>> good afternoon. i call this meeting of the health service board for the 8th of december 2022 to order. >> thank you, president scott. call to order at 1:04 p.m. >> would you please join me in saying the "pledge of allegiance."

["pledge of allegiance"] >> madam secretary, would you call the roll. >> yes. agenda item no. two, roll call. president scott? >> present. >> vice-president mary hao is excused. commissioner breslin? >> here. >> commissioner canning? >> present. >> commissioner follansbee? >> present. >> commissioner zvanski? >> present. >> with that we have quorum. >> thank you. we'll go to item 3. >> agenda item no. 3, resolution allowing teleconferenced meeting

under california government code section 54953e and this is an action item and presented by president scott. >> this has been continuing and we know what it stands for and why we're doing it for. i entertain a motion for adoption. >> mr. president, i move that we accept the resolution findings to allow teleconferencing meeting. >> second. >> second. >> it has been properly and moved and seconded. any board discussion? hearing none, we'll ready for public comment. >> thank you, president scott. i'll be reading those instructions aloud. in person -- oh, yes. our moderator. >> there is a note from sfgovtv to please unmute the caller as well. you may still be in practice mode. >> thank you for the update. i'm

checking all systems. there we go. i'll be looking for any messages from sf gov. thank you, moderator. our public comment will continue. in person public comment will be first and virtual perk. for anyone waiting in person, you're welcome to approach podium now. each speaker will be allowed three minutes to comment unless the chair deem more public comben. a caller may ask questions but there's no obligation to answer or engage with dialogue. i want you on the call and state your name clearly although you may remain anonymous. i'll give you three minutes and 30 seconds that you have left. viewing is available on webex. public comment -- you can dial the number on the screen and the

dial-in number is 415-655-0001. when prompted, use access code 24956355266. again 24956355266 and press pound and pound again. you'll enter as an attendee and dial star three to be added to the public comment queue. when your line has been unmuted, this is your time to speak. for those on hold, wait until you have been unmuted and we'll begin with in person comment. no one has approached the podium. our moderator will notify us of virtual public comment. >> secretary, we have three callers on the phone line. one caller entered the public comment queue at this time. other callers may enter the queue as public comment continues. i will indicate when

there were no more callers in the queue and you'll hear a brief silence as we transition in between callers. elevating caller one now. board secretary, if you could transfer host privileges, i'll unmute -- >> hello. >> welcome, caller. >> my name is, hello, my name is richard rossman and i'm a retiree worker in the health system and i have an issue with my eye where i need to see an ophthalmologist at caller. >> caller, i want to pause for a second. this agenda item is for the resolution allowing teleconferenced in california government code and i believe you want to move -- you'll want to log back in for the agenda item no. four which is general public comment. so, we'll be looking for your comment then. thank you. moderator, you can look for the next caller. >> board secretary, there are no

additional callers in the public comment queue. a reminder to all callers on the line, you must dial star three now if you want to join public comment for this specific tell commute agenda item. we'll wait five 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. >> roll call vote. >> roll call vote starring with president scott? >> aye. >> commissioner breslin? >> aye. >> commissioner canning? >> aye. >> commissioner follansbee? >> aye. >> and commissioner zvanski? >> aye. >> the item no. 3, resolution passes unanimously.

[gavel] item no. 4. general public comment - an opportunity for members of the public to comment on any matter within the board's jurisdiction that is not on the agenda, including requesting that the board place a matter on a future agenda. this will be presented by president scott. >> thank you. this item is open for public comment at this time. >> i'll be reading the public comment procedures aloud. in person public comment is first and virtual. anyone waiting in person, you can approach the podium. you have three minutes unless deemed otherwise by the president. a caller may ask questions of the policy wouldy but no obligation to engage in dialogue with caller. when i welcome you on call, state your name although you may remain anonymous. i'll give you a warning when you have 30 seconds remaining, when your three minutes have ended, i'll thank you for your call and placed

back on mute and the next caller will be unmuted. the opportunity to speak during the public comment are available by dialing the number on the screen and the number is 415-655-0001. again, 415-655-0001. use access code 24956355266. again, 24956355266. then press pound and pound again. you'll enter the meeting as an attendee on the public comment call line and dial star three to be added to the public comment queue. when the system message says your line has been unmuted, this is your opportunity to speak. for those on hold, wait until your unmuted. we'll begin with in-person comment. no one approached the podium so we'll move to virtual public comment. our moderator will notify us of public commenters in the queue.

>> board secretary, we have three callers and one did enter into the queue. this is the last comment from the last cycle. if you're waiting to submit your public comment, please press star three to lower your hand or it will repeatedly show in the queue. a reminder to all other callers on the line, you must dial star three now if you want to join public comment for this specific agenda item. we'll wait five more seconds and then close public comment for this agenda item. >> moderator, i'll unmute this caller. welcome, caller. >> oh, good afternoon, commissioners. this is richard rossman called and i'm a retiring member in the health service system. i'm in kaiser but you have an issue with my eye where i needed to see an ophthalmologist and when i was

seeing her, she wanted to see my eyeglass prescription, but she couldn't because it's not online. i called vsp and they don't have -- keep eye records online and so, i had to call my eye doctor and have him fax it to me and then e-mail it to her. you know, we should have an integrated system. vsp can't provide an integrated system, then we should go back to kaiser. my eye doctor at kaiser, my ophthalmologist should be able to see what my prescription is in looking on her computer or have access to vsp. if vsp can't provide online service, then it's time to go back to kaiser.

i can't see why the eye doctors can't upload the prescriptions into the vsp database. and vsp has it in their date da base that i went to the doctor. i hope when you negotiate the new contractor for any year that you require them to put the prescriptions in a data base and prescriptions to doctors and if not, it's time to go back to kaiser and you need to include the phone system. i called the open enrollment and got somebody's voicemail and nobody ever called me back and also, i believe supervisor chan is no longer on the health service board. thank you very much. >> thank you, caller. i'll unmute the current caller and moderator can let us know if there's further commenters in

the queue at this time. >> board secretary, we have two callers on the phone line. zero additional caller have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial star three now if you want to join public comment for this specific agenda item. we'll wait five more seconds and close public comment for this agenda item. bore 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. >> we'll proceed to item no. five. >> agenda number five, approval with possible modifications of the minutes of the meetings set forth below. this is for the november 10, 2022, health service board regular meeting and presented by president scott. >> i'm willing to entertain a motion for the adoption or any comments or edits of this item.

>> i move to approve the november 10, 2022, minutes as presented. >> second. >> okay. it has been properly moved and second. i have an edit i would like to insert. i believe it's on the, it's on item no. seven as listed in the minutes. it says president scott commended the staff for their collective and individual work on open enrollment with their efforts compounding improvements each year like he benefits. i think i said or if i didn't say it, i meant to say it, with their continuing efforts and improvements each year like e-benefits. so i'd like to make that small edit. >> thank you, president scott. noted. >> thank you. is there any other

input from the board? or edits or comments? if not, we'll now have public comment on the minutes. >> thank you, president scott. in person public comment will be first and virtual public comment. anyone waiting in person, you're welcome to approach the podium now. each speaker will be allowed three minutes to comment in length unless the board president deems public comment time limit. a caller may ask questions of the policy body but there's no obligation to engage with the caller. your encouraged to state your name clearly although you may remain anonymous. when your three minutes have ended, i'll thank you for your call and placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv and online using webex and you can dial the number on the screen for public comment. 415-655-0001. when prom pd, use access code 24956355266.

again, 24956355266. then press pound and pound again. you'll enter as an attendee and dial star three to be added to the public comment queue. when your system has been unmuted, this is your time to speak. those on hold, wait until the system indicates you have been unmuted. we'll begin with in-person comment. no one has approached the podium. our moderator will notify us in public commenters in the queue at this time. >> board secretary, we have one caller on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, dial star three if you want to join public comment for this agenda item. we'll wait five 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. >> we are ready to vote on this item by roll call vote. >> roll call vote starring with president scott? >> aye. with the edit. >> okay. and commissioner breslin? >> aye. >> commissioner canning? >> aye. >> commissioner follansbee? >> aye. >> and commissioner zvanski? >> aye. >> thank you. the motion carries unanimously. we'll move to item no. 6. >> item, agenda item no. six is the president's report and this will be presented by president scott. >> yes. i would like to call to the board's attention a very detailed memo from the board secretary requesting our participation in the board self-evaluation survey and it's due by december 21st. that's a few days before christmas. so if you'd like to get it done immediately, that would be

helpful. prior to the deadline date and i am requesting that all board members plan to complete the survey and if not, within the next few days, certainly by the 21st. that is my president's report. we'll now have public comment. >> in person public comment will be first and virtual public comment. for anyone waiting in person, you can approach the podium now. each speaker will be allowed three minutes unless deemed otherwise. the public comment should be made for the agenda items presented. there's no obligation to engage in dialogue with the callers. you're encouraged to state your name but you can remain anonymous. i will let you know when you have 30 seconds and put back on mute. remote viewing is available on sfgovtv and webex.

public is available by phone by calling 415-655-0001. when prompt use access code 24956355266. again, 24956355266. then press pound and pound again. you'll enter the meeting as an attendee and dial star three to be added to the public comment queue. when the system says your line has been unmuted, this is your opportunity to speak. for all others, wait until the system has said you have been unmuted. we'll begin with in-person comment. to one approaching so we'll move to virtual public comment. our moderator will notify us of callers in the public comment queue at this time. >> board secretary, we have one caller on the phone line. zero callers specifically entered the public comment queue at this time. a remind tore all callers on the -- a reminder to all callers, press star three if you want to join for this specific agenda item. we'll wait five

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. we'll go to item no. 7. >> agenda item no. 7 is director's report. this is a discussion item and will be presented by abbie yant, sfhss executive director. >> good afternoon, commissioners, abbie, executive director, san francisco health system. i'll be brief today. the covid pandemic is still with us. if you haven't gotten your booster, please do. we're seeing an increase in the need to have mask on, et cetera. so i think that we should continue to be vigilant. we hosted a mental health forum on tuesday, december 6th this week. and it was really quite extraordinary.

we had our health plan and their subject matter experts in behavioral health and many of their contracted vendors that are also working in this space along with a number of key city department representatives to look at sort of current state, future state of the mental health of our membership as well as areas for improvement. we are compiling the findings from the forum. it was very rich. it was seven hours of pretty much continuous dialogue and so we will be compiling that information and bringing a full report to this board currently slated for february of 2023. so, i look forward to just the, the analysis of what we heard and the process that we will use to formulate recommendations that

will come before this board. they are broad and a lot to do with -- not just seeking services but how to maintain your mental health in your current work environment. and we had lots of good examples of how that is done and how it can be done, so i think there's a lot of opportunity before us. we continue to be very involved in discussions around racial equity as it relates to the precision of health care as well as the disparity of healthcare that various groups experience and i did just learn earlier today that, much earlier than anticipated, the department of managed health care issued their recommendations and so, i found the url and that's as far as i have gotten. [laughter] the document is lengthy, so more to come but it's very, very,

very helpful to have their authority and their expertise in putting forth recommendations because these -- there's many questions and it's a complex matter to address and it's very helpful to have this kind of information because many tables this have been discussing equity and health care over the last couple of years have grappled with fundamental definitions and what conditions we talk about and what materials we talk about and how we slice the data,et, et cetera. dmc started this discussion here in california so that's very helpful to know and we'll be pouring over that and bringing you a summary at our january meeting. we continue to experience personnel shortages in our department. first and foremost, i want to recognize all of our staff that is working, like, double triple

hard to maintain our quality services to our members. we are in conversation with department of human resources on how to get more personnel assistance and to hire because our volume is so high right now that one person can't handle it. so, we're working on that and then a number of hopefully creative solutions to get through but we are experiencing delays in answering the calls and that's not comfortable for us at all but it's the reality of where we are at today. so we're continuing to address those issues as rapidly as we can. the, in addition to that, i think most of us in the room are aware of the payroll issues at the san francisco unified school district, which has a very

significant impact on benefit enrollment for our members who are employed by the unified school district or their dependents and they have declared a state of emergency. we are in touch with the new superintendent. we're meeting with them weekly. we are together, trying to sort of identify root cause where benefits are being dropped so we can jump on that sooner rather than later. there are stories that are being talked about publicly about individuals that have found out they didn't have benefits when they went to seek services. that's kind of worst case scenario for us so we're working diligently to figure out a way to know who these people are because the system is just messed up. and so, we're working very diligently and so, i've been in conversation, not just with the superintendent, the

mayor's office and education liaison is very interested and we're trying to encourage and i'm saying this publicly, we're encouraging anyone who has an issue to please call us because talking to your friend about it isn't going to fix it. we can fix it. so, i've made that exceedingly clear to people here at city hall and so, it's very, very helpful if we're made aware of these problems because we can fix it but if we don't know that it has happened, we can't fix it. >> may i ask a question about this. is this been in development over the last month or two or -- >> it has been going on since may. they put in a new payroll system and they've really struggled with the implementation and it just -- we've been aware and have been working with them but some --

it's the data that we don't see that is the problem. you know, if we were -- if we had -- if their new system communicated better with the existing systems that we -- that we depend on which is the way it used to be, this wouldn't be an issue but i'm not the techie and i wouldn't want to put my staff in the position of having to explain the problems that usd but we are grappling with the impact of it. >> and in your context -- your contact with them, have you come up with either a joint plan of how you're going to try and address this going forward or -- >> we're meeting with them weekly because the plan is constantly changing as we learn more. >> okay, thank you. >> if there was a simple solution, it would be done. >> yeah.

[laughter] >> thank you. >> this is commissioner follansbee. i've been aware of public comment on all this. the question is, when an employee finds out they don't have coverage, are they able to get care emergencily or urgently or with retro active coverage? what's happened to the people who find out that they don't have, supposedly don't have coverage? >> most of all, certainly in an emergency, all the laws cover people to get covered so that's important. but there are delays in care, care can occur when insurance can't show up in their system as currently being enrolled and we're encouraging people to call us directly because we can expeditiously correct that. the plans have been responsive and helpful. so the problem is not knowing exactly who is having this

problem because of the failure to deliver their information to us because you can imagine when you have tens of thousands of people in these files, it's hard to know who is missing. >> well, just an additional comment, i guess the other compounding factor out of this is that some people may be seeking care and getting care on an urgent basis but we also know there's also sometimes bills sent to people and so on and so on and trying to figure out, are we looking at just this issue person by person or trying to put together some longer or more expanded response on our part. you know, how we're going to follow up? are there any common issues, that type of thing. >> very good question. ones we're working with the school district. they are in control of this information so we have to work with them to help them understand what we need and look at the system that's are there to a -- the systems there that's

there to adopt the information. we don't see, you know, thousands of people being impacted at this point. what we do know are, you know, a couple of hundred and so we're trying to develop systems that expeditiously push people through system once we're able to flag who they are and so we're working diligently to do that. as far as dealing with bills, our plans are super helpful with us doing any kind of billing corrections that need to be made on an individual basis because they do, they don't often happen but they do happen from time-to-time in the normal course of business and so, they are capable and responsive for that, so i think once we know where the problem is, we're able to take steps to correct it. our problem is it's a lack of clarity on that and that's a highly technical question that i won't try to answer. >> all right. thank you.

>> uh-huh. >> i think you're going to hear a lot from our coopt team very shortly so i'll leave it at that for today. thank you. are -- are there questions? >> on the personnel and staffing, i'd like to thank those folks who are retiring from our offices and wish them well in their future, but as we look at these vacancies, is there a broader -- i know that everybody is having problems recruiting in every category that you want to look at, but have we also in parallel, taken a look at the compensation structure for some of these positions, whether they are currently classified competitively, that type of

thing, can you comment on that? >> yeah, yeah. the whole 1200 series which we have several classifications that's active in our -- in the quarter part of our staff is use by a number of other city departments and so, we have had a conversation with the compensation division of the department of human resources to do an analysis of these positions to be sure that we're all, a, using the right classifications which i don't think there's a serious question about that but we want to make sure because i'm personally only familiar a couple of classes that we use but i do know other departments have opportunities in that series or in other series that are promotional opportunities for our staff, so i think, you know, it's kind of the good news. the bad news is that, we have very competent staff that's taking average of these opening -- taking

advantage in various departments so it's hard to tell but anyway. compensation is working with us to do that analysis so we have a good sense of where those issues are. the other thing that's being worked on and it's even more challenging but the director of human resources, carol izen is clear there's barriers where the civil system itself, so she has outlined a number of initiatives that requires civil service commission approval in order to enhance the hiring process. >> all right. thank you. are there other questions from members of the board regarding -- >> -- yeah, this is commissioner follansbee. i attended the webinar on the crisis of health care personnel. and general

medicine group and they ignored our staff and they ignored the administrative staff. the people who uni-face the client so i know you reported a month ago on an offsite, it's not like it was a good experience for the health service system staff and morale, but can you comment again on how the morale is going for the holidays while in the face of all this stress? >> we are having a holiday party next thursday that the leadership team put together for staff. i don't want to sound like i'm just being, you know, falsely indicating. our staff is working very hard and i think they do appreciate acknowledgement of that and they are pretty dedicated and want to do the right thing and it's a

challenge, you know, to be able to keep up with the work and, you know, realize that you've got people waiting in the call queue and you've got real problems that you really want to work on and solve and it's a difficult time we're going through but i think we're hanging in there and we continue just to support each other as best we can during this challenging time. >> thank you. i want to add my -- my appreciation and admiration for all of your staff, not only in times when there's a crisis but during the times when there is a crisis. i consider this to be a crisis in terms of staffing and and not talking the emergency room and nurses and first responders and doctors and mental health but the staff of hss. they play a critical role in the health case system so i want to add my

appreciation for all they do and will continue to do and hope we can get some resolution to this. this leads into my next comment which to be, i would be remised not to make a comment on covid and congratulate our healthcare numbers. our members have gotten the primary course of vaccination but at least one booster shot and i would like to remind everyone including all of our clients, our members that you know, the full course of boosting would be three doses and if someone has not been boosted in the last five months, i would recommend that they seek another booster dose. again, we're entering the holidays and despite a lot of what we hear about, you know, escape mutants

of this virus and some of the therapies being pulled off the market, a, there are still therapies available and oral and taken and short course for covid and number two, the boosters including in the new booster do work to at least help modify and minimize the symptoms. and particularly, as we -- as we contemplate gathering with families and friends and we should reinforce messaging about testing and also self-screening and that means, i have several friends exposed to covid or thanksgiving because people were in attendance and complaining of a sore throat and didn't think it was covid and it was. they didn't know because they didn't themselves so my husband and i test ourselves before any

gearing even if we're asymptomatic and we wouldn't go to a gathering because we have friends and families who are more vulnerable than we are. we suggest that we redouble our messaging about not only vaccination of boosting but also testing recommendations and also seeking care early if one develops symptoms. not only a treatment for covid as we know but treatment for influenza and so, i think that probably our influenza vaccine is prey good as well and i appreciate that staff and the collaboration of getting their members vaccinated against influenza. but there's treatment for influenza. the third part of this pandemic of the rsv, there's no vaccine andville lens and protection and protecting themselves from that but others for frequent testing

and marginalizing our own health is really important so i thank everyone including our health plan partners for their collaboration in this ongoing effort. >> thank you, dr. follansbee. are are there any other -- yes, commissioner zvanski >> yes, i want to thank our staff. they did an incredible job during open enrollment given the staff shortage. i think it's rather phenomenal and they should be commended for it. some of the work that i used to do when i worked for the city involved personnel and classifications and i've often looked at our classifications and think that they are probably correct unless we did something that created a unique class of benefits, specialist that would be unique to the health service

system and the specific kind of benefits work we do as opposed to other work done in other departments with the same classifications but i'm glad you're talking to carol eizen about it because that's where the discussion should be had. i don't know if creating a special classification would make it more difficult to recruit or easier to recruit a specific kind of specialist or staff person for those jobs but i think we do have to look at them. and to do whatever we can do, i'm glad to see that there are opportunities for promotion from within because i think that's always very helpful. but what i'm noticing because i get the retiree list from the retirement system is, we have an

inore nant number of personnel retiring from city and many of them taking vested retirement and -- we have many people leaving city service and i'm hearing that that's an issue in many industries so i don't know we're unique and i know other cities in the bay area are experiencing the same problems, so we're just going to have to figure out how to deal with it going forward and give as much support as we can to the staff who remain and also to try to, i guess, appeal to our members to be patient and to help us help themselves as much as possible. i was impressed with the e-ben is options and i'm hoping -- e-benefits option and i hope that's working for a number of

people but i want to commend staff on job they are doing and hope we can get forward to get the best. i think we have the best people in the jobs that we have and i hope we can keep as many of them as possible and recruit more. thank you. >> thank you, commissioner zvanski. are there any other board comments on this item? if not, we'll open it for public comment. >> thank you, president scott. in person public comment will be first and then virtual public comment. for anyone waiting in person, you're welcome to approach the podium now. each speaker will be allowed three minutes to comment in length unless dreamed new public comment limit during the meeting. all public comment to be on the agenda item presented. you may ask questions but there's no obligation to engage in dialogue for the callers. the callers on the line, you're encourage to state your name clearly although you may remain anonymous. i'll give you a warning when you have 30 seconds left. and then the moderator will unmute the next caller. you

can view on sfgovtv and webex. you can call 415-655-0001. when prompted, use access code 24956355266. and then press pound and pound again. you're enter the meeting as an attendee on the public comment call line and press star three to be added to the queue. when the system says your line has been unmuted, this is your time to speak. those on hold, wait until the system indicates you have been unmuted. we'll begin with anyone in person public comment. no one has approached the podium. we'll move to virtual. our moderator will notify us of public commenters in the queue. >> board secretary, we have one caller on the phone line. zero callers entered the public comment queue at this time. a

reminder to all callers on the line, you must dial star three now if you want to join public comment for this specific agenda item. we'll wait five more seconds and then close public comment for this agenda item. board secretary, there are no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is closed. >> thank you. item 8. >> agenda item no. 8, sfhss financial report as of october 31, 2022: (discussion) presented by iftikhar hussain, sfhss chief financial officer. >> good afternoon. so i'll go to the highlights of the october financials. so our trust fund is about 14.7 million ahead of our planned target because of a settlement we received and this

settlement will be used for planned year 2024. as far as claims are concerned, we are -- claims are running close to target. there is, however, a higher claims on the medical side and lower claims on the dental side but in total, they are close to plan. we did receive pharmacy rebates. we got 4,000,000 in october. we're on track for $13 million for the year. the health sustainability fund, we are expecting to end the year at $2.7 million, which is pretty healthy. and on the general fund because of vacancies discussed earlier, we're running $600,000 ahead. and as the vacancies get filled, we'll end up closer to budget as we fill the vacancies. i'm happy

to answer questions of financials. >> are there questions for the chief financial officer? i hear none. i just like to thank you for the clarity, brevity and comprehensiveness of your report. >> thank you. >> with that, we'll open it up for public comment. >> thank you, president scott. in-person public comment will be first and virtual public comment. for anyone waiting in person, you're welcome to approach the podium now. each speaker will be allowed three minutes to comment. all public comment are to be made concerning the agenda item presented. a caller may ask questions but there's no obligation to engage in dialogue. you're encouraged to state your name but you may remain anonymous. remote viewing is available on sfgovtv and using webex. opportunities to

speak during public comment is available by dialing the number on the screen, the dial in number is 415-655-0001. when prompted use access code 24956355266. and then press pound and pound again. you'll enter the meeting as an attendee and press star three to be added to the queue. when the says emsays you have been unmuted, this is your time to speak. those on hold, wait until the system has indicated you have been unmuted. we'll begin with in-person in public comment. no one approached the podium. moving to virtual comment. our moderator will notify of us calling in the public comment queue at this time. >> board secretary, we have one caller on the phone line. zero callers specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial star three now if you want to join

public comment for this agenda item. we'll wait five 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. we'll now proceed to item 9. open enrollment report. >> agenda item number 9 is report of open enrollment activities for plan year 2023: (discussion) presented by rey guillen, sfhss chief operations officer, -- >> i would like to commend the executive officer for going through enroll rollment. >> chief officer rin. today, select members of the hss management team and i will walk you through a report that

reviews the activities and outcomes from the open enrollment period for planned year 2023. next slide. i'll start with a reminder of the reasons we have an annual open enrollment period and review the membership we serve. i'll be presenting a summary of the highlight from this year's open enrollment. i'll turn it over to bryan rodriguez you are o project manager who will review the open enrollment plan with you. which helps to ensure no steps were overlooked. and jessica, our communications director will go over our strategy, our enterprise system and an let i cans director will go over. i'll back in and discuss the assistance provided to members. i'll review how well we accomplished the key

initiatives for this year's open enrollment and kick it over to carrie, our well-being manager who will provide a report on our flu clinics before opening up with the enrollment results. next slide. so, open enrollment is a one-time a year that our members can change their selected benefit coverages. it is also the time of the year which they can add or drop a dependent from their health coverage without a qualifying event. such as a marriage or birth of a child. if members don't submit any changes during the open enrollment period and it rolls over into the next planned year with the exception of health flexible spending accounts, which requires members to reelect every year, this year open enrollment ran from monday, october 3rd, through monday, october 31st. with changes becoming effective january 1, 2023. next slide. as a reminder, we provide benefits that covers

over 77,000 members along with their covered dependents. currently, 43% are employees of the city and county of san francisco. 45% are retirees. 10% are school district staff and reminder is staff of the superior court and city college. next slide. this page highlights items we wanted to bring to your attention at the beginning of this presentation. one issue as executive director yan mentioned earlier, we're facing a staffing challenge. both leading up and throughout the month of october, over one out of three of our hss positions was vacant. this not only affected many services where we lost several of our long-term employees as they promoted to other positions within other departments within the city but also in key areas such as our communications team. despite these vacancies, we did make some progress through the

key initiatives that were set for this year. first, we achieved a significant reduction in the number of paper enrollment applications that were received as we continue to promote online enrollment and transitioning 667 families from flit carrier. we still managed to answer over 7,000 member calls during the month of october which is twice the amount we normally receive in a non-enrollment month. during the middle of the pandemic, we introduced the health plan net canopy care. the enrollment target that fhss and partner were expecting were not reached. during this year's open enrollment planning process, our staff took all available steps it could identify to educate

members about the canopy care plan and also offer health net opportunities to build member awareness of their plan. as a result of these combined efforts, we saw a 97% increase in the number of enrolled lives into the health net canopy care plan for 2023. we were also excited to reintroduce in-person health fairs this year which had to be suspected due to the covid -- suspended due to the pandemic. next slide. i would like to introduce bryan rodriguez who will walk you through the open enrollment project plan. >> good afternoon, commissioners. bryan rodriguez, project manager and as well as the informational systems administrator and primary, excuse me. project is administrator. you probably know me in that role. the project team is made up of from every department of hss. you can see numbers wise, we have a few

folks from each group on the team. we coordinate every everything from the rates, data analysis and contracts and anything the members need during the month of open enrollment. many of us meet weekly and check in and in contact using our digital tools to ensure that rates, communications, events, flu clinics, webinars and the materials we provide to our members and need to understand to use their benefits are always up-to-date. i do my best to keep the schedule, notes, and everything else shared in one place so we can have a look, anybody can see them whenever they are needed and also you'll notice in one of the listings there, we do include the flu clinics and webinars in our open enrollment project plan. because they are critical during this time not only for the flu vaccinations but for the benefit

fairs we're able to introduce this year. we included a e item for uhc health plans this year as we were going through that rollout as well for those two new plans. next slide. and then for open enrollment in general, it is a massive undertaking for each of us here at hss. personally, this is my seventh year, project managing open enrollment for hss. it has been different every year, which actually is rather exciting. dare i say, i like the challenge. and so as a project manager, i like to keep the ten thousand foot level of what's going on for open enrollment but i don't take any problem with having to get into the weeds and see what's really going down in the details. and as you probably see, i'm a visual person, so what you're seeing are snapshots of the schedule and project plan that are put out and each group

within hss is assigned a specific color in the project plan, so they can look at their tests specifically and also see, you know, what task may be being done with other folks within their various groups and then building on what is learned from the open enrollment team, tasks were removed and added all the time year over year to make sure everybody understands what needs to be done. and then we not only work in internally within hss but we have external dependencies on the controllers office and dcd and it's a juggling act. for me personally, the open enrollment project never really ends. the open enrollment for the next benefit year, so for right now, for planned year 2024 has already begun. i started working on that last month. so, it is an ongoing process. and it's never

quiet but always interesting. and with that, i'm going to turn it over to communications and the communications director jessica shih. >> thank you so much, bryan. my name is jessica shih, communications director for the san francisco health service system. and so, many of you may know that our members still struggle to understand the differences between our health benefits and plans, so to address some of these, to address their needs, we have five objectives to meet their goal and use a multimodal strategy with a mix of print, online tools. our first objective is always educate members about the benefits. we also want to reduce any unnecessary calls to member services to free up for them to deliver deeper and better

service and decrease paper applications and increase e-benefits. we want to pre-emptily address the concerns over the split family change from a blue shield to united care epo plan and finally, we also wanted to continue to increase our awareness of our newest hmo plan, health net canopy care plan much. on the right side, we're trying to shepherd the members to meet their elections on this journey and path. next slide. i hope our commissioners who are retirees or active employees, they were able to receive their packets this year. we sent out almost of the 6,000 packets, about 1,000 -- no, oh, yes. about 1,000 -- oh no, a couple less than last

year. sorry. where are my glasses? each year we make sure that the packets are sort of -- you'll see it has an eye catching envelope. we want our members to open it and review their benefits and this is where we also provide additional information if they want to attend our webinars and how to get that information online. thank you. one of our tactics is to send out weekly open enrollment e-mails. this year we distributed one every week starting the week prior to open enrollment, so that's about six weekly e-mails. every week we had a call to action and because we know our members are in different points on their journey in path to making their benefit elections, so we always promote our health plan partners office hours, our vendor micro site, webinars, and our of course, our own open enrollment page and you'll see the image of

one of our e-mails, it's sort of a heat map and the bigger the circle means that that's where our members have been clicking on and that happens to be our dead changed open enrollment web page and the chart below shows you the spikes on that web page, which coincide with when we send out and distribute those e-mails. >> can you help me with a clarification. what is a bounce rate? [laughter] >> you know, we had to look that up ourselves. thank you for asking. bounce rate is when a member comes to the page and then leaves from that page. >> so, they don't stay or search, they just check it and might have done it inadvertently. >> if they came to open enrollment and said i want to schedule an appointment, they

have left our site and gone to the vendor site. >> thank you. >> thank you for asking. i have to keep that definition on my notes. one of our objectives was increased e-benefits utilization. we updated our e-benefits page with last year. we actually had weekly, dedicated webinars to explain how to navigate benefits of the last year was the first year where every group and employee and retirees had access to e-benefits so it's exciting. this year we took that webinar that we've created and posted that onto our web page and we saw a 69% increase of that page from last year. thank you. this year we did things slightly differently. so you recall, we always want to reduce the

unnecessary calls to member services because sometimes members need more detailed information. maybe they want planned specific information, so all of our health plan vendors were gracious to offer us one-on-one consultations and office hours for our members and you'll see on this chart just how many office hours were completed for each of our health plans and we had 7 vendor hosted webinars -- 17 vendor hosted webinars. last year we combined the webinars and combined vendors. this year we decided that each vendor will have the opportunity and the time to go more in-depth with their benefits. thank you. and of course, one of our objectives was to educate members about the split family transition from blue shield, hmo plans to united healthcare epo plans and to do that, we actually wanted to make sure, to not overwhelm our short staff member services, we mailed outpost cards three weeks in

advance of open enrollment to inform members about this change, to inform impacted members. we followed that up about a week and a half later with e-mail to remind them and at that point, we also had access to our united health care micro site that had more information because what we learned from the prior year when we introduced the new ppo plan was our members wanted to know if their doctor was in network. so with that access to the micro site, they could do the doctor search. and finally, united healthcare made sure to reach out to all members via telephone to follow up and see if they had questions. of course, one of our final objectives was to continue to create awareness for health care canopy net plan and in order to accomplish this, we also developed, actually health net developed a postcard that we

distributed to approximately 5,000 of our early retirees to make sure they knew. we thought this would be important because this year health net hmo plan was competitively priced and we thought our early retirees would especially appreciate that. we also had leading up to open enrollment, we had health net stories and featured in our newsletters and open enrollment e-mails. we about had four dedicated canopy care webinars so members would have the opportunity at various times to be able learn about those benefits and what makes them different and we also invited health net canopy care team to three additional flu clinics to gain more exposure to our membership. i would like to introduce you to be rin, our director of enterprise systems and analytics. >> commissioners, good afternoon. it's a pleasure to

see you. rin, director of enterprise systems and analytics and talking about the esa team. we do the foundational work to ensure all of our key information technology systems and data is ready to go to support that successful open enrollment. you know we wanted to eliminate the complexity from the split carrier, enrollment. those are the split care families but we have them on multiple carriers so you approved the new epo plans to help us with more seamless benefited administration but that doesn't mean everything is easy. implementing new plans actually takes a lot of effort and so, to introduce those two plans, we had to in the system, consider four new benefit plans and associated those with all of our benefit programs. i think some are between 30 and 40 of those. also we had to modify or

create a number of interface files and there's the hip file that's go to the carrier. we have deduction files and alike with the other employers, and the pension systems, payment files get impacted. we want to make sure the money is moving appropriately. and to do that also, we needed new deduction codes and then we absolutely wanted to make sure this was a seamless experience for our members, so to do that, we preenrolled the split family members into the plan and what they align to and sounds easy but it's not. [laughter] we have to dig around in the system and figure out which dependent goes where and write the scripts for that. and then, there's also the part where we had to eliminate the plans in our system. not the plans -- we still have access and plus trio

but make sure no one could still enroll in that fixed carrier. so we had to undo all the other things so that was net new work on the administration side and you take that and there's the usual activities that we have to do, modifying all benefits admin components to roll into the new planned year, so some of those types of things are adding in all the rates for your medical, your dental, your life, ltd, flex credits and cobra, updating your fss amounts and the zip code tables are very important to the service areas and the geographical rules that happens in the system and updating text descriptions of those plans, the correct url web links for people linking on items and then we still, in addition to all of the changes that you all approved, we had mou changes that went into effect january 1st so we

had to make sure those were configured so that kept us busy but people -- next slide. it's not our only key system. we have a number of other key systems. we have our enterprise contact management system where we call our ecm and i think you know that's really like our digital member files but we do a lot of routing and workflow activities based on incoming documents and so, we needed to update various routing rules and that picture on the top right, that's a look at that work flee chart where we go and do the configuration to give you an idea of the complexity there. also, we have a daily process, so now that we e-benefits and members can upload their supporting documentation, we run a batch job to get that to our systems to supported documentation can end up in their digital file folder. we are monitoring that every single day, making sure

with increased volume that there weren't issues and you may or may not have heard that, i think around the 20th of october, there was a few hours system outage and so, we were impacted by that but nothing too dramatic. we actually learned a few thing from it which was nice. it did mean that we were making sure nothing got missed so we went through and just -- [laughter] reuploaded every document for the month because rather safe than sorry so there's a lot of monitoring activities that happened. our website is critical to us, so we we're assisting with -- we're assisting with website update and last minute technology issues and rate calculations that are rates -- usually the simple rates that get presented to you by our aon team but we have to take that and split out the allocations and different components of what gets paid whereby benefit plans so it's probably something like 40 data

points and 4,000 of these detailed rates and it's a heavy lift to get all those done. sales force is another system we use. we use that for our case management when our members contact us so we can ensure we're tracking issues and following up and escalating as necessary so we worked on some additional modifications in that system to match some of the workload request coming out of our member services area so they can manage that incoming work. there's a number of work streams we have around member benefits. they can do passwords for retirees. we were staying up on that and taking care of our retirees and you heard about our vacancy rates so it was an on hands-on deck month. we a sieved with virtual consultations with our members and helping them navigate e-benefits and e-benefits itself although it's

a layer on top of people's soft, it's its own separate system. we had to have a whole test and cycling and modifications because of epo plans. i want to give a shout-out to partner departments, we worked closely with the systems division at the controllers office with the changes we have to do. likewise, they have an employee portal support help desk there, so during the month of october, some of our members aren't able to log into the system or unclear on what to do, most of those calls come into fhs but the callers at the employee desk -- they are seeing increased call volumes at this time to help us so we thank them for their partnership in helping our members. and finally, it's also a huge data stream. you heard from jessica just a moment ago about all that target

communication we had to consider our objectives so we have to make sure we're providing the right data and the right layout to support all those targeted communications and so, there's just a look in the bullet points, some of the groups we were trying to target messaging to the non-medicare retirees. of course, the split medicare group and nonusa residents and we look at our data and provided test cases to our print vendor so we make sure all of that is looking correct before it drops into the mail. months ahead of time, we're modifying the main data program we use to extract data for the oe letters and we also are sending our print vendor the national change of address files. members do not always update their address with fhs. this is my plea to members to do so, however, we want to make sure that that communication is

getting to the member so we take on that additional effort. we get these files back that shows anybody who has filed a change of address with the post office and we're doing the work to get that updated prior to pulling the data that goes for the letters. we created data files for 22 eo letters and -- that requires a lot of data manipulation and the screenshot on bottom left, after we pull the data out of the system, we run it through a data base and running -- 40 is my magic number but we run 40 different inquiries to manipulate it and add elements needed and get in the right layout for where it's going and who it needs to get to. that's just a view of the tremendous work that happens in esa and i thank my team for their excellent work and at this point, i would like to turn it back to rey guillen.

>> again, rey, chief operations officer. since our member - he's taking well-deserved off, i'll step in for her and reviewing the efforts of our members services team for carrie. this slide summarizes the activities taken by fhs members so we had 2,972 members change their medicare plan, 109,303 -- 600 to their medical plan. 554 dropped dependents. every year the irs requires members to reenroll in flexible spending accounts, both medical and dependent care. during open enrollment, 7,368 members enrolled in the fsa for

2023 and 1503 members enrolled into the dependent care fsa. as i mentioned earlier, 7,381 calls came into our member services call center. this is a 22% reduction in the number from last year. this reduction was partly due to fact that we didn't have major plan changes that impacted a large portion of our members outside of the medical split family transition but due to efforts of our communications team to proactively educate our members and reduce their need to call us. next slide. with this slide, we are introducing a new member services dashboard which we plan to utilize going forward to report metrics related to member interaction with our call center in which we plan to build on in the future to include metrics related to optimizing efficiencies within member services that were included as part of the new three-year strategic plan and customer services satisfaction. related

to the month of october 2022, member services handled over 7,000 callers. the average amount of time a member waited in the call queue before a live member services staff answered was approximately 8.-- 8.5 minutes. this is higher than we would like, considering that we had, on average, 7 of our 23 member service positions vacant during that period, and also normal member staff absences, i consider this an accomplishment of the remaining staff. staff conducted 348 virtual consultations or appointments that pulled further, further pulled them off the phones during those appointment times. although we weren't open to regular in-person appointments, we did help and assist any member that showed up at our door so they were not turned away. someone went out and made sure we provided assistance to

them on a one-on-one basis. >> can you pause on the call metrics? >> yeah. >> do you have some sort of benchmark that you're going to use going forward. you have introduced the metric. are you comparing it to our work, call center, call data, any type of benchmark? >> yeah. going far, we're going to compare the call, the top call reasons as they come in as to what we were expecting. as we go forward, we're going to further train staff on how to specifically outline the reasons for the call. right now, those calls drivers are very broad in categories and so you'll see the vast majority of calls that came in during the month of october were just listed as open enrollment inquiries. some of those calls, the next greatest group of calls that came in was

eligibility. some were listed as a retiree call and some would overlap with one another. as we go forward, we look to further -- to further differentiate what the call reasons were, that way we can do the comparisons you're talking about. right now, it's pretty broad and we're not able to gather a whole lot of data from the information that we have. a further example, you'll see down below, we have calls related that mentions uhc but we're not clear as to whether those call were related to just the uhc plans in general or some call were related to the split family transition, but staff did not have a way to identify which were which and so those were things that we would hope to capture further in the years to come. >> and with the call metrics of wait times, are you using some sort of external benchmark around that? >> so, what i will say, the call

wait time is a lot higher than we would like. there is, again, there is no industry standard in terms of an employee call center for employee benefit issues, but we do look and compare ourselves to target that some of our carrier partners are able to achieve. for this year, we're off the mark from the call centers of blue shield or uhc, which often tiles -- often times measured in seconds instead of minutes. we have a way to go especially in situations where we're down staff. but we do really want to work towards significantly reducing that call time. >> well, i would ask you to do some research on that regarding external benchmarks for a customer service center. and whether it's healthcare or other

industries because i think that i have seen in other settings those types of benchmarks and we may want to, over time, say this is where we are. we're not going to get down to seconds immediately but we want to reduce the number of minutes and i recognize that's going to be staff related as well. so, just an observation. >> thank you. we'll look into that. next slide. as you can see here, the number of calls and transactions increased and the open enrollment e-mail that our communications team sent out. also, calls and transactions spiked at the end of the open enrollment period drew closer. we're looking at this data to see if there's possible ways to make changes in the way we schedule open enrollment that might better help the calls

evenly during the open enrollment. >> you would have to intervene on human behavior. everyone waits to the last minute. >> yeah. again, we want to get creative here. again, there is no -- it's not dictated how long an open enrollment needs to be. we have open enrollment during the month of october. we're looking at, would it make sense to have shorter open enrollment period but break it up by segments so maybe we do a two-week open -- open enrollment for retirees and we can spread that call volume a shorter period of time so even those out. we're look to look at these metrics to see if there's a better way to handle it because there's no good to have a very long open enrollment period if everyone is going to wait to the

last minute. next slide. this chart overlays a total number of calls received each day of october. over the average number of calls handled by each staff member in attendance that particular day, so on the (indiscernible) days, it's 17 calls per staff member on days like the 13th and up to 40 calls per staff member on october 31st. as mentioned, calls did spike towards the very end of open enrollment and again, as we've talked about, you know, staff appreciation and satisfaction with the job, we did want to celebrate staff's effort so on october 31st, halloween, during that lunch hour, we did have pizza party for staff that was contributed by executive director (indiscernible) and myself. we're trying to make sure that we maintain some staff positivity during even those

very busy days. next slide. next, i'm going to provide a summary of how well we a believed the key initiatives for this year's open enrollment. the first initiative that we wanted to review is the transition to on line enrollment via e-benefits. it's much more efficient and accurate. as you can see here, the vast majority of enrollments are submitted via e-benefits including those from retirees and of the 1,605 retirees who submit open enrollment changes this year, almost 75% of those retirees utilized e-benefits. if they preferred to submit via paper, we were happy to provide that paper form to them and provide instructions on how to do it. next slide. this is the transition from paper to e-benefits open enrollment over

time and you can see, this year of all the tran actions submitted, we only had 661 paper applications that we needed to process this year. the systems we currently have in place, we'll never get rid of paper applications completely because people thought to hold one transaction in the system at any one time. if someone came on during the month of october as a new employee, that new employee is going to hold that transaction so people would not able to log in and submit open enrollment change for the following year so unfortunately, those members would need to fill out the paper application and we'll process the transactions in order. so, there is still some need for paper applications but we do hope to reduce that significantly as we continue on. this graph shows the result of the split medicare family

transition. as rin mentioned earlier, this board approved staff's recommendation to transition non-care members a part of a split medicare family with at least one family member enrolled in our united healthcare medicare average ppo plan and one non-member to united healthcare plans including two new exclusive provider organization plans, uhc select network, epo and doctors ppo. the reason for this action is reduce the complexity of managing families split between two different providers. this chart displays the result of the transition. on this slide we not only displayed the hmo plan but the pp plan that our non-split families have access to. some of the existing split families enroll in this non-- in this ppo

plan rather than transitioning to the new epo plan. for the non-medicare family split members we started with 418 enrolled in the blue shield access plus plan. 266 enrolled in the blue shield trio plan and 212 enrolled in the uhc ppo. for 2023, 408 members moved to the uhc to select epo. 214 moved to the uhc doctor's plan and the uhc-ppo membership grew to 268 members. don't worry, you'll see there's 890 members for 2023 and 896 members currently, we didn't lose 6 members. two members did move to kaiser. two waived their medical coverage. one dropped their medicare dependent and one of those members aged into medicare, so they are no longer

a split family. we made sure we didn't lose anyone in the transition. the last slide shows the increase in the health net canopy care membership by both number of enrolled members and number of enrolled lives and so, our number of enrolled members grew by 84% and the number of enrolled lives increased by 97%. now, i'd like to introduce our well-being manager, carrie who will discuss the fluke links. >> good afternoon. carrie, well-being manager with hss. i'm excited we brought back health fair. it has been 2019, so two, three years ago and we were able to actually bring back ten. in 2019 we actually offered 11 so it's great to be able to bring them all back. the only location we weren't able to tackle this

year was rccfs which takes place at the scottish wright center. they didn't hold an in-person meeting this year so it was virtual. however, we were able to add two additional locations for health fairs this year, which were police and fire. so that was really exciting to expand our food clinics to add the health care and all of our health cares also had a food clinic tied in with it. so some of the things that i wanted to highlight, also prior to the pandemic, the airport offered two health fairs. they added one for late-night, so 10:00 p.m. to 12:00 p.m. generally to host for their field workers. we were able to bring that back and we had our staff there. it was great. they collectively between the two health fairs had between three and four hundred attendees so it was a huge success for that event. we generally try to look at where we see volume of ease of people coming to

locations whether it's for our members, all of our members or specifically high volume for our employees and that's for health fairs in general and then for flu clinics as well. one of the things that we did this year that i think was really helpful to guide our vendors is doing an actual webinar so the webinar prepped all vendors in advance on what to expect for the health fair because some had not attended. some attended back in 2019 or may have forgotten so that was successful to give them key responsibilities in what we would expect of them on the day of. one of the things i mentioned about police and fire being new is we were able to include our external mhn vendor that started last month and the cordico wellness app. it was great to add both of those locations. next slide. and in regard to our flu clinics, we

hosted 25 clinics out of a total of 24 locations and the department of emergency management, we host two and that's to serve the shifts. and the work they do there. we had a total of nine open clinics. open clinics are those where there's easier access for all of our members to get into the building and then we had 16 locations that were restricted generally for just those departments. we added one new location for animal care and control this year. i'm excited that we piloted two locations to offer covid boosters as well. we were a little late in the game knowing we have some time we have to plan in advance to offer clinics in general. we were able to offer one at our location and one also at the rec. and park county fair building. we actually estimated about 80 boosters. we ended up distributing 82. so, we were

excited. the rules around doing a covid clinic were very different than our flu clinic. they required an online registration, people had to bring their vaccination card to show proof. their medical card and the paperwork was slightly different. the other thing that was interesting, we had to have a minimum of ten people because each vile had ten vaccines. we had to order in ten and make sure we weren't wasting, so i was happy we were able to meet our numbers for the covid locations. and then overall, we, for our flu vaccines, we saw just over 2300 vaccinated which is about 8.5, a little over 8.5% increase from prior year. and to put it in perspective, i pulled some numbers looking at pre-covid. we probably averaged around 4500 vaccines so we're about 48% below that. but our

goal again is with the environment we continue to be in, the hybrid work environment, we're still learning as we go so we felt this year was a successful flu season and health fair as well. i'll open it up for questions. >> i'm glad to see that you were able to engage in some level of covid, booster shot. i raised that question earlier when you were planning and i'm glad to see that we were able to try and do that so my hope is we can expand it as we go forward and planning for next year. >> thank you. >> great work. >> i will turn it back to rey guillen. >> thank you, carrie. rey, chief operation officer. i'll go into our results of open enrollment period. this shows our medical enrollment migration for our active employees and i do have

to acknowledge there is one typographical error on this slide. this shows current members on each of the plans and the number of members that are enrolled in the plan beginning 2023 and the number that either increased or decreased. and so, the first blue bar for kaiser permanente, that second number in parenthesis should be an increase of 90 instead of equaling 90. so our kaiser increased by 90% and access member increased by 247. blue shield trio decreased by 201. blue shield ppo enrollment increased by $58 and health net canopy care -- increased by 121. we did gain 377 additional members. some of those were from

people that previously (indiscernible) but the majority were from people that joined the organization during the open enrollment month. the next slide shows a medical enrollment migration for retirees. we did see a drop in the number of enrolled in the blue shield ppo plan and we will take a look to see what caused that. but the majority of the other shifts in the enrollment in the retiree plan was related to the split family transition. next slide. we went through the same exercise for dental. it shows active employees and it was a stable population. again, increased mostly due to new hires during the month. next slide. for retirees, we did see an increase in retirees. this is mostly due to the number of new retirees and so in terms of staffing shortages throughout

the city, a large portion of it was related to retirements where we unfortunately have not been able to replace a lot of those retiring members and so, retirees did increase by 319 lives but no real shift in the dental enrollment. for vision, we did see some enrollment from the vsp basic plan to the vsp premiere plan. there was a significant enrollment shift from vsp basic to vsp premiere. and we did see a similar transition for retirees as well. again, from basic to premiere for people choosing to pay up for those more robust benefits. so that concludes my presentation. but i did want to conclude by expressing my deep

appreciation for our staff throughout and leading up to open enrollment despite our staffing shortage, our staff showed up energized everyday and ready to jump on the calls. there was some frustration with not being able to get to those calls quickly enough and so, staff were doing whatever they could to wrap up their current calls with, at the same time providing great customer service, but they did want to get to the members waiting on the line. everyone stepped in, even whether it was not their normal job and so, we had a lot of help from the different units within hss, even from our finance team, and the team members stepping in where they could to help us out in member eshen they were able to do so. deep appreciation for staff for hanging in there during this challenging open enrollment -- enrollment period.

i stand for questions. >> that's a comprehensive presentation from all members. i call on board members for questions, or comments or observations. >> i echo what president said. that was a very thorough presentation and a lot of work put into that. thank you all. >> anything else. dr. follansbee, and commissioner zvanski, i can't see you but call you on about the presentation. >> i found it very comprehensive and very informative. and i had reviewed it prior to the meeting to really take a look at how open enrollment has improved and also i'm more interested in the e-benefits and especially with regard to retirees because i think a lot of us are still at the paper stage, which is a little bit reflective of our generation. but i was impressed

with the numbers and i'm thinking if the staff has any conclusion or comment on the effectiveness of e-benefits with regard to retirees and their ability to transition and use more of the e-benefits program and less paper for the future? and that was the one area that struck me. also, the plan changes what i've been hearing actually from a number of people. it had to do with what commissioner breslin has brought up in the past and that was some of the dissatisfaction with delta so i was looking at the changes in dental plans and dental options and then also, while i see many have upgraded to the vsp premiere, i think as

mr. rosman pointed out and i received several calls about problems with vsp and i was kind of surprised because they've always had very good service, so i think we need to take a look at, make sure vsp and see if some of their benefits or their, i guess, as a coordination or collaboration that they can share with ophthalmologist that are in the other medical plans and not necessarily on the vsp panel. although, what i find is that most access to most ophthalmologist are very extensive through vsp. but again, the dental issue and the e-benefits, if there's any comments with regard to those. thank you. >> thank you for the feedback, commissioner. in terms of the

e-benefits, we do know that we do have a member, a portion of our retiree population that's not ready to transition to e-benefit but we try to train and provide educational information to the retirees that want to try the e-benefits so staff will walk the members through e-benefits step-by-step and resetting pass words where needed and we do try to include in our communications a step-by-step guide on how to walk through the e-benefits enrollment. again, we were pleasantly surprised, again, for our retirees, 73% of retirees did complete via e-benefits and it's a work in progress. we do show your goal, commissioner, of reducing paper. we want to be as environmentally friendly as we can. at the same time, we struggle with the limitations on the amount of paper we can cram in those envelopes, so we will

be taking a fresh look at our open enrollment materials for the open enrollment period for planned year 2024. we're going to ache a fresh look and start from scratch just to make sure we are as economical as we can, but provide the member education that's needed. we were hoping to do that this year but as a member mentioned earlier, we did have staffing challenges with our communications staff. it is a mighty staff of three normally, so we have a communications director, graphic artists and then a communications specialist. unfortunately, right as we were gearing up for open enrollment, our communications specialist did need to go on a leave of an -- absence and later retired so our team was down to two. it was, in year's past, the primarily workload of that communications specialist to develop the open enrollment materials, so as we went through, our communications

director and our graphic artist and other staff throughout the organization chipped in to relearn how to actually do a lot of the task related to creating the letters, conversing with our supplier in terms of our printer and so we had to learn a lot of this from scratch. we now know that we need to make sure that everyone is cross-trained going forward so we won't have these challenges in the future but we believe next year, we'll have be able to thoroughly review the communications and provide the information that retirees need in order to transition to e-benefits. >> thank you. >> thank you. one other last thing if i may, i forgot when you mentioned the possibility of having shorter open enrollments like two weeks for active and two weeks for retirees, the point i think i want to make here is, that's going to be more difficult, i think, for our

retiree population. and that's mostly because of the, first of all, getting the information distributed but we have had in our mind for so many years, october, open enrollment the whole month and i think that would be very challenging so, think about that and we may have to have some discussions and maybe even doing some, what would you call it, some testing or some questionnaire. something we can send out to the retirees to say if we did this, would you participate and would you find this more helpful? for example, a two-week time period where it would be split and that was the other concern that i had, but we have a year to work on it. >> thank you, commissioner. >> keep that in mind. thank you. >> yes, thank you, commissioner.

one thing, the feedback is appreciated. again, i just mentioned that it's a possibilities, it's certainly not something we decided yet. in terms of our pressure look at our communications material, it's our plan to reach out to our groups, both retired and active and ask them what went well with the communications and enrollment and what we can improve on. we haven't decided on the exact format and whether it will be a paper or electronic survey or focus groups but we're committed to make sure that we do learn from our members on what we're doing right, what can be changed and we'll incorporate that into the plans for next year. >> thank you. commissioner follansbee, do you have any comments? >> yes. a couple of comments. one, as a commissioner, therefore considered an employee of the city, i received the whole packet. i want to compliment you and your staff on the clarity of the packet. in

bold letters, if you want to make the changes, you don't have to do anything which was great and the color coding based on categorization was great. i went through the packet just to see how easy it was to navigate the paper and i really appreciate the clarity that has continued to evolve and improvement i also have witnessed now in my seven years on the board, this transition to e-benefits which i find really remarkable. i know we always want to reach 100 percent and know what the barriers are, but it has been a really wonderful process to see it evolve. i do think that a lot, sometimes very explicit instructions from vsp providers, you know, that can provide you a member, you know, your prescription in e-mail and with an e-mail, one can actually send

or forward the content of the prescription to your are ophthalmologist. a lot of members get confused over the legal practice restrictions between optimist and ophthalmologist. members should have access to all ophthalmologist. this is an important piece of information in terms of what the prescriptions really are. there's probably some fairly easy steps that every member who has e-mail could utilize if vsp would step up to the plate and offer to provide those prescriptions in e-mails, for example, without more complex, having to scan into one's own computer. again, these are all steps that can be taken and made and would seem fairly simple and help further the goal, which we all would like to see as a unified medical record across health plans and across

providers so again, i compliment you in your work. and all your staff who are working double and sometimes triple hard to accomplish this, thank you. >> thank you, commissioner. are there any other comments? hearing none, we'll now take public comment on this item. >> thank you, president scott. in person public comment will be first and virtual public comment. for anyone waiting in person, you're welcome to approach the podium now. each speaker will be allowed three minutes. all public comment to be made concerning the agenda item presented. a caller may ask questions of the policy body but there's no obligation to engage with the caller. for the caller s the line, welcome. state your name clearly although you may remain anonymous. i'll give you a warning when you have 30 seconds remaining. remote viewing is available on sfgovtv

and using webex. opportunities to speak are available by dialing the number on the screen, 415-655-0001. and prompted, use access code 24956355266. then press pound and pound again. you'll enter the meeting as an attendee on the public comment line and dial star three to be added to queue. when system says your line has been unmuted, this is your opportunity to speak. those on hold, wait until you have been unmuted. we'll begin with in-person comment. no one has approached the podium. we'll move on to our virtual public comment. our moderator will notify us of public commenters in the queue at this time. >> board secretary, we have zero callers on the phone line and zero callers have entered the public comment queue at this time. a reminder to all callers

on the line, you must select star three now. if you want to join public comment for this specific agenda item and we'll wait five more seconds and close public comment for this agenda item. board secretary, there are no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is closed. >> thank you. the mind can comprehend only what the end can endure and we're going to take a recess of ten minutes. ten minutes. we stand in recess. [gavel] [recess]

>> thank you. >> thank you, president scott. >> present. >> commissioner breslin? >> present. >> commissioner canning? >> present. >> commissioner follansbee >> >> present. >> and commissioner zvanski? >> present. >> thank you, commissioners for being prompted and those in the

meeting room for -- for cooperating as well. item no. ten. >> thank you, president scott. agenda item no. 10, notice of intent for sfhss to release actuarial services and consulting services request for proposal (rfp) for services in january 2023 for -- this is a discussion item and introduced by director director abbie and michael, contract manager. >> director abbie. director a -- director of assistance service health center. this is where i started almost five year ago, so i'm having a flashback but capable, michael will explain how we're proceeding with the rfp for actuary. the contract is

expiring the end of june. we're ahead of the game and michael will explain. >> contractor administrator manager, michael. >> who is the colleague sitting with us? >> to my left here is, my right hand man whether it comes to contract, patrick chang had experience from our department of public health. >> thank you. >> thank you, president scott and thank you commissioners, breslin and thank you director canning and on the phone, commissioner follansbee and zvanski. so, as we presented to all of you in september, we are doing our actuary services, rfp and releasing this in january. >> step a little closer to the microphone. >> sure thing. >> thank you, president scott. we'll be releasing this in january of this year. i will go

through a brief introduction of the process that we covered back in september and any slight changes we have made in the intervening months and go into the brief recap of the process. we keep a very tight ship here at sfhs and we have strict policies as to procurement and we'll be to this with our procurement like others. as mentioned back in september, this is in relation to health service board terms of reference and selection of vendors and that's why we present this to you. it's not in the best interest of this board to oversee every single procurement for particularly important and key lines ever business such as that for an actuary. we want to present to the board, the contract for approval. we will also be after this presentation incurring a blackout notice like with note notices and rates to

make sure there what no am prop communications. the scope of services is going to be very similar to what we're using our actuary for and we have learned a lot in the last two years and what additional services we can leverage through actuaries and health benefit consultants. we want to evaluate all providers of those services for a contract that will begin in july of 2023. so, from the actuary services standpoint and this is a recap of september, again, considerable work with us on the annual rates and premium contributions process, our ten county survey and supporting sfhss and the work we do there especially with a member of our cfo, and (indiscernible) team. they are valuable members of our team when negotiating renewal

plans and the process is starting right now. we want to extend this to the work they do to support us when it comes to audits. one thing we have done is advance our agreement with our can't actuary to really expand upon detail the audit schedule presented and approved by this board and account for ad hoc auditing and one of those which will be covered in our expanded scope as part of our rsp is to allow performance guarantees and in the next item presented to this board, we'll go into great detail about expanding reporting and performance metrics that's a part of our health service planned agreements and making sure we have a backstop to all of that and the ability to truly dive into them at the end of a given planned year and audit those results is going to be a critical part to making sure we stay compliant and continue to advance the best possible care

for our members. in addition, we go through the extensive work we do with our trust funds and reserves. the annual financial statements, support for external audits. there was of course, both ad hoc and scheduled reporting and extensive research. now, two additional areas that we wanted to carveout that were typically included in our contracts but we did not include in our presentation in september and i wanted to very much highlight here today is the extensive role our actuary and consultant plays whether it comes to our -- when it comes to our health care and trust and consultants and compliance. we want to leverage our partnership with our actuary to improve upon our voluntary benefits administration, our ab528 administration when it comes to community college and school districts and health care and department care flexible

accounting. as we have discussed last time was benefits discrimination testing but we wanted to highlight that because compliance is at the forefront of what we do in our contracts department and what hss does as a whole. to recap briefly, our schedule, there are no changes here from what i have presented in september but as a brief recap, we we'll begin our blackout notice within the next agenda item and the rfp released in january and proposals due in march. we'll have our evaluation panel, evaluate the proposals received between march and april and that evaluation panel is comprised of individuals inside ffhss inside and outside the city to give us the widest range of subject matter experts to weigh in on this important contract and have the best possible provider of the services to sfh, s and this

board and members and we'll culminate with interviews like in our last process. we do that to receive the highest care -- and with us, as sfhss. we'll present in may of 2023 on the results and that will be for your review and approval. that will give sufficient time to start a new agreement, if a new vendor is selected my july 1, 2023. we do that by making sure a key component of our rfp is include the very clear, comprehensive city terms and conditions that we will review and approve in advance with city attorney's office and include

and a part of that rsp that the attorneys and in-house attorneys review and respond back with terms and conditions they have issues with prior to the start of the rsp process. that allows us to have this more abbreviated timeline to ensure we're not going to have those issues during the contracts and negotiation phase. again, as i spoke to earlier, we keep a tight ship when it comes to contract and processes. we ensure that members of our team complete a detail evaluation whether they have conflicts. they understand the strict con any deniality. they have to provide the highest -- for san francisco health service system and this board and members --

owe i'll open it up to questions since my september presentation. >> i'm pleased to see the slight expansion of the services a few slides back. we know those things were going on as a sidebar and the fact that you have now included them in the scope of service, i think it's great. so, are there other comments or observations from board members? hearing none. we'll now open this up for public comment. >> thank you, president scott. in person public comment will be first and virtual public comment. anyone waiting in person, you can approach the podium now. each speaker will be allowed three minutes to comment. all public comment is to be made concerning the agenda item presented. a caller may ask questions of the policy body but there's no obligation to engage with the caller. those callers on the line, welcome on the

call. statement your name clearly although you may remain anonymous. i'll give a warning when you have 30 seconds left. remote viewing is available on sfgovtv and online using webex. opportunities to speak during the public comment period -- it's available on the screen. 415-655-0001. use access code 24956355266. then press pound and pound again. you'll enter the meeting as an attendee and press star three to be added to the comment queue. when the system says your line has been unmuted, this is your time to speak. those on hold, wait until the system indicates you have been unmuted. we'll begin with in-person public comment. no one has approached the podium. moving to virtual public comment. our moderator will notify us of any callers in the

queue now. >> bore secretary, we have -- board secretary, we have zero callers on the phone line and zero callers in the queue. a reminder to all callers on the line, you must dial star three now if you want to join public comment for this specific agenda item. we'll wait five more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue. >> thank you, moderator. public comment is closed. have thank you. thank you, michael, for your leadership and those members of your team who are here today to work on this process on our behalf. we look forward to the end result in may. >> thank you. >> we'll take, move to item no. 11. >> agenda item no. 11 is the notice the blackout periods. this is an action item and presented by abbie, executive

director of sfhss. >> director yant. >> executive director of san francisco health service systems. holly, do you have the memo to -- >> to present. >> -- to present. >> yes. we'll display the notice of the blackout period. so while we're calling it up, this is a dual notice. it is notice for the actuary rfp you heard from michael and that blackout notice period begins in january, right, michael? and will continue until the con track is approved by -- until the contract is approved by this board, we anticipate the later of june. we are entering the rates and benefits cycle. we're about to drop our renewal letters to all

of our health plans as early as tomorrow if not monday. and so, the rates and benefits cycle has begun so this board is on notice as well as all health plans, et cetera, that they are restricted communications -- their restricted communications is in effect. there, it is. blackout period for actuary services and health benefit will begin on january 8th and conclude after the board's final approval in june as stated and the blackout period for annual rates and benefits for the '24 will -- after the board's final approval of the healthcare plan of 2023. this is an action item, i believe, for the board. >> thank you. are there any questions from the board? hearing none, i'm willing to

entertain a motion. >> mr. president, i morph we accept the notice of two blackout periods as presented. >> second. >> properly moved and seconded that we accept the notice and approve the notice of blackout per as indicated in the communication. any further discussion? hearing none, we'll take public comment. >> thank you, president scott. in-person public comment will be first and virtual public comment. for anyone waiting in person, you're welcome to approach the podium now. each speaker will be allowed three minutes to comment in length unless the board president deems public time limits. comments are to be made for the agenda item presented. you may ask questions but there's no obligation to engage with the caller. i want to welcome the callers and state your name clearly although you may remain anonymous. i'll give you a 30-second warning and you'll be placed back on mute.

remote viewing is available on sfgovtv and webex. you can dial the number on the screen for public comment. 415-655-0001. when prompted, use the access code 24956355266. then press pound and pound again. you'll enter the meeting as an attendee and press star three to be added to the public comment queue. when the system says your line has been unmuted, this is your time to speak. those on hold, wait until the system indicates you have been unmuted. we'll begin with any in-person public comment. no one approached the podium. we'll move to virtual public comment. our -- our moderator will notify of us caller in the queue at this time. >> board secretary, no callers on the phone line and zero callers entered the public comment queue at this time.

reminder to call callers, dial star nine if you want to join public comment. we'll wait five more seconds and close this item 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. we're ready to vote by roll call on this item. >> roll call vote, starting with president scott? >> aye. >> commissioner breslin? >> aye. >> commissioner canning? >> aye. >> commissioner follansbee? >> aye. >> and commissioner zvanski? >> aye. >> notice for blackout periods resolution or letter passes unanimously. [gavel] we're ready for item 12. >> item agenda item 12 is the sfhss data. what we measure, standards and express dashboard. this is a discussion item and will be presented by rin,

director of enterprise systems and and analytics and michael. >> good afternoon, commissioners. i decided to move, no. abbie, i did want to introduce this matter because there's a story to it so just to highlight the outline, thank you, i'm going to talk about the story about how we got here today and turn it to the team to talk about population health and measure and plan itself and timeline and process as well as how this aligns with our strategic plan that you have recently approved and what the next steps are. in addition, rin will give us an update of the quarter two expressed dashboard she pulls out of the all payers claims database. so, to talk a

little bit about our story, i'm trying to see if these are your notes and not mine, so i'm trying to find the slide. but our story began a couple of years ago when which started talking about the rfp for the medical plans and we have a new term i hate today, we have developed a, the time i've been in the agency in addition to the acpd, we have what is called a data lake where we all have, we have so much data right now that it's hard to determine where to start and what's the most valuable and all of that. when we did the rfp, we put in there that we were looking for forward-thinking on how we would, as a system, look at our data and prioritize it and take action and so we began those conversations with the health

plan several years ago in that we would come to an agreement on what data we were talking about, we would take time to establish a baseline for everybody to get on the same page and what is our baseline and then we would begin to set targets and benchmarks and measures to measure our improvements in this area, so a standard process on data, but kind of not industry wide standard in the healthcare industry. to fast forward through all of this, you know, we -- we've had this discussions, the plans have been great, these are not easy conversations to have. they involve lots of different parts of these very complex organizations and we bring it together, in the meantime, many of our like organizations, business groups on health and integrated health care

organization, department of managed health care and low and behold, cms, medicare and medicaid, everybody is having the same conversation. we were an a little clear (indiscernible) in recognizing that. in many ways, this makes it easier for us to work toward a shared vision and goal and have some alignment but it doesn't mean it's less work on our team's part to try and pull this together and get all of that data for us to work on. so i'm going to sort of stop at that point because i think and as i've mentioned earlier, the other thing that has happened that has made us all, you know, responsible for the health of our population is this whole discussion around health disparities. and how that has become mainstream, frontline conversation. we went so far to

say it was equity first in our strategic plan and and that's cutting edge and a big challenge to all of us that work in health care is to identify weak points in the system that do impact negatively certain populations so it couldn't be done any other way, i mean, it has to be alignment. there has to be full force of orgss going far. as big as we are, we're not the majority of any health plan or provider and you can't expect the providers and the hospital systems to customize their work for us and we wouldn't want that. you don't want to go into your doctor and get a different treatment because you're on health plan verses a verses health plan b, verses healthcare c. you want the same health care no matter what so that's what we're working towards with

developing a common set of measures that we can determine, a, where we are today and, b, how to get to a better future, so i'm going to turn it over to patrick, is it you next? oh, michael. okay. here we go. >> thank you, again, director. michael, contracts manager. as director yant, we're looking at how we got here. we're going to define the key terms and some introduced as far as our presentation december of 2010 when we introduced social determinants of health and the great work by my colleague, letitia harris as well as

presented to you last year by derrick soy of our analytics team in november. we'll do a recap and we'll look at it from a 30,000 foot view. as director yant mentioned, there are many different parts working in close concert now as we've talked about historically, they were not always working this close coordination on these things. we go back historically with this data and looking at electronic medical records and analyzing databased on claims and looking at the health of individuals. we're looking at population health. population health refers to the health status and health outcomes within a group of people rather than considering the health of one person at a time. i think it's very appropriate that we can discuss this in the time that we are because i believe the covid-19 pandemic brought to the forefront what this is like. with the example of covid-19, while everyone in the entire

globe was affected by this, we saw the specific populations, those of increased age, those with preexisting medical conditions, experienced the pandemic in different ways. some of them far more detrimental effects. what we're trying to do with this level the data is delve into those details and populations because if you're looking at a group and you look at them as a whole and they look great on a metric and hitting whatever the national standard is, but you look to a subgroup and they are experiencing detrimental affects. that could be many different things but if we don't look at that level of detail and dig into that data which would be impossible without my colleagues who you'll hear from shortly, rin who is our director of enterprise and analytics. we wouldn't have this process we're looking forward to in the next three to four years.

so, as a brief re-- recap on how we got here. the presentation on health. this is the environment which we're born and work and age, generally in which we live that affect a wide range of health, our internal functioning and the quality-of-life that we experience, both the outcomes and the risks and when we look at these social determents of health and this why we introduced this back in december was we look at the whole person, health and well-being. this includes health disparities, this includes anything that would inform our strategic plan when we look into the effects that it may have on our delivery of care to individuals and looks at the outcomes that they may be experiencing. now looking at our measurement planned process and we'll go into this briefly before we look at a high level

view of how this works together with our strategic plan, how this works with the rfp we spoke to earlier and how this will work with our alignment with these organizations, that director yant spoke to including the business group on health and the business group on health and the integrated healthcare association and the department of health care and cms. the first staining in this process is we standardize and enhance the collection of patient data across all plans and all of our populations. this is included by race, ethnicity, across narrow age bands and gender and we want to be able to grind down into the details of specific populations that may be experiencing hidden equities and disparitys and outcomes which are barriers to their care. without that data -- we will not have that level of insight. the next step is we take that insight and we look to the

health trends for those specific populations. from there, our goal is to of course, improve the quality of care for our members. already. so this is my 30,000 foot view slide which i couldn't have done without the support of the patrick chan who is the analyst to my left. take a look at the different moving parts that need to be done in close collaboration and the number of different individuals at sfhss and health care plan offices that allow us to dress that. you'll see our health plan rfp which our director yant spoke to moments ago, informed how we will address this improvement in the level of data we're getting from our health plans. we saw that our 2020 to 2022 strategic plan strongly

influenced our focus on increasing the level of data. we have taken this a step further to both inform and look to further our 2023 to 2025 strategic plan. from a contract standpoint, this started back in 2020 with us improving performance guarantees, with us aligning them across our different plans and with us bundling them to increase the effect that we would have on our planned partners to meet those requirements and we have established these core metrics, we're going to align those and work on the same path as the national and regional entities that includes of course ppgh, inter granted healthcare association or hia ask subgroups of those, for example, we're a member of the pilot program for the advanced primary care initiative for ppgh. over the

next three years, sfhss will detail our health data and partnerships to advance our strategic plan. as we presented in september and november of this year, the key aspects of that strategic plan and the fundamental goals are to foster equity, include intentional organizational culture, accessibility, inclusion and belonging, to advance primarily care practice and member engagement, to provide affordable and sustainable health care. to support the mental health and well-being of our membership. and as we discussed earlier today with our in depth view of level of service we provide to our members, particularly during open enrollment to optimize the service for every one of our members that we can provide. what we have done with this slide and look at a way to best encapsulate how the measurements

that support individual goals within our strategic plan. you will notice that every one of them affects health equity. you'll notice certain ones effect primary care and others affordable and mental health. some address multiple ones and this is important to consider because again with all of this, this data that we're collecting here, we cannot look at these in a silo. we have to look at each one as they can affect our tells in different ways. as we further our data process and collection and analysis in partnership with our health plans and in collaboration with these organizational groups such as ih -- we can improve the care that our members will receive. so over the next year beginning with the annual renewal process which has begun for 2024, sfhss

will incorporate these into targets and performance garren teases. this process will align with the timelines that are already in place and support the ppgh and california clabtive and iha or amp and the pbgh initiative pilot. so, going forward, we will leverage the successes that we have already had with our health plans. we will take this data with our analyst division and partners to set baselines and improvement targets. and in 2023 and 2024, using the benchmarks and improvement partners, sfhss can analyze data and identify the disparities or health care or outcomes or barriers to carry

spoke to earlier. i believe through this active and sustained coordination between sfhss and our health care partners and alignment with key national and regional partners, we can develop insights into the health, trends of our population as a whole and under served segments of our population so we can improve the quality of care received by all of our members: i'll pass off the mic to our director rin, director of enterprise systems and analytics for the expressed dash bore, thank you. >> hello again, commissioners, rin, director of enterprise system and analytics and thank you patrick for being my left-hand person today. >> director coleridge, before you begins, the clock stopped on

the wall as we've noted earlier today. we have about 30 to 40 minutes and we know that we also want to go into the poor education portion so depending upon how many you're presenting -- we can carry it to the next meeting, we can do that. i just give you those options as we proceed. >> thank you very much, president scott. i feel confident i can move quickly through this. >> okay. [laughter] >> i cannot control the questions or comments that we may have to provide time for. none of less, i'm presenting to you the sfhss expressed dashboard for the queue 3, 2022 so this covers the period offen occurred claims through june 2022 and paid through september. we allow for that run out to you don't allow claims

when comparing your previous period to your current period. and you know, we've been talking to you about our measurement plan and our strategic plan goals and objectives. our all payer claims database is one of our complementary tools we have to use towards those goals. it allows us to do that additional measurement and monitoring of the health of our population, so whether we're looking at those chronic conditions or the preventions and screenings and wellness indicators as well as quality indicators and very important, the mental health of our populations, so this compliments the healthcare but it allows us to do further drill down and analysis. this is a summary dashboard but we have access to a lot more data so michael mentioned that and next slide, please, patrick. i won't read all these expressed dashboard notes to have you. you

have reference and you know what they say but i'll callout important things. one is that we do not yet have the data for health net canopy care. we've been working closely with our health net partners and things are moving and we're working close to get that in place. a reminder, we do not get the financials for the medicare population and lastly, i just wanted to callout the time period of this dashboard crosses to planned year and you recall we moved our administration from the ppo from united healthcare to blue shield in that time period and so, as you look at the full dashboard, you might see some corky things where both are represented that more happens with any measures that don't look at continuous enrollment, just to put that as a callout for you. let's take a look at what those key observations were starting first with our non-medicare population and to put this into historical context, gosh, it seems to long

ago and yet it wasn't. but in july of 2021 which is the beginning part of the period of this report, we had a heightened state of covid cases at that time. they were increasing and it was a gradual drop off that kept increasing through october and by december of 2021 and then this year, that's when things spiked again. both of those things contributing to utilization and cost. part of the utilization, other people getting their screening or vaccinations but feeling like they can come back for their normal health care types of engagement with the health care provide ares but then the spike in covid cases so we did see increases in admits for a thousand and 1.8. acute admissions would stay. visit to the er, increased to 35.9

patients per thousand and outpatient -- on and outpatients per thousand increased by 3,941. the adult preventive visits and child visits, those increased double digits on the adults from previous period to well baby visits that decreased a little bit. chronic conditions and look at these. those are our biggest cost drivers and -- prevalence is increasing by diabetes and asthma was up. back pain up 2.7. as we look at our top 11 mental health episodes of care, we see an increased patient and visit counts across almost all of those episodes and really taking a look at the depression and substance abuse depressions. 265 patient count increase and 3,279 increase in the visits, so we

are at least seeing visits as well as patient counts go up and substance abuse, a gain of 20 patients and 1,154 of the visit counts over previous periods. on our next slide, we'll take a quick look at the key observations for our medicare population. again, we were seeing that with this population as well. admits increased five. outpatient services per thousand up 8,770 over that previous period. and pretty large increase in our er visits per thousand at 49.2. adult preventive visits, that also had a double digit increase and i see our members getting back to their preventive care. we see increases in diabetes of 16.8.

hypertension, 4.9 and low back pain increased 12.37. quality indicators revealed that we have increases in readmissions per thousand at 1.3 and avoidable missions were up 1.1 and complications 1.8 and a look by risk ban which revealed increaseses in the struggling population compared to previous period. we're going to take a quick look, the -- on the detail of those key observations on the next few slides. so, you know, when we talk about our strategic plan, we're looking at those cost utilization trends. they tie to our affordability and we're working with, whether we hear for example, the increase in the er visits, just coordinating with our plans and the right care at the right

setting and again, some of these increases in utilization with those outpatient services, it's not a bad thing at all and ultimately, it's a good thing. and we can layer that equity lens over all this and dive deep. same on a primary care perspective. this is how the tools compliment because we want people to get through those preventive visits and we did see the double digit increases for most of those. on the next slide is where we look at these chronic conditions and certainly from an affordability perspective, these are key cost drivers for our populations. especially diabetes, i think it's the top driver. and we see that increased 2.1 patient per one thousand. so, again, we'll drill into those populations. we can monitor those episodes of care to see what were acute flare ups verses maintenance type of visits and that gives us some indication about how well managed the populations are and

we can work with our planned partners on that. next slide, please. thanks, patrick. and finally in our non-medicare population, here's the drill down on the 11 mental health episodes and almost all of them we're seeing increases in patients and visits over that previous period. we no there's -- we know there's increasing need for mental health services. out of covid as well as the stigma associated with mental healthcare is decreasing which is nice to see. so, out of our strategic initiatives, it's working with vendors and city partners to identify our best practice resources for members to be able to access and utilize their healthcare services, so an increase is actually a good thing for us. just to call out on the previous data points, the ones that's in a darker pontchartrain, the two bottom rows were inverted and it's

corrected in the version that did go onto the website, although the website you have predated that. i want to call that out, commissioners. into the medicare population on the next slide, a remind he -- a reminder, there's no financial but we can look at it from an equity lenses. when we see the visit to the er and other quality markers when looking at the readmission rates or avoidable missions, you know, there's certainly indicators of increased cost and so, just doing further analysis to ensure that all of that care was appropriate and we're taking -- taking advantage of that. a note on the risk of our medicare population so this is a stratification by categories based on risk scores moving from

healthy to in crisis. we did have an increase of .8, i think it was, 1.4 into the struggling and yeah, one percent increase of our population that moved over into the in crisis and so, we know our population as they age are going to have one or more chronic conditions and so, you know, and they have significant care needs and it's about, you know, working with our planned partners who do have care programs for the advancing age population in ensuring that again, we've got our members engaged into that, so i'm going to end my comments there: the dashboard reference is in the appendix and i'll leave it there for michael and i do entertain questions or comments you have. >> any questions from the board?

>> this is commissioner follansbee speaking. sorry, i got disconnected in the middle of your presentation, michael. i have one question for you, the slide is gone but it showed several categories that were sort of put into the five different strategic plan initiatives. how was that slide generated, for example, depression, administration of the depression scale, primary care wasn't listed but at least, when i was in practice, we were asked as primary care providers to look into depression, considering both independent but in a situation with diabetes, for example, and to administer the phq9 questionnaire and then do it again so i was wondering how that slide got generated and why primary care was not listed

for some of the conditions on the sort of y axis. do you know what slide i'm talking about? it's not on the screen anymore. >> thank you, holly. yes. so, as to that slide, this is only meant to be an example of how we will be aligning these across them. i think you make an excellent point. as we delve into each one independently, i believe they will cover many of more categorys and the goals of our strategic plan. you brought up an excellent one, so thank you, dr. follansbee. >> great, thank you. because the high dose opioids, they are being prescribed by primary care providers so i think as we explore this in more detail, we might find a more and moreover lap. and then, the second question or comment i have for rin, i'm sorry you've made these presentations before and they

are superb and detailed but i'm confused how the data gets generated. i know admissions and the er visits and some of those things are very clear and there's no squabble but dhs looked into various medicare average for plans and diagnosing year-to-year. i'm not always clear where you look at encounters whether you're looking at the primary reasons with lower back pain or diabetes or ancillary pain that's added and it increases the score -- and medicare population, of course that extends over to our

non-medicare population. >> thank you, dr. follansbee. that's a good point. the dashboard itself, which is just a pre-kandor report, that's looking at the primary care -- with have ad hoc reporting tools that let's us go into granularity. so depending on the review on populations, we're looking at all diagnosis cos on the record or that exist for that patient. so, when we've done analysis before trying to capture various pieces of information with regards to initiatives, we want to under take for our population. i'll say one of the other uses we've done this with claims database previously is look at that data. i'd say from a bit of an auditing perspective, if they

are there, there, we have heard up coding and there was things happening with farm suitable and we looked at the data and didn't see that in our population. so, but yeah. both things but the report here is looking at primary diagnosis. >> thank you very much. because i want to say that again when -- my role as a primary care pro viced at various point in my career -- i have seven, eight, nine diagnosis for a visit and because me trying to address all the problems on a problem list and some was driven by, you know, not necessarily -- not necessarily my visit because i was salary but by the acute of the health plan desired as well, so i never was fraudulent but there may be 7 or 9 and one reason put as primary but the others were secondary diagnoses that had to be addressed during

that visit in both evaluation and prescriptions or planning or whatever. so thank you very much. >> all right. are there other questions? hearing none, we'll take public comment at this time. >> thank you, president scott. in person public comment will be first and virtual public comment. anyone waiting in person, you can approach the podium now. each speaker will be allowed three minutes unless deemed otherwise. all public comment is made concerning the agenda item that's been presented. a caller may ask questions of the policy body but there's no -- i'll give you a warning when you have 30 seconds remaining and when your time has ended, i'll thank you for your call and your time will end. remote viewing is available on sfgovtv and using webex.

opportunity to speak is available by dialing the number on the screen. the number is 415-655-0001. whether prompted, use access -- when prompted use access code 24956355266. then press pound and pound again. you'll enter the meeting as an attendee on the public comment call line and dial star three to be added to the public comment queue. when the system message says your line has been unmuted, this is your time to speak. those on hold, continue to wait until the system indicates you have been unmuted. we'll begin with any in-person public comment. no one has approached the podium. we will move to our virtual public comment. our moderator will notify if there's any public comment in the queue at this time. >> board secretary, we have zero caller s the phone line and zero callers entered the public comment queue at this time. a reminder to all callers on the line, you must select star three now. if you want to join public

comment for this specific agenda item, we'll wait five more seconds and then close public comment for this agenda item. no caller in -- no public comment in queue. >> public comment is closed. >> thank you. i'm going to suggestion that as chair, we'll carry over the board education segment until the next meeting and at this time, we will take up item 14. >> agenda item number 14. reports and updates from contracted health plan representatives. this is a discussion item. >> i'm given to understand that there are no updates from the planned representatives. is that any anyway changed or modified, would all of the plan representatives please, who are

in the room, please stand. on behalf of board, we would like to thank you for working with us during this past calendar year and wish you and your families a pleasant holiday season. thank you. and with that, having had no comment from the plan representatives, we will not need to request public comment, so i'm now moving to item 15, which is to adjourn this meeting and wish everyone a very happy holiday season. [gavel] >> adjournment at 3:57 p.m. thank you.

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