Madame secretary. Roll call. President breslin . Here. Vice president . Present. Commissioner hao is expected. Commissioner scott is present. Commissioner canning is here. We have a forum. Quorum. Number 4, please. Approval with the possible modifications of the minutes set forth blow, regular Meeting Minutes from november 14, 2019. Action item. President breslin okay. Has everyone read the minutes . I have no corrections. I would like this comment, according to the minutes i talk too much. [laughter] so im going to try to be better. I keep you all here. Its terrible. But i have no corrections. Since he has no corrections, ill second the motion. President breslin all right. Any Public Comment on this item . Seeing none, all those in favor, aye . All those opposed. There are none opposed. Its unanimous. Item number 5. Item 5, general Public Comment on matters within the boards jurisdiction. This is a discussion item. Please come forward. Good afternoon, commissioners, my name is richard rothman, retired city worker. I thought after i retired i wouldnt have to come to these meetings, but i guess i do. I want to talk about the health fair. I went to the one at city hall and i found out that some of the vendors there had staff who could not answer questions. So i think when you ask the vendors to come, they should have staff who are familiar with our health plan and can answer questions. Because i think thats a good way to get answers, you know, through their bureaucracy. Although, i did go back to the health fair the last week down in h. S. S. Building there and found out from delta dental for the retirees that i think theyve been miscalculating the retirees dental benefits. That 1250 maximum should be excluded from the dental cleaning and they were if you reach the maximum, they were charging people for the dental cleaning, which was like my wife. And although it clearly says on the dental delta form on our web page that part is excluded. So theyre going to change it for my wife. And i think the staff needs to make sure that all other retirees get the same adjustment. That they dont have to pay for teeth cleaning and if they reach the maximum. And the smile program, too. Thank you for telling me about the smile program. But i found out that the dentist, when they look in the system, dont know youre in the smile system. So you might ask delta dental to look into that issue, too, thank you. President breslin any other Public Comment. Seeing none, item number 6. Item 6 is the president s report. This report is given by president breslin. President breslin i just want to question and bring up something that happened at the last meeting. It was the employees Assistance Program report when they were talking about First Responders. And knowing they need Specialized Service, but then, when i asked about for retirees, would they be included, and they said no, they could get their counseling through the system. And, of course, this group of people, the First Responders need Specialized Service for them to just go to the Mental Health program and get regular counseling would not be work very well. So i think and it said theyre going out for r. F. P. Does this r. F. P. Include retirees. The r. F. P. On behalf of five city agencies are deemed First Responders and it is not my understanding that it includes retirees, but we can investigate that. We are concerned about the Mental Health access for all members and active members do have access to employee Assistance Programs and there are specialized ones for First Responders. The question that you raised on whether there is Specialized Services for First Responders in retirement is a very good question. And were considering that. Weve been talking with all of our plans about Mental Health services and about specialization for First Responders. And so thats a conversation that is under way. And i think its something that is obviously worth investigating, because, probably, for sure people carry these issues into retirement. And hopefully, theyre able to transition their care, but as youll hear later in our report about member focus groups transitioning into retirement has a lot of legs, that whole issue, and well add to that. President breslin yeah, this is really important because it may get worse in retirement, maybe not better. Because in retirement, they have less to do and lack comradery testify at work, so it often gets worse. I think the suicide rate is the heightest in the Police Department in highest in the Police Department in the country. My limited understanding from talking with members of the Police Departments behavioral science unit, there is a gap. I think that conversation is very important to have going into retirement. At least the first five years of accumulated Mental Healthtype issues, exposure to things and that certainly does extend to all First Responders and likely other members of the Health Services themselves. Im happy to hear that is something that is being considered for retirees. Yeah, and i think as important is looking at ways to prevent the stresses from becoming a Mental Health issue for officers and other First Responders, our wellbeing program is working with various First Responder agencies to get in front of some of this. So i think thats as important as treating a condition once it occurs. President breslin so this, you think, will be in the r. F. P. , something to do with retirees . I dont think were waiting for the r. F. P. On this. Im sorry, the r. F. P. That the First Responders are doing, i cant speak to that at this moment. President breslin thank you, id like to hear a report back on that. Okay, i have nothing else to report. Is there any Public Comment on this item . This is item number 6. Seeing none, item number 7, please. Item 7 is directors report. This report is given by abbie yant, the executive director. Thank you, good afternoon, commissioners and i do, before i forget, want to wish everyone a happy Holiday Season and stay safe and dry. Kind of nice to have a wet season. So today a number of things that i spoke to in my strategic or my directors report will be spoken to further on the agenda. I do want to call out that we did provide an update on the progress that weve made in this first year of the strategic rolling out the strategic plan. Its been a very busy year and weve done a lot of discovery and investigation into all of the many the very long list of business initiatives that we overambitiously outlined in the report. And we have made progress on many of them. We are as a staff, were going to work intensively next week to really revisit those business initiatives and to be smart about what were going to focus on in 2020. And so were looking forward to doing that. The details are in the report and if there is any questions, we can speak to those today. We also just wanted to update, because i did get news about the sutter inn. We recently learned that the Class Action Lawsuit settlement terms are scheduled to be released on december 13th, thats tomorrow. Thats an original moveup from the original february date. We dont know if the settlement will have impact on h. S. S. , but well report back as we learn more about it. There are a number of followup items that ive addressed in this report. And one of them is working with blue shield and the brown medical group. Weve had a number of conversations with both the organizations and ive invited to the brown and tollen medical groups to come join us today. Can you call up their slides. Theyve prepared some slides that help explain the changes that are going on within brown and tollen. And im very appreciative they were able to be here today on rather short notice. And i think we heard the last time about the disruption we had during our open Enrollment Period because of these changes. And theyve offered explanation and status of the organization. Ryan, if you would go to the mic and introduce yourself . Thank you. Chief strategy officer. And Senior Vice President of network and business development. A couple of things that we were here to address, one is just to talk a little bit about changes at brown and tollen, kind of viability, stability, high level representation of kind of where the organization is going. Recognizing we make up a significant number of providers in the city. And the second, well speak about the evolution with sutter and the impact that has had. Apologize for the technical difficulties. There it is. There we go. So just to quickly summarize. Brown and tollen, been in existence for around 26 years. Weve represented and are included in seven bay area counties. We have ambitions to grow across 10 counties. We have 106 specialties represented. We have a network of over 2600 across the bay area. Approximately a little less than half of that is in the city or the west bay. And over the last year and a half or so, the organization has gone a transformation to really move the organization to one that is sustainable, diversifying products. And really expanding our product set. Several hmo products as well. Over the last year, weve renegotiated somewhere around 15 of our plans, both hmo and ppo. Weve started to really turn the organization around in terms of physician reimbursement, implementing a 10 improvement in physician reimbursement for those in our network this year. Another 7 next year. This plan, as well as addressing some of the specialist pay. Weve also been able to strike additional hospital contracts. And increase revenues by about 12 in 2019 from 2018. Increased our network size, number of physicians by over 25 . And then reduced our kind of business expenses, corporate expenses by over 25 as well. So really, you know, focused on turning around the business. These five pillars on this slide represent our key the key elements of our strategic plan. We are now in well, 2020 will represent the third year of that strategic plan. And obviously, moving to the next slide there, driving really transformation across all of these areas. Improving our Care Management capability, which is really wrapping around the physician, the kinds of healthrelated services that it really takes to provide good preventative and intervention care. Focusing on a new infrastructure, new technology in the organization, add on economical price for physicians to be able to survive and thrive. Were bringing on medicare products. We have overall eight plans . Eight plans total. Three new ones for 2020. Could i ask you to come to the microphone so this can be recorded and i can hear. So we have four new plans launched in 2020 for brown and tollen, so we are growing with all of our m. A. Plans with all of the national affairs. And you are. My name is teresa. We are in some ways lengthed with fetter and we have over the years developed a complicated set of contracts with fetter and we embarked upon an initiative this year to do a lot of cleanup of those contracts. And recognizing that sutter has its own competitive ambitions, as we do we. We recognize that in the city, there were 34 primary care fashions that were part of s. P. M. F. , that would be terminating. Its not really terminating, but their contract with brown and toland would be expiring at the end of the year. And we created reciprocity agreements so that sutter could access the brown and toland network and we could access their network. That number is 34. We have in place today, a reciprocity agreement that does achieve what ultimately our new agreement is interested in also achieving in terms of reciprocity around both specialist groups, but it is quite old and outdated and were interested in establishing something new as the current contract expires at the end of the year. Weve been in negotiations with them on this for better part of the year, nearly half the year or so. We have an m. O. U. , were hoping to execute that will bridge us into next year. We hope to have the reciprocity agreements in place by the end of january. So teresa will describe about the nature of the impact of these 34 physicians whose contract with brown and toland expires at the end of the year. I have a few slides. So complete what ryan was saying, late 2018, sutter, brown and toland began conversations with look at all of the agreements we have to reduce the administrative burden, to operationalize it, but this also included the physicians, hospitals, ancillary agreements and all agreements under sutter. So it was quite a large undertaking. Somewhere in the summer sutter communicated to us it was going to build their own network in San Francisco so began the conversations with terminating those pcps from the brown and toland network. We began conversations with them about the specialist as well as the pcps we started to have different conferences to minimize disruption with the membership. Through these conversations, sutter held strong they wanted to terminate the pcps but were open to the specialists. So we began looking at creating additional agreements that would support brown and toland specialists, sutter specialists, being able to see all of the members on either side. To solidarity date were to date, were continued those conversations and both sides want to complete this and support that access. Next line. As we look at the impact to this group, when we did this snapshot, we do hold reciprocity agreements. So to the member, it should seem seamless. We have the ability to refer and they have the ability to be seen by anyone from sutter as from a specialty care, or vice versa, if they need to see a brown and toland specialist. This is impact to us because we hold the risk for us, so it is a burden that brown and toland is bearing to make sure we have that access. Members assigned to nonsutter pcps should not see a disruption in care even if seeing specialists in the Sutter Foundation. It turns out we have 34pcps terminating from the network. Network add quays. Of those remaining, 2011 are open. We have opportunity and capacity to move anybody who wants to be moved. So we do have Contact Information from the brown and toland side from Member Services. Theyve all been trained and equipped to help navigate that and select a pcp that may be in their geography or based on their choices. President breslin am i hearing there are only 34 that may have a problem . 34pcps, our roster has 34 that we are early nating from the terminating from the brown and toland effective 2020. President breslin they will to anyone assigned to those 34pcps will have to look at either staying with those physicians or choosing a brown and toland doctor. President breslin so theyll have to choose a new doctor . Or they can stay with the sutter pcp . Does that put them outside the network, if they stay with a pcp that is not contracted by you. If they select a sutter pcp, it is a different network, and i think only one of your plans have that. They have access to brown and toland specialists through the reciprocity agreement. They dont have access to the brown and toland pcps, but theyll still see the cardiologist, et cetera. Have these folks been notified this is happening and how . What is being communicated. Paul brown from blue shield. We have two plans with you. We have trio and the access plus full network. The physicians that are leaving brown and toland and going to sutter are in the access plus network. They are not in the trio network. There are approximately 1500 members that are impacted by these physicians who are moving. About 1450 are in access plus, so they do not have to change their primary care physician. They can change their medical group to sutter and retain that pcp relationship. Or choose to stay with brown and toland and choose a new physician. There are 50 of your members in trio that would have to select a new primary care physician, because sutter is not in the trio network. The good news is this happened in open enrollment, so we did member notification on november 1st. Were required by the dmhc to give 60 days notice. So we released letters to all 1500 members explaining their options around november 1st. Right during open enrollment, or close to open enrollment, so if anybody wanted to change plans to align with their physician or medical group, they could do so during that open Enrollment Period. So really minimal disruption overall. But thats how we handled this from the health plan perspective. Background to say i was one of the original brown toland specialists. I think i still have my certificate of ownership of stock. So the question i have basically is, if someone who was one of the 49 or 50 shows up at the wrong office, they show up at office of somebody who now is no longer with brown toland, what will happen at the front desk . They do this february 1st. What will happen at the front desk . If this member has been assigned to a sutter pcp well, this member cannot be assigned to a pcp at trio if theyre a sutter member. So they will be assigned a new one. If they go to the sutter physician, the front desk should run eligibility and say you are not assigned to this particular doctor. So can you assure us that the mechanism is in place that we wont get angry phone calls for people who check in because even though i know theyve been informed and gotten letters, mistakes happen. Absolutely. Commissioner follansbee part of the problem i have, obviously, i was a physician for many years, but for members, patients, these medical groups are somewhat transparent. There is hill and this and that and there are all kinds of things, so people get very confused and may not fully appreciate. I guess the question is, can you assure