Healthcare continuum is really in the community. So there are four walls of our care settings. The clinics, the centres, the diagnostic centres, the procedural centres, and you look at things like e. M. S. Or ambulances. How do we effectively connect what is happening in the field, and the prehospital or precare setting where patients are actually seen a lot, and is the primary mode of transit or entry into our system. So not surprisingly, the ambulances and what we call the e. M. S. Services, they brought their own version of Electronic Health records and they have a whole different electronic standard. We were able to map those standards together so that if a patient is seen by an ambulance in the field, they are able to connect and do the same kind of korey about patient formation and transmit that to the hospital or anywhere they want and pilots that we have done that came out of some initial successful pilots out of southern california, we did one in sacramento with the county fire to reduce unnecessary transfers for high utilizers who generally are not, because they are not connected to community providers, or they have had Behavioral Health needs, and this is where we actually put an advanced practice practitioner in the van or in the ambulance, and it they were to respond to a call and add it and get the patient coordinated right in the field without a transfer to the Emergency Department, saving millions of dollars per year. Another thing that we have activated that i am proud to say really helped with some of the devastating fires that we have had, is an emergency disaster response. Were trying to figure out, is there a way we can effectively connect First Responders in the setting of a Natural Disaster or a major epidemic outbreak, and this is just how it works that if you are a designated First Responder or have that kind of access in these settings, you will be able to access and identify patients and really get them the care they need. Other cases about interoperability, there is an Opioid Crisis in this country. All of the states have their own version of a registry of controlled substances that the patients are getting, and this is a way so right within the platform you are using, you can send out a . To the state registry and see they the history for the control substances for the controlled substances. Youre exchanging all this data, we see it as being underutilized , and we are really still not at the point where it is truly seamless, liquid data interchanged with the patient at the centre. So theres a couple ways how we get there. One is, how do we scale this up . Im going to use the cell phone analogy. I dont know if you remember back in the early days of cell phones, i had to pay a lot of money. And so these were separate networks that connected to each other. That is where we are now in terms of Health Information exchange. Theres a framework of networks now that basically connect those networks together so lets say from a pointtopoint connection youre on a network and you get six clinics, you get a few dozen visit few dozen physicians and a couple hundred patients, if you connect six networks, that exponentially increases and you get thousands of physicians and tens of thousands of patients. Getting that data and managing populations is really the only way you will be able to get to that kind of scale. As an example, if you look at just our e. Health, our internal , our local facilities, testing california, and then what we call federated sources, there was another question about federated sources. If we federated things and the information is not centrally controlled, so there is one method called a centralized hie where, for instance, your dignity, you are set or, you argue c. S. F. Data, all those with a central repository, and then it is requested that way, that is not the standard space model that exist today. Federated means that the information is that dignity, and they respond to incoming . That is managed or federated through those networks. Were on the e. Health exchange. If you look at the map here, if we just go to that framework of care quality, we start to really extend expands the connections in the community that we have. If you look at adding the common well alliance there, then we see just in california how much that expands our capabilities. I am going to actually skip over a lot of this stuff. I think im really passionate about this, but im taking a lot of time, but this is really about communitybased population care which is what were talking about with care coordination, which we have heard about. The other aspect of how we get true interoperability that is meaningful from a clinical standpoint that is really transforming care. We need to talk about what the meaningful data is. Yes, there are data points when the patient enters a healthcare setting that is important, and things like medications and problems and procedure history and allergies are really important, but the majority of care are out in the community. There are other data factors and variables that contribute to peoples Overall Health and how they respond to treatment in the tape and the type of interventions that should be thought about carefully when health plans and Healthcare Organizations are determining how best to improve the quality of their care, and that is the real continuum. A lot of you have heard about social determinants of health, and Health Disparities in social determinants of health are the most single impactful variables that determine how a patient is going to respond to their care. What if the patient doesnt have a home or they are transient or they dont have stability in their home . What if their local supermarket doesnt really look like this with lots of Healthy Options and fruits and vegetables . What if they are like an island and we have local Convenience Store that has a local dont a bunch of junk food . This is not isolated to underinsured or not insured or medical patients, medicaid patients, these are all of our patients in all of our communities. Do they have transportation . And even more importantly, what are their Community Resources to engage in care . Do they have support centres, what kind of resources do they have to engage in their care . What is the level of engagement it doesnt have to be hightech. Theres a very lowtech versions of engagement that patients can be empowered to use to really help with their care. And again, the type of information needs are changing over time and our traditional thinking is that information is expanding to the larger kinds of data sets and information to help with predictions. Going from a population down to an individual patient. So you see the importance of this kind of data in coordinating care and it being liquid and seamless, or the whole Person Care Initiative with some of the initial cases to identify atrisk homeless populations and engage and share that dynamic care coordination as they traverse the care settings. Here in San Francisco, the department of Public Health is engaged in Healthy Cities Initiative which really is to show that the largest proportion of Disease Burden is preventable and not wellmanaged. So had we partner with communities and get data out of our systems to devise and create truly meaningful strategies and interventions in the communities to give the resources across the continuum first at the hands of the patients, but connecting them with the care providers . By doing things like extracting this data and doing what we call geocoding which is spot mapping it throughout the communities, you can identify those who are at the most need for resources and give the resource information to the patients and then measure those outcomes. It goes to show that at scale, what were talking about with interoperability is not just sending my chair summary from one Emergency Department to my primary care provider. It extends and is much more important to that. So some really great initiatives that are coming out of legislation that will drive the meaningful advancement of the use of technologies, which is really meant for Foster Research , improve the Opioid Crisis, coordination of care, but theres a huge emphasis on interoperability and the use of healthcare and information technologies. And then theres legislation around information blocking. Providers, health plans, it is not just the vendors. Locking of information related to patients has been used as a competitive advantage both the health plans, Healthcare Providers, and the vendors. Those days are over and theres actually legislation being informed in terms of defining that, and putting large penalties and enforcement on those actors who are engaging in that bad behavior. Considerations, when i think about that truth of health plans and the contracts that they have , so we are getting into a lot of these valuebased care systems. They really that cannot be done without the use of interoperability as being foundational. The way that they enable their patient populations and this goes to what we are getting at here. It is beyond administrative claims data. It is largely what has existed in these databases for least 30 years. We need to move beyond that because those are not correlated highly. Those are correlated highly with being able to report metrics, but theyre they are not correlated highly with outcomes. So these plans need to be driving strategies that address the communities and populations, and i mean real populations. Not Population Health as a means from a managedcare standpoint, the managing populations in their care. Adopting and employing the emerging standards that the technology enables, because it will really get to the point where the patients are going to be able to have all the information at their fingertips and directed all around using different technology, and all of the peers, all the pharmacy databases, all the different type of administrative data and Clinical Data will be held to the burden of being able to use those standards to improve the care of patients. I think, finally, but the most important, is the degree to which these plans are focusing and incentivizing consumer and patient engagement. The patient needs to be at the centre of all this conductivity, and the degree to which the Networks Connect needs to be seamless for data liquidity. Sorry if i took up too much time i could talk about this for days thank you. Thank you. Any questions . This is herculean. And i applaud your enthusiasm and the information you have put together, which is quite amazing and i guess, i dont think theres any way to understate the complexity. The data was sometime summaries, but not the primary data, and when he talk about 11 , people dont trust the accuracy of what they are getting. They dont trust the accuracy of the reports they are getting, and theyre not seeing the lab results. So i just trying tried to integrate all this. The v. A. Tried to give away its Health Information system to any user to try and encourage this decades ago, into my understanding, no one took them up on it. So we have a married of systems. And i know all of my colleagues in private practice who bought systems through incentives had to then buy another 12 years later because it was deemed inadequate or whatever. I think this is great, im just curious to know if you have any sense about when we will achieve this. Right. Meaningful use, the incentive programs to help information technology, the huge vendors really got really became billiondollar corporations from this and the patients and their care providers were left last, because really, the promise at the end of meaningful use, because we are in stage iii, is just that. We have come a long way, and i do think that when i look at the legislation, the burden is shifting from the Healthcare Provider and here Healthcare Organization to the vendor in terms of saying, you know, not only does our technology deliver this, but we deliver it in a meaningful way and a usable way. The other thing is, we are we orienting ourselves and just being able to say, you know, weve got from faxes and papers, and we are getting the data, but the data doesnt mean anything in the context. We are not getting the data we need and the way we need it. That pushes happening. I think the emergent standards that we are seeing is really driving this. Im optimistic. Theres a long way to go. I think that the incentives are wellpositioned, and i am engaged in this and we learned the lessons of the past, lessons learned, meaningful use, we found a use of technology, costs will go down, quality will go up , neither happened. And the legislation put around it. We have learned the lessons of the pastor frame how we will drive interoperability. I think that this drives towards the patient at the centre who is also really essential and going to facilitate that. I will be brief. We have heard today that they focused on a single payer in california. I would like to remind ourselves in the audience of the singlepayer bill got hung up in committee. The providers did not need to use Electronic Medical record. It actually allowed them the luxury of not using that, and so i dont think the singlepayer the way it can work its way through and we will answer these problems because there are lots of forces trying to prevent this right. Thank you. Any other questions . Any Public Comment . Thank you, doctor. I greatly appreciate this presentation. I like the sharing of information and i like the accessibility of the patient to all this information. The only thing i request is this system be simple and be comprehensible, because i went to a war with my printer today, and if it wasnt for canon, a customer support, i would have been lost and probably wouldnt have attended this meeting today , i would still be at my printer. It should be simple, it should be usable by everyone. Thank you. Any other Public Comment . Seeing non, Public Comment is closed. We will go back to item number 11. Item 11 is approval of the infertility benefit policy statement presented by anne thompson. Thank you. We have several documents that we posted as part of this item. Im primarily going to walk you through the powerpoint presentation, in addition, there is a policy statement and a summary of the 2020 benefits coverage for the three health plans related to inFertility Benefits. Just do the highlights, please and what the change is that will be voting on. Yes. With that, on page 1, just to say that we continued dialogue as part as far as the rationale, a couple of changes from the june presentation that we looked at, which was the second item, adherence to current stateoftheart professional standards, and looking to ensure equal access to Infertility Services, the second to last bullet. We are new there are new additions as we did our research that we felt needed to be stated as part of the rationale of the coverage provisions under the health plan. On the next slide, i mentioned that separate handout of the benefit coverage, primarily a 50 coinsurance. There is a deductible under the plan, and not on the other two because theres not a deductible on page 3, just an overview of the evaluation process. We had spoken to this previously , but again, we spoke with many different folks in the area, health plan partners, really to evaluate the inFertility Benefits covered under each health plan to ensure the programs were generally consistent and available to all members who wish to build a family, regardless of partnership status, Sexual Orientation, or gender identity. This included discussions with each health plan accounting, leadership, and Clinical Experts , as well as a review of coverage language, clinical guidelines, clean processes, network credentialing, and Member Support programs. From those from this evaluation process, the findings on page 4, we determined that the overall infertility benefit coverage is available to all members who meet the clinical criteria regardless of partnership status, Sexual Orientation or gender identity. Another finding was that there was an opportunity for the plans to better assist and educate the population on the pharmacy benefit for prescription drugs used for the treatment of infertility. That would include dedicated care coordination, assistance with locating competitively priced prescriptions, and clarification about the estimated share of cost for all Services Related to treatment. Throughout the discussion, it became clear that kaiser has practices that providers follow and that are inclusive. And further follow the professional standards included in oversight committees and organizations listed at the bottom of page 4. On page 5, for next steps, we are requiring the health plan provide a response to the Vendor Performance annual report out which is contained in the appendix of this presentation. This would be to identify any service gaps and commitment to corrective action when needed. Second, offer advocacy and enhanced care coordination to members seeking Infertility Services pick this could be providing either inhouse through the Health Planner through a third party, and then lastly, to provide concurrent reporting to the board of any new infertility policies, programs, or services that are implemented so