>> [unable to hear speaker] >> thank you president scott. roll call at 101 p.m. call to order at 101 p.m. and we'll do next agenda item. >> i pledge allegiance to the flag of the united states of america, and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all.

>> thank you president scott. roll call. [roll call] >> i can't hear several of the commissioners, and president. i heard commissioner breslin but can't hear anyone else. are the mics off? >> thank you, i'll check momentarily. let's see. president scott, will you speak into the mic? >> present. can you hear me now? >> yes, i can hear you

now. >> good. >> commissioner zvanski will be arriving late today and with that, we have quorum. >> thank you. we will move to item number 3, which is resolution allowing teleconference meetings. >> thank you president scott. the item 3 is resolution allowing teleconference meetings under california government code section 54953e, this is action item and presented by president scott. >> as we have been doing throughout the period of pandemic, we have been following the guidance provided by the city to us regarding board meetings and committee meetings that are both held in person as well as electronically. so, this resolution has come before us numerous time and at this time i will be willing to entertain a motion for adoption. >> president scott,

commissioner canning i move we accept approve the health service board resolution findings to allow teleconference meetings. >> second. >> been properly moved and seconded. is there any discussion among the board members? hearing none, we'll have public comment. >> thank you president scott. in person public comment will be first and virtual public comment. anyone in the room welcome to approach the podium now. each speaker will be allowed three minutes unless the board president deems public comment time limits during the meeting. all comments should be made concerning the agenda item presented. a caller may ask a question but no obligation to answer. for those on the line when i welcome on the call you are encouraged to stay your name clearly but may remain anonymous. remote viewing is available on sfgovtv

and using webex. opportunities to speak during public comment are available by dialing the number on the screen. the number is 415-655-0001. when prompted use access code 24839534365. 24839534365. then press pound and pound again. you will enter as a attendee and dial star 3 to be added to the queue. when the message says your line is unmuted thiss is your time to speak. for those on hold continue to wait until the system indicates you run muted. we'll begin with in person public comment. no one approached the podium so move to our virtual public comment. our moderator will let us know if there are commenters in the queue at this time. >> board secretary, we have one caller on the phone line. 0 callers have 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 agenda item. we'll wait 5 more seconds and close public comment for this item. board secretary there are no callers in the queue at this time. >> thank you moderator. public comment is closed. >> roll call vote on this action item. [roll call] >> motion carries. item 4. >> iletm foyer is general public comment

an opportunity for members of public to comment on any matter within the board jurisdiction that is not on thugenda including requesting that the board place a matter on the future agenda. >> i'll read the instructions for anyone during this virtually. in person public comment . you can approach the podium now had. each speaker is allowed to come (inaudible) unless deemed new time limits. all public comment are to be made concerning the item presented. a caller may ask questions but no obligation to answer or engage in dialogue. for those online when i welcome on the call you can state your name clearly. i give you a warning when there are 30 seconds remaining. opportunity to speak during public comment

are available by calling 415-655-0001. you enter the meeting as attendee on the call line and dial 3 to be added to the queue. when the system says your line is unmuted this is your time to speak. for those on hold continue to wait until the system indicates you have been unmuted. we'll begin with in person public comment. no one approached the podium so move to our virtual public comment. the moderator will notify of any callers thin in the queue at this time. >> board secretary we have zero callers on the line and zero callers have entered the public comment queue at the time. you must fall oeinstructions to dial in and 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. twl are still no callers in the queue at this time. >> thank you moderator. hearing no furger callers pub lic comment is closed. >> move to iletm 5 approval with possible modification of the minutes. >> yes, 5 is approval of minutes september 8, 2022. this is action item and will be presented by president scott. >> any edits modifications, clarifications, syntax misspellings, any of those thingss we might want to call out this point in the minute? if not, call for a motion for adoption. >> president scott, i move we adopt the minutes of the regular

health service board meeting of thursday september 8, 2022. >> properly moved, is there a second? >> second. >> been properly moved and seconded that we approve the minutes as distributed for the september 8, 2022 meeting of this board. any comments from the board? if not we'll go to public comment. >> thank you president scott. public comment will be first. anyone in person approach the podium. [giving public comment instructions] we'll

begin with in person public comment. no one approached the podium so move to virtual public comment. the moderator will notify of callers in the queue at this time. >> board secretary, we have zero callers on the phone line and

zero callers entered the queue at this time. reminder to all listening use the dial in instructions and select star 3 now if you want to join public comment for this specific agenda item. we will wait 5 more seconds and then close public comment for this agenda item. >> hearing no callers public comment is closed. >> thank you. roll call vote on approval of september 8, 2022 minutes of this board. >> roll call vote- [roll call] >> motion passes unanimously. item 6. >> item 6 is the president report. this is discussion item and presented by

president scott. >> i ask all present in the chamber who served in the united states military to please stand. if there are any veterans, please stand. join me as a veteran discharged 50 years ago this year. again thank you for your service and happy veterans day not only in the chamber but all watching this program. that's the president's report. >> we can move to public comment. >> yes. [providing public comment instructions]

>> we'll begin with in person comment and no one approached the podium. the moderator will notify of callers. >> we have zero callers on the phone line and zero callers entered the public comment queue at this time. reminder to all listners use the dial in instructions and press star 3 now if you want to join public comment for this item. we'll wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no caller ins the public comment queue at this time. >> thank you moderator. hearing no callers public comment is closed. >> thank you. we'll go to item 7. >> director report. executive director report. >> good afternoon

commissioners, abbie yant executive director. happy to report our entire organization strives for pinnacle experience in the month of october and we had one. open enrollment went as planned and we'll give a full report out in december, correct? and i just want to acknowledge the leadership team that is present in the room. not sure who signed on virtually but i know (inaudible) our chief operatoring office (inaudible) enterprise system and (inaudible) gosh help me. is in the room and jessica (inaudible) hats off to the team for the work that culminated in a excellent experience for members. we have attached covid slides on the update on the figures and it's obvious it is becoming harder to track in many ways, and as the

pandemic winds down we are in many ways looking forward to a new state of being as the pandemic winds down, but there will be a new set of complexities as the burden of paying for much of the covid testing vaccination and treatment as we shared with there federal government and that will be going away, so more to come on that and let's hope that we have gotten through the worst of times and have days ahead. we are continuing to grapple in many ways with high demand for mental health service everything from prevention to acute care. our plans and their organizations are all working really hard to expand workforce to understand mental health needs to provide the right level of treatment and understand where we get the best outcomes. to that end we are in

the planning phase of the mental health summit with all the vendorers to learn about how this works from member perspective. we also were successful after two year effort to have a joint contract between sheriff police fire and hss to provide their eap service that are specialty services for public safety and i really commend the line staff, the leadership teams and the chief of those departments who have really helped us get to this point and we are really pleased everyone is-we have a lot of room to grow, but i think we are well positioned to do that. one of the activities we did to ready ourselves for open enrollment was we did first ever all staff retreat on september 29 i believe it was. very well received by the team. we were able to enjoy

some of the public properties down at pier 1. the weather cooperated and are it was a beautiful day. so, moving on i wanted to acknowledge as you know that hss is very active member in the pacific business group on health. they issued a new strategic plan and they recognize the public purchasers are different then the private purchasers and to that end they created a committee to the board and advisory committee and public purchasers. very honored to be at the table with the leadership of calpers and cover california and expand under to washington state who are very progressive and recently i think the conversation about colorado joining the group so they continue to be very ambitious and we are working-i think the word of the year is alignment and we can be more effective when we are

appropriately aligned, so that's a new update. lutischa harris does lead the organization and diversity equity inclusion and now we added the a of accessibility and she provides a very well informed update in each of the monthly reports. looking at the different issues that are populations and such that we celebrate as well as other issues. this month being filipino american history month and there is focus on disability inclusive workforce that we also enjoy very much. we have been successful in getting all of our plans to engage with the international firefighters association services for firefighters for

residential care for substance use disorders. the one facility that is currently operating is in the state of maryland. has plans to open a second facility in california next calendar year as i understand, and so that program adds to the list of the many programs that are currently available to all of our workforce and so for those that are able to make the effort to go all the way across the country for those services, we have ways for them to be able to take advantage of because as we know when people experience substance use disorder that window of willingness to get treatment is very small and we want to be able to respond in a time ly way. we also are continuing our robust conversations with delta dental. they are like every work force i know right now

experiencing significant turnover, and they are tracking with us how that is impacting our members and we are looking forward to seeing those detailed reports from delta dental on a regular basis. i don't expect this problem to disappear over night. literally every workforce in health care now is experiencing shortages. i think we will see the fall-out of that in many other ways. i did include in the personnel report because speaking of shortages the city has 4500 positions open. we are not unique. we have a number of positions open, a number of great staff have taken advantage of open positions and made moves to other departments and other professional opportunities, and hats off to them for having that opportunity. it does put a burden on us though to try to push the system as fast as we can because we all know it is built to be slow, so we are being very aggressive in recruiting replacement for those staff

members and i do wish them well. i think it is complementary to the agency that we produce really good people that others want to poach. it is not fun to go through the transition though. i think that kind of sums-the last thing i wanted to highlight, we also in october hosted the city wellbeing champions of the celebration on a cruz cruise on the waterfront well received. champions have a wellbeing as a duty assigned. none of them have a full time job, so for them to get that kind of recognition was just unheard of. and wellbeing also delved into the world of covid and had-we did a covid vaccine clinic at hss and that went well and hats off to the team because that is no small task. the

administration of the covid vaccine is very different then the flu vaccine so we had to accommodate all that and thank the partners kaisers who has been good in supporting both clinics and covid clinics. with that, i will end and should there be any questions, happy to entertain them. >> are there any questions on the director's report from board members? >> commissioner follansbee, can you hear me? >> yes, we can. >> i ask the speakers to speak more directly into the microphone. i hear but not very well. i maxed the volume on my health service board laptop. i want to applaud the health plans for covid vaccination numbers. it is quite outstanding, and just remind our members

that getting one dose isn't enough. you are not considered completed the initial vaccination until you have gotten two vaccines so hoping the small number of people who initiated are planning or have received a second dose somewhere else. of course we don't have information on boosters, but it is quite clear the boosters are working for all the circulating variants of which there are now many in various percentages both locally, nationally and internationally. also want to comment on the (inaudible) option. i want to complement kaiser for updating their information to members to urge them to contact their providers to be screened for appropriateness. i think it is too much to ask if we-ask our various partners what

the adherence to that is. there is no doubt that (inaudible) for documented cases in the setting of additional risk factors not only shortens the course, improve the risk of spread, but also seems to have a positive impact on long covid, which is the area of very deep concern. as many people of all ages who experienced an active covid-19 infection whether vaccinated or not seem to be at risk for long covid and (inaudible) available orally does seem to help lower that risk and so, i just want to comment on those issues. i also wanted to ask executive about the personnel number. my calculation we are down a third of our

staff, and i notice that the cruise was a success with morale and getting people together. i wonder if you have comments of the impact of having so many vacancy apparently across all parts of the health service system? >> we are continuing to be highly functional, and there is always a certain number of positions open just because of the time it takes to hire and often we take the opportunity to consider (inaudible) point in time and so sometimes we make adjustments in classifications and that adds to the timeframe. there are a variety of things that go into it. it is a higher number of vacancies at this time which is why i chose to put the report in the way i

did because i think we need to continue to track that. there's-and also the way that the position control is done in the city is very convoluted and hard to understand let alone explain, but i think that we are well on our way to hiring into the positions in a priority order because it does-we can't do them all at the same time, and the-so that continues. >> if i'm correct we have 58 or 55 authorized positions total in the department. something like that. >> something like that, yeah. >> thank you commissioner for your comments. i would want to commend the entire staff for their hard work on behalf of the board for their hard work during the course of open enrollment. i know the numbers are going to come and all that but it has been a

compounding and improving effort every year, particularly with the e-enrollment process so i want to thank the staff collectively and individually for their hard work during that time. thank you. we'll move to public comment on the director's report. >> thank you president scott. [providing instructions 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 callers in the queue at this time. >> we have zero callers on the line and zero callers have

entered the queue. use dial in instructions and select star 3 now. if you want to join public comment for this item. we'll wait 5 more seconds and 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 closed. >> thank you we'll move on to item 8. >> item 8 is sfhss financial report as of september 30, 2022. this is discussion item presented by iftikhar hussain. >> good afternoon chief financial officer how are you? you look none for the wear after the audit. you survived. very good. >> it was a team effort and are the results were very clean and we'll hear more about that in the other presentation.

the one bragging right i want to say is the controller told us we are the first to finish the audit of all the departments. >> well done. well done. thank you. >> trophy. [laughter] for the first financial result i'm presenting are the first three months of the year. we are catching up. the fund balance increased by $14.7 million all most entirely due to the settlement payment we will talk about later on the agenda. by the end of the year, this is 14.7 net addition will come down to about 4.7 addition, and that's mainly because of stabilization built into the rates that we are now using, and the other thing i want to point out as far as claims are concerned, the claims are running

high across all plans and it really is this unpredictable cycle. we thought after covid the decompression of claims had plateaued but we see another increase in claims. it isn't covid related, it is just people getting normal services and normal care. we'll watch the claims and update you to see where the trend goes. the good news is (inaudible) would be high because the rates keep going higher so we project about 800 thousand increase but it would be-that is very conservative rfx , it will be more then that. the health sustainability fund we are projecting year end balance of $2.7 million in that fund and in the generalfund we are expecting

surplus. those are highlights on the financial. happy to answer questions. >> are there questions from it board regarding the financial statements and this is for the period ending september 30? >> that's correct. >> any questions? if not, we will go to public comment on this item. [providing instructions for public comment] we'll

begin with in person public comment. no one approached the podium and move to virtual public comment. the moderator will notify of callers thin queue at this time. >> board secretary, we have zero callers on the phone line and zero callers entered the queue at this

time. reminder to listners use the dial in instructions and select star 3 now. if you want to join public comment for this 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 closed. >> thank you. now move to item 9 ck that is action item on the annual audit report. >> item 9 annual audit report. action item andprinted by iftikhar hussain. >> would you please introduce your colleagues chief financial officer hussain? >> my colleagues are independent auditors. [laughter] >> we'll call them colleague s for this round. >> happy to introduce our team from mgo.

craig harner and (inaudible) >> i ask that you come to the microphone and articulate their names, so we can hear those. >> it is craig harner is a partner on the engagement and yia yiang is the manager. >> i'll ask you it repeat that, i could not hear you. >> i'm sorry. i'll let them- >> let them introduce themselves. please sir, come forward and swallow the microphone. >> for the record craig harner general serving professional partner and with me is yia yiang, manager supervisor. >> thank you and delighted to have you today. >> thank you. before

we start our presentation i want to thank the management and the staff at sfhss for all the assistance for the audit. we ask a lot of questions, ask for a lot of supporting documentation so a lot of piles on to their normal work schedules and especially during times when you are going through enrollment and rate setting and fixing the system so it is a big ask, but they always have been able to respond to us timely somewhere as you heard we are the first agency to issue a report for this year. we are here to present the results of our audit for fiscal year ending june 30, 2022.

we performed a audit of the financial statements and these financial statements include the benefit trust fund, it doesn't include the general administrative fund. as part of the issue we issue three reports. two of them are independent auditor reports. they go inside the financial statement document. the first one is independent auditor report just on the financial statements themselves and the very end is another independent auditor report on internal controls and compliance. the very first auditor report we have is concerns the financial statements. it is in the very front of the financial statements again and we are pleased to report we issued unmodified opinion on those financial statements. we issued the report on october 26, 2022. and again for the record, the unmodified opinion is the highest level of assurance a independent auditor can give a organization regarding

their financial statements. the second independent auditor report we issue is a report required by government auditing standards so we perform the audit of the employee defendant benefit trust fund and this adds additional responsibility on ourselves again relating to internal controls and compliance. we don't give any assurance or opinions on the internl control but we have to consider them and if we come across deficiency in the internal role that rise to significant or material weakness we have to report those to the health service bord and we are happy to report there are no such deficiencies or internal control weakness. for compliance we have to take into account laws regulations contracts grant agreements that could in and of themselves have a significant effect on the financial statements and report any non compliance again to the board and

we are happy to say no such instances of non compliance. and then moving on, the second report or third report- >> could i interrupt on this for the public record could you go back to slide 2? you indicated third bullet that there were no compliance deficiencies. i would like to have that somewhere reported in this presentation as well. if you could add that note for the record. >> we'll add that. >> thank you. please proceed. >> just real quick, we'll go over the responsibilities of both management and ourselves if the (inaudible) we are not colleagues we are independent from him, so it clarifies the both management and us

at the independent auditors. management is responsible for preparing and fairly presenting the financial statements in accord ance with the u.s. gap or generally accepted accounting principles. responsible for designing implementing internal control over the financial statements and also evaluating whether there is concern or considerations or anything they are aware that place doubt about the entity to continue for a period beyond a year. which there were no such instances this year. ourselves as your independent auditors are responsible for exercising professional judgment, maintaining professional skepticism throughout the audit and why we ask as many questions as we do as we are probing and inquiry what we are told makes sense given what we are seeing. we also identify assess the risk material statement. the risk of something in the financial statements

is materially misstated and we design and perform audit procedures to respond specifically to those risks. as mentioned previously, we obtain understanding of internal control. again relevant to the audit. not for the purpose of opining on internal controls, but just for helping us to understand the entity and design procedures. we also evaluate the appropriateness of accounting policies used by management and then the reasonableness of significant accounting estimates that are used to prepare the financial statements. and also conclude if there are conditions or events that give doubt to the ability to continue as a going concern for a period beyond a year. we'll move to the last report we issue is a report to the health service board the board of supervisors and honorable mayor. this report is called the required communications and what this contains is our professional audit standard require at the end or conclusion of audit communicate

matters to governance in this case the helths service board so i'll go through some of the required communications right now. for significant accounting policy, management is responsible to select appropriate accounting policies and there were no changes and no policies that guidance. there was nothing out of left field trying to do. significant accounting estimates, there are two. the first one being the fair value of investments. this requires management to estimate fair value of those investments and those are estimated based on the trust position in the city treasurer pool so we have all the money in the treasurer pool, we also audit the pool so look over the pool as a whole, make sure investments are fairly valued and the proportion of share of that is calculated

accurately. the second accounting estimate for the health service system is probably the most significant, reserve for claims or ibnr incurred but not reported claims and this is based on calculations claims reported and also assumptions about the claims that are not reported and this is based off membership data and then the claims lag information that is calculated by aon. we are not experts in the actuarial science, we hire our consultant who is specialist in health care so we give him the same exact data that aon uses to calculate the reserves. he does a independent calculation and analysis and compares the two and then we are happy to report there were no significant discrepancies or differences between the work of aon and our actuarial specialist so we were able to conclude

everything was reasonable and in accordance with the appropriate accounting standards. >> thank you. >> and then finally, we are also required to report if there were corrected or uncorrected audit misstatements which there were not. there were not financial statement disclosures or significant differences. there were not for this year no significant or unusual transactions. the significant financial statements disclosure again is (inaudible) goes over the reserve s for claims information i just talked about. we didn't have difficulties encountered during the audit and didn't have disagreement with management either. as far as we know there were no management consultations with a outside auditor. that would go against something we are saying. and lastly, there is one

subsequent event reported in the notes of the financial statement relating to about receiving settlement proceeds from sutter health. that happened towards the end of september , early october and because that happened before we issue the financial statements we have to put a note describing that transaction because of the significance. >> thank you. >> that concludes the presentation and happy to answer any questions. >> questions from the board at this point regarding the annual audit? i would also point out to the public and those who look at some of the documents that are more detailed then this presentation, the actual report is a part of this item, and in the report there is a great deal of background and history about the governance structure, the things we have done in the past and so forth. it

was quite revealing this year. i guess i hadn't looked at for some time but there is a lot about the background, process and governance of this board and the health service system so commend the document or reference for anybody looking for additional information about what we do, how we do it and why we do it. to chief financial officer and his team, i commend you for your hard work and diligence throughout this process so thank you. are there any other questions from the board? if not, we will have public comment on this item. >> thank you president scott. [providing instructions for public comment]

>> can you pause, i like to call for a motion to approve this item. i did not do that before and didn't want to interrupt read ing. before we get public comment i will not have you reread the guidance. i'll pause and entertain a motion we adopt the auditor's unqualified unmodified excellent report. >> i move we accept the audit report with gratitude to mr. harner and mr. yiang and cfo hussain with note of no compliance deficiencies on slide 2. >> is there a second? >> second. >> been moved and seconded we accept the report with the other descriptors provided in the motion and having done that and having no comments from the board and having had the guidance read under

the open meetings act, we will now entertain public comment. >> we do not see anyone in person for public comment. we be able to move to virtual public comment and the moderator will let us know if there are callers at this time. >> we have zero callers on it phone line and zero callers entered the queue at this time. reminder to all listners use the dial in instructions and press 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. there are still no call rs thin queue at this time. >> thank you moderator. hearing no further callerspublic comment is closed. >> thank you. we'll have roll call vote on the approval or acceptance of the audit report.

>> roll call vote. [roll call] >> thank you. we'll move to item 10. >> thank you president scott. item 10 is sutter health settlement distribution approval. this is action item and introduced by abbie yant and presented by iftikhar hussain chief financial officer. >> thank you. i think our board is very well informed of the long story of the sutter lawsuits that occurred and so i would like to shift our conversation today to talk about the fact that we did receive settlement funds and as you heard they have been deposited and we are expecting a second

payment. we have worked with actuarial, city attorney office, the third party attorney to bring the recommendation to you today, and i'm going to let iftikhar do the presentation. i also want to comment that we were a little delayed having the most robust conversation before this committee and so we did make changes to the memo and the slide that were in your packet and we have given hard copies here now and iftikhar will point out where the changes were made. >> so- >> this is commissioner follansbee, since i'm not in the room, is it possible to transmit copies of this to me electronically so i can review those? >> i can send you the url to connect on the website-are they on the website?

>> i can make sure he gets it. >> it is hard to vote on the item if i don't have the information. thank you. >> you'll see it on the screen as well. >> so, we invited emma hu from (inaudible)-she was involved with this issue 10 years back. if there are questions about the background of this information she is available to answer those questions. >> is she in the room? >> she is remote. >> she is remote. hello emma. >> i can see she is listening. >> okay. thank you. >> just confirming i'm here. >> thank you emma. >> just housekeeping item. i will outline the changes between the posted material and what you see here today. first of all,

the amounts that you see here are the corrected amounts. there were two distributions confusion about the first and second disbution total amount about the distribution received is $14.8 million. the second distribution 6 months from now would be another $2 million estimated. so-and then in the recommended action i think it still says 17, it should be 17.5, because- >> are we rejecting the most current one? >> yes are. this is the most current one, correct. >> the motion at the bottom says 17, it should be 17.5, so not sure what happened there. the reason is the second distribution will be a true-up so could be slightly more then $2 million. the motion says up to an amount,

so i thought it is prudent to make it 17.5 in case that amount is higher. so, the thing i want to point out is that the charter does not really address specifically how legal settlements should be handleed so this is something that requires board action. typically what we do is we estimate rates and in the rate setting process we have a process called stabilization, which has very specific rules about how surplus and deficits are used for the purposes of rate stabilization. this is not rate stabilization, it is just information used in the trust to set future rates in a process similar to rate stabilization. we are calling the process underwriting process. we are not calling it stabilization. >> would you repeat that again? >> we are calling the

process--the original write up used the word rate stabilization which has a specific meeting and bound by policy so-the term we are using here is the underwriting rate setting process, which is a broader term then just rate stabilization. so, the process-so, the $14.7 million along with the second distribution, we would use in the rate setting process beginning with plan year 2024, because 2023 rates have already been set and approved by the board of supervisors. >> iftikhar,b sorry to npt interrupt. in the recommendation slide instead of saying for the rate stabilization you would use the underwriting rate

setting procedures? beginning in plan year 2024? >> that is correct, yes. >> (inaudible) >> it should say underwriting rate stabilization process. >> those are you only changes including the amounts? >> correct. >> okay, thank you. >> happy to answer questions about this. again, this is a lawsuit from 2014. lots of history, and we are happy to have the funds and use that to reduce future rates. >> are there questions from the board regarding receipt of this and the proposed recommended action? >> this was strictly sutter, right? united

health care we use sutter doctors through them so when you say only blue shield members would be--rates would be changed. i don't understand that. >> yeah, so we did have a united ppo product, city plan back then, so all those numbers were used so that is now administered by blue shield. as we set future rates it is through the blue shield product. >> so, when did this end i mean when did this start the lawsuit? >> the lawsuit started in 2014. >> before we had united health care. the retirees in united health care we have sutter doctors too? >> so, we-we have a city plan i think is mostly with the claims. we submitted claims that were

eligible under the class action and so we-regardless who was administering them since we went through changes with blue shield and united. >> i think you raise a important question. i think we can creg that and that's why we wanted to be a lilt more open about how we would distribute the funds, so we are asking today for us to support the fact we deposited the check and it is in the trust, and then with the help of our actuarial and legal advice we might need, we'll carefully consider the distribution, but it isn't my recollection and maybe emma knows i'm not sure, but this lawsuit included the medicare population. that's-it is a good point and we will look into that. >> definitely, because- >> i don't think it

should impact [multiple speakers] i hear you. i hear you. we did when we wrote this originally we were being trying to be very how we would distribute it and after we had more robust internal conversation we determined we need ed to think about as we set the rates next year. there is a lot of time for consideration of questions like that, so if there is others we really appreciate hearing them and we'll be sure to address them before we bring it to you. >> i can't remember exactly what other plans we had back then. besides-i don't know-when did united health care start? >> 16 i believe. >> was it 16? >> something like that. >> commissioner follansbee, correct if i'm wrong but my understanding is the lawsuit really involves sutter health system which is the

hospital system. the medical groups, unless the physician became a sutter physician through this more recently enacted mechanism most physicians involve medical groups that are different from the sutter hospital system, and so i don't know this would effect the physician bills and billing and all that for the various medical groups, i dont think it would. am i wrong? >> emma can you respond to that? >> yeah. it is specifically based on the hospital claims that were submit ted by the carriers between a period starting in 2003 to 2016, so it would not cover medicare advantage, it is just commercial self--funded or flex funded plans. >> thank you for the clarification. are

there other questions or observations from the board? hearing none, ready to entertain a motion. >> mr. president i move we approve the sutter health settlement distribution as discussed with future considerations as noted during our conversation. >> second. >> been properly moved and seconded we accept the recommendation as discussed. are there any further questions or comments from the board? if not, we'll open up for public comment. >> thank you president scott. [providing public comment instructions]

there are no zero callers in the public comment queue at this time and zero callers have entered the public comment queue. reminder to all the callers on the line dial star 3 to be added to the public comment queue for this item. we'll wait 5 more seconds and close public comment for this item. there is still no callers in the queue at this time. public comment is now closed. f >> thank you. we'll have a roll call vote on this item. >> roll call vote- [roll call] >> motion carries unanimously. we have

done very well up to this point and we have a foot slog ahead of us in terms of a presentation so i'll request we now take the next agenda item and then take a brief break before 3 o'clock when our guest presenter will come aboard. thank you for your cooperation and limiting your comments and observations. at this point we'll take item number 11. >> president scott we are going to wait for our item 11 at 3 o'clock and move item 12 now? >> 12? i have here the strategic plan is what i was calling for. >> yes. agenda item 12 is sfh is rks is

rks strategic plan 2023-2025. this is action item and introduced by executive director abbieient and presented by lutischa harris. >> good afternoon commissioners. abbieient executive director. it is my pleasure to present our strategic plan for the year 2023-2025. we have been through a lot of change over the last number of years and it isn't slowing down. so we went through a rather arduous and lengthy process internally to put this plan together. lutischa lead the effort. it is like herding cats and getting us on the same page and we did choose a style of planning that is different then what we used in the past so that was a big learning curve for all of us. but i have to commend the management

team who put in a lot of effort and work directly with their staff to develop the objectives that are already embedded in the plan. with that, i will have presentch >> good afternoon. leticia harris. the previous draft presented in powerpoint form on the screen now is a picture of the 2023-2025 strategic plan narrative form. at the september board meeting commissioners introduced to tactical approaches refresh activities and overview of environmental scan. to better understand the internal and external factors that shaped our strategy. for today's presentation, i'll begin by reviewing the strategic plan framework including mission vision and values. i'll share approach to leading with equity and are highlight the goal

setting methodology that frame implementation moving forward. i'll point out how commissioner input from the last meeting is actualized in the goal s and wrap up with lessens learned. leadership team exercise the core value of inclusivity by inviting managers and supervisors to take part in the strategic planning process. our staff enrich the process by bringing and contributing diverse divisional perspective in addition to unique lived experiences as a part of the membership. this includes reflection of the past and future station of mission vision and values. our updated mission centers equitable sustainable quality benefit to enhance wellbeing of members and families throughout the life cycle. the updated vision reflects engagement and personal ized care that centers disease prevention and equitable service for

optimal health. ourifiable set of values are inclusion compassion operational excellence collaboration alignment and the addition of accountability per the request of staff. our most recent staff engagement activity took place at the all staff meeting and retreat held at the san francisco pier last month. staff were asked to select value most reflective of them as a person and professional. our staff show up and show out in service of membership. not only as a obligation or civil service, but with sincere willingness. the addition of accountability shows we strive to promote high level of work to promote honesty, encourage dependability and garner trust from the membership we serve. we want to show staff that we hear them, that we see them and we want them to see their feedback manifest in this strategy. per request of the commissioners, we took care to

reevaluate the terminology used to describe the goals including the verbs. to make aspirational and brans balance what is within our sphere of influence and impact. as goals and objectives displayeden the screen i'll describe the revisions. goal 1 we drawn a clear (inaudible) to benefit our external customer service approach. as we await city wide directives around racial equity planning and reporting, we'll use data provided to us by the department of human resources for both analysis and informed discussion. for goal 2, the language has updated from advance primary care to advancing primary care practice. addressing the practice of primary care promotes active member engagement to deliver right care right time in right

setting. for goal 3, affordable sustainable. we highlighted the relationship between insuring long range financial stability of the trust and active ongoing commitment of the health service board in stewardship responsibility. this includes the continued provision of diverse educational activities access to subject are matter experts and areas of fiduciary actuarial legal and administrative matters pertinent to their role. the system that coincide with level of awareness has also been adjusted as reflection of knowledge individual expertise and experience they bring to this role. for the mental health wellbeing goal, a actively engaging vendorers and city partners to identify best practice resources for membership around access utilization to address mental health wellbeing and clinical needs. as announced in september, on the cusp hosting a mental

health vendor summit that will impack implementation. goal 5 we observe board recommendation to embed objective jz key result that account for job satisfaction and opportunity for growth within. as debut the strategic plan we want to make clear leading with equity is the core of our approach. since 2018 inis ception of the plan confronted racial inequities and civil unrest in a nation and (inaudible) these times also shed light on many forms och inequity that stem from structural racism. one form this takes is unequal distribution and access to health care resource. lead with equity to support membership accessing

care that they need when they need it regardless of personal characteristics such as gender ethnicity, geographic location and socio economic status. as we advance the strategic plan also aligning with leading health authorities to insure equity is ingrained within the fabric of mission vision values and goals. the plan will guide activities from adoption trow december 2025. the leadership team will monitor progress toward the stated goals through the development of annual implementation plan based upon the foundational objectives and key results that correspond to each goal area. objectives and key results are effective goal setting methodology and tool for communicating what sfhss wish to accomplish and milestones we need to measure to get there. objectives and key results are used by world leading organizations to set enact strategies. as

a foundation for the development of more detailed systemic implementation planning. review implement agz planning quarterly with annual presentation to the heblth service board. the report will include measurable targets for each strategic goal area expressed in the form of objectives and key results. adjustments will be made to elements of each strategy area as appropriate to changes in the benefit environment. the board will be active in implementation assessment and evaluation of results from the health service system strategic plan for 2023-2025 and beyond. i like to share lessens learned. the strategic plan 2023-2025 process represent a shift from proles vision of benefits to deep er understanding of the helthd of our population. delivery system transformation aimed at better

outcomes requires care models that integrate a broad array of services to address physical behavioral and social needs. our department recognizes that race and the social determinants of health conditions people live born work play worship and age play a significant role in wellbeing. having a job and health benefits is isn't enough. our members need support and are navigating the social clinical barriers that stand in the way of their health and wellbeing. in the medi-cal world social determinant are understood and evidence but because the population has a job and insurance the system makes assumptions about those that are commercially insured. we entered the conversation to dispel those myths and establish our position as a trusted alley for our membership. we hope the strategic plan inspires hope and sets a clear expectation of what lies ahead. to close with acknowledgment we like to express

gratitude to health service board to the san francisco health service staff, actuarial consultant aon and members providing invaluable guidance comments and suggestions as our strategy evolved throughout the years. also like to extend a special thank to the graphic designer ryan close. if you are watching thank you for working behind the scenes to breathe life into the form we advance to the board for approval today. thank you all for your time. >> thank you. are there any comments from the board on the strategic plan? it was sent out with the meeting materials, so-- >> goal number 2 improving primary care, how do you plan to do that? this is desperately needed but don't see it improving, i see it getting worse actually. big picture.

>> on primary care- >> can you introduce yourself to the audience? >> hi, this is iftikhar hussain the cfo and part of the leadership team building the strategic plan. the advance-improvement in primary care was a area that i focused on and the key-there are models of improved primary care (inaudible) in the industry. (inaudible) and recognized by others groups including calpers so the goal is align with other payers like cover california and calpers and to influence change on health plans and the providers to improve access, to improve integrate behavioral health into primary care and so it is i

understand it is a aggressive goal and because it is aggressive we need alignment with other payers. >> the access is the problem because there are not enough. >> yeah, so access specifically- >> i don't know how you improve that. >> the way to improve that would be a leverage model where you have not enough-infrastructure and system and teams supporting the physician is and taking care of patients. given there is a shortage of primary care physicians. >> at one point i saw there they were offering students bonuses if they were going to go in primary care field. i read this somewhere quite a while back but i don't know if that is true anymore. it is so obvious now. >> part is the payment structure for primary care is not very lucrative. to be a specialist you can make a lot more money

and pay off medical school debts quicker. this is industry wide delima we are all grappling with and i concur with iftikhar statement it does take alignment working with the other purchasers shifting the payment structure to pay more for primary care. that will help. and then there is support mechanisms with either front office or back office systems. it systems et cetera that allow the physician to be the physician, and those can be more-make the practice more robust and fulfilling for everyone and many primary care practices are embedding behaviorist to help with mental health issues managed primary care and burn out with

primary care. there is a ton of model jz we are not by ourselves. hss can we have a impact on this? no. but together with pbgh, inticated health care association, with many other like-minded folks we are pushing forward. >> seems like it will be a very long-term goal, because there is such a shortage and takes a long time for student to get through medical school. >> yes and no. we have watched the reemergence of brown and toland the physician group over the last few years so we see where there is some of the supports that are coming from other organizations that primary care can be properly supported. can we do enough quickly in time to keep from continuing to go the wrong

direction? it is a outstanding question. >> i would only add to the comment and i understand the concern the commissioner is raising. the fact that we have during the preliminary phase of developing the strategic plan began to focus coming out of the last strategic cycle on primary care as a issue and we spent what two plus hour s in a room here in the city main library talking about it and so forth, so the point is, it is a longitudinal goal and we need it to kind of craft the structure around it and now we are saying that over time this is where we are going to head and i think that is the real essence of this. we are not in it by ourselves but the fact we are saying that this is an issue for our membership and we need to be directionally aggressive and intentional about how

we are going to proceed, so it is not that we said we will solve the issue, we said we are going to focus our attention on trying to get the qualitative services needed over time. so, i think it is a good start and a well articulated goal in our plan and we'll see as we go over the next 3 years cycle how we are able to marginally or maybe major ways come up with solutions that will make sense for our members. >> also want to add a thought. i think things have changed as well. the time-my provider days, there was a lack of folks in primary care, you don't really make money in primary care. there isn't a lot of attention and it has evolved on the need for primary care and the importance in the continuum of care, so i think we would-i'm

optimistic getting alignment from others and taking on this goal. >> are there other questions? >> commissioner follansbee. can i follow up on the issue and bring up another miner point? one is that, i really appreciate the very comprehensive background information we were provided as part of the agenda, including the evolution of strategic goals slide which looked at area explored and inclusive areas where we had concern and influence so i applaud executive director comments about the alliances with other groups to bring this issue forward, and so i didn't think that from my perspective our leadership is really focusing on this in many ways. one way is possibly we can begin to maybe explore asking for metric in terms of not only what

percentage of our members have primary care providers like we question delta dental in response to a complaint, but also what the access time is for some of these primary care functions as well. we begin to develop metric maybe in conjunction with other partners. again, i think the slide looks at areas explored including where we have influence and where we may need to partner is a important part of the packet. i want to make one other comment and that is, look at strategic goal number 4 and i want to alert-basically reassure our membership that the second objective under enhancing program to support retirey and wellbeing grew out of discussion we felt maybe there were deficiency and what we were able to support

holistically. by no means implies we will ignore those people still working. at times the board is criticized for focusing too much on early retirees and retirees but highlighting this grew out of deficiency and doesn't mean we are going to be less diligent about supporting mental health and wellbeing for all members including the active employees. >> thank you commissioner. i would also like to as a footnote point to page 14 in the document. just as you move the chronology down so that the later years were sort of chronology order, 23, 24, 25, there is one bullet i missed in terms of providing feedback to you on page 14, second

bullet, q2, 24 should be at the bottom of the list. that is my error, not yours. >> thank you. >> are there other questions or comments from the board regarding the plan? >> thank you president scott. i want to commend you and the team for this wonderful product you produced and thank you for indulgeing in all my verbs and other issues. i think it is important that anybody who picks up this plan be able to understand and catch your vision and know where you are going, and i also read through this plan this deep commitment to the members and lives that are touched by the health service system and not to just do a cursory customer service type of service but to dive deeply into the things that matter and the way they receive care

and the sustainability of that care, so well done. >> other comments? i would like to read into the record the letter of endorsement of the board, so we have a clear understanding that this is not just sort of like a one and done kind of thing. health service board is dedicated to making high quality affordable comprehensive health care benefits available to sfhss members and administering the trust in accordsance with the chapter. we are committed to our rule as fiduciary to assure benefits paid for by the trust are available to all sfhss members without special favor or privilege. the mission and vision of the strategic plan will inform and frame our efforts in the near future. this plan as a whole will serve as a policy

reference, planning guide, and communication tool as the board interacts with all constitchancy leadership and staff and office of city government. acknowledgment of that understanding, the board at this meeting approve the design and development of the strategic plan. as the result, the board will be active and diligent in the implementation, assessment and evaluation of results of the strategic plan for the year 2023-2025 and beyond as we seek through responsible stewardship to better serve our members. by adopting this plan today i will call for a motion. we are making that commitment and we again commend the staff through the

executive director and project leader mrs. harris and all of those individuals on the administrative team who contributed to bringing us to this point. i'll call for a motion. >> president scott, i move that we approve and adopt the sfhss strategic plan for the years 2023-2025. >> second. >> been properly moved and seconded that we adopt the strategic plan for 2023-2025, and we'll now have public comment. >> thank you president scott. [providing instructions for public comment] begin

with in person public comment. no one approached the podium, so move to virtual public comment. i'll check our queue to see if there are callers for public comment at this time. we have zero callers on the phone line and zero callers have entered the public comment queue. reminder to all callers on the line or trying to dial in, please dial number across the screen and press star 3 to join the public comment for the agenda item. we'll 5 minutes--5 seconds and then close pub luck comment for this agenda item. so, no callers joined the public comment queue. public comment is now closed. >> thank you. we'll have roll call vote for on this action item. >> roll call vote- [roll call]

>> thank you. the strategic plan as described and edited is adopted. [gavel] now by my lights, it is now 233. roughly. i would like to have us convene at 255. we'll stand in recess until that time. thank [meeting reconvened] >> we are ready to reconvene our health service board meeting, and we are prepare today undertake item 11. this is a board education segment and we have a guest presenter and we'll start by having

executive director yant. once the item is read to introduce the segment. >> thank you. >> president scott. >> yes. >> can we do roll call vote since we had a long break? >> i'm sure we are all here, but would you have-call the roll again, please? thank you, commissioner. >> roll call vote- [roll call] >> alright. thank you. we have a quorum. we ready to begin and ready to turn it over to our board secretary to announce this item. >> item 11 is bord education with focus on addiction services including medication assisted treatment. this is discussion item. interdiced by abbie yant exectsk director for sfhss and presented by eric haram

consulting llc. >> thank you, abbie yant executive director. pleased to have the presentation before us today . we committed doing a board of education substance use disorder in this calendar year and trying to find the good speaker, i listen to eric's presentation he did for the purchase business group on health few months ago and what i found most useful is his focus is on commercially insured population. we have many esteemed colleagues at the department of public health who focus is on issues and fentanyl overdose and things like that and i was able to forge new partnership with dph. they can be thought leaders on issues

maybe highlighted in the presentation. eric being a third party from maine so why he is attending virtually, but i did find his presentation very comprehensive and how we think about the commercially insured population and are substance use issues all our departments see within their workforce and we care for through the health service system. thank you very much eric for entering our virtual world. >> while we transition we will have our slides presented. eric, let us know you are see our slides. we'll make sure you are not on mute. >> there we go. i see them, however they are very very very small.

not on the main screen, which i see hsb secretary. but rather across the top in the gallery. >> it may mean from your end being able to adjust the view, the layout. there is quite often underneath a row presenters are names, tool bar you can adjust that. >> my apologies. >> eric, this is our moderator, if you hover over the

presentation slide, do you see several docs come up that allow you to pin it to the screen or make it larger? >> i do. it says move to stage. >> yes, perhaps trying that is one option. >> there we go. that helps greatly. >> thank you moderator. >> again, my apologies for the tech difficulties. i think i can see-if i need to i'll go get glasses. >> welcome and when you are ready to start. >> okay. thanks very much for having me with you this afternoon. i say this afternoon, i believe it's 3 o'clock your time, 6 o'clock mine, and so good afternoon

and good evening. we'll take a little time and this evening, i think we have scheduled to 4:30 your time if we have robust discussion and questions following the presentation we may need all that time otherwise i think there is a fair amount of buffer built in. >> this is president scott, if i may just to be clear about our timeframe, we have another portion of our business meeting to conduct, and we are hopeful that we can conclude before 4:30, because our room here in san francisco is going to be taken over by another commission, so we are hopeful that we can have the type of discussion and your presentation in such a way that we can do all of that. >> duly noted. thank you. launching in we are going to be

looking at substance use disorders and what employers should know and look forward for their employees. next slide. our objectives is provide a overview of substance (inaudible) best practice for employers, framework for evaluating substance use disorder vendors or treatment providers that you may elect for your employees to use and what employers should look from these specific type of vendors. next slide. as exectsk director abbie yant noted, i provided this slate of information to the specific business group early summer and june. they connected a what they call a vendor showcase for a

range of employers. i believe san francisco health system was in attendance and we wanted to try to provide good framework on how employers might evaluate the vendors they would like employees struggling with the issues to access and they hired me to help develop this evaluation criteria which we'll go through in some detail. there is a fairly robust appendix to this slide deck that really unpacks all these areas and so encourage you to review that on your time following. next slide. so, a little about me. next slide. as i was introduced my name is eric haram and live and work in the mid-coast region of maine. lived here

since 1997. relocating after a lifelong in another cold place in min neapolis and st. paul. i have been operating haram consultant a strategic planning workforce development and clinical technical assistance consulting firm since about 2016, and work primarily with states county government, city governments, health systems in transforming their response to public health and safety where substance use and substance use disorders are concerned. next slide. so, for our agenda we'll cover these 4 areas, a brief overview of substance use disorders, look into best practices for employers consideration, provide

a framework for evaluating these types of vendors or treatment providers on behalf of your employees and what you may be looking for from them in return. next slide. so, what is substance use disorder? we start with a clinical definition. it is a chronic relapsing and remitting brain disease that is characterized by compulseive drug seeking and use despite harmful consequences. the additional decision to take substances is typically volen material with continued use the person ability to exert seft control is impaired. that is impairment is the hallmark of substance use disorders. there are screenings measures for substance use disorder and risk

and examples include the world health organization screening tool. next slide. how do we see this revealed in substance misuse and dependence? substance misuse refers to the use of substances for the purpose that is not consistent with the legal or medical guidelines. often involves prescription medication and could mean taking more or less then prescribed. medication not prescribed specifically to you or taking a substance at a time when the obligations are inconsistent with use. and those are examples of misuse. dependence or substance use disorder-the lines between misuse and dependence may become blurred in the presence of clonic use when regular use results in one or more

of the following, professional assessment really is in order to help identify the extent of the problem and how best to intervene and when we find health complications as a result the inability to carry out daily responsibilities with consistency, the presence of physical dependence, meaning in the absence of the substance withdraw syndrome is revealed and that individual is struggling with cravings and preoccupation and things like looking forward to the next episode of use. so, nuance between misuse and substance use disorder and hopefully those lines help clarify that is a little bit and what resources may be needed to help sort of get to the bottom of things. next slide. we talked about tolerance as a hallmark of substance use disorder so let's ubpack and look at

that closer. what we mean with this in the absence of use or tolerance, we sort of feel normal. if you look at this fulcrum or teeter todder, that is depicting the fancy word is (inaudible) neuro biological action that underlies really everyone's ability to feel pleasure. companionship, nurturing kids, self-efficacy, good food, water, intimacy are all examples of neuro bilogic action that interact with pleasure for us, and in the normal state that tone is what we call normal. when we introduce substance the use leads to effect of the drug. repeated use leads to tolerance or a reduced

hedonic tone. the opposite of normal or healthy tone is called (inaudible) that is reduced ability to experience pleasure. person uses a substance and experiencesuephoria, perhaps decrease pain sensitivity, sedation or feeling energized depending on the substance and often lowered inhibition. those are by-products of intoxication. if we look at the next slide, the opposite effect is tolerance. so when a person comes up they come down and the flip side of euphoria is perhaps hang over and consequence. behaving

in ways we didn't intend or contrary to our values or obligations. in fact withdraw. the absence of that with this teeter todder back and forth repeatedly what begins to happen is the person experiences reduced pleasure over time, and the amount of dysphoric or an hedonic consequence is greater and duration longer. eventually a person is using substances not to experience euphoria but just to feel normal. substance use disorder is disrupt decision making and we can see substance use disorder emerge across the 3 domains you see

in this-call a stair step table. beginning with binge and intoxication. over time drug use individuals begin to learn the effect. begin to anticipate the effect. absence of that effect negative affect or withdraw or hangover begin to emerge to where then in the final stage where we see readily or constant preoccupation or anticipation. this is really because there is a neuro biological process happening. there's regulation of a neuro transmatter called dope mean that is big part of our pleasure center and as a result

decision making can be diminished, and we find individuals preoccupation is all most too mild a term. what we are referring to is the person becomes all consumed with wanting to escape this state. this state of the absence of intoxicationer becomes misery. and that is a cyclical thing that feeds the compullson to continue to use. let's look at the national perspective. there are 9.5 million or 3.8 percent of adults over the age of 18 that have both substance use disorders and are mental illness. substance use

disorders effect 20million americans 12 and over. most common are related to cannabis and prescription pain relievers. in 2018, 3.7 percent or 9.2 million of all adults age 18 and older in the u.s. had both major mental illness and at least one substance use disorder in the past year. next slide. so, when we look at drug use among age groups, there are emerging trends. younger people are more likely to use drugs that are the rates of drug use among 50 and older is increasing faster then among younger age groups. genx are getting older and the habits acquired in the 80 have fallowed them. drug related death rates for users over

50 increased 3 percent annually, 75 percent of deaths from drug use disorders among users age 50 and older were caused by opioid. 6 percent deaths 50 plus age users were from cocaine and -i have to say the vast majority of our patients are in the late 40's, 50's and early 60's. that's both unique to the geography, maine is the oldest state in the nation and york village is an amazing place to vacation. none the less, i see this in our client base. as of 2022,

close to 1 in 10 full time working americans met criteria for alcohol use disorder. 1 in 10. the rates of alcohol use have increased substantially, including among the employed population. reports show increased alcohol use during the work day. additionally, use of alcohol and drugs among adolescent and young adults remain high. next slide. so, i put this in because we will talk about what has happened national trends of substance use, particularly these last two years during covid. i use this slide because community norms really are a big deal. we have our own thoughts, feelings and values about the use of substances. there are also community norms.

these were examples during early covid, the first 6 months of advertisements i thought spoke to those norms and so a an icdotal post er from veterinarian society, day drinking and stoned clients thin covid era. how do we deal with that? cathy lee, martha and snoop. there was a about 4 minute video on saturday night live early covid musical number called let kids drink and then we have ida our (inaudible) with the gigantic

cosmo. early studies show that social isolation and other covid-19 related stressers were big contributing factors that increase substance use. in fact, 13 percent of americans reported increase substance use in 2020. also in 2020the u.s. saw the highest rates of drug overdose ever recorded. approximately 30 percent increase. that trend continues. fentanyl has been a significant factor in those overdoses. stagling statistics and many employees may have families and their families and kids may be among covered members. among adolescent fatal overdoses increased 94 percent from 2019 to 2020. i will pause for a minute because that is a very sobering statistic. let's look at best

practices for employers to consider now that we are armed with the lay of the land. substance use disorder working populations further. next slide. so, let's look at productivity. studies show substantial correlation between alcohol use disorder and absenteeism. despite only making up 9.3 percent of the population, individuals with alcohol use disorder accounted for 14 percent of all absences so if we look at the table from the national data and looking at the level of alcohol use severity, correlated with days of missed work annually, no alcohol use disorder the average employee miss 13 days with a mild alcohol use disorder increases to 18, moderate, 24 and

severe alcohol use disorder just over a month missed work per year. i have not included in the slide deck, but a an icdotal survey done one year post covid state of emergency declaration polled 3 or 4 thousand employees from fortune 100 companies and asked them about their drinking behavior and the question simply was, have you been consuming enough alcohol during your work day you're concerned about returning to the office or to the workplace? in other words, returning from a virtual situation. the positive response to that was, 40 percent

, which is remarkably high in terms of thinking about culture and what happened and what kinds of things were occurring when we went home for two years. alcohol use disorder are more common among full time workers who are men, younger individuals, white or hispanic. alcohol sales increased from 2019 to 2020 by about 20 percent. additionally over the course of the pandemic alcohol use patterns were altered substantially. the death rates from alcohol related complications have skyrocketed. so, if we think about diverse populations and patients with substance use disorder up to 50 percent of substance use disorder patients are fully or partially employed and that fall into the two columns on the right.

moderate stable housing, level of employ access to transportation and perhaps under-insured versus the stable column where individuals are stablely housed employeeed, have a personal vehicle and private insurance. look at the next slide. so, we need to take time and talk about health disparities, which is in my field of behavioral health and substance use disorder is talking about institutional stigma and bias and i think sometimes pull the punches by using language like disparities, stigma when really what we are talking about is discrimination and racism occurred at a institutional and cyst

systematic level. lack of cultural understanding by health care providers contribute to under diagnosis or misdiagnosis of mental illness in people from racial and ethnically diverse. black patients are 77 percent less likely to receive medication assisted treatments or opiate disorder or (inaudible) lead to greater criminalation resulting in greater reluctance of individuals to seek help. there are entire factors of the national substance use or drug court treatment systems that have significant problems with blocking access to diverse populations as

bonifyed diversion programs. next slide. there are populations we know to be more at risk. people with existing mental health or substance use conditions may experience and did during the pandemic experience increased distress and trauma symptoms. the treatment may have been disruptive and care providers put under additional strain where we saw many people the past few years fall through ever widening cracks and our safety net. older adults and those with cognitive decline or problems with self-care, people at risk for sexual or jnder base violence and adolescence with (inaudible) so, again when we talk about this on slide 4, we identified substance use disorders as a chronic illness, chronic disease i want to underscore

that with this context substance use disorders are perceived and treated differently then other chronic conditions, yet the relapse and remit rates are on par. in other words, the potential for relapse with substance use disorders as you can see is very much aligned with type 1 diabetes, hypertension and asthma. we onin primary care however don't take people off the treatment panel for a1c not moving or not taking their hypertensive medications or doing the other sorts of maintenance that all people with chronic conditions be29 begin to take ownership over as they move into sustained remission. next slide. how can

employers support employees with substance use disorder? one, reduce stigma and bias against substance use disorders and empower to seek help for themselves or family member. the main thing there is nobody wakes up one day and says i think i like to acquire a substance use disorder and need professional treatment. it isn't a goal people have. it is something that happens to them and it happens sudally. it is a sudictive process and before people know it they are in up to their neck. then telling someone that and asking for help is very very difficult. our response to that are providing pathways for that are hugely important at being able to help our employees make a u-turn and engage in

recovery and move forward becoming valuable productive talented employees for you. promote availability of timely accessible relevant and engaging treatment options. that sounds fancy but it is not. when a person needs help and needs to be there. it needs to be easier to get then to avoid. and once they show up stuff they are provided needs to work. it needs to be relevant and needs to be delivered by people who engaging. understanding the power of language. modifying to align with non-stigmatizing messages. your words really do matter. examine the culture that relate to substance use of norms of business or life, stress relief, modify. to infuse normst

thaimpuv health wellness and accom aidate the expanding workforce in remission. if you have a population of employees concerned about you feel are at high risk, getting folks together outside a happy hour would be a worthwhile endeavor. next slide. so, there are resources that i want to make folks aware of. these are in fact employer tool kits. these are three such that are really i think salient. you will not get a lot of fluff from these. you will get right to the facts and some real great examples of the types of things employers can do to reduce stigma and in fact show employees if you need help we can help you obtain that. next slide. so, if we put this all together we are talking about

substance use disorder as a cycle. of the three pair of glasses i have here, none are the right ones. we are starting to see the cycle of addiction in the middle-swooping arrow at the bottom is active use. then we have person emerging remorseful. they may have a recommitment and begin to engage in abstinence or use reduction and recovery oriented activities. then some trigger may occur for an individual and for some it may simply be boredom and wristless

(inaudible) dangerous things for folks early recovery to sit with because it sets off this chain of events again and so next slide. so, when we think about substance use disorder in the course of recovery, i-what is most important here for folks to grapple is is that there sadly isn't a magic wand. for those that saw some of the movies promoting treatment and recovery in the late 80 early 90, the programs that meg ryan went to and rekindled with andy garcia are fewer and farther between. the

film clean and sober with michael keaton, similarly. there is again this car nisty to substance use disorder that involves phases of relapse and remission and what we see is that individuals who struggle with substance use disorders do so for a good long time before they move into full sustained remission, and most individuals with substance use disorders, particularly working adults, are able to be highly functional and sustain a very high level of professionalism and career mobility in spite of perhaps a pretty significant substance use disorder and what we see is people self-initiate cessation taemps for 4 or 5 years secretly on

their own before beginning to seek professional help. when i see somebody for treatment and it is their first time coming to a professional for treatment, what a lot of people dont know, that person often has been really really working hard to regain control often times for 4 or 5 years before walking through the door the first time and saying i have a problem and need help. and i think that is the biggest thing i want people to be aware of is by the time someone comes to you and says i think i need some help, there is a lot that has been going on that nobody really knows about in terms how hard this person has been trying up to that point. and i say that because i hope if you find yourselves or any of your business leads,

directors, managers et cetera find themselves in these conversations with people, if you contextualize it that way first it is easier to find empathy and what folks need in that moment is some empathy. certainly some (inaudible) expectations and boundaries and understanding of what's tolerated and not, but most importantly is this may be a difficult conversation but i want you to know you did a good thing bringing it up. let's start there. next slide. so, i am not a expert on california law, but it is a big enough deal that i wanted to include this here and this relates to sb221. the initial law that of course required initial appointments and no greater then 10 days after the initial

request and as of july of this year further requires that follow up appointment offered no more then 10 days from the initial appointment as well. systematically what that means for the state and service system and people who run these type of programs and businesses, quite complex for employers and employees and individuals needing this help, it is a really really big deal. i'll say from the engineering side of the work that i do, what i know to be true is individuals who ask for help for mental health or substance use, if they can acquire it within 48 hours, two days of that initial request, 85 percent of the people will show up to that appointment. any amount of time longer then 48 hours or two days there is highly correlated reduction in the show rate to

that first appointment. the same is true of the second. this is a pretty big deal to try to do this in 10 days and legislate it, it is 8 days longer then the data tells us to be predictable of capturing and engaging up to 85 percent of those people requesting that first appointment. so, 10 days is great progress, but if we want to get everybody in who says i want to go, you got to try to get that in faster. next slide. so, access. front end process in the patient impact. these are just universal truths and things for you to be aware of. the behavior. the access characteristics of the programs that you want your employees to be interacting with. also steps we take from the first contact through the end of the

first clinical appointment make or break a prospective patient resolve to attend and return. no one aspires to have to go to substance use disorder evaluation or treatment program. the many steps thin road to recovery are not palatable in the first contact or appointment. there is very little use in asking someone to take a sip of water from a fire hose. they won't come back. rules and lists at the initial point of contact are distracting from the intent of that first contact. i am at my end of my rope, feel horrible about myself, keeping this secret and calling and asking for help. what again the person needs to hear in that moment is, well, when it seems like all these things have been going wrong, you did really good thing today. you did call the right

place, we know what to do and can help. let's get started. because if we all think about our experiences in the service industry, particularly health care, we rarely remember what we are asked in the pre-appointment paperwork. we always remember how long we wait and we do remember if people were nice or not. on the front end of this, basic customer service is what you are looking for. are people nice? do employees have to wait? next slide. so, we are moving way ahead of pace and i think any concerns about timing of this evening's event are well in hand. as we look at the third itedm now i want to talk about a framework for evaluating substance use disorder vendors. these treatment programs and providers that maybe want to contract with

your particular entity or health care provider or third party payer, these are kind of the things that i think you want to know. another way of talking about this is kicking the tires of the programs that you like your people to get help from. so, the desired characteristics for the best impact are when you interact with those programs, people are spoken to in real time, a human being answers that first phone call for help, and the place accepts walk-ins. we characterize substance use disorder as a chronic illness and something we call window of opportunity illness, which means there are times when a person is open to this idea and when that window of opportunity is just a little open and they-i think i

want help-the folks need to pull them in and that's what you get with this real time human being interaction and the ability to accept walk-ins. multi-cultural competency. availability of multi-lingual professionals. clinical triage versus financial. what's going on with you versus what is your insurance? we will get to what your insurance is, but it doesn't have to be the first question. provider for what is tolerableo back to the drinking from the fire hose analogy. the physician that is the medical director in my program is also a family medicine provider and primary care and when she first diagnosed a patient with diabetes she talks with them about what we will be doing in the next 30 days. she doesn't talk about what happens over a life span in that first appointment because you will scare the heck out of them and

may not come back. so, again, availability to troubleshoot barriers. do you have problems with transportation, child care, medication assistance. during covid do you is a smart phone and are you able to attend appointments on zoom or webex, and do you have the right technology and bandwidth and all that? employers should look for these access characteristics in programs that they purchase directly or indirectly. another thing i'll say, a sud program in 2022 that doesn't include medications for addiction treatment is not practicing in this time. these medications received fda approval and overwhelming evidence of their efficacy to improve outcomes and

reduce mortality in 2004, 2005 . if we haven't gotten there now, you are not providing a relevant service. next slide. so, the current evidence base around treatment. let's look at alcohol use disorder opiate disorder and stimulants and of course, many of our employers and individuals that are struggling with substance use disorders may be struggling with multiple uses of substance, and so for alcohol use disordser want you to be aware of assessment and treatment of withdraw. always be careful to assess a person withdraw from alcohol. fda approved medications for treatment of alcohol use disorder cognitive behavioral treatments

that include motivational interviewing, prevention strategies that reduce stigma so those are the components you like to see. for opiate cognitive behavioral trement, overdose prevention, relapse prevention and fda approved medications. for stimulant, motivational interviewing. contingency management. this is simply put as really incentivized based care, and community reinforcement approaches. meaning there are multiple professional actors involved and wrapped around a individual's journey with treatment and recovery. next slide. treatment comes in lots of different flavors and packages now, and the good news is there are

national medically accepted standardized patient placement criteria to describe these things, and to match the level of acuity or how ill a person is with the type or intensity of treatment that may be best aligned to need. and so we do have digital options. these are things like treatment programs that live on our phone. there are a number of them that are very very high quality. they often most frequently provide what we call american society of addiction medicine. outpatient to intensive outpatient levels of care so may be individual therapy once a week, it may be group therapy for hour and a half once or twice a week. the minimum and maximum might be intensive outpatient program which would be typically 3 hours of duration 3 times per

week for 9 hours of treatment each week total. that's what we see in the digital platform which are able to monitor breathalize, urine drug screen, technology through smart device blue tooth and commitment they may send to people in treatment is a part of the cost of care can all effectively be delivered in this modality. digital treatment that is difficult is it is really hard to tangibly put through the paces. how do knroe know this is a quality product because it lives out here in the internet and ether? the best way i can say to do that is think of coordination of care. thou our treatment may be app based i might have a primary care physician, a eap

program, a number of professionals involved in my life that are invested in this treatment experience that we are all paying for, and the way a digital solution or treatment provider coordinates is really important. they have to be able to do that relibly and credbly. there are brick and mortar programs that deliver outpatient individual counseling family counseling groups, in person virtual hybrid models the same with intensive outpatient programs discussed. short and long-term residential programs that range from say 1 to 4 weeks up to 18 months depending upon the intensity of need and duration of need.

there are clinically managed inpatient and hospital based inpatient floors. this is where we would find mostly the need for inpatient withdraw management. the new term for years referred to as detox. next slide. again, thinking about this continuum of care and the types or flavors of treatment i want to see the full continuum moves left to right beginning with early intervention, outpatient service, intensive outpatient services, day treatment programs that may be 6 to 8 hours a day, 5 days a week and are then into the varying intensities of residential and inpatient hospital based programs. criteria which employee assistance program professionals and the programs and

professionals they contract with would be very aware of and if they wrnt polk that would be somewhat problematic and something i think you would want to look into. next slide. all of this is what we are getting at with this american society of addiction medicine criteria is, aligning the person's functioning with their intensity of need and we do that by looking at 6 domains or life areas. we are interested in the persons level of intoxication and withdraw potential. any bio medical conditions that underlie that complicate or make things more dangerous. emotional behavioral cognitive conditions that add to complexity like mental health conditions, learning disabilities, individuals mental

status and then look at readiness to change. relapse or continued use potential risks, and then their environment. what is it like where they reside and living. we simply raise those across severity of low, medium or high and then that array if we look at the one previous slide-there we go-let us know which flavor or bubble on it continuum is most appropriate for that given person. let's go two slides forward. there we go. so, the rational for medications for addiction treatments we heard about (inaudible) exectsk director abbie mention thatd at the beginning of the introduction and would be remiss if we didn't take a moment to underscore. the rational for medication for addiction treatment and when we say map, what we refer to is medications for

addiction treatment. the formulary. mat is the integration of fda approved medications that assist in stabilizing treating maintaining sustained remission from substance use disorders. medication for opiate use include methadone, bup morefen or suboxon (inaudible) come in tablet form medications individuals take orally or there is extended release injection that individuals can elect as well. alcohol use disorder, naltrexone (inaudible) for

(inaudible) all the medications greatly improve mortality rates, treatment outcomes and sustained remission. next slide. what is recovery and what is the goal of recovery from a substance use disorder? that is the process of change through which individuals improve health wellness and livl a self-directed life and strive to reach full potential. that is definition of recovery from substance use disordser and with our last 2 or 3 slides, let's underscore again what employers should be looking for from treatment providers that you may develop relationship with on behalf or pathways for employees. next slide. one more. so, if we pack all this in

and just salient slide here, high quality substance use disorder solutions or treatment programs include these 5 characteristics. one, use evidence based behavioral modification, change approaches. include medication assisted therapy or medications for addiction treatment. and they have high quality engagement strategies. if you ask what percentage of patients attend their first scheduled appointment, they ought to be able to know that statistic and talk about it proudly. they should have a welcoming first contact and intake process designed to maximize engagement. that is what we call low demand characteristic versus high demand characteristic. we are talking a window of opportunity and so proving that you really are ready, prove you deserve the treatment and trully

motivated to come in. those are examples of (inaudible) high demand characteristics versus low. we want to provide timely access within 24 hours to the first clinical appointment and multiple referral channels. no wrong door is what we mean by multiple referral channels and direct cooccurring mental health conditions. 80 percent of individuals with a substance use disorder have are a trauma history or a mental health cooccurring condition such as anxiety, depression, ptsd. we want to understand and strengthen clients environment and support system. that means family, their ecology, employment. their social world. lastly, we want welcoming intake process and robust assessment with

validated tools. next slide. thinking about these key features substance treated. are they treated alcohol, (inaudible) offer a continuum of care that match a range of acuities? is there high quality referrals and coordination if they don't provide intensity of service a person needs. are they using evidence based behavioral modification approaches? integrateed medications into their clinical landscape? provide for co occurring mental health conditions? access access access. knowing pathways to getting in treatment and being able to articulate their performance in those areas is really important. care coordination and integration with

existing providers. do they coordinate for the person's primary care provider? other existing health care mental health care providers that may be involved and again (inaudible) in the mix. is it equitable? is access and cultural care. are there peer services integrated and opportunities for families and community support? i think that might be our last slide. let's look at one more. key outcomes for selection. again, if we look at these in chunks, thinking about access for your people. thinking about engagement and satisfaction of their customer base. improvements and outcomes. able to demonstrate that it's measured and articulated and

continually improved. and then behavioral health improvement. what types of metric standard tools are used to determine pref-post outcomes for individuals. the last two items in blue are accreditations. do you have a level of accreditation from a national body like the joint commission for example. i think-next slide. so again this is a quick list of the 12 areas that we did develop in that showcase for employers to that different treatment programs they wanted to direct contract with so that is included here and think if we look at one more slide we are done. so, with that, i will turn this over to our moderator.

maybe i should stop my-- >> thank you very much for the presentation. it was very comprehensive. i have one leading question. we have been going through a crisis in california with providers and i notice a number of these things employers should be doing and looking at as they consider the access is that you are talking in terms of not only a state requirement of 10 day s but further recommending we get people assessed within 24 hours after the first contact and i don't know how that is going to happen in our current staffing environment with most of our health plans. i know they are working on these things diligently and trying to negotiate with existing staff and recruiting and training new staff, so there is a real tension in my view of

trying to use some of this guidance in the current environment. you have any reaction? >> i see why. i don't have a simple solution. what i can say is i think the legislation is strong and certainly points towards investment in individuals accessing these services much more rapidly. that meeting 10 days is a gigantic lift. currently it is something i empathize with as a employer and individual who runs a substance use treatment program as a part of the community fabric here in

southern maine. what we are getting at i think or what i'm wanting to convey as a non california resident or legislator is we find the performance and outcomes for individuals with these conditions greatly improve when the rate of access gets better. if you are used to be 4 weeks and have a new reach goal of 10, that is significant amount of progress. that still does point to sort of our data that demonstrates that the faster you can get someone in the more likely they are to show up. people begin change by showing up and so the first rule of thumb is you can't get treatment if you are not in it. we

just start there. people will fall through the gaps the shorter the wait time is. start where you are and go from there. i think- >> can i ask a subsequent question? commissioner follansbee. can you maybe briefly outline what the future is of virtual encounters and for access? is this a area of active investigation? are there data that would support it or not support it at this point opposed to in person access? >> that data is of course emerging. what we learned the last 2 and a half years we were underutilizing that technology. what we see from the data is that not only have

outcomes remained consistent as good as they were pre-covid or pre-virtual care, more people are able to access the service. anecdotally i have patients that say we work very hard where i work to live these values and outcomes and assure people can get in as swiftly as possible and our patients are often in disbelief when the happens that way and again it backs up to that really basic thing that a individual cant engage in treatment if they are not in it. this technology is very very functional and the data is showing us that the outcomes have at least been the same then before we used

this technology. compelling enough that federal and dea wavers granted during covid are going to be sustained at the end of the public health declaration. you will be able to see patients with substance use disorders on zoom for health care, you will be able to prescribe controlled medications and wont have to necessarily establish with a face to face encounter before doing so. those rules from those bodies don't change easily and that we moved into that i think are really strong bellweathers about utility of virtual treatment. >> are there other questions from board members? none. well, i thank you for the presentation and we can certainly use this

as a reference as we continue to focus on this strategically and operationally going forward and my hope is that as we do this and we know there is a increased need, how we get the resource and the person together at a appropriate time early on as you are suggesting is going to be the continuing challenge in all of this. so, i thank you very much for your time today and sharing this information with us. >> thank you very much mr. president and i appreciate you all thinking of me and feel free to reach out as you move through this complicated work. >> alright. anything else director yant? >> no, i don't think so at this time. >> okay. >> thanks eric. >> thank you. >> thank you. trying

to see if there is public comment on this. there is public comment on this presentation. please. >> thank you president scott. in person public comment is first and then virtual. anyone in person welcome to approach the podium now. each speaker is allowed to comment for 3 minutes each. all public comment concerning the item presented. caller may ask questions of the body but no obligation to answer. for those on the line when i welcome on the call state your name clearly but you may remain anonymous. give you a warning with 30 seconds remaining and when ended thank you for the call and placed on mute. remote viewing is available on sfgovtv and online using webex.

[providing instructions for public comment] we'll begin with in person comment. no one approached the podium. we'll begin virtual public comment and the moderator will notify of caller in the queue. >> we have zero callers on the phone line, zero callers entered the public comment queue at this time. reminder to all, please use the dial in instructions and 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. there are still no callers in the public comment queue. >> thank you, hearing no further callers, public comment is closed. >> thank you. we'll move to a committee portion and i will take a rest and turn the gavel over to the governance chair for this board, commissioner follansbee. >> thank you very much. we have agenda item 13. >> thank you. item 13 is health service board annual self-evaluation and employee performance of sfhss exectsk director evaluation and timeline frz the plan year 2022. this is action item and presented by the governance committee chair follansbee. >> thank you very

much. outlined in our packet the committee met with a full participation of our three members on november 2, 2022. this item deals with the health service board self-evaluation timeline and draft as well as performance evaluation for exectsk director for 2022 and the draft. there is one correction. i dont know if our board secretary has hard copies of that, but the self--health service board self-evaluation itself item in the packet item 3, which dealt with the assessment of the orientation was inadvertently dropped and added back for consideration with a new category which is

not applicable. in other words, if health serveerse board commissioners don't feel they can address the-this is the old-this is the incorrect form. the correct one is not available. three was inadvertently taking out and added a few category and this category which isn't applicable. helths service board member did not participate in orientation in the last calendar year, they would indicate not applicable. in addition, item number 16 moved to item 15 on the incorrect form so don't know if we have the correct form in front of us. 16 we eliminated the word single word, routinely from the statement the board routinely

adheres to the policy. number 16 should read, the board aderhoos to its own policies. with that, the timelines and the rest of the form is as we reviewed and i will--this- >> commissioner follansbee- >> this is the incorrect draft 15 here should be 16 and because when we add 3 back which is the board orientation then everything moves down one number. hope that is clear to everybody. sorry we dont have a correct form here for you to review. with that, i'll entertain discussion or questions. >> if i can- >> board secretary. >> for commissioner follansbee, thank you for noting the edits. what is currently posted online you're right is incorrect. now that you noted them they will be updated with approval today.

>> alright. i move that we adopt the self-evaluation forms and timelines as distributed and edited. >> second. >> if i have a motion in addition to adopt performance ealivation outlined in the timeline to have a vote on all 4 items >> that is-apparently i didn't say that correctly. i move we adopt the self-evaluation timelines and forms as distributed. >> second the amended motion. >> any further discussion? if not, open up for public comment. >> thank you. [providing instructions for public comment]

we'll begin with in person public comment. no one approached the podium and move to virtual public comment. the moderator will notify of callers in the queue at this time. >> board secretary, we have zero callers on the phone line and zero callers have entered the queue. 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 public comment queue at this time. >> thank you. public comment is now closed. >> thank you. >> thank you very much. i will now ask for roll call vote on approval of the four items under this

agenda item as proposed and seconded. >> thank you. roll call vote- [roll call] >> passes unanimously. thank you very much and again i apologize for not having hard copy of the correct self-evaluation form for you. now move to item 14. >> item 14 is health service board annual education planning process. action item and presented by governance committee chair follansbee. >> thank you very much. again, we were waiting approval of the three year health service system strategic plan which occurred today. before we go ahead and develop a more

detailed education plan, which we will do at subsequent meeting of the governance committee. with that, i will open up for-all we are asked to today is to approve the process as simply outlined. i think it isn't projected, at least to me but think you have it in your packet. any discussion? >> thank you chair follansbee. i move we approve the health service bord annual education planning process as presented. >> second. >> moved and seconded. further discussion? if not, open up for public comment. >> thank you. [providing instructions and public comment] begin

with in person pub lic

comment and no one approached the podium. the moderator will notify of caller er in the queue at this time. >> board secretary, we have zero callers on the line and zero callers entered the queue at this time. please use the dial in instructions and select 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 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 approve health service board annual education planning process calendar as outlined and now call for roll call vote. >> roll call vote- [roll call]

>> passes unanimously. thank you very much. we now move to item 15. >> item 15 governance policy in terms of reference 2022 review process and timeline. this is action item and will be presented by governance committee chair follansbee. >> i refer you back to the agenda packet, which again states that the governance committee met on november 2 and approved timeline to review health service board policies and terms of reference. remind all of us that this is an off year for the comprehensive review, the last comprehensive review was performed and approved by the board on february 10, 2022 under the excellent leadership of then chair scott and prior to that february 19, 2019 also under the

expert governance chair leadership of that opponent chair scott. so, we have three items that we identified for review. the first is a policy 210 regarding reassurance stop loss and how that is handled by the board. we review this annually as everyone recalls and we recently had a nice presentation from (inaudible) about this. the second item is review audit and compliance language to make sure that it is up to date and adheres to what the policy has been and the third area was brought up as we reviewed the self-evaluation, and took out a word from the question number 16 for our self-evaluation as health service board regarding our compliance with our terms of reference and policies. and we

realized we need to review them to see if we outlined a policy to on the very rare occasion make exception which we have done really incredibly rarely in the past to handle some more urgent matter so we want today review that. the committee will meet early 2023. our policy and procedures mandate that these changes be circulated 10 days prior to a board meeting for a lot of the time for the public and board members to review completely rather then the 5 days that is mandated for the regular agenda. in order to accomplish that, we will meet beginning 2023, finalize the changes and circulate 10 days before the march 2023 regular health service board meeting. with

that , i ask for any questions or comments and then a motion to approve the timeline and process for the health service board governance for reference review for 2022. >> mr. chairman, in light of a recent action by this bord today and letter contained in terms of the settlement received there were no terms of reference or charter policy, charter guidance regarding the receipt of monetary it says legal settlement, but think we need to add-i move we amend the topics to include topic 4. receipt of legal/monetary settlements. we need to have a more defined process. this was kind of as i understand it, we got the money, it was

reviewed internal administrative consultation, consultation with legal our legal counsel and so forth and then the recommendation was brought forward, and so we have-it has been without precedent i guess more recently, but there could be this type of issue that confronts us again and might make a different decision so i think we need to at least include it. we may not be able to decide all the aspects of this by the time of the rest of the terms of reference review, the other three we talked about, but i would like to highlight that that gap needs to at least be addressed so i would at it -add it to the list and may have to come back at another time. my motion is that we add a fourth topic, receipt of legal/monetary settlements. >> i'll second that

motion. >> so, can i interpret your motion to say that you move we approve the statement as outlined with the addition? >> yes. >> of a fourth area for evaluation discussion and possible presentation back to the board at the regular march circulation of march meeting 2023. the motion includes reviewing the three areas already outlined, correct? >> that's correct and adding a fourth one. >> thank you. commissioner canning i think your second includes those 3 items as well. >> correct. >> in addition to the fourth, correct? >> that is correct, mr. chair. >> thank you very much. okay. any further discussion from board members? >> commissioner follansbee i want to clarify, the board packet indicates january 2023 meeting, so but you have been saying march, so is it

march or january? >> i think-good question. let me-i don't see the outline. >> if i can commissioner, we talked about this timeline and we would try to get it done originally by december, and then we realized we were biting off more then we could chew so we said january, but we have a complete authority if we can't get it done by january to move it further. but we said we would move it out of december and into january as a target. based on the completion of the work. >> you're absolutely right. i stand corrected. we added-haven't established a date yet, but we approved the committee approved addition of additional meeting early december to deal with the three issues that the committee talked about and now the fourth

issue with the idea that a final policy change would be circulated by monday january 2 for review at the thursday january 12, 2023 health service board meeting so stand corrected, you are absolutely right commissioner. thank you very much. >> you're welcome. >> so, we have a tentative december 1 governance committee meeting scheduled. tentative at this point. any further questions or comments? >> i move- >> open up for public comment. >> thank you. [providing instructions for public comment] we'll

begin with in person public comment. no

one approached the podium. we'll move to the virtual public comment. the moderator will notify of callers in the queue at this time. >> we have zero callers on the phone line and zero callers entered the public comment queue at this time. please use the dial in instructions and select star 3 now if you want to join public comment for this item. we'll wait 5 more seconds and close public comment for this agend a 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 closed. >> thank you very much. it is moved and seconded that we approve the process and timeline for the review of the 2022 governance policy in terms of references with the three areas outlined in the agenda

and the addition of a fourth area to review regarding the possible mechanisms for handling receipt of financial settlements as a result of legal or other actions. with that, i like to call for roll call vote. >> roll call vote- [roll call] >> passing unanimously and that concludes the business of the governance committee and turn the agenda back over to president scott. >> thank you commissioner follansbee for your timely conclusion of that committee meeting and the results. with that, i have understand we have no presentations from any health plan representatives, and they have sat here

dutifully throughout this meeting today and we want to thank them for coming and sharing their time with us and listening to what was a rather routine we think meeting. i want to wish they and their families very happy thanksgiving so thank you for coming. with that, we stand adjourned. [meeting adjourned]

[gavel] >> the meeting will come to order. welcome to the public safety and neighborhood services committee. i'm chair gar do not mar, and and soon will be