Transcripts For SFGTV Health 20240704

Good afternoon. I welcome you to the Health Service board. August 10, 2023 meeting. I like you all to please join me in saying the pledge of allegiance to the flag. 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. I guess to make the protocol correct, i call this meeting to order and well now have a roll call. Thank you president scott. Call to order 103 p. M. Roll call, president scott, present. Vice president hao is excused. [roll call] with that, we have quorum. Thank you. Well now move to item number 3. Agenda item 3 is general Public Comment. A opportunity for members of the public to comment on any matter within the board jurisdiction not on the agenda including request that the board place a matter on a future agenda. Well go over the instructions of remote Public Comment and Public Comment in person. Health Service Board welcomes public participation. There will be a opportunity for the general Public Comment to comment on the beginning of the meeting and opportunity to comment on each agenda item. In person Public Comment will be first then virtual Public Comment. In person you are welcome to approach the podium now. Each speaker are allowed 3 minutes to comment unless deemed the time limit is different in the meeting. The caller may ask questions but no obligation to answer or engage in dialogue. The Health Service board will hear up to 30 minutes of remote Public Comment total for each item. Remote Public Comment from those who received accommodation with a disability will not count towards the 30 minute limit. Members of the public attending via phone, dial 4156550001. When prompted enter access code 26618811477,. You will be prompted to enter the pasdsward, 1145 and press. Star 3 to be added to the queue and you will hear the prompt to raise your hand to ask a question. Please wait till the host calls on you. When your system shows the line is unmuted this is your time to speak. You will be muted when your time is expired. For those watching the meeting on webex click on raise hand icon. A raised hand icon will appear next to your name. When you are unmuted request to unmute will appear on the screen. Please select unmute to speak. Once you hear me say welcome caller, you can begin speaking. When your time is expired you will be muted. Please click on the raise hand icon to lower your hand. Members of the public are encouraged to state their name clearly but can remain anonymous. When your three minutes end said i they think for your call and placed on mute. Thank you to sfgovtv and are media service. We will begin with in person Public Comment. Again, this item is for Public Comment on items that are not a part of todays agenda. So, it is anything that this board has jurisdiction over that is not on todays agenda. That is what this general Public Comment is inviting. Number of people are in the audience and i think i know the topic that draws you here. Welcome your presence, but well get to that during the directors report. I want to make a motion to reconsider an item that i voted yes on may 25, 2023. Item number 6 and i agendize this for september 14, 2023. After many contact from members stating that this is not affordable for early retirees and they will not be able to pay this and other comments from people, i have decided it would not be an item a fiduciary duty to have voted for this. Thank you for that comment. I think i need a second. Alright. Is there a second . Second. It has been properly moved and seconded that a motion for reconsideration has been made for a item on a prior agenda, may 25. May 25 . Right. Alright. Is there board comment on this reconsideration motion . I just want to be clear. I assume this was a benefit issued . Right. It was. Passed by the board of supervisors . So, im not quite clear what the impact will be on something we already voted through has gone through committees. Probably not but i want to be on the record as not voting for that. Okay. Our regular counsel is not here. Do you have guidance on this . Reconsideration mike is looking. Im not sure what the effect of that would be if it has already gone through the mayor, because it seems like we wouldnt go back through the whole process. You couldnt undo it, so there wouldnt be in terms of the process a legal effect to doing this. Just goes on the record, it doesnt change the mayors vote. But you putthe thing im concerned about, you put it in the form of a motion, and that is now requiring this board, members present to vote on it, so if it passes, all of us support this motion, it could be more then just changing your vote or not. If we all voted for it. So, it could have a legal effect beyond just you wanting to change thats not what im asking for. Im just asking to change my vote. But you put it in a form of a motion today for us to take action. Right. Is that what you want to do or do you want to just make a Public Statement withdraw the motion making a Public Statement you would have voted no on i made the statements that i thipg that was a error on my part. Point of order, are you just asking for the minutes to be corrected . No. Shes asking for a motion from us today towhat your motion said to me is you wanted us to reconsider your vote my vote. Your vote, and that means that we have to take action as a full board in the way you proposed it. If your intent is just to put on the record that during that meeting you would have voted differently you wouldnt be calling for us to act on a motion at this point. Thats all im saying. What does the City Attorney say . I think i have concerns aboutmy understanding of the motion it can would be to actually reopen and do another vote, but because this is already gone through the process and the board of supervisors has approved it, we really cant go back in time and undo that action. I think the better course, if you want to make a Public Statement, but that attempting to put this back on the agenda when it has already gone through the process, i dont see how that is a proper thing to do. The motion itselfthe motion you are making is out of order. If you want to make a statement saying that you would have voted differently during the may 25 meeting and your vote would have been no i have made that statement. No, you put it in a form of the motion and asked for a second, and im saying im ruling the motion out of order. If you want to make a statement without a motion want me to repeat the statement . Yes, would you please . Okay. On may 25, 2023 item number 6 i want to state that i did noterror i voted for that and i rescind my vote, which i dont know i can do that at this time. Seeing that it is probably going to make this unaffordable for some early retirees, and they will not be able to pay this as a fiduciary i think this is something that i should at least express and the members that also did not have a chance to express their concerns about this at the time. There were very few members here as i recall. Youre talking about 19,000 per year for a early retiree and two dependents, which in my opinion is unaffordable for a lot of people. A lot of these people do not make 6 figures like people here, you know . They are making maybe 60 ,000 a year. It is unaffordable. Alright. I thank you for your comment. It is so noted in this meetingswill be noted for this meetings minutes. Are there any other Public Comments on this item . Just as reminder we are under general Public Comment. Yes. So, we can call for in person Public Comment. I would ask you to raise the microphone and look like you are eating it. [laughter] there you go. Not exactly my cup of something i want to eat. I know, but Alfred Sanchez, protect our benefits. I applaud the reconsideration. I applaud claire wanting to be on that board and i got a lot of feedback on this particular thing, especially from early retirees. They were never aware that it was going to be anything as tough as this. Like you say, some of them they are not police and fire. 75 of city retirees are miscellaneous workers. Some of them pensions, 30, 40 thousand. This is a choice about their lifestyle whether they can pay their utility bill or hey, i have to have the heat on in my house, but maybe ill have to roll the dice and not have healthcare anymore. I really appreciate the courage, especially from the elected bodies. Theyre fiduciary. I know it was a tough thing but appreciate the reconsideration. That thank you. Thank you for your comment. Other general comment on this item . Seeing none, i move to virtual Public Comment. And we have one caller on the phoneline. One caller has raised their hand. Ill indicate where there are no more callers in the queue and will hear a brief silence as we transition between callers. And with a update we have three callers on the phone line. I will unmute our first caller. Welcome caller. Good afternoon. This is sharon johnson. Welcome caller, you can proceed. Thank you. I was calling regarding the itemi dont know if it is a item before you or this is general Public Comment. I dont have an agenda in front of me. This is Public Comment. Regarding the resolution between uhc and indiscernible caller, thank you. The item you will be speaking to is agenda item number 7, so if you stay on the line when that item is called you will be able to speak under Public Comment for that item. Item 7 is the directors report, just to be clear. Thank you. We have two more callers on the line. Zero callers raised their hand at this time. With that, Public Comment is closed. Thank you. Well now go to item 4. Item 4 is approval with possible modifications of the minutes meeting set forth below, may 25 Health Service Board Special Meeting minutes and june 8, Health Service board regular meeting minutes. Alright. Willing to entertain a motion to adopt the minutes of the may 25, 2023 Health Service board meeting. Special meeting and the june 8, 2023 Health Service board regular meeting. I move approval of the may 25, 2023 Health Service Board Special Meeting minutes and the june 8, 2023 Health Service board regular meeting minutes. Thank you. Is there a second . Second. Been properly moved and seconded that the minutes of the meetings cited on the agenda be approved. Mr. Chair. Is there board comment or question . I have a question. Given the comment that commissioner breslin offered in with regard to her vote on may 25 special board meeting, is there an amendment to be made to these minutes to reflect that, or are we Going Forward with the minutes as stated . As presented. Based on our prior discussion, i think we have to go on the minutes as stated. Based on the fact that we took the action, she voted for it and today she make a Public Comment that after further consideration, which means as of today, she would have voted differently and thats been noted in the general Public Comment. To say that that wasnt the action taken on the 25 of may meeting would be inaccurate. Thank you for the clarification. Appreciate it. Mr. President , if i may ask just formay be more technical, but would it be proper to attach the comment commissioner breslin made to this action item opposed to general Public Comment . With her permission, i wouldsuggest that is where it would be. It be made as a footnote to the action on the minutes. It wasnti didnt bring it up at that meeting. No, but you brought it up today and we are considering the minutes from that meeting, so would you mind putting it close to the actual minutes, or do you want to leave it for Public Comment . Not sure if that is proper indiscernible i think from my perspective i think in terms of ease of access for reference, under the commissioners discussion of the approval of the minutes that that comment would be appropriately listed there and the Public Comment be moved to the Public Comment on the minutes as well so people if they wanted to look at outcome of that meeting would look at the final approval with the comments incorporated into the discussion today, but i think it makes sense for ease of access so that you could refer back and other people could refer back to your position. Put it in number 4 today . Yeah, as a commentwe cant changeyou cant change the minutes, but in terms of the comment you can comment that today you would not wishthe comment you made. If that would be okay withyeah. Alright. Okay, so the general comment made by commissioner breslin would be noted with the general Public Comment on the minutes relative to may 25. That she would have voted, no. Alright . The Public Comment that was made in response to her [multiple speakers] i have been indiscernible i would have said please hold that until we get to the minutes, but i didnt know what you were going to say. Alright. I think im clear and i hope that the secretary most importantly is clear and we are on the record. Any other board comment relative to the minutes approval . If not, well have Public Comment on the minutes. Thank you president scott. General Public Comment is open or Public Comment is open. Instructions are displayed on the screen those watching. In person will be first then remote Public Comment. Those callers on the line press star 3 to be added to the queue. Those watching the meeting on webex, click on raise hand icon. Well begin with in person Public Comment. No one approached the podium, so move to the virtual Public Comment. Once again, Alfred Sanchez, protect our benefits. I think im addressing the minutes from the may 25. What im saying is, this is not a futile action. Im sure the board of supervisors as well as the mayor will understand what dialogue took place here, so it will be effective that people are getting very upset about the rate increases, so thats the purpose of what you are doing here today. It will get out. Thank you. Thank you for your comment. Is there any other Public Comment regarding the approval of the minutes for these two meetings . From the virtual Public Comment, there are three callers on the line with zero callers have raised their hand for this item. We can wait 5 more seconds for anyone to raise their hand or join Public Comment. There is still zero callers raising their hand. With that, Public Comment is closed. Alright. Well have roll call vote. [roll call] the motion carriesue unanimously. Well move to item 5. Item 5 is president s report. This is discussion item and will be presented by president scott. I have no report. Well move to item number 6. Thank you president scott. Item 6 is the board president assigns Committee Members to the finance and Budget Committee and the Governance Committee for fiscal year 20232024. This is an action item and will be presented by president scott. It is in accordance with the terms of governance for this board and the secretary will pull up the recommendation for the Standing Committee assignments. We have two Standing Committees of this board. There is a Governance Committee, and a finance and Budget Committee. Im recommending that the Board Members that will be presented on the slide be assigned to these committees with these members serving as chairs. That is the motion. Is there a second . Ill second the motion. It has been properly moved and seconded that the Standing Committee assignment s for the Health Service board 20232024 be accepted as presented. Is there any discussion by members of the board . Hearing none, well now have Public Comment. Thank you president scott. Public comment is open. Instructions are displayed on the screen those watching. In person Public Comment will be first then remote Public Comment. For those callers on the line, press star 3 to be added to the queue. For those watching the meeting on webex, click on raise hand icon to be placed thin queue. Well begin with in person Public Comment. No one approached the podium so move to virtual Public Comment. There are three callers on the phone line. Zero callers have raised their hand at this time. Well give a 5 second pause to see if anyone wants to raise their hand. We have zero callers raising their hands. With that, Public Comment is now closed. This Public Comment closed we will now have a roll call vote on this item. Roll call vote [roll call] motion carries unanimously and now move to item 7. Item 7 is directors report. This is discussion item and will be presented by abbie jant, sfhss executive director. Good afternoon commissioners. I wanted to start my directors report by acknowledging four new members of Member Services that are present today. We are nearing our full complement of staff in Member Services. I introduce to you if you would stand please, jason hammock. Please remain standing so all robert are identify. Ray indiscernible and berry indiscernible welcome. We like to say on behalf of the board, welcome you to your new assignments as Staff Members of the Health Service system, and we are very glad you decided to spend this portion of your career in service of our members, so again, welcome to each of you and we look forward to having you come back on just to observe us during the course of your career here. Thank you. Thank you for coming. Just to stay on the operations theme of my directors report until i get into policy issues that are important today, i did want to recognize that the Member Services has worked very diligently during this last year with all the staffing shortages to accommodate or to meet the demands of our member s, and it has been a struggle. I really want tohats off to ray and olga for leading the team and all the efforts it take tuesday bring people into the environment. We are seeing the results and calls handled in a much more manageable timeframe so this team will really complement that and so we are just thrilled to be here. I think well ramp up and put a lot of focus on the training that needs to take place to prepare for open enrollment that is well underway. It does take a village, it just Member Services. The enterprise system and Analytics Team does a lot of work to support the open enrollment and get all these rates loaded into the system. There is over 9,000 at the end of the day, so it is a heavily reliant on the enterprise systems Analytics Team. The contracts team too has continued to do a outstanding job on keeping us very current with the very many many many contracts that we have. What comes before the board of course are the major Health Related plans, beutthere is a lot of administrative support plans, not the least of which you approved most recently aon contract. The wellbeing Team Continues to work really diligently to address Mental Health needs through their eap program that is also has a external contract that is really helpful to us. It is very difficult to hire and recruit Mental Health workers simply because there are not enough. We are very fortunate to have a external resource that is quite good to work with throughout the pandemic and continues to support our membership. So thats it the operations end of the directors report. I wanted to just go back and highlight some of the things that were written into the report. As acknowledged the rates and benefits package was approved by the board of supervisors so can celebrate a complete cycle. The healthcare affordability board ill continue to report on is the state entity that has an Advisory Committee that im a part of. They have a very very very aggressive timeline to identify targets for spending. In 25 because the year those targets will be measured and penalties associated with will be in play is 2026, but thatyou wont see the results of that until 27 and 28. I cant believe im talking about 2028 right now, but thats the timeline and even though it seems it is far away in cycle time, it is not far at all, so there is a lot of cutting edge work that is being done as we speak. We are presenting one of our board education topics today, out lined in the report are others that are scheduled to become before you. We dothere is also a presentation shortly that michael will do that talks about, this is the time of year when we need to consider whether or not we will do any competitive bids for any of our contracts, so that we can adjust our workload accordingly so well talk in more detail about that later today. There also is the announcement the University California San Francisco at their most recent uc regents meeting approved the acquisition of the general care acute care assets of saint mary medical and Saint Francis Memorial Hospital so that was big news under the merger and acquisition category. John muir health will acquire San Ramon Regional Medical Center and that transaction is also underway so consolidations is happening right here. Thei will talk about the ucsf, uhc thing in just a second. I just want to make surethe School Districtwe continue to work with the School District on the technical issues that they have. We are far from resolution. We are concerned and we will continue to report on this. I am escalated some of our concerns with them as we speak. Miner comments on dr. Follansbee pointed the last meeting in the aon contract approval, we corrected that or recognized it wasnt necessary. We do have some race Equity Diversity inclusion updates, transjnder History Month is this month and there is quite a bit of activity in the city celebrating that. So, that leaves me to talk a little about the subject many people are here and sure listening on the call. We had been informed that the United Healthcare is working toon their contract with all five university of california medical sentter for their ma product. It is my understanding that the University California San Francisco medical group and United Healthcare have not agreed on a reimbursement rate. It is a little hard to explain, so let me try in that, it is not that theythey havent had a contract. They have been a willing participant in medicare so United Healthcare would pay the standard medicare reimbursement rate for willing out of network provider. Is that right monica . And thats the way it has been for years. This year leadership at ucsf decided they wanted to negotiate a rate and not do this willing out of network practice. I also understand that the other four medical centers have agreed to a rate with united so ucsf stands alone. We as hss cant get in the middle of negotiations, and our relationship is with United Healthcare. However, we are talking to other employers that have this similar problem. The university of california San Francisco itself has this problem. Calpers as this problem. So, there is a lot of interest in this and we would really like to see it gets resolved. Our members are kind of stuck in the middle and one of the bigger challenges is the university various practices and scheduling offices and billing departments because it isnt all unified at this point in time, is not always giving the most accurate and helpful information to our members. There is a lot of inconsistencies, and our members as they learn about this are getting worried will this effect me . United assures us that claims are coming through very steadily and readily, so apparently quite a number of our members are successfully getting treatment and advice at the university and so, we are pushing hard to get both parties to the table to get this resolved because it really puts or members in a difficult position. United has indicated to us that they trained their Customer Service center so when our members call the number on the back of the card which is what we encourage them to do if they have a question or concern about this, that they will get hss specific information that is more accurate then what folks are being told by the university. Accurate to it degree that we know, because we dont know always know what the University Staff is being told to tell our members. We havent figured that out yet. But we are talking about this literally every day in the office and talking to united as well. So, ill pause there and see if there is any questions on this matter or any other matter in the directors report. So questions from Board Members on the directors report . So, ucsf owns sf general, saint marys, Saint Francis acute care. Are all these effected by that decision . Ucsf is a Health System. Does not own s General Hospital rnsh but there is ai dont know how it is working today. There is a contract between the Health Department and ucsf to provide medical care at San Francisco general. I dont know if those folks are considered part of the medical group. They may or may not be, im not sure. And then there is the group that is the medical group that is a lotthat medical group as a entity is then growing and there is many practices that have worked relatively independently over the years, but now they are being standardized with administrative support, et cetera. I cant tell you in this moment where things are at with the medical staff of the two dignity hospitals. That transfer of them to be on the medical staff at ucsf im sure is one of the many items on the todo list with this acquisition. So for people that have appointments and the doctors are seeing them, they just continue with that, right . That has been occurring. Commissioner follansbee. Number one, do we have a date . You said in the report that ucsf medical group has instructed doctors to stop providing medical service. Is there a date to stop providing medical service to new requests . I appreciate the thoroughness of the report from the standpoint, a lot of times positions dont understand what is going on with the billing and they may provide services and the staff may make appointments for months and all a sudden bills start getting sent back and so there may be as you pointed out in your report i think accurately, a lag. I just want to remind everybody, make sure we are on the same page that the medical groups are separate entities then the hospital systems, and so the ucsf hospital system, which has outlying clinics and all that, is different then the medical group itself and the ucsf medical group is different then every other medical group any other uc hospital system. It is quite possible that the positions at ucla, uc davis have through their medical groups have signed contracts and the group at ucsf and not ucsf itself. Medical service so if you referred for a mri scan or ct or some procedure, but there will be athere will often be a professional fee associate would that referral so you may get your scan but the way this reads it is possible you may get a bill from a anesthesiologist or somebody. Several medical centers such as sutter have foundations for physicians so when the health plans sign agreements with hospitals, the foundations get rolled into that, but ucsf, this is medical group not a foundation, so this has to be negotiated separately is the way i understand it rchlt i want to make sure everyone is clear about the complexity of these relationships and dontit is not appropriate to throw a hissy fit in front of the ucsf Administrative Offices because it is the medical group. I dont know where the offices are so i will not comment on that, but that is the way i understand it. It is close. I dont knowlook on the website, they have a vise president of the ucsf Health Network, because their Health Network is both the medical group, but they have a 20 county reach, so there are other hospitals and medical groups that are part of uc family. Legally i dont know exactly how it is all established, but it is consolidating for certain, so thats the that we are approaching it is just trying to get the attention of the networks, the medical groups, contacting team to just let them know we are concerned, so we continue to express our concern. Commissioner canning. After commissioner follansbee question, is there a direct date that they noted where we need to keep a benchmark or highlight to be monitoring . We know that theywhat united told us is that on the 30th of june they elaborated they were prepared, ucsf were prepared to configure the system to turn away new appointments and plan to see existing members through the cycle treatment and few days later united received Employer Group inquiries about canceled appointments so they have done something. It does not look like they have done any broad brush because of the number ofwe had a handful of members contact us and only one or two that contacted united directly that have a particular issue. We have others and i think they are in the audience today as well that are worried that they will have a issue, and we know people are being seen because the claims are coming through. So, we got a little of everything happening. It is very messy and not as cleanto try to make a bad situation better, one way is to have some consistent communication from uc to our members that is helpful, because right now they are advising people to get another insurance plan. It is like people can just do that. Thats not helpful information. We would love and relish the opportunity to work with the university to be sure that if they feel the need to give advice to our members that they at least have accurate advice to give. It is better if they got the advice from the United Healthcare. Commissioner zvanski. I want to clarify because in my brain ucsf is on the hill, but we have moccasin people and you said that there are a number of satellights but the other uc satellights all have contracts as i understand. This is not in any way impacting any of our folks up at moccasin unless [multiple speakers] okay. I just want make sure because sometimes we forget they are up there. There are five uc medical groups or centers in the system. One is uc davis, one at uc sand diego, ucla and uc irvine in addition to the one in San Francisco and the one not contracted with United Healthcare to date is uc San Francisco, so the focus is around that issue. Are there other questions from the board . If not, well now have Public Comment. I just wanted to ask commissioner breslin. Can you speak fl into the microphone . Is the staffing going and how are the phones being answered . I had somebody who was go nothing to the office and tried a phone and couldnt do either one. I reported the operations functions are far better then they used to be or have been for the last year. We are getting close back to our standard meeting goals and stan ards. How about coming into the office . Not yet. indiscernible the staff . Or the member s . Staff. Staff. It is hybrid. Some people come in but not accepting anybody, members to show up there . Not yet. Okay. We need are they answering the phones for the members . Yes. That is important. Right, and it has been a problem for a year and all most gone away. What did you tell me yesterday, one or twoyou are welcome to take the mic and make those comments. Yesterday it made me smile. Yes. Please identify yourself. indiscernible we are happy to report that the issues regarding the phone system are much resolved. This week the majority of calls were answered directly. Over the week we averaged between 10 and 4 voice mails per day, meaning that the call was not answered in a period of minutes, and rolled to voice mail, so we are receiving a very few member of voice mails and very few number of abandoned calls. With the average length of time that the call is abandoned at like 6 minutes, which is much improved from where it used to be. We are on track to successfully answer all member calls within a reasonable period with the addition of the new staff we are just anticipating that that will be very soon. Alright. Thank you. Are there any other comments or questions from Board Members . Maybe you can answer the question. Does our system let members know what the wait time is and give option as many systems are learning to, if you want we can call you back and confirm the number . These programs. Is our system capable of that . Our system updated may last year to the current version. Since that point in time, not only us but all other city departments utilizing the system have experienced some technical challenges related to the system where we have not been able to implement some of those advanced features. We rely instead on voice mail so if a call goes unanswered for a certain number of minutes and we can vary the range between 1020 minutes if the call isnt answered by that time it rolls to voice mail. We have found that that is the most expedient way to handle these issues just because of the fact the length of time calls varies widely so we prefer to set a scheduled point in time where we can return those voice mails at the end of the day. The vast majority of voice mails if one is answered the same day, if not the next day. We used to rely a lot of mandatory overtime on saturday to return many voice mails, but we are not at that point any longer. Thank you. Just say as a consumer in other areas i find these upgraded systems rather useful because to sort of leave a voice mail and say well call you by the end of the day, when iim sure our members have other agenda items as well, may not be as pleasant for them as it is for us, so if there is a way to maybe work with the rest of the city on these upgrades it might be useful to our members and help ameliorate a lot of the anxiety over calling and the complaints. Yes, definitely we can look into more of those advanced system functions. Thank you. Any other questions from the Board Members regarding the directors report . Hearing none, well now have Public Comment. Thank you president scott. For this item wellival in person Public Comment, remote Public Comment and ill read allowed the written Public Comment. In Public Comment isPublic Comment is open. Instructions are displayed on the screen. In person Public Comment will be first then remote Public Comment. For those callers on the line press star 3 to be add td to the queue. For those watching on webex, click on the raise hand icon to be placed in the queue to speak. Well begin with in person Public Comment. As we are going to begin this Public Comment, if you heard a portion of your statement being made by a predecessor, Public Commenter, it would be helpful if you not repeat that. Not trying to restrict anyone or restrict the time, but that you not repeat the same thing that may have been said right before you. Im asking everyone to be attentive to each other as they are making their Public Comments, please. Thank you. You just ripped off half my speech. Alright. Alfred sanchez, protect our benefits. Good afternoon to the board, to the executive director. It is very clear, very very complex, ongoing, wont be decided today. How i became aware of this is director of Firefighter Union 798 who is here today so he can comment on a lot of things i was going to talk about it, he brought it to my attention because his mothers friend, a retired city teacher got a letter from uc and we are still trying to figure out how did urk c decide who got the letters and who didnt get the letters. The letters essentially said what you already talkedthat they were not go toog pay for United Healthcare Medicare Advantage which is a out of network hasnt been in network in over 10 years. What we are really concerned is, these seniors who are by far the most vulnerable group, many on fixed incomes below 30 thousand annually. They simply cant afford to pay for this out of pocket. They paid for their Health Service plan their whole career with the expectation that they would have outstanding healthcare in their golden years. I was happy to see that it is in the directors report because that really brings light to the subject. Clearly more dialogue and education must take place before a decision can be made. I suggest ucsf, the medical group, the unc people, the doctors and patients who are wanting this care can sit down and come to some reasonable accommodation that at the very least a continuous for another year because open enrollment is in october and these people are in a panic and there isnt much competition. Who are they going to go to and when they call up doctors because some are already doing that, im sorry we are not taking any new patients. This is something that is very complex and here in the city of Saint Francis, let compassion prevail and dont throw the seniors out with the bath water. Thank you. Thank you for your comment. Other Public Comment in the room . Please approach the podium. [coughing] good afternoon. My name is germia indiscernible director of local 798 San Francisco firefighters. I like to thank the board and abey yant, we had dialogue regarding this. We hadi was contacted by members who were receiving bills and pretty much as director said, told get a new plan, and i dont want to repeat my brother too much but the group told to get a few plan will have a hard time so i appreciate you guys making this a issue among united and whatever we could do to maybe encourage them to come to an agreement and work something out just for the benefit of our retired members. Greatly appreciated. Thank you for your comment. Other Public Comment . Another firefighter. Good afternoon commissioners. I just want to put on the record seeing now it is important today that the firefighters active and retired both support all the comments that have been said already at this dais, and just a thought, 4 of the 5 ucs have come into contract, that means the issues for us are very glaring and out there and should be directly addressed. Everything else seems to be working fine. Thank you. Name please for the record . For the record, who are you . Dennis krueger. Retired firefighter and spouses. Thank you. I know who he is, but there may be others who dont. Is there other Public Comment in the room . Good afternoon. I dont know how to address everybody im going to ask you to speak up please. Thank you. I dont know how to address everyone. I wasnt planning on speaking. My name is kim lee, a retiree from city college of San Francisco. I want to talk about personal experience and moreover my concern as the gentleman expressed for others who may not be able to handle all the confusion that is going on. First of all, i want to say, as far as trying to find a new primary care physician, which is what i was told to do, i was given a list by uhc of about 10 physicians. One of them i noticed the name was recognizable to me. The reason . She was my daughters pediatrician so 5 of the people on the e list were pediatric doctors that didnt help the Medicare Advantage folks. Another person who was on the list was a gertitian. Wow, they are hard to find. Called them up, he doesnt do that anymore. He hasnt done that for ages. He is now in dermatology. Even though you can call up and try to find somebody new, chances are it is going to be really really difficult. Another thing i wanted to say was, my experience is kind of interesting because the reason i found out about this was because i was called kind of a cold call one i normally wouldnt pick up, but i picked up and the young woman i think her name was jennifer or Something Like that, she said, she was calling from uhc, and she was calling to see if i needed my Wellness Checkup with my primary care physician. She was very friendly and offered to make the call for me to my primary care physician, so she had been so nice i said do you get credit for this . She said yes. I said then go ahead. I can make the call myself, but if you get credit then go ahead. She made the call, found out that my primary care physician was not taking uhc anymore. So, whats the irony ramification uhc rep called, found out uhc is not approving ucsf primary care physicians. Ill leave it a that. I have another anecdote but ill leave it at that as my time is up. Hope that was helpful. Thank you for your comment. Is there other Public Comment in the room . Board secretary, is there Public Comment online . Thank you president scott. Ill be checking. We have five callers on the line, and two callers raised their hand at this time. Please be adviceed there is a 3 second pause as we transition between callers. Ill unmute the first caller. Welcome caller. Hello. This is sharon johnson, retired city and county employee, and i first of all want to say thank you to director yant for doingfor her report and the followup going on between uhc and university of california. I concur with everybody who has spoken about what they know and care about in terms of our seniors that are members of the Health Service system and will support you in any way to continue getting these people to negotiate. As the director said, it takes a village and the village includes as our last speaker as the patient who did not receive the best service she could have received. Lets all join together and do what we can for our members. Thank you. Thank you for your comment. Thank you caller. We have one more caller with raised hand. Ill unmute the caller now. Welcome caller. This is herbert winer. In addition to the email i sent you, i have the following comment. I am a disturbed share holder of United Healthcare stock and receive Health Benefits as well. Uhc assist in the fortune 500 with profits [audio cut out] caller . I think we lost connection. Let me make sure we can get you back. Caller . Herb winer, are you able to hear us . Yeah. Continue. In addition to the email i sent, i have the following comments. United healthcare assist in the fortune 500 with profits of 20 billion 120thousand Million Dollars in profit, and given its revenue of 33 indiscernible i find it difficult indiscernible [audio cutting in and out] the worst victims of indiscernible are the patients. indiscernible excessive demand and backup in appointments. This is indiscernible if retirees have another plan then kaiser who should also beand kaiser is overloaded. But retirees are stuck indiscernible as a share holder and beneficiary of united health, im requested if not demanding indiscernible thank you. Thank you for your comment. Is there other Public Comment on pp line . We have 5 callers on the line, zero callers raised their hand at this time. With that, Public Comment orwell move to written Public Comment. Alright. Public commentwe have a written email that have come to the board during the course of the last few days regarding this topic and the board secretary will summarize those emails at this time. Thank you president scott. One of the emails was by herbert winer who just spoke. Another email is larry busettee, San Francisco veteran Police Officer association who expressed concern over the city county San Francisco ucsf uhc negotiation and urge the board any and all influence for a quick redlution with Medicare Advantage contract. Third email is Timothy Obrien retired firefighters and Spouse Association also urged the board to advocate for fair resolution with problem between the ucsf and uhc. The fourth email was lieu ease indiscernible dcsf retire and shared request for medical service not adhered to. She requested the board use any and all influence to help with the swift resolution for the Medicare Advantage contracts. Five email is linda beck who urged the board to do anything to encourage both parties for resolution as soon as possible. Robert price, city college of San Francisco retiree who urged the board to do anything within their influence to help with resolution contract. Seven email is deborah, city college of San Francisco retiree who urged the board to find a swift resolution for Medicare Advantage contracts. Louise scott, protect our benefits and retired emplyees of San Francisco. Also a convener of the federation of retired Union Members and urged the board to do whatever possible to support equitable resolution between ucsf and uhc. Sharon, retiree who urged the board to do anything within their influence and control upon the ucsf uhc resolution. indiscernible retired instructor who urged the board to do anything within their influence upon the ucsf and uhc resolution of the contracts. The 11 email is from ron indiscernible retired sf firefighter captain who urged the board it a do anything within their influence for quick resolution. With that, there is no more written Public Comment and we can close Public Comment. Alright. Public comment on this item is closed. Im going to claim the privilege of the chair to offer the following motion, i move that the hss board give a strong commendation and support to executive director abbie yant for her initiative and leadership to date in prompting discussion between United Healthcare and the university of california San Francisco Health System. The uchss board directs executive director yant to continue to insist that United Healthcare and university of california San Francisco Health System immediately undertake negotiations by convening meetings, to exchange specific proposals that will lead to working contractual relationship between the parties, which will be a benefit to hss members. Further, the hss board directs executive director yant to work with the ucsf medical group to ascertain that accurate, sensitive and timely information be provided to hss members who are trying to schedule appointments with the ucsf medical group. Second. Been properly moved and seconded that this motion for action be adopted. Comments from the board . This sounds quite appropriate and i just want to again thank director yant for working with other employer gruchs groups in the city as part of these efforts and make sure that this memo supports that intent to band together with other Employer Groups in this effort. Thank you. Any other board comments . Hearing none, well entertain Public Comment on this motion. Thank you president scott. Public comment is now open. Instructions are displayed on the screen for those watching on tv and webex. In person will be first then remote Public Comment. For those on the line press star 3 to be added to the queue. For those watching on webex, click on raised hand icon to be placed in the queue. Alfred sanchez, president of protect our benefits. I applaud the motion. It is appropriate and i want to say, i dont speak for them, but when you hear protect our benefits, we work very closely with retired employee city county of San Francisco, the gray panthers, cara meeting is at the same time as here or they would be here, so we are all together on this. We learn from prop c that united we are far stronger, so it is a lot of people, not just protect our benefits, thank you. Thank you for your comment. Anyone else in the room . Public comment on this motion. indiscernible i want to again kim lee retiree from ccsf. It is a wonderful motion. Thank you for coalescing everything into one statement. My only concern is that people might not know about whats happening unless they call to make an appointment, and so i think it would be good for members to be apprised of what is happening before they happen to you know, make an appointment because ontimes we dont make appointments until we need them, so if the language could be adjusted a bit to not just people who call, but maybe a statement to go out to all the people who are in the ucsf system. I dont know. Thank you. Thank you for your comment. Any other Public Comment in the room . If not, is there Public Comment online . Thank you president scott. Ill be checking our virtual Public Comment. We have 5 callers on the line. Two callers raised their hand and there is a brief pause as we transition between callers. Ill unmute the first caller. Welcome caller. Caller, we can hear you in the room. Ill unmute this person. It may have been a leftover and move to the next caller. All hands have been lowered. We can close Public Comment. Public comment on this motion has been closed. We are now ready for a roll call vote. Roll call vote [roll call] motion carries unanimously. I would ask the director yant take into account in following the intent of this motion that as necessary, we may need to have a communication to our members about this particular issue or those who were seeking services to ucsf at some future point. I like to comment because that is due consideration. We have a draft notice that we would send out to a select audience. Under review at united, our concern is the number of claims coming through and people are receiving services that we will create a indiscernible stress on our members that would be expressed to us through increase in calls and as we are getting ready for open enrollment, so it is a balancing act and we do speak about this every day and so thats why any feedback that any of our members have about the information that they are receiving, good, bad or indifferent, please let us know and we are going to stay on top of this. Hopefully this effort will be shortlived and the contract will get signed and move on to other things. Alright. Thank you for that. Alright. With that, we are now ready to move on to the financials. Item 8. Thank you president scott. Item 8 is sfhss Financial Report as of may 31, 2023. This is discussion item and will be presented by sfhss chief Financial Officer iftikhar hussain. Good afternoon. Good afternoon chief Financial Officer. How are you after a month of not being here . Very well. Thank you. I have to get the slide up. The one Development Since last month indiscernible we are in the middle of our close for the yearend, and as we close that activity is continuing. The financials im presenting are as of may, and the message actually is consistent with prior months. This year you see the claims are higher but increase in claims happen the later half of last calendar plan year. This n ye since january the claims have been very stable. We had large claims last year. We luckily are not seeing those this year yet. The indiscernible is pretty stable. Interest you notice is quite a bit higher then what we saw last year due to high interest rates. The pharmacy rebates also are higher corresponding to higher pharmacy indiscernible working effectively to audit and capture those claims. As far as projection for yearend, we do havewe are stating coming close to budget but we are quite a bit ahead, because of the vacancies we had in our staffing. Are there questions of chief Financial Officer hussain . Hearing none, well now move to Public Comment. Thank you president scott. Public comment is open. Instructions are displayed on the gene screen for those watching on tv and webex. In person is first and remote. Those on the line dial star 3 to be added to the queue. Those on webexclick on the Public Comment icon. Well begin with in person. No one approached the podium so move to virtual Public Comment. We have four callers on the line. Zero callers raised their hand at this time. Well give a 5 second pause for anyone who may want to raise their hand or join the call. There are no callers in the queue at this time. Public comment is now closed. Thank you. At this point, im going to ask that we will go into recess for a period of about 13 minutes. We will reconvene at 2 30. [recess until 2 30 p. M. ] [meeting reconvened] good afternoon again. We are out of recess. I ask the board secretary to call the roll. Thank you president scott. Begin with roll call [roll call] we have quorum. We do have a quorum so proceed with item 9. Thank you president scott. Item 9 is board education healthcare eco system and market overview. This is discussion item andprinted by mike clarke, aon and chief Financial Officer iftikhar hussain. Hi, i like to do interdeckz the Health Service board does a Education Plan every year, so to remind the board that this year the requested education topics were healthcare cost trends, equity data reporting, and data transparency. These education sessions of course are open to the public and members are encouraged to attend, and we will be asking the commissioners to complete a education evaluation after every session within a week when we know it is still fresh. Be looking for that in your email and with that, i will turn it over to mike and iftikhar. Before we begin, it was a veryi would say in some ways painful conclusion to the last benefit cycle, as we had some very difficult decisions to make, and among those decisions were ones that have resulted in some of the discussion that preceded this particular agenda item and opened this meeting today. It is my hope that coming out of these education sessions over the next week that we will use this, not only as a board, but encourage the general public to refer to these presentations and this section of the agenda as we go into the benefit cycle starting in january of next year. Because it is kind of a overview and thats what the board requested, that we jointly educate ourselves about what the mega trends are, what the environment is, what real things can this board do and what things may take some effort by other partners here in the city and county of San Francisco. So, with that, michael, welcome back. You had maunth off. I know you have been rested and thank you for preparing the presentation. Absolutely. Mike clarke aon. Chief Financial Officer hussain and i will copresent on healthcare eco system and market review while relizing the echo system is biological term. You will see a document on the slide that shows how complex and interconnected the Healthcare System is so the referenced system. Well start with background on the board education modules today through december. Just talk about the complexity in the u. S. Healthcare system. That includes slides that chief Financial Officer hussain was able to source from a great report that is referenced, so we have appendix slides and youll see the name of this report in the appendix but we brought up slides in the main presentation hell go through. Well talk about Healthcare System merger and acquisition impacts. Two big ones happening concurrently in the bay area. Well talk about strategic focuses for health renovation. Cfo hussain will walk through some initial consideration factors for indiscernible knowing michael will present more thoroughly later in todays meeting. Outlining views on control versus influence and recap of the modules that we will present to you in september, november and december. As background on page 4, at the Health Service meeting late may early june, request was made to better understand just what our current state developments in healthcare, what is out there forveneder invasion and also conversation how benefit design can support the hss strategic plan. Today as just background on u. S. Healthcare eco system as well as introducing these three education modules in september present on market and Health System invasion, module 2, benefit design and assessment tools in november and then wrapping up in december with future state opportunities. Page 5 just presents a really nice pick torl going deeper into expectations on the agenda. Foster equity, advance primary care, affordable sustainable, supporting Mental Health and wellbeing and optimizing service. So, when you look at the Healthcare System, well talk a lot on the next couple slides about public and private financing. There is roughly 50 50 split in this country between public and private financing, and as Plan Sponsors kind of deal with this very complex system and how that impacts the realty is that Healthcare Providers includes hospital, doctors, other practitioner, pharmacy and labs have to operate within a very very complex Revenue Source and regulatory eco system. Im not going through this chart, but i think it is accurate representation of the environment that these providers have to operate in, and the many many influencers whether government influencers, health plan, employers, private insurance and so forth that operate within what we call a u. S. Healthcare. This slide shows what you suspected. The u. S. Cost of healthcare in the u. S. Is higher then other countries, developing countries, both in terms of cost per capita or pending as well as percentage of gdp. The higher cost is not really correlated to Higher Quality as measured by life expectancy. On the next slide, this slide very busy but it shows the blue line to call your attention to the blue line, which is rate of inflation on healthcare spending, versus the gold line, which is cpi. Since 1969 you can see consistency the healthcare inflation outpaced general inflation and gdp, and so as you see the cpi going up, healthcare cost go up higher then cpi. The very last blue shaded section is when the aca passed and coverage expanded and actually that increase in healthcare cost was quite a bit lower then in prior years, so actually thethey did not increase spending on healthcare more so then others in the past. The next slide on slide 9 you can see spending by age group. Clearly very sharp increase by age and really a function of the intensity of services as people get sick, age higher and get sick. The differences between male and female are muturnty and longevity for women. Im dating myself but i remember clearly before my retirement where the gdp was 7 percent of Gross National product. And now healthcare is 18 percent of our Gross Domestic Product and climbing. So, with that background, i mentioned earlier roughly 50 50. It is 46 of u. S. Healthcare respond in 2021, the last measured year or 1. 65 trillion came through Medicare Medicaid and public insurance programs. Just as refresher, medicare covers those age 65 plus as well as qualified disabled americans and those qualifying with end stage renal disease, medicaid primarily low income americans and Children Health program. To note to this percentage has been increasing over the course of time, so if you go back and look at where the percentage was 20s years ago, 20 years prior in 2001, it was 29 percent. 2011, 43 percent and now 46 percent. The pressure this puts on Employer Sponsored Healthcare is with providers being paid more and more of their revenue from government sources, which tend to be lower reimbursement wants. It just puts that much more pressure on the prices charged through private insurance, Employer Sponsored Healthcare. You can see what is really causing a lot of this rise. The Government Programs obviously, the federal money directed to programs like medicare and medicaid who dictate reimbursement guidelines to hospitals and doctors. For providers to balance their revenue needs higher prices need to go to other forms and other patients to recoup the short fall on what they receive from the government. Page 11 just noting key stakeholder positions and what really is overall 4 trillion system. Obviously the Health Systems like we talked about ucsf today who remain financially Strong Enough to survive to continue to drive their growth. Some happening organicly but a lot through merger and acquisition as well, about we know the labor pressures, decel systems are experiencing. We talked about that in the rate and benefit cycle. To the lower selfhealth Plan Administrators and insurers, so blue shield, kaiser, United Healthcare et cetera press to deliver optimal cost control via provider discounts and fee while advancing member advocacy and Health Improvement platforms so there is a lot to do competing in a ever expanding new Solution Market place where we are seeing a lot of it funded by what you see at the upper right, private equity firms and large retailers like amazon and walmart. Getting more and more into the healthcare space. Why . Because it is 1 out of every 5 we spend in this country. They see substantial revenue potential with digital that improve access to healthcare with goals improving individual health. Government programs and continue to be a foundational part of how healthcare is delivered in this country, but they need to continue to act to limit growth in Public Program funding so just recent examplesmedicare process. You read a lot about that in the news. I talked at length in june about the cms funding changes for Medicare Advantage plans so those are two recent examples. It creates pressure back to the Health Systems from the government sources that continue to result in higher and higher prices from Employer Sponsored Health plans. Can i make one comment on the slide . Maybe my cynical side, but the last phrase under private equity firms improvaling individual health. You actually said the goal was and i think thats their promise, but this is a revenue decision, and so i think what we as consumers in allpromise of better healthcare, but i think im not quite sure if you have evidence that this is improved individual healthcare. If not, i might amend that statement tounless you can show me proof about improvement healthcare with all these movements. I am suspicious. Your skepticism is well founded. I agree. One thing that we try to do, in my organization and other organizations in Health Consulting is trying to understand the value, the evidence of success that these organizations are delivering when they promise better management of mus a lot of new players we see come out in the Mental Health space. Trying to respond to market place needs. There is no question in the private equity environment, the goal of these organizations, the ultimate goal is to try to drive revenue for the investors, but doing so in a way that is trying to promote a idea, promote a concept that can hopefully improve Member Health, hopefully lower trnd lines for employers but i saw a lot is largely improvement at this point. Organizations like us are trying to understand company by company what seems to be working out there. From a Merger Acquisition standpoint, we decide a couple studies on this page that were recently performed. One in 2020 by the Kaiser Family foundation observing just the higher cost elements that result from integration, including one observation in california about highly concentrated hospital markets. Found increase in the share of physicians and practices owned by hospital came with 12 percent increase in premiums for private plans sold in california market place. May 2022, a study showing vertical integration between physicians and large Health Systems lead to substantial increases in primary care and splshest prices and we have the refances at the bottom of the page so if you wanted to see the source articles, those are on the bottom of these pages. Then of course the latest bay area news, ucsf talks to acquire saint mary medical and Saint Francis hospital and executive director yant mentioned the john muir san ramon medical center. Focuses for health vendor invasion for us at hss is primarily hmo Network Strategy trying to partner with Optimal Health plans. There is the ppo plan available to members who prefer a more open provider access model and to provide coverage for those who live outside hmo plan areas. For active employees and early retirees that is non medicare ppo plan and medicare retirees that is United Healthcare and ppo plan. Hmo plan choice was expanded for active employees and early retirees coming along blue shield and kaiser hmo and medicare retirees have uhc nationally but also uc kaiser in certain regions. Noting that these plans do have the highest star rating possible from the federal government at 5 stars which is medicare measure of quality and performance. Strategic focuses plan invasion comes from advancement of primary Care Initiatives as well as advancement in advocacy models and you see the examples here hss is continually working with the Largest Health plans with kaiser a lot of discussions about Workforce Health and wellbeing resources, how to bring more awareness to those and are engagement in those, as well as review of Health Outcome data. Kaiser does consistently deliver high quality results. Blue shield hmo, frequent meetings with the two primary medical groups in the aco model brown and toland. indiscernible advance primary care focuses and then with United Healthcare quarterly meetings to review program engagement, indiscernible utilization certainly the goal is to continue to advance awareness and engagement for members to use the right services and programs with the right time. Talk more about the [multiple speakers] i apologize for interrupting because i know we are talking about uhc and ucsf and a lot of what we are dealing with here. Does blue shield have a contract with ucsf . Im assuming and may be wrong, with exception of kaiser most of the other groups like blue shield would have contracts with ucsf medical groups. Active employees and retirees have access to ucsf through those plans. Okay. So, our deal unique with uhc . And Medicare Advantage plans specifically. Thank you for the clarification. I appreciate that mike. Sorry. Just to clarify uhc split family, which is ppo for early retirees that is not effected by this right because they are not Medicare Advantage. It is gradually sinking in. Thank you very much. The rfp discussion, every yearengage with health plans and work with them to improve care, improve affordability, access and every 3 to 5 years we actually open up our process to look at other health plans or other people who may be able to serve our members. So, our goal in going through the rfp process is to look for lower cost, improving affordability and to look at high quality as well as to improve access. All are indiscernible in california where if you can improve access to those providers by broadening our network, that would be a goal of an rfp process. For Medicare Advantage, our goal also is toone thing we look for is network of reliability. We will be looking at partners who can assure us that the disruption to the network is minimal while providing good care. For the dental plans, again, the same theme of access and cost and quality is what we would look for. Next slide. So, this chart on this page describes what the board has direct control over and what it can influence. Direct control on annual basis we look at the Health Plan Design and the rates, and then on a infrequent as needed basis we look to develop new policies, update our policies and rfp process as needed. On the influence side, it really is things around having making sure our members are aware of the services that we offer, as well as impacting policy and educating our members on the effects of the policies longterm. I wouldim going to take a indiscernible commissioner follansbee book in terms of the title for this particular slide in terms of control versus influence and then you defined control via our authority to approve, and the first one of these is total healthcare cost rates. Yes, we can approve or disapprove the rates after extensive negotiations, but in terms of controlling what is provided to us from the health plans in terms of those rates,b that is a back i forth that may or may not result in lower premiums, and i think that many times as we sit in these meetings, it is assumed that we have absolute control over the final outcome of the negotiation in terms of premium rates, and we clearly do not. We can get into very aggressive negotiations with our health plan partners. We can look at rfp as a way to try to impact total cost, but in the moment any given year we dont absolutely have all of the control. It is just about our authority to approve and a lot of the out of sight activity is really done between our actuarial and the h is hss staff. That is what we charge them to do. Be thorough in the analysis and negotiation with the health plans. Thats just a clarifying point on this particular slide and it one i think we need to be reminded of as we go forward. Commissioneri would add that instead of the term approve, in my mind it is accept. [laughter] because what finally comes before us, yes we approve as a board because thats our authority, but we are actually accepting what has been presented to us and because we cant say we are not go ing to prove it, go back to the draw ing board. That rarely happens, so i dont want to change any documents, but just understanding the realty of what i see us having to do here. It is really accepting what is presented. May was a good example. Yes. Approved it and it may be unaffordable for a lot of people. Yeah. Who is on our negotiating team . [laughter] so, it is abbie the executive director leads our negotiation on behalf of this board. She is charged with that. There is a team. Our team is here, ray, iftikhar, mike, myself and others as needed. Michael of course. Our contract manager to make sure we are doing everything legal. The executive director, the chief operating officer, the chief Financial Officer, and the manager of contracting, or is it director of contracting . Not sure the title, but manager or director of contracting are the staff that we as a system have charged to work on our behalf day in and day out around this particular issue, and our chief acuary is responsible for looking at claims data, healthcare trends, contracting issues somewhere make comparisons external as well as internal to what hes seeing and recommending in terms of trends regarding how plans are operating. Thats kind of where we are, and in my experience in this field for over 40 years those dynamics have not changed. It is matter of trying to get the partners in constant conversation as was alluded to in a prior slide so that you can anticipate where some of these things are going. In order to negotiate you have to have good negotiating team, but you also have to have a alternative to say we are done with you. That is what we really need. And that would be great in the abstract. That is probably true, but in realty we all know that to make a health plan change is a major major undertaking, and not only because of the contracting, but also the impact upon our members. It is not undertaken lightly, but has to be done with some large anticipated forethought on our part whenever that would come to pass. Not prolonging too long. Over my term on this board i would say that hss has made tremendous progress in our ability to understand through our all claims data base and lots of efforts going on hss, so we had opportunities to review and approve one or twoone of two options for plan features in terms of copays and all that for new proposals for plans and we are asking for accountability for some of those decisions we made in the past. What polk the impact . We have been promised we get accountability for some of these design features as well. I dont want to underplay the power the board has in reviewing this and the partnership with hss, which i think is only in my tenure is only improved in terms of our ability to actually influence andnot only influence but control some of these issues. This is complicated. No doubt about it. Thank you. This wraps up our presentation. Just restatement on page 17 of the modules coming up in september, november and december and wont go through the appendix slide, but good information to review. We had a lot of discussion. Are there other questions or comments from the board regarding this overview presentation . If i can make one comment. You alluded to the Kaiser Family foundation, and all Board Members have access to all of their ongoing Educational Programs and i have been taking part in some of them. I just listened to one on the issue of the new obesity drugs. It is very enlightening and they tape these and available to all of us and it seems like a microcosm, but in fact, the microcosms add up to our ability to control influence and control healthcare cost. I really urge as Board Members and others with access to kff because they do a very broad and deep dive if into issues on big basis and individual basis and havent indiscernible they are due to come in the next year or 2 or 3 or 4. They do daily email alerts, anybody can go to the public website and sign up for alerts, articles come out periodically. It is a incredible resource. Thank you. We will now move to Public Comment on this item. Thank you president scott. Public comment is open. Instructions are displayed on the screen for those watching on sfgovtv and webex. In person will be first and then remote. For those callers on the line, press star 3 to be added to the queue. Those watching the meeting on webex, click on the raised hand icon to speak. Well begin with in person Public Comment. No one approached the podium. Well move to remote Public Comment. We have 4 callers on the line. Zero callers have raised their hand for the Public Comment queue at this time. Give a brief pause for anyone who may want to raise their hand for Public Comment. There are no callers at this time. Hearing no callers, Public Comment is now closed. Thank you. Well move to item 10. Item 10, board education healthcare transition fraump active employment to early retiree status. This is discussion item and will be presented by mike clarke with aon. Mike clarke, aon. Going to talk today about the implications when an individual is transition from active employment to early retiree status on their Health Plan Benefits and member contributions. Just summarizing the start, this outlines those transitions in Health Plan Contributions as well as plan s in some case. On the left side of the page there isthis is the summary page of the presentation so a lot of good information behind it, but if there was one page to reference what stayed the same, deductible copays coinsurancethose remain the same transitioning into early retirement. And member contributions to purchase the vision plan. What changes and what are the focuses that are someone transitioning early retirement . First the member contributions for the medical drug and basic vision as well as dental coverages. Dental plan deductibles. Coinsurance and annual maximums, and then also just recognition that the employer provided Life Insurance, accidented death and longterm disability do end upon active employment. Page 3 just shows the distribution of total covered lives. This is active, retirees and dependents. You can see over the course of 5 years how the figures changed. There has been increase over time in the number of covered lives through medicare who are medicare eligible. You see that in the middle bar. On the right side slight decline in the number of covered lives who are early retirees, but it is still over 9500 individuals are covered in some form either as early retirees or dependents through sfhss health plans. And those plan costs are higher early retirement because there is no government federal funding like there is medicare retiree where the majority of funding is through the federal government as a medicare retiree. So, for the medical Prescription Drug basic vision plans, Health Plan Contributions generally increase, not always. If you are single tier, but generally increase for a person transitioning to early retirement and again i bold especially for those covering dependents and well talk about why in the presentation. First reason is just higher total cost rates for early retirees versus active. You saw on the slide that cfo hussain present ed cost increase with age, so early retiree rates are higher then active employee rates. Just because of the higher cost on average of healthcare. The second reason is differences in the employer contribution amounts for the city contribution between active employees, which are driven by the memorandum of understanding and early retirees driven by city charter where the differences increase as you cover more dependents. So, on the next page, we show what the 2024 member contributions on a monthly basis, so if you go to the page youll see for instancepage 5. Commissioner breslin. indiscernible the second reason is clear the first reason is not clear to me. When i look at the charter. Higher cost rates for early versus active employees. Here is it charter. Monthly cost for retired persons may be higher then the coverage for active employees. The city county the School District Community College shall contribute funds sufficient to defray the difference in cost to system and provide the same health coverage. The only difference in the charter is the mous so i dont think that first reason applies or shouldnt apply. We should well talk how the city charter balances that. The charter says this then how can they say thats part of the problem and yet they are not supposed to consider the difference in the cost . The city charter does provide for the difference in total rate between employee only as a active employee and early retiree only as part of the city contribution. If you look at page 5, the big reason why plans like trio, canopy care and kaiser actually have a lower retiree contribution for the retiree only tier then for the active employee tier for 93, 93, 83 is because of that full differential in the total cost rate. Early retiree only versus active is provided for as a city contribution for the early retiree. Ill review that in a couple slides. The charter clearly wants not to be anymore and indiscernible accept for the mou. Would you continue . These are thefor the active employees city county of San Francisco, we show the two active employee mous, 93, 93, 83 on the left which represent the percentage the city contributes to total cost of healthcare for each of these tiers. For the active employees and early retirees are based on full city charter contribution which well talk about in a bit. I know at the last meeting it was requested how many early retirees fall into each of the tiering buckets. You can see that 64 percent all most 3500 retiree, only but 1 in 3 early retirees do cover at least one dependent. 482 individuals are covering retiree plus 2 or more. So, page 6 is a pick toral exhibit of active employee city contribution and just noting page 7 for sfusd and city College Employees, the employer contributions are determined based on agreements those organizations have with their employers. You can read the description. We have agreements for employee plus 1 or more. indiscernible pay no contribution for medical or vision. We tend to focus on the ccsf active employees when we go through rate cards but to give you information on how that works with the other three employers. All the employers come together under one city charter as retirees, and retirees hired on or before january indiscernible receive the full contribution you can see are based on three building elements. The first element that is the same for all plans and whats always approved every year in march is the 10 county account. That is determined by the annual survey and the same dollar amount for all plans and all dependent tiers and as you see on the next page, thats what is going to be represented in the lighter blue bar. Second element, that is represented on the next page by there darker blue bar, is what we call the difference, but it is essentially what i was talking about earlier. This is the provision of the city charter contribution that basically bridges that gap in retiree only versus active employee rate for each given plan. That provision that is trying to make the early retiree more or less whole for the difference in total cost rate from active employment to retirement, this is the specific element that addresses that and how city charter contributions are calculated. And then there is a second element what you see in the gold bar on the next page that varies for each of the plans and that is retiree prop e contribution. The way i think about it is, when you start with your total cost rate as a retiree and then you deduct the 10 county, deduct out the difference, what is left is essentially paid for 50 percent by the city for both the retiree only tier and the retiree plus one tier. This is a very important distinction here because this prop e contributionyou see on page 9 and we show it for the two highest plans, access plus and kaiser. You can see how that amount is higher for retiree plus 1 then it is for retiree only. When the other two bars are the same all the way across, but the key distinction then when you are covering 2 or more dependents as retiree is you are only getting city funding for the first retiree. So, thats why the bars are basically the exact same between retiree plus 1 and retiree plus 2 or more. So, the impacts for early retiree from the way the city contribution formula works, first of all, most of the dollars paid by the employers go to the retiree coverage not dependents and you can see that pretty clearly. The bar is covered most of the way in retiree plus 1 by what the retiree only does. The prop e portion of the formula provides some city contribution for the first dependent, but a far lower dollar amount then for the retiree coverage. Again there is no city contribution for the second and further dependent in retiree coverage, so that retiree has to pay the full cost increment between retiree plus 1 total rate and retiree plus 2 total rate to cover the second and higher dependents. Contrast this to as a active employee. I may get a lower percentage when i go from employee plus 1 to 93 percent or 96 percent to employee plus 2 or more at 83 but still get 83 percent as a active employee. Contrast that where you can see in these charts that the incremental amount for the first dependent is a lot less then it is for the base city charter contribution for the retiree, and then there is no incremental contribution with adding the second and further dependent. Ill pause in case you have any questions after having gone through that. So, if you like pictures page 9 is for you, words, page 10 is for you. If you are a ccsf employee in either of the 93, 93, 83 the middle column or 196, 83, the right column and transition to early retiree status when you are a employee and just covering yourself, it is a relatively modest difference. There are some plans you pay less in retirement. There are some plans you pay more, but generally speaking if you are 93, 93, 83, it is similar. indiscernible are going from paying nothing because of the hundred to paying something. Then the gap starts to widen as you take on one dependent and it is the widest gap because you are not getting incremental city funding for the second or further dependent. So, thats going through the full city contribution picture for those hired on or before january 9, 2009. If you are hired after january 9, 2009 there was a change in the city contribution based on your years of service. So, if you have at least 5 but less then 10 you dont get a city contribution. If you are hired after january 9, 2009. 10 but not quite 15, 50 percent of that amount, 15 and not quite 20, 75 percent of that amount. It takes at least 20 years of service in order to achieve the full city contribution if you are hired after january 9, 2009. At the bottom i stress the thes is increasingly important for individuals who plan retirement in the future. indiscernible retired and receiving less then the full city contribution for retiree coverage. So, the full picture, page 12 and this replicates the slide you saw for the rates and benefit renewals for acive employees and early retirees. You see the full picture about total cost rates. How they vary for active employees and early retirees. The employer contribution based on calculation formulas as well as the resulting member contributions. And then just talking about dental and vision on page 13. Dental coverage does not vary whether medicare or not. For dental we just say retirees. It is one bucket of coverage no matter the age or retirement. Dental coverage becomes fully member paid. For the active employee ppo and indiscernible you pay higher indiscernible higher coinsurance and plan annual maximum. There is variance. There are some retiree ppo plan provisions that are more generous then active. We have in the appendix in case you want to compare and corast the ppo plans. The big difference comes in the contribution you pay for coverage. Active employee you pay 5 a month for single, 10 two party or 15 full family. As retiree you pay the full amount. There is no city funding for retiree dental coverage. Just reminder, the sfusd and city College Employees do not receive dental plans through hss but they are eligible for the retiree dental plan through hss in retirement. As mentioned before, for vision the member contributions for the plan stay the same. In summary page 14, just have to stress advanced planning is key. The healthcare contributions will increase most notably for those active employees transition to early retirement who cover dependents and especially 2 or more dependents. The dental will be more expensive going from mostly funded for ppo or all funded for hmo and active employment to fully paid by the retiree. Someone is relying upon their Life Insurance mechanism to be what they received through the city, again just a strong reminder here that Life Insurance ceases as retirement as well. As i reviewed earlier, planning is all the more pronounced if you are an individual hired after january 9, 2009 who doesnt plan to work at least 20 years. President scott. Are there questions on this presentation . I raised one question with director yant as to the type of communication that may happen or should happen or could happen between retirement system and Health System as we communicate with people planning retirement and so forth and my hope is that if this is currently going on that we arewhen a person is active they are getting kind of Key Information from us and from us as well as the retirement system as they are approaching retirement and the information is somewhat consistent regarding the cost impact of healthcare and so forth as they approach retirement. Yes, this has been a priority for us for the last i think two years. Ray has come in and communication director jessica has done a bang up job with putting Cost Calculator and other communication tools on our website. The biggest challenge is working together with retirement,er which is also underway of having more of a trio of agencies as the Human Resources retirement and us working together, but itsthis planning has to start well before one is coming to retire. Thats the challenge and im sorry that Alfred Sanchez had to leave because he is putting together a group of stakeholders because that is hard for us to directly influence. I think it has to come peers and labor unions to help them appreciate this from the getgo. I think everybody is looking forward to that pension check, but they dont think about healthcare becoming an expense, so to fiend a way to get that introduced early on and repeated over the years so it isnt sticker shock at the final moment is i think our biggest challenge and something that we will need quite a web of folks to help us determine how best to do that because there is probably no one way, there is probably multiple ways, so thats where we are at with it. We are definitely being very diligent about helping those that are coming to us as they retire very close to retirement, but for this kind of consideration i dont think thats an adequate amount of time for people to be prepared. Thank you. Are there other questions or comments . Commissioner zvanski. I like to make comments because there is a number of preretirement seminars held by poa and other employee groups and i attended those quite consistently over the last few years. All of this is essentially voluntary on the part of the employee. The reaching out to employees at some point during their working life rarely happens so if they are not active in their unions or other organizations that might bring these issues up unless they come to the retirement system at one of their preretirement seminars or they call Health Service doesnt happen. I want to say i complement abbie and this is true for some of the predecessors. Health Service Always had good staff that attended those seminars when the request comes out and theres something planned we always send someone, so it is not just some that go and talk because we are associated with those groups, but we had the staff that go in and provide the real nittygritty and the facts. Ill say things like, the numbers are a little different and tomorrow when you meet with the hss staff they will give real figures. But it is voluntary that way and so this sets up a different situation because even if employees have discussions at the work site they dont always follow through to find a seminar or go forward with the information. They think they will find it out some point down the road and so thats just kind of the reality and then they get surprised. Any other comments from Board Members . Well have Public Comment on this item. Thank you president scott. Public comment is open. Instructions are displayed on the screen for those watching on tv and webex. In person is first and then remote. Those on the line, pless star 3 to be added to the queue. Those watchs the meeting on webex, click on the raise hand icon to speak. Ill begin with in person Public Comment. No one approached the podium. Well move to our remote Public Comment. And there are three callers on the line. Zero callers have raised their hand at this time. Well give a 5 second pause for anyone who may want to raise their hand and join Public Comment. Zero callers raised their hand so hearing no callers, Public Comment is now closed. Thank you. We have an agenda decision to make. We have a member appeal today, and i believe the parties are with us or very close at hand, and we have one more presentation on Competitive Bidding and my understanding is that we have one plan representative who wishes to make a comment. Im going to call on the plan representative to come forward and make their comment at this time. Should we announce the item . The item will be number 11. No, number 12. Thank you. Item 12 reports and updates from contracted helt plan representatives. This is discussion item. The floor is yours. Thank you. Thank you president scott and commissioners. Tiffany gil, blue shield of california. Wanted to take a chance to announce a groundbreaking collaboration between blue shield of california and mahmee. Providing hss members with unparalleled maternal care and support throughout their journey from conception to baby first birthday. This collaboration reflects ongoing commitment to your Member Health and wellbeing and excited to bring hss comprehensive program at no additional cost through 2024. Members gain access to array of personalized resources which includes dullas and support insuring a smoother empowering experience during this remarkable chapter of a members life. Thank you. Are there questions . I want to make a comment. I applaud the fact that youthis program goes through the first year of the infants life. Over half of Maternal Mortality around pregnancy occurs after birth, and so this program should help impact women who are at risk for a variety of reasons for death after they have given birth. The story does not end then so i applaud blue shield for this program and i think hopefully well see improvement in some of these statistics nation wide. Thank you. Thank you. Is there any other questions or comments from the board member . Thank you for bringing this to our attention. Ill call on Public Comment on this item. Can we ask, how do members learn about this program . Excuse me, please. Can you come back . Sure. We actually have sent out emails already to some of the staff or members of child bearing age and also there will be a mailing done with the program and then we have also provided materials to executive director abbie yant and team and then we also have a webinar that will be coming up and all that will be provided information wise to the membership. The program is in effect already . It just started august 1. Oh. Okay. I just wanted to accent to the board thewe are very pleased we are able to put this in place relatively quickly because of what dr. Follansbee mentioned and to accent that, the Maternal Death rates among women of color particularly African American women are horrifying and so thats why once this was identified as a opportunity to blue shield it is like lets do it now so i wanted to be sure the board was aware that we are lookinggoing beyond reporting on statistics that tell us Health Outcomes are harmful and kaiser does a lot of stuff too, but i wanted to have blue shield mention this particular program at this time so thank you. Thank you very much. Well take Public Comment on this item at this time. Thank you president scott. [providing instructions for Public Comment] no one approached the podium and move to remote Public Comment. We have three callers on the line. Zero callers have raised their hand. Well give 5 second pause for any of callers who may want to raise their hand. No callers raised their hands so Public Comment is now closed. Thank you. So, if the competitive bidlooking at director yant, are we doing that today or differ it . I think it is ideal if the appeal goes quickly that we do that. Come back . Alright. Yeah. Okay. Ready to move to item 13 on the agenda. Item 13, vote on whether to hold closed session for member appeal. This is action item and presented by president scott. Ready to entertain a motion that we go into closed session to hear a member appeal under the provisions outlined in the agenda. So moved. Second. Been properly moved and seconded that we go into closed session under the provisions provided in the agenda. Is there Public Comment . Thank you president scott. [providing instructions for Public Comment] no one approached the podium and move to remote Public Comment. There are three callers on the line. Zero callers raised their hand. Well give a 5 second pause for anyone who may want to raise their hand for this item. No callers raised their hand so Public Comment is now closed. Roll call vote on item 13 whether to hold a closed session to hear the member appeal. Roll call vote [roll call] motion carries unanimously. Well now go into closed session. Thank you all. [closed session] [meeting reconvened] im ready to entertain a vote as to whether we disclose any or all of our discussion held in closed session. I move we do not disclose from closed session. Second. Properly moved and seconded that we vote on not to disclose any or all of the discussion held in closed session. Is there any comment from the board . Questions . We will entertain Public Comment at this time. Thank you president scott. Well be taking Public Comment for item 14, which is to vote whether to elect or disclose discussion held in closed session. Public comment is now openment instructions are displayed on the screen for those watching on sfgovtv and webex. In person Public Comment is first then remote. For those on the line press