I meeting of the Health Service system board. To order for may 20 5 2023. Would you please stand and join me in saying the pledge of allegiance . Watch allegiance to the flag. Of the United States of america and to the republic for which it stands one nation under god, indivisible with liberty and justice for all. Before we begin our roll call for this meeting. I would like to introduce a new member. Of our board. Ah as you know, we have elected representatives and appointed representatives and one of the appointments is that we must have a member of the board of supervisors. And after much diligent searching, we found one and hes with us today. Thats uh, district district six supervisor met dorsey. I just like to give brief bio on supervisor dorsey. He has a large long City Government association, both with the San FranciscoPolice Department as the communications director. And then serving for nearly 14 years and over 14 years in the city. Attorneys office, where he helped to support groundbreaking cases around marriage equality. Educational access public health, tenants, rights and workers protections. Prior to joining the Police Department and 2020. Supervisor dorsey led it. Tobacco free kids communication strategy for the 2019 no on prop c campaign. As you may recall, that proposition was soundly defeated. Ah by even though there was a multi Million Dollar campaign by the vaping giant, youll labs super duck visor, dorsey is committed to providing passed to recovery for those struggling with addiction. Supporting new housing at all levels to make growing demand and investing in Public Safety resources to assure that all people can feel safe in their communities. Supervisor dorsey we welcome you to this board. Thank you so much. Thank you. And with that police call the room. Thank you. President. Scott roll call, starting with president scott president , Vice President hill present commissioner breslin. President commissioner canning president supervisor dorsey president commissioner follansbee present and commissioners bronski will be arriving super towards thank you. We have a quorum. The next item is general Public Comment agenda item number three is general Public Comment an opportunity for members of the public to speak on any matter within the boards jurisdiction that is not on the agenda, including requesting that a board the board plays a matter on a future agenda item. Ill be reading are full instructions. The Health Service board welcomes Public Comment during the Public Comment periods. There will be an opportunity for general Public Comment at the beginning of the meeting and an opportunity to comment on each agenda item on the agenda in person. Public comment will be first, then virtual Public Comment for anyone waiting in person. Youre welcome to approach the podium now. Each speaker will be allowed three minutes to comment in length unless the board president deems new Public Comment time limits during the meeting, all Public Comments made concerning the agenda item that has been presented a column ask questions of the policy body, but theres no obligation to answer or engage in dialogue with the collar. The Health Service board will hear up to 30 minutes of remote Public Comment total for each agenda item. Remote Public Comment for people who have received an accommodation due to a disability will not count towards that 30 minute limit. Remote Public Comments via web webex are that the members of the public attending the meeting via phone, um, calling in 4156550001. When prompted enter access code 2596583247. Then press pound youll be prompted to enter the weapon password. 1145, then press pound press star three to be added to the Public Comment. Q and when you hear the prompt you have raised your hand to ask a question, please wait to speak until the host calls on you. When the sister message says, your line has been muted, this is your time to speak. You will be muted and then i need and then muted when your time is expired for those watching the meeting on webex click on the raised hand icon to be placed in the queue to speak. A raised hand icon will appear next to your name. When youre in muted in the system. A request to unmute will appear on your screen. Please select on mute to speak. When you hear me, say, welcome caller, youll begin speaking. And when your time is expired, youll be muted. Please click on the raised hand icon to lower your hand at the end of speaking members of the public are encouraged to state their name clearly, although they may remain anonymous, ill give an audible warning when you have 30 seconds remaining, and when youre three minutes have ended. I thank you for your call. Youll be placed back on mute and ill meet the next color. We like to thank sf tv and Media Services for sharing this meeting with the public will begin with any person Public Comment. And no one has approached the podium, so well move to our remote Public Comment and ill be checking to see if theres anyone in our remote public comic you at this time. Yeah. We have four colors on the line. Zero colors have raised her hand at this time. Ill take a five second pause to see if anyone would like to raise their hand. No colors have raised their hand at this time. Public comment is now closed. All right, thank you. We have a particular focus where the special meeting normally there are other board matters like financial reports. Directors report of president s report and then any specialized items that are on the agenda, along with rates and benefits. A few years ago, this board reconfigured its standing committees, and we decided that we would do rights and benefits as a committee of the whole rather than having a subcommittee, review it and then come to the board with another review of the same material, so all of us are acting if you will, as a full board. On the rights and benefits item. The structure of this meeting is rates and benefits. And i would like to make a few opening comments to put a context around the action items that follow on this agenda. We have since january have been very diligently looking at a number of issues that have been impacting the results of the rates and benefits that you see before you today and i would just like to go back. To the presentation that was made. And our last word meeting in may. By our chief Financial Officer hussein and our lead actuary, mike clark. Because that really begins the framework. The influencer. If you will, for a lot of the outcomes that youre going to see in these action items they updated a report that they had provided to the board in february. And there were large drivers if you will. That influence the overall trend underlying trend. For what would later translate to us as Health Premium cost, uh, coming from our health plans. Ah one of the issues that weve noticed over the past two years that we have had a very substantial underutilization of health plan services, and thats largely been been driven by the pandemic. And we knew that and we knew also that at some point we would be coming out of the pandemic and people would be then going back for various. Services utilizing the health plan resources that they had not used during the pandemic. We also knew that over this 2 to 3 year period of time, there has been a very large disruption in the labor forth. Across the entire. Labor force, particularly in health care services, and we have been impacted. As a system in our operations were about 50 staffed at this point in time, and id look at our chief operating officer to see if thats an approximation. And weve been diligently recruiting and pressing and so forth to get more folks in our operations to assist with members, quarries and so forth in our Client Service area. But Health Systems have also been impacted by those same forces. We also know that there have been increased. Chronic conditions that have been magnified by the pandemic. And that, too has had an impact on the utilization and the healthcare trend. Theres been a substantial increase in mental Health Services and Substance Abuse services during this period of time. And then there has been cautious sting from the federal government. To the health plans in terms of how they are reimbursing. Theres a whole coding Reimbursement Structure thats coming into place during this plan year. And we know that there has been some efforts to restrict how people want qualify for medicare at the state level. And so knowing these trends in these drivers were going to be there and having an update on this last month. Whereas award and i looked around. I wasnt presiding at the last meeting for personal reasons. But i noticed that we had zero callers on the line. And no. One in the chamber during the Public Comment period about this particular report and most of the other proceedings of the board last time. And thats been true for a couple of months and we have been trying to diligently ah show not only the external trends that were going to impact this result that were going to be seeing today but also taking a very good look at our own demographics and the change, uh of factors and utilization within our own claims system and analysis, and we had that report brought before us. We knew that aon was bringing to us and expectation that there was going to be a core. 7 rate if you will trend and that is almost double. What we saw the year before. The core medical inflationary trend double in one year. And weve had indications of that, as weve worked with her plant Health Plan Partners as our staff has gone into analysis and discussion negotiating around the contract renewals. And weve also know that there are any number of other factors and pharmacy. And other types of services in the health plans that are also influencing these trend factors. So the question for us as a board and as a system is, how can we respond to these things . And we would like to be masters of the universe and say okay, we can control all of these factors. And we can ultimately influence and make the unilateral decisions about what the total cost of increase is going to be and what were going to pay for it. Well were not masters of the universe. We find that weve got some tools that we can exercise as aboard some. We have to make recommendations to other bodies here in the city, other Administrative Offices in the city. Before we can actually act on them and incorporate them into our approach. With the health plan. Theyre probably three large buckets. That we. Will be dealing with not only in this plan year but in the coming two years of our Strategic Plan around these issues. One of them is Cost Shifting. And as soon as we say that i feel a very mild earthquake under my seat because people in this room, though, that if were saying Cost Shifting, is that problem to the employer or is it to the employees . Well it may be that we have to look at both of those things. But we cant do that unilaterally as a board. It requires actual contract negotiations. Negotiations with the unions of the city. And so forth, and that has to be put through the department of Human Resources and then actual collective bargaining agreements have to be struck and so forth. And do you do that out of cycle . No you dont. But as we go forward, will we be trying to look at those issues . We dont know. Theres also in the Cost Shifting area, things that we could be looking at in terms of ah income based contributions. Uh that you people learning certain amounts of money would pay out slightly higher premium than those paying that are earning less. There are any number of organizations and im familiar with it do base their premiums on the gross earnings of employees. But if we were to do Something Like that, that again, its not a unilateral decision by the sport. It has to go through a whole process. We could talk about increasing the benefit waiting period before you become eligible for benefits. A change like that would require the same type of structured ah, discussions, negotiations and so forth. So just to look at this from a Cost Shifting standpoint is not a unilateral decision by the sport. It would be something that would have to look at proposed and then have it fit in with a larger strategies of the city as an employer. Another broad areas to take a look at the Delivery System and the various plans that we offer. And that strikes at the issue of planned design. You just cant go in one moment to the health plan and say, hey, we want to change or Health Plan Design and therefore we want you to give us a quote on this new plan design. In one necessary season. It will take some effort on the plans part to come up with a response to the Design Options that were ought more suggesting they have to price them out. We have to look at them to see if they fit with what were trying to do, and its a back and forth, but its not something that can be immediately implemented. When we hear that were going to be, uh , possibly faced with large premium increases. Theres also the issue of pharmacy management. And the issue of pharmacy management is a very complex one. We dont control what ah, the pharmacy benefit managers do but. We tried to look at the various incremental systems of rebates and so forth. But again. Its a matter of costs that are being driven by other forces outside of our control. The last big area that we can begin to look at is we could also under plan offerings eliminate certain benefits. But when you start to do that you then go into the competitive recruitment market because the benefits that we might be eliminating maybe the very ones that are attracting employees to go with another employer. So again, our options are limited. Lastly theres a whole area of administrative and operational changes to simplify those activities that their in house or through our partner carriers. One of the big levers in that area is to go out and do Competitive Bidding on the health plans. That is a massive undertaking, and it takes at least a year to get the rfp to go, uh, into the marketplace and so forth, so it wouldnt have any Immediate Impact on any current plan here, but youd be looking at a new plan year beyond that, so we were to go out and competitively bid. This year. Had we done that . It would be something that could impact 2024. So if were to undertake that, in 2020, for it wont be until 2025 before any Competitive Bidding changes could be made. So uh, the other side of that is that we might say okay, lets uh buckle up and begin to do our own thing internally. Beef up our own healthcare system. Ah resources to maybe directly contract with health plans and directly contract with others, maybe create a i collaborative to bid with Partner Companies or organizations with health plans , or maybe move to a line with calpers in some way, so we create a larger purchasing block in the marketplace. Any of that type of administrative or operational change again is something that will take either time to consider. Both the pros and cons as well as to begin to implement that. So were left with very, very few. Outcomes. Other than trying to educate ourselves on where we are today. How we got here. And to begin to publicly share and educate as we try to do over these past several months in these meetings ah to the membership as well. So the results that were looking at today are not something that sort of jumped full grown from the browse zeus. It just sort of like came out of nowhere. Weve had months of effort of analysis. Discussion. Negotiation and here we are today. And we hope that as we go through Public Comment that that background that i provided will help to frame the discussion. Uh we are on a timetable. Ultimately these rates have to go before the board of supervisors. We had to provide a preliminary estimation of costs. We knew it was going to be higher. And we know that next year just like rust. Premiums will probably go up again. Its just like rust. Its always with you. The question is how much and we will try diligently as a board. And through our staff and actuary and working with our health plans to try to come out of that process with something that is in a more agreeable results, and we might see today but any of these larger changes will indeed take time. And i just wanted to put that out there as part of the opening comments as we consider these particular action items during the course of this meeting. So i thank you for your indulgence and patients for allowing me to speak. At this point, we will move to item number four. Thank you. President scott agenda item number four is the presentation on the 2023 rates and benefits calendar for the plan year. 2024 this is a discussion item and will be presented by executive director abby yet. Calendar for us, hmm. Okay. Thank you. Yes the reason benefit calendar obviously was adjusted for todays meeting. And will also, um uh, we have put a temporary hold on a should we need a second meeting in june following the medicare presentations on june 8th the they