we have people talking about nutrition and gender disphoria and managing it while waiting for surgerywe're able to talk about hiv and prep with our patients. we have post-surgery support groups and we talk about sexuality post surgery and we have done a number of in-service training including the lgbtq sensitive trainings for the staff. and as i said, we secured a program location and that was huge. most do an intake and if you do intake with us you'll learn something. we'll do information on the procedures so you know what you're getting into. we do surgery, education and preparation and we've been bringing the surgeons who do these in to do this for us. everybody is able to have a peer navigator go to appointments with them and walk them through the process. we have a nurse practitioner to assist with those worried and are having complications and they're not comfortable talking to their surgeon and we have a nurse practitioner with them and so someone who has a significant mental health issue or medical issue that's interfering with access to care we can keep them moving forward. w

often for gender disphoria. [please stand by] . . >> so maybe that's the worry. not so much what we're doing here, but that there aren't enough providers to respond to the -- we've got a bottle neck, and that has really been a concern from the beginning. >> thank you. >> yes, commissioners. >> i have a question. well, actually, it pertains to actually the education in preparation within the various disciplines. 'cause you mentioned that we have a very highly trained, talented group of surgeons, and the fact that we have an increase in surgeries, and the increase is decided by our colleague here, i guess the thought that sort of flashed to me is that the different specialties that are certified by san francisco general, we have, iklike urology, which haa number of specialties in it that participate in numerous, i assume, surgeries here, and they have the residency program where they have a major cohort, and their subspecialties, where they have outstanding training programs, and the list to rotate through the general has grown substantially. but my -- not concern

. >> and also just as reminder in 2017, we may not remember these things but we improved our disphoria benefits. i believe its watt march meeting we asked all of our plans to align the benefits specifically using blue shield as a model, and then the board adopted a policy on looking at medical necessity for benefits for gender disforium and we continued our work with best doctors of 2017 and we are hoping to do the same for 2018. and we are hoping to do the same for 2019. and new technologies for member services. as we mentioned before, we got rid of 100,000 paper files. one other important aspect of that functionality, and that technology we brought in, is open rollment was the first time the staff was able to take all the open rollment applications and process them in an electronic way versus flipping through paper. so we received 14,000 applications. that's a first as well that i know of in my history with hss but on top of that it was done through an electronic work-three process. and even -- work-flow process and each the staff were happy to pull up the work whether they have them