spending is on people and on top of that basically every priority of the mayor has in some way shape or form touches dpw so that that makes this hard to do, right? you're sort of between a rock and a hard place there but but >> does that create a delay? should not be for the member at you know also that sort of the citywide i think it is all? important to keep that in mind here because the math doesn't correct. no member impact. like work fundamentally with >> we do have service level the revenues and the sources agreements with counterparts to and all those uncertainties make sure that claims and where could break our way. there are no provider issues we could, you know, issue with that. mortgage bonds and we could there should be no delays. shift people on to refuge rate >> okay. >> we are not members are not sources and everything. >> but none of that's going to hearing from providers they are no matter what you do there not getting reimbursement with and none of that's going to end up with the same amount of people cleaning the streets regard to this? >> you are say thering is no that we have now based on the general fund. issue for the member. and so i think we should just keep that in mind that we still but if the provider is not need to do something about about the general fund. getting service that information will get become to the member and i was just kind of looking through some of the mayor one way or another? >> we don't anticipate any priorities. >> right. and it sounds like they said, you know, keep positions vacant issues for the provider as well. i'm going to assume politically unacceptable as a euphemism for no layoffs. once again our association folks

>> i think that's fair to say here. it seems like they were focused with process timely send it to on cbo and contract spending us to work with under service and so, you know, kind of looking through your your set level agreement time lines and of solutions that you guys process appropriately. propose, it looks like a good >> okay. >> thank you. >> i have another question. chunk of them i think about 30% >> commissioner sass can you would kind of be cbo funding of >> yea. what you're proposing of the >> transition, the the kwhart i $13.8 million. >> so i actually thought it would be a little bit higher if looked at said that onll track. i'm being honest with you because it did sort of seem like the guidance was pushing but that the date is january of the department towards, you know, protect protect your this year. so we are now half we into staff and cut the external spend where possible so i was a january of this year is it on track? little surprised to see that >> yes the pharmacy transition the cbo cuts that low. >> i mean it sounds like there has been complete. might be some opportunities on the pit stop program to to we have we are with our pharmacy minimize the impacts while still reducing the spending. so i would you know, encourage reimagined partners and amazon to continue kind of going down is a partner for our home that road as much as we all like having the pit stops again, it's it's not about what we want right? delivery service. it's about what we can afford at this point. and and i do think it will be interesting at the next sort of the question is we want to not have issues with the transition. presentation you do before this

commission and maybe before you submit something to the mayor's >> transition would require office, you know, so two things members to know these things. i don't know i'm not aware of an that i sort of picked up on. one was there might be some potential fee schedule changes amazon may be that was explained and that might create new somewhere >> that is part of the welcome revenue for the department and i don't know if the mayor's kit in there as well. office will allow you to count that as part of your target but and all members outside of hss that would potentially be an avenue. >> and then the second one other members with blue shield you're you're shaking your head. so i assume that's a no or have recard so they have the they're not going to go up very, very much which is great for the taxpayers. pharmacy information updated and then the second was just a information so they can get maybe point of clarification. there pharmacy service and >> you may not have the answer on this but there is this new hiring freeze in place for the medication. city. right. and so once you know what >> i guess you say completed and positions are frozen and we some say on track. know most of the public works i was trying to understand the positions are probably not going to be frozen, i'm difference with. >> okay. assuming you will probably i apologize and we'll make sure start to accrue some salary we are more concise and clear savings from not filling the nonessential positions. moving forward. >> i don't know if you have any sense of what that means, what that could be and whether or >> i don't know if you were not those you know if you say so you froze this position you here earlier we had a member came up and commented about know position a that became transition she was going through

vacant on february 1st. with her family and the problems now if there's a hiring freeze in place that's probably going she had with the east/west service. are you familiar with them to be through next fiscal year. so do you get to count those savings towards your target? >> with the chiropractors? >> i think that might sort of help offset some of these other cuts you've you've discussed >> yes. i spoke with her and we are commission are very good questions as well in terms of going to continue on look in the increased revenues, the situation we understand we got additional details we will be in instructions were pretty clear even if you have increased contact. >> great. thank you very much >> of course. revenues you need to cut your >> are you the talking about expenditure by 15%. silver speakers is that going to so if we had theoretically a come back >> yes. that is an item we are the $13.8 million increase in revenues we would still need to have to reduce our expenditures fwhafs we are look to enhance by 13.8% to address that structural problem with the red and a concern has been the line in the blue line that was number of facilities contracted shown and i believe slide six. so we absolutely have that in we are working with silver sneakers to get feedback from terms of the hiring freeze, you're spot on. membership. sometimes vocal feedback and many of the positions that are likely going to be the ones understand gaps in coverage that we will either ask for an and -- do our best with silver exemption or will likely be approved and i'm making some sneakers to highlight the prior assumptions here are going to use where we have gaps and need be again many of the core

to do better service ones that are out there >> you came out with i list yet? providing the services that i am assuming the mayor's office >> we don't. the issue is for 1/1 that is wants the public wants that are really what is our core function and that's cleaning part of the process, usually. through doing illegal vending enforcement throughout the when we start those are city. >> so while we will have that facilities that are not any request going forward it is longer accepting members. likely or correct again that and so those impact the facility there will be some salary and we that way we take that as savings. so as part of the budget team and every cfo in the city we a trigger to -- work to increase meet with the mayor's office in the comptroller's office every six months and every nine months and give them an update of what our numbers look like the backup facilities >> thank you very much. >> on that we heard a comment in the budget in the current year. >> we had that meeting earlier this week and we're just now earlier about silver sneakers starting to formulate that programs being available in and your assumption is i think spot on we will likely have some savings. marin county can you look into? we just don't quite know what >> sure. those are yet because we don't >> thank you. know fully in terms of the hiring freeze, what are the >> okay. >> any other questions before we open for public comment? exceptions that are going to get approved. we're still we still don't have >> i want to add to the issue direction yet of what that is full disclosure. on silver sneakers, i don't that's because we haven't even think a week guess by i don't submitted anything yet. we just got the form and the get 2-throw comments from

template for this process is members worried about silver organic and still evolving but sneakers. and will it continue and what i think we will have a better sense of thatain and can can pre happened to their provider that thing this is a very vital clarification. program. and especially of the people >> one thing i would also add on the pit stop we there are contacting me are primary low some direct funding we get from retirees and silver sneakers the jcdecaux restrooms, the big green restrooms throughout the city that are direct funding. programs help keep them healing competence active and so it's technically considered a general fund but that funds understand this is a really some restroom locations that are the jcdecaux the one significant benefit and program. >> absolutely. we recognize it is a critical outside city hall buy a bill graham auditorium and the main program for the health and well being of our members. library. absolutely. that one for instance is ajc, the co funded directly by >> thank you. >> thank you. >> we will open up for public jcdecaux. so there are some limitations in terms of how much we and how comment. why thank you. deep we can go in the pit stop public comment is open. instructions are displayed on program. but good points and we'll we'll take all of those into account . >> so just i guess a follow up the screen. question. one would probably expect on february 13th when you guys come back that that list of what you're doing to get to the 13.8 will probably have changed

to some extent. >> i think there will be likely some refinements as as we go forward. i think in terms of the data as i said, we're really trying to put the operational impact and what the impact will be and a little more granularity and we'll provide that. and as itioned earlier we want to see you up here >> i have a letter if a member in some examples, if we see that we're cutting it in the wrong spot where this will have she asked i forward it to e a huge operational impact, we'll look elsewhere. board, which i did. i hope you read it and i hope we're trying to have as minimal you got it. operational impact as we can here it is. on january second, 2025 i had an knowing that there will be operational impact. we're just trying to minimize appointment with a spine doctor. it so not too few but there will likely be some changes in which was an hour and a half from where i live. i knew the insurance was post six month report with our changing. so i called blue shield ahead to six month meeting with the comptroller's office you might make sure there would not be i also have a better sense of what your year end spending projection is and that might problem the represent assured me also might also plan to this, there would not be a problem i correct? we can do that. called the spine doctor's thanks. office, also. oft dave appointment i walked the doctor's office i received a >> thank you commissioner see me for your cold shower comments but very but very call from the office saying that valuable but very valuable and important comments and i i would havehv to reskechld the

had been on hold for blue shield seriously seriously thank you for them commission maybe we'll reach out to bart and see if bart can provide additional and said yes could get procedure funding for some of our national personnel. but would not get formal approval. i made calls called the number >> all right. there are no other comments or questions we'll open this item on my card and told wait 15 to public comment members minutes. health service got a long record members of the public who wish and the end gave a number to call special tryd that number to make three minutes of comment in person on the and told it would be 15 minutes. department of public works fiscal year 2025, 2026 wait time i decided to call and fiscal year 2026 and 2027 someone i knew with the service operating budget and priorities [inaudible]. after having wasted this time of may line up against the wall to the audience left if commenting driving out there and the disappointment not getting this from outside the chamber press the raise your hand button in epidermal for the pain in my back i left and started the the webinar or press star three drive back home. on your phone to be recognized karen was able to reach someone and put the wheel in action when i was close to home i received a call from gregory a supervisor with blue shield. as having tb. we do not have any callers apologized for the confusion and asked for the doctor's name and

and that concludes the public information and get back. comment. unfortunately the doctors only there on tuesday and thursday. >> thank you and i apologize. we've gone a few minutes over it is now set up for the next but i believe we do not need item five general public comment continued so at this thursday january 9. i will live with pin for another point our next public works week this is an example of how easy it is to reach hss and easy commission meeting as we've all heard will be on thursday, it is to reach blue shield. february 13th here in this room for await at city hall at 11:00 trary to what mr. lee said this three weeks from now. i can't imagine how the finance has been a major problem beam getting anyone on the phone. team will be spent in the next three weeks. you call the phone and you want i mean i don't know how long humans can go without sleep. >> i don't think you can go three weeks straight without hss. they insist you are a retiree sleep. >> but anyway, thank you all you go to blue shield. again, this was a very helpful joinon. how do you get a hold of hss if thank you to our colleagues on sanitation str fr valuable input as always and we blue shield is not doing what are now adjourned you think they should be doing that's where you make your complaint you feel can't get a hold of anybody. thank you. anyonel can approach will for in person comment.

i apologize for being slow. maureen >> you can hold the mic down if you like. >> retired adult probation department of the until about a year and a half ago, i enjoyed good health i have not am not familiar with health insurance plans. i do think my concern that i will let you know about today. are very valid. beginning of december, i became very correspond because i had received no medical card and no verification that i was transferred into blue shield. good afternoon am everyone and after trying to contact the happy new year welcome to the

healing service by phone, first health service board several times and only getting meeting of 2025 am all rise and voice mails,ile was calling join me in the pledge of 0s during business hours. i resorted to calling the allegiance, thank you. [pledge of allegiance] mayor's office. and said she would contact the healing services system and i received two phone calls from the san francisco retirement system. finally, i received a message from a representative from the >> thank you. board secretary call the roll. health service system telling me i would receive my card december >> start being with president 16th and giving me a number to hao. will caw at blue shield. >> present. >> vice president zvanski. >> here i think that i should have >> commissioner cremen. received a card no later than >> here. >> commissioner howard excuses. commissioner sass. december first. >> here. >> commissioner wilson. and probably november first and >> here. >> we have quorum. >> thank you. representatives from blue shield next item. >> agenda item throw. general public comment. attributed it to the fact they

this is an opportunity for members to comment on any matter did not receive the information within the board's jurisdiction not on the agenda including from the. san francisco health service system in a timely fashion. requesting a burden place a member on an item. i will read our full my next concern was the instructions. difficulty in reaching the remote viewing is available online using web ex. healing service system. i called many times and i spoke welcomes public participation during public comment periods there will be an opportunity for to a voice mail and never general opinion comment and opportunity to comment on each returned received a return phone item. in person comment first and call. virtual. for anyone in person you can now i'm speak as a taxpayer. approach now. healing service system is a city each speaker will be allowed 3 departmentful i would think that minutes unless new time limits. they would answer phones from 8 all made concerning the item has been presented. o'clock to 5 o'clock. a caller may ask questions but no obligation to answer. i believe thatship answer from 9 o'clock to 5 o'clock which is the health service board will hear up to 30 minutes remote acceptable.

comment commendations will not under 30 seconds remaining count toward that limit. >> 30 seconds. >> so i am finished and thank members attending the meeting via phone dial in calling. you for your attention. and enter code 26636415839 and >> in person comment is open if you would like to prop the pound. when prompted press pound againful you will be asked to podium. enter the password and then pound. star 3 to be added to the queue and will hear the prompt you yea fred sanchez from protect have raised your hand. our benefits. wait until i welcome you and the it is not what i was told in the message says your line has been plaza city hall don't worry about this. it is going to be the unmuted. differences will have a so those watching on web ex different membership card. click on raised hand to speak. this did not pay out. it will appear next to your name but i am going to say that blue when you are muted or press unmute will appear select unmute shield especially like tiffany to speevenlg once you hear, welcome caller, time will begin. when your time is expired you scombren what jessica's got from will be muted and click on the raisad hand to lower hand. you jumping over houj boulders

members are encouraged to state doing everything in capacity their name although they possible to solve these miremain unanimous. problems. i will thank you for your call that karen talked about she is and you will placeod mute and having her appointment today. unmute the next caller. yes , it was an extra week of thank you to sfgovtv for shareing with the public. bad pain but you know, sometimes we begin again this is our i have another one where a guy general public comment. is on chemo therapy and i with any in person comment. brought it to their attention and refused chemo therapy. no one approached. our moderator will notice if callers in the queue -- we have they got authorization you fax someone approaching. gi think someone is approaching in things up. in the office where on their the podium. side the woman is not in the hi. office every day. i'm sarah cole i wanted speak on as much as we are trying to the new health plan blue shield resolve problem its is not all on blue shields or hss staff i'm medicare retired have done workedful things but firefighter. and we have been already denied a clinic that my husband and i huge glitches. attended the left 11 years

east/west service an acupuncture clinic in china town they have offices in daly city and excelsior district. they when we were with blue shield before, the we were covered and then united health care to being it on as well. now we are told because um -- blue shield contracts out with american special health for a contract they have for acupuncture. and chiropractics. but east/west service does not work with them. and they also don't accept medicare. so now -- we are being told we cannot use that clinic anymore. i got my card yesterday. we had united health care, they than i said, bad address. i gave my address to machine to still covered it just lieshg it

was a part of the plan. input it. i never got a welcome packet. and -- it is just extremely disappointing. if you can show to bring up if we relied on this clinic over the years for different issues. you had this blue shield card. it is -- kind of goofy. my husband has health sxrbs just this is for the future on the gave him a free visit he had 10 top says blue shield ppo. years of visits with them. and with the bottom there is a of going there they gave him a free visit. and he has good religions with suitcase ma medicare advantage people there. they helped him a lot. ppo. this is in the future like u so, just you know >> i know we were told there night the health care they if you on one part on the bottom would be no change this is a said united health care medicare change and it is not i'm angry advantage ppo. may be the design of that card. about it. and you have been. these are things that you know . anyway that's my comment. will work out but the things on >> thank you. delays where people like chemo. series things like that that is we'll move to remote public unfortunate. comment. this is general public comment

and have an item where our staff will present on the blue shield anyone can approach. ppo transition. where comments for that item can hi. be addressed. so our moderator will notice us i'm david i'm a schizophrenic on of callers. knowing that we'll take general 5150, three time in my life. i don't know why i'm here i public comment. wandered in and wanted to say it >> we have 12 callers on the costs throw thousand dollar a phone, 4 entered the public night to stay in a mental queue at this time. other callers may enter as hospital. 5 thousand dollars to take an public comment continuous. ambulance ride and a lot of i will indicate when there are no more callers and you will people with the psychiatric hear a silence as we transition. disabilities like me are extreme low disvajd and poor and don't have insurance like -- i'm welcome, caller for general paying to be under surveillance public comment. and it is a bit much. i wanted say that and nut in hello? welcome. you can begin your time. your minds. thank you. my name issela, can you hear me no onel approachedit move to

>> i like to speak about the remote comment. >> i will check to see if there are callers in the queue. kaiser plan. because many of my friends and thank you for taking of my irrelevant tifs enroll in kaiser comment. there are i would echo what the plan and are senior advantage plan. they automatic get the ot c over previous people who come up to the counter benefits. mention their occurrence. since it start since january of one major concern that needs to 23. the benefitville monthly be addressed how hss benefits for over the counter communicates with blue shield. items you know -- not a lot many prescription drug become over the counter. and then being somehow i think this benefit is really disconnect today happened more with hss then and there it has beneficial for senior to have. and the regular kaiser plan with blue shield. senior advantage plan have the referrals back and forth contact benefit automatic included. when i called them since i enrolled my husband a new i never got the corrected letter retiree and enrolled in sf. on must go through a blue shield health plan. with kaiser senior advantage

plan i thought i should have that i dmaul and say, no, doctor. that has been addressed by the because it just because as of blue shield represents i did not [inaudible] does not prescribe get had letter. and i also have an okay this benefit. puncturist who does not take blue shield. nor does she work with ash. drugs and not in part of the prescription. i like to -- address this benefit for the board members consideration for the upcoming open enroll am health plan. thank you. is there further callers for thank you. public comment. caller. >> thank you. there areit callers wherevero >> moderator will notice us of raised their hand. public comment is closed. callers in the queue. >> thank you very much. >> all right. if we don't have questions we will move on to the next item

>> item 18. >> hss strategic plan 23-25 and progress report to the health board this is a discussion item and presented by several staff welcome other caller. hello? yes, you are coming through. members. go ahead. >>well, my husband is on medicare and his depentants, we on the screen is a picture of have nonmedicare benefits the san francisco health service through the city. system strategic plan approve in >> thank you. but through blue cross we have the 2022. at this time the board endorse exclude approved the assessment not received our cards i have to and evaluation of initiatives to call to make sure that our son vance strategic planning 23-25. this presentation reflects and i were covered. commitment to a report out on and my husband has medicare and progress.

n slide provides over view of also has to pay his part bcd the gone. the agenda is complimented by benefits. so, i wanted to say that it was our strategic framework. difficult for us to understand including our mission, vision and values. the transition. i will begin today by sharing a at this point. time line of strategic plan from united health care to blue development mile stones. how equity in the mission, shield. and i wish that had been made vision and values. easier for us to understand. then myself and copresenters will share progress reporting and we knew that on we for each goal area with a wrap transferred i think 2 years ago up on strategic execution to united. concepts for the road ahead. which were a surprise. an important point we are and i wish that this transition reports on subset of active 2024 could be made easier for the rural areas only. beneficiary or the you know the last year of annual the -- people that are progress. we are not reporting on initiatives that have just beghun january of 25 or those departments. yet to begin in 25. thank you. we want to asurety board and members of public this no initiate 95s are missing or omitted they will be highlighted

moderator. notice us if there are other to come. in the packet a pdf report. callers in the queue. and power point slide that had there are upon 11 caller on the more detail. phone line, two callers remain as always we are aim to seek in the comment queue at this input from the board. i have been informed we have a time. mere 15 minutes. 25 slides and 4 speakers passing the mic if it is possible for commissioners to field questions at the end. they promised a seamless transition and it hasn't been case. >> 23-25 plan includes all

blue shield card it was at the levels of stake here engage am the voice of staff and informing our mission, vision and value to former address. reflections of other county hopefully they have changed my departments vender per ins and experts and members of the address. public at the strategic plan so i can consider notification. board meeting of 20 twoochl our now this is working a hardship commissioners played a role in on other individuals they then reviewing the current state tool kit assessment. our report, dash board and disc need life saving therapies and report and other data we needed to review to create the chemo therapy. iteration of our plan. you seet in 2022, 2023 and i believe they did not convey 24 our diverse educational opportunity provided commissioners including expertise on matters that are per nan to role. made it a point to seek insights about how staff members see complete information. themselves and work and the strategic plan reflect in the they were a [inaudible] team. our all staff retreat agenda and

this is really going to raise concepts in the 2024 member services open enroll am survey. havoc with beneficiaries of the the distribution of the 2024, plan. you got to correct this, this is your opinion matters survey, your responsibility. helped our department insights we were really sold a phony bill on the types of support received from member services in the last of goods here and it is life threatening to some people. 12 months. help us to understand the gaps so, please, please correct this with the current and future states of offerings in relation to practices in the field. immediately. because some people's lives may it helped shape programs and be at stake. services to meet the nieced of thank you. >> thank you, caller. the diverse populations we serve. i hope this time line was before i move do you want to helpful in setting the stage how we arrived at the report out. check in with our had the to the time line remindses us continue with public comment. everything we accomplished when okay. let us know if there are other we go forward we raise the bar callers at this time. and challenge our limes of cape >> board secretary we have 11 callers on the line. abilities. as we approach the final year of reminder to callers dial star strategic planning we want toup throw to lower your hand in the hold equity leading with it to

queue. support membership in accessing thank you. care regard will of i can seat hands still raised. characteristic of gender, i will unmute the last raised location, statute and this hand that has not spoke yet. includes the intersections of our goals. welcome, caller. >> caller muted. [reading fast] this leads me to with that, there are no more hands and our general public comment is closed. present area one equity. >> there is someone. a clarification that this is who is trying. annual progress report centers around advancement for staff. thank you very much am i'm gail future reports will center healing advancements for bloom and i am a blue shield membership. member at this point with the medicare ppo. i wanted to bring to your attention something that i was with other initial net works of very confused about. regional and state governments. in all the benefit summaries, created as a new divifthz human right.

they list in that work and out right's commission in july of of network costs. 2019. office racial equity was when you get to the wellness guaranteed authority to credit a one, it says basic wellness. citywide framework and completion of action plans for ma'am. could you speak in the every department in the city. on a national scale the city of microphone. >> sure i thought my mouth was san francisco is also joined by big enough everybody would hear a handled cities and 30 states me. wellness hope programs on page 9 in the government alliance. again this progress report of benefit package. centers advancement for staff as shows a benefit of basic gym recommended by the san francisco office of racial equity and access. and then it says through silver future reports enter advance ams sneakers. i inferd that to mean the in for our membership. network and it has an out of >> prior to 2024, the network column this is not expectation of the office racial equity each city and county meaningful because there is no out of network benefits. department recruit internal staff to form work groups. i called health services they reflection of the mile per hour's mandate. referred me to blue shield. blue shield referred neil to office shiftd that strategic silver sneakers. and the best suggestion they with a fresh and more effective have was i go recruit a vender collaborative approach.

the pier learning cohorts are in my county. organize in the 4 pipelineos marin county has no in network department racial priorities shown on the screen. participating in what is the culture core. facilities. i was suggested that i go to centers around sharing and reflecking practiceos creating either san pablo or richmond. belonging and safety. array of space. both of which bridge tell and assessing roles and skill set in traffic. thank you very much that's not our department. meaningful. and so i wonder if you could take some notice of this and the office of racial equity what i'm looking for is a single approved our request to case agreement. participate in suite of staff i think that is the promote way training through the be the change consulting the sessions to approach this. no one offered me the manner in affordings supervisor and nonsupervisor leader the opportunity to deepen knowledge which that would happen. thank you. and tools. >> and with that, public thanks to the experienceship comment is closed. from office of racial ecquit >> thank you. >> next item. added 47 hours of trin to >> agenda item 4 vote on ledgers to carry out smiments in whether to hold closed session alignment with our plan. this is an action item and

presented by president hao. developing a culture of >> thank you. belonging. as you recall we heard a member employee development and approach to retention and appeal at last month's meeting. vancement and designing and and it was continued to this implementing performance reviews among other topics. month. when we combine hours in so -- i will entertain a motion trainings like these, with and second to move us to closed internal d. human resource session. >> so moved. trainings reporting july of 24 >> it is is moved and there was through june of 25 or department a second. is helpful way to molting the we will open up for public goal. i will speak to on the next comment. public comment is open. slide. >> a new equity measure and anyone may approach for in person comment followed by remote commentful for those dial goal part of the performance program to monitor in the nothing call and enter the code mayor's budget book for quarter followed by pound and pound one of 25 the new measure again. star throw to raise your hand. includes mixed training hours to watching on web ex click on expand collective knowledge about diversity. raised hand to put in the queue racial equity. to speak. in person public comment? this performance program reports no one approached. we will move to remote public data for every department this comment and moderator will contributes to our performance

notify us of callers in the scorecard. we are not alone in the work public comment queue. >> we have 10 callers on the other different graph titting to phone line zero enter the queue the inclusion of metrics for at this time. >> thank you. scorecard to demonstrate a hearing no callers public upon commitment to fostering equity comment is closed. >> thank you. through organizational culture. >> absent other discussions i would like to pass the mike to from board members we'll take a vote. president hao. ceo to cover primary care >> aye. >> vice president zvanski practice and affordable goal >> aye >> commissioner cremen >> aye areas. >> good afternoon. second goal >> commissioner sass. >> aye >> commissioner wilson. is [inaudible]. >> aye. >> we will recess to closed and if you can go to the next line. the mile stones for 2024 and the session. all party the gallery members who are not party to closed happy to report we met the mile session we will ask you to stones. leave. [inaudible] and the next slide the room. you are welcome to return when we seat mile stones that closed session is over. and we are back in open session. continuing to the [inaudible]. thank you.

>> welcome to those of you just joining us and thank you. as we come out of closed session. so. call would you call the roll. >> a roll call starting with president hao. >> present. >> vice president zvanski. >> present. >> commissioner cremen. >> present. why commissioner sass. >> present. >> and commissioner wilson. >> present. we have quorum at 1:55 p.m.

>> thank you. item 6. >> upon agenda 6 vote to elect whether to disclose all discussion in closed session with a san francisco administrative code 6712a this is an action item and presented by president hao >> thank you. colleagues zee an opportunity to decide whether or not we will discuss any or all discussions we held. so,il entertain a motion. >> not disclose any of the information held in closed session. >> second. >> all right. there is a motion. not to disclose and a second. public comment. please. >> public comment is open. and strugzs are displayed for those on sfgovtv and web ex.

no one approached we'll move to remote public comment. board secretary we have 9 callers on the phone line one has entered the queue at this time. other callers enter as public comment continuous i will indicate when there are no call and you will hear a silence as we transition between callers. >> thank you. i'm going to remind everyone on the call this is agenda item number 6. first caller. welcome, caller.

no response from the caller. >> welcome, caller. il put this caller on mute. move to our next caller. this is for item 6 regarding closed session. we'll take a vote, please. >> roll call vote with president hao >> aye >> vice president zvanski >> aye >> commissioner cremen. >> aye. >> commissioner sass. >> aye >> commissioner wilson. >> aye. >> item 7. >> agenda item 7, possible report on action taken in closed session. under government code.

in san francisco code section 6712 b an action item and presented by president hao. >> great. thank you. and so i will entertain a motion about possible reports on action taken. we don't report on action taken in closed session.

one call are entered the queue at this time. other may enter the queue. i will indicate when there are no callers in the queue and hear a brief silence as we transition between callers. i will unmute the first caller. yu choose it have a public hearing but there is no discussion for the people that are listening on in the room to a better understanding of what was discussed. that's it. thank you. thank you. caller.

president hao yoochl aye >> vice president zvanski. >> aye >> commissioner cremen >> aye >> commissioner sass. >> aye >> commissioner wilson. >> we'll move on with regular matters starting with agenda item 8. >> agenda 8. approval with possible modifications. this is an action item and will be presented by president hao. colleagues we have the opportunity now to approve the two sets of minutes. >> emi don't know if you have a

chance that need to occur. if there are edits go ahead and either state them now or forward them to holly. are there questions or discussions? if not i will entertain a motion for this item. for the two sets of minutes. >> i move to approve the minutes. >> second. >> we have a motion and a second to approve both the december 6, 24 committee meeting minutes as well as the december 12 board regular meeting minutes. we will open up for public comment. public comment is open.

for those watching on web ex click on raised hand icon to speak.ex■ public comment is now closed. >> great. thank you. next item, >> we have to take a vote >> shoot. >> okay. let's vote >> a roll call vote president hao. >> aye. >> commissioner zvanski. >> aye >> commissioner cremen. >> aye >> commissioner sass. >> aye >> commissioner wilson. >> aye. >> thank you.

i vo i brief report this month. first i want to note that it is job posting for the recruitment of new executive director to succeed abbie is posted and live it is on the city's job's website as well as on the website of our executive recruitment firm that is berkeleys search consultant. berkeley as in the city. search consultant. it is through and we look forward to the applicants who will responded. second item i want to preview since abbie's retirement date is upon us in march. we doment to make sure -- leaders there is no vacuum in leadership in the department.

>> we'll take public comment now. those watching sfgovtv and web ex. in person comment will be first followed by remote comments. no one -- i didn't think i would speak come hao when you said the february meeting you were in closed session discuss a possible interim replacement for abbie.

people of the public are going to want to know who possibly can be occurred and might have things to weigh in on that possible. why you guys just being isolated you know -- you will never know of may be concerns. so much i'm just -- i know you don't comment on what we say but that's a concern that other people might want to know who the possibilities are.

>> hello. thank you, thank you. i want to echo what the last speaker said and in addition to that, why have a public hearing with that is behind closed doors where the public community hear may be if you could not be in an agenda item if it is not open to the public. thank you. >> thank you, caller. >> moderator will notify us if others are in the queue. we have 9 callers on the line one additional caller enter the queue at this time. >> on the next caller.

i would like to know what the criteria is per people who are beneficiaries of the health service system. thank you. place you on mute. and we will be notified if there are other callers in the queue. board secretary there are 9 on the phone line no callers entered the queue at this time. >> moderator hearing no further callers are now closed. >> agenda item 10, please. >> agenda item 10 director's report.

a discussion item and presented by abbie yant executive director. >> good afternoon. happy new year. the first item i would like to ask to step to the podium to introduce her new staff member. >> good afternoon. gives me pleasure to introduce the newest member of my team on my right. eli join in the 2017. working people soft development and -- production support of was with the d. emergency management. and most reasonable with the controller's office. he was doing the production support for the payroll we and not love. anyway. recruit eli to our team. welcome. >> welcome. >> welcome.

rfp is out and had a number of responses to adjust the rfp and the deadline is now accepting proposals between january 13th and february third this is moving right along. and as commissioner hao noted i do continue to plan to retired on march 15th. also what is important to note is the election for a member. seat is under way. i believe -- that seat vacates in may of 2025 and so the

election process is official. as of today. and nomination forms are available. and this is this election as you know is very highly regulated by the registrar of voters. it is i -- it is a solid process. the -- racial diversity and cultural heritage celebrations the martin king junior a noon concert at the old st. mary's cathedral and other activities occurring the asian art museum. culturally we are rich in celebrations in upcoming weeks and months. i did continue to participate in

the health care affordability boarded as -- and advisory committee tackling really difficult challenges of trying to understand to set they have set targets for the increase the total cost care and looking into many other related issues around this point talking about mental health measures. later in today's presentation. we are -- very dedicated to working through the transition. with our members that are moving from the united m ap d productivity blue shield product. and so, yea those are the highlights of my report for today. i know we have a packed agenda i will not take your time i will

entertain questions you might have. public upon ment is now open. >> call 415-655-0001, code and pound and pounds againful press star throw to raise your hand. for those watching on web ex online click on raised hand to be placed in the queue to speak. in person first followed by remote. no one approached. we'll move to remote comment and our moderator will notify us of callers in the queue.

agenda common law the financial report. this is a discussion item and we will be presented by sfhsf chief financial officer. and principle administrative analyst. [inaudible] >> thank you. joining virtual special available to answer any questions. >> great. >> this report is for 5 months

of fiscal year and end of november and projections through june 2025. [inaudible] the year -- 3 million. health care fund decrease by 2 million ending balance of 4.6 million. and general fund administrative

fund, ahead of budget due to vacancies. are they higher or lower then and there usual? >> [inaudible]. you want to take this? or? he is joining online we are having trouble hearing you. i it take this. they are for [inaudible] and

self funded plans and we normally receive them quarter low basis. and it is a function on pharmacy claims and single shated i think it is pretty consistent. colleagues other questions? public comment is now open. instructions are being displayed. for those call nothing call and enter the access code and pound and pound again. press star throw to raise your

hand. on web ex online click on the raised hand i conto be placed in the queue. in person will be first followed by remote. we will begin with in person comment. no one approached we will move to remote public comment. upon item 12 budget instructions for general fund budget for 24-25. and fiscal year 25-26. this is a discussion item and will be presented by chief financial officer. i will do a tech check to make sure he is coming in clearly. are you in the room

>>. s proceed. i can't seat screen. we are up in the room everyone in the room can see it. you would not be able to see it. >> okay. good afternoon. [inaudible]. want to convey to you the instructions and the [inaudible] said let me know when slides are up. >> they are up. >> i will support with that. the next is coming up for you. >> okay. >> if you go to slide number two. which is the budget [inaudible]. in the -- so the reason why our

impact on the city is made of 3 piece. the highest impact is for what we do with the [inaudible] our total cost to the city. and the employees is 1 million dollars. there are [inaudible] manage the self funded plans and [inaudible] as i during the city's budget process, we are focus on the general fund. [inaudible]. in the general fund, our expenses 13 million dollars. this year because of the [inaible] that we are talking about [inaudible]. the health sustain ability funds

5.5 million dollars and [inaudible] from [inaudible] the annual [inaudible] includes [inaudible] 33.3 million and hae a process for the plan to support on going the priority this is year are similar to left year. and expense [inaudible]. and society focus is to focus is that direction is [inaudible].

on slide 4, you see the -- general fund impact. if you go to slide 4. the good news is the city is fine the [inaudible] reaches higher than the growth [inaudible]. creating [inaudible]. 6 billion [inaudible] [echo and muffled] go to the next slide. so look at all the [inaudible] and look at efficiencies. and so propose [inaudible] next

upon month. we will take into account the instructions laza what we need to do to provide an fortunate operation. there is a finance committee meeting for the 13 in the morning. that will be the second opportunity for input. the final budget present to you at the board meeting on the 13th. and the board of supervisors will approve the budget or view it -- this year. this is my presentation, happy to answer questions on the instructions. thank you. question sns >> a question/comment. i think these instructions make

sens they were mayor breed's instructions and i wanted s new upon 27 hours ago. i suspect well being be other instructions if i listen to his -- there are. >> acceptance speech >> well is a press release today. >> there are not other things every department. the budget was a priority and went throughout standard expectation of department head and how they respond to the mayor's directions. and -- he has announced there is an immediate hiring freeze. and there is a ga zillion dwhaes come with that.

don't ask the answers are not available. but he is looking to curb spending. and -- structure of the staff and the mayor's office is designed to foster a collaboration amongst departments we know this tha is a challenge and having a structure in place may have really good impact in that regard. i think that will be fine but i

think as we -- enter in this environment it is not it is going to be confusing. and will be stressful and difficult for any of us this have been through the kinds of constraints environments and careers know how hard it is we manage to get through. that's where we are at the moment. thank you. any questions or comments. public comment is open.

remote public comment and moderator will notify us of callers in the queue. there are 10 caller on the line zero in the queue at this time. public comment is now closed. >> thank you. >> item 13, please. >> item 13 is the approval of the resolution ordering the board 25 election for one expiring term seat and authorizing staff to initiate and proceed with the election an action item and introduced by abbie yant. and presented by board secretary myself hole. >> yes. i think i spoke to my director's report the election is under way

and holly, louder. closer to the mic. >> yes, i mentioned my director's report we have a member seat election. that is ready to get started holly can describe the process. >> holly lopez board secretary. hello, commissioners. health service board election materials were presented today. i come before the board to review the materials terror edits or suggestions. as executive director may 25, one member's term will expire and under charter section 12. 200 and san francisco code section 16. 550-16.554 when a

term of office expires an election must be held. the resolution buffer today out lines the intentions for that election including the dates. and that packet included public notices. schedule. nominations for candidates and fact sheet.

and include active and retired employees who are enroll in the the health plan. and qualified surviving spouse or domestic partners of active or retired employee. and term length is 5 years. and the commissioner coming in would start june of 25 and term would end may 15th, 2030. nomination period begins tomorrow of and open until february 14th friday at 5 p.m. and materialless will be available on our election web page on the healing service board system website. then will be available in our offices for anyone who drops in. and the there -- when candidates valdatd under the components zeal an orientation session.

surviving spouses and domestic partners and voting dates will begin may 16th and go for two weeks on may 30 at 5 p.m. and the d. elections will need 1-2 days to count the results june second to june 4 and year's past that will go quicker the new member would need to take the first meeting in june and now under the rates and benefits calendar will look at another item the first reading may be june fifth for the first meeting. election information distributed on our web page i will meet with jessica our executive -- communication's director to

develop a plan. and then i will be cord narrator for any and all questions if there are questions for the department of elections i will be able to be in contact with them. expiring in may of 25. and sets the dates for election thirzs san francisco health service staff to narcotic it and authorizing staff to prosecute seed with dates and deadlines.

>> all right. so -- a motion and second. >> a motion. >> you can present it. >> so, i'd like to move that we sept staff recommendation to order the 2025 health service board election for one seat expiring may of 25 this we set the dates for the election authorized the health service to narcotic the election and authorize the staff to proceed with the election. >> second. >> a motion and second. >> open up for public comment. >> public comment is open. instructions are displayed for those watching on sfgov.

>> we have 9 callers on the phone line. zero enter the queue at this time. >> thank you. public comment is now closed. president hao yoochl aye >> vice president zvanski >> aye yoochl commissioner cremen. >> aye. >> commissioner sass. >> aye >> commissioner wilson. >> aye. >> we have a vote. we are at the end of the regular meeting matters before we go in rates and benefits section of our agenda it is now a great

time to take a 10 minute on the nose break. >> thank you. we'll reconvene starting off with a roll call. please. >> roll call starting with vice president or president hao >> present. >> vice president zvanski. >> present. >> commissioner cremen. >> present. why commissioner sass. >> present >> commissioner wilson. >> present. >> great. thank you. we will start our rates and benefit's portion item 14. >> agenda item 14. presentation of rate and benefits process and calendar for plan year 2025 this is a discussion item and presented by

mike clark. introduction by abbie yant. >> thank you. >> you have on the screen the rates and benefits calendar for plan year 26. as of today. as we know things get adjusted throughout the cycle this is the plan as of today. and -- so we are kickoff with a depth explanation of the cycle we have a couple new members. if you have questions raise them during the presentation. this silent rates and benefits.

what other upon responsibilities for entity and other elements that will cover during the rate and benefits cycle from today through the june meeting. so, you see a full agenda but each correlates page in the presentation. starting on page two duties and responsibilities under the sanning front city charter section a8. that is 422 the health service board. that does play an important role in designing the benefit plans covered include adopting plans for the rendering of medical care and members and designing the benefit plans and changes. to members covering the health plans, medical and prescription, dental, vision, life insurance and disability. an important note, i channel the late prosecute scott the full

board meets as a whole. y way back when. serving as lead healing service board. rates and benefits are important that the entire boarded meets as a committee to review the rates and benefits. the benefits and rates and process guides our board to approval health plans for the following calendar year of page 3. really shows january-december. the cycle time line today. we start with the release of rates and benefits and later in the meeting i will present on the reported and reserves. and then february through june. the health service board approved the plan and rates. that then leads to july the rates and benefit package reviewed by the board of supervisors first the budget and finance and the entire board of

supervisors once those are confirmed renewal letters are signed by the health plans. we work those during the board of supervisors cycle. when that pleads we release the letters and have the health plans provide their sign off. and the system programming also begins in earnest. and commences or leads to open enroll am where they are mailed in september. and october the open enroll am occurs. in december confirms the elections to be effective the start of the following year. you heard >> michael leading the benefit contract and assessment and so the contract division does report on the status under jurisdiction every year. in august specific low.

informs of planned request for proposal or requests for information for primary service providers. you seat process formal proposal required financial commitments, the renewal processes a plan add administrators. presents the recommendations to the health service board for review and approval. with this approval required prior to the submission and rates package of the board of supervisors or alternateively requests for information are brood forward look nothing scope. asking voluntary commitments no contracts award it may be conducted as a market assessment or narrow the scope in determining the timing of the future rfp. the serve approvals again start today i will talk through that report reserves and the reserves. and then later in the cycle the

march time frame will present on rate stabilization process. >> the funding types for the plans are 3 core manageds and every health rate presentation that we do in the june touches on these funding methods. it is a graphic you have seen before in prior rating discussions every year. and so thought it would be helpful to include them just to illustrate the difference in funding methods the plans. that engage each will self funded the claims. that are on service delivered are paid by the trust and administrative fees to manage the plans. flex funded plans the hmo and health net carried through hmo insurance prop for most claim dollars bazed on services paid

through the trust. certain fixed costs for capitation and plan administrative fees and large claim reinsurance that applied the blue shield plans can apply, for full insured health plans that is the 6 dollar premiums with our scrutiny and negotiation. so, the health service board rate policy does apply to the self funded scomplans flex funded not to fully very insure they are set by the plans. health plan ewe lagz experience reviews every year before we present. rates for approval. so again in the march/april time. we very well view the costs will and experience for plan with you. this experience serves to help guide what is expected for rating. for the flex fund fully insured and self funded plans.

which could include for medical looking at the claims. top spend categories, in patient admission. out patient visit and health status and preventative care rates. industry resource are important the 10 county survey is prescribed by the charter. and so you see the typical language. typically in march presented to you results of the survey of the cost across the plans for the 10 learningest counties in california. that served the basis for the employer contributions for the members. the work is performed by you heard from earlier today cents roll to this analysis. and we present it for approval in march. we all conduct a bench marking study typically in april, this

looks at costs and benefits for the medical plans for active employees relative to the data base of 800 employers. and supplemental information from time to time cfo will upon present on general information in the marketplace you will hear from us next meeting with an update on health care. the rate i will not go in detail i will have a detailed presentation in the next item. out lines information on how we perform the calculations for actives and retirees and get in this in more detail in the next item. page 10 we will bring the rates and help make changes to the board and the health service board approves next month will present on vision and will take

us through june for the medicare plans. >> and then finally after the health service board approves the package that is submitted to the board of supervisors for review by budget and finance at board and then what follows upon their recommendation to cascade to the full board their action in july. per charter the approval of the following rate and benefit's package requires approval from throw fourth members spread across 2 meetings a first and second reading. and once that occurs the mayor will present it. tell be helpful to go through more detail what is coming in front of you. >> today through june. and beyond. >> thank you. mike and happy new year to you and ann. thank you.

>> any questions about this presentation and time line? it is thorough. >> thank you. >> when you put it reduce it down to one presentation i'm like we do a lot, you do, too. thank you. no questions or comments we'll open for public comment. thank you. >> public comment is open instruction on the screen for those on sfgovtv and web ex. for those dialing in call.

board secretary there are 8 callers on the phone line. one caller enter the public queue at this time. other callers may enter as comment continuous i will indicate when there are no caller in the queue will hear silence as we transition. >> thank you, i will unmute the next caller. >> welcome. caller. >> talking to me. >> caller you are unmuted you can begin your time. >> hello. are you talking to francine austin. >> hello. >> yes, caller we hear you in the room this is public comment for the agenda item about the rates and benefits. for the health service board you have throw minutes to comment. >> i'm sorry. i wanted raise my hand for another topic. >> thank you.

>> thank you. bye. >> moderator will let us know if there are callers in the queue. no further callers public comment is closed >> thank you. >> we will go ahead and move to agenda item 15, please >> item 15, board education. nonmedicare rate setting methodology a discussion item and presented by mike clark lead with aon. >> mike clark. we first asembled this with the intent to deliver it in person but our service board in spring of 2020 we know what happened. we did at that time create a 4 part series educational series we post on the website. with yours truly. we thought with the evolution of

the board and certain as we start the rate and benefit's cycle. here we are 5 years later it would be helpful to do a refresh of the information on how the rates are set for the healing plans you all have presented to you. as well as the public on how the healing plan rates are set for the medicare retiree populations. include discussion of relationship of health plan rates accountability actives and nonmedicare retirees. single coverage for employee only or retire each two party coverage including retiree or employee and a department and family coverage with 2 or more within a plan and across the health plans offered. and the multiple employer contribution determination rules

are also touched on in this presentation. will often just focus on the city and county of san francisco. methodologies when we presents. rates to you in the presentations but this contains information for city college, and superior court employees. >> so, when we finished the process you get this table on page 3, which is included in our sumization documents. m may and june and everybody wants to know how we get there. that's what this education helps to supportful today's discussion in 4 topic areas how it is funded. and the healing plans report activities for next year rate recommendations. developing the total costs and

from there segment to employer and member contractions for active and retirees. historical perspective back to 2013, on the health plan rate relationships across the plans. coverage tiers and how it evolved to the current state of the relationships and some modifications. thank you to holly. there is a health care glossary of terms i will try not to overwhelm in this i can tell thank you is a fantastic resource on understandsings all the different terms. this are utilized you know across the plans and the rating work we do. first, with the methodology the self funded plan rates we caththose rates for all the

plans including medical and dental. you see the various plans. that roll up under self or flex funds arrangements and the plans not listed above there are fully insured the premiums are developed by the plans kaiser is an example that the medicare advantage plan. most of the dentsal plans with the exception being the active employee ppo plan self funded and theed vision plans and then in addition it is not listed the life insurance plans are fully insured. the self funded plan rates you see this graphic is a high level a 5 step process. starts with the prior period claims apply trends factor. to account for you inflation of medical costs as you go over time. accounts for those design and head count changes if

applicable. add fees and then the cost elements like the sustainability fund charge. and so those developed a prosecute jection period rates by plan and tier. each the next couple pages with page 8 touch on the 5 steps the total rates on step one is starting with the prior period claim experience. and certainly a fully credible population for a large population and the plans. and we are starting with the claim experience from the sipically the most completed calendar year for prosecute jections if we see anomalies through the data, the first quarter before we present on the rates we could incorporate that.

on page 9 aplied health care cost inflation and again. cfo and i will present on current trend and this is something we keep a close eye on. when you see increases and plan equalization. talked about that in november with the prescription drugs with our pharmacy expert. want to incorporate the fact that health care costs increase over time. when is the appropriate factor for us to fwhld those protections? so, we applied those factors on mid point to mid point basis to make sure we adjust the timing

properly with the experience period and projection period for the blue shield plan will develop a trend factor we review carefully. with the blue shield team for the nonmedicare ppo delta dental ppo we developed the trend factor using statistical methods. as well as national trend factors. the claim and rating include the prosecute vision for prescription drug rebates that was a question earlier in today's meeting. we incorporate expected increases the rebates as prescription drugs happen and the changing landscape and prescription drug rebates as well as the capitation levels to the fixed costs for services that apply in the plan and and the large claim pooling for blue

shield hmo plans. those factor on how we take prior experience and forecasted to -- the projection date. we look in plan design and head count changes that could occur. factor this in. to the projections. and they could influence the claim costs. could incorporate changes in any health risk or drfks the great reporting kosh are provides if we see change in health risk or population composition in a plan we could incorporate that. we don't see that historically in the data. but we are prepared if we do see it. page 11 the fees. those are based on fee catharsis provided by health plans. as well as again for the blue shield hmo's the pooling fees we

built those inform could be legislative fees. california's mco tax was approved for continuation by the california legislator. that is a component of cost that is built in the flex punldz everfunded plans. the other specific cost elements we make provisions for change in president claim stabilization reserve. so that -- certainly is an important part of the rating we do that is us specific. those amounts determined every year in the march/april time frame and the health care sustain ability fun charge moved 4 dollars per month. per covered member. as well as the basic vsp vision insured rates that are part of the medical plans. you see those line items on those medical rate cards. >> so, that's how we take the prior data all the other cost

elements we know project them to the new plan year. and then how do we allocate that across the 3 coverage tiers. you know for example, this is a -- exhibit that it shoes what plan rates could be based on how costs are allocated across the retire rew. verse you employee and retire weee with two or more. we are taking a figure per plan and across to be 3 tiers. we'll talk later in the presentation about how that is applied. allocating costs you start with the premium and budget dollars. the left side of the page the 5 elements i walked through and am get segmented based on the

population distribution across each 3 into the rates using the tier ratios. and another complication. are the three tiers for split families the split family retirees that have the members and family tiers and also certain covered in the families the medicare plans and others in nonmedicare that factor in as well. segmenting the rates to the employer and member contributions i will talk through this for active employees. the employer form lapse funds negotiateded mou's and you will see the two common ones will call them 196/83 and 93, 9383

the percentage. cost across left side employee only. middle employee plus one department and right side employee plus 2 or more departments the percentage of cost the city is covering for this given employee. and depending on the m u someone may have this cost sharing verses the 93, 93, 83. those contribution amounts for the medical and drug and vision for most expensive plan are the same for the second most expensive plan. now the ppo is done the most expensive plan and those contribution dollar amounts are tied to the second most expensive mrafr dh is blue shield access plus. it changed with the cost of plans change. but these are the relationships. and then the employee contributions for the healing plans the total cost rates.

the routes and plan and tier. for dental the mo u prescribes employees pay 5 dollars for sing and he will 10 for two party and 15 for family per among for delta dental. no contribution for the hmo's and those electing the vsp plan they pay the difference in rate between the core or basic vision plan. part of the over all medical costs determination and the premiere plan it was addd and i believe 2018. it has been successful. we will talk next month how it increases in the premiere plan. for the usd population, the contributions vary. and anchor in the 10 county amount of the could be higher. for begin employee segment.

and/or plan. now in 2025, for kiez and health net hmo the employee only contribution equals the premium. the employee contributions for the plus one and [inaudible] do vary by employee type and planful based on the agreements but the krksz for the family plans increase with the total rate increase simple and the employee contributions bank account difference between the total rate less when the employer is paying. usd does not offer dentsal. so they have dental through other means and the same applies for the vsp premiere plan. city college similar in nature to usd. could be different agreements but generally, empyee only is anchored to 10 county amount.

with the employer contributions. varying by typor plan but the family tiers increase with the toll rate increases. and the other elements are similar to usd. and for superior court most pay no contributions for medical, drug or vision. they pay no contributions for dent yam vsp applies. you will see page 20 the form lapse to round out the section. which involves flejs credits can be spent on benefits. including heck and employer krksz equal to the 10 county

amountful employees in the dentsal delta ppo plan. . superior court employees pay no contributions for dental and buy out for premiere aplies. a lot of information tell be posted by [inaudible]. and transitioning to the retirees. society employer krksz guided by city charter formula for hired on or before january 9, 2009. the medical will prescription drug and core vision plan contribution amounters based on the throw components. as described below in the city charter. two are developed separately the one is the same is 10 county amount that gets approved in march. the first element that vary system when we have called the difference. what it means is a difference in

the single tier premiums the nonmedicare retire and he was active employees. there is -- stlor what the active employees would receive. this is what is covers that difference. between the retiree only rate for a plan and the active rate for a begin plan. and the second element is the prop e contribution provides additional contribution for the retiree only and the family tiers. it is geared the cost of retiree plus one tier. we have common this is show that. and then the prop e contribution is the same for both retiree plus 1 and 2 or more this provides additional city contribution for the retiree

only and the first department of a retiree covering family members. so, an example here -- so we got several but this is for the health net canopy care plan. light blue the bottom part of this chart on page 23 is the 10 county amount. you will see that is the same amount for all plans. the dark blue is the difference, which is the upon difference in total cost rate with the retiree only and active. employee only. and then for anything left, 50% of what is left for both retiree and plus one tier is the prop e contribution where again, the you don't have additional funding for the second department and more but the additional contribution for the first. and then page 24, shows that

side by side across the 4 charts for other plans the plans most common law enrolled in by the nonmedicare retirees. blue shield access plus. kaiser hmo and the nonmedicare ppo. retiree plans with no retiree contributions tier, for retirees hired on or before january 2009 the relationship of the cost of the coverage. relative to the 10 county amount. so, employer krksz limited to be no more than the cost of coverage because these amounts are lost in the 10 county amount for the kaiser hmo. upon nonmedicare retirees.

i mentioned difference in time when a begin retiree was hired. for those hired on over after january 10, 2009 the medical contributions do vary by service. someone can earn the full charter amount if well is 20 years of service. if well is less than 20 years of service a time of retirement it say partial formula or perhaps no employer contribution if someone has 5, less than 10

year's service. and for the dental and premiere plan the dental coverage is fully corrected for all retirees and premiere plan also applies for retirees. transitioning to historical context, the health plan rate relationships. so, how the plans treated the rate add-ons. i think they have helpful context for the insured plans. every plan was insured prior to 20 dmraen have the same dollar value rate add-on. . blue shield hmo plan now the access plus plan time transitioned to flex funds nothing 2013 and maintained this same dollar value leadership for departments actives and nonmedicare retirees in the first year. kaiser had this feature and

continues today. butt rate and add-ons for the ppo plan for the active employees and medicare retirees had rate ratios. the mathematical relationship when dividing the family rate divide by single rate had been different than the hmo plans a greater spread for the portion of the nonmedicare p po rates and retirees versus blue shield, health net and kaiser hm oshg plan this is is on page 30. a bit of a history extinguish here this is rates in 2013 along with the various rate increments the ratios and one tiers you see what is highlighted here are for the blue she said access plus plan. the same relationships the same difference between a begin

family tier and single tier. versus the different rate ratios that applied for nonmedicare ppo. the other key observation from 2013 rating the active employee during nonmedicare employee. there was a small gap for the nonmedicare ppo versus other plans. nadifference is one of the 3 elements up from the charter how the contributions is determined for the nonmedicare retirees. >> the two key rating difference existed historically between the nonmedicare ppo plan or the city plan and the blue shield and kaiser plans the treatment of the add-on beyond employee and retiree only tier, and as laz rating difference

with the active employee and nonmedicare retiree only. so f we fast forward to current. for many of the elements of returning over the years and play out in the day in 2025 rating. but the two developments in plan rating you finish we go back to when i started work width board and the 2017 and 18 time frame. sustainability the ppo was a huge issue. a large reserve being drawn down export to make sure it could sustain. so. transpyred and what is approve in the april of 2018. first all active employees and nonmedicare employees living where the plans are not available.

the focus on the city charter form well in evaluating how the costs and rates play out by various retiree tiers. in the it does vary in dollar amount and we ash count for that when we perform the plan rating the good news is if we close out the presentation on page 39, we

were concerned about ppo sustain at in 2017-19. we have seen growth in the plan from active employees in each the last couple years helped create environment the rate increases for the ppo plan than other years. talk about and make sure

everybody knew more information was available. you may have upon rendered us speech little. i think this is detailed, thank you and i do want to point out for my colleagues if you have not read the glossary it is finish taftic and think when we think about election and what it is to be on the board we want it to be required reading it really is suburb, thank you, mike. >> in two sentence or less can you explain again how the retiree plus two the prospect e employer contribution work sns >> yes, it is after you take the ratio of the employer contribution from the 10 county amount and employ are contribution that again actual difference.

it is irrelevant retiree only minus active employee. half behalf is left over is what that is. for both retiree only and retiree plus one. >> and then the retiree plus two or more. the same employer contribution as retiree plus one. the city is not providing additional. contributions to the second or more dependent it is the same employ are contribution as if i cover myself in one department. >> thank you and the people who are hired after january 2009 at 5 year mark they have access. >> yes. access of 5 years special emplayer contribution at 10 years. full emplayer contribution starts at 20 years. prospect b, i remember. >> thank you. >> all right we will take

public comment. thank you, mike. >> public comment is now open. instructions are displayed on the screen. woo is 8 callers on the line two raised their hand. there will be a brief pause. and i will unmute the first caller. >> welcome, call are public ment is open.

>> welcome, caller. no response. and transition to the next caller. again this is for public comment for our board education item. hi i am having difficult [inaudible] formulating my question i will pass. >> thank you. caller. >> i will place you back on mute. looks like there are 8 in the queue but no further callers with public comment is closed. >> okay, great. thank you. >> we will go ahead and take item 16. >> number 16 approve the june 30, 2024 incurred not reported ibnr reserve and reserve amounts

for self fundd and flex spend health plans an action item and presented by mike clark. >> mike clark, introduction is on page two. policy for reserves are captured within the website. in the governs policies updated based on left month's meeting for the reserve policy. today's presentation questions the board approval for the ibnr. as well as 95th percentile conference level reserve amounts that are calculated as the end of the most completed fiscal year june of 24 for the self fundd and flex funded health plans. and on page throw today's recommendations focus on the first two of the over all throw reserves. the incurred but not reports are

actual estimate of unpaid liable for run out claims services happened on or before a given date. june 30 of 2024. butt claims had not been paid. and these are the reserve amounts the auditor careful low analyzes and you heard the report if the audit team in late of ever2024. contingency reserves protect against funding estimate short falls that could occur. on stabilization aranual financial gain or loesz for plans. and calculated at the end of plan year. december therein and will be presenting on those in the march/april time frame. so reserves on each self and

flex funded plan and the active employee dental pp oshg plan are held. and you see the plans that these apply to. for the medical plans and prescription drug plans. applies the applies to the dental plan. for the medical and prescription drug planos page 50 reserve policy says will develop reserve recommendations for the self fund exclude flex funded plans. 3 confidence interval levels 95, then and 99th percent tliel is an exhibits in the back it out lines what do they mean and real terms that has to do with expected deviation from an average. and -- 99% produces the highest

level of -- reserve amount and was what was used for contingency reserve determination. last year on the review of things we can potential low do to mitigate budget occurrence and xresdz by employers at the february 24 meeting in march 24 meeting approved a statement of the june 30 of 23 reserves to the 95th confidence level. based on recommendations. we are continuing the use of the [inaudible] in our recommendation here today. then, the dental in prior year reserves held but talked start nothing march 2024 about how we felt a reserve was not necessarily applicable for a

self funded plan. we followed up then with the committee on december 6 and the full board on december 12 to essential low e eliminate the ppo plan from the policies. the reserve is no longer held on the self funded employee ppo plan. with that background the reserves you can see here are reducing between june 30, 2023 and june 30, 2024 over all. for the medical and self funded dental plan and a lot of that has to do with claim processing speeds compromised coming out of the pandemic because of staffing issues by the healing plans did not have enough people relative to the claim volume to process the efficiency as they like and the most part the staffing levels returns to prepandemic

levels that is the contributor where we calculated the decrease in over all reserves for the incur am reported. >> reserves on total increasing 4.5%. these contingency reserves are fully fund. and you know they are reflected on the balance sheet by k fo hussein. and we wanted to show you what the amounts are across the three percentiles as out lined in kohning contingency policy 210 for medical plans and again we talked last march about the approach we feel the 95th percentile provides protection from a standpoint and much more consistent what we see with aon working with public sector customers. with that, it is recommended the

service board approve in 95th percent reserve amounts as. june 30, 2024 present in the this material. for the self fundd and flex funded health plans that are listed here below. noting the changes in contingency reserves a component of the 2024 stabilization reserve calculations we perform and present in early 2025. >> great. do we have questions? thank you very much for the thorough presentation. >> yes. >> if no questions at the moment we will go ahead and take a motion. to regarding today's recommendation with respect to the ibnr. and the contingency reserve amounts for self and flex fund health plans.

okay. give this a try. i move that we approve the health service board approves ibno95th %ile contingency reserve amounts presented in the material before us. second. >> we have a motion and second we will open up for public comment. please. public comment is open. instructionsor the screen.

public comment is closed. in we don't have more questions we will take a roll call vote >> a roll call starting with president hao combroochl aye >> vice president zvanski. >> aye. >> commissioner cremen. >> aye >> commissioner sass. >> aye >> commissioner wilson >> aye. >> thank you very much. >> thank you. >> we return to our regular board meeting matters. at the top of the lineup is item 17. >> agenda item 17 blue shield medicare advantage ppo

transition update a discussion item and presented by operation's manager and charles lee blue shield of california senior manager of group retiree. >> good afternoon will of gal operation's manager health service system. this month's blue shield medicare ppo u. we will go over going over the hss implementation dash board. success and sb4 call metrics we will have a review of the implementation dash board. call center metrics and followed by a review member engage am experience addressing occurrence blue shield medicare program and care and will we will wrap up with a look ahead. last month all tasks on our hs

circumstance implementation dash board are complete and completed timely. work streams for payment and reductions file and it is cms and other report are on track for future 25 dates. >> wield like to highlight the successes of transition. that were accomplished in december. 19, 100 members sent to blue shield for enroll am allowed id cards and welcome kits to begin to be mailed out on december 16th. as we mentioned in last month's open enroll am the process is does not end at open enrollment takes several months accomplish with annual manual processing and large numbers of data entry and corrections. our goal with blue shield to send them out early as possible to get the major of our members

id cards by mid december. due to the need to expedite we saw sen % of the record sent it blue shield requiring manual processing this was completed by december 20. with next steps taken for those members and ensuring their id cards and kits were sent out. a small portion of that 7% of the record experienced error due to manual processing the case are getting expedited as they come up ensure members experience limited to no experience with access to care. i like to take a brief moment to focus a feature i talked about in our previous presentations. we continue to solve a --

functionality in our hss call center system where by member who is call hss directly are able to self select or triage and be connected to the blue shield concierge call center without transferred or call another number. to get connected to blue shield inform december. this had a highest usage since we implement in the october of 2024. over all, our call center metrics are consistent from month to month we seat resolution is over 90%. we are seeing consistency in the average handle time. and we see biwe see an increase in the average speed of answer we saw a significant spike in over all call to thes call center during the month of decemberful in december we had factors contribute to our long are call wait times. confirmation letters went out

increasing call volume with the holiday closures saw significant increase of call in both weeks that had holidays which is did she then and there when we see with monday and tuesdays or high volume days. and member services team has only 11 benefit analysts who are responsible for both phone and in person support processing new retiree and new hire applications along with qualifying life events venter reports and internal audit reports. we did have holiday time off schedules in december ruszing or team. i point out to the board that the member team has a block out period the left 2 weeks of sept through november vacation time cannot be taken to accomplish all of our administration for open enrollment. i expect our call volumes will

remain the same in january. as we work to back fill positions that are open on the member services team. i will lo like to fasz over to charles lee. >> thank you, olga. >> welcome charles. happy new year. charles lee blue she said. you see on the deck a similar to hss, the transification for blue shield has been positive. we completed a variety of tasks required for the implementation for one line and we are on track for various post implementation items such as medical transition ensure transition is successful and transition as well. so since january 1 we have not

experienced major system or other issues of prior post, knock on wood there. but in the effort of transparency we acknowledge we have experienced wind number of issues with the transition. i will speak to those later. but in more detail. but we want to reassure the board and retirees that we are working diligently with the staff and -- with additional advocacy groups to understand those issues address them, quickly and get them resolved. and lastly, 19, 100 members did receive. their welcome kit and id cards. i will pause and go to an upon call metrics. i want to highlight this is for

our december and so it shares the experience this retirees had prior to 1/1. the number of id card inquiries the hot topic for retirees. and so, we have certainly stheen a cost hike as a result of the questions and the same time you will see the average speed answer unfortunately it went up from the usual commercial that i talk about and like a superbowl commercial a 60 seconds there. i want top reassure the board again that we have increased staff. from our 22 concierge folks and i believe 34 to be able to bring this down and address additional call volumes that will report

out in january. lastly of course the 64 second system an average we have heard of instances where the timing of the call wait time exceed the 64 seconds in minutes. and we attribute that to spike in calls. i had a sample id doored share that are did in the get to us in time of i am sharing a with the board a hard copy of the welcome kit we shared with members once they are enroll exclude they have received in december. once again, we had no major system issues id cards and

welcome kits were delivered in decemberful thank you. so the next item we have is addressing member concerns. so, we wanted share with the board that we did have a hiccup in terms of a confirmation of enroll am letter. that's in and a letter we sends once we get information from hss and we submit it to cms to confirm transition to blue shield. unfortunately, that is a templeted letter inform a confirmation enroll and want unfortunately, there was language on there regarding out of network coverage and requirement for prior altogether. unfortunately, those letters

were sent out like i said in error. and i want to be clear it was an issue on blue shield's side sent out by mistake without editteen though temptleted letters we have the ability to update and should have dhn to make it clear not all out of network services require prior authorization. at the same time what we did was once we understood the issue and heard about it we worked with staff to quickly sends out a correction all right to correct that misinformation and hopefully that will lessen the concerns for retirees moving forward. the same time we have a corrective action in place to be able to review all member materials or letters that are going to be sent out in the future to make surety edits are incorporated and not general

templets sent out. >> in addition to back to prior authorization issuance as well. we received some reports of providers not accepting our prior authorization process. for them. that is partially an education issue with providers to help them understand the 90 day transition process we have in place for hss members. and the same time, what we did is we have created a developed a written authorize. in addition to verbally talking to provide and assuring them that the prior authorization is accepted. we didn't extra stow develop a written authorization as well as to reconfirm and reassure them that the prior authorization is in place and they see the members as needed.

>> hopefully after this is settled down after the new year we look forward to working with hss staff and being able to be proactively engaged with our members moving forward to make sure that they stay healthy. some of the item this is we look forward to working with is to be able to have a cohesive cobrand campaigns to be able to educate folks on availability of the programs we have. listed below. such programs health vs. mailed kits and got membership appreciation programs which incentivize participation with gift cared ranging from 10 dollars to 50 dollars.

so -- all those programs is the goal main goal is to able to get data for our retirees. with that data, what we want to do is able to have them be able to access additional programs in care to help them stay healthy as well. what we want to do is get that data and identify folks that could participate in -- targeted out reach and support and services such as areas behavioral health. pain management, depression. cancer and et cetera . what we want to do is take that data and be actual actionable about it and proactive and reach out to member and offer them additional assistance and programs and resources to be able to engage them and keep them healthy

again. thank you very much shares the programs we would offer to folks to be able to focus acute care, pain management. chronic conscience. nutrition, et cetera. we have the programs set up so we can guide? folks through the process and through the resources available to be able to have them work through healing issues and occurrence. and i our goal here for the programs is -- the right care at the right time to make sure we engage them in a proactive manner. >> and the last slide we wanted mention to the board that we are excited and we look forward to you know engaging members with those programs we want to be out there and engage with the

retirees educate them on what is available and able to work with them on health care moving forward. we will make sure that access is not an issue that will be addressed proactively. we will continue to take a look and make sure that the very popular groups weep typically utilize hss members such as stanford. dignity. and john mere have no access issues. >> we'll be proactive about pharmacy reimagined. blue shield as you heard were trying to break the mold on the terrible pharmacy benefit manager system. and so we want to make sure our efforts bear fruit and that they had positive impacts to members. i want to mention that this is an exciting time for blue shield. we are excited and can't down

play the level of effort that we coordinated with hss to beally to transition 19,000 members successfully to blue shield. and so, we want top move from implementation to the expectation and deliver on the first class care and service that we all want to deliver for the members. at the same time acknowledge we are not perfect. and that however, we are here to be committed it is quickly addressing issues and able to resolve them and make sure that there are no on going issues. with service. i open up for questions >> can i jump in, procedurally. it was handed out need to make sure it is in the record so that

the public can see it. later. given the board has looked it a will work with blue he would to get a copy to post. >> i have a couple questions on the card i received says blue shield of california and i on the back has -- billing to gallon to blue shield of california i live in california if you lived in arizona will the back have the arizona addressos it for billing or still california?

upon >> good afternoon will xhfrns customer healing service system. i will focus goal 4. which is supporting the mental health and well being of members reducing stigma and addressing barriers to care with stake holders. well are throw focus areas i will cover. the first is reporting out on our mental health vendor summit in december of 23. we continue to do the work in around that summit. we are look to identify our next action items in regards to priorities in three areas around communication, training and assessment and we are continuing to work with our graphic artist and digitizing that journey map.

enhancing retiree well being the last year of 24 was ensuring thereof an aline am in the services and support and monitoring the mental health and behavioral benefits for the transification from the uch flon blue shield ppo transition. we vehicle receiving from our healing plan and continue to dive deep in that. third focus area is our annual health in may of every year i will focus highlights our goal is to next our engage am 5%. year over year.

this last year from 200 throw to or 2023 to 2024. we saw a 59.9% increase in equalization. the web narc and group exercises class we offers. one big components to the campaign we partnered with 13 department heads to creative don't wait we are hear for you. that was successful it 930 views and had more since then. and then we have a lot of clicks in the e mills people clicking and ewileizing the resource. we have 5 different areas we look at encombaj the one is

through trainings and w shops and webinars and exercise classes in highlights. we look at how many individuals accessed our credible mind website and took an assessment and how many sessions to credible mind or how many going in the website and clicking and ewileizing the services and the number of e ap case those are when people call. seek service. how many that get when we call a case to seek services through a clint iing. and one thing i wanted note is that you will see in three of the 5 areas we had a decrease but because we had a significant increase in training and we are seminars we offerd that helped % goal. and i will turn it over to olga.

operation's manager. i will go over 4 areas under opt miization of everybodies system with gospel advancing stake holder engagement. in 24 we established a base line for members satisfaction with support they receive in the person and through the phone special our goal to increase the satisfaction 2%. we received 2,000 responses to the survey with rate of 58%. among those who -- satisfaction or highly satisfaction in service. one element was the member survey was called the net promoter score ape mark research that measures how likely customers are to recommend a product or service to others.

our score was 26 which is in line with industry standards for health care. in 20 twitch we will continue the survey, process and evaluate the strategies implemented throughout plan to evaluate how they are increasing the satisfaction of our members and increasing our met promoter score. the next several goals of our 23-25 plan look at improving staff experience and knowledge which is directly linked to improved member satisfaction. part of the high level strategy do you meaning all member service divigsz operating procedures in 2024 we were able to document 11 procedures. able to update 5 of our member

communications. conducted nime trainings followed by a staff survey of their reflections to which we had a 90% satisfaction rate. we'll take back the staff's recommendation and incorporating them in our 2026 plan. and our last completed element of service plan to incorporate quality assurance members to the administration of benefits. the goal was deferred until all operating procedures were documented we were able to adopt a system used by other

departmented for exalt quality assurance. i want to mention that is only one of the work streams of many the quality of informationa is shared. each supervisor on the member service team reviews two calls per staff per month evaluating them against crip tear enthusiasm the information is used during staff one on one sessions and coaching and guidance for future calls. we utilized the dhr customer training during our all staff retreat last year. that created a foundation for our staff of 4 customer service

expectations. this goal allows you to capture areas of improve am. and you can see from the appendix on page 2610 of the 22 areas scored a quality assurance of 90 or above. we will take the learnings from the reviews and search for staff training happy to pass the presentation to low litesia for final remarks. in 4 direction of the plan completing the hear vard strategy execution course. i want to share themes that amfight lessons we learned. strategic plan implementation. knowing the various tensions leadership face. and building a frame w for

managing them effectively. think burglar how to optimize the design of key jobs to aline them everyone understands their work and role. want to apply techniques among employees example to live by our values and inspire and guide them. aim to create measurement system