>> this is a [inaudible] worked with the residential, the merchants in the neighborhood, the non profits to make sure this is a vibrant area. >> even if you don't come to the convention and enjoy the public space, it is something that helps revitalize the neighborhood and bring energy to the neighborhood and more people to the neighborhood and shops and retail and shocase san >> i pledge allegiance to the flag of the united states of america, and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all.

>> thank you all very much. i am now calling the health service board meeting to order. thank you for the pledge and madam secretary, would you please call the roll? >> roll call starting with, commissioner-vice president hao, excused. commissioner zvanski, present. commissioner cremen, present. supervisor dorsey, present. commissioner howard, present. commissioner sass, present. commissioner wilson, present. with that, we have quorum. >> thank you very much. okay. this is when the first item of business is number 3, madam secretary do you want to read the-yes? >> item 3 is general pub lic comment. a opportunity for members to comment on any matter within the board jurisdiction not on the agenda,

including requesting a board place a matter on future agenda item. with that, i will read allowed the comment instructions for those joining online. anyone can approach the podium and i'll call when ready. remote viewing is available on sf govern and online. welcome public participation during the public comment periods, there will be a opportunity for general public comment at beginning of the meeting and a opportunity to comment on each item. in person public cault will be first then virtual. anyone waiting in person you are welcome to approach the podium now. each speaker is allowed three minutes to comment unless the board president deems public comment limits. a caller may ask questions but there is no obligation to answer or engage in dialogue. the health service board will hear up to 30 minutes of public comment. remote public comment for people who received accommodation due to disability do not count toward

the limit. members of the public attending via phone can call by dialing 415-655-0001 access code 26606226515 and press pound. you are prompted to enter the password, 1145 and pound. press star 3 to be added to the queue and you hear the prompt, you have raised your hand to ask a question. please wait to speak until the host calls on you. when your line is unmuted this is your time to speak. you will be muted when your time expired. for those watching on webex click the raise hand icon. a raised hand appear next to the name. when you are unmuted a request to unmute appears on the screen. select unmute to speak. once you hear, welcome caller you can begin speaking. when your time is expired you will be muted. click on the icon to lower hand. members are encouraged to state name clearly but you may remain

anoninous. ymous. i give a warning when 30 seconds remaining and placed back. we want to thank sfgovtv and media service for sharing the meeting with the public. we'll begin with in person public comment. >> good afternoon commissioners. dennis krueger, active retired firefighters and spouses. this is my first opportunity to congratulate director yant on her retirement as i missed the last meeting. both of the organizations we want to thank you for everything you have done for the health service system and the fact you will stay on longer for a smooth transition. on behalf of the active and retired fire fighters and spouse, congratulations on your retirement and thank you for the fine work

you have done over the years. >> thank you. anyone else can approach the podium. >> good afternoon commissioners, chair zvanski and director yant. i'm scott, protect our benefits, fred sanchez couldn't be here today so i'm here in his stead. i think like the rest of us, i have been watching a transition nationally as we have a whole new administration coming on, and my concern-maybe shared by others is how changes in federal administration and the laws will affect the insurance programs of our own health service board.

i am wondering-i understand that the board has advisory committees, whether actually there is some kind of study group or group of experts that will be working and hopefully organizations like protect our benefits could participate as well in anticipating and planning responses to major changes that may be presented to us. last year when the threshold changed on copayment on the pharmacy program it seemed to put out of business insureers. even a tweak in legislation can cause major shifts and i'm expecting there might be more then just tweaks, so that

was my concern of thinking ahead to the future. us retirees are accused of resistant change, but sometimes it is thirst upon us and i hope we can be proactive with it. thank you. >> thank you. anyone else for public comment? i'll much to virtual. the moderator will let us know if there is anyone in the public comment queue at this time. >> board secretary, there are two callers on the phone line, zero callers entered the public comment queue at this time. >> thank you modert ra. hearing no callers, public comment is now closed. >> thank you. that was your last chance. okay. thank you very much. now let's move to item number 4. >> item 4, approval with possible modifications of the minutes of meetings set forth below for

the september 12, 2024 health service board regular meeting minutes draft. this is an action item and presented by vice president zvanski. >> are there any-i'm asking colleagues on the board, any amendments or corrections for the minutes? anybody have- >> none. >> nope? good. okay. seeing none, i will make the motion that we approve the minutes as presented and let's go forward with any public comment that there might be with regard to our minutes. >> second. >> thank you. seeing no public comment-- >> i can take a virtual in case

anyone is calling in. >> okay. >> public comment is available for anyone who joining remotely. instructions are displayed on the screen watching webex. those on the line, press star 3 to be added to the queue and those watching on webex, click raise hand to be placed in the queue to speak. our moderator will notify of callers in the queue at this time. >> board secretary, we have two callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no further callers, public comment is now closed. >> good to hear. thank you. i keep forgetting we got phone lines too. okay. general public comment is now closed. we are now going to take a vote for the approval of our minutes as presented. >> roll call vote starting with

vice president zvanski, aye. commissioner cremen, aye. supervisor dorsey, aye. commissioner howard, aye. commissioner sass, aye. commissioner wilson, aye. with that, unanimous vote. >> okay. thank you. good to know. and now number 5. >> item 5, president reportism this is discussion item and presented by vice president zvanski. >> thank you all for joining us today. our open enrollment period was successfully completed. october was the magic month so now we are moving forward and we'll see what the new year will bring us and concluding out this year.

i'm missing president hao with this point, but i'm sure she will be back next month and i like to now ask if my commissioners colleagues have any comments that they like to add to the meeting today? no? thank you. mrs. yant, do you have anything you like to add at this point? or you go for number 6, director's report? >> director report. >> sound good. okay. double checking. thank you very much. i guess that concludes our report for the moment. >> i can- >> public comment. >> any public comment with regard to this? we don't have a lot to say yet. just wait. >> with public comment open, i'll notify everyone that who joining on sfgovtv and webex public comment is open. in person public comment will be first

which no one approached the podium. callers on the line press star 3 to be added to the queue and on webex click raise hand icon to speak. our moderator will let us know if there are callers in the queue at this time. >> board secretary, we have three callers on the phone line, zero callers entered the public comment queue at this time. >> thank you moderator. hearing no further callers, public comment is now closed. >> great. thank you very much. and now let s move to number 6, director's report. >> item 6 director's report. this is discussion item and presented executive director abby yant. >> good afternoon commissioners. abby yant, executive director health service system. i echo commissioner mments about open enrollment. it is good to be in november

but doesn't lighten the work load. there is a lot of follow up and open enrollment went very well, especially in light of the transition of the retiree healthcare united to blue shield. there was a lot of pre-work that was done that i know you were informed about, but that made a big difference. congratulations to the team. it was really successful and true partnership with blue shield and went very well. we'll be hearing the details of the open enrollment at the next meeting and then later in my director's report there is operation report for the month of september since we did not have a regular health service board meeting in october. i also mr. krueger stold my thunder. i did decide to delay my retirement until march, so you have to put up with me a few more months and

recruitment efforts are underway with dhr in bringing on berkeley search consultants, so that is moving forward as we outlined at the last meeting. the ethics commission has a lot of new laws and regulations that we are all trying to understand about our relationship with people outside of the city, and so many have attended some of the trainings and there is often more questions then answers, so i think these next couple months will shed light on and clarity around what is permitable and what's not, but if any commissioners has a question, please let us know and we can research that particular question with you and for you, so we all kind of stay compliant with these new rules that are

quite detailed. the-i know there is a kaiser representative in the room. they are good good informing of us the strike still occurring in southern california with mental health workers. we have been assured the members are being served often without network providers, but their needs are being met is and i know we all like to see that resolved sooner then later. i do still sit on the healthcare affordability bord advisory committee. they have a monstrous task undertaking how to contain health cost in the state of california and there's just ongoing work being done to do it. it is a very very comprehensive project and we will-they are starting to see impact already with some mergers and

acquisitions being reported to the board. nothing where there is any kind of finding or anything thus far, but it is giving a number of folks staff included at the state experience in finding out the regulations really work in the real world, so we'll continue to follow that closely. i wanted to take a moment to ask carrie to introduce the newest member of employee assistance program. yeah, if you would, please. >> good afternoon commission. carrie, with hsf. very excited. we are adding to our team. we've searched long and hard. i think took maybe a year to fulfill our senior e a p counselor position so i like to welcome doug sear to our team. [applause]

doug has quite a bit of back ground working with first responders and excited to bring him on. >> the program continues to expand or have a good reputation and uptick throughout the city with champion model we have and there was a celebration down on presidio couple weeks back or maybe months now, and so it is rewarding i think to see the stickiness, if you will, of the well being program. you'll hear from michael visconti the contract manager later on the agenda on life and disability rpf about to be released and if you have questions about contracts you can let me know. there is a operation dashboard in the director's report showing the

activity in september and as i mentioned earlier, there was a quite a effort to get a lot of calls and webinars started early and it paid off, so we are very happy to report that that was a really good success and we are looking now actually looking at what that first quarter of 25 will look like from a member service support point of view and the team i think is ready to address that and take it on building on the success they had in the pre-enrollment time. so, i think that is all i have. any questions? >> any questions colleagues? no. that was very thorough. thank you. we look forward to 2025 and seeing what's going to change and what's going to-what we have to deal with at

that time. thank you so much. and now, is there any public comment with regard to the director's report? going once? going twice? public comment is closed and we will move now to item number 7. >> vice president zvanski, shall i check the public comment online? >> apologize. yes, please do. >> public comment is open. callers on the line press star 3 to be added to the queue. for those watching the meeting on webex, click raise hand to be placed in the queue to speak. our moderator will let us know if there are callers in the queue at this time. >> board secretary, we have four callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no further callers public comment is now closed.

>> thank you. interesting now we are up to four callers. we are usually just have two. i'm glad people are interested and at least calling in to listen. that's a good sign. okay. is there any public comment on this item? okay. let's move to item number 7. >> item 7, sfhss financial report as of september 30, 2024. this is discussion item and we will be in the presence of yuri the wb analyst to present and iftikhar hussain sfhss chief financial officer is joining remotely. >> great. welcome. >> good afternoon board members. my name is yuri. principal administrator.

your attention in san francisco health service and financial report highlights for [indiscernible] the fiscal year balance is projected to [indiscernible] the decrease is due to $9 million in stabilization and settlement and higher medical claims based on the experience for the first 3 months of the year. [indiscernible] projected around $16 million. interest income of the year projected at $3 million. healthcare sustainability fund, projected to decrease by $2 million with ending balance of $4.6 million.

general fund administrative fund, net activity is ahead of budget mainly due to vacancies. audit update, mgo presentation this month during this meeting. iftikhar and myself will be happy to answer any questions. >> do you have any thought as to why the healthcare sustainability fund will decrease by as much as 2 $2 million? >> yes, this is iftikhar. last year in the budget process there was the wellness activities was moved into the trust as a result of the budget discussions with the mayor. that's causing a higher use. we are still solvent.

projected to be positive the next couple years, so at some point people have to look at how much are in the fund or look at the assessment which is now $4 and possibly increasing that. >> great. thank you very much. are there any questions? comments questions? hearing none--okay. thank you for that explanation. >> thank you. >> and now- financial report. >> i can open public comment. >> right. just want to make sure the report is complete? public comment on this item. this is your chance. it is all about money. it is always all about money isn't it?

okay. seeing no one approach for public comment- >> i can open remote public comment. >> please do. >> any of those who are on the call can dial in and press star 3 to be added to the queue. those watching on webex, click raise hand icon and place in the queue to speak. our moderator will notify of any callers in the public comment queue at this time. >> board secretary, we have three callers on the phone line, zero callers entered the queue. >> thank you. public comment is now closed. >> thank you very much. let's move to item number 8. >> item 8, annual audit report. this is action item and we have our staff members from mgo, including craig harner and yia yiang to present and iftikhar hussain is joining remotely

for any questions. >> great. welcome. >> alright. good afternoon members of the health service board. craig harner, partner with mgo. my responsibility is overseeing the audit services, making sure everything is done on time and then signing off on the final audit reports. with me today is my supervisor yia yiang responsible for day to day audit work and overseeing our staff that works on it, so he works directly on a daily basis with iftikhar and yuri to get through the audit. today we are going to present the audit results of the june 30, 2024 financial statements of the other employee benefit trust fund, so i want to let everybody know, the audit does want include the general fund or sustainability fund t is just the benefit trust fund. >> okay. >> we'll go through-next slide. go through three areas. the result of the audit, our results of any internal control items or

compliance, regulations and the last part will be is required communications and these are summary of how the audit went that we are required to present to boards when we come and present the results of the audit. first we'll do the audit results. we issued the report on october 21 and happy to report we issued unmodified opinion on the financial statements and unmodified opinion, the highest level of assurance we can give the organization. this is called a clean opinion. another year, another clean opinion on the financial statements. so, we perform audit in accordance with what is called government auditing standard and this adds additional layer from the normal audit procedures we have to do and what it is, we have to consider internal controls over financial reporting and then any compliance with law and regulations. we dont provide assurance or

opinion on internal controls, but as part of the audit if we become aware of any defishanies we have to report to the board in the report. happy to report there were no such internal control deficiencies for the year. secondly, any compliance with laws or regulations. again, we don't provide assurance, however if during our audit become aware of any non compliance with laws or regulations that could materially effect the amount in the financial statements we have to report that to the board and happy to report, there are no such non compliance with laws or regulations. last we'll go through the required communications. next slide. we break up into different areas, what we call the qualitative aspect of accounting and other matters

including the audit. there were not any new accounting standards, nothing the governmental accounting standards board required to implement over the last year, so another year they left the trust funds alone. there is something coming in i believe next year or year after that will effect the management discussion and analysis but we'll work with iftikhar and his team for what those are. with that said, there is a couple of qualitative aspects of accounting and auditing sns just numbers there are judgments that have to be made to produce the financial statements. the first being the accounting policy and these are the policies that management chooses and these are what dictates how transactions get reported and recorded in the financial statements and reported here in the report. there were no changes to the existing policies and no current policy

lack authority guidance so everything is on the up and up there. the second and for this set of financial statements, probably more important is significant estimates and disclosures. under accounting management is required to make estimates on balances that go into the financial statements and the biggest one effecting the benefit trust fund is there reserve for claims. the reason why this requires complex calculations done by aon using claim experience data lag triangles and assumptions about the future with run out. what we do here is we actually contract with our own actuary and provide the same information aon gets and they reproduce the results to make sure the amount are reasonable so happy to report again, we were able to get assurance that the assumptions

and methodology were reasonable and accordance with accounting and actuary standards. no significant difficulties during the audit or working with management and the team at hss. we didn't have disagreements with management and as far as we know, they didn't consult other accountants for second opinions how to record transactions. no issues there. we didn't have any what we call uncorrected misstatements and no material corrected statements. all in all a very clean audit once again. with that, i'll be happy to answer any questions. >> are there questions? >> how many years have been you been doing the audit? >> i believe since fiscal year

2020. >> thank you. >> yes. >> we have anything more in depth to ask? >> i would comment. the report is very high level. it doesn't provide any significant detail about individual plans. uhc, kaiser, some on kaiser, but blue shield and so on, so it really isn't at a level that provides a whole lot of analysis for us. i can ask questions about it, but i think the important thing is if you have unqualified opinion on the financial statements that good and if internal controls no deficiencies in internal control that is good so the value of the audit is the audit opinion and assurance and we appreciate you guys taking care that.

>> thank you. >> thank you very much. i actually appreciate your expert opinion on this, so thank you very much. any questions from board members? nope. seeing none, thank you very much. >> thank you. >> i can open public comment. >> yes, you may. >> public comment is open. instructions are displayed on the screen. in person public comment will be first fallowed by remote public comment. for those on the line, press star 3 to be added to the queue. for those watching the meeting on webex click raise hand icon to place in the queue to speak. anyone may approach the podium for in person public comment. no one approached the podium. we'll move to remote public comment and our moderator will notify of any callers in the public comment queue at this time. >> board secretary, there are

three callers on the phone line, zero callers entered the queue at this time; >> thank you. hearing no callers, public comment is now closed. >> thank you. keep forgetting that. thank you for reminding me. appreciate it. okay. if there is no further public comment anywhere, shall we go to item number 9? >> item 9, board education. pharmacy benefit trends. this is discussion item- >> are there votes? on the audit findings? >> you are correct. annual audit report is a action item. >> okay, do we need to take roll call vote? >> starting with vice president zvanski, aye. commissioner cremens, aye. supervisor dorsey, aye. commissioner howard, aye. commissioner sass, aye.

commissioner wilson, aye. unanimous vote. >> unanimous, great. thank you very much and thank you for reminding. >> i'll repeat the item for those in the room and online. item 8 board education pharmacy benefit trends cht this is discussion item . >> thank you. good afternoon commissioners and supervisor. this is-i'm account executive with aon pleased to introduce to kelvin richards. vice president and pharmacist within our pharmacy practice and brings 15 years of pharmacy experience with over 10 at large pbm leading strategic develop and clinical initiative and served as [indiscernible] as worked within the retail pharmacy setting.

he is going to education with you today and i'll turn it over to him. >> welcome. >> thank you. good afternoon. thank you for having me. kelvin richards,er a pharmacist with aon pharmacy practice. i'm here to present insights on pharmacy benefits. some of the trends we see in the marketplace and activities concerning and good. to go over a few of what we expect-a few items we expect to happen over the next few years that might be relevant to this group. the agenda outlined on the next page while it is simple there is plenty for us to talk about in each of the topics i outlined. the over arching trend will be

certainly the pharmacy marketplace. we'll take a couple minutes and dive into clinical insights. we'll talk about a medication class called glp1. get into what those are in a second. some of the new invasion in the specialty medications, how they impact the plan and members. also talk about the marketplace in general. we'll look at the pbm's, some good and some bad. what is said bay the ftc, some lawsuits ongoing and wrap up looking at some of the legislation that is facing this space quite a bit on the front from the states, some federal, lot for us to consider, a lot of possible changes, the election was mentioned will bring that up briefly on what could happen, but a lot for us to talk about. on the next slide, i outlined our view, aon's view on the pharmacy marketplace. it is certainly complex. there is a lot to read on the slide.

this is something i put together as a reference for you hopefully later on. we'll dive into each pillar here in just a second. we'll talk about some of the major changes that we are seeing in the world of diabetes, medications used to treat weight loss. talk about invasions, new market entrance in the specialty medication and talking about medications like humara and talk about legislation and pbm's. kick off diving into my personal favorite topic, the clinical insights and glp-1 glucgone like peptide. a group of medications comprising nearly 10 at this time used to treat diabetes or can be fd a approved to help with weight loss. this medications are incredibly effective. they have been around since 2005.

we had quite a bit of experience. much more news recently given the cost and popularity we have seen over the last 2 or 3 years. medications work by suppressing appetite, slowing digestion. effective controlling diabetes. the lizard is relevant. this is a point of conversation for you all tonight. this is the hilo monitors. researchers discovered this critter eats once or twice a year due to compound we later use to develop the first medication here. it is the predecessor i think for all of this part of the discussion that we will have here. as i mentioned, glp-1 medication have been around since 2005. early medications were not as popular due to the fact they require

daily injections. some more modern medications. what i presented is information from the warehouse. on the left side spend. two groups of glp-1 group medications those for diabetes and those where weight loss and the spend in the last 2 years due to new medications entering the marketplace, like ozempic, mon zaro and [indiscernible] is hard to go out and not see a ad for medication. they are incredibly popular and over the last 3, 4 months spend increased. obesity impact more then 50 percent of individuals and expect the drug to be heavily utilized as more research is done so this is a problem we are facing

with increasing cost that isn't going away any time soon. oen the next slide, look at diabetes specifically and put a pin in weight loss for a second. we'll look at 2023 versing 24, glp-1 utilization on the left. the number of utilizers. the growth, the trend on the right, the percent changes period over period and different medications specifically approved for diabetes. on the left has nearly no utilization at this time. nearly 20 years old, the newer medications that are administered once a week, have better weight loss and more popular and you see monjaro and ozempic present the kidneys and heart and populararity sky rocketed. >> excuse me, when you talk about the

popularity, is that based on mostly the individual requesting that or is that really coming from the providers as they find that these medications are more effective? >> i would argue it is a combination of both. certainly weight loss is a big component of individual requesting these medications. the newer medications can cause weight loss between 10-20 percent individual body weight. the closest thing to a silver bullet for weight loss. at the same time, research shows the medications are effective controlling blood sugars, protecting kidneys and heart. the 2022 recommendation by the a d a do recommend the medications as a option for first line therapy for diabetic patients. in certain populations. i think our individuals moving to these sooner then they would 5 or 10 years ago because they are better choice then some of the older medications

might have put peep in the hospital because of hypo glycemia and these medications don't have that problem and i expect that will change moving forward as more oral medications come into the market. now most people are scared of injections. natural deterrent. we have one oral medication now available to us, but many more studied and the new ones have just as much weight loss associated with them as the newer injectible products. that answer your question? >> that does. thank you very much. and i also understand i'm not adverse to injectibles but i xoe know a lot of people are, so the progress with more oral medications that is probably more effective in the long run. >> agreetd. agreed. >> and helping people with anxiety over injectibles. >> agreed. >> thank you for the explanation. >> of course.

as you imagine given the growth we have seen in this space, a lot of plans had trouble trying to determine how best to cover these medications both for diabetes and weight loss. we move to the next slide. there is not one perfect solution. plan specifics population has to be considered, we have plans we worked with who moved forward with hands off approach. putd no restrictions in the medications through the pharmacy benefit to acsess them. no lements. limits or prior authorization requirement. you can imagine that is very costly endeavor very quick given the popularity they are experiencing, and on the other extreme, we have seen plans had to remove coverage completely given the costs associated with these plans. claiming if they were to continue, they could end up in bankruptcy which certainly a concerning problem given how effective these medications

can really be and we had experience with everything in between. there is a lot of different options and how to approach the medications and won't say one is the best, but we do have i think majority of the plans considering some level of minimum control for these medications. there are generics for some of the older products that are still viable options. they are still reasonable options that might be good first line treatment options. some plans prefer to push those before moving to the more expensive newer brand name medications. >> do you see the costs going down at some point or basically moving to they also will become generic? >> i wish i had better news and you teed up the next slide nicely so i appreciate that. slide 9, i outlined the current glp-1 immediateications available on the marketplace. the right side of the slide you see which are fd a approved for diabetes, and which for weight loss

specifically and the anticipated generic launch dates. i wish i had better news for the board, but none of them are around the corner unfortunately, or none of the major players. the ones we expect to see in the near future. >> can you go back one slide? the minimum restrictions. the bmi, above 27 percent. who makes these rates? >> good question. some is set by respected pbm and? ? nationally. europe is different. europe has more restrictsive criteria what they consider someone to be obese. over 30 or 35. there is element of subjectiveness in

this. >> is that by each health service makes their own or is there a standard? >> there is a standard definition across. plans can choose to be more restrictive if they feel that is in the best interest of the population, but interest is a national definition set by endocrinolgist what the number is, the 27 and 30 is where it comes from. >> thank you. >> is it significantly different enyou'ref? >> it is higher. obesity starts at 30 and 35. they are more aggressive i would say. >> interesting. >> we have seen plans choose to mirror that in their design elements. not saying it is wrong or right, but relaying facts. >> it is what it is. >> go ahead. sorry. >> i seen a number of stories in the popular press about the promise

these might hold for addiction medications for substance use disorders and alcohol use disorders. this is stuff i read in the newspaper. somebody familiar with the space, is there discussion this is something that looks like might hold promise? >> it is a possibility and you will see on the future slides. they are studied for multiple indications, alzheimer's is one, addiction, cardio vascular disease, erictile dysfunction. there is elements to truths that. obesity is associated with a lot of different conditions. even infirtility there were no news article called ozempic babies. there is a element of truth to that. whether they should be used to treat it is another discussion point i think.

>> any other questions? >> good conversation. i appreciate it. >> thank you. >> we will skip ahead to slide 10. i did want to speak for a second, we talked about the future state of this medication class. beyond pharmacy benefit managers helping to control costs drive appropriate utilization we have vendors who entered into the space, for diabetes and weight loss to help control and promote health in these individuals, most of these services coupled with health plan are introducing nutritionist, endocrine aulgist, new technology in the space to insure we get the best outcome possible. we are seeing more and more, weight watchers changing their business model to accommodate the glp-1 and expect we will see more moving forward. before we switch, i want to set up what i expect for the future of this.

this is slide 11 relatively complicated picture and apologize for that but i want to show research being done. in green, glp-1, every number here represents a specific study being done by a manufacturer. glp-1 are just one facet of all the research being done in this space. manufacturers are starting to look more and more into how to combine these agents with other entities to approve weight loss and glycemic control. it means more expensive medications in the future so expect this to continue in 25, 26, expect we are already tracking new oral medications we expect to come out next year and new indications as you mentioned if we flip to the next slide is a big part that as well. looking how the medications

might help to use individuals in heart failure or dealing with substance abuse e disereders. there is expanded research being done to drive the trend for the significant future. any questions before? >> not seeing any. >> alright. we will switch to bio similars and a more positive outlook on the financial piece of the pharmacy benefit for the foreseeable future. before we dive into the topic i will set the stage for what they are. they are biologic medications that are actually grown in living cells and different then traditional medications. because that, they don't have a true generic available to them. they don't have a copy that can be leveraged by a manufacturer. we call them a bio splar. similar. they are similar to the brand product

but not identical. they are still a brand medication in the eye of the fd a, have a different approval process. because of it competition it drives down the price. humara is a great example. in 2023 the patent expired and see manufacturers create and get approved medications for humara to drive down cost for the plans. on slide 14, outline data for the plan specifically now looking for the san francisco plan, the number of bio similar prescriptions based on number of prescriptions in 2023 and you see increase in bio similar in the kaiser plan at the very bottom. blue shield ppo and hmo, didn't

see bio similars as they made their decision late and were looking to get the best bryce for a bio similar available to them. and also insure there was adequate supply. i do think as we move from 23 to 24 we will see a much different graph, especially into 2025. >> okay. >> i didn't to present data from two big pbm on the next slide. exspress scripts looks at the bio similar utilization for the first 7 months of 2024. both of these companies took mandatory formulary approaches during the begin ogf the year that forced utilization. there was uptick of bio similars. i expect other pbm will adopt a similar strategy moving into 2025 now that we have 10 different bio similars available for humara and see considerable cost savings because of it. between 40 and 60 percent off

the list price. >> wow. >> questions? >> just go back for a minute. there is a marked difference between the cvs health versus express scripts. do we know why cvs health went into bio similars sooner and to a much greater capacity or degree? >> cvs introduced mandatory requirements on the form yul ari. express was later then year. i would argue all pbm acted later only because sourcing, supply was a major concern here. there is a tremendous [indiscernible] nob most prefer not to move those patients multiple times. if you move a bio similar you do once

and stay on the specific bio similar for at least a reasonable amount of time and not move them if you have sourcing issues. >> that makes sense. thank you. >> of course. real quick on the future of bio similars, more exciting news as we have the medications sculara a cousin to humara. a bio similar launch in 2025 as well as imbrel in 2029 so a lot of positive new changes in the marketplace specifically in this space, the dry cost savings. it is starting to balance out the growth we are seeing in diabetes and weight loss and glp-1 space. this something many have been waiter for quite some time. >> i see [indiscernible] is also- >> nova log is another one. sim pony, relatively popular medications for variety of conditions, diabetes, multiple-i think it

will take time. the true generics see cost savings in 6-12 months and bio similar probably have to wait 12-24 months for savings because it takes longer to manufacturing these medications, harder to manufacturing, harder to get to patients sometimes. you will see savings there. >> okay, just matter of time. >> just matter of time unfortunately. >> thank you. >> the last topic on the clinical insights i'll mention and this will focus on the next time we meet has to do with gene therapy. this is what many considered to be science finkz fiction for the longest time. we manipulate genetic material to cure diseases and have a handful of products available in the marketplace. typically not administered through the pharmacy benefit, usually the

medical side given the care is and administration. they are incredibly costly in the millions of dollars. and i have in the appendix outlined all the medications and those studies to discuss moving forward. i think it is important for plans to know these exist to understand patient population s, some might be more prone to using these medications then others to make sure we are ready for the future. any questions on the clinical insight before we move on? >> i will make a quick comment. i think one thing we see is incredible progress in healthcare and pharmacy that benefit people and i think the challenge we have as a board and society too is none are cheap so we balance how to help people live longer or better and at the same it time do in a fiscally sound way, i think it is great you are coming and keeping educating everybody and update because nobody chose the number of

dollar signs attached, they are very expensive but when we take the view, the person who is obesity is well managed or diabetes is well managed we save the kidney disease down the line and save eye disease down the line, so big picture ways to look at it and that is is a challenge ongoing but thank you for coming. >> greet. great. >> good point because we is a finite population we specifically deal with, so we want to watch that and provide the best education we can for our constituents. thank you. >> the big picture is the best approach. look at hepatitis c we were able to cure 95 plus percent. they were expensive. cost $95 plus percent. they were expensive. cost nearly hundred thousand dollar. when you compare to the cost of hospitalization, transplant, very much a clear winner there. we will shift and talk about

the pbm industry, pharmacy benefits and what is going on there. they have been the news good and bad. we have now in this country over 300 registered pbm's. large, small, medium, all over the place. the majority of prescriptions are certainly handled by the big 3, cvs, optm and exspress scripts. it doesn't mean the others are less important and certainly working to drive change win the space. talking about what that is. some of the integration we are seeing among the big three. what they are trying to achieve, other themes in the smaller pbm. what that means for the industry and what they are trying to do. little about wlaut what fdc is concerned about before we dive into the legislation. for we look at the big three they hold roughly 80 percent of the prescriptions

that areed a ministered in this country. cvs, express script and optm. i will not go through the vertical integration efforts. we'll talk about cvs as a example given it is first on the list. purchased etna 4 years ago combining the prescription manager with plan sponsor. etna and silver script for medicare. they own cvs specialty pharmacy and introduced clinics taking hold of the prescribers and also driving all the rebates through the aggregateer, zincer. they consolidated healthcare into a single point hoping to drive efficiency and reduce cost. there is the concern that not allowing others into the rkt maplace might do harm as well so there is good and bad like with anything else. it is a common threat we are

seeing and one i don't expect to change. there was rumors cvs was considering breaking up with their new ceo. that seemed to have squashed and dont expect anyone to change that moving forward. outside the big 3, page 21 here, we have some of the smaller pbm's, companies like [indiscernible] focus on clinical initiatives. they believe that big three pbm's are encouraged to drive as much volume as possible. that how they make money, and these others are trying to focus on the clinical value they offer trying to follow guidelines as much as possible, reduce utilization of certain medications. certainly may not be as efficient or organized as bigger players but they are working to disrupt the marketplace a bit. we have others focusing on price. companies like capital rx and

mark cuban cost plus trying to drive initiatives moving from traditional transparent arrangement of new ways pricing drugs, which ultimately at the end of the day really bring out the need for better transparency and understanding how these drugs are priced, who is paying for them and what is creating the astronomical cost we have to bear fwr the brand medications. >> i like your comment, know there are different shades of transparency. >> there are different shades of transparency. >> very important to know. >> the ftc has taken a keen interest in the pbm market play place this year. early summer they published their findings looking at the role the pbm play in the price of medications and concern with vertical integration. it was over 70 pages that

looked at the role in independent pharmacies as well. pharmacy closures and good or bad, had points that were certainly caught up by congress and others to look deeper into what has been going on. in september, the ftc sued the big 3 for their role in increasing prices of insulin. that is ongoing lawsuit. the big 3 have come out and refruited several of the points made in the argument and i do think again there is two sides to every coin and lot of fingers to point but this is a major point of discussion i believe will continue into 2025. looking at ways we can improve oversight here. the last piece i'll mention on pbm is audit fiendings at aon. oversight and insuring that what is delivered is actually delivered is important. 2024 if we move to slide 23, we

saw 75 percent capture rate of meaningful errors for the plans we audited. up from 55 percent only 5 years ago. we have 65 percent recovery. investment and audits. not saying the plan should audit with aon in way shape or form, but there is certainly a need to make sure we make sure that what is delivered is actually delivered. i don't think pbm are operating under any nefarious activity but we are human and there is a lot of moving parts in the system. any questions? >> is there a reason why they increase so much? >> a large part has to do with the volume we are seeing. the changes in the glp-1 utilization and complexity in the plan arrangements between the manufacturer and pbm. >> okay. >> these are cumulative totals?

>> correct. alright. the last topic we'll touch on is legislation and i'm not a lawyer. i have to say that. but i will do my best here to go over some of the interesting trnds at the state and federal level. we have at the close of 2023, 1 50 bills that focus on pharmacy practice. there is a lot of discussion here, again some growing off the ftc concerns how to better regulate this space. we will start the discussion with california. seems to make the most sense. the biggest bill we had in recent history is california senate bill 966, which attempted to put in some additional controls on pbm's insure they were sharing the fees, the calculations on their fees, ultimately this bill was vetoed by the

governor in september of this year and i have put in here some of the comments he made as to why he thought maybe there will be a better approach moving forward. if we look at other states, california isn't alone wanting to try to get better transparency and understanding of drug pricing on slide 27, we have 5 other states who passed very important legislation, florida, minnesota, tennessee, west virginia, oklahoma. trying to drive change in the space. requiring parody between retail and mail pharmacy, prohibit mandatory mail practice to no longer to use mail order and prohibiting exclusive specialty arrangements so giving members the choice. there are other things here to do with pricing, insuring transparency there. this is i think a likely continued effort by the state. wouldn't be surprised if california passes something in the neex

nerks year or 2. >> these are all southern states, why these particular states have accept minnesota, have really focused on the issue and other states perhaps in the midwest have not? >> every state started to look at this in some form or fashion. some are more aggressive then others, and they have been. part has to do with population whether a growing number of retirees in that state and the way those prescriptions, the access to the prescription impact those individuals could be a cause. i don't think i represent 5 here, it is limited to just these 5 states. >> i don't-you don't see the northeast here. when you talk about retirees, i look at these states and i go--these

states attract retirees because the cost of living are a lot less then some in california. >> i a little warmer. it isn't to say the northeast isn't doing anything about it. if we flip to slides 28, states have started to create what we call prescription drug affordability boards. these are groups specifically tasked with trying to determine why pharmacy prices are so high and trying to create ways to reduce pharmacy prices. this started in maryland in 2019, the first state to adopt this. 13 have followed suit and created similar boards. california doesn't have one quite yet. there is a similar entity that is working to better understand drug costs in california. the healthcare access information group. you see on the right side of the slide

is tasked with very similar activities trying to understand why these drugs are priced the way they are, try to get ahead of the new drugs coming to marketplace to understand where they fit in. slide 29 we will switch to the federal side of legislation. it hasn't been as active as individual states. there have been discussions in both chambers with pbm and with drug manufacturers, trying to figure why these medicationerize so expensive. sometimes in combination. no action has been taken to really drive down prices. there has been some preliminary legislation passed. the ira. unfortunately sweeping yet to try to reduce costs, but it will be ongoing piece of conversation as we

move into 2025. was there a question? >> no, just commented. going forward we can see that. >> yes. it is looking at the future of the prescription drug legislations. i do think at the end of the day, we will see more bills pass because 5 started to press heavily on it and expect others to follow suit. we are estimating between 10 and 15 states will have passed transparency bill by the end of 2026 and we'll start to see federal action as well. on that note, if we move to slide 31, and the slide that in full transparency i created before the election last week thinking this might take longer for us to vet out, there are things we can discuss around what the republic party might do with regards to perception drugs. i think the platform is looking into why the cost of drugs are so

much different then other countries, other developed countries. we pay more for medications here then countries in europe do and that is a point of concern. trying to understand if sourcing medications outside the united states is a viable option. those are two big topics regarding perception drugs specifically that could be discussed in the next year or two. alright. the last slide here is the second take home slide. summary of perception drug legislation outlining what was discused at the state and federal level. again, a lot of active discussions how to approp this. there isn't a silver bullet but a lot of common themes. there is much more we could discuss if we had a few more hours as we wrap this up we talked about ozempic babies and can talk about pharmacy closeier and impact of the pop ulation and

activities. small taste what is going on. i appreciate the time and opportunity to speak with you all. any questions? >> excellent. >> thank you. very comprehensive. a lot of food for thought here. >> a lot to think about. thank you. >> thank you very much. okay. is there any public comment on this presentation? this is your chance. >> without anyone approaching the podium we can move to remote public comment. >> i think so, let's do tat. >> the instructions are displayed oen

the screen. those on the line press star 3 to be added to the queue. those watching on webex, click raise hand to be place in the queue to speak. our moderator will notify of callers in the queue at this time. >> i will support the moderator. seeing there are three callers on the line and no callers raised their hand. with that, public comment is now closed. >> very good. okay. with that, let's move to the next item then. >> item 10, blue shield of california medicare advantage prescription drug ppo plan transition update. this is discussion item and presented by rey guillen with chief financial officer supported by olga

stavinskaya-velasquez joined by rob smith with blue shield of california and tiffany gil, strategic account executive with blue shield of california. >> seeing everybody moving forward. good idea. >> good afternoon commissioners. rey guillen, chief operatoring officer for health service system. i along with hss operation manager olga stavinskaya-velasquez and senior leaders from blue shield of california will provide you with a update related to the transition of the hss medicare advantage ppo plan from united healthcare to blue shield. i'll start high level review of the project as well as reminder of the key objectives set to help insure a successful transition. present a dashboard that highlights progress related to task and

necessary to ready the systems for the new plan. review mile stones from the member experience and review metric our staff and blue shield tracked to insure we stayed on path towards success. olga will step and provide a report of various member engagement activities and metrics. we'll turn it over to blue shield to provide a update from their side and finally let you know our plans for transitioning focus from monitoring plan enrollment and implementation to measuring and insuring our members continue to receive the same level of care and service from blue shield they currently enjoy. at the june 2024 meeting this board approved blue shield of california to replace united healthcare as the administrator for hss medicare advantage ppo plan effective january 1, 2025.

this involves transferring 18.500 medicare members and 1500 non medicare members from united healthcare to blue shield. from the outside we set two specific objectives to guide our plans and efforts related to the transition. one, deliver a smooth transition for members and two, address the concerns of members and reassure them they will continue to receive the same excellent care they are acustom to. a plan transition of this type requires a lot of set up from our various systems and processes. this progress dashboard highlights several of the important work streams needed. many of these items needed to be completed prior to the start of open enrollment such as calculating the premium rates and configuring the plan details and various systems. others such as the development

of the plan documents are targeted to be completed by january 1. the one item noted at resk is development of the electronic data interchange files used to transfer member enrollment information back and forth between hss and blue shield. we still have work to do on the files prior to december 2, when we are scheduled to send our first production file to blue shield. our enterprise system and analytic team is meeting daily with their blue shield counter parts to help insure we meet our deadline. again, one of the key objectives is it assure members they will continue to receive excellent care they are acustom to and address concerns from members as we become aware of them. to do this we develop implemented a very comprehensive education campaign. in the update to the board in

september, we outlined efforts up to that point. on the slide we are presenting our member experience milestones that occurred in the month of september and october and also looking forward to january 1, 2025 when the members blue shield coverage becomes effective. in september and october, we partnered with all our major retiree association groups to host in person and virtual town hall meetings where we explain the transition in detail and responded to member questions and concerns. of course, open enrollment ran from september 30 through october 25. during that time our office was open to inperson support and we also had on site representative from blue shield able to sit down with members as they walked in and had transition related questions or issues. from the outset in collaboration with blue shields we established a set of

shared success metrics we jointly monitored to make sure we meet our objectives. the metrics designed to track efforts resolving member issues and concerns and inform us on how well our member education efforts were proceeding. i'll turn it over to olga stavinskaya-velasquez to review results with you. olga. >> good afternoon. olga, stavinskaya-velasquez, operation manager. as partf the joint effort to insure members were informed about the blue shield transition, sfhss in collaboration with blue shield and key steak holdsers including veteran police office association, protect our benefits, retired employees and united educators of san francisco held in person and virtual events with the goal of educating members about

upcoming plan changes and how they are able to access different level of support they were looking for. in terms of supporting with the transition. this is one many avenues of support that were built out for this transition plan. we focus on engagement and education. the goals to continue member outreach and engagement efforts into plan year 2025 and we are exploring additional workshops we can hold for members as we get into the plan year. another avenue of member education was live webinars. hss hosted three webinars dedicated specifically to the blue shield ppo transition where members had a opportunity to view and introductory video and ask specific questions about the plan transition, access to care questions that were answered directly by a blue shield representative. additionally, we held three

more retiree healthcare webinars where members had a opportunity to seek comparison information between the offered plans. the webinars were posted online for those not able to attend and able to view those webinars and review the questions that were asked verbally during those sessions to gauge whether their question were going to be answered during the recording. throughout the implementation process, we continue to track how the variety of information resources developed for the transition resonated with member engagement. during the open enrollment period for open enrollment reminder e-mails weresent out including medicare--blue shield medicare stories. the data shows that the initial interest was quite spiked up fallowed by a slight decline.

the same engagement trends are seen with the attendance during the webinars. this trend is understandable as there is a variety of resources to educate about the transition and gave them a opportunity to engage with those resources early on as early as august so everyone was not forced to seek information at the end of open enrollment. as you will see from the next two slides, we have continued to support members through the call center and the blue shield call center and we are stoin r continuing in full force. beginning august and just through to beginning of open enrollment, member service staff interacted with 197 members seeking support with the blue shield transition and this was over the

phone through the call center and 5 members came in for support in the lobby. one features we were able to build out before open enrollment and through open enrollment was a direct connect through the call center to the blue shield call center. basically members could call directly to hss and triage and get connected to blue shield. we were able to support 178 members through that process prior to open enrollment and that number increased during open enrollment to 822 members. the other thing i want to point out is, our first contact resolution right before open enrollment for this specific topic. the plan transition was at 91 percent and increasing to 94 percent during the month of open enrollment.

here you will see comparison between open enrollment and preopen enrollment data. we continue to provide members with resources and insuring the smooth transition continues to go forward. we maintain a very close and collaborative relationship with our blue shield partners. i'll pass the presentation over to blue shield for a update. >> good afternoon. tiffany gil, blue shield of california. thanks for having us here. wanted to go through a little of the dashboard for our blue shield implementation timeline for the group medicare advantage folks. there are two updates that are here from last month. one of them as rey mentioned is the at risk for the electronic enrollment file. we are still working through a

few miner issues, but blue shield created a work around to work through fall out that comes as a result of those issues for our open enrollment file. with that, this is assures the members will be in our system and cards in hands by january 1. we are also not anticipating a lot of fall-out due to the issues that are still being worked through. second, we also moved from at-risk to on-track for the medical authorizations. as we looked internally to accept the united healthcare authorizations, with no member action required. those are updates on that. i'll turn it over to rob smith, our senior director of medicare and charles boss. that is why charles isn't here today, so just to make sure-exactly.

>> thank you. good afternoon commissioners and supervisor. robert smith, senior director of growth at blue shield of california. in october, many were made aware the center of medicare and medicaid service released the medicare advantage star ratings for 2024. as a reminder, the star ratings is a scoring system of 1-5 stars developed by cms looking at over 40 measures related to various health outcomes and provider satisfaction by medicare advantage members. the blue shield medicare advantage ppo plan dropped from 3 and half star to 2 and a half star in 2024. a factor of this was reduction of the lack of member engagement with preventative care screenings and ll this score does not reflect the hss members, since the membership was not active at blue shield in 2023,

which this 2024 score is reporting. this score is not reflection of our commitment to insuring the hss membership have a smooth transition with access to their existing doctors and providers and medications. must share blue shield learned a lot since 2023 how to improve member engagement and we have translated these learnings into the special support we offered to the hss members, including dedicated member service, customer micro site, and the partnership between the hss staff and blue shield in developing strategies to engage the members. we will continue to build on this partnership with hss staff to work on tactics and reporting how hss members are engaging in health and

wellness activities in the coming years. we will share this status with about your members in future boards reports. next slide. over the past several months as the hss staff reported, blue shield of california staff have been actively engaged with the hss members and their stakeholder organizations. we engaged in public forums and through the customer service call center. we had the opportunity to share information about benefits and more importantly, hear directly from members any questions or concerns they may have regarding their benefits and the transition to blue shield. one item of concern raised by a few members was the blue shield reduction announced in october. while reduction of staff is always concerning and disconcerting to us as employees, the 61 positions were made up of closure of medi-cal clinics in southern california.

this reduction in force was not related to star rating, and will have no impact on the hss members experience. additional concern raised by some members at the open enrollment meetings this past month was around the pharmacy network and in particular, walgreens. the blue shield network is made of preferred pharmacy like cvs, safeway, [indiscernible] and non preferred pharmacy like walgreens, rite aid, walmart and others. all the pharmacies are part of the blue shield network, including walgreens. the only difference is, members keep a copay savings if they go with preferred pharmacy, meaning, two copays for hundred days of medication. we continue to work with staff to insure members understand they

can continue to go to any of the network pharmacy, and remind them how to save money on the cost of prescriptions by looking at preferred pharmacies. finally, we received a couple of concerns from members who were concerned about our new mail order pharmacy that manage the delivery of medications to their homes. that would be amazon pharmacy. members currently using mail order from optum will have the maintenance medication transferred to amazon pharmacy. members will receive communication early december telling how they can create an account to continue to receive their home mail service. this mail service though i want to make sure i'm clear is optional. if members dont want to use amazon pharmacy, they can use something else that works best for them. there are retail pharmacies

that do offer home delivery for prescriptions. these retail options allow members to receive the same cost sharing at preferred pharmacies as they can receive from the mail order delivery service. members can call our customer service if they need guidance how to switch prescriptions from mail order to retail pharmacy. the next couple slides are showing call metrics that the san francisco health services system blue shield dedicated call center has been adjudicating. this slide shows you that our call volumes from august 5 to september 27. our calls are well below the goal of speed of answer of 18 seconds. agent are taking the time to discus with members more then 15 minutes each call. here are stats from september

30 to october 25 during open enrollment. again, the call center stats and resolution of member issue s continues to trnd better then goal. it makes sense questioned around open enrollment, benefits and network. call centers agent are trained and coached to make as much time to resolve any and all questions. the next couple slides highlight traffic to the hss blue shield micro site. the site continues to get a lot of activity with members looking up if their doctors and pharmacies are in the network. here are volumes of searches from august 5 to september 29. open enrollment from september 30 to october 25. activity decreased but one area that stands out is members searching

for formial ari tool. we want to share direct quotes from the hss members who took the time to leave voice mails regarding the great service they received from our member services team. reading these testimonials reinforce to me why we do the work we do in our medicare division. hearing from barbara in san francisco who is 82 saying, jasmine was patient. holding my hand. daniel from escolon said, samantha was perfect. thorough and knowledgeable. gale commented, gabby spent a lot of time with her and she appreciated that. larry from san francisco shared, sandra went above and beyond to help. sandra is terrific. cliff ord from berkeley saying, great listening skills and great assistance. he could have not asked for a

better experience. these member testimonials are what we all collectively hoped for during this transition. we at blue shield will continue to provide this great services throughout the remainder of the year and continue to work closely with the hss team to provide the same level of care and compassion that your members have become used to and deserve. thank you. >> again, rey guillen, chief operating officer. just in conclusion, we continue to be extremely confident that all impacted members will be successfully transitioned from united helt care to the new blue shield plan january 1 with minimal disruption. staff will shift the focus from monitoring plan implementation activities to verifying that our members continue to receive the

same level of care and service from blue shield they currently enjoy under united healthcare. we are working with aon to develop a score card that monitor the care services and customer support that blue shield will be providing to our members and benchmark against the care services previously provided by united healthcare. some of the measurement areas include preventive care and screening and pripshz drug and care and medical care and disease management. we are happy to answer questions the board may have. >> questions? comments? thank you. that seems pretty comprehensive and we thank you for that report. seeing no questions, i just like to- >> i would just like to commend the teams from blue shield and hss.

i think there were a lot of doubts how we were going to be able to manage this and from the lack of questions i am assuming we have exceeded your expectations and so i want to offer congratulations to the team and i know rey has named some of the challenges that we are put in front of us because the rubber meets the road january 1 and the team demonstrated the ability to work together to very clear goals and objectives and will continue to do so. >> thank you for that. very encouraging and thank you all team members for your work and participation. it is not always simple and easy. takes a lot of energy to work collaboratively on these kinds of things and they are difficult and complex issues sometimes, so we truly appreciate it. it is easy for us to sit up here and just sort of go, thank you and kind of pass it off, but i think we

really understand because quite a few here worked for the city and we really understand what it takes to get this work done, so we thank all your very much for your efforts and the results that have come from that. we wouldn't have these positive results if it want for your collaborative ability and the work you guys put in so thank you so much. >> if i may, i also like to acknowledge that united healthcare has been incredibly cooperative working with us on the transition and as we mentioned during the whole decision making process, there was never a question about the quality of care that united provided and their ability to work with us through the transition has just been highly professional and very much appreciated. >> very good to hear. thank you. any other comments? no. that was good to hear director

yant. really appreciate that. and hope that the members of the team appreciate those comments as well. speaks well for all your professionalism and all the efforts that you put into your work. thank those that are not here. make sure they- >> we'll pass that along. thank you very much. >> thank you. okay. any public comment on this issue? i see someone coming forward now. i recognize him. he's going to speak. >> public comment is open. we'll move forward with our in person public comment first and those watching remotely call in by dialing star 3 to be placed in the queue and those on webex click raise hand to be placed in the queue to speak. and i welcome the first public comment in person. >> dennis krueger, active retired firefighters and spouses.

as one who had great concerns about all this, i have to say after talking with the people on their call line, my hopes and everything have been raised quite high. i only hope this time next year i can stand up here and say, boy was i wrong. but, i have one question because it is passed on to me. through the chair to blue shield, do you have a timeline when our identification cards and our pharmacy cards will be sent out to our members? i'm already getting questions and hopefully you have some kind of answer. >> people are always anxious about those cards. they want them sooner then later. even though some may misplace them when we get them sooner then later, but that's not relevant. just means it is what happens.

thank you. do we have any response on when we know those cards come out? great. thank you. >> tiffany gil, blue shield of california. we are on track to get identification cards out to the members the last two weeks in december. before january 1. >> before january 1. >> yes. >> we'll take that back to our members, right dennis? and actually [indiscernible] and others. we'll put it out to the members. >> they can also call member services any time if they don't have their id cards yet in mid--by the last week of december. >> i don't wants them to be urged to call sooner then that. have to let the process take its time. >> exactly. >> it has been-as far as i can tell it is very comprehensive and exact.

there are very few people that had a problem and usually when there are problems it is not generated at our end, it may be something with the mail or something external that causes a hiccup somewhere. otherwise, good at that. thank you very much. >> thank you. >> last two weeks of december. okay. >> i'll move to the remote public comment. >> please do. >> the moderator are checking for any callers in the public comment queue at this time. >> board secretary, 5 callers on the phone line, zero entered the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. five callers. we are increasing in our caller listening group, which is

pretty good. okay. what is next? any other public comment? i guess not, it is closed. we'll go to number 11. >> item 11, helt service system announcement of request for proposal for life and ltd insurance benefit for 26 plan year. this is discussioniterm and presented by michael visconti, sfhss contract administration manager. >> welcome, michael. >> good afternoon. michael visconti, contract administration manager for san francisco health service system. today i'll present announcement of life and disability rfp. walk through the scope will be, we will discuss summary of what the currents benefits are. i will review slides in august of rating actions markets trends and impact assessment and

objectives for the rfp minimal qualification and respondents and timeline to date and where we are over the next 3 and a half months. to read into the record, the announcement of life disability benefit for plan year 2026. beginning january 1, 2026. hs, intend to issue competitive bid or request for proposal or rfp to the follow life disability benefits with coverage beginning january 1, 2026. first, employer paid life and long-term disability or ltd insurance require through union negotiated m orks u for actival city and county of san francisco and san francisco superior court employees. two, volunteer employee paid supplemental life insurance.

three, voluntarily employee paid accidented death and dismemberment and 4th, volunteer employee paid supplemental short-term disability or std insurance. to cover roles and responsibility throughout the process, hss responsible to notify the board of the initiation of rfp or formal solicitation of the selection of primary service provider. determine the scope, the minimum qualification to bid, the questionnaire and scoring criteria and initiate and conduct solicitation process. we appraise the health service board throughout the process as necessary and we will present the selected vendor and rates to health service board for approval. we expect this to occur around

march 2025. the health service board which is the next item is responsible for initiating the black out period when notified of competitive bid process. we do competitive bids with the annual rates and benefit calendar so black notice also includes the annual black out notice we are familiar with for rates and benefit process through approximately june of next year. as summarized previously, the following slides shows the mentioned benefits that are going to be bid in the rfp. basic life, long-term disability, [indiscernible] all provided by the carrier of the heartford. employer paid benefit are life and long-term disability and 100 employee paid benefit a dd and short-term disability. it should be noted we have the

carrier histories i presented in august in the appendix and as a summary, the following benefits in the chart represent approximately $8 million in total annual spend, $7 million is the city for employer paid benefits $1 million is employees voluntarily paid benefits. the following two slides presented august 2024. we want to present them again here and if there are any questions i can be joined by our lead actuary. the reason for the rfp are multiple. we are looking for-had a excellent relationship with incumbent vendor and want the high standard of service. we have seen there is potential ability to capture certain improved rates and though this benefit is not

often used and that is a good, we have a low number of employee deaths and long-term disability claims for our population, it is very important benefit for those effected and we want to insure the high standard for who is selected as a result of the rfp. there are also gains we had and also want to continue to capture. the dij tuization of life insurance. looking for streamlined process. having all these insurances continue to be under one um brella often having one user portal making communications and administration easier for us as well as improved administration for hss as a organization. ologist also seen market growth and i'll show the expected respondent to the rfp based on minimum qualifications.

over the next three slides i will cover the impact we expect as a result of the rfp. we are expecting little to no impact on members, and only beneficial improvement for hss and members as a result. that is because we have very strict minimum qualifications to bid and the requirement that many of the existing benefits all remain as they are currently, so there is no changes from the employee side. important things i want to cover here though, if you are disabled emploeee as of dest 31, 2025 you have zero disruption as a result. we will consolidating short-term disability provided through manhattan life with long-term disability. this will improve administration between the two which is often the case move from short-term to long-term disability. we look forward to the opportunity to enhance our performance standards. we have very robust performance

guarantees and we'll continue to have very robust performance guarantees for the selected respondent. we are also insuring we retain dedicated support from the selective respondent both for members and hss from administrative and claim processing standpoint. for minimum qualifications to bid, we are insuring we only have the highest qualified vendors available to provide the service insure they have to size and capability to support population such as hss. and we are also insuring they retain the basic life and ltd designs already negotiated in our union memorandum of understanding. >> what are cross subsidized

rates? >> we want to avoid cross subsidized rates where they artificially lower one rate so they are able to-raise another rate so to lower or make more attractive another rate. we want no cost subsedation and everything independently rated. good question, thank you. for the potential rfp respondents, we expect very large familiar names you probably are familiar with in this area. these are entities that through research and assessment and support from partners at aon believe meet the minimum qualification and provide the level of services we have and will continue to have as a result of the rfp. as mentioned i want to go through briefly timeline. we began the process in july of 2024. we presented august 8 to this

board with our annual assessment of all theict contracts and benefit and this as a opportunity for improvalments in services and cost for the city and all our members who avail of these benefit s. again, we have spent the last several months consolidated the scope, working with our partners at aon and subject matter expert in life and disability field to have a concise questionnaire and public facing rfp document posted to the hss web page in the coming week and a half. again, we expect to release the rfp early december. our timeline is similar to other rfp. we will conduct a question and answer period. we insure the highest level of transparency and accountability by requiring all communications related to this rfp to be provided in writing viae-mail to the contract unit. all questions will be answered

and answered publicly posted to the web page in the form of addenda to the rfp. we will also conduct oral interview processes. as we all know, many of the organizations have exceptional teams to write proposal mptd we want to insure the individuals who will be serving us our members and you the board are also top notch and provide that level of service and expertise we come to expect. we will be have live oral interviews and present them with hypothetical situations they may face and challenges they may face supporting san francisco health service system and members then future. after final scoring which occurs late february, we will again come before this board with our selected highest qualifiedveneder as a result of the rfp along with rates. those rates will be presented every year for your review and

approval. i like to open up to board discussion at this point. as you are aware and reviewed what is posted online and presented to you earlier, we do have a detailed appendix that is there, particularly to reemphasize the strict procedures, hss has in place for every rfp and high standard we hold to when it comes to impartialty, transparency and accountability. thank you. >> thank you. questions, comments board members? anyone? >> i see there is 10 companies that are approximately qualified for this. do you reach out to those companies or you just-you actually reach out to them and give them- >> yes, as much i love our rfp page is one of the book marks on the browser we make sure we reach out to all of them. again, always done in writing

at the same time. didn't mention, we insure all communications are done at the exact same time, so no one is given advance notice or additional hour to present or prepare for any part of the rfp process, so the second posted to the web page, thats is when we notify them. >> any other comments, questions? nope. it is good to know about the fact it all goes out to everyone at the same time. it is essential. critical. thank you. >> thank you commissioner. >> seeing no further comment. thank you very much. >> you're welcome and be back shortly for the black out notice. >> okay. commission secretary, do you have- >> open up public comment. public comment is open. instructions are displayed on the screen for those watching on

sfgovtv and webex. on the line press star 3. watching the meeting on webex click raise hand to be placed in the queue to speak. we'll begin with in person public comment. move to remote public comment and our moderator and i will look for any callers in the queue at this time. >> i will start looking for glue on the seats because no one seems to be moving. maybe worrisome for the near future. just in case. invitation to come forward is always there. >> board secretary, we have 4 callers on the phone line zero entered the queue at this time. >> thank you moderator, hearing no callers, public comment is now closed. >> okay. thank you. i guess that concludes this issue and we will move on to item number 12, if

i'm following correctly. >> item 12, blackout notice from november 14 through june 2025. this is action item and will be presented by michael visconti. >> thank you holly. miking visconti, contract administration manager for san francisco health service system. this memorandum serve as the black out period notification to health service board that begins today november 14, 2024 and extend through both the completion of the san francisco health service system formal request for proposal for life and disability benefits and the completion of rates and benefit process for 2026 plan year. both of these are expected to be completed by june 2024. again, as we have seen in recent times there are reasons to be extended so this black out period extends until the completion of both items. now, during this period board members

are prohibited communication and activ ities with the rfp and are rates and benefit prauz for the 2026 plan year. pursuant to board policies as well as numerous codes in san francisco code as well as city charter and the san francisco campaign government conduct code. during this black of put period board members prohibited from communication or activities with current or potential future providers or representatives, agents, employees or officers on matters relating to the san francisco health service system competitive bitd for life and disability benefit outside public meet ings of the beard for the annual rates and renewal process. communications and activities include face to face conversations, conversations through one or more third parties, telephone, e-mail,

text messages letters, faxes or any other social media written or electronic communications. any communications with current or potential future service providers for reasons unrelated to sfhss during the period must be disclosed in writing to the executive director and board. we will be posting this black out notice as we do with all black out notice to the rfp web page as well as a summary of the requirements for restricted communications related to rfp. those instructions are written in that page throughout the year. they do not change and there are examples of notices there for reference. this is action item for the board and with that, i will leave it open to board discussion and action. thank you. >> thank you. entertain a motion.

in regard to this item. >> i move that we vote to prove the black out period notice on november 14 through june 25. >> second. >> moved and seconded. we have that motion on the floor. let's go forward with roll call vote. >> shall we do public comment first? >> that's probably good idea. okay. >> okay. . >> any comments from other board members? seeing none, do public comment. >> public comment is open. instructions are displayed on the screen. in person public comment will be first fallowed by remote public comment. those on the line press star 3 to be added to the queue. for those watching on webex click oen the icon to be placed in the queue. no one approached the podium and move to the moderator who notify of

callers in the queue at this time. >> board secretary, there are 3 callers on the line and zero entered the queue at this time. >> thank you. hearing no callers, public comment is now closed. i can start with roll call vote. with vice president zvanski, aye. commissioner cremens, aye. supervisor dorsey, aye. commissioner howard, aye. commissioner sass, aye. commissioner wilson, aye. unanimous approval. >> okay. going forward. we have the blackout period and if you can't remember the date or get confused, you can always call holly. >> if i may madam chair, prior to the pandemic i don't know if this is occurring since them but prior to pandemic now and again i would get notified that there were sales

people trying to sell life insurance at police stations and fire houses. it is just-i don't know if it is still going on, but we'll work through hr to send a reminder because we haven't done a rfp on this product for 10 years so i want to make sure people understand that because it would not be helpful to the process if that were going on during this black out period. >> no, and are we-because police and fire both have their own unique employee organizations, i am assuming this information goes out to all the employee organizations as wem? >> we'll consider what we need to do to get the message out. if you get wind of anything

yourselves, certainly you understand you should not accept anyone that approaches directly, but if you hear from constituents and colleagues, please let us know and we will remind folks that is not-it isn't any solicitation is not acceptable in the work place, but i know this problem creeped up time to time. these companies that we expect to get bids from are highly reputable companies and often not the company but brokers seeking business, so i just want to put a caution light out because that has been past practice brokers show up at different employment sites around the city and it is not appropriate any time, but particularly during this process. it is not acceptable. >> i would add to that that if there are any employee organizations, meetings or retiree meetings that involve our employees and

retirees that it is inappropriate for them for those vendors to also be at those meetings and trying to solicit different venues. we must make sure that those vendors are not allowed access to members and retirees at any point. >> health benefit contracting negotiations is the responsibility under your correction as the commission. we need to draw a bright line on that. >> would it be appropriate for hss to send a notice saying, that isn't appropriate. allow vendors to remind them and remind them that there are products hss offers that employees might not realize they are in the system. >> do two different things. we'll think about how to message it so we don't compound the situation giving too much information.

we are just closing open enrollment when people have the opportunities to enroll in the products. let's give consideration around messaging. jessica and the team are talented figuring that out, so we'll work on that. >> good. thank you very much for that. any further comments? okay. shall we go to public comment at this point? we closed that before the vote. >> do we take a vote? >> we had unanimous vote. >> we did. let's go to public comment. >> we can close public comment for item 12. i can move to item 13. m >> okay, did you do the telephone as well? >> yes. >> good. okay. we are set and let's go to item 13. >> item 13, reports and update from contracting health plan representative. discussion item and

representatives can approach the podium for updates. >> good afternoon, denise rodriguez with kaiser. there will be a change effective january 1 how kaiser permanently covers medications for weight loss. starting with january 1, coverage for glp-1 drugs and other antiobesity drugs will no long cover in the base benefit. specifically to our commercial population and when those drugs-if prescribed solely for weight loss for anybody with bmi under 40 is where it is excluded. i do want to note however that we will continue to cover glp-1 drugs along with antiobesity medications when prescribed as part of the

disease management program. some of these diseases include type 2 diabetes, major adverse cardiac event and sleep apnea. for those members that will be impacted by this change, kaiser permanente will provide communication to members and include details on the changes in the coverage including information about other comprehensive approaches we take to weight management outside medication and other resources that will be available to them. the member communication will go out as follows. for members where we have e-mail addresses, they go out november 21. those members where we don't have e-mail we will send letters and those drop on november 22. the number of members that are

part of san francisco health service system is very minimal and that's 173 members will be impacted, which is less then.3 percent of your commercial population. so, at this time are there any questions about this change? >> 173 are the total health service board members that qualify for this what we are talking about? >> there is 173 people that will no longer have access to these drugs or the treatments specifically for weight loss. >> got it. >> and they get the communication i referenced. >> is there a alternative for them? >> the only alternative for them is to participate in the other weight management programs, which is very

specific around education, diet, nutrition and things like that. they will always have the option to pay out of pocket, so they may in collaboration with their group physician decide they still want the medication for weight loss and there is no adverse concerns. they will be charged the full price for that. >> thatd that is whole price not subsidized by- >> right, they pay the non- >> become very expensive. >> potentially. because the drugs are quite expensive. >> quick follow-up question. the people who have disease and obesity they will still qualify because they are in disease management program? >> yes. diabetes. yeah, the ones i mentioned, others outside that will be based on physician clinical--

>> did the bmi number of 40 which is mor bid obesity change or the same all the way long? >> under california-new change going into effect in state of california starting january 1 is, anybody with a bmi of 40 or above can get this medication for the treatment specifically of weight loss, so they are not excluded from this. it is just anybody with the bmi under 40. yeah. >> thank you. >> you're welcome. >> that's a important question and issue. any other questions? >> thank you. >> thank you very much. >> i can open public comment. >> yes, please. >> public comment is open. instructions are displayed for those watching on sfgovtv and webex. in person is first followed by remote.

press star 3 to be ated to the queue. those watching on webex click raise hand to be placed in the queue to speak. we'll begin with any in person public comment. no one approached the podium. our moderator will notify of any callers in the public comment queue at this time. >> board secretary, 3 callers on the line and zero entered the queue. >> thank you. public comment is now closed. >> thank you. okay. it looks like we are coming to the end of our meeting, because the next item number 14 says adjournment. so, it isn't 10 after 3. as opposed to 4 o'clock adjournment. if there is no further business and no further comments, i will declare this meeting adjourned. thank you all very much.

have a very happy thanksgiving and see you all in a month. if not sooner. stay well. [meeting adjourned]

my name is doctor ellen moffett, i am an assistant medical examiner for the city and county of san francisco. i perform autopsy, review medical records and write reports. also integrate other sorts of testing data to determine cause and manner of death. i have been here at this

facility since i moved here in november, and previous to that at the old facility. i was worried when we moved here that because this building is so much larger that i wouldn't see people every day. i would miss my personal interactions with the other employees, but that hasn't been the case. this building is very nice. we have lovely autopsy tables and i do get to go upstairs and down stairs several times a day to see everyone else i work with. we have a bond like any other group of employees that work for a specific agency in san francisco. we work closely on each case to determine the best cause of death, and we also interact with family members of the diseased. that brings us closer together also. >> i am an investigator two at the office of the chief until examiner in san francisco. as an investigator here i

investigate all manners of death that come through our jurisdiction. i go to the field interview police officers, detectives, family members, physicians, anyone who might be involved with the death. additionally i take any property with the deceased individual and take care and custody of that. i maintain the chain and custody for court purposes if that becomes an issue later and notify next of kin and make any additional follow up phone callsness with that particular death. i am dealing with people at the worst possible time in their lives delivering the worst news they could get. i work with the family to help them through the grieving process. >> i am ricky moore, a clerk at the san francisco medical examiner's office. i assist the pathology and toxicology and investigative team around work close with the

families, loved ones and funeral establishment. >> i started at the old facility. the building was old, vintage. we had issues with plumbing and things like that. i had a tiny desk. i feet very happy to be here in the new digs where i actually have room to do my work. >> i am sue pairing, the toxicologist supervisor. we test for alcohol, drugs and poisons and biological substances. i oversee all of the lab operations. the forensic operation here we perform the toxicology testing for the human performance and the case in the city of san francisco. we collect evidence at the scene. a woman was killed after a robbery homicide, and the dna

collected from the zip ties she was bound with ended up being a cold hit to the suspect. that was the only investigative link collecting the scene to the suspect. it is nice to get the feedback. we do a lot of work and you don't hear the result. once in a while you heard it had an impact on somebody. you can bring justice to what happened. we are able to take what we due to the next level. many of our counterparts in other states, cities or countries don't have the resources and don't have the beautiful building and the equipmentness to really advance what we are doing. >> sometimes we go to court. whoever is on call may be called out of the office to go to various portions of the city to investigate suspicious deaths. we do whatever we can to get our job done.

>> when we think that a case has a natural cause of death and it turns out to be another natural cause of death. unexpected findings are fun. >> i have a prior background in law enforcement. i was a police officer for 8 years. i handled homicides and suicides. i had been around death investigation type scenes. as a police officer we only handled minimal components then it was turned over to the coroner or the detective division. i am intrigued with those types of calls. i wondered why someone died. i have an extremely supportive family. older children say, mom, how was your day. i can give minor details and i have an amazing spouse always willing to listen to any and all

details of my day. without that it would be really hard to deal with the negative components of this job. >> being i am a native of san francisco and grew up in the community. i come across that a lot where i may know a loved one coming from the back way or a loved one seeking answers for their deceased. there are a lot of cases where i may feel affected by it. if from is a child involved or things like that. i try to not bring it home and not let it affect me. when i tell people i work at the medical examiners office. what do you do? the autopsy? i deal with the enough and -- with the administrative and the families. >> most of the time work here is very enjoyable.

>> after i started working with dead people, i had just gotten married and one night i woke up in a cold sweat. i thought there was somebody dead? my bed. i rolled over and poked the body. sure enough, it was my husband who grumbled and went back to sleep. this job does have lingering effects. in terms of why did you want to go into this? i loved science growing up but i didn't want to be a doctor and didn't want to be a pharmacist. the more i learned about forensics how interested i was of the perfect combination between applied science and criminal justice. if you are interested in finding out the facts and truth seeking to find out what happened, anybody interested in that has a place in this field.

>> being a woman we just need to go for it and don't let anyone fail you, you can't be. >> with regard to this position in comparison to crime dramas out there, i would say there might be some minor correlations. let's face it, we aren't hollywood, we are real world. yes we collect evidence. we want to preserve that. we are not scanning fingerprints in the field like a hollywood television show. >> families say thank you for what you do, for me that is extremely fulfilling. somebody has to do my job. if i can make a situation that is really negative for someone more positive, then i feel like i am doing the right thing for the city of san francisco.(musi >> today wire he emergency si

operations center for england with one activation so oversight board that one of the many activations have locations which probably has between to one hundred people at this time 340r7b 25 different city departments and hundreds of partner local partners and straight and fell partners we're in the echg a critical consultant of emergency center and surcharged with the single voice communicating with media about all issues with the apec and go a lot of preparation went into stemming up this e oc and little actuated managing things as they come up and the people in the room and making sure that

everyone is in the next step and doing count work of a single set of objectives with a single idealogy in mind many is having an apec that runs smoothly. >> i basically organ the agency projects and um, whatever this is in-person, transmissions have (unintelligible) to we're never (unintelligible) i will get a response right now and (unintelligible). >> please check in. >> my role here in the agency to help the cooperation and the way to do that is by sharing information corresponding activities and some cases requesting additional resources when the cfo steady the property of the departments working at the moment and one of the first

agencies that was called the energy planning for the agency that we do streets and pipes and others involving a to point b. >> and this activation there are parts of the city cut off limited access points and information is sometimes confusing and so the information that not necessarily always refined for their knowledge and this activation is different from the activation we're waiting for something to happen if or if we don't have the resources available we we have to piecemeal it because 6 departments we are able to make things happen and from my department is the 9-1-1 features and be able services which runs

the emergency operation center where we are right now. >> by insuring the rights of people to exposure the first amendment rights our job we don't want people to think that because the federal government was coming into town that for federal government will be cracking detain on protesters looking to demonstrate and also the law enforcement partners insures that people could do that while keeping everyone safe and something we are doing. >> the jet has responder to over two had the and advising people of the impacts and plan for delays and plan their travel of entertainment commission and wounding to do that without people. >> what is happening on event

like this people love individually and because they find integrity in themselves that didn't go know was there and have to rise to occasion they didn't know they'd have to and really across the board for us and the city to make us a better city. >> and really a good learning experience xrefrns city augment but amazing departments across the city working together or working together in the same room and part of this in a meaningful way it everyone is united truly everyone. >> what we do matters a lot of i can't take credit. >> when i'm done with that all we can tie the bow on that and send it off. >> i'm he getting an

opportunity to find it exciting that's what we're here to do to serve the city we love and wanting really great learning experience. >> extremely rewarding and the great relationships with the people

>> driver, bye. >> hi. i'm will b. mixture weltake a walk with me. >> i just love taking strolls in san francisco. they are so many cool and exciting things to see. like -- what is that there?

what is that for? hi. buddy. how are you. >> what is that for. >> i'm firefighter with the san francisco fire department havings a great day, thank you for asking. this is a dry sand pipe. dry sand pipes are multilevel building in san francisco and the world. they are a piping system to facilitate the fire engineaire ability to pump water in a buildings that is on fire. >> a fire truck shows up and does what? >> the fire engine will pull up to the upon front of the building do, spotting the building. you get an engine in the area that is safe. firefighters then take the hose lyoning line it a hydrant and that give us an endsless supply of water. >> wow, cool. i don't see water, where does it come from and where does it go?

>> the firefighters take a hose from the fire engine to the dry sand pipe and plug it in this inlet. they are able to adjust the pressure of water going in the inlet. to facilitate the pressure needed for any one of the floors on this building. firefighters take the hose bunked and he will take that homes upon bundle to the floor the fire is on. plug it into similar to this an outlet and they have water to put the fire out. it is a cool system that we see in a lot of buildings. i personal low use federal on multiple fires in san francisco to safely put a fire out. >> i thought that was a great question that is cool of you to ask. have a great day and nice meeting you. >> thank you for letting us know what that is for. thanks, everybody for watching!

bye! [music] >> like to call the meeting to order. the transbay joint power regular meeting of november 14, 2024 to order. the meeting is held in person. members may attend in person erwatch on channel 78, 28 or 99 depending on the provider or visit