>> city county of san francisco to order. [gravel] please stand and join me in the pledge of allegiance of the flag? >> i pledge allegiance to the flag of the united states of america, and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all. >> thank you. we'll now have roll call. >> thank you president scott. roll call- [roll call]

with that, we have quorum. >> we now have a quorum and i would like to claim the privilege of the chair to make some adjustments in today's agenda. we are going to have-it is rather lengthy agenda. we have two closed sessions attached to it, and there will be multiple presentations, so i'm going to ask everyone cooperate as much as possible in terms of observing the time that we have allotted for this meeting. in that, another commission comes in here at about 4:30 to 5 o'clock and we need to clear the room, and we don't want to co-join the missions in san francisco ever, so we have to keep our business separate and allow them to come into this room. so, with that, the following modifications to the agenda will be made.

item 9, demographic report will be incorporated into the director's report. and then for the closed session, we have one closed session that will be considering the evaluation of the executive director and one for a member appeal, and those items are item 19 and the related items of 20, 21 and 22, they will be considered after. i repeat, after item 23, which is the member appeal and its related items so we are switching those around. the member will be present. i understand i want to be sure that we are not if we do run out of time we might have to differ the closed session on the executive director's evaluation and we dont want to have the member come

back again to hear the appeal. so, with those changes, i am now ready to entertain or open-move the meeting to item 3. >> thank you president scott. item 3, resolution allowing teleconference meetings under california government code section 54953-e. this is action item and presented by president scott. >> move acceptance. >> it is properly moved. is there a second? >> i second. >> properly moved and seconded by . this st. the last of the resolutions we will be doing coming out of the pandemic with the effective date of the changes for public meetings. i know there is still more discussion being held, but at this point i will consider this to be possibly the

last time we'll be doing this kind of as a global or blanket change to the board operations. are there questions or comments by the board members or anyone? okay. we'll now have public comment. >> thank you president scott. in person public comment is first then virtual. you are welcome to approach the podium. each speaker is allow 3 minutes for comment. all public comments made concerning the item presented. i'll give a warning when 30 seconds remaining and 3 minutes left ended i thank you for your call, you are placed on mute and unmute the next caller. remote viewing is available on sfgovtv and webex. opportunity to speak are available

dialing the number on the screen, the number is 415-655-0001, 415-655-0001. use access code 24890380169 then press pound. enter the webinar password, 1145 and pound again. enter it meeting as attendee and dial star 3 to be added to the queue. when the line is unmuted this is your time to speak. for those on hold continue to wait till the system indicates you have been unmuted. we'll begin with in-person public comment. no one approached the podium so move to our virtual public comment. our moderator will notify of any callers in the public comment queue. >> board secretary, we have zero callers on the phone line and zero callers

entered the queue at the time. >> public comment is closed. >> we are ready to vote and have a roll call. [roll call] >> alright. passes unanimously. we are ready to move to item number 4. >> item 4 is general public comment. an opportunity for members of the public to comment on any matter within the board's jurisdiction not on the agenda including requesting that a board member place a matter on a future agenda. i'll read our instructions allowed. [providing instructions for public comment] no one

approached the podium and move to the virtual public comment. our moderator will notify of any callers in the public comment queue. >> board secretary, we have one caller on the phone line. zero callers have entered the public comment queue at this time. reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda item. we'll wait 5 more seconds and then close public comment for this item. board secretary, there are still no callers in the queue at this time. >> thank you. hearing no further callers, public comment is closed. >> thank you. move to item 5. >> item 5 approval with possible modification

of the minutes of the meeting set forth below january 12, 2023. presented by president scott. >> i'm ready to entertain a motion on the minutes. >> i move that we approve the minutes of the january 12, 2023 health service board meeting. >> second. >> properly moved and seconded we approve the minutes attached to the materials for the meeting for the january 12, 2023 board meeting. are there any comments, edits, modifications or suggestions from the board members? >> i did receive edits from commissioner braslen and noted them. >> those have been incorporated as far as i know. anything else from the bord? if not we'll have public comment on

this item. [providing public comment instructions] we'll

begin with in-person public comment and no one approached the podium so move to virtual public comment. the moderator will notify of any comment callers in it queue? >> we have one caller on the phone line, zero callers have entered the public comment queue at this time. reminder to all callers on the line, dial star 3 now if you want to join public comment for this specific item. we'll wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you maderator. hearing no callers public comment is closed. >> thank you. at this point we'll take roll call

vote. [roll call] >> thank you. the minutes are approved as distributed. we'll have the president report, item 6. >> president report. discussion item and presented by president scott. >> i just have one comment. i believe all the commissioners received an ethics committee e-mail this wreak requesting that we complete our form 700 by april 3, and i'm sure we are all going to comply with that request, so that is my president report for today. public comment. >> thank you president scott.

[providing instructions for public comment]

>> we have caller on the phone line, zero callers entered the queue at the line. dial star 3 now if you want to join public comment for this item. we'll wait 5 seconds and close public comment for this item. board secretary, there are still no callers in the queue at this time. >> thank you moderator. no further callers public comment is closed. >> thank you. ready to move to item 8 the director's report. >> thank you president

scott. i believe 7 director report which is discussion item and will be presented by sfhss abbie yant. >> good afternoon. abbie yant. executive director san francisco health service system. thank you for bringing to the attention the fact we will be resuming in person meetings next month. our office is very excited about that. i are hope you all are. the covid-19 is-beginning to i think to look a little in the rearview mirror on the pandemic. as we know, there has been declarations of the ending of the pandemic status as the federal and state level forthcomingism in the mean time it does look like we should all get used to the notion getting a annual covid vaccine. that is what the fda is working towards at this time. i do want to remind the

board of your obligation to the blackout notice since in a blackout period of the rates and benefits of the health plans and actuarially service s and we continue to work closely with the unified school district on their issues regarding the pay roll system and interface files that transmit information to regarding their employees. they have not been able to automate the process yet at this time so thinks are pretty clunky but continuing to work through the changes that are necessary. >> i know we want to be able to pull up that slide on the screen for all of you. i believe it st. the top document and iftikhar will help with that. thank you. for the outline of the director report. >> we are continuing to work towards the implementation of

the strategic plan and you will hear a update on the mental health forum as a 80 key initiative. i do want to acknowledge that it is black history month. lots of activities going on to celebrate the history of african americans in the community and continue to be really impressed with what the library is able to do with community events. it is just a very different library then what i grew up with. i think that is really great. we continue to work very closely with the department of human resources to fill the vacancies that we have in our department, and we are making inch worm progress not nearly as significant as we need to make, but we are continuing to improve. i did want to acknowledge that our communication director

jessica shin is appointed to a permanent department. there is a list of recruitment. we are strained in the member service department because of the staff shortages and again i just want to publicly acknowledge the hard work they are doing and how frustrating it can be. we have a staff who likes to do a good job and hard on them when they cant meet their own personal standards and those of the dp apartment so appreciate them hanging in there and work ing with small tweaks and changes here and there that make a difference so i think the idea we can improve the limitations we have is embraced by the team and much appreciated. and our contract team continues to work through. we had quite a hiccup this month. we were

notified by mhn mental health network who we contracted with to help us with the employee assistance programs with the public safety department, sheriff, police and fire that they were getic mhn is no longer in the business of employee assistance programs, and so michael bicante our contractor helped us find a very viable option we can put in place very quickly and that is with a company called com (inaudible) stood up beginning of the pandemic to provide 24/7 service for all the city. we are encouraging-there is a set of specialty providers that have been vetted by police, fire and sheriff that had been under contract with mhn and encourage them to jump on board with comp psych to have a seamless transition and smack in the early days of

trying to make that happen and will keep you informed but fully committed to making it work. it was a-there is a very complicated why this occurred but it is-because of the size of the organization, which mhn belongs to and i explain it in more detail, but they also own the (inaudible) department of management healthcare told them they couldn't have two companies that each did the services. that's the legal reason why it happened and we were alarmed and very surprised by the whole thing. i called the department, the chief, fire and police and sheriff to them this had happened and we are working closely with their teams to make it happen, but i want to acknowledge carrie and michael worked

together a lot to try to figure how to manage this and so it is one thing that that work and the relationships that we are going to pay off. i think at the end of the day the individual public safety personnel won't see the difference. that's what we are aiming for, it wont effect them on a individual basis. so, that was our challenge of the month. and then i where did want to also acknowledge president scott noted we moved the demo graphenings report into the director's report and i want to thank (inaudible) and her team that puts this together every year. this is the document on my desk every year. i do reference it often in old time paper format because it is interesting. there is good information that helps understand the population we serve and so we did just put together couple highlights. there is a ton of

information in here that we are available to talk through should we need to, but we did see a total membership reduction. that is not surprised. we have 4600 vacancies in san francisco. we are seeing that in our numbers so we are adjusting accordingly. we did see changes related to the split family resolution, which i appreciate the board helping us with that. it really went pretty darn smoothly and so that-there were changes with that population. we are gaining momentum on getting race and ethnicity data that is good. and we continue to see the kaiser continuing to increase their membership as a percentage of our population and most of us-40

percent of employees live in san francisco, but majority of the retirees, 91 percent continue to reside in california, so i know look at the geography is the point there on a annual basis to be sure we are adequately serving populations outside the city and county of san francisco. those are highlights, and we can entertain any questions you might have on my report or on the demographic report. >> are there any questions from the board members regarding the demographic report? >> just one comment. i notice the membership has been reduced for the third year in a row. wonder where all the members go? is that aging out? >> it coincides with the pandemic, telecommunicating, resignations, all kinds of

things and this isn't unique to san francisco and certainly across many industries there is significant employment shifts. now unemployment is record low so i think we will be competing for resources as we try to hire where ever we work. y >> i like to add my comments. thank you and your team for diligently tracking all of this stuff. it is amazing year after year the quality of the report improved, the graphics are great, and it does tell a story and i really appreciate the work that you've put into this. thank you. >> i want to congratulate you abbie and (inaudible) working

on the mental health contracting fl several of the members and think that is always a challenge and it sounds through the report the priorities are right on to try to make this as seamless as possible. also want to thank you again for the update of staffing because i thirng think we are concerned about the mental of the staff. under the circumstances being down so many hss employees. i want to congratulate continuing to keep us abreast of the situation within the department. last i want to comment that visa vi covid pandemic local state and federal government declared this over, but i want to remind everyone between 500 and thousand people died of covid in this country, so people are still dying and so we need to continue urge not only vaccination but appropriate measures to prevent

people from acquiring particularly those people more vulnerable and yes the fda are putting revised guidelines. my understanding is people at higherb risk those people with suppressed conditions who are older will be recommended to be revaccinate #d every 6 months and the routine population every year. i think we need to make members aware of these sort of pending recommendations and urge our health plan partners to comply making available boosting for vulnerable members every 6 month intervals if that does turn out to be the recommendation which i think it will be. i thank you. >> thank you commissioner follansbee. as always, great inset on the medical side, really great. thank you. any other comment said

from the board regarding the director's report? again, on behalf of the board, commissioner follansbee made the comment, but i do want to say to the staff that on behalf of the membership, we appreciate your diligence and hard work day in and day out to continue to perform the mission and we know it is stressful and the director and executive leadership are trying to do everything they can to promote and relieve the process, but we know we are a bit hamstring by the procedures of hiring and sourcing candidates for the vacancies and as this report shows, we got nearly 50 percent of the positions that are vac ant in the department and it is a great strain on everyone and we appreciate the diligence of your work and consistency of

it. so, with that, if there are no other questions, we'll open it up for public comment. >> thank you president scott. [providing instructions for public comment]

we'll begin with in-person public comment and the first comment is ready to go. >> hello, my name is fred sanchez president of protect our benefits and nice to get a opportunity to come and start monitoring you guys again. it is great. i'm tremendously encouraged by how seriously you have taken the mental health issue. this police and firefighters, i have a lot of family involved in that and the staffing issue is directly related to the stress because

they are working fires like 3, 4, shifts. it is just not healthy because their family is at home, away from the family and strain on spouses and partners. police officers see pretty egregious things and not able to go home and kind of just relax for a while where they are working so much overp ptime they have hard times hiring and i guess i need to attend more board of surprisers meeting there and try to address how related the hireic issue, the length of time. there was a lenty article in the chronicle about it takes 280 days to hire one person. this is all about the mental health issues. it is so related. i get frustration from members calling and saying that unfortunately they call member services to try to get through to you guys and you have the same issue. it isn't your fault and know you are

trying to address it so thank you for that. that is all i have to say. >> thank you for your comment. i don't see any other in-room comments so board secretary, please. >> we can move to virtual public comment. our moderator will notify of any callers in the queue. >> we have one caller on the phone line, zero callers specifically entered the public comment queue at this time. reminder to all callers, dial star 3 now if you want to join public comment for this specific item. we'll wait 5 more seconds and close public comment for this item. sthr are no callers thin queue. >> thank you. no callers public comment is closed. >> thank you. since this is is a discussion item we'll move to item 9. sorry, 8.

>> item 8 is sfhss financial report as of december 31, 2022. this is discussion item andprinted by iftikhar hussain chief financial officer. >> good afternoon. you have the material in the package. i'll just make a few brief highlights. starting with the trust fund balance. we are projecting the trust fund balance to decrease by $15 million dlou the end of the year that takes down to pre-pandemic levels. we have seen surplus which made the fund grow over the last couple years but now it is back as we reduce rates to (inaudible) we are seeing this year that the claim experience is high. particularly in the access plus product. the blue

shield product. we see very high claims related to high volume of acute cases, and we are working with blue shield to dig deeper to understand those trends. to see if they are temporary or ongoing and it has a bearing on the rate setting process for 2024. the pharmacy rebates are coming in quite well so $14.7 million this year. interest we are project $800 thousand for the year consistent with prior year. the health sustainability fund, projecting year end balance of $2.7 million. and the general fund we are expecting surplus this year because of the vacancies we talked about in our operations. happy to answer questions. >> questions regarding the finance report?

hearing none-you do, sorry: >> thank you very much. my question has to do with you talked about the pharmacy rebates and the big news in the last couple months had to do with the reduction in the cost of insulin from significantly high costs to a lot of individuals. not sure how that impacted our system, but will that have impact on pharmacy rebates that you can tell or know about? >> yeah, the insulin had to do with protecting how much patients have to play and our plans are pretty-our plan design is quite good with patient responsibility is quite low so we were not impacted. >> okay. good to know. thank you very much. >> other questions from the board? if not, we'll take public comment on this item.

[providing instructions for public comment] we'll

begin with in-person public comment and no one approached the podium so move to virtual public comment. the moderator will notify of callers at this time. >> we have one caller on the phone line, zero callers have entered the queue at this time. reminder to all callers in the line, dial star 3 now if you want to join public comment for this item. we'll wait 5 seconds and close public comment for this item. there are still no callers in the public comment queue. >> thank you. hearing no callers punlic

comment is closed. >> thank you. we'll move to item 10. >> thank you president scott. item 10, board education healthcare cost influencers. discussion item and presented by iftikhar hussain chief financial officer and mike clarke with aon. >> good afternoon commissioners. mike clarke with aonalong with chief financial officer hussain will present the board education topic. this is timely given we are about to enter rate and benefit season for the health plans so we want to take a few minutes today to talk about healthcare trend influencers what we see in the market place. so, start with historical view comparing sfhss and compareters, i will talk about drivers of cost and

expectations influencing medical trends and mitigation strategies. we'll both talk about the importance of wellbeing primarily prevention early intervention and advance primary care initiatives and cfo hussain will close to talk through trend mitigation and potential strategies at sfhss. >> i'll show some trend data here and the three lines you see on the slide, the purple line is san francisco bay area cpi. that is all goods and services not just medical services. you can see the purple line dropping but in 2020 with the pandemic more so then the medical trends. generally you see an upwards trend in inflation where in 2022 there was a general increase in cost across the board for all services

including medical services. go ahead, next slide. the blue line we added in this slide shows the sfhss trend and you can see pretty consistent with the other-and then this last line here the dotted line is a trend mainly driven by the 22-23 performance downward trend in the rate negotiations. >> just so i'm clear on this, just for a moment if you would, we have been tracking national trends kind of consistently for the past few years and now it looks like we are going to accelerate like the

rest of the national trends and inflation, is that going to draw from these lines? is that what you are telling me? >> yes. you could see in 2022 all those trends are actually moving in a high direction as inflation is increasing and at the same time, the compounding problem we had low increases at sfhss over the last couple years so we have to be creative and do the rfp process and mitigation we are talking about otherwise we will see this rebound. >> alright. it is just-just putting a peg on that because it is going to translate if to the rate setting process, and so this is a early warning that there will be some movement beyond what we have seen historically here. thank you. >> if i may, that is precisely why we are here.

>> sorry? >> that is why we are here to set the stage both with this board and the mayor's office. >> thank you. >> great comment and it leads nicely into slide 6. the national viewpoints that i share here. certainly we are expecting up tick in healthcare trend and as you see from the data we are tracking, with aon from 22-23 expectations vast majority is driven by price. price utilization continued advancement in technical-we continue to be the dominant force behind medical trend. there is market consolidation. we talked to the board about the impact of health system activity over the last couple years there is also the need to look for alternative

revenue sources now that some of the pandemic funding has run out for health systems and so we continue to see price as a primary concern. these bars are relative differences or relative expectations in trend. we expect the percentage increases in cost to be higher in pharmacy before rebate improvements but rebates continue to escalate to help off-set the trend. you see on the lower left key trends in pharmacy, rising cost, lot of concern about expensive gene and cell therapy. phenomenal treatment frz individuals require these medications but they come at a high cost for these patients on high cost therapys and the integration of specialty pharmacy and healthcare organizations and you see influencers on the right we continue to

track. on the next slide, just presenting some information from survey data that we collected. what are the key influencers? we group into three broad categories. rising general inflation, workforce continues to age, and the worsening health of the workforce from recent survey we connected, 63 percent of survey respondents and organizations across the country say wellbeing has become more important since 2020 at it outset of the pandemic so there a lot of focus on employers working with plan participants to try to address the risk factors that make employees ill. those are certainly a big contributor behind higher medical premiums and trend year over year, so we do feel improved member

wellbeing and integrative primary care have significant potential to mitigate some of this risk. keep in mind too, when we think about the aging workforce we tend to focus on the baby boomer population working their way through and now genx starting to age through into the mid-upper 50's. we are not just seeing chronic risk in these generations, we are also now seeing chronic risk in millennial generations, one of the major health plans reported half millennials have a chronic condition or on pace to develop a chronic risk condition so see expansion of chronic ringe risk in the population. it isn't just the baby boomers we focused on. page 8 we talk about price is the dominant component of trend

along with service mix utilization and plan design influences. lifestyle risk. what is happening in the economy and how health systems respond to that and pricing of services. certainly over the course of my career there are waves of regulation impacting trend, but with aca being a major component of that, but a lot of regulation right now just as noted on the enslen medication is great example. there is a lot of regulatory and legislative focus trying to make health more affordable, price transparency et cetera and other things that are driving cost. system consolidation, imfact labor shortages and the unknown of covid. there is appendix slide i won't cover but interesting commentary how we feel post pandemic, what covid might influence trnd going

forward. there is a lot of great mitigation activities starting with advance primary care initiatives. member wellbeing focus like i mentioned earlier. trying to improve the health risk of the population. navigation. a lot more information then ever to help members navigate their care with their physicians and choice of providers and then with the pandemic seeing the uptick and virtual care delivery as well and hoping to see that continue going forward. and some data points from a global survey of the clients, you see percentage of organizations who stated this was a top focus across detection, advanced assessment, education and coaching and wellness programs. you see the elements of those to get a sense of what those

broad categories are about, but certainly these are much higher percentages then we would have seen in a 2019 survey. >> intuitively, the prevention and primary care being closely related you would think that would lower the total cost of care if that care is effective. this is a scientific study done by chcf in 2021 that shows that when you increase primary care spend and that last highlighted column, the top quartile,s the total cost of care goes down and the reason is because the er visits reduce and the hospital usage

is reduced. and then on the next page-we looked at trend earlier. this shows healthcare expenditures going back between 20 years and you could see that we are in-currently we had a big drop on the right hand side from the pandemic and we are now pretty close pre-pandemic state of expenditures and prior increase in healthcare you see 2010-2014 had to do with aca where coverage was expanded and (inaudible) but there is a very sharp increase you see here, but it is going back pre-pandemic levels. so, the healthcare is mostly labor so when you have a

high (inaudible) unemployment rates the one that happened to healthcare is the great resignation really a lot of the experienced folks working in healthcare exited the market so creating labor shortage and you have seen the impact of labor and provider financial's. it is taking a hit on the financial's. the margins declined so we expect some of that to effect future rates that we pay. we also remind you that healthcare typically tends to be higher then inflation, and the general inflation being high, the uptick we saw earlier. so, what can we do about it? work

with health plans and partners to implement medicare models so we have-you see in the table the majority of this plan we have are hmo plans where care is managed with a high use of emphasis on primary care, and we go through a rfp process every 3 years and the next one would be after 2024. the demographics our wellness programs and the health mitigations goes back to the wellness programs, timely care, the alternative care settings of making sure that the right setting is used. pandemic reduced virtual care, which is a very good way to

provide very quick access to physicians and declined somewhat, but it does prevent people going to the er and getting better care from the primary care doctors. the advance primary care initiative that we are working with our plans, also promotes wellness and reduce hospital and er visits when it is effective. lastly, the plan design. how deductible and copays are set, the rx formularies have a bearing on the cost. >> thank you. i want to go back to page 12 if we can for a moment, just to focus on a couple things here. price increases will have delay appearing in medical claims because provider

contracts are renegotiated every 2 years. so, i would take that to mean that we are on the front end of continuing increases in the future years of 24 and 5. we are going to start in 24 and going to go higher in 25. is that kind of what you are saying here? >> yeah. i would say we started to see-what is interesting not necessarily in san francisco but national data across the client a up tick in threatened terminations between carriers and helt systems. i see starting in late 2020 early 2021, so from a contracting standpont i say the cycle already started, so we are starting to see hp like for instance, i know we will talk about this when we have our blue shield hmo

experience presentation next month but we saw a higher level of large claims in especially access plus plan we have seen. the amount of claims reimbursed through the large claim pooling mechanism, the $1 million mechanism in place with blue shield hmo is higher then it has been since i have been tracking it. some of that could be driven by price inflation on services and facilities. we will be continuing to dialogue with blue shield and other plans about what is happening in the contracting environment, so in my view this is started to fold in bay the time we get to now it maybe wasn't folded in late 2020, early 2021. >> so we are in the price increase incline at this point? >> correct. >> we should expect

more going forward? >> correct. in our collaboration with sfhss we are constantly working with the health plans to understand all the force s driving trend. equalization as well, not just price, even though price we feel is dominant trnd driver, but across all aspects of trend and talking through some of the mitigation strategies with the plans collaboratively that also benefit members that can help reduce the impact you see in renewal time. >> are there other questions from board members? . >> thank you president scott. i go back to page number 6 when you talk about market consolidation and what struck me was that there are laws with regard to corporations and there is a point at which they sort of hit federal laws with regard to

consolidations and can't-forget the name of the law way back when, but is anybody monitoring what is going on in the healthcare industry with regard to the consulidations of major health plans and are they subject to those federal regulations that say, oops, you can't consolidate into one big whatever or two big corporations that you have to maintain certain levels of that. i'm concerned about it consolidation issue because obviously that has to do with rate setting and market trends that impact the cost overall if they were allowed to have just one big organization. can you speak to that a little bit? >> it is for profit systems that are publicly traded entities have to go through the same department of justice review and everything else at the federal level that

any other publicly traded organization has to go through. what we have been wincing over the years in healthcare, some is large system consolidation and also been numerous instances just small provider practices being purchased into larger practices and that's happened over the course of time. i don't know if dwrou you have a view on this from the former health system environment looking what could be the impact of consolidation. i think has been ongoing enough i don't expect there to be some surge in big price inflation because of ongoing consulidation, but at least for major system consolidations, especially publicly traded organizations they have to go through the same doj review. >> i think it is true

(inaudible) healthcare prices are much higher then southern california. that speaks to the higher consolidation in northern california market. having said that, on the provider side i don't see that as a problem going forward because healthcare systems are scrutinized. the bigger danger is the pharmacy, the patents where there is a lot of bid on public policy and we need to-as a policy matter we need to make sure that the patent laws are not being used to--as a sword to increase prices. >> i would like to suggest we consider having someone, dr. (inaudible) from uc berkeley or someone who is expert in merger and acquisition in the market consulidation because it does continue to concern us

and i don't know what hss can do about it, but i think it is worth sort of paying attention to these trends and so i recommend we consider trying to put together- >> i think that is useful future discussion. in addition to the consolidation, with these consolidations i notice at least as i hear the news reports various retail pharmacies are taking on other kinds of businesses because they are providing different services in pharmacies. one level saying that is convenient for the public, but in another level it may have impact in terms of pricing and delivery and staffing and all of the other factors we are talking about today. it would be a useful discussion i think.

>> i think one piece we are keeping eye on is venture capital funding of primary care. we know primary care is a big solution to a lot of concerns in the health system and having that provided by venture capture company makes me nervous. i think there is lot to be paying attention to as we go forward to understand what is driving the cost of healthcare today. >> other questions? >> commissioner follansbee did you want to say something? >> no (inaudible) >> the last time we attempted that i believe it was in 2020 that wasn't particular ly to the kaiser plan and

not warmly greeted so do you have a recommendation how we approach that if that is a strat egy we pursue? >> we don't really have recommendations at this point but- >> in general. >> i did look at the 2021 kaiser and- >> i think in general it is arm and arm with human resources to negotiate these type of benefits with the employees. us trying to do it on our own isn't go toog go very far very fast so i think that would be one strategy is to consider how those things can be negotiated. when you think about the way the san francisco attracts employees to come fill a 4600 vacancy it is total compensation package is the

salary and benefits so that is the context these are looked at. it is total package. others in the-city faces its current budget deficit and projected those questions are going to come up. >> thank you. >> other comments from the board? commissioner follansbee, please. >> yes. i like to-this is a really broad comprehensive attempt to simplify all the issues and other issues were raised. i want to go back to the fact the power of the demographic report and how the improvement we see capturing demographics we can now possible tie those to the wellness programs. how are the health plans doing targeted certain populations whether by age, racial

background, body mass index, whatever to certain type-we know can have other effects in terms of health outcomes. even the issue around virtual care. who is using it? which population characteristic is not and how can we be more inclusive and these offerings to make sure that our members are all have equal access to some of the programs in the area of wellness which should help diminish the cost down the line. >> thank you for the comment. other board comments? if not, thank you for the presentation and we'll take public comment on this item. [providing instructions for public comment]

>> we'll begin with in-person public comment and start with our first person. >> (inaudible) protect our benefits. i want to share a thought. we all know inflation is taking place and when you are doing long-term negotiations on rates and they talk about inflation so we need to increase those rates. can you also at the same place triggers in place so as deflation takes place that automatic triggers will cause those rates to lower. you have to put hard things in that trigger that force them to say okay we understand inflation, and understand why you want increases, about at the same time we never see cost when things go down they don't come down and the only way you can actually have that take place is you place those

triggers in there that automatically lower those rates. just a thought. thank you. >> thank you for your comment. i see no other persons in the queue in the room. >> move to virtual public comment and the moderator will notify of callers in the queue. >> we have two callers on the phone line. zero callers entered the queue at this time. dial star 3 now if you want to join public comment for this specific item. we'll wait 5 seconds and close public comment for this item. still no caller ins the queue at this time. >> thank you. public comment is closed. >> thank you. i'm going to

take the privilege of the chair and say we will go into recess at this time for 10 minutes. at 2:19 we ask everyone be back in their places. thank you. [recess] >> reconvening after the recess and like the board secretary call the roll. >> thank you president scott. [roll call] >> thank you. we have a quorum and ready to proceed to item number 11. >> mental helt forum update discussion item and introduced by executive director

abbie yant. >> good afternoon. abbie yant, executive director san francisco health system. as mentioned in the director's report we do have a initiative identified within our strategic plan to address the mental health concerns and emotional well being concerns of the population and to kick off that initiative, we hosted on december 6 mental health forum. the guest included vendors along with clinical subject matter experts, sheriff, police fire and department of human resources, hss staff. the purpose is to align and understand what the opportunities were to help us and help members navigate the many services supports

and resources that exist to help us with our emotional wellbeing and our mental health concerns. the forum was supported by aon's team lead by alisa of our planning team included carrie (inaudible) lisa harris, holly lopez and myself from health service system. we have already begun follow-up sessions with our stakeholders. initially with city departments with the department of human resources who is monitoring the meetings here today. we had a great meeting with them and very aligned on understanding how we can more holistically support active

employees during employment so developing work plans that help in that regard and then we work with the plans and the subject matter experts in these areas, again mapping the-helping understand the navigation of the services and systems that are there. it was a really fun intense day. there were-we held at the light house for the blind which is the building next to us on market street which is a delightful building and it was good to be there. the format of the meeting and elisha will talk more specifically but engaged a graphic artist who helped us map the conversation because it was really divided into three sections and i'll let elisha tell you. we have the maps. not quite ready for

prime time because we want to make sure they are accurate because they were captured thin in the moment and things may have been miswritten so tuning those up and will make them available to the public and yourselves as well. and it was very engaging. i have done workshops like this before and it is a added element to engage participants in the work when they see what they are saying is on the wall literally. so, it was a good day. the result s we'll touch on today. we have a lot more work to do obviously, but i wanted to just thank elisha and (inaudible) for all this workshop. i told people i tell people i was very surprised of the outcome. i thought we would spend the day whining how we

didn't have enough clinicians. there so much more to emotional wellbeing and mental health then engaging with the clinician. that was a big ah-hah for myself and hope you see in the presentation elisha will give now. >> thank you and welcome. >> thank you. good afternoon commissioners. my name is elisha engelen. we have a slide deck we'll go through and you can get a copy afterwards as well. what we will first go over i'll highlight from agenda perspective, what we went through at the mental health forum and who was there and also the analysis we did and recommendation and what was is to really understand the lived experience of the active members. we can really understand what it is like to be in their shoes and look how to create clearer pathways for mental healthcare. today as

abbie mentioned we were able to take this one piece towards the strategic goal you have and look for the feedback on the draft recommendations. i think it is important to acknowledge we need to lead with equity with mental health and the great thing about san francisco, you have a lot of diversity and need and that is ability kwr and something we took into consideration and take great provide continuing to do. this next slide looks at the timeline that went into getting where we got at the mental health forum and you'll see the list of events. i won't read off to you but what is important is build up and intention and how we got here and the importance of the partnerships throughout the course of the time getting to that point. what is cool, it could be hard to explain something but we have a picture that will take you

back to what we were able to do at the mental health forum and what was wonderful is we had 50 people there and it was across the spectrum of san francisco members, city departments, thought leaders, health plan leaders and clinicians and are vendor partners along with aonand abbie and her wonderful team, and we came together and were able to look at the lived experience of the members, and as abbie mentioned the light house of blind and visually impaired is a great place to have that that day. you get a sense from the picture. the next picture will start to give you a look how we brought in the graphic artist. we up able to capture the collaboration partnership and discussion real time so people see their voices were heard which i think is part of what unique with these experiences as we look at active members and what they experience. the other

thing i want to take a moment and acknowledge is that when we looked at this process, we were very intentional about bringing all of the audience into play as mentioned. we had a presentation from the health plans. they were able to come in and talk about current state and be part of the discussion and we also broke into interactive sessions where we were able to go through the lived experiences and talk from the perspective of the different audience members so very intentional bringing those groups together. and then had small group discussions which you will see pictures here where we used post-its and have fun. i never knew office depot was that short of post-its and discussion where people can make comments on presentations. from aex ecective summary perspective highlighted by abbie december 6 is with we gacktered and what we gathered to do is understand and figure

how to create clear pathways for mental health and how can we do that in a way that is equitable for the members. i'll talk about about how we went and did that and then all the data we are table to receive from the mental forum went into analysis and recommendations. as mentioned we started with this view of looking at what the members experience and what the provider intersect and help them and you will see on it next slide how we expanded that holistic view and how there is a upstream approach and clinician perspective it is exciting there is other avenues we can take and we'll talk about that now. we lookedt a the current experience the member has with our health plan partners and how the health plans have been challenged to evolve and recognizing evolution and giving a opportunity to talk

about the roadmap of service. it was a great kick off and energy to remember what we have in place. what we did is looked at the current member experience and through the member experience is when things started to expand. we were able to look at and hear from our audience around how this is bigger then the clinical care, it is about prevention and risk reduction and how in a organization that individual what they bring is really impacted by team and leaders in the organization and what they bring forward. the last piece i highlight before the next slide is when we started to look at all the opportunities and create a future state, psychological safety on day 1 was key. what we want to look to create and part of the recommendation is psychological safety from the beginning and then being able to really look at that whole member eco system. everything you bring with you to work and everything the job brings and how those combined and how

looking at mental health. go to the next slide. so, on the left hand-top left hand part of the slide you see where we initially took this forum and looked at the member experience at the core. that member. we talked about the talent is so important and people make things happen. and we also looked at the external layer at the end from the contractor perspective. and we were able to validate through the mental health forum these are still critical and if you look at the right side we have this opportunity of that space between to do more things. so, from departmental standpoint from a leader and team standpoint and vendor partners in san francisco services a well. the right side gives a depth and breath of the things you can do of on-boarding, field safety training, peer support groups, those

things people can get in between and in the work day that can help with the risk and prevention and then as abbie mentioned, we can't lose sight of clinical care and that is listed on the left side around evidence based and measurement needed and ideas we came up with as well. the next slide with the draft recommendations, there is 5 themes that came out of here. we had a lot of data out of the session. these are 5 themes. one is equitable pathways. a big theme we recommend to bring forth and through that theme you will see on the side talks about on-boarding, assessment that help people understand when they need care and also insuring interconnection in the care people get. the second theme we found was the member centric eco system and how bringing in the

standard on-boarding having people have a sense of purpose and belonging, having the workplace support them and bring them up. the third is about member stakeholders. think about your teams and leaders and how we put them and educate them and what they can do to bring the day to day experience. the 4th theme is enhancing vendors so prevention through treatment and enhancement of what san francisco health service system is doing with the wellbeing and eap and items how to develop measurement goals and bring about our systems and have people aware of what is offered. very important is effective measurement. how we audit the measurement today, how do we do surveys and frequencies of those. and then before i welcome feedback and comments, lessens learned. at the end of the day mental health is health. we know these clinical and subclinical lens needs to be looked at but also that holistic

upstream approach in the ability to make a impact. more proactive then reactive and then also knowing we have a huge variance so one size isn't going to fit all. our next steps is the referenced earlier is continued partnership with the department of human resources and health plan partners who have been really great to work with and then future analysis to define how we have influence and then last for next step is continued feedback and reporting to all of you. >> thank you for this work and your leadership and support of us in this effort. very much greatly appreciate it. are there comments from board members regarding the report at this juncture? or questions? >> if i may. a brief-had a question. my compliments to you and the team as

well. (inaudible) mental health is very much tied to our ability to operationally serve the needs of san francisco and every city department. i feel that this is my personal experience there is a cultural acceptance and shift in desiring these type of services and i feel there is some appetite for this among department heads and my question moving forward and and realize this is a process, are you finding creative recommendations from other outside of san francisco for ways to incorporate the idea mental health is health? what i mean pie that, we are looking at cost benefit analysis of our widgets our people, resources and i don't know if mental health component is incorporated within that personalizing i think the value of our resources, our

staff. are the things others outside san francisco have done or is this still front end of our journey towards incorporating mental health being the health of our people? >> one thing i would say is working with clients recently something that is really positive that working is doing mental health first-aid training or something comparable to help upskill leaders and even members of the organization. in addition i say employee resource groups have been really popular. even i can say we have that and it has been a great outlet for folks to get together and be educated and support one another so you think about the opportunities within the systems you have today those are 2 things that come to mind and ties into the first piece reducing stigma and

increasing the culture to be psychological safe. another idea i will give is we are seeing a trend-if you think about safety historically or physical fitness, we do physical fitness assessment as kids, we don't do mental health assessment so that is looking how we help people take a questionnaire to understand how they deal with stress and also seen a trend in industries that when they put out questions or education around safety, how you lift things, how do you climb a ladder and see talk about mental health and stress. expanding safety to being mental health too. >> thank you. i realize my question was broad so applaud you and the team for making this priority. >> other board member questions or comment? we

understand director (inaudible) you did say someone is here from human resources today? >> we will try to monitoring the meeting. >> they are monitoring the meeting. department of human resources as well. this is the beginning of a process. we understand that, but the fact we have taken a substantial first step is a critical starting point and point to be emphasized. it is very consistent what we identified as a part of the strategic plan so very pleased to get this report today and look forward to the next steps in the process. thank you again. with that, we'll take public comment. [providing instructions for public comment] >> i was receiving notifications public comment wasn't available and it is incorrect on the agenda. i have been working with

sfgovtv. it is posted again on the website but there is someone that is trying to reach out for general public comment and wondering if jennifer we could understand if how to go back and make sure general public comment could be put on the agenda so people can comment. >> if that person is in the queue if we can complete this item of public comment then we'll allow that person to get into the queue right after this item. >> okay. >> is that okay? >> that's fine. the whole time the public comment hasn't worked so why early on we-they were not able to speak so we'll give- >> yes. let's complete this item and then we'll have that person or persons if there are more then one come in for general public comment item which is item 4 on the agenda genda i believe. >> okay. thank you. we'll call public comment for this

agenda item and will read the instructions aloud . [providing instructions for public comment] we'll

begin with in-person public comment and no one approached the podium so move to virtual public comment. our moderator will notify of callers in the public comment queue at this time. >> board secretary, we have three callers on it phone line. one caller has specifically entered the queue at this time. reminder to all callers, dial star 3 now if you want to join public comment for this specific agenda item. i will indicate when there

are no more callers in the queue and hear a moment of silence before transitioning to callers. >> thank you moderator and just to make sure for anyone who is just joining having gained access with our updated webinar access code we are-will be having general public comment come back as another agenda item. i'll unmute the first caller with the raised hand. welcome caller. just making sure they can unmute. welcome caller. if you hear us, you can begin. caller, you have

full functionality to unmute. >> can you hear me now? >> yes, caller, welcome. >> okay. awesome. thank you so much. good afternoon to the board. my public comment general comment is around the staffing issues at the health service department. it- >> caller i'm going to interrupt for a second. i believe you have been waiting for general comment. the comment we are taking now which will finish up quickly is for item mental health forum update and finish that quickly and move to general public comment so thank you for being patient. moderator, any ort callers in the queue for this item? >> board secretary, there are no other caller in the queue. >> thank you very much. moderator, hearing no further callers, public comment is closed. >> did we call for public comment in the room? >> no, we didn't. no one approached the podium so can

close public comment. >> with this discussion item and appreciate again the work of all those concerned on it. we will now go to general public comment, which is item 4 and the reason for going back so we are all clear is we had a technical issue and were not able to allow people to comment during that portion of the agenda. at this time, we will have general public comment. >> thank you president scott. item 4 will be called again general public comment. opportunity to comment on at mayor within the board jurisdiction. i'll read the public instructions aloud. inperson public comment is first then virtual public comment. you are

welcome to approach the podium. [providing instructions for public comment]general

public comment. opportunity to comment on a matter within the board jurisdiction. i'll read the public instructions aloud. in-person public comment is first then virtual public comment. you are welcome to approach the podium. [providing instructions for public comment] we'll begin with in-person public comment. nobody approached and move to the virtual public comment. our moderator will notify of callers in the queue. >> board secretary, we have three callers on the phone line, one caller has specifically entered the public comment queue at this time. other callers may enter the queue as public comment continues. i'll indicate when there no more callers in the queue and you will hear a silence between callers. unmuting the first caller now. >> our caller has been elevated and unmuted. caller, when you are ready.

>> hi. good afternoon. again (inaudible) field representative with local 1021 and my general public comment is to raise if the board is unaware the fact health service system is operating with 50 percent staffing shortage. there is a personal contract to contract out a call center for health service system. i don't believe that is best practice and ask this board agendize an item to have further investigation or bigger discussion around how this item will effect the budget, how it effects the workforce and if there is a actual comprehensive hiring plan to fill the 50 percent shorting staff of full time positions versus contracting out the work. this is something not given the proper attention that it

deserves and believe this board as well as other commissioners need to be aware of it and there needs to be a discussion. that is my comment and i- >> thank you caller for your comment. >> thank you caller. we look for the moderator to see if there are any other callers in the queue at this time. >> there are no other callers in the queue at this time. reminder please select star 3 now to lower your hand in the queue so we dont repetitively unmute you. thank you so much. >> thank you moderator. thank you to all callers. we have been patient to making sure public comment is accessible for all. with that, public comment is closed. >> thank you. we'll move to item number 12. >> item 12 is reports and updates from contracted health plan representatives.

this is discussion item. we do have one plan representative. >> there may be another, but please go right ahead who is at the podium at this time. please introduce yourself. >> good afternoon commissioners. monica (inaudible) with united healthcare retiree solutions and i wanted to share today with the board that we are introducing a new wellbeing program called, let's move and it will be introduced next month to all group medicare advantage members. the program is designed to help medicare retirees explore ways to eat well, be active, improve mental health and stay connected and there is no additional cost to the retirees or to sfhss. the programming will be available in 6 different dimensions. the first is focused on nutrition. the second on physical activities, the third

related to mental health will be highlighting self-care options such as one of our applications called able to, the fourth area is social wellbeing and promoting connecting with our community. t : the 5th is caregiver wellbeing. a lot of retirees have care givers and the last is financial wellness and we'll focus on topics how to live healthy on a budget. we will be offering wellness challenges to promote engagement and we look forward collaborating with sfhss on the new initiative. >> thank you for the update and the title of the program is again, let's move? >> let's move. >> thank you. are there questions or comments from mens members of the board? >> i have one question. you said you are looking at the fact that some of retirees have care fp givers. are

you considering the fact a number of retirees are caregivers and is that part of the program? >> very good question. our caregiver support would be available to any caregiver whether a member or a caregiver of the member. absolutely. thank you for your question. >> are there other questions from the board? if not, thank you very much for highlighted information. >> thank you. >> we have another plan representative approaching. >> hi. good afternoon commissioners. debbie (inaudible) with kaiser permanente. couple updates i want to share. first given the recent ongoing gun violence in the u.s., kaiser permanente committed to undertaking meaningful efforts to reduce gun violence in america as part of the role as a mission driven healthcare organization. we expanded our work to address

the causes of health consequences of gun violence with $25 million commitment to our recently established center for gun violence research and education. the goal of the center is to reduce the insdants and impact of gun violence including partner violence and suicide in the u.s. this investment extend over 5 years and advance gun violence research and education. as part of this investment kaiser is also formed a new partnership with health alliance for violence intervention to help coordinate the work of the center for gun violence research and education. for my second update i wanted to let you know we recently opened urgent care clinic in san francisco. this clinic is located on the first floor lobby of the geary boulevard medical office building, that is 2238 geary boulevard and the hours of

operation, monday-friday, 1030 a.m. to 7 p.m. weekdays and holiday 9 a.m. to 5 p.m. members can make an appointment or walk-ins may be available. >> thank you very much for that information. are there questions from the members of the board? if not, thank you again. >> thank you. >> with that, we'll go to public comment. sorry. yes, i'm sorry. pardon me. >> i will join the party too. (inaudible) county executive to the sfh is rks s team and health service board. want to take a second to let you know we added two new members to the team that is servicing the health serveish board. we have gabby (inaudible) account manager out of the sacramento office and grace wu(inaudible) gabby is here today and asked her to stand. grace was not

able to join us today but you will see her in the future and we are excited to let you know about our new additions. thank you. >> welcome to you both and we look forward to your expertise and support as we move forward through our rates and benefit policy decisions and all the other stuff that we call on you for as a very good actuarially partner so thank you and welcome. are there other plan or partner representatives in the audience that have any updates or what have you? seeing none, we will now have- >> i have a question for the kaiser rep. you said and heard about the urgent care from friends who are san francisco kaiser members, but wondering if there is a urgent care option on the peninsula, daly city and south city, if there are urgent care options there? >> i don't know

off-hand but great question. happy to follow up. >> i appreciate it because what i find and this is my experience some time ago, but i hate to see the er filling up with people who aren't that ill so having a urgent care option is helpful. >> i will follow up. >> are appreciate it. >> are thank you. hearing and seeing no other plan representatives or other comment, we'll go to public comment on this item. >> thank you president scott. [providing instructions for public comment]

>> no one approached the podium. move to the virtual public comment and the

moderator will notify of callers in the queue at this time. >> board secretary, we have three callers on the phone line, one caller remains in the public comment queue from the previous round. reminder to callers on the line, dial star 3 now if you want to join public comment for this specific item. reminder to dial star 3 again to lower your hand in the queue. we'll wait 5 seconds and close public comment at this time. board secretary, we can elevate caller user number 4 to see if there is additional public comment. otherwise public comment is closed. >> okay. we'll wait a moment to see if caller would like to speak. welcome caller. with that i pleev believe the caller was hand raised from the last item. with that,

public comment is now closed. >> thank you. we will move on to item 14. >> thank you president scott. >> sorry, item 13. >> thank you president scott. item 13 is presentation on the 2023 rates and benefits calendar for the plan year 2024. this is discussion item and presented by abbie yant. >> good afternoon. abbie yant, san francisco health service system. the rates and benefit calendar in the packet is still current and i would suggest to the president that you consider canceling the hold on the february 23 service board meeting at the conclusion of this meeting. >> thank you. we will act accordingly by not haveic a meeting. isn't that great? is there public comment on this

item? >> thank you president scott. i will read the instructions allowed. >> thank you. [providing instructions for public comment]oud.

>> thank you. [providing instructions for public comment] no one approached the podium so move to the virtual public comment. the moderator will notify of callers in the queue at this time. >> board secretary, we have three callers on the line, zero callers entering the queue at this time. reminder to callers, dial star 3 if you want to join public comment for this item. we'll wait 5 seconds and close public comment for this item. board secretary, there are still no caller in the queue at this time. >> thank you

moderator. hearing no callers public comment is closed. >> thank you. since that was discussion item we'll move to item 14. >> thank you. item 14 review and reapprove the hartford fully insured rates and contributions. this is action item and presented by mike clarke. >> i will walk through the presentation. this is the first rates and benefit approval request for 2024 rates contribution fwr for the plans. there is a lot of good information in this material. hoping you had a opportunity to read through it. i'll go through the highlights. this is the second year of a 3 year rating commitment the hartford delivered last year this time so keep in mind the rates i will ask for approval do not change from 2023 to

24. this comes off of a negotiation from last year's cycle for the current three year rating agreement where there was substantial savings delivered. page 6 shows that last year. substantial savings across each insurance lines from 22-23 and the rates continue for 2024. so, you see for employer paid coverage for life insurance on page 7, long-term disability on 8, rates and enrollment in each of the plans. starting page 9 and showing the supplemental rates for member paid coverages and then overall on slide 10 just to give a sense of the aggregate premium expected to be paid in 2024 based on existing volumes for january 2023 projected out for the entire year. or the rates are the same for 2023 as for 2024.

with that, i will take you to slide 11, and ask for your recommendation and approval. it is recommended the health service board accept repneumof all fully insured life insurance, (inaudible) premium rates in the presentation for the 2024 plan year reflecting (inaudible) made by hartford this time last year for the 2023-2025 plan years and hartford plan years will be requested for approval at next year rates and benefit cycle. president scott. >> thank you very much. is there a motion? >> move we approve the hartford rates and contributions as presented. >> second. >> include we will be seeking rates for 2025 as well

as requested in the acuary recommendation. with that, any board comment or questions? hearing none, we will now move to public comment. >> thank you president scott. [providing instructions for public comment]

no one approached the podium so move to our virtual public comment. the moderator will notify of commenters in the queue. >> board secretary, we have 3 callers on the line, zero call rs specifically entered the public comment queue at this time. reminder to callers on it line, dial star 3 now if you want to join public comment for this specific item.

we'll wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you. public comment is now closed. >> thank you. and are thank you again for yourk work on this. we will take roll call vote. >> roll call vote- [roll call] it doesn't see commissioner follansbee is in the meeting now. i'll have to check in with him to see if he has access.

>> alright. >> the final vote is commissioner- >> it accepted by the commissioners at this time and we'll find out and determine commissioner follansbee vote on the item. it passed. thank you. >> thank you. >> just to give a sense of orientation about this agenda, we are going to do the finance committee budget items that are listed, then going to take a brief break after we vote to go into closed session. we'll take our break with that transition because there is a whole set up with technology and all the rest of that and we'll come back in the closed session item- [talking in the

background] the closed session item will be considering is the member appeal. as i said at the beginning of the meeting we didn't want the members to have to come back because we had gone in accordance with the printed agenda so made adjustment so the member appeal will be the first closed session, then after that is concluded we will go if to another closed-come out of that and go into another closed session to hear and review the executive director's performance evaluation. i just want to give everyone a sense of orientation where we are on the agenda. in the next 2 items will start with item 15 at this time. >> item 15 is approval of the san francisco health service system fiscal year 23-24 and

fiscal your 24-25 proposed general fund administrative budget. this is action item andprinted by iftikhar hussain chief financial officer. >> hello again. so, the finance committee reviewed the budget so i'll go through a few slides beginning with slide 3. so, in the general fund, what the mayor had proposed reductions to tied to the deficit, what we are proposing is a budget that is million 3 higher in 24 and million 6 higher in 25 from the targets we have been given by the mayor, and what makes up the difference is we are asking for a quality improvement position because we implemented several systems over the last

couple years. they never have been optimized and procedures haven't been documented so we think that this is really critical we have a position where we can optimize all the systems. the increase the mayor is asking for we feel that would-her concerns about wait times and ability to respond to member questions and concerns, so we think the increase in the attrition would hurt us. and the lastly we are asking for human resource-increases in human resources support to fill vacancies more quickly as they open up. if we can advance two slides. one more. this--the green column show what

we are proposing to the board. two columns before that is a budget that starts with the mayor target. that is general fund. i should-let's move on to the health sustainability fund. >> they are separate on the agenda. >> separate, sorry. >> happy to answer any questions from the board. >> are there questions from members of the board? we just had a finance committee meeting this week. we invited all the board members to come and participate if they had questions and some of us did that, so we are raising questions for the board members at this point on any of the budgeted items or total proposal at this point. hearing none- >> thank you for the presentation and think

as i for the benefit of the entire board at there finance committee i asked what the plan was if the proposed budget from hss did not go through, and so is there a plan b so to speak? >> yes, the plan b we would -like to fill vacancies minus attrition and would not be increase hr support. it is possible to manage but at the same time not optimal and we think we would-would have a impact on services. >> there is no other funding strategies to fund these? >> not really. we can do substitutions but in total the funding would be-what the mayor is looking for is a target. >> thank you.

>> alright. other questions? if not, i am ready to entertain a motion on this item. >> president scott- >> i move the general fund administrative budget. >> second. >> properly moved and seconded we approve the recommendation of the general fund administrative budget for the year 24-25. other questions from the board? hearing none we'll take public comment on the item. >> thank you president scott. i will read the instructions aloud. [providing instructions for public comment]

no one aproched the podium so move to the virtual public comment. the moderator will notify of caller in the queue at this time. >> board secretary, we have 3 callers on the phone line, zero callers have entered the public comment queue at this time. all callers on the line, you must dial star 3 now if you want to join public comment for this specific item. we'll wait 5 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 callers public comment is now closed. >> thank you. we are ready to vote on this item. >> roll call vote- [roll call] >> thank you. passes

unanimously. we'll move to item number 16. >> item 16, approval of san francisco health service system fiscal year 23-24, and fiscal year 24-25, proposed healthcare sustainability fund budget. this is action item and presented by iftikhar hussain chief financial officer. >> go through the just highlights page, and the key changes that we are seeking for next year is website improvement. our website is a little dated and we also need general improvements. the advantage here of communication vastly reduce calls. the more information people can get on line is available 24/7. the

second project is secure electronic communication for documents. when we do (inaudible) exchange electronically through our website. the third item is sales force automation which is a tool whereby members could use (inaudible) to get answers to simple questions. there is no fte change so those are the main highlights of the health sustainability fund budget. >> alright. are there questions or comments? this item was considered in the finance committee earlier this week. board members were invited to attend the meeting. i'm ready to inert entertain a motion. >> i move we approve the proposed san francisco health system healthcare sustainability fund budget.

>> is there a second? >> second. >> moved and seconded that we approve the san francisco health service system healthcare sustainability budget for the years 24-25. any further board comment? hearing none, we'll go to public comment on this item. >> thank you president scott. i'll read the instructions aloud. [providing instructions for public comment]

no approached the podium. move to virtual public comment. the moderator will notify of any callers in the queue. >> board secretary, we have 3 callers on the phone line, zero callers entered the queue at

this time. reminder to all callers, dial star 3 now if you want to join public comment for this specific item. we'll wait 5 seconds and close public comment for this item. board secretary, there are still no callers in the queue at this time. >> thank you moderator. hearing no furter callers, public comment is closed. >> alright. having no further public comment on this item, we are ready to take a roll call vote. [roll call] >> alright. thank you. we have now completed finance committee matters and i overlooked something. we'll do the governance committee items and then we'll vote to go into

closed session on the member appeal. item 17, please. >> item 17 review and approve the 2022 board education report and education plan for 2023 draft. this is action item and i presented this at the governance committee meeting this week but will hand it over to chair follansbee. >> thank you very much. can you all hear me okay? >> yes, we can. >> great. thank you. thank you. the governance committee met february 6 and had all three members present. the first item is to approve the 2022 board education report and education plan for 2023. holly if i can have the next slide. this is just basically a

summary you have the full deck of information in the packet sent out to us earlier from holly. this was the experience offered in 2022. i note that since i was the only to report self-education hours in 2022, i fully suspect that all the board members had additional hours not declared and there were several city wide and hss required trainings completed by all board members. if i can have the next slide. the education plan for 2023 is based on a survey that went out to all board members. listed the first, second and third ranked topics, and commissioners suggested (inaudible) board of education resource. and the resources that are available to board members are listed

below. and just remind all board members we receive formal fiduciary training every 3 years, the next time is 2024. next slide. education plan for 2023, 2025, outlined in the strategic plan also proposed with 2023-2025 and these are the educational goals to be addressed in the upcoming 3 years as part of the strategic plan. next slide. recommendation from the governance committee is approve the 2022 board education report and education plan for 2023-2025. entertain a motion. >> mr. chair, i move this is

commissioner canning, i move we approve the health service board 2022 education report and the education plan for 2023-2025. >> second. >> there was a second, yes. commissioner zvanski seconded. >> thank you very much. i open up for questions or further discussion. i would like to add that the assistance and suggestion of our secretary holly lopez, we will modify the questionnaire for 2023 to include a question about for each commissioner to report as part of the survey, the hours as part of that report so it is easier for members to commissioners to at least total the number of hours to get that formally into the report in the future. any other

questions or discussion items? >> just brief comment commissioner follansbee. even though you graciously allowed for the under reporting in the report, even there were hours reported in the prior report none have come to your standard, so you're to be commended for your devotion to education and self--study as you serve on this board, so thank you. >> thank you but again i want to say that based on my assessment of the contribution from all board members, i think there is--self-education that goes on throughout the year and i am not sure that i'm worthy of that praise. [laughter] thank you very much anyway. >> you are. >> any comments or questions? >> i see none. and hear none. >> okay. hearing none we can open up for public

comment. >> thank you chair follansbee. i will read the instructions aloud. [providing instructions for public comment]

>> no approached the podium and move to virtual public comment. our moderator will notify of caller in the queue. >> board secretary, we have three callers on the line, zero callers specifically entered the queue at this time. reminder to all callers on the line, you must dial star 3 now if you want to have public comment for this item. we'll wait 5 seconds and close public comment for this agenda item. board secretary, there are still no callers in the queue at this time. >> thank you moderator. hearing no further callers, public comment is closed. >> thank you. we'll

take roll call vote. sorry- >> go ahead. do roll call vote. [laughter] >> roll call vote- [roll call] >> the approval of the board education report and education plan for 2023 passed unanimously. thank you very much. we can go to the next item which falls under the governance committee. >> thank you. item 18 review and approval the 2022 annual board self-evaluation report draft. action item and presented at the governance committee earlier this week. chair follansbee will present the item. >> again, thank you very much holly and again, the governance committee met oen the 6 of

february and addressed this item and prepared this recommendation as part of that meeting. we have the first slide? this is just review of process and self-evaluation areas. i would like to commend we had hundred percent completion rate and also like to comment that the comments that each board member submitted were quite detailed and very helpful in the deliberations of the governance committee and included in the larger slide deck as well. again, i wanted to commend everyone for their thoughtful and complete comments in this regard. go to the next slide. just going to summarize the highlights, to show compared to

2021 and 2020 there was a significant improvement in the total score in all four areas for evaluation, and i think this is commendable and shows the board has responded to concerns from previous self-evaluations and seems to be on the right track. if we can go to the next slide. concludes to focus on 2023 actually is-call for 2023 is broaden the educational platform and invite more speakers we are beginning to address based on discussion earlier in this meeting, and there was a comment made by one of the commissioners to remind all of us to stay on topic during discussion to help keep the discussion focused and then

there was significant comments made on a few questions. number 24, the board communicates effectively to plan members and i think we need good governance committee in 2023 will review the wording of this question to make sure it is clear to all of the commissioners what the intent was of this because i think the consensus on the committee was there are a number of ways in which the board as a whole communicates to plan members through the news letter, the annual report and then detailed summary of all the member inquiries to on-board members as well. likewise, 27, there were confusion over the e wording of this question how the board communicates to the city and there was consensus among the committee members that there was multiple avenues of communication so like to

clarify intent of this question to make it clearer to all the board members. number 34, which is board insures management has necessary financial and human resources to achieve the organization's goals and again i think we want to commend the executive director and finance chief for reviewing this monthly including vacancies in staff in hss so we want to make sure this question is clear to all board members, and the number 38 the question feasible board engages in succession planning. this needs to be rewarded. the only succession management system is the role of the executive director and not other senior staff or other staff in hss and so we clarify that the wording of this question on the future

questionnaire so these are the tasks that outlined for the governance committee in 2023. with that, if we can have the last slide i think. maybe that is the last slide. >> you are correct commissioner follansbee, it is the last slide. >> with that, i entertain a motion to approve the 2022 annual board self-evaluation report draft. >> this is commissioner canning, i move we approve the 2022 annual board report draft as presented. >> second. >> moved and seconded. open up for further discussion and questions from all the board members. any questions-this is a brief overview of the material provided in greater detail to all of the health service board.

hearing no further questions or discussion, we can open up for public comment. [providing instructions for public comment]

>> no one approached the podium. the moderator will notify of callers in the queue now. >> board secretary, we have 2 callers on the line, zero callers entered the queue at this time. all callers on the line, dial star 3 if you want to join public comment for this specific agenda item. we'll wait 5 seconds and close public comment for this agenda item. board secretary, still no callers in the queue at this time. >> thank you moderator. public comment is closed.

>> if we can have a roll call vote on this agenda item. [roll call] >> thank you very much. passes unanimously so close item 18. i like to particularly commend our board secretary holly lopez for really preparing really detailed information on both of these items and having it available for us for our meeting on the 6th and today's meeting as well. it is task to bring this together and i want to congratulate her on her diligence in this process. thank you very much. >> thank you commission follansbee. i'm ready to entertain a vote-a

motion on whether we are to hold a closed session for member appeal. >> i move that we go into closed session for the purposes stated i believe for- >> member appeal. >> member appeal. >> is there a second? >> second. >> properly moved and seconded we vote to hold closed session for a member appeal. is there further board comments? hearing and seeing none, we'll go to public comment on this item. >> thank you president scott. this is item 23, public comment. i'll read the instructions aloud. [providing instructions for public comment]

>> no one approached the podium so move to virtual public comment. our moderator will notify of callers in the queue. >> board secretary, we have 2 callers on the phone line, zero callers specifically entered the public comment queue at this time. reminder to all callers on the line, dial star 3 now if you want to join public comment for this specific item. we'll wait 5 seconds and close public comment for this agenda item. board secretary, there are still no callers in the queue. >> thank you moderator. hearing no callers, public comment is closed. >> thank you. we are now ready to vote. roll call. [roll call] >> roll is called and we voted

unanimously to go >> we are out of closed session and willing to entertain a motion whether to disclose any or other discussion in closed egz is. >> make the motion we will not disclose whatever discussion and whatever decision we made in closed session. >> is there a second? properly moved and seconded that we are voting not to disclose what was discussed in closed session. any further discussion by the commission? >> i can take public comment. [providing instructions for public comment]

>> no one approached the podium so move to the virtual public comment. the moderator will notify of public comment callers in the queue. >> we have one caller on it phone line, zero callers entered the public comment queue at this time. you must dial star 3 if you want to join public comment for this specific agend aitem. we'll wait 5 more seconds and close public comment for this agenda item. board secretary, there are still no callerss thin queue. >> thank you modraert. hearing no further callers, public comment is closed. >> roll call vote on this motion. [roll call]

>> the motion passes unanimously. >> i believe one more- >> yes. >> entertain a motion on reporting on any action taken during closed session. >> i move that we do not report on any action during closed session. >> properly moved and seconded we do not disclose our actions taken in closed session. we'll now have public comment on this particular item. [providing instructions for public comment]

>> no one approached the podium so move to virtual public comment. the moderator will notify of callers in the queue. >> board secretary,

one caller on the line, zero callers entering the queue at this time. reminder to all callers, dial star 3 if you want to join public comment for this specific agenda item. we'll wait 5 seconds and close public comment for this agenda item. board secretary, all are still no callers in the public comment queue. >> thank you moderator. no callers, public comment is closed. >> public comment is now closed and ready to vote on this item. [roll call] >> it passes unanimously. we had another agenda item for closed session. that closed session will be differed until our next meeting and with that, this meeting is

adjourned. [meeting adjourned] the san francisco music hall of fame is a living breathing world that's all encompassing about

music. [music playing] it tries to do everything to create a music theme. music themes don't really exist anymore. it is $7, the tour is two floors, (inaudible) so, each one of these frames that you see here, you can-you are and look into the story of that act, band, entertainment and their contributions to music. affordability

is what we are all about. creative support. we are dedicated to the working musician. we are also dedicated to breaking some big big acts. we like to make the stories around here. ultimately legends. >> shared spaces have transformed san francisco's adjacent sidewalks, local business communities are more resilient and their neighborhood centers are more vibrant and mildly. sidewalks and parking lanes can be used for outdoor seating, dining, merchandising, and other community activities. we're counting on operators of shared spaces to ensure their

sites are safe and accessible for all. people with disabilities enjoy all types of spaces. please provide at least 8 feet of open uninterrupted sidewalk so everyone can get through. sidewalk diverter let those who have low vision navigate through dining and other activity areas on the sidewalk. these devices are rectangular planters or boxes that are placed on the sidewalk at the ends of each shared space and need to be at least 12 inches wide and 24 inches long and 30 inches tall. they can be on wheels to make it easy to bring in and out at the start and the end of each day. but during business hours, they should be stationary and secure. please provide at least one wheelchair accessible dining table in your shared space so the disability people can patronize your business. to

ensure that wheelchair users can get to the wheelchair accessible area in the park area, provide an adequate ramp or parklet ramps are even with the curb. nobody wants to trip or get stuck. cable covers or cable ramps can create tripping hazards and difficulties for wheelchair users so they are not permitted on sidewalks. instead, electrical cables should run overhead at least ten feet above sidewalk. these updates to the shared spaces program will help to ensure safety and accessibility for everyone, so that we can all enjoy these public spaces. more information is available at sf.govt/shared spaces.

>> you are watching san francisco rising with chris manners. today's special guest, carolyn mante. >> hi, i'm chris manners and you are watching san francisco the stow about restaffing rebuilding and reimaging the city. the guest is carolyn manteto talk about the organization is helping to preserve the city cultural heritage and architecture.

welcome to the show. >> thank you for having me e. >> good to have you here. >> can we talk bat the history of your organization and the mission. >> sure, thank you. san francisco heritage started 51 years ago and the main mission is to preserve and enhance the architectural and cultural identity of san francisco. when it started out the focus was really on the buildings, historic landmark listings and really concentrated on downtown area with all the development happening. our organization was raising a reg red flag with historic landmarks in danger and victorian mansions so a hallmark of our organization is moving these victorian mansions in the way of development to inwestern addition neighborhood and other areas to get out of the way of development and preserve them. our organization was around before there was the historic preservation commission of the city so we were at the

forefront drawings attention to historic preservation, landmarking and over the last 51 years we have seen how there are more then just buildsings in safeguarding the city cultural resources, there is also small businesses and the different neighborhood icons that make a neighborhood special, so our outreach has really-it is really come full circle in a way because it moved downtown into the neighborhoods and now with the covid epidemic it is really going back to downtown again looking at how we can play a role in the economic recovery and revitalization of downtown san francisco. >> that's great. so, now i understand your organization is also responsible for maintaining a couple properties. could you tell us a little about those? >> yes, our non profit was gifted in 1973, the historic (inaudible) house. it is now a historic house museum

but this was a family since 1886 built this victorian mansion in the same family year after year and one of the last resident of the family when she passed way gifted the mansion to san francisco heritage so since then we have been running this historic house and the home of our office. in 2018, one of the long time members nor aa lasten gifting a building on the e h-as hate polk became a commercial corridor after the earthquake, the owner at the time, he raised the house and put 6 store front underneath in order to take

advantage of the commerce so we are in charge of the house on the corner and it has been a wonderful way to get new numbers, new audiences interested in the work of our organization. during the pandemic, we have been using it as a artson residents and partnering with different bay area artists as well as cultural institutions, cultural districts and then one of the storefronts we converted into a pop up galleries so gives a opportunity to raise awareness of the importance of the art and cultural resources in san francisco. >> that's fantastic. so, now, let's talk about legacy business. what does the designation mean? how does somebody get add today the legacy business registry and what benefits does being named a legacy business? >> i love this program. it was started by san francisco heritage and adopt ed by the city and run by the office of small business but the

program looks what are the businesses really contributing to san francisco and the neighborhood. when we started the first focus was bars and restaurants but over the years it exb panded to include other businesses so these are places that contribute to the character of a neighborhood, so sam's grill downtown, the amazingarian press in the presidio. book stores like city lights oergreen apple recently named. this year we had a lot of attention on the legacy business program. we put out a contest to the public of what you think should be the next legacy business and one of the businesses that was recommended was the club deluxe, jazz club on the corner, and 2 or 3 days after we launched the contest, the owners announced they would have to close. the rent was driven up, they couldn't afford it, coming out of the

pandemic so we worked at speed to get that application submitted with them and that status convinced their landlord to negotiate with them a lower rent and this way they have been able to stay, there was a lot of social media support around this, so when you become a legacy business, not only do you get marketing and business support from the office of small business, but you also eligible for grants and we work closely with the legacy businesses as we do our work for san francisco heritage. >> that's great. so, apart from architecture and buildings, you also work with cultural districts, and the castro theater strikes me as a place that is both. a beautiful building and cultural hub and center. what has been happening with the recent acquisition by new owners; >> it is leased to

another planet entertainment and been in contact with planet entertainment by the castro theater is historic land mark building. it is recognized as a very important architectural monument. one thing-one of the main activist organizations of the preservation of the theater we work together with supervisor mandelman on a interior landmark historic landmark designation for interior, but what happened over the is summer and people learned is there is a lot of concern not just by san franciscans but people all over the world, movie directors, stars who are very concerned about the risk to the

lgbtq and film programming at the castro theater. another planet hosted community stakeholder in august, and it was so moving to see the number of people who took the microphone-everyone had two minutes to say their testimony of what castro theater meant to them and those testimonys showed this building is contributing not just as a architectural monument but plays a role in the lgbtq community that is irrelaceuble able. >> it is beautiful theater. >> it is. my involvement in the theater raised awareness to not only the castro theater to be emblematic of the lgbtq culture and history but also there are many other sites in the city that also contribute to the identity. that is why so many people come to

san francisco as a place of freedom and diversity so in my previous work i worked at the world heritage center, so when i joined san francisco heritage i was thinking why isn't san francisco a world heritage city? for the architecture alone it could be inscribed. golden gate bridge to name a few but the city is so unique in the architecture, the mansioned and historic landmarks so hoping to start a conversation on that with city stakeholders this year. >> that is great. let's talk about your relationship with other agencies. you mentioned economic and office of work force development and planning commission. how do you unt integrate to them? >> these relationships are essential. we are working with office of small business for the legacy business program and

the planning department is really one of our most crucial relationships. we meet quarterly with them and we really see how we can support not only historic land mark listings and historical cultural context statements, strategy for culture districts and city survey among many other activities that really are of concern to both of us. for the office of workforce development, i attended a etmooing recently that the chamber of commerce organized with them on the downtown revitalization and a key goal in that meeting and in the downtown revitalization is to make sure that the city historic culture resources play a key #r0e8 in the economic recovery and revitalization especially after the pandemic. the office of workforce development has the city build program which is admirable program where youth are trained in construction

techniques for rebuilding and especially with the new housing legislation, and we really want to see how can that workforce be expanded to include training in historic preservation. we have so many victorian homes, historic buildings and other places that really need a skilled labor force to make sure that they are preserved and that they help keep the special identify of the city. we really value these relationships, we meet quarterly with the various organizations and we are really grateful for grants of the arts we receive and other supports so definitely that is a key relationship for san francisco heritage. >> the city build is great. i like that a lot. thank you so much for the time you have given today. appreciate you coming on the show. >> thank you so much raising awareness about san francisco heritage. we hope the people watching will join us in the mission to help keep san francisco special.

thank you. >> that's it for this episode. we'll be back shortly. i'm chris manners, thanks >> the market is one of our vehicles for reaching out to public and showing them how to

prepare delicious, simple food. people are amazed that the library does things like that. biblio bistro is a food education program. it brings such joy to people. it teaches them life skills that they can apply anywhere, and it encourages them to take care of themselves. my name is leaf hillman, and i'm a librarian, and biblio bistro is my creation. i'm a former chef, and i have been incubating this idea for many years. we are challenged to come up with an idea that will move the library into the future.

this inspired me to think, what can we do around cooking? what can i do around cooking? we were able to get a cart. the charlie cart is designed to bring cooking to students in elementary students that has enough gear on it to teach 30 students cooking. so when i saw that, i thought bingo, that's what we're missing. you can do cooking classes in the library, but without a kitchen, it's difficult. to have everything contained on wheels, that's it. i do cooking demonstrations out at the market every third wednesday. i feature a seafood, vegetable, and i show people how to cook the vegetable. >> a lot of our residents live in s.r.o.s, single resident occupancies, and they don't have access to full kitchens. you know, a lot of them just have a hot plate, a microwave, and the thing that biblio

bistro does really well is cook food accessible in season and make it available that day. >> we handout brochures with the featured recipe on the back. this recipe features mushrooms, and this brochure will bring our public back to the library. >> libraries are about a good time. >> i hired a former chef. she's the tickle queen at the ramen shop in rockwood. we get all ages. we get adults and grandparents and babies, and, you know, school-age kids, and it's just

been super terrific. >> i was a bit reluctant because i train teachers and adults. i don't train children. i don't work with children, and i find it very interesting and a bit scary, but working here really taught me a lot, you know, how easily you can influence by just showing them what we have, and it's not threatening, and it's tasty and fun. i make it really fun with kids because i don't look like a teacher. >> in the mix, which is our team center, we have programs for our kids who are age 13 to 18, and those are very hands on. the kids often design the menu. all of our programs are very interactive. >> today, we made pasta and garlic bread and some sauce.

usually, i don't like bell pepper in my sauce, but i used bell pepper in my sauce, and it complemented the sauce really well. i also grated the garlic on my bread. i never thought about that technique before, but i did it, and it was so delicious. >> we try to teach them techniques where they can go home and tell their families, i made this thing today, and it was so delicious. >> they're kind of addicted to these foods, these processed foods, like many people are. i feel like we have to do what we can to educate people about that. the reality is we have to live in a world that has a lot of choices that aren't necessarily good for you all the time. >> this is interesting, but it's a reaction to how children

are brought up. it is fast-food, and the apple is a fast-food, and so that sort of changes the way they think about convenience, how eating apple is convenient. >> one of the things that i love about my program out at the market is the surprise and delight on people's faces when they finally taste the vegetable. it's been transformative for some people. they had never eaten those vegetables before, but now, they eat them on a regular basis. >> all they require is a hot plate and a saute pan, and they realize that they're able to cook really healthy, and it's also tasty. >> they also understand the importance of the connection that we're making. these are our small business owners that are growing our food and bringing it fresh to the market for them to consume, and then, i'm helping them consume it by teaching them how to cook. >> it connects people to the

food that they're buying. >> the magic of the classes in the children's center and the team center is that the participants are cooking the food themselves, and once they do that, they understand their connection to the food, to the tools, and it empowers them. >> we're brokering new experiences for them, so that is very much what's happening in the biblio bistro program. >> we are introducing kids many times to new vocabulary. names of seasonings, names of vegetables, names of what you call procedures. >> i had my little cooking experience. all i cooked back then was grilled cheese and scrambled eggs. now, i can actually cook curry and a few different thing zblz

. >> and the parents are amazed that what we're showing them to cook is simple and inexpensive. i didn't know this was so easy to make. i've only bought it in the market. those comments have been amazing, and yeah, it's been really wonderful. >> we try to approach everything here with a well, just try it. just try it once, and then, before you know it, it's gone. >> a lot of people aren't sure how to cook cauliflower or kale or fennel or whatever it is, and leah is really helpful at doing that. >> i think having someone actually teaching you here is a great experience.

and it's the art of making a meal for your family members and hope that they like it. >> i think they should come and have some good food, good produce that is healthy and actually very delicious. >> cooking is one of my biggest passions, to be able to share, like, my passion with others, and skills, to h h h h h h h hh

[bagpipes playing]

>> welcome to mayor breed's balcony here at city hall. for those of you who don't know me i'm joann haze-white and i'm happy to be host of flag. the flag has played a role

including building, engineering, science, mathematics, education, and public service. my father emigrated from ireland in 1949 and like so many immigrants here to california specifically to san francisco, he found opportunity and a very warm welcome. he also found the love of miz life, my pom patricia haze, a native san franciscan but her parent. so my siblings and i have been raise withed a great pride in san francisco and also in our irish heritage. i'm happy to be joined by my sister patricia haze and she was 1991, rose of trolly. so let's get on to the program. first and for most, the reason we're here today because she is wonderful leader also a native

san franciscan, i would like to introduce the 45th mayor of san francisco, mayor london breed. [applause] >> mayor breed: thank you so much chief for stepping in to serve as our mistress of ceremony in this irish flag raising ceremony and it's always a tliet delight to have you here every year. in fact what i notice every year when we do this flag raising, you start really really early and you don't leave until city hall closes. liam, it still trying to understand what that is all about. but it reminds me of my family when you don't see each other for a long time, it does feel great and one of the other thing that i appreciate about this time of year is it feels

like spring is coming. we're start to go see the sunshine, people are coming together and able to celebrate like we were not able to do during the pandemic. so we appreciate it so much more than ever before. when we talk about the rich irish history, i cannot think about the great water that we are able to drink because of hetch hetchi and san francisco has the best drinking water without a filter anywhere in the country! and thank you so much for that contribution to san francisco because it saves me a lot of money on purchasing bottled water. but also, i just want to express my appreciation for just the support that i've received from this community. you know when i first became mayor under very challenges circumstances, so many of you supported and embraced ed lee

and when we lost him and i became mayor, this community truly embraced me. and i was really excited and honored, i still wear this even when it's not saint patrick's day to celebrate the irish in san francisco. but in 2019, pat, i can tell you this because you can appreciate it. when i agreed to serve as the grand marshal i committed to every single responsibility that i was required to do and liam said, well you don't have to do everything. and i said no, i'm taking my role seriously, i'm going to show up to all the events and activities. so pat, it's your serve serving as one of the prestigious grand marshal it's an honor to do so. not just because of the great parade but also because you have an opportunity to represent the community in so many amazing ways.

this community really truly represents public service. making sure that the shut in are not forgotten and that the community is supported. i'm looking forward knowing you are the chair of the famine memorial committee and now that you're grand marshal, we're going to work hand and hand to make sure it gets done in san francisco. [applause] and i'm really excited that, although i miss robert drisco, he was so great. we welcome you, we look forward to our continual relationship. our new council general, if you have not met him i would be

surprised because he's making sure na the relationship between the san francisco and bay area and irish community and ireland continues to exist. we know so many of you, many many years ago, your families migrated here for a wonderful opportunities. and at a point in san francisco's history, this represented a significant part of our communication and what chief alluded to, really helped to shape the city through engineering and mathematics and so many other marvelous things. as we celebrate and uplift this community, it's a chance to reflect on that history and make sure that we're doing everything that we can to carry on the legacy of the people who came before us. so with that, it is my honor to truly thank you all for being here. and to ask council general

smith to come forward as we, celebrate today's flag raising, i want to also say that tonight city hall will be lit up in green during the day of the parade in san francisco, city hall will be lit up in green and on st. patrick's day, officially march 17th, city hall will be lit up in green to honor that history and on behalf of the city of san francisco, i officially declare an irish-american friendship and heritage day in san francisco. [applause] and i have one more proclamation for pat unique, i want to ask you to come on up and thank you for your work with the treasure island soccer

team and so many other great things that you do in the community. we appreciate your advocacy and i know that your children, you have many of them, that they will carry back the legacy of the work that do you and give back. on behalf of the city and county of san francisco, i officially declare patrick martin uniak day in the city of san francisco. [applause] and with that, everyone enjoy the festivities, enjoy your city hall but please don't get in trouble. i want to make sure that you all get home stavely as you all have a really good time during this flag raising ceremony and all the other great activities that will exist in san francisco over the next couple of weeks.

and we turn it back over to chief joann haze. oh, liam is crashing the ceremony. thank you. >> so last year liam gave me a shamrock crystal, it is absolutely beautiful. this year, it is the american flag. very beautiful, thank you. [applause] all the way from ireland. where waterford crystal is made. so thank you again. thank you deny to dormont or sister city and i know the pandemic stopped me from going to ireland. i cannot be the first mayor in the history 1984 of the sister

city relationship to not go to ireland dermont. i'm looking forward to working on a trip sooner than later. thank you all for being here today. [applause] >> thank you so much, mayor breed for your remarks and for your leadership in our city. at this time, i would like to introduce the relatively new consul general from ireland in san francisco and ironically, the office that i work in is one floor above yours. so i'm down and it's a beautiful place. woiz like to have consul general approach. thank you. >> just look around, my first few months in the city, this is truly amazing. this will really do your heart good. i want to thank mayor london breed for being such a friend of ireland, of the irish and of

irish-america and in my short time here, i see what you do for the people of san francisco, thank you. and we will have you in ireland in the next few months, i can promise you. i thought that was for me behind me. keep it going. today we raise the flag for irish flag in san francisco and not just the heritage but the city that has been a melting pot, the people from all over the world, a community of values and diversity and inclusion and acceptance. this is long been a home to the irish, this is a city that the irish helped built and shape and it's a city where the irish have forjd multi ethnic, friendships and unions. for st. patrick's day this year, we celebrate 100 year in

support of peace and international order. i want to recognize, the fact that artmiss the international community for the past 100 years. member of eu and ecc for the last 50 years and with and sign with the help of irish america. we also celebrate the fact that it's been nine years since the consul opened here. it's a great privilege for us mayor. we also marked the first just resent rethe first anniversary of russia's invasion, the further invasion of ukraine. the u.s. continues to stand with the people of ukraine and we also support as people flee the country, we welcome them to ireland and we support in and

imposing sanctions upon russian a. i want to recognize the consul general. i ne the people here of irish-america has been supportive of you. slavi ukraine'. thank you to liom frost and the board of directors, i know the work that they do every year throughout the year to ensure that st. patrick's day is celebrated across the city. thank you. i also like to recognize the grand marshal pat uniak and his wife, great people and his initial that lead on many initiatives an honor could not be better deserved. thanks, pat. [applause] i should also recognize and

thank the mayor's team and maroon, mark, sean, i know is not here, thank you for all of your support. merriam, chief of protocol thank you for welcoming me. as it flies along the stripes, it's the irish flag is 1 75 years old this year. its history france ireland and u.s. tomas france mayor, a young irelander, brought material orange white and green to ireland. this young irelander finished his days in montana and both u.s. and ireland. i leave it there, but all i can say is, look forward to enjoying this st. patrick's month ahead. by the end it, i will look ten

years older, but i'll have a great smile and big heart. thank you. [applause] >> thank you, consul general smith. and i think we're going to be treated to the murphy irish school of dancers for their performance and while they're setting up, i would like to acknowledge the consul general of ukraine, thank you for being here. and also a friend to many people and excellent city attorney, david chu, thank you for being here. so i leave it to irish dancers. [irish music playing]

[applause] >> thank you to the murphy

school irish dancers, let's hear it again for them! [applause] next up i would like to call liam frost, president of the united irish society of san francisco. >> thank you joann and thank you for stepping up and being the mistress of ceremonies for us. i do want to welcome everybody to the 172 st. patrick's day season, thank you all for coming. i want to thank the san francisco bagpipers and murphy school of irish dancing for entertaining us. those kids are going to be the ones out here either at the podium or sitting where you are continuing our traditions. so it's great that we see them out there and that they're supported in every way that they can be. thank you again. i want to thank the mayor for

host hading the flag raising and making us feel welcome. every year we come here, whether it's the covid or we have to move, it's great to get us back in this area. it's amazing what the flag being raised and everybody being able to come here to enjoy this. i want to thank kevin birmingham and ma rhone from the mayor's office for putting this together. i get a couple of phone calls and they make everything work smoothly and it's amazing. and i do want to welcome our new consul general, niehal, his wife, claire, sorry, the brain thing. and the vice consul general, jennifer chadwick, thank you. i want to thank stephani and

the one person that helped her put it on adrian roach and sponsored by the soe, of realtors. so thank you. [applause] putting on the parade and the festival is a lot of work and i get up here and get the opportunity to get the accolades but it's all the people behind the scenes, my board but especially for parade, kathleen, teresa and james quinn. [applause] and then closing down san francisco to allow us to have that parade, we need the help of a lot of your city agencies, and they do a great job, bill scott, his station, my good friend captain doug and derek and then the man with the boots on the ground, sergeant tobey moore. they do an excellent job for us. [applause]

and i want to thank and congratulate our grand marshal, pat uniak, and all the families of the honorary grand marshal. it's definitely a honor but it's also a commitment and as the mayor said all the events with her busy schedule, we can hope that she leads the way and you can follow. but we appreciate it, your wife una and pat is getting all the accolades but we know you'll be helping him out, so we get it pat. as well as all the families of the grand marshals. thank you. [applause] so it is the season to be irish, we invite everybody to be irish come out and celebrate with us. especially the irish from san francisco, those are two great traditions. the irish traditions are faith, family and community and by all your support, that's what it's

all about. let's move forward and hurl into the future. thank you. [applause] >> thank you, very much liam. we're all looking forward to the parade next weekend. next up, i would like to call, you've known me since i was a little girl. we have retired deputy chief and he served with distinction. [applause] >> thank you, mayor breed, ladies and gentlemen, we are very very happy again to be here with you in this great beautiful city hall to welcome everybody to the st. patrick's day celebrations. and to see, for so long there,

we've always taken the mayor back so you are our next candidate to go to ireland. as far as the celebration is concerned this year will be as good as ever. going way back the first parade was in the 1860s along kearny street. at the time the paper said, and the consul general would appreciate this, that it was lead by a group of is to lar irish men carrying custodycudgels. they were carrying curling sticks. he's also a fine fine athlete coming from ireland. if any man knows how to handle a curling stick is pat and he helped to field the fields. wonderful wonderful candidate and we applaud him and thank

him for being the grand marshal of this year's parade. thank you very much and have a great great. >> have something for you. >> thank you merdent. and i would like to present a certificate of honor you've been involved since the beginning. thank you so much. [applause] >> and next i would like to ask the bagpipers band to come up and receive a certificate from

mayor breed. [applause] all right, i see brendan o leaery. come on down, the irish pipers. thank you to the irish pipers. and finally for their wonderful performance today, the murphy school of irish dance. [applause]

so just to close things up, thank you to mayor breed for her welcome into city hall. and saving the best for last, our grand marshal patrick. i know patrick that you knew my father and i always say, big city small town, i went to school with his daughter teresa who is here today. and the uniak family, pleasure to know you, but our sons, your son and my son are good friends. that's what the irish is about, building communities and friendships. please come out and honor the grand marshal next weekend, march 11, the start of the parade 11:30. thank you. with that, there is a reception for to you enjoy and continue to communicate with each other and celebrating irish heritage. all right. >> are you ready?

>> okay, here we go. [applause]

good morning it meeting am come to order welcome to march second, 2023 molting of government audit and oversight committee of the san francisco board of supervisors i'm dean preston joined by vice chair stefani and supervisor connie chan the clerk is stefani cabrera thank sfgovtv for staffing the meeting the board of supervisors and committees are convening hybrid meetingly allow in person attendance and public comment is remote access and public comment via telephone. equal access is essential and take public comment as follows.