>> you would rise for the pledge of a liege yens. [pledge of allegiance] would you call the roll. >> roll call starting with -- president scott is excused.

vice president hao. >> present. commissioner breslin. >> present. >> commissioner canning. why present. >> commissioner follansbee. >> present. why commissioner zvanski. >> here >> item 3 is general public comment an opportunity for members to comment on a matter in the jurisdiction this is not on the agenda and including requesting the board place an item on a future agenda item. we will post our instructions. >> so. -- the health service boarded away public participation. an opportunity to general public comment in the begin and on each item on the general. in person comment first and then virtual. wait nothing person you approach now. each speaker will be allowed 3

minutes unless the president changes that. concerning the item presented i call are maid ask questions well is no obligation to answer. the board will hear up to 30 minutes of comment. 415-554-00012599 242 5119 ##. >> when the system saysure line has been unmuted you can speak.

for those on web ex click on the raised hand icon to speak. tell appear next to your name when you are unmuted unmute will, peer. select unmute to speak. once you hear, welcome you can speak. when your time is expired you will be mute exclude click on the hundred icon to lower your hand. members are urge today state their names clearly. il give you a warning at 30 seconds. thank you to sfgovtv for share thanksgiving meeting with the public. we'll begin with in person comment we move to remote public comment and moderator will notice us if comments are in the queue. thank you, moderator.

public meant is closed. >> thank you. >> item 4. >> agenda item 4 is approval with possible modifications of minutes of meeting below. this will be presented by vice president hao and for the minutes of the april thenth 23 meeting. >> are there questions or edit to the minutes? if 91 may i have a motion. >> step in the without objection. >> second. >> it hen moved and seconded. miwe have public comment. >> thank you for voip hao. public ment is open. instructions are displayed on the screen for those on sfgovtv and web ex. in person first and remote.

we'll move to remote comment. there are zero callers in the queue. thank you. hearing no callers, public comment is closed. >> thank you. >> item 5 j. we need to vote. >> sorry. i think he got to my brain! [laughter]. may we take a vote, please. >> vice president hao. >> aye. >> commissioner breslin. >> aye >> commissioner canning. >> aye >> commissioner follansbee. >> aye >> commissioner zvanski. >> aye >> thank you. they are trying to get us out on time. [laughter]. come to. >> agenda item 5, please. >> item 5 is the president's report this is a discussion item

and can be presented by vice president hao. >> thank you. i don't have a report for today. other then and there to will say we have a hefty items to consider today as well as our next meeting thank you for being present. >> so. i guess we are public comment on those brief comments. >> open that up to public comment. public comment is open. instructions are displayed on the screen. in person public comment first. and no one approached. we'll move to remote opinion comment and moderator will notify. callers in the queue. >> there are zero callers.

thank you. public comment is closed. >> thank you. >> agenda item 6, please. >> item 6 director's report this . is a discussion item and presented by executive director yant. >> my report is broef this month. i want to call attention that the obvious we are in the blackout period with negotiations in plans and so -- and to reiterate commissioner hao's comments, we will have a special meeting on the 25th of this month. and am we'll speak to this at rates and benefits calendar. also i want to call out it is may is mental health awareness month. and our team well being team are focused on mental

health awareness month and have activity and links that have been set out to city champion and so we are attending to this important issue temperature is asian-american pacific islander month. this month was chosen to for the first known japanese immigrant to the united states and honest are the railroad built by 20,000 chinese workers in 1869. there are other references in my director's report we join many city agencies in celebrating this month together. if also, there are a deck of slides in my report calls out in detail the return to hesitate normal but come off of the

public health emergency if state that we have been in at a federal and state level. i think as you may recall, the san francisco state of emergency ended in february. but today is a hall mark day for the end of the covid-19 public healing declaration. so that's quite a moment us occasion. you do this once every 100 years. i'm hoping the guidance in the materials that are in your packet today are as/khrer as than i can be for membership there is a variation in how different plans are how they are regulate exclude what has to be covered by the complan what costs we pick up in the reimbursed by plan or members absorb on their own there is a bit of denail there. i'm hat's off to aon and our

communication's team at hss for pulling this information together and making available to member services teams and our members at large. we be going through confusion i'm sure i had that discussion with my husband this morning telling him to pick up00 autotest kit bunkham how they would be paid for. took longer. but because it is confusing. i think we will go through this for a bit. >> school district is continuing to unwind their complicated problems they have with the payroll systems. our indications of the calls that we are receiving. things are improve nothing this we are getting less calls and continue to have dedicated line and service for usd employees having challenge and we are everyone is look forward to an

end to the resolution to get thanksgiving working. 100%. >> also i think the board is aware of the study that we did upon partnership with catalyst for payment reform by the peter son foundation and uc berkley on population that is begin through blue shield of california. partnership with interesting results there will be a web near boy payment reform that will air live next wednesday. bull be available orm a recording as well as people want to weigh in a different accomplice in time so the commissioners would need assistance in watching that let holly know. we are challenged not having

enough people in chairs in member service. we are making progress. we do have interviews lined up. we are hopeful to get good hires in few weeks. and that's really great. we also received civil service commission froufl proceed with contract service to help us with call answering. work with contract's team to get request for principle in shape to get this out in the market very soon within it is next week so we can engage this service. and we are staying bchlz lots of activities this continue on and will gift and finance report short low that is all i need highlight now. i will take questions.

>> thank you. executive director yant. questions? >> i couple comments one the position needs to make a comment about costeroid remind staff and members that there is an update in the recommendations for boosting. and so that the second the vaccine available 8-9 months ago was not recommended fall under categories include age, but a second dose is now visible. i got mine yesterday and i'm here. remind everyone that it is director yant said we are living with corid not gone tell not go away but we have a responsibility to care for ourselves. i want to applaud the health service staff regarding the

school district issue. one article in the chronicle out line the problems with payroll and with retirement benefits. it was notable in absence of come mrinlts about interruption of heck health care a tribute met low to the staff and working with the san francisco school district to make sure this there was not an interruption of health care benefits. 19 there are articles i missed i want to thank the staff to work on this. we will take public comment >> thank you vice president hao. public comment is opened. instructions are on the screen.

keep will begin with in person comment. move to remote comment. we have one caller. zero in the queue.

hearing no callers. public upon comment is closed. >> thank you. call item upon 7. >> agenda item 7 the financial report as of march 31st of 23 this is a discussion item and presented by hussein chief financial officer. i will make sure that come up on the screen. okay. >> good afternoon. [no mic] seeing in beginning with fall last year high medical claims. eased off and -- am that's a big plus. looking at power present agsz high doctor claims that's. >> could you get close to the

microphone i'm not sure if everyone is hearing you i'm having difficulty. i don't believe the screens are coming through. they are >> okay. >> okay wrochlt there we go. thank you. why i will say that again. the projection now is a net even we were in prior projecting a decrease in the first balance the end of the year. reason for this is that the claim experience in the first quarter is improving. the high dollar climbs we saw all of 22 for are not there in q1 but it is early so they could come in. the other thing i point out i talked about in the report the timing upon differences.

so the revenue manage in come on pay per basis. and the expense go up month low. there are months in the pay periods march was one. that's yet 9 month column shows a surplus. if the pharmacy rebates are consistent weapon when we were expecting. enter is higher this year, due to higher rates. and we are expecting budget on the fund and the general fund. had i plan the vacancy we talked about. >> that's my report. happy to answer questions. >> thank you. >> clothes do you have questions? >> no. >> i have a question. pharmacy rebates. there they are less then and there projected >> that's the 8 opinion 7

already collected through much we expect 14 by then. more coming? >> yes. >> thank you. >> so 8.7 for the fiscal year to date. >> yes. >> we are expecting another 6 million before june 30? >> okay. all right. thank you. . no other questions we take public comment. thank you. public comment is open. instructionsor screen. we'll move to remote.

are there callers in the queue? i'm going to step in and check for us. one call or the line and zero in the queue. i will indicate when there is no one in the queue. and give 5 more seconds for anyone had may want to raise their hand. there is no public comment. departmental progress report a discussion item and presented

hsh senior healing program exert racial equity. the record i'm low tits why harris racial equity lead. tech support is in control of the sharing the screen. if you queue and -- verbally. >> okay. >> you no longer need to which we'll have it through tech support. >> thank you. this report highlights work going on at the city, department and nation in religion to the citywide man dachlt the experience and discuss our data driven is approach.

areas to the strategy plan. and implemented and learnings we like to get from other city departments. advance to this next slide? the agenda on the screen with reporting progress and input from our commissioners. and members of the public. >> next slide. strive to be a change upon nineteenth this work. westbound our department expect city partners across san francisco. we wanted set context in religion to the efforts going on and the historical perspect i was how it was formed. for context the basis for the presentification. >> at the city level the office of equity formed i new division of the human right's commission. office is ore for the purposes of this presentation.

guaranteed authority for i framework and mandate racial equity action lance. the government alliance for equity learning cohort this served fundation for the work we have been doing. we wanted make sure our framework is alining leaders in san francisco division. phase fwhon summer of 2020 and highlights staff program and policy. including the completion of racial climate survey.

results served the fundation for building work place environment. phase 2 framework distributed in 2023. focus on deliver of external services and promise targeting community engagement and equity indicators the commissioners are program than i are full net facets of the w we await the frame w from the city. next slide, please. experienced mile stones over years of working on the mandate. since 2018 the following contributed to our development process. train and bias training for staff. we had discussions around experience with race. an equal staff environment and

look at demographic's data the board is familiar with reports about part of the director's report we echo the report outs at meetings as well. >> next slide, please. the city requires only biannual reporting on progress, actually presented our action plan progress reporting to the board annually. i wanted call attention to the screen done business reports. updates and progress report that we are presenting today and all of the reports are available on our website. just for historical purpose and i deeper dive >> next slide. throughout the development of the plan we spent a dial of time thinking how to measure success and who is better off as a result of this work. ground each in i baseline did

the/a from availabling sources including race and equity data available for membership. draw a parallel with this report and the annual report to show that our race and equity data improve in the 23. by over 5,000 employees. in 2023 the number who did not enter race dataroused 1800. categories for race data collection are wildly in our collection system across the city. that may affect communities of color in our population. similar to race and equity data

absence of gender identity data make its difficult to quantify the needs of lbgtq+ population. they're working with partners to expand sexual orientation categories with the ordinance passed by the board of supervisors. the categories inclusive of nonbinary trans female or male. gashg lesbian and bisexual. that are used today and are not all inclusive by themselves. the latter part focuses on 2 questions of asked of every department by office of equity the first, what is an equity practice your department implemented in the last your it can share? remember hsh is leading with equity in support of membership and the care than i need when they need it regardless of

demographics. actually unique in departments in the city that equity seengrained as a goal but a facet of our mission and have yous as limp the plan process represents a shift from benefit services to a deeper understanding of the pop lagdz need in alignment with prince pals. a grasp on health equity of influence religion to equity action plan and mirroring the framework to tackle internal and external phases of work is when we wish to share. since the inception of the plan we have confronted. if the pandemic highlighted the disparity in society. we are alining with authorities to make sure it is engrained. the intersections with each of

our goals is on the screen. the intersections with equity, fordable and sustain okay, primary care. mental health and benefits administration services. hsh is taxling phases of w we wish to mile per hour or the city framework this notes internal actions. we discussed with the board the internal lens is equity. as it applies to the workforce and applies to health service board. the actions noted in the past year of progress we are looking into survey toonls reproduce engage am serving. diverse opportunity with our board and staff. our director's reports and sfaf train to normalize and operationalize new behaviors for our staff am we held a retreat.

and employee appreciation pot luck to thank employees for the good w they do with our values. will when staff move on to opportunity in and outside of the city, hsh is seek to conduct exit interviews to increase the responsibles of our staff to improve excellence retention and engagement. the internal actions to apply our 11s demonstrate inclusion and belanguaging from internal aspect. this slide has the external actions. am external applications are for health equity. upon in our customer service 11 and health plan partnerships request being health statements declarations from our healths plan partners having if they have working groups to task with out come.

auditing practices as mentioned for did the/a to expand categories. we are asking them if than i are applying national standards for cultural promoteness and they are seeking accreditation to the best of their abilities or plan to do so. we presented national conferences and also web narc on accel braterateingly in underserved community and rep centation on health care quality committee as limp partnering with experts at every opportunity like the purchase business group on health to talk about investments of time and energy and why worth for others to invest in health and equity. the second question by the office of racial equity to all departments in the city what it is a practice a prior for your departments from which you wish to learn in the year?

met with the office of racial equity tow let them know we are receiving asks around mental health support. we talked about this mental health awareness month and are receiving relation to a direct you have from racial equity tells out city department this is they must provide environments for groups prioritizing emergency nalized people. they from in employee resource groups, affinity groups. we have been receiving requests for thez export to upon very manies to the board that there is a national shortage of behavioral health clinicians. those this are blk, indigenous and people of color. why made steroid in thes area of mental health. we want to better understand how to independent to the asks especially since directly to the office racial equity mandate.

we wanted let the office of racial equity therein is a direct link with behavioral health and equity competiunderstand thinks we have around the determine nanlt and share am staff this show that certain populations vulnerable are more at risk for depression, substance use they are like low to be persistent and experience stress merchandise the equity has i kruck to the experience of meth relating to citywide work. nature the asks we have been receiving relate to funding, staffing, tools, resources and best practices. also a need for clinicians that can heel and lead the circles through afinity. point in time exactly on going and want a call out for populations in the city that are in nev.ed afinity group support.

>> we have shared with the office of racial equitiet strides we made to support the membership include the e ap services in response to the maelths crisis lunching apps. meth, wearness campaigns. presentations to the board from experts. and ena goal in the plan. we want to represent the rich diversity of our membership and the forum we created personace to do this. >> in addition to the noted efforts we therein is so much more to learn how to experiment mental health for membership. we are potion the questions an area of learning. how was the office of racial equity cataloging resource groups. if we-it would be a red resource the e apped passport and handled

out. we want to have a difference whether the resource groupers internal. service departments or cross pollinate for more of an up tick. we want to understands how the office racial equity independenting to staffing. and budgetary supportful tech help us understand as the city is experiencing short angios and staffing and budget how can we support other groups and having resources they need to support mental health as a boekon with well being situated. and lastly, are there existing tools best practices we help through our well being networks and otherwise. final slide. i wrap this up i want to

reiterate the mile stones for office of racial equity afford the opportunity to share when we learn exclude acquire more knowledge and further our understanding posing educated questions to other department this is are willing to share their knowledge. it learn more with efforts i invite to you visit our web page. under the about us link close to our strategic plan with our strategic plan to highlight the relationship. i invite to you facility second link which shows all racial equity action plan for all 60 department in the city. can be difficult to understand how this work is going on. . but i find it good to see we are not alone and taking shape in many ways. thank you. iffed >> thank you. colleagues any comments or

questions. >> thank you very much. concise and detailed appreciate that. i'm impressed with a couple of the items you bring up about cordination you showed the map of california, many of almost all including merced are in our area for. and he was departments who are commute nothing to the city. and so i wonder if you can addressest efforts to coordinate with the other health county. and then impressed you are integrating andarc sesz to the plans from all 60 departments. may be can you clarify how the departments also -- work together. them is all you know critical. >> absolutely there is one racial equity lead this tanlds i

monthly meeting by office racial equity an opportunity to hear about best practice and tools for other department and helped to inform working groups around reporting mile stones every month. in relation to learningy remember gentleman, lines for race and equity they have an on line data base you ask questions and contact with divisions when you went through the training for us in upon 2019. i was blessed have participated with budget cuts. we have that knowledge and year long experience able to keep in touch with the others from counties impacted by member sxhp readily visible to share, too. i amrauchd you for when you are doing temperature an

exceptional -- i have family members working up at ucsf on issues in -- will not the so much mental health but physical health treatment that various yd individuals receive or don't receive. because of their ethnicity. exclusive i guess i always thought that our exception was of city employees because we had -- good coverage and good insurance and access to health benefit and that those were not, about i see thatir since learned nathose it can still impact our mixture when they go out to see their providers weather they get the same consideration.

individuals down 18 huh common some don't wish to report i worked with people who indicated it was human race not any other. i wander if we have other way we are tracking the services this are employees and retirees are receiving from their health service providers to than we have we are not dealing with a number of inequityys based on race or culture?

yea. i think that is served the -- the primary aim of in work is to feel identify patterns of behavior that are structuraly racist in the wait care is delivered temperature is a sensitive -- matter and one that i00 eye think that our health systems embraced. i upon be mote with our plans we

look at the data that is available. based on ethnicity and race and -- there are many program in place throughout the city. they are clearly demonstrated throughout the pandemic inweekityys exist in the people taking up the test and vaccine and other things and it gets complicated quickly. i think there was tremendous learnings throughout the pandemic intent here in san francisco to be sthrn we were reaching heard to roach populations. and learning wham the barriers may have been. and work to break them down. upon so. this suspect upon not a quick fix and there are many issues merit in play i will say that -- through our healing plan partners it is not a subject we shy away from and there are, let of good evidence of things working. but this does not mean things are all good. that's when we are identifying where the issues are and when we do to claesz it. >> this evening i have one last question. i upon spent time up there. hetch hetchy. we know are getting reports from

that area temperature is in the necessary low a diverse area with regard to our workforce. anything that come down. no. you know it would be a special study -- to understand it is i mall population. doyle draw conconclusions from the data. but we you know our have to consider that. mall population gets mall whenever split up against the plan and providers, we have to think that through comprehend we find a way to ask the questions anyway. only door to that? >> we will have to consider it. am of how we do temperature is sheer numbers. >> it would be descriptive and careful about hay and other things we consider about a small population. the populations in general we

have barriers to and it is very much a nationwide concern. hospitals that are closing -- throughout the united states. so become a major issue. throughout the country. so. thank you. it is interesting. that is a real conversation happening one thing with the partners partnered with blue shield the california conference board. and we talked but dispelling the myth the population does not have social needs. we talked about community health

advocacy. this is unclear and -- >> people have trouble seeing a doctor. >> i am or they don't mind this is a problem not anything to do but it is a problem. it relates to the social determine nans and geography you pointed out >> you think the population would need support. we are hearing from members via community advocates in their communities that need exists. we have not readily accesspable

through helling plan resource. >> i think it relates to different social determine nanlts. food access and transportation. may be to gain acstoesz depending where than i live. different factors. english second language and different things not just a shortage of doctors. >> if i can comment as well. this is something critical and i think until we ask the questions this is what is doing we'll not get to the answers. you know data shows that african americans the social class access dermatology have a harder time because of the education of dermatologist around skin problems with african americans and misconceptions in medical education. and likewise a study this looked at infant mortality across

interracial -- groups but matched them for social economic status and in the highest social status african-american women had worse out come. it is more than simple low an upon skin color. until we look at all these. access would access to health care. the sense to the, regarding that group we'll not know them until we ask the question and look at the data and did a dive. that's what this is powerful. i want to thank you for bringing that up. i noticed that the mortality rates among african-american women in child intirth higher than any group x. same is true for breast answer. and a number of other condition and for you bring update issue.

language. i for got this and i shouldn't buzz it hen an initial my family if you mean cannot access providers who were can help with the language or are have that language proficiency, because not everyone has the 8 to have someone in their family help trans play it it is difficult. e approximately if you have older members of the family needing care and are the young are person is the whon can translate x. they are going in a difficult social situation. with. i dpgz this member of the family. language barriers are significant as limp race is an issue with regard to a number of conscience for women of color and that's why i bring it up. i'm glad we are monitoring that and staying tuned. we have an incredible workforce. we have thousands of people and

i continuing is important for us to continue to monitor that. will i would expect this our -- members will report to us when they discover within their own nest works. and reports from their provider members with regard to issues that may impact a number of individuals they serve with regard to race, color, language and others. thank you. >> i have fwooinl question about employee population you said standard iegz exit introduce. what are you learn inspecting and are you learning there are diversity inexclusion hot spots. joy will defer i'm not on the management i will defer. >> unfortunately we were not

able to do the exit introduce on the am large number that left if but in prior to that when we do and kinds of when you expect we did not see anything along racial lines. more occurrence about some of the management which is where people leave jobs. and when we may have heard. last summer. commercial opportunity. there is just we are not that bipartisaning don't have many promotional opportunity in our department and there are steps up that people have throughout the city. that is a mixed bless and this arena. what i have been taught to attend to is trying to help

people managers manage their employees well so people don't leave because of a manager that is not an issue at the time in phase 2 more service focus of the ore's am director directions. do you anticipate that the things you already have been planning and items will mesh up or do you anticipate strong tweak when you have in the plan. when we already have identifying populations and equity indicators alinement exists there will be expand learn when the framework is distributed and did frak work one first toft have this working from the inside out. around or culture t. is participated for late 23 and early 24.

i would imagine significant alignment. i add for if yous and retirement we have a different lens on external the external is us. and -- so i think upon you know has faced that challenge helping them understand who we serve. with respect most of them public comment notice. thank you vice president hao.

>> instructions are streaming across the stream. we will begin with in person comment. now remote public comment. il look through to see if there are callers on the public meant queue. one call are raised their hand i will unmute you in a moment.

hello and i'm sorry thank you very much for affording me this opportunity. it is admirable to be fair i did not comment at the beginning of your meeting good that the healing serve board is conducting this important discussion. what i would like to say, and i'm don't thank you is xhant cal is that i think it is person consideration here even miles an hour than the word equity is look at equality. equality suggests something more and suggests someone exacting. most person thing implementation and action in terms of the directive of this plan fulfill

exclude this i think in the learning are challenge for all of us. not just the health service board. i think if some of you commenters e loveded and people eludeed is this the challenges in terms of the challenges this black women face and brown women and others face. doing the thing people should do and seriously i think frank low machine wo is a black man in san francisco, is desperation time and beyond that for as black people and brown people. in these difficult positions and in society beginning. and i don't know if anyone will responsibleful i do think and think pertaining my comment i

would say that the language has to be strong exert you need to watch your hear nothing context if we talk about racial equality versus equity we are given to burrow deeper when you need do to solve thank you, caller. no more callers at this time. zero callers in the queue at this time with no further callers public comment is closed >> and so the next up normal agenda. portion of the our meeting. right before we dive in rate and benefits i continuing is present

to take a 10 minute break. that president scott would also agree with that. want to do him proud 10 >> here. commissioner canning. wo present. where commissioner follansbee. >> present >> commissioner zvanski. >> present. >> we have quorum >> about on enter now the rate and benefits portion of our agenda would you call item 9. >> agenda item 9 the presentation on the 2023 rates and benefit for plan year 24 this is a discussion item and presented by abbie yant executive director. >> good afternoon. abbie yant executive director the rates and benefits calendar in your packet does reflect the change this month that activates our whole meeting on may 25th.

it it is a special meeting where we hear the active rates from our partners at blue shield and kaiser. and -- we will sort of set the stage for that at the next agenda item here today. we do have holly, were you able to pull the healing service board? it was just displaying is it coming up? >> yea. no , i'm talking a possibility this we may need a second mote nothing upon june and june 22nd meeting does not work for some reason i can't remember. you were going to approximately to see. >> here temperature is for the 22nd we confirmed with the submission for the board of proirz this is date is too late. we'll i will give a pool for everyone for commissioners to

find an and terrible hold date. >> >> we discoverd that. that's why we are pulling this meeting. >> yea. hopeful low we'll not need it but we will secure a date in case we do and holel follow up with each of you to explain and get your availability. with that. that is all i have to say. >> thank you. public comment. thank you. commissioner hao. public comment is open. instructions are displayed for those watching.

no one approached. we'll move to virtual public comment. i will moderate for the meeting for our remote comment. i will check if there are callers in the queue at this time. there are zero on the line. no further callers public ment is closed. >> thank you. >> next item 10. >> agenda item 10 is board education health care cost trends influencers update. this is a discussion item and presented by hussein chief financial receive and mike clark.

mike clark aon. today we will be our first recommendation for the 24 plan year for a medical plan we had prior discussion on dental, vision, life and disability. but thinking that we are discussing for the first time a medical rate recommendation today. chief financial receive hussein and i thought it would be prudent to deliver an occupant when we are benching in the market accomplice 3 months since we were before you in february. >> on the agenda page, 2. we'll discuss new information that are influencing cost fund and 2024 plan renewace. since our february presentation to the board. include a focus health care. labor cost growth. inflation.

covid-19 expense impacts. behavioral health impact and pharmaceutical impacts. we'll discuss new information for medicare advantage plans from i reduction in the growth of government payments this are expected to create pressure on advantage plan premiums. >> the slide on page 3 on the next slide you will rescue noise it from our february discussion the view comparing historically the performance of medical rate in total. percentage increase in promotium changes relative to 3 bench marx the premium changes. mers study and consumer price index for san francisco. as we noted favor okay trends for hsh and did voice concern in february about economy wide

inflation and the likelihood driving rates up may drive negotiated price up with the health plans. >> fast forwarding to today. escalated medical trend drivers and cfo comment on a couple after this slide. 4 elements that we are seeing influence in the presentful first all the health care wage and supply cost inflation is veryfully talk to the health plans they renegotiate their contracts with providers, we are seeing that influencing the price in those locations. slides are not advancing.

health care wage and supply costs and impact on negotiated providers will impact different plans at different times because areaier provider cycles do vary. they are tip kelly renegotiated every 2-4 years, we are ceiling early evidence of that present in to discussions with the health plans in 2024. maelths and substance abuse and cost condition to increase. provide everybody fly is great. veil of services to members as population demand vksz. the upper write chronic conscience. magnified.

few individuals questions of law fifor medicaid in the 40. you read the government will go through a medicaid redetermination process. and that willrous the number of u.s. citizens this are on medicaid. as well as the federal government reducing the growth payment in thes medicare plans which will touch on later in the presentation and i will turn it over to hussein. this slide talks about research done boy mc kenz competence asks a total national health care expenditures versus gdp growth on the right slide looks at a post covid projection.

you can see in a graph on page 3 our payment increase in 2023 were low there is a wave of higher increases coming begins according to the slide and 2023. and so this supplies and then following that large wave in 23 you have a gradual reduction. around 6% number according to the forecast. and and the reason for that the if you can i will get the reason. advance the slide. and the graph shows a rate inflation and it is core litted to the right side. as people the supply of

workforce or health caring shrunk and people exiting the workforce the inflationary pressure but ghen this trend you see this inflationary pressure easing toward the end of 2022. as the work people went back in the workforce or health care was able to bring back people -- get the recruitments up and mitt gift that shortage. >> which is the right side shows. slide 7 earlier service pricing. complex care needs are escalating. weo in client data. as are the costs of complex

needs due to over all inflation and the processes that providers are providing as well as the rising costs of advanced health technologies. lawyer amazing developments in the medical field. that -- impact the ability to treat conscience more effectively in today's environment versus 3-5 years ago and development in pharmaceuticals that all come as a process. service pricing for claimant an services driven by inflationary trends. supplies and labor and negotiating power hospital and health system consolidation and nondiscounted charges. high cost claim an incidents increases by technology to treat the conditions. as well as over all declining

health of population over time and one carrier noted from 2020 to 2021 the total booked business increased by 19%. in -- march i presented the information at the bottom of the slide to the board from the blue shield of california 2022 plan experience. the number of claimants in the access plus plans that exceed 500,000 from 28 individuals to 49 in 2022. that may not seem like an empicture when you consider the magnitude of the penned we are talking about here. you know quickly addsum in terms what cascades the plan experience.

a quarter of health care costs are associated with one of 4 complex conscience the heart muscular skeletal. bones and muscle makeum cancer and kidney disease. we are seeing ewile wragz by declining health. long-term impact of covid on the body. long are survival rates for river conditions in part because of the medical technology. and as many as one out of 6 people recover have symptoms sick months later. you know based on a study. on the right side is a screen shot from the risk report that reported to the board last

month. showing for active and early retiree populations the distribution of chronic continue element this is drives pend by status of health in the population. next slide i will turn it over to cfo hussein. this slide showsling other affect of covid. even the pandemic hospitalization stage is over we are seeing on going need for care. so -- the -- the -- kyle the tune here is to provide the time low care. and as much care in out patient opposed to the pandemic stage a high, high frequency of hospitalization. yea. and i guessil talk about mental health on the next slide.

so one of the lingering affects is mental health this . graph shows you the demographics you can there is an indication here it is -- we are seeing the stigma gradually go, way. more people are seeking stream. there is a shortage of workforce. which is also being addressed. but you see younger people report in treatment and male and females -- men never see doctors. but you then and there is one of the areas this we the initiative that she describe side to remove bear dwroers care and to create programs for people seek care for mental health.

address where conscience you know in in the marketplace with tremendous developments and cancer treatments the lower left. there are similar drugs on the way. one in specific drug everybody is talking about when we'll see the biosimilar on the market.

these are describes drugs that are more being thought about and utilized for weight loss use beyond original intent. the next slide pivoting to what is happen with methodology change in gentleman reimbursements asciiing medicare advantage plans the majority of the medical and prescription claim costs covered through federal government payments by center for medicare and medicaid. the premiums this we ask to you approve every year are what is left after the total plan costs.

the increases in revenues consistent with the percentage claim costs renewals for the plans have been favorable. but changes in how cms redefined the processes for medicare advantage plans, will lead to a gap in the increase between the total cost and increase that cms will present in their revenues. tell create pressure to the plans. we will talk further about this when we present our plan renewals at board meeting. in close, final slide. we reviewed cfo hussein and i

observe when we see in the market accomplice that is happening trend and with updates from when we presented in february. . the degree of the influencers we discussed will impact the plan will vary. over all the team is someplacing a 7% for plansination wide in 2024. in in addition to trend the forces are like low result in hire rate renowals for some plans than project when we spoke with you on the topic in february. the plans cost influencer

impacts discussed with each plans recommendation both today for the plans that will follow and the hsb meetings. questions or comments? >> well, thank you very much. you then and there is you are again it is not good news. we all recognize that. i guess you know, rather than trying to dissect a wachl all the influencers. certain areas pharmaceutical costs seeing abiz malresponse at the federal flefl this regard. dropping the dose of insulin has not impacted much else. as you negotiate and look at

these things where does the board have input into -- what we can ask. plans to -- come up to the table about. i see we staffing and salaries we all support this. there is no way oui will demand or cut become on staffing or saul reese. where are the -- you mentioned drug for -- weight loss. and i don't know if it has approval for this. but there are lots of drugs utilized for nonindicated indications based on [inaudible].

for another reason temperature is, maze to me. the question is where can we impact. one of the, you don't address is this the reporting about fraud through the health plans medicare advantage in terms of billing and over coding and all this. we don't claesz this . it is something this mihave an impact. should be addressed and what can be addressd and the impact might have if we are more adamant to look at the over coding. that occurs not so much the 27 or 48 patients in the hospital. the majority of patients seek

out patient care. you can address all or none. we will talk on june 8 about 3 key drivers behind the increase of the of cms revenues one is reclassification and technical term the old dying noveltyic classification was icd9. and icd10 advanced framework for diagnose adopted and 2024 is the first year factoring into reimbursements for plan. androusing in rougs the amount of dying noveltyic information captured on members that feeds into the ref now formulas for

various medicare plans. i will stop there. what do we ask the plan when is we mead with them. from a price stand point. how are you advancing into alternative payment models and trying to move away from service to frameworks this reward for value and out come delivered. that is a critical element how a plan negotiates the next wave of the contract with the space of providers. this is manage we are keeping an eye on.

trying to understand know when are the going plans to try to hold the line on any change in process for service. from equalization stand point. just doing best to try to help reduce sdand for services the healthier we are the less we need care. care is inevitable but -- trying to engage the planos preventive care and risk factors occurs. when care needs arise. that could be more cost effective. you know strategies around

pharmaceutical management. fall in that. i could go on for 2 hours. we have a say this board and hsh and the selection any time of change and destruction from this data it is important to partner xup look for the winners and losers and make sure that we are alined. with those this bring in high have you and efficiencies. i think the more integrated the more managed the plan works more

effectively than the open >> to develop disruptive models and do creative things as we look at 25 and beyond. short term we have a problem. active and retire exclude providing affordable quality health care for the dollars and the afford at. the city and county of san francisco that also has to be considered with regard to had it contributes we have the form

list are spelled out. we don't have a lot of availability, i think in terms city can provide the sea is locked in where it is and the rest fulls to members. when i look at that how do i justify saying to my colleagues and my friends and the people i serve on the board who put me here to watch for their best interests with heck and ability to continue to afford quality health care. i don't get creative but we look

at the quality and negotiation and when is out there. going forward you are right. none of us will argue the fact that people want and deserve living wages and spent years in labor. i will never go against that and the providers compensated what, factors can we influence. what gos with medicaid? what goos with medicare? what goes on in the drug strep and the pharmaceuticals with regard to all of these wonder drugs that come out and it exciting. great opportunity butt processes

are way up here. it is a human right. not a privilege not something we should have to dweel nicole and diming we need a way that everybody can do temperature for whatever idea this is come forward, i'm begging for the ideas, coprescription from our plan and what we have to on do to serve both our members we got a deficit we all have to figure out where we help off set that.

thank you we are crunching the same. i have i q. with all the great detail benefits the cost of routine visit beyond the annual physical. the cost to er and hospitalization. we weigh in the on that. i remember when we objected to rise in copays. the patient to the right person early and not put in a barrier such as a copithat might improve care and access and out come.

can we hear of changes in cost sharing. i will say discussed and terrible for design could be something the board could take into consideration. are we bring out. how do we what can we anticipate we are hearing? at this point the plans presented a few planned design alternatives. that create what i consider to be minor.

the discussion becomes, do you proceed? with copay increases. deductible increases when have you? that generate perhaps less financial influence. than would be preferred? or longer term consider other strategies? this could help a longer term trend mitigation past 2024. i appreciate that. we have time to look after 2024 for strategy changes i think had is fits being us now is plan year 2024. i think that the news you presented is daunting. it putsure board in a very odd position. to is anybody's fault i anticipate we'll be in an

awkward position to make a decision up or down on these changes. and it also makes me concerned about the whether these plans are sustainable. given shock they anticipate we are about to receive. >> so. ify woor able to come to an agreement what are next steps for the system? i mron presenting a recommendation to the board on the 25th.

we know they are substantial partnerships -- that impact tens of thousands of people. not able to find a -- viable recommendation would be precedent setting i don't know that's where anyone wants to be. i'm -- looking forward to being able to present a recommendation we may not be comfortable with it, we will -- understand it.

where -- you know in ways every penny count and other ways we want to be sure we are disrupting in an effective way that does not cause have unintended consequences. so i think we are considering all of those. our employers. we have the city the school district, city college. and the courts are all struggling with budget practicals. and so they are anxious for us to resolve this so their budgets can be completed. that adds to the pressure for us to get through this. and -- soon are rather than later. >> thank you.

i appreciate it. all right. no more comments we take public comment >> thank you vice president hao. >> public comment is open. instructions are on the screen. keep will move to the remote public comment. i will check to see if there are callers in the queue. zero caller. public ment is closed. >> thank you. call item 11. >> agenda item 11 review and

approve health net care medical rx flex fund nonmedicare hm oshg plan 24 rate bunkham contributions. this is know action item and presented by mike clark. mike clark this will be our first medical prescription drug renewal presentation for the 2024 plan year for health net canopy care. flex funds nonmedicare hmo plan. on the agenda page. we will run through a quick rate setting preface. that will cascade through presentationos plan renewals. the health net internal plan

rating present the rate cards that are recommend for healing service approval today. and then the, pennedics rate card footnotes the 23 rate cards in a glassary of terms it is there for reference. >> moving ahead to page 4. looking at different plans and the funding methods for each. the health net canopy care plan is flex funded plan. you see in the middle of the page. flex funded plans insurance prop most of the climb dollars are based on service delivered to members paid out of the trust with fixed cost for health care service. and as well as the administrative de feo in thes blue shield plan 1 million annually.

for canopy care medical costs through capitation. so locked at the cost trend assumptions presented by the plan and join them with plan administrative [inaudible] in the for this plan but the blue shield the pooling fees. general low under writing starting with prior period claims and inflation factor for trend. any design or head count adding in the administrative and other dpees adding in the specific cost of elements such as visual and 3 dollars sustain ability fee >> on page 6. just to note that today we are presentoth health net canopy care the remaining nonmedicare retiree recommend eggs 2 weeks from now on may 25th.

on page 7 to refresher how the ccsf america ou form lapse play into the determination of how total cost rates were shared by employer and members more the 93, 93, 83 prop that means employer is paying 93% of the employee tier costs and 93% of employee plus one tier cost and 83% employee plus 2 or more and certain employees we have 196/83 approach employees pay the remained are at the top of the barb charts >> for early retirees. employer contributions are determined by city chart exert the member contribution becomes the difference with the total

plan rates calculated. and so you can seep here that -- there are 3 elements of the emplayer contributions this in in to the calculation of the employer contribution for the retirees. on page 10 this is the recommendation that i gallon through with you. recommending the health service board approve 2024 health hmo rate cards. reflect a 3.7% increase in the over all health net care hmo plan medical, prescription and fee costs from 23-24. am we'll move to page 12.

health net provided their financial information in the healing plan renewal submission used to determine the rates. the health net canopy plan design is the same for the blue shield plans the elements of cost include claim costs the mall portion of medical fee for service and all pharmacy claim and rebates. capitation charges cover most medical service the fees that were determined part of the rfp fall approved by the health service board in february of 21. in 2024 the last of the 3 years for that fee agreement. which will state same.

current. and as well as rate buy down of within 18,000 approved by the board on march 23rd. >> compoens of the cost change what you will see here again this is the first year we are able to see plan experience. the upon plan rate reduced by 10.4% and drop in the capitation rate was learning component of that. thetation rate is increasing by felony.3% in 2024 that rate is lower. than when was in accomplice for

2022. the fee for service claimers increase thanksgiving mall component of the medical cost the benefit to the pharmacy is health net level pharmacy cost in the rfp press this was higher. that time left year there was not enough experience year to date in 2022 to adjust that pharmacy per member per month cost componentful now a full year and into 23 known for the costs for sfhsh and less then and there anticipated by health net in the rfp submission. you will see a significant cannot reduction to the pharmacy cost compoint rate in 2024. and the other 2 are strict low

to the agreements struck with the 3 year period out of the rfp a 3% medical fee increase and no change in farm avenues and administrative fees. when you put all this together t is about a 5 opinion five % projected increase in the over all cost. before the bedown is applied. going ahead to page 15. the rate cards on these page the 2 employer contribution models we discussed the early retiree based on city charter form lapse the relationships of the rates other same as what exists for blue shield plans. on page 16, you will see the change in the rates. both for active employees and early retirees and the 93, 93,

83 and you will early retirees on the right side. the plan will continue on have no contributions for early retirers. with that i will take to you

page 21. to close. the recommendation for healing service board action staff recommends the health service board approve the health net hmo rate cards as presented reflect i 3 opinion 7% increase in canopy plan. projected medical prescription drug and fee costs. vice president hao. >> thank you, mike. >> clothes any questions or comments. i move we approve the recommendations of the health 98 medical therapeutic fee flex funded hmo plan rates contributions. where second. >> it has been moved and seconded. we gallon to public comment. you think we can still talk about it >> sure. >> i have questions. it was clear and all that. is there prosecute jection about

how you e loud to the fact this it is going to be lower then and there when we will see with other nonmedicare plans in the coming weeks. how this might impact enrollment. in the next cycle in october. being a numbers person i encourage every year understanding the physician and facilities this there are per of their health care community i would you know every year encourage members to electric at the comparison of rates by plan.

>> i think the enrollment it is improved in a percentage matter in terms of slout numbers is still small fraction of the population. if i >> are that's corrects there is a modest enrollment but it has grown. >> opinion ment is open. instructions are displayed on the screen.

>> no one propped the poed where you will we will move to remote comment i will see if there are ay tendees in the queue. we have zero callers on the line. public ment is closed. >> we will take a vote, please. >> roll call starting with vice president hao. >> aye. >> commissioner breslin. why aye. >> commissioner canning. why aye. where commissioner follow fol. why aye >> commissioner zvanski. >> reluctant aye. >> thank you. it is unanimous with i bit of reluctance. thank you. >> move on to item 12. >> review and, prove suspension of the stabilization policy and,

prove the use of 2 thirds of active employee delta dental pp oshg stabilization surmras as of december 21 of twoochl approve the active employee dental rates for delta dental plan. insured delta care hmo and united health care hmo plan this it is an action item and presented by mike clark. i will not repeat what board secretary lopez said. we have a multirecommendation excuse me first to revisit, and revised rate stabilization action agreed upon for the delta dental ppo plan i will explain rational example also review the plan rates for the self funded plan for active employees with

delta and actsive ppo and fully insured plans visible it active employees and ask for approval and recommendations the plan designs for active employee plans in this document for reference and will not review them. looking head it ping 4. without going through detail a reminder that one of the plans is self fund the delta ppo plan. and 2 are insured. the 2 will hmo's. i'm going to look ahead to page 7. march 23rd meeting you approved half of the stabilization reserve surplus or 5, 557,000. which was a half of the total

surplus 11 million. applied for the delta dental ppo plan for 2024. in discussion. this has occur exclude looking for upon opportunity to try torous over all the levels of -- budget increase in the 2024 it was identified and suggested this we consider the use of 2 thirds of the stabilization reserve surplus for the plan to be considered in rating for 2024. i knoll is still maintains enough of i stabilization reserve in the plan employs we have i charter in here they have been significant surplus. there was i 2 third's buy down approval. do you to building i have no occurrence about the viability of rerising the recommendation.

in asking for this burden to approve 2 thirds for today. which reflect i bedown of 7 million, 49,000 in the 24 rates. this would produce an additional 1 million in 2024 active denialal p po buy down relative to what was approved on march 23. looking ahead to page 9. just renewal summary. last month on april then. today focus on the active employee plans. they are reminder on page 10 employees offered city county of tan san francisco.

and 15 per among for employee plus 2 or more for the ppo plan there are no contributions required for employees selecting the 2 hmo plans and employees pay no contributions for any of the plans. it is important to note the school district and city college employees those organizations don't elect to offer the dental conferage for active employees. on page 11. just to give you a sense of when i will ask for approval of today. the active employee dental influenced by plan experiences well as the adjustment to rate

stabilization buy down prosecute posing 6.9% reduction in total rate and the fill insured plans delta care and uhc proposed no change in rates for 2024. most elected employees are electing the ppo plan. i e louded earlier to the substantial rate stabilization surplus built in the plan do you to favorable claim experience and so with the recommendation that upon 7 million, ployed 24 plan year rates and will still leave 3 million in rate stable wragz in 2025. upon around the favorability of the plan.

talk about the delta dental ppo. so first this is a renewal cycle. the rate of fees for the planful and so with the rates decrease 6 opinion 9% a slight increase in administrative de feos for twenty tor. on a per employee per month basis. they have been locked in the last 5 years at 4 and 62 cents per employee per month the proposal to move to 470 cents for next year and part of the year 2 and 3 stated commitment the fees move to 4 and 82 for 2025. >> rates themselves along with the distribution of enroll am by the pierce for ppo plan are shown on page 17 including the recommended self insured

recommend rates. that are 6.9% low are than the 2023 amounts. >> on page 19 quickly. no change in rates. the commitment so they are proposeed be locked in for 3 years today we are asking for 2024. no chink in rates. than i provide a year rate renewals and you see what the rates on per employee per month basis are. for each the 3 coverage tiers. for each the 2hm oshg planos page 20. >> with this on page 22, i'm asking you for 5 approvals today. today's recommendation is recommends for health service board approval the following 24

active employee stabilization plan and rating fee actions. and noting the specific information i just reviewed with you. number one susspends the board approved self fund policy. on a one time bases the delta dental ppo plan, approve use of 2 thirds of december 31 stabilization surplus 7 million. or 2 thirds of the existing surplus. to be applied toward buy down the delta dental plan for year 24. number 3 approve the followingly recommended dealt dental pp oshg rating actions. first the increase in per employee administrative fee of 8 cents. 2 a level 4.70 per employee per

month and 6.9% decrease in the funded cost rates from 23-24. 4, approve the delta care usa dental hmo plan. no change in insured rates from 23-24. and number 5 the following united health care hmo plan recommendation in change in rates from 23 to 24. requirement hao. >> thank you. i don't know if you ever asked for 5 things at once >> a record. >> any questions or comments. >> i move that we approve the 2024 active employee stable wragz and rating fee actions. with specific information on each recommendation provided by mr. clark and in the record. >> second. >> it has been moved and seconded are there additional comments or questions before

public comment? >> i like to comment that you again the term favorable claims responsibles upon is sdwo edged sword we get messages from our members regarding access to delta dental providers and so you know even though this is good now in terms of reducing the rate a bit it seems like the problem is in the based on the plan rates itself it is based on access member initiated or am upon attempts to narcotic. we need to redouble our efforts to encourage you know accountability for the depo providers as well as encourage members to ewe likewise the services than i are paying for. first,able claims experience looks good on paper but in the for the general health. >> a kwij remind in march 23 we

presented on the may 22 plan. many of those data points backingum your comments are in that report. >> i want to add that for those this go to the preretirement accept narc and poke it clothes we stele them to get dental work done before than i sign the retirement paper and is think looking at when we're presented with here this is -- prove they need do that. one question i do have -- mike, is this couple of years ago we did another 2 third's stabilization where we -- did this, i think because we needed to. and do you see this as some type of trend for the future or think buzz you are telling us that -- we can still do this and have enough reserve left to be able

to -- take care of business for the future. whoa is your prediction with going forward. why sure. my thought is i am hope thanksgiving is the left year i need come to you for the exception to the board stable wragz policy and be able to return to the typical amtorwragz of the surplus overnight 3 year period. exit think we should all focus on trying to elevate equalization and preventive care and services in the dentsal plan as that will certainly promote over all helling for members. >> thank you. >> i think we can go to public comment. public ment is open. instructions are on displayed on

the screen. we will start with in person comment and no one approached we will move to remote comment. i will look to see if there are attendees in the queue the this time. there are zero callers on the line as of now and with no further callers. >> that concludes the rate and benefits xoergz return to the regular board >>. let's take a vote. >> role call vote vice president hao. why aye. >> commissioner breslin. >> aye >> commissioner canning. >> aye >> commissioner follansbee. >> aye yoochl commissioner zvanski. >> aye.

>> unanimous and that really concludes the rate and benefits portion of our agenda. we are moving to regular merits call item 13. >> item thrown reports and updates from condition transacted health plan representatives a discussion item. any plan reps can approach the podium. good afternoon good to be in person. account management on public seconder team new to the team that will be working with the hss burden and team members. thank you. thank you and looking forward to interacting with you in the near future i have family here in the san francisco area within the

city limits. welcome, we are fun. thanks. anybody else? this is your big chance. [laughter]. all right. seeing no more presenters we take public comment. >> thank you, public comment is open and instructions are displayed. in person ment in no one approached. we'll move to remote public meant. i will electric to see if there

are callers. thank you and our final item >> final item is adjournment >> i called this meeting of the healing service board on may 11 of 23 at 2 adjournment. thank you.

hi, sandy, how are you? >> hi, fine, thank you. how are you? >> good. i want to ask you what inspired you to be a paramedic?

>> that's a good question. you know, i wanted to go into med school and after i found out how much time it took and all of that, i decided that that was going to be a little too much schooling, but i still wanted to figure out a way that i could provide medical care and doing that as an emt as well as a paramedic was a way to do that. >> can you give me a break down of a typical day for you? >> i come to work and sit at my desk and then i respond to e-mails and try to figure out what are some of the issues we need to address. can we hire more people. what kinds of policies we want to try to create that will help us do our job as ems. >> what does it take to be a female paramedic? >> you know, it takes quite a bit of schooling, but also required somebody who's empathetic. it can be a very stressful job and so we want people to be able to hand that on a day-to-day basis. >> so what's your greatest

satisfaction in your job? >> trying to make sure that the work that we provide and the services that we provide to the community is the best that we can in ems so that when we go out to see you if you call us for an emergency, that we'll be able to treat you in the best way possible and that you get the care as quickly and as effectively as possible. >> why is it important for young girls, women of color to see women in these roles? >> i think it really is important for us to be able to get into these roles because we are effective, we are able to reach out to the community. we are able to do the job in a very effective manner and to be able to relate to the community and be able to do that is one of the best things that we can do. and people of color and as women of color, you know, we are in a great position to be able to do it.

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you're watching san francisco rising with chris manners. special guest is david chu. hi i'm chris manners and you're watching san francisco rising the show that's about restarting rebuilding and re imagining our city. i guess today is david chiu, the city attorney for the city and county of san francisco , and he's here today to talk to us about the opioid crisis, reproductive rights and the non citizen voting program. mr chu, welcome to the show. thanks for having me on happy to talk about whatever you want me to talk about, so can we start by explaining the difference between the city attorney's office and the district attorney's office? i think it could be slightly confused. that is a very common fusion with members of the public so um, if you get arrested in san francisco by the san francisco police department, all criminal matters are dealt with by the san francisco district attorney

. we handle all civil matters on behalf of the city and county of san francisco. what that means is a number of things. we provide advice and counsel to all actors within city government from our mayor. every member of the board of supervisors to the 100 plus departments, commissions boards that represent the city and county of san francisco. we also defend the city against thousands of lawsuits. so if you slip and fall in front of city hall if there's a bus accident if there is an incident involving the san francisco police department, we defend those matters. we also bring lawsuits on behalf of the city and county of san francisco, where most famous for litigating and obtaining the constitutional right to marry for lgbtq couples have sued gun manufacturers, payday lenders, oil companies, you name it, who are undercutting the rights of san franciscans and the city and county of san francisco. so now moving on to the opioid crisis. i understand you've had some

success in court, um, dealing with manufacturers, distributors and pharmacies. could you elaborate a little bit on that for us, so the opioid industry and by that i refer to the legal industry that prescribes pain pills. um over years. uh, deceived americans and resulted in literally thousands upon thousands of deaths and tragedies that we see on our streets every day when it comes to the addictions that folks are experiencing. many of the addictions really stemmed from what happened over a decade plus period where the prescription pain industry marketed prescription pills in ways that were false. we were one of thousands of jurisdictions around america that brought a lawsuit against the opioid industry. but we've had a particular set of successes that others have not. ah we initially brought a lawsuit a few years ago against every part of the

opioid supply chain, and that included manufacturers, distributors and retailers, including pharmacies over the course of four plus years. a number of these corporate defendants settled with us. we've as of this moment brought in over $120 million of cash and services. to the city to help address the root causes of what we're talking about. but a few months ago, we had a really historic verdict against the pharmacy, walgreens and their role walgreens was responsible for literally over 100 million pills, flooding the streets of san francisco over a period of years where they flouted federal law that require them to track where they're pills were going to. they had a what? what we refer to as a phil phil phil. pharmacy culture where folks would bring in their prescriptions, and the pharmacist would just fill them without checking why someone was

coming in multiple times without checking why certain doctors were seen a 100 fold increase in the number of opioid prescriptions that they were prescribing. so we had a historic judgment against walgreens recently, but it's been a very intense lawsuit. and we know that will never bring back the lives that we have lost to opioid addictions. but it's critical for us that we get the resources that we need. maybe one other thing i'll mention because it's often confusion. a large percentage of folks who are addicted to street level drugs say heroin or fentanyl started their addictions. with painkillers, opioid medications that were prescribed through doctors provided through pharmacies and so literally the suffering that we're seeing on our streets was caused by the opioid industry over many, many years and has created the significant crisis that we are dealing with right now. right right now moving on. i understand after the recent

supreme court ruling, striking down robust as wade that you've put together an organization that's designed to help mm. provide free services to people who are both. seeking abortions and providing them can you tell us about the organization? sure so, um, before the dobbs decision came down, but after we learned about the leak from the supreme court about the draft that suggested the decision would be as bad as it has turned out to be, um, i reached out to leadership from the bar association of san francisco because we knew that if that decision came down there would be tens of thousands of patients around the country as well as providers whose legal situation would be in jeopardy. women doctors, nurses who could be subjected to lawsuits who could be arrested who could be prosecuted, particularly in red states? 26 states where rights are being rolled back or in the process or have already been rolled back because of the dobbs decision. so we put out a call

to lawyers all over the bay and frankly, all over the country, and as of this moment there have been over 70 law firms that have answered our call to be part of the legal alliance for reproductive rights who have committed to reviewing cases and providing pro bono assistance to patients and providers who are at legal risk. we also are looking at potential cases that these lawyers can bring against various states. in these areas that are looking to deprive women and patients and providers of their of their rights. um it is a very dark time in america, and i'm really proud that that barrier attorneys, the legal community care have stepped up to answer the call. it's very important that's great. so now the non citizen voting program that was passed by voters just for school boards has faced them court challenges recently, but it was in place for the most recent election that we've had. how do you see that situation panning out? in fact, it's been

in place for now. five school board elections. um so a little bit of background in our san francisco schools over one out of three kids. has a parent who is a non citizen who doesn't have a say in the election of the policy makers that dictate the future of our san francisco public schools, and so over a number of years, there has been a movement to allow immigrant parents to vote in school board elections. few things i'll mention about that is our country has a very long history when it comes to allowing immigrants to vote. from 17 76 for 100 and 50 years until after world war. one immigrants were allowed to vote in most states in our country on the theory that we want to assimilate immigrants in american democratic values and institutions, and it wasn't until an anti immigrant backlash in world war one that that sort of ended. but in recent years, um cities across america have allowed this to happen. in fact,

at this moment, believe there are over a dozen cities that have voted to allow non citizens to vote in a number of context. now, this is particularly important in our schools just given how challenge our schools are, and given that we know that when we engage more parents in her school system, regardless of their citizenship it helps to lift up our schools for all parents. and so in 2016 the voters of san francisco past about measure that allowed this to happen. unfortunately earlier this year, there were conservative organizations that came to san francisco to bring a lawsuit to try to overturn this , and i should also mention it is obviously the perspective of our office and our city that this is constitutional. nothing in the constitution prohibits non citizens from voting. and in fact, there's an explicit provision in the constitution that allows chartered cities like san francisco when it comes to school board elections to be able to dictate the time and manner of those elections. and

so, uh, we are involved in litigation on this issue. there was an initial ruling that was not good for us that essentially said at the trial court level. we shouldn't allow this. um we appealed it up to the appellate level. the appellate court made an initial decision to allow this past november election to proceed as it has for the last previous four elections. we're going to be in front of that court soon. stay tuned. we'll see what happens. it was good to hear that the city was able to reach a settlement with the center for medicare and medicaid services are meant laguna honda could still operate. how did you manage to reach that agreement? it was not an easy conversation . just a little bit of background. so laguna honda has been an incredibly important institution in san francisco for 150 years, taking care of our most vulnerable patients are frail, very elderly patients, many of whom are at end of life. and a few years ago, there were some issues in that hospital.

some violations of rules that we very much want to make sure don't get violated. there were folks that weren't using proper ppe, who are bringing cigarette lighters into the facility, who might have brought some contraband into the facilities. we have zero tolerance for that and have made that very clear. we self reported some of these violations to the federal authorities. and unfortunately from our perspective, they took the very disproportionate step of ordering the closure. the permanent closure of lugano, honda. problematic on a number of reasons. first and foremost, there are just no skilled nursing facility beds not just in california but around the country. after their order came down. we literally were putting 1000 calls a day to skilled nursing facilities around california and around the country and could find nowhere to move the 700 patients that we had had in the gonna honda but just as disturbingly as we were forced to start moving some of these patients, a number of them died. there's a concept in medicine known as transfer

trauma. when you move someone who is that frail and unfortunately, folks folks died and we were at a point where we were five weeks away from the deadline for the federal government. that they had provided to us to close the facility. so uh and we have been trying for months to get the federal government to reconsider their action, so i was compelled to bring a lawsuit on behalf of the city and county of san francisco and very pleased and appreciate that we were able to come to a settlement whereby transfers will be delayed at least until next year. we're going to have at least a year of funding. to keep the facility open, and hopefully we can get back up on our feet and ensure that no future violations occur because this is an institution that has to stay open for the good of these patients. quite right, quite right. so finally, congratulations on winning an important public power service dispute with pg and e. um why is it important that the city's

rights as a local power provider maintained well, so san francisco has been a local power provider for decades. we are fortunate to have access through our hedge hetchy hydroelectric system to provide electricity to a number of providers, particularly public recipients of that. and unfortunately, pg any has used its monopoly when it comes to private electricity to try to stop that, and to block that, and from our perspective, they violated federal law in adding literally tens of millions of dollars of expenses to san francisco and institutions that we're trying to ensure um, public power infrastructure. put years of delays on our ability to do this, and so we had to bring a number of appeals in the federal commission. ah we were successful in those appeals, and there was a decision recently that basically held the pg and e could not use its monopoly to unfairly delay or add tens of

millions of dollars of cost. to the city and county of san francisco, as we are trying to move forward with our vision of public power. clearly pgd has not been able to serve not just san francisco but northern california. well we all know that with the wildfires with its bankruptcies, with all the issues that they've had, we think there is a different model to move forward on and we are grateful to the court. and providing a ruling that allows us to move forward. well thank you so much for coming on the show. i really appreciate the time you've given us here today. i appreciate and thanks for your thanks for your questions. thank you. well that's it. for this episode, we'll be back with another one shortly for sf gov t v. i'm chris manners. thanks for watching. yeah.

>> my name is holly doudiet. h2 firefighter with the san franciscowired. what inspired me to be a firefighter was in 2008 i graduated college . the recession had happened so there weren't any jobs. i was having troublefinding a job. and i was kind of looking around . my dad was a firefighter and i thought what a great career he had. so i asked my dad, never thinking about it at first

before. i said dad, what you think about me being afirefighter and he goes yeah, thatwould be a good idea . i took some classes, i ended up loving it . i grew up and actually and i think it was a good fit for me because it's a physical job and it's enjoyable. you never know whatyou're going to get and it's a team effort . i first realized i was part of the lgbt+ community in sixth grade. i looked on the other side of the classroom and i sawthis girl i thought was really attractive and i thought i want to be her boyfriend . though my experiences in the city growing up in the city and countyof san francisco were always verypositive . i came out in high school . i actually ended up being prom king my senior year in high school and a lot of peoplewere very supportive . myparents were very supportive . they just let me do my thing and my dad knew of a lot of

lesbian women in the fire departmentthe time because he was a san francisco firefighter . for me it's very important to be part of a community and organization and an agency that supports my lgbtq status because if you're not yourself, how can you perform to the best of your abilities? you're always holding back in some way whether it's your personality or your abilities or your overall skills and with agency that supports me being a lesbian i can truly be myself. i can be happy. i can be social with other people. it makes me want to work as a team and we all work better together when we are happier and we can be ourselves. >>. [music]

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