That is our intention . And i just want to close with your questions. It feels like a half a dozen topics, but it could be a few more. But these are items that are being discussed, and i really appreciate you raising them and starting that dialogue here. Supervisor preston and thank you for your willingness to have the conversation, and thank you to all the frontline workers who have really formed both the questions and stood in the ontheground reality with folks that are living this crisis. I appreciate everyones work on this, and thanks again. Thank you. President breslin any other comments or questions . Vice president follansbee yeah, this is commissioner follansbee. I think [inaudible] Vice President follansbee regarding potential usefulness which is, of course, not firmed. So the bottom line is if a patient did not get their medications because of some complicating thing, we shouldnt be rewarding the rates based on the unavailability of medications because of overutilization elsewhere. One other thing i want to make very clear is we as a board have a very Important Role to make sure that people can manage their health care as appropriate. Theres been a National Trend of underutilization of Emergency Rooms for things like strokes and heart attacks and progress with incredibly body outcomes. As we talk about rate doe rate to make sure that our members, regardless of this effect on future rates is critical to a healthy population. So i dont want anyone to walk away from the board feeling today that we are urging them for some future rate discussion to not utilize the health care that they are entitled to in any way, sense, or form including mental health. And then, the last thing i want to mention is c. D. C. Guidelines around personal protective equipment and issues. I think were all aware of the issues that happened in some of these agencies that are novel or enhanced. And im hoping that these policies that are prevalent in all of the medical centers and clinics are being reviewed by the expertise that exists within kaiser itself, and as an Infectious Disease physician, now retire, i will applaud my colleagues and hope that theyre having discussions into personal protective equipment, used and not used and not simply relying on some federal guidelines, which, when i read them, to some extent, theyre appended by when appropriate or when possible, and that is not really in the interest of employee safety or protection. So im assuming that not only kaiser but all of our Health Care Partners are listening to their own expertise as they develop programs and plans for issues such as this. I dont have any questions, i just wanted to talk. Thank you. President breslin any other questions. Yes, commissioner. This is clare zvanski, and i want to get to utilization because i do Pay Attention to marinas demographics and the reports that she puts forward. And when i was listening to some of what lorena was talking about in regards to setting of rates and utilization, i noticed that no one mentioned age, and while im looking at and i appreciate all of the kaiser staff that was here and appreciate the comments by supervisor preston and totally appreciate dr. Follansbees comments, im thinking overall. One, is this demographic that were working with here with early and active retirees, do we have some kind of skewing of the average age that were looking at, and does that have an impact on utilization [inaudible] really are impacted by the age of the population that eve were looking at here. And the last thing that i want to add a comment on, it doesnt impact currently. But while the utilization may below right now in 2020, its still a fact that people are afraid to go out. And the message to our retiree members is you need to get your health care, and youre not walking into a contaminated area at kaiser. The people that are hospitalized with covid infections, its one thing to say okay, youre symptomatic and you have the virus, but if youre hospitalized, and you need that treatment, and people are staying anywhere from two to four to six weeks being hospitalized and under incredible treatment, that the cost of those kinds of treatments will probably offset the utilization of any other kind of utilization that most of us are used to, and i wonder if you have any speculation with regard to that. Something im really interested in is how age may or may not have influenced rating. Thank you. Thank you for your question, commissioner zvanski, and welcome back to the Health Services board. I very much look forward to working with you as youre welcomed back to the Health Service board today. Thank you. Let me address the first part of your question, and then, id like the kaiser representative to address the specific covid19 treatment impacts. This particular segment of the sfhss membership in the Kaiser Permanente plan is approximately 90 of the members or roughly 50,000 total members and their dependents and approximately 5,000 total lives are early retirees and their dependents. And as part of our overall review, when we periodically work with kaiser to evaluate costs and utilization information and also produce the renewal, we do look at employee utilization cost and utilization. I fully recognize today that as we have this discussion, we routinely present to the board every year our experience on Blue Shield Health plans and united city plans, and we do not on Kaiser Permanente. So we will be working to present Kaiser Permanente on an ongoing experience in a similar formality. Recognizing that that was not part of this years cycle and i dont think its been a part of prior years, so clearly, something we need to bring to the board Going Forward is the same type of information on kais Kaiser Permanente cost and utilization overall every year. One statistic that we reviewed this year is 92 or 93 of total covered lives in the kaiser plans between active employees and retirees is the difference between the 2018 and 2019 experience. We call that persistency. Its a basic word, but it basically means one percentage of the total population was covered last year because we would like to see patterns of change not only on the entire population but also whats happening on a constant enroll population on an aggregated basis between one year and the next. In that instance, we having observed certain demographic changes. You will recall reetas report from two weeks ago, there was a risk of about 2 to 3 in this kaiser population, so were keeping a close eye on that as well as the overall utilization pa patterns and the data. With that, i will turn it over to kaiser to answer your second question. Hi, commissioner zvanski. You were breaking up a little bit on the second part of the question, and i think it had to do with the overall utilization during covid and covid related treatment and others, so maybe if you could clarify what youre asking, and ill make sure that we answer that. Well, i was just wondering that it seems to me that there are extremely high costs in treating covid19 in the hospital, given the nature of how it needs to be treated, isolated, the intense staffing, and also the extremely lengthy actual hospitalization. And if the costs of those treatments and i dont know how many patients kaiser has with covid19 and if any of those are from our population, our membership. But the extreme cost of those treatments, that would really supersede utilization rates that would be set by what we normally look at as the everyday treatments of going to kaiser, whether its the colonoscopy or taking the kids in or whatever it is. Seeing that, in my brain, it says the costs to those hospitals are going to exceed anything that people are talking about with current utilization of low regular health care benefits. Does that cover it . Yes. Thank you for that. Were all watching this very closely. Youre correct. Were all watching the severe covid19 cases, and they could be very costly. Whats key is reviewing information regularly and reviewing your actuary and the board on whats happening with the utilization. So there is the covid19 costs and there is the possible pentup demands that can be very real, and then, the possibility of a second wave of this. So a lot of unknowns, but youre right. Those are the types of costs that were watching very closely as we go forward. And as it relates to how your rates will be impacted, we will be looking at this years utilization when developing the 2022 rates, and that will play out in that rate discussion. Yeah. Just to add one small additional item as part of what kay was saying around the pentup demand, etc. , as kay said earlier, we have been partnering with test city San Francisco, but also in our own facilities, theres the covid19 testing, the expectations and desires of Many Employers to figure out that dynamic before they return to work, as well as the Antibody Testing that were really just starting to get our arms around in terms of the Antibody Testing and if were fortunate enough seeing, if its produced before the end of the year, the costs associated with delivering vaccines, etc. So theres a lot of nuances that will happen, not just for those that end up in i. C. U. Care in the hospital and in those dire straits. I appreciate that. And because we represent a lot of the folks that are first line workers we have police, fire, paramedics and im also hearing from a lot of my colleagues working at sfgh who are meeting people every day who are coming in for services through our facilities, as well. And so all of those employees and we are disaster workers the concern is, youre right is youre right about testing. I think a lot of employees feel that if were on the frontline, we need testing, and possibly periodic testing, multiple testing. Its not like i test today, and oh, im covid free, and hooray, i go off. Its going to be more than that, so i appreciate your comments. Thank you so much. President breslin okay. If there arent any other Board Members questions, ill ask for a motion supervisor breslin, if i could go back, supervisor preston asked a question that i was able to get an answer back on. If any of our care providers test positive for covid19, they are put on a paid furlough for two weeks until they test negative, so they are not asked to work. Whether they have symptoms or not, if they have a positive test, they are on a paid furlough for two weeks until they test negative. Thank you. President breslin okay. Does anybody commissioner breslin, this is randy scott. I would move that we accept the presentation as presented on page 21 of the presentation. Number 1, that 5. 8 insured plan increase from 2020 to 2021, and the resulting rate cards that are identified in the presentation. President breslin is there a second . Sorry. This is commissioner hao. I second that. President breslin okay. Now well have Public Comment. Remember, this is item number 4, kaiser. Clerk thank you, president breslin. Were going to take a 30second pause to allow for members at home who are watching us on sfgovtv to hear this advisement. I want to remind everyone calling in, you must press onezero to be added to the queue. Otherwise, you will be just living to the listening to the commentary and questions by the commissioners and mr. Clarke, so were going to wait 30 seconds for the callers. Thank you. Clerk all right. Well now begin the Public Comment for item number 4, Kaiser Permanente nonmedicare rates and premium contributions. Moderator, will you please open up the lines for the first caller. Operator you have two questions remaining. Clerk hello. Good morning. Hi. This is [inaudible] from the San Francisco labor council. I understand these rates need to be approved for the upcoming fiscal year and but it does not excuse kaisers poor performance regarding p. P. E. S. It does not excuse kaisers attempt to silence and gag workers that work for it. City employees need to go somewhere where they can go and know that theose workers have the absolute right to speak out against kaiser in a concerted and collective way, and that i think that the board of supervisors needs to have a hearing on this and change these timelines so the community can, if need be, look for someone else clerk miss, thank you so much, but your time is up. And take care of the workers. Clerk thank you so much. We appreciate the comment. Thank you. Moderator, can we have the next comment, please. Operator you have two questions remaining. Hello. My name is sylvia alvarez. I respectfully urge the commissioners to vote no on the increases to the people of the city and county of San Francisco. Kaiser has millions that they can spend more wisely to address the Health Issues of its members. Thank you. Clerk thank you very much. Moderator, can we have the next caller, please. Operator you have one question remaining. Clerk hello. You are on the Public Comment line. Hello . If you are here to give Public Comment, your line is open. Okay. Moderator, can you please see if any other callers are left on the line, please. Operator you have zero questions remaining. Clerk okay. Thank you very much. President breslin, that concludes Public Comment on this item. President breslin okay. So the motion has been moved and seconded to approve the staff recommendation for Kaiser Permanente nonmedicare rates and premium contributions california members. All those in favor, signify by saying aye. Any opposed . All right. Then, this is unanimous with the ayes. Okay. The motion passes. All right. Now, i suggest that we have a tenminute break at this time since weve all been sitting here for almost two hours, so we will be back at 1 10. Is done by mike clarke from aon. Mike clarke, aon. Next slide, please. This will review a quick preface on rate setting methodology. Ill focus specifically on blue shield of california plan elements. A 2021 plan rating summary of the blue shield renewal, present the monthly rate cards for the access plus and trio monthly plans for early retirement employees, close with a recommendation for Health Service board action, and information in the appendix is information that i will not be reviewing in todays presentation but is available in the deck. Next slide. Next slide, please. So in the last presentation, i reviewed this page in detail. I want to just remind on only the flex funded column as that pertains to the Blue Cross Blue Shield of california h. M. O. Fund. Flex funded means theres an insurance approach where there are claim dollars based on services by members. These dollars are paid by the trust but with fixed costs for services and health care. For example, this covers physician services, laboratory costs, radiation costs, and other services that are typically part of a physician element of delivered care. As well as Plan Administration fees and large claim reinsuran reinsurance mechanism whats calling pooling. I as the aon actuary set the recommended plan rates for the access plus and trio plans using cost determined trend plan assumptions that i validate as the actuary with required pooling fees and legislative fees that we also provide scrutiny over as the actuary. In the last row, you will see that this flex funded plan does have application of the Health Service board Rate Stabilization policy, and to the extent that there are claim variations from original forecasts in a given year to address the concepts that supervisor preston asked about in the earlier presentation, any change in experience will flow to the Rate Stabilization reserve for future reuse in rating of the flex funded plan. Next slide. Same fivestep process that we used before, accounting for any design and head count changes, which again, no plan design changes are proposed for 2021 for this plan. For blue shield specifically, before Rate Stabilization adjustment, access plus would be recommended increase of 4. 4 , and trio, 7. 1 . I will speak shortly as to the difference in rating recommendations for these two plans. After Rate Stabilization adjustments, the increases are less than before Rate Stabilization adjustment because we have a surplus in Rate Stabilization that was approved by the Health Service board earlier in this rates and benefits cycle, and so the blue shield access, its 4. 5 , and trio, its 6. 3 . You can see the placement of the plans on this page that we reviewed earlier in the kaiser presentation. For the monthly total cost rates that are recommended for each plan, comparing 2021 recommended rates to 2020 actual total cost rates and showing the dollar difference and percentage difference in those rating forecasts for 2021. Next slide. And this is a reminder of the two contribution approaches that are displayed on rate cards for the active employees in the city and county of San Francisco. Next slide. And a reminder of the three contribution components from the employer from the city charter for early retirees. Next slide. And with that, i will start with a recommendation to the Health Service board and then explain the rationale for these recommendations. The staff recommends that the Health Service board approve the blue shield access plus plan renewal proposal for a 3. 6 rate increase from 2020 to 2021, the blue cross trio increase of 6. 3 from 2020 to 2021, and the rate cards presented in the Materials Today