We have a quorum. Thank you. Number four please. [agenda item read] anyone have any corrections to the minutes . I move that the minutes of the january 9, 2020 meeting be approved. My Public Comment . All those in favor say aye. Its unanimous. Item 5. [agenda item read]. Im chair of the retired Division United educators of San Francisco. I like to get up here to publicly thank diane who has been attending these meetings regularly. She is now been replaced who will be also assistant. Our new Health Service chairperson, she will be coming here regularly too. We want to make sure that diane get some public recognition for amazing work shes done for all of us. We are in her debt and appreciate it. Well continue to be part of the Health Service committee people. Thank you. Thank you diane, i know shes watching. My name is gail, im from retired teachers. There are couple of issues that have come up in the time that ive not come here. First of all, i like to know if theres a help line for people to call when they have a dental plan and they are charged something that doesnt fit our formula . Thats what happened to several people. They pull you to a room and they say this is what it is, this is what you covered, sign. I like to be able to call somebody with the u. H. C. Dental help line crises line, support line, something. Also, for kaiser, several of my friends are diabetic and theyre on this medication called med forma, have you heard about it . It seems that its been recalled several times because theres a direct correlation to cancer. Fairly, soon too. Its like you wait 20 or 30 years. Its within five to seven years. I know two people that are on it. The third person is 92 and she got off of it but it was so expensive that the doctor, the caretaker at u. H. C. Got a coupon for her so she can afford it. The waiting time was about a month for her to transition in to the medicine and its working quite well for her. Thats my other issue. My third one is about hoping for the board to consider having this charge meal deliveries for kaiser as well. Its a wonderful thing to have for u. H. C. Thank you. It seems that u. H. C. Medicare p. P. P. O. Are allowed 84 home delivered meals per calendar year. Can kaiser provide some kind of home delivered meals for people who had post delivery and postoperation situation . Thank you. Somebody will followup on the delta dental issue. I have a question, med forma, thats been taken off the drug list . No. All right. Any other Public Comment . Hi there commissioners. Im a city employee. I want to try get through three points that i like to share with you today. The first is regarding initiativeinfertility benefit. My experience was validated by data and unfortunately it was not unique or isolated. For my current understanding, the memo that was passed voted on by the commission in november, makes no measurable impact to lesbian couples or single moms by choice. Im hoping that im misunderstanding but i would love to be correct. It makes no measurable impact. I do believe the commission heard the concerns. If theres no further action is considered, i wouldnt want to waste your time or take my advocacy elsewhere. The second item i like to bring up is in regard to specialty medication thats not covered by copayment. I brought this issue up many months ago. This is my experience. If i can have the overhead turned on . Specialty drugs that are not covered under your copayment, its 50 of the negotiated rate. Its what you pay. This was an example of prescriptions that i was given. The rate that i was given with my insurance, this was the cost, the rate the pharmacist was nice and give me if he paid 100 out of pocket, this was the cost, significantly less. I called a local pharmacy, because this pharmacy was in boston and this was the cost thats not core covered under insurance. 100 out of pocket. Significantly less. By suggestion is to request negotiated rate for 75 to 100 most prescribed specialty drugs. Then have 1822 or 1823 analyst or even an intern call those pharmacies that are covered under the plan and ask for the out of pocket cost. Then negotiate or demand a better rate for those drugs with the discrepancy and the cost and at minimum, it is the responsibility of the department to notify every Single Member that if you are prescribed any of these drugs with a list, you should ask what the out of pocket cost is and pay for it that way. Third item is in regard to the paratransit contract. This might have been dealt with already. We already dealt with that. I think it was a misunderstanding. They take on wheelchair people but they want d they get then but they bring the wheelchair on. Wheelchair the person right on to the truck or whatever it is. Okay, glad that issue has been dealt with. Thank you can i ask one question, item 2, to make sure im clear, the freedom on the outer pocket expenses, is member responsibility for freedom with insurance 50 , not half of that negotiated rate. That is the negotiated rate. Presumably the rate they quote was 1600 for go now. Is that what you saying . Correct. This was what i was quoted would be my cost. 1600 opposed to you spending 479. Okay, this helps me understand. Thank you. Any Public Comment on this item . Item number 6 please. [agenda item read]. President breed i want to welcome dean preston to the board. I think we all look forward to working with you. Thank you. Supervisor preston thank you very much. President breslin thats all i have on this report. [agenda item read [become. I want to publicly acknowledge dianes service, wish her well. And welcome gail to the position that youre now occupying. The directors report, the first item on there is the vendor blackout reminder. We are in negotiation season with our vendors. That blackout period begins today. Theres memos attached to my directors report instructing the commissioners on what that means. If you have any questions, please let us know. The board election, theres a seat open for a member, nominations are due by tomorrow. We will let folks know what is received at the end of the day tomorrow. The federal antitrust case as you know, had a preliminary settlement and as i understand it, the final settlement scheduled currently for februar. We wont know the details of that after that date. With the question last month, i believe commissioner lim about the blue shield cards and some folks were confused why they were getting them. Marina enterprise systems and Analytics Team did a very thorough research of that issue. As many things in the complex system, there was no one reason for this. There were several. They are all being resolved as we speak and were monitoring that situation. There was also question as to the references benchmarks that we were using for the postenrollment survey report. Theres details in the directors report. I think youll be reassured that we are using standardized benchmarks. Also of note, our pamela levin has announced her retirement. I want to congratulate her on a major life decision. Just restate for the record that pamela has been in Public Sector since 1982. She worked in various cities across the u. S. After 13 years of working with city and county, she was selected to be the chief Financial Officer for hhs. She was helping drive our financial and operational improvements. Shes played a significant role in helping us develop our Strategic Plan throughout the years and having an impact on health plan and premium cost containment. Were appreciative, shes helping us facilitate a very smooth transition. We will begin the recruitment process for her replacement officially in march. Weve already secured all of the approvals and have the money in the budget and blessing of dhr to move forward with a successor that we aim to have in place long before she leaves so she or he can shadow pamela over the six months prior to her departure. On behalf of the board, and the leadership team, and all of our members we thank pamela for her dedication. She will begin her next journey in santa fe, new mexico. She had lot of time to reflect on her 38year career shes delighted to looking forward to retirement. Im sure well be having a celebration which all will be invited. Pamela, thank you for your service. [applause] a topic of discussion that we have had at several board meetings. Weve undertaken an effort to put together a proposal for new General Fund Budget to expand our e. A. P. Services due to the increasing demand. In this proposal, we are coordig with other city departments that have e. A. P. Services. As i mentioned, at this time, the Fire Department and several First Responders agencies have prepared to request for proposals. It is not yet public. It is likely to go out in march for external e. A. P. Services for the First Responders. M. T. A. Also has a contract for externally e. A. P. Services. Theyre a significantly large department. Were working with workers comp regarding new law that makes posttraumatic stress disorder as a work injury for Police Officers and First Responders for claims filed after the first of this year. Worker comp claim can be filed with up to five years postemployment. Thats a separate piece but obviously closely related and were joined at the hip with the department of Human Resources so these messages may get very confusing. The e. A. P. Program expansion will allow us to serve more City Employees and continue to advocate on behalf of our members with our contracted health plans and share the proposal with the board when it is complete. That will be relatively soon. I understand it, Mayors Office will be requesting a new budget proposals during the month of march. President breslin i have a question. You said theres an r. F. P. Coming out our department . Correct. President breslin coming out of our department . No. President breslin just out of the Fire Department . Yes. President breslin that would coordinate with our e. A. P. . Yes, we throughout this whole conversation thats going on for six or eight months. Weve been recognizing the need to coordinate our services. We have limited resources. We can all benefit from better coordination because the workforce out there with Mental Health counselors is what it is. Theres a Workforce Shortage. Its important that we understand how were all accessing and using services so we can be advocating for the right priorities at the right time from the same page if you will. Its been a really rewarding opportunity to work so closely with the Fire Department and the Police Department and m. T. A. On what theyve done in the past and where they like to go from here. During this last year, weve worked closely with our e. A. P. Team to be sure that other members, as well as First Responders, should they have access issues with any of our health plans, that we have all the plans on speed dial and have a shared understanding of how we can resolve issues when they are brought to our attention. President breslin anybody with an issue will go to one phone number . We havent gotten to that level of detail yet. I dont imagine that will be the case. Certainly as i understand it and commissioner canning can comment. The Behavioral Health in the Police Department has been in place for many years. They have very extensive Peer Support Program and other services that in that culture, theyre accustomed to accessing. Those are things to be discussed. I spent some time with the Police Yesterday talking about possibilities on how we could Work Together to better coordinate our efforts on behalf of our members. Let me followup briefly to that. There are two concerns, one is the access of technicians or practitioners who can support a population and providing additional benefit to the entire population we serve with the understanding that there are particular groups that are exposed to trauma that may require some additional attention. I was curious as this r. F. P. Goes out, members of these agencies are concerned they may lose access to that pipeline they used to accessing for severe, not chronic opposite of chronic. Acute, when they are suffering from a need. If anything, were wanting to support the efforts that have been so successful thus far and to ensure that they remain in place and enhance them where were able to. President breslin we brought up including retirees in this. I know that ptsd inclusion now, that was for five years after retirement. I think thats very important. I was reading this morning about access. The statistics are pretty dim. I suspect this will be the biggest problem. I dont know what the reimbursement rate will be for h. M. O. Ps. This is a problem with physical therapy and other issue. I think thats going to be a big issue is how these providers reimbursed. I know that was a discussion point in the development of the r. F. P. I cant speak to whats in the r. F. P. I havent seen it and i couldnt talk about it if i had. Theres also the fact that theres a market in play here. The demand for Mental Health counselors is up across the board. Its definitely increasing the reimbursement rate for providers. I know that kaiser has experienced and is responding the needs of their members and their workforce. The dollars that theyre setting aside for improving mental Health Services is certainly helping them and their members. That in turn, just following basic economics will play out for the other carriers as well in order to have the providers on their rosters, the reality is, theres a limited number of licensed Mental Health counselors. If you think about it, it kind of makes sense that the Mental Health system has been functioning as system that only really was focused on the severely mentally ill for the last four years and earlier Intervention Services and counseling and such was not as well utilized and demandedded for as ieddededdedfor demands today. The ability to hire new counselors no matter what you pay them is really limited. Theres not that many. Itsag. There really is a need fn r. N. , ive experienced nursing shortages every 10 or 15 years. It seems theres often a table created to address the Workforce Shortage. Im not aware of that. I know that individual companies and carriers are trying to address it. I dont know that weve had a collective effort to address that issue that i found yet. President breslin [indiscern ible] essential it will help. Any Workforce Shortage situation, you need to look at the pipeline. What attracts people and what brings them in to the workforce. When i was speaking to mr. Howard yesterday, he was explaining, theres a significant number of internship hours that licensed person needs to acquire in order to get their licenses. Those are often unpaid internships. Its either thousand or 2000 hour. Its somewhere up there you can imagine how difficult it is for people in this city to be doing that number of hours without compensation. I know those are the types of things that Workforce Shortage folks are looking at. President breslin thank you. I want to point out overlaps in housing. I know every pay grade, housing becomes an issue in the bay area and San Francisco becomes unattractive even for the people who do have licenses and would be able to practice in all oft. This is really monumental issue. To the degree, it can be helpful helpful, mental Health Services seeing uptick in utilization. Which can work for some population but not all. I did have few other things to add to the directors report, we have hired some new staff. Hes joined the enterprise system Analytics Team. He has a background in Health Metrics research. We will be the one that will be helping us on Population Health approach to h. H. S. So welcome. We also have two benefit technician that have been filled. Welcome to the team. Weve been we had two projects that have been regard to get to the final implementation date. One is getting our Credit Card Service up and running and the other has been the new telephone system. Im not sure whos going to get to the finish line first. The. Just got an update today one telephone system. It is moving forward and we are projecting go live date in march. The credit card system, im not sure that we have a go live date yet. It too will be very soon and that will help a lot of our members that have to make payments and make things much easier for folks. Were looking forward to those operational improvements. That concludes my report. Vice president follansbee ge tting back to the blue shield cards. I appreciate that we had an extensive look to see what the situation was. Was everyone identified who received inappropriate card, were they proactively contacted to make sure they understood that card was not active or needed to be destroyed . Member who brought it up and the supervisor lim, other members maybe confused. Im not sure if were aware if everyone has been contacted. We know who everybody is. I know that blue shield is not here today. Its a useful practice to make folks aware. Vice president follansbee i would like to add my thanks to pamela levin. Its been a challenge to not appear too stupid. Shes always dealt with me and my questions with calm and expertise. We have six more months to come up with a question that really is too stupid. I appreciate your expertise and ability