That contract was signed by pg e and they made a deal with the city, that is a breach of contract. If they pulled out and did not keep up their end of the bargain, understand me. That is an additional lawsuit that should be filed against pg e. Pg e has been busted by investigator that showed that well over several years ago they were told about their defective equipment and the electrical wires, and the electrical poles could cause a fire hazard. They did not do a damn thing about it. That is further proof. A minimum of 89 people have lost their lives in that fire, that took place, on the other side of the bay. Its disgusting. About you, talking about you want to take over their system, and their defaulted equipment is a waste of money. You can start by going and gathering god damn new semi get that 21 billion that he put in, and stop rebuilding and build your own system to distribute electricity that you already didnt it demonstrated that you can generate on your own behalf. Also, sorry. Your time is up. Next speaker, please. Hello supervisors, i am a resident of district one. I am also an electrical engineer, retired, a graduate of davis and berkeley. I think i am probably the only engineer, graduate engineer in this room, of the presenters we saw today. I appreciate, mr. Peskin, you are a person with with attention to detail. That is what engineers do. Supervisor peskin i think the general manager of our puc is an engineer, but go ahead. Many people who talk about being an engineer, there are many with different flavors. My degree is in Electrical Engineering specifically. I wanted to speak to the risks, and challenges, little bit and say am probably in favor of the option that nobody wants. One of the things pg e has now is what they call a scale. The city will lose some of that. It costs that the city wont increase almost certain because of that. Im not going to go into details, but i think you understand what the scale is. Things like distribution facilities, maintenance facilities, all of the things that needed for infrastructure to support the operation are distributed along its territory and can be shared within the territory. We will lose out in San Francisco. Supervisor peskin we have some of that upcountry. May be some, not all. Not to the extent that pg e in terms of responding to largescale things like how many power lines down. Im not going to get enough time to speak. In terms of the cost, we just talked about the park escalator canopies, and the unexpected high cost, and that is typical. It is a very common thing. Im not going to go into that any further. Finally, about the employees, it has been reported the employees already saying if theyre only in San Francisco they will lose the ability to transfer out. They will be competing with tech employees for their salaries. Supervisor peskin thank you. No, sir. Are there any other members of the public who would like to testify on this informational hearing . Seeing none. Public comment is closed. Ms. Hale, general manager kelly, godspeed. Any additional comments from Committee Members . We will be hearing from you quarterly about the red, yellow and green lights of which i think around that long list you last furnished us which was pages long. Everything else was predominantly red, little bit yellow. If anybody out there, from pg e is watching and they have legions of lobbyists, Governmental Affairs people, would you at least be decent to the city on that issue. This is amounting to extortion. This has nothing to do with the rest of the conversation we are having. Why dont you stop that nonsense with that. We are adjourned. Clerk is there a motion on the item . The item . The Health Services board will now come to order. Please stand for the pledge of allegiance. [pledge of allegiance] madam secretary, roll call, please. Yes. Item three, roll call. [roll call] there are some commissioners excused and rafael nadal him and is also excuse. We have a quorum. Item number 4, please. Item four, approval of possible bulk possible modifications of the meetings set forth below. June 13th, 2019, and the special Meeting Minutes from july 11th, 2019. Are there any corrections to the minutes . Of either meeting . Seeing none, i will entertain a motion. I will move that the minutes from june 13th and july 11th meetings be approved. Second. Okay. Any Public Comment on this item . All right. All in favor . Aye. Any opposed . It is unanimous. Item five is general Public Comment on matters within the boards jurisdiction. Is there any Public Comment, anyone who would like to speak at this time or have a question . Hello, i am a retired teacher with the united educators of San Francisco. Is this an appropriate time to give feedback on the presentation last time . Because i wasnt here until the end and i did have some feedback to give because im thinking it might be a good time because the minutes were about the last meeting. I think it is fine. Thank you. I want to say that the motto that was the model that was presented was quite amazing and just show that theres a lot of change going on. I would like to, as a teacher, when we do something new, we have a pilot, and im wondering if there is a pilot where you start off with a very small group of people and you they volunteer, and you get a good Cross Section and you can take out some of the bugs there. And also, is a former bilingual teacher, im going to ask if there will be accountability for many of the families who probably speak another language, and that is something to be considered with the new health plan models. Also, i was reading something, coincidentally i think it was the july issue, and they talked about healthcare, and they talked about two models that were successful. One using the preventative model , and the two cities were denver and austin, and they have done the vertical integration, so i am wondering if it might be useful for you to know about that. Those are my general comments. Thank you. Thank you. Any other Public Comment . All right. Public comment is closed. Item number 5. Item number 6, please. Item six is the president s report. This report is given by president breslin. I have nothing to report at this time. Is there any Public Comment . Seeing none, item number 7, please. Item seven is appointment of the Health Service Board Committee chairs and members for fiscal year 20192020. This is presented by president breslin. All right. My duty as president is to recommend the chairs of the committee and the members of the committee for the following year , on the finance and budget committee, as chair, commissioner lim, and Committee Members commissioner monsey and commissioner mandelman, and for the governance committee, im recommending as chair, commissioner scott, and members, commissioner canning and commissioner how. I would entertain a motion to approve these recommendations. Can i ask one question . Who are you appointing yourself to . Either. As president , i am ex officio on all boards. I move approval of the two committee two committees appointed as outlined. Second. Any Public Comment on this item . Seeing none, all those in favor . Aye. Any opposed . It is unanimous. All right. Item number 8, please. Item eight is the directors report. This report is given by the executive director. Thank you and good afternoon. I would like to start my directors report by recognizing , on behalf of the Health Service system and the Health Service system board, our staff member, florence lamb, who is retiring as of september first. Their certificate of commendation reads, in grateful recognition for your enduring commitment to exceptional customer service, the Health Service system and the Health Service board thank you for your 19 years of service, your work ethic and positive attitude is extraordinary. Your initiative and willingness to go beyond expectations has significantly contributed to the success of h. S. S. We really appreciate, and many of the staff had lots of wonderful things to say about you and the extra hours that you put in during open enrolment, the dedication that you have, in particular to the School District personnel. I thank you are the go to person on all things School District, which is terrific, and bringing in new employees is another great skill that you have. I know you answer every question that ive ever asked, and i see you often in mitchells office hanging out. Im sure that says a lot. It is really a pleasure to i have had a very short tenure with you, but obviously you have made a lasting impression on the Health Service system and our members. For that we thank you. [applause] i personally want to thank you for your service and wish you a very happy, healthy retirement. Any other comments . All right. I will return to the reports. I will just highlight a few things. One is we did make it through on time with rates and benefits approval. It was a little dicey in some moments, but there is no controversy about the rights and benefits package that we put together this year, and i personally want to thank my entire team for the tremendous work that went into creating the rights and benefits package. I appreciate it. I also want to think, in his absence, supervisor mandelman for sponsoring legislation and for seeing the process through for us. In addition, pamela will note in her finance report, but in the parallel timeline, we also had our Budget Approved of the board of supervisors, which is no small task, and i wanted to recognize pamela for the effort that she puts in on that every year. It is Pretty Amazing the process , so thank you, pamela. As a followup to the market assessment, we are having we are engaging communities and collaboration with the Member Engagement process. The design of that is not complete, so im not here to tell you what thats going to be today other than we are working on it and we will have information coming out to our members shortly where we will be designing a few workshops and focus groups. It did come to my attention recently, and i just wanted to add this clarification that apparently a few years ago, when there was the change in the medicare product for our members , there was an extensive number of outreach and town Hall Meetings to educate us about a change. I did want to say that is not the approach that we will be taking with this because we dont have something to educate people about. We are also we are actually in a very targeted session to try and get a sampling of the wide array of members that we have to get their input. It is more of a focus Group Approach and i dont think i know i wasnt aware of that prior methodology, so i just wanted to manage expectations around how what we would be doing. To that end, i just wanted to recognize shenae, who is in the room from community and collaboration and as part of the team. There she is. She was helping us design our workshops. I will be facilitating more to come on that shortly. The new hours of operations for the Member Services is in effect as of august first, and i noted this morning coming in that the team is hard at work at 8 00 a. M. In the morning, not that their doors may not be open to serve members, but they were fully engaged in some of the process improvement training and work that they are doing, so i did want to assure the public and our board that those hours are being well purposed with the team and it is very much appreciated to be able to have that time to do the training and process improvement work and all the new, knew everything, constantly changing. People need time to take up that information. Pamela has helped me put together a pretty comprehensive legislative update report in your packet. As you are aware, there is a lot going on, both at the state and federal level. We will try to keep you abreast. We could spend hours on almost anyone of these topics if the board wishes to have additional information, or has a keen interest in any particular item, please let us know and we will do our best to keep folks updated, but i did want to call out, in particular the governor in california. We did past the healthy california for all. There is a commission that is being formed to really look at the singlepayer issue. It is my understanding that that commission has not be full been fully appointed yet, but that will be something to pay close attention to. As we all know, Governor Newsom has a passion for healthcare. Also, we have pamela who uncovered the m. C. O. Tax. It is actually being considered in california as we speak, so we will see what happens when the Legislature Reconvenes in september. So theres much more i could say , but i felt that at this point, this is a pretty nice summary of what is going on, and we will keep that up to date for your information. I did just mention the lean process improvement. I will be talking about that as part of the Operations Report for some time to come because we are very much learning how to become a learning organization and learn process improvement that will, that is already having an impact on things outside of the project itself and just learning new ways to work together. The Member Services team and others are meeting daily to go over the things that they are working on to improve, and thats going to carry forward, even though we will take the our eye off the ball a little bit during open enrolment, the daily meeting huddles will continue, which i think will really enhance the ability for the team to Stay Together and focus through open enrolment. We are very excited about that. I did want to acknowledge Sean Lovering here from blue shield of california. There was news that see pmc is now part of the trio network as our board may recall. That negotiation took almost three years, but they are now part of the trio network. So i think there are members that wish to participate in trio , and that was holding them back. We could take a look at that again as an option during open enrolment. We have had some issues that we have worked through with our account Management Team at kaiser where we did have some changes in the way that they did procedures for terminating members from kaiser. It was setting off some alarms in our office, and we have worked through these issues. It has been a real roll up your sleeve, trying to determine what the root cause of this problem was, and it has been a joint effort to resolve that. Will be monitoring that closely in the days and weeks to come to ensure that it is resolved. As a followup to the june 13th meeting, mike clark worked diligently to create the answers to some complicated questions about how the tax works with our various providers , and why we see the yeartoyear medicare plan variation. If Board Members have any questions, mike is here and can take those questions. Operationally, in addition to florences retirement news, we have had a number of promotions, and i believe some of these folks are here. Carrie is now our wellbeing manager. She has been our acting manager from time to time over the last couple of years and has persevered, and is now the manager for the vision and we are very pleased to have her in that role. Michael, is michael here or not . He is our contracts administrative manager and he received that promotion. Eileen is promoted to the senior benefit analyst. Weve had a lot of movement and i did acknowledge in the report, shannon, who is a senior h. R. Consultant who came back after a Maternity Leave and has been really amazing and clearing the backlog we had of unfilled positions. We still have some open winds, and in particular, we are being very focused on the benefit analyst positions that we need to have in place for open enrolment. Those lists are out and i know the team was behind closed doors yesterday, going through applications. That is moving forward really quickly at this point. I think the last thing that i wanted to call out, because it is such a big part of open enrolment, is the electronic benefit process. It continues to move forward. It is a very big moving target for the active employees who are very were fairly confident that things will move forward. There could be delays in rolling it out to more of our retirees and some of the School District employees, with that is not our intention at this point. As we look at things may not meet the timeline, those are the areas that are more vulnerable. But we are optimistic that we will have a significantly different experience this year with the selfservice benefits. That concludes my directors reports report. I can take any questions. I have two questions. One, you may not be able to answer and has to do with this commission being established with a singlepayer, although it is early, do you know what the composition will be . Will it be representation from the Public Sector so that we know that we have a voice, and in one sense or the other in this commission, assuming there will be transparency. Im not sure. Pamela do you recall i think that was part i think it is a bit of a mystery now at this moment as to how that will be divvied up, but we will follow this closely and let you know as soon as we do. I think we have a vested interest in seeing how these discussions go and i would hope that the Health Service board would be behind a recommendation to make sure that the Public Sector is represented on this one way or the other. Whether it has to go through the board of supervisors or whatever , but i would recommend that we see that is the case. Okay. Second question i have, has the expansion of blue shield, it is just two im confused about how the campuses there actually are right now. Three. Thats what i thought. So it includes only the mission, burnell campus and the davies campus. And the venice campus. It does, i didnt see that listed okay. It wasnt listed in the report. Adjusted those two campuses only yes. Okay. , good. All the main campuses are included. Okay, theres no questions. The Communications Collaboration person, what part of the budget does that come out of . It is out of our professional services budget. Okay. , and how are you going to engage the retirees . We actually have a matrix right now naming all the subpopulations and then we will figure out how to best reach those people. They are our most vulnerable group, so most times the active they are being his picked up by city employers. It is very important. Totally agree. Theyre going to be harder to reach, of course,. That is why we need to do targeted outreach to specific groups. Okay. And when you were going through this process, you want to make sure everybody is quite aware of what is allowable under the charter in any new plan that we have, and choices the members need to have a choice in the charter, we know that, and we also know that the board can adopt the plans, so that is also part of the charter. Just so everybody is aware of that. When looking at different models , the county survey that we have, and there are a lot of other counties in california that are good to look at, as well. I was looking at napa, that has a lot of options. I didnt see were going through this process whether you looking to see what other counties are doing. Some of them have a lot of choices, some of them dont have so many. California, as you know, is unique to other areas, and certainly to wear a on is working in different states, for sure. I think it is important to look into that part. Im glad to hear that this is a real outreach instead of many times these things are done and theres a preconceived idea, which you will have anyway, before you get the material out there. Members get very frustrated when they go through process and then at the end of the day, their input is not even considered. Im happy to see that that is part of that. And the other thing i was asking about, the lead process, is that a citywide . The support that we are getting for learning is coming through the controllers office, and it is it is one of several process improvement models that are out there. It is one that im quite familiar with because it is very typical in healthcare. Both hospitals, laguna honda and San Francisco general, have very robust process improvement unique using lean methodology but it is not a Citywide Department process . No, but i am not i cant say off the top of my head what other departments are using it, but all departments are encouraged to have some kind of process improvement. When i came onboard and started exploring what options were available and learned about the controllers office, and they provided without any funding from us, they get funding elsewhere, that seemed quite attractive, and theyve been it has been a good fit, it has been a really good fit. Excess tax repeal, is there anything more anything more of that . Excise tax . That is mentioned in the report on page 3, of which, i think it is still on the senate calendar. Theres activity in both the house and the senate, but that doesnt really say much. So nothing new . Nothing new. Okay. Very good. But we are following it. Any Public Comment on this item . I just wanted to give a little bit more information on the question on the committee for the healthy california that you asked about. I have the legislation in front of me. The first thing i wanted to point out is that it says that the commission is going to meet for the first time on or before september 1st, and shall have meetings at least quarterly. It says the Commission Shall be comprised of 13 members, the secretary of California Health and human services, or the secretary shall be the chairperson. Six members will be appointed by the governor, the members shall be appointed by the Senate Committee on rules, three members will be appointed by the speaker of the assembly, and then it says there shall also be a fifth ex officio nonvoting member of the commission who shall be the executive director of the California Health benefit exchange, the director of the healthcare services, and the chief executive officer of the Public Employees retirement system, or theyre officially designated representatives. Thank you very much. That is very helpful. My concern is that they are all political appointees, and they are political appointees by political committees in the Governors Office and the senate and the other branch legislator, but without looking for a spectrum of input, and as i think we do have a responsibility to at least suggest that at least one member represent the Public Sector, not necessarily the Health Services system and San Francisco, but some Health Services system. Would potentially impact us considerably. I dont know how to go about that process at this point, since we are only three weeks away from the first meeting. I just put that out there. I will talk to the folks at city hall to find out more about our ability to provide input. Certainly i heard in the ex officio person is there. There is some public representation, not that they are asked, that we are likeminded in many ways, but i will do further research and see how we can stay in it. I would also say, knowing the way the government knew some operated when he was mayor and created healthy San Francisco, he was very certain have subject matters experts at that table. I would assume that be criteria for some of these members to have healthcare knowledge. The appointee shall have appropriate knowledge and experience regarding healthcare coverage refinancing, or other relevant expertise, and there may be advisory committees that include members of the public with knowledge and expertise in healthcare that support stakeholder engagement, and analytical process by which the Design Options are developed. Theres no other specificity. All right. Public comment, please. Good afternoon, commissioners im representing the retirees. Everybody but the teachers who are here representing themselves in the firefighters who arent here, but i will speak for all the retirees. Basically, we want to congratulate all of the staff on the promotions. A lot of us, while we were active employees, really looked forward to the opportunities for promotions from within, and this is really exciting to know that we have had that happening within Health Service, and then we look forward to having those other vacancies filled from the outside. We want to especially congratulate florence. Some of us, in our various groups, are looking forward to seeing florences applications to our organizations, so we will be chasing her down. We wish you luck in filling all the positions, but again, and especially to pamela, for her job every year working with that legend. I dont know how she doesnt. Its really just amazing, but thank you and congratulations to everyone. We look forward to the day when they join as, but we are also very happy when we see that they get the promotions that they deserve and that they will be serving all of our members. Thank you. Any other Public Comment . All right. Item number 9, please. Item nine his Financial Report as of may 31st, 2019. This presentation is given by pamela leven, the chief financial officer. The report in your packet summarizes the actual revenues and expenses of the trust in the general fund through may 3rd, 2019, as well as projections through june 30th, 2019. In terms of the trust, we started the trust balance in june 30th, 2018 at 77. 4 million. We are projecting using data through may 31st, a balance of 88. 4 million, which is an 11 milliondollar increase. We are seeing unfavourable claims experienced for the plan. We are for blue blue shield access and trio plans, an adult and dental selffunded plans. The claims experienced continues to be favorable. No rebates have been received since the last report, but in the yeartodate year to date is 5. 8, but the yearend projection is 7. 9 million. The healthcare Sustainability Fund is projected to have a yearend balance of 3. 9 million which is carried forward into the current fiscal year that we are in in 1920. A total of half a Million Dollars has been received in performance guarantees through may 31st. We paid out 105,000 under the servicing and adoption assistance plan for a total of 200,000 since it was first offered. The allocation of that has been 300,000 a year, so over, basically a year and a half, we started in 2017, so we have had a considerable amount of time and not a huge number of requests. The forfeitures for the flexible spending accounts will be reflected in the reports coming to the september board meeting, but we are not technically available. They were still under review as of may 31st. We have provided grafts just to ground everybody. The goal of setting the rate for the actual cumulative expenses to be equal to the total revenues, including the stabilization reserve by down or buy up, plus the value of the Rate Stabilization over the course of the year. The chemo to of expenses are tracking higher than revenues for the plan, and the cumulative expenses are tracking lower for access plus, and trio as well as delta dental. In terms of the general Fund Administrative budget, based on the results through may 31st, we project to end the year at 300,000. Again, that is mostly due to savings. To the extent that we end up the year greater than which is expected and counted on by the ninemonth report that the budget analyst puts out, we are trying to request every penny to be carried forward into this current year. We had some really strong justifications and we had staff that is very good at crafting these things so they will be accepted. In terms of the budget, the only change in the budget that was originally provided by the board , it is a small increase in attrition savings, and i am confident that we will be able to get that because we do have, you know, people coming and going more so than we used to. We used to have a lot of people that were there for 30 years, but now we have people coming in and then moving on and moving up we have vacancies, so there is also is of movement that we will be able to sustain that. I would be glad to respond to any questions. I would just like to take a moment to complement the staff who are here for h. S. S. A 300,000dollar salary savings really means that the work is being done by the people who are here, and while we are attempting to fill all our vacancies. And likewise with attrition. I think we all recognize the stress that it puts on the staff you are here, when there is attrition. The retraining, the expertise, the mentoring and all that. Again, it is an opportunity to thank those who are here and to have been here for 29 years and to congratulate them for their hard work. We see our budget is so tight, and this does translate to really hard work by the people who we employee for h. S. S. Any other comments . I have one question. I know i asked this before, but you were saying here about money from the healthcare Sustainability Fund going to the general fund. I know that is a separate fund and it is only to be used for certain things. There is something saying in here saying that. It says transfers out. That is a transfer out from the trust fund for the forfeitures for the flexible spending account. The i. R. S. Regulations allow for that to be basically say that it is to be that its supposed to be used for the administration of those services , it just happens at the administration of those services is actually in the general fund rather then in the trust, so there is a transfer. You mean in the citys general fund. Right. Our administrative budget is here, the trust his here, the revenues coming into the trust for forfeitures im talking about the Sustainability Fund. I know the forfeitures there is nothing in the Sustainability Fund that transfers. 0. 1 million here under transfers out. Or am i reading this wrong . No, the transfers out is a separate line. It is totally a separate line. The court categories are self insurance, insurance products, savings and investment and transfers out. Thank you. Okay. Any other comments on this item . All right, now we are moving on to item number 10. Item ten, Care Management vendor presentation. This is presented by dr. Neil mills. , natalie, you are fine. I just wanted to introduce dr. Mills. He has spoken with us before, so he will walk us through his presentation. After he walked through his slides, we have asked the three medical carriers to spend about five minutes coming up in alphabetical order, for lack of anything better, to present a little bit on their care coordination program. That is part of this item. We will begin with dr. Mills. Hello, everyone. Neil mills. I am delighted to be here again. Todays presentation will really look at some of the emerging trends and best practices and some of the new players in this care coordination and Care Management realm. Lets get started and lets get on to the next slide here. Okay, the very first piece of this, as we think about the Member Experience in the Healthcare System today, the goal of what we are going to go through over the next few slides or over the next few minutes is what are the potential Member Support programs at various test points in the healthcare journey , and how can we potentially do this better, and what are some of those pain points . And what are some of the solutions that the carriers and the vendors have come up with. With our one click Going Forward here, theres three different aspects we can think about in this healthcare continuum. The first is the well, or maybe the worried well where there are more preventive type screenings that are focused towards this. Lets go forward just one click. The second click looks at people that have decided they need to interact with the Healthcare System, but they havent yet, and they may looking for guidance. And the third click is the focus of the rest of our slides. In fact, there is a red box here where you see it closed, both advocacy and digital and live navigation. We will define those to find those for you, but thats with the rest of these slides address , and that is our focus. So what might advocacy look like , or what might live navigation tools look like, and how can they improve the Member Experience . Lets go forward one slide. So to get to that discussion that i have promised you, lets look back real quick over the last two decades of how care coordination has evolved. Back in the early to thousands, the focus was almost exclusively on those highcost claimants, and it was initially focused, and that was the language that was spoken. And typically these were services that were provided by the carriers themselves. And then over the last decade, we have seen some new trends where there were these passive disease management programs, those were something where maybe somebody had a couple of chronic conditions or something in the mail, or maybe by email, and frequently unfortunately these went into the garbage, but these were disease focused. And finally, in the last few years, we have seen Holistic Care through new Population Health management programs. These are focused on the individual, and have a holistic wellbeing based in meeting the individual needs. These could be provided by either a vendor or the carrier depending on what type of hybrid model is actually used. Lets go forward another slide. Okay. As we begin to delve into these frameworks and how they are changing, and how best to understand the marketplace, maybe the best place to start, is how are we defining Population Health management today . At the lowest necessary cost, it really includes a proactive application of strategies and interventions, were defining cohorts of interventions cohorts of individuals and the interventions we would like to apply, and were looking across the entire continuum of healthcare delivery. So to achieve this fullspectrum of Population Health management, we have to look at the success of our care coordination and management programs. Lets move forward to the next slide. And a couple of other presentations, because ive had the privilege of serving you over the last year, we talked about the quadruple. I will not be labor those pieces today, but if you look at the hexagon here that speaks to program navigation, this optimizes the use of programs and resources that track the impact and Ongoing Program management pieces. So what does that look like, and what does that mean . Lets go forward another slide, because now we are getting really close. This is the power of a strong employer who is a leader in their community, and all the potential places of impact. If you look down to the bottom, the policies and programs, being an employer that preserves the city and the county, there are physical environment influences that you have, not only for your employees, but the places you live. Theres also the health factors, the socio and economic factors because of the income, the incentives, and Educational Opportunities that can be provided. Ultimately, Health Outcomes are actually driven by you as well, since you are financing healthcare because of the Clinical Care that we can influence, and how it is delivered, and how we can address healthy behaviours. So through these frameworks, we can finally get started with what is happening in the marketplace. Lets go forward another slide. Okay, we will bypass these goals because they are a bit of a simplification for the prior goals that we have already addressed in a prior slide, some of the pain points where these vendors and carriers have begun to focus more energy on their resources, are what does my plan cover . We have all heard about medical surprises where we saw sought that we are seeing an in network physician, maybe we did go to an in Network Delivery system, but maybe the anaesthesiologist was out and to the surgeon was in. Who will help them member through that experience so theyre benefits are fully realized and they are not left holding a medical bill . How do you find the right doctor what is the right doctor look like . Is there a centre of excellence for this particular condition that i have, or maybe there is broad variations in care. Finally, what are the Treatment Options . I have to have surgery. So when you look at the way employers engage with consumers in the market today, it is much broader than this when we talk about the vendors and the carriers and what theyre able to do now. The current lever points increased when you start to include digital and these Life Solutions in the navigation space. To give you a really simple example, for a point solution, what if you have a member who does not have responsibilities back to the job, that they have the luxury that they can drive across town, find parking, and see if physical therapist . How can it be communicated to this member who has chronic low back pain that there is a virtual physical therapist that they can receive care right in their home for low back pain, or maybe for knee pain . That is a really simple example. Of course, this is the ubiquity of our Smart Devices now. It is possible this could reach a vast portion of your population who we serve. On the other end, live, how can i connect to human being who can understand what the issues are while im having a struggle and navigating the Healthcare System so one more click. Because of those two solution points and various hybrids that exist there, there is a new way that we can connect our employees and our population to all of these employer resources. I will give you another example because this is a pain point throughout the u. S. Behavioral health. Perhaps that when a member has acknowledged, they have cut through that wall of shame and they have said, i have anxiety and i will get treatment for this, however, every time they call a therapist, either no one returns her phone call, they never get through, or the therapist is no longer accepting new patients because they are completely full, or now theyve changed to cash only. What about all the Virtual Solutions . Visiting with a therapist online , all the Cognitive Behavioral Therapy solutions that are online, all the other interventions that are Available Online provided by employers through some of these niche vendor solutions. By the way, the more talk, the warmer it is getting in the room have you all notice . [laughter] we will move on to the next slide. Well go through a couple of clicks here. Theres a couple of takeaways that i thought would be useful for you, and it is more then the detail, it is hoping im hoping this is what you will really remember. There were several key points and shared understandings that we had to share before we could get to the slide. The first take away is there is a lot of vendors who have come to the table and also carriers that believe that they can do better in the Member Experience and how people experience the healthcare today. Because of the low barriers to entry and the problems of venture capital, have taken on this onus that they believe they can do better. What i will hope you will remember is everyone of these members, none of them endorsed by us, by the way, these are simply examples, provide a scope of services for various pain points that we probably have all experience ourselves and we also hear from our populations, but that scope of services is dynamic in that a lot of these vendors are wanting to expand the scope of their services, but this is where some of these vendors stood, so if you absorb the feedback from your populations and you did the surveys, and you knew where those pain points were, then by asking the question, what are they, and what are the possible solutions, and what are the best practices. This could be a Guiding Light for your strategy Going Forward. In addition to these vendors that are listed here, keep in mind that Health Plans Offer multiple care coordination and management models which vary across the spectrum. This includes both of those domains that we originally started talking about a few slides ago, which include the live and the digital. I will now give you some specific examples from this. I will stop and pause just to see if theres any questions. Now we will go through a couple of examples. And first i will draw your attention to that blue sphere in the centre of the page. While it does read telephonic care advocate, it could read simply care advocate or simpler, and advocate. That could actually be a human being or some type of technological solution, or an intervention. The goal on this slide is for us to think about what could happen differently if we looked over the art of the next two years, how would we like this to change and then i thought maybe the best way to walk through this is come up with an example. Lets think about a member, we will go back to that one where there is some confusing medical bill, and the employer, because they are not satisfied with maybe the adjudication process, and theres a lot of feedback coming to the employer, that theres conclusion around medical bills and how to navigate the appeals process, or maybe the medical bills dont even realistically reflect what has actually occurred. And through this intervention, theyre connected to someone who is proficient experts in helping get this matter resolved. Another example, a member has decided they have done their Due Diligence in trying to lose weight and they have decided it is time for bariatric surgery. They dont know whether those benefits exist, or if they did, if there is a particular centre of excellence that is recommended. Through provider upward optimization tools and navigation tools and through this intervention, the employer has the opportunity to influence a different way and go upstream with how the employee is actually going to interact with the Healthcare System. The provider example might be that a referral for a special type of therapy, maybe immunotherapy that we have already about, the providers will say, who provides that type of service and to this type of spherical tape influence that we have here. They could be referred to a place that is in network and consider the best in class. Those are two life examples. On our next slide, and it is our final slide, as we walk away and open this up for discussion and for the carriers to come up and talk about how they are addressing this today, theres various approaches you could take in acknowledging these pain points. One is, the approach is it is health centric. You work with the carriers to work on the pain points that you are getting into, your strategy accordingly. On the other extreme, approach number 3 this is a complete carveout where this is handed to a vendor and some of the processes, maybe it is utilization management, Care Management and a bunch of the other processes and services that we referenced on the other pages, are simply put in the vendor spot and somehow it interfaces with the vendor ecosystem because of interoperability. I will stop there and see if theres any questions. I have some experience with this over my 32 years in practice, and it all makes sense i see these different approaches its just there is chaos in terms of each health plan and all the tries to find vendors who understand the change. We just heard that blue shield opened up the hospital system, so how does that information how quickly does that information get transmitted to a vendor in this situation, and then to the subscribers, and that is a major change. There are minor changes that happen all the time as we look at our benefits packages in terms of transportation and nutrition support. It all looks good on paper, but when the rubber hits the road, i guess, ill get back to comment that was made earlier about where what are the outcomes from pilots on maybe more contained, smaller programs. Yeah, it has taken a while for me to be able to actually in the last two years, i have been studying this on a weekly basis so i could convey these ideas. There is a massive onslaught of information, and it is very difficult to distill that and receive it in a way that it is actually actionable, but it is not too much information and thats why these companies have come forward. To get back to some of your pieces around what is actionable here, many of the vendors and carers are willing to put performance guarantees in place around what they can form and the medical trends they are willing to guarantee. There are outcomes, there are publishable materials no love to share that. That will be another 20 minutes to work through those. I can tell you that it is not just coming from the vendors but that is actually validated through independent consulting firms. Weve done that with some of these vendors and we would look through various cohorts to see if they had that are outcomes and whether the medical trend was affected by it. That is my highest level answer. I appreciate that. We have already had experience with some vendors and outcomes, claims for dollars saved, or whatever, there is no doubt, in my mind, that Member Satisfaction is very high when they can talk to somebody or
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