On october 23rd to 2019, the main fax number stopped working, so i thank you can appreciate during these last days of open enrolment thousands of applications can be faxed in at that time. We identified that the issue was with the phone line and not the fax server or the software. We reached out to the Technology Partners and they just so completely understood our sense of urgency around that. They were able to get at t out to our premises and then they kept doing additional onsite troubleshooting with us as we looked at the fibra networks and the Telecom Lines and they were able to meet me outside Business Hours to resolve things as expediently as possible. And ultimately they diagnosed a loose wire in the basement. Isnt it always Something Like that . They were tremendous. The individuals were deeply invested in getting us back up and running. Im so very grateful for the expertise and assistance. Thank you to the department of technology. Thank you. Thank you, marina. So with that, i will transition to do a presentation on the Employee Engagement survey. I will go to the podium. Following my presentation, i have asked carrie to present to you a brief presentation on the e. A. P. Critical Incident Response is that the team has done for a long time, but particularly this year it has been quite a year. We had the opportunity to present this to the Mayors Department head meeting yesterday which is why i did not put it out in advance. I didnt want to usurp the mayor mayors viewing of it. They literally the only changes the fact that carrie will presented to you rather than myself. I will step to the podium. Okay. Do we have it on the screen . There we go. Okay. First and foremost, i would like to thank all the Staff Members that actively participated in this process. It is profoundly important as an employee that your voice is heard and thus we named it. As an organization, we are committed to survey results to create action plans to improve Employee Engagement on a continuous basis. We appreciate the opportunity to work with Talent Systems intelligent Talent Management consulting firms based in palo alto. Hs as a worked in partnership with its to review the 2016 total with approving the statistical validity and productiveness of the 2019 survey results. The survey went quite well and we thank you will be interested in the results. This presentation will cover the surveys purpose implementation and overview of survey scales. The survey resulting by scale and category and the themes that emerge from the survey and proposed next steps for Action Planning. The purpose is defined to the extent in which employees still who are passionate about the jobs and are committed to the organization and put discretionary effort into their work and are willing to refer. Engaged employees produce a greater output and a Higher Quality level and less engaged employees, and will stay with the organization longer. This leads to increased retention and organizational knowledge and reduced training and turnover expenses. The survey has a dual purpose during the strengths of employees in identifying areas of continuous improvement. Let me get on the same page here the survey was administered in august through september. They were a total of 52 items. Fortynine on a 15 rating scale and one multiple choice, and two open ended items. The double rating scale allowed us to look at effectiveness and importance. Fortyeight employees responded that as an uptick from the prior survey in 2016, there was a 90 Response Rate and a 96 Response Rate in 2019. The only persons who were not able to participate or were on a leave of absence. The engagement i want to clarify, these rating scales will be defined in detail further in the presentation. I want to note that its has been in the business of Employee Services since 1999. They stated in 96 Response Rate was the highest they had had from any organization. This excellent Participation Rate indicates a high level of trust. We had a small number of staff taking the survey for the first time, and the rest were experiencing a subsequent time, yet we had stability in our scores and above average, minimal downward trends and substantial upward trends reflected in the data on future slides. Slide five. Engagement survey scales. Items marked on the survey roll up into five scales. Alignment, fit, team, growth, valuing, with Employee Engagement being the outcome at the centre. These five categories represent action areas that drive or detract from Employee Engagement each of the five categories are defined on the righthand side of the slide. Next slide. Overall, results by scale, as mentioned earlier, the survey used a double rating scale showing its importance. They reflect how important it is to staff and how positively staff feel they support the focus area. The goal is to have minimal differential between the scores for each category. H. S. S. Had less than one point difference between the categories. We had a 1. 7 differential in supporting the category of growth, which is one area of focus for Employee EngagementAction Planning discussed later in the presentation. On the rating scale of one through five, scores of three or higher are above average for any organization. H. S. S. Meets this threshold across all categories. On slide seven, the Overall Results by category. The favourability score is this defined as the average of the respondents that rated agree or strongly agree on the survey items in each category. Increases in favourability ratings were seen in the areas of alignment, valuing, team, and fit. That represented the highest increase at 9. 97 and speaks to our ability of onboarding the right staff for the right positions. Decreases in favourability ratings were seen in the areas of Employee Engagement and growth. These minimal decreases range between one and two . These areas are still considered important. Slide eight, Staff Members, we were assured anonymity and in responding to answer answering openended questions. Open ended question one. Open ended question number two. What are some of the opportunities for improvement in this department . H. S. S. Worked with i. T. S. To analyse scores for effectiveness , importance, favourability, and open ended question responses to identify overarching themes that lead to Action Planning. The three themes for the 2020 Employee Engagement action plan include collaboration, Employee Recognition, career, and Employee Development. Slide eight reflects the staff to do perspective on the current state of each focus area and future visioning for improvement opportunities. Slide nine, Employee EngagementAction Planning steps based on themes. Slide nine identified Action Planning steps in the areas of collaboration, Employee Recognition, career and Employee Development, and three themes that steph identified as being top priority for them. These Action Planning steps are a combination of improvements to existing h. S. S. Programs, processes, as well as new endeavours and collaborations that we plan to pursue within and across divisions. As you can see on the action plan and collaboration, were talking about the lean 101 Quality Improvement initiative which we reported out to you on several occasions and we will plan to continue to do so. We have recently had a meeting with the department of Human Resources to work with them in partnership on some improvements that we have identified. The lean training itself in that way and that way of thinking and working has been fully embraced by the staff. We intend on continuing to use that methodology for other process improvement and it will expand the opportunity for staff to develop skills in process improvement. Employee recognition, we will continue to diversify staff celebrations, support the culture of the person and wellbeing. We are developing an interdivisional committee tasked with developing an ongoing Employee Recognition program. And enhance employee performance appraisal process by incorporating opportunities for management to recognize and nurture professional development goals, identified by the staff. In the career and Employee Development area, we are looking at developing a Baseline Assessment of skill level by position and classification and use that analysis to enhance skill building pathways that improve effectiveness in the staffs roll and prime them with Transferable Skills for advanced position within or outside of the department. We are partnering with the department of Human Resources to provide refresher education on training and professional Development Opportunities that are available to the city and county staff, including career counseling and advisement. So throughout this engagement survey, we learned about our organizational strengths. Employees find that the work they are doing is meaningful. Employees feel their personal strengths are put to good use and the type of work that they are doing. Employees know how to contribute to the department and Division Success and they are highly committed to the departments mission and purpose. We also learned that opportunities exist to further support our Employee Culture of recognition for good performance , to evolve our staff in more process improvement projects that would support across collaboration and provide additional opportunity for ongoing learning and Skill Development that increases staff effectiveness and future professional positions within h. S. S. And beyond. As an organization, were committed to using these results for Action Planning that improves Employee Engagement on a continuous basis. We again thank the staff for the feedback. Any questions . I had a couple questions. Number one is, im assuming can you clarify whether a survey was done online and whether employees have the opportunity to do it outside the workplace . Was there access to the portal so they could do it privately at home or wherever . Yes, and yes. Okay, good. How long does it take on average to complete the survey . Ten minutes 12 minutes. And under Employee Recognition, what are the issue one of the issues that i think we all grapple with is how our members also acknowledge employees for their outstanding experience that they have had, and also when they are maybe have less than outstanding experiences. How does that fit in to the action plan for Employee Recognition, or is that an issue that is addressed separately . We havent discussed that. I think that is a really nice perspective to bring to the table and to look at it. I know we have a Strategic Plan and an effort to and we have the new phone system coming in and looking at how use salesforce and capture the nature of the calls are coming into Member Services. There is an obvious opportunity in working continuing to work to understand the roles that Member Services plays and how well they are doing. I think that is one area, and then soliciting member engagement. We have been doing it through a variety of special interest focus groups over the last year. We have done three different series of focus groups to speak directly to the members, but i do think that what you are calling out is worth consideration and we shared think through how we do it. I dont know if our managers are here that have experience of hearing some of the accolades we do get from our members and how that is shared with their staff. And then, of course, when there is issues that of performance, then the council needs to review it. This is from the 2016 survey. These are some remarks and sustained improvements. I commend you for undertaking this activity again, given the fact you have been here a little over a year and a half or so, but i think the inputs from the Management Team and the commitment to the managed team to support what you have identified is going to be critical over the next few months. So to the degree that you are committed to move in the direction, i commend you. Thank you. Okay. I would like to turn the podium over to carry carrie who will talk about the a. P. For managers in times of crisis. Hello. I am the manager of h. S. S. I will spend a few minutes talking a little bit about the presentation that abbey did yesterday. We want to talk about e. A. P. And a time of crisis in the service they provide to managers. We have three e. A. P. Counsellors their pictures are in front of you. Collectively they have over 50 years of experience and all three of them are licensed and f. T. E. E. A. P. Has two main core services. They have personal services and organizational services. Under personal services, they offer counseling and they do referrals, and her organizational services, they offer consultations, workshop training, mediation, and critical Incident Response. Today i will spend some time focusing on personal referrals and the organizations organization 20 around the critical Incident Response. E. A. P. , in regards to referrals, they actually do a lot of work when a member will call and have challenges on how to Access Mental Health services through their health plan. They will actually help to navigate that system. They also have liaisons within all three of our health plans that provide them a direct line. So should there be an issue or a concern a member is having that they dont feel they are getting the right type of care, they connect with these liaisons through our health plans, and those liaisons can actually react very quickly. They also work to do a lots of collecting data to see what is working and what is not working, and that information is provided back to our liaisons to see how the health plans can improve the services and getting the right type of line of connection to our members to the right people. I will pause there to see if theres any question specifically about the referral process. Are the e. A. P. Team members all full time . Yes. So for organizational services, i will focus on critical Incident Response. A critical Incident Response typically is an event that overwhelms an employee when it comes to something that is not atypical to their Work Environment and theres actually two kind of pieces to this because we do understand that there is a large portion of the workforce within the city that our First Responders and that type of work is very typical. So please note we will talk more about responders a little bit later in the presentation. Some of those items you might see our work violence, workplace violence, death of a coworker or patient, or client itself. Death to a family member, natural disasters, Sexual Assault or even a physical assault. We would you find it, marina. We have seen quite a bit of an increase in regards to the Critical Incidents over the course of the last several years , so as you can see on the graph in front of you, it actually will show you that we have seen an increase by a substantial amount. We do relate this to very heavily being that the word is getting out there. That people know e. A. P. Is here for them and they are really able to utilize that service for them. So for this year alone, we have actually had 64 trauma responses where e. A. P. Has been called out to act and to provide support for individual employees and or departments as a group. In regards to the response, one of the things that we have learned through the process is not one situation is the same, so it is really determined by a case by case basis. However, there are some typical best practices that they move through as they are dealing with a department who has suffered some sort of a Critical Incident these would include an initial consultation. They have a point of contact within the department and someone who is of a higher level to get them engaged to talk about how they want to approach their group. They do an assessment, they will provide some sort of negotiation or agreement on how they are going to work with the department, and then they will work to inform and move forward through next steps. Some of the materials that they provide in the response is they do have some resource materials. Those are always on hand. Those are things they can give out immediately. They often will also come onsite to a department to do group discussions. One of the things that they have learned is by coming onsite, they have a lot more effective connection in dealing with the response when it is in a Group Setting, and opening up individual consultations through our office location. We have found it not to be successful to do individual counseling at the site location itself. That is also an extension of what they do offer, but they offer that at 1145 Market Street and then there is also a followup process. And depending on the engagement, the severity, the situation in which they are dealing with, the department, that feedback loop and the ongoing support can continue on. I will pause there. Are there any particular questions before a move into First Responders . Okay. We have started to engage with our First Responder group. As you know, First Responders to , every day, deal with a lot of trauma. These groups are your police, fire, sheriffs, department of emergency management, and medical examiner groups. These groups have collectively come together in partnership with us and we are really looking to address the needs of our First Responder group. There is some things that we are working on. Some of that is getting them in front of our health plan liaison to ask specific questions, and then doing some deeper digging and research on how we can continue to serve our First Responders. Our e. A. P. Team is here for our managers. They are here for our employees, but in relationship to the services that they provide, we have a lot of our information where we do provide on our website. The slide you are looking at has direct contact information. We have an 800 line as well that people can connect to. And then this last slide really highlights some of the resources that we have available. They are very easy and one click away. Are there any questions . It is an impressive presentation. I dont know i could talk all afternoon about the trends and kind of Critical Incidents or whatever, but i guess the question i would have is how is your capacity . Do you have a sense of how your three managers are working overtime, or are they not working overtime . What is the assessment of this . That is a great question. We constantly have meetings about looking at priorities. We do identify that Critical Incident is a priority response. At times, we will meet to discuss what does that mean in regards to client load, how long are we pushing client sessions out further, and looking to address what other projects and work they are doing on, as you say, in addition to the Critical Incident and client responses. Theres a lot of other work they do do. Right now i would definitely say it is very tight capacity. I know jeanette is here and she is one of our e. A. P. Consular his and she can agree to that. There are three counsellors to do a lot of work for 45,000 employees. It is a lot. Could we use more . Absolutely to do the work that we are doing. Right now we are managing with what we have and we are reprioritizing where we need to. I will just follow up then. Thank you very much. It is very clear that you have some metrics. Is there anything that the board can do in reviewing those metrics or understanding better, you know, because obviously you are reprioritizing and you are reprioritizing to the two of need, and that is something that we should all be aware of in terms of how that is being determined and what we can do as a board. We have actually been in conversation and are starting to inquire outside of the organization as to what is the best way to approach the understanding of what the need is versus the vibe dont viability to respond. I think what we are noticing here is that we have a very strong and professional e. A. P. Team that has become widely recognized around the city, and therefore, we are getting an uptick. On top of, these are trying times. There is a lot of reasons why the demand for services is increasing, and i fully expect we will continue to increase. We are really considering how we go about perhaps getting an internal consultation to come in and help us project what our what we could and should be doing and seek the resources to do that. All things Mental Health are a priority in this administration, but the Mayors Office and i know when i did this presentation, several of the Department Heads were very gracious and theyre acknowledging how helpful our partnership has been because i think that is the way we have approached it. Either through the Department Head or their point of contact has had a very strong relationship with one of our counsellors who has gone in. In some cases when city attorneys were critically ill, prior to his death we were noticed and able to go in and work directly with the team there. Other times we learn about these things afterthefact, as you know. But it is clear that theres a very nice, professional recognition of what is going on. I think we will continue to see this rise. We need to develop a plan on how we need to meet the increasing demand. Thank you for doing the presentation. E. A. P. Is usually the group that is not recognized or doesnt give an importance until there is a need for it. Thank you to the aep e. A. P. Staffer the staff for the work that you have done. Outstanding job that you have done. Although thank you. What about retirees . The retirees currently are not eligible for internal e. A. P. Our e. A. P. Counsellors directly work with the active employees. Our focus with the retirees is to be able to provide their services through their health plan. So like that the Police Department and the Fire Department have their own behavioral the Police Department does, the fire does not. They have a peer assistance program. The Police Department has the behavioral science unit, which they do outsource their e. A. P. To an external vendor. So right now that is part of what these 51st responder groups are looking to do is actually collectively come together to be able to provide an e. A. P. Service similar to what the behavioral science unit receives through the Police Department for all five of those First Responders. [please stand by] yes, historically, and we were very aware of that situation. Suicides are up in a number of populations across the nation, and Police Officers are vulnerable, for sure. Im happy to hear youre working with the other yeah. Weve had some excellent conversations where were just really facilitating that, and i think its its important for, you know, as Mental Health 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 are very aggressive cancers. The good thing is you dont have a whole lot of them, but the bad thing is they do metastasize very quickly, and they tend to go through the lymph system, and you may be treated for a melanoma, and it shows up in your brain or your lung a few years later, and by that time, you probably have a lot in your system. So that is an active cancer that is aggressively treated. And as we go through there, we watch through your wellness during the summer, particularly identifying an area like san francisco, we have cloud cover we called it fog when i was younger. But you do get sun burned even if its overcast, and sometimes people dont realize that. [please stand by]