of services during the pandemic. i think this is still a appropriate question. as i look at the reports coming out it seems many plans report members of beginning to return forue teen visits and health sceneing but still below routine sceneing so urge all our health plan members and health service system enrollees and families to please resume their routine health care. there is catch up to do. i say parathetically i had surgery two weeks ago, one of three cases scheduled by my surgeon. the other two were canceled because the members

had covid in 6 weeks of the surgery date, so i was the only case of the day. to no fault of the health plan or the members. the pan demic is still influences availability and accessibility. the members still need their procedures done i presume. i don't know if they are health service members but the pandemic operative. please stay safe and also please catch up on all the health care maintenance. this is is a important ongoing issue and look forward to reports from the health plan partners on utilization in the future. >> commissioner breslin, i have a comment about that. you would not know by trying to get an appointment with the doctor people are not going because there seem to be a long waiter period for everyone. specialist or primary

care person or anything, so i don't know. >> i think-i appreciate that. i think we need to be hold our health plan partners account able for the issue. i speak prnl experience i went for my second covid booster as i registered through my health plan provider, the register person said, are you available for a routine visit today because your provider has appointments. accept the fact i had a meeting with the health service board i could have taken it so integrateed systems do help address some of the issues and so we need to continue to hold all of our health plan partners accountable for this very important issue you bring up commissioner breslin. okay with that- >> and dental. >> and dental, yes.

all health plan services we are responsible. with that, like to move to item 15. >> thank you. item 15 review and approve the united health care uhc medicare advantage ppo fully insured medicare retireeerks 2023 rates and contsbution mpts action item and presented by mike clarke. >> mike clarke. my final presentation today will be the unitsed health care medicare prescription drug plan rates for 2023 recommendation. i'll make introduction on the plan, talk about rate history and come commentary on the present renewal leading to rate card and recommendation and you see information in the apenedx including definition of choice not available if you have questions about that aspect of the associated non medicare ppo plan for split family members in this united health

care medicare advantage plan. as i will present today, staff recommends the board accept the united health care medicare retiree rate card with a 4.7 percent increase in the 2023 plan year. introduction slide 4 you'll see there is 17.432 total medicare eligible retirees and depend dependents in the plan and rate per month basis for insured plan from united health care for 2023 is $447.22 per member per month with no plan design changes so status quo plan design and program. this represents 4.7 percent increase (inaudible) something to keep in

mind the last couple years of the plan is upon recognition of the claim suppression occurring in 2020 with this plan, a united hlth care proposed a 2 year stabilization adjustment so not having anything to do with the health service board stabilization policy but internal underwriting on the program which reserve dollars into applying towards rates both in 2021 and 22. if you recall, as we presented the renewals in the past years, there was a $15 per member per month stabilization offset available in 2021 rating and $10 for 2022. so, part of this increase this $20 pmpm increase for 2023, half $10 is

the expiration of the claim suppression element and remaining $10 is underwriting influence of looking at the needed rate by united health care for 2023. we also footnote that there is a part b only plan rate. there are about 150 members who do not have medicare part a because they don't qualify for it. there are certain elements of qualification most specifically paying 40 plus quarters during work lifetime paying medicare taxes. granted 153 out of 17432 is a relatively low number, less then 1 percent of the population but there is recognition that for some of these members who don't qualify for medicare part a the hospital benefit that there was a part b plan only rate made available that also includes services that medicare otherwise would pay

for if that member were eligible for part a. just reminder for the non medicare dependents of retirees enrolled in the uhc plan as well as non medicare retirees and dependents where at least one family member is medicare eligible and enrolled in the plan. uhc is the administrator of the ppo plan available to family members in split family or mixed medicare family presentation. there will be a presentation on this project in the next item but to reinforce for the ppo plan, uhc will continue to be the administrator. today the non medicare family members were at least one family enrolled continue to have the same plan choices in 2022 for the blue shield access plus plan, trio plan and the uhc non

medicare ppo plan so that is the availability of plans today again addressed during the item. so specifically for this renewal, the uhc plan does include the following invasion benefits that support enrolled members at no additional premium for 2023. there will be some structure changes in the programs. for instance with fitness is and gym membership, renew active is a vendor that replace silver sneakers that provide a greater number of gyms for members. healthy at home is the post discharge transition back home program that includes meal delivery and added benefit up to 6 hours for personal care and added benefits at no additional cost

include rally coach that includes personal wellness coaching as well as a personal emergency response system so think of that as the electronic device if you fall you can have that available. that will be made available to uhc plan members. so when setting the premiums not just incorporating the total premiums from uhc but also the vision plan premiums previously approved at the april meet ing and health care sustainability charge. just recognizing the rate card does have the distinct mixed medicare family columns for each plan available to those individuals. and as in 2022, health net will not be available for mixed medicare family enrollment for non medicare members. and as i stated in the 2 earlier presentations, the

rate card shown here are for those who earn the full employer contributions. there are partial employer contributions for some as well as coverage for some but no employer contribution. those provisions are outlined on pages 8 and 9 of this material. that leads to page 10, proposed uhc2023 plan monthly rate card. the left three columns show rates for the tiers where all members are on medicare and the right 3 columns show rates for full family circumstances where 2 members are medicare and 1 or more member of the family covered life is non medicare. and then page 11 shows the comparison of monthly retiree contribution

(inaudible) between 2022-23 dependent on the individual covered tier as well as medicare or split family medicare non medicare family circumstance. with that, i'll close on page 12 with recommendation that staff recommends health service board accept united health care medicare advantage drug medicare retiree rate card as presented today which includes 4.7 percent insured premium increase into the 2023 plan year. president follansbee. >> thank you very much. entertain a motion to approve the recommendations as outlined. >> this is commissioner scott, i move we accept the recommendation as described in the related underlying rate cards for uhc-mapd medicare retirees. >> second. >> thank you. been

moved and seconded and open the meeting up for discussion or questions from commissioners. any questions from board member? >> yes, i do have one question. the change from silver sneaker to the new vendor, what prompted that by uhc? >> if i can ask united health care representative to speak to that. >> good afternoon. monica (inaudible) united health care retiree solution. i want to thank you for the question commissioner scott. really during the pandemic one of the things we really observed is we wanted to make

enhancement to certain programs like our fitness benefit and by moving to renew active that is a united health care owned fitness program. it really gives a lot more flexibility, so that is really the reason for the change. >> thank you. >> will we need another card for that then? how does that work or do you send out cards? >> thank you commissioner breslin for your question. we will be sending a notification about the new program and it will give instructions on what to do, but there isn't a separate card at all. it is the same united health care card. >> we used to have a silver sneaker card. >> actually, a lot of our retired members comment they really enjoyed silver sneakers and want the program to continue. as long as they have the same services,

they will be happy. thank you. >> thank you. they will have the same services and even greater choice. >> that may be even better. thank you. >> any additional questions or comments from health service board commissioners? hearing none, we'll open up for public comment. >> thank you president follansbee. in person public comment is first and virtual public comment. anyone waiting in person you are welcome approach now. each speaker is allowed to comment 3 minute in length. [providing instructions for public comment]

we will begin with in-person public comment. no one approached the podium so will move to virtual public comment. the moderator will notify of caller in the public

comment queue. >> secretary, we have 5 callers on the phone line, zero callers have entered the queue at the time. reminder to callers on the line, dial star 3 now if you want to join public comment for this specific agenda item. we'll wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you moderator. hearing no further callers, public comment is now closed. >> thank you very much. so, i will-moved and seconded that we approve the uhc medicare advantage ppo rates and card that follow. call for roll call vote. >> roll call vote.

[roll call] >> thank you very much. passes unanimously. and i want to thank you again for really clear presentation of both background perspective and clear recommendations. the speed we go through this and depth of understanding on part of each of the commissioners the clarity of your presentation and that of colleagues who protection of this. thank you very much. >> thank you. >> move to item 16. >> thank you president follansbee. item 16 recollect review approve change in non head care plan administrator united health care for non medicare split family lives where one or more family covered lives is medicare and enrolled in united health care medicare advantage

ppo. this is action item and we will have two presenters today. rey guillen sfhss coo and mitchell griggs. mitchell griggs is joining virtually and want to do a sound check. and see your camera on. can you hear us mitchell? >> yes, i can hear you. >> thank you. mitchell, mr. griggs, can you just test your mic one more time? >> yes, mr. griggs, chief operator officer. >> thank you. did that come in clear for everyone here? yes? okay. >> yes. >> mitchell will begin the presentation. >> thank you president follansbee and members of the board. we are going through this staff recommendation today. [audio fading out] >> you are cutting out. can't

hear you. >> can you hear me okay now? >> now i can hear you. >> now that you are closer to whatever mic you are using. >> so, good afternoon president follansbee and members of the board. today we will go through this presentation of a staff recommendation on slide 1 presentation. just go over what this presentation will include and are the staff recommendation which is asking the board to approve a change in the non medicare plans. (inaudible) we will go to the current state for rational for the recommended change and then some protected (inaudible) and repeat at the end the recommendation. just to review so everyone is aware,

i want to define a split family. a split family is active employee retireee or dependent isn't eligible for medicare but there is one or family member that is medicare eligible and enrolled in the ppo. currently united health care is handling the medicare plan for those that are medicare enrolled family members but hss needs administrator to handle non medicare coverage and (inaudible) so, if we can go to slide 3. again the staff recommendation is for the board to approve change in the medicare plan administrator to united health care from blue shield. that means uhc handles the non medicare ppo plan we call the companion

plan but we add two additional plans and those plans are exclusive provider organization plans. so that would be a total of three plans in epo would be the same current benefits provider network and plan design of the blue shield plan of access plus (inaudible) slide 5, please. as we are aware especially going through the rates we just did we have two medicare advantage plans and kaiser permanente, all non medicare family members are handled easily within that (inaudible) medicare family members are in the non medicare ppo companion plan or one of the two blue shield plans. slide

6. some may remember back in 2017 for the plan year 2017 we moved blue care (inaudible) stopped offering blue care medicare advantage and once we wrp doing this we realized for non medicare family members moving from blue shield that if we put them in the ppo plang with united health care that would not be cost effective for the member. the rates would be a lot higher as well as the point of service there is coinsurance and desductibles where the hmo is simply copay so tried best to minimize the financial impact to the members and (inaudible) did a award winning solution providing programming (inaudible) [audio cutting in and out] between two different.

one in united health care and one in blue shield for non medicare families. this dird create a complex administrative burdens on hss and health plans. eligibility system eligibility enrollment systems are not meant to split families in the way. usually the family always follows the subscriber, so we were running into a lot of difficulties with that and since 2017 and before my tenure is up pi think we found a solution for this that would also not cause a lot of member disruption. we did this in 2020 starting with the leadership of abbie yant started looking at a different plans. home grown network and health plan and noticed with united health care the epo and

we can closely align the benefits and provider network while eliminating the need to maintain all the criteria in the system between two different carriers. next slide, please. slide 7. just a little information to show you the type of administrative work it takes in order for us to do this over the past 5 years. as you can see there are many computer programs interface files and configurations of event rules a people soft term for allowing enrollment for certain times and coverage codes and additional 443 premiums that we have to create. that is all for about 800 members which is half of 1 percent of the total covered lives. when you do things like this benefit administration field you center to think about the liability we put on our fiduciary

responsibility to all our members. we put that at risk when we have a disproportionate amount of resources that are going into such a small part of our membership. next slide. slide 8. some of the burdens and issues that come up by having this configuration to them system, we have issues we have to resolve like a(inaudible) data we try to (inaudible) getting deductions because we are talking about two different premiums going into one pension member deductions and then of course every time we touch anything like reports we have to mine maintain the customized programming and that does cause a lot of member

confusion, two id cards and carriers. sometimes they get incorrect deductions we have to correct and (inaudible) dependents also have to go into their providers and facilities and let them know how this insurance works and then when the members do transition into medicare from retirement and then they have non medicare family members (inaudible) we have to give our members. next slide on slide 9. so, this basically is hopefully showing you why we have recommended this change. you can see in the graphic here united health care medicare advantage ppo a disconnect with the blue shield plan and (inaudible) which we are after a lot of work looking into it

has minimum (inaudible) at this point i think the rest of the presentation will go to rey guillen to be looking to implement this change. >> yes, thank you mitchell. so, commissioners, on the next slide we have a chart that attempts to show the projected impact of this change. the universe we are talking about is 1224 split families with at least 1 family member enrolled in the uhc-mapd. thegood news is 392 of those families are currently enrolled in the uhc non medicare ppo for the non medicare family members and so there won't be knae any change for those members just roll to the non medicare ppo which they are currently in, no disruption to the providers or

impact to the cost. the next group of people is blue shield access plus families, 529 families. 525 of the family will be matched to the uhc broad network epo. in this case, there is a 95 percent provider match so what we did and we had blue shield send over a file to uhc with the providers that our members visited over a 12 munthd period of time. the good news there is a excellent match of 95 percent and this again we need to be careful here. some of these unmatched providers only had one to two patients during that 12 month period of time and so it is a very excellent match here and the cost impact will be neutral for these members. these 525 members will just be mapped over to the broad

network epo plan. there are a very number, 4 families they live in the area where the uhc network plan is not available so this is less then 1 percent of the population but they would need to be mapped to the uhc non medicare ppo plan. the good news there is a excellent provider match. there won't be discorruption due to providers but there could be an increase in cost depending on the family composition in terms of the premium and also again we are talking ppo plan where there would be coinsurance and deductibles. moving to the blue shield trio plan, talking 303 families. 279 of the families will be mapped to the uhc doctor plan. a similar plan to blue shield trio. there is a less of a provider match, 52 percent

provider match for those providers visited in 2021. however, there is a much closer match for those disrupted providers if the member move over to the uhc broad network epo so the 48 percent that would have a potential disruption they can move to the broad network epo with a increase of course in the premium cost. there is 24 families where the -there is no coverage available under the uhc doctor plan. the good news here unlike the blue shield access plus members where the geographical overlap wasn't as good, these folks would be able to be mapeed to the broad network epo plan where there is a excellent match for the providers they saw in

2021. agains, for the ones that were not match, only had 1 to 2 patients we are seeing in 2021. of course, the broader network that the cost in terms of premium, so there would be a cost impact for those members that transition to that broad network epo. next slide. the key here is again, we are talking very small number of our population but we do realize there will be confusion in disruption so our team and the united health care team stand ready to support the members in any way we can. we are attempting to provide that level customer support to explain the recommended change and how they might be impacted. we will make sure that we do whatever we can to provide the necessary training to our staff. we are prepared to send

communication to each impacted member via custom mailer and e-mail. we will have call centers support ready to answer their questions. we will also make sure to schedule uhc office hours so members can have ready access to uhc staff to answer any of their questions and also insure that uhc calls all impacted members to inform them of the change and of their plan choices. going back to the recommendation for the health service board action, again we are asking that the health service board approve the change in the non medicare plan administrator to united health care for those non medicare split family lives where one or more family members covered under medicare and enrolled in united health care medicare advantage ppo. commissioner

follansbee, i will turn it back to you. >> thank you. before i open up for discussion, i would like to entertain a motion. >> i move that this-commissioner scott, i move we accept the staff recommendation as presented and outlined on page 14 in detail. i just with that i like to make a comment once the motion is (inaudible) >> second. >> moved and seconded that we approve the change in non medicare plan administrator to united health care for non medicare split families. open up for discussion. commissioner scott you said you had a question or comment? >> yes, this is the (inaudible) hustled with nearly 5 to 7 years even before we made the decision in 2017 and this issue really came to light once we began the open

enrollment planning for it, and as this item came to my attention and discussion with abbie preparing for the meeting i said i thought we had settled this administratively and we had this in the system somehow that we were managing this and she said no, we are still using the same spreadsheets. excel spreadsheets to administer this and this is dangling for years so i commend mitchell for his diligence and abbie for her leadership and your ability to help with this implementation. it is long overdue. >> thank you very much. i just have one question before we have other comments. i hear two possible consequences for those certain members. one is that they will be change in provider and the second is will be a change in cost

because the health plan may change. can you break that down a little bit more to tell us how many people will need to-just simply a change in cost and see the same provider versus how many people have to change provider and incur increased cost, so we have a idea about numbers and then is there a estimate about what the cost change based on the current rate cards we approved and submitted to the board of supervisors might look like for these members who incur increased cost? >> thank you commissioner. obviously the answer is very complicated. in case of blue shield access plus members as i mentioned there are 4 families in which case the uhc broad network epo plan is not available, so they have access to the blue shield hmo

plan but those 4 families need to be mapped to the uhc non medicare ppo plan. it really depends on their family composition which to what extent the cost will increase and it is really those individuals that have a non medicare retiree with medicare family member that will have a increase in cost in terms of the premium. again, it is really specific in that case. for those members where it is the opposite where the retiree is the medicare member, their premium cost would go down but we got to keep in mind they are going from hmo plan to ppo plan depending on utilization of service they can have increase in cost based on coinsurance and can deductible so it is a complicated matter but we are

talking 4 families that will deal with the very specifically in terms of reaching out to them. the other group that we are talking about is the blue shield trio members, so there is currently 24 families that live in a blue shield trio service area where they will not have access to the narrow network doctors plan. in that case those individuals will need to be mapped from that trio plan to the uhc broad network epo and are again it depends on the family composition in terms of what their cost would be but in general if they are retiree and one dependent we look in the neighborhood of $39 a month to about $102 a month if they have multiple dependents ungder the plan. the final group is 279 blue shield trio members who have access to the

blue shield doctors plan but again there is 52 percent provider match and again when we talk about provider map again we are talk providers visited in the 2021 year and doesn't necessarily correspond to 52 percent of the enrollment. again, they look at each individual doctor visited and so we are not exactly sure what number of those 279 would be affected because some of these doctors were only seen by 1 to 2 patients during the year. but, for the folks their doctors do not match they have a choice. they can change their provider be mapped to the doctors plan with no increase in the cost or they can make the election to

change to the broad network epo plan and continue to have access to those providers. again, that would be the same increment difference i went over between $39 and $102.08 per month dependent on family composition. >> thank you. that helps me understand the impact of this. further questions? >> yes. commissioner breslin. this definitely looks complicated and it looks like there will be a fair amount of disruption. i don't understand is the uhc-ppo plan. that is what our city plan was called, so is this different then that since uhc does not (inaudible) blue shield does. i'm not sure what you are talking about when you are talking about

uhc-ppo plan. the medicare retiree can't join the medicare ppo plan i assume too. i can't be clear on that. this is all a result of separating the retirees from the actives and not allowing them to be in the same plans. prior to 2017 that is what happened, you could belong to blue shield, you can braung plaung to a city plan and kaiser and none of this was a problem which i oppose at the time the segregation and these things are a result of it. i would like a answer to understand the ppo. generally the ppo are more expensive. higher cost then regular like medicare advantage plan. >> sure. again, in

2017 when the blue shield ppo plan transitioned to united health care there was two plans that were created. a uhc medicare advantage ppo plan for those medicare eligible individuals and then a uhc-ppo for non medicare family members so this ppo is again put into place for those retirees groups and not necessarily active. i don't know mitchell if you can elaborate on that at all. >> commissioner breslin, yes-what we are calling the united health care companion plan ppo is identical to what blue shield is administering today beginning this year. what we called city plan at the time. it st. the same plan with coinsurance and

deductibles and that kind of leads to the split family issue is the fact we had to keep some of the members in the united health care ppo or city plan because of not being able to administer the split family (inaudible) at a more rate-more configuration we mentioned earlier. specifically the united health care ppo is-can be used in the city if they elect that and california if they elect that but mostly for the people who live outside california. >> would it be very expensive? more expensive? >> it is a more expensive plan. >> anybody that only has that choice will pay a lot more money? >> rights,b and they have been. this is the same choice. >> (inaudible) >> right. >> okay. >> same plan.

>> alright. thank you. very confusing. >> confusing- >> commissioner scott again. yes. >> where we know there are disruptions with providers if there is ongoing conversation with uhc to see if some of these can be resolved and they become a part of the network? many times when we sign on with plans we have disruption and we try to work at over time to see if additional contracting and what have you can resolve this. has any of that been discussed? >> i think i will ask representatives from aon if they can chime in and provide input to that. >> we do have a plan

to address each individual need as it arises and i think our recent track record where we moved the ppo population from one to another was a great experience to have had very recently where we know how to do the outreach to all those folks and united is very much being a partner and i am sure that we will come up unusual circumstances here and there that needs very specific remedies so for instance if you have someone in the middle of cancer therapy where continuity of care is the overriding concern we will address that. that is the plan is be very proactive about this transition and to do before open enrollment so there is not caught in the noise of opening enrollment so there is very much a plan to do this in partnership with united and our member services team. >> thank you.

>> president follansbee thank you for your comments. abbie i think you raise a issue that sounds like there is flexibility certain members this will be a tremendous hardship because they are in the midst of intensive therapy as mentioned for cancer or for-whatever the disease may be disruption of services would be quite not only costly to the member but disturbing emotionally to the member and family so these are important issues. i think the issue around individual contracting, my suspicion is most positions provider groups now contract through their ppo and so the single family practitioner with a shingle on a corner is not doing a lot of contracting him or herself so expect this is a complicated solution to try to enroll more practitioners

because many can't enroll as single practitioners anymore because of the other affiliations to ppo and hmo so this is complicated but the flexibility you describe director yant i think would be reassuring to all of us as we consider our vote on this. >> i would just say that that type of activity is not at all unusual for member services to do and while every individual counts this is a very small proportion of our entire membership, so i think we'll be able to work through this with a lot of care and compassion and rapidly. >> if i can provide clarity to the networks utilized for both of these proposed plans. for the broad epo it is network that is united health cares so they are negotiating and why it is broad network. for the doctor plan they are

leveraging canopy care so the same canopy part of the health net plan is leveraged by united health care for the narrow network doctor plan in northern california, so we learned about canopy care affiliation with both health net and united health care during the non medicare rfp process that took place late 2020 early 2021 so the reason for the provider disruption going from trio, blue shield trio to uhc doctor plan is due to the composition of the narrow network available through uhc which is actually canopy care. i hope that helps distinguish the differential in the network between the broad epo which is more access plus like versus the doctor plan narrow network which is more trio like.

>> thank you for that clarification. i think it drives home the point the comments by director yant and your response as well. it is not a one and done situation here. i think that you try to give clarity and assurance to our members that as we are approaching this implementation it will be out reach and consultation and are looking at individual cases as required, and i think that should be reassuring for everyone. the larger risk in this issue if we don't approve this today is that we are at risk of all of the other outlying complications and are mistakes that could be very costly for not only the care delivered but also from a fiduciary standpoints so think it is a must we move forward. >> i agree with you

commissioner scott. the one thing i thought i heard was that this impacted when we talked about the uhc broad network we talked about people out of state but it looks to me when i read the description of where most of these families are seeking care, that they are within california pretty much. el camino, stanford clinic and (inaudible) cpmc and eden medical so closer in and we don't-i don't know if we have anybody out of state. probably not. >> with we talk about disruption we are talking about those individual previously enrolled in blue shield access plus and trio plan so local plans. the out of state

members were already enrolled in the united health care ppo plan so no disruption for those members. >> thank you. disruption is usually what makes everybody crazy so thank you so much. i appreciate the clarification. >> thank you. any other questions or comments from commissioners? if not, open up for public comment. >> thank you president follansbee. in-person public comment is first and virtual public comment. [providing instruction for public comment] we'll

begin with in-person public comment. no one approached the public. the moderator will notify of public comment in the queue at this time.

>> board secretary, we have 6 callers on the line, zero callers entered the public comment queue at this time. i remind to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda item. we will 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you. hearing no further callers, public comment is now closed. >> thank you very much. moved and seconded that we approve the change in non medicare plan ad min strairt to united health care for non medicare split families. call for roll call vote. >> thank you president follansbee. roll call vote. [roll call]

>> pass unanimously. thank you very much for this really detailed analysis and a lot of work went into preparing for the presentation of the members effect ed and in what way and appreciate that in the midst of all the complexity. with that, welike to move to item 17. >> thank you president follansbee. item 17 is board education retiree health care discussion item we will have two in-person presenters, executive director abbie will do a short introduction. >> yes. hi. good afternoon. dr. mason. we meet. i am pleased to welcome dr. michael mason from kaiser permanente as the director of gerattics continuing care and

complex needs. his bio is in the director's report i believe this month and last and he's our first presenter from kaiser and will help us understand what we are experiencing as a population of aging and following him we'll bring dr. joe as we call him, dr. joseph agostini from united health care to speak as well. i will say as we were putting this together we presented a great challenging have two esteemed experts in the field and think they both attended the national jir atric confrnsh a few weeks ago so getting all the latest news and so i think we will help us inform our strategic plan going forward how we think about our retirees health so welcome and thank you. >> thank you, can you hear me okay? >> yeah, you are welcome to take your mask off during the prezeningitation. >> thank you health system board commissioners

and president follansbee having us today. it is my honor and privilege to be here. i can tell you as a cid growing up in san francisco i would go to grade school but they never took us on a tour of city hall. this is my first time being inside city hall so this is like-a honor for me so i appreciate you bringing me down here. my interest in jerry attics started because of my grandmother. my grandmother would come her friend and talk about living in the 1906 earthquake and he was in san francisco and talk about the bed rolling from one room to the other. the stories i hear from my grand parents and friends stipumented me to stay this is a part of medicine i enjoy and want to go into and entered the fields with fellowship and training. it is something near and

dear to my heartmany years. my story when i decided to become a doctor, i was 5. my dad had a 1950 cadillac and we were dribeing across the bay bridge and dont know if anybody has been a 50 cadillac but it had no seatbelts. i would in the back of the car and jump up and down holding the velvet rope and my dad said what due you cht to do when you grow up and i said the president of the united states or doctor. i'm not the president so here i am. think for listening and indulgeing me. today we are going to talk about some topics that hopefully will stimulate thought and maybe questions and i will be more then happy to entertain those has we go through the slides are not typically my typical presentation to staff but i think it is varied and will cover a lot of different topics

but free to address anything. one thing i really like to start with which grounds me as a patient story. what i will do is it is very long, part is on the slide because this grounds me in what i do. people and stories people have. the story is from a patient's niece. she said my uncle is 79. he had multiple health ish aoos diabetes high blood pressure. (inaudible) not vaccinated and isolating himself. after talking with his doctor dr. allen i was able it talk him into getting vaccinated and because my mom his sister is under my care i was able to show how to take care of my mom medicine and took him to doctor appointments. dr.

allen referred to case manager program and met tina and the team. tina is a example of all the great things happening at kaiser. she is kind compassionate patient, knowledgeable efficient professional resourceful... i can go on. tina reviewed all the meds and explained use. helped set up a pill box and schedule. we were able to get my uncle meals delivered as a result of the options provided. my uncles health improved. (inaudible) tina communicated with dr. allen and changed medication that improvaled health more. my uncle is off insulin and lost 20 poungds. i attribute to kaiser and care received through dr. allen and his team. dr. allen promolts health and wellness and makes you feel supportive. i believe he saved my uncle's

life and my family is grateful for what you do. that is a real story somebody having a lot of trouble and a physician by him or her is lf cant solve that and a nurse-it takes a team of people sometimes for us to solve problems. pulling that team in to take care of somebody is our goal. as we know there is a trend in america-this looks at state of california. we are growic the oldest old and so technically theic percent och the population growing is over 100 but this graph shows the over 85 is growing at 275 percent. between 2010 and 2060 we expect to see a growth of 275 percent of people over the age of 85 so those are very elderly people. if we drill down to the state of california, san

francisco county we will grow our patients over the age of 60 a lot but the key is over 85 which is close to 400 percent. these are numbers that help stimulate me and our teams and program to say what can we do for our patients and for our members. how can i think about that person in their whole care from very healthy well people to people who have chronic advance disease. one thing to think about is the specialty of geriatrics. it has been around 75 years. we have been caring for older adults and decades kaiser has a program focused improving the health and care for older people and coordinate the care. one key is education (inaudible) that number is declining every year now. we

are not rising. even though we have trained dollars we are losing more then gaining. one of the ideas or part of the senior strategy is to look how to train everybody else to know what i know and take care of patients as i would want my own mom grandma, dad and families to be taken care of and that is a key so there are many programs i dont get into but embedded in the system how to take care of people throughout the spectrum of life as they age. : it is specialty focused on high quality person centric care to improve the health independent and quality of life. person centered care is the core, puts the person at the center of everything we do. it is not my needs, the health system needs it is the patient the person and desires and needs gets in the center and that is consistent with something called the

(inaudible) which is expanded to 5m. medication mobility meditation what matters and multicomplexity people in multiple chronic ish aooze and what is important to each person. medication for seniors are different in number and quantity then effects in younger people. there is lists of medicines we shouldn't use and combinations not to use and how to educate on those things. medication goes to changes that happen as we age. it is not always when your memory isn't as good or (inaudible) and mobility is keeping people safe. a big endicator of decline in function is a fall so we don't want people to fall and develop programs to deal with that. the next slide talks about the common

word used which we all try to avoid is frailty which is a abstract word. what does frailty mean it is a combination of shared risk factors that combine to cause syndromes. that leads to poor outcomes. dependence disability institutionalization and death. looking at the shared risk factors if i modify those i can prevent the syndromes that lead to frailty. one thing you mentioned is american geriatrics society. it was held in orlando florida and this is a example of topics i found especially interesting. one of which is a study we are working on now which

is pharmacist driven deprescribing program (inaudible) causing harm and how to pull people off the medicine to decrease harm. so that was one topic the optimal prescribing how it relates to fall reprevention and demenseia care. they have a list of drugs call the fall risk increasing drugs. really how to do crease those. there was a article about population diversity and the importance of community engagement. evidence based prescribing and deprescribing. especially in the late stages of (inaudible) what is happening as we get covid-19 and get older what can i expect to happen? what is the latest literature experts say. how to manage chronic pain. reduce provider frustration using up to date

assessment and mangagement approach and ort things such as-this is touching on the hundreds available. managing old er adults with mental illness. a lot of topics across areas that effect all and we take back and share with each other and other people. the next slide goes into what we developed as a strategy in northern california and are it is saying all kaiser permanente patients have timely access to specialty care that is centered around goals and along with family caregivers supported by a team of kaiser providers across care settings. in the middle is the patient and family empowerment using the age frnd friendly approach the 5m combining life care planning and (inaudible) majority of the care is providing by the primary care doctor. how to give information education and

tools so they are successful with what they do preventing illness. if somebody does develop illness how do we develop systems thatenage those. a example is developed a senior surgery care program which is when anybody over 75 goes for elective and now in-patient procedure there is a group of people who evaluate what is the risk and what can we do about the risk for somebody to prevent them having a post operative complication. it is a complex medical and surgical combined approach using a board then to review what is happening with expert opinion to come back is and give options to patients and families. other examples are memory clinic we have to help evaluate and enhance memory in patients across northern california. i wish i wasn't good at pinging the microphone but apparently i'm good at it. and then lastly is when people become frail is pulling them in and manage those

patients the teams. as a patient is more complex they get more care from us. wunk way to think about it is conceptualize on patient care journey as the patient starts healthy with the primary doctor it is education. as they move along the path it is providing the tools and those kits to help prevent detect and prevent syndromes. it is providing acute care and if somebody were to have a fall or fracture how to provide care for them. and then if they decline how to pull care to the home and lastly to provide people with the end of life as well. thinking about the entire care journey for our members our patients as they move through their care spectrum. and then the last couple slides one is care coordination and this is a area i think our

organization does an amazing job because of integration. i'm able to communicate both through the electronic record as well as the phone with everybody whether case manager cardiologist on cologist (inaudible) use technology thooenhance the care and is a key and new ways everybody is working to do this is rather then always saying the patient family must do what we say is say what can we do with what the patient and family want and those are things we like to do. i saw right care right place right time. lastly, this is a complex slide. you see all the different things happening with memory clinics and outpatient clinic and emergency room. we are working on a ed in kaiser san francisco and many of the hospitals so they are

geriatric frndly. training the nurses to recognize (inaudible) senior care. skilled nursing and nursing homes. one thing we do is provide kaiser physicians nurses and case managers to follow the patient. they are never out of the system from under our eye so able to understand and know what is happening with somebody across the care journey. providing life care planning which is goal (inaudible) asking what you want at this stage and how can i help you get that. pallative care, hospice, home base and after hour care connect with patient and family. and coordinate with everybody whether primary care cardiologist nephrology. everybody is part of the team. i want to do a quick brief overview and that's as quick and brief as i think i could do. i am more than happy to answer questions if there is anything you have for

me. >> president follansbee thank you very much. i guess the question i would have is really what do you think is the optimal way to engage this support team? when patients become home bound there is home care and they move from one primary care provider to another through a home care program but there is a spectrum or gap between so you mentioned some ways that you have optimal way with these services can be sort of phased in so it isn't all or nothing? >> that is awesome question and leads to a topic i didenth touch on which is data. i can use-because of theant grated electronic medical record i can use doota to determine who is highest risk and we are using proactive modeling and actually setting messages to primary

care providers saying your patient here is high risk for a problem, i like to provide the services for them and so it more and more proactive about knowing what is wrong with somebody before they know. we got many programs where we start to do that now both again throughout that care spectrum if you are well and healthy how to get health education to you whether push through your app through health education recollect primary care doctor so you don't have to ask. as people are more frail and ill it is understanding that and then pulling them into a system. we developed the care management programs that are embedded in the primary care moguals where a nurse case manager pharmacist social worker connect with a patient that is high risk and help modify them and once they are under control they back off but the patient never leaves the primary care provider and people who end up needing to stay at home and cant get into

the primary doctor, it is developing teams not just home health but who will actually continue to follow somebody in their own home environment whether a home or assisted living or memory care and then there is the advanced thing such as hospice. i dont know if that answered your question but it involves a lot of data and proactive modeling which is the state of the art of where we are going. >> thank you very much. it does start to answer the question because this is works in progress. thank you very much. any other questions or comments from commissioners? >> yes. you (inaudible) are your other regions paralleling this type of capability? we have folks in oregon and washington and hawaii.

>> excellent question about integration. we do meet-i'm focused on my control is northern california but i meet with southern california counter parts and regular basis from from kaiser from mid-atlantic george goorj, nort west, washington colorado and hawaii all going in the same direction with how we understand and assess what is happening. we have the benefit in northern california of being the pioneer even though we are the largest who take programs and usually push them the most. most of the other programs in northwest and colorado are much smaller then what we have with our patients in northern and southern california. thank you. >> sure we will have additional questions so stay tuned. >> thank you. >> thank you very much. very informative. now doctor joseph

agostini. i welcome from united health care. >> hello. thank you. that is why they call me dr. joe because my name is hard to pronounce so feel free to do so also. thank you very much for having me. i'm also a geriatric physician. i think how to improve the quality and outcome of care for older adults and the reason why i got into first is around patient stories and thinking about the journey people have as they age. i got interested in internal medicine residency and research and top population health and transitioned from individual patient care to really thinking about how you care for thousands of retirees in medicare overall. you start with one individual person but how do you expand the capability to people who here in san francisco

oregon or south florida? how do you scale those programs and those capabilities up? i also think about my own parents like many have family and loved ones who are aging. my dad worked for about 35 years for a state government in the norkt northd east and retired to southern california because of the weather and grandchild. they are on united health care group ppo plan and just last week they were telling me how grateful for high quality health care with access that is affordable and starts to meet their needs. really that is what i think about a lot and know you do. quality, cost, affordability in my field and retiree population. happy to share a thoughts on both the

journey i have seen and where i think we are going. on the first slide you may say why am i showing you a picture of oil paintings of rembrandt aging? it is because he was a prolific self-portrait artist and many or some may know this if you studied art history but he painted dozens of self-portraits over the time and i use this slide with medical rez dependents and bring in front of them what can you are learn about the aging paragraphs. we don't have photographs from 400 years buts what was happening in the time of rembrandt and how it is similar the aging process. the goals he and his family wanted at that time. he went through loss of his wife and loss of multiple children. he went through financial

insecurity and bank rups. these are common circumstances that happen to all. they happen 400 years ago and now. how we deal and adapt to change how we become resilient as we age are important concepts and principals and something to be learn over time when what happened in the past and now. just someone who likes medical history there was a physician in england who overlapped during the lifetime of rembrandt named john sawyer. he wrote the fist book in english on care of older adults. he had a lot of common sense approaches eating well fresh air exercising taking care of yourself, temperate of use of alcohol and

tobacco. it sounds common. we built a lot but there is a lot historically we can look at it that said this made sense over time, how do we incorporate the learnings build on the medical evidence and drive really high quality health outcomes for older adults. that is enough of history and art history lessen. to the prenth present day, dr. mazeen did a great job looking into demo graphics. he shared data on california in particular. there is no doubt we are facing a aging populationen on the next slide some things i would draw out of demo graphic trends and context to think about we will have over 1 in 5 adults over 65. other countries are ahead in aging population. we need to learn from them. countries like japan how they are dealing with a rising number

of older adults. if you live to about 65 now you will probably live another 20 years on average if you make it to 65. with the pandemic it is the first time i think since world war 2 life expectancy dropped. usually incrementally improveped year over year, with the pandemic it dropped a bit. the other demo graphic and aging related trend is growing diversity of older adult population due to a variety of trnds in the country. fewer white as a proportion of population, more people of color, how to do with the diversity in the population and address the specific needs sense tivly. health care needs that may differ. the ort i say is diversity in education. if you look a third of older

adults have a college education or bachelor degree. there is very significantly by race and ethnicity across the country and that presents opportunities and challenges for us as we think about caring for older adults here in san francisco or anywhere in the country. those are a couple of trends i would point out as you consider your planning and strategy in the future. on the next slide, the fact is very clear that of course we accumulate more chronic conditions as we age and this is data from the federal government or thesenter for medicare and medicaid services conditions like arthritis, high blood pressure, hypercholesterol are very common as we age but also much more common to have multiple different chronic conditions so this distinction betweeng the ablthive population where you usually deal with one

condition in your older adult population multiple different chronic conditioness. the vast majority have more then one. when i look at your retiree population on the united health care medicare ppo plan, about 51 percent of them have 4 or more different chronic conditions. if you look in the past year at the medical claims that come through, 4 or more is majority of people on the plan. a lot of complexity, a lot of health care utilization that accompany that. on the next slide i won't go through detail. this is data from cms. the main point is a condition someone with a condition like heart failure which is a very bottom line of that slide, most probably has 4 or 5, 6 other conditions to deal with. there is a blue sliver line with heart failure. that is the number of people with heart failure and no other

condition. most everyone has multiple other challenges with chronic conditions to deal with. i think if you look in your population and the data we look at, it means there is a lot oof utilization so average we say 8 and a half physician visitss per year. that is average so some are much higher some much lower but 8 and a half. there is a lot of utilization and when you think couples there are a lot of doctors appoint that need to be scheduled and coordinated. care coordination comes up repeatedly. i talk to my parents and they are still back on a calendar system where my mother is complaining all we do is visit doctor appoint and have to keep track for your dad and me and grateful for the health care but the complexity is astonishing especially with primary and specialty

care that is widely available and scheduled frequently for people with chronic conditions. the other set of context i share with you is a slide here on physical functional so self-reported data. how many self-report difficulty with vision and hearing or memory problems? you can see 20 percent are more average across the categories self-report some difficulty as we age. mobility is is a big one you can see in the center. and that gets to a need to really think about in a holistic way how to address all these needs as people are aging. on the next slide move ahead, this was already covered the 5m so won't go into them but it is a good framework to think about how you provide high quality care focusing on mind and mobility.

i'll draw out one to a finer point. the one on what matters most. when you think what matters most i think that transsends the other m in the sense it is really important if we go to the next slide to think about how do you really engage a patient, a person to understand what are the values and preferences as they age. there are a lot of trade offs that happen as we age. if you take a 85 year old who has 5 different conditions maybe taking 8 or 10 different medications there is a lot of complexity there. there are trade offs. if you take multiple different medications you may have side effects from one or more. patients value differently symptoms health outcomes, we need to talk continuously people about what is your goal, what is your outcome. not everyone

wants perfectly controlled blood pressure so they are dizzy or falling down or someone with diabetes they are at risk for other complications. what is the medical evidence and what dize that person want and need. that is the point is thinking what do people value so we incorporate that into the decision making and the clinical care plan. the other thing when you say what people want and value, i would share with you this survey. it has been-type of survey has been done many times but thris is current from 2021 the national survey aarp people want to eare main independent in the home as long as possible.

the interesting thing about this survey, the majority of people say they want that and if you ask what do you think you need to do to your home for example if you remain independent and you start to get answers back on i probably would need to do some modification in the bathroom because i probably have difficulty getting and out of the bath tub or address stairs in the home or access or mobility as i lose physical functioning. interestingly people say i need more technology in my home and if you look at the slide closely i need a emergency responsem or censors that turn on the lights so when i get up at night i'm not at risk of falling or tripping. increasingly people as they age are starting to give that data back which i think is really informative to

us as we think how to support an aging population. the self--reported data can be very valuable. on the next slide, i would say there are solutions that we can start to bring on how to support people. if they want to remain independent the homes what tools do we need to provide? some in the health plan we can provide rather it is monitoring equipment. it is one reason why we offered a emergency response system. we are seeing the potential need for that and maybe it is a small number of people 1 percent who need it but the piece of mind and safety for them sevl family and care givers can be important and we do phone outreach providing more support that traditionally health plans haven't done. providing home delivered meals. providing care at home for light house keeping. things

that keep people independent that otherwise force them to move or go somewhere they don't want if they didn't have the level of support and encouragement. on the next slide, i know the work of the staff and there board here arond trying to address social barriers and that is something of the things we are just talking about meals and transportation to identify the aspects of health care or overall health that can be improved and addressed and they haven't really traditionally been addressed within the health system. we have been doing a lot of work and doctors office and hospitals are doing a lot of work actively screening people trying to connect them to the resorsss maybe resources in the health plan or community, how you make sure people get the support they need that can keep them out of the hospital or stay at home longer because that is the

purpose of this. all when you think about it togethers on the next slide is that all person care concept and was mentioned but want to reinforce the fact we look at social bear barriers and provide care coordination needs. trying to think in a whole person way how you meet the needs of someone not just the physical health, but their emotional health, social support they need to stay independent and active for as long as possible. and to that ngd i have a couple examples on the next slide of things that many are thinking about and doing, so we can use technology more and more to scale outreach to people. how to provide one on one coaching. on the phone on the smart phone or via video or things like disease prevention. how to prevent diabetes or focus on weight loss one on one or group coaching you can do easier via

technology now. these are the type of things to embed much more when we think about improving population health. another example on the next slide when we think about mental health. during the pandemic we worked with certain clients and populations thinking about how to push education around teaching people providing support around resiliency and gratitude and wellbeing during a time of social isolation, during a time people are less well socially connected. there are means to do this through videos and online tunlts. you can do in person, it is harder to scale that so have b to creative thinking of solutions. another example on the next slide of some tools i wont go through focus on the concept of resiliency because it is a skill that potentially can be built up in people and they have better health outcomes if they are able to adapt to changes in their

health over time. and then couple more examples i would just put forward, videos. i'm proud to say our clinicians didenth think of this but during the pandemic many staff said we are not doing enough to reach out to people who are isolated and try to get engaged in a activity. these are examples of videos. on the left there is a painting series. we hired a college professor who did a series of very short videos how to paint a sun flower or sunset. really well done that are engaging to people and allow them in their own home to really be stimulated in a different way. i are just put that out there there are many different new avnewss to reach out to people and to get them stimulated. of course there is a health plan is just

like spoken before we want high quality care in the doctor office, good care coordination. there is more we can do in the health plan and health system side to address all the aspects of health much more broadly. there is one more slide on aspects of helping people take care of relaxation. mindfulness and during the pandemic again especially this is one example of resources that have been rolled out to really help people both through music or health care tracking, meditation, really take more control of their health in their own way. so, i covered a lot of ground ing a short period of time also. appreciate your attention. i leave you with a couple points on the last slide. i would reinforce that the older adult the medicare population is a

specialized population. they have unique needs. we need to think of customized ways to both engage and design programs that bring value. that really in a whole person way address all the care needs of that population. and that take into account the personal values and preferences of older adults as they age. we have a lot of new tools and capabilities both through physician offices through health care systems through the health plan really to design customize programs and mentioned some of those tools and resources but we need to think collectively how do we thoughtfully and coherently package the resources together. how to guide people to the right level of support so throughout the health care journey whether in the doctor office or spend most time at home they have access

and know about the resources that we can put together. so, thank you very much and happy to also answer any questions you may have. >> that realm of post acute care skilled nursing or rehab facility provide much needed service for people who need intensive care and rehabilitation but we have seen over time is there is a shift doing more and more in the

home, so some of those services some of the people going into skilled nursing we can probably get eequivalent in the home and achieve the same or better outcomes while someone is in their own home so it is a balancing act we always need in-patient type facilities but want to use them wisely efficiently because again back to the certain people want to be at home so if you can provide more of the care at home my montra is how do we do that so people are more comfortable. they generally will participate more and have a better happier time when they are in the comfort of their own home. i dont know if dr. mason wants to add anything. >> (inaudible) >> maybe you fixed it. it is really we talk about the aging population and since the baby boomers have been growing there are 10 thousand people

hitting 65 every day. we hear about the numbers yet the number of nursing homes beds is decreasing not increasing and projection out through 2025 is we will not grow the nursing home beds so we are actually technically decreasing the percentage of people that are go pg into nursing homes. just like he said, many more people are doing care at home. much more care diverted to the home but we also see much more frail and sick people in a skilled nursing home. gone are the days when i trained when somebody come for a total knee replacement and get therapy in the nursing home and go home for home health. the only people we get is people with infections and big problems and multi-complexity problems so the population is not only smaller but sicker j frailer so there is a huge trend and that is a prediction that will continue in the trend. we hear about problems like at the

nursing home here in san francisco. it is not for people in the industry don't think it is surprising because the patients are very different now then they were 20 or 30 years ago. they are much sicker people. >> one issue that comes up is that a lot of these services need to be sort of orchestrated with the support from families. family of choice, biological families, whatever and often before anticipate procedures hospitalizations chemotherapy and the issue is how can health plans help facilitate the engagement. i know in india we heard a presentation years ago on (inaudible) how to take care of the children while they are

still in the hospital, which facilitates getting home and safer environment sometimes then hospitals with infection et cetera. >> i will make one comment just about helping people navigate through the health care system. one thing for example we have done in the health plan is identify the highest risk people and assign them a navigator. if they go for a planned procedure, we already know about that because it has been scheduled. how do you assign a family or care giver who can help them and anticipate the needs and care journey whether they need to go to nursing facility or go home and you can guide and complement any of the education that is happening in the doctor office or maybe not happening as much with resources through the health plan so think those are opportunities for us to continue to invest in

that care coordination and navigation. >> thank you. >> dr. agostini mpth i like to bring up something that when i read this from both of the physicians, and talking about aging in our homes and i think there is no question that a lot of us want to stay home. it is comfortable and whether it is neat or messy it is comfy, it is our little den. but it is also isolating. not all who retire have families nearby or families aroungd. i grew up with parents more like my grandparents then parents so big age gap with other family members and the isolation issue is what concerns me. for some of us we are very

involved in what goes on in our neighborhood or friends but when you bring services into the home while that is helpful, we know that as people get older and some of your stats prove it, depression increases. isolation creates depression and if people-it isn't just mobility but they have to be interactive with others and i think it might be a little challenging, but if at least health care providers physicians nurse practitioners everybody who interacts with those who are aging encourages some kind of social activities-years ago people are clubs they went to or wnt out once a week and played cards but think there isn't enough of that right now and so if we

suggest not mobility and other activities but somehow interaction maybe they find some place in the neighborhood that they sort of hang out or go to regularly, and get to know your neighbors better, there is a lot of neighbors are younger and a lot of them might not have-some have children and some not, but getting to know your neighbors increase the socialability and i think that's something that needs to somehow be brought into probably the mental health therapy that isn't really labeled mental health, but every time that primary care physician or nurse practitioner is talking to a member, a patient, an older person, there is mental health that is going on. i see that >> thank you very much commissioner. these are important points. we are under

time crunch. we have been-the city hall decided we don't fleed to meet as long as we used to so i will call a halt to questions and comments. i need to open up for public comment to address the last two items quickly. >> thank you president follansbee. in-person public comment is first and then virtual public comment. [providing instructions for public comment] we'll

begin with inperson public comment and one person approached the podium. >> my name is herbert wymer a city retiree, 83 years old and greatly appreciate the last two presentations. seniors and disabled are really the step children of this population. it extends to

discharges from the hospital, it extends to so many lack of availability of resources and the fact this population favors the young over the old and the survival of the fittest and it is horrible because of the senior generation where the custodeiums of this nation history. we have a lot to give and the services that were just described enables this. now, it is a waste of national resources and we simply cannot be thrown into the ash can. so i greatly appreciate the concerns of the board and two presenters and i wish it exteneded to the rest of the population. the least i can say for the two presenters, they are more compassionate then the municipal transit agency which throws people under the wheels. thank you. >> thank you very

much. no one else approached the podium so move to virtual public comment. the moderator will let us know if there are public commenters in the queue at this time. >> more secretary we have 4 callers on the phone line. zeros callers have specifically entered the public comment queue at this time. reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific item. we will wait 5 more seconds and then close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you moderator. public comment is closed. >> thank you very much and thank you to the presenters. move to item 18.

>> thank you. item 18 vote on whether to cancel the july 2022 health service board regular meeting. this is action item and will be presented by executive director abbie yant. abbie yant anything to say on vote to cancel? >> we can go ahead and call for a-action item, we can call for a motion. >> i move that we cancel the july board meeting. >> second. >> moved and seconded. open for discussion. any comments, director yant or anyone elseen the health service board? >> (inaudible) >> thank you very much. hearing none, open up for public comment. >> thank you president follansbee. [providing instructions for

public comment] we

begin with in-person public comment. no one approached the podium so move to virtual comment. the moderator will notify of callers in the queue at this time. >> board secretary, we have 4 callers on the phone line, zeer ro callers entered the queue at the time. reminder to all callers on the line, must dial star 3 now if you want to join public comment for this specific agenda item. we will wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you moderator. no further callers public comment is now closed. >> thank you very much. i call for a roll call vote on this item to cancel the july 2022 health service board regular meeting. >> thank you president

follansbee. >> roll call. >> roll call vote. [roll call] >> thank you item 19. >> 19 reports and updates from contracted health plan representative. >> we have brief reports to health plan representatives. >> no one approached the podium. >> thank you very much. also indicated wish to speak from the health plans over the phone so won't need to call for any public comment on this. with that, i like to adjourn the regular meeting of june 9, health service board with city county of san francisco. thank you very much.

>> happy 4th of july. >> happy 4th of july. >> same to you all. >> adjourned at 448 p.m. [meeting adjourned]

>> >> my name is sofy constantineo and a documentary film maker and cinema togfer, producer and director. it is inevable you want your movie to get out and realize yoi need to be

a commune tee organizer to get people together to see the story you will tell [inaudible] pretty rich and interesting. in what we do as film makers is try to tell the best story possible so i think that is where i [inaudible] learn everything. lighting and cinematography. i got jobs of stage manger at some place and projectionist. i kind of mixed and matched as i went and kept refining i feel like it isn't just about making things that are beautiful and appealing and rich and [inaudible] the way that the films [inaudible] it has to tell a story. >> my name is sumell [inaudible] free lance multimedia produce. my project is [inaudible] mostly oof street photographry with a few portraits. i'm going arounds san francisco and

capturing the [inaudible] as we started to do this project i was reading about the decline of african american population in san francisco and i wondered where the remaining population was and what they were doing and how life was for them. >> i wasn't very inspired by school, i wasn't very inspired by continuing to read and write and go to class. i watched a lot of movies and saw a lot of [inaudible] i said that is what i want to do. i had this very feminist [inaudible] and i felt like there was not enough of a womans vision on the stuff that we see, the movies that we make and the beginning of the [inaudible] the way we look at women and the roles women take in the

stories being tolds. they felt [inaudible] they did want feel complex. i was like, i have a different frame i like to see the world shaped by. >> my grandsmother was a teacher and taught special education for 40 years in los angeles and when i was growing up she inspired me to record everything. we recorded our conversations, we recorded the [inaudible] we recorded everything to cassette players. learning multimedia skills, from the other crossover employment opportunities for young people. someone who grew up in la rks san francisco feels like a small town. i lived in western addition and i was looking for someone to cut my hair, i found [inaudible] he seemed like a very

interesting guy and grew up in the neighborhood and had a lot to say about something that was foreign to me. that local perspective and so important to me because i think as someone who isn't from here, knowing that history allows me to be more engaging in the community i live in and want the same for others. i want people to move into a new neighborhood to know who was there before and businesses and what cultural and [inaudible] shape what we see today. >> my guiding principles have been, if you stick to something long enough and know what it is and go for it you will get there. [inaudible] where i want to go, what i want to do and it is totally possible so, the impossible is you know, is not something to listen to.

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>> hello everyone, i'm san francisco mayor london breed and i am so excited to be here today announced the budget for the city and county of