>> good afternoon i'd like to call the regular meeting of the health service board to order for our thursday, april 23rd 2023 meeting. >> please, join mow in saying the pledge. [pledge of allegiance]

>> thank you. now have the roll call bier board secretary. >> thank you. president scott. roll call president scott >> penitentiary. >> hao >> present. >> commissioner canning. >> present. >> commissioner follansbee is combuzed. and commissioner zvanski. >> present. >> we have quorum. gee will move to item 3 which is general public comment. i will pull up a slide for those watch and reading the

instructions aloud. is there general public comment. >> if we can if you would. if you wish to disclose your name you may do so and then in addition we would like to have you look likure eating the microphone have you to be close for us to hear and you for you to be heard. thank you. [inaudible]. [be cannot hear speaker] access

code: 2485 642 0957 ## access code: 2485 642 0957 ## 592 183 # >> scott and ken noise to meet you i might run into you in the haurl and i wanted to say hello, okay? thank you very much. >> thank you. >> and any other comments. president scott i will read the

instructions aloud for anyone virtual. >> so. the healing service board away all public participation and there will be an opportunity for yes or no public comment and an opportunity to comment on each item. in person comment is first and then we will move on to remote public comment. each speaker will be allowed 3 minutes unless the president deems new time limits. all comments made on the item presented. a member may ask questions. and the board will hear up to 30 minutes of remote comment total for each item. each person will receive remote public comment from public received accommendation will not count toward this 30 minute limit. members attending via phone deny by calling 415-655-0001, access

code: 2592 183 9383 ##. then enter the pas word 11 priand then pound. press star 3 and you will heart prompt, you have raised your hand. for those watching via web ex press the raised handled i conto peek. a raised hand will appear next to your name. when you request select unmute to speak. once you hear me say, welcome, caller you can speak. when your time is up you will be muted. click on raised hand to lower your hand. state your name clearly or remain unanimous.

we would like to thank sfgovtv for share thanksgiving meeting with the public. invite anyone for in person comment. no one approached. so we will move to remote comment. we have 2 callers on the line zero in the queue at the time. all callers you must dial star 3 if you wish to comment for this item. we'll wait 5 more seconds and then close public comment for this agenda item. there are no callers in the queue at this time. >> thank you, hearing no callers public comment is closed. >> do you wish to cover e mail

we received. >> yes. an upon written public comment. board secretary, we have an e mail address for members to send concerns, raise questions about benefits or whatever. and from time to time, the e mails don't fit in a benefit's category but a person raising a question general low and they are not here in person to do so. sometimes we'll have the e mails read other times they have been responded through staff. so. if you would, board secretary. >> thank you, president this came in i will sum rise it from an active employee paul and discussing the dental provide are dropped from the delta dental plan and no longer accepts the coverage. contacted 6 providers and found

one on the 7th try. attached coverage options and costs. and wanted to make surety board was aware the california dental association filed a lawsuit against delta there are not enough providers to care for the members. offered providers that may have better choices including met life ppo, pdp beamful etnacome level benefit and thanks the board. >> thank you. . we will take that under review i did want to highlight it. public ment is closed mou move to item 4. >> thank you. agenda 4 approval of minutes of meetings february 6 finance and budget. february 6 governors and the march 23 regular health service

board meeting. >> i'm red to entertain a motion for the adoption of the minute and may seem like we are doing deja vu with the governors committee of february 6 and the finance committee of february 6. upon check contrary to the impression i left at the last meeting the minutes were not approved and so therefore we need on approve them today. the difference was the board secretary knew the meeting had occurred on the 6. and our board meeting was the ninth and she did not have the minutes red in 3 days, that is why they were on the agenda the last time. since we did not approve the last time thinking they were approved previously we are approving them today.

everyone got that clear? so. i'm calling for a motion for adoption at this time. mr. president i move we adopt and approve the minutes of the member 6 finance and budget meeting as well as the february 6 upon governors meeting as well as the march 23rd regular health service board meeting. >> second. >> properly moved and seconded. the minutes in the agenda be approved. also i understand this vice president hao had edits for the regular board meeting on march the 23rd it was largely the presence of one owe absence of one member it is listed in the minutes the person was present them will be corrected. all right. is there further discussion from the board about any of these

minutes? or comments or edits? >> if not, we'll have public comment. thank you, board president. i will display our instructions. joining online. public ment it open and the instructionsor on the screen inform person first and then remote. for those on the line press star 3 to be added to the queue. for those on web exclick on the raised hundred i con. we'll begin with in person. no one approached. we'll move to remote comment and moderator will notify us. we have 2 callers on the line,

zero for comments. to all callers on the line you must dial star 3 if you wish to join public comment for this item we'll wait 5 seconds and then close public ment for in agenda item. there are no callers in the queue at this time >> thank you, hearing mow callers, public ment is closed. >> before we take a vote there was a question of clarification i wanted to make based upon the new ordinance or guidelines to city commissions and so forth following covid. we are doing everything in person. a question at the left meeting were we continuing public comment limp is guidance on this

and we are comply with that. also it was question whether we needed to have a roll call vote for each action item or could we historically did all in favor say, aye. all opposed? and any abstentions. wo got clarification under the new guidance we need have a roll call vote there are people who make turned in tune in the using the closed caption feature or have other impairments. to assure that everyone knows how the board votes, we will have roll call vote after each action item. thank you. so we will have a roll call vote on the approval of the minutes y. roll call veet president scott >> aye >> vice president hao yoochl aye >> commissioner canning >> aye >> commissioner zvanski.

>> aye. >> passes unanimously. we will move to the president's report. >> agenda 5, president's report. presented by president scott. >> one of the agenda items that is coming up today is the annual report for the health system. and in that report there is a statement on behalf of healing service system board i'd like to read in the record as my report for this meet manage. the san francisco health service system board is dedicated to make high quality and affordable medical, dentsal and vision care available to sfhsf members and the trust with the city charter and for the benefit of the members of the mission, vision and values of the hs

circumstance strategic plan framed our efforts for result and accomplishments defined in this year's annual report. in addition to the department executive leadership changes, this has been challenging to hhs operations and meeting our high service stoornsdz of cline service. on behalf of the hss board, i wish to commend the hss leadership and staff and i'm talking about all of those who are doing the back office work of claims and -- customer service and phone calls and all of the other things our members do. under the outstanding leadership of executive director aby yant for commitment and dedication to providing quality service to hss

members in these extraordinary times. board renews commitment to be active in the implementation, assessment, communication and evaluation of the health service system. strategic plan for the years of 2023 and beyond. we seek to better serve our members through stewardship of the benefits administration process. i sign that on behalf of myself and the board of directors. and we will hear more detail about the accomplishments of the year's strategic plan in our annual report item on the beyond. i wanted to be sure this statement on behalf of the board was highlighted. and we are open for public comment.

>> i will read public comment instructions aloud and viewing them online. one moment, please. >> we are not able to rowel it online. i will read them, loud and a short falls so anyone can catch up yoochl public comment is you in open. instructions are displayed on the screen in a moment.

we will give a 5 second time for people to join and watch and listen in. in person comment will be first and remote comment. for those on the line press star 3 to be added to the queue. for watching on web ex click on the raisad hand icon to speak. we'll pause for 5 seconds. we will begin with in person public comment. no one approached we will move to our virtual comment. moderator will notify us of callers at this time. . we have 2 callers on the line. zero have entered the queue at this time. to all callers on the line you must dial star 3 now if you wish to join public comment for this

item. we'll wait 5 seconds and close public comment for this item. >> there are no callers in the queue at this time. >> thank you, moderator. public comment is closed. >> thank you, we move to item 6. >> thank you, item 6 the director's report a discussion item and presented by executive director abbie yant. in my report upon today i updated everyone with the fact we are still in negotiations with the major's office regarding our budget. it is daily and hourly wrestling match. will keep you posted when we will know what the budget is on may first. the school district we had

successful communications with leadership at the school district to get a better kayedance so there is clarity around progress and how we work together. this has been helpful. they are aware our board is interested and understand we will report on our scientists emergency problem they have regularly. they have full intention to have everything resolved by october. so -- it has a long list of things beyond the benefit's problem that compete for resource. we understand and appreciate how difficult that is for their team. and so we do want we are being supportive of them in many ways some of our expertise with reason and her team can be helpful to them and the controller's office. we are all in and trying to get

things finished. i'm sure they would be putting resources to other endeavours as well. notice that the blackout that is in affect. mike clark provided the health value initiative bench marking study that is in your packet. it reminds us of the rich benefits that our members enjoy as compared to other bench marks. we -- i wanted it highlight in our operation's report. as we spoken the last several months we have an unacceptable high number of vacancies. we work with the hr on expediting resource. we did agree to in our funning a

recruiter to help with our efforts. our member service's team lead by olga and under guidance of ray are working irrelevant hard to meet the needs of our members. 91 of us are satisfied with the wagz we inform labor union is interested in resolve thanksgiving problem. we are in active discussions with them. so more to come. we are getting some progress. we added 3 people this week to our team in so this was a welcome, to bring people on board. so we will keep you informed as we go. i think the other thing that is not in the director's report, my apol gees but we have time, i wanted let you know that the tim

brown from uc berkeley that did the study with blue shield on the aco and had that published. is going to putting together a webinar that catalyst payment reform on may 17th we will send you the information we have time to be sure if you want to watch it live we can get you access to that. information. >> real minds the board there are educational hours attached webinars. >> great. yea, those other highlights. and i will take questions. >> i do have a quick observation. i know that you have been diligently working the issue of trying to get our staff recruit am up and people on boarded and so forth. we have expressed our concern. i want you to than this board if in full spchlt all of the tools

you are trying to turn internal low and external lowly to support this issue. we want you to have been you have our support for all you do daily. i stress looking at internal, resources and means as well. and external means. so -- my hope is we will see the progress we seen the past month and thank the prescription's manager for representing her team. thank you. that's all i have, are there comments or queries? >> i like to comment we welcome our new staff and look forward to filling our other vacancies. i hope that our new staff feels welcomed and we look forward to

them joining the full team. we have an exceptional department. and exceptional staff and we welcome the 3 new members and let them know the board is really happy they are here. >> thank you and if i may, one last thing i did in the call out the fact that it is national minority health month. i will tie it to rashes i make during the report. we are at hss and i see this every level in the industry getting more atuned to race and equities and other social drivers of health. it is remarkable i -- have to pinch myself i never thought we would get this far. it will be great the years to coming. people have miles an hour understanding how health is different amongst our

populations. we can more be more personalized to get better out come. >> thank you. why other comments or observations in the board on the director's report. we will go to public comments at this time. thank you, president scott. i will read ano vow in a moment. public sment open. instructions are displayed for those watching on sfgovtv and web ex. in person comment will be first

then remote commentful for those on the line press star 3 to be added to the queue. for those watching online click on the raisad hand to be placed in comment to speak. we'll begin with in person and no one approached we will move to remote comment and moderator will notice us of the callers in the queue. >> we have 3 callers zero for the queue. to all callers on the lineup you must dial star 3 now if you wish to join public comment for this item. we will wait 5 more secondeds and close public comment for this item. >> board secretary there are no callers at this time >> thank you. hearing no further callers public ment is closed. >> thank you. we will now move to item 7.

>> agenda 7 is sfhsf financial report february 28 of 23. a discussion item and will be presented by hsf chief financial officer. >> good afternoon. >> good afternoon chief financial officer, how are you. >> well, thank you. >> glad to hear it. >> good to be here. society report this month is similar to last mont. the benefit trust fund we are expecting a year end decrease of 10 million due to stabilization by past surplus. net for the currents year is negative we see higher claim in it is product. and you will hear more rates

with for future years. the pharmacy rebatesor track 14. 8 million for the year. and -- we are projecting interest 2 million for the year higher than prior the higher rates. the health program is at a surplus because of delayed projectses. projection is to close the year at budget. and in the general fund we are ahead because of vacancies we talked about earlier. i do want to add a budget update. and the city's projected revenues are declining. and so the staff asked us to -- double our target for reduction in expenses. we are negotiating now. we will update as things change.

is this for the coming fiscal year increase to 400 thousand dollars. >> that's correct. >> thank you. >> are there questions from the board? >> a quick question what about the projections for year 2. the 2 year budget cycle. >> so that's another 100 thousand for the following year.

for remote comment call 415-655-0001, access code: 2592 183 9383 ## press star 3 to enter the queue yoochl we have zero callers. a reminder you must dial star 3 now if you kwish to join public comment. we'll wait and close comment near this item. >> thank you. hearing no further callers. public comment is now closed >> thank you we will move to

item 8. which is an action item >> agenda item 8 is 22 annual report an action item and presented by hsf abbie yant. >> good afternoon, commissioners. i get a different view of you. executive director san francisco health service system. good afternoon. i'm here to give a brief over view of the annual report that the complete version is in your packet i will speak to a shortened version today. and that we are highlighting the strategy plan from 2020 to twoent 22 in this report. as you know we are in a transition year and this board adopted a strategic plan for 22-25. so i want to thank you and -- recognize that our communication

team lead by jessica has been working with us on ways to engage our membership. and one of the things we have done is change the format of the report from reporting on each division core business activities, which are relevant and important; however, if we are going to aline with the strategic plan the activities will elsewhere. so and we are -- learning how our divisions being able to presentow collaborative our work is. it not -- people don't work in isolation there is no scyllos for the most part and part of this is physical location we are able to work together closely. and i want to acknowledge [inaudible] for graphic design skills and abilities. he is magical in being able to

make the reports look wonderful. moving on who we serve, you saw the demographic report. we grapped a couple of snapshots to put in this report to highlight the -- membership 122,000. 81,000 active. 40,000 retired. you are familiar and understand theville um of the work that we do. one of the strategic goals is that is foundational is organizational excellence. the member services staff under the leadership of olg approved the hybrid member service model when we returned in person supporting new employee orientation and virtual

consultations. we are in a hybrid world. our staff has work schedules this allow them to work at home and in the office other, we are monitoring our abilities so we have the right number of people on staff. all the design and has been successful in having appointments schedule, for some of our people that are transitioning to retirement decisions category emotional and complex. and so it is helpful to have an appointment to be able to manage that. i want to mention how ray lead the team to complete a sample size verification audit. we had an outside vender assist with auditing our population in the past. we learned a lot from that process and done it ourselves once. and will be doing it again not

quite sure when approximate what population we are committed to dog that on a consistent basis so the biggest message gets out that if you are trying to bends the rules you may get caught. we i think that is the intended kwens of the audits not just to punish individual its is to send the message this will not be to the ritted. the next slide we talk about sustaining our cost. and figuring our rate increases ahead of bench america 22. michael leads his team in contract's administration and they are diligent in getting contracts through. they have a number they are working on simultaneous low much of the time the organizational skills and the tenacity and

persistence in seeing them through they don't move by themselves. they really require a force to be reckoned with and keeping things moving that it is all size said of contracts the learning health medical plan providers or small consulting services we may use to help with specific projects. we focus again on the strategic goals in that00 eye want to commends the systems and analytic under leadership for years they developed split medicare family plans. we did undo this this year. it really spoke well to the experience of our team as well as the health plan team that, project went very smooth.

and it is appreciated that we had the quality of the professionals to work on this to novelty cause a huge disruption for members. that was terrific. the finance team under the leadership demonstrated efficiencies. they process a lot of transactions on the people software i need member telling mow what to do it is not an intutive software it takes trained eyes and experience to manage the software for the invest number of trans actions. the next, tracking population to improve equity. i pull third degree from the demographics reportful and the equity did not rise to the

strategic planning eleven. but we were approximate kwshging on it. it it is a leading strategic goal in our plan going forward, i wanted to draw our attention to the work this we have been doing. in partnership with the department of human resource. everyone knows there were many a long time employers were in the encouraged but discouraged. from employees in the process. developing culturally sensitive prefer and processes and training staff to collect that information is having an impact in san francisco. we are seeing the numbers of our members are active employees that are willing to give their data upon employment that is helping us upon understands our population and will work also with all of the health plans are

learn to do this as well and so i think we will and there are variations in how that data is the collected or imputed in men cases. and i thank you is something we'll see progress on. overnight coming years. it is telling that the city is committed. and so is our workforce. so. the summary of the accomplishments well being in a p team usa under cary's leadership they continue to raise the bar on -- it all of the services they provide. we have worked hard to expand the. programs for our first responders with fire and sheriff at the table really taking that police model that has been in accomplice for 20 plus years and stabilizing it. and in fire and sheriff:service

also continued to do clinics and health fairs and helpeds puts out our mental health forums. it hen a rich year of experience and work for the well being program. so our looking forward to being able to report out on the strategy goals. toward the end of at the end of this year. we did have our first quarterly meeting on progress yesterday and i have to say it is the part its is magic in the planning press is how you know when you do a collaborative planning process you involve all the will will people this have a responsibility for carry thanksgiving out. the work gets done. and when jessica pull third degree information together for our report it was remarkable how we already have many tool in

place to measure progress. for the plan going fared and so -- weer track. to able to measure progress and report out to you in the year to come. thank you. again, i want to commends you and the staff and management on all have you done in a challenging year of transition and executive leadership and changes in operation. it has been outstanding. so. i call on the board for questions. compliments to you and the team. easily digestible fashion and demonstrates leadership of you and your team and the effort they put in to improving our department and service to members, thank you.

why thank you. ditto plus. it is clear your whole department was involved not just a leadership lead effort. fingerprints of everybody who touched the members are reflected and i want to thank you for putting the members first and think about the voice of customers and their needs and how you serve them. thank you. zvanski. >> ditto and add that i continuing is remarkable with staff shortages it speaks to the commitment of staff and the quality of our staff this significant work can go forward and reflect everyone. he should thank everyone on

staff. a great report. and your leadership is noted here. and our i think we have exceptional employees in the office. they need ton we support them. >> any other comments from the board? we will have public comment. we will display instructions for those on web ex and i will read them aloud. >> i'm sorry we need a motion. i got a member of close colleagues here that keeps me straight. mr. president my honor. make a motion to approve the annual report. >> second. >> is there any comment from the board?

we now have public comment. public ment is open and instructions are being displayed. in person is first then remost. for those online press star 3 to enter the queue. on web ex press the raisad hand icon. we will begin with in person. no one approached. now to virtual comment. we have 3 caller on the line zero in the queue. we will wait 5 seconds and close

comment for this item. public comment is closed. we are entering with the next agenda item rates and benefits portion. after the take our vote we will go in rates and benefit portion of our meeting. madam secretary. call the roll for this vote. >> roll call starting with president scott. >> aye. >> vice president hao. >> aye. >> commissioner canning. >> aye. >> commissioner zvanski. >> aye. >> passes unanimously. now rate and benefits. i said this several times one time there was a standing committee of the board this did rates and benefits and the board

would review the same material again and found that was inefficient we have we do as a board. as a matter of committee as a whole. we will move to item 9. >> thank you, agenda item 9 is presentation of 23 rate and benefits. no. april 27th i'm a month ahead of

myself. >> sorry. >> yea. >> well is a hold on the calendar for april 27 should we need that meeting if we get through everything today we will not. that's what i will call out. >> thank you very much. director. we will have public comment. any comments or requests from the board the rates and benefit calendar you in we will have public comment y. thank you president scott. public comment is open instructions on the screen for those watching and on web ex. in person first and remote. for those on the line.

there are 3 callers. zero have entered the comment queue at this time. you must dial star 3 now if you wish to join comment for this item. thank you. public ment is closed. >> we will move to item 10. >> agenda item 10 health plan report. a discussion item example will be presented by reason director of systems and analytics. >> thank you. >> how are you. we have a presentation to

display. bringing to you great. today. the -- 2022 health plan risk scores. a summary of the key finding in your board pack and he online. you will find the full report. i would like to certainly acknowledge the work of my team and ryan on angels can's team to get the data and package in a format to present to you today. thanks to them for their hard work on this report. you know the scores are billed on claim s and experience and are indicators of resource, consumption and cost. we use groups a patient system that helps cost that equalization. models predict 12 months current and look at 40 we call the

perspective risk score. and so you know the model we use is based on commercial population when you look at medicare in the report they will appear high. report itself you will see 4 time period says in that. certainly one name is to give you i trend exported get this fourth time to give you context precovid. and in the report, the current time period is actually from october 2021 through september of 22. the reason we role that is so we have the report in time to bring to you for rate and benefits. next slide, please. >> here is a look at total population. lives, medicare and nonand when we have done is we have broken them out by age and

jendtory risk profiles. and as we age you will see more of those older populations in crisis and so good news is 58% of the population is categorized healthy or stable. and 42% in the other 3 categories. here looking at next slide what we have done is breaking it out by segments and active early retiree and had is that concurrent risk score temperature is looking at indicators of health spend in the current period. looking at acute and chronic conscience. when we bench is decreases in risk for early retiree and medicare retiree populations. still in both and as we did

investigation it locked like we have more claim and more patients in the populations, we also had a higher number of nonor low utilizers. those are individuals this have not had equalization or claimed data t. is based on age and gender. in the next slide we are looking at perspective risk our predictors of future costs. chronic conditions costs in the current period but there are future costs like low from the chronic conscience. comper se that if you had a broken arm or leg from an accident. you have prediction for costs in the current period that would in the translate to on going costs

in the future. when perspective scores are developed. they tend to take in account more the age and gender of the population you are trying to predict you don't know the conscience. those in in play more. in active population the perspective risk score unchanged. and the concurrent, slight change that it was almost the same. and same thing not utilizers impacting the risk on medicare and nonmedicare we see lower numbers there. and this next slide, what you are looking at is the brick down of just the nonmedicare population. no medicare folks here. but those health risk balance we looked at. and now we are looking, what are the conditions impacting the groups in the risk bands across our total population muscular

schedule cal is the largest driver of the health risk at 14 percent by neoplazas and diabetes, cardiovascular and psychiatric disorder. contributing 7% to the make up of the risk scores. our next slide on the left this is that same break down the population banded in risk profiles. now we look at the how that translates to the cost. the 2% of population in crisis is contributing to 79% of costs. in our next slide here what this is doing and this swon our only slide in the sum row thereupon does break out by plan. look at the full report on line you will see slides that do per

plan comparrisons. a couple thing when is we look at by plan. first sufficient that we change the administrator of ppo from united heck to blue shield. that was the beginning of the plan year for 22. i said we are rolling a quarter from the previous period and then 3 quarters from 2022. you got only 3 quarters where you look at this being under blue shield. so, calling out the lower risk score and medicare retiree population. it and that's as we adjust the risk and look at actual costs per member per year to expected that risk or lower than expect side on the ppo creating a value that will make more sense in

another year and as we look at kaiser, their expected to actual is lower when, justing for risk. our actual was greater when adjusting for risk for the blue shield plan and trio and ppo's. i want to call out there is no healing net canopy claim's data you will not emfinds in the larger report anything this breaks out. we have been working with healing net on get the data and hopeful low we'll see this in another mont did not have that for this report. here is where we have taken our population and looking at the risk score by race. as you we are seeing here. you will not have every single

race ethnicity represented. we have to have a certain number and populations are mall. if you are look at the risk score and the trends line we can see that there are variabilitieds in the score by the race groups. i will tell butt slide. i. appreciate the work of the cdc puts out a social vulnerability indevenlgs rate low to high and they are doing it based on census electronic and looking at indicators listed in the big are report. and when we wanted do is crosswalk become to populations using recommendations we got zip code data from the department and crosswalked it and said, where are these high

vulnerability areas? and we took those and did a dive and said for those zip codes, what is our population? this is here. we got sick zip code in san francisco that are high on this vulnerability index and looking at population and looking at the primary risk contributor and race and age. and other demographic information this this area. in the larger report you find typeset for both our nonmedicare and medicare populations xu see it for zip codes that are in san francisco and outside of san francisco. look in the adendzics you see the primary contributor to the risk butt top 5 of the conscience. in for people in our vulnerable areas. moving to the next slide.

again lower risk scores driven by the low group. so working with carriers around their pg and preventive care and getting people inform their doctor's office. and our well being and communication at large. we see them in health in the populations, work to get race data to carriers to help improve quality of the information to be data driven in approaches. we have work in play for this and pleased to report we will look at this in the action plan come social health strategies and communication and the transmission of race current in fliechlt muskal skeletal

disorders. we evaluate cost effective methods. and in the earlier slides when we looked at those in crisis contributing most to our cost the 2% of the 79% you know a portion of that are individuals within state -- in state renal disease. and we were looking and seeing in nonmedicare population. that this was the 4% of costs we want to work with plans to ensure they are proactive with medicare eligibility for this population. so that point -- this completes the report exit will take questions. >> thank you. i have the same question i raised yearly. why do we do all of this in what

does this data and how is it is linked to premium increase and that stuff? >>you know our plans when they're meet and rating and i know we can get you better insight. they are look at the previous cost equalization and the risk. predicting out the future costs and premiums to account for the costs. this it is a sanity check on what is data looking like. where do we seat risk and opportunity in our populations. >> don't our carrier dos that. the same analysis. why don'ts we rely on their information. >> you know i will say that in a way we are relying this is their claim's data. and some information they may pull out of a system and we are look nothing claims only. however, we continuing is part

of our due diligence to double -check and see if we are in alignment. >> thank you. >> it it is an aren't of the board to garth all information making financially impacting decisions on the trust and the funds. and also to try to understand the, of the members. and so this is why this report, while looks bizarre in its mass and detai chi tail is critical to our work. thank you for presenting this information in a clear way. thank you very much. president scott. >> are there other questions from the board? >> i have some questions. this is awesome report. and welcomed. but my concern is this when i look at the demographics in the high vulnerability zip codes and

i look at page 16 social vulner ability index. this allegedly, tracks the percentage of our members lives. when i'm not sees is the information i expect and that i have electroniced overwhelm the years. i robbery working for the city and retired. this sunset and richmond, we don't have the information for those districts as well as the mission district where we know significant numbers of our active retirees live. and i'm wondering why they were not add to the extent to the work on this report? why those districts were not considered important enough included with ~igator~ detail.

there are issues with racial issues and especially the high risk contributors and ages. >> thank you very much for that question commissioner zvanski. . in the appendix there were zip codes listed and when we did internal low we do more data to help drive our strategies. we first focus going by the first the risk of the population in that area. the 1s that had the higher risk score or the deep dive in the presentation. these were higher we selected them for presentation. social vulnerability index is based on tracks. you end up weapon this many tract to 1 zip code. you find happen nothing some

yours is some parts of zip code in sunset and richmond are low on vulnerability index and some are high. we looked at zip codes where all census tracts were high on that vulnerability index. is that does not preclude us from looking at those. we do. >> not this they are excluded these are highlight exclude rise to the top. all the data is included? correct. not like we are leaving out the population. >> we are tracking and looking at had the claimless would be in the area and it is populations and how it impacts our over all system as well. okay. that's what is bothering me based on hair know and

experience daily and what it seems to section out. i want to thank you and your tome for the thoroughness you bring to this and the 10 factor and all the other stuff this criminalities to the mechanics of getting our side of our story clear so that mike and his team can go do battle or negotiate. i guess a better word with the partners during the course of the year >> thank you, gwen if your work and dill yens on this effort. >> are there other questions. we will are opinion comments.

thank you president scott. >> public comment is open. instructions are on the screen for those watching sfgovtv and web ex. press star 3 to be added to the queue. for those on ebb ex click on raised hand to speak. >> we'll begin with in person comment and no one approached. we'll move to our remote comment. we are 3 callers wherevero in the queue. all callers dial star 3 now if you wish to join public ment for it this item.

>> thank you. hearing no callers public upon ment is closed. >> thank you. and i'm going to claimant privilege of the chair and suggest tht moindz can only comprehend what the end can endure. i will call for a recess of 10 minutes. so i'm expecting reconvene at 2:20. thank you.

we have reconvened. zoel a roll call. >> thank you. president scott. roll call starting with president scott. >> present. why vice president hao yoochl present y. commissioner congressman >> present >> commissioner zvanski. >> present. >> >> we'll begin with item 11. thank you. item 11, review kaiser permanente early retiree hmo plan am claims experience. i discussion item and presented by my clerk. >> how are you? >> mr. clark. you well? >> doings well. >> good >> excited be here to you will hear my voice for the rest of

the meeting starting with our review of kaiser permanente active employee and early retiree hmo plan. we'll go through this i will provide insights on the data thataiser presented to us and there is detailed monthly claim and member account information for reference. this captures plan year experience on medical and prescription plans including plan equalization and quality indicators for the nonmedicare insured plans that are offered. to members. met of when you will see here is for the active employee and early retiree population. there are problems state's exhibits in the back for the

medicare population as limp this will be the base you of the plan experience kaiser will use for premium rate for 24 plan year i will present at the next hsb meeting may 11. >> all the information you see was provided to us by kaiser. to give reference to the total spend that is specific to pfizer. 22 premiums for nonmedicare members 420 million dollars. 52 million dollars for medicare that reports 48% of plans. in 22. covid-19 hit the plan especially during the heist pandemic in 2020.

typical levels of care and equalization. just one note here there hen a reduction in direct costs for covid-19 care from 2021 to 22. 21 a bit over 10 million and 22, 6 and a half million it is an influencer on over all costs of care delivered by kaiser to members. >> there is detailed information on covid-19 cares. on page 8 you see for 2021 and 2022, the over all membership of the planful covered lives and then the per member per month for claims. that occurred in the plans. the active employees average

to.3% increase on the medical side and marginal increase on prescription drug side. redrukz of 1300 covered lives. and the count in the kaiser plan between 2021 and 2022 for you act of employee population. early retiree population stayed steady. and reduction in plans spends over all on a per member basis. although higher than increase in prescription drug when is you look at the data. >> can i ask a question about this. ful 1276. you would attribute that to people enroll nothing other plans or terminating employment with the city. the larger driver? >> nightmy view is every plan had less average enroll inspect

22 versus 21 a function of the total number of active employees and departments eligible. >> thank you. the next slides are interesting the way to look at what top dying noveltyic categories. active employee population the factors influencing healing status includes things like covid care. and also includes preventsive care. we saw a return to preventive care over the course of the last couple years. you see basically left to right it is the comparison of 4 years of data 2019, 2021, 2022 it is good to see how spend compares across each of the 4 years.

cancer where the second highest source of spend. you see a bit low in 2022 versus 21. the third system after suppression in 2020. increasing level of costs there you know over all is a key driver within san francisco. and the risk score data here in the kaiser data and to rounds out injury upon poisoning and you know other things which were the rounding out the top 5 am pharmacy side on page 10. antiinfective agents lower spends over all in the last couple years. and anti-inflammatory and dermatology and the antineoplasticics and cancer medications the top 5. for the early retiree

population, you can see circulatory fair low significance increase in the over all spend. for system conditions. and little baptist backing away from factors influencing health status in imfekzs and diseases attribute that to less covid pend in 22 versus 21. cancer spends neomrs.asm stabilizing a bit. from the pharmacy perspective on the retiree population high or antiinfective. higher on endocrine. the one area we saw increase spends from the initial page was early retiree pharmacy with these 3 categories on the left

side of this page. >> i mentioned earlier covid-19 expense this we have the information for active employees 4. sick million in 2022 early retirees shy of 2 million. you see a few areas where the data is high in an among. this is a graph that goes across the months of 2022. higher spend for the active employee population in january, february and july. and if you remember there was a bit of a covid cost at the start of 2022. and then for the early retiree population. yes or no low moderate and then high cost spends that occur in the april. why i like to electric at a function how the plan is being utilized. comparris 21 to 22.

or yenlt you see the statistic in the top that little rectangle at the top comparing 20 ton to 2022 with the change percentage in between. active population on the top. early retiree on the bottom. and for the active population from admission's stands point typeset is lower. rate of admissions they are per thousand covered lives. another way to look is 3 behalf % of the population you know incurring in patient on the active population side 5 and a half upon the population on early retiree. they have lower rates of admission in 2022. where the care increase some on

the out patient side. out patient visits increased. especially in the mental health your. you see more members getting care. which is good. this access is increasing so that there was an increase in the out patient mental health visit rate. and you are seaing increase in emergency room care, although most of the emergency room care is delivered within kaiser facilities. employees on 15 and early retireeos 16. not the rate of the increase on the out patient mental health you see a double digit rate increase in the out patient of mental health. and higher equalization in emergency room again. page 17 the telehealth. still continues to be a key and

viable access strategy for members with physicians. you know more on the video visit side then and there the phone side the are visit is for each of the months versus phone visits on the left am active employee population. more of the visits through video early retiree, half and half. >> last slides we will look at do with happening with healing risk inld indicators measured boy kaiser and the preventive screening rates. looking at page 18 active employee population and early retiree population how that compares to the averages. and the health risks in line a bit lower than what is benched by the average. and again it points out haare

the key health risks to focus on. the kaiser population. and also seeing some increases in many of the screening rates relative to the regional average. good to see it is higher but you like to see higher rates for screening. i mentioned the 1 slide for medicare retirees. same data. focused on medicare retirees. fa concludes my presentation. but president scott? are there questions by memberos this information? commissioner zvanski >> with regard to pharmacy medication use.

the kaiser's policies have impact on whether or not their patients are demanding or requiring more of the medications we see advertised on television continuing in the media. do they have something built in that controls that or do they -- participate in whatever the patientsment? i can peek to is i think a general observation. certainly kaiser has policies, strategies within the organization. with regard to you know00 oop upon what medications get dispensed. close cord nigz with physicians. planned management strategies dictate trying to achieve appropriate dispensing of

medications to members. and i would imagine that is in accomplice i can ask a representative. >> if you would they are anxious to speak for themselves. thank you for your rep centations. >> hi, denise road rotted g kaiser. good afternoon. so one of the strengths of the program is we have a group of pharmacists and physician this is work together to identify the most effective pharmaceuticals available and look at generics and also electric at brand drugs where well is not a generic. when physicians proib they hear i saw this ad and have a conversation why it may or minot work n. collaboration with physician if they feel the medication might be a better solution they have the ability without approval to have it

written as a request. so our generic compliance rate is over 90%. and we are successful i think one this is a huge strength of our program. i think because we don't spend time with pharmaceutical reps we do it through physicians and pharmacists. >> thank you. >> while you are there. in i noticed this for both medicare retirees and the active early adult settentary seem tom have -- higher percentages. anything this kaiser -- is doing with regard to those populations and -- i know there are various programs. are there specific out reach. this is going on regard to that. >> one of the first steps we

took was measuring activities as a viling sign. physicians say i my you are in the moving talk about why this is important with chronic conditions. if the chronic condition and there is real children they can refer them to our well being departmentful than i can go there. there are clsdzs and resource. kaiser does promotion to members through e mail. the medical center there is information visible for members. and if you near a chronic condition program there is a lot of commitment with the people this are running the programs to enengage to get you moving. it is a huge issue. one thing we say is -- you know not moving or sitting is the new smoke. i think san francisco health service system does a great job

with the well being prosecute advocate for good health includes moving. >> all right employed thank you. >> thank you. are there any other questions on this presentation? if in the we will have public meant. where thank you, president scott. for those on line after the break i would like to read the long are instructions so people know how to payment y. so opinion comment is open. in person comment will be first then virtual comment. in person approach the podium now. each will be allowed 3 minutes to speak. all public mentes concerning the item presented. a call are miask questions but mow obligation to answer. the board will hear up to 30 minutes total remote comment. approximate people who received

an accommendation will not count toward the 30 minute limit. call until by dialing 415-655-0001, access code: 2592 183 9383 ## then press star 3 to enter the queue.

we will begin with in person comment. nobody propped we'll move to virtual ment and the moderator will notify us. >> there are 2 callers on the line. zero for the queue. all callers on the line, dial star 3 now if you wish to join public ment for this item. we will wait 5 seconds and close public ment for this item. there are in callers in the ment queue at this time >> thank you. hearing no callers issue public ment is closed. >> thank you we move to item

12. >> thank you. president scott. item 12 review self funded medicare ppo plan and, prove the use of a third of the reserve deficit action for 2024.

this is an action item and presented by mike clark. >> mike clark. we'll review the nonmedicare pp oushgs plan for 2022. followed by the rate recommendation to apply in 2024 rating for this plan. summarize on page 3 with the stabilization funds policy asks approval of the use a third of the december 31, 22 amount 746 thousand dollars. a third of 2 million toward the buy up of rates across all rating tiers for the ppo. for plan year 2024 and applied with active employees and early retirees remaining carry forward of 1 million, 492, 000. >> to capture information on the nonmed car pp oshg plan with the add administrator for most of the covered lives change nothing 2022 from united health care to blue shield. you seat distribution of the members. the. and he was retirees as well as the covered lives. which are the members. in each of the 2 add administrators. blue shield as the majority of covered live in 2022. but for those nonmedicare lives one or more family members is covered by united health care

medicare ppo plan, you see there are 41 total employees retirees representing 336 total covered lives. most of those retiree split family lives are departments the observations you see include for 2022 the blue shield and united health care experience did thea where we had it compare to the experienced data at time left year for 2021 from united health care. you see as we go through this, we will have data in section 2. one important note reference to high cost claim in this presentation. they are individuals exceeded 50,000 in medical and pharmacy climb in aical dar year. the claims gent ritted by member use flow throughout trust.

for medical and prescription drug expenses. with the associated fees applying as limp the cost rates represent the best future estimate for the plan year of claim in administrative expenses. >> and00 we will will have this information serve as a bases for the under writing and rate development for 20 torthis will present next month. with this back grounds. planned bfrgsz over all, from a medical claim standpoint an 8% increase in per covered life claims between 2021, all under united health care. and 2022, combination of blue shield and united health care for the plan. saw mod rigz and prescription drug expense we'll look to cost prit favorability we bench in

the blue shield. over all, from a total planned claim experience benched 7% increase in medical prescription claim experience is rit in line with our expected trends from 20 ton to 2022. on page 10. benching high cost claimants 50,000 or more in a year they have a magnifying influence on the over all spend. you will see there was an increase from 116 individuals in 2021 to 176 when you combine what was benched in blue shield administration of the plan and united health care administration of this plan. you expect a higher percentage ouring nighted health care you have an older population. reference and presented earlier. that the united health care has the highest costs because it is

an older population. and key dying noveltyic categories for the climb analysises we benched are cancer and muscular skeletal. with blue she said compare did thea that they provide us with the ppo plan and the hmo populations they cover for trio. and this is an interesting chart to show percentage of the population in this plan you know relative to the percentage of the combined population this bench a chronic condition. and i think highlight and becomes up what reason present body this plan, higher risk population. and it plays out here when you look at the prevalence of chronic conscience. all case higher the ppo side

relative to the blue shield hmo's. mech lawyer skeletal leadings the way in reason's presentation. referenced earlier prescription drug costs benched per script basis lower in 20 upon 22 under blue shield relative to united heck in 2021. you will see in the chart below this is in the a perfect comparison 2021 is full year under united. blue shield provided data at january-search 22 period. the first 9 months of mraurnd blue shield you see that the costs per script is lower in that translates in the paid claims per member per among. equalization was about the same year to year. look ahead this is the highest

average cost population and we will talk in the next section about rate stabilization recommendation on the way to presenting the rate recommendations for 20 terror to you next month. as we transition to page seventeen 15. stabilization reserve is one of 3 policies for t. reserves in the january meeting and today first ppo focused on stabilization categoried the the left dave plan year. stabilization policy requires annual determination of financial gainor loss and amortization per policy over a 3 year rate period. we saw for years through 202019

for long-term sustainability of the plan the health board choose to apply the funds in full. toward the active employees and early retiree rates and the pandemic happened. responsibles in the plan in 2020. and so -- you not deficit did exist in 2020 and 2021. on page 18 the climb experience turned favorable in 2020 that affected the stabilization action apply in the 2022 rating and generated the surplus. and so that flipped back to deficit for 2023 rating base on the 2021 results we are in deficit. going into the cycle. on page 19, the calculation we have result in a billions of 2

million dollars carry forward in 2024 of which i third or 746,000 is the buy out figure in 2024 rating. the math of that are shown on page 20. comparing the expected experience that was built into 2022 rating originally versus what transpired now that 22 is finished. >> and so with that, i will close on page 21 by -- stating today's recommendation with the stabilization fund policy approve the use of a third of the december 31 of 22 stabilization deficit amount of 7 frisk thousand i third of 228 thousand dollars across all tiers the nonmedicare ppo plan for plan year 2024 and apply between active employees and

early retirees. president scott. >> you heard the recommendation on this item. are there questions? from the board in i'm red to entertain a motion. iy move we approve the use of a third of the december 31, 2022 stabilization reserve deficit amount applied to the rates as presented. why is there a second. it is moved and seconded this we accept the recommendation as stated in the motion. are there questions by the board? comments? we will take public comment at this time. thank you. president scott. public meant is open and instructions are on the screen for those watching on soft soft

and web ex. in person first and then remote. press star to be added to the comment queue. on web ex in person comment. >> there are 2 call are on the line zero in the public ment queue. if you wish to comment press star 3 now. we'll wait 5 seconds and then close public ment for this item. there are several callers in the queue. >> thank you. no further callers. public ment is close said y.

zeal a roll call vote on this item y. roll call starting with president scott >> aye >> vice president hao y. aye >> commissioner canning. why aye. >> and commissioner zvanski. >> aye. >> pass unanimously. with this we will move to item 13. >> item then review and approve the vsp vision insured 24 rate and contributions. this is an action item and presented by mike clark. >> now just to give a context the first step of rate approval. that we had for the next planned year. it is like we have gone through off the backgrounds. we looked at claims experience. we looked how we might funds through buy downs and et cetera, et cetera. we are now going to talk about actual plan rates. this will be happening the next

2 meetings. so we start today. mike clark y. thank you. motorcycle clark. presenting. president scott stated the vsp vision rate and contributions. i will provide a quick preface. the guide for health care rate setting and get in the experience and be renewal prosecute visions for 2024 for various plans. . just to reminds everybody there are really 3 different types of funged methods across plans offered. self funding. an example is the plan we discussed. the blue shield ppo plan and united health care split family ppo. flex funds. examples are the blue shield and health can open hmo's and the

vsp plan is fully insured. the descriptions of funding methods. who sets the recommend rates and the role of myself:in each the funding methods. pacific plans and as well as the application of rate stabilization. for vsp it is a fully insured plan. data today rate from general the process starts have prior claims. trend factor. design or head count changes, administrative and sdpees other cost elements that are built in the rate planning process. lead the calculation of rate changes for the next year. focus the renewalal there are

different plans the basic plan offered for many years. part of enroll am by members and medical plan. and am premiere which was offered in 2018 is a second plan providing high level benefits. low are member copay and higher allowances for frame and lenses. that is member paid imincrement a difference with the basic plan and premiere plan rates and 19,000 employees also have access to a computer vision care benefit through vsp. so. today's recommendation is to approve the rates presented which in the end no change from 2023 to 2024 for each plans. just back grunldz on renewal. we are in the right in the middle of a 5 year rate

agreement. so just to make it clear i asked the board to take action and approve 2024. but we do speak to the plans about put nothing place possible multiyear direction for expectations for rate renewals and it happens that 2024 is in year 3 of a rate agreement that started january 1 of 2022, where 2024 rates are set the same as 2023 rates and computer vision care they remain level through 2026. there were rate adjustments in 2023 and certain enhancements bruto the plan and approved by the board this time last year. the next pages look at what is happening with the comparison of premium come claims over time you know over all the vsp hen i

great partner. and you know we have been wing to try to gent low get the lost rit i don't back to an expectation where premium fees are consistent. but just this does point out with the introduction of the plan in 2018, the financial pressure over all it statute very successful benefit we see through what happened over the course of time. page 11 the promotium for the basic plan is -- you know the greater than the claim and fees for this plan and more then and there made up for on page 12 by what happens in the premiere plan and the upon experience there. you see on the next page of here is where the civic premiere plan is played out.

introduce in the 2018. 15% membership elected it. you see now that is more than doubled. a third of members enrolled in the vsp plan are chose to be in premiere. they are chose to pay a higher member contribution and also for a richer level of benefits. this is a success story over this course of time, the enrollment increases every year. for 2024, no change in rates the 23 rates are the same of they are for 2023 rates remain as 2024 and means the member contribution rates for the premiere plan on page 15 remains the same from 23 to 24. on page 17, recommendation is

that the healing service board approve the 2024vsp plan promotium rates and member contributions the 2024 rates remain at 20 tea levels for basic plan, premiere and benefit. president scott. >> are there quests from the board? hearing 91 i'm ready to entertain a motion. >> president scott i move we accept the vsp vision fully insured 2024 rate and contribution as presented by mr. clark. >> second. moved and seconded we accept as presented and described. further questions from the board. we are red for public meant. next. public ment is open. instructions are displayed for thez watching on sfgovtv and web

ex. in person comment will be first then remote. for those on the line press star 3 to be added to the queue. watching on web ex click on the raisad hand i con. we will begin weapon in person comment. we will move to remote public comment. moderator will notify us of callers at this time. if you wish it comment on this item press star 3 now. we wait 5 seconds and then close public meant for this agenda item. there are no caller in the queue at this time. >> thank you, moderator. hearing no callers public

comment is closed. >> we will take a roll call vote >> president scott. >> aye. >> vice president hao. >> aye >> commissioner canning. >> aye yoochl commissioner zvanski. >> aye. jot motion carries unanimously. we are ready for item number 14. thank you. agenda item 14 review and approve retire yee 2024 dental rate and contributions for fully insured plans delta dental ppo. delta hmo. uhb/hmo an action item and presented boy mike clark. >> mike clark >> this is the first rate approval for retirees. for the plan year of 2024 employment to put a few bench marks here. >> one note this is offered active and retiree.

>> right. >> the 3 plans offered include the delta ppo, and hmo from dealt and united. reminder on the agenda page will present active employee dental 20 torrate renewals at the next meet nothing may. the recommendation sum reese. asked the health service board approve the dental rates as presented. to get context of the enroll am distribution of the plan. by far the most member of enrolled retirees in the delta dentsal ppo with 23,000 enrolled retirees, there are also populations in each the 2 dental hmo's. recommendation summary for the delta dental ppo and

insured rate increase of 2% from 2023 to 2024. this is the first year of a 3 year renewal cycle with delta. the first year of a 3 year rate commitment for annual 2 percent increases through 2026 for delta denta. delta care usa, there was a one time benefit to retireeos this plan for 2023 as a result of claim suppression benefit to the rates. so was a walk through the rates i'm asking to you apruf for this plan the delta care usa hmo the seam in accomplice in 2022. een though the dip in 2023 a recognition of a suppression credit begin to the retiree in this planful united health care

rates the same for 2024. >> and these were full insured in the going through the same slides reminder that each of these mrnlgs are insured the rates set by the health plans and then on page 8, these are the twenty 23 premiums remindser the retirees pay the full premium of the plan to enroll in each of the 3 plans. 2023 was the second year of a 2 year agreement with delta dental. the rates are generally presented on a mum year bases for delta. united health care quoted annually of left year the retiree ppo rates to 2023 the present year increased by 7.7% it reflect 2 benefit enhancements for january first

of 23. both aim to increase use preventive dental services by members. 21 migrate the planned play coinsurance from 80 to 100% for premiere dentives equalization of dying noveltyic and preventive services and the second was to reduce the deductible to 50 dollars 100 family for use of premiere and noncontracted. and i explained the delta care retire yeast hmo a one time rate reduction to reflect the dan temic credit for the plan. move to page 11, the delta dental renewal it statute first year the new throw year rating agreement. experience observations. we like to see higher equalization preents havive service about 2 thirds of the total equalization is dying

noveltyic and prep ventive service. we saw a higher equalization of of people having one clean nothing 2022. 67% versus 66% year before it is lower than total covered lives on the plan that used one cental clone nothing 2019. that was the goal of the plan design changes. >> from network distribution, we know there is conversation about you know the network and how it is evolved. you see here there is higher equalization. in the premiere network relative to ppo network. there was higher equalization in 2022 versus 2021 the service distribution to noncontracted dentists. you see that jump from 7% of

total service in 2021. to 9% of service distribution in 22. you can see how the evolution of the percentage of the population change friday 2029 through pandemic suppression in 20 and now 2022 the percentage of members who are not seeking a cleaning. and then again this distribution overnight course of longer time as limp you seat increase the percentage over time in total services to noncontracted dentists. for renewal stand point off of 2023, looking at expected dentsal trend. delta dental proposed a 2% increase to preparia rate in 2024. reflects a trend but increases

in fee schedule payments to certain providers that took place in 2023. move to delta care usa. retired renewal on page 16. 2023 explanation of the promotium refunds built into the rates for 2023. and so when you look at the chart on page 17 you see how the 2024 rates return to where those rates were in 2022. and finally united health care reee retoiree renewal simple will the 24 rating action is a rate hold, uhc does in the provide multiyear for the plan.

page 21. and it is recommended that the board approve the 20 torretiree rate actions. provide earlier. most specifically 2% increase in dental delta ppo and returning to 22 rate levels for delta care usa and no change for uhc. president scott. are there questions from the board? if not i'm ready to entertain a motion. >> can i ask a question. >> yes. >> to haextent as the expansion of the smile away program the,dition and expansion of the mile away program impacted rates we are looking at? >> i can ask delta dental represent to speak about rate

impact we have seen a higher number come to smile away. because of information that is now passed securely between kaiser and delta dental to increase the identification of individuals eligible with the smile away program increasing from 5 chronic conditions to 9 for part of this identification. i can speak to this if further i ask for a delta dental representative? is there a delta dental person in the room? do you have comment or observation in response to commissioner zvanski's question? motorbike a premature question yoochl it is but jewel's fernandez. it is so we did go from 5 conditions to 47 there are 9 additions. did not expect there to be a huge impact in terms of

equalization. . we strive to get the preventsive service up. i apologize it is we are 3 month in but excited to see how it impacts in a positive way for the population. >> great. >> we look forward to that. thank you for this comment. are there other questions? if not, i'm ready to entertain a motion. >> president scott i move we approve the retiree 24 dental rates. for delta dental ppo, delta care plan dealt care usa hmo uh c devonal for all of the fully insured plans. >> i will second the motionch >> properly moved and seconded

this we approve the recommendations as presented. and discussed by our actuary regarding coverage for plan retirees. now public comment. thank you. public comment is open. instructions are on the screen for those on sfgovtv and web ex. in person first then we mote. for those on the line press star 3. for those watch being on web ex click on the raised handi conto speak. >> we will begin with in person comment. and no one approached. we will move to our remote public comment. our moderator will notify us anyone in the queue. there are 2 callers on the line zer over entered the public meant queue.

reminder to callers, you must dial star 3 now if you wish to comment on this agenda item. there are no callers. >> thank you. public ment is closed. thank you. we will have a roll call. >> president scott. >> aye. >> vice president hao >> aye >> commissioner canning. >> aye yoochl commissioner zvanski. >> aye. >> motion carries unanimously. we are ready for the final rates and benefit item for this meeting. item 15. >> thank you president scott. item 15. sutter health settlement 2024 recommended rating action.

per healing service board policy. for bsc, hmo and uhc and ppo plan. this is an action item and presented by mike clark. yom excuse me so we have context. there was a settlement that -- result in the i think 16 or 17 million dollars of funds coming to the trust. and we created a board policy and how we might utilize the funds going forward. this statute first time this we have taking action on this fund'sutilization. it needs to be noted for the record this is not created on a cloth. we went through the terms approval a few months ago and knew this would be coming this is our first time to act on this

type of result. please >> thank you. mike clark. presenting on the first application of healing service board policy 213 specifically for the plans you see on the agenda page. the hmo plans by blue shield of california. acis, plus and trio. as well as united health care split family life plans. those covered lives. fit under this hmo plan contruck. and as well as the nonmedicare ppo plan, which is given primarily by blue shield and for split family lives by united health care. so today's recommendation have the rating by done action to reflect monies received to date. as of today. so. today's recommendation with the

new board legal settle am policy victimeded the board aprove use of sutter health legal settlement dollars to date for use in 2024 health plan rating. for the blue shield access, plus and trio plans. uhc, ppo this is by blue shield and uhc. plans offered at the time that the sutter health actions transpired why they are selected for the rating buy down of settlement dollars today. so president scott noted on page 5 board policy 213 is new. i will not read this but the next 2 pageos pages 5 and 6, you see the entirety of the legal policy 213. for upon reference.

as we go through this discussion. sutter helling roached an agreement employee benefit trust on behalf of the class of california payors and the california attorney general. the settlement 2 antitrust lawsuits over sutter health's approach contract with insurance companies as an integrated system the first is i class action lawsuit in 2014 on behalf of group healing plans provide. xees member's health insurance. self fund payors the second of the lawsuits a lawsuit brought by the attorney general in 2018.

california base self funded group healing plans started to receive payments with the amounts determined by the plaintiffs jikt it i plan of allocation approved by the court. and the claim's administrator is responsible for all claims and providing information to the settlement class members. at the top of the next page. a settlement class member and received 16 million of amounted to be by the time all paid 17 million award part of the over all 575 for the lawsuits the allocation received to date as calculated. by plan time for the blue shield epo plans 11 million am.

and nonmedicare ppo2 million, 943. the reupon mainder discuss the allocation methodology. of the sutter health settle am dollars received to the 2024 are self funded including flex fund plans rating. further healing sutter helling dollars mior may not be fourth coming. should than i receive additional settle am amounts with march of 23 and march of 24. they would apply to buy downs on the plans out lined the 2025 plan year. pursuant to the board approing this recommendation.

page 11. walk through the first of 2 pages the calculation of rating by recommendations how we arrived at the application. of the upon 11 million dollars. when we look at this moncompetence how it translates on the expected can have the for the hmo plans of 375 million. 2024, that converts to approximately 3.tw % of expected 2024 plans. so there is precedent bedown and up conciliations the rate stabilization we do each year base on the recommendations of the board for each of the plan its is recommended to allocate the funds in 2024 rate buy downs

by department coverage for. and he was early retirees to be consistent how those amounts are distributed in rate stabilization calculations. pred in the rate cards by tier will total allocation based on what the enrollment to be for each populations of the plans. make this determination make this allocation recommendation for on a month low basis across each the 6 tier's. 3 for active. xees 3 for early retirees the amounts monthly for the settle

am rating buy down you will see next month in the recommendations on the rating for this plan in the may board meeting. and then for the nonmedicare ppo page 13 and 14. similar approach. different dollars. different population. but the 2 million, 943, 342 based on when we been enroll am today. on page 14 is recommended translate into the month leap amount for legal settlement 2024 rate buy down amount in thes table on the bottom of page 14. >> with that, to close page 16, with the new healing service board settlement policy recommended the board approve the use of sutter health legal settle am dollars to date for

use in the 2024 health plan rating buy downs for the following plans presents in the this material. the blue shield of california, access mru and trio hm nonmedicare split family and uch-ppo and nonmedicare ppo by blue shield and uhc in this material. president scott >> thank you for the presentation. are there questions or comments from the board regarding this presentation? noted. we are using all of the settlement money for this coming out of this settle am we received to date. in one fail swoop. that's for the record. simple low stated. we have gone through other presentation and talked about using a third of manage and we taining a third is not when we have decided to do with this

legal settlement policy in terms of reference. so it is all being applied to this year. any benefit in 2025, motive come from something else. we can't spoke to that today. want to make that point. for the record. no further questions i'm treed hear comments. i'd like to have a motion. i move we approve the ufts sutter health legal settlement dollars received for the rating buy down plans. >> second. >> moved and seconded that we accept the presentation provided by the actuary and board policy. for the bedown of rates for the plans that are as presented and

described. >> further questions if the board? comments. if not we will have public comment. >> thank you, president scott. public comment is open. instructions are on the screen for those watching on sfgovtv and web ex. in person will be first and then remote. for those on the line press star 3 to be added to the queue. watching on web ex click on the raise hands i contom speak. in person comment? >> good afternoon, commissioners dennis kruger retired active firefighter and spouse. i'm sure it has been discussed there must be alost people look nothing at this hearing commission meeting that would like to know why medicare recipients are in the included in on that and men explain it to them and me.

why thank you. >> return to the executive director and our actuary. do you have an explanation or response? >> i will defer to [inaudible]. chief financial officer. >> yes the litigation did not involve medicare. it was only self employed healing plans, commercial plans and so the principle we use is that the affected groups match as close low as possible to litigation and damages were awarded. why so the settlement that not involve medicare recipients. >> correct. why and the principle this we apply is this the affected pol population the beneficiary of the funds received? >> correct. >> thank you. >> are there any other public

comments in the room. >> thank you. move to remote comment. and moderator will notify of callers in the queue. there is zero caller in the queue. to all callers you must dial star 3 now if you witch to comment on this item. we will wait 5 seconds and close comment for this item. >> there are no caller in the queue at this time.

>> thank you. of public ment is close said. >> we'll take a vote >> president scott? >> aye. >> vice president hao. >> aye yoochlt commissioner canning. >> aye. >> commissioner zvanski. >> aye. >> it passes unanimously. thank you. >> thank you. i'll be back. [laughter]. appreciate that. >> you need have a different attitude with that comment. why we are back to regular board matters and item 16. thank you president scott. item 16 reports and updates from contracted health plan representatives this is a discussion item. anyone can approach the podium. >> are there any comments, updates, retractions, revisions

from any of our plan representatives for today? this is your chance? >> thank you. we are adjourning this meeting according to my time line an hour early or 45 minutes early and with that, the meeting of the health service board is we have to have public comment on plan representative updates since there were none there is nothing for the public top ment on. so we are now going to move to item 17 to adjourn this meeting at this time. thank you. adjournment at 3:33 p.m. i

didn't - >> sound familiar do you keep on getting up there's an easier way. >> of course there's

easier way get rid of of mosquito they breed whatever this is water no water no mosquito mosquito feed on good blood the eggs hatch and stay near the waters san francisco to breathe and the adult underlying mosquito waits on the as many until it's sexuality hardens water pools in any areas and creates places you'll not normally think of budget and any container that holds water and hidden in bushes or else were dump the water and do it over soil not into a drain the larva can continue growing in the pooled water is sewage disthe first of its kind the area if the sewage is two extreme have a

licensed plumber assist water pools in rain gutters and snaking and cleaning out the water when keep the water from pooling and keep in mind that mosquito breed in other waters like catch balgsz and construction barriers interest crawl spaces with clmg is an issue you may have is week to cause the water to collect this is an sour of mosquito so for buildings just fix the clean air act drains and catch basins can be mosquito ground it will eliminate it as a possible location keep shrubbery and growths estimated any water to can be seen and eliminated birdbath and fountains and uncovered hot tubs mosquito breed but it is difficult to

dump the water out of a hot top can't dump the water adding mosquito finish rids the source of mosquito there are also traditionally methods to protect you installing screens on windows and doors and using a mosquito net and politically aau planet take the time to do the things we've mentioned to eliminate standing water and make sure that mosquito are not a problem on your property remember no water no mosquito [music]

>> san francisco is known as yerba buena, good herb after a mint that used to grow here. at this time there were 3 settlements one was mission delores. one the presidio and one was yerba buena which was urban center. there were 800 people in 1848 it was small. a lot of historic buildings were here including pony express headquarters. wells fargo. hudson bay trading company and famous early settlers one of whom william leaderdorph who lived blocks from here a successful business person. african-american decent and the first million airin california. >> wilwoman was the founders

of san francisco. here during the gold rush came in the early 1840s. he spent time stake himself as a merchant seaman and a business person. his father and brother in new orleans. we know him for san francisco's history. establishing himself here arnold 18 twoochl he did one of many things the first to do in yerba buena. was not california yet and was not fully san francisco yet. >> because he was an american citizen but spoke spanish he was able to during the time when america was taking over california from mexico, there was annexations that happened and conflict emerging and war, of course. he was part of the peek deliberations and am bas doorship to create the state of california a vice council to

mexico. mexico granted him citizenship. he loaned the government of san francisco money. to funds some of the war efforts to establish the city itself and the state, of course. he established the first hotel here the person people turned to often to receive dignitaries or hold large gatherings established the first public school here and helped start the public school system. he piloted the first steam ship on the bay. a big event for san francisco and depict instead state seal the ship was the sitk a. there is a small 4 block long length of street, owned much of that runs essentially where the transamerica building is to it ends at california.

i walk today before am a cute side street. at this point t is the center what was all his property. he was the person entrusted to be the city's first treasurer. that is i big deal of itself to have that legacy part of an african-american the city's first banker. he was not only a forefather of the establishment of san francisco and california as a state but a leader in industry. he had a direct hahn in so many things that we look at in san francisco. part of our dna. you know you don't hear his anymore in the context of those. representation matters. you need to uplift this so people know him but people like him like me. like you. like anyone who looks like him to be, i can do this, too. to have the city's first banker and a street in the middle of financial district. that alone is powerful.

[music] (clapping.) the airport it where i know to mind visions of traffic romance and excitement and gourmet can you limousine we're at san francisco inspirational airport to discover the award-winning concession that conspiracies us

around the world. sfo serves are more 40 million travelers a year and a lot of the them are hungry there's many restaurant and nearly all are restaurant and cafe that's right even the airport is a diane designation. so tell me a little bit the food program at sfo and what makes this so special >> well, we have a we have food and beverage program at sfo we trivia important the sustainable organic produce and our objective to be a nonterminal and bring in the best food of san francisco for our passengers. >> i like this it's is (inaudible) i thank my parents

for bringing me here. >> this the definitely better than the la airport one thousand times better than. >> i have a double knees burger with bacon. >> i realize i'm on a diet but i'm hoping this will be good. >> it total is san francisco experience because there's so many people and nationalities in this town to come to the airport especially everyone what have what they wanted. >> are repioneering or is this a del. >> we're definitely pioneers and in airport commemoration at least nationally if not intvrl we have many folks asking our our process and how we select

our great operators. >> ♪♪ ♪♪ ♪♪ ♪♪ the food option in san francisco airport are phenomenal that's if it a lot of the airports >> yeah. >> you don't have the choice. >> some airports are all about food this is not many and this particular airport are amazing especially at the tirnl indicating and corey is my favorite i come one or two hours before my flight this is the life. >> we definitely try to use as many local grirnts as we can we

use the goat cheese and we also use local vendors we use greenly produce they summarize the local soured products and the last one had 97 percent open that. >> wow. >> have you taken up anything unique or odd here. >> i've picked up a few things in napa valley i love checking chocolates there's a lot of types of chocolate and caramel corn. >> now this is a given right there. >> i'm curious about the customer externals and how people are richmond to this collection of cities you've put together not only of san francisco food in san francisco but food across the bay area. >> this type of market with the

local savors the high-end products is great. >> i know people can't believe they're in an airport i really joy people picking up things for their friends and family and wait i don't have to be shopping now we want people take the opportunity at our location. >> how long has this been operating in san francisco and the late 18 hours it is one of the best places to get it coffee. >> we have intrrnl consumers that know of this original outlet here and come here for

the coffee. >> so let's talk sandwiches. >> uh-huh. >> can you tell me how you came about naming our sandwiches from the katrero hills or 27 years i thought okay neighborhood and how do you keep it fresh you can answer that mia anyway you want. >> our broadened is we're going not irving preserves or packaged goods we take the time to incubate our jogger art if scratch people appreciate our work here.

>> so you feel like out of captured the airport atmosphere. >> this is its own the city the airline crews and the bag handlers and the frequent travels travelers and we've established relationships it feels good. >> when i get lunch or come to eat the food i feel like i'm not city. i was kind of under the assumption you want to be done with our gifts you are down one time not true >> we have a lot of regulars we didn't think we'd find that here at the airport. >> people come in at least one a week for that the food and service and the atmosphere. >> the food is great in san francisco it's a coffee and i

took an e calorie home every couple of weeks. >> i'm impressed i might come here on my own without a trip, you know, we have kids we could get a babysitter and have diner at the airport. >> this is a little bit of things for everybody there's plenty of restaurant to grab something and go otherwise in you want to sit you can enjoy the experience of local food. >> tell me about the future food. >> we're hoping to bring newer concepts out in san francisco and what our passengers want. >> i look forward to see what your cooking up

(laughter) ♪♪ ♪♪ ♪♪ ♪♪ ♪♪ >> today we've shown you the only restaurant in san francisco from the comfortableing old stand but you don't have to be hungry sfo has changed what it is like to eat another an airport check out our oblige at tumbler datinit. >> shop & dine in the 49 promotes local businesses and challenges resident to do their shop & dine in the 49 within the 49 square miles of san francisco by supporting local services in the neighborhood we help san francisco remain unique

successful and vibrant so we're will you shop & dine in the 49 chinatown has to be one the best unique shopping areas in san francisco that is color fulfill and safe each vegetation and seafood and find everything in chinatown the walk shop in chinatown welcome to jason dessert i'm the fifth generation of candy in san francisco still that serves 2000 district in the chinatown in the past it was the tradition and my family was the royal chef in the pot pals that's why we learned this stuff and moved from here to have dragon candy i want people to know that is art

we will explain a walk and they can't walk in and out it is different techniques from stir frying to smoking to steaming and they do show of. >> beer a royalty for the age berry up to now not people know that especially the toughest they think this is - i really appreciate they love this art. >> from the cantonese to the hypomania and we have hot pots we have all of the cuisines of china in our chinatown you don't have to go far. >> small business is important to our neighborhood because if we really make a lot of people lives better more people get a job here not just a big firm. >> you don't have to go

anywhere else we have pocketed of great neighborhoods haul have all have their own uniqueness. >> san francisco has to all

>> what's going on everybody. i'm nona at holiday

plaza. just got off the bart and getting ready for the parade (inaudible) [horns and cheering brash >> did you say you came off a flight to be here? >> i live in jacksonville florida. >> how long have you been a warriors fan? >> my firs game was (inaudible) >> (inaudible) >> the stands. the energy you get. that is one thing i miss about living in the bay. it is hard to explain till you see it. and we are not done. we still got (inaudible) i'm really really looking forward coming back next year. >> we'll see you back again next year. have so much fun. >> have a great day darling. [cheers]

>> we are at a point where we have this dynasty and will be here every single year. >> that's right. one more! let's go! [cheers] >> how old are you? >> 8. >> you are 8 and you have been awarrior fan 8 years so your whole life. >> yep. >> how awesome is it to be at this parade today, are you excited? >> i'm really excited. >> is it your firs parade? >> yeah. >> it is awesome and so much fun. who are you excited to see? >> (inaudible) >> has he been your favorite player 8 years kblrks yeah. >> i love it. [cheers] >> how long have you been a warriors fan, sir. >> my goodness, 70. i was in 75- >> 75. >> actually i won a

free throw contest at 10 years old and basketball signed by addles and thermman, a san francisco war riors. (inaudible) >> how awesome is to see them acquire what they have and have this dynasty kblrks it is super cool to see this and see the players. it is fun. >> you feel that is where we will stay or get (inaudible) >> (inaudible) i think we have (inaudible) i do. >> i have no doubt. have so much fun. >> thank you so much. have a great day. [cheers] >> we are going to head over to make our way to the main stage and check out all the action up close and personal. let's go.

how awesome is it to be part of this parade today? are you guys stoked? so excited. yes! if you can only hear how load that was. all the way in the front in the vip section. the warriors players are up on the stage. lelts polk hear what they have to say. >> the finals, stefen curry! give it up for your 2022 world champion golden state warriors! [cheers] what does it mean to have the first parade in san francisco? how much are you looking forward to this one? >> let me tell you, i'm so excited the streets are lined up and blue and gold,

we are going to give a homecoming like no other. welcome home warriors! >> we represent you guys. the life you give us, the inspuration and free males meals and standing ovations in had kitchen. all those things matter, because this is what it is all about is entertaining you guys, giving you something to cheer for and be passionate about. giving us the tonight to do amazing things that haven't been done in history and represent the entire bay area in the process, so it means a lot. we all been here the entire time and try to continue to build this. it means the world and now we back having a parade and san francisco, so let's go do it. >> the warriors team was just introduced behind me on the

stage. london breed just gave a heartfelt speech. a beautiful asunny day in san francisco, a wonderful day for a parade, so let's get it going. [cheers] >> and that is it for the 2022 golden state warrior parade. huge thanks to everybody involved and the city of san

francisco. the cleanup crew getting the city back to tip top shape. for more information about the great city departments, >> >> >> >> >> my name is bal. born and raised in san francisco. cable car equipment, technically i'm a transit operator of 135 and work at the cable car (indiscernible) and been here for 22 years now. i grew up around here when i was a little can i. my mom used to

hang in china town with her friends and i would get bored and they would shove me out of the door, go play and find something to do. i ended up wandering down here when i was a kid and found these things. ♪ [ music ] ♪ ♪ >> fascinated by them and i wanted to be a cable car equipment from the time i was a little kid. i started with the emergency at the end of 1988 and drove a bus for a year and a half and i got lucky with my timing and got here at cable car and at that time, it really took about an average five to maybe seven years on a bus before you could build up your seniority to come over here. basically, this is the 1890s verse ever a bus. this is your basic public

transportation and at the time at its height, 1893, there were 20 different routes ask this powerhouse, there -- and this powerhouse, there were 15 of them through out the entire city. >> i work at the cable car division and bunch with muni for 25 years and working with cable cars for 23 years. this is called the bar because these things are horses and work hard so they have to have a place to sleep at night. joking. this is called a barn because everything takes place here and the powerhouse is -- that's downstairs so that's the heart and soul of the system and this is where the cable cars sleep or sleep at night so you can put a title there saying the barn. since 1873 and back in the day it was driven by a team and now it's electric but it has a good function as being called the barn. yeah.

>> i am the superintendent of cable car vehicle maintenance. and we are on the first and a half floor of the cable car barn where you can see the cables are moving at nine and a half miles an hour and that's causing the little extra noise we're hearing now. we have 28 power cars and 12 california cars for a total of 40 revenue cars. then with have two in storage. there's four gear boxes. it's gears of the motor. they weigh close to 20 tons and they had to do a special system to get them out of here because when they put them in here, the barn was opened up. we did the whole barn that year so it's difficult for a first of time project, we changed it one at a time and now they are all brand-new. engineer's room have the four monitors that play the speed and she monitors them and in case of an emergency, she can shutdown

all four cars if she needs to. that sound you heard there, that's a gentleman building, rebuilding a cable. the cable weighs four hundred pounds each and they lost three days before we have to rebuild them. the cable car grips, the bottom point is underground with the cable. it's a giant buy strip and closes around the kab and they pull it back. the cable car weighs 2,500 people without people so it's heavy, emergency pulling it offer the hill. if it comes offer the hill, it could be one wire but if it unravels, it turns into a ball and they cannot let go of it because it opens that wide and it's a billion pushing the grip which is pushing the whole cable car and there's no way to let go so they have to have the code 900 to shutdown in emergencies and the wood brakes last two days and wear out. a lot of

maintenance. ♪ [ music ] ♪ ♪ >> rail was considered to be the old thing. rubber tires, cars, buses, that's new. there were definitely faster and cheaper, there's no question about that. here at san francisco, we went through the same thing. the mayor decided we don't need

cable cars (indiscernible), blah, blah. we can replace them with buses. they are faster and cheaper and more economical and he was right if you look at the dollars and cents part. he was right. >> back in 1947 when they voted that, i'm surprised base of the technology and the chronicle paper says cable cars out. that was the headline. that was the demise of the cable cars. >> (indiscernible) came along and said, stop. no. no, no, no. she was the first one to say we're going to fight city hall. she got her friends together and they started from a group called the save the cable car community, 1947 and managed to get it on the ballot. are we going to keep the cable cars or not? head turned nationwide and worldwide and city hall was completely unprepared for the amount of backlash they got. this is just a bunch -- the city came out and said basically, 3-1, if i'm not mistaken, we

want our cars and phil and her group managed to save what we have. and literately if it wasn't for them, there would be no cable cars. people saw something back then that we see today that you can't get rid of a beautiful and it wasn't a historical monument at the time and now it is, and it was part of san francisco. yeah, we had freight back then. we don't have that anymore. this is the number one tourist attraction in san francisco. it's historic and the only national moving monument in the world. >> the city of san francisco did keep the cable car so it's a fascinating feel of having something that is so historic going up and down these hills of san francisco. and obviously, everyone knows san francisco is famous for their hills. [laughter] and who would know and who would guess that they were trying to get rid of it, which i guess was a crazy idea at the time because they felt automobiles were taking the place of the cable

cars and getting rid of the cable car was the best thing for the city and county of san francisco, but thank god it didn't. >> how soon has the city changed? the diverse of cable cars -- when i first came to cable car, sandy barn was the first cable car. we have three or four being a grip person. fwriping cable cars is the most toughest and challenging job in the entire city. >> i want to thank our women who operate our cable cars because they are a crucial space of the city to the world. we have wonderful women -- come on forward, yes. [cheers and applause] these ladies, these ladies, this is what it's about. continuing to empower women. >> my name is willa johnson is

and i've been at cable car for 13 years. i came to san francisco when i was five years old. and that is the first time i rode a cable car and i went to see a christmas tree and we rode the cable car with the christmas worker and that was the first time i rode the cable car and didn't ride again until i worked here. i was in the medical field for a while and i wanted a change. some people don't do that but i started with the mta of september of 1999 and came over to cable car in 2008. it was a general sign up and that's when you can go to different divisions and i signed up as a conductor and came over here and been here since. there were a few ladies that were over at woods that wanted to come over here and we had decided we

wanted to leave woods and come to a different division and cable car was it. i do know there has been only four women that work the cable car in the 150 years and i am the second person to represent the cable car and i also know that during the 19, i think 60s and women were not even allowed to ride on the side of a cable car so it's exciting to know you can go from not riding on the side board of a cable car to actually grip and driving the cable car and it opened the door for a lot of people to have the opportunity to do what they inspire to do. >> i have some people say i wouldn't make it as a conductor at woods and i came and made it as i conductor and the best thing i did was to come to this

division. it's a good division. and i like ripping cable cars. i do. >> i think she just tapped into the general feeling that san francisco tend to have of, this is ours, it's special, it's unique. economically and you know, a rationale sense, does it make sense? not really. but from here, if you think from here, no, we don't need this but if you think from here, yeah. and it turns out she was right. so.... and i'm grateful to her. very grateful. [laughter] >> three, two, one. [multiple voices] [cheers and applause] >> did i -- i did that on

purpose so i wouldn't. ♪ [ music ] ♪ streets. >> (speaking foreign language.) >> i wanted to wish you a best wishes and congratulations the community has shifted a lot of when i was growing up in the 60s and 50's a good portion of

chicano-american chinese-american lived in north beach a nob hill community. >> as part the immigrant family is some of the recreation centers are making people have the ability to get together and meet 0 other people if communities in the 60s a 70s and 80s and 90s saw a move to the richmond the sunset district and more recently out to the excelsior the avenue community as well as the ensuring u bayview so chinese family living all over the city and when he grape it was in this area. >> we're united. >> and growing up in the area that was a big part of the my leave you know playing basketball and mycy took band

lessons and grew up. >> (speaking foreign language.) >> allergies welcome to the community fair it kicks off three weeks of celebrations for the year and let's keep everybody safe and celebrate the biggest parade outside of china on february 11th go best wishes and congratulations and 3, 2, 1

happy enough is enough. >> i grew up volley ball education and in media professional contrary as an educator he work with all skids whether or not caucasian hispanic and i african-american cumber a lot of arrest binge kids my philosophy to work with all kids but being here and griping in the chinese community being a chinese-american is important going to american school during the day but went to chinese school that is community is important working with all the kids and having them exposed to all culture it is important to me. >> it is a mask evening. >> i'd like to thank you a you all to celebrate an installation of the days here in the asian art museum. >> one time has become so many

things in the past two centuries because of the different did i licks the immigration officer didn't understand it became no standard chinese marine or cantonese sproupgs it became so many different sounds this is convenient for the immigration officer this okay your family name so this tells the generations of immigrants where they come from and also many stories behind it too. >> and what a better way to celebrate the enough is enough nuru with the light nothing is more important at an the hope the energy we.

>> (speaking foreign language.) >> relative to the current administration it is, it is touching very worrisome for our immigrant frames you know and some of the stability in the country and i know how this new president is doing you know immigration as well as immigrants (fireworks) later than you think new year the largest holiday no asia and china those of us when my grandparents came over in the 19 hundreds and celebrated in the united states chinese nuru

is traditional with a lot of meaning. >> good afternoon my name is carmen chu assessor-recorder i want to wish everything a happy new year thank you for joining us i want to say. >> (speaking foreign language.) >> (speaking foreign language.) >> i'm proud to be a native san franciscan i grew up in the chinatown, north beach community port commission important to come back and work with those that live in the community that i grew up in and that that very,

very important to give back to continue to work with the community and hope e help those who may not be as capable in under serving come back and give

>> good morning. this meeting will come to order. welcome to the april 6, 2023 regular meeting of government, audit and oversight committee of the board of supervisors i'm supervisor preston chair. joined by vice chair stefani and supervisor chan. clerk is stefani cabrera and our thanks to sfgovtv. >> board andom