Transcripts For SFGTV Health Service Board 2917 20170210 : v

SFGTV Health Service Board 2917 February 10, 2017

City, we arent that large that we dont really have [inaudible] of San Francisco. And clearly a number of steps have been taken, but they do appear to take an awful long time to get there. Even if we ignore the fact that this is a 2015 report because we did get an update on the current priorities and in 2016, were hoping to hear better information, but the fact that after all the discussion, that saint lukes is just an example. It has taken almost three years in order to bring about one additional bilingual staff member. And was apparently some question that there is community input. So i believe that from at least the health standpoint, we certainly are on point with most of the agreement. I do think that im somewhat concerned from director dods first comment that we didnt have the fee assessment within time, but we had agreed to have an assessment and i would ask staff that those points that are in compliance or within the compliance, but clearly if were behind in that, then the issue of the cost of our health care for City Employees may in fact be overstated, if in fact the study shows that there were problems. So i think that needs to move forward. Its a small point, but so many are on our city plan. I would think that i dont have all the details on how that audit was supposed to work, but if its supposed to be sure that the rates are appropriate, then we need to be sure about that a lot earlier or perhaps its within the time schedule. Im not sure. But i do think we need to understand that a little better. I think the other broader things that i would also like to echo is that i think that going beyond the letter of the agreement is the spirit. And the spirit does say that we involve those who actually are in need of the care from our communities and may be able to benefit and even better, to be able to enhance the services that may well be provided and our commissioner spoke about other organizations within each of the communities that may well be a synergy to the work owe open Advisory Board comes up about how formal and how informal, but to have the community input. Its what we do at the department of public health. We actually hold all these hearings and involve we must have three, four dozen Advisory Boards so that we understand what the communities what our target populations need and therefore we can also have them as partners as we move forward to the goals that we have for our own organizations and i would say that where you have two campuses in two great areas to make that impact on our communities, working with the communities really is going to make an even better agreement and a Better Health care system for all of us. So i would encourage that, and lastly, i would encourage we not only look at the letter of whether or not we are meeting cultural competence, but its really an issue of are we actually creating a better environment for Health Care Decision making, which is what its all about. So its not merely complying with the very pretty picture of 15 standards and where we have all the people in place to do it. Thats a progress and a process, but that we understand the outcomes. You have that on your interpreters but i encourage as we look at this and the class standards, and theyre not there to be checked off, but to be there to be sure and its not easy. We have made a difference by having appropriate class standards and not just the numbers that we have. From our standpoint, i commend our own Department Staff for the work they have done in responding to this. Thank you for cpmc for filling out all these forms and thank you to the Health Commission and thank you to city staff. This is a ton of work and especially to the coalition that have been a driving force in get this agreement done and implementing it. So thats all. Do you want indeed it is. I believe the commission will break before our regular hearing for 30 minutes. Yes, if youre here for the 12 00 Planning Commission hearing, were going to take a break. Were finishing up our 10 00 meeting and well be back here at 12 45. Thank you. Good afternoon everyone. I wish to call the regular meeting of the Health Service board to order. Would you be jointly in the pledge of allegiance . [pleage of allegiance] thank you i will call on her secretary to call the roll call president scott present lim present harrisdawson here supervisor farrell excused ferrigno expected to involve the present sass present we have a quorum thank you. We will now move to action item [inaudible] as the president of our Retiree Association enters the room lightning, thunder and static all the same time. [laughing] again, we will now move to action item number one secretary item number one approval with possible modifications the minutes set for forth below regular meeting of january 12, 2017. I call for this time for any additions, edits, to the minutes of the last regular meeting of this board . M. Sass yes. I think its on item 7, the third bullet theres a reference to governance code section 53 600 i think the california code g3 600. Thank you you are correct. All right. Any other edits or corrections were additions . If not im ready to entertain a motion for adoption. Moved to approve moved and seconded up the meeting of regular meeting of january 12, 2017. Any discussion on the board . Any Public Comment . Hearing none, and seeing none, we are now ready to vote. All those in favor say, aye. [chorus of ayes. ] opposed, say nay. It passes unanimously the edits. Item number two item 2 discussion item general Public Comment on matters within the boards jurisdiction not appearing on todays agenda. We are now calling for any item or Public Comment for any items that do not appear on todays agenda. Is there any Public Comment . Hearing none, and seeing none, no Public Comment we will now move to our next item which is the rights and benefits committee. Again this is for those of us were not always playing inside baseball. We used to have a Standing Committee[static] we used to have a Standing Committee of the board on rates and benefits. That committee was dissolved when he amended our terms of governance a few years ago. Now the board handles matters of rates and benefits as a committee as a whole. So that is what we are doing at this time. We are addressing items that would come before the rates and benefits responsibilities of this board. The first one is action item number three and are secretary will call that out in just a moment. We try to find out with the static is. Be on my talking in the room. Im sorry no problem item 3 rates and benefits thank you item 3 action item initiation of blackout period for all hss vendors for duration of 20 teammates and benefits process. Director john director dodd each year we agree to the blackout period. You have it in your packets. Other questions . This means you dont have conversations with the vendors that we are negotiating with. Are there questions . That means, just as a point of clarification, any contact. We really should not be engaging the vendors directly as members of this board even when we are not in a blackout period because sometimes those matters will come before this board to be voted on in that member may apply themselves conflicted as a result of having having had a conversation get this is particularly true when were in a bidding process. So there are specific guidelines for me to follow. If theres any questions, i would ask that you direct them to the board secretary or to our counsel. So that we all clear about what we are doing. Is there any board comment on this action item im willing to entertain a motion for its adoption . I move that we approve the blackout period during 2018 rates and benefits process peer is there a second . Second. Spews is been probably moved and seconded that we adopt the guidance in the blackout period. Any board comment . Regarding Public Comment . Hearing none, and seeing none, no Public Comment, we are now ready to go. All those in favor say, aye. [chorus of ayes. ] opposed, say nay. The motion carries. [gavel] action item for item 4 action item approved city plans administrative fees for 20 team plan year into it we now bring to the podium and gentlemen thats going to be with us through the rates and benefits process. Estes english ashbury from a on. And i think that we are is that going to come up on the screen . The presentation . Okay. Thank you good afternoon. Actuary. Duly noted as your distinguished actuary. So thank you ray much. I looked up my colleague from unc over here because we have two benefits that we are adding into this exercise for the administrative fees for the United Healthcare city plan, [inaudible] for active in early retirees. You have before you the deck that outlines with the fees were. I ask you to turn to page 3 of this deck. Right now, were being 49 dollars and . 95 for a set of services that heather can outline in more detail if you ask any questions. The proposed increase for 2018 is 43. 04 and i would like to let you know that this includes . 44 great benefits known as reproductive Resource Services. So i wont say anything about that benefit but that benefit is included there. So the overall increase is 2. 6 initially we got a higher number and renegotiated with my colleague at this, United Healthcare. They added the . 44 in and reduced the cost. So starting from where we are to where we are now like to highlight the fact that they were flexible in giving us a very good renewal and we want to acknowledge that publicly at this time. So i will continue with the overall set of numbers and then i will askalso included in this is a real appeal but thats acclaimed based program so was not part of the administrative services. It is a program thats going to be offered but it generates a claim. So its a service that they can now have. Before i go forth i like to say in addition, under the United Healthcare structure, there are various components of how they do business where if you go to outofnetwork provider they negotiate a lower savings than what you would have gotten and eight you share the difference in the savings. So some of these numbers are basically the first to the shared savings in the reasonable and customary are allocations to the administrative fee because you will get a charge for those dollars. You will see the net fee and then you will be paying United Healthcare. They keep 35 of the savings. So with that being said these are revised numbers valuebased pricing is that they negotiate with contractors to do something analogous to our hcl and youve heard about claims targets before. So this is an allocation to fund any incentive payment and so we left it at the last years allocation and with all that being said, i would like to say that we have good news. Weve added our fee is that we put in our sustainability fee for what is paid to hhs. We priced and our shared savings. Weve added the . 44 were buried in the renewal. We have a new program. And we are recommending that you accept these fees which means the overall cost impact is [inaudible] what is not presently in the rates at 49. 49 to 51 and 61 something if you do not mind, i would like to stop here and let heather outlined the two programs and then we can go back to business that would be fine. Please, give your name full name and your responsibilities thank you good heather shen l United Healthcare on your accountant executive for city plan. Active in early retiree thank you you are welcome reproductive Resource Services i know they provided a flyer. This program we recommended the city is looking to enhance and does have a nice rich set of benefits around the Fertility Services that they provide for your members were doing with that. When we use the reproductive Resource Services this gives a clinical nurse case manager to those families that are doing with the reproductive infertility issues and helps them both understand everything thats available to them, help them find centers of excellence that about i success and are highly rated with her providers and really got them through that process for all the resources that are available. So this would be a program that is built in and would be available for anyone that has the need to use or want to use the Program Giving him a clinical support. If you would just cause there. Dir. Dodd is this consistent with the other Health Plan Providers are doing similar . It is similar but it is actually more than the other health plans are doing. All right. , thank you. Okay. The real appeal program is something we are excited about. Aion and hss vastness was United Healthcare doing to help control diabetes and other chronic conditions and so real appeal is a fantastic Interactive Program that would be available. As i mentioned theres not a cost for this program because its a clinical weight loss Management Health management program. So its available for anyone that would have a bmi of 2329 or 30 and above and potentially comorbidity condition did so they potentially have diabetes, Heart Disease hypertension, and so what is done is that members who i can we do a full rollout implementation of this plan so your members are aware of it and then the members actually have a clinical intake. So that is done with someone to understand all of their needs should once they are essentially approved and enrolled into the program than a claim is built like a medical blanket we have a Network Within our system or these clinical providers would go a claim. It is great because its not where the sixweek eight weeks work and help you. This is a full year. Its 52week program. Ongoing they will have coaches that they will meet with virtual imaging they work with. You have seen the materials potentially does a wonderful kit that literally is shipped to each member. This has workout dvds. Has a blender. As a weight scale. It has all the tools and resources for Healthy Eating. This no cost to the member to get this. Once they have that they will work with her coach to the great thing about this program is we do not build a claim unless a member is being successful and they are on target. So if they continue to work with her coaches and have their meetings and meet their weight loss goals as they have those coaching sessions that additional claims are billed through the system. So its great support tool. Not just for weight loss management but for chronic conditions as well. Thank you, thank you very much. Thats quite a feature. Are there questions from members of the board . Yes. I like to ask a couple of questions. What about on real appeal. Take up positions order . No. Okay. You mentioned to bmi ranges. Is the 2329 with a cold morbid and then anyone 30 and above regardless of what they have regardless okay. We can even talk about that and has some flexibility in there to make sure meeting the requirements of the population that we want some get some axis did so part of the intimidation will be ensuring that we are doing a good job getting to anyone whod benefit from that program. So theres no prescribing of diet or anything . Theres no physician component professional component you are doing is theis the dietitian interestingness . Yes. The clinical coach with as a background thats working with them. Yes. Okay. Commissioner harrisdawson in calpers in their letter they start january 1 all Calpers Health plans are required to offer Diabetes Prevention programs and they must meet the center for Disease Controls innards. At no cost to a notable members. Do your standards me back the center for Disease Control . For the real appeal program right. Yes. We can get Additional Information. We can even have some someone from the real appeal program, at a future meeting if you want to know what the clinical components of that. But, yes all right. Never calling joining please identify yourself i michelleof your Vice President sales and account management for the sector i manage a toddlers account as well in real appeal program is what we rolled out to meet those needs so theyre actually so the working with the center for Disease Control . Correct. As part of this program they rolled out . So yours is basically the same exactly. The program we rolled out for calpers to meet those records is the same program we been going out to city and county. All right. So we got something on a par with or better than the largest plan in the state. Thank you. Any other comments . Any of the questions from the board . How much extra is this costing us . Be so it does not cost you in the form of an administrative fee from us. The member thats participating, it will be billed just like a medical claim so the initial assessment is 103 claim. If we paid at your benefit level. That number doesnt have any cost out of pocket pocket for that and its going to be dependent on the members participation. Because of you have 52week soda numbers extremely engaged the total maximum cost is 691 but what we are seeing is the average cost the amount of times they are meeting with coaches and having them is about 300 per member for the 52week program. The return on investment the are like theyre showing as always 221 getting them under control with a loss management and Healthy Eating and everything headed in the right direction. This article said one i

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