>> good afternoon. i welcome you to the health service board. august 10, 2023 meeting. i like you all to please join me in saying the pledge of allegiance to the flag. >> i pledge allegiance to the flag of the united states of america, and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all. >> i guess to make the

protocol correct, i call this meeting to order and we'll now have a roll call. >> thank you president scott. call to order 103 p.m. roll call, president scott, present. vice president hao is excused. [roll call] with that, we have quorum. >> thank you. we'll now move to item number 3. >> agenda item 3 is general public comment. a opportunity for members of the public to comment on any matter within the board jurisdiction not on the agenda including request that the board place a matter on a future agenda. we'll go over the instructions of remote public comment and public comment in person. health service board welcomes public participation. there will be a opportunity for the

general public comment to comment on the beginning of the meeting and opportunity to comment on each agenda item. in person public comment will be first then virtual public comment. in person you are welcome to approach the podium now. each speaker are allowed 3 minutes to comment unless deemed the time limit is different in the meeting. the caller may ask questions but no obligation to answer or engage in dialogue. the health service board will hear up to 30 minutes of remote public comment total for each item. remote public comment from those who received accommodation with a disability will not count towards the 30 minute limit. members of the public attending via phone, dial 415-655-0001. when prompted enter access code 26618811477, #. you will be prompted to enter the pasdsward, 1145 and press #. star 3 to be added to the queue and you will hear the

prompt to raise your hand to ask a question. please wait till the host calls on you. when your system shows the line is unmuted this is your time to speak. you will be muted when your time is expired. for those watching the meeting on webex click on raise hand icon. a raised hand icon will appear next to your name. when you are unmuted request to unmute will appear on the screen. please select unmute to speak. once you hear me say welcome caller, you can begin speaking. when your time is expired you will be muted. please click on the raise hand icon to lower your hand. members of the public are encouraged to state their name clearly but can remain anonymous. when your three minutes end said i they think for your call and placed on mute. thank you to sfgovtv and are media service. we will begin with in person public comment. >> again, this item is for public comment on items that

are not a part of today's agenda. so, it is anything that this board has jurisdiction over that is not on today's agenda. that is what this general public comment is inviting. number of people are in the audience and i think i know the topic that draws you here. welcome your presence, but we'll get to that during the director's report. >> i want to make a motion to reconsider an item that i voted yes on may 25, 2023. item number 6 and i agendize this for september 14, 2023. after many contact from members stating that this is not affordable for early retirees and they will not be able to pay this and other comments from people, i have decided it would not be an item a fiduciary duty to have voted

for this. >> thank you for that comment. >> i think i need a second. >> alright. is there a second? >> second. >> it has been properly moved and seconded that a motion for reconsideration has been made for a item on a prior agenda, may- >> 25. >> may 25? >> right. >> alright. is there board comment on this reconsideration motion? >> i just want to be clear. i assume this was a benefit issued? >> right. it was. >> passed by the board of supervisors? so, i'm not quite clear what the impact will be on something we already voted through has gone through committees. >> probably not but i want to be on the record as not voting for that. >> okay.

>> our regular counsel is not here. do you have guidance on this? reconsideration- >> mike is looking. i'm not sure what the effect of that would be if it has already gone through the mayor, because it seems like we wouldn't go back through the whole process. you couldn't undo it, so there wouldn't be in terms of the process a legal effect to doing this. >> just goes on the record, it doesn't change the mayor's vote. >> but you put-the thing i'm concerned about, you put it in the form of a motion, and that is now requiring this board, members present to vote on it, so if it passes, all of us support this motion, it could be more then just

changing your vote or not. if we all voted for it. so, it could have a legal effect beyond just you wanting to change- >> that's not what i'm asking for. i'm just asking to change my vote. >> but you put it in a form of a motion today for us to take action. >> right. >> is that what you want to do or do you want to just make a public statement withdraw the motion making a public statement you would have voted no on- >> i made the statements that i thipg that was a error on my part. >> point of order, are you just asking for the minutes to be corrected? >> no. she's asking for a motion from us today to-what your motion said to me is you wanted us to reconsider your vote- >> my vote. >> your vote, and that means

that we have to take action as a full board in the way you proposed it. if your intent is just to put on the record that during that meeting you would have voted differently you wouldn't be calling for us to act on a motion at this point. that's all i'm saying. >> what does the city attorney say? >> i think i have concerns about-my understanding of the motion it can would be to actually reopen and do another vote, but because this is already gone through the process and the board of supervisors has approved it, we really can't go back in time and undo that action. i think the better course, if you want to make a public statement, but that attempting to put this back on the agenda when it has already gone through the process, i don't see how that is a proper thing to do. >> the motion itself-the motion you are making is out

of order. if you want to make a statement saying that you would have voted differently during the may 25 meeting and your vote would have been no- >> i have made that statement. >> no, you put it in a form of the motion and asked for a second, and i'm saying i'm ruling the motion out of order. if you want to make a statement without a motion- >> want me to repeat the statement? >> yes, would you please? >> okay. on may 25, 2023 item number 6 i want to state that i did not-error i voted for that and i rescind my vote, which i dont know i can do that at this time. seeing that it is probably going to make this unaffordable for some early retirees, and they will not be able to pay this as a

fiduciary i think this is something that i should at least express and the members that also did not have a chance to express their concerns about this at the time. there were very few members here as i recall. you're talking about $19,000 per year for a early retiree and two dependents, which in my opinion is unaffordable for a lot of people. a lot of these people do not make 6 figures like people here, you know? they are making maybe 60 ,000 a year. it is unaffordable. >> alright. i thank you for your comment. it is so noted in this meeting's-will be noted for this meeting's minutes. are there any other

public comments on this item? >> just as reminder we are under general public comment. >> yes. >> so, we can call for in person public comment. >> i would ask you to raise the microphone and look like you are eating it. [laughter] there you go. >> not exactly my cup of something i want to eat. >> i know, but-- >> alfred sanchez, protect our benefits. i applaud the reconsideration. i applaud claire wanting to be on that board and i got a lot of feedback on this particular thing, especially from early retirees. they were never aware that it was going to be anything as tough as this. like you say, some of them they are not police and fire. 75% of city retirees are miscellaneous workers. some of them pensions, 30, $40

thousand. this is a choice about their lifestyle whether they can pay their utility bill or hey, i have to have the heat on in my house, but maybe i'll have to roll the dice and not have healthcare anymore. i really appreciate the courage, especially from the elected bodies. they're fiduciary. i know it was a tough thing but appreciate the reconsideration. that thank you. >> thank you for your comment. other general comment on this item? >> seeing none, i move to virtual public comment. and we have one caller on the phone-line. one caller has raised their hand. i'll indicate where there are no more callers in the queue and will hear a brief silence as we transition between callers. and with a update we

have three callers on the phone line. i will unmute our first caller. welcome caller. >> good afternoon. this is sharon johnson. >> welcome caller, you can proceed. >> thank you. i was calling regarding the item-i dont know if it is a item before you or this is general public comment. i don't have an agenda in front of me. >> this is public comment. >> regarding the resolution between uhc and (indiscernible) >> caller, thank you. the item you will be speaking to is agenda item number 7, so if you stay on the line when that item is called you will be able to speak under public comment for that item. >> item 7 is the director's report, just to be

clear. >> thank you. we have two more callers on the line. zero callers raised their hand at this time. with that, public comment is closed. >> thank you. we'll now go to item 4. >> item 4 is approval with possible modifications of the minutes meeting set forth below, may 25 health service board special meeting minutes and june 8, health service board regular meeting minutes. >> alright. willing to entertain a motion to adopt the minutes of the may 25, 2023 health service board meeting. special meeting and the june 8, 2023 health service board regular meeting. >> i move approval of the may 25, 2023 health service board special meeting minutes and the june 8, 2023 health service board regular meeting minutes. >> thank you. is there a

second? >> second. >> been properly moved and seconded that the minutes of the meetings cited on the agenda be approved. >> mr. chair. >> is there board comment or question? >> i have a question. given the comment that commissioner breslin offered in with regard to her vote on may 25 special board meeting, is there an amendment to be made to these minutes to reflect that, or are we going forward with the minutes as stated? as presented. >> based on our prior discussion, i think we have to go on the minutes as stated. based on the fact that we took the action, she voted for it and today she make a public comment that after further consideration, which

means as of today, she would have voted differently and that's been noted in the general public comment. to say that that wasn't the action taken on the 25 of may meeting would be inaccurate. >> thank you for the clarification. appreciate it. >> mr. president, if i may ask just for-may be more technical, but would it be proper to attach the comment commissioner breslin made to this action item opposed to general public comment? >> with her permission, i would--suggest that is where it would be. it be made as a footnote to the action on the minutes. >> it wasn't-i didn't bring it up at that meeting. >> no, but you brought it up today and we are considering the minutes from that meeting, so would you mind putting it close to the actual minutes, or do you want to leave it for public comment?

>> not sure if that is proper- (indiscernible) >> i think from my perspective i think in terms of ease of access for reference, under the commissioners discussion of the approval of the minutes that that comment would be appropriately listed there and the public comment be moved to the public comment on the minutes as well so people if they wanted to look at outcome of that meeting would look at the final approval with the comments incorporated into the discussion today, but i think it makes sense for ease of access so that you could refer back and other people could refer back to your position. >> put it in number 4 today? >> yeah, as a comment-we cant change-you cant change the minutes, but in terms of the comment you can comment that today you would not wish-the

comment you made. if that would be okay with-yeah. >> alright. okay, so the general comment made by commissioner breslin would be noted with the general public comment on the minutes relative to may 25. that she would have voted, no. alright? >> the public comment that was made in response to her [multiple speakers] >> i have been (indiscernible) i would have said please hold that until we get to the minutes, but i didn't know what you were going to say. alright. i think i'm clear and i hope that the secretary most importantly is clear and we are on the record. any other board comment relative to the minutes approval? if not, we'll have public comment on the

minutes. >> thank you president scott. general public comment is open or public comment is open. instructions are displayed on the screen those watching. in person will be first then remote public comment. those callers on the line press star 3 to be added to the queue. those watching the meeting on webex, click on raise hand icon. we'll begin with in person public comment. no one approached the podium, so move to the virtual public comment. >> once again, alfred sanchez, protect our benefits. i think i'm addressing the minutes from the may 25. what i'm saying is, this is not a futile action. i'm sure the board of supervisors as well as the mayor will understand what dialogue took place here, so it

will be effective that people are getting very upset about the rate increases, so that's the purpose of what you are doing here today. it will get out. thank you. >> thank you for your comment. is there any other public comment regarding the approval of the minutes for these two meetings? >> from the virtual public comment, there are three callers on the line with zero callers have raised their hand for this item. we can wait 5 more seconds for anyone to raise their hand or join public comment. there is still zero callers raising their hand. with that, public comment is closed. >> alright. we'll have roll call vote. [roll call] >> the motion carriesue unanimously. we'll move to

item 5. >> item 5 is president's report. this is discussion item and will be presented by president scott. >> i have no report. we'll move to item number 6. >> thank you president scott. item 6 is the board president assigns committee members to the finance and budget committee and the governance committee for fiscal year 2023-2024. this is an action item and will be presented by president scott. >> it is in accordance with the terms of governance for this board and the secretary will pull up the recommendation for the standing committee assignments. we have two standing committees of this board. there is a governance committee, and a finance and budget committee. i'm recommending that the board members that will be presented

on the slide be assigned to these committees with these members serving as chairs. that is the motion. is there a second? >> i'll second the motion. >> it has been properly moved and seconded that the standing committee assignment s for the health service board 2023-2024 be accepted as presented. is there any discussion by members of the board? hearing none, we'll now have public comment. >> thank you president scott. public comment is open. instructions are displayed on the screen those watching. in person public comment will be first then remote public comment. for those callers on the line, press star 3 to be added to the queue. for those watching the meeting on webex, click on raise hand icon to be placed thin queue. we'll begin with in person public

comment. no one approached the podium so move to virtual public comment. there are three callers on the phone line. zero callers have raised their hand at this time. we'll give a 5 second pause to see if anyone wants to raise their hand. we have zero callers raising their hands. with that, public comment is now closed. >> this public comment closed we will now have a roll call vote on this item. >> roll call vote- [roll call] >> motion carries unanimously and now move to item 7. >> item 7 is director's report. this is discussion item and will be presented by abbie jant, sfhss executive director. >> good afternoon commissioners. i wanted to

start my director's report by acknowledging four new members of member services that are present today. we are nearing our full complement of staff in member services. i introduce to you if you would stand please, jason hammock. >> please remain standing so all- >> robert- >> are identify. >> ray (indiscernible) and berry (indiscernible) welcome. >> we like to say on behalf of the board, welcome you to your new assignments as staff members of the health service system, and we are very glad you decided to spend this portion of your career in service of our members, so again, welcome to each of you and we look forward to having you come back on just to observe us during the course of your career here.

thank you. >> thank you for coming. just to stay on the operations theme of my director's report until i get into policy issues that are important today, i did want to recognize that the member services has worked very diligently during this last year with all the staffing shortages to accommodate or to meet the demands of our member s, and it has been a struggle. i really want to-hats off to ray and olga for leading the team and all the efforts it take tuesday bring people into the environment. we are seeing the results and calls handled in a much more manageable timeframe so this team will really complement that and so we are just thrilled to be here. i think we'll ramp up and put a lot of

focus on the training that needs to take place to prepare for open enrollment that is well underway. it does take a village, it just member services. the enterprise system and analytics team does a lot of work to support the open enrollment and get all these rates loaded into the system. there is over 9,000 at the end of the day, so it is a heavily reliant on the enterprise systems analytics team. the contracts team too has continued to do a outstanding job on keeping us very current with the very many many many contracts that we have. what comes before the board of course are the major health related plans, beutthere is a lot of administrative support plans, not the least of which you approved most recently aon contract. the wellbeing team continues to work really diligently

to address mental health needs through their eap program that is also has a external contract that is really helpful to us. it is very difficult to hire and recruit mental health workers simply because there are not enough. we are very fortunate to have a external resource that is quite good to work with throughout the pandemic and continues to support our membership. so that's it the operations end of the director's report. i wanted to just go back and highlight some of the things that were written into the report. as acknowledged the rates and benefits package was approved by the board of supervisors so can celebrate a complete cycle. the healthcare affordability board i'll continue to report on

is the state entity that has an advisory committee that i'm a part of. they have a very very very aggressive timeline to identify targets for spending. in 25 because the year those targets will be measured and penalties associated with will be in play is 2026, but that-you wont see the results of that until 27 and 28. i can't believe i'm talking about 2028 right now, but that's the timeline and even though it seems it is far away in cycle time, it is not far at all, so there is a lot of cutting edge work that is being done as we speak. we are presenting one of our board education topics today, out lined in the report are others that are scheduled to be-come before you.

we do-there is also a presentation shortly that michael will do that talks about, this is the time of year when we need to consider whether or not we will do any competitive bids for any of our contracts, so that we can adjust our workload accordingly so we'll talk in more detail about that later today. there also is the announcement the university california san francisco at their most recent uc regents meeting approved the acquisition of the general care acute care assets of saint mary medical and saint francis memorial hospital so that was big news under the merger and acquisition category. john muir health will acquire san ramon regional medical center and that transaction is also underway so

consolidations is happening right here. the-i will talk about the ucsf, uhc thing in just a second. i just want to make sure--the school district-we continue to work with the school district on the technical issues that they have. we are far from resolution. we are concerned and we will continue to report on this. i am escalated some of our concerns with them as we speak. miner comments on dr. follansbee pointed the last meeting in the aon contract approval, we corrected that or recognized it wasn't necessary. we do have some race equity

diversity inclusion updates, transjnder history month is this month and there is quite a bit of activity in the city celebrating that. so, that leaves me to talk a little about the subject many people are here and sure listening on the call. we had been informed that the united healthcare is working to-on their contract with all five university of california medical sentter for their ma product. it is my understanding that the university california san francisco medical group and united healthcare have not agreed on a reimbursement rate. it is a little hard to explain, so let me try in that, it is not that they-they haven't had a contract. they have been a willing

participant in medicare so united healthcare would pay the standard medicare reimbursement rate for willing out of network provider. is that right monica? and that's the way it has been for years. this year leadership at ucsf decided they wanted to negotiate a rate and not do this willing out of network practice. i also understand that the other four medical centers have agreed to a rate with united so ucsf stands alone. we as hss can't get in the middle of negotiations, and our relationship is with united healthcare. however, we are talking to other employers that have this similar problem. the university of california san

francisco itself has this problem. calpers as this problem. so, there is a lot of interest in this and we would really like to see it gets resolved. our members are kind of stuck in the middle and one of the bigger challenges is the university various practices and scheduling offices and billing departments because it isn't all unified at this point in time, is not always giving the most accurate and helpful information to our members. there is a lot of inconsistencies, and our members as they learn about this are getting worried will this effect me? united assures us that claims are coming through very steadily and readily, so apparently quite a number of our members are successfully getting treatment and advice at the

university and so, we are pushing hard to get both parties to the table to get this resolved because it really puts or members in a difficult position. united has indicated to us that they trained their customer service center so when our members call the number on the back of the card which is what we encourage them to do if they have a question or concern about this, that they will get hss specific information that is more accurate then what folks are being told by the university. accurate to it degree that we know, because we don't know always know what the university staff is being told to tell our members. we haven't figured that out yet. but we are talking about this literally every day in the office and talking to united as

well. so, i'll pause there and see if there is any questions on this matter or any other matter in the director's report. >> so- >> questions from board members on the director's report? >> so, ucsf owns sf general, saint mary's, saint francis acute care. are all these effected by that decision? >> ucsf is a health system. does not own s general hospital rnsh but there is a-i don't know how it is working today. there is a contract between the health department and ucsf to provide medical care at san francisco general. i don't know if those folks are considered part of the medical group. they may or may not be, i'm not sure. and then there is the group that is the medical group that is

a lot-that medical group as a entity is then growing and there is many practices that have worked relatively independently over the years, but now they are being standardized with administrative support, et cetera. i can't tell you in this moment where things are at with the medical staff of the two dignity hospitals. that transfer of them to be on the medical staff at ucsf i'm sure is one of the many items on the to-do list with this acquisition. >> so for people that have appointments and the doctors are seeing them, they just continue with that, right? >> that has been occurring. >> commissioner follansbee. >> number one, do we have a date? you said in the report

that ucsf medical group has instructed doctors to stop providing medical service. is there a date to stop providing medical service to new requests? i appreciate the thoroughness of the report from the standpoint, a lot of times positions don't understand what is going on with the billing and they may provide services and the staff may make appointments for months and all a sudden bills start getting sent back and so there may be as you pointed out in your report i think accurately, a lag. i just want to remind everybody, make sure we are on the same page that the medical groups are separate entities then the hospital systems, and so the ucsf hospital system, which has outlying

clinics and all that, is different then the medical group itself and the ucsf medical group is different then every other medical group any other uc hospital system. it is quite possible that the positions at ucla, uc davis have through their medical groups have signed contracts and the group at ucsf and not ucsf itself. medical service so if you referred for a mri scan or ct or some procedure, but there will be a-there will often be a professional fee associate would that referral so you may get your scan but the way this reads it is possible you may get a bill from a anesthesiologist or somebody. several medical

centers such as sutter have foundations for physicians so when the health plans sign agreements with hospitals, the foundations get rolled into that, but ucsf, this is medical group not a foundation, so this has to be negotiated separately is the way i understand it rchlt i want to make sure everyone is clear about the complexity of these relationships and don't-it is not appropriate to throw a hissy fit in front of the ucsf administrative offices because it is the medical group. i don't know where the offices are so i will not comment on that, but that is the way i understand it. >> it is close. i don't know-look on the website, they have a vise president of the ucsf health network, because their health network is both the medical group, but they have a 20 county

reach, so there are other hospitals and medical groups that are part of uc family. legally i dont know exactly how it is all established, but it is consolidating for certain, so that's the that we are approaching it is just trying to get the attention of the networks, the medical groups, contacting team to just let them know we are concerned, so we continue to express our concern. >> commissioner canning. >> after commissioner follansbee question, is there a direct date that they noted where we need to keep a benchmark or highlight to be monitoring? >> we know that they-what united told us is that on the

30th of june they elaborated they were prepared, ucsf were prepared to configure the system to turn away new appointments and plan to see existing members through the cycle treatment and few days later united received employer group inquiries about canceled appointments so they have done something. it does not look like they have done any broad brush because of the number of-we had a handful of members contact us and only one or two that contacted united directly that have a particular issue. we have others and i think they are in the audience today as well that are worried that they will have a issue, and we know people are being seen because the claims are coming through. so, we got a little of

everything happening. it is very messy and not as clean--to try to make a bad situation better, one way is to have some consistent communication from uc to our members that is helpful, because right now they are advising people to get another insurance plan. it is like people can just do that. that's not helpful information. we would love and relish the opportunity to work with the university to be sure that if they feel the need to give advice to our members that they at least have accurate advice to give. it is better if they got the advice from the united healthcare. >> commissioner zvanski. >> i want to clarify because in my brain ucsf is on the hill, but we have moccasin people and you said that there

are a number of satellights but the other uc satellights all have contracts as i understand . this is not in any way impacting any of our folks up at moccasin unless [multiple speakers] okay. i just want- make sure because sometimes we forget they are up there. >> there are five uc medical groups or centers in the system. one is uc davis, one at uc sand diego, ucla and uc irvine in addition to the one in san francisco and the one not contracted with united healthcare to date is uc san francisco, so the focus is around that issue. are there other questions from the board? if not, we'll now have public comment. >> i just wanted to

ask- >> commissioner breslin. >> can you speak fl into the microphone? >> is the staffing going and how are the phones being answered? i had somebody who was go nothing to the office and tried a phone and couldn't do either one. >> i reported the operations functions are far better then they used to be or have been for the last year. we are getting close back to our standard meeting goals and stan ards. >> how about coming into the office? >> not yet. >> (indiscernible) >> the staff? or the member s? >> staff. >> staff. it is hybrid. some people come in- >> but not accepting anybody, members to show up there? >> not yet. >> okay. >> we need- >> are they answering the phones for the members? >> yes. >> that is important. >> right, and it has been a problem for a year and all most

gone away. what did you tell me yesterday, one or two-you are welcome to take the mic and make those comments. yesterday it made me smile. >> yes. >> please identify yourself. >> (indiscernible) we are happy to report that the issues regarding the phone system are much resolved. this week the majority of calls were answered directly. over the week we averaged between 10 and 4 voice mails per day, meaning that the call was not answered in a period of minutes, and rolled to voice mail, so we are receiving a very few member of voice mails and very few number of abandoned calls. with the average length of time that the call is abandoned at like 6 minutes, which is much improved from where it used to be. we are on track to successfully answer all member calls within

a reasonable period with the addition of the new staff we are just anticipating that that will be very soon. >> alright. thank you. are there any other comments or questions from board members? >> maybe you can answer the question. does our system let members know what the wait time is and give option as many systems are learning to, if you want we can call you back and confirm the number? these programs. is our system capable of that? >> our system updated may last year to the current version. since that point in time, not only us but all other city departments utilizing the system have experienced some technical challenges related to the system where we have not been able to implement some of those advanced features. we rely instead on voice

mail so if a call goes unanswered for a certain number of minutes and we can vary the range between 10-20 minutes if the call isn't answered by that time it rolls to voice mail. we have found that that is the most expedient way to handle these issues just because of the fact the length of time calls varies widely so we prefer to set a scheduled point in time where we can return those voice mails at the end of the day. the vast majority of voice mails if one is answered the same day, if not the next day. we used to rely a lot of mandatory overtime on saturday to return many voice mails, but we are not at that point any longer. >> thank you. just say as a consumer in other areas i find these upgraded systems rather useful because to sort

of leave a voice mail and say we'll call you by the end of the day, when i-i'm sure our members have other agenda items as well, may not be as pleasant for them as it is for us, so if there is a way to maybe work with the rest of the city on these upgrades it might be useful to our members and help ameliorate a lot of the anxiety over calling and the complaints. >> yes, definitely we can look into more of those advanced system functions. >> thank you. any other questions from the board members regarding the director's report? hearing none, we'll now have public comment. >> thank you president scott. for this item we'llival in person public comment, remote public comment and i'll read allowed the written public

comment. in public comment is-public comment is open. instructions are displayed on the screen. in person public comment will be first then remote public comment. for those callers on the line press star 3 to be add td to the queue. for those watching on webex, click on the raise hand icon to be placed in the queue to speak. we'll begin with in person public comment. >> as we are going to begin this public comment, if you heard a portion of your statement being made by a predecessor, public commenter, it would be helpful if you not repeat that. not trying to restrict anyone or restrict the time, but that you not repeat the same thing that may have been said right before you. i'm asking everyone to be attentive to each other as they are making their public comments, please. >> thank you. you just ripped off half my speech.

>> alright. >> alfred sanchez, protect our benefits. good afternoon to the board, to the executive director. it is very clear, very very complex, ongoing, won't be decided today. how i became aware of this is director of firefighter union 798 who is here today so he can comment on a lot of things i was going to talk about it, he brought it to my attention because his mother's friend, a retired city teacher got a letter from uc and we are still trying to figure out how did urk c decide who got the letters and who didn't get the letters. the letters essentially said what you already talked-that they were not go toog pay for united healthcare medicare advantage which is a out of

network hasn't been in network in over 10 years. what we are really concerned is, these seniors who are by far the most vulnerable group, many on fixed incomes below $30 thousand annually. they simply cant afford to pay for this out of pocket. they paid for their health service plan their whole career with the expectation that they would have outstanding healthcare in their golden years. i was happy to see that it is in the director's report because that really brings light to the subject. clearly more dialogue and education must take place before a decision can be made. i suggest ucsf, the medical group, the unc people, the doctors and patients who are wanting this care can sit down and come to some reasonable accommodation that at the very

least a continuous for another year because open enrollment is in october and these people are in a panic and there isn't much competition. who are they going to go to and when they call up doctors because some are already doing that, i'm sorry we are not taking any new patients. this is something that is very complex and here in the city of saint francis, let compassion prevail and don't throw the seniors out with the bath water. thank you. >> thank you for your comment. other public comment in the room? please approach the podium. [coughing] >> good afternoon. my name is germia (indiscernible) director of local 798

san francisco firefighters. i like to thank the board and abey yant, we had dialogue regarding this. we had-i was contacted by members who were receiving bills and pretty much as director said, told get a new plan, and i don't want to repeat my brother too much but the group told to get a few plan will have a hard time so i appreciate you guys making this a issue among united and whatever we could do to maybe encourage them to come to an agreement and work something out just for the benefit of our retired members. greatly appreciated. >> thank you for your comment. other public comment?

>> another firefighter. >> good afternoon commissioners. i just want to put on the record seeing now it is important today that the firefighters active and retired both support all the comments that have been said already at this dais, and just a thought, 4 of the 5 uc's have come into contract, that means the issues for us are very glaring and out there and should be directly addressed. everything else seems to be working fine. thank you. >> name please for the record? >> for the record, who are you? >> dennis krueger. retired firefighter and spouses. >> thank you. i know who he

is, but there may be others who dont. is there other public comment in the room? >> good afternoon. i don't know how to address everybody- >> i'm going to ask you to speak up please. thank you. >> i don't know how to address everyone. i wasn't planning on speaking. my name is kim lee, a retiree from city college of san francisco. i want to talk about personal experience and moreover my concern as the gentleman expressed for others who may not be able to handle all the confusion that is going on. first of all, i want to say, as far as trying to find a new primary care physician, which is what i was told to do,

i was given a list by uhc of about 10 physicians. one of them i noticed the name was recognizable to me. the reason? she was my daughters pediatrician so 5 of the people on the e list were pediatric doctors that didn't help the medicare advantage folks. another person who was on the list was a gertitian. wow, they are hard to find. called them up, he doesn't do that anymore. he hasn't done that for ages. he is now in dermatology. even though you can call up and try to find somebody new, chances are it is going to be really really difficult. another thing i wanted to say was, my experience is kind of interesting because the reason i found out about this

was because i was called kind of a cold call one i normally wouldn't pick up, but i picked up and the young woman i think her name was jennifer or something like that, she said, she was calling from uhc, and she was calling to see if i needed my wellness checkup with my primary care physician. she was very friendly and offered to make the call for me to my primary care physician, so she had been so nice i said do you get credit for this? she said yes. i said then go ahead. i can make the call myself, but if you get credit then go ahead. she made the call, found out that my primary care physician was not taking uhc

anymore. so, what's the irony ramification uhc rep called, found out uhc is not approving ucsf primary care physicians. i'll leave it a that. i have another anecdote but i'll leave it at that as my time is up. hope that was helpful. >> thank you for your comment. is there other public comment in the room? board secretary, is there public comment online? >> thank you president scott. i'll be checking. we have five callers on the line, and two callers raised their hand at this time. please be adviceed there is a 3 second pause as we transition between callers. i'll unmute the first caller. welcome caller. >> hello. this is sharon johnson, retired city

and county employee, and i first of all want to say thank you to director yant for doing-for her report and the follow-up going on between uhc and university of california. i concur with everybody who has spoken about what they know and care about in terms of our seniors that are members of the health service system and will support you in any way to continue getting these people to negotiate. as the director said, it takes a village and the village includes as our last speaker as the patient who did not receive the best service she could have received. let's all join together and do what we can for our members. thank you. >> thank you for your comment. >> thank you caller. we have one more caller with raised hand. i'll unmute the

caller now. welcome caller. >> this is herbert winer. in addition to the e-mail i sent you, i have the following comment. i am a disturbed share holder of united healthcare stock and receive health benefits as well. uhc assist in the fortune 500 with profits [audio cut out] >> caller? i think we lost connection. let me make sure we can get you back. caller? herb winer, are you able to hear us? >> yeah. >> continue. >> in addition to the e-mail i sent, i have the

following comments. united healthcare assist in the fortune 500 with profits of $20 billion 120thousand million dollars in profit, and given its revenue of 33 (indiscernible) i find it difficult (indiscernible) [audio cutting in and out] the worst victims of (indiscernible) are the patients. (indiscernible) excessive demand and backup in appointments. this is (indiscernible) if retirees have another plan then kaiser who should also be-and kaiser is over-loaded. but retirees are stuck

(indiscernible) as a share holder and beneficiary of united health, i'm requested if not demanding (indiscernible) thank you. >> thank you for your comment. is there other public comment on pp line? >> we have 5 callers on the line, zero callers raised their hand at this time. with that, public comment or-we'll move to written public comment. >> alright. public comment-we have a written e-mail that have come to the board during the course of the last few days regarding this topic and the board secretary will summarize those e-mails at this time. >> thank you president scott. one of the e-mails was by herbert winer who just spoke. another e-mail is larry busettee, san

francisco veteran police officer association who expressed concern over the city county san francisco ucsf/uhc negotiation and urge the board any and all influence for a quick redlution with medicare advantage contract. third e-mail is timothy o'brien retired firefighters and spouse association also urged the board to advocate for fair resolution with problem between the ucsf and uhc. the fourth e-mail was lieu ease (indiscernible) dcsf retire and shared request for medical service not adhered to. she requested the board use any and all influence to help with the swift resolution for the medicare advantage contracts. five e-mail is linda beck who urged the board to do anything to encourage both parties for resolution as soon as possible. robert price, city college of san francisco retiree who

urged the board to do anything within their influence to help with resolution contract. seven e-mail is deborah, city college of san francisco retiree who urged the board to find a swift resolution for medicare advantage contracts. louise scott, protect our benefits and retired emplyees of san francisco. also a convener of the federation of retired union members and urged the board to do whatever possible to support equitable resolution between ucsf and uhc. sharon, retiree who urged the board to do anything within their influence and control upon the ucsf/uhc resolution. (indiscernible) retired instructor who urged the board to do anything within their influence upon the ucsf and uhc resolution of the contracts. the 11

e-mail is from ron (indiscernible) retired sf firefighter captain who urged the board it a do anything within their influence for quick resolution. with that, there is no more written public comment and we can close public comment. >> alright. public comment on this item is closed. i'm going to claim the privilege of the chair to offer the following motion, i move that the hss board give a strong commendation and support to executive director abbie yant for her initiative and leadership to date in prompting discussion between united healthcare and the university of california san francisco health system. the uc-hss board directs executive director yant to continue to

insist that united healthcare and university of california san francisco health system immediately undertake negotiations by convening meetings, to exchange specific proposals that will lead to working contractual relationship between the parties, which will be a benefit to hss members. further, the hss board directs executive director yant to work with the ucsf medical group to ascertain that accurate, sensitive and timely information be provided to hss members who are trying to schedule appointments with the ucsf medical group. >> second. >> been properly moved and seconded that this motion for action be adopted. comments from the board?

>> this sounds quite appropriate and i just want to again thank director yant for working with other employer gruchs groups in the city as part of these efforts and make sure that this memo supports that intent to band together with other employer groups in this effort. >> thank you. any other board comments? hearing none, we'll entertain public comment on this motion. >> thank you president scott. public comment is now open. instructions are displayed on the screen for those watching on tv and webex. in person will be first then remote public comment. for those on the line press star 3 to be added to the queue. for those watching on webex, click on raised hand icon to be placed in the queue. >> alfred sanchez, president of protect our benefits. i applaud the motion.

it is appropriate and i want to say, i don't speak for them, but when you hear protect our benefits, we work very closely with retired employee city county of san francisco, the gray panthers, cara meeting is at the same time as here or they would be here, so we are all together on this. we learn from prop c that united we are far stronger, so it is a lot of people, not just protect our benefits, thank you. >> thank you for your comment. anyone else in the room? public comment on this motion. >> (indiscernible) >> i want to again kim lee retiree from ccsf. it is a

wonderful motion. thank you for coalescing everything into one statement. my only concern is that people might not know about what's happening unless they call to make an appointment, and so i think it would be good for members to be apprised of what is happening before they happen to you know, make an appointment because ontimes we dont make appointments until we need them, so if the language could be adjusted a bit to not just people who call, but maybe a statement to go out to all the people who are in the ucsf system. i don't know. >> thank you. >> thank you for your comment. any other public comment in the room? if not, is there public comment online? >> thank you president scott. i'll be checking our virtual public comment. we

have 5 callers on the line. two callers raised their hand and there is a brief pause as we transition between callers. i'll unmute the first caller. welcome caller. caller, we can hear you in the room. i'll unmute this person. it may have been a leftover and move to the next caller. all hands have been lowered. we can close public comment. >> public comment on this motion has been closed. we are now ready for a roll call vote. >> roll call vote- [roll call]

>> motion carries unanimously. i would ask the director yant take into account in following the intent of this motion that as necessary, we may need to have a communication to our members about this particular issue or those who were seeking services to ucsf at some future point. >> i like to comment because that is due consideration. we have a draft notice that we would send out to a select audience. under review at united, our concern is the number of claims coming through and people are receiving services that we will create a (indiscernible) stress on our members that would be expressed to us through increase in calls and as we are getting ready for

open enrollment, so it is a balancing act and we do speak about this every day and so that's why any feedback that any of our members have about the information that they are receiving, good, bad or indifferent, please let us know and we are going to stay on top of this. hopefully this effort will be short-lived and the contract will get signed and move on to other things. >> alright. thank you for that. alright. with that, we are now ready to move on to the financial's. item 8. >> thank you president scott. item 8 is sfhss financial report as of may 31, 2023. this is discussion item and will be presented by sfhss chief financial officer iftikhar hussain.

>> good afternoon. >> good afternoon chief financial officer. how are you after a month of not being here? >> very well. thank you. i have to get the slide up. the one development since last month (indiscernible) we are in the middle of our close for the year-end, and as we close that activity is continuing. the financial's i'm presenting are as of may, and the message actually is consistent with prior months. this year you see the claims are higher but increase in claims happen the later half of last calendar plan year. this

plan year since january the claims have been very stable. we had large claims last year. we luckily are not seeing those this year yet. the (indiscernible) is pretty stable. interest you notice is quite a bit higher then what we saw last year due to high interest rates. the pharmacy rebates also are higher corresponding to higher pharmacy (indiscernible) working effectively to audit and capture those claims. as far as projection for year-end, we do have-we are stating coming close to budget but we are quite a bit ahead, because of the vacancies we had in our staffing. >> are there questions of chief financial officer hussain? hearing none, we'll now move to

public comment. >> thank you president scott. public comment is open. instructions are displayed on the gene screen for those watching on tv and webex. in person is first and remote. those on the line dial star 3 to be added to the queue. those on webexclick on the public comment icon. we'll begin with in person. no one approached the podium so move to virtual public comment. we have four callers on the line. zero callers raised their hand at this time. we'll give a 5 second pause for anyone who may want to raise their hand or join the call. there are no callers in the queue at this time. public comment is now closed. >> thank you. at this point, i'm going to ask that

we will go into recess for a period of about 13 minutes. we will reconvene [meeting reconvened] >> good afternoon again. we are out of recess. i ask the board secretary to call the roll. >> thank you president scott. begin with roll call- [roll call] >> we have quorum. >> we do have a quorum so proceed with item 9. >> thank you president scott. item 9 is board education healthcare eco system and market overview. this is discussion item andprinted by mike clarke, aon and

chief financial officer iftikhar hussain. >> hi, i like to do interdeckz the health service board does a education plan every year, so to remind the board that this year the requested education topics were healthcare cost trends, equity data reporting, and data transparency. these education sessions of course are open to the public and members are encouraged to attend, and we will be asking the commissioners to complete a education evaluation after every session within a week when we know it is still fresh. be looking for that in your e-mail and with that, i will turn it over to mike and iftikhar. >> before we begin, it was a very-i would say in some ways painful conclusion to the last benefit cycle, as we had some

very difficult decisions to make, and among those decisions were ones that have resulted in some of the discussion that preceded this particular agenda item and opened this meeting today. it is my hope that coming out of these education sessions over the next week that we will use this, not only as a board, but encourage the general public to refer to these presentations and this section of the agenda as we go into the benefit cycle starting in january of next year. because it is kind of a overview and that's what the board requested, that we jointly educate ourselves about what the mega trends are, what the environment is, what real things can this board do and what things may take some effort by other partners here in the city and county of san francisco. so, with

that, michael, welcome back. you had maunth off. i know you have been rested and thank you for preparing the presentation. >> absolutely. mike clarke aon. chief financial officer hussain and i will copresent on healthcare eco system and market review while relizing the echo system is biological term. you will see a document on the slide that shows how complex and interconnected the healthcare system is so the referenced system. we'll start with background on the board education modules today through december. just talk about the complexity in the u.s. healthcare system. that includes slides that chief financial officer hussain was able to source from a great report that is referenced, so we have appendix slides and you'll see the name of this report in the appendix but we brought up slides in the main presentation he'll go through. we'll talk about

healthcare system merger and acquisition impacts. two big ones happening concurrently in the bay area. we'll talk about strategic focuses for health renovation. cfo hussain will walk through some initial consideration factors for (indiscernible) knowing michael will present more thoroughly later in today's meeting. outlining views on control versus influence and recap of the modules that we will present to you in september, november and december. as background on page 4, at the health service meeting late may early june, request was made to better understand just what our current state developments in healthcare, what is out there forveneder invasion and also conversation how benefit design can support the hss strategic plan. today as just

background on u.s. healthcare eco system as well as introducing these three education modules in september present on market and health system invasion, module 2, benefit design and assessment tools in november and then wrapping up in december with future state opportunities. page 5 just presents a really nice pick torl going deeper into expectations on the agenda . foster equity, advance primary care, affordable sustainable, supporting mental health and wellbeing and optimizing service. so, when you look at the healthcare system, we'll talk a lot on the next couple slides about public and private financing. there is

roughly 50/50 split in this country between public and private financing, and as plan sponsors kind of deal with this very complex system and how that impacts the realty is that healthcare providers includes hospital, doctors, other practitioner, pharmacy and labs have to operate within a very very complex revenue source and regulatory eco system. i'm not going through this chart, but i think it is accurate representation of the environment that these providers have to operate in, and the many many influencers whether government influencers, health plan, employers, private insurance and so forth that operate within what we call a

u.s. healthcare. >> this slide shows what you suspected. the u.s. cost of healthcare in the u.s. is higher then other countries, developing countries, both in terms of cost per capita or pending as well as percentage of gdp. the higher cost is not really correlated to higher quality as measured by life expectancy. on the next slide, this slide very busy but it shows the blue line to call your attention to the blue line, which is rate of inflation on healthcare spending, versus the gold line, which is cpi. since 1969 you can see consistency the healthcare inflation

outpaced general inflation and gdp, and so as you see the cpi going up, healthcare cost go up higher then cpi. the very last blue shaded section is when the aca passed and coverage expanded and actually that increase in healthcare cost was quite a bit lower then in prior years, so actually the-they did not increase spending on healthcare more so then others in the past. the next slide on slide 9 you can see spending by age group. clearly very sharp increase by age and really a function of the intensity of services as people get sick, age higher and get sick. the differences between male and female are muturnty

and longevity for women. >> i'm dating myself but i remember clearly before my retirement where the gdp was 7 percent of gross national product. >> and now healthcare is 18 percent of our gross domestic product and climbing. so, with that background, i mentioned earlier roughly 50/50. it is 46% of u.s. healthcare respond in 2021, the last measured year or 1.65 trillion came through medicare medicaid and public insurance programs. just as refresher, medicare covers those age 65 plus as well as qualified disabled americans and those qualifying with end stage renal disease,

medicaid primarily low income americans and children health program. to note to this percentage has been increasing over the course of time, so if you go back and look at where the percentage was 20s years ago, 20 years prior in 2001, it was 29 percent. 2011, 43 percent and now 46 percent. the pressure this puts on employer sponsored healthcare is with providers being paid more and more of their revenue from government sources, which tend to be lower reimbursement wants. it just puts that much more pressure on the prices charged through private insurance, employer sponsored healthcare. you can see what is really causing a lot of this rise. the government programs obviously, the federal money directed to programs like medicare and medicaid who dictate

reimbursement guidelines to hospitals and doctors. for providers to balance their revenue needs higher prices need to go to other forms and other patients to recoup the short fall on what they receive from the government. page 11 just noting key stakeholder positions and what really is overall $4 trillion system. obviously the health systems like we talked about ucsf today who remain financially strong enough to survive to continue to drive their growth. some happening organicly but a lot through merger and acquisition as well, about we know the labor pressures, decel systems are experiencing. we talked about that in the rate and benefit cycle. to the lower self-health plan administrators and insurers, so blue shield, kaiser, united healthcare et cetera press to deliver optimal

cost control via provider discounts and fee while advancing member advocacy and health improvement platforms so there is a lot to do competing in a ever expanding new solution market place where we are seeing a lot of it funded by what you see at the upper right, private equity firms and large retailers like amazon and walmart. getting more and more into the healthcare space. why? because it is 1 out of every $5 we spend in this country. they see substantial revenue potential with digital that improve access to healthcare with goals improving individual health. government programs and continue to be a foundational part of how healthcare is delivered in this country, but they need to continue to act to limit growth in public program funding so just recent examples--medicare process. you read a lot about that in the news. i talked at

length in june about the cms funding changes for medicare advantage plans so those are two recent examples. it creates pressure back to the health systems from the government sources that continue to result in higher and higher prices from employer sponsored health plans. >> can i make one comment on the slide? maybe my cynical side, but the last phrase under private equity firms improvaling individual health. you actually said the goal was and i think that's their promise, but this is a revenue decision, and so i think what we as consumers in all-promise of better healthcare, but i think i'm not quite sure if you have evidence that this is improved individual healthcare. if not, i might amend that statement to-unless you can show me proof about

improvement healthcare with all these movements. i am suspicious. >> your skepticism is well founded . i agree. one thing that we try to do, in my organization and other organizations in health consulting is trying to understand the value, the evidence of success that these organizations are delivering when they promise better management of mus -a lot of new players we see come out in the mental health space. trying to respond to market place needs. there is no question in the private equity environment, the goal of these organizations, the ultimate goal is to try to drive revenue for the investors, but doing so in a way that is trying to promote a

idea, promote a concept that can hopefully improve member health, hopefully lower trnd lines for employers but i saw a lot is largely improvement at this point. organizations like us are trying to understand company by company what seems to be working out there. from a merger acquisition standpoint, we decide a couple studies on this page that were recently performed. one in 2020 by the kaiser family foundation observing just the higher cost elements that result from integration, including one observation in california about highly concentrated hospital markets. found increase in the share of physicians and practices owned by hospital came with 12 percent increase in premiums for private plans sold

in california market place. may 2022, a study showing vertical integration between physicians and large health systems lead to substantial increases in primary care and splshest prices and we have the refances at the bottom of the page so if you wanted to see the source articles, those are on the bottom of these pages. then of course the latest bay area news, ucsf talks to acquire saint mary medical and saint francis hospital and executive director yant mentioned the john muir san ramon medical center. focuses for health vendor invasion for us at hss is primarily hmo network strategy trying to partner with optimal health plans. there is the ppo plan available to members who prefer a more open provider access model

and to provide coverage for those who live outside hmo plan areas. for active employees and early retirees that is non medicare ppo plan and medicare retirees that is united healthcare and ppo plan. hmo plan choice was expanded for active employees and early retirees coming along blue shield and kaiser hmo and medicare retirees have uhc nationally but also uc kaiser in certain regions. noting that these plans do have the highest star rating possible from the federal government at 5 stars which is medicare measure of quality and performance. strategic focuses plan invasion comes from advancement of primary care initiatives as well as advancement in advocacy models and you see the examples here hss is continually working with the largest health

plans with kaiser a lot of discussions about workforce health and wellbeing resources, how to bring more awareness to those and are engagement in those, as well as review of health outcome data. kaiser does consistently deliver high quality results. blue shield hmo, frequent meetings with the two primary medical groups in the aco model brown and toland. (indiscernible) advance primary care focuses and then with united healthcare quarterly meetings to review program engagement, (indiscernible) utilization certainly the goal is to continue to advance awareness and engagement for members to use the right services and programs with the right time. >> talk more about the-

[multiple speakers] >> i apologize for interrupting because i know we are talking about uhc and ucsf and a lot of what we are dealing with here. does blue shield have a contract with ucsf? i'm assuming and may be wrong, with exception of kaiser most of the other groups like blue shield would have contracts with ucsf medical groups. >> active employees and retirees have access to ucsf through those plans. >> okay. so, our deal unique with uhc? >> and medicare advantage plans specifically. >> thank you for the clarification. i appreciate that mike. sorry. >> just to clarify uhc split family, which is ppo

for early retirees that is not effected by this >> right because they are not medicare advantage. it is gradually sinking in. thank you very much. >> the rfp discussion, every year-engage with health plans and work with them to improve care, improve affordability, access and every 3 to 5 years we actually open up our process to look at other health plans or other people who may be able to serve our members. so, our goal in going through the rfp process is to look for lower cost, improving affordability and to look at high quality as well as to improve access. all are (indiscernible) in california where if you can

improve access to those providers by broadening our network, that would be a goal of an rfp process. for medicare advantage, our goal also is to-one thing we look for is network of reliability. we will be looking at partners who can assure us that the disruption to the network is minimal while providing good care. for the dental plans, again, the same theme of access and cost and quality is what we would look for. next slide. so, this chart on this page describes what the board has direct control over and what it can influence. direct control on annual basis we look at the health plan design and the rates, and then on a

infrequent as needed basis we look to develop new policies, update our policies and rfp process as needed. on the influence side, it really is things around having making sure our members are aware of the services that we offer, as well as impacting policy and educating our members on the effects of the policies long-term. >> i would-i'm going to take a (indiscernible) commissioner follansbee book in terms of the title for this particular slide in terms of control versus influence and then you defined control via our authority to approve, and the first one of these is total healthcare cost rates. yes, we can approve or disapprove the rates after extensive negotiations, but in terms of controlling what is

provided to us from the health plans in terms of those rates,b that is a back i forth that may or may not result in lower premiums, and i think that many times as we sit in these meetings, it is assumed that we have absolute control over the final outcome of the negotiation in terms of premium rates, and we clearly do not. we can get into very aggressive negotiations with our health plan partners. we can look at rfp as a way to try to impact total cost, but in the moment any given year we don't absolutely have all of the control. it is just about our authority to approve and a lot of the out of sight activity is really

done between our actuarial and the h is -hss staff. that is what we charge them to do. be thorough in the analysis and negotiation with the health plans. that's just a clarifying point on this particular slide and it one i think we need to be reminded of as we go forward. >> commissioner--i would add that instead of the term approve, in my mind it is accept. [laughter] because what finally comes before us, yes we approve as a board because that's our authority, but we are actually accepting what has been presented to us and because we can't say we are not go ing to prove it, go back to the draw ing board. that rarely

happens, so i don't want to change any documents, but just understanding the realty of what i see us having to do here. it is really accepting what is presented. >> may was a good example. >> yes. >> approved it and it may be unaffordable for a lot of people. yeah. who is on our negotiating team? [laughter] >> so, it is-- >> abbie >> the executive director leads our negotiation on behalf of this board. she is charged with that. >> there is a team. our team is here, ray, iftikhar, mike, myself and others as needed. michael of course. our contract manager to make sure we are doing everything legal. >> the executive director, the chief operating officer, the chief financial officer, and

the manager of contracting, or is it director of contracting? not sure the title, but manager or director of contracting are the staff that we as a system have charged to work on our behalf day in and day out around this particular issue, and our chief acuary is responsible for looking at claims data, healthcare trends, contracting issues somewhere make comparisons external as well as internal to what he's seeing and recommending in terms of trends regarding how plans are operating. that's kind of where we are, and in my experience in this field for over 40 years those dynamics have not changed. it is matter of trying to get the partners in constant conversation as was alluded to in a prior slide so that you can

anticipate where some of these things are going. >> in order to negotiate you have to have good negotiating team, but you also have to have a alternative to say we are done with you. that is what we really need. >> and that would be great in the abstract. that is probably true, but in realty we all know that to make a health plan change is a major major undertaking, and not only because of the contracting, but also the impact upon our members. it is not undertaken lightly, but has to be done with some large anticipated forethought on our part whenever that would come to pass. >> not prolonging too long. over my term on this board i would say that hss has

made tremendous progress in our ability to understand through our all claims data base and lots of efforts going on hss, so we had opportunities to review and approve one or two-one of two options for plan features in terms of copays and all that for new proposals for plans and we are asking for accountability for some of those decisions we made in the past. what polk the impact? we have been promised we get accountability for some of these design features as well. i don't want to under-play the power the board has in reviewing this and the partnership with hss, which i think is only in my tenure is only improved in terms of our ability to actually influence and-not only influence but control some of these issues. this is complicated. no doubt about it. thank you.

>> this wraps up our presentation. just restatement on page 17 of the modules coming up in september, november and december and wont go through the appendix slide, but good information to review. we had a lot of discussion. >> are there other questions or comments from the board regarding this overview presentation? >> if i can make one comment. you alluded to the kaiser family foundation, and all board members have access to all of their ongoing educational programs and i have been taking part in some of them. i just listened to one on the issue of the new obesity drugs. it is very enlightening and they tape these and available to all of us and it seems like a microcosm, but in fact, the microcosms add up to our ability to control influence and control healthcare cost. i

really urge as board members and others with access to kff because they do a very broad and deep dive if into issues on big basis and individual basis and haven't (indiscernible) they are due to come in the next year or 2 or 3 or 4. >> they do daily e-mail alerts, anybody can go to the public website and sign up for alerts, articles come out periodically. it is a incredible resource. >> thank you. we will now move to public comment on this item. >> thank you president scott. public comment is open. instructions are displayed on the screen for those watching on sfgovtv and webex. in person will be first and then remote. for those callers on the line, press star 3 to be added to the queue. those watching the meeting on webex, click on the raised hand icon

to speak. we'll begin with in person public comment. no one approached the podium. we'll move to remote public comment. we have 4 callers on the line. zero callers have raised their hand for the public comment queue at this time. give a brief pause for anyone who may want to raise their hand for public comment. there are no callers at this time. hearing no callers, public comment is now closed. >> thank you. we'll move to item 10. >> item 10, board education healthcare transition fraump active employment to early retiree status. this is discussion item and will be presented by mike clarke with aon. >> mike clarke, aon. going to talk today about the implications when an individual is transition from active employment to early retiree

status on their health plan benefits and member contributions. just summarizing the start, this outlines those transitions in health plan contributions as well as plan s in some case. on the left side of the page there is-this is the summary page of the presentation so a lot of good information behind it, but if there was one page to reference what stayed the same, deductible copays coinsurance-those remain the same transitioning into early retirement. and member contributions to purchase the vision plan. what changes and what are the focuses that are someone transitioning early retirement? first the

member contributions for the medical drug and basic vision as well as dental coverages. dental plan deductibles. coinsurance and annual maximums, and then also just recognition that the employer provided life insurance, accidented death and long-term disability do end upon active employment. page 3 just shows the distribution of total covered lives. this is active, retirees and dependents. you can see over the course of 5 years how the figures changed. there has been increase over time in the number of covered lives through medicare who are medicare eligible. you see that in the middle bar. on the right side slight decline in the number of covered lives who are early retirees, but it is

still over 9500 individuals are covered in some form either as early retirees or dependents through sfhss health plans. and those plan costs are higher early retirement because there is no government federal funding like there is medicare retiree where the majority of funding is through the federal government as a medicare retiree. so, for the medical prescription drug basic vision plans, health plan contributions generally increase, not always. if you are single tier, but generally increase for a person transitioning to early retirement and again i bold especially for those covering dependents and we'll talk about why in the presentation. first reason is just higher total cost rates for early retirees versus active. you saw on the slide that cfo hussain present

ed cost increase with age, so early retiree rates are higher then active employee rates. just because of the higher cost on average of healthcare. the second reason is differences in the employer contribution amounts for the city contribution between active employees, which are driven by the memorandum of understanding and early retirees driven by city charter where the differences increase as you cover more dependents. so, on the next page, we show what the 2024 member contributions on a monthly basis, so if you go to the page you'll see for instance-page 5. >> commissioner breslin. >> (indiscernible) the second reason is clear the first reason is not clear to me. when i look at

the charter. higher cost rates for early versus active employees. here is it charter. monthly cost for retired persons may be higher then the coverage for active employees. the city county the school district community college shall contribute funds sufficient to defray the difference in cost to system and provide the same health coverage. the only difference in the charter is the mou's so i don't think that first reason applies or shouldn't apply. we should- >> we'll talk how the city charter balances that. >> the charter says this then how can they say that's part of the problem and yet they are not supposed to consider the difference in the cost? >> the city charter does provide for the difference in total rate between

employee only as a active employee and early retiree only as part of the city contribution. if you look at page 5, the big reason why plans like trio, canopy care and kaiser actually have a lower retiree contribution for the retiree only tier then for the active employee tier for 93, 93, 83 is because of that full differential in the total cost rate. early retiree only versus active is provided for as a city contribution for the early retiree. i'll review that in a couple slides. >> the charter clearly wants not to be anymore and (indiscernible) accept for the mou. >> would you continue?

>> these are the-for the active employees city county of san francisco, we show the two active employee mou's, 93, 93, 83 on the left which represent the percentage the city contributes to total cost of healthcare for each of these tiers. for the active employees and early retirees are based on full city charter contribution which we'll talk about in a bit. i know at the last meeting it was requested how many early retirees fall into each of the tiering buckets. you can see that 64 percent all most 3500 retiree, only but 1 in 3 early retirees do cover at least one dependent. 482 individuals are covering retiree plus 2 or more. so, page 6 is a

pick toral exhibit of active employee city contribution and just noting page 7 for sfusd and city college employees, the employer contributions are determined based on agreements those organizations have with their employers. you can read the description. we have agreements for employee plus 1 or more. (indiscernible) pay no contribution for medical or vision. we tend to focus on the ccsf active employees when we go through rate cards but to give you information on how that works with the other three employers. all the employers come together under one city charter as retirees,

and retirees hired on or before january (indiscernible) receive the full contribution you can see are based on three building elements. the first element that is the same for all plans and what's always approved every year in march is the 10 county account. that is determined by the annual survey and the same dollar amount for all plans and all dependent tiers and as you see on the next page, that's what is going to be represented in the lighter blue bar. second element, that is represented on the next page by there darker blue bar, is what we call the difference, but it is essentially what i was talking about earlier. this is the provision of the city charter contribution that basically bridges that gap in retiree only versus active

employee rate for each given plan. that provision that is trying to make the early retiree more or less whole for the difference in total cost rate from active employment to retirement, this is the specific element that addresses that and how city charter contributions are calculated. and then there is a second element what you see in the gold bar on the next page that varies for each of the plans and that is retiree prop e contribution. the way i think about it is, when you start with your total cost rate as a retiree and then you deduct the 10 county, deduct out the difference, what is left is essentially paid for 50 percent by the city for both the retiree only tier and the retiree plus one tier.

this is a very important distinction here because this prop e contribution-you see on page 9 and we show it for the two highest plans, access plus and kaiser. you can see how that amount is higher for retiree plus 1 then it is for retiree only. when the other two bars are the same all the way across, but the key distinction then when you are covering 2 or more dependents as retiree is you are only getting city funding for the first retiree. so, that's why the bars are basically the exact same between retiree plus 1 and retiree plus 2 or more. so, the impacts for early retiree from the way the city contribution formula works, first of all, most of the dollars paid by the employers go to the retiree

coverage not dependents and you can see that pretty clearly. the bar is covered most of the way in retiree plus 1 by what the retiree only does. the prop e portion of the formula provides some city contribution for the first dependent, but a far lower dollar amount then for the retiree coverage. again there is no city contribution for the second and further dependent in retiree coverage, so that retiree has to pay the full cost increment between retiree plus 1 total rate and retiree plus 2 total rate to cover the second and higher dependents. contrast this to as a active employee. i may get a lower percentage when i go from employee plus 1 to 93 percent or 96 percent to employee plus 2 or more at 83 but still get 83

percent as a active employee. contrast that where you can see in these charts that the incremental amount for the first dependent is a lot less then it is for the base city charter contribution for the retiree, and then there is no incremental contribution with adding the second and further dependent. i'll pause in case you have any questions after having gone through that. so, if you like pictures page 9 is for you, words, page 10 is for you. if you are a ccsf employee in either of the 93, 93, 83 the middle column or 196, 83, the right column and transition to early retiree status when you are a employee

and just covering yourself, it is a relatively modest difference. there are some plans you pay less in retirement. there are some plans you pay more, but generally speaking if you are 93, 93, 83, it is similar. (indiscernible) are going from paying nothing because of the hundred to paying something. then the gap starts to widen as you take on one dependent and it is the widest gap because you are not getting incremental city funding for the second or further dependent. so, that's going through the full city contribution picture for those hired on or before january 9, 2009. if you are hired after january 9, 2009 there was a change in the city

contribution based on your years of service. so, if you have at least 5 but less then 10 you dont get a city contribution. if you are hired after january 9, 2009. 10 but not quite 15, 50 percent of that amount, 15 and not quite 20, 75 percent of that amount. it takes at least 20 years of service in order to achieve the full city contribution if you are hired after january 9, 2009. at the bottom i stress the thes is increasingly important for individuals who plan retirement in the future. (indiscernible) retired and receiving less then the full city contribution for

retiree coverage. so, the full picture, page 12 and this replicates the slide you saw for the rates and benefit renewals for acive employees and early retirees. you see the full picture about total cost rates. how they vary for active employees and early retirees. the employer contribution based on calculation formulas as well as the resulting member contributions. and then just talking about dental and vision on page 13. dental coverage does not vary whether medicare or not. for dental we just say retirees. it is one bucket of coverage no matter the age or retirement. dental coverage becomes fully member paid. for the active employee ppo and

(indiscernible) you pay higher (indiscernible) higher coinsurance and plan annual maximum. there is variance. there are some retiree ppo plan provisions that are more generous then active. we have in the appendix in case you want to compare and contrast the ppo plans. the big difference comes in the contribution you pay for coverage. active employee you pay $5 a month for single, $10 two party or $15 full family. as retiree you pay the full amount. there is no city funding for retiree dental coverage. just reminder, the sfusd and city college employees do not receive dental plans through hss but they are eligible for the retiree dental plan through hss in retirement. as mentioned before, for vision the member

contributions for the plan stay the same. in summary page 14, just have to stress advanced planning is key. the healthcare contributions will increase most notably for those active employees transition to early retirement who cover dependents and especially 2 or more dependents. the dental will be more expensive going from mostly funded for ppo or all funded for hmo and active employment to fully paid by the retiree. someone is relying upon their life insurance mechanism to be what they received through the city, again just a strong reminder here that life insurance ceases as retirement as well. as i reviewed earlier, planning is all the more pronounced if you are an individual hired after january 9, 2009 who

doesn't plan to work at least 20 years. president scott. >> are there questions on this presentation? i raised one question with director yant as to the type of communication that may happen or should happen or could happen between retirement system and health system as we communicate with people planning retirement and so forth and my hope is that if this is currently going on that we are-when a person is active they are getting kind of key information from us and from us as well as the retirement system as they are approaching retirement and the information is somewhat consistent regarding the cost

impact of healthcare and so forth as they approach retirement. >> yes, this has been a priority for us for the last i think two years. ray has come in and communication director jessica has done a bang up job with putting cost calculator and other communication tools on our website. the biggest challenge is working together with retirement,er which is also underway of having more of a trio of agencies as the human resources retirement and us working together, but it's-this planning has to start well before one is coming to retire. that's the challenge and i'm sorry that alfred sanchez had to leave because he is putting together a group of stakeholders because that is hard for us to

directly influence. i think it has to come peers and labor unions to help them appreciate this from the get-go. i think everybody is looking forward to that pension check, but they dont think about healthcare becoming an expense, so to fiend a way to get that introduced early on and repeated over the years so it isn't sticker shock at the final moment is i think our biggest challenge and something that we will need quite a web of folks to help us determine how best to do that because there is probably no one way, there is probably multiple ways, so that's where we are at with it. we are definitely being very diligent about helping those that are coming to us as they retire very close to retirement, but for this kind of consideration i don't think that's an adequate amount of time for people to be prepared. >> thank you. are

there other questions or comments? commissioner zvanski. >> i like to make comments because there is a number of pre-retirement seminars held by poa and other employee groups and i attended those quite consistently over the last few years. all of this is essentially voluntary on the part of the employee. the reaching out to employees at some point during their working life rarely happens so if they are not active in their unions or other organizations that might bring these issues up unless they come to the retirement system at one of their pre-retirement seminars or they call health service doesn't happen. i want to say

i complement abbie and this is true for some of the predecessors. health service always had good staff that attended those seminars when the request comes out and there's something planned we always send someone, so it is not just some that go and talk because we are associated with those groups, but we had the staff that go in and provide the real nitty-gritty and the facts. i'll say things like, the numbers are a little different and tomorrow when you meet with the hss staff they will give real figures. but it is voluntary that way and so this sets up a different situation because even if employees have discussions at the work site they don't always follow through to find a seminar or go forward with the information. they think they will find it out some point down the road and so

that's just kind of the reality and then they get surprised. >> any other comments from board members? we'll have public comment on this item. >> thank you president scott. public comment is open. instructions are displayed on the screen for those watching on tv and webex. in person is first and then remote. those on the line, pless star 3 to be added to the queue. those watchs the meeting on webex, click on the raise hand icon to speak. i'll begin with in person public comment. no one approached the podium. we'll move to our remote public comment. and there are three callers on the line. zero callers have raised their hand at this time. we'll give a 5 second pause for anyone who may want to raise their hand and join public comment.

zero callers raised their hand so hearing no callers, public comment is now closed. >> thank you. we have an agenda decision to make. we have a member appeal today, and i believe the parties are with us or very close at hand, and we have one more presentation on competitive bidding and my understanding is that we have one plan representative who wishes to make a comment. i'm going to call on the plan representative to come forward and make their comment at this time. >> should we announce the item? >> the item will be number 11. no, number 12.

>> thank you. item 12 reports and updates from contracted helt plan representatives. this is discussion item. the floor is yours. >> thank you. thank you president scott and commissioners. tiffany gil, blue shield of california. wanted to take a chance to announce a ground-breaking collaboration between blue shield of california and mahmee. providing hss members with unparalleled maternal care and support throughout their journey from conception to baby first birthday. this collaboration reflects ongoing commitment to your member health and wellbeing and excited to bring hss comprehensive program at no additional cost through 2024. members gain access to array of personalized resources which includes dullas and

support insuring a smoother empowering experience during this remarkable chapter of a member's life. >> thank you. are there questions? >> i want to make a comment. i applaud the fact that you-this program goes through the first year of the infants life. over half of maternal mortality around pregnancy occurs after birth, and so this program should help impact women who are at risk for a variety of reasons for death after they have given birth. the story does not end then so i applaud blue shield for this program and i think hopefully we'll see improvement in some of these statistics nation wide. >> thank you. >> thank you. is there any other questions or comments from the board member? thank you for bringing this to our attention. i'll call

on public comment on this item. >> can we ask, how do members learn about this program? >> excuse me, please. can you come back? >> sure. we actually have sent out e-mails already to some of the staff or members of child bearing age and also there will be a mailing done with the program and then we have also provided materials to executive director abbie yant and team and then we also have a webinar that will be coming up and all that will be provided information wise to the membership. >> the program is in effect already? >> it just started august 1. >> oh. okay. i just wanted to accent to the board the-we are very pleased we are able to put this in place relatively quickly because of what dr. follansbee mentioned

and to accent that, the maternal death rates among women of color particularly african american women are horrifying and so that's why once this was identified as a opportunity to blue shield it is like let's do it now so i wanted to be sure the board was aware that we are looking-going beyond reporting on statistics that tell us health outcomes are harmful and kaiser does a lot of stuff too, but i wanted to have blue shield mention this particular program at this time so thank you. >> thank you very much. we'll take public comment on this item at this time. >> thank you president scott. [providing instructions for public comment]

>> no one approached the podium and move to remote public comment. we have three callers on the line. zero callers have raised their hand. we'll give 5 second pause for any of callers who may want to raise their hand. no callers raised their hands so public comment is now closed. >> thank you. so, if the competitive bid-looking at director yant, are we doing that today or differ it? >> i think it is ideal if the appeal goes quickly that we do that. >> come back? alright. >> yeah. >> okay. ready to move to item 13 on the agenda. >> item 13, vote on whether to hold closed session

for member appeal. this is action item and presented by president scott. >> ready to entertain a motion that we go into closed session to hear a member appeal under the provisions outlined in the agenda. >> so moved. >> second. >> been properly moved and seconded that we go into closed session under the provisions provided in the agenda. is there public comment? >> thank you president scott. [providing instructions for public comment] no one approached the podium and move to remote public comment. there are three

callers on the line. zero callers raised their hand. we'll give a 5 second pause for anyone who may want to raise their hand for this item. no callers raised their hand so public comment is now closed. >> roll call vote on item 13 whether to hold a closed session to hear the member appeal. >> roll call vote- [roll call] >> motion carries unanimously. we'll now go in [meeting reconvened]

>> i'm ready to entertain a vote as to whether we disclose any or all of our discussion held in closed session. >> i move we do not disclose from closed session. >> second. >> properly moved and seconded that we vote on not to disclose any or all of the discussion held in closed session. is there any comment from the board? questions? we will entertain public comment at this time. >> thank you president scott. we'll be taking public comment for item 14, which is to vote whether to elect or disclose discussion held in closed session. public comment is now openment instructions are displayed on the screen for those watching on sfgovtv and webex. in person public comment is first then remote. for those on the line press star 3 to be added to the queue. for those watching on webex click on the

raise hand icon to raise your hand to speak. we'll take in person public comment and now one approached the podium so move to our remote public comment. we have two callers on the line. i will be checking to make sure they come through. remote public comment is coming through and we s one caller on the line. zero callers raised their hand at this time. we'll take a 5 second pause to see if any callers want to comment on this item. no callers have raised their hand at this time. public comment is now closed. >> we'll have a roll call vote. >> a roll call vote- [roll call]

>> passes unanimously and move to item 16. >> item 16 is possible report on action taken in closed session. san francisco administrative code section 67.12b. this is action item and presented by president scott. >> ready to entertain a motion whether we report on actions taken in closed session? >> i move we do not report on actions in closed session. >> second. >> properly moved and seconded we do noot report on actions taken in closed session. any questions by the members of the board? if not, we are ready to take public comment on this item. >> thank you president scott. public comment is now open. instructions are displayed for

those watching. in person will be first and remote. for those on the line press star 3 to be added to the queue. for those watching the meeting on webex click raise hand icon. we'll begin with in person public comment. ask there is no in person public comment and move to remote public comment. we have two callers on the line, zero callers raised their hand at this time. we'll take a 5 second pause for any callers who might want to raise their hand. no callers raised their hand at this time, public comment is closed. >> thank you. with that, we are ready for roll call vote. >> roll call vote- [roll call] >> passes unanimously. we'll now pick up where our agenda left off with item 11.

>> thank you president scott. item 11 is annual consideration of sfhss competitive bids. this is discussion item which will be presented by michael visconti, contract manager. >> thank you. thank you commissioners. michael visconti contract administrative manager. for appreciate director of contracts, by randy scott earlier today. i'm here to do a very brief presentation that will be a precursor to the presentation in september about the annual competitive bids and why we dee them in the schedule we do and how they are a tool in the arsenal that is sort of additional to discuss item 9, the market assessments as well as the very excellent negotiations done by our negotiation team, including our consultants at aon. with that, we'll go quick overview of my slides here. again,

we'll go briefly into why we do these competitive procurements. due diligence as the health service system and the board. comparison of rfi and rfp. go into a very brief history of the most recent rfi and rfp and reflect on considerations seen during item 9 and considerations we will be presenting to you in the september meeting. with that, competitive procurements serve multiple purposes but we are doing due diligence and duty to member jz participating employers reviewing all the current and future needs of the our members as well as making sure we are making sure our benefits are affordable and sustainable going forward. we

always do evaluate throughout the year whether there are new opportunities partnerships or services that we haven't considered yet, and what we do is then weigh whether these are opportunities service or benefits available to us through a competitive bid. we do balance that against potential negative effects. for example, we don't want to do a rfp if based on market assessment we will not gain anything from the process. a lot of successes we had with prior rfp were due the great work done by the team and very beneficial market conditions. we also want to weigh those against the member disruption. right now there is a difficulty finding a new primary care physician if someone does have a new plan available to them is there too much a barrier to move to a new plan because of that issue? again, these are all factors we take into

consideration about the timing of these rfp, but again this is another great tool in our arsenal to make sure we are doing the best service to our members and getting the best benefits competitive prices and make sure we keep this sustainable and affordable going forward. so, brief comparison of the rfi, rfp. from a high level, rfi allows us to do something broad and forward looking. it is much less narrowly tailored then a rfp. a rfi can lead to a rfp because it allows to narrow the scopes so not asking questions or looking into services that are irrelevant to the ultimate needs. from a schedule perpective and from the burden on our team and aon, again much different between the rfi and rfp. a rfi can be conducted in 2 to 3 months. we did this in 2021. we are doing a r if rks

p talking about health benefits or any benefits this could be 6 to 9 months. from a process standpoint, as we remember from 2021 with medicare rfi, this is a much more fact finding and discussion process. we have members from the board reviewing the responses to the rfi. we leverage subject matter experts and present what we have learned to the board in open session. as opposed to rfp, where again we have a special evaluation panel as we did in 2020 for the health plan rfp. we have subject matter experts, detailed analysis, ranking by that panel and recommendation from sfhss to this board that this board can accept or reject. when it comes to whether binding again, rfi are non binding, low barrier to entry and get a lot of responses. rfp is binding so when we issue rfp we are

looking for the things we secured in prior rfp like stability in our rates, stability in administrative fees, we have seen this both through negotiation and rfp. for example with the rate caps in certain benefits. again, rfp binding, much more time consuming, more narrowly tailored and controlled process. >> michael, we understand the history the differences shown on this slide so can you move forward to slide 5? >> absolutely. again, if slide 5 we just discussed this. this is a timeline but again, for 2025 plan year benefits, if we are going to conduct a rfp for health plan benefits for non medicare benefits this would be on the same schedule that we did in 2020 and 2021. we would release in september, we present the results to you in february and that line us up with our rates and

benefits calendar. for medicare, we could delay the medicare rfp slightly from a calendar basis and that's because the cms rate announcement where they give the financial information for this year was not released until april 3 so again, we cannot do the rfp until we have the financial information so we would start it in december, conclude in may. there is time to do a rfi similar what we did in 2021 for medicare prior to doing rfp if that was our recommendation. again, when we are looking at these plans what our consideration, this is a similar slide what you saw in item 9 so we'll skip over this. as our cfo and mike clarke highlighted there are many unique considerations. we will present our recommendation in september and again that will cover all our plans and benefits. again, thank you for your time. thank you

for your patience and indurance. this has been a very long day and thank you for the time to present this. we very much also look forward to this being a regular occurrence having this presentation in august of every year and making sure the board ask hss is doing due diligence to members and all the benefits. >> alright. i would suggest we normally don't meet in july, but some reference to this probably needs to happen at the end of june, because based on your calendar, you're going to go to do one of these things the very next month and i don't think that's-to me it doesn't- (indiscernible) so, we need to have some sort pre-notice here realistically to do this next month.

>> you are not meeting so i think us presenting in august is fine. we are a little tight this year because it is the first year we formalized but miking things this way all of the time. just getting on paper and discuss and bring it to you so i think we are good. >> okay. but, i think for me it says if we are planning to do an rfp, which is a actionable one, we are really talking about implementing something that will be at least a year or two away from where we are today. >> i think you are recalling correctly when we did this in 2020, granted it was a very different time and pandemic just started for us the first mention in the director's report waseter may or june of that year, so thank you. noted. >> yeah. tweaking us, just

wake us up it is coming in june so that we know. >> i think more importantly is i think the message is appreciating the role that the health service board has in this whole process and understanding that competitive bids are actively considered on a annual basis. >> yes. >> alright. again-- >> (indiscernible) >> something for early retirees and some competition for blue shield. >> absolutely. as we mentioned in item 9, these are a lot of considerations that we are taking to heart right now and we'll present on that in september, yes. thank you. >> thank you again michael for your work and diligence and thank you for your patience today. >> absolutely. thank you commissioners. >> thank you for sticking with us through this meeting. this meeting of the health

service system board- >> some of us still remember-is there public comment on this item? >> we can introduce public comment. public comment is now open. instructions are displayed on the screen. in person public comment will be first and then remote public comment. for those callers on the line, press star 3 to be added to the queue. for those watching the meeting on webex you can raise your hand using the raise hand icon and will be placed in the queue to speak. we'll begin with in person public comment and no one approached the podium and move to remote public comment. there is one caller on the phone line, zero callers raised their hand at this time. we'll take a 5 second pause in case anyone wants to raise their hand. no callers raised their hand. public comment is now closed. >> thank you. again,

michael thank you for your work and diligence and also to the chief operating officer and financial officer, thank you for all you are doing as well on behalf of our members. and with that, the august 10, 2023 meeting of the health system service board is adjourned. >> adjournment at 445 p.m. [meeting adjourned]

>> you are watching san francisco rising with chris manners. today's special guest, carolyn mante. >> hi, i'm chris manners and you are watching san francisco the stow about restaffing rebuilding and reimaging the city. the guest is carolyn manteto talk about the organization is helping to preserve the city cultural heritage and architecture. welcome to the show. >> thank you for having me e. >> good to have you here. >> can we talk bat the history of your organization and the mission. >> sure, thank you. san francisco heritage started 51 years ago and the main

mission is to preserve and enhance the architectural and cultural identity of san francisco. when it started out the focus was really on the buildings, historic landmark listings and really concentrated on downtown area with all the development happening. our organization was raising a reg red flag with historic landmarks in danger and victorian mansions so a hallmark of our organization is moving these victorian mansions in the way of development to inwestern addition neighborhood and other areas to get out of the way of development and preserve them. our organization was around before there was the historic preservation commission of the city so we were at the forefront drawings attention to historic preservation, landmarking and over the last 51 years we have seen how there are more then just

buildsings in safeguarding the city cultural resources, there is also small businesses and the different neighborhood icons that make a neighborhood special, so our outreach has really-it is really come full circle in a way because it moved downtown into the neighborhoods and now with the covid epidemic it is really going back to downtown again looking at how we can play a role in the economic recovery and revitalization of downtown san francisco. >> that's great. so, now i understand your organization is also responsible for maintaining a couple properties. could you tell us a little about those? >> yes, our non profit was gifted in 1973, the historic (inaudible) house. it is now a historic house museum but this was a family since 1886 built this victorian mansion in the same family year after year and one of the last

resident of the family when she passed way gifted the mansion to san francisco heritage so since then we have been running this historic house and the home of our office. in 2018, one of the long time members nor aa lasten gifting a building on the e h-as hate polk became a commercial corridor after the earthquake, the owner at the time, he raised the house and put 6 store front underneath in order to take advantage of the commerce so we are in charge of the house on the corner and it has been a wonderful way to get new numbers, new audiences interested in the work of our organization. during the pandemic, we have been using it

as a artson residents and partnering with different bay area artists as well as cultural institutions, cultural districts and then one of the storefronts we converted into a pop up galleries so gives a opportunity to raise awareness of the importance of the art and cultural resources in san francisco. >> that's fantastic. so, now, let's talk about legacy business. what does the designation mean? how does somebody get add today the legacy business registry and what benefits does being named a legacy business? >> i love this program. it was started by san francisco heritage and adopt ed by the city and run by the office of small business but the program looks what are the businesses really contributing to san francisco and the neighborhood. when we started the first focus was bars and restaurants but over the years it

exb panded to include other businesses so these are places that contribute to the character of a neighborhood, so sam's grill downtown, the amazingarian press in the presidio. book stores like city lights oergreen apple recently named. this year we had a lot of attention on the legacy business program. we put out a contest to the public of what you think should be the next legacy business and one of the businesses that was recommended was the club deluxe, jazz club on the corner, and 2 or 3 days after we launched the contest, the owners announced they would have to close. the rent was driven up, they couldn't afford it, coming out of the pandemic so we worked at speed to get that application submitted with them and that status convinced their landlord to negotiate with them a lower rent

and this way they have been able to stay, there was a lot of social media support around this, so when you become a legacy business, not only do you get marketing and business support from the office of small business, but you also eligible for grants and we work closely with the legacy businesses as we do our work for san francisco heritage. >> that's great. so, apart from architecture and buildings, you also work with cultural districts, and the castro theater strikes me as a place that is both. a beautiful building and cultural hub and center. what has been happening with the recent acquisition by new owners; >> it is leased to another planet entertainment and been in contact with planet entertainment by the castro theater is historic land mark building. it is recognized as a very important architectural

monument. one thing-one of the main activist organizations of the preservation of the theater we work together with supervisor mandelman on a interior landmark historic landmark designation for interior, but what happened over the is summer and people learned is there is a lot of concern not just by san franciscans but people all over the world, movie directors, stars who are very concerned about the risk to the lgbtq and film programming at the castro theater. another planet hosted community stakeholder in august, and it was so moving to see the number of people who took the

microphone-everyone had two minutes to say their testimony of what castro theater meant to them and those testimonys showed this building is contributing not just as a architectural monument but plays a role in the lgbtq community that is irrelaceuble able. >> it is beautiful theater. >> it is. my involvement in the theater raised awareness to not only the castro theater to be emblematic of the lgbtq culture and history but also there are many other sites in the city that also contribute to the identity. that is why so many people come to san francisco as a place of freedom and diversity so in my previous work i worked at the world heritage center, so when i joined san francisco heritage i was thinking why isn't

san francisco a world heritage city? for the architecture alone it could be inscribed. golden gate bridge to name a few but the city is so unique in the architecture, the mansioned and historic landmarks so hoping to start a conversation on that with city stakeholders this year. >> that is great. let's talk about your relationship with other agencies. you mentioned economic and office of work force development and planning commission. how do you unt integrate to them? >> these relationships are essential. we are working with office of small business for the legacy business program and the planning department is really one of our most crucial relationships. we meet quarterly with them and we really see how we can support not only historic land mark

listings and historical cultural context statements, strategy for culture districts and city survey among many other activities that really are of concern to both of us. for the office of workforce development, i attended a etmooing recently that the chamber of commerce organized with them on the downtown revitalization and a key goal in that meeting and in the downtown revitalization is to make sure that the city historic culture resources play a key #r0e8 in the economic recovery and revitalization especially after the pandemic. the office of workforce development has the city build program which is admirable program where youth are trained in construction techniques for rebuilding and especially with the new housing legislation, and we really want to see how can that workforce be expanded to include training in historic preservation. we have so many

victorian homes, historic buildings and other places that really need a skilled labor force to make sure that they are preserved and that they help keep the special identify of the city. we really value these relationships, we meet quarterly with the various organizations and we are really grateful for grants of the arts we receive and other supports so definitely that is a key relationship for san francisco heritage. >> the city build is great. i like that a lot. thank you so much for the time you have given today. appreciate you coming on the show. >> thank you so much raising awareness about san francisco heritage. we hope the people watching will join us in the mission to help keep san francisco special. thank you. >> that's it for this episode. we'll be back shortly. i'm chris manners, thanks

as a society we've basically failed big portion of our population if you think about the basics of food, shelter safety a lot of people don't have any of those i'm mr. cookie can't speak for all the things but i know say, i have ideas how we can address the food issue. >> open the door and walk through that don't just stand looking out. >> as they grew up in in a how would that had access to good food and our parent cooked this is how you feed yours this is not happening in our country this is a huge pleasure i'm

david one of the co-founder so about four year ago we worked with the serviced and got to know the kid one of the things we figured out was that they didn't know how to cook. >> i heard about the cooking school through the larkin academy a. >> their noting no way to feed themselves so they're eating a lot of fast food and i usually eat whatever safeway is near my home a lot of hot food i was excited that i was eating lunch enough instead of what and eat. >> as i was inviting them over teaching them basic ways to fix good food they were so existed. >> particle learning the skills and the food they were really go

it it turned into the is charity foundation i ran into my friend we were talking about this this do you want to run this charity foundations and she said, yes. >> i'm a co-found and executive director for the cooking project our best classes participation for 10 students are monday they're really fun their chief driven classes we have a different guest around the city they're our stand alone cola's we had a series or series still city of attorney's office style of classes our final are night life diners. >> santa barbara shall comes in and helps us show us things and

this is one the owners they help us to socialize and i've been here about a year. >> we want to be sure to serve as many as we can. >> the san francisco cooking school is an amazing amazing partner. >> it is doing that in that space really elevates the space for the kids special for the chief that make it easy for them to come and it really makes the experience pretty special. >> i'm sutro sue set i'm a chief 2, 3, 4 san francisco. >> that's what those classes afford me the opportunity it breakdown the barriers and is this is not scary this is our choice about you many times this is a feel good what it is that you give them is an opportunity you have to make it seem like it's there for them for the

taking show them it is their and they can do that. >> hi, i'm antonio the chief in san francisco. >> the majority of kids at that age in order to get them into food they need to see something simple and the evidence will show and easy to produce i want to make sure that people can do it with a bowl and spoon and burner and one pan. >> i like is the receipts that are simple and not feel like it's a burden to make foods the cohesives show something eased. >> i go for vera toilet so someone can't do it or its way out of their range we only use 6 ingredients i can

afford 6 ingredient what good is showing you them something they can't use but the sovereignties what are you going to do more me you're not successful. >> we made a vegetable stir-fry indicators he'd ginger and onion that is really affordable how to balance it was easy to make the food we present i loved it if i having had access to a kitchen i'd cook more. >> some of us have never had a kitchen not taught how to cookie wasn't taught how to cook. >> i have a great appreciation for programs that teach kids food and cooking it is one of

the healthiest positive things you can communicate to people that are very young. >> the more programs like the cooking project in general that can have a positive impact how our kids eat is really, really important i believe that everybody should venting to utilize the kitchen and meet other kids their age to identify they're not alone and their ways in which to pick yours up and move forward that. >> it is really important to me the opportunity exists and so i do everything in my power to keep it that. >> we'll have our new headquarters in the heart of the tenderloin at taylor and kushlg at the end of this summer 2014

we're really excited. >> a lot of the of the conditions in san francisco they have in the rest of the country so our goal to 257bd or expand out of the san francisco in los angeles and then after that who know. >> we'd never want to tell people want to do or eat only provide the skills and the tools in case that's something people are 2rrd in doing. >> you can't buy a box of psyche you have to put them in the right vein and direction with the right kids with a right place address time those kids don't have this you have to instill they can do it they're good enough now to finding out figure out and find the future for

>> i'm a firefighter here at station three 1 i grew up in texas and kind of boundaries around to bunch of different cities before i came to san francisco lived in new york and was going to school there i had never been here before the moment i knew san francisco i knew i was in the right police station like the place and was proposed to be. >> i was with change and cyclist transportation throughout the city and actually end up getting in a car accident not a big deal but i was in the back of ambulance he decided a

good idea to tell me about the job and how amazing i thought about that at home and i said you know what see this sounds something might be great aligns with me and my values i started to pursue to see what it was like i did and the moment that was pretty interesting how doors kind of opened i put at effort and get any emt licenses and interviewed to be in the refreshed what is of the in the academy engineering that and so on and so forth had that moment of like this is what i'm spoke up to be doing this is this is the it this is me. and it of the great and therefore, be it resolved that worked out and

after the lgbtqia+ this is my work with one was (unintelligible) (sirens) what i thought way back when that being a firefighter that was not something i thought i could do. and i think that a lot to do would not seeing my in the representation of what a normal firefighter will be so i really like to make an effort when i'm at work to have other girls little girdles and boys seeing me though orientation or race or any other orientation we want to be able to be that person and know they can do the job if they want to. >> as a mom i feel like a

different person actually. that pretty interesting to have a stark difference in from the person i became a mom in the fire serve and the person after the fire services being a mom is a learning exercise and the same going back to the fire service you're heart is a little bit more vulnerable i like being a mom the harder thing i've done and prior to being a mom this job or some of the things we do on the job are some of the harder things that kind of levels each other out so i okay. come to work and feel like i'm cable and can go home and

capable a whole >> good morning, everybody. want to thank you for joining us and coming to the san francisco chamber offices this at the yard a busy one the last 6 months with better together coalition. i want to thank everybody who has been here almost every month a couple times. that is the bay area council, downtown sf. the golden gate restaurant

association. hotel council. sf new deal, sf travel, purand the union square alliance. thank you and briefly this group come to make suggestions to get on the same page at the same table to understand our needs for san francisco. make recommendations to the mayor's office the mayor's office is listen to many requests. and that is part of where we are going today. thank you for coming and i want to turn it over to mayor breed. [applause]. >> all right. is it still morning? >> okay. i have been at a few things fwrit to be here with all you have. is this working. testing 1, 2. >> you guys don't have a microphone? >> first, thank you all so much for being here temperature is

has been a long road to recovery and i want to take us back a bit because san francisco needs to be reminded of who we are. and many of you were at this state of address where i talked about challenges we over come and consistent low whether it is after the gold rush. after the quake. after the various pandemics, upon often times people consistent low have tried to write a different narrative about san francisco. and when we are. now, like any major city, we know we have problems. we know we need to combat the issues around crime and public safety. and afford at. >> i'm optimistic about the future when we are see nothing san francisco is something like nothing else. we have the poltd to be when we want to be and to reminds us what we used to be. think about mission bay and had mission bay used to be.

mission bay was nothing but railroad tracks. golf shooting range and an e spree outlet now the newest, hottest neighborhood in san francisco. concerts occur and so many things helping. testifies flooded with people overnight weekend had the grateful dead did the second or third final concert. and the fact is people want to be here they are excite body san francisco and i'm sure you spent time out and about at events and activities and enjoying park and open space and neighborhoods and seeing a revitalization of our neighborhoods. with, let of new businesses. a let of places to eat. and excitement. the excitement in the air where do we go. thank you for the work on the chamber and comments about recommendation its is add vo

kaes. we need your support more than ever because often time what is is happening, policy are being made without an understanding of the impacts it is creating on businesses. i have been talking to companies all over the san francisco. i have been meeting with mall business owners trying to get at the heart what are their issues. and, let of their issues center around uncertainty about economic future and the ability to survive in san francisco. especially for our start ups and for our new businesses that are all over our neighborhoods and community. what do we need. of course, we need revitalize downtown and push upon the various strategies we plan, in fact, in my state of the city this february, i made it clear that our economic recovery, specific low relating it downtown needs to center around

a number of things which sarah phillips will highlight and talk about today. not just when i said we would do but when we have been doing. i'm excite body the progress we made around supporting businesses and removing barriers around taxes to create economic certainty and my hope working with this group we'll take real tax reform measures to the ballot next year. i'm excite body when we have done about first year free. almost 5,000 new small businesses have opened their doors all over san francisco because of first year free and the investments we make it to make it easier for people to do business in san francisco. and so we have we know a lot of work to do, i gotta just highlight a couple before i turn it over to sarah. many of us talked about the deficit. how are we going to provide incentives taxes and how are we

going to transform public safety and close a 780 million dollars budget deficit. guesses what? we d. did it with maintaining the promise, prosecute voiding tax incentives and investing in public safety like never before. we saw recently one of the largest police academy classes since before the pandemic. my hope is we will begin to see the numbers increase with our increase in pay, retention bonus and other incentives we saw less officers retire. and we are looking forward to continuing to do our recruitment in order to increase our law enforcement agency because the end of the day with ambassador and programs and having eyes and ears on streets; there is a need for police officers. to be out there but also to dot investigations and the work necessary to keep the people of san francisco safe. you hear about a lot of the incidents that occur. oftentimes what you don't hear

is the hard work this go in overing merchandise and making the arrests. and making sure this people understand they will not be able to get, way with the crimes that i have committed in our city. from a learning are perspective we upon this a lot of violent crimes and other things are done compared to other major cities in the country row. we have, let of work to do around burglars in the staechl my hope is working with increasing the police force. the cameras we will be implementing all over the city and some of the great work and tell help to transfwhorm we need to do around public safety. i'm looking forward to that. so when we are see nothing terms of of a change with this new hope and optimism and the great weather. we are seeing an increase in office attendance by 42%. we are looking forward to folks returning i think people are tired of work home in pajamace

they may not want to come back 5 days a week but they are fear of missing out. missing out on the great things helping in the city. we are no longer a financial district downtown. wore activating downtown with events and creating entertainment zones. where people are able to the have great events and not deal with show much bureaucracy with the city. supporting downtown mall businesses and react have aing our plaza, trance forming them and think burglar what is possible. and look, i get temperature people want something nouchl they want fast, instant and so tuck burglar for example, a soccer stadium in the future does not seem like within reach. electric at chase center. it was talked about years before it was built and now it is home to the initial champions the golden state warriors. they won before. don't worry we'll be back.

>> so -- not only that, concerts and other activities. we are seeing an increase in office demand. artificial intelligence is ticking flight in san francisco like no nothing else and it is in the happening anywhere in the world. in fact, of the top 20 companies of artificial intelligence the top 20, 13 in the bay your and 8 in know front. will and all of the investments are happening here in san francisco in the first quarter of this year over 15 billion dollars of investment of ai they are on the hunts for 800,000 square feet. open the doors and be willing to be creative on the other hand how we use space in downtown san francisco. speaking of using spaces, we made it easier for people to

convert. so office space may be the ceilings are low to do a building like this. but lap space and office space requests housing on the rise in downtown. so we have you know a 30% vaccance we office space but for the life sciences and biotech and the folks creating the now alternative medicines and foods and the other things, 3. upon 7% vacancy rate. we than if we make adjustments and we allow our new are buildings to be adapted there could be possibilities. and i'm looking forward to easier and sarah will talk about the changes we already made for conversion to housing and lap space. more importantly the victory changing the inclusionary numbers to get more housing built in san francisco. we expect 23.3 million visitor

in 2023 up 6.2% from 2022. i believe next year we will be back to prepandemic levels we have conventions and activities planned. including dream force a hit in san francisco. nothing will be like apeck the asian pacific economic collaborative this event is going to be a significant can event. and just to help you understand the magnitude of apeck. now -- about 40,000 people number san francisco that is the same for dream force butt difference is we have 21 heads of state. we are about 1200 ceo's who are committed. we have thousands of delegate and others from countries all over the world. and in fact, will this is the most significant international event san francisco has ever

seen no event of this magnitude ever exist instead city since 1945 when the united nations was established. that is the other global significant we had heads of state and international events but not of this magnitude with 21 heads of state what this means for san francisco is significant. when you been it and when that will do to drive the economy. when it will do to open the businesses especially frequently arab enthusiasm asia is a place where many visitors when you electric at the tourism numbers hotels this are from my understanding close to the 80% occupancy rate it was before the pandemic. think about if the doors were open from asia what that would mean for conventions and visit sxors all the things necessary to get san francisco on the road to recovery. our head of state our president as well as the president of china plan to do a meeting here

that will happen with many other great things and opportunity around growth and develop and want business. it is our opportunity to shine as a city. we will have over a thousand foreign press. our opportunity to present san francisco in a way had demonstrate when is we are capable of and get people excite body coming to san francisco. you have been hearing from visitors who said san francisco is in the what people are saying it is. let's be clear we have problems. they are like this is like other cities i have been to. than i have the same problem in some case worse i will not put a city down and use an example. the fact is like any major stele we have challenges but people are surprise when than i are coming to san francisco and they are having the great experience. so. i'm excite body had we are doing and what we will continue to do to improve san francisco for the

future. i want to touch a bit on transportation. and muni. we are seeing increasing in the number of people riding mount tow 33,000. bart up 25,000 daily riders. more people rely on public transportation it get to the downtown your temperature is why we brought back the one california and creating easy options for people to use public transportation to come downtown because i think people want reliable transportation. they want to make sure the bus are safe and clone and those are things we are working of the people have better experiences public transportation system with our plans to do a number of public safety initiatives. quick build where we are able to do bulb outs. more important low the red bus listens to move people from the

west side of the city and dun town your, quick and efficient so than i don't use their vehicles. i'm excited about that. i want to touch on the most pressing issues this seem to get, lot of attention in the city that is the open air drug deal and using. the fact again i go back to this is in the a problem unique to san francisco. there are other cities all over the country dealing with this. and i have been in touch with mayors to figure out way in which we can collaborateerate through the u.s. conference of mires i got cosponsors for resolution asking the biden administration to do more to help with us this problem temperature is in the a san francisco problem. it is a world problem. it involves a number of other countries and involves our verse federal, state and local law enforcement agencies. who have been working very heard to help us combat temperature i'm grateful to speaker pelosi

who has been really incredible in providing support with drug enforcement agency and support from the u.s. attorney's office and they have been working hand in hundred with the california highway patrol and san francisco police department. their efforts have been amation. and -- just to give you a few numbers this is the prepare. year to date. 502 arrests for drug possession of sales. that number has exceed left year's numbers in total. so year to date numbers now for arrests for possession and also for public into beingcasion increased. we are arresting pep for committing illegal actos street whether selling or using what have you, with a goal of getting

people in treatment of the but accountsability. because that is a big piece. puzzle missing. and when i appreciate about the department is all the w they have done to really get us to a place where the chp and seizing fentanyl and drugs and weapons with the w they do. specific low targeted to the south of market area and tenderloin community. made a world of difference. police are doing incredible work as well. we are grateful to the dea because a lot of their work leads to rests that involve the federal court system. of rather than the local court system it has been challenge to get accountability introduced in the foeldz that hen a game changer. we believe with that along with un plaza and investments we make to credit a skate park. a carnival starting thursday will be amazing. activating a luing fells to not

just come to a farmer's market but twice a week but do more every day in the your this is when will be a game changer for when we need to do to turn the plaza around and deal with the crisis this challenged our streets significantly. i can go on and talk about so many great things happening in the staechl i know sarah wants to talk about our progress on our recovery. so our progress really is this is what i said we would do this is when we have done and how much more we still have to do. and the reason why this was important to in to the san francisco chamber it talk about it especially with so many of you who represent the various agencies is we need more than a letter of support. for policy this is we try to push through. we need advocacy. we need it in a very aggressive way. because i do think that it is important that not only you as a

leader had understand when is going on but you as leaders you have a number of people you represent. and those people should be made away in how easy it is for them to sends an e mail or call the members of the board of supervisor when is we try to push things through. when we fought for the over time budget for the police department before the budget, we got support from community. and a number of community organizations rallied folks to get people to submit letter and advocate and that was notteen for it was to keep had we had at the very basic level and my goal to get us to a better place. of course. we need advocacy and support and people to write letters and send e mails and need them to show up to board meetings and make sure people understand the impacts of the decision this is we are

trying to push through and what not just means for downtown but for the city as a whole. if downtown does in the recover, all the programs that the board is approve andment to pay for, those programs don't happen. we have to cut, cut, cut. this year we balanced the budget next year tell be harder to balanceful cuts will hurt more. my hope we work to get city on the right path and make sure that the business community is at the foreupon front of helping us not only craft the decisions but get those decisions through. we will have to take a number of things to the bell on the and a number of things to the board of supervisors and my goal again is to work to help them understand the significance of this. i think than i are starting some get it more than others.

i think they are starting to get it buzz this was a struggle for them to make a decision around the budget this past year. my hope is we will move forward. and as i said to remind people of who we are -- as san franciscans, we took the embarcadero a freeway and took it down and jim is smiling he was a part of the effort to push for this. but, you know san francisco was built different low over the years. from being horse and carriage to cable cars special the cable car was invented in san francisco. and it went to the rail cars and then vehicles. the western edition was taken apart and split up with item an town and western edition to credit a freeway like geary boulevard. this was the financial district. now san francisco very well with all of the changes and the

things, is important to remember that when change happens, we did not say, san francisco is doomed or themmings are over t is in the coming become. retail is different now. people shop on line and shop different low. but luxury retailers are doing great in san francisco, in fact many of them are expanding. it is still different how retail changed in our city. as things e involve how do we come up with the creative idea to transform san francisco in a way to get people excited? i go become to this in terms of a soccer stadium in the heart of downtown. and will when that can mean not just soccer but concerts and events. how do we make downtown more then and there a financial district with housing and other space in the a place that is a guest town at night or the weekends. how do we revitalize it and get

more living here this is why i invited uc. not just ucsf butt uc system, berkeley and others educational institutions to think about how we repopulate the downtown with students and activity and excitement every day like any other neighborhood in san francisco. the place that looks at something going on now and creates a possibility of nothing something that can be done bfrment pier 70s was in the available to the public for over 150 years the power plant, those are neighborhoods wield never touched and electric at had they will become for san francisco. that's where i did nile state of the city to prove a pointful important to remember when we're not as others define us about but roll up or sleeves to get work done for this city. i'm excited work with the

chamber and the various organizations here to get it done. left but not least, i think, i think i said that i will say it again. i want to just talk a bit about apek and initiatives around community and the public and people all overnight world our message whatting san francisco is. one of the things that we are doing is we are getting the communities and people excited about how they can participate how tell be an economic engine by talking about san francisco as a city. the place this invented the television. the place this invented the cable car. place that inknow vented leave eyes den they meant actually enjoyed and everybody roadwayed perfect it. it start in the san francisco. i talk about this it does all start here it start in san francisco. when we talk about innovation and creativity.

clap on and chi a pet star in the san francisco everybody wants a smart home to turn on lights or whatever condition they inspect their homes or beds or whatever you call it. when i think about creativity and technology it starts here. it starts in san francisco. and we need to make sure that we are reminding the public and through efforts around campaigning and talking about and advertising and getting people to love san francisco, we have to start talking about it different low. w with advance sf they are work to create another campaign that out lasts the push but a campaign to get people excite body what san francisco has been and what san francisco will continue to be. because it is in the okay for others to say when we are it is time we make it clear who we are and looking forward to dog that and turning the narrative

around. thank you very much. [applause] >> hi. thank you. mayor breed. i am sarah phillips i met men of you in the all of you. i joined mayor breed 2 months ago as director of our office of economic and workforce development. the mayor went over the most exciting point this wills be lack luster but there we go. back one. i'm here to talk about the 6 month in that we have done on road map to san francisco's recovery. in february of 2020, covid hit. impacts extend beyond public healing leaving permanent changes on the way we work, shop and interact. recognizing that mayor broed and

the team here released a road map at the end of the covid emergency in february 2023. to deal with the changes. as the state of emergency ended. we that road map and we will talk on 5 priorities, right economically diverse job engine. the welcoming clean and safe environment and you heard that in mayor breed's priorities. a dynamic destination active all the time. the world class transportation experience and that's a fight we will work on with you and equal economy this everyone can participate in. and i will go over each one of our 9 strategies the reason i'm here today and the reason the mayor came to make this important in front of you is this we want upon to road map to make progress and move us forward. we have made progress. you are our partners in getting the word out about that progress. you are our partners in helping

to move the city forward on the next 6 months we need where we have more initiatives. and we needs to you help us on those upon front get the word out and move forward when you have is the 2 pager this will contain everything i will go over. we want to make sure that everyone of your organization his this. tell be on our website we give you more and i'm happy to talk about it where needed we want something easy to be shared with the public and whefrn cares about where we are going and when we are doing and the progress we had so far. everything i will cover is on that 2 page aril give you details so you feel comfortable with partners ask the out reach you do to your member organizations and continue to spread about had is happening already in san francisco. strategy 1. ensure downtown is clean, safe and inviting. there is a bunch improvements we made and the mayor touchod smchl

a big part we strengthens sfpd funded 200 police officers. expand recruitment and retention. result of this you see this on the left was the largest police academy in 3 years. we increased starting pay so we are the highest in the bay area and very competitive to joint police foefrms expand ambassador programs deployed retired police officers on foot beat and budgeted 50 million to support the programs of nonpolice safety professional in thes streets as we move forward and homelessness, obviously will continues to be a prior for the city and addressing and tell be a challenge but we are making headway on that challenge. sick00 new shelter beds funded. a thousands permanent mental health housing placements were

funded. we have all capacity to expand addiction programs to deal with the services that mayor breed mentioned. we want people in the right place so they are success and we have success on our streets. >> strategy attract and retain industries and employers, there are ways we do tht one thing that i of course read neil heard mow say and i will say it san francisco is open for business. everyone from our biggest businesses in technology to smaller coffee shops are part of our economic recovery and wore here to support themful progress we made extend tax relevel for the most impact friday covichld retail, restaurants and arts and entertainment. we passed part of the new budget and offer attraction benefit

grow in san francisco. and we launched this is exciting and the mayor mention woad need your support a tax reform press to make the business tax system more balanced and sane. this is important as our companies staying and growing here the mayor went over the staff that we are seeing they are encourage. office attendance is not where we typeset and where tell land, we see more growth than any city in the left year. year on year increase in office attendance exceed every other major city. we started further behind because of tech we are moving forward. strategy 3 facilitating new uses and flexibility in buildings. this is everything not just residential conversion its is art use the most creative office and work place issues. mayor lead legislation to

prevent city codes to ensure c3 has flexible zoning. for example we got an office sector in the mission we will figure how we make that so that companies can grow and locate there and we don't have things on the books that stop the progress we want to make in our neighborhoods. we established an adaptive reuse for under utilized office building and housing. we mentioned the code changes. permitting changes made there. what we are also trying to do is identify partners to if silltate individual conversions and with planning we got 6 response back of actual buildings and partners we can move forward on a conversion. and the player mentioned we are working to bring more public employees downtown. weather through school, city collegeor city itself. some of you may know the mayor

sent a letter to agencies the school districts, city administrator and city college an among ago asking to exam whifrn we need. we got the reports from the partner agencies now we are workingllow that analysis and working with the partners to see what opportunity can we take advantage to feel groat real estate need in places we want to see activity. all right. make it easy to start and grow a business. there is a bunch of anyone who ever tried to open a business in san francisco knows how byzantine our system was. we are making significant progress on this . first year free program a dramatic success. 4, 873 businesses have taken advantage of new business starting their first permits throughout city. and that means new businesses

like the don club you joined me and read no last week. that are open upon and thriving for business. we're matching aspiring entrepreneurs and vacant space downtown throughout program of glad simon is here we will launch the first cohort of that cest with sf new deal in assessment and got more cohorts to go. what you will see open nothing september is the first start of what we will be able to do through that vacant divide program. we are supporting our small businesses moving forward. we are providing grants, loan and train for example now and existing small businesses and i got an update we launched a program am 3 months ago. to store front opportunity grant program. so far awarded 1.1 million in training grants for small business who want to grow.

and got 20 businesses had reached out to seek funds to open a new stove front in a vacant space. we expect merchandise we have some language training going on for our entrepreneurs not english speakers. after that we will see more interests in the vacant store front funds. you will see new businesses opening as a result of it. >> last in terms of support, katie tang in office of mall business worked on great legislation facilitate a handled changes to ease the permitting of grounds floor commercial temperature is pending investigation and going to be for the planning commission in assessment. we want your support i'm happy to reach out to you to tell you who to sends letters to and we need to move them forward if we care about small business. >> all right. grow and prepare our workforce. and this is across all sectors.

what you see here i'm excited about i learned about workforce programs our out reach sxendzed in hospitality. and health care. and the small business sector and the construction sector. and a part that our access pointses we grown through neighborhood job centers and got 4 now continued to funds throughout mayor's budget what you see here are exciting events you will see more it. got pictures from the health care academy we held at chase center. you see a couple of women if women's construction at mission rock near to my heart we had 33 women that would -- started career in construction and build this. we have our partners at mission bit here the last who provide tech and coding trin to high school and college students to get them in the company this is are grow nothing san francisco.

we got our emt frank program the per inship with the dream and keeper's program. we do more work for programs with deem keeper initiative we are serving african-americans within san francisco and removing barriers. and china town culinary program. most of the people were in the native english peeshgs we're work to grow and tap in resources we have through the inter~ national pop commission prosecute void that benefit we have through small businesses so residents tap in this great toed they provide and park stewards and a picture with mayor breechld points about that, in the first 6 months of 23 we enrecommended 2600 inference france in workforce services. and over 2,000 of those came

from our neighborhood job centers. those are actual people who are receiving jobs in the first 6 months of thissier in san francisco. strategy 6. transform downtown to leading art and night life destination. we have work to do. this is an never the road map perform as it is you see successes. we have started so many act visions and events dun town and throughout the city. images are night market we will have an event upon in september. we saw 10 thousand at the 2 events already. those people spent 90 dollars on average what they came out to the festival. we got union square in bloom. got the undiscovered sf block parties this happened last weekend. the watch parties were a great

success. we drew crowds of over 4,000 to the village events with 3 venders when all sold out of their food and beverages. . i discovered the partnership with fill pino that brought in 6,000 per event. strategy 7. enhance public spaces. well is a let going on one will open on thursday our downtown civic center carbon nal on thursday evening. and that will just be a lunch of a series of imimprovements including the new skate park that will recapture our spaces for san franciscans. our shared space program permanent this year we are excited and will w with businesses through the pain points to make sure they are allowed use paces to support their businesses. landing lead store will open in

september that is another downtown public space that will recapturesllow robbie's work in the partnership we are excited about this. and funding efforts to reini havingerate powell street. and the workshop for the street improvement system tonights. see maisa if you want to go and can go. strategy8:invest in transportation. funds for example transportation hen a challenge through the pandemic and will continue to. we are excite the fudging secured for public transportation. to prevent service cuts now and we are irrelevant thankful to senator wiener for his supportful we are working on his legislation for additional funding. so this we can not see further cuts. but tell be a xhfrj is need your passport on that because when makes downtown work is transit system this is at risk we will need to fight for funds to move

this forward through pain points. while we are going throughout pain points of fungdz, we lunched programs to increase downtown accessibility. we launched the one california pilot. increased morning rush hour service we saw growth. we developed with golden gate transit to add for other downtown bound trip fist mirna and hallow get people in office. we launched the california line cable car day pass that sold close to 10,000 more cable car tickets on the california line than the normal operations. the result is we see muni boardings increase and bart ride areship increase. won'tment them to increase more and make sure we support that service so we don't see a decrease again. the last strategy had is big one and so many of you in the room

are contribute to efforts on this. they are critical. tell our story. right. our city as the mayor emphasized is not what the initial mead yald like to you believe. the anal gee i use we other yankees in a slump and everybody is excited point we need show the ways we are having success. we were success for a long time people want to see us fail. the always san francisco visit are campaign sf travel is leading. heart of sf social media campaign the w this we are doing on a peck am lunch in september and will be strong and show case san francisco internationally. and some private sector efforts happening through local resident who is start social media campaigns the good things help nothing san francisco. we need to contribute i'm

thankful for the media supportive the left couple months we have seen progress. we need help tell had story the 2 pager we hand out is part of that. reenforce when it come will be a part of that. apeck is part of that. we need to expand our audience beyond this recommend so people with recognize that. that was a let. i wanted make sure you guys have the point when is you go out to your members you help trumpet this w we're 6 mont in. we got more work to do in the next 6 months we are excited work with you. there is, let. we need n. the mayor hen out to a number of businesses already this summer >> we want to talk to as many companies we can. both those here and those who want to be here to increase investment in san francisco. we will continue to do this road show through the fall. we have our inclusionary housing amendments will simulate

construction and wing on affordable house know bond so some of the construction is toward our supportive and affordable how doing the mayor prioritizes as well. and the change the mayor mentioned to residentialize our tax system. they are big efforts we need to work on fall over the next 6 months. so stay tune exclude work with xus we are excited about the next 6 months. thank you. [applause]. next. mayor breechld thank you this is exciting and we start it put it together in this 9 strategies. you see all of the work that is being done here the business group representatives companies and employees and employers and we get assignment to advocate it share this word and ghet out to companies and have them advocate for the tunes in san francisco. there are a couple minutes near

questions for the mayor or director phillips. [laughter] no questions. yes. great. [inaudible] the letter this mayor breed sent to [cannot hear question] >> just to be clear, well is interests from the uc system. we are not in a position to talk specific low about it. but we have been in touch with the uc administrator as well as conversations uc berkeley with the chancellor. we can't say, i know well is interests in housing.

there are interests in lab space and for the most part, the conversations happening there. i think this you know the other conversation we are having with city college they have a camp that yous underutilize that is within the fourth and mission area. so we are definitely having conversations about the entire area. how we collaborate and work together and when we have something more tangible we will share it with the public. [cannot hear question]. there are active conversation and right now we ever working with the architect to develop preliminary design work on what potential low is possible. and i'm excite body you know when wore able to share that

with the public we will. i'm excited about what that will do. we want to give people an understanding when could happen and get the developer and others excited about making investments into this stadium as a way to diversify what happens in the downtown your we are talking about bart, muni,or transportation system there. cable cars there and the potential for a place that could not only host sock are matches including potential low matches with fifa. but concerts and other activity this is will come peat with the shore line and other venues because in chase center we have 18,000 seats this could serve 25 or more. we hope to share this information with the public soon. and get the bull rolling.

there have been other interests in the west field mall. interests in the hotels a couple months back. my hope we will see good news come. i want to mention i k ea is opening tomorrow. and the store looks amazing and that they had a friends and family weekend than i said it was pack exclude lines out the door. so when they open tomorrow i think this will be another exciting opportunity for mid market area in san francisco >> my shope we start stealing a vision for transforming downtown in a different way. >> mayor breed, you talked about municipal competence bart experience to downtown's recovery can you comment on the pause on senator wiener's bridge toll the funds municipal and he bart how important was that it getting mount competence bart recover in the a place to support downtown in how worried you are about this measure going

forward? >> i think that transportation and the xejs of transportation has gone up considerablely. and we are at a place where we have to start thinking about how do we fund this not just now and maintain a level of service and opened a new cents ral subway increasing capacity making sure we have the infrastructure necessary it move people under the housing element. we have another 82,000 units we need to build. and so how do we get them to use things other then and there their vehicle. transportation resources are significant because materials and supplies and labor are expensive. and so as we continue to delay the option to get important resources like that. it puts us at a disvaj

advantage. the last budget we had a life safer that will not increase increases to public transportation infrastructure. >> >> somewhere exciteded somewhere skeptical using it as an opportunity to go back. [inaudible] what do you feel like make it success and will more companies. joy will take credit for getting i k ea to come here it is trough they were here jerry brown had the event this summit around the environment and they were in town and they were looking around and we i immediately had a meeting and said san francisco is where you want to be. over the months we had conversations about the kinds of store. you know they furniture warehouses they wanted lunch a new option and especially sudden front in our history and record around sustainability and the environment is why they felt this was the place for them to do it.

and people will talk about this narrative. it is unfortunate often times the same people talking about that and writing stories in the paper. are in the people who live here. and who are experiencing san francisco. than i are taking the vos from i mobile home or the worse case of that is help nothing san francisco and running with that. rather than speaking from a place of experience. directly. that is unfortunate. and it is why our local press is important because our local press can't be the 1s to need this narrative i'm not suggesting you don't be honest and report the new and do what is necessary to talk about this. but who in the press talked about this crowd event of beer, pizza come bagel in norths beach which you could not get in it was sold out. it was packed. super excite pregnant. had businesses all over san francisco an amazing event long with so many other things that

happened the past weekend. we need to start talking about what is happening in san francisco. and our various experiences. i was on fillmore this weekend and upper fillmore i could not believe how much people were out and about shopping in the various stores ice cream, eat nothing restaurantses. it was i'm familiar with fillmore i have in the stein this pack in the i really long time. so there are a lot of great things happening all over san francisco. and it is important that along with reporting the news that we report what is actually happening. we report you know like soon as a store closes like all of the sudden like no conversation around the challenges of retail, whether or not anybody is stepped not in nordstroms i don't know how long they talk about the closure. we are not talking about channel

who are expanding stores in the downtown area. expanding their fop or neiman marcus better then and there they have done in a long time in the luxury brand retailers. and now i k ea. all the things dwoel and work with people who are living in the tenderloin and struggling with poverty. i k ea will be a perfect fit for a lot of different people and their goal is not to -- not include the surroundings community they want to be a part of the community. they want to work with the community they have been working with number of community based organizations trying to figure out ways they can be a partner and give become and hiring from the community. i think between the ambassadors, staff and other things they are dying think tell be a huge success are we going to work

hard for mid market? yes. we have property owners and that area and including the folk who is the family who owned the flood building who are committed to making changes and investment in the area. and i am optimistic about what tell deliver. i say instead of guessing when it might do let's wait and see. >> mayor, what do you think about the [inaudible] i think the cost building in san francisco is expense you have now since 2018 we passed by voters another 14 tax, i believe like every time you look a tax for this and de feo for that. a this and when you look at the cost. developers will make money the business communities. people in business to make money they are not going to shy away from their expense of what think

they will walk away with. upon where does this money get taxod? to the various units and all of the other things that come with this including all the city's expenses fee and requirements and everything you can think of. this is not help us get housing built. this is the first most environmental sustainable buildings we build in san francisco that provide office and business but also housing. it is like the perfect use for mixed and green infrastructure stuff this they are doing with the building. it is a ream loss to the city they had to pause and will not beably to move forward. because of of the expense related at this time development of the project. so i thank you when we have done with the inclusionary housing fees will be of help to this project. but we gotta do so much more. we have companies saying, it it is not worth it for you to come

become in the office because it is cheaper for us to not have employees in the office. based on the city's tax structure and when we charge people. we cannot continue to add-on the expenses just because president companies, they can probably ford to pay it but than i don't have to pay it they can choose to go other places. what does this money? we lose the taxes and the benefit of the people of san francisco having job opportunity. in our city, we lose so much when we pile on tax, tax, tax, fee, fiching you can pay it because you are rich. you know what, i wish they would but reality is that will not happen. we have to make adjustments and my hope is that the changes will get this project on the right path the developer said we are committed and want to finish this project. financial low now it is in the possible. i want to make a correction to mystery things i said earlier i don't think i put them in the

right context about the narcotics arrests. year to date 2023502 rests. left year the entire total of narcotics arrests were 273. so this gives you perspective. the fence not seized left year total 71.6 pounds this year 197 pounds. of fent until this is 44.6 dose. these are just sfpd numbers not highway patrol. these are not the department of the drug enforcement numbers. these are just san francisco police officer numbers. and the ability to do that has a lot to do with the changes we made in investments in the department of i wanted correct the referred on this and nut in perspective. >> mayor, over 14 from

[inaudible]. let's not talk about me talk about anybody who the mir. >> yes. >> anyone who is mayor. and has more [inaudible]. easier to help know front recover. if than i inform place. i have not read the report i can't speak to had it said. but the end of the day mayors and members of the board of supervisors come and go. butt impact of the decisions this are made can live with us for decades. and it is important for my perspective no matter had the mayor is an executive is able to do the job of being mayor and

decisive, make decisions and move as aggress testify solve the problems of the city based on what people expect. i can use the -- covid response as a perfect example when i had the ability to make decisions we were able to move fast am we use experts. we had like a whole set up and we saved lives. did unpopular things the business community was not happy. but, but came long and made hard decisions and san francisco got praise for saving lives because of this global pandemic. the ability of the executive office to dot job of being mayor without dealing with layers of bureaucracy of a bunch people and people who are not elect exclude held accountable to

voters. so, the police department is i will use the police appointment process as an example to explain where this does not work. so -- years ago. supervisor supervisor peskin before he was on the board again. . took to voters a ballot measure from the mayor a poisoning members of commission to now the board gets reappointments and the mayor gets 4 but all of them go through the board of supervisors for approval. and i will not talk about the number of quality candidates i cannot through the board rejected. but who is being held, countable for public safety? the mayor. people like why don't you do this or that. and i'm held accountable the people who have the ability to send a recommendation of a chief to me are the commission. i can't say i want to hire this

person or want this person to be my chief. they are appointed if the mayor will be held, countable for public safety the mayor should hire and fighter police chief if the mir accountable for transportation, and when happens with infrastructure the mayor should have ain't to hire and fighter director. i'm not implying but the fact that so many of the department heads naw for the city are not directly accountable to me in a way that delivers for the people is when the problem is. with the current system. buzz there are too many cooks in the kitchen. 2 many. everybody is the head chef and this is per of the problem. >> to be clear about this in the process and. i think this the police commission is needed. there needs to be the thing

around developary action and public inpump officer involved shootings reforms we do when it come to the leadership of the department or any department in san francisco, any mir in this position this way than i are successful investigate ability to held accountable for the department heads they hire that is how you move to a better direction. companies are wondering why won't can't run san francisco like a business we can't because of bureaucracy. public input is important. advocacy is important. commissions are important. but they have got so complex this even you know the ability to be as effective as you want and move things faster has been impacted in my hope we'll get on a better place. >> you had you are with the press is this >> no. bay area counsel i k ea

organizing tomorrow sdpt ninth circuit. >> thank you. about this injunction that prevents i stele from referring people unsheltered pep to shelters and the key part of your strategy one i wonder if you had comments about the case. words of warning. >> well, i do and i will be at the rolly tomorrow to advocate for the of -- we have a court decision made about the tenderloin that says have you to clear all encampments and clone the streets the other hundred we have case that say us can't move people unless you have a place for everybody. this hen challenging because the way the city workseen if we have something for everyone, we still can't force people in to shelter or housing or what have you. since have been mir since 2018,

we added you know another 5 ,000 place ams on top of the 10,000 we already had to help people of am why we saw a reduction in unsheltered homelessness at 15% left year a reduction because we have been building up our capacity. but we can't upon just have a place for everybody nor can we force everybody if we did in a place. i think the biggest challenge is we need the ain't to at least clear sidewalks and try to get people this treatment. we never clear unless wore offering an althoughive and -- you know the the case just to use an example of a bit of the, bus is you know the person who is at the pot row barn on castro come market who refuses to move we got in shelter and decided to leave. and you know when we were trying to move the encampment and clean

the let mow call my lawyer before i do anything. right. and my problem with this is i get people suffer from mental ill expense, diction and than i are complicated but if we have a place for people to move we should not be forced allow people to be on the sidewalks and street. we could not let the beer, pizza bagel festival use the walks a way during their festival but we can let people live on our sidewalk? and that's okay? this is a problem. you know, so our plan is to try to get them to reverse their decision. and wore proached take this to the supreme court. we are not backing down. david chu and his team doing a great job and we have to be able to clear and clone up the streets. and it is in the okay what is happening now. is making difficult for us to remove encampments i want to

remember under the fricome in certain yours and the freeway entrance and exits we have been able to clone and clear them out and get people in treatment and shelters we built. so we are not saying move. we are saying come with us and let us get you on the right path. and this is continuing to be a struggle. but if you can yoin us there tomorrow at 9 a.m. i think it is 7th and mission? yes. join us there we are rallying and get people fired up because you know we are not criminalizing homeless. but we are saying this is in the going to continue to help in the same way. we have been a compassionate city and tolerated a lot for too long at the expense of able to develop the resources necessary to help the people we are trying to help. >> all right. >> appreciate it. >> [applause] thank the mayor

come director phillips for coming out and we will see you soon. thank you. clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear clear television. >> in 1948 swensen's ice cream

used to make ice cream in the navy and decided to open up an ice cream shop it it takes time for the parent to put money down and diane one of the managers at zen citizen in arena hills open and serve old-fashioned ice cream. >> over 20 years. >> yeah. >> had my own business i was a firefighter and came in- in 1969 her dad had ice cream and left here still the owner but shortly after um, in here became the inc. maker the manager and lead and branded the store from day to day and in the late 90s-

was obvious choice he sold it to him and he called us up one night and said i'm going to sell the ice cream store what you you talking about diane came and looked at the store and something we want to do and had a history of her dad here and growing up here at the ice cream store we decided to take that business on. >> and have it in the family i didn't want to sell it. >> to keep it here in san francisco. >> and (unintelligible). >> share worked there and worked with all the people and a lot of customers come in. >> a round hill in the adjoining areas loved neither

ice cream shop in this area and support russia hills and have clean up day and give them free ice cream because that is those are the people that keep us the opportunity to stick around here four so many years next generations have been coming her 20 er thirty or 40 years and we have the ingredients something it sold and, you know, her dad said to treat the customers right and people will keep on coming back and 75 or 74 years, you know, that is quite an accomplishment i think of it as our first 75 years and like to see that, you know, going into the future um, that ice cream

shop will be around used to be 4 hundred in the united states and all gone equipment for that one that is the first and last we're proud of that we're still standing and people people are you tell people it's been around in 50 years and don't plan on

francisco. >> my name is fwlend hope i would say on at large-scale what all passionate about is peace in the world. >> it never outdoor 0 me that note everyone will think that is

a good i know to be a paefrt. >> one man said i'll upsetting the order of universe i want to do since a good idea not the order of universe but his offered of the universe but the ministry sgan in the room chairing sha harry and grew to be 5 we wanted to preach and teach and act god's love 40 years later i retired having been in the tenderloin most of that 7, 8, 9 some have god drew us into the someplace we became the network ministries for homeless women escaping prostitution if the months

period before i performed memorial services store produced women that were murdered on the streets of san francisco so i went back to the board and said we say to do something the number one be a safe place for them to live while he worked on changing 4 months later we were given the building in january of 1998 we opened it as a safe house for women escaping prostitution i've seen those counselors women find their strength and their beauty and their wisdom and come to be able to affirmative as the daughters of god and they accepted me and made me, be a part of the their lives. >> special things to the women that offered me a chance safe house will forever be a part of

the who i've become and you made that possible life didn't get any better than that. >> who've would know this look of this girl grown up in atlanta will be working with produced women in san francisco part of the system that has abused and expedited and obtain identified and degraded women for century around the world and still do at the embody the spirits of women that just know they deserve respect and intend to get it. >> i don't want to just so women younger women become a part of the the current system we need to change the system we don't need to go up the ladder we need to change the corporations we need more women like that and they're out there.

>> we get have to get to help them. >> >> (indiscernible) i just know it. excuse me boys, but does anybody have sun block to block this skin from the sun? >> yes. that's right, i need to get my (indiscernible) >> many of us last summer

(indiscernible) reapplying sun screen is like getting the second dose of mpox vaccine. >> wait, two doses- (indiscernible) >> isn't it too late to get my second dose? >> girl, it is like sun screen, never too late to put more sun screen on. >> that's right, i need to get my second dose of mpox vaccine before the summer starts. >> let's (indiscernible) 21201 to find the closest location to get the vaccine or go to sf.gov/mpox. >> thank you for the information (indiscernible) >> excuse me boys, do you mind checking please? >> sure. >> that doesn't look like a sun burn, you might want to getd it checked out. >> what do you mean clecked out?

>> checked out. i was told if i got my second m pox vaccine i would have less severe symptoms. (indiscernible) >> maybe i schedule the second dose just to be safe from mpox. >> most vackeens offer you a level of protections, just like sun block. sometimes you need to reapply for more protection. the m pox vaccine is based on two shots several weeks apart to provide the strongest level of protection. visit sf.gov/mpox to get yours. >> thank you boys for that reminder! make sure your are fully vaccinated for m pox this summer. text summer vibes to 21201, to get >> i'm alice king this is my husband shawn kim and we other ordinance of joe's ice cream in san francisco. joe's ice cream in rich

mondistrict since 1959 and we are proud to be registered a san francisco legacy business since 2017. and we offer more than 50 flavors of homemade ice cream. and delicious home style burgers, sandwiches, hot dog, salad and more. we have a lot of different ice cream flavors both classic, long forgotten but classic and asian flavor inspired flavor like 3 red bean and black and now we also brought the korean i'm from korea. korean coffee krooem. we mix our traditional and trendy flavors all together. shawn and i are the first generation of the immigrants here in san francisco. so as immigrants, we have a

special connection to this diverse community, san francisco richmond district. so we made this place our home. that is where we are trying to build our business as a place where everybody can feel welcome like we felt when we first came here what really makes fisher or joe's ice cream we have been growing together with our community. so we support our local schools throughout the fundraiser. we provide job opportunity for high school, i hire them every year. built a beautiful parklet outside funded by donations from over 200 neighbors and friends and i think this really shows how joe's ice cream and our community like lives together. so -- you see our mission is to

serve as a fun community hub in san francisco and richmond district. so, i hope that we can stay this way for many years. >> >> shared spaces have transformed san francisco's

streets and sidewalks. local business communities are more resilient and our neighborhood centers are more vibrant and lively. fire blocks and parking lanes can be for seating and merchandising and other community activities. we're counting on operators of shared spaces to ensure their sites are safe and accessible for all. when pair mets, firefighters and other first responders arrive at a scene, they need clear visual access to see the building entrances, exits and storefront windows from the street. that means parklets should be transfer in the areas above inches above the sidewalk level. it's best if these areas are totally unobstructed by transparent materials may be okay. you can check with fire department staff to make sure your site meets visibility requirements. emergency response crews and their equipment need to be move easily between streets, sidewalks and

buildings, especially when they are using medical gurneys, ladders and other fire fighting tools. that means that parklet structures need a three foot wide emergency feet every 20 feet and 3 feet from marked parking spaces and emergency access gaps need to be open to the sky, without obstructions, like canopies, roofs, or cables and should always be clear of tables, chairs, planters and other furnishings. emergency responders need to use ladders to reach windows and roofs to buildings and the ladders need unobstructed overhead clearance and room to be placed at a 72-degree angle against the building. clearances needed around the ladders to move equipment and people safely up and down. so not all parklets can have roofs ask canopies depending on the width of the sidewalk in your area. please make sure that your electric cables are hung so they are out

of the way and (indiscernible) to the structure, they can be pulled down by firefighters. cable connections need to be powered from an outdoor reciprocal in the building facade because hard wire connections are much more difficult to disconnect quickly. these updates to the shared spaces program will ensure safety and accessibility for everyone, so we can all enjoy these public spaces. more information is available at sf dot gov slash shared spaces. >> when o'shaughnessy dam opened

1923, there was a grand celebration that was an achievement of ensuring san francisco's new water supply but it was the beginning of a unique collaboration between the city of san francisco and yosemite national park. >> lands around the dam are critically important. we, along with the park service have a very common goal thereof protection of that watershed, both for national park values and water supply values in yosemite is the cub tree's premiere national park visited by millions of visitors but the protection of our watershed and the city provides significant outside funding for the national park, over $8 million a year is for trail maintenance and wilderness education and park operations and security keeping the water safe and the park a haven. >> one hundred years ago when the dam was first built, there was a different view of the

environment back then, than there is today. and the dam was part of changing that view across the nation. that brings an importance to our work here at o'shaughnessy dam, how we manage this dam and manage our releases and the environment downstream, it's very important to san francisco that we need that challenge. >> for 100 years, o'shaughnessy dam and the park service ensured the bay area has clean water, along with ongoing stewardship much our precious natural resources. >> here we are responsible to oversee the drinking water distribution system. in san francisco changes in the fire code required anyone doing

representtro fit to the home to get a new fire service this caused the need for new water services to spike. we used to do 200 a year. now we are up to 600. >> if you are building a new house you need fire protection. you have to make application to the water department for that. if you go through the process we come out and install the new line and the new fire line. >> the project got kicked off by two of our a gms, steve and eric. they recognized the need for improving this process. they pulled together the project and selected the team members and asked me to lead the effort. >> on c cd there is permit and no parking signs and installing the service, having water caught at the check off and pave. >> it is a lengthy application

process with manual tracking. for construction because we communicate with ccd we have to stay in touch with ccd to inform the customer for updates. >> at one time there was three separate visits to activate the fire service. water quality and gate manment and then gate man would go back. now the gate man goes one-time, one visit and it is done. >> we dissected the process and looked for ways to streamline the process and use technology to make the experience smoother and what we are building is an online portal for customers to apply without coming downtown and they can get updates. >> with the online application everything is there. it is built in condition logic with tracking to communicate with the customer without having

to take notes. >> we want to tell you these are 10 steps and you are on step three or four. >> we streamlined the process. we knocked it down to 65 days. the goal is half of that. from the time you make application to put the check on the table to the time we pave the street, we want it down to 30-days. >> i am proud of the team for the work to get together to understand each other's work and come up with solutions. i really wanted the rest of the team to understand the time and deliberation and thought so they could get the recognition that they deserve.

>> president ajami. >> here. >> vice president maxwell. >> here. >> commissioner paulson and rivera are excused. commissioner stacy. >> here. >> thank you. members mimake up to 2 minutes of remote comment dialing 415-655-0001, access code: 2592 058 3232 ##. then star 3. you will hear i chime had you have 30 seconds remaining. you must limit to the topic of the gone item discussed. unless you are