Well worth it. I do want to go back up a little bit to operations and talk about some of the outcomes of the enrollment. We had several big things that happened this year one of them as you know, the implementation of blue shield trio and well get in to more details in the next presentation after the direct report with blue shield but again as we knew that would be a big task and that was a big enrollment movement. That was a big set up in july, august and september and in october when open enrollment is live and people make changes and as we move on after october and in to the first of the year, that is also a big a lot of work for us. Any time we make plan changes and any time is expected well save money next year for it and its going to cause work and so its well worth that work. We have some occurrences back in august and september where we felt perhaps our abilities and communicating our plan choices appropriately and we took some preemptive and proactive action with them and along with erik the City Attorneys Office we sent a letter to them making sure they knew that any communications to our members about our open enrollment or our boards decision could be run by us and its a good thing we did they showed their hand they had prepared a communication that would have seriously confused members and especially if it got outside of the members they were referring to. That started a dialogue between me, them and the Mayors Office as well because i contacted the Mayors Office about our request not to communicate to these members so we were all to collaborate on the communication that where 80 ok with so we did mitigate some damage there. Other than blue shield trio well get more in to it in just a bit i want to mention some of the other enrollment results we did we implemented the kaiser multi region plan so we offered kaiser in hawaii in the northwest, oregon and washington so we had a total of 38 subscribers enrolled and its good and that is not the total so i dont have those numbers yet. That message out got out there and im sure in the following years we will continue to get good membership with that. Outside of trio, non medicare and blue shield decrease about 127 subscribers so they did lose some membership. Kaiser active enrollment increases 406 subscribers and it tripled that number so that was a good addition for them and city plan members increased by about 31 subscribers. Healthcare, medicine care, vantage, ppo increases by 171 subscribers and cruger senior advantage 150 were gained. So i just wanted to give you those numbers and just so you know how our Communications Work and what type of migration and activity is going on out there and theres just a ill finish up here. Vision premiere plan which was another very popular addition that we did this year we have many, many, many compliments from membership thanking us and the board forayeding this. We enrolled 10,123 members. Thats huge. And 9,000 dependants so 19 lives all together. Last year we introduced voluntary benefits, these are your pet insurance, supplemental life, accident insurance, those types of things. We put those out there foreign rollment again this year and we received another 1100 enrollment s were total of about 5,000 for the supplemental benefits. A move on to finance and accounting, so when we wrapped up open enrollment now its budget time so we are preparing for the fiscal year 20182019 of this year and 1920 budget season in january there will be a presentation on the budget and the budget instructions that were passed down from the mayor s office just a week or so go. We have executed Service Agreement with a partner in our web design so were looking forward to im certain by open enrollment but hopefully earlier have a brand new website so were really looking forward to that work. Finance and accounting always help us out a lot during open enrollment and sometimes we dont give them enough credit for that and they help us a lot with their rates calculating our rates and going to the m. O. U. S and looking at the things and the differences between the m. O. U. S and how the employer contribution comes out and then when we get all that information and we start developing and writing our materials, theyre key in reviewing those materials and make sure theyre accuracy. So we have great participation in that from finance and accounting and communications always plays a big role. Again i want to do a shout out to Carole Karimi who is our new Communications Manager she came in and got the materials all drafted and so she helped us get them together and she was a huge help and she really dug in and what this is especially now with our Communications Going out with our confirmation letter she was key in that process as well. We did have a large website present as you can see, 58,000 website its in october and 2017 and again responsible for producing all the member materials and just recently we created 75,000 confirmation letters mailed and most of those have been received by membership according to our call volume which goes up when we mail something. Wellbeing will be presenting later the review of the wellbeing program, data and successes soy just want to mention that again we did 26 clinics, flu shot clinics in october and some in november as well and that is one of our big out reach during october the flu shot clinics along with providing either a help fair and open enrollment all at the same time and its really bringing in members and were there to answer questions so its been definitely. Its a bit fanatic and we might want to work on that next year but we did the same as we did last year with 4,131 flu shots between october and november. Speaking of off sites, we are geting and i know shavon will mention this a bigger percentage of participation so we go to department of Human Resources and the p. U. C. Building, we come to city hall, and those types of things and we saw about a 22 increase in participation this year and some of those i enjoy going that is ruccsf and we have a health fair with a flu shot and its great talking to the retirees and they have Great Questions and i learn a lot as far as Customer Services and things that they rely on us on and then got an opportunity to say a few words at the beginning of that. Kind of going over what is going to be new for 2018. One of my other favorite off site events is going up to mock sin and talk to the hedge employees up there and its my third year going up there and its great because i lose cellphone coverage before i a arrive so they have cellphone coverage but not my carrier and its nice and its a nice little break talking to them again they have a lot of questions and theyre very appreciative of us coming up there and going through these changes and answer ing their questions but theres a distance and a separation there. I also want to note too that we had opioid followup questions that i have included in the report. If you have any questions i can ask them and were also going to do an opioid update in february which all this information will be include inside in part of the presentation including commissioner press lynn breslin regarding job classes and what types of jobs are accessing or needing opioids and a few other questions that were clinical which came from dr. Follansbee and do they have any non opioid Pain Management policies or in development and what type of provider training and dr. Follansbee you saw the printed answers coming from the carrier. Yes, i thought the responses were quite appropriate and encouraging. And we have had a couple utilization meetings just this week from two of the plans and looking at some of the pharmacy utilization you can see the results from their opioid management plans that we went over last month. So at this time, if you continue through and look i can leave this after page 13, its right behind the directors report you will see the Operations Management reports. It starts off with calls and person assistance in october 2017. The top. Thats page 13. Yes. Ok. All right so im go to ask sha von conner our Operations Manager to come up and give a review of open enrollment metrics. Can i ask questions about the directors report or do you want to wait for the presentations. Is it something thats been covered . Its something thats been covered. Please. Flu vaccinations close to my heart so i appreciate it and im curious to know does the department see it mostly as a way to draw people in to get the flu vaccine but also to hear about other programs enrollments so thats really the sort of card to get them in not because our employees think they dont have access through their health plans or other means . Right. And stephanie, so one of the things when stephanie first started with h. S. S. And my discussions with her s. What can we do during open enrollment as far as not only increasing the participation in flu shots received but also its open enrollment this is the time to have the plans to ask questions and time to have h. S. S. There to ask questions. So i think the combination of those things has really added to the value of the flu shot, its encouraged more flu shot like i said theres 22 increase and thats just the people that are coming to us and asking questions and were tallying those so every year were doing this and including the flu shot its i believe its benefitting both divisions and stephanie would agree. Questions of the board . Im sorry to followup question. Are the recipients given a card that theyve gotten the vaccine and what the vaccine was and the lot and all that stuff in case theres a recall problem or something that the department is now responsible for in terms of administration or something . We partner with kaiser who provides those flu shots and im not sure what they give. I can tell you. Ok, good. Sorry. They give you a piece of paper but they dont give the details information. Its more like what the flu, i dont think they give you the lot and batch number and if its a recall it says a basic vaccine and who type of Adverse Reactions you may have. The fact they partner with a provider actually solves that problem. I think no member would want this with the lot and wait for f. D. A. Announcements so that answers the questions and i think its perfect. Great. All right. So any other questions . If not please. Shavon oconner will go over our Customer Service metrics for open enrollment. How are you . Im very good, thank you. How are you . Just fine. Health Services System and we have slides. I cant see them but i wrote a script. First i want to say im honored to be in Service Employees and retirees in the city of county of San Francisco. Its a privilege to ensure they have benefits, this Service Orientation is the north star by which Member Services does everything. To that point, open enrollment 2017 for a plan year 2018 was exceptional in every regard. Most notably as you can see we took 14 more calls, and then in 2016, we provided 13 more third floor inperson consultations and 22 more off site consultations and mostly at the largest benefit fares you will see in a later slide. We provided 19. 5 more first floor inperson consultations and we received and processed 24 more applications than last year which was the largest year in the history of h. S. S. We did 24 more this year. We also had roughly 10 fewer staff hours and this year instead of having 20 days of active open enrollment we had 21 days which is part of the underlying foundation for the bigger numbers. So 2017 Member Services benefited from the longer open enrollment in october so we had 5 fewer calls and because we process open enrollment in the beginning of november we allocated the staff almost exclusively to processing with a few people answering phones and it worked out really well and we processed in a timely fashion and we were only officer vis level by one second which i consider i pulled together a slide that shows you plan year 2015 over 2016 over 2017 so if you take the long view from 2015 to 2017 call volume is up by 32 inperson consultation is up by 54 and applications received is up 35 so the demand is rising at Health Service system. You can see the increased call volume hit the Service Level and speed of answer was over a minute which is not the best and its an expected impact with this kind of call volume. The next slide. Slide 6. I also did a day by day comparison of 2016 over 2017 we took 1400 more calls in 2017 than we did in 2016 part of it was due to the extra day of open enrollment in 2017 we took 962 calls. Also, there was a higher call generated by the new plans and answering those calls took a little bit longer because we wanted to make sure that people understood what the v. S. P. Premiere was and what trio was. The next slide. To me the real gamechangeer this year was technology and enabled for open enrollment and the the past few years the staff ing is flat but this year the Member Services team was really apt and fluent in the electric content Management System deployed at Health Service last year and instead of handleing application on paper by hand we scanned them all in to the e. C. M. And process them out of the e. C. M. And counted them and it allowed us it probably saved us at least 333 hours and thats a conservative estimate its probably more like 400 to 500 hours which helped us close the delta between the staff hours we had last year and what we had this year and still gave us a little bit more. Next slide. Our inperson contacts have increased and our inperson contracts have been on the first flor because Brian Rodriguez who mitchell mentioned earlier came up with a idea of having these little mini scanners at each station so instead of xeroxing applications and gives them back to members for the records we scan the application in on the spot and it linked in to the system and we gave the original back to the members so it was not only efficient it was green because we probably on the first floor alone scanned five or six thousand applications and thats five or six thousand pieces of paper we didnt have to replication replicate. The largest off site fairs were busyer. City hall was dish sent three Staff Members to the city hall off site benefits fair and they didnt get a break they were talking all daylong and people had tons of questions and it was similar and some of the fairs were flat and one of the p. U. C. Fairs but the bigger fairs we had that are more around the civic center are much bigger this year and Unified School District had a benefits at john owe owe owe we didnt get an accurate count because it was so many people that just like helped them as fast as can you. The next slide. The impact of o. E. , the demand of o. E. Impacted the abandonment rate and when the abandonment rate goes up because people dont want to wait anymore the call volume goes up because theyre going to have to call back and they have questions that need answers so for we were stretched thin because we were out across the city and our calls lasted a little bit longer delinquency and termination volume for october and november had what i consider to be year over year the normal fluctuation its higher this year but i wont go through the slides unless you request. We have the material in front of us. Thank you. I feel open enrollment is like christmas to me and its my favorite time of year. Its also a very challenging time of year and this year was more so and it takes h. S. S. Village to pull this off it takes everybody on our team to finance teresas team, marinas team to pull it will off and Member Services is more front and center and i consider everybody at h. S. S. To be a hero when were doing a really good job, no one knows were there when someone needs us we step forward to help out and it took many hours of evenings and start as every year during open enrollment to process 14,000 applications and so i want to recognize out of the hero some particular people who were there literally every night until 7 00 every saturday veterans day and they are florence lamb, yak chow , marine chan, ruby diaz and jesse. Our newest member. Each one of these people every hour of open enrollment whether on straight time or overtime so thank you to them but i wanted to list every person on the members Services Team and that was edited so thank you Member Services team i much appreciate it and i also really want to thank anthony who is blazing fast at work and he has a very complicated demanding job and already, he processed over a thousand open enrollment applications to help support the members Services Team and i want to acknowledge our noble leader who is the calm force in the storm and its very helpful to have someone just kind of say, slow your roll, focus on forward and keep going so thank you. All said this years open enrollment was epic and spectacular and i appreciate the opportunity for getting this experience. More importantly i really appreciate the team that i get to work with. Thank you. Thank you, are there questions from members of the board . I just have one question, you point out it was a wonderful report and i think also want to add congratulations to the team for all the work and it was spectacular and as you alluded to, call abandonment escalates particularly members anxiety, anger, hostility, and so do you have some idea about how long a member was on the phone before they were abandoned. Interview i think the average time before people abandon was about 65 seconds, i can look that up and provide it to the board. It looks to me like if i were called i would go back to the slide and maybe you had an average answering time and i think it was it was 73 seconds which is a minute and 13 seconds. Abandonment time is 65 is actually longer than the answer ing time i mean, again if there are ways where they look forward. I can look it up. Just look forward to how you can message when the calls come in and are there better times to call . Not better days. Avoid monday and friday but better times to call so members who are thinking about abandon ing their call because they just cant wait might have it would be left with a message how to maybe not be so angry and call at a better time . We did message that call volume was increased and it would we expected a longer hold time and i dont think that we put up messaging if you call first thing in the morning or between 4 00 and 5 00 and you have a better chance of getting through right away and one of the things about i. V. R. S and theyre frustrating as well and so when people finally get through pushing the buttons and listening to the message theyre already like grrr so i think everybody on the team knows that during open enrollment people are going to be frustrated and you just kind of have this practical mentality of like bring this person down and let them know theres no problem that we cant fix and that is the truth theres hardly any problems that we cant solve one way or the other. They may take time but part of this thing is delivering that message because if someone escalated but they know fundamentally well get them where they need to be and they calm down pretty fast. There are a few people that dont and thats just their nature so as Customer Service professionals and benefits professionals we have to deal with that. The comments were addressed to maybe not be fixed at the moment and fixed for future and look at some of these metrics and thank you for the wonderful report. You are welcome. Are there questions or comments . Commission commission lin. Thank you to all the staff that helped during open enrollment and for your leadership during this hard times when we didnt have our director so thank you for all your hard work. Thank you so much we appreciate it. Any other comments from the board . Well, on behalf of those who are silent and those who have spoken i want to say thank you directly and to the individual members of all the teams that you cited that what you have done here particularly this year with the new tools and new complexity that we the board and our decisionmaking delivered to you and you executed on it very well and an outstanding manner and were profoundly in your debt and so are the members of the system so thank you. Thank you so much. Are there any click Public Comments . Good afternoon, claire, i just wanted to add that retirees were grateful for mitchell and the team that came out and we were also very greatful to the kaiser nurses who put up with a lot of chaos, we had people who received shots and they werent prepared and we werent prepared for the response we got and it increased a lot of these off site visits are very, very important and theyre important for retirees because its one of the few places where we gather as a group and i also spoke to some potential Fire Department retiree and i also speak to all the potential Police Department retirees and we talked to them about the fact that we do these clinics and that theres more special attention given to them during open enrollment and we cant thank the staff enough and we cant thank the leadership enough for all of what gets done for us during open enrollment and yes, it was that piece of paper thank you supervisor, i was about to say that, so just a big thank you and we hope that there will be were waiting for electronic complete electronic open enrollment everybody has been calling for that since before i retired but one of these days well get there. The scanning idea was brilliant, it saved a lot of trees and we want to reiterate that we as retirees are extremely grateful for the service we get, especially during open enrollment. Thank you, any other Public Comment . We thank you the plans for being present as well. Thank you. Director griggs. Im also just wanting to mention and i was going to do this at the beginning but, this was a particular tough week for h. S. S. With the passing of mayor lee and a lot of us worked closely with him and his office so it impacted our office and our staff as well and i want i wanted to thank the Employee Assistance program, we were training messaging 5 30 that morning and her team had already prepared a communication to give to all the city on the employees and those department thats were more directly impacted like the Mayors OfficeController Office and memorial and i was able to deliver that to our Emergency Department head meeting that morning and i delivered that message to the director of the d. H. R. And the Mayors Office directly. Thank you. Do we provide e. A. P. To the retirees and the message is this is available to them because the woman that trained me had been a city manager for a while and our department and she was quite upset. She knew mayor lee quite well and believed value over the decades. Unfortunately we did not provide it as a retiree . Id also have you take note of several articles that are contained in the directors report both for your education and he had theyre not pinpoint ing any particular provider or Health System but they are of interest of our working relationships with some of these entities so i would call that to your attention and also i believe buried in the report maybe its coming up in the finance report and ill be corrected by you is a highlight were working on r. F. P. S . Working for something in particular . Yes. Well it was not in my report. Its not in your report, it must be elsewhere. So with that are there any other questions . Any Public Comments on the directors report if not well move onto the next item. Update on blue shield trio h. M. O. Implication, janette moan blue shield of california. Welcome. Thank you. Now that we have crossed the bridge together [laughter] we are now entering New Territory and we expect to see you here frequently in the next month or two. I really appreciate you, i think weve crossed a bridge. Ok. Um im janette and im with blue shield of california thank you for having me and i wanted to do a recap and some Lessons Learned from our open enrollment. We have a presentation that was submitted in advance and i want to let you know some of us here at our level, its not public, but all of the screens are flickering now up here so well be an uninformed group for a while. There is goes. Now it stopped now that i said something about it. Now its going again and dont worry as long as its clear on the screen well proceed. So please. Thank you. We have a presentation. Thank you. Thank you. I want to let you know in advance of going through this presentation that the numbers here were losely based on ex pecked enrollment based on employee who enrolled so some of the numbers are soft and we indicated with special equal signs that they are i just wanted to review the objective of trio in the first place and number one, was to make an affordable highquality health plan available to the h. S. S. Members. The current access plus h. M. O. Is very well run and it has a cost trajectory that could be perceived as non sustainable as a non kaiser alternative so the intent is to provide something to our members that is sustainably for our future. In addition to that the trio product leverages all the good work that h. S. S. And blue shield have done with our deep partnerships bringing that to the next level. We want to create more competition in the work in the Healthcare Delivery system which will also lead to more affordable prices and also higher clinical outcomes for our patients. We intend to transform Healthcare Delivery and of course the bottom line is ensure highquality care for everyone. Part of the plan was to do a threeyear rate guarantee for starters, trio is 10 lower than the access plus pricing and that trickles down to the members theres a trio 2019 rate cap of 5. 9 and a 2020 rate cap of 8. 5 the provider partners including dignity, ucff, are making investments in the product and Financial Investments as well as operational investments. And in addition to that theyre also investing in Clinical Innovations that are providing higher levels of care and hospice in patient counseling, et cetera. Blue shield is invest north this trio offering as a broader bay area strategy to ensure highquality Cost Effective healthcare plans in the bay area long run. And this pi chart i want to re illustrate of the 38,000 blue shield h. S. S. Members, 62 were already using the trio product and when i say the product i mean the network, the same providers in the end we got 40 of those 62 to remain enrolled which actually would be great to be 62 but we learned a lot along the way there are provider nuances and its a great start. We wereen rolling auto members in to trio for january 1st and that again was based on their providers their primary care physicians being in the trio network as well. We had to reduce that number for auto enrollment by 3,000 members and those 3,000 members were because within brown and toll around who generously stepped up and creed to create a custom trio network just for s. S. F. It was discovered later that sutter objected to some of their primary care physicians being included in trio and those were the Sutter Foundation primary care physicians, if you think about it, Healthcare Delivery is a business and sutter is not part of trio so our foundation p. C. P. S should not be part of trio either so we removed 2800 to 3,000 members who were originally thought to have been on the docket for auto enrollment and we took them off. Because we did not want any disruptions to primary care physician relationships. In the end we auto enrolled 22,000 of which 14,500 remains. Trio enrollment savings for 2018 alone is not 15 million its actually 12. 6 million based on 14,500 membersen rolling and my numbers are slightly different because again i updated it. Since we found out the actual enrollment. Is everyone following so far . And so its 12. 6 for 2018 and 2019 and 2020 should be more significant and the missed opportunity are those several thousand members who did not remain auto enrolled and who went back to access plus and they are constituted 2. 7 million in savings. And that again. I wanted to just to talk about the imitation a little bit and the Lessons Learned. They had interesting nuances mentioned in the sutter primary case physicians which we responded to immediately and there was confusions about specialists who are also employed by sutter. So that work is continuing and identifying those in determining whether they impact anyone and everyone enrolled as of january 1st or enrolled at any point in the plan is eligible for continuity of care so any treatments they have in progress they get to continue on with those providers for those treatments. So were not concerned about patient disruption but it was a lesson that we learned along the way in creating this Custom Network for h. S. S. We got a lot of feedback from members being happy that now they had ak stows ucsf so that was something positive that we learned that we had not anticipated, even though we know ucsf is a worldrenowned medical institution in the United States we didnt know our members knew that as well. We did have some sutter interference with the enrollment and there was a lot at stake for sutter and it was a lot of revenue to be lost should they lose thousands of patients and not having them fill their hospitals and this is a normal reaction they did want to do a Communication Campaign and fortunately city and county of San Francisco took a proactive approach and approached them directly through the City Attorney office asked them if they were and then collaborateed in the communications and it above been ideal had they not done anything because they were confusing and created noise but they worked in h. S. S. As far as an outsideer could see. There was an additional robocall that did cause further confusion and the noise hit the target, there was definitely confusion and reaction to the letters as well as the robo calling and dis enrollment during this period from the trio plan. At the same time, we need to recognize that sutter is a partner as well, just not in the trio product at this time and we appreciate what they provide on the access plus. We do have some lessons around communications and our letters really predominantly focused on primary care physicians and they could have focused for the hill and all the other trio providers , it was going to be the same. We really focused on p. C. P. Because that was the logic to develop the letter list so thats a Lesson Learned for next year. As a result of that, not identifying that we did lose 800 members that theres no reason that they would be in access plus because theres no difference between what access plus and trio for them and as far as network the only difference is that they have a look contribution out of the paycheck but they elected access plus still so thats an opportunity for the future and it would have been nice to have better control over sutter it was amazing control over sutter but the city was able to perform and perhaps we should talk to them earlier next year. We need to better understand in the future the complex relationships our provider partners have with other partners and that could there could be more that we havent thought of so i just wanted to be honest about that and we dont think there is but we didnt think these were coming up. I just want to be honest and transparent and where we would like to continue this to be very flexible and collaborative and working with the provider partners and h. S. S. In the event something ups and another observation is do we do auto enrollment again for those people for which the only difference would be a lower contribution so its just a thought. Its a question that they wait and explore all kinds of autoen roll and not discovered and whether we want to engage in that process again its really i think something that prolonged discussion and i would expect there would be some necessitys to bring forward if we decide to mh370 of this that direction and some engagement of this board before we make the final decision and. I wasnt look forgeron a decision. Thank you. Does anyone have any questions . Commission commission sheehy. I did find it confusion and i know a lot and i think identifying a specialist problem i still havent figured that out and the web sites are not very good on a i wasnt clear whether my primary care physician was in the network or not and i was one of those who was delighted because ive had trouble, i was at ucsf before here and shes been my doctor for 20 plus years and so at one point i was paying her out of pocket because when you create those relationships you want to keep them but so i think really a lot more clarity and a lot more ability to identify whether the various providers if you are like me and you have complex heath needs that would be helpful. If you are thinking about the ucsf fees was under sold and a lot of people, i know myself i was excited to be able to really be able to have my doctor and uc sf access so you might start earlier and work with ucsf talking about that relationship and again i have a buy as because i worked at ucsf but i think a lot of people in town recognize the excellence of that institution and so that is the main thing. I just these things, i mean i know a lot, ive been doing this for years and i really found it a couple of times i was completely confused and almost slipped back because i thought i lost my primary care physician because the information wasnt able to be accessed and like even when you go to soy went to get my flu shot as people have identified and also to do the enrollment and talk about trio and it wasnt really easy to get the information like one person looked on the screen and said my doctor was not in trio and another person looked on their screen and said that my doctor was in trio and so that level of confusion i didnt talk you are reminding me. We had another there were lots of nuances i didnt mention but i recall there was a lot of provider confusion at the open enrollment meetings and so brown and toll around again, they customize this network and protocols just for h. S. S. And they had representatives at the open enrollment meetings who didnt fully understand it and we did hear about that because fortunately they are right next door to each other so we mitigate it but it did impact some people so that was a huge lesson to learn as well. Thank you. Other comments from commissioners . Yeah, from members i very much exactly what is said. And especially there was a meeting over here at the hotel, there were two meetings there i believe and people i know and the members said they were more confused after they left than when they got there because they did get a different story from brown and tollhappened than they did with blue shield and i dont like the auto enrollment at all and i wonder who is going to take the burden of putting these people back in when they go to their doctors and find they cant access them. Will blue shield be doing that work or will it all be on you . So, after we end open enrollment and we send out a confirmation letters changes permitted are Administrative Changes and administrative errors . People can appeal anything and we do handle those appeals in open enrollment and we always get a lot of appeals after open enrollment so theres an appeal process if someone wants to move back in to access. The reasons that we would do it outside of appeal for some reason we demonstrated an address issue, a Mailing Address issue because that was one of our Key Communication is the mailing, a second one would be an issue about continuity of care if someone is in the middle of treatment. Other than that they would need to send an appeal and it would be reviewed by h. S. S. First and according to our member rules after that if we up hold the denial they can appeal to the board. What was the last thing you said director griggs . The first level appeal is handled by h. S. S. And if we up hold the denial, our own denial then the member can request to appeal to the board at the second level appeal . All right. There shouldnt be a lot of communication putting people back to the access plus because a lot of members did not opt for this and they find this out and otherwise the board here is going to be inundated with appeals there was an appeal letter already here from a member who said it appears compulsory as i did not effect to make the change nor was it clear i would need to check the blue shield access so that the enrollment wasnt clear and i cant imagine how timeconsuming its going to be for staff and everyone if you would have to take these back to the board and i mean, if these are honest mistakes, and theyre not gaming the system, i just dont think it should put a lot of extra work on anybody and it should just happen because, i had two other people that were automatically enrolled and each one of them, their husbands and children had ten different providers and i dont know how you can plus infusions and they were automatically put in to this trio also so i mean, it seems to me like its going to be a lot of this issue. Right. As far as the provider 5,000 have no change and this is more than 5,000 so half of them have no change at all and the other half would be the brown and toll en and they have a change in hospitals so for that reason there was a robust marketing and Education Campaign around that including multiple phone calls to every member and of course we had a lot of members call us and custom mailedings whether theyre enrollment resulted in a Network Hospital change or not and then informational sessions as well as open enrollment meetings so there were significant attempts to and that doesnt again to talk about the Electronic Communications so there were significant attempts to educate all members on what the changes meant. As far as infusions, transfusion s, now theyre going to go for an infusion and they wont accept you, now you have this date set up and thats a big deal. Yeah, that is if people are in the midst of treatment they would continue on with those same providers for that treatment. Commissioner. I mean i was just having been trained at ucsf and attempted to practice there early in my career and then having my career in fee for Service Practice with myriad contracts my medical group had multiple contracts with every provider in the city and then half of the time at kaiser i think i have some experience with this and im saying the complexity overwhelming, i mean i know my own former colleagues what kind of contracts they have with sub specialists and its just amazing to me that this could be navigateed easily or quickly and im surprised that any Sutter Foundation primary care provider had any contracts because they have because they have control if theyre not foundation documents, that said, the percentage of what you call missed opportunities switched backout and speaks the fact that members were alerted to what was happening and had the had sometimes people see the glass as 10 full and they sent out letters further pulled members what was happening and should have raised some red flags for those individuals so it seems to me that i had a major concern about auto enrollment and i think that actually the result was encouraging despite some individual experiences and really i do think the sub specialist issue was predictable and we talked about it here and hopefully you can navigate through some of that. Its always difficult. I like your perspective. If i could add anything, im glad you brought up sutters robocalls and that letter, i spoke about it in the report. The one issue that we definitely made sutter agree on is the only people that would get this communication are patients of the Sutter Medical Foundation so werent auto enrolled to begin with. The 10 that we didnt agree with was one word in there that they were giving members direction to select access plus and so when that i think what went wrong is people had that letter and came to the office and talked to their coworkers and that word the mouth and the word spread, emails spread but the commercial communication between sutter, as far as my knowledge, because i agreed on with sutter to the Sutter Medical Foundation patients and we didnt autoen roll those. I was consulted as part of that process and pushed it in the letter as well. So, whether we do this like process like this next year or not, to me its a subject that needs to engage us early and so that we can get some sensing about the results of this year because were right now just doing it and weve made the journey across the bridge and we have not traveled further so the consequence is ahead of us so thank you for your report and are there any other comments or observations from the board . Well expect follow on reports as we go forward. Is there Public Comment on this item . No Public Comment well go to the action item 6. Clerk item 6, action item. Presentation of audited Financial Statements for fiscal year 20162017 and 2016 and kpmg director levin good afternoon good afternoon, pamela levin financial officer, we had to make sure everything was set right. Who do you have in your company . We have a presentation. I want to first turn the presentation over to the kpmg auditor, this is gi walee and we worked with them for several years and shell talk about the audit process and i will quickly give a overview of the Financial Statement. You might find it for someone to sit in the chair and assist you so you can maintain eye contact with us here. Ok, yeah. Thank you. Ok. Good afternoon, everyone. My name is key wa lee and im an auto manager for kpmg so im here to present the Financial Statement auto results for the fiscal yearending june 30th, 2017. So i have in front of us the presentation so lets go down the first slide. The most important slide is the auto results and you can see that there is a result of our audit and there are no uncorrected or corrected misstatements and weve issued a unqualified opinion with a clean opinion and there are no issues and control noted during our ought i had. Im going to add emphasis to this. Its always an audit speak and i just wanted to be on the record that you found nothing outside of the audit expanders that would cause a question about how the funds been disbursed, managed or controlled during the course of this year is that not correct . That is correct. Theres nothing that we found. That is deemed to be report able to the board. Thank you. Ok. Ok and going through the next couple of slides these are required communications that presenting to the board so the first one called the management over of controls so this is a re but the able and this is the fact that across all entities theres some risks associated with the management override of controls so its part of our audit procedures and we are required to have procedures in place to evaluate from the control of substantive area if theres anything that deems to be a warrant that there is control and as a result you can see on the presentation that theres nothing that came about that everything resulted from a procedures that warrant any