Wellness center here at the Health Services. At the end, we at the end of the day we had 117 individuals participate in the focal groups, representing 34 of the unique departments across the city. With that, id like to turn the mic over to heather and shenay to talk about the presentation of the core findings from this endeavor. Thank you. Thank you. Hi, commissioners, its nice to be here with you today. Im heather imboden, im with communities in collaboration. Were an oakland based consultant. We also do program evaluation. Im here with my colleague, shenay hawkins who also supported this project. Im going to breeze through the beginning of this presentation because abbie so thoroughly covered a lot of the introduction, so were going to talk to you about the work we did. Were going to focus on what we heard from members who participated in this process, both through the focus groups and also through an Online Survey that was made available for members who are not able to join us. And then well talk about the implications for hss and some of the things that hss is already doing to address the needs that were heard. So abbie covered the purpose of the engagement. Ill recap. It was to hear the experiences of members and understand their priorities, but also to test those Health Care Models presented to the commission earlier in the year. And understand what the questions and ideas that members had about those models might be. We targeted active members and retirees who are not yet eligible for medicare, primarily because those models were focused on nonretiree, nonmedicare backing up on members who are active and who are not yet eligible for medicare. Medicare eligible members have a different set of plans as you know. So we did not folk our efforts on those members, but we did have a number of medicare eligible retirees who participated and their input was certainly taken into account. As i mentioned, abbie went over the process, so i wont go into that here. We did hear from a great group of people. We wanted to hear from a really Diverse Group of members and so as we were receiving our demographic surveys from participants, we kept an eye on that throughout the process to make sure that we were hearing from different departments, different locations, people with different enrolled in different plans and other demographic factors. So we did additional outreach throughout the process to make sure we were really hearing from the broad diversity of members. So the meat of it. I want to talk to you about what we heard from the participants. And this is reflective of their personal experiences with their health benefits. So we tried to put this from their perspective as much as we could. I want to say at the outset that we asked a lot of questions about a lot of different kinds of care. And most participants were quite positive about their experiences. So im going to talk about some of the things we heard lots of good things about and then ill go into areas where we heard consistent messages about room for improvement. As far as primary care choice and access were really key for our members, as well as being able to stay with a provider that they trusted. One participant told us i would walk through fire for my primary care provider. That is a particularly emphatic statement, but when someone is happy with their provider theyre very happy. Access to specialists. Members really appreciated being able to get to a specialist quickly. And being having access to high quality specialists. Being able to be referred out of network when that was called for was also appreciated and making sure there was good communication between specialist and primary care providers. We asked about urgent care. And there were many members who felt very positive about urgent care because it was more accessible to them and they felt that the quality was very high. So that convenience of being able to access urgent care outside of regular Business Hours was really valuable to members and they felt like they were getting good care when using those services. We also heard a lot of positive feedback about apps and digital records, which are being used more and more by members. Again, there was the convenience factor that was very important to members. And knowing that their providers could see their records as well was very appreciated. One member said you can make appointments, email your doctor, lots of things through the app, its very easy. Going to skip and talk to medicine, because we heard something similar about telemedicine for members who appreciated not having to leaf the comfort of their office or home to access care. Sometimes it was easier to get an appointment over phone or video. And they felt that quality of care was there for those services, so that is something we heard theyre looking forward to using more in the future. And then dental care, again, really appreciating the ability to stay with a provider over the longterm. And trusting their providers and having friendly relationships with those providers was very much appreciated. One member actually told us they liked their providers because the provider laughed at their jokes. Its the little things, right . So there were three areas where we consistently heard messages of room for improvement. Where members felt like there was opportunity and needs that werent being met. One of them was in Mental Health and Behavioral Health. We already spoke about that a little bit earlier today. They felt that they had a very hard time finding providers who were covered within their networks. Even if they had a list of providers who were technically within network, they might not be able to find one who is actually accepting patients at that time. They wanted more robust coverage particularly for care before its an emergency. We heard from members who had crisis, Mental Health crisis within their families, they had good coverage and care when the crisis happened, but they felt if there were more robust coverage leading up to the crisis, the crisis might have been averted. We also heard that some members had trouble finding providers that met their needs as far as being a match and understanding their background. And the more diverse providers, so that was another area members were seeking more support. Another area where members were seeking more support was in wellness services. And they talked about that as far as fitness, as far as Nutrition Counseling and weight loss support and being able to access those things in some cases just being aware of the benefits that were available to them, they didnt realize were available to them. And if they were available, being able to access them outside of regular 9 00 to 5 00 working hours. We heard from some people with nontraditional working schedules who said, there is exercise at my office, but its from noon to one. If im a shift worker, that doesnt work for me. They were looking for more Robust Services outside of those traditional 9 00 to 5 00 hours. Then the last area where we heard pretty consistently a desire for support was in alternative medicine. Primarily chiropractic care and acupuncture. Again, finding providers who specialize in those areas was difficult. For members to find covered providers. And so members often were paying reported paying out of pocket or using their fsa funds to access those services with providers that they felt met their needs. And actually we heard that around Mental Health as well. There were members who had Mental Health care providers that they wanted to stay with and ended up using their own funds or fsa funds to stay with the providers because they were not covered in their networks. And with that, im going to turn it over to shenay who will talk to you about the feedback we received on the models. Good afternoon. As part of the engagement process, we presented five models of potential or possible Health Care Model options are or options that are hypothetical options that members were could potentially look for in the future. The first model during this presentation, members were able to share questions ask and share questions about the models, look at the models in detail to figure out what things were appealing and then also talk amongst themselves. Really to determine what models were appealing, what questions they had and what were priorities as they select future Health Care Benefits. The proposed models, there were five selected. The first one was the current plan offering. I wont go into too much detail about that. The second model that was presented was the plan offering third party navigation and advocacy support. For this model, support is considered to be any Third Party Service provider that is not at h. S. F. That is not the members employer and not the Health Care Provider or insurer that advocates for the members and supports them throughout navigation process of health care. The third proposed plan was a consolidated plan that included kaiser as well as one other Insurance Company. And that one Insurance Company provided will provide both an hmo and ppo. The fourth model that was offered was a system competition model. That model offered kaiser as well as three other fully integrated Health Care Providers and another ppo. The fifth model was the private Exchange Model and this was described to members as the cover california model. So you have a variety of insurance providers that offer multiple and various insurance plans at different price points and Different Services. That is created to offer a little bit of flexibility and choice around offerings, as well as price point for members. One thing that i should note, kaiser was available in each of those proposed models. Ill give you a little bit of feedback from each the models, the model one was the current offerings, i so wont go into detail. Model 2 is the current plan offerings with Third Party Support. When we think about or analyze the data, one of the Key Takeaways we got from the model, was there was mixed feedback around what Third Party Support services were. When they asked question, it was really around trust. Can you trust the Third Party Support provider . What is their level of expertise in the Health Care Profession and medical needs . Are they going to this Third Party Provider held accountable to the same hipaa standards and laws in the medical field. This was about trust and wondering the fidelity of the provider. One of the key questions that came from that was how Third Party Support impact complicate the overall experience of care. So while members were fairly interested in this, they had a lot of questions about trust fidelity and the bureaucracy that might come, or the complication that might come with the Third Party Support providers. Model 3 was the consolidated plans. That provides two options. The Key Takeaways around that was how does having three options for Health Care Benefits impact choice . Is it going to minimize the way that im able to select a provider . Is it going to minimize my selection for doctors . Will i lose different options around that . And similar with coverage. If we only have three health care options, how does that impact the way that i receive coverage . And the last one was around cost. Some people thought that having only three Insurance Options would either drive up costs, because with only three, that limits the competition. And others thought because more people might be under each plan, that could drive down costs. That was a big question around costs and there were varying sides of that. The fourth model is a system competition model. This included kaiser as well as three other fully integrated Health Care Insurance providers as well as another ppo. For those of you who arent clear about what an integrated Health Care System is, it is all of the care provided under unumbrella. Theyre provider, Insurance Company, et cetera. One of the questions was how will integrated systems impact ability to receive coverage outside of network . So by integrated systems having housing all of their services inhouse, how would that impact members in seeing specialists or getting second opinions. That was a big concern. And finally, the private Exchange Model, t this model rad a number of concerns. Some of the biggest questions were around how might the plan options and choices affect equity, quality and accessibility in relation to care. A lot of the insurance providers will provide Different Services at different price points and a lot of members wondered if i select a lower price point for my Health Insurance plan will that mean that im selecting a lower quality of care. So there were a lot of questions around there. There were things that came up around all of them. Third Party Support services were offered in three of the five models. And they wondered if Third Party Support, could that be offered in all of models . And another thing that came up again as i mentioned was the level of quality and accountability that the Third Party Provider would have. As we explore different, or as members explore the different options, everyone is worried about coverage, or a lot of people questioned how their coverage is impacted once they retire as they travel or for members independence who live out of the country and out of the bay area. Im going to talk about the major themes of the asks that members had. We asked them if there were any other services they were looking for when they think of what hss provides to members. And some of these are going to be overlapping with what shenay said about the models. A key theme we heard was around Service Standards and accountability. What can hss do to extend more support for members to make sure that standards are met and make sure that patients are being served particularly around can we make sure that there are Mental Health providers available to us. Can we make sure that if the benefits say they cover alternative medicine, that the providers are there within network . And could we think about the Third Party Support . Because having support in the navigation and advocacy were something members were interested in if they believed it was going to be a high quality benefit they could trust. Members also, a lot of issues around communication. Again, support around the advocacy and problem solving, communicating in general about benefits. I know that hss does a lot of communicating, but there was still a lot of things we heard about from people, where members just werent aware that the service was available to them. So there was they were looking for better communication. And another area where they were looking for communication was around the transition to retirement. Would say in every single focus group we held, this question came up, either from people who are approaching retirement, people who recently retired, questions around what is this going to do to my benefits . How can i plan for this . What are the implications for me and my family . There were many, many questions that people had about that transition. Then the last theme that arose was meeting populationbased needs. I know that abbie mentioned we had some focus groups specific to particular populations we know have specific needs. Some of those are first responders. Some are lgbtq members or members who live outside of the bay area. And there is work to be done to engage those subgroups and really make sure that were meeting the needs of those people. I want to note that there are some things that hss is already doing around those areas. That these acs are actions are under way. One is around the Service Standards and accountability. As h. S. S. Enters the renewal period, this is an opportunity to deepen the conversations. Abbie mentioned they were having conversations about access to providers, particularly Mental Health providers. As far as enhanced communication, there is an open position for a communications director. There is a search going on and when that person is brought on board, it is hoped they can promote hss Advocacy Services that do exist and make sure members are aware of when its appropriate to call hss. We heard mitchell talking about people calling during open enrollment, but one of the things we heard in the focus group, members didnt actually think to call the Health Service system when they had issues that arose. We might hear about challenges in finding providers, but very few of them called hss for the support that could have been provided. And lastly, around meeting populationbased needs, hss is working to develop strategies to monitor and enhance services to meet the needs of these groups and that is actually something that is part of the strategic plan. I want to talk a minute about just how the things we heard and the things that hss have opportunities to take action align with the strategic goals that have been outlined in the strategic plan. One of the things that members asked for was that hss continue to negotiate really hard for affordable comprehensive and high quality care. We heard a lot of apprecia