Folks feel theyre on a highend of that 010 scale and that for us to have influence and slide 12 just sam ar eyess and Weight Management and physical activity and Healthy Eating and Emotional Wellbeing and the organizational caring and those things are highly correlated if theyre good wellbeing is good and wellbeing and associated and productivity measures of absenteeism and performance and costs things like higher preventative screening rates and hospital costs and workers com many in the research we do not have that data to look at that in our population at this point. That is what we started with looking at how we happened in our population and then it takes you in to our mission because one of the things that we didnt start with and weve really grown in to is who we are and in 2017 we defined wellbeing as living and feeling and being better every day and understanding that when we do that there are things that happen today, today we have more energy and we feel better and thats where you really see those enhancements on your productivity and tomorrow, hopefully those things accumulate and in to us preventing Health Conditions and berman age Health Conditions and in the longterm really allowing our quality of life to improve and so thats where our mission came from. On slide 14, you have those factors that are associated with wellbeing and a list of the some of the programs we offer to address them and you will get my usual overly long annual report in the new year that summarize those programs and how theyve been doing and we report on them as they come up and lots of different data points for you so theres no one like look at that and we did that for wellbeing its all of these different programs and its all of these different concepts theyre all driving that number so they all play a piece so i cant just give you one. I am working on being more brief are there questions from the board. I forget some of your methodology of the assessment on the numbers look great but i dont know how many people harmed so it would be helpful to add a little n equals 3 for the healthy and equal 700 for the unhealthy, whatever, just because it gives us a sense of the magnitude and maybe how we can look at the whole populations so that was just one suggestion. Yeah, definitely. Take a minute to review the methodology but maybe for the few. The other question i had was having just finished the two hour training on harassment, which took three and a half because of the system i understand weight and height are protected catagories so i i just am curious with all of these how we protect against harassing people who might not be eating healthy or consuming five you know, and serveings of vegetable and fruit theres an opportunity for peer harassment or manager harassment or whatever, if people we think gee, you should be in our Healthy Eating program and you are not and how come . Harassing people and im just curious how the wellbeing program accomodates that. Just high level 20 of our employees took the survey so that is the underlying and why have the catagories off the top of my head. To your second point, a couple of things. Its definitely the tone that we set and with my previous employer, the companies that we worked with very often took a approach of you have to do these things to get this premium, right, and that creates a culture of people judging and forcing, and a lot of negativity and a lot of stress and a lot of those factors you brought up and the approach that we have taken is everything is fun, everything is optional and we admit openly that not every program is for everyone that our program is about being better every day and whatever that means to you and we want to you live healthy, we want you to feel good and get care and we know that wellbeing is this huge concept and everybody is working on Different Things at different times so opening the program with the wellbeing assessment defines wellbeing like that instead of saying our wellbeing Program Means you need to have these numbers and you need to be a healthy weight or if you are not doing these things you are driving up our costs, right if we had taken that approach thats the culture that you create but we took a very different approach and its slower, its harder, its harder to explain to you being having an impact when you take that type of approach but if you set the culture wrong on the onset, it is so hard to take that back. Other questions. Thank you for all of your efforts to you and your team and we look forward to your report in january. And soy understand that theres part 2 and thats the diabetess. Yeah, so today we were excited that the timing of the data report actually coincided really nicely with us getting back the initial data for the diabetess Prevention Program which was a partnership with kaiser and the division of research to really target a Higher Risk Group so a group that is at risk for diabetess theyre not diabetic but theyre at risk for diabetess and so two years ago, we set out on this journey to recruit participants to see if a work placebased program or an Online Program worked better and the program regardless was the established diabetess Prevention Program which is a Proven Program that came out of n. I. H. And c. D. C. Research and is a crediting programs all over the country and c. M. S. Is looking at the importance of including diabetes s Prevention Programs so its not like we made up an intervention we took an intervention and testing is it better inperson at the work site or is it better when delivered online so that was slide 16. Slide 17 shows we were able to recruit 158 people and we, i didnt, i had nothing to do with it, Kaiser Division of research randomized them in to two arms and 80 people and 78 people and of those folks, we asked them to give us their initial measure ment and they attend 12 weeks of classes and hold line or inperson every week for 12 weeks and then they go every other week for a few months and they go once a month for a year so we asked these 158 people to do something for a year which is why were reporting this out to you two years after we started and it took a long time to get those folks and check them for a year. At the end of the year, we had 43 of the online folks show up again to get measured and it doesnt mean they completed it and it doesnt mean they didnt complete it it just means they shove off measured again and we had 54 of the work site folks so all the data you see really comes from those folks who showed up at both points. It isnt uncommon to have this drop off and it probably is somewhat took tell tale there was unanne drop off and the other thing that you have here, are the list of locations and i included that not just as a thank you to those departments and those champions who actually found rooms for these things, can you imagine trying to book a Conference Room once a week for 12 weeks and every other week for a year in the city where were so space constricted, it takes a lot of work but it also shows all the different types of workers so we were out at dp yard and we were at the library and we were at laguna honda so a lot of different work environments in this study. So slide 18, of those folks and we lose weight what percentage of weight did they lose and some say d. P. P. 66 of them lost weight so those in the online d. P. P. 63 of them lost weight and thats of the people who showed up at the end to get measured. On slide 19 the average weight loss so we measured them at six months and again at 12 months and its really important to see if it was holding up you expect a bigger weight loss at the beginning of a program but sustain tag isnt as easy so what we saw was at six months, they had about a four to five pound weight loss and the online group started to regain by the end and the work site group lost a little bit more so most importantly they sustained that after six months because you dont expect the biggest amount of weight loss in the first six months. Slide 20. This is people who participated that were over weight versus obese because there are its incredibly important looking at those highrisk obese folks trying to reduce them because theyre probably closer to becoming pre diabetic or diabetic than the over weight but theyre also, they tend to respond differently so what was great to see was the work site program both over weight and obese folks lost five to six pounds but you did not see the obese participants lose very much weight at all. Slide 21 is, i bet you had to read this one twice. So this is about how many pounds they lost. So based on how many sessions they showed up for so in theory if they come to more sessions theyre do better. The people in the work site program who didnt come to more than eight sessions actually gained seven and a half pounds which say negative seven and a half pound loss and the people who came to eight or more sessions averaged the weight loss of seven pounds and looking at slide 22 we asked participants what they liked and what they didnt like six and 12 months so some of the helpful features that showed up or having a lifestyle code so both programs had a lifestyle coach but one was inperson and one was emailing with you, right. And tracking food intake was a key factor and the content people actually learning the educational information behind all of these classes was really important to folks and some of the barriers to participation was the farm at and some thought it wasnt conducive to them and another barrier was they lost interest and another barrier was poor resources so you can see that there was the folks in the work site Program Reported the helpful features a lot more frequently and the people in the on Online Program reported barriers more frequently. On slide 23 you have a quote that i could have just not given you any of this presentation and just given you their quote sums up everything about the on site program that was successful. And slide 24, we asked them why they participated and when we asked them if being offered by the employer was important 83 to 86 that was a major motivator for them and having no cost was a major motivator for them so some of the implications of this incredible long is that i am Person Programs are an important component of an he can tive wellbeing program and it doesnt mean that Online Programs arent going to be an important part but when it comes to something as important as a very integrated behavior change like weight, this study showed that the i am Person Program was substantially more helpful, folks appreciate no cost programs this program in the Community Cost 400 and just that up front cost can be a huge barrier for folks. Sometimes i equate the work place to schools if you want to teach kids something you get to them at schools if you want to tell adults something get to them at work and people hearing things from their employer because they spend most of their time and so its just important that the employer be promoting resources whether its something at the work place or just what the health plans are offering and its important that we continue to communicate and through the employer its the flyers in their office and its the champions telling them its not just unfortunately it cant just be things we mail home to them it has to be things theyre getting at work. And hopefully you took the time to watch the video and we have seven different videos up on our website now and as we look for a different reason we were looking for videos when people wanted to be the face of our better everyday brand and it just happened she was in the diabetes s Prevention Program and it had a big impact but her story talked a lot about how her work place makes it easier are for her to engage and its been a big opportunity for her but shes one of our big Success Stories with the 23pound weight loss during the program and so take a look at that and hear it from a real people and the real workers. I would like to have the representative from kaiser to come forward for just a few questions that i have and i thank you stephanie for the overview of the program. Are you doing this type of program with any other of your employers, this type of not approach or pilot . Sure a number of employers are interested in this and some are we have not done this sort of a formal Research Study with any other of our employer customers. To the degree that theres any other comparative data with other employers within your contractor to partner and what is your plan, whats your larger outcome here from your standpoint . Were enthusiastic about it and stephanie and what is in it for and you what do you plan to do with it and. Were looking at how we offer the program the ymca who delivered the program here and they are nationally going to leader in this program so we right now are looking at 9 learnings using different models and they will help us formulate with our strategy. Members any questions . I have a couple questions, one is im assuming that the class ideas on the employees own time that they were not provided during working hours . Because i mean the i want to know what the average age was because you know, if you can do it any time and go over with your coach at 6 00 in the morning for the Young Technology people whats the age and make sure im clear about the on sight timing of the classes. Ill have to full the average age we have all the demographics and we are looking to publish soon and i have some of these findings but, to answer your question when it was offered it was offered during the work hours at the dpw cesar chavez yard it was at the beginning of the day before they went out so it was slightly different and it was designed to be facilitated by bringing it to you by making it free but it was not designed to take away from work time. The other question i have, as a diabetess prevention study and we know that weight is an important part but insulin resistance is related to exercise, tolerance and lean bod owe weight so do you actually have the ability to get a hemoglobin a1c and the active participants or some other objective measure that would actually relate directly to diabetess or pre diabetess as a opposed to just weight . So, the screening was weight plus the cdc weight screener and we chose not to do a blood draw because of the realities of recruitment are hard and its very hard to get people to show up to an information session to commit to a 12month program to come once a week for 12 weeks to be like and were going to take your blood twice was more than we thought we could handle and the screener is approved way of doing it according to the diabetess prevention protocol so we opted for the screener instead but it was looking at other risk factors in addition to weight. But that is why we dont have the hemoglobin a1credit data. You presented one aspect of the screener which was weight, i gathered. Or weight change. As opposed to you know, b. M. I. Or any of the other parameters on the screen so you have the other parameters to look at in this group not just their absolute weight gain or loss but also some, Something Else that might be associated with elevated blood sugar. The other outcomes that we have everything was also done in b. M. I. I felt its easier for people to wrap their head around a fivepoint weight weight loss than a. 1 reduction in b. M. I. Was harder and they are correlated and we also had had waist circumference change so theres trouble there and what we dont have yet but we will have is the report physical activity which will be really valuable as well. Theres a lot of the survey data that hasnt been processed yet and we only had the pre imposed physical assessment data in. Commissioner sass. Just wanted to get an understanding of how you collect some of the weights. If people are coming to a work place session are they being weighed in each session . Is that done or is this monitor ed and tracked . Yes, so the folks who participated in the work site program were encouraged to weigh in each time. What about the online people . Is this an honor system . They selfreport that. We cant really validate the two its an honor system online and how do you really draw conclusions between two different kind of methods for determination. Its a job of correctioning. Throughout the Program Weight was tracked in those two different ways but the six month and 12 month assessment everyone came back to be physically measured. Other questions from commissioners. Well thank you for your initial efforts in this area and we look forward to more. To the longer report andel correlations and comparatives with other employers and we appreciate your partnership with us on this project and these are Public Comments. Thank you, again. All right. We are ready to move on to item 10. Thank you. Clerk item 10 discussion item network and heath plan issues if any. Network and health plan issues. And this is normally where we have our perspective plan representatives to come forward and we have one coming. Please do. And you are would you i am lisa and the company that provides the online voluntary benefits Enrollment Services. Im going to ask you again to just dont be afraid of the mic, bend the head so its right at you like you are getting ready to eat it. Ok. All right. So we provide the online voluntary online Enrollment Services as well as Third Party Administration services to reconcile the payroll and pay the carrier invoices so the two issues we feel we need to bring fourth to make you aware and one is last thursday e. B. S. Experienced a reduce in force and i want to assure the board and the city that the people who were let go were not part of the team that takes care of San Francisco and their employee and well be able to continue with our services. And Customer Service call center or any of the people that are behind the scene taking care of the citys benefits. So you had a