certainly that is always on the mind of sfhss. looking at opportunities to consider direct contracts. this is something we will want to think through, you know, pause it as we develop the questions around the rfp. specific to helping people navigate the system. helping decide what may be the best approach to network based strategies. >> on this slide, where would you put us now? >> you do a little bit of each of these. i would say more in the middle, because that is where we focus especially with the accountable care organization platform. that's been the primary focus from a blue shield standpoint. i would say from akp standpoint there is probably elements across all of this, certainly from what you provide within sfhss itself, the support you do provide two members certainly fits into that high touch advocacy. the fact that people can call, and visit the office on the third floor, and receive support with sfhss, with guidance on their needs, certainly as an example of how that is being t to -- delivered today on the left. i thin

not any other employer, not any other person outside of sfhss. considerations on 36, a lot of choice. member disruption could happen depending on the choices a given member makes. it does add complexity. people now need to understand both carrier choice as well as plan design choice. it certainly dilutes your ability to look at data for the population, as a whole. it really puts pressure on all party claim database to bring information to look at information as a whole. it's somewhat limit your control. in a sense this is, you're almost outsourcing the financial control to the health plans and telling the health plans, don't compete for my members. we do see, as you can see here at the end of the day, probably not viable for 2022. we will see how this evolves. it's been around for several years. there are concepts out there that some employers have latched onto. it will certainly be a viable opportunity for the future. we will certainly get inputs on this along with the other models we have looked at. i just wanted to state here. we may not see t

the bottom line is, we are looking for partners that will work with sfhss for the strategic goals thatset last summer. with that, our framework for today, we will dive into the industry and market review. beginning on page six, we wanted to take a broad perspective bringing it down to the san francisco market. nationally we have seen significant vertical integration as health plans have allied with a pharmacy benefit manager. the major national players listed here, at the and cvs health, i just looked out of this morning, it is in process still. signal with expressed scripts will be completed in december last year. and united healthcare and optima are. many of these pbm's will partner outside of these relationships. for example blue shield partners with cvs. we are seeing this alignment of plans coming together and the different components instead of having your medical claims here in your pdm here, and mental health here in these buckets and create the full spectrum. of note, kaiser is a fully integrated system, it has been that way since inception. they own their own pbm. focused on