All right. Madam secretary, roll call, please. Roll call. [roll call] we have a courtroom. Okay. Item number four. Item four is the approval of possible modifications of the minutes of the meetings set forth below. The regular Meeting Minutes from september 12th, 2019. Are there any questions corrections to the minutes . I move the minutes from the september 12th, 2019 meeting be adopted. Second. Any Public Comment on this item . All those in favor of approving the minutes signify by saying aye. Aye. Any opposed . It is unanimous in favor. Will all right. Item number five. Item five is a general Public Comment on matters within the boards jurisdiction. Do we have any Public Comment this is the time to come forward if you have any questions or concerns about something. Please come forward. Hello, my name is jason and i am from ucsf. Currently vaping and ecigarettes are still widely used and there are many programs in place that offer Preventive Health care screening and Mental Health care consultations. What are your thoughts about implementing or expanding the Tobacco Cessation program . That is a good question. Could i ask our director about that . Im sorry. I have only heard part of what you were saying. Yes. What are your thoughts about implementing Tobacco Cessation programs . There are many preventive screenings currently in place, but there is none for tobacco use. We do have Tobacco Cessation programs, correct . Through the health plan. Yeah,. Through the wellbeing program . What was that . Maybe you could come up and say something. She is mentioning that the newer Tobacco CessationProgram Addresses vaping in particular. Let us do an assessment with the health plan on whether that is currently the case. I imagine that it is but i can affirm that with the health plan , but, yes, tobacco is one of the leading preventive measures that we can do and we will take a look at that. Thank you. Thank you for bringing that to our attention. Thank you. Any other maybe we could find out if our own Wellness Program that we operate deals with tobacco or not. I heard you say no. I am not clear that is the case. Yes, currently we have Tobacco Cessation programs through our health plans. We currently do not have anything that we offer directly through the wellbeing program. We used to when we had one of our counsellors here probably about five years ago who went through a particular training, Tobacco Cessation training that she did offer to city employees, however, when she retired a few years back, we did not actually supplement that by getting an additional person trained because we felt, at that time, the health plans were able to meet the need. It wasnt tobacco specifically, but as abbey indicated, we have to do an assessment on the vaping case. What im worried about fake being is is it the same addiction or different addiction it is also an addictive disorder. There is a collective concern about the uptick of teenage utilization which is exactly what the sales of Tobacco Products target. Then you get someone who is addicted for a long time. I think it is a very valuable thing for us to check into and report back on. I think with the report back weekend maybe assessed if there is something that needs to be enhanced within our own program and to our own employees that we can assess that when we hear what the health plans are doing. Okay. I just read that another person died from it in california here. I think it was around this area or something. All right. Okay, any other comment on this item . Seeing none, Public Comment is closed. Item number six. Item six is the president s report. This report is given by president breslin. I have nothing to report at this time. We can move on to the Governance Committee issues. Item seven is the approval for the initiation of the Health Service board annual selfevaluation process regarding the fiscal year of 2018 through 2019. This will be presented by Committee Chair scott. Thank you. The Governance Committee met earlier this week to review both the Health ServiceBoard Evaluation form, as well as a timeline that is proposed working in strong cooperation with the department of Human Resources, which is really the administrator of this survey. After reviewing the survey itself, we agreed that the survey that was used last year should be used again this year, and that the timeline would start this friday with the notification to Board Members or the selfevaluation and to continue on for about two to three weeks to allow members to complete the selfevaluation, and then we would come back in january with a the report of the results. So that is a broad timeline. It is outlined in our terms of governance that we do this annually, and this is, i believe , the fourth year we have conducted a selfevaluation of board activities. With that, i would like to move that the recommendation of the Governance Committee, that for the selfevaluation form and timeline be adopted. I will second that. I have one question. During the Governance Committee meeting, somebody brought up the issue of being a unable to assess the new Board Members. I dont believe we ever added on an extra item for that. Did we . I will defer a bit to the secretary, but my understanding is that we have not done that. We have tried to maintain consistency with the prior administrations survey, and that Board Members who are not able to assess any particular item or area of the survey are asked to complete that in the comments section of the form. That is correct. I have the same concern, particularly around the orientation since most of us have not be reoriented since the last survey. So if we dont answer the question, then is the survey not complete . We have to answer the question in the comments and say, please ignore my response to question number whatever and whatever . Essentially, there are further guidelines that will be emailed to you all tomorrow, but we are asking every question be answered. If you select neutral because you feel as if you do not you cannot answer it in any other accurate way, we ask that at the end of the section for that grouping of questions, you explain the neutral responses in a sentence or two sentences to give context. And then the neutral will be discarded . No, it just basically is ensuring every answer every question is being answered. We still have the same number of questions from last year without altering the survey completely by giving six response questions we did not want to alter the survey. We may have to cook to may have to consider the results as we start and not compare them to the previous years. I can tell you, speaking as an individual, if im going to change my answers to some questions because of the neutral option where i feel there has not been anything that applies to me in that question. So there will be some changes, but you will just have to contend with the account if you are not going to ignore it. But you will also have an opportunity to comment about your neutrality or why you didnt respond. They are doing the analysis. Okay. So it has been moved and properly seconded. Is there any Public Comment on this item . Hearing and seeing no Public Comment, we are ready to vote. All those in favor of the item as presented, signified by saying aye. Aye. Opposed . It passes unanimously. All right. We are back into regular board matters. Number eight, please. Item eight is the directors report. Thank you, good afternoon, commissioners. I would like to begin my directors report by acknowledging the passing of the c. E. O. Of Kaiser Permanente. Im sure many of you have read the many accolades of bernards contribution contribution to healthcare. I know i didnt have the opportunity to work closely with him, but i know many who have, and people who worked with him since he was a medical records clerk all the way back. So he is a very revered and, as i said, the accolades i dont know in my memory of ever seeing a Healthcare Executive receiving the types of accolades that he has upon his passing, and it just speaks highly to his contribution. I did want to acknowledge that. I know their archives a representatives representatives here that may have additional comments. Good afternoon, i am from Kaiser Permanente. I thank you for the opportunity to say a few words about our very highly esteemed chairman and c. E. O. Of Kaiser Permanente bernard thyssen. I come up with a heavy heart. We started our careers around the same time. He was with us for over 30 years and has been our c. E. O. For the last six years. He was passionate, a passionate leader. Not just for the people, but also for our members and in the healthcare industry. He was an advocate for a lot of change around pharmaceutical companies and challenging them on some of the costs, so he was very active and really believed all people should have access to healthcare. And very committed to the wellbeing of the community. So reaching out and trying to help the communities that we serve to be healthier and have a healthier lifestyle. He was an amazing visionary. I can tell you, being an employee of Kaiser Permanente, what i experience. It was a visionary with a really big heart. If you ever had the opportunity to talk with him, you felt that. He always felt like he was a friend. We are going to miss him greatly we are confident with our interim c. E. O. , greg adams, who worked very closely with bernard he has a lot of experience inside and outside of kaiser. We are very confident that his work will continue to move forward in this organization. I will share with you there will be a viewing of his body that is open to the public on sunday in oakland. It will be from 11 00 a. M. Until 3 00 p. M. For anybody interested it will be at the oakland rotunda, 300 frank all applause in oakland. Thank you for this opportunity. Thank you. If i can make one comment as well. Having been in my professional career at Kaiser Permanente, this is to remind the audience that kaiser is a three like its tool. It is a Nonprofit Health plan and a nonprofit hospital and it is a medical group. He was the c. E. O. And head of the Nonprofit Organization which was the health plan and hospital system. Speaking as a physician, one can see throughout my years on the board some of the tensions that can occur between physicians and health plans and physicians and hospitals. I would say that he was a true partner in working with the medical group and furthering goals, so i know that the physicians share the extreme fondness and loss of the leader of the other two thirds of the stool. But to make sure everyone is understanding that this partnership, as you can tell from the press, is always tense in healthcare delivery. He managed to really show that there is a way forward. And for that he could also he should also be recognized and modelled in all health plans and medical groups. I would only add to that the reason why i am in San Francisco is that i was recruited by bernard to serve as a Vice President for h. R. In a prior structure at Kaiser Permanente called the golden gate service area. I also have a personal relationship with him through a professional mens organization that he and i are members of. Both from a professional and personal standpoint, he was and had been a friend of mine throughout my early career here in San Francisco in Human Resources until my leaving kaiser in 2001. I will miss him personally and professionally. Thank you. Thank you. Turning to the directors report , in the packet it highlights the highlights included are the decision not to release a request for health plans for plan year 2021. As the board knows, we have been monitoring the marketplace and it continues to evolve. There are one of the things that has occurred since we last met was the announcement of the settlement with sutter, and that settlement will not be public until late february, early march of next year. It is possible that it will have impact on the market here in San Francisco. So that is one that we are anxious to see what the settlement entails. We are also continuing to serve the development of the can be product and watching the sutter product develop. We will be coming before the board again in december to talk about the member focus groups that we did throughout the month of october where we did a significant number of listening sessions with the members to understand their current experience and to get their input regarding their questions and concerns about possible models. Going forward it was very informative. I have reviewed the polemic area results and have the draft final report on my desk unread at this point. I am anxious to call through it go through it and make the presentation to the board in december. We are also in the process of updating the Strategic Plan based on the activities that have occurred over the last year and, again in december, plan on reporting out in the form of the annual plan and Strategic Plan update simultaneously, since they are so interlinked. We are anxious to do that. We have done some initial assessment about accomplishments for this year, and as always, when you take the time to do a look back, is always amazing how much you get done. We are pleased about that and we will be looking at those areas that perhaps we didnt accomplish and understand why. It could be that there were dependencies or sequencing that we needed to recognize or give more time to the Strategic Plan. It was written over a threeyear period and was quite ambitious in the number of activities that were suggested to accomplish some of the goals. We will be reporting that out to you in december. I will, at the conclusion of this directors report, stand at the podium and give to you the results of the Employee Engagement survey. I will defer on that for now. Also as a followup to an earlier meeting when the care coordination presentations were done, we had a breakdown in communication with kaiser and have given them the opportunity to put together a presentation on complex care coordination which be which would be more comparable from what you heard from the other plans. That is in process. There have been some investigations into some of the issues that some of our members are experiencing. We want when they choose to buy a concierge service, but it is not required to be a one medical participant and it is precluded from positions to charge an extra fee, but it is considered an ad on option that members may choose to charge. As we become aware of any of these situations, we are better able to investigate. We have heard it mentioned that there was some issues with some providers. We have communicated to them at large. But as most of us know, it is very difficult to correct a problem when you dont really know where it exists. I really do encourage the members to advise h. S. S. When they have questions or concerns about their plan coverage. We do hold that information, the privacy of that information and would protect the member from any procedures and retaliation that they maybe fearful of. I would encourage people to talk to us. Can i ask . Yes. Two questions. I guess there are two parts to this topic. One is that the one medical. So when you just walk into one medical, because they are everywhere, the front windows now say they are associated with dignity and the healthcare system. There is one in west portal that i walked by. So our potential patients given a sheet that alerts them upfront what the fee schedule will be and that they are, maybe at risk for paying those fees depending upon their health plans . I dont know how this works. Someone is nodding yes. So they are given one they walk in the door. It is my understanding, at least from their website, that you can join and pay a fee on the website. What is not clear is we have done some secret shopping and tried to understand where the confusion might be. I think one medical in their general marketing practices do advertise a membership fee and they state it is for their extra attention and concierge Type Services and receiving appointments. What our plan is, particular with the ma p. D. Is prohibitive if you are under contract. I dont know how every one medical Office Brooke operates in as far as informing members, but it is important that if you are a member that you dont have to pay the fee. Okay. So that is evident to our members, how . How do they all remember this day today when theyre walking down the street . It is fairly to folk typical. Once they determine youre not there for an emergency, the next thing they ask is for your insurance card. Again, we need to continue to ensure that when medical is following these procedures and assists the members should they require assistance. Okay. The second item has to do with tolling. We have talked about these additional fees on other occasions. So what i understand you to say is the board is clear on this. Sometimes, and maybe other health plans positions who are also not as clear on this or members are not as clear