continue to unravel. i just want to cautious everyone that you should always check so that you're not surprised in how things work for you in your particular health plan. but in general things are moving to the health plans to be responsible for the vaccines and testing. and some of these are a little shoft because there is a stockpile of vaccines and they're trying to make sure all of that stuff gets used up. so that's really complicated. that's why things are a little bit vague. but as the stockpiles get used

up, we're treating covid more like influenza and other infectious diseases and coming out of the pandemic. so that will get clearer as we go forward. i think that's all i have to report unless there are questions. >> are there any other questions regarding the director's report. >> so has the vacancy changed? has more been hired? >> that was as of 17th, so yes, i update these numbers are hr month low. >> good. it gets even more confusing because we're in this overlap period of having our next year's budget reviewed and approved at the mayor's office.

so sometimes our count are different. and trying to get the people that we need to do the work that hhhs has. it's always a challenging time and with the budget shortfall that the city is experiencing, it's particularly khal epging. --challenging. i have not seen these shortages in years. >> any other question. >> just one more question. i'm always interested in epa report, are we noticing the diminishing of number of calls that are now coming in since things are changing with the whole covid?

>> you know, it's too soon to tell. we continue to heavily promote mental health services and with our health plans because we know that one of the problem that's still exist but it was great impact was the stigma that prevented people from mental health t.stablelized at a higher level so we have assurance that people are getting the help that they need. and then we're continue to go work with other initiatives that will help people earlier in their their mental health needs. >> if not, go to public comment. >> thank you, president scott. public comment is now open

instructions are being displayed on the screen for those watching. in-person public comment will be first and then virtual public comment. for those callers on the line, please press star-3 to be add to the queue. for those on web ex, please click the raise hand icon to speak. we'll move to our in-person public comment and nobody has approached the podium so we'll move to our virtual public comment. and our moderator will notify us. >> madam secretary, we have three on the phone lines and zero have entered the speaking queue. you must star-3 now if you wish to join the queue. we'll wait 5 more seconds and then close public comment.

>> thank you, hearing no public callers, public comment is now closed. >> item number 7 is financial report as of january 31, 2023. this is a discussion item and will be presented by hussein, chief financial officer. >> welcome chief financial officer, how are you this afternoon? i'm glad to hear that. >> we had plan to decrease to we were having a 14 and a half for this year. we're coming in, we expect to

have a 12 million dollars drop because of two unexpected items. one we had a item off the settlement of 14.7 million that didn't help the trust fund but also experiencing very high claims on the on our blue shield medical plan. and we're work withing blue shield to understand that that comes into play when settling rates the following year. so more to come on that as we go into the calendar for 2024. 14.7 million and really good very consistent from year to year. because the higher interest rates this year, stability

fund, we expect the year at 2.7 million still very healthy. and on the general plan, we're running ahead of plan >> happy to answer any questions. >> any questions from the commissioners? if not we'll have public comment. >> thank you president scott. public comment is now opened. in-person public comment will be first and then virtual public comment. for those in the room, approach the podium. we'll move to our in-person public comment and nobody has approached the podium. we'll move to our virtual public comment. and our moderator will notify us. >> madam secretary, we have

three callers on the phone line. zero have specifically have joined the queue at this time. for callers on the line, you must dial star-3 now if you wish to join the public comment queue. we'll wait 5 seconds and then close the public comment. board secretary there are still no callers on the queue. >> thank you, moderator. hearing no public comment callers, public comment is now closed. >> thank you, we now move to rates of agenda. we use today have a standing committee of rates and benefits that was sub set of the board as our finance and budget committee and governorance. we changed that about six years ago after a review that we were

redundant. and it's added a lot of sanity to the process. given that, we're ready to take number 8. >> item number 8 is the presentation for the plan year 2024. this is a discussion item and will be presented business xek tough director of hhs. >> good afternoon, commissioners avi executive director shfhs. you have in your calendar the rates and the only change reflects the march 9 meeting cancellation and today's meeting otherwise everything else is the same.

>> this is a discussion item. >> thank you, are there any other questions about the upcoming rates and benefit calendar? from the board member, we'll now go to public comment. >> do you need a motion? >> no this is a discussion item. this is a discussion item. we've had continuing discussion buzz the rates and benefits on calendar. >> public comment. public comment is now opened instructions are being displayed on the screen for those watching on sf gov. tv and web ex. in-person public comment will be first and then virtual public comment. we'll move to our in-person and

nobody has approached the podium. >> board secretary we have three callers on the phone line and zero have enter the comment queue. a reminder on the line, you must dial star-3 now if you wish to make public comment. we'll wait a if you more seconds and then close public comment for this agenda item. board secretary there are no callers on the queue at this time. >> thank you, public comment is now closed. >> thank you, we'll now move to item 9. >> agenda item number 9 is move and approve, this is an action item and will be presented by

hussein of, sfhhs chief financial officer. >> getting logitics organized. so any report, i'll point out some highlights. we it does show the report the premium as well as the county contribution for a single coverage that they offer to their employees. so one of the thing we do is look at the employer

contribution, not a premium and also reproject the premium. so the net result is an increase of about 3 points 3 percent, i think, 3.2 percent in the calculated for the >> happy to answer any questions. >> that moved the dollar amount to 85 and 85 cents monthly? >> correct, it's 3.21 percent. excuse me. all right. >> i move that we approve the results for 2024. >> it's been moved and seconded that we approve the recommendation to of the result

of the survey under the city charter provision for the plan year. >> we have a question about san diego county, they had a significant drop of 1.89 percent. there was one health plan that dropped out, basically i'm confused how they calculate this. is this waited? how do they calculate these averages or percentages or whatever, because that drop was quite outstanding compared to every other county. >> so the way the formula works is a simple average of the plans offered. >> so it's afternoon. >> and yes and because it's on data, it's not available.

so the formula is simple average of the plan. and anytime, they had some high cost plans that got dropped that you would expect so it works both ways. >> so it's an average and not weighted average. >> no, we don't have that. >> thank you. >> and also we're limited in terms of how comparable the designs are. if i'm not mistaken. described how these plans would line up against the plan benefit provision that's we're providing prince. >> yes, so the premiums can change for two years. >> right. >> so i think that we need to just make that footnote that this is an average of numbers, it's not looking at planned detailed or other policy issues that may drive decisions at

this board level, it's really a numerical calculation. >> that's the way it's always been done. >> yes, it's always been done that way but i'm just highlighting what this does present and what it limits there are around the data. >> i guess, sorry, i was just struck, i don't remember. i've been on the board for 7-8 years and i know this is the way it's always been done. i was struck with san diego county, that one of the plans was a drop of 100 percent and one is 42.2 percent, and that really changes that number. and thep it goes washed out.

note this, that it is sort of a limited, number in that regard. >> it actually is an average. >> right. >> so the minus 1 does not kick in that plan. but i see your point. it's a fairly straightforward calculation. >> but the power of a ten county average is really to sort of minimize the impact of one sort of counties, or radical changes and plan and might affect their contribution their that year. because in the last, it was with everyone else's. >> sant clara county has always helped us out. >> this is the highest.

>> i remember having a friend that lives there and they have very good benefits. >> clarify, did you say that this is based on a single? >> yes, all the numbers shown are more, we had to pick coverage. so in the formula, it says single employee rates are used. >> so what are the single employee, rate, thank you. >> all right, are there any other questions or comments on this item? if not i would like to entertain a motion for its adoption which we've had. and is there any public comment? >> we can move to public comment. so public comment is now open. instruction right side being displayed on the screen for those watching on sf gov. tv

and web ex. for those callers on the line, press star-3. and those on the web ex, click on the raised hand icon to speak. nobody has approached the podium so we'll move to our remote public comment. and our moderator will let us know if there are any persons on the queue. >> we have three callers on the phone line, zero callers have entered the queue at this time. a reminder on the line, you must dial star-3 if you wish to enter public comment. we'll wait 5 seconds and then close public comment. >> still no callers at this time. >> hearing no more mod raiders, public comment is now closed. >> roll call. >> aye.

>> commissioner breslin. >> aye. >> commissioner follonsbee. >> aye. >> aye. >> it passes unanimously. we're now ready to move on to number 10. >> review blues shield of california, h m.o. plan 2022 claimsed and aoutization experience and approve the reserve surplus as of december 31, 202 2, this is an action item and will be presented by mike clark with anne. >> good afternoon, michael and welcome. >> thank you, mike hart from anne, here to present on 2022 claiming aoutization experience for the blue shield flex funded plans and ask for your approval for use of one-third of the

stabilization reserve for 2024 rating. so the agenda, you'll see what we'll cover. i know that chief financial officer hussein has talked during today's finance update as well as prior board meetings. i'll go into more detail as to what is happening in the blue shield h m.o. experience for 2022 quaoe cost utilization. and at the end of my presentation is what i'll ask is your approval of use of one should ieder of what is now a deficit in the stablation --stabilization. of the calculated stabilization deficit balance of 10,077, 000. as the epo plans for 2024 which

would leave 6,718,000 remaining for 2025. so first, for my high level just talking through the experience on plan, just reminder there are two plans in place, and please keep in mind that the uhc split familiar life was introduced. so just wanted to be clear that this does cover even those split family that were for 2022 so just to be clear on that. the plans have been available for many years that was first available in 2018.

when we look at the high level information, i'll review more dough tails on cost utilization here shortly. contingency reserve increased 13% on a per employee and retiree per month basis or pbpm. this came on increase, the 9% increase was largely due to the lower 2020 because of medical claims due to the pandemic. what is driving the 13% increase is largely a substance increase in large claim expense that occured in the plan for 2022. sxl just as a reminder that would be a larger percentage had not the rfp happened leading to the recommendation and passage by this board and february 2021 because it as a resulted in substantial reduction in the administrative service fees as well as a shift

from partial rebate sharing in preparation drugs that started in 2022. and you'll see the item details in this report. this also coincided with total premiums collected with 1% from 2021 levels into 2022. then in part reflected the benefits that were delivered through the rfp process. which means that overall expenses were higher collected, largely driven as you'll see in this report by a substantial increase. the next page what the cost change was going from 2020 to 2021 primarily for fed med cal driven by a more suppressed 2020 claim level. you can see the difference in the percentages for medical between before large claim

reimbursement. the large influence was primarily primary happened with both price and utilization. the next page, you see the benefit on a per employee basis. that occured in the 2022. cap tation, which are fixed cost for certain position

delivered medical services, increased at a typical trend rate 6 percent and as we reviewed with you in january, we had reserve increases for both and con teng end see for this plan in to 2022. the other element that declined overall by 4.4 percent between 21 and 22, driven in the sum part with migration, there is a little bit of plan migration that happens every year, that was general number of total eligible lives reducing. employee per month base shows the clear indication especially when you look at the right hand column what the percentage change was from 21 to 22.

you'll see the large reduction in administrative fees, benefit from the rfp but offset bit medical claim increase where a lot of that was large claims. the benefit of the pharmacy rebates, the rebates grew by a percentage but the claims escalating the way they are in large part due to specialty medication influence. and then the next page, early category in particular, you'll see last claim in total. and it turned out there was 17 individuals that exceeded 1 million dollars in claims during 2022. i would say prior years tend to average somewhere in the neighborhood of 5-8 individuals.

so there were many more, 7-figure claimants and many got into the 3 million, 4 million and even higher range. there was a lot of pressure on large claims so. that large claim pooling amount was over twice as high as it has ever been. the next highest was a little over 9 million in 2019. so that gives you a sense of the pleasure that they put on the plan. you have a large plan pulling in place for this because it was a dollar reimbursed by blue shield but also, you know, the plan is still responsible for the first million and there were many more of them in the past year than in prior years.

so some of the key drivers, 49 in total. 49 covered lives where there was 18 in 2021. so again you can see the higher pressure, the 49 individuals that exceeded 49,000 accounted for almost 60 in the plan. now again, 21.7 million was reimbursed. but that compares to 4.3 the year before. the categories you know, if you look at just the typical diagnostic categories that make up the large claimants, didn't change a whole lot from last year. it's primarily childbirth, expensive new born and cancer and cardiovascular and also

casdosemia was a factor in 2022. you know something else that we spend time with blue shield looking at, is what is happening to the overall health of the population. and i know that talk next meeting and have that information on the impact of 2022, what blue shield tracks is the individuals who have a chronic condition. and this is en insightful because it tracks a three-year period. starting with the pandemic, october 2019 through 2020 is going to capture some pandemic experience. but you can see how changes in these categories and the you know, what this happens is incidents.

for instance, at the top, you can see a quarter of the population, has some form of skeletal condition. 12% more population, exhibiting a skeletal skull. the cancer diagnosis, 16% growth, and 17 growth in cardiovascular life. so it could be a function to people returning to preventive care or new diagnosis or perhaps just a function of how health is, progressing for individuals.

you know, that we're a couple of years out from the start of the pandemic. certain preventive categories including general preventive screening at the bottom of the page as well as specific cancer screenings, the good news is we're seeing increases for this population in the most resent 12 months available for preventive screening. but you can see telling that first column which represents about half, generally much higher rates of screening that occured versus what was observed in the blue shield data for the resent 12 months. including some preventives, we've seen some bounce back but not to the level that existed prepandemic.

some good news is members have started to embrace mental health service delivery in service. about 30% through their provider but half overall of mental health visits and you can see the progression and how they varied in terms of utilization but about half being processed through blue shield is happening through virtual. so virtual is contributing for mental health needs support. and then pivoting the prescription drugs, claims per covered life had 11 percent increase. versus the prior, and it was

fairly evenly split between cost and utilization, but no surprise and very consistent with what we see with other client data nationally, almost half is driven by especially medications and it's just an emerging, you know, cost concern that we're going to continue to see as drug manufactures continue to focus on expansion of available medications to meet member needs. drug class that's were driving, included dermatolgical drugs and cancer drugs. so with that, we go to three reserves for the self funded plans as you see. we addressed the ibr back in january and today's focus with

this presentation and the two that will follow is stabilization. and this is based on the health service board plan policy for each flex funded plan and then adjustments that we bacon that experience. just some history for most of the time. there has been a deficit position but it did change to a surplus as of december 31, 2019 due to the favorable plan for 2021, covid influenced that.

there was a buy down and that resulted in a surplus carry forward of 13.2 million that gets applied start thising year and forward. now with that surplus position, it's helping to cushion, i guess to stabilization, given the sizable reason for what was expected. so that lead the surplus to deficit. that then produces which is calculated to 359,000 that is recommended buy out figure representing about 1 percent of the estimated 2024 blue shield plan rates which will review

with you for recommendations in the may 11, 2023 board meeting. you know, details calculation right side shown on the next page comparing to expected were again, significant deviation in the actual experience due to claim increase that we just discussed. which then takes us to the recommendation page. for the recommendation for 2024 rating. so in summary, today's recommendation is in congruent with the stabilization policy to approve the use of one-third of the december stabilization reserve deficit or 3,359,000 which is one-third of 10,077,000 to be applied

towards buy up rates across all tiers for the blue shield h m.o. and uac split family plans for the plan year 2024 and apply proportionately between active employees and early retirees. >> you've heard the presentation, are there questions? >> comment, the prescription -- ~>> can you speak. >> the prescription drug, always just amazes me the high cost. and i wonder, aren't there more classes or something that we can do to educate people, you know, to try to stay away from drugs when they don't have to take them sometimes? >> i think that you said the largest increase was in the specialty drug area. >> that's correct. >> and that would apply to more

advanced diseased than the normaltive drug. >> would i like to sort of, ask the amount for specialty drugs in the media is overwhelming. i find it mind blowing and i'm always trying to figure out reading all the little notes at the bottom of the screen, would you in the mindings for this, do you think that all of that advertising is what is impacting the specialty drugs and the increase in the request for those? and maybe as a result

prescriptions. >> i think the brand brings awareness to the individual than when they go to have a physician visit. what we're seeing is a lot of research and development, to bring updated, i can remember that the pharmacist talks through with you some of the development with gene and cellular treatmentr, something we're keeping an eye on. humera is in the process of coming off patent where we'll see lower cost for humera, it has to run its course through,

the manufactures legal attempts to you know. but it's, so i guess long story short, most of your members don't require these drugs. one percent of your members do in this plan and just because of the cost of the medications, it's almost half of the planned cost. >> i think, we had good educational experiences regarding medication cost and these specialty drugs and this is a big deal. i'm assuming that the capping of insulin will have zero o februarying. so we need to focus on the real issue not as the importance of the capping of insulin.

this data is truly alarming to me, because it's a tsunami affect of people who delayed diagnosis, and maybe that is a, that is a to some extent, the drop in hypertension rates in the bsc plans but everything else went way up. and ien childbirth in terms of a lot of women getting their prenatal care have these other conditions whether it's bmi that is too high or diabetes or hypertension, if this is a tsunami affect, maybe this is less alarming because the tsunami will pass and then we'll get to back a base line. if it's a rapid increase and detieration of our population which si doubt is a major affect. and that's very concerning, if these numbers continue because

of that issue alone, would be terrible. i'm assuming that this is a tsunami affect of diagnosis. the board attempted to encourage our members to continue their screen anding follow-up. how many of these were newly doctoreding or these people who had disease who's disease progresses and moved into a high cost. do we have a sense of analysis? that we can help with. to me this is a very alarming trend, if it is a trend. >> yeah, we did look, blue shield will provide a high level of diagnosis. i cannot stress how deidentified this data is, so please i hope everybody understand that. but they are automobile to

provide a primary category as well as to help us understand how much of awe given our claimant versus pharmacy. in looking at the data at least half, now some being those who may be developed, you know, unusual condition. but as you go downstream from there and look at significant figure claimants, you see more influence there for chronic conditions like diabetes, cardiovascular creating surgical needs and things of that nature. and again, the one point, page i would point you to is that page that shows the change, you

know, over the three-year period of the percentage of the population or number per thousand lives. that does concern, it's good to see individuals returning back to preventive care. good to cece that three of those four cancer screening increased at a double digits percentage going into the most resent measure 12 month period. you know, it just has to be an on going effort to try to help people understand this be health risk early, work with their practitioners early to address those health needs before they become major facility costs. >> are there other questions from board members?

i'm willing to accept a motion regarding the recommendation. this is an action item. >> i move that approved blue shield flex funded non medical h m.o. plans 2022 claims and aoutization experience and approve the use of one-third of their stabilization surplus as of december 31, 2022. >> second. >> it's been properly moved and seconded. >> president scott, can i ask. with all due respect. commissioner--said surplus, it's a deficit. >> it's a deficit. >> but it's listed on our agenda as a surplus. >> my apologies with the agenda being inaccurate, it's a deficit.

>> it should be deficit. >> it's incorrect in the agenda, follows a at if you can put up the last page of the recommendation so that we're very clear >> it's in bold. >> my apologies. >> none at all. just so we're clear. commissioner breslin is moving and it's been seconded by commissioner zvanski? is there any additional comment from the board? if not, we will have public comment. >> thank you president scott. i'll be displaying our instructions.

[reading instructions onscreen] we'll move to our in-person public comment. nobody has approached the podium. our moderator will let us know if there are any callers on the queue. >> we have three callers on the phone line, zero have entered the comment queues. we'll wait 5 more seconds and then close public comment. board secretary, there is still

no callers on the public comment queue at this time. >> thank you, public comment is now closed. >> we're now closed on comment and now ready to vote by roll call. >> roll call vote starting president scott. >> aye. >> commissioner breslin. >> aye. >> commissioner follansbee. >> aye. >> commissioner zvosnski? >> aye. >> it passes unanimously. we're going to take a break for ten minutes. it's 2:25, we'll come back at 225, excuse me, and we'll come back at 2:35. >> president scott, the clock may be off. in the room. >> all right. >> we'll take a ten minute break from this time. >> thank you. >> it's 2:20 according to my, so we'll

>> we're now reconvening from our recess and i would like to have a roll call. >> roll call starting with president scott. >> present >> commissioner bres independent lin >> here. >> follansbee. >> president. >> commissioner zvanski? >> here. >> we now move to item 11. >> approve of the use of the one-third surplus as of december 31, 2023, this is an action will be present bids mike clark with anne. >> mike clark ang, the first year of the plan offered through as well as the recommended rent stabilization action.

so to summarize on page 3 runs with the stabilization policy i'll recommend approval of the use of one-third of the december 31, 2022 stabilization reserve surplus which is 118,000 or one-third of the total 35 3000 to be applied towards the buy down rates h m.o. and 2024 to apply between that and early retirees. this will leave of 235,000. so the experience we can present on health net is limited just due to the relatively low enrollment plan, although it did grow through the course of the year. we do not show active and retiree population given the retiree population and again this is the first year of the plan offering. what we can show is just the

month by month experience detail where you can see the vas majority of the health plan cost is cap tation. so with health net almost all of medical services fall under capitation, medical claims primarily capture out of area experience. pharmacy claims are self funded, so you can see the pharmacy claims line items as well as separate cost for mental health and chiropractor services, you'll see that exhibit. and overall, favorable for the plan in 2022. the other thing that you'll observe is the study increase in enrollment from the very start in january through december total 40% increase in

plan enrollment from january through december. you know, relative to then, what transpired for 2023, rating, there was an over rate adjustment. if you recall from our may 2022 last year, so it didn't surprise me that the loss ratio was favorable for this plan given the adjustment that it incurred for rating. sxl that grew by 40% from january to december. so the influence it has on the rent stabilization, recommendation going past page 9, you know going into page 10. we are recommending the usual application per policy of one-third of the newly emerging

surplus for this plan, given that 2022 was the first year. this is the initial calculation for rent stabilization reserve for the health net h m.o. so you see the experience how it plays out on page 11 for the plan, relative to contributions, there was an increase in the contingency reserve which somewhat offsets the surplus to create the carry forward total stabilization surplus balance of 35 3000 as of the end of 2022. so you'll see one-third of that becomes our recommendation. so in summary today's recommendation in congruent to approve the use of one-third of the december 31, 2022,

stabilization reserve surplus or 118,000 which is one-third of 35 3000 be applied towards the buy down of rates across all tiers for the h m.o. plan for plan year 2024 and active employees and early retiree. president scott. >> are there questions regarding the presentation? if not, i'm ready to entertain a motion. >> i move that we accept as recommendation to approve the use of one-third of the december 31, 2022 stabilization surplus for 118,000 applied to buy down of the rates across all rating tiers for the health net h m.o. plan for the plan year 2024 to be applied proportionate between early retie' and employees. >> second. >> it's been moved and seconded that we accept recommendation as described. are there any questions from

board members? if not we'll open this up for public comment. >> thank you, president scott. public comment is now open. instruction right side now being displayed on the screen. in-person public comment will be first and then remote public comment. for those on the phone press star-3 to be added to the queue. we'll start with in-person public comment. and no one has approached the podium. we'll move to our remote public comment and our moderator will let us know if there are any speakers at this time? >> board secretary, we have three callers on the phone line, zero callers have entered the public comment queue at this time. a reminder to callers, you must dial star-3 now if you wish to enter the public commentment we'll wait 5 more seconds and then close public comment.

board secretary, there is still no callers on the public queue at this time. >> thank you hearing no commenters, the public comment will now be closed. >> roll call vote, president scott. >> aye. >> commissioner breslin >> aye. >> follansbee. >> aye. >> commissioner zvonsi? >>y. >> review delta dental of california, active employee ppo plan 2022 claims and aoutization employees and approve one time suspension of the stabilization policy and approve the use of the surplus as of december 31, 2022. this is an action item and will be presented by mary clark. >> mike clark ang, you'll see

today's approved actions as just read by board secretary lopez on the first page. and i'll go through the discussion of what is transpired from experience stand point and the delta dental that leads to this recommendation. one remind per of the bottom of the initial page is today's dental recommendations are for the active employee ppo plan, 2024, retiree dental plan renewal and experience information for the retiree ppo will be presented by health service board next month. general background, again, policy is tip like amortization over a three-month period. we're once again asking for a change of that, suspension of stabilization policy an

application one half of the surplus. just a reminder that all dental plans are fully insured, this is the only dental plan where the stabilization applies. ended favorably again in 2022, it has in each of the last prior years. and that's why it's recommended that a highser level of rent stabilization is applied. and stabilization or 5 million 557,000 towards the buy down of rates for 2024 that preserves a stabilization carry forward for 2025 and beyond.

you know from a lost ratio stand point, 2022 rate had a much larger buy down because of how favorable 2020 plan experience was. so that's why you see dental loss ratio in 2022 of 120 percent. we applied two-thirds of the stabilization in 2022 rating because 2020 plan experience was so suppressed due to the pandemic. still it didn't change the line of that we've seen except for that pandemic year, right around 120 dollars. and that continued for 2022. you know part of the reason unfortunately is we continue to

see loss stabilization that we would like to see. in typical years only about one in every three covered lives don't have a dental claim. so two would have a dental cleaning but one would not. and that continued in both 2021 and 2022 in fact there was a higher percentage of individuals that did not have a dental cleaning in 2022, 35.5 percent versus 2021 at 34.1 percent. about three thirds of the services are considered diagnostic and preventive and you see the rest of the proportion across the basic categories and the major categories as well as the orthodontic organization. we do have detail data for 2022 in the append i can for your reference. you know, we talk periodically

in delta dental as well. viewization is increasing and to the kaiser file paoed that is now in place. so it's helped more than double in the smile away program for the active employee ppo population as you see the statistics on this page. sol that's good news that more of the members are being identified to have the enhanced benefits that with the smile away program through identification of certain conditions that merit the identification for it. and just a reminder on page 8, encouraging individuals to use ppo dentist but also

recognizing that many dentist are premier only and that's through 100 percent benefit that is available through premier dentist in this program. so i'll skip ahead a little bit to just talk through now know what we're observing across the network types. if you look at page 10. slight increase in the percentage from 2021 to 2022 utilizing ppe, still below the delta dental. so we know that a lot of individuals in this plan will continue to use premier network dentist so important to overall just promote use of dental services. you know the good news is 95%

of services are delivered within the network environment in delta dental. this gives you the listing of procedure counts by counties. so more services delivered. >> can you pause for the moment. for the clarity to the public we're on page 11 on this presentation, as we're begin to go discuss at this time. so if you can go back to that, there you go, right there. that's what should be described, they were ahead of us on a couple of others. so i wanted to pause it here. so please continue. this is the.

page 1 according to the presentation, is the county description that you were just talking about. >> correct.

give us one second,. >> so we're not talking about something that the public says that they have not seen or what have you. we need to try to see. >> mike, can you speculate on why premier dentist are utilized more than ppo dentist in san francisco. is it the availability? >> in my view, it's the distribution of dentist and you know, kind of a function of have been premier only. over the years when new dentist are brought into the network by delta dental so recruiting. they are in both the ppo and the premier. but, you know, there are many

long time dentist here in the area that are premier only. i think in your packet, we don't have this in the online version. although i believe that this is posted in the march 9th version, so perhaps if we can go back. >> that's all right. >> thank you. >> you know, there is a fairly desperate distribution between ppo premier and non contracted in aoutization--utilization by county. >> and i think that's the next slide. >> there you are. right there. >> what we're referencing online is the march 9th version of the material so everybody knows which was not intended to change for today. what was intended for today.

but you can see here, you know, as an example, you know solona county san joaquin county, over 60% is through ppo dentist. on the other hand, you have counties, san francisco with 30%, sonoma, 38%. different counties have different levels of ppo that is likely a function of the proportion of ben fist who would be ppo versus premier that would be my sense. >> we went over this delta thing a couple of years ago pretty in depth and why people are not going to ppo dentist. and it's good reason probably.

and except in these other counties where you don't have any other options. >> thank you for that. >> and interesting, only one in three has a cleaning which is is, we encourage delta dental to get more information but i don't see any information in the mail that says, should be something scary show somebody without any teeth. >> weren't they suppose to be. to follow-up with individuals at the time of their first appointment that they would get a reminder from the dentist.

they were doing that at one point. >> i'm also hearing from members that they're not getting any information from smile away. and i've been contacting them through a retiree organization and they're getting more information from us than from delta which surprised me. but smile away, seems to be increasing and utilization, we need to keep up information, because many qualify now that they've expanded. >> so five conditions expand today nine and now there is, a kind of direct file speed between kaiser and delta dental to increase awareness and notification. >> thank you. >> okay, so moving ahead, looking at the historical experience, so page 13, you can

see this plan has been in surplus, you know,? in general surpluses have built up overtime which has lead to resent recommend atesing sxz advertisings by the health service board starting in 2020, to suspend policy and use, one half or even as much as two-thirds because of the pandemic of the destabilization. now the goal is to try to get the plan more in alignment between the expected and actual experience and reduce the stabilization balance. you know administration expense a little bit lower than expected. contributions a little bit lower than expected. generating a adjustment to the

go forward surplus of about 5.8 million generated by 2022 experience and then that leads to the rent stabilization cal could youlation on page 15. where the stable ilization was as high as 10 million, it grew to 11.1 million. so the suggestion is to apply one half in rate buy down for 2024. so with that, i'll close with the recommendation page where there is two approval actions on number 1 is to suspend the health service board stabilization policy for one time basis for active employee ppl plan and approve use of one

half of the december 31, 2022 surplus. with i is one half of 11 million to be applied towards the buy down across all rating tiers for the dental delta plan. president scott. >> you've heard the recommendations are there any other questions from the board? hearing none. >> i would like to make a comment. are the delta dental people here? >> yeah. >> i would like to request that if you can come up here. >> thank you, mike. >> her name is. >> valerie lane. >> thank you, valerie for bringing that down. >> yes, i would like to make a request that you do more out reach for considering there is

only one in three have clean anding it's free for people. and especially for actives, this is for actives in fact but for retirees as well. there really has to be something in the mail that says, something like i said, like scary like i said, this is what happens. >> sure. >> i do believe that we have preventive care reminders for you folks that we're sending every, every 7 months we're reminding people to make their appointments if they're registered with us. so we're doing that. >> sending that in the mail. >> na is going through emails to individual. >> email? >> and snail mail? >> no, email. >> yeah, for actives, for retirees, you probably need that. but once, every 7 months. >> what we do is if we look

back and if they have not had a cleaning for 7 months, we send them a reminder. >> are those mostly emails. >> no they're the emails that the individual has enrolled with us. so if you're passing email on your file, we're using those unless that person has given us a different email. and the reason i mention that for active, sometimes active right side on leave or they change jobs or something happened. and getting personal emails might be more affective than the work email. we always override and use their personal. >> good to hear. >> all right, are there any other questions or comments? >> if i may, i want to add that there was a direct mailed in july of this year, that delta did to everyone. >> is that for smile a what? --smile away.

>> no it's a way get your clean up get your teeth cleaned kind of message. >> since you increased to 9, the types of conditions that qualify people for smile away, have you sent out additional, additional notices? what i hear from the members that i deal with is that they're getting nothing with delta. and they only got it through our publications. >> so we do two things, first of all, we're getting the files from your carriers so they're registered for that and we, we increased those diagnostic this past january. and the second we communicate with the dentist.

letting them know that this is available for the so they can have the conversation when speaking directly. the dentist is aware that they have an enhancement now. >> thank you. >> okay. >> thank you very much for your comments. we're now back to not action item on number 12 and you seen the recommendation, it's before you and i'm ready to entertain a motion. >> i move that we accept the two recommendations from ai, number one to suspend the standard self funded plan stabilization policy on one-time basis for the delta dental plan for 2024 and number two, approve use of one half of the december 31, 2022

stabilization reserve surplus of 5,557,000 to be applied towards a buy down through the delta dental active employee. >> second. >> it's been properly moved and seconded that we accept the recommendations as described in the motion. are there any comments? any further comments from board members? if not, we'll have public comment. >> thank you president scott. public comment is now open. instructions are being displayed on the screen. in-person will be first and then remote public comment. for those listening, press star-3 to speak. we'll begin with our in-person public comment and no one has approached the podium. so we'll move to our remote public comment and our moderator will notify us of any

public comment at this time. >> board secretary we have three callers on the phone line, zero callers have entered the public queue at this time. a reminder to all callers, you must star 3 now if you wish to join public comment. wile wait 5 more seconds and then close public comment for this agenda item. there are still no callers on the public comment queue at this time. >> thank you, mod rater. public comment is now closed. >> thank you and i would have it noted that we did post the sign that we probably should have been posting each time that we went through the public xoment section, the slide i should say. about public comment.

on webebbsing. >> thank you. >> thank you, so at this point we'll have a roll call vote. >> roll call vote start withing president scott. >> aye. >> commissioner breslin. >> aye. >> commissioner follansbee? >> aye. >> and commissioner z vanski? >> aye. >> and we now go to regular business. >> agenda item number 13 is >> reporter: from representation. this is a discussion item and i believe we have one representative wanting to give an update. >> these are reports and updates from health plan representatives. so anyone in the room that is

representing your health plan, please come to the mic at this time. >> good afternoon, i'm lori comings and the director for health net. i've recently taken over the oversight of the san francisco health services account along with my colleague fred which you may have met before. is look forward to working with you again. there is a couple of you that i recognize that when you had health net previously, i had the honor of working with you. so i'm glad to be back and look forward to providing updates going forward. >> thank you for introducing reintroducing yourself and welcome back. >> thank you. good to be back. >> are there other health plan representatives? here that wish to make a comment of any kind? pausing. none?

no other health plan representatives are present. out of obligation we'll have public comment at this time. >> thank you, president scott. our public comment is now open, instructions are being displayed on the screen. in-person public comment will be first and then remote public comment. for those callers listening in, press star-3 to be added to the queue. for those watching on webex, click on the raise hand command to speak. nobody has approached the podium so we'll move to our public comment remote. and our moderator will let us know if there are any public speakers on the queue at this time. >> board secretary we have three callers on the phone line, zero callers have entered the public queue at this time. a reminder on the line, you must star 3 now if you wish to be added to public comment.

we'll wait five more seconds and then close public comment. >> no public comment at this time. >> hearing no callers public comment is now closed. >> thank you and we're now going to go to a governorance committee matter that will require us to vote on whether we're going into close session et cetera as printed on the agenda. and with that, i'll turn it over to my distinguish colleague the chair of the governorance committee and immediate pass president, dr. follansbee. so agenda item number 14.

>> vote on whether to hold close session to approve the 2022 annual employee performance evaluation draft report. this is an action and will be presented by the governorance committee chair. >> thank you very much. just a reminder the governorance committee met in february of 2023, we were unable to deal with this item in closed session because we didn't have the it support in order to do so. so today's board meeting will be in fact acting as entire governorance committee and board in this matter. so with that, i would urge, i recommend that we entertain a motion to go into closed session to deal with this performance evaluation and report. >> i'll move that the board now go into closed session for purposes stated with regard to the governorance committee action. thank you.

>> i second the motion. >> moved and seconded, we go into close session on this item. are there any discussion from board members? hearing none, we can open this up for public comment. >> thank you, chair follansbee. public comment is now open. in-person public comment will be first and then remote public comment. for those listening on the phone press star-3 to be added to the queue. for those listening in web ex, click on the raise hand. nobody has approached the podium. we'll move to our remote public comment and our moderator will let us know if there are any callersers on the queue at this time. >> we have three callers on the phone line, zero callers have entered the public queue at this time. a reminder, you must dial star 3 now.

we'll wait 5 more seconds and then close public comment for this agenda item. board secretary there are still no callers on the public queue at this time. >> thank you moderator hearing no public callers, public comment has will not closed. >> thank you very much. it's been moved and seconded that the health service board move into closed session. call for a roll call vote. >> roll call vote, start withing president scott. >> aye. >> commissioner breslin >> aye. >> follansbee. >> aye. >> commissioner zvoanski. >> aye. >> we're going to ask everybody to leave the room. if you look at the rest of the

agenda after the board reconvenes in open session, the two items are perform regarding the actions of the close session deliberations and then adjournment. so there are no other agenda items beyond that. [health service board in closed session] >> chair follansbee, we're now in open session. >> i'll now reconvene from closed session and i'll turnover to charles. >> we should have a roll call attendance. >> or, chair a roll call starting with president scott. >> present. >> commissioner bres independent lin. >> present. >> present. >> and present. >> with na we have quorum. >> thank you very much. so the next item is item 16.

>> agenda item 6 possible report on action taken in closed session, this is government code section and san francisco administrative section 672b this is presented by governor committee chair follansbee. >> so a possible action. >> i move that we not report of actions in closed section under appropriate section. >> second. >> it's been moved and seconded. any discussion? with that we'll open to public comment. >> okay, one moment please. i'm making sure that all of our video is being pumped through the public. >> don't you have to open the doors. >> that's true. i'm going to pause and i'll go do that. >> we need to take the sign

down and open the doors. >> correct, thank you. >> video is now on in webex. >> thank you from the technical side. we do want to open the doors for anyone that may be waiting outside.

>> to to anything. >> i move that disclose, 57.1 and administrative code has listed. sxl with that nrs no discussion from the board members and now we'll open up to discussion. >> thank you, committee chair. >> public comment is now open. instructions are being displayed on the screen. finish watching on webex.

we can start with our in-person comment and nobody has approached the podium so we'll move to our remote comment. >> board secretary we have two callers on the phone line. zero commenters have entered the queue. you must dial star-3 now if you wish to enter public comment. woel wait five more seconds and then close public comment for this agenda item. board secretary there are still no public callers. >> public comment has been closed. >> it's been moved and seconded that we take no action, based, we not disclose the action of the health service board in

closed session under the government and administrative close listed. all those in favor signify by saying aye. >> aye. >> aye. >> aye. >> we should take a roll call vote. >> thank you president scott >> aye. >> and commissioner breslin. >> aye. >> follansbee. >> aye. >> commissioner zvanski? >> aye. >> and item 17. vote to disclose any or any all information held in close session. it's an action item and will be presented by governorance committee chair. >> thank you very much, so i'll entertain a motion on whether to disclose any or all of the discussion of the service board held in close session today. >> i move that we not disclose

any of the discussion held in closed session under the administrative code as listed. >> second. >> any discussion? hearing none, we'll go ahead and open this up for public comment. >> thank you. i'll be posting our instructions. [reading instructions.

>> chair >> >> aye. >> aye. >> aye. >> aye. >> it passes unanimously. >> so now i turnover to president scott. >> thank you, this meeting of the health service board stands in adjournment. >> thank you, adjourned at 3:44 p.m. >> thank you for your

cooperation.

>> the meeting of tuesday april 4, 2023. i like to thank secretary morewitz for his work to refine the processings of the meeting as we go back to in-person meetings with opportunity for public comment. with that, secretary morewitz, would you call the roll. >> sure. [roll call]

>> and a hearty welcome back to susan christian. we're happy to see you and happy to have you back with your valuable experience and perspective. >> thank you. it's great to be back. >> next, we'll have commissioner chow offer the ramaytush oholone land acknowledgement. >> it's my privilege to give the land acknowledgement. -- the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush ohlone who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional

homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. thank you. >> thank you, commissioner chow. our next item is approval of the minutes of the health commission meeting of march 21, 2023. commissioners, you have before you the minutes. if there are no amendments, do we have a motion to approve? >> motion to approve. >> second. >> all right. secretary morewitz, do we have public comment on this item >> yes, forks on the line, if you would like to make comment on item 2, press star three. moderator, please unmute the first caller. i'm sorry, i saw a hand up. i do see a hand. here, i'm going to unmute the person.

caller, are you there some >> yeah. it took a while, mark. my code for today is yy. >> please begin. >> i'm grateful, mr. morewitz, included in these minutes, i my written testimony congratulated commissioner bernal on his reelection as commission president. i testified that commissioner bernal and the full commission should take action on laguna honda's governing body to direct roll and pickens and have a written waiver request to cms slash cdph for an exemption for

cms's two (indiscernible) asking with city attorney's office to make sure a written waiver request is submitted quickly to cms and cdph. i have provided you with information on 42 psr section 483.90 and e and parenthetically roman numeral three, dated march 3, 2023, which provides the survey agencies, meaning cdph (indiscernible) and grant and variation on vacations per room -- when facilities were questioning writing an exemption request with the variation to section 483.90e1 roman numeral

one will not affect residents health and safety. during san francisco's career shortage, killed nursing facility beds, excuse me, i urge you, again, to do quote, everything you can, end quote, to see the written waiver to save laguna honda's 120 beds. please do so rapidly. thank you. >> thank you, caller. that is the only public comment for this item. >> all right. commissioners, any comments or questions? seeing none. secretary morewitz, all those in favor in approving the minutes, say aye. >> aye. [multiple voices] >> opposed? all right. the minutes are approved. our next item is general public comment. secretary morewitz.

>> i have a statement to read. sorry. >> for each item, members of the public will have an opportunity to make comments up to three minutes. it's to provide input and feedback from those in the community. the process doesn't allow questions to be answered in the meeting or members of the public to engage in back and forth conversation with commissioners. the commissioners do consider comments from members of the public when discussing items and making request to the dph. please note each individuals allowed one opportunity to speak per agenda item. individuals may not return more than once to read statements from other individuals unable to attend the meeting and written public comment may be send to the health commission, health dot commissioner dot dph at sfdph dot org. if you wish to spell your name for the minutes, you may do so without taking your allotted time. city policies along with federal, state and local law prohibit harassing conduct against city employees and others during public meeting and not tolerated. we'll take public comment from those

attending in person and take remote public comment from individuals who have received an accommodation for a disability. i have given each individuals a code to speak when they begin their comments to prevent others from speaking and then we'll hear public comment from other individuals. there's a time limit of 20 minutes that can be heard on each item from those who haven't received accommodation for a disability. because of remote comment procedures recommended by the office of city administrator and city attorney's office, please to not raise your hand to make remote public comment on an item until your category is called. all right. so, there are two folks who have put in a request for in person before we go to remote. >> thank you. i forgot how much i love holding these public comment forms so thank you for those who filled it out. first we have, billy gene wall i have a timer. when i say time suppose, finish your statement. >> welcome.

>> good afternoon, members of the commissioner. my name is billy jean. i have been a part of the exercise program at dave hey lost for ten years -- davie hospital for ten years and everyone had to complete an attachment form to the primary care physician and return it to the hospital and wait until an opening and class became available for us to go ahead and start attending the classes. we were very, very lucky because the classes were so very structured. they were taught by incredible instructors who were very skilled and well-learned and who have our best interest at heart and really wanted to improve our quality-of-life. and i just want to say how much i actually miss that program. i've

noticed how much i personally have deteriorated since that program has come to a halt. since the program was discontinuing, i'm noticing my mind and bodies are deteriorating in many different ways. my muscle tone is weaker. my skin quality has changed. my flexibility is rigged. arthritis in my hands and fingers are very painful. i'm starting to have fingers that look like my mother's which is really not something that i want. i have developed trigger finger in both of my hands. my (indiscernible) has changed and i'm falling a lot. i have dislocated my shoulder. i dislocated my hip. i've had four epidurals. i've

had many bouts of botox injections and if i continued doing that program, i probably wouldn't have had to have those procedures done. and in addition, my fibromyalgia flairs are frequent. they are worse and my brain fog is worse. i can't concentrate. everything is more prevalent. if i don't write things down, i forget them and i write down the wrong information sometimes. i just see myself losing all the ground i have grained from that program. it's very disturbing. i have felt more isolated. i'm more depressed. i've been taking more medication, which is not

something i like doing. the warm water -- >> your time is up. >> the program was the best medicine i could ever have i and i wish to thank you for your careful consideration in making a prop q hearing for this. thank you very much. >> thank you for your comment. next, we have collett hughes.

>> good afternoon, secretary morewitz, commissioners and fellow san franciscans. my name is collett hughes. i participated in the cpmc outreach community program for 20 years. about this program, the neuro path i can pain, i have become less mobile and trimmers and spasms increased. like disabled people, i can't tolerate my physical therapy or strength exercises. only in the pool. that's the only place i can do it. to participate in the program, i had to be cleared by my physician and health care information cpmc. i (indiscernible). it doesn't matter if you (indiscernible). i agreed to follow all rules and checking in at the assigned time and respecting the privacy of all and the clinical space and

entering the therapy pool unless a therapist was present and forming the therapist of any change in my condition and following exercised therapy instructions during the group sessions and whatever we had to do. we followed those instructions. individual assessment of pain and function occurred at each session. no medical -- such as free swimming happened as represented by cpmc during this process where all and special medical pool and receiving instruction from cpmc clinical staff. when cmpc did not reopen the pool for a few months in '22, (indiscernible) the local program was not reopened. instead the same type of warm pool, small group exercise classes were offered but only to people needing them on a short-term basis. who had the right interest and could afford the co-payments. they

were called therapeutic procedures for which they billed and the small group sessions were therapeutic and medical to the non-pool patients and it was therapy for us as well. it was therapy for us as well. medical slight (indiscernible) is dangerous. a test to this from my own experience in both sets of classes. the health commission needs to schedule a prop q hearing on the closing of san francisco's only hospital aquatic program that served elders and people with disabilities like me for decades. i think now of the people who were at the pack pool who were thrown out of there because they were told they had to move to davies and they were transferred and they went. and some of them were very comfortable because it was new and they were fragile. many very old at that time. they went to davies and what happened? they were told, goodbye, goodbye, and goodbye without a reason. there's no justification for this. this has to be really

carefully vetted. we need a public hearing. please have a prop q hearing without delay. thank you so very much. >> thank you for your comment. secretary morewitz, do we have anyone on the line who is requesting accommodations? >> we do. so, folks, i gave accommodations to two people and i see many more hands than that, so i'm going to reiterate, if you received, if you haven't received accommodation from me personally by e-mailing or calling, put your hands down. only folks at this point who received accommodation can speak. jeanette, try and unmute those folks and those with accommodation have a two-letter code. as they begin their statement, they will start with that code and that's how we know they have gotten accommodation. this is a procedure passed down to us by the city administrator's office. i know it's arduous. jeanette, please

see if the caller has a code. >> dr. palmer, code ww. >> thank you. dr. palmer, begin. you have three minutes. >> as a community true significance and family physician, i'm calling to advocate for proposition q hearing for the davies warm pool group program. it is -- the sutter told city attorney some kind of crap that led city attorney to conclude that these were not, that the program does not constitute the elimination or clinical services and doesn't prompt proposition q notice requirements. this is not true. these are clinical services and there's one pool. sutter shutdown their other pool in

2017. the low cost group (indiscernible). the same type of medical information that people that are short-term participants who pay with major medical insurance supply. furthermore, cpmc davies provide the identical service on a short-term group basis when approved and paid for by medical insurance and billed towards as a therapeutic procedure, therefore, cpmc sutter is trying to get out of giving these services because they don't generate the revenue, not because they are not clinical. and this is detrimental to the community. these are low cost services that are needed by the community cmpc is a nonprofit organization. look at the facts and schedule a prop 2 hearing. thank you.

>> thank you, caller. jeanette, please unmute the next person. >> yeah. it is wwata patrick. the director's report doesn't mention laguna honda. this prevents historical information about -- >> sorry for the interruption. if you have a comment on the director's report, that's during public comment. these are for items that do not appear on the agenda. >> this isn't about the director's report, which does not mention laguna honda. so this is testimony. start my three minutes over, mr. morewitz, please. >> how would you like to proceed. >> go ahead. >> (indiscernible) since laguna

honda sexual abuse scandal in 2019. they received 138 citations for violation of 78 (indiscernible) related upticks. plus, an additional 20 (indiscernible) violations for physical plant deficiencies, all across the (indiscernible) three years and four months and the root cause report identified 66 root causes requiring 454 collective (indiscernible). add in 123 substandard care violations uncovered during laguna honda's first (indiscernible) in june 2020. that totals 261 violations of federal regulations, suggesting severe problems with regulatory

compliance to provide all health safely to laguna honda vulnerable residents and march 17th, there were 23 more deficiencies. laguna honda typically was in substantial compliance with cmc (indiscernible) and routinely passed state inspections who would view any regulatory violations. what is known is the recent massive mismanagement of llh. i want to add my voice to the previous callers calling for prop 2 hearing on the closure of the warm pool. my mother, for years, went to aqua therapy in wisconsin and i know how

important it is for patients with severe arthritis to receive that therapeutic intervention. you must hold a prop q hearing on this and not fix your responsibility to make cpmc continue to provide these vital service to san franciscans who solely, no pun intended, need it. thank you. >> next caller. >> all right. so, there are only two folks who had accommodations. anyone else who would like to make remote public comment, you may do so now by pressing star three to raise your hand and we'll move into a 20-minute time limit for the overall of the comments. janet, i'm hoping you have kept track of those who have commented, so we'll go to those who have raised their hand and let's go to the first person. caller,

are you there? >> yes. can you hear me? >> yes. please begin. have you three minutes. >> okay. thank you very much. hello commissioners. my name is (indiscernible) and i'm a resident in san francisco. and a member of the great (indiscernible). and i want to urge you to stop (indiscernible) san franciscans (indiscernible) and also [hard to understand caller] thank you very much. >> all right. please unmute the next caller. >> is there any more -- no more callers, great. that was the only other hand, commissioners, for general public comment. >> thank you to the members who called in and came to the meeting. next item is the director's report. for this, we

have dr. grant coal next. director of health. director colfax. >> good afternoon, commissioners, grant colfax. i have an extensive director sheet that i'll go through. the first item is non-written item. it's a laguna honda update. just wanted to again, emphasize that the department of public health remains fully committed to cms recertification and the long-term civility of laguna honda and their families. as shared during the last commission meeting, the cms 90-day survey may talk about the changes happening and we're on the path to recertification. as an example during the first 90 day monitoring survey, we received a total of 124 deficiencys and the second survey saw a decrease in findings with an anticipated

total of 23 preliminary deficiencies. in addition, laguna honda staff and leadership submitted all 77 march deliverables for the action plan. this comes after completing all 126 general milestones in the 133 january milestones successfully. as we celebrate improvement, we recognize there's much work to complete before we are ready to apply for recertification and in that regard, over the coming weeks and months, we'll continue to complete all action plan milestones, prepare the facility for the next monitoring survey and complete the (indiscernible) to apply for recertification. i would like to thank the hard-working staff and partners at the local, state and federal levels. our partnership with the unions as well as laguna honda residents and their families. next item and this is moving on

to the written of part of the report. this is an update on san francisco's five-year financial projection and additional budget instructions. on friday, march 31st, the mayor's office controller's office and the office of of the budget and legislative analyst issued an update to the five-year financial projection. unfortunately, reporting in worse of the two year deficit. the factors around the increased deficit compared to the december 2022 report includes revenue inspections compared to the prior forecast. in addition as the city is in negotiations with the police and firefighters unions, and with the in home support services and provider union and the outcome of the negotiation will impact the projections. the policy decisions with fiscal impact including addressing the structural staffing short arranges in the police department and analyzing the

public works street cleaning supplemental and approval and pending by the supervisors and continuing the community ambassadors and (indiscernible) the loss of one time state funds to maintain shelter operations and several other appropriations for new program initiatives pending at the board. with this news, mayor breed issued an instruction on march 30th, requesting that departments have additional options to reduce general fund support. equivalent to at least five percent by april 7th. for the health department, a five percent reduction represents approximately 50 million of savings in its annual budget. given the request, the mayor's office agreed to allow dph submit its proposal after the april 18th health commission and department staff will work on developing the instructions -- for its review and approval.

just an update on a very challenging, even more challenging budget environment that again we'll update you and the public on here in this room on april 18th. next item is watching the epic welcome at dph. next week, dph will welcome solution. welcome will help our patients prepare if their visits with us. patients will receive text messages reminding them to prepare and check in for their appointments via my chart and patients and their designated family members can receive charts and message their care team. if documentations is required, patients will use ipads to review signed documents as needed. welcome land -- and over the next several months, will launch our hospital -- will launch in our special settings and welcome will be available in

six languages. next item is an update with regard to black health wellness and empowerment form. march 29th, the dph office of health equity hosted a community forum to present findings from the office of health, equity and findings as a part of a process for black community. we sought to see what san francisco's black african american population believes contributes to a vice plant and success way of loss. this is based on strength rather than deficits. the study deferring, which shared aspects of these lifestyles contributed to their joy and contentment and explore how black african americans have been able to maintain their joy dispute race and poverty. after the presentation, attendees had the opportunity to discuss the findings and recommend initiatives and activities to

promote black joy to improve health outcomes for black san franciscans. next item is zsgf, impacts of pro (indiscernible) commercial power outage. like much of the bay area last week, actually it wasn't last week. it was march 21st and 22, the hospital was significantly impacted by extreme weather on those dates. as the city's largest primary care facility and the only one level trauma center serving san francisco in southern san mateo, it's critical that the hospital is providing care during power outages and a series of power outages that began on late afternoon of tuesday, march 21st caused problems throughout the entire campus and more significantly building -- the main hospital where emergency services operating rooms, icu, nicu and family