. good afternoon everyone and welcome to the health service board meeting february 13th, 2025. these all rise and join me in the pledge of i pledge allegiance to the flag of the

united states of america and to the republic for which it stands one nation under god indivisible with liberty and justice for all. >> thank you. >> all right. if you will please call the agenda item number. >> agenda item number two is a roll call starting with president how present vice presidents of lansky present commissioner kremen present supervisor dorsey present commissioner howard. present commissioner sas present commissioner wilson present. >> all right we are all here very much. next item please agenda item number three is general public comment. this is an opportunity for members of the public to comment on any matter within the board's jurisdiction that is not on the agenda including requesting that the port the board place a matter on a future agenda item. i'll be reading our viewing

instructions aloud. remote viewing is allowed and available on a set of tv and online using webex. >> the health service board welcomes public participation during public comment periods. there's an opportunity for the general public at the beginning of the meeting and an opportunity to comment on each agenda item in person. public comment will be first and then virtual public comment for anyone waiting in person you're welcome to approach the podium now each speaker will be allowed three minutes to comment in length unless the board president deems new public time limits during the meeting. all public comments are to be made concerning the agenda item that has been presented. a caller may ask questions of the policy body but there's no obligation to answer or engage in dialog with the caller. >> the health service board will hear up to 30 minutes of remote public comment total for each agenda item. remote comments from people who have received an accommodation due to a disability will not count toward the 30 minute limit. remote members of the public attending the meeting via phone can dial in by calling (415) 655-0001 enter access

code 26620569486 and pound when prompted press pound again you'll be prompted to enter the webinar password 1145 then press pound press star three to be added to the public comment queue you'll hear the prompt you have raised your hand to ask a question. >> please speak until please refrain from speaking until the host calls on you when the system message says your line has been unmuted this is your time to speak you'll be muted when your time is expired. for those watching the meeting on webex click on the raise hand icon to be placed in the queue to speak a raised hand will appear next to your name when you're unmuted in a system a request to unmute will appear on your screen. please select unmute to speak once you hear welcome color you can begin speaking when your time is expired he'll be muted . please click on the recent icon to lower your hand members of the public are encouraged to state their name clearly although you may remain anonymous or give an audible warning when you have 30s remaining and when your three minutes have ended. i'll thank you for your call. you'll be placed back on mute animal on mute the next caller

thank you to speak of tv and media services for sharing this meeting with the public will begin with any in-person public comment for this general public comment agenda item no one has approached the podium oh oh oh there's lois. good afternoon director yante and commissioners my name is lois scott. i'm vice president of protect our benefits and i guess it's a rainy afternoon. >> not too many of us are braving all the raindrops but i wanted to make some brief comments. i admire that. how much work it is to oversee 14 insurance programs. then as claire's vance ski commissioner says, over 100,000 lives in terms of where are your responsibilities and fiduciary responsibilities lie i've learned a lot just visiting and participating in

the last year or so particularly questions that are important to ask both i think as commissioners and as consumers right now one of the important questions i would have asked is the ratio of human beings that help you in a particular program versus artificial intelligence s and how much resources go to artificial intelligence versus how much go to pay human beings on the other end of the phone or in person to help you? another question that i would ask is how many sub contractors does a particular insurance program employ to administer programs? i think this has come up and maybe we'll be talking about it later in the agenda

how do we hold subcontractors accountable? >> how do you know what they're doing? we didn't even hear about some of the contractors that one of our big providers one of our big insurance programs is using when we review that program. and then there is the bigger question and i guess we saw them orating all night to try and hold off an appointment that many people thought was unwise in terms of the national picture and managing health issues. >> what is the future of medicare? what's the future of medicare advantage? >> it seems like it's under pressure both from the top where it looks like it costs more than just plain medicare by a lot and it looks like people who are in the program are also dissatisfied with it.

>> we are i think people are increasingly unhappy on how the medicare advantage program insurance programs do play out and i think we're in very uncertain times and it makes it even more challenging as you recruit new leadership in for the health services. but thank you for all the work all of you do and have done. >> thank you. thank you, lois. >> and no one else has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue at this time. >> secretary we have 11 callers on the phone line. one caller has entered the public comment queue at this time additional callers may enter the queue. you will hear a brief moment of silence as callers are elevated

. >> welcome caller hello can you hear me? yes you're three minutes begins my name is. thank you. my name is christine ellen block. my mother was a teacher with the san francisco unified school district for over 30 years and was part of the health service system then united health care. and recently late last month or last year we learned that united health care was no longer going to be providing health care to both my mother and my father who's over 100 years old. my mother is 86. i am an attorney. i have navigated the irs code i have navigate it criminal law proceedings was a former public defender in san francisco and i can tell you without a doubt that the rollout and the conversion from united health care to the blue shield that my mother and father are currently dealing with has been a

complete disaster. my father is over 100 years old like many other world war two veterans, has a lot of injuries and ailments. i cannot now receive a 5% white cane patch for my father which he was receiving without any problems before under united health care. >> it would be easier for me and for francisco right now to go and get sentinel to blocks from where you are sitting than from what i am having to deal with to try to justify the use of a 5% later claim patch for a 100 year old individual who was referred to a cumbersome website having to go through the system of what is and is not approved under this new regime that you have put in place. i would like to know why san francisco made this switch away from united health care. what was the rubber stamping

that went on here? something is very wrong in san francisco when you are not able to take care of your elderly 100 year old people not a phone call, not a warning, nothing. now every year we have to justify this. i will be back next month with an update on the y2k impacts. he also is no longer eligible for picc lines for infections that he needs to treat at home . what type of system have you put in place here? what genius negotiated the deal with san francisco? with regard to the united health care switch, no 100 year old person or 85 year old person should have to justify 30s remaining under the current plan that they need a 5% white skin patch. we have i have had to negotiate this for both my mother and my father. when i spoke to the lovely lady on the phone from the field she told me that the welcome calls that were supposed to be given

to all of the people that were being converted were canceled due to the overwhelming overload of phone calls that were coming in from the multiple recipients of this of the insurance because they were so confused. >> huff thank you. caller. your time is expired. we'll move to our moderator to know of any other callers in the public comment queue at this time or secretary. there are ten callers on the phone line. two additional callers have entered the public comment queue at this time. you will hear a brief moment of silence as we transition between callers. >> thank you. we'll be on muting the next caller while the caller. >> hello. my name is marie and i am a recipient of the benefits that i get through the city and county of san francisco. >> much like the other caller i expressed extreme frustration.

it was a dream as compared to blue shield. worse yet i get communications that you have to do. one of my medications is not in the formulary and my doctor sent me approval to color. >> you've been paused this topic is later on in our agenda. we're going to move on to our next callers and this is a reminder to any callers on the line. this is under general public comment and will be answering for anyone who's interested in the general public comment. we can tell that there there may be callers for the empty agenda item that is later on in the agenda will be happy to hear callers then. >> moderator will you notify us of any other callers in the public comment queue at this time? >> but ward secretary there are ten callers on the phone line. one additional color is in the public comment queue a reminder to all callers to lower their hands by pressing star three

thank you. >> moderator all on mute the next caller welcome. >> caller your time has begun for general public comment. >> hello my name is herbert weiner and one question i have is why weren't the benefits that people had with united health why weren't they automatically transcribed to blue shield? >> caller i'm going to mute so your topic is related to an agenda item further on in our agenda we'll hold you on the line and bring you back with agenda item for the may pd update a moderator you can let us know if there are any other callers in the public comment queue at this time. >> board secretary there are ten callers on the phone line. zero callers are in the public comment queue. a reminder to all callers to

please press star three unless you're waiting for a future agenda item. >> thank you. >> with no other callers raised hands public comment is now closed. >> thank you. and just a note to everyone in in person and also online at that general public comment is usually for something that is not on the agenda and the matter about the blue shield transition is item 13. so we're happy to hear from callers and speakers at that time on this item. >> thank you. >> all right. next agenda item please agenda item number four approval with possible modifications of the minutes of the meeting set forth below this is an action item and will be presented by president howe. the meeting minutes are for the january 9th, 2025 health service board regular meeting. >> thank you colleagues. have you had a chance to take a look at these minutes and are there any edits or changes or comments questions that we have? no all right.

seeing none i'll entertain a motion to approve these minutes for january for the health service board meeting of january 19th, 2025 motion to accept the minutes as presented second. >> all right. there's a motion and a second and we'll take public comment. >> public comment is now open. instructions are being displayed on the screen for those watching on tv and webex for those dialing in call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak. we'll begin with any in-person public comment and no one has approached the podium who moved to our remote public comment and our moderator will notify us of any callers in the public comment queue at this time. board secretary there are 11 callers in the queue at this time. three have their hand remain from a previous round. >> >> we'll give callers a five

second pause to lower their hands in case this is an agenda item that is not one they want to speak to. >> moderator can you notify us if there's any movement in the remote public comment board secretary there has been no movement in the public comment queue. thank you. moderator with that public comment is now closed. thank you and we'll take a roll call vote please. >> roll call. vote starting with president hill i. >> vice president semansky by commissioner kremen i supervisor dorsey i high commissioner howard all right commissioner sass i and commissioner wilson i. >> great thank you. next item please. >> agenda item number five presidents report this is a

discussion item and will be presented by president hall. >> yes my report this month is very brief. i am doing the one month countdown lament of losing abby to retirement and so but we are also excited to hear from our recruitment firm the leader on the agenda who will tell us a little bit about the process and all of us about the process that they have undertaken to find our next next executive recruiter and so thank you. we'll take public comment on that. >> thank you. public comment is now open. instructions are being displayed on the screen for those watching on a set of tv and webex for those dialing in call (415) 655-0001 and enter the access code followed by pound in pound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comments will begin with any in-person public comment. no one has approached the podium.

we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue at this time or secretary there are 11 callers on the phone line zero callers have entered the public comment queue at this time. >> thank you. moderator hearing no further callers public comment is now closed. thank you. >> item number six please agenda item number six director's report this is a discussion item and will be presented by absent sfh access executive director good afternoon commissioners. >> just a brief report today the life and disability request for proposals is underway and going well. according to plan the qualified applicants that have been received and accepted will undergo a review process both financial and non financials. the intent of the team is to bring to you a recommendation on a selection at our april

10th board meeting. >> as a reminder the blackout notices remains in effect through july when the rights and benefit package is approved at the board of supervisors. >> quick update on the san francisco unified school district. they are still moving forward with yet a new system it has continues to be a hardship for each assessed in that many of the functions that had been automatic are not so now and then. so there's a lot of extra work that our team is doing but we're happy to do so to maintain the health coverage and for the members from the unified school district, the health service board election as you know there's call for nominations that closes tomorrow and so if anyone is interested there is a lot of information on our website so that we you can avail yourself of those tools.

the selection or those those individuals who complete to successfully complete the nomination process will be invited to participate in a board overview and orientation on march 6th. so that would be the next date. the election itself occurs during the month of may. >> also we have our usual racial equity diversity and cultural heritage celebrations noted in the directors report and i just want to call to our attention that it is black history month and there's many activities that are occurring around that. one of which latisha harris, who's our senior health program planner did find that i thought was noteworthy was the black joy month and celebrated in oakland which really highlights a black infant health which continues to be a very disparate outcome for women

black women bearing children. so it's a it's good that that is gaining recognition so that interventions can take place. the health care affordability board for the state of california continues to meet regularly to try to well their charge is to contain the cost of health care which is a bold and important goal. i have been sitting on the advisory committee to the board since its inception just about two years ago. i have tendered my resignation since my departures pending there and there is and it is not coincidental that i did this at a time when there is a general call for nominations to the advisory committee. that information i didn't include in the directors report but would be happy to do so if there's people that would be interested in that committee. >> it's it's it's a lot i will

wolfer warn you they're there very long all day meetings just packed full of useful information and they have a very broad network of specialty groups working on everything you can imagine that has drives the cost of health care and those meetings are virtually available and recorded. so if anyone's interested but i will forewarn you they are at least seven hours long and so yeah that's concludes my director's report. our operations as you know continues to support the transition to blue shield. the call center numbers are dropping as they normally do this time of year and so that makes it easier to get through to us as which i think will help a lot of people's concerns when we continue to work on on a lot of contracts as you see in my director's report we do

report out on many of the contracts that we do on a regular basis and the wellbeing programs continue to support citywide activities and we were talking at the budget meeting earlier we do support the first responder agencies of sheriff police and fire with special 24 seven support and particularly for critical incidents that has been a very successful program that we started. i think we started that with the onset of the pandemic. so it's it's been a it's been a very successful program. that's all i have. don't take any questions. >> thank you. any questions for executive director he and then we'll go ahead and go to public comment . thank you. public comment is now open. instructions are being displayed on the screen for those watching on srf gov tv and webex for those dialing in call 4159646550001 and enter

the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment will begin with any in-person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue at this time for secretary there are 11 callers on the phone line. zero callers have entered the public comment queue at this time. >> thank you. >> moderator hearing no further callers. public comment is now closed. thank you. >> agenda item number seven please. agenda item number seven sfa process financial report as of december 31st 2024 this is a discussion item and will be presented by iftikhar hussain as of hhs chief financial officer good afternoon. good afternoon. afternoon.

the happy to present financial reports. the trends we're seeing is a consistent upward pressure on claims so we're projecting that the trust fund balance will decline by about 37 million by the end of the year. part of that is due to the stabilization built into our rates about 9 million. but we're seeing both pharmacy claims medical claims, highest job losses, even dental that is always typically lower has come back. so people are coming back from a pandemic using services and we're seeing that and you'll see the result of that. you know, when we discuss rates in the flex plans down the road ,the general trust and the general fund is ahead of budget by about $260,000 mainly due to vacancies we had committed to mid-year savings to the mayor and we are honoring those

savings that we had committed the pharmacy rebates are on track. interest is about 3 million a year most likely higher. so we are we are in a good position in the trust fund balance. thank you. i have a quick question for you. so when you said that there are more claims coming in, is that just do you think it's is it a function of the part of the year that it was that you're looking at the last six months of the calendar year or is it just like increasingly coming out of the pandemic? you've seen that higher higher ,higher. >> we're seeing we're seeing a general increase in utilization beginning beginning in october . okay. and it has kind of continued to continue through december. okay, great. thank you. any other questions for mr. hussein? >> just a just a general comment. >> i'm just just was reading just recently that there's extremely high incidence of flu

more than covid happening right now and that hospital emergencies are fall. people are having a difficult time getting in to get care and and there are and there are a higher number of admissions going on currently as well. so i think you know certain amount of claims processing although there's a lag it's sometimes as reflective of just seasonal changes in health you know, as we go through the year. >> yes. so we would the detail level. so right now we're looking at, you know, who the money's going to and how much is going out. twice a year we sit on a blue shield. our flex wanted to partner and go through the claims and just look at what types of illnesses we're down and the kind of things that you've discussed. the impact of the flu would show up there. but so far what we've seen is well our information is a little dated but but we've seen pharmacy increases and in the next report i'm sure we'll see

the impact of the flu. >> great. thank you. any other questions or comments ? okay. if not, we'll go ahead and take public comment. thank you. >> public comment is now open. instructions are being displayed on the screen for those watching on tv and wimax. for those dialing in, call (415) 655-0001 and enter the access code followed by pound in pound again press star three to raise your hand. for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak. we'll begin with any in-person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue at this time. >> >> ward secretary there are 11 callers on the phone line. zero callers have entered the public comment queue at this time. >> thank you. >> moderator hearing no further callers public comment is now closed. thank you. and now we'll move into our finance and budget committee

part of our agenda. >> and would you please call item number eight? agenda item number eight approval of the san francisco health service system general fund administrative budget for the fiscal year end 2026 and the fiscal year end 2027. this is an action item and iftikhar hussain sfh as us chief financial officer is available. our committee also met earlier this morning. >> okay. okay. so so just to give an overview. >> go ahead. yeah. let me just i'll try and do an overview myself. >> okay. and then if there's questions obviously i'm very grateful that you're here to help answer any questions that i can answer. >> our committee met at 10 a.m. this morning. we had a full presentation on both the the health care service system general fund budget and which goes to the mayor's office and another presentation on the health service system health care sustainability budget which

does not go to the mayor that is part of the the trust fund and it's the responsibility of this commission to do make sure that there's adequate funding for the expenses associated with the health stability fund. >> we were joined by commissioner wilson and so at the committee which i'm very, very grateful for she had many questions that she asked as did all the members and we're very helpful. but as a consequence when it came time for a vote we actually had a full quorum of commissioners present and in both instances we we recommended approval of both the health system general fund budget and the health system health care sustainability budget if i'm if there are questions again i may not be able to answer every question but if i can't i would ask our cfo to help us. sure. >> yeah. happy to answer any questions. appreciate.

>> so with respect to the general fund so i noticed that you're losing some fte so there are being told by the math you did for the fte counts for each fiscal year that you're it's actually being reduced. it's not just being frozen in your budget. >> yes, this is on fte. he's in a couple of things going on. number one and two point to note is our budget fees are actually higher than we're running because we have vacancies so we have a total of ten vacancies now six of which we will fill and 4 or 4 of which we're giving up as part of the mayor's goal to the cost reduction goal to fix the structural deficit in the general fund we have a hiring freeze. so any positions that need to be hired we have to file for an exception and we have filed for an exception for those six positions and it's currently under review. okay. so it is affecting it is it is affecting our service.

i think that when the call volume peaks and isn't the issue the savings from vacancies actually is costing us on on on the service we're able to deliver and part of that we we mitigate with an outside call center to the last year and then the blue shield call center which is active now . thank you so taking number item number eight any questions or comments on the general admin budget for srf us no claire just question i just want to go back a minute. um, do we do we have a sense of how are you going to get approval to to fill the six vacancies and how that's that process is going to work. we so we've been talking to me

as budget office which has to take the take the assumptions forward. we filled out all the paperwork ,talk to them. we've conveyed to them the service issues that i just discussed right and then need to fill those immediately were optimistic that those exceptions would be granted. >> yes. okay. that's positive. that's what i want to hear because it has to do with service directly to act both active as well as retired city employees. yes. and that's significant if we want our our employees to continue to get their benefits in a timely manner. yes. thank you. and please keep us updated on that process progress. >> thank you very much. >> all right. if we don't have any more questions or comments, i will entertain a motion to approve this item.

i would move to approve the just the san francisco health service system's general fund administrative budget for fiscal year 26 and to one second. >> all right. there's a motion a second and we'll go ahead and take public comment. public comment is now open. instructions are being displayed on the screen for those watching on s.f. gov tv and webex for those dialing in call (415) 655-0001 and enter the access code followed by pound impound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment will begin with any in-person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue at this time. secretary there are nine callers on the phone line. >> zero callers have entered the public comment queue at

this time. thank you. moderator. hearing no further callers public comment is now closed. >> thank you. we'll go ahead and take a roll call vote please a roll call vote starting with president howard i vice presidents of nancy i. commissioner chrisman i commit supervisor dorsey high commissioner howard high commissioner sas i and commissioner wilson i. great thank you. agenda item number nine please. >> agenda item number nine approval of san francisco health service system health care sustainability budget for fiscal year end 2025 and fiscal year end 2020 excuse me fiscal year end 2026 and fiscal year end 2027. this is an action item and will be presented by iftikhar hussain sfh as chief financial officer. also introduced by committee chairs as thank you on remind me what the this this motion

includes an increase to the sustainability budget. >> could you just explain that $4 to $6 to $4 in the supplemental remain to $6? >> i know in our in our presentation we looked at a a five year looking forward chart that showed what shows that there is in fact a need for the $2 increase and that that month to $2 increases made to the pmpm to the budget that it looks like we are stable for the next five years with that increase so it it it appears not needed and without that we would not be able to maintain a stable fund balance and that budget is that correct? >> that's correct. so it'll be effective plan year 26 the plan year 2026 correct. >> okay. and we think five years is is reasonable to expect that to be yeah. >> so we have a good sense so

we do a five year forecast because we want the ability to have one time projects using this fund and based on what we know now we have a good sense of what we need. we need some infrastructure improvements to improve our services which will lead to efficiencies down the road and and the further out the further out you go in the future the less a little less is known. so what we do to make the fund solvent is to make sure that at least for the things we know for the next five years that we have the funds and that's what we based the that's how we set the pmpm charge. thank you. i think if i can add i think one of the things that moves into the sustainability fund is the wellbeing activities. so those are important. they've been sitting in general fund and they'll be moving into wellbeing i'm sorry moving into the health services fund going forward. >> correct. beginning with fiscal with the current fiscal year the wellbeing activities were moved into the health care

sustainability fund the like right now yes. >> okay. okay. >> thank you. any other questions or comments? thank you for your presentation so seeing none or dr. wilson did you know okay we'll go ahead and take a we'll take a i'll entertain a motion sorry all out of order in my head. so let's go ahead and entertain a motion for this item. >> okay. i'd second that on. is it okay to second the commissioners house moves to approve? >> i would like to second that that to approve the proposed san francisco health system budget health care sustainability fund budget for fiscal year 26 and 27 second all right with the motion the second we'll go ahead and take public comment. >> public comment is now open. instructions are being displayed on the screen for those watching on a set of tv and webex for those drilling in

call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment will begin with any in-person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue board secretary there are nine callers on the phone line zero callers have entered the public coming queue at this time. >> thank you. moderator hearing no further callers public comment is now closed. thank you. we'll go ahead and take a roll call vote roll call vote starting with president how i. vice presidents of ascii i commissioner kremen i supervisor dorsey i commissioner howard i commissioner sas i and commissioner wilson i thank you. it is unanimously passed will

now move out of our finance and budget committee matters into your rates and benefits section of our agenda starting with agenda item number ten agenda item number ten presentation of the rates and benefits calendar for the plan year 2026 this is a discussion item and will be presented by absent as a feature says executive director . >> good afternoon commissioners the rates and benefits calendar that it was included in your packet and is posted on our website has no changes as of today. what i do want to call out to your aention is we do routinely put the fourth thursday of the month on as a hold and we're asking for the next several months. for sure please make that hold real real go from pink to red or whatever color it is on outlook and secure that time so that that could be available for the selection process of the executive director. those times should should work work well and of course will be

released and if not needed any questions about the calendar now. >> all right. we'll go ahead and take public comment is now open. instructions are being displayed on the screen for those watching on a set of t, v and webex for those dialing in call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex online. click on the raise hand icon to be placed in the public comment queue to speak in person public comment will be first followed by remote public comment will begin with any in person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue or secretary. there are nine callers on the phone line zero callers have entered the public comment queue at this time. >> thank you. >> moderator hearing no further callers public comment is now closed. >> thank you. next item please.

agenda item number 11 board education health care cost trend influencers update this is a discussion item and will be presented by mike clark with an the lead actuary. good afternoon mike and and good afternoon commissioners mike clark and we thought it would be helpful to as we start to enter the kind of the rating cycle starting next month with our presentation of 2024 plan your experience for the self-funded and flex funded health plans are to step back some more. what we've done in prior february's to just talk through what we're seeing in the current environment of health care trend as chief financial officer hussein commented on previously today we are seeing upswings and plant experience and so we wanted the opportunity to talk through you

know what those drivers are. so i developed this jointly with cfo hussein. certainly he's available to answer any specific subject just ask questions that i can't answer. but this is much talk more generally about, you know, what the trend environment is. so on page two again we're presenting new information about what has influenced health care costs over the last year and this will guide the medical and pharmacy benefit. >> you know, trends that will be utilized both by the health plans and by us for the cell phone and flex funded plans for 2026 renewal rating. so on page three again we're seeing escalated medical trend as highlights the primary reasons and we expect to continue into 2025 even higher slightly higher trends for 25 what we're showing to driving this you can see on the upper right our employment levels are

rising within the health care sector so that's good. two years ago we talked through the impacts that employment difficulties were having in health care subsectors of those employment levels have risen but without of also come the salary increases for the employment within the health care sector. so that's a contributor to medical trend mental health and substance abuse services we continue to see the upticks in the utilization which again is great the ability of the system within mental health and substance abuse to serve numbers but without increased you know demand that continues the supply increases but that comes at a cost and then cost shifting from the government to the private sector continues. obviously there's a lot of unknowns about what could transpire, you know, from a federal government standpoint with the change in leadership in washington.

we'll certainly keep tabs on that. we don't anticipate any immediate impacts and certainly nothing that would impact your 2026 plan their rating. but we'll certainly be keeping a careful eye on just the whole industry around financing from the government for public plans for government plans and how that could impact down provider pricing practices. you know back to the commercial insurance sector. so just a view on page on the next page around what we're seeing with average employer budgeted cost increases. so keep in mind these were determined primarily in the spring and summer months of last year so didn't necessarily incorporate the second half of 2020 for experience but just gives you a snapshot across 750 employer clients of ours that represent 5.5 million employees and 88 billion a projected 2025 health care spend. you know what we do see is some

employers making plan design or program changes that could manage down those initial projected status quo increases while we continue to see nationally employers absorb more proportionally more of the increase though those averages for increases were proportionately shared among the west region and national public sector employers within our data you know kind of proportionately between employers and numbers the 7% average plan cost increase for employers nationally is the highest that we've seen in recent years compares to 6.6% for 2023 6.5% for 2024 and then also a little bit higher than what the srp just us budget was for all plans combined for 24 at 6.6%. so again just helpful information to see you know for all of our employers total survey represents about 750 and then the subset of our database that is both west

region employers as well as public sector employers you see what those increases are. you know, generally in the 7% range and then you know most importantly that last bullet we do expect cost trends to be lower for managed hmo plans than for fee for service peoples. i think this is what's helped support lower the national average increases over the years for us of hsr us because 97% of the covered members within our surveyed resource are within our managed hmo plans for the trend line. just looking at the different marketplace you know perspectives looking at the class of trend line compared to the california ten county survey over the last many years as well as the consumer price index nationally historically those health care costs do outpace general cpi and that we also see our survey shows us costs are generally in-line or favorable versus the time

county benchmark and we'll be presenting next month the ten county study the renewed study in the march health service board meeting we saw higher rates in 2024 just lagging impact of that rising inflation that started to take effect post-pandemic a couple of years earlier. you know, we also know, you know, kind of what transpired with the medicare advantage rfp and then you know, leaving overall to the favorable 2025 profit of 6.6% versus an 8% benchmark service pricing influences especially you know we keep track of both what's happening with plan utilization upon among people as well as what's happening with provider pricing. we're really seeing that impact of service pricing for large claims. there is always going to be growing complex care needs by populations and certainly those

those costs increase to meet those needs although the ability of the system to deliver on those needs is really phenomenal. so a lot of that has happened as you see on the left side driven by general inflationary trends on supplies and labor that i talked about earlier you know provider negotiating power power continued consolidation in the hospital and health system environment and on discounted charges once you get past higher spending thresholds. but we're also seeing incidence increases with high claims technology advancements drive that you know folks are able to survive these high complex care that maybe they weren't able to 5 or 10 years ago especially with cancer and premature infants. an interesting start that was reported by some life as you see in the footnote here is a 50% increase in the incidence of million dollar plus claims over the past four years. so you really see about you know playing through i see it on our client data specific to

us about just us looking at claimants of 100,000 or more on the blue shield plans just to give an idea of you know, just how much spend is driven by the relatively few that do incur high cost claims on the hmo plans 1% drives 30% of the spend and 1.5% of the population. the ppo drives 42% of the spend. so this is the beauty of insurance. it provides financial protection for those who have these high cost needs. the next page looks at the population health risk impacts more broadly based on kaiser family foundation data and you can see the web link at the bottom of the page. you know a lot of rich information here in terms of health plan you know, spend and utilization patterns and so forth. but this does show again a small proportion of the population does account for a large share of the health spending and in this case, for instance, 5% of the population accounted for half of all health spending on next page

same resource, just a different chart among the many that was presented was just looking at spend by age and health status . you know as we think about populations, you know we've always kept an eye on how generations are moving through the system and right now baby boomers are continuing to age into medicare. so that'll happen until 2030 when the first gen x myself hits medicare. you know, you see see this graphic below based on 2021 data that's been published by the kaiser health family foundation you know, aging and health status certainly do have a pronounced impact. i think we can, you know, kind of reason that that is probably the case. what's great about this data is puts quantification to it so you can see in the first set of bars by age just looking at a bright line at 55 years

and older versus 54 years and younger, you know the inferential on the share of the population versus the share of total expenditures 55 years and older is about a third of the total population on and yet drives over half the cost. and then as you can imagine, you know, vast majority of the population nine out of ten people have good very good or excellent health as reported. but those and fair poor health are driving a disproportionate share of the total spend so you know, we'll continue to keep an eye on this but this will continue to also influence costs on a macro level given that baby boomers are still working their way through towards medicare eligibility. behavioral health needs again continue to escalate as access concerns also continue. there was a couple of really insightful kaiser family foundation articles that we came about doing our research for today you can see those web links at the bottom again so encourage you have time, spend a couple of minutes reading those articles.

some of the key highlights at least for an uninsured adults who describe their mental health as either fair or poor say there was a time in the past year when they needed mental health services or medication but couldn't get them. so again the whole concern about the supply relative to demand still exists pronounced racial disparities among adults who report fair or poor mental health white adults are more likely to say they received mental health services in the past three years than black or hispanic adults granted low percentages across the board but higher for white populations. 44% of insured adults who didn't receive needed mental health care said they couldn't find a provider they trust. 36% didn't know how to find care 34% say they were afraid or embarrassed to seek care. so these are still issues, you know, being worked through on the system. you know, last bullet i guess maybe the one somewhat bright point here was it was compelling and the recent kaiser health family foundation survey over half of adults who

received mental health services did say they were very or extremely helpful. so when folks are able to seek the care, you know more and more folks are saying it's very helpful. so turning to pharmacy, i know my colleague kelvin was here in november talking a lot about the dynamics of what's impacting pharmacy on a macro basis just to kind of highlight some of the elements that that continue today and will continue into the near term. you know, specialty drugs are certainly continuing to escalate in cost. so we keep a close eye on that as we evaluate, you know, the data for us to be precise as that leads to the underwriting ,the utilization of branded generic drugs will increase gradually because again population health risk is going to continue to escalate. you know new development although still rare and we haven't necessarily seen any in the hospitals population but you know given cellular therapies they provide, you

know, very important lifesaving treatments but at a very substantial cost. and as kevin said back in november we do expect to see a doubling in the marketplace in two years which in cell therapies and then the gop one and some more medications for treatment of diabetes as we continue to see escalation there. but it's really shift in 2024 towards application of weight loss control rather than diabetes in prior years. but the good news here is we're starting to see emergence of biosimilar medications. humera being the first and i know kelvin talked about his own personal experience back in november. we expect to see more and more of that start to play out the health plans for you have started to roll these out to these populations. the drug stelara will have biosimilars available soon and we'll continue to see a ramping up so page 11 i'm not

going to go through this but just kind of as a bridge on everything happening in pharmacy. we replicated this from the november presentation just because so so much rich information here about what's happening in the gop one space innovation and new market entrants and what those future forces are and again we'll continue to report as we see massive developments that come out of washington. >> you know, we'll report on them frankly we can't speculate at this point. so those pharmacy cost drivers on page 12, you know, we've got a database in our among our pharmacy programs that we support for our clients of 4.3 million members continuing to see these key specialty medications being a top truck driver. those the influence that the shift from computer to biosimilars is having is very positive to see that you know we saw cbs out first with this and then other pbms following

into this year and then again obesity and diabetes driving trends. you know the next slide shows as i mentioned earlier, you know, we saw this uptick over the last several years in the utilization percentage of members with the prescription fill overall in our database for diabetes reasons. that's the lower part of these bar charts. but where you really start to see starting and you know, start of 2023 and especially into 2024 is the ramp up of utilization for anti-obesity. so you know influencers as a relates to what i'll be presenting to you on reading recommendations and plan experience in the next couple of months, you know the degree to which all these are going to influence us as a major source and certainly very, you know, very plan specific. we do expect about 9% typical cost trend for plans nationwide

into 2025 but again lower for managed hmo plans and this is about 1% higher than those average client budget increases that i presented earlier. we're obviously going to continue to work diligently with the health plans to understand those specific trend drivers and i'll be sharing a lot of information next month that you know we'll look forward to discussing and those and that will lead to you know, what you see on the last page here with you know focus on plan experience as well as the ton county amount presenting the kaiser plan experience for 2024 and april as well as the also pictures us with scores which are always insightful on understanding how the health risk broadly in the population is evolving leading to the 2026 plan your medical and prescription drug renewals that will present in may and june. >> great. thank you. i made a very moving presentation not the best news i know it was earth

shattering. yes. did you feel the earthquake didn't faze him at all? >> i know we're all san franciscans. we understand this. >> so mike, this is a lot of information and data and i guess in your professional opinion, are there things that our our board can consider or should be considering given all this information about how we keep our benefits high quality at sustainably funded? yeah. i mean for me it's continuing to emphasize with member populations the resources that are available to individuals to you know help help guide care decisions, help guide care protocols as preventive care certainly continues to be critical as you know, i talked

to so many people that maybe don't engage in preventive care and then they find out there's a really serious diagnosis that as you know well down the pathway that had a preventive care occurred, it could have been in a position to be more easily, you know, treated and so forth. so to me it's just the combination of understanding everything that's there to support you, you know, because ultimately the the sum of all the costs that hit the program even for, you know, a large organization like our surveyed just us 126,000 covered members happens on an individual basis happens in the interactions you know members have with their providers members have with their family members all about so obviously you know i as the an actuary in the estimate resource team you know leadership and everybody will continue to you know seek to optimize the spend you know

seek to you know rein in anything we see in a renewal that we think is higher than it should be. you know, i spend a lot of time and certainly cfo hussein and others looking at plan experience to understand what's reasonable than in a forecast you know, rate forecast but also just beyond you know, claim experiences just the roll up of individual interactions that members have with the system. >> so you know just kind of working it all together are you finding things we could do better or differently in some way that would make this better ? >> well, i, i would say, you know, each of us has done a more effective job, you know, managing health care cost trends over the years than i

would say my typical client. i would say, you know, continuing to, you know, hold the health plans accountable for things that we can do better to optimize spend making ourselves aware of those things. but i also do think just again bringing to light resources that are available to people to support them, you know, in their own health management journeys you know, preventive care, those sorts of things. >> that's that's what i seem to get better educational programs or systems or to me it's just just reinforcing. so i don't think it's coming up with something that's not already there. i think it's just continuing to bring delight, you know all the

great things that you know as a trust us and the health plans make available as resources to members. >> if i may i'd like to acknowledge that the board has supported the development of two strategic plans under my watch. the current one that ends at the end of this calendar year. so we've had internal discussions about how to move forward with strategic planning efforts in for future years. but i do think that the board has been progressive in selecting our strategies that help us contain the costs somewhat and and do benefit the outcomes that we're looking for in our population. so and i would just, you know, remind the board that it's supporting primary care which can do a lot to contain the cost of health care, supporting the mental health which we've spoken about several times today addressing equity issues,

being more efficient operationally all lead to affordable and sustainable care. so i would just remind us that those have been our guiding stars for a number of years. we know the board may elect to continue those or or change the emphasis somewhat but i would state that there's sort of two underpinnings that that come up repeatedly that we need to understand what is going on in a positive way and that is the extreme workforce shortages in health care in every discipline. and so those extreme shortages impact all of us. and so i think that's one thing that we need to get behind in any way that we can to support the development of a new workforce. and that and i say new because in behavioral health there's whole new jobs that have been recognized that are necessary to support the mental health of our population. so i think that that that is

something we need to pay attention to and the california health care advisory board that i spoke to earlier, we need to really look at their leadership and what they're providing because that is giving you a very clear view of what is intended over the next probably decade to get us there. but the shortage of of workforce is something that we are all contending with and i think should be therefore a part of the solution. so i appreciate the mike and i work well together going back and forth on how you do find a way to have impact on some of these seemingly impossible situations and so i would just encourage the board to be thinking about the strategic plan before we even get a formal process up and running. >> sounds good. thank you. any other questions or comments from mike? thank you.

thank you very much. all right. we'll go ahead and take public comment. >> public comment is now open. instructions are being displayed on the screen for those watching on a set of tv and webex for those drilling in code (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex click online. click on the raise hand icon to be placed in the public comment queue to speak in person public comment will be first followed by remote public comment will begin with any in-person public comment. >> welcome. good afternoon again director janet and commissioners lois scott from protect our benefits . i appreciate the emphasis on the workforce and on the labor costs and this analysis and i would like to know whether we are able to tease out artificial intelligence ins

versus human labor costs and what the trends are in terms of the mix of artificial intelligence and people who answer telephones or people who give prior authorizations and so forth whether there is now a metric that can be looked at in terms of artificial intelligence. so that's kind of a question within to mike clark and in the methodologies of these reports ,i think part of the problem is defining exactly what ai is. but i would like us to be tracking that and understanding it better. >> thank you. thank you. and i just want a piece is plb has been made aware of some class action suits one of them in the east bay or originating in the east bay from a member

perspective on the issue of overuse of artificial intelligence and harm to members. oh interesting. yes. fred sanchez president to protect our benefits. >> speaking about a.i. there is two class action suits one against blue shield and the other one is against united health care. so they're both getting hammered on using artificial intelligence. and one thing that we have found out each can select their own algorithms which they want to use. >> and on the case of blue shield, 90% of the people when they put in they're denied. and it's very unfortunate because if they know things about the expedited process and stuff, if they follow

through and keep fighting that 80% of the people that actually appeal they win their appeals eventually it's a big hassle but they do win. but they're ahead because 90% of the people just go okay, i'll pay the extra co-pays or whatever and they just give up. and very few people know of our accuracy. i mean you know how many people are calling us and we've got hundreds but how many people know about protect our benefits and it shouldn't be our responsibility anyway. it should be no fall on you trying to get those welcome letters and inform people what's going on in the transition. thank you. thank you. thanks and no one else has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue or secretary. >> there are eight callers on the phone line zero colleagues

have entered the queue at this time. thank you. moderator hearing no further callers public comment is now closed. thank you. we'll go ahead and go to agenda item number 12 agenda item number 12 review and approve vsp vision fully insured 2026 rates and contributions. this is an action item presented by mike clark lead actuary with an mike clark and today will present the first of many rate renewals for the 2026 pioneer this for the vision service plan fully insured 2026 rates and contribution. so as you can see on the agenda this involves the insured plan renewals for the basic vision plan the premier vision plan, the computer vision care program and the buy up member contributions for the premier vision plan. >> so just to step back and level set all of the plans that will present between today

and the june meeting you have three different levels of funding method self-funded flex funded and fully insured. and you can see the descriptions of the funding method you know who calculates those rates in some cases is the actuary and in some cases the plans thoughtfully insured which plans fall under which funding method and you'll see the vsp vision is fully insured. so that is on the right side. and then we'll start to discuss rate stabilization policy impacts next month and you can see those apply to the self-funded and flex funded plans but not today with the fully insured vsp plan and the five step process that is taken by you know, us as the actuary as well as the health plans you know, plays out in what you'll see today with the vsp plan and the future meetings with the other plans you know starting with the prior period claims applying a trend factor accounting for any design or headcount changes, adding administrative and other fees

as well as cost elements. but that is not applicable for vision. so essentially the increase becomes what's the total projected plan costs for next year divided by the rates times of more months for this year is the need to change. so with that as background for vsp, the two vision plans have been offered basic plan for many many years premier plan since 2018 and it continues to grow in popularity which is great to see. we'll see that here in a bit. and then there's also a specific computer vision care plan for about 21,000 employees are based on mou that provide some added benefits for those folks. >> on the next page, you know, you'll see the recommendation here essentially to approve the rates in this material, all of which are remaining at current rates going into 2026. this is the end of a five year

renewal agreement that was developed going into the 2022 plan year between us surveyed just us and vsp. you can see over the course of that agreement and some years the rates remained flat same as the prior year in some cases and not to exceed 2% are based on you know plan experience and how that played out the year before the computer vision care benefit rate has remained the same as well as the rates adjusted into 2023 for four year to to reflect the addition of certain lens enhancements that included ultraviolet light protection, blue light protection and anti-glare in the vsp vision coverages. >> mike can i excuse me can i ask have there been any additional or any requests for computer vision care? so from a retiree group or four from those not not actives i am not aware of that.

i do know that this is part of an mou i'd have to defer to us to be precise of there have been any requests. >> okay because i just don't no part of that we may need to follow up governance. >> okay. yeah maybe we can find out about that down the road. >> thank you very much. so you can see what the rates are for 2026 again no change from the 2025 rates. we'll look at some plan experience starting on page 11 . and you know one thing that happened when the premier plan was first introduced for the 2018 plan year it was the second year of an existing multi-year agreement than and vsp was able to, you know, offer this new benefit and initially because of the additional benefits you know, the loss ratios were high frankly for 2018 and 2019. you know 2020 helped by the pandemic but still not that low

of a loss ratio at 97.5%. but the loss ratio was generally improved over the course of time as more members have elected the premier plan. you can see on page 12, you know for the basic plan over the course of time the loss ratios have generally been below 100% which is the claims plus fees divided by the premium. but for the premier plan on page 13 you've generally seen claims have exceeded premium levels and so when you also add in the fees for vsp to administer the program you know generally the cost of the premier plan has exceeded the premium paid for that plan. but when you look at things in aggregate we have seen those loss ratios improving you know, to the point where the renewal for this year is no change in the rates. you know the other good news is on page 14 just the progression of the enrollment increase over time in the premier plan originally and when first

offered about 10,500 employees and retirees it's now up to 27,300. it really shows the value that members see in having those enhanced benefits available through the premier plan. we do have an exhibit in the appendix that does show the side by side. so if you wanted to see how the basic and vision and the premier visit plan benefits compare there was an exhibit on the appendix. so the rates really no change total rates stayed the same the member cost for the premier plan by up stays the same as part of the fifth year of that original five year rating agreement. and then page 16 just shows you know what's the aggregated projected spend and it's all based on the current premiums annualized from january 2025 for the basic plan itself it's ou 3.4 million in total premium and then you also look

at the premier plan because the basic portion of that is also embedded into the medical rate cards. so in total you know within the medical rate cards you know something in the neighborhood of 5.6 million of which is shared about 88% by the city, you know, based on various cost sharing formulas and 12% on average paid by members and then that premier plan increment is about 6.1 million about 260,000 for costs for the cvc benefit. so one total you know overall premiums about 12 million which is roughly when you work through all the math about you know split half and half between members and the employers. >> so recommendation for health service board action on page 18 as recommended the health service board approved the 2026 psp vision planth preum insurance rates and premier plan member contributions as

outlined below which are all no change from 2025 to 2026. >> great. thank you. >> thanks for kicking us off for good news there. any questions or comments for mike? >> do we need a motion or we're coming up? i can make a motion. i'll move to approve the 2026 vsp vision plan. monthly insured premium rates and premium plan member contributions as outlined. >> second. second. all right. >> we have a motion the second we'll go ahead and take public comment and thank you mike for that very comprehensive presentation. really appreciate it. >> thank you. and public comment is now open . instructions are being displayed on the screen for those watching on a set of tv and webex. for those calling in call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand. for those watching the meeting

on webex online click on the raise hand icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment. we'll begin with any in-person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue or secretary. there are eight callers on the phone line. zero callers have entered the public comment queue at this time. >> thank you. moderator hearing no further callers. public comment is now closed. >> great. thank you. we'll take a roll call vote please. a roll call vote starting with president hill. hi. vice president stransky. i. commissioner kremen i tuberose dorsey high commissioner howard. all right. commissioner says i and commissioner wilson i. >> all right it's unanimously passed. thank you. we'll go ahead and take agenda item number 13 please. >> now we are in our regular board meeting matters again. >> agenda item number 13 blue shield medical medicare advantage ppo transition

update. this is a discussion item and will be presented by regan savages as chief operations officer. august to vince gray on mollusk is as a business operations manager and tiffany gill with blue shield of california senior manager group retiree. >> you need to sit. no, i'm good. thank you. welcome. >> thank you. good afternoon, commissioners. reagan chief operating officer for hhs. together with hhs operations manager august devin sky velasquez and senior account manager tiffany gill from blue shield. we will provide you with an update on the blue shield medicare advantage ppo plan for january 2025. >> i'll start off the presentation and provide a quick overview of the january 2025 activities and then move on to review a small number of reports of apd members receiving different levels of benefits under the new blue shield mdt plan as compared to what was received under hhs as unitedhealthcare plan.

>> i'll provide a comparison of the care sorry i'll provide a comparison of the core medical services provided by both plans as well as show how the supplemental benefits of the two plans align. olga will then step in and walk you through the dashboard for the january 2025 call metrics for the hhs as call center. at that point tiffany will join in and provide the call center data from the blue shield side highlight key categories that they will be monitoring going forward and wrap up with the upcoming member engagement activities. blue shield has planned for our members will then stand ready to answer any questions the board may have. >> following more than six months planning communications to our members and system setup the blue shield and apd ppo plan became effective for 19,100 hhs members effective january 1st, 2025. overall, the planned transition

was highly successful and although we always strive for perfection, we need to keep in mind that we are only six weeks into a brand new plan transition. >> although the blue shield concierge call center handled the vast majority of calls related to the planned transition, hsa staff did need to handle 139 escalated calls. this number of calls is in line with what is normally expected every january. and staff was able to resolve the vast majority of these issues quickly. >> however, a primary concern to us as staff were reports of members feeling that they had experienced differences in the benefit coverage through blue shield as compared to what was received through united health care. following a review of these reports it appears that most instances relate to the way certain providers such as ucsf are billing blue shield rather than a difference in the benefits themselves.

tiffany and gil will walk through the steps blue shield is taking to ensure members don't continue to be impacted by such situations. >> as a reminder, hsa staff carefully reviewed blue shield's response to the rfp to ensure that all benefit coverages and copayments for all core medical services match those offered by our prior unitedhealthcare plan. >> the most utilize of those core services are listed here. the benefits for all core medical services are outlined in the official summary plan description and detailed in the evidence of coverage document both of which have been finalized and posted on the hhs website. >> where there are some differences between the two plans are in the supplemental or value added benefits. when benefit variances were identified during the rfp review and implementation process assessed directed blue shield to provide an improved

benefit wherever possible. >> however, there were a few benefits that blue shield simply could not match. however, most differences are either neutral or an improvement to our members. we have attempted to highlight all such variances on these next two slides. >> often the difference is simply that blue shield may use a different vendor than uhc to provide certain services such as is the case with acupuncture and kaiser hector. >> but it should be noted that none of these benefits are very highly utilized as compared to the core benefits. just as an example, on average an mpd member has nine physician visits per year and 40% 42% of our members had at least one outpatient procedure. but for comparison 3% of our members utilized their personal transportation benefit and less than ten members participated in personal care.

>> one benefit they will like to address is the fitness benefit. 9% of our members participated in the fitness benefit in 2024. >> blue shield offers members access to gyms through the silversneakers program which partners with over 15,000 gyms nationwide. this is a same fitness program that unitedhealthcare offered to hsa members prior to 2023 when it changed to the renew active program which partners with more than 25,000 gyms including local ymca ace. >> what is important to note is that united health care's 2025 renewal for hsa also included a shift back to silversneakers effective january 1st, 2025 due to the program's high cost. therefore hsa members would have experienced the transition back to silversneakers either way.

one area for which both hsa and blue shield have received a high number of calls is a prescription drug benefits. and this makes sense since 92% of inmate heat mpd members had at least one prescription in 2024. >> but this chart shows is that the blue shield plan offers the same four tier cuzmy copayment structure and copayment amounts as our previous uhc plan provides two enhancements. first, rather than supplying a 90 day supply for mail me for maintenance medications through mail order. blue shield supplies a 100 day supply at the same copayment amount. >> second blue shield maintains a network of preferred retail pharmacies where members can walk into and receive the same 100 day supply of maintenance medications at the same reduced copayment amounts as mail order . this was a benefit that was not provided by united health care

. but what i would like to say is that we do recognize that there is a small amount of disruption even with the shift from drug benefit through the rfp. again, what we noted as compared to all the prescriptions are received from our members. there was a 98% match in both the tier and copayment amounts. however that is not 100%. as we look at that 2%. we can see that in a population of 19,100 members that's close to 400 members. and so for these minor differences in benefits, there could be a number of our members that are experienced a change. but by far the two benefits of the two programs match almost exactly. >> any time there is a change there is going to be some level of disruption. but what we have been doing is committing to our members that we will assist them in the transition wherever possible and we have partnered with blue shield to do to do the same.

>> do we know if most of those members are local or somewhat local like bay area or northern california? >> something like that. commissioner bensky what i would say is again the vast majority of even our retired members live within the bay area. >> what i would say is we have received a number of calls from members that are outside the state although the number is few. again it would seem that folks that are out of state are seeing a higher proportion of issues than those within the bay area. so even though it's a very small sample size and because of the fact that the out-of-state population is so small that we're even recognizing the calls, it shows that the proportion is higher for out-of-state members. >> thank you. i appreciate the fact that you're monitoring that because we want all of our members to get all of the benefits that they can. >> thank you.

so i'll now go ahead on one other question on this slide before you move on. i'm kind of just going to say that on the unitedhealthcare side you're showing a 30 day supply. you're not showing the rates for a 90 day supply. you have a mail service column but you don't have a column for you know, just 90 day supply. i know that in my in i know my own case that i've got a couple of medications that were able to get 90 day supply on just front from our pharmacy and that was under unitedhealthcare and it still exists. >> that same thing exists under blue shield. >> you know i haven't i have not yet experienced any kind of hundred day offer from anyone yet. i mean i'm still getting 90 day supply of my medications under blue shield that i was getting 90 day prescriptions under unitedhealthcare and neither it's not shown on the non-healthcare column and it is and it's not technically showing on this one either. and you've got 200 a day and that's only from a preferred pharmacy.

>> so it doesn't you don't have the standard retail numbers for that either. >> so i'm not sure that this really covers all of the circumstances that somebody might be using. >> commissioner sasser, i will ask that we wait for tiffany gill from blue shield to come up during her presentation and hopefully she can answer that question for you. and so at this point i will now turn it over to august 7th sky velasquez who will review the january call center numbers with you. >> good afternoon commissioners augustine skip, alaska's operations manager health service system. in the january call center report out we see that the hhs member services team has once again been challenged with a significant increase in overall calls. this is something that happens every year with a change in

plans and change in benefits for members on one one. >> the increase in calls did however, result in a challenge and a struggle for my team to able to answer all of the incoming calls not just our blue shield transition ones. i do want to assure the board that our february numbers are looking much, much better. our average speed of answer and abandonment rate compared to january numbers has significantly already been showing an improvement. >> diving into the january data . member inquiries primarily focused on plan enrollment and id card issues. members are utilizing our call center and are coming in in-person for membership short for the blue shield transition. >> we're also seeing a continued interest and utilization of the phone system's ability to connect members directly to blue shield. and so we've seen a slight

decrease from our december data but it's still a high utilization of that feature. we have seen a slight decrease in our first contact resolution but we are keeping above the 75% goal at 85%. >> i anticipate again that the february engagement we see will improve performance as the current data has already shown us that our average speed of answer is at four minutes compared to our current data at 14 i'm sorry january data at 14. we have also made some slight changes to operations to increase member support. while we're not yet able to fill our four vacancy positions in member services. staff are working mandatory overtime to allow for more phone time dedicated during our business hours. this is a short term solution but it does allow us to connect

with all of the incoming calls at this time. >> i will go ahead and turn over the presentation to tiffany gill for blue shield updates. >> thank you. okay. good afternoon commissioners. tiffany gill with blue shield of california major account manager. >> go ahead. >> okay. thank you. in january we handled 9333 calls which was 115% increase from december. checking provider access was the number one call driver and prescription was the second. we were happy to see that our efforts to ask members to call proactively paid off. >> most of these calls were confirming the contracting status of the providers and checking to make sure their drug was on the formulary. >> we also got calls from members where we sent letters in december explaining how to

access their amazon pharmacy mail order prescriptions or that their drugs with united are not on our formulary. >> we received many calls to help the members set up their amazon pharmacy account or discuss drug alternatives. we did have longer wait times and the average wait time was three minutes and 47 seconds. and then we also had we added the abandonment rate on on to our to the statistics and we had a 12% abandonment rate in the first two weeks. but that improved to 3% in the second two weeks in january. >> next slide. >> we have many things that we are monitoring and will continue to monitor but the top ones are listed here. we were seeing some errors with those members that were enrolled manually and we instituted a full eligibility system to file comparison with each weekly eligibility file that we received from hhs.

we do this normally on a quarterly basis and we'll continue doing that going forward but we will make sure once we're comfortable that we continue or until we're comfortable we'll continue to do this weekly with the hhs files. >> we are also using a letter for providers to give them a level of comfort that we are honoring prior authorizations in the first 90 days. some of the information that we were hearing in the beginning of january has died up in terms of care and access to care. >> we successfully paid over 37,000 prescriptions and claims for 11,910 unique hhs members in january of 2025. that means approximately 66% of the medicare advantage population received a prescription in that month. 3% of these prescriptions paid through the cms transition fill

process that we have for those that didn't match our formulary providers and members were sent information ordering them to submit a prior authorization or consider alternatives but they were given the prescription for the 30 days. >> 8% of the prescriptions paid through amazon pharmacy with our mail order program which is higher than our average which is normally around five percent . >> we are creating a dashboard for the hhs team in order to monitor the appeals and denials on the hhs population and we will be giving the hhs team that information and if there's anything to alert you all about, we will make sure that that that gets to the provider's services. phone line also experienced an increase in volume in calls in january they handled 193,151 calls. their average hold time was 511 seconds or a little over eight

minutes and their goal for the medicare team is 500 seconds. the amendment rate was at 10.44% and their goal is 2.5%. so we're working with that team to make sure that improves in february and we've already been seeing improvement. >> i will discuss a little bit more about the member engagement in the in the next slide. but we also on the last piece here we have pulled reporting from our claims because we just wanted to make sure that we were seeing claims come in and we've seen them come in from sutter, ucsf john muir and stanford among others. i think you know we were there was some concern about specifically john muir being out of network or stanford is out of network and whether those claims would would be billed to blue shield and we are seeing claims without an issue. >> next slide. we have been sharing our member materials and planning outreach for this first quarter

and second quarter this year the in-home visit program is similar to the one united had that many people let us know they appreciated at our face to face meetings our relay messaging program is very popular with our individual medicare members and we expect the same for the hhs population. we've also begun working with the retiree advocacy groups to set up meetings to help members navigate our programs. lastly, we are expecting that the hhs membership will engage with these programs and we ask that the members review any emails or phone calls made from blue shield because in some instances we need their permission to engage in these great programs. >> yes, a couple of questions. i know and last couple of slides you got a line about denials and you commented that you reviewed denials to make sure they don't exceed read

expected levels. okay. i am i guess i'm i want to make sure that that you know given that this is the second month of a new program with a new new administrator and that can be rocky and there and we've had a there were a couple of calls earlier if you were here concerned about, you know, some hundred year old patients and so on. >> i would hope that that denials or you know, you are these are being made by individuals and not some computer arised algorithm. okay. because there was also some discussion of that i would like to just understand that better and i and i'd also like to understand what are the expected denial levels and how does that how does reviewing something against a statistic really respond and to the individuals that have received denials and are and are understandably probably upset about it and there is several different layers of of denials. so we're going to be starting

to kind of get more information on on all of them. but the one that kind of seems to have been talked about on some of those calls were the prescription you know, kind of the prior authorization and the denials moving in to so those are denials that can be based on formulary. some of them can even just be you've come too early to get your prescription. you've asked for two, you know, pills that are over the the amount. right. so there are there are a certain expected number of denials. we have been we i don't have the exact numbers on the different like what our denial rate is expected to be or would be normally but we are asking our team to put that together as we start to look at the hhs ,you know, kind of program in comparison to our other our other clients and kind of even on our individual side. >> okay. i can appreciate all of that. i think what i'm this is this is a large population of people experiencing significant change and they are seniors and by

definition okay and it's not everyone is as skilled at working through you know, a problem like that and it's not clear to me at the moment i'd like that exactly who do you call? who do you ask? who do you speak to and so on and what what is the phone number that you call when this happens? >> i think there just needs to be a i think people have to we have to find some way to to make that process clear and not fall into a an automated phone system you know ask you know that that has you gave you a different buttons to push depending upon what the nature of your questions are and all the rest i don't know what what that experience is. i haven't tried it myself so i'm not criticizing what's there right. >> but i'm concerned that what is there needs to be very clearly communicated to people so that they know you know

and it has to be communicated in a way that you know, if there's a phone tree hey joe, i'm the phone tree. send everybody the phone tree. okay. if you have a denial and you don't feel satisfied with the process, call this number and there should be an advocate somewhere you can call that will help you get through that. >> i mean i, i expect personalized care for our members period and we expect you know, we are you know, that's exactly what we expect as well. so we have our it's basically the same message that we had prior to enrolling in the plan right which is our our concierge member services line. so that team has direct access and can and they will stay on the line and they will call over to our pharmacy department or in some instances maybe they will need to call you know call over to our pharmacy line and then call the member back. but the members should absolutely be calling the concierge member services line. there were some reported, you know, kind of issues in terms

of maybe the amazon pharmacy gave a 30 day instead of the 90 day things like that. if if you you know, as soon as we got kind of somebody in touch with that member, we were able to fix that right away and that any of the fixes have been coming through our concierge member services line. so there there isn't a phone tree on on that line because that is a dedicated line for us ve kind of an overarchingso statement so i'm kind of this a lot of the stuff has been prescription but there's also medical prior authorizations, right? so with medical prior authorizations we do use ai to help us approve, you know, kind of some some that are very easy to approve with all the right information that we have any time a denial is is made we have a a provider making that

designation even with the denial so there is not on the medical authorization side there is not an a i you know, i you know, a system that that would deny any sort of medical treatment. >> does that does that help answer that's helpful. okay, great. and i just point out that if if you have to go through two steps especially with a retiree as some of whom and i am one of them or not techno savvy at all that you are now entering a new level of frustration and and difficulty and god help you if the second step didn't work or didn't work quite as you expected or whatever and there you are and now you need additional help even with a

help line it's very, very frustrating and so whatever we can do to resolve any of those issues and and catch that potential sinkhole at step one is what we're really aiming for . and what i find is for myself and for colleagues that i know who are much older or less even less technical savvy than i am and i'm at the bottom of that whole the frustration level is so great that they'll hang up and they will not get the service they need. it may be delayed. it may never reoccur again. there's a number of outcomes that are not satisfactory. so whatever we can do to snag whatever the issue is and keep that member engaged and involved so that there's a

follow up and some effort to make sure that while we thought when we hung up that everything was okeydoke, we're now finding oops, it's not it's two days later and we hit that wall again so if you sort of get my drift when it comes to customer service especially with our aging population and some of us who are not so techno savvy, we may need some extra attention. >> agreed. and where you know we don't want you to feel that you're you know, hitting up against any wall please do not hesitate to call back again. there was a question or you know, kind of coming through on how many people have called back more than than one time and we pulled some statistics. it was a little bit hard to kind of figure out exactly but but from what we could kind of glean from the majority of of

the calls, there were only 21 individuals who called back more than three times in january. >> okay. so but but you know, i don't want people to feel like they can't or shouldn't the we don't want you to get frustrated. we want you to call back and we want you to get the help those first two weeks the you know like we were saying the call wait times were longer especially on those first few days when everybody was very excited about the new program and i totally you know, we were excited too. so i get it. but but yes, now things have calmed down. there are not you know, long wait times and our abandonment rate is is way down. so so i would what i would say to people that have expressed like i called in that first week and now i am frustrated is call back again because everybody was calling in that first week and so what what we're trying to do now really is you we are still spending an average of over you know over 15 minutes on each call

and even if it's walking everybody step by step on how to use amazon pharmacy or to access our provider directory etc. we're working through it and i'm you know i've been pretty amazed at how patient and just even kind of listening you know, we're kind of seeing some of the notes from the calls i've been very impressed with, you know, kind of how the follow up has been with when they have called member services. >> yeah, because that is significant and we have several retiree organization ones as you are aware and so different people get stuck at different places and we'd like to be able to pull out those members and make sure that they do get the service they need and that they don't get frustrated. >> i found it myself. it's like how many times have i been doing this and i keep you know, what is what is the definition of insanity that you keep doing the same thing over and over again with the same

result. okay. i've been down that road on it completely but we'd like to see that our members that somehow we make sure that there's an intervention or there's a follow up of some kind that says member x did you get this member z? did you get that? and so that we don't hit those walls and hit those snags and like for example the transition fill process for the pharmacies? >> right. we we are sending out a notification to the provider and to the member and if we're not hearing back they are making a proactive phone call out to the provider. so so those kinds of things are happening and that's good to know because as you know we are all so attached to our medicare medications. >> i'd like say our drugs we are all very attached to our medications and for some of us those medications are really

significant. it's quality of life for the rest of that day or for the week or for the next hour. we just don't know. and so these are very significant issues. thank you. i agree. attention to that. we really it's very it's a very significant part of the member services. we want to make sure our members get agreed. >> thank you. i have a quick follow up on that. >> i maybe ask tiffanie this is great to hear about. i think maybe some numbers to it would help because i do think that oftentimes that that different prescription is such a hot button and it's hard to yeah proportionality. so you just said 21 like that's that's really helpful. so maybe next time we can have a little more of a dashboard related to this because it is i think most of the time it's very smooth but when it's not it's very personal. it's very painful. there's a timeliness and service piece. so just i think that's an ask but i do have a couple other quick can i get you to add to that when something gets switched to generic? mm hmm.

and the member isn't informed like oh, this this this medication is the same as what you got. it's just the generic for some people generic doesn't work. there's a lot of issues involved so there needs to be this constant follow up that goes with that and excuse me back to you. >> sorry it can i ask again that a dashboard you were talking about like because i gave some of the prescription numbers but like kind of similar to buy and i think you mentioned them i don't think i noticed them in the slide. i just like to look at the numbers and then be okay. i think we've got 19,000 people got 100 you know, have it on the slide but okay did not so in some way just to sort of perfect so that we can look at would be helpful okay but i do have like just another quick follow up. so i think you have i think blue shield does do these in-home wellness visits. right and that's a good thing. but it's not the ongoing provision of chronic care that i think was one of the things in united is that right? >> right. no. one we care for we're not saying they're the same thing because i think they're

actually have different functions. right and is it is more like a wellness check in a way. >> right. one time correct. >> an ongoing annual so it's an annual annual wellness coding things that go on. >> i appreciate what it's trying to do but i don't think it's doing the same thing as what the united more embedded if you will or ongoing provision of chronic care to home based employees. >> is that right for retirees? so we do have i mean talking about in-home care i mean yes, you're right. >> it's a completely different program. it's not a promotional but if there are members that are you know, have different needs. right. we do have in in-home you know, kind of visits that can come from providers in the bay area we use i know that united use landmark and we use altius oak. >> oh great. so i don't think we i'm not sure i knew that because i remember that was one of the issues in the transition that there were a number of retirees who were concerned that they had been getting here from a

landmark. so it's great to know that that is now there is something taking the place of yes, thank you. >> and then last question sorry there are a lot of providers that called early on in the transition. did that sound like did you put a high number and was that something that they bucketed into? >> is this my patient? how am i getting paid? like what kinds of questions did providers call with and has that sort of tapered off? was that just sort of the jan blossom if you will? >> right. i mean i think that the 193,000 that i quoted was overall right? >> it was not us as providers that was our overall we don't really have a way to track what it says specifically on the provider line, okay. like we do because we have a dedicated line for services but yes so but yeah you know from what i understand majority of the calls were you know, what are the benefits who's you know who's covered and and then also prior authorization how do we get authorization got it. >> yeah i think you did say

193,000 was like that's a big number. >> yes. no, sorry. i should have qualified. >> that's fine. thank you. we have any other questions or comments? thank you for your presentation . if not then we'll go ahead and take public comment. >> thank you. thank you. public comment is now open. instructions are being displayed on the screen for those watching on a set of tvs and webex for those calling in call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment will begin with any in-person publi c welcome. >> hello again lois scott from protect our benefits and there is a letter attached from protect our benefits called discrepancies on acupuncture and other specialty must go

skeletal provider services between uhc and blue shield california i'm wondering the phone line the concierge phone line does not seem to cover the situation where there has been a subsequent act with american specialty health who covers the listed benefit of acupuncture and chiropractic treatments. >> so i had experience in calling american specialty health just to ask them who are your in benefit providers in san francisco? i put it in writing and i phoned them. i got absolutely no response and this goes back to what is on the information sheet for this item. i think it said on page four where it now says as far as those benefits the only ones that are going to be allowed are the preferred provider are

american specialty health and that's a big, big change that's as i understand the what's been happening some people who are patients at sutter, some patients who are with other acupuncturists and providers in san francisco are getting cut off after five treatments and i'd like to get a clarification about who handles those calls and how many other benefits that are listed are subcontracted some cutted, some contracted out to another providers so that they can't get the benefit of the concierge comprehensive and helpful advice that people get when they call blue shield california good comments good questions.

>> hi, good afternoon. >> my name is elaine economists. i'm a 30 year s.f. pd retiree. i was invited here by the president of the veterans police officers association to voice my concerns about this transition. >> i've made only two phone calls so far just to make some basic inquiries. one was to find out whether i could make my annual appointment prior to when i made it last year. so last year was in march and then i wanted to know if i could make it now. my doctors said that it would probably be a good idea. i had a couple concern urns so i called the customer service line and they answered rather

quickly which is great but i have never been met with such incompetency. >> that's just a basic question can i make my annual appointment now instead of march? i could not get a straight answer. the person i was talking to didn't seem to be even listening to me first she said yes you have to wait. and i said are you sure? >> because she didn't sound sure and then she said do you need help making the appointment? i can call and make an appointment for you. i said no, that's not what i need. i just want to know can i make my appointment my annual appointment one month prior to when i made it last year? there's a lot of typing going on i hear on the computer. then she said she was typing to her supervisor. the supervisor came back

and said what is she waiting for? i still didn't know how to interpret that answer and then the person i was talking to all of a sudden said are you trying to make an appointment for a mammogram? >> i was like no. and then she seemed to get annoyed and then i called back and i got someone else and then i made a complaint about it and then i called yesterday about 30s left. okay because my doctor had requested a thyroid exam for me. >> that's a basic thing and the person i spoke to on the phone said she didn't know whether was covered or not and then said well go ahead and try and if we deny it will deny it . and i was like i don't want to waste my time. can't you figure that out?

>> and no, they couldn't. so the seamless transition that i was promised is anything but . >> thank you. >> it's hard to come up here and try to address so many things because each thing takes another thought. i applaud commissioner sass your concerns about the questions about denials are shared by us also we love to have a special meeting where we can meet with the people from blue shield, the commissioners whatever and spend hours openly discussing what are these transitionary problems? how can we iron this thing out ? because the bottom line is we want to get quality health care for everybody. we have people i mean tiffany

guild if i was going to do a start up company and i was a millionaire she'd be the first person i steal from blue shield. she is absolutely fabulous. i call her and we've had a real serious case where a guy got denied his chemotherapy and she got on it call doctors did that stuff. she was able to get it rescheduled but it was a week later and he have to have chemotherapy once a week for the rest of his life. so that's shorten his health. you know i don't know. we won't know hopefully not. we've had shoulder surgery denied. tiffany jumps in again bam positive outcome gets it rescheduled, get it done. she's helped out in numerous cases but there's also cases where a person in florida couldn't get their epidurals drove 90 miles to get there. tiffany got on it, finally did get home. the doctor called that woman

back on behalf but she was already home and they had to reschedule it for the following week. so she was bedridden with pain for a week as a result of missing that epidural. i mean there's numerous cases too many for me to sit here and articulate in three minutes i said a letter to all of you talking about the various issues. some are real big, some aren't so big the gym issue well if you live in marin county there is no 24 hour fitness. there is no facility under silversneakers you would have to go to santa rosa or come all the way to san francisco and as a result those people are saying hey, i'll pay the $400 out of my pocket, i can't do this but i'm asking to please get a motion from hopefully from one of the appointed supervisors that we can have a

special meeting to try to really openly look at this stuff and try to resolve it because i know you guys all want to resolve this issue. i mean you all have their grandmothers that one grandmother it's so important to me so please keep that in mind. i hope to get somebody here to entertain a motion for a special meeting specifically on this issue. >> thank you. thank you, fred. good afternoon, ladies mandelman. my name is mr. okoro oliver okoro, retired employee of city and county. i work for the city and county for 20 nearly 26 years department of transportation. i sent an email to the board. i don't know what are you guys how do you know him? >> okay. >> i used to have our united health coverage before the board switched us to blue shield and for the past five years i had it i used to pay

for p five dollars special special to visit $15 the emergency $65 and the same thing we ten the blue shoot card here is something the road but recently i went to ucsf for a follow up appointment the same amount that i paid the same visit that i paid $15. the bill came they charged me $100. then i called them. they said that that's what they charge that i should talk to the board and the blue shield. i don't know why they are charging $200 for a visit. something that i used to pay $15 for a specialty visit so i'm trying to see what you guys can find out and clarify that

too because i talked to the billing department for a very long time. they keep arguing that that's what they charge. did you call health service and speak to a member of the staff of health service with regard to this? >> yes, i talked to the secretary and she told me to put it in the email and i and i wrote the email and she's actually going to give it to you guys. that's why i'm coming today. >> so sir, we thank you for your comment. we're not able to answer questions but we we're happy to take down any information from you. staff will be able to take confirmation look into this for you. >> thank you counsel something but when you guys transferring us from united health to blue shield didn't you guys find out the doctor ucsf as a provider will charge $100 for a visit before you decided to transfer

us from unitedhealth to blue chip so what am i going to do $100 for a visit? i as i said, sir, we're not able to answer your questions from the dais where this is public comment and so we've heard your comment and you're welcome to follow up with staff from health service system to address your concerns but it does send me to where i came from where i was before. >> you have staff in the room, sir. >> thank you. hopefully a staff person will be in touch with you and no one else has approached the podium. >> well move to our moderator who will notify us of any callers in the public comment queue at this time for secretary there are eight callers on the phone line three callers have entered the public comment queue at this time.

thank you. moderator on meet the first caller welcome. caller hello, welcome. caller three minutes begins. thank you. my name is darcel grace and i'm a retiree and i'm i'm concerned about prescription benefit and i got a prescription benefit for mail order from my doctor for 90 day supply of generic medicine and initially amazon said that all they could give me would be 43 days and then if i wanted the rest of the prescription i could pay out of pocket. >> i got a call from member services to follow up on that and the young lady at member services looked looked at up and said well you we only

dispense that at 30 a 30 day supply at a time so you'd get 30 day 30 day 30 day i said and would i be required to pay just $10 for that or what i have to pay $10 for each and so she said i would have to pay $10 for each. i asked what does my plan call for and she verified that the plan said that a prescription a generic prescription 90 day supply would only cost $10. >> and i said to her, well are you saying that blue shield's formulary overrides our plan benefit? >> and she said yes and i have never and i've worked in insurance health insurance for a long time and i have never encountered that without the consent of the plan. >> and so my question to be answered is does blue shield have the authority to override the plan?

our plan benefit to charge me $30 for something that my plan says i only have to pay ten for? >> and then she told me that if you go to a retail pharmacy a 30 day supply for generic medicine is only $5. so she was even doubling the charges on me. so that's what i'd like to know . >> thank you. caller thank you will meet the caller and our moderator notify us of any other callers in the queue or secretary there are nine callers on the phone line. three of them have entered the public comment queue at this time you will hear a brief silence as we transition between callers. >> thank you. moderator we'll welcome the next caller. welcome. caller oh, this is herbert weiner and i am really

concerned about the fact that this was supposed to be a seamless transition that all yeah, i stand for something else and that's administration insincerity. this is first a problem for people because things are being handled on case by case basis and what should have happened was that all the benefits the individuals receive under united health should have been automatically transferred to blue shield and this did not happen. and we have several of people being denied chemotherapy, other benefits, people having to go through administrative hoops, placing a burden on the

people who administer the program on the health service system. it's really wretched so that's really sad for us. no, i'm not blaming blue shield in particular. i'm blaming the people who made the promise that this would be a seamless transition very, very made the promise the only thing that would change would be the blue shield card and that clearly is not the case now what i would like to see is perhaps blue studio could publish the names of appeal when claims are denied that would be a good thing and that would be a service because otherwise people are going to be going through hoops and people are going to give up and maybe at the risk of their lives. so please correct that so far i

haven't been directly affected but the ball is my court eventually i'm following on behalf of everyone else. >> thank you. thank you. thank you. caller we'll look to our moderator for any other callers in the public comment queue board secretary we have one caller in the public comment queue. you will hear a brief transition of silence as that caller is elevated. >> thank you. moderator welcome. caller welcome. >> caller yes, can you hear me? yes you're three three minutes begins now. >> okay great. my name is ray casada. i'm a retiring member of the

health service systems. i had the same issue that the gentleman who spoke in public did with ucsf. apparently ucsf charges for both physician services and for facility charges as a separate charge united health care would pay the physician service minus the $15 co-pay and the facility charge they would pay the full amount that was allowed. i researched what they've paid previously and in a 2 to $300 average submittal for facility each charges the balance do that you know the health care paid was about 80 to $90 so i had a similar case where blue shield said that they were owed $94 but declined to pay it because they treated it as a

outpatient hospital visit and were applying the $100 deductible to it. so what would happen would be that if you see a specialist you see even if it's not in the hospital been in one of their offices or buildings blue shield would look at this and the co-pay would be $115 rather than just a $15. and i heard during the meeting that there were other problems with ucsf so i'd like to see or hear how this might be addressed because as i said and the gentleman said with the united health care we only pay $15 as a co-payment. the other thing i would like to with a couple of minutes with respect to the review act it's the ymca has a much better program than all these gyms do

and they're especially friendly to senior citizens and i think senior citizens will get much more benefit with the ymca membership than they would with 24 hour fitness membership and thank you. one last thing on a positive the amazon pharmacy has been working very well when i've ordered something i usually get mail order within a day or two and so that is working well. >> thank you. thank you. caller we'll look to our moderator for any callers in the public comment queue board secretary there is one caller in the public coming queue at this time you will hear a brief silence as we transition between callers. thank you. moderator welcome. >> caller yes, hello.

>> hello you're three minutes begins now. thank you. julie collins i sent an email to holly asking that she distribute it to the board members. my specific question is about the ach american specialty health group who goes around to blueshield blue cross, cigna, aetna and kaiser. they are a subcontractor. >> it is up to them to approve or deny chiropractic physical therapy and acupuncture. yes, hello julie. oh yes, we're hearing you continue. thank you and may continue. >> yes, you may continue. >> thank you. my car practic office medicare usually gives them 43 to $46

for a $77 charge but ach was only willing to do about $19 and a portion of that was they were charging the patients so the office would get $19 but the patients would pay 10 to 15 of that. so the doctor was getting about $4. >> it just sounded like a horrible scam and continue yeah they thank you and they ash are the ones who are deciding or if you can receive physical therapy, acupuncture or chiropractic and they will deny you out of hand without any challenge because it is out of blue shield's hands. they have subcontracted with this organization ash who has an absolutely dismal reputation and if you go to w w w complaints board.com forward slung american specialty health

you will see how terrible they are and it's a shame that blue shield decided to get in business with this group at our expense so right now our co-pay might have been 15 to 20 now it's 78 or $56 depending on which of those services we need from our doctors physical therapists, acupuncturists we are respectively 82 and 86 years old and i think it's a horrible way for us to be kicked to the curb and i expect the board to be able to look at that and address this hopefully when they meet with fred sanchez and protect our benefits. thank you very, very much. >> thank you. caller we'll look to our moderator for any further callers in the public comment queue. >> welcome. >> $76.

>> board secretary there are no additional callers in the public comment queue at this time. >> thank you. moderator hearing no further callers public comment is now closed. thank you. so that closes out that agenda item. we are going to pause now and take an eight minute break so we'll be back at 330. we do have several more items to get through in time to vacate this room for the next commission that meets shortly after 430. so eight minutes 330. >> see you soon

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roll call please a roll call vote starting with president how present vice president stransky present commissioner cremin present supervisor dorsey present commissioner howard present commissioner sas present and commissioner rosen here with that we have quorum thank you. >> we will now move on to agenda item number 14 please agenda item number 14 as of access demographic 2025 demographics report this is a discussion item and will be presented by robin coleridge, sfh access director of enterprise system and analytics

. >> good afternoon commissioners encourage director of enterprise systems and analytics presenting to you the key findings from the 20 2020 2020 five sfh access demographics report. this is the speed round. i'm going to move very very quickly because we have limited time for this. so as you already know we have a very stable populatn 25 plan a result of implementing the blue shield medicare ppo and discontinuing our united health care plans and overall lives have increased by 2273 individuals to 139,136. so that also includes those that have waived coverage our employees and retiree members as you can see in this slide have increased and from the resignations and now our retiree member population increased by 9% and despite possible slowdowns in hiring due to the hiring freeze, our employee membership has also

surpassed those pre-covid levels and so our workload just continues to increase. delta dental ppo that continues to be the dominant dental plan selected by our employees and retirees accounting for 86% of this population and there's a premier you heard our actuary speak about this earlier but since its inception that has that plan has proved to be very, very popular and it increased enrollment by double digits again this year. so here we look at our voluntary benefits and our fica ,sfh, ss does have initiatives to increase our participate in the pretax benefits from osa fsc plans and those did increase by a pretty significant amount this year. we've done some digging in to try to figure out why and at this point i have no real answer except that every couple of years we see a big jump. what i can tell you is the majority of those that are enrolled in fsas or the i should say the average age of that group runs late 40s to

very early 50s. and here's the distribution of our employees by race category . we believe the collection of race data is important and the effort to ensure health equity so the ranking order of these racial groups has remained the same as prior years although there's been some slight shifting in the percentages. >> and here's a look at something we presented last year but this is the distribution of retirees and the applicability of 2009 part b to those individuals. so of course the contribution tiers other than the 100% employer contribution are growing and most retirees within the 0 or 50% employer contribution categories do waive coverage right now there's a drumroll to announce the new home of the sfh assessed demographic report. this has been the culmination of eight months of work that was led by sharmini bhatnagar

who's sitting here on my left today and the goals of our initiative were one we wanted to increase efficiency in producing this report annually . it takes four of us the better part of five weeks to put out that report. but we also wanted to improve readability. we know that is a very dense report and it's very challenging for people who consume that report to find what they're looking for by migrating to our new platform we've increased our capabilities and so we've got the ability to provide more data, more slices of data, more years of data and also like some of our hipa compliance where we mask numbers that are small numbers, we can all do that programmatically now instead of hunting in that report every time there was a number that we needed to suppress and doing that manually and then finally what we've accomplished by this is it brings us in alignment with the city's digital accessibility and inclusion standard and as part of that standard they are encouraging

the move away from pdfs. so on that final slide there you also saw the url i'm not going to spend a lot of time and how to log in your appendix and the summary presentation tells you that but we want to at least give you a quick orientation so when you come to assess open data this is the landing page. the easiest way to get to the report is just type in that search box as the page access demographics and then the title of our report will come up you can click on it and then you'll get to our landing page. so on the landing page we've got that color coded with blue there and just like the demographic report that you've always seen, this is the first section of the report and it's looking at overall lives. >> you know another goal we had with migrating this report to the cities open data platform is to also increase our department visibility and educate site visitors of who we are, who we serve, who our population is, what are our

rules. certainly people do confuse us with and so as we have navigated down on the page where we've stopped here is one of the takeaways and i want you to appreciate which is we are not limited by a pdf page layout anymore and so we can give you more information. and so for the first time here's another data point we provided to you it's our employer paid benefits of life and ltv that are included now in your report as you scroll all the way down to the main landing page you're going to see these color coded tiles and this is all organized the same way the demographics report has always been organized which is to say we give you four different perspectives when you want to look at things by the employer group that's clicking on the red tile and by employer group i mean all your actives, your retirees, all their dependents associated with one of the four employers for whom we administer the benefits the gray tile there that's that's the lens from your access member or subscriber if you will. so that's just looking at the

employee and retirees and then we have a green tile which is the active population. it's your employee members and their dependents and then the orange tile which is your retiree members and their dependents for the sake of today we're just going to jump to the retiree page just so we can again orient you and know how to use the new demographic report you saw the orange header we linked from an orange tile all the tabs on all the tables on this page alternate orange banding you're going to see we've done that color coding with every section of the report to help give you visual clues as to where you're located. so what on a table what you can do is there's two up arrows there that lets you collapse the information. >> so if you want to view more of a summary this is one that is showing medical plan enrollment the two down arrows. that's how you expand the information. now a lot of times these tables may not show the full information on the page. they're scroll bars on the right so you can scroll up and down as germany is demonstrating for you right now

at the bottom there's also potentially a left right scroll bar and there's page by bar. so if there is more information than is visible on the screen, the other thing you can do is you can click on column headers so that you're altering the saw order maybe to help you focus in on what you're looking for and then we have this inverted pyramid at the top that inverted pyramid is your filters. >> so one of the things here that you'll see is a year filter and this is how you can choose anywhere currently over the past five years as what we've put in here and then we also have a filter there. for example this is showing members independents and maybe you only want to see the count by members. you just select member apply your filter close that filter box and your data has updated like that so you can get to what you're looking for hopefully very quickly also with all of our tables or charts you can view the source and export so if you can scroll back up for me quickly germany there's three dots at the top

of that table and if you click on that that's where you can view the source data and that's in the open data platform or you can export it to csb that is completely aggregated and de-identified data but you can take that and work with it in other ways. should you wish. all right. so one of the things we had talked about in the in the report was that prop b retiree enrollment. and so what i want to demonstrate here for you is the versatility that we have by using this platform. so in in pdf it's static. i was showing you total number of retirees and i said most of them wave. what you could do here is you could go to that 0% you could use that filter and we have a coverage elect as one of the filters and if you set it to waived and apply that filter your data is going to update i think the count is something like 469 whereas we saw for there was 510 in that 2025 category thereby proving my point most people wave but you

very easily got the splicer that information you might have wanted to look at and then as we scroll down a little bit further you've seen our maps before. these are bay area county look it's very static in that pdf now we've even added another map below that which gives it to you counties across the u.s. but you can do things in a map like pan which is moving around. you can scroll i'm sorry not scroll but you can zoom and you can zoom out and you could even go global if you want from here. so so that's that and then if we move down the page to our table around retirees by plan and gender what i want to demonstrate here is sometimes we have data nested in more than one level. so as we collapse the information up you'll see that we can select once to expand and then we can do that a collapse bar a second time. >> so again depending what view in summary level you want an aggregation in these reports you have the ability to do that

and now as we scroll to the bottom of the page what i'd like to show is on the landing page the home page you get the tiles on every other page if you want to jump around to these different perspectives they're all just these links that you just click on to to move through the report as you will. and so shami is going to scroll through and just show you some of the other pages what they look like while i wrap up the report is live it is available for you to explore and we certainly look forward to hearing how we can make this more useful to you. s to the end of our presentation and i'll take any questions. thank you for the speed round but but also thank you. i love that. >> that's great. you are not limited anymore so thank you for this great information. >> i think it was a very impressive and i'm sort of i'm a little bit of a data geek so i'm looking forward to doing this. it was interesting when i went to i typed s i went to data s.f. you may want to flag this for them.

i put a h s s and what i got was the call center sent center metrics. >> it didn't come up until i said s f s h s s you may want to just flag it for to make it easier to search because it wouldn't be obvious to me to to do that. >> yeah that's good feedback we can control that consider that change done within the hour okay. >> very good. and i have a question about sort of how long so the live data is it updated on sort of live or monthly like this is the annual demographic report and this as i said took us eight months to get here. but the good news is that was building out a lot of structure. it was all the back end data structure. we architecting what it needed to look like and so i do believe we're little resource constrained right now you know that but i do believe we can do more frequent refreshes now because we've written all the queries we can schedule and extract data, dump it in and then just update and we're good. so that is the goal over time. >> got it. thank you. great. thank you ron. thank you.

>> we'll take public comment on this item. public comment is now open instructions are being displayed on the screen for those watching on a set of tv and webex for those darling in call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex online click on the recent icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment will begin with any in-person public comment no one has approached the podium. we'll move to our moderator to let us know if there are any callers in the public comment queue board secretary there are nine callers on the phone line. zero callers have entered the public comment queue at this time. >> thank you. moderator hearing no further callers public comment is now closed. thank you. agenda item number 15 please agenda item number 15 reports and updates from contracted health plan representatives. this is a discussion item and will be opened by mary howe

president miriam are there any representatives who would like to make any announcements? no. yes. oh yes. yes. okay. >> quite a few please please come. >> good afternoon. board of commissioners heather chandler with united health care more still around for your dental plan offering. so i wanted to take a minute today to introduce my colleague monica andrade as she may be coming to board meetings interacting with the sfo assist staff as well and get a chance to see you all this year. >> so thank you. thank you. welcome be here and look forward to working with everyone. thank you. welcome. >> anybody else see no one else. all right. we can go to public comment. >> public comment is now open. instructions are being

displayed on the screen for those watching on a set of tv and webex for those dialing in, call (415) 655-0001 and enter the access code followed by pound in pound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person public comment will be first followed by remote public comment will begin with any in-person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue board secretary there are ten callers on the phone line. zero callers have entered the public comment queue at this time. >> thank you. moderator hearing no further callers public comment is now closed. thank you. agenda item number 16 please agenda item number 16 sfh access executive director recruitment update this is listed as an action item on our agenda it is a discussion item it will be introduced by president hill and presented by amanda keller with the berkeley

search consulting firm. >> good afternoon amanda and fta and so it's great to have you here. >> we as you may recall we retained an executive recruitment firm berkeley search consultants spearheaded by f ten with his team of amanda and julia who i assume cannot be here today to help us with our intergalactic search for our next executive director. and so they are here to give us an update of that effort. so i'll turn it over to you. thank you. good afternoon, president halbert. my name is amanda keller and as i mentioned, this is often how junior who is my leader and has played a key role in this recruitment effort. and in lieu of time i will do my best to swiftly go through these slides. so we'll walk you through the recruitment process, our strategy and we'll wrap up with where we are currently standing in the search. >> so our philosophy at berkeley search consultants we believe that a strong and diverse talent pool leads to strong our leadership.

and our approach is really rooted in ensuring access to a broad and diverse range of candidates and ensuring transparency in our process in alignment with san francisco health services systems expectations and needs. >> so what does that look like? we actively utilize diversity job boards, associations and targeted outreach to identify and engage candidates from underrepresented of backgrounds. and our sourcing efforts focus on communities of color women, lgbtq plus disability and veterans groups to ensure we find the best talent. >> so we cast a wide net and strategically engage with industry leaders, professional groups and organizations that prioritize diversity. so that ensures that the executive director pool is reflective of san francisco health service systems values and commitment to inclusive leadership. back to the team. there we are. our team is so the success of any recruitment to executive search excuse me depends on the team behind it.

so our team brings a wealth of experience in health care and public sector hiring. our team team includes captain hall junior who is our senior vp of health care and public sector practices. julia who is the vp who is not here today? and then myself amanda keller, the director of health care and public sector practices. so our team also includes 15 other staff members that have extensive experience in placing senior executives in the health care and public sectors who support with sourcing efforts, operations and recruiting. so we are backed by a team of professionals a a few of our firm statistics. >> so our placements consistently demonstrate high retention rates which is a testament to our thorough vetting and alignment with client needs. so we have built a network that spans industries and disciplines allowing us to source talent beyond traditional sourcing methods. so these numbers showcase our ability to attract top talent for our organizations like san francisco health service systems. >> yeah.

>> yeah. all right. so this slide details our key recruitment figures, our outreach numbers applicant volume and diversity representation. our team has a collective 160 years of experience and a lot of that experience probably has been working with the city and county of san francisco. and we tracked these numbers seen on the screen to measure the effectiveness of our strategy and to adjust and ensure that we're reaching the right candidates. yeah. >> so how do we structure our recruitment process? >> this right here is a slide to show how we approach, identify, attract and secure the right executives for a search like this for the san francisco service systems. so that includes conducting in-depth research to identify potential candidates, leveraging our extensive network to source talent and then engaging with industry leaders and stakeholders to find referrals.

>> and for this search we had 81 direct applicants and we did outreach to 330 candidates. so we got these numbers by personalized outreach, passive and active sourcing. >> and as we know, many top executives are not actively seeking new roles but they may be open to the right opportunity. so the key really is on that path of sourcing and personalized outreach. when was the afternoon? i couldn't our brochure. >> so over the next couple slides the brochure which you can find in the link on our website as well as san francisco health service systems and within the brochure itself. >> so this first page right here is an overview of san francisco health service systems mission and value key responsibilities and impact and community commitment equity

and wellness. and then this rolls right into what the position is about what we're looking for the key responsibilities and leadership expectations and our ideal candidate profile. >> and then we wrap it up with the brochure where we see the minimum qualifications compensation benefits, where to apply and our contact information. >> so this is all done in tandem with human resources and present and how. >> and this brings us to where we are today. this is a breakdown of our search process with san francisco health services ems and where we're at with this executive director recruitment. so we've completed the initial candidate sourcing. we've done the screening and evaluation. we've shortlisted. and then we had our final filing date on february 5th. so now we're currently wrapping up the process vetting the candidates and reviewing all applications to make a recommendation of top candidates for interviews.

>> so we will be working on this in concert with our h.r. >> partners and president and how and we anticipate sharing a detailed presentation with the board on february 27th. from there the candidates that are selected will be interviewed by the board in march on march 13th and 17th. >> there will but i'm sorry 2027. my apologies. march 13th and 27th there will likely be space for about 3 to 5 candidates depending on the board's recommendations and the length of interviews after the interviews the board will rank the order of the candidates and we will help facilitate the offer and pre-employment process for the selected candidate. additionally, berkeley search consultants does stay in touch with the selected candidates after her start date and we do continued resources. we do offer continued resources with cisco services and our clients. so if you thank you very much

and we're happy to address any questions i sped through that fast enough but thank you very much for having us today. >> thank you. let me just say i've already told them they should tell about any candidate that is confidential. so if the questions are going to get about, you know, where candidates come from or sorry you're right where the candidates are coming from that would not be appropriate in open session. so it's basically just talking about the overall process right today. >> right. well, that's cruz my question. >> thank you. >> just just to i'm available for all of these meetings. >> i know i will not be here for march 27th. some concern about missing that but and depending upon what the date of the offer is, that's you know i'm i'll be traveling between that between march 27th and into early april. >> thank you.

any other questions? general questions about the process. >> how many applicants did you get? 330 direct applicants. >> that was an oca i mean average 81 direct applicants. >> good turnout for though. can i assume that there was no consideration given to any candidates who are more local or who might be local northern california or the bay area specifically? there are local candidates. >> yeah that's right. please. there are local candidates in this pool that will be presented if you can imagine dropping a pebble in the water at s.f. hsc and it radiates out so we start local heavy concentration exhaust the local community and continue to rate radiate out national early.

>> and the reason i ask that is that we have a very unique population. and while our members at least in retirement end up all over the country and in some cases all over the world basically we're a pretty heavy duty bay area concentrated northern california concentrated population and have been for a long, long time and that demographic that situation doesn't seem to change significantly over time at least not since i started with the city in 70 1973. and what i've noticed in my colleagues and in working with our colleagues over the years we're pretty heavy duty still bay area or northern california. so that's why i'm asking these questions because understanding

our population and the area involved and the fact that a good number of our active members well we no longer are required to live in san francisco as active employees once were it's safe to say many most live in the northern california area or extensive bay area expansive bay area and retirees while they do move, a lot of them don't move very far. so i think it's very important that we understand the area in which we live in the area in which our colleagues are coming from and are going to provide services for within our population. so i i guess what i'm saying is i'd like to have a sense of whether or not that's any

consideration with regard to the research that's going on to find a new director. >> yes, very excellent point you've made. and in fact that point has been delivered to our firm from the very first meeting where the firm was being considered and appointed awarded the service opportunity. i remember that comment being made at that point as well. so it has been definitely taken into consideration as part of criteria along with obvious other skill. quite criteria experience criteria both hard skills and soft skills. >> thank you. just despite all my experiences i remain a local yokel so and a native so i've got that still in my brain. >> thank you very much. like my aunt and i, you know i'm probably as important as everything that claire said it. >> i've i've worked in the bay

area my entire life and i went to cal and i've been here in the bay area ever since so what happens over the years when you get it when you're professional as you do relationships are really very important and you can you have the ability to attract, you know, a good director can attract qualified people. abby is a good example. she's worked in the bay area for many, many years and so and has history with the health department's so it i think she's built an excellent team and that's because and then she's able to do that with the relationships that she has you know all over the bay area and that's really great value. so and i know you're aware of that because i know you work with you myself so i too am a bay area product. i've lived here my entire life. yes, i live more than 40 miles from where we're sitting now. >> right. longer than me we are a bit provincial in that sense but we

know san francisco is unique and our employees are unique. >> thank you. and i will say that often and amanda and julia have really taken a lot of time to understand the health service system and to understand our are the members that we serve and the mission that we have. and so i think that while they may not know us intimately but i think they do they have kept all of these considerations in mind as they vetted potential candidates. so i want to thank you for that. it's my pleasure. all right. are there any other questions or comments? all right then. thank you very much and thank you for also engaging in the speed round. >> and so we will take some public comment on this now please. thank you. >> public comment is now open. instructions are being displayed on the screen for

those watching on tv and webex for those dialing in call (415) 655-0001 and enter the access code followed by pound in pound again press star three to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person public comment will be first followed by remote public comment will begin with our in-person public comment. >> fred sanchez protect our benefits. i hear some of the comments about trying to find somebody who's pretty local. i mean one of the biggest things i heard about abby and i agree is that abby was actually lobbying to come here because of her vast experience working in the public health sector and working at st francis and she knew the complexity of our political system here with district supervisors and the mayor. it's a really, really hard job

and to come here from far away it's going to take you years to try to figure out the complexity of san francisco so we would hope that we can find somebody who's local who's pretty familiar with the health care system in san francisco. >> thank you. thank you, fred. >> no one else has approached the podium. we'll move to our moderator to notify us of any callers in the public comment queue. >> board secretary there are seven callers on the phone line. zero callers have entered the public comment queue at this time. >> thank you. moderator hearing no further callers public comment is now closed. thank you and thank you again upton and amanda for coming. >> thank you. and president how can i confirm that the board will reconvene on february 27th a date that's been held as executive agents head for rates and benefits will be switched? yes.

>> okay. we will repurpose that date that's being held to review the candidates. so we will. yes. okay. thank you. start time to be announced very shortly. >> yes. all right. now we can move on to item number 17 please. >> agenda item number 17 vote on whether to hold closed session regarding the appointment of san francisco health services. tim acting executive director this is under california government code 54957b and san francisco administrative code section 67. 10b. this is an action item and we will be presented by president hill. thank you. so colleagues we have the opportunity to recess and to closed session to handle a personnel matter about with respect to appointing an acting executive director for the time period after executive director against retirement and the arrival of the new executive director and so do we have any

questions before we take a motion now? >> okay. okay. i'll entertain a motion for this item. >> please move to closed session second. >> all right. there's a motion a second and we'll take public comment. >> public comment is now open. view instructions are being displayed on the screen for those watching on tv and webex for those dialing in call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex click on the raise hand icon to be placed in the public comment queue to speak in person public comment we first followed by remote public comment will begin with any in-person public comment no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue or stick chair there are seven callers on the phone line zero comments have entered the public comment queue at this time. >> thank you. moderator hearing no further

callers public comment is now closed. >> great. we'll take a roll call vote please roll call vote starting with president how i. >> vice presidents of asking i commissioner kremen i supervisor dorsey high commissioner howard high commissioner i and commissioner wilson i all right thank you very much we will now recessed into a closed session. >> don't go too far away

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all right thank you. we are now back in open session and so please call agenda item number 19 please. agenda and item number 19 vote to elect whether to disclose any or all discussion held in closed session regarding an appointment of san francisco health service acting executive director under the san francisco administrative code section 67.21 to a this is an action item and it will be presented by president hall eric colleagues i will entertain a motion for this item. >> i'll make a motion to disclose our findings in closed session. second to disclose so we have a motion and a second and we'll take public comment. >> please. >> public comment is now open. instructions are being displayed on the screen for those watching on a set of tv and webex for those dialing in

call (415) 655-0001 and enter the access code followed by pound in pound again press star three two to raise your hand for those watching the meeting on webex online click on the raise hand icon to be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment will begin with any in-person public comment and no one has approached the podium. we'll move to our remote public comment and our moderator will notify us of any callers in the public comment queue at this time. board secretary there are three callers on the phone line. zero callers have entered the public comment queue at this time. >> thank you. moderator hearing no for the callers public comment is now closed. thank you. we'll take a roll call vote please a roll call vote starting with president how i. vice president semansky no commissioner carmen i supervisor dorsey high commissioner howard all right commissioners as i and commissioner wilson i.

>> all right thank you. we have one no and six eyes thank you. motion passes. next agenda item please. >> agenda item number 20 possible report on action taken in closed session regarding appointment of san francisco health service system acting executive director government code section 54957.1 and san francisco administrative code section 67. 12b. this is an action item and will be presented by president howard. thank you and once again colleagues i'll entertain a motion for this item. i'll make the motion to report on the action taken in closed session regarding the appointment of an acting executive director for health service. >> thank you. all right. we have a motion and a second and we'll open it up for public comment. >> public comment is now open.

instructions are being displayed on the screen for those watching on a set of tv and webex for those dialing in call (415) 655-0001 and enter the access code followed by pound and pound again press star three to raise your hand for those watching the meeting on webex click on the raise hand i can be placed in the public comment queue to speak in person. public comment will be first followed by remote public comment will begin with any in-person public comment no one has approached the podium. we'll ve to our remote public comment and our moderator will notify us of any callers in the public comment queue. >> board secretary there are three callers on the phone line zero callers have entered the public comment queue at this time. thank you. moderator hearing no for further callers public comment is now closed. >> thank you. we'll go ahead and take a roll call vote a roll call vote starting with president howard i. vice president semansky i commissioner kremen i supervisor dorsey i commissioner howard all right commissioner says i

and commissioner wilson i all right if there's a unanimous vote on this and i would like to let everyone know that we have appointed ray reed as the acting executive director effective march 15th, 2025. so congratulations. commissioners and if i could just thank you for the opportunity and i look forward to holding down the fort in abbie's absence. we know that it's a great loss to the organization to lose such a tremendous leader but i think i've learned quite a bit from her. i try to absorb as much as i can and i look forward to holding down the fort in her absence. >> thank you. thank you. >> we now have two jobs. congratulations. very good. all right, without further ado, we are at adjournment.

>> so thank you very much for attending today's service board meeting and we will see you on the 27th adjournment at 4:29 >> van ness avenue runs from market street to bay street in san francisco.