Recommendation and also wanted to let the public know that, at that meeting, the Budget Office shared a lot of helpful information about the timeline for the year, and i encourage folks, budgets are important, and i encourage folks to come out to budget meetings. It is the best committee ever. If they go online they can also see what we are going to be covering over the year, so that when we make decisions those things are not surprises. I encourage folks to come out. You can also reach out to me im happy to share with communities how were trying to make things more transparent for families and staff, how we make budget decisions. That will be happening throughout the year. There is lot of opportunities for folks. Thank you. Thank you. Do we have any board member delegate membership updates . Okay. Seeing then. Any other reports from Board Members . I briefly want to thank ida wells, and a few other schools that i went to parade. [laughter] all of the schools, the academy. I think i said them last time though. For having the other school sites. I appreciate the site tour, and the students at walden bird that took me on a tour of the school. Also, what are you doing here . I thought you retired . Oh, it was rita, my bad. You are not allowed to leave. Stay put. Commissioner norton . I want to remind everybody the Student Assignment committee is meeting on monday at 6 00 oclock. I am really excited about, i just did a planning meeting with ms. Okeefe who staffs the committee. We have some really good items on the agenda for this year, as we move towards redesigning the Student Assignment system. This monday were going to talk about particularly about diversity and different ways on how we define that. It really would be great to have attendance from as many of you that could make it. Im anxious to have as much as possible engage in these discussions before we get to an actual redesign proposal. Thank you. Anyone else . Im going to announce the next Upcoming Committee meetings. Budget and Business Services on wednesday, october 2. Rules policy and legislation monday, october 7 at curriculum and program monday, october 14 at 6 00 p. M. Buildings and grounds and services monday, september 23, 6 00 p. M. Committee on personnel matters, the meeting will be scheduled soon. Committee on Student Assignment will be monday, september 16 at 6 00 p. M. The joint City College School district, and board of supervisors meeting scheduled for october 11, friday at 10 00 a. M. That meeting will be held at the city hall. Section and, other information items. There are none tonight. Section o, memorial adjournment. There is none tonight. At this time we will take Public Comment for those who have submitted speaker cards were closed session items. Five minutes for Public Comment. Any Public Comment on closed session . Seeing none. The board will now going into closed session welcome back. Following closed session. We will resume regular board meeting. I will read the actions from tonights closed session. In the matter of the department of social services sfusd, Education School case number 2019060075, the board approve the stipulation to settle an early Education School license revocation matter. The board gave direction to general counsel. That concludes tonight board meeting. Good night. San Francisco HealthService Board will now come to order. Please stand for the pledge of allegiance. I pledge 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. Roll call please. [role call] we have a quorum. Item number four, please. Item 4, approval or modifications of the minute of the meetings of forth below. Regular meeting minute from august 8, 2019. Does anybody have any corrections to the minute . I move that the minutes be adopted as distributed. Second. Any Public Comment on this item . All in favor . Opposed . It is unanimous. Item number five, please. Item five is a general Public Comment on matters within the boards jurisdiction. Any Public Comment on this matter . This is a chance to speak up on anything within our jurisdicti jurisdiction. Seeing none. Item number six, please. Item six is the president s report. This report is given by president breslin. The airconditioning is is not working here today. Hopefully this will be a brief meeting. Other than that, i dont have anything to report. Thank you. Item number seven, please. Item seven. Vote on whether to cancel the october 10, 2019 Health Service at meeting. This is presented by president breslin. Its been a tradition that we do not meet in october. Due to open enrollment and giving the staff a little more time to prepare. If there isnt any objection, i could use a motion on this. I move that we cancel the october 10, 2019 meeting. I will second. Any Public Comment on this item . All in favor . Any opposed . No. Okay. This passes unanimously. I didnt see any objections. [laughter] all right, number eight. Item eight is the directors report. This report is given by mitchell griggs, the chief operating officer. Mitchell griggs, chief operating officer of the san Francisco Health system. I want to highlight our executive directors report here, and the first thing is we are doing our member focus groups. We have already started sending out the invitations. This is going to a wide variety of members. We are asking them about their experience with the Healthcare Delivery system, and our benefits and hope to get information about what can hss benefits look like going forward. This includes San Mateo County and alameda county. I also want to mention that we have worked with the health plans on Development Communications on second opini opinion. As you know in 2020 we will not be contracting with best doctors. We wanted to make sure we had readily available information for people to get second opinions, if that is what they would like to do, through their health plans. I also just to make a clarification about trio and what blue shields trio hmo will look like in 2020. We talked about this a couple of times and there has been some communications out there. I wanted to emphasize that trio 42020 will include california Pacific Medical center. That will be the new facility on van ness, davies and Mission Bernal campus. That is one of the biggest things we are highlighting for 2020. As the board knows, we worked really hard in 2017 in getting on new products, it was a narrower network from access plus to make the rates lower. That did have an affect and they gave us this exclusive deal, for the city and county employees only. Thank you. Wanted to mention, too. Under operations, in the general management report, you will probably see a lot of work there has been done on open enrollment. Each division is working hard on their open enrollment. Im trying to find the page. Of course, i dont have it. I wanted to also mentioned that we had an internal promotion. Our benefits tech shem has been promoted to a benefits analyst on has filled one of our 1210 positions, and scanned the audience today. Weve also hired, as a Senior Benefits analyst an 1813, jenna wong who comes with a lot of high level benefits and administrative experience. She is also in the audience today. If they would like to stand, and greet the board. [applause] thank you. Almost there any other questions about the directors report, that is all of the highlights that i have. All right, thank you. Any comments by the board . Any Public Comment on this item . All right, seeing none. Thank you mitchell for filling in. I appreciate it. Item number nine, please. Item nine, presentation of the open enrollment and e benefits for plan year 2020. This will be presented by mitchell griggs. Every year we try to briefly highlight the work that has been done, as far as operationally and putting out the communications, setting up for open enrollment. As you know, its a whole monthlong event, starting october 131. You know, we start work on open enrollment as soon as you guys approve the rates, and all of the new benefits. On the first slide, want to show you the theme that we are using, it is the same thing we have used over the past two years, in sense of having an out to help people realize that packet is there open enrollment, so they are supposed to open it, so it is the o. We are using our photography. We went out early last year and got, hopefully to encourage employee engagement, we went out to all of the departments, you know, employees in the field, and some retirees and took a bunch of pictures. We are using that again this year. On slide two, speaking of that photography, these are the benefit guides for 2020. These are mostly used by new hires. And any other member who wants went throughout the year. Our communications area, for open enrollment, all of the employers and groups will be receiving a condensed version of these. It is much more paper friendly and a small or too male. A less expensive. The retirees, we send them the full benefit guide which is the one in orange there. If you of the numbers, we email a little over 76,000 packets every year. The numbers are broken down, through the various employers and groups. Its only about 60 more packets than last year. We are also doing a much larger scale, online benefits this year covering all of the city and countys. We are doing about 4500 bar retirees than we did last year. We are doing a pilot with the school district, so were doing about. About 100, i believe. 300. Larger than i thought. That is tripling the amount that we did last year. We first started as a general rollout last year with selfservice so thats about trouble as much. On the next slide, i want to demonstrate here, that we have 12 different variances of these mailings. They are different letters, different enclosures, all in all its 12 different variances. We write all of this and develop these communications. We work with the printer getting this organized again this is a good bit of work. I just wanted to show that to you. Maybe youve already answered this, but can members opt out of receiving mail. A lot of us do that with our health plans, we want to get electronic only, is not an option, or is that not possible are the regulations of her bed that . There are regulations. Currently you have to elect to opt out, and have to opt out every year, that is the regulations. However we do not have the infrastructure to maintain that opt out database. We are working on that. Now that we got this selfservice, one of the high things on our list to do next is for people to be able to go in and say i want Electronic Communications for this year. We are working on that. The next light, i want to show you our events calendar. We have over 20 events this year, this is our Health Benefit fares, this is where the Health Benefits come in, they have tables and talk to members about the particular plans, analyst or theyre talking about the changes, going over the rates and answering any questions. We also have flu shot clinic going on. Several of those which are pretty large. It does vary a little bit. Its over 20 events its pretty much spread out through the entire month. Some days theres more than one. Some of them we do not put on here because they are closed to all of the city, specific to maybe that department and again, one last shot of some of the photography that we are using this year. The next section of this, i want Marina Coleridge to deliver. She was key in making this happen this year. This was a whole lot of work working with three agencies. The Controller OfficeSystems Division and the department of technology. Whenever you get three or more departments trying to get something this big together, with the city, you can just imagine. Marina kept that contain, kept our goals and our specific look very much in the forefront. These departments dont necessarily understand our compliance issues and our timelines and that type of thing. Marina was key in making this happen. I was really glad she was around to do it. Im going to let her present this next section. Thank you. Hello commissioners, Marina Coleridge, enterprise systems and Data Analytics manager. I want to re echo our appreciation to various other departments. There is different groups within those departments, within the department of technology, very key in getting the assistance from the department of Technology Help desk as we try to onboard more retirees and a population from the Unified School District. To help from the identity and Access Management people. These are not employees that authenticate to our employees systems. Theres a lot more work, and that team is in the middle of two massive upgrades right now. For them to be able to weakly support what i need from them is a big push, as well as the systems provision that handles the infrastructure. A big thank you to those teams. This slide is showing where we are in terms of our rollout of selfservice so the chart on the top left and blue shows where we were last year, a number of my eyeglasses cannot see from here. 7900 roughly active employees could go in last year for selfservice, i love that trajectory on our chart this year, because we got them all. Anybody who wants to will be able to with our open enrollment from the city and county employees and the superior court employees. In addition to that, the slide was saying probably Unified School District pilot, because it was still in flex given the resource constraints around the city. Im happy to say, it is moving forward. We will have a pilot with Unified School District this year. And then the chart on the right, for the orange, is where we are with the onboarding of retirees. Seeing the number the Previous Year that was 4800, now that has gone up to about 7700 retirees we have done the work in setting up their accounts. We sent them communications in terms of how to go in and create their accounts, and then went open enrollment opens up, they could go in and do it online. Not all of them will unveil themselves, but those that want to will be able to, we continue every year adding to this group. I encourage retirement organizations to spread the word if those folks got the letter from us. And then on the next slide, its just a look at what we are doing to support open enrollment online this year. We have kiosks available, inside of our offices. Theres is also another number of kiosks around the city, because people need to go and do their time entry into things like that. They may work out the field, but not at a computer or desk. Any of those places, employees will be able to pull up open enrollment, and do their elections there. We are collaborating very closely with our communication manager on a video specifically instructing people how to go through e benefits. We will have that available and on our website, once it is rea ready, and then we are also, all of the oe events that mitchell showed with you on the calendar, obviously our benefit analyst will be there helping to advise our members on their plans. We will also have members at the site specifically to help with navigation questions about using online enrollment. Telephone assistance they can call into our offices and we will have on the website stepbystep job aids that take you through how to do the different tasks and e benefits. It is a change in four people, we are hoping we can help people get there. Heres a little screenshot for you of how you access open enrollment, once we get to october 1, people who log into peoplesoft on the employee portal will be new for a number of people, but for our employees, it is pretty familiar to them as they go here every week are to be touch of their time. There will be on alert on that main page that says Health Benefits enrollment. Or theres an employee tab, which in a screenshot is that middle tab, from there there is a benefit section, you can click on the Health Benefits enrollment and that also get you right into our open enrollment, and yes, even if its a retiree logging in, that tab still says employee. That is not something we can configure. The next slide, please. There is a next slide. What we are really encouraging people to do, this is the first time people will see their own information. We know what we have had on people for years, but you do not know what we have on you. That is the good, the bad, and the ugly. We might have some data quality issues. Sometimes annually we do our change of address and we are getting updated from the mail house of peoples addresses have changed. We may not touch your home address since youre a little bilge since your eligibility is tied to that. Any number of reasons why data may be inaccurate. This is a wonderful opportunity for people to see they have a really old phone number for me, let me get that updated. It is important in terms of making sure we continually provide those benefits and can do outreach whether it is your 1095, or inviting you to focus groups, that we have the right information for you. This is another benefit of being able to go online, you can also update your personal information to make sure we have really wanting to do a big push without awareness with our membership, the more and more big online. Under emergency contacts, jane doe, the screen doesnt show any contacts information. Is that available . When you hit jane doe, does that pop up so you know how to get in touch with jane doe if you need to . That is an excellent question. I cant remember the answer for that. I would certainly hope so. Im going to go look at that and get back to you. I dont remember. Just a question. We want to know how to reach people if theres an emergency for certain. And then on the next page, once you have actually logged in, this is what we had worked with our external vendor, it gives you that shopping cart approach with breadcrumbs at the top where you see the green dot, and the red dots that help you see where you have video and everything that walks you through this. That is an actual screenshot of what the open enrollment interface will look like. That is that. Thank you so very much for your time. Any other questions. When one goes through current information does not include dependence, so they have to verify each year, given the problems we had. The dependence will show there, they dont have to do a re verification of them in terms of auditing their eligibility, but, you know if they are adding a new dependent, they can do that online, and then, they have to provide us with supporting documentation. They can do it online, they can upload it. If theyre not comfortable doing that, they can fax and or drop it by our office or and then our Member Services when they are processing that enrollment, just because you go online and submit it does not mean it is final. We need the expertise of our Member Services team to see, did you divide enough supporting information to let me finalize you and rolling that dependent. Also, the option to delete someone of that no qualifies . You cant technically delete somebody, because it is a legacy system of record. If im doing two audits, we are pulling audit information as who you dont want to delete someone from the system. If you are no longer a valid dependent for the sake of your Health Benefits, for your Life Insurance you might want your neighbor to be your designee, but that neighbor does not qualify under h. S. S. For Health Benefits. Weve done things on who you can see on some of those screenshots. The other thing you can do, is this enroll enroll dependents. You know, ill just put in a plug, the work we are wrapping up, you become a new hire, or you have now had a child, you dont have to wait until october you will be able to go in online, at the dependent, and roll them, or, you know usually we do the disenrollment on a dependent that hits the age limitation, but presumably someone can be proactive and go in a disenroll. Just by checking or unchecking their name next to the benefit. Great question. Thank you. Any other questions or comments . Thank you very much. Quick one, marina. Once you make changes, is there a confirmation that goes back to the employee. It is not an email yet. Where we are at, this year, the same process as all of our other years. We would get letters in the mail to you that will hopefully hit somewhere around thanksgiving. Those employees that would not have access to a computer in that packet without include the form that they need to fill out if need be . Yeah, so what we have done is for large departments, police, those packets include a form and with the packet. For everybody else else the fuzz on the city, it does not include the form available, or it will become october 1st on our website for some want download and print should they choose to go that route. You have employees that are out of most of the town, like san mateo. We did not include puc. Have a lot of employees are out of the area. I think when we go for our hetch hetchy event, we take a lot of enrollment forms with us there. For the others, puc was not included. People, other than going online and printing it, which is the preferred option, if somebody needs us to, we can put it in the mail, or the by our offices. Thank you for your question. Any other questions . Just one. I apologize. Is the vision to have changes or modifications versus marriages, divorces or things of that nature, that the member can submit everything online with whatever certificates are need needed . Yes. That is the goal. We are inching our way there. Fantastic. Any Public Comments on this item . Seeing then. This was a discussion item. Item number ten, please. Item ten, presentation of the sfhss presentation of the court 2 2019 cost, utilization and quality dashboard. This is presented by Marina Coleridge, enterprise systems and Data Analytics manager. Good afternoon commissioners. Marina coleridge, enterprise systems and Data Analytics manager. [laughter] oh, look, it is already up. Most of you are familiar with our quarterly that we produce, i know we have a new commissioner who may not have seen this dashboard before. We have a database that we receive feeds from all of our plans on medical and pharmaceutical claims data. From that we are able to produce these dashboards which gives us an opportunity to do some comparison across all of our health plans using similar methodologies and also give us our own objective view of what is going on with our data, as well as it empowers us to be able to do a lot of analysis by having that information. When we are looking at plan design changes, or looking into various specifics that are going on in the industry, we have that ability to do that. This particular dashboard is for incurred dates, april 2018 through march 2019. It is paid through june. The risk scores are rescaled to our population, and they may not always add up to 100 due to our members shifting around between medicare and non medicare. We do not have the financials on the medicare site. You wont see the dollars when we get to that population. And then, i will not read all of those notes. Any questions im more than happy to respond to. Claimants for our perspective, still using 50,000, which is still an industrystandard in many ways, although it does not take much to wrap up 50,000. Some of our key observations starting on flight three, no surprises on drugs. Specialty drug costs continue to increase. Thirteen of our top 15 are in fact, specialty drugs. Three of our top of those, in the, or top we do weather and traffic every 10 minutes. 12018 on global sales. That is how predominant those drugs are. A new drug in our top 15, is something called for psoriasis. We are seeing on our active early retirees, about 83 dispensed generic and medicare, right behind his 82 of those being generic. Yeah, high cost claims continue to trend up slightly. 45. 9 of total spend results from high cost claims, the next slide, nothing new here. Our population that is in the city plan, higher risk score, smaller population about 3,000 lives. You tend to see some of these metrics impact of that group a lot more, the lives to spread the risk out on. I will call that out in a minute i guess. And then our trends in the medicare population. Visits to the er. Scripts and supply rx has decreased. 79 of the population is categorized struggling are in crisis risk profiles, we would take a look at that and a couple moments. We will also look at our top problem conditions. Our dashboard is broken up into a non medicare dashboard and a medicare dashboard. It includes our active employees and our non medicare retired population. On page two, on the top right you are just seeing some demographics. For example weve got 93 to 81 lives total. You can see the breakout across our floor plans that we have. Average age in that population come across everybody, is 37. 6. Here is a look at the bottom edge or high cost claimants. Those are trending upwards slightly. Trio had more high cost claimants. Everyone else had an increase in a number of high cost claimants. Moving to slide three, just want to call out here. This is taking a look at our cost, per employee, per year. It is broken out into multiple settings. Your lab, other services. Looking under the u. H. C. Column, that dollar figure, 6,840 per employee, per year. Normally even though we see the shift of services to an outpatient setting, it is a lower this population here for u. H. C. , has consistently seen their outpatient ends up being costlier than the inpatient. Excuse me. I want to go back one slide, demographics. I am looking to the right, the demographic listings, you have employee percentage mail, and numbers mail, why is that identified that way . It is part of the score methodology. When youre looking at risk scores, if youre not doing things, here prescription cost groupers, you are looking at age and gender. Women can be costly. That is a consideration, that is why we are looking at it. For example, right below there, too. You are at the risk scores. Looking at our risk scores is understanding potentially where we are at and cost current or future. The way that we do that, as we are looking at what we are spending money in terms of the drugs, the services on the procedures. We are also looking at the makeup of the population. One of the things that goes into a predictor of cost is your age and gender. Why not put the of female . You could. This is within the database. It is the default metric that they have identified it as. If you want to know why they chose the shift, i will have to take that and come back to you with it. Would you please. A lot of this demographic studies that go on, Clinical Trials and what have you, there is always a gender bias and its either male or female, and they exclude children, certain ages or selfworth, that jumped out at me, why would you focus on that . As a dimension of demographic. Thank you. I am sorry. Are very welcome. Thank you for the question, commissioner scott. Making sure we are addressing any biases that how we come upon that information. One brief question about the downward trending trio, is it a significant trend . No, these are varying between five hi go on claimants in the period. For the trio, even though the the number of high cost claimants went down when you spread the cost per patient, the allowed amount that pretty much remained flat. No cost savings, and conversely if you look at kaiser with that thousand 27 high cost payments they had in the previous. They had 995 high cost claimants. Actually there allowed amount per patient dropped foz will not timeframe. They had more claimants, but the was last and the increased lives in that population. It just worked out, when you look at it per patient. The numbers were down. Great question. Here we see the outpatient costs have consistently been higher over the last couple of years. Usually you would expect her inpatient cost to be higher. What is driving that is specialty drugs, other than chemotherapy. These are just your cost and utilization trends. Some of your key metrics you would want to look at in terms of your length of stay, your days of admission, all of these that that are cost drivers. We monitor those area for the most part, these numbers have remained relatively flat. The visits to the er for examp example, is completely unchanged from the previous timeframe. Here again, you see the breakout of the risks scored by the population. United healthcare if you can the risk scores 192. 9. Just so you know, normally out there in the world, a risk score is based on a 1. 0. You would normally say 1. 92. But with our health driven database, they do it on a scale of 100. Thank you. Moving on to slide five, here is a look at our chronic conditions. In facts, yes, what you are seeing is diabetes, hypertensi hypertension, and low back pain. They are the big prevalence conditions amongst our population. I dont think that is a surprise to anybody, because we have certainly been looking previously at board meetings and terms of diabetes and various studies. We have looked at, in terms of low back pain, and terms of other physical therapy and those sorts of things. And, going on to slide six, here is where we take a look top right, it is episode grouper that is built into the ibm and health methodologies. This is distinguishing some of our chronic conditions between acute flareups and maintenance. These could be chronic conditions that could be maintained, for example, as non hypertension. What we are seeing here, they get stratified between how many of those visits for those people, those conditions that were acute flareups. You want to keep the acute flareups that minimize, where they are being effectively managed. The bottom left here again, using some of the methodologies, we are taking the population, based on admissions and discharge code, of course, our goal is the Health Service system to keep people in the healthy and stable categories as long as possible, before they are moving up. As you look at this data, while you may have 6. 8 of your population struggling a 1. 7 in crisis, they are contribute in 42. 8 of your cost. That is why we are mindful of not having them move further along to continue them. Page 7,. Have a question about the last page there. Autism is the highest in the Mental Health episodes. Has that been that way all alo along . This is basing it on. The way this is sorted is by the allowed amount for that episode. Based on a dollar, that is our higher amount. If you would look at patients or episodes, or even the number of visits which are your last three columns on the right. Our top condition on here, just my patient count, and also by visit count for those with depression. Thank you for that question. Moving on to slide seven. Here is a drill into our drugs. We have organized on the left there, on the right we are looking on the right, the actual drugs themselves, here again that list, bottom right chart, 13 of those are specialty drugs, call that out earlier. Seven of those are actually for hiv, and a couple are cancer related. Slide eight, heres is where we are taking a look at the generics versus the brand, trying to keep those drugs down to the more affordable levels area prescription specialty drugs continues to inch upwards. You see the change over the previous timeframe here, are not specialty drugs decreased 2. 5 , specialty increased 5. 5 , on the professional side 19. 7 . It is not a surprise, you all know that is happening with specialty drugs out there. That brings us to the conclusion of the highlights of the non medicare dashboard. The medicare dashboard, for the most part repeats it with the bond medicare dashboard looks like. There is a few pages missing. Starting out on page one of the dashboard, the same thing, you get a look at your demographics. You can see, you have 28,005 in a 43 lives, 22,841 members or subscribers. Most of our retirees do not have dependents. When you look like the active population it is to point something. The age of this population is 74. 4. If i were to maybe do some quick math, 56. 3. How did i do . 55. 3, how is that . Below that, again, the cost and utilization trend, these are all going up. I know in my notes from the beginning i said decrease, i kind of tripped over that. These were all increasing. We will get that corrected. Your services, your visits, your scripts come all of them, going up. Moving on to page three of your dashboard, here is again a look at the chronic conditions, its the exact same conditions we saw in our active population. , the low back pain. Down in the bottom left, you see this and the other dashboard as well. We have quality markers. We are looking at our emergency room visits per thousand. We are trying to see what percent of those were admitted, and account per thousand and how many of those were avoidable admissions. This is additional cost to the system. That may not necessarily need to be there. Your visits, your avoidable admissions here in the retiree population that you see is 24. 9 per thousand, i think that was Something Like 2 and the active population. A lot of admissions that are potentially avoidable. And then moving on to page four, these are your top summary groups, again they are sorted off of the criteria that is not in him. Episodes on patient count to get a look at what the top side of episodes we are having amongst our medicare retiree population. No dollars for the episode type, but we can at least look at the episodes based on the stratification on the top right. Heres a look at the population in terms of the wrist the wristband profiles. This should not be a surprise, as we age we going to have a couple of chronic conditions. Whereas before the active population, sitting on the Health Stable environment. We have huge numbers, at risk of struggling in crisis. The final page here is your view of what is going on with drugs. No surprise, non specialty down 8. 1 , and specialty up at 64 . This brings us to a close of the highlight of your quarterly dashboard. Any other questions . Have talked to us in the past about this, im still a little confused under page two, under chronic conditions, quality markers, avoidable admissions, complications. What criteria are you using for avoidable. I know your avoidable admissions. I know there is standard criteria. I know medicare has them et cetera. Is that is what is being generated . Yes, it is using sustained methodology. I dont have it on the top of my head today. What specific criteria it is looking for. It is looking tomorrow in terms of certain visits and activiti activities, it might also be looking at were there two different medications prescribed in a timeframe that could cause an interaction. Its doing a number of things. What i really need to do is write all of that up and bring it back for you, next meeting that we have in a board report. I definitely cannot speak in detail to it, just off the fly. Its absolutely amazing, what we now have at our fingertips. For us to understand where we can have some impact. When you look at complications, avoidable admissions, readmissions. Readmissions, at least, as i recall, for medicare criteria was within 30 days. Maybe that has changed. But that was considered potentially avoidable if the person was discharged too soon, or whatever. These are the things that drive up the cost a lot, in this population which is a significant percentage of cost. If youre going to ask our health plans for some plans on this, it would be nice if we knew a little bit better ourselves, why this occurs. Absolutely. I agree wholeheartedly. We will get back to you. Any Public Comments on this item . Thank you very much, commissioners. No Public Comment on this item. All right, item number 11. 11, approval of revisions to the Health Services to membership rules presented by mitchell griggs, the chief operating officer. Mitchell griggs, chief operating officer in the Health Services system. Every year this agenda item in the following which is section 125 cafeteria plan, is it brought before board for your approval. The purpose of that is we make general modifications based on some plan changes, or perhaps city charter changes, or operational changes. These are the rules that we use to administer benefits as far as eligibility is concerned, and enrollment. When we make changes to those, we ask for the board to approve them. So you are aware, and the publics notice that we have made a change to these two documents. If there is an appeal by a member, if we deny eligibility or enrollment, and it gets to a board level appeal. This is what h. S. S. We bring to you and point to, as this is why we made that particular decision. That being said, 2020, there is just one change, one Material Change, and then smaller change. The summary is there on top of the entire rules document. I just pasted the Material Change below the summary, so we would not be paging through 14 pages here. As you can see, section e, which is on page 14, we are updating the language to define dependent eligibility audit, in this section of the rules, we are talking about how it is the members responsibility to notify h. S. S. When a dependent becomes ineligible. As we were talking about earlier, they can do that during open enrollment. Now in self service, they remove ineligible dependents. We want them to disenroll them at the time they become ineligible, within 30 days of that particular event. All of the language in here in the first paragraph, his existing, the second paragraph we Start Talking about, we may audit dependent eligibility. As most of you remember, last year, around this time, we were wrapping up our first dependent eligibility verification audit. We were going out to members who had dependent spouses or domestic partners existing on their audit and asking them if that situation was current. Some of the things we ask for to prove that relationship is still in existence, we decided to add that into the audit, to further define that audit. The next time we go around and do this, which we are kind of planning tentatively, 2021