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each speaker is allowed three minutes to comment unless the president deems new time limits. concerning the item presented. a caller may ask questions of the policy body. the health service board weremote public comment for each item. remote public comment for those with accommodation due to disability will towards the 30 minutes. you can dial by calling 15-655-0001,

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comment. any comments to future agenda items or general public comment. >> good afternoon commissioners. director yant. dennis krueger, active and retired firefighters and spouses. i'm here today as a 50 year member of the service system and a 35 year service commission meet shz. as i look around this room, i only see commissioner zvans have the institutional knowledge of this commission history. so, to have watched one of the most respected boards lose all its fe and credibility was a very sad day for me. to see the optuse treatment ofthe appointed members of this extremely disappointing. when the attendees became emotional because of the restricted comment time they were allowed, you called the iffs. the history of blue shield is

one of bate and switch. how is it possible to offer the same coverage as united healthcare, but 20 million less? i tell you-- deny treatment, deny medication or both. it is history is any indication which we , g will be back here to ask for adjustments on they have done it before, they will do it again.s placed in the city budget before it was eveby this board and then to watch the appointed commissioners twist themselves into pretzels to get the results the mayor wanted, ing the removal by the mayor of one of the compassionate, knowledgeable, and respected commissioners who did ght thing. this very disinheartening. you you do

not meet demands of this m. this board has shown it lf is to be nothing more then a political arm of the city. rather then the independent commission it was created to b3e. when blue shield returns here asking for more, i hope you r what was said today and that the membership from you. thank you. nder this is general public comment. we have a item specifically for the blue shield plan. fred sanche protect our benefits. i'll just say, to say. i where don't want to stay up here and just say the same thing, but the feelings are echoed by not only protect our benefits, our coalition with recc, cara, l the different senior advocacy groups, they all feel the same. the disruptions y

happening. a member will call intoday on he got a letter that as of august 15, it rk will no longer be available to him.v i'll complement the staff and the chief operating officer. r him, but said he would look into it, so the staff istheir jobs and i'm still complementary of the staff here. thank you. >> >> i'm not sure if we are talking in- >> talk in the microphone. >> if we are talking about united healthcare and switch to blue shield. >> this is general public co do have a specific agenda item- >> yes. >> so, the earlicomments were just- >> the earlier comments were a general public comment that had those in them. if you had a or blue

shield the opportunity is on item 12. kg >> okay, i'll be back. thank you. >> hi. because i don't know if till that agenda to speak to the switch. i sfu surks d teacher and are taught in the district 29 years and served the district and worked in the hardest schools where you now cant get teachers, and when i retired got united healthcare and the healthcare was eligible for improved dramatically and my copays went was able to see doctors i wasn't able ford to see when i was working and had blue shield and upset and disappointed and outraged at the prois moving this contract over to blue shield. thank you. >> thank you. no one else approached to the move to the remote public comment and the moderator will

notify of callers in the queue at this time. >> board secretary, we have 9 callers zero callers entered the public comment queue at this time. hearing no further callers, public comment is now closed. >> thank you. agenda item 4, please. >> item 4, approval with possible modification of the minutes of this is action item and will be presented by those minutes include the june meeting, the june regular board meeting. >> colleagues we have three sets of meetings ggand i welcome any cofeedback or corrections you may have noted. >> move approval of the three minutes june 7, june 13 and june 18 meetings. properly moved and seconded and we'll take public comment these items. [providing instructions for

public comment] no one approached the podium and move to remote public comment and the moderator will notify of callers in the queue at this time. >> board secretary, we have 8 callers on the zero callers entered the queue at this time. public comment is now closed. >> alright.vote, please. [roll call] >> i am going to pass since i was not attending but they abstain. these minutes are passed. thank you. so, next agenda item.

>> item 5, election of this is action item and will be presented by president hao. >> well, we have come to that time of the year where we will set up new standing committees this board, so i would like to nominate the this board for the following committees. for like to nominate vice presid chair of the committee, and she will be joined by commissioner wilson as well as me and for the finance budget committee i like to nominate commissioner sass and joined by commissioner cremen and howard.> so moved. second.

ved and seconded. we'll take public comment on [providing instructions for public comment] and move to remote public comment and the moderator will notify of the queue. >>ar on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no caller, public comment is now close roll call vote, please. >> thank you. and thank you for your sevice upcoming committees. we'll take the next item, please. >> item 6, president's report. this is ussion item and

presented by president hao. to the new fiscal year and new cycle of our board meeting. we will soon find thinking about for plan year 2026. we just closed out a where there were some changes to our plans that has caused some concern, but pe to be able to work through those with the staff and to alleviate any concerns you may going forward. but we look forward to serving bers and to being thoughtful what that will look like in the upcoming year. and happy to take public comment. [providing instructions for public comment] we'll begin with in person public comment. no one ap to remote public comment and our moderator will notify of

any callers at this time. >> board secretary, we have 9 callers the phone line, zero callers entered the queue. >> thank you modera hearing no callers, public comment is now closed. >> thank you. and agenda item 7, please. >> item 7, director's report. this is discussion item and will be presented by sfhss executive director abby yant. >> thank you. i just wanted to acknowledge as we all know the full approval at the board of supervisors and passed on the second reading, so we are proceeding with our implementation plan which gets a snapshot later on the agenda. note of equity inclusion update luteesha harris provides r us noting august is transjnder history month. honey mahogany is appointed as the new director of transgenter initiative and welcome her on board to continue the

great work that office lbqghas begun. the last report lease agreement. we did move off the first floor, the wellbeing center, and we relocated eap and wellbeing to the second floor of the 1145 building we occupy and so that's pretty much done. there is still like all good construction projects has a solid 5 percentto get completed, but we have a great relationship with trinity and everybody is proceeding as planned. the healthcare affordability board and advidesy committee ijat the state level continues to grapple with the issues we grapple with on the local basis the cost of healthcare, im the primary care subs and behavioral health and the work is monumental, so i just would like you to know closely. it will have impact over time with the work we dohere locally. i do want to welcome on board joined

the finance team. thank d welcome. >> welcome. >> we continue to enjoy a great relationship with our homan resources department personnel officer efficient and helps us fill really pleased to continue to rate low. we have some turn-over. the majority is people findinwithin the city, stow it is a good thinfor them and then it does require a replacement staff. much of the other report, i would call your to the operations dashboard really--the tool itself really developed and i ves you a good snapshot in time ions has really stabilized and improved their services and continues to do so as we ready for open enrollment that will be quite busy with the plan change for the retiree medicare product.

big part that, so we got a method for monitoring and tracking the acti we'll talk more about how our call shield call center in very quickly rit now. we are actually in a soft launch now quitely testing all of the systems. carrie provided us with the activities on the areness month. that has really grown over the years.howard and i just spoke earlier the great mental health services that eap particularly for the public safety department is really taken hold, services are available, our members are using them, the difficult, but it continues and we get our enjoy the mental health services provided by our health plans. i think that's all i have can take estions. >> we do have a ac sy working very

well for us, loud. it is coming through out to the public via webex and sfgovtv it that, but i'm guessing the crowd might need us to speak a little closer while the air is on. thank you. >> we can't hear each other. >> okay, yeah. >> we like a efficient ac system so thank you. but, executive director yant, i want to commend you and the staff for improvement in all er year. i recognize data doesn't always tell the story of possibly the complexity of the calls and other things and so, but i do want to appreciate the improvement and services to the members. >> absolutely. >> any other questions or comments about the director's report for director yant? >> [indiscernible] >> alright.

thank you. public comment] we'll begin with in person public comment and no one apprr remote public comment and our moderator will notify of any callers in this time. board secretary, we have 8 callers on the phone line, zero callers entered public comment queue at this time. >> thank you moderator. £ no callers, public comment is now closed. >> thank you. next agenda item pleaseism sfhss financial report as of may 31, 2024. this is discussion item and presented by iftikhar hussain, sfhss chief

let's make sure your mic >> can you hear me okay? too loud, sorry. >> alright. good afternoon. the cfo for hss. happy to report the trust balance in the 11 month of the year look good. we did see an uptake in claims, which is seasonal and consistent, but what we saw last year. in the detailed r this month, we added last year's data for comparison and you can year activity was with last years. in a good place. we think about the end of is drop of $5.3 million, which is healthy becaus we d built into the rates a $14.9 million stabilization which would have dropped the balance. the pharmacy [indiscernible] intergone up, 5.2, the highest we had, because of ra the sustainability fund net increase because we got reimbursed for

activities or expenses we had last year, so the reimbursement came in this year and increased. we do expecthe general fund to be ahead of plan and we had committed to the controller that we would come in ahead of plan mid-yethis year, so we will exceed those targets. the primary variance remains due to vacancies we filled. and then the audit activities we have mgo looking at the st balance and we are in the year-end close process and they will do the w and we'll present their results in november at the november meeting. happy to answer any questions on the financial's. >> thank you so much . i have a quick question. when you say th seasonal, is there a particular reason for that or just saying trend we experienced? >> that is the trend we experienced. i think the claims come in 45 days-paid 45 days late, so i think this is realy coming through. >> okay. thank you for the clarification.

pardon me? >> thank you for the clarification. >> any other questions or comments by board members? alright. thank you for your very thorough report. we'll take public comment. = [providing instructions for public comment which are di the screen] we'll begin with in person public comment and no one approached the podium. we'll move to remote public comment and our moderator will notify of any callers in the queue this time. >> board secretary, we have 9 callers on the phone line,zero callers enter the queue at this time. >> thank you moderator. callers, public comment is now closed. next agenda item, please. >> item 9, dependent eligibility verification audit. 2024 update. this is a discussion item

andprinted by olga operation manager with sfhss. >> good afternoon commissioners. hope you can wonderful. operation manager with th:y health service system. i'm excited to share today the of the 2024 dependent eligibility verification audit that this year. before we the deva audit i want to highlight a few of the notable this year we audited 985 of our active employee members with a dependent on of 2127. we had a completion rate compliance rate of with the financial savings of $417 thousand on a annual basis for terminating coverage of ineligible dependents. the depwent eligibility verification audit is a dependents that are covered r and dental benefit.

it is health plans in r insure that benefits are only provided eligible dependents. the result of the audit help to reduce the cost related to and insure sustainability in premiums across the people who are not eligible benefits provides a financial risk to the plan administration and to eligible a little bit of history of the dependent eligibility audit conducted by the health serveest system, audit conducted in 2018 with the full the system retirees and active members being audited be population the audit was conducted by a were some challenges, specifically around consistency of verification documents that could be provided by the members in compliance, and so taking the learned from

the 2018 audit, when we chose e audit in 2022 be a lot of research done on th practices among other entities who conduct the deva to evaluate what kind of documents they collect for continued eligibility and that was utilized in the 2022 retiree pilot. we had population of 634 and domestic partners were included in ratio of members to dependents and we had etty successful completion rate there as well, 97 percent of e dependents passed the audit. i believe only 19 dependents terminated due to ineligibility at the time. now, taking the again from the previous in-house audit we applied the lessens the 2024 population with however, here we did include children as pof the audit so you can see that that ratio between membpendents have increased so we are looking at a population

over 2,000 dependents audited. taking a look at the frame in terms of the communications we sent out a pretty robust campaign of on their requirement to comply, how to educated which of their dependents were going to be what documentation they can provide to insure compliance withthand the pathways to be able to do so a robust communication do members audited with this pe compliance period, which was april 1 through april 30, we also sent additional letters to our members. first, those who attempted to comply but maybe sent an ineligible letter or wr we communicated with #24e78 know what is missing to meet compliance. those wh

all by mid-point of the audit we sent a reminder letter to increase a high rate of compliance for those members. at the end audit after everything was processed we communicated through disposition to inform they successful or inform them to let them know their dependents would have the coverage we wanted to make sure all notice requirements were met. wehave three groups of members that were being informed. those who wethe happy pass and let them know their depefor those who failed to comply for any of re notified those dependents would be terminated and the date of the termination and then the third category where it was the mix where they complied for some dependents and not others and we were able fy them of those who they complied for and those who didn't. for the population of members

who failwith the verifications for their dependents, we also sent out that kind of spiked more compliance among our membership. and here you'll see, we tried to be ó,as creative as possible with this really ope that all our deva communication team to encourage comply, because making sure they were able to complydependents were eligible, because they are actually complying as ewe are maintaining eligibility and intaining coverage for the dependents who are actually eligible. and the full implementation of this audit is very much a ('comultiple divisions of the health service system. the communication team was involve said in the letters, the education materials for our members, the development website and leading s to resources that educate them how to comply and

the we included a list of acceptable documents with our communications along with posting them on our website and providing our members samples of the type of documents and what need to provide in order for them to make it easier the compliance process. unication team also was very much involved in making sure that thrts necessary for the disposition letters were so that we are communications with members were timely. alytic team did a lot of work within our systems to make were able to complete the audit internally both in buout the e-benefit platform for our members to insuring we were able to keep track of our compliant members within the sales force system and integration between the people soft system and our document management system where we were able to view the documents provided by our members. lobehind the

scenes planning, a lot of implementation of system changes, and so i believe that we did a great job in being able to coordinate needs from what member services needed in order to implement the support of communications and our enterprise analytical team. jumpoing as we can see, we audited three ent populations here, children for children members were required to provide a birth certificate. for a spouse, members were required to provide their federal income tax returns for year 22 23. specifically indicating they were filing taxes jointly or separately dependent on the situation and also had of registered domestic partners audit and that was a split population where there were some partners claimed as irs qualified dependents, and for those the

member was required to provide income tax t< again for 22 or g the dependentancy. for those partners who were not claimed as tax of other documents that they could provide as verification that continued inter-dependentancy. >> do you also do verification of for example, adult children who remain dependents? >> that is a separate audit. adult dependent student were excluded along with unified school t.sh >> you require documentation when signing up >> that is correct and the audit is forthcoming. >> thank you, just appreciate it. >> of course. and % we had a really high compliance rate or response rate among our members, especially during the early part of the

audit period and that ing to get to the high percent of compliance. as you can see, at the time the data was pulled after the compliance period, dependents were terminated for ineligibility, which is that 5 percent of the population audited. now i'll jump to the construct of the way =4meer services supported or conducted this audit. we had dedicated benefit analysts that processed the over 1400 documents that were submitted they were also dedicated to a for our members, who were calling to get we had one supervisor also dedicated to this project to insure the documentation of process was available, the training were available to and to insure any

escalated issues would be as you see here, a lot of our members ended up complying e-benefit portal, 77 percent,b which is of time to develop that pathway for them to comply and it was a resource heavily utilized. interestingly enough, i did a look at our 2022 data, the numbers were flipped. only 25 percent of our retial in the 2022 auditill have a ways to go for the portal. one thing i also want to point this parallel approach with insuring that majority of the children we were auditing were going to remain eligible, because most likely they would be and the type would be providing would be their birth certifthe parent relationship wasn't dpoeing to be changing. the audited population, we evaluated 1200 ndents. this was a very manual process to review oudocument retention

system and of those all most 800 identified as having complied already, so that allowed us to keep high number of child with their coverage. now i'll jump into the we see across three audits completed in 2018, 2022, and this year in 2024. as you can see, the annual per savings for ineligible dependents is rand overall saterminated for ineligibility is quite significant on annual basis. before i conclude, i wanted to address a few of the lessens learned and the challenges that we experienced with of course, making sure members are educated about why the audit is happening was one of the challenges. a lot feel this was with

any audit there is going of feeling like they-it being highlighted for doing something wrong, which technically this absolutely wasn't that. j made sure to address that by identifying that all of our members getting audited and that the consistency in the approach of audit was going to be applied to all of the population to secure that trust that no one is singled out.it is that, in the see, the populations audited were quite in order for us to increase the volume of members audited on a annual basis will require additional strategy whether the audit next time will

members knowing that it is only those documents that are going to insure their compliance and they knew everyone else was going to be requested to as well. and so as far of next steps, we are still evaluating how we can proceed with audits going forward, the capacity we will have internally or externally and what that population is going to look like. as a note, the general appeal period ended yesterday for those members who had their terminated and potentially second level appeals may the next couple slides are just general in the appendix are much more in depth information for you on the status of the different populations we au and their compliance within each of the populations and also the type of communications we sent out and the volume sent

out. be happy to answer any >> thank you. thanks for the very thorough presentation. any questions? >> i like to know, for the ones-i'm just looking at done with phone calls other efforts to get their attention and get some kind of response from them? >> yes, we had a couple of follow-ups for our members. for those who had not responded in the middle of the compliance period, so middle april, we sent them a second for those who also failed to respond by the end of the em an e-mail. what we really did with this population, bere still--we are doing it as a pilot to see what works best, for those members who ended up complying after after the termination during the appeal period, as long as they complied we went ahead and

insured we continue their benefit so result is three months woof communications, and a opportunity to be able to comply. >> okay, that's a lot of work. >> definitely is. >> kudos to the staff for following through. >> thank you. >> really very tedious and i have to admit,dy who is now retired, we don't always on behalf of my colleagues, i apologize appreciate the tenacity of the staff and also what it means to our system; what some don't realize is that translate sometimes it is saved dollars, and sometimes it is dollars that need to be spent for dependents who need those services and somebody drops the ball, so there is a lot of work uvaed. >> thank you. i have a couple questions too. how did you select the 985? how many appeals have you received?

>> the 985 actually started off with a thousand. some ended up reducing due to no longer employed with the city and things like that by the time we sent out the letters. the process had early in january, letters weresent out late march so there was some discrepancy. the way the members were identified was through identifying all active members and we digit of the dsw number zero and selected a sample of those who met the thousand mark. and in terms of i believe-- afternoon commissioners. rey guillen. if a member responded after the deadlines or after their dependents were initially terminated, as long as they are able to verify the dependents we reinstated coverage so no

appeals were necessary from that group. in total i believe we received 8 appeals from members that failed to the audit. a number appeals for spouses that were terminated because they are not filing taxes as a married couple and so, as olga mentioned, and i believe it there was one other situation where the dependent couldn't provide any acceptable documentation, but as olga mentioned, those appeals, if the member decides to proceed with the second level appeal will be making their way board probably beginning next mon very small number compared to the total population was audited. >> i want to commend you and thank you for your flexibility in the way you have worked with the members to sure they-even though they were late, that their coverage continued.

>> very helpful. >> yes. >> it also means a lot of us don't get extra phone calls. [laughter brash ]. thank you. that is a lot of work. >> alright. any other questions or comments? so, let's go ahead public comment. [providing instructions for comment which is displayed on the screen] >> board secretary, we have 9 callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. public comment is now closed. >> thank you.e next item,

please. >> item 10, board education health insurance portability and accountability act, hippy. a training 2024 year. discussion item and will be presented by rin enterprise system and analytics. >> you don't get a break do you rin? >> sorry? u don't get a break. >> it happens. good afternoon. rin coleridge director of enterprise system and fulfill the role of the hippy are doing our annual training today, and today for the benefit of new commissioners, we are going to revisit high level about what is and for our ongoing annual training also do a quick visit what is new for 2024. so, let's start by talking about what so, it is actually comprised of z

the key ones are ivacy ru security rule and notification rules. at the end of the day is trying to protect privacy for patients around information and around protected health information and we'll pget into that define that. and there is penalities involved with this as well. but, really the privacy rules gives a array of rights with reto what patients or the individual have control over their own information, but it also defines for the rest of us that how we can use that information so that it is protected and so for us hss, we are allowed to phi for treatment, payment there is also the security rule and this more if you think on the system it side. it lays out rious rules to be held accountable for

are making sure the we are checking the integrity of the information and also information stays confidential. putting all it to move. it is trying to again between protecting information and allowing it to flow forward and just so you know, it to our subscriber and members and the detheir hipaa rights as well and deceased members and dependents also covered under hipaa. hipaa guidance for those individuals. it applies to medicaldanter prescription drug, long-term health and flexible spending accounts. now, let's flip that around and see what hipaa is not. is actually never limitation al who is the subject

of the information. if a member wants their own information, they are absolutely allowed to do that. there isn't restriction on that. i think what is a important note is that it is not necessarily applicable to employers, 4rdepartments, agencies educational institution or law enforcement and so, wlaut applicable to is something we call, covered entities and so a cover entities could be healthcare provider so i think you understand that. it could be a healthcare clearinghouse so that might be things like a party organization maybe doing repricing or doing billing the third item in that area is health plans and this is the the health service system falls under. we are considered a covered entity. our restrictions-we aring phi with the employer, but likewise, i think about experiences in my time in the city wher had to work with other departments and we might need data from them help with

long-term disability claim and i hear people in say, that is under hipaa, we cant give it to you. that doesn't work, because a couple reasons, one you see here a later bullet point, but disability insurance doesn't necessarily come under hipaa guidance and then the other thing is, the actual hipaa regulations, who has to protect that information is a covered entity. not all city covered entities. certainly when we think department of public health, no-brainer, public entity. those are distinctions consider, but we are covered entity. >> covered entities can communicate with each other and share the information? >> generally speaking and if is third party have business associate agreements and there are is legal framework how we were able to then share inform thank you. >> the other times you can potentially shar third party

is if that individual themsevl request it. on our website, there are forms whi to your rights as the individual where you can say yes, i want my information or i want my information shared with this other third party. >> bue member? >> that's right. >> it has to be documented. >> absolutely. it is reviewed and we have a work flow around that. let's continue to talk about what hipaa is not. sometimes it may not apply to pharmaceutical companies. pharma is not a health plan. certainly if they are doing maybe some kind of research activities where it is involving patients and other some of the constructs but as a general rule, they are not hipaa. it is again this to call out, does not apply to long-term disability, worker comp, accident or life insurance. the other becoming more prevalent is around wearable health technology. i got my watch doing some

things, and people with their phones and their apps, and so, maybe in maybe out. i a education point for members. if the company providing the app or wearable technology is working directly as a business associate for a health plan, maybe you see this if it is a heart monitor. your provider sent you home with the monitor so you wear that and tracking the monitor may be provided by a whole other company, but in that under it. if it's just somebo is like, track your sleep or twrack the member of steps and just a tech company doing that and you are tracking for self, that is not necessarily a hipaa thing so that is how es fit into this. certainly, if you take your own data you are tracking and then yor to the healthcare provider and say hey, look at this, then nowthalities that's with the healthcare provider back into hipaa land. let's take a look at the next slide.

>> interesting. >> let's get into exactly what information is protected. so, this is the rm we'll use, phi, protected /3heal sometimes people say personal health information. i like to say protected. you got the identifier. this is something that makes identifiable and if you go to our 18 identifiers. ifat phi land. you may dealing with information where doesn't have a individual identifier, but if there is reasonable is you can identify who we are talking about, that fals phi. here is a example, maybe i say mayor has x, the mayor of san francisco has x.think some person jumped into your head now. as you can see, i never gave names, didn't give social security numbers, i gave no individual identifier but there is a reasonable basis yoknow how who i'm talking about. when you are dealing phi think from that perspective as well. you take your individual

verifier and match again, it is either created or received by a list of things there that i wo necessarily list, but-and it relates to your past, present or future physical or mental health condition so keep that in mind that's what protective health information is. you might see in the list it is created or received by and might see life insuring or school or university and i had previously said, they were oen the hipaa is not these things slide. because we get back covered entity. organizations that deal with health information but that doesn't mean they are subject to the regulations under hipaa and that is the covered

entity piece. let's talk about you. you and your role as commissioners of course might receive and consider upon second level appeals and so as part of this process you may encounter significant amount of protected health information, and likewise, i know you all tend to receive communication directly member outside the appeals process and that may contain phi. it is up to the member what they want to do with ustheir information. if they want to communicate it to you, by all means. now that you received it and you are part of the covered entity you are under hipaa requirements how you treat we like to comply with the minimum necessary requirement. it is a easy mantra to get you out of trouble not doing things you shouldn't, so what that looks like is, keep every minimum as necessary. if you dont need it, don't save it or request it. if you are trying to resolve

some sort of vision issue u don't need somebody's dental hijistory. we try to keep the information very restrictive to what is required for the matter at hand for answering the question for whatever the issue is,a really good guideline for that. the other way we deal with hipaa is you deidentify it. if you are back to not having it meet that phi definition foanof being individually identifiable with the health information, which essentially means the 18 identifiers in the appendix are gone, then identified so it isn't phi, not there is requiremen on the size of the geographic region like the can only be the first 3 digits. that is how aggregate sometime youz have to keep the nrfshz. bad news. if we go wrong, there are fines. and i won't read all of these on here. you can see there's a little

chart that goes green, which is still good, but the lower penality, versus the red with &0 the higher penality and the variability with how these are terms of the fines is was there neglect and timeliness remediating the issue. there are could also apply and other consequences we have of :lawsuits, restitution and termination. also, if we ever have a that impacts more then 500 individuals within our area we also have to bmmedia outlets. i think you have seen some pop up in the media time to time, so we doing our best not to be one of also reported to health and human serviceattorney general office. all sort of ing thes we done want to get there. let's talk about cybersec because this is a integral component of hipaa when we talked about the security rule and also when we talk about

willful neglect. we should be able to address the things reasonably a lot of actors doing things with phishing e-mails, really good people hacking into various organizations. we know we shouldn't be sharing pulse words. the eastuff be shouldn't reply to an e-mail that says you have to right away. in the past we had breaches with every we absolutely have. you can see that in the news about the different organizations impacted. in 2024 care which is part of uhc and estimated ththird of all americans. a more recent one, kaiser wasn't a threat act but realized they were out of in the website and that information was shared with third parties having your

trackers is sort of a common tool in web sites to help taylor information better that impacted 13.4 million individuals so that is happening and happening every day. i don't want to say on the port, because i feel like i'm testing fate. let me knock on wood. we have not incurred a breach, part that. here is resources for you all. we got annual cybersecurity training and health service board secretary will coordinate that with all you and so there is-they are quick videos online to give tips and tricks how you can little bit more informed about what to do and what not to do, because generally speaking the weakest link continues to be us humans. if you are ever in doubt, feel free to k up the phone, privacy officer as a resource, and other people. it is always best to ask before

and complying with minimum necessary a very easy way to limit the information getting out there. usage standards, and the reason we provide you computers is also kkto help keep us more secure so you don't have information going on your personal machines et cetera, et cetera. other family members may be using or leave somewhere. we also information gets left on network drives. we have multi-factor authentication set up and never give out log-in credentials so easy items. we put resources i got the url in the deck, but you can type in data breach in the search site up for you, but this is to help educate our members about how you can stay safe well as a individual, and also helps all of us ation. another resource you may able go to, health human service has a ton of stuff

on their website related to hipaa. hipaa training and using your city e-mail account for any of your work here we do as part of the heand covered entity so again we got the information locked down and have çall sorts of security around our government tenant for e-mails so that is use our city system and resources. let's finally take a look what is new for 2024. just the one. it was announced in april by our-all said harris administration. our administration. put into place to support reproductive healthcare and so, i won't read all these to you time, but again, it did help try to protect some of those reproductive rights.

win the appendix the language of the security privacy rule. if you have any questions i can take those now. >> thank you. thank you for our annual refresher, and also for giving context to our new commissioners. any questions? >> i like to really thank you. this was a lovey and plain spoken presentation, because hung up in tech thoughtful and really appreciated it. >> thank you very much commissioner wilson. >> thank you.other questions? if we have questions we can call her back up. lpth. if not, we'll take comment on this item. thank you and thank you again. [providing instructions for public comment which are displayed the screen]

we'll begin with in person public comment. no one approached the pode im and move to remote public comment and wi:ç callers in the queue at this time. rp board secretary, there are 9 callers on the phone line, the queue at this time. >> thank you moderator. hearing no callers, public comment is closed. >> thank you. let us take a 10 minute break. we will see you back here at 2:20. please be diligent and return we do want to be respectful of those who are attending this meeting remotely so they are not lingering and waiting for us. 10 minutes. [meeting reconvened]

>> welcome back and thank you for the 10 minute break, being so diligent with your time.roll call. >> roll call starting with president hao, present. vice president zvanski, prese commissioner cremens, present. supervisor dorsey, present.ward, here. commissioner sass, here. commlswe have quorum. >> thank you. we will take item 11, please. >> item annual benefit contracts market evaluation and assessment.discussion item

andprinted by contract manager michael visconti. >> welcome. >> thank r you holly. thank you president hao. michael visconti, manager for the san today we'll present on the annual benefit consideration and market evaluation as well as our announcement of a upcoming rpf we are planning for life and disability. this presentation will be parts. i will begin going through our current plans and benets purview, we will transition to approach to assessing the individual plans which happens throughoutmore ernest way this year between the then a recap of the powerful tools you are all familiar with and we use to insure our excellent benefits and make sure they are sustainable year over year. after that, we will announce what we in the fall which is

release rflife and disability benefit and transition to partner mike clarke from aon to walk th history of voluntary life and ú disability benefits and employer paid basic life and -term disability benefits as well as the applicab voluntarily benefits currently available through the partnership. rating actions, go through utilization trends, dmarket and disability rfp later this year. the 2026 plan year as wetened to do these during this time of year, conclude them in the late g next year in time and in line with the rates and á benefits process. so, again, these contracts are under the purview of the sahealth service system. these are our benefits for course health benefits for the population and life and sabi benefit jz we'll go through each of them as each year we do assess them and the board and

whether or not we believe it is brudant to competitive bid or rfp. b@present during the rates and benefit process the approximately 12 major contracts that overvee our benefits for your approval as to the rates and the benefits. in alreements there are approximately 27 minute plans medical, dental and vision and numerous life and disability certificates through partnerships primarily with hart ford and one with manhattan life. in summary, i the benefits presented here and walk th believe it is prudent to engage is year for basic life and insurance and selected voluntary benefits d determined that at this time an rfp or competitive is best assessed for future plan years for the

other benefits and we'll walk through each as we go through this. so, i mentioned in opening that this process is done by the executive team hss, our managers, our esteemed and actuary as aon through the year and in we do more targeted market assessment nf d present to the board whether we determine a competitive bid such as rfp or formalprocess like a rfi may be warranted. of course, when there is rfp for these benefits we announce that to the board and tyese coming months we analyze what that scope will be for narrow the scope down, and ultimatelyprint the final scope will be in advance of issuing a notice of the rfp, a black-out period insuring there are no inappropriate communications during that time and wehave a

transparent and above board process for we present the results to this board. as many know you worked in the city long enough to knobetween rfp and rfi but it is good to go th they are powerful tools. a rfi, the last time we used a rfi is in a lead-up to our of both competitive and-sorry, of the ac again. if any reason you cant he let me know and i'll speak up. the last time we engaged uain a rfi is was 2021. this is a forward looking. it is still a formal process. thankfully only takes 2 to 3 months for us. the responses to it are voluntary. there is no requirement to submit financial's so the financial's may be submitted, and again, it can usually lead us to a future competitive bid or narrow down the scope or determine which respondent to reach out to insure a competitive request

for proposal.rfp are narrowly tailored. they take 6 to 9 months. it is extensive working relationship with us at aon and our management executive team. mandatory that rfp responses include financial's.fees, premiums, any other costs associated with have a detailed comprehensive process with evaluation panel and recommendation to the board. so for those who are not on our board when we last coucmajor commercial rfp, the follow slide is summary of process that leads termination to conduct a competitive bid. for the d in 2020, we began this process in ernest in 2017. there were presentations assessments and private evaluations by us and the team at additional plan offerings that may be beneficial

to our members.to improve on rebate share percentages. evaluate the fees premium perfor our then current benefits. through 2019 and into the early part of 2020, we identifithe self-funded ppo and flex funded hmo plans as and prudent to conduct competitive bid and conducted numerous meetingsto discuss what we were ideally hoping to gain from our rfp what our research told us would be a t. the benefit that was, a very í beneficial result to us and members. we expanded the cial benefit offerings offering the helt care canopy o plan in 2022. the population doubled all most every year since then partnership with remains strong with health net and 7team. we achieved a 100 percent prescription drug rebate share and we lowered administrative fe we also increased performance !&

guarantees and benchmarking across all the plans as we made that a requirement of the bids. and finally, we had a very successful transition from active ppo administration at that time to the blue shield team. as we go into shortly, our determinaand long-term disability with contracts pire at the end of december 31, 2025 will be to issue a competitive bid for those benefits for the d2026 plan year. however, we do assess our benefits and i like to go through each transitioning over to mark clarke from aon to rfp. we assessed our dental and on benefits. both have either a rate lock or a rate cap for the next three years. that expires at the end of ber in 2026. for that reason, we are going to assess both zwbenefits for potential rfp for the 2027 plan year.

such an rfp would be discussed in front next year and rfp for such a-for those benefits would not be released until approximately 14 again, we have time on those. the underlying reasons are on the page why we are considering this assessment at this time. again, we may conduct early renewal next year in july and 2025, rather then typical renewal november and december with we may issue request for information as we did in 2021. give us the opportunity to narrow the scope of s9 rfp's, to determine what are important minimum qualifications to bid, as well as to determine the potential sure a comp for the well aware, we just completed our rfp process for the 25 plan year.0j

we are going through implementation process at blue shield or medicare team and doing reporting to the board throughout the process and into next year. hmo and senior advantage plans, we determined staff model, was integrated competitive pricing gained through the expert negotiations of our execive team and partners at aon made it determine it isn't prudent to rfp for the 2026 plan year for the hmo or kaiser senior advantage benefit. for determined that this very stable and long standing enrollment of approximately 1900 individuals and very competitive annual renewals as well have made it not timely to do an rfp for this population either. is our flexible spending ap count and cobra high degree of market comp tgz a rfi in

2025 to determine whether a competitive bid or rfp would be prudent for future plan years. with that, i will hand this over to my esteemed mike clarke our lead actuardiscuss intent to issue life and disability rfp. >> thank you michael. good afternoon commissioners. mike clarke, aon. so, as michael indicated, there isaq intent to issue life insurance long-term disability insurance rfp that will take place in coming this would include but not limited to basic life and ltb insurance required through the negotiation mou's for active city county san francisco and san francisco superior court employees with coverage beginning january g6 1, 2026. of note, these plans not provided through sfhss for the san

francisco unified school district or the city colleges of san francisco, so why it is just ccsf employee also these benefits are offered to active employees onnot retirees. just history on the carriers these programs, these actually haven't been rfp dozen years. the last rfp took place in 2012 for effective in the 2013 plan when etna was selected to provide these insurances and during last dozen years, specifically hartford insurance book of business from etna. was entire book of business acquisition in 2017 and followed were contractual updates, getting everything over d paper" for plan year 2020, e one in place year today the three year

commitment from 2023 to 2025. the benefits themselves basic life insurance, we do report on the enrolled employee counts when we do the prso this past february. for instance this is where you r the basic lifelong term disability insurance, most of the employees are in the $50 thousand basic life insurance, but there are couple other levels up to $150 thousand. longlevel is based on mou for specific employee groups. you can see the web links here for where you nd more information on these covered benefits for employees on the sfhss.org website.z supplemental life, accident death and dismemberment and sht-term insurance is available to employees-for this ccsf and superior court. the supplemental life insurance are both employees and dependents.

the accidental death and dismemberment provides protection in case of accidental death or some form berment, vision loss, for and manhattan life provesfor certain employees. historically, i say we've a good progression overall in the rates for these benefits. 2017, there have been three different sets of three year agreement periods. currently the basic life insurance ra ns with the hartford and long-term disability insurance rates and insurance rates for those employee paid cov erages, but we review with you every yearthe rate renewals, the experience-what is called los ratio. what the carriers are experiencing for to the premiums being paid, and we do feel they remain favorable to the insurer so

there is potential to reduce rates not just for the employers through employer provider coverages and also for the employees for supplemental benefigive a framework of how many claims are typically submitted a year, there is aths a year and 30 new ltd claim and we s on each of +éthe statistics every year when we do the presentation to the board with vg e most recent being in february. so, trends themselves, what are we looking for? certainly looking for favorable employers and employees, but i say the advancements in etplace is thinking about life have come a long way. with the digitalization, the techniques life insurance companies use, not >&only in under writer and policy management process and also how for instance, big issue in life insurance is people have named beneficiaries.

people may not have tht fe insurance setting up a will or setting up a trust b of trying to and their family members setting up those protections in case stuff happens, because certainly when a ost things are not set up, it is very difficult for families to get :y ses, so understanding these capabilities from the marketplace will be a big part of this rfp. enhanced support for those surviving families members and disabled employees. t does it look like? there is high degree of competition. always has been and continues to be. we list the prominent organizations and life insurance disability marketplace at the bottom page, and market growth. something we report on every in our rate presentations is percentage oyees purchasing supplemental life. we feel it is low and we hope bring more visibility to the importance of supplemental life insurance benefits to the membership and see growth

in the percentage of eligible employees purchasing supplemental life because this is a great platform ire those coverages. based on the recent rating actions, to the carriers as part of this process, we expect from a competitive rfp? affordable and predictable rates for emth minimum three year rate commitment is customary over the last 9 years. there is about million in total spend in the basic life program, 1 million spent by members for those nt expect to see material impact to those costs.iiu' the reduction in the cost. reduction in the premiums is a goal supplemental life and insurances visibility on education, increased enrollmentand other member resources that come with michael and i are happy to yrtain any questions from the board. >> thank you. thank you so much.

i'll start off with my question. baeven with the rate reductions over time basically it is still-the claim favorable to insurer. can you flush that out for us? >> sure. so, every-life insurance is a little more straight forward, because an event happens. disability has to do ?with somebody becomes disabled and have to forecast individual disability, what might the insurance company need to cover the future cost of those benefits. if weat the actual claim experience, which is going to go up an insurance, just depending on the number of deaths, we have seen over the course of time generally the premi paid is higher then the claims being paid out.of the last 9 years, we did see bad years of experience in the late 2010's, so period where

increase their basic life insurance rate . [indiscernible] i remember standing up here saying, we need to stay on top that and if the experience gets be nsider that in our negodid start to see improvement in the death claims able to negotiate reduction.disability, what transpired over time is frankly, the ú?experience just has not kept with the insurance hartfoered -ford is a great partner and trying to bring leverage. they also have to agree to it we still feel the claim experience is not at a level that is keeping up with the premium and we look these processes, we will frequently engage in our with our clients on rfp for life

certainly to try to keep line, and again, give them everything and all and especially post-pandemic families to bring visibility how people can protect themselves before those instances may occur. they ity instances during active employment but they do happen and are when they happis you are protected. >> thank yor questions or comments? >> i have quick question. thank you. you might have mentioned this and if you did i'm sorry if i missed it. what percent take advantage of the supplemental? >> i can speak for suppl m insurance, it percent. during the time working sfhss, other benefits-i dont know about short-term disability program so not sure how many individuals are to 8 percent raisk. ran we love to see that get higher. >> great.

bq >> any other questions? comments? well, thank you. wu this rfp-- will you be coming back to our board with additional timelines, et cetera? >> if necessary we can present that the board. we do this over the nextfes. the timeline for the logically not begin until early december so line up with our other meetings. >> it is great if you can come back in to let us know basically the that we are fully tracking with the progress. >> look forward to it president hao. >> thank you >> just is aware, the way things work-say hypothetically there is a jpon starting january 1, 2026, anybody who iscurrently on disability as of december 31, 2025 willtheir claim adjudicated

with the hartford, so that is the way it works. it is based on data disability and the insuring organization at that time. same thing with the death claims. if is a death were happen december 31, 2025, that is under the current with the hartford. >> thank you for the very important distinction. alright. if we dont have other questions or comments, we'll take thank you very much. which are displayed on the screen] we'll begin with unperson public comment. the moderator will notify of callers in the queue at >> board secretary, we have 8 callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing s, public comment is now closed. >> thank you. next agenda item, please. >> item 13, of

california medicare advantage gá drug, mapd ppo transition plan. this is discussion item and presented by rey guillen, sfhss officer, olga stavinskaya-velasquez, operation manager, tiffany gill, blue shield of california major ive and charles lee, the blue shield of california manager ofretiree senior markets. >> great. good afternoon again commissi rey guillen, chief operating officer for health service system. as secretary lopez mentioned, i some esteemed colleagues from internal th operation manager and also some repes from blue shield and together we will walk you through the joe blue shield medicare advantage preferred provider organization plan. today i will begin short background and outline of the key our planning. introduce e

we have assembled to assist with the transition. then olga along with tiffany and charles from blue shield will walk low plan details. taking time to highlight shield's tasks and those assigned to the h is highlight the metric tracks along the way to verify we are on the and by the conclusion of our presentation al is assured you that we got this. we are very confident members will be enrolled in the blue shield plan january 1, and that effective january be any empedements to the care that our members are acustom to. year, this board approved the blue shie ppo plan to replace the existing united re plan effective january 1, 2025. the benefits of the new shield plan match the existing uhc plan and the plan provides thsato all the doctors and healthcare providers just like our existing uhc plan.that this

type of change can stressful to our members use of the fact that basic healthcare is one of the primary basic of every individual and so we are going to be make sure that we have informed our they need so that they can transfer over to the without any impedement to that care. on the screen are the two main objective we set for this transition. e taking every available step to make this a smooth and our members. second, with esented, we are efforting to anticipatand address any concerns our members may have in order to zn them that they will continue to receive the excellent care that they are acustom to.

to insure the assembled a experienced and capable team to both joint transition plan. have leveraged subject matter experts from actuary and benefit consultant, aon ing all aspects of our plan and communication materi confirm woe are following best practice.sess blue shield claim and operation al up correctly and match all commitments that were made the blue shield proposal. so to iterate, the key our joint transition plan include, a continuous our members through excellent customer support and blue shield teams and proactive communication. in addition, we will be leve internal and external expertise available to us and build

upon prast transition experience, including our non-medicare ppo plan transition michael went through that happened for the split medicare family transition that we went through for year 2023. in addition, we each individual member as with their own unique needs and concerns, but focus on the fact this is the same ppo plan with open access to all medical providers nation wide the same benefit and copayments that currently are enjthe existing uhc plan. finally, we are going to insure all our processes and systems are set up and ready to go our members only experience a smooth transitio so, i'll turn it over to tiffany gill 5from blue shield to walk through the specific blue shield component of the transition plan. >> thank you. tiffany gill, blue sh good afternoon.

i wanted to let know about blue shield. there are new commissioners and wanted to make sure that everyone was familiar with we are a tax paying non profit healthcare company that headquartered in the bay area, and our mito provide and create a healthcare system that is worthy of our family and friends and sustainably affordable. we believe in operating with transparency and efficiency and are these are the tenants that will get us to our mission. we also building a diverse workforce that mirrors our members.to make sure that all of the plans that and programs we put into a diverse workforce that understands those and healthcare needs of all our members in california and nation wide. our mission also i believe aligns very closely with the sfh ss

strategic plan, speci affordable and sustainable healthcare. the primary care, and also making sure that we have excellent customer service. fwr example, we actually have increased our supporting our physicians with different programs in helping them with achiwith member satisfaction, in doing that, and the programs we pute 2022, we were able to increase what we call, we score for our physicians, which is just basically gsfaction measurement, and we 21 points in 2022 to 44 promoter score, which is actually impressive seeing the healthcare industry average is at we definitely appreciateat you have to serve the

medicare eligible retirees, just as we have the active e members that are under age 65 that are retired as well.6- i have been around long enough to be able to know i can't stand up here and say i'm going to guarantee there isn't going to be questions orat are going to come from this implementation, but can promise is that we will immediately act on any concerns, any questions, any oe issues that arise. i have a full team that will be xd me and we are as anticipating any questions and needs that come up and in of communications and any member that come through. with that, i actually want to introduce charles lee who is our blue shield senior manager of group retiree and senior markets. he is going to and has already been standing side by side with me and be helping anticipate and help with any your member

needs. >> thanks tiffany. charles lee, medicare group retiree ervice, senior manager. we realize obviously there are a lot of questions and concerns from the membership, so we have actually set up already a soft launch with a blue shield dedicating model, member services. the number is live gh we are already answering questions and concerns about the upcoming plan. >> my paper says 8852. is it 52 or 42. sorry, i misread that. thank you commissioner. service staff are going to be to the hss population and familiar with the plan and they actually reviewed quite a few of ard meetings and understand the concerns and so we absolutely

are ready kand all questions. along with the member service, we also have access experts and resources, such as registered nurses, pharmacists, 0ú pharmacy technologist, social workers and dieticians as well. so, we've got a variety yóof resources available to on staff on the phone to be able to address variety of questions and a variety of issues. these folks are available 7 days a week, 8 to 8, the only holidays are thanksgiving and christmas.these experts andf sta, we also have a subset of care navigators. with our e recently, we noticed that getting appointment has been a challenge for folks with the capacity with folks getting back from covit"d, so have a specific set of folks that their to help gain access and be able to with

appointment scheduling and care coordination. all these folks to assure you have been hand selected to support hss. to be frank, these are the best of the best. to insure that communication is clear, honest, coare able to meet the needs and expectations of our members. we want to work in partnership with hss with the members and with our aprovide the best care available. and, continuing with our partnership i think olga will continue on with our partnership efforts with hss. >> can we know why we are only available to 1 p.m.? that for in-person support? >> right, in-person support. >> right now the health service sy in-person support is open from 9 to 1

for our for in-person support. due to the low staffist year, we still haven't transitioned to opening the in-person center that we have, we have been available duringbeen twracking the number of members that do utilize the services both to come in for f support and for drop in support and we have not a large increase other then during open enrollment last year. it is based on the needs of our members, >> okay. and we are not getting complaints or members calling saying, i tried to get access and ul 't,en late enough? >> we tried to help them if they are we are doing our best to be able to help them in person as well, call center itself is actually open from 9 to 5 every day, so accept for thursdays it is 10 to 5. we are still open and available as a resource during the hours for calls, correct.

>> just wanted to confirm that. thank you ve appreciate it. >> so, operation manager with health service system. the operation team has been workin blue shield implementation team to insure sition for our members and handle increased capacity and phone callss that is a result of the transition. a way of background last year at this time, my team member service division was at 50 percent staffing so to [indiscernible] open enrollment we engaged in person contract with vsa, a off site call center group to ort all our members that are calling during the open period. this year we again anticipate that high volume of callers, again due to open enrollment and of couto the transition that will be happening to the blue shield ppo plan and very excited to say that we are staffed at member services and ready to

be able to support our members, buto engage with vsa for that off-site call center support and to be able to handle any sort of overflow in phone be originating due to the transition. and with our partnership with blue shield, we want to ma that any of the transitioning members have that approach to the services they i know executive yant mentioned the soft launch.been testing the service by engaging several retirees to test how their expe is with calling the call center, utilizing the website. this week has been very heavy in myself and some of my team calling those members to engage them and see whether they are willing to par tace pate and get the early start getting the transition happening for a couple of folks respond already.really great feedback, especially the website

and overall their feedback on the customer sebeen quite positive. and has been mentioned, we ar open for in-person, so call center support isn't the only way for members to reach out. our lobby is open and one of will have in supporting the transitioning members is shield representative in our lobby during our business hours, so that would allow for those members more comfortable having the one on one in-person approach ñb to have the opportunity there as well. we have been working with blue shield on staff training, making sure all our teams are ready and prepared to support this the transitioning population and open enrollment overall. the major focus of all the training has been on customer service. and in the slides, you will

see set up we developed with no wrong door approach. goal is to insure our members have a first contact resolution experience. member services team from sfhss along vsa team will continue to support our members with the general open enrollment questions, support and making changes for open enrollment, but we soft hand off approach to the blue shield am to the team when questions very specific around the members plan of care or support with provider access, when those kinds are asked, we want to make sure that hand-off is smooththe blue shield team and as we rough the warm transfer process to our counterparts continue to insure that the level of service that is provided to

the members is that first contract we want to make sure when the member comes off the phone with either our tblue shield team, they have the answer they are we do note that there may be situation wheres call-back may be required. as a example, support that both teams will be providing, when erare calling to insure their provider is going to be their provider under the blue shield plan, this may require a for the member, because what we've identified is providers may need some education on medicare billing, and so team is dedicated to doing outreach to providers ng billing and connectic bag with members to insure they get resolution for their inquiry. additionally the escalation process we established our members, because there may be issues that come up, we want to make sur set up as well. all these things have been ou through and planned out.

teams trained and confident to be able to handle this transition. we've--in the next slide, between the wo slidessee the escalation and the transfer process between both the blue shield and the uhc team so there isys that the member when they get off the phone with us are either going answer, or know somebody is going to be calling them a answer upcoming. >> what does rm transfer mean? >> so, warm transfer is generally when a one agent transfers a call another agent without leaving the member to kind of reexplain the full situation to the new agent they will be speaking with. we give a little bit more of the information to the agent before connecting the member shield side. >> thank you. >> my understanding is that we'll have a team of 20 or so blue shield staff with opportunity for 20 more, 26 r any overflow calls.

as you can see, the volume of will be available for calls to be answered is going to be quite high. i will go ahead and transion to blue shield plan highlights. >> thanks olga. arles lee, medicare group retiree.as olga mentioned and to clarify a feature of warm transfer. it is so call back or make another call. it is so they a couple teams to be questions are answered in a timely manner and so that they don't have to get back into a queue. we actually got a great system in which mw we can call each other through back channels and get to the head of the queue and support members in a ly as mentioned, we got 20 blue shield members or service fol along with 36 overflow capacity d, as well.

we are going to get this. we got this. i will move forward tothe blue shield plan--shoot. we are back here. to help reiterate and emphasize the key featuresplan. as you notice, it is very similar to the current plan and that's by design of course. one key features at we maintained is the access to same network iders that folks are using today, and shield network and through the medicare ork. i'll talk about that in a up couple slides. we also have joint copay and coinsurance with rich formulary to minimize disruption. we also got additional benefits and not limited to annual physical exams, nurse health 24/7 along with teledoc. so a variety of ways to service

you need. talso offers benefits above and beyond medicare, as routine--hearing exam, we got silver sneakers as a added benefit, we got transportation to and from medicadoctor appointments and we also got meal service for the hospital for example so they dont have to worry what they have to cook and how to take care of themselves from a meals perspective. as i was talking about on the other blue shield medicare ppo plan give members flexibility and choice. with this blue shield plan, you got blue shield state wide ors expansive network of doctors, but in addition got

the blue cross blue shield association network nation wide to support our members as there may be innetwork providers that may not take new members, but rest assured, continuing members will continue to get their care in network provider they have we maintained consistency with the benefits and member cost share no surprises 1-1. twork providers. so, out of network providers is ve key as well. even though we got the california providers, the nation wide network as well. this is a key facet of this plan along with the current plan, which is the abilsee any medicare participating provider. onc medicare

participating provider. as long as blue shield and participating re program, their services they offer members will be covered. in lwthe unlikely situation where maybe a providerwith the blue shield of all it takes is for us to reach out to , be able to explain to them the plan and how we would reimbursement the hundred percent fee for service schedule without a contract so there is no strings attached and no contracting, this is the same would receive from original medicare, this is actually all it takes for providers to continue services, because they want to continue to serve their members, to serve their patients obviously. the next slide we got titled as

pharmacy transition. it is very similar process and methodology for medical transition as well.on pharmacy transition our team will work together aff and with the current prescription drug vendor, optm rx and work together to insure a seemless transition. how we do that is requesting historical member level that very specific that have prescription claim history, open refills, nt information, all the data we need to insure that we have got got the history, and we got ability to adjust and put in our system prior to 1-1. e again, these are typical measures we take measures we take, work with hss staff and united to insure we e information moving forward for a smooth 1-1 transition. specifically on

side, we pay particular focus for open refill for home delivery an pharmacy. we recognize there is a specific and critical need these pharmaceuticals and there cannot be any we pay particular attention to that to insure that they continuity of care with those medications. that team supporting those g to be proactive about transition. meaning, we are not waiting until 1 to communicate any changes in r form iary or pharmacy or medical, we will reach out to them in december and make sure communication if there is any impacts to their care. lastly, blue sh recognizes that along with the medical aspect and pharmaceutical aspect, there

obviously mental and behavioral aspect of health, so we recognize that specific need and importance of it, so one of our goals is we do not forget behavioral health aspect to transition folks. we want to folks on the various tools and programs blue shield offers and provides, at the same time, r current care that they are receiving and insuring that that is stable and continues as well without any interruptions. what is the mental health benefit? is it contracted through majellen? >> correct.is our in-state provider and outside california, we bcbsa network of mental health providers outside california a second layer of mental health as i was trying to emphasize as much as i could, medicare participating providers. it doesn't matter ifare on one side of the country versus the

other side, as long as they medicare and bill blue shield, we will >> so, if anybody is using like united healthcare now for their mental health benefit, is that same obviously if they use medicare-- >> absolutely. >> not using the united healthcare-- >> as long as they are medicare participating provider, even if t have a contract with them, let's say they have a contract only ,th if they are able to bill they will be--that visit and those services will be covered. to do the billing to blue shield? >> yes, they have to willing to bill blue shield, but they will doing without a contract. one thing we explained our team will explain is they don't need a contract, we are to a contract. we are not trying to get them example, 98 percent of medicare or 102 e not going to play those games so to speak, weexactly as

original medicare will pay. it is simple as that, and typically folks understand that an that's without a contract and usually folks want to continue to patients. >> do we have issues with blue shield refusin >> sorry, one more time? >> do we have issues with blue shield refusing to pay? >> no. we should not have any issues with blue shield refusing to pay. this is a ppo network and we recognize the flexibility that this plan needs to have for folks, opposed to traditional hm that is the key difference. this is also a ppo wwith the flexibility and knowledge and operations to take out of to the traditional hmo fee for service model. >> got it. thank you for that explanation. >> are that have dealt with blue shield before anhad

unpleasant experiences and don't want to deal with blue shield anymore? re there is. to be quite honest. i'm sure there is negative experience, but what we want to do is we want to move forward and what we want to do is also have our member-the best of the best give them a em, hey, this is my name, this is my number, if you have any issues with your claims moving forward, you got our information, you can call us we will work through it. that's our commitmentthe members, to the providers and to th staff that we will take care of any issues. that was a issue i heard that people out of state that their doctors do not want to deal with blue shield at all. >> of course and that is le. you are way out there on the west coast. why do we want to deal o what we would do like we said is to give them a call, explain to the plan works, give them help the member. we are both here to ber and that is the ultimate goal and at least gib us a shot.

>> essentially you are the medicare intermediary for everyone? >> right. >> throughout the country. dividual blue shield offices, it is one address for bills for medicare go. it is like on the back of everybody's insurance card with uhc all is number to call and address to bill to and on a id card, the same instruction will be on idit gives the phone number, the address for billing, and it is medicare advantage ppo and i say most physicians wo most physicians certainly understand what that means and th medicare program that is essentially paying them and you are the sort intermediary and the administrator program aspects of !s plan if not mistaken is that true? >> yes, we are. mention that, by law medicaneed to cover mininally option as hss has as i include supplemental benefits, transportation,

the meals. we also hav ra pers system. it is system, fall monitoring system as well that is retirees so we go above and beyond medicare. >> if i may, estion. i think my comment because i think we might ch2xange people with the slides. i really appreciate your team shield listened to the hearings up to this period of time. it is very thoughtful comments people brought and i think hearing their concerns is really going to help your team unde gether or faq, clearly the confusion g one and more we make sense what is ppo healthcare is confusing. i say as a physician, it is confusing, confusing for everybody so the more you le to make clear on that, i think is very very everybody and reiterating it.

my question though is really out focused on the pharmacy piece, but it gets back to member concerns and nd transition. we heard stories and e-mails about people who were undergoing cancer treatment and worried that will all stop and i think the more we get out there and reassure. on a claim standpoint they will see so and so ischemo therapy every 3 weeks and so important to not miss a e more we can reach out and say, we got this, we really want to make sure that that happens and we understand that. i think really that-i use the that feels at was my question at the end. >> i just and great point about attention to s. that's actually that was very

valuable tool for our team to take a look at the videos and concerns, and to that point, actually we have to-i toa pat on the back along with hss staff. we've developed a mailer that goes out here all these concerns, addressing these to at least at a ial level answer some of these concerns and then if you got personal one on one situaof the best team bep available. we will we need to get back to them later on with care concerns-i listened to a call this week and heard about potential care that folks are going to ed outside the state and next year, and so that is where we them know, hey, as long as they providers take us, we can certainly make the outreach and insure you got that care when you

it available. >> when are you starting the outreach and mailer to everybody? >> sorry? >>are you starting the outreach and mailer to all the united the information? >> point i'll answer the question. re officer for hss, soon. we will go th you right now and so, our she developed a very comprehensive communicatiothat is about to be launched and so, sdcharles mentioned faq document prepared and ready to go out next week to our members, and will again, note a lot of concerns we have heard from in the public meetings and e-mails will be addressed in the document that is about we held off a bit in case there was feedback from today's meeting we want to make sure address in the document, but it is prepar and ready to launch, but has

developed this communication campai fully educate all uhc members ]é about this transition and we are calling

to adjustment and we are going to adjust we go along. this is multi-channel communication approach. we learned from our split family transi we do things and make them better, and so we do plan that includes postcards because we know a j9'f always open the envelope, so we'll send opostcards in the mail with e on the front and back and detailed with a more detailed document in inside. we will send letters because they offer the opportunity to then a postcard. we have webinars we have planned. we are going to reach out to the various organizations, such as protect our benefits retired police association and offer to cohost town halls with them to get in front of the members. one of the new tools and it is new to us, but not new to , but e-mail. we are going to rely a lot more on e-mail then we havethe past, and we also have developed website with blue shield with all this on

it and we can change it on a dime. if we have any particular issues that ar address them quickly on that micro site. all the communications won't matter unless the systems are set up, so this is very a group assignment. each division of hss along with our external partners ar in implementing the systems and processes that will be required. rest assured,ited to start this. we started these chand system changes quite a while ago, so michael visconti from the contract team, his group is already working on finalizing all the plan documents and all the details are consistent with the existing plan and the al that blue shield received. iftikhar and all the finance are

setting up the different premium rates required and setting up billing systems. rin from our enterprise system and analytics team is designing all the data files that will be used to snd our members enrollment information to and from blueso the coverage is ready and in place for 1, 2025, and to make this transition azeezy as possible. anyone in the uhc will automatically be migrated to the blue shield plan unless they elect to go to a different plan. they will not need to fill won't need to log into our system, they are the blue shield plan. they are not going to get their medicare card and send that to us. they are automatically transitioned over. and rin is also busy working on alui other systems, because it is a big load to make get everything transitioned. we have people soft system, em, we have a document retention and management system. to be updated to hold the information for the

ew plan, but all that is ay. this is a summary of our transition timeline our dashboard we are keeping track of.portant tasks with the due dates to make we have weekly calls with blue shield. weekly calls occurring with blue shield. some on á&d#thsition plan some on communication and this is a very the transition plan, the joint plan we have with blue shield is over times as long as what is presented on the screen, but we are insuring we meet deadline we have and we are leveraging the support blue ld is providing to make sure that together we don't drop the on anything. in addition we agreed to success metric that will be monitored to indicate ho transition is proceeding. we will be tracking that first call resolution boside and on blue shield's side to once a member reaches out they don't have to

call multiple times to get the issue resolved. we will track d members are calling and address in future communications. our goal is to educate each and every impacted so that they are aware of what's going on and arthat they are not going to get lost in the shuffle.d so, in addition to our communications, we are track participation in our webinars for our mailed communication, we are actually ÷p developed a qr code we will ask members to scan from their phones to let us know they received the communication and on to raise their hand in that qr code and say, i need someone to reacme and blue shield has agreed to make a ermembers to walk them through so they don't have to the phone system, they can just say, i back and we'll make sure someone gives them a callback. in addition, we do still rely lot on us mail and to meet r

fiduciary responsibilities under our caf tearier plan, so our system en that mail is returned, we are going to make suwethe members by phone and see if we can get a good address for them and make sure they get the communications so make work with blue shield to make the out-bound calls to track down each and every member where a piece of mail is returned. so, in closing, again, i just we believe we have this.g; we have some quite a bit of experience in making plan transitions. we are leveraging e from partners both blue shield and aon to make sure follow best practices. all our divisions are working together seemlessly and i got to thank abby yant even within departments divisions operate in has been working feverishly to break of our managers is used working together to make sure we looic a look at the project we

are not the particular task so nothing is dropped, no dropped as we go through this. we do feel we can assure members that they will be transitioned up and we do know they will, we are going to address those immediately and use those as a learning experience to make sure that the rest of the transition goes even smoother. with that, any the presenters are available to answer your questions. >> when you hit the wall where maybe you find a e-mail works, or phone call or something or mail have other processes that you use to try to >> with every mailing we send out and again, we have a lot of members and so th every mailing that is sent out, we do make an effort to try to get a good address for those members, but we are that by leveraging e-mail more then we have past that really help the receipt of our information.

because we know that in today's day and age not as many open their mail box as frequently as they used to so we to leverage mail to make sure we meet our duties to in addition, like i mentioned, blue shield ag we will split up the responsibility to piece of returned mail, so we do-this isn't something we have done in the past, but something we are efforting to on a go-forward basis. >> are u contemplating using relationships with member organizations?ve retiree organizations and active employee organizations.those to help sfwh ? >> yes, after the conclusion of this meeting is on the project plan to reach out those retiree organizations to offer again, to cohost seminars and webinar, in halls, ready to go on the road and so, to whatever level that organizations

request, we will be willing and rt. >> it is helpful. >> can i ask a follow-up question relate today that? will be people where we cant find them and maybe they are off doing a transition will happen and they will come back from travels and say i shield card because they don't need to do anything, do i have that right? so, any existing uhc member is automatically going to be transferred over to the blue shield plan. they don't need to do anything so won't have break in cov b+erage and automatically transitioned over. agreement blue shield made with us and the way we proceed so no one falls the >> perfect. thank you. >> soap and all the work everybody is doing on is i was reminded there was a period of first was a consultant and did competitive bids and sometimes got them and good news sometimes when i win a bid, i

got the contract. bad news is, this competitive process and there will be a lot of scrutiny and i think less about it is to blue shield. but, we heard loud and clis that there are some real deficiencies with blue shield of californ as i said privately and will a lot of contversery about this lot of people to really consider spending the extra $67 million over a period of three years because of the problems our member employees and are some retirees have had with blue shield of california. at the end of the supported the winning bid. not because of my shield. it was because of my confidence in hss and myin aon. i don't know whether i should hald.

not saying this individually, but i saying the right about excellent customer service, commitment to member satisfaction, but you need to knowfrom the members that are not seeing a commitment to satisfaction. that was a hundred percent the problem that played out not just on this board, but at th5board of supervisors and in the s office and i want you to know what a big deal this is.is, you got it. the bad news is, there isn't going to lot of sympathy if you don't get this right.i think i speak for my colleagues on the board of supervisors and probably many people hegoing to ask members who reached out who were stay in touch with us to me as an elected official and member this board. if this isn't the onus is really on you now.

prove your critics wrong or you will have a lot more critics. i just hope that comes through loud and clear and i get there may be the best of the best, but maybe you need to send a message to the people who are not the best and part of your organization too, there is things spilling over. at the end of the day, i supported this as bear majority make sure blue shield is getting the message that it was the health service system, my confidence in them and aon that won by vote and got blue shield to make sure we regret it. >> thank you. >> i'll now it is our job to earn the trust of the members. we returned the trust of hss our past relationship on the active side. we earned that trust initially, now it is time to step up and

over the folks and earn that trust moving forward. need to reearn, because there were a lot of us, we took the other way out. the are not going down this road again, so you need to work of our members. >> absolutely. >> i can't emphasize enough. >> absolutely. >> thank you. very serious issue. >> we do open invitation for you. a required invitation for blue shield for tiffany and charles and whoever you want to bring.for public comment yet. we will let to regularly each monthupdate %" us, perhaps we will have standing item on our agenda to do sobe do want to understand--i also supported the move to blue shield, but it is very similar to what supervisor dorseyas well. also, i must your earlier hesitation answering the question, i know you do not have a crystal because

by using the word should be covered, 8+n1 everybody. you don't have to apologize, just letting you know that language, action matters and so turns into a will and but to be very candidate with you. now that we have chosen you we want to invest in your success and also need for your to demonstrate your partnership and commitment to us. thank you. >> i will share we are planning to be at next month's board meeting as well and so we anticipate ongoing communications updates dashboard metric to be able to share be able to identify and pivot where needed adjust the questions and to address 1-1. >> we will be hearing from members, but we dont want problems with our staff. we want r work to go as it should, smoothly. not be taking extra time with this, they should be doing this as a matter of their course as

should your people, so we are monitoring all the way around, and i hate to put it this way, but i will say it.gébefore, we can dump you again. aughter] and you can quote me on that, because i will work for it if you dont come through. i have been on this board a long time d committed to the members. the members are and foremost and they must get the services. ? their services, their piece of can get and that is the minimum we expect.as we sit here. bear that in mind. we have access to a couple offices down the hall. some worked here before we know how to crawl there and we kthe back doors. so we can get in when we need to is very very serious and our members work fo for the people who live in san francisco. a lot of us are born and raised here and but we are strongly committed to san francisco, to our city and county

and we expect that we get the best we can get for our health benefits and the other benefits that we bargained for and we work for and we expect no less then thcan get from everybody. we give our best and we expect so, we look forward to those ongoing from you. thank you. >> while you heard is board, we do also want to partners we are in it together so we want to work with you. we do want this effort of the transition to be 3su hear our words correctly, that we are serious, we have but now we also are expecting a lot from you. thank you. any other comments or questions? alright. let's open up for public comment. >> sorry. >> i just want to acknowledge that our partnership, we have approached this exactly that way, it is strong partne regular executive meets with both organizations and

we have assurances from the top of blue priority for them and they'll make it right. we will hold them accountable for that but i want you to know that relationship is in place, ongoing, it is transparent, and we-our s risen to the challenge. i th but it is truly remarkable to see how well we are doing and i hold my team accountable for making sure i know where they are taking care of everything. i use the rocket ship analogy that i don't want a rocket ship blowing up because somebody didn't want to tell us they were using wrong glue. that is how we are approaching this, team and it is this train is and but everybody is on-board and the shield continues to be strengthened. i cant problems with blue shield of 10, 20years ag i can speak in the partnership

with acive emplworks very well, and so we are building relationship and not relationship of a plan that was taken care of by none of the people in this room. so, i just make that very clear we are starting from a positive holding us accountable. that is great. we already got members helping test our system jz will continue to do that, and we will be back next month with update. >> thank you now we are ready for public comment. [laughter] [providing instructions for public comment which is displayed on the screen] we'll begin with in person public comment. >> thank yname is alyssa

afternoon, good evening commission. i that supervisor dorsey made. those are some of my concerns. i am retired teacher of 50 years with san francisco district. i retired three years ago, i think tiffany talked about how she rs had been through this before and i'm going to say this first rodeo with healthcare transitions. three years ago i sitioned from blue shield to united healthcar i'm very happy with united healthcare. g as a member and it is really important that you listen that this system serving--it was anything but smooth. teachers retire on june 30. we had keep blue shield until june 30 and there was nothing coming

from united healthcare as july 1. my husband is disabled had neuro surgery. i kept calling hss, p"kept calling blue shield to find out what kind of documentation he could present to his neuro surgeon and nothing was resolved, so:(fhe had to go to his appointment so he is standing at the desk of p( his neuro surgeon at ucsf they cannot serve him because that was not consairj was available for. finally they called me because i'm the insured member. nobody could tato my husband or i couldn't talk for my huba because of hipaa. hipaa didn't allow discuss that he's covered. you have to really know that ls. there is part of this meeting

where i thoulght i was back ying to decide if i should go for the extended warranty where they bring you office and you don't know what you are getting. that is how it feels. >> 30 seconds. >> i'm done. ÷4need to really pay attention and i heard that you are paying attention. you can promise the world, but unless it actually serves the members, you have not anything, you saved money, but you put us all in peril. thank you fo thank you for having remote access. in this building commissions do, but you do, so thank so much. >> thank you for your comments. >> appreciate your testimony. thank you. >> hello. i am dr. toby diner,

physician employed by the public health department, and i like to about the process by which you came to switch from united healthcare to in june, dr. steven follasbee, who was a long time commissionmember was the only healthcare expertatize on g and reading all the material provided at that meeting, he voted for the switch, because it was clear that no one could explain how blue shield was going to e the city $22 million a year without diminishing the service to a week later, dr. from the commission and a new aced on the board. she was sworn in the morning

and in the afternoon she that reversed the board i think it needs to be on the public record that was an appalling way for the commission make a change in such an important process as who retiree members have providing their healthcare. $22 million in savings is a great zram still unclear how it is that blue shield will provide vm"the same services, have the same providers" and yet save the city $22 million. this makes no fiscal sense. it makes no sense to me. i was a provider privately for i worked for the public health department. someone will lose and it will be the members. there will be providers who

will refuse to see because blue shield will underpay them. >> 30 second said. >>be very clear how you ev thank you. >> thank you for your comments.welcome to approach the podium. my name is norm galeman, and i'm a retired city gardener, and i just wanted to echo the previous speaker of the confusion that happen the change. i came to the june meeting, seem s like okay for united healthcare, and then i gosaying it wasn't and come down to this meeting, so quyour time. >> thank you for your comments. anyone else is welcome to approach the podium. çx

>> fred sanchez from protect our benefits.i hear today is encouraging. i am only half crazy, not totally crazy. [laughter] yes, like x1oregon said that during the reason their only hospital got rid of blue shield is because their capitation rates were higher, so they said, hey, they just got rid of them, but that's in hopefully we'll now where we are finding difficult so you work with people, make phone calls to educate that hospital will be the same. that is encouraging.this is three year contract and i heard different things where it was $67 savings and at another meeting million savings, so which one is it? i'm not sure which one but, it is a three

if hopefully this doesn't year we find bad things are not happening, can we get out of the contract? is there something in that contract language that iis as if they do not meet these-the cost copays, whatever things there are, you can look in it, but is a caveat somewhere in that contract this three year agreement to be terminated after a year if there is just cause? thank you. >> no one approached the podium. we'll move to our mo let us know if there are callers in the remote public comment at this time. >> 9 callers on the line, zero entered the queue at this time. >> thank you moderator. hearing no further calls, public comment is now closed. thank you. do we have final comments or questions from no. so, thank you tiffany and charles. we are generally very nice

bunch, but we are making sure the members concerns are to the family, and we really do look with you and we will hear from you. we look forward hearing from you next month. thank you. and so, call the next item. >> item 13, reports updates from contracted health plan representatives. this is a th plan reps can approach the podium. >> good afternoon. denise rodriguez with kaiser permanente and coming up to let you all know that debbie who has been your senior executive account manager for the last 6 years has made choices and one is to move to southern california, so she moving into the same position working on county çh of la, so he has a thing for big counties i think. so, laura zamen is her new senior executive account manager. i will hand it off to dbia few things

and laura will come up and do a quick introduction of herself and i know we are out of time here. thank you. >> thank you very much. i just wanted-debbie, kaiser permanente. i want to say thank you so much for allowing me to serve you. it has been a ivilege and just wanted to wish you all well and continue doing the great you are doing, thank you. i er to laura. >> thank you debbie, all the best to you. >> thafor coming. >> hi, good afteryou too long because we are over time. laura zamen and work with kaiser. >> can you speak into the mic. >> i am replacing debbie d anunited healthcare a long time ago. look forward work wg you all. i have history in insurance for years and the public sector, so happy to answer any questions, bu forward working with you all. >> welcome laura. thank you. alright. no other updates.

we'll take public comment. [providing instructions for public common the screen] we'll begin with in person public comment. no one the podium and move to remote public comment and the moderator will notify of callers in the queue. >> board secretary, the are 7 callers on the phone line, zero callers entered the public co >> thank you moderator. hearing no further callers, >> thank you. just one quick note. we actually can go until 4:30 but we need to get out by 4:30 so we don't intrude on the next commission. i appreciate being mindful of time with all that, i call this health d meeting to adjournment. thank you.

>> adjournment, 404 p.m. [meeting adjourned] (music). >> hi, i'm emmy the owner o emmy's spaghetti i offers workingth some kind of

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>> without firth r ado, will begin with the anthems countries, the united states of america, state of samoa, and the

of american samoa. thank you. london breed. appreciate having us