Transcripts For SFGTV Government Access Programming 20240713

7 that had access to selfservice decided to send us a piece of paper instead. So not too bad. Last year, when our pilot, when we did about those numbers i mentioned earlier about 12,000 or so, when our first rollout. I think adherence was about 20 . Compared to todays 24 . So on slide 6, i think some of the things that helped us have success and the lower number of phone calls as well as e benefits is our outreach. Back in september, i told you we did improvements to our communication and i think it showed based on the feedback i got from the staff that speak to the members enough, that they were understanding our guides better. We did a lot of work on the inside improving on the graphic look, making it easier to read. In many cases, it worked on the copy without changing top of the actual meaning. I think this was a success too. Its the first time we were able to demonstrate that our communications improved the open enrollment experience. On the next page, continuing with outreach, just to go over the specific numbers of our direct Member Engagement. These are the offsites. You can see the numbers here. A lot more people show up to these things and we actually spend time with this, so those numbers are actually bigger. But i want to look at air here. Thats airport. Sfo. About 200 people. That was 11 to 2 or 10 to 1, two to three hours we were there in the morning. We also did a second shift, marina and i, went out from from 10 p. M. To midnight to speak to a lot of the staff that are starting the third shift. So marina did her advising on ebenefits and i tried to help everyone with the benefits, but it was a great experience and we saw at least 200 people from that time, 10 00 p. M. To midnight. A lot of good feedback. A lot of these offsites were health fairs where we included flu shot clinics and i didnt want to mention for carrie here, that we did increase the number of flu shots to 3. 1 increase from last year. So total of 4,482 flu shots this year, 204 being high dose. And thats just about 18 but the goal was 4500, so they missed it just by 18. Thats good to hear, its increasing 3. 1 over the year. On page 8, i want to talk about the outreach. Again, this is one of the reasons that i think we had such good success with ebenefits is part of the outreach. And a lot of that has to do with the fact that some marina, including marina went to the offsites and promoted e benefits. The benefits analyst had on blue shirts that San Francisco Health Service system and what i called the geek squad, had a note on there, saying ask me about e benefits. So i think that did a lot to promote ebenefits. We also had a howto video on the website along with the regular open enrollment video which was nice. We had codes. We pass these out, so its easy to access ebenefits are their smart phone. So i want to step into another category on page 9. Talking about the planned enrollment. In is looking at the migration of what happened, this is results of the open enrollment as far as plan changes are concerned. This is preliminary. There is a lot of work that takes into getting these numbers exact and looking at the reasons and thats why we present the demographic report in february. So there may be some more additional information, but just a few things. Comparing to 2019, and those orange columns, this is the variants. And some things that are a given, city plan pretty much decreased the most, with 14 employeeonly moving out of the plan. 12 employee plus one and five families moving out of that plan. But another thing ive noticed is that employeeonly and kaiser and blue shield trio, both decreased. Now there could be a few reasons for that, which were looking into, and this takes a lot of time, were working with peoplesoft. These could be employees only moving to family coverage or adding a dependent and staying with the same plan. I want to do a little more research, are they staying in the same plan, or migrating to a different plan. We have to keep in mind that diva happened in 2018 and some are putting spouses back on, because we only allowed them to perfect their claim for the dependent eligibility through september. So and then during open enrollment, they were allowed to put them back on for 2020 if they provided documentation. There was some of that going on, too. Also noticed that 85 people left waive, that means having no benefit and moved into some of these plans. Again, id like to see where they went and get a little more information about that. But that in general shows you overall, there was an increase in employ plus one of family coverage. So definitely some interesting things here that i think is worthy of us looking into and maybe having an addendum to this in february with the demographics report. On page 10, quickly, as many of you know, we have the split family situations for families that have one medicare member. They can be in United Health care, ma, ppo and then have one in city plan, they could be in blue shield. So we just look at a little bit of that migration, kind of the same thing. With a little bit more leaving trio this year. On page 11, this is our dental plans. I see a good number of people here to the far right, the variants, leaving what we all our dental hmos and moving into delta dental. I dont think thats too uncommon as those plans seem to continually be more unpopular. Then there are benefits weve added this year to delta and the rates have pretty much stayed the same. Then on slide 12, vsp, this plan is extremely popular. This is our premier plan, if youre enrolled in a medical plan, youre enrolled in basic, but you can double your benefit. You get glasses every year. Frames, allowance, 300, et cetera. So again, there is significant increases in here. We went from 15,000 to almost 18,000 for 20. And just for if you remember, when we first started this plan for the plan year, well plan year 2018, the enrollment was 10,801. That was the first year. As you can see, weve increased significantly. On page 13, weve also significantly increased, thanks to two open enrollments, of voluntary benefits that we initiated for all city and county a couple of years ago. You can see here that we increased by 1900 from november. And just so you know, or recall, we had a mid year open enrollment for these voluntary benefits around july. So we went up from july of 9,274 to 11,000. Our initial enrollment prior to july was just 5600. So quite a significant increase in voluntary benefits. I think the word is getting out and people are like can the benefits liking the benefits. Just a couple of comments on page 14. This is a snapshot of enrollment, these pages that i just went over. So you know, from january 1 to november, when we started looking at this. There is plenty of retirement. There are people who leave the city and new hires. So those change throughout the year. So this is looking at november. Whereas the demographics report will go from january to january. And that will be showing january 1st. I think thats about all i wanted to say, except for the fact, something new we did this year, we provided two surveys. One was to our own staff and Member Services asking them about their thoughts on their preparedness for handling open enrollment. And then we did a followup survey with the staff after that. We also surveyed the entire membership asking for their feedback on open enrollment. And we received almost a thousand responses on the membership survey. So i was going to add a little bit of that in this report. But i got so interested in it, that i wanted to provide a little more information in january on the results of that survey and followup items well be doing. But thanks to marina and her staff. She pretty much directed the whole plan of getting selfservice up on the past two plan years. Working not only with the department of technology, or not only the controllers office, but the department of technology and getting that going. And if you see three departments in the city working together that well, its unusual. I think it has a lot to do with her and her personality and to get everyone working together. Like i said, huge successful ebenefits rollout for the entire city. And again, the staff. The Member Services staff for taking all the phone calls and talking to those people and perfecting those enrollments and that type of thing. Our Communications Department that did all of the hard work. Care and ryan on improving those materials. And also finance. If we didnt have finance, we wouldnt be able to print those rates and talk about those rates correctly. Again, everyone really stepped up and did a fabulous job. It was a very good open enrollment. Any questions . President breslin just want to thank you for your dedication. Did i hear you went to the airport at 10 00 at night . Yes, we did two offsite events at the airport. Health fairs. We sat there and discussed president breslin thats great. And they werent flying out that night either. Taking a flight after . Yeah, it was tempting. [laughter] open enrollment wasnt quite over yet. Commissioner follansbee on behalf of the members and this board, i know every year this is a herculean effort for you and your team, youre to be commended and i thank you for your diligence, each and every one of you. Thank you, appreciate that. I would concur. This is spectacular in terms of the migration to ebenefits. Its something that makes sense in this era. I have a couple of questions. One has to do with the people who show up in the lobby on the third floor. Number one, do you have a sense about what their encounter time is . How long are they there to get their questions asked and answered. As awalked through, there are several terminals, i think. So are members able to complete their ebenefits there . Is there staff to help them so they can actually use the equipment in the reception area . I was impressed with the number of terminals and the possibility that could facilitate the learning curve and next year, you might have fewer facetoface encounters. Absolutely. We have some idea of the wait times in the lobby. It is right now the system that were using the sales force, the people log in when they come in and the timer starts there. And the timer changes time whenever theyre called in and then it changes time again when they leave. It rounds off to like an hour. So its very inaccurate. And were looking at more ways of gathering that information. But we do notice it. And it also depends on the problems, but the staff is really good of keeping an eye on because they can see through the sales force, how many people are waiting and most of the offices, you can see how many people are waiting outside. Did you want to Say Something about wait times . Okay. So what we did this year, we have staffed our reception desk in the lobby when you come in. There is always one that has been there for a while. We staffed reception desk and put some footprints on the floor there to guide people on how to sign it. Because it does get a lot of traffic. And footprints leading people to the terminals. The terminals are functional for them to look at the website, the health plan and access selfservice. That individual that was sitting at the reception desk is the desk top support specialist for those people. Encourage them to try ebenefits on the kiosks. Thats why theyre there. And when we start new hires, hopefully, by the first or Second Quarter of next year, the new hires come in, that will be there, using those kiosks. It reminds me to give accolade to the receptionist. I came in to pick up the ipad, so i didnt sign in, but she was right on it. Can i help you . She went looking for the right person. And i was not dressed i was dressed in street clothes. I didnt look like i was really important, although i think she did ultimately recognize me. But she was very personable and i think that really makes a big difference, because the visit starts as soon as you get off the elevator. And that really makes a big difference. I think it does, too. And we have lots of other times, other than october, there are times we have a lot of retirements or sometimes there is new hires, a lot of new hires at once for the larger departments, so its good to have the reception there and facetoface contact. It really does help a lot. So, mitchell, its amazing you went out to the airport at 10 00 at night. Are there other strategies for the 247 operations for other locations . This was our first one. Going outside of our typical Business Hours. With the exception of School District, we do go there until 8 00 at night, because a lot of the teachers are at many different schools throughout the city, and were at a spot with the School District benefits team, so we stay until 8 00. Right now for the 247 we dont have any. We tried this. And like i said it was very successful. And we got a lot of positive feedback from the airport administration. So we do want to look and do that more often. Because it showed me, marina and i there just there for two hours, and talking to 200 people, it showed the need, they definitely need Member Engagement. President breslin thank you. Any Public Comment on this item . Seeing none. Well move onto item number 11. Item 11, Market Assessment part 2. Sfhss Member Engagement presence. This will be done by both are you presenting by both heather imboden, principal communities in collaboration as well as shah nay hawkins. Id like to focus this on the Board Meeting that delivered indepth content of the rapidly evolving market place. That covered the impact of industry activities at a national and local level, defined the Major Players and opportunities in Todays Health Care ecosystem. Outlined a spectrum of health care design, explored factors driving health plan Market Assessments today and models for the San Francisco Health Service system. The opportunity to hear directly from members allowed them to give voice to their Health Benefit experiences. This process was an additional step in informing the health care Market Assessment. Following that in july, we announced plans with support from communities in collaboration, specializing in inclusive strategic planning, research and evaluation. We shared a comprehensive outreach plan with the Health Service board targeting diverse members, and adult dependents who could speak to Health Care Priorities for our member groups. They coordinated nine focus groups in San Francisco, san matteo, alameda, including the San Francisco police department, the San Francisco international airport, the public libraries, office of transgender initiatives, oakland public library, moccasin folks and the Health Service and at the Wellness Center here at the Health Services. At the end, we at the end of the day we had 117 individuals participate in the focal groups, representing 34 of the unique departments across the city. With that, id like to turn the mic over to heather and shenay to talk about the presentation of the core findings from this endeavor. Thank you. Thank you. Hi, commissioners, its nice to be here with you today. Im heather imboden, im with communities in collaboration. Were an oakland based consultant. We also do program evaluation. Im here with my colleague, shenay hawkins who also supported this project. Im going to breeze through the beginning of this presentation because abbie so thoroughly covered a lot of the introduction, so were going to talk to you about the work we did. Were going to focus on what we heard from members who participated in this process, both through the focus groups and also through an Online Survey that was made available for members who are not able to join us. And then well talk about the implications for hss and some of the things that hss is already doing to address the needs that were heard. So abbie covered the purpose of the engagement. Ill recap. It was to hear the experiences of members and understand their priorities, but also to test those Health Care Models presented to the commission earlier in the year. And understand what the questions and ideas that members had about those models might be. We targeted active members and retirees who are not yet eligible for medicare, primarily because those models were focused on nonretiree, nonmedicare backing up on members who are active and who are not yet eligible for medicare. Medicare eligible members have a different set of plans as you know. So we did not folk our efforts on those members, but we did have a number of medicare eligible retirees who participated and their input was certainly taken into account. As i mentioned, abbie went over the process, so i wont go into that here. We did hear from a great group of people. We wanted to hear from a really Diverse Group of members and so as we were receiving our demographic surveys from participants, we kept an eye on that throughout the process to make sure that we were hearing from different departments, different locations, people with different enrolled in different plans and other demographic factors. So we did additional outreach throughout the process to make sure we were really hearing from the broad diversity of members. So the meat of it. I want to talk to you about what we heard from the participants. And this is reflective of their personal experiences with their Health Benefits. So we tried to put this from their perspective as much as we could. I want to say at the outset that we asked a lot of questions about a lot of different kinds of care. And most participants were quite positive about their experiences. So im going to talk about some of the things we heard lots of good things about and then ill go into areas where we heard consistent messages about room for improvement. As far as primary care choice and access were really key for our members, as well as being able to stay with a provider that they trusted. One participant told us i would walk through fire for my primary care provider. That is a particularly emphatic statement, but when someone is happy with their provider theyre very happy. Access to specialists. Members really appreciated being able to get to a specialist quickly. And being having access to high quality specialists. Being able to be referred out of network when that was called for was also appreciated and making sure there was good communication between specialist and primary care providers. We asked about urgent care. And there were many members who felt very positive about urgent care because it was more accessible to them and they felt that the quality was very high. So that convenience of being able to access urgent care outside of regular Business Hours was really valuable to members and they felt like they were getting good care when using those services. We also heard a lot of positive feedback about apps and digital records, which are being used more and more by members. Again, there was the convenience factor that was very important to members. And knowing that their providers could see their records as well was very appreciated. One member said you can make appointments, email your doctor, lots of things through the app, its very easy. Going to skip and talk to medicine, because we heard something similar about telemedicine for members who appreciated not having to leaf the comfort of their office or home to access care. Sometimes it was easier to get an appointment over phone or video. And they felt that quality of care was there for those services, so that is something we heard theyre looking forward to using more in the future. And then dental care, again, really appreciating the ability to stay with a provider over the longterm. And trusting their providers and having friendly relationships with those providers was very much appreciated. One member actually told us they liked their providers because the provider laughed at their jokes. Its the little things, right . So there were three areas where we consistently heard messages of room for improvement. Where members felt like there was opportunity and needs that werent being met. One of them was in Mental Health and behavioral health. We already spoke about that a little bit earlier today. They felt that they had a very hard time finding providers who were covered within their networks. Even if they had a list of providers who were technically within network, they might not be able to find one who is actually accepting patients at that time. They wanted more robust coverage particularly for care before its an emergency. We heard from members who had crisis, Mental Health crisis within their families, they had good coverage and care when the crisis happened, but they felt if there were more robust coverage leading up to the crisis, the crisis might have been averted. We also heard that some members had trouble finding providers that met their needs as far as being a match and understanding their background. And the more diverse providers, so that was another area members were seeking more support. Another area where members were seeking more support was in wellness services. And they talked about that as far as fitness, as far as Nutrition Counseling and weight loss support and being able to access those things in some cases just being aware of the benefits that were available to them, they didnt realize were available to them. And if they were available, being able to access them outside of regular 9 00 to 5 00 working hours. We heard from some people with nontraditional working schedules who said, there is exercise at my office, but its from noon to one. If im a shift worker, that doesnt work for me. They were looking for more Robust Services outside of those traditional 9 00 to 5 00 hours. Then the last area where we heard pretty consistently a desire for support was in alternative medicine. Primarily chiropractic care and acupuncture. Again, finding providers who specialize in those areas was difficult. For members to find covered providers. And so members often were paying reported paying out of pocket or using their fsa funds to access those services with providers that they felt met their needs. And actually we heard that around Mental Health as well. There were members who had Mental Health care providers that they wanted to stay with and ended up using their own funds or fsa funds to stay with the providers because they were not covered in their networks. And with that, im going to turn it over to shenay who will talk to you about the feedback we received on the models. Good afternoon. As part of the engagement process, we presented five models of potential or possible Health Care Model options are or options that are hypothetical options that members were could potentially look for in the future. The first model during this presentation, members were able to share questions ask and share questions about the models, look at the models in detail to figure out what things were appealing and then also talk amongst themselves. Really to determine what models were appealing, what questions they had and what were priorities as they select future Health Care Benefits. The proposed models, there were five selected. The first one was the current plan offering. I wont go into too much detail about that. The second model that was presented was the plan offering third party navigation and advocacy support. For this model, support is considered to be any Third Party Service provider that is not at h. S. F. That is not the members employer and not the Health Care Provider or insurer that advocates for the members and supports them throughout navigation process of health care. The third proposed plan was a consolidated plan that included kaiser as well as one other Insurance Company. And that one Insurance Company provided will provide both an hmo and ppo. The fourth model that was offered was a system competition model. That model offered kaiser as well as three other fully integrated Health Care Providers and another ppo. The fifth model was the private Exchange Model and this was described to members as the cover california model. So you have a variety of insurance providers that offer multiple and various insurance plans at different price points and Different Services. That is created to offer a little bit of flexibility and choice around offerings, as well as price point for members. One thing that i should note, kaiser was available in each of those proposed models. Ill give you a little bit of feedback from each the models, the model one was the current offerings, i so wont go into detail. Model 2 is the current plan offerings with Third Party Support. When we think about or analyze the data, one of the Key Takeaways we got from the model, was there was mixed feedback around what Third Party Support services were. When they asked question, it was really around trust. Can you trust the Third Party Support provider . What is their level of expertise in the Health Care Profession and medical needs . Are they going to this Third Party Provider held accountable to the same hipaa standards and laws in the medical field. This was about trust and wondering the fidelity of the provider. One of the key questions that came from that was how Third Party Support impact complicate the overall experience of care. So while members were fairly interested in this, they had a lot of questions about trust fidelity and the bureaucracy that might come, or the complication that might come with the Third Party Support providers. Model 3 was the consolidated plans. That provides two options. The Key Takeaways around that was how does having three options for Health Care Benefits impact choice . Is it going to minimize the way that im able to select a provider . Is it going to minimize my selection for doctors . Will i lose different options around that . And similar with coverage. If we only have three health care options, how does that impact the way that i receive coverage . And the last one was around cost. Some people thought that having only three Insurance Options would either drive up costs, because with only three, that limits the competition. And others thought because more people might be under each plan, that could drive down costs. That was a big question around costs and there were varying sides of that. The fourth model is a system competition model. This included kaiser as well as three other fully integrated Health Care Insurance providers as well as another ppo. For those of you who arent clear about what an integrated Health Care System is, it is all of the care provided under unumbrella. Theyre provider, Insurance Company, et cetera. One of the questions was how will integrated systems impact ability to receive coverage outside of network . So by integrated systems having housing all of their services inhouse, how would that impact members in seeing specialists or getting second opinions. That was a big concern. And finally, the private Exchange Model, t this model rad a number of concerns. Some of the biggest questions were around how might the plan options and choices affect equity, quality and accessibility in relation to care. A lot of the insurance providers will provide Different Services at different price points and a lot of members wondered if i select a lower price point for my Health Insurance plan will that mean that im selecting a lower quality of care. So there were a lot of questions around there. There were things that came up around all of them. Third Party Support services were offered in three of the five models. And they wondered if Third Party Support, could that be offered in all of models . And another thing that came up again as i mentioned was the level of quality and accountability that the Third Party Provider would have. As we explore different, or as members explore the different options, everyone is worried about coverage, or a lot of people questioned how their coverage is impacted once they retire as they travel or for members independence who live out of the country and out of the bay area. Im going to talk about the major themes of the asks that members had. We asked them if there were any other services they were looking for when they think of what hss provides to members. And some of these are going to be overlapping with what shenay said about the models. A key theme we heard was around Service Standards and accountability. What can hss do to extend more support for members to make sure that standards are met and make sure that patients are being served particularly around can we make sure that there are Mental Health providers available to us. Can we make sure that if the benefits say they cover alternative medicine, that the providers are there within network . And could we think about the Third Party Support . Because having support in the navigation and advocacy were something members were interested in if they believed it was going to be a high quality benefit they could trust. Members also, a lot of issues around communication. Again, support around the advocacy and problem solving, communicating in general about benefits. I know that hss does a lot of communicating, but there was still a lot of things we heard about from people, where members just werent aware that the service was available to them. So there was they were looking for better communication. And another area where they were looking for communication was around the transition to retirement. Would say in every single focus group we held, this question came up, either from people who are approaching retirement, people who recently retired, questions around what is this going to do to my benefits . How can i plan for this . What are the implications for me and my family . There were many, many questions that people had about that transition. Then the last theme that arose was meeting populationbased needs. I know that abbie mentioned we had some focus groups specific to particular populations we know have specific needs. Some of those are first responders. Some are lgbtq members or members who live outside of the bay area. And there is work to be done to engage those subgroups and really make sure that were meeting the needs of those people. I want to note that there are some things that hss is already doing around those areas. That these acs are actions are under way. One is around the Service Standards and accountability. As h. S. S. Enters the renewal period, this is an opportunity to deepen the conversations. Abbie mentioned they were having conversations about access to providers, particularly Mental Health providers. As far as enhanced communication, there is an open position for a communications director. There is a search going on and when that person is brought on board, it is hoped they can promote hss Advocacy Services that do exist and make sure members are aware of when its appropriate to call hss. We heard mitchell talking about people calling during open enrollment, but one of the things we heard in the focus group, members didnt actually think to call the Health Service system when they had issues that arose. We might hear about challenges in finding providers, but very few of them called hss for the support that could have been provided. And lastly, around meeting populationbased needs, hss is working to develop strategies to monitor and enhance services to meet the needs of these groups and that is actually something that is part of the strategic plan. I want to talk a minute about just how the things we heard and the things that hss have opportunities to take action align with the strategic goals that have been outlined in the strategic plan. One of the things that members asked for was that hss continue to negotiate really hard for affordable comprehensive and high quality care. We heard a lot of appreciation that hss was doing that work and they want to see it continue. Another of your goals is reducing complexity and fragmentation. And one way in which hss can do that is supporting that transition to retirement. And also encouraging improved communication among providers. We heard from some members who felt like there was just a breakdown in the mune indication of their communication of their network and perhaps hss could advocate for better support around that. Engage and support. We heard from members who wanted more variety and more frequent communication around the plan materials. People access different access their information in a lot of different ways, so making sure its available to them early and in a variety of formats was asked for. We heard from a number of members who asked for greater Translation Services and support. For both support for open enrollment, but in other areas as well. There are lots of languages spoken by hss members. And, again, just increasing the awareness of the services that are offered by hss would be beneficial to members. Choice in flexibility. Advocating for improved and expanded access to providers, particularly those Mental Health providers, alternative medicine and the primary care. And as far as whole Person Health and wellbeing, ensuring the Wellness Programs are accessible to all, including shift workers. We also heard a request that maybe hss had a role to play in providing members with checklist of questions they could ask of their providers, or insurers to help them be better prepared for their own advocating. And we heard a lot of positive things about eap services and members were looking to have those continued and expanded. So i just want to go over big picture summary of what we heard, our Key Takeaways. Number one, the work we did, when we do this kind of conversation with community members, sometimes you hear big surprises. That wasnt the case. What we heard really affirmed a lot of things that staff is already aware of, both the positive and the negative, which is really valuable information to have. It raises some really important questions for hss around what are the barriers to prevent members from calling hss when they could . And how can this organization strengthen communications with members about plans and benefits . How can we better support members through the transition to retirement . What are additional ways hss can hold providers and insurers accountable for excellent care . And are there targeted approaches to improving outcomes for populations with specific needs. As i mentioned in many of these challenges are already being addressed in actions taken by the organization right now. With that, were happy to take questions. President breslin any questions . Commissioner follansbee i have a couple of questions. One, its impressive and i like the summary about this enhances a lot of the themes that weve already been discussing and helps us feel tuned into what the members are. Are you happy with the sample size . Was that what was your target . And number two, i was kind of curious about the response to the urgent care issue. Because urgent care has a broad weve been dealing with this to some extent over other issues. They have a broad it has to do with availability, location, shift workers, all sorts of things. And also without integrated care model, which we support some nonintegrated, urgent care has the specter of actually not bringing communication. So im just curious to know if you have enhanced first the question about the numbers and then about the urgent care issues and if you have a sense of what members thought that meant and what they wanted. So the first question, i think we were aiming for more. And i will also say we were happy with the turnout we got. Primarily because the representation was so diverse. We looked at so many different measures for where people worked, where they lived, what their educational background, languages, race, ethnicity, all these factors and plans. And we felt like we were hearing from the spectrum of members. I think we were aiming for more like 200 and in the end we got 117 focus group participants. And then additional close to 50 who provided surveys. So we got close to our number. And as i said, i felt like the representation was good. I also felt that there was a lot of consistency in what we heard which is useful to hear. You know, the things that people were happy with, the things that people were frustrated with, and the questions they had around the models. When you start hearing repeats of the themes again and again, then you know youre hitting a lot of what you want to hit. The question around urgent care. I should mention that there is a report that were finishing that has a lot more detail on all of these aspects, so youll be able to look at that when thats complete. But i would say its interesting that you bring up that point of the connection and coordination between urgent care and other care. Because one thing that people did say was that they liked urgent care particularly when it was available in association with the hospital, so not Free Standing urgent care clinic, but the urgent care aspect of their own network, because then they knew that the information would be communicated and if there was a problem that urgent care couldnt take care of, it could be escalated to an emergency room in their network. That said, there was a lot of appreciation for the Free Standing urgent care clinics. Especially those who cant make it to a doctor during the regular office hours. I would be interested, now that weve had this foray in terms of getting feedback from the director. And weve made a larger decision to defer, going out to the market, how were going to sort of keep this fresh to align with that action. Nice queue up for my Closing Remarks on this. Thank you very much. I didnt even pay him to do it [laughter]. I want to say that the recommendations concludes our findings are in alignment with goals. While there are areas identified as opportunities for improvements, the findings reflect a positive experience interacting with Health Care Providers. These findings are really qualitative in nature and confirm that the benefit design serves members through quality, sustainability and wellbeing, core facets of the mission of hss. And we are staying abreast of the Health Care Market place in an ongoing way. As we begin this renewal process for plan year 2021, we will in parallel continue the ongoing Market Assessment to determine what the right time to advance one of the new models for the health plans and restart the procurement process. So this is kind of a moving train which we, i think, have on reflection have really its been of great value thinking deeply about what it is were trying to accomplish and getting this input from experts and members that is complimentary. So i think that will all inform us. Ive asked my team to help put together what that parallel process would look like to sort of doubleteam an annual renewal process, while we fully prepare for a new procurement process. Just because of the length of time that it will take to do the full procurement process, we will have to do it in parallel. And i believe well be able to do that this year. The market is the market. The sutter decision i think will be very informative. The rollout of the canopy product that you see is going full force. So there are some major shifts occurring in the market. Anthem is making a play in town. So there is quite a bit happening that were tuning into and paying attention that that is the rationale behind why we delayed in this last year. So it seems as though it were the right decision looking back on it. But it is something we have to look at in parallel with our responsibilities to have a solid renewal for the 21 year. I just want to thank the consultants because i think that the report shows number one, understanding of the issues that we are concerned about, and also from the responses that i heard, that the respondents who participated also were willing to respond in depth. And did not respond in a superficial or casual way. Thats something we should thank you and all the respondents who did participate by questionnaire or in person. I want to thank everyone. President breslin any Public Comment on this item . Seeing none. Item number 12. If i may, i would just like to add one thank you to natalie and letisha on the team that led the effort to engage our members. And it is a herculean effort. Its an area of growth that we have and the reason were bringing in a communications director, because we dont have the best way, clearly, yet, to communicate around these types of issues. The open enrollment messages are get through well, but we perhaps can learn from that and continue down that path to more readily engage members on asneeded basis. Item 12. Reports and updates from contracted health plan representatives. Good afternoon, Denise Rodriguez with kaiser permanente. Last time, i stood before you and you had many questions about the transportation benefit were adding january 1. I wanted to come back with more information. We were remiss in not providing an upsooner. So a update sooner than now. So my apologies. What i would do is start with defining the benefit. Commissioner scott asked what are we paying for. I want to explain the exclusions and what caused the exclusion of a particular benefit and what our plan is moving forward. The benefit and i also want to emphasize that the rates that youre charged for the benefit does not include the excluded benefit. Ill walk through that. So the benefit, if we cover up to 24 oneway trips i just woke up with a scratchy throat, so im sorry if im not clear. We cover up to 24 oneway trips, 50 miles per trip per calendar year. Its for nonmedical transportation. There is a few conditions that need to be met. Need to be going to a appointment for a covered benefit in the evidence of coverage of course. They have to use the vendor that we contract with. So pretty basic stuff in terms of that. This cost that a member would pay for the transportation is zero copay. So thats covered at 100 . There are nonmedical transportation exclusions. I think the one that was particularly of interest last time is transportation for members who require a gurney wheelchair van. That is excluded and i want to explain why. Let me emphasize though, if somebody is in the wheelchair and can make it to the curb, then the driver will assist them getting into the vehicle, store the wheelchair and get them out. And getting them in the wheelchair again on the way to the appointment. So when we rolled out and offered the benefit, it was with the idea it wasnt going to be fully implemented, that we were going to roll it out with what we could provide in a short time frame we had. We started discussing the benefit in may and june. Many of you commented, and from i think the audience as well, last time, there are many vendors that pride that service. That provide that service. That is correct. The challenge is we have to go through a regulatory process to contract with them and cms has requirements that we have to meet. And we have to get system changes done to track it internally. And that takes about a year. And so what we try to do to get this to go to market for january, was to look at what is a vendor that were already approved to use. And thats the vendor we use for the medical population. They dont have the same requirements for the gurney, were able to access other services to provide that benefit to the medical population, but because of cms requirements, were not able to that now until we contract with the new vendor. So thats the challenge that were faced with right now. I also want to emphasize that in no way are we trying to exclude anybody. That is certainly not our intention. Our intention was to try to meet the needs of what we heard from the medicare population with San Francisco Health Services system to provide a benefit that would benefit the majority of the population initially. I do also want to say this is the benefit that were only offering to San Francisco effective january 1. So its kind of special in that way were the only one were doing this with because you had so much passion around this. As we continue to fully implement the benefit, we expect to add the benefit going forward. I cant give you a time frame. If its going to happen 2021. But what i am committed to doing is having more check ins with you all. You can decide how frequent that can happen. I need to stay close to mitchell and abbie executive director yant, around how the implementation is going because this is a new benefit. And we want to make sure that any bumps in the road get addressed quickly and effectively and efficiently. So i will stop there and see if you have any questions or comments. Well, thank you for answering my preliminary questions. And from what you said, where you are at the beginning