Becomes a more acceptable conversation and the stigmas reduced, theres just a lot of learning on what needs to happen on what services are available and who they help the best because theres a lot of misinformation out there about what Mental Health services cannot do because it covered everything from the homeless methamphetamine addicted person on the street to the officer that is responding to these behaviors as a result of addiction. The Ripple Effect is pretty large. So many, many City Employees are experiencing the stress of their work today. So, like, three those three employees cant handle too many people, so do they refer to your health plan . Do they have contacts within the health plan that they send people do . They do. So thats the health plan liaison where we have direct phones, direct lines, and all three of our e. A. P. Counselors do utilize those. I am somewhat familiar as a Police Officer with the model there. I imagine that the model that im familiar with is is, from what it sounds like, trying to mirror for all members, which would be helpful to have a list of what is my understanding acceptable vendors to provide these services. I understand that three people cant provide these services to every member that might have a need. Is that the model that were trying to replicate for all City Employees . So right now, what were trying to make sure is the care that they get is the care that they need and it is at times immediate. Were also looking at what type of care are they getting and do we need to look beyond that . Weve also spoken to our health plans about how they are addressing First Responders because although the Police Department does have their own internal program, they do access external people, and its not for anyone but First Responders, so we are working to one work to enhance what we offer and work with health plans, as well. I think its a very good understanding. It took some time for the culture to change. Its acceptable for a lot of my colleagues and coworkers to treat things that would be very severe. I commend you for your work on that, thank you. I think the title Mental Health is sort of a standoff, too. This could be called something else. Behavioral health. Yeah. Behavioral health or counseling. Mindfulness. So thats a yeah. Some people oh, like, mental. Yeah. And we certainly will look at it when determining what path forward we need to take. E. A. P. Services is what we call it and how we promote use of our services. Any other questions . Thank you. Thank you. Thank you very much. By jumping ahead, i didnt allow for any questions on the directors report, so i wanted to see if there were any. Any questions . Any Public Comments on the directors report . I guess just one question. You have a tracking list of issues with six items on it, including the kaiser transportation benefit, which we had questions about. Do we have any updates on the tracking of that issue . That benefit goes into effect in january, correct . As i recall, the issue was that the transportation benefit didnt didnt include wheelchair access, and so maybe we have some update on that, sort of a gap. Are you prepared to respond to that today or we have it on a pending list of agenda items . So its up to you. At this time, were still working through the details for our transportation benefit. There is not wheelchair transportation available . We are in the process of testing the benefit to go live january 1 and well keep you informed as we continue to roll this benefit out at things change. Im a little confused about we understand that the current benefit did not include wheelchair access. Right. And so are you saying that that youre testing vendors for whole chair access. I mean, there are certainly lots of vendors who can provide wheelchair access. Im a little curious as to what youre doing. Were actually evaluating providing that level of transportation. I guess i can say on the record right now that i cant confirm that well have that benefit available when we go live with the transportation benefit as of this moment and not sure in the process when well be able to add that. Let me be clear what i think i heard you say, your transportation benefit is going to go live january 1. Are you continuing to aceasses whether youre going to provide wheelchair accessibility or whether youre going to at some subsequent point. So the service is expected and well give you an update after that january 1. Without the wheelchair so as of january 1, the information i can provide is we dont have the wheelchair accessibility. Okay. Ill have to go back and review the minutes of what our concerns were, but i dont think at least from my perspective, i dont think it was an acceptable out come that we would, in our rates and benefits, approve transportation without wheelchair benefit. And ill have to look and see exactly what we did approve and to understand a little about because what im hearing is that, again, if you are going to provide wheelchair then there will be an additional per member per month cost or something is what im anticipating kaisers going to come back with, and i dont think that was what we really intended. We intended to provide a transportation benefit and not exclude a certain percentage of our members, which is what the current benefit does that will start january 1. That is exactly how i remember it. That is correct. That we werent going to have it unless you did the wheelchair. So debbie mcconaughey, kaiser permanente. So the plan that we have january 1 will have the ability of transporting in a wheelchair, but we cannot transport them sitting in a wheelchair. So for example, its not a van where you can be transported sitting in your wheelchair, but if you have the ability to be transported where we would help assist the person in a wheelchair to get into the car, we could fold up their wheelchair, put it in the trunk, transport them, and then put them back in. Currently, we dont have the ability to transport somebody who must ride in a van in their wheelchair. Well, again, this is not my area of expertise, but as someone who observes wheelchair access in the community, a lot of the problem includes the fact whether the wheelchair can be accommodated in a vehicle and securely to meet, you know, the safety requirements, but also access to that vehicle. And sometimes if vans have steps and all that, a person who is wheelchair bound may not be able to so unless youre saying the benefit would not include a hoist to lift the benefit up in the chair to be safely seated, im still confused about the gap. Its one thing to transport the wheelchair itself, and thats pretty straightforward, but its the access into the fan. And since we witnessed people falling, trying to get into vans and falling trying to get out of vans, we want to make sure that the whole transportation is safe, not simply the ride itself or the wheeling up to the door of the van. Is that clear or am i no, i think its clear. Debbie, are you able to clarify assistance into the van because well need to get back to that. I dont want to confirm something thats wrong. Would you do this . Yes. Be prepared to speak to this definitively, which is prior to your implementation date. Yes. And im going to ask our director of services to review this particular area to see if it was specifically included in the rate quote that we accepted from you. Okay. Thank you. Okay. Are we back to Public Comment . Yeah. Thank you. By the way, even munis paratransit, a lot of our members are taking paratransit and medivan. Theres all kinds of services that will transport you in your wheelchair, so im not sure what kaisers problem is in finding a vendor or contractor to provide those services. Oh, claire svonsky. I go back to the jean miranda days of the e. A. P. , and im so thrilled that this is getting the expansion and maybe the attention that it deserves. I think i fought hard for 30 years with the city to just keep e. A. P. And to finally get it here with catherine at Health Services because it was at a number of departments and it was almost defunded a number of times. Theyve been through war themselves. Im not surprised that jeff litner doesnt have ptsd. He survived over the years with jean trying to keep e. A. P. Alive, so im thrilled to see it here and see the service where it belongs. By the way, muni has its own service. At least it was when i was there. Thats the third to coordinate besides police and fire. But im still concerned about this medical thing. Is this a medical group . Is this an urgent care facility . I think im not sure what one medical is. It says a Network Provider, and it sounds to me like if theyre a Network Provider like any other physician or provider, that when seniors show their card and they have their benefits there, that they should know who and what, and they should know what fees or copays are charged and shouldnt be adding these other fees, so i would just like a little more clarification as to what one medical is and what it means because i do write the newsletter for our organization, and this information is going to go out in about 1. 5 weeks or two weeks to all our raccf members to know what they should expect or be aware of when they go to Seek Services through one medical. Thank you very much. Yeah. Fred sanchez. Im the chair of protect our benefits. Two things about concierge service. Yeah. Thats unclear, and i dont want to comment on anything that i find unclear, and youre still figuring out what is on it. Im waiting for you to inform me, and i can inform our members. Currently, weve got three or four different even Board Members that say yeah, i pay an extra fee for the doctor. Says its overhead of the office, so theyre getting Different Reasons as to why they should pay a fee, and i dont even know who that fee is what that fee is, so thats something we await you to find out what these various concierge fees are, whether its individuals or medical doctors, but i dont think its good for us to comment until youve done your homework. The other thing id like to comment on is these e. P. A. , you know, coordinating with police and fire units. I know that the new chief has created a chieflevel position. Its called the health and Safety Officer. Its just a newly created officer im going to recommend to the chief mantha health and Safety Officer start to the chief that the health and Safety Officer start attending these meetings because theres a lot of things they could learn by attending these meetings. We had an officer before who tried to accept people with addictions and things of that nature. But even there, coordinated with the city e. A. P. Because they didnt want their employer to hear about this, and even though this was supposed to be confidential, they would rather maybe go through another avenue. And then, on a casebycase basis, like in the 89 earthquake, they contracted with Behavioral Sciences to come in and come to the fire houses and talk to the firefighters as to what theyre experiencing, and for the first time, i was shocked. Some firefighters started crying about their experiences. And then, there was peer pressure. They didnt want it viewed by everyone. Im a little wimp because i didnt respond like all the macho guys responded. So if they can go as individuals rather than Group Setting is rather than good. So i commend you for doing that, but i hope they coordinate it with the various different departments. Thank you. Thank you. Any other Public Comment . All right. I believe that were on number 10 now. Director yes. Item 10, presentation on cancer care thats relative to the sfhf proposition. Thisll be presented by page seitz metsler. Good afternoon. Im page seitzmetzler. I would like to start out on the first on slide two and look at the center of the chart. And what youll notice is there is that and this is just for 2018. 7 of your population was actively treated for cancer during that year. It doesnt mean that there you know, you would expect your population theres a lot more cancers, but during the year 2018, 7 were treated. That resulted in 10 of your medical spend. And if we were looking at the top cancers going clockwise starting at the top, what you see is that skin cancers, breast, cervical, prostate, and for medicare retirees, youll see skin, prostate, and breast are most commonly occurring cancers. Your most common with breast, leukemia, lung, and lymphoma. And specialty drugs for cancer can occur either through your pharmacy benefit or it can occur through the medical benefit, depending on the site of administration and the person providing it. So what i would like to do then now is just also note that kaiser is the only h. S. S. Plan that is exceeding the screening benchmarks. They are meeting the 2020 Healthy People 2020 goals in most screenings for most screenings. So if we look at page 3, what you will see is several things that is causing cancer to bubble up and become one of the number one expenditures. Of course, musculoskeletal is always up there. The population is growing older and people are living longer. That gives me the opportunity, if dr. Follansbee would allow me, for people to mutate. Secondly, treatments have changed. We now have immunotherapy, general treatments that target these cancers. We now have new models of care and youll see as we go through the place of service therapy, how its occurring now in the patient setting or even in the patients home. And lastly, we are improving. One of the things that youll see as we go through this is the stage of the disease when it is identified or being treated for, has gone down. So instead of being stage four, when its widely metastasized, theyre catching it earlier than stage four or earlier in treatment. I would mention that in 1975, your survival for Prostate Cancer was 68 . In 2012, your survival rate has moved up to almost 99 , and thats just because of education and treatment opportunities that are available. Can i ask a question about that. Sure. When you say survival, is it fiveyear survival, threeyear survival, tenyear survival . Five. So when somebody has lymphoma, and theyre getting some scans on an annual basis, do those costs include a history of . No. So its only for active treatment. Okay tiactive treatment. So if they had a scan, and those scans were related to cancer, they were captured in the treatment. But if someone had no Breast Cancer and there were no bills that came in related to the diagnosis for Breast Cancer, there would be no claims cost for that. So, for example, if a woman underwent a mastectomy because of a history of Breast Cancer. It would be captured in the cost. Even though it was in the okay. Any other questions . So moving onto slide four, what youll see is ultimately the best treatment is Early Detection. When our screenings rate is able to increase the stage at which theyre caught decreases, and youll notice an early cancer is only about 16,000. A latestage cancer is 41,000 or greater, depending on the stage of treatment. So with that, ill switch screens and turn it over to marina. Marina coleridge, Enterprise Services manager for the Health Service system. This is looking at 2018. The columns are looking at the screening rate by each of our plans, and here, were looking at our active and nonmedicare retiree population. And the gray shaded part is looking at utilization. And then, just to make this chart even more busy, weve added on a couple of targets. Weve got the national average. Thats the gray line, and then, the Healthy People 2020. And i know page mentioned that earlier. Thats a department of health and Human Services program from 2010 that has, like, i dont know, 1300 or so metrics that get covered and looked at all under four, you know, overarching goals around health care. So i wont go into details on it right now, but but to say orange line is for Healthy People 2020. I would say those groups tend to have the higher screening rates. Youre seeing some of the lower prevalences of the cancer as noted by the gray shading there. So our cervical screening for the population is just shy of the Healthy People 2020. All of our plans are below the National Screening rates i dont understand that because kaiser looks to me that its above your line. Yeah. Thats what i was looking at. Sorry. I think that was a version thing. Different version control. Ignore my comments. Kaiser and access plus are close to hitting the targets. And again, the gray shaded are the targets that were seeing. And then, we get over to colon cancer, and where we have a prevalence for the condition and the targets. And then, when you go to slide 6, this is the same layout, except this is looking at our medicare populations, and we only have the two plans. Again, kaiser performing really well here, and you can see in comparison to the screening rates, the preview dencedence the kaiser population than the screening population. So then, if we look at slide 7, what were looking at here is the top 15 cancers by population count, and what you see is skin is number one, both in the medicare retirement and the nonmedicare or pre65 retirees. Breast cancer comes in for the active population whereas prostate comes in on the medicare side, and it goes on down. The good thing to see is you have very low incidences of some of the things like ovarian and colon cancer is very hard to treat. So if we move onto slide 8, lets talk about skin. In the active, you notice that squamous skin cancer is number one with 2800 people being identified with squamous cell cancer. Thats a good thing in that squamous cell cancer is extremely slow growing. And although they can metastasize, and because theyre on those areas that have been exposed to the sun, your face, your arms, your torso, they are caught early and treated early. Whereas medic whereas melanomas a