Aye. [gavel] meeting adjourned at 7 31. This is one place you can always count on to give you what you had before and remind you of what your San Francisco history used to be. We hear that all the time, people bring their kids here and their grandparents brought them here and down the line. Even though people move away, whenever they come back to the city, they make it here. And they tell us that. Youre going to get something made fresh, made by hand and made with quality products and something thats very, very good. The legacy bars and restaurants was something that was begun by San Francisco simply to recognize and draw attention to the establishments. It really provides for San Franciscos unique character. And that morphed into a request that we work with the city to develop a legacy business registration. Im Michael Cirocco and the owner of an area bakery. The bakery started in 191. My grandfather came over from italy and opened it up then. It is a small operation. Its not big. So everything is kind of quality that way. So i see every piece and cut every piece that comes in and out of that oven. Im leslie ciroccomitchell, a fourth generation baker here with my family. So we get up pretty early in the morning. I usually start baking around 5 00. And then you just start doing rounds of dough. Loaves. My mom and sister basically handle the front and then i have my nephew james helps and then my two daughters and my wife come in and we actually do the baking. After that, my mom and my sister stay and sell the product, retail it. You know, i dont really think about it. But then when i sometimes when i go places and i look and see places put up, oh this is our 50th anniversary and everything and weve been over 100 and that is when it kind of hits me. You know, that geez, weve been here a long time. [applause] a lot of people might ask why our legacy business is important. We all have our own stories to tell about our ancestry. Our lineage and ill use one example of tommys joint. Tommys joint is a place that my husband went to as a child and hes a fourth generation san franciscan. Its a place we can still go to today with our children or grandchildren and share the stories of what was San Francisco like back in the 1950s. Im the general manager at tommys joint. People mostly recognize tommys joint for its murals on the outside of the building. Very bright blue. You drive down and see what it is. They know the building. Tommys is a San Francisco hoffa, which is a germanstyle presenting food. We have five different carved meats and we carve it by hand at the station. You prefer it to be carved whether you like your brisket fatty or want it lean. You want your pastrami to be very lean. You can say i want that piece of corn beef and want it cut, you know, very thick and i want it with some sauerkraut. Tell the guys how you want to prepare it and they will do it right in front of you. San franciscos a place thats changing restaurants, except for tommys joint. Tommys joint has been the same since it opened and that is important. San francisco in general that we dont lose a grip of what San Franciscos came from. Tommys is a place that youll always recognize whenever you lock in the door. Youll see the same staff, the same bartender and have the same meal and that is great. Thats important. The service that San Francisco heritage offers to the legacy businesses is to help them with that application process, to make sure that they really recognize about them what it is that makes them so special here in San Francisco. So well help them with that application process if, in fact, the board of supervisors does recognize them as a legacy business, then that does entitle them to certain financial benefits from the city of San Francisco. But i say really, more importantly, it really brings them public recognition that this is a business in San Francisco that has history and that is unique to San Francisco. It started in june of 1953. And we make everything from scratch. Everything. We started a you we started a off with 12 flavors and mango fruits from the philippines and then started trying them one by one and the family had a whole new clientele. The business really boomed after that. I think that the flavors we make reflect the diversity of San Francisco. We were really surprised about the legacy project but we were thrilled to be a part of it. Businesses come and go in the city. Pretty tough for businesss to stay here because it is so expensive and theres so much competition. So for us who have been here all these years and still be popular and to be recognized by the city has been really a huge honor. We got a phone call from a woman who was 91 and she wanted to know if the mitchells still owned it and she was so happy that we were still involved, still the owners. She was our customer in 1953. And she still comes in. But she was just making sure that we were still around and it just makes us feel, you know, very proud that were carrying on our fathers legacy. And that we mean so much to so many people. It provides a perspective. And i think if you only looked at it in the here and now, youre missing the context. For me, legacy businesses, legacy bars and restaurants are really about setting the context for how we come to be where we are today. I just think its part of San Francisco. People like to see familiar stuff. At least i know i do. In the 1950s, you could see a picture of tommys joint and looks exactly the same. We havent change add thing. I remember one lady saying, you know, ive been eating this ice cream since before i was born. And i thought, wow we have, too. Everything is done inhouse. I think it is done. I have always been passionate about gelato. Every single slaver has its own recipe. We have our own we move on from there. So you have every time a unique experience because that slaver is the flavored we want to make. Union street is unique because of the neighbors and the location itself. The people that live around here i love to see when the street is full of people. It is a little bit of italy that is happening around you can walk around and enjoy shopping with gelato in your hand. This is the move we are happy to provide to the people. I always love union street because its not like another commercial street where you have big chains. Here you have the neighbors. There is a lot of stories and the neighborhoods are essential. People have they enjoy having their daily or weekly gelato. I love this street itself. We created a move of an area where we will be visiting. We want to make sure that the area has the gelato that you like. What we give back as a shop owner is creating an ambient lifestyle. If you do it in your area and if you like it, then you can do it you like it, then you can do it on the streets you like. Working for the city and county of San Francisco will immerse you in a vibrant and dynamic city thats on the forefront of economic growth, the arts, and social change. Our city has always been on the edge of progress and innovation. After all, were at the meeting of land and sea. Our city is famous for its iconic scenery, historic designs, and worldclass style. Its the birthplace of blue jeans, and where the rock holds court over the largest natural harbor on the west coast. Our 28,000 city and county employees play an Important Role in making San Francisco what it is today. We provide residents and visitors with a wide array of services, such as improving city streets and parks, keeping communities safe, and driving buses and cable cars. Our employees enjoy competitive salaries, as well as generous benefits programs. But most importantly, working for the city and county of San Francisco gives employees an opportunity to contribute their ideas, energy, and commitment to shape the citys future. Thank you for considering a career with the city and county of San Francisco. In 201,755. 7 million passengers traveled through San Francisco international airport. We have on average 150,000 people traveling through the airport every day. Flying can be stressful so we have introduced therapy dogs to make flying more enjoyable. The wag brigade is a partnership between the airport and the San Francisco therapy Animal Assistant Program to bring therapy animals into the airport, into the terminals to make passenger travel more enjoyable. I amgen fer casarian and i work here at San Francisco international airport. The idea for therapy dogs got started the day after 9 11. An employee brought his therapy dog to work after 9 11 and he was able to see how his dog was able to relieve passengers jitter. When we first launched the program back in 2013, our main goal was to destress our passengers however what we quickly found is that our animals were helping us find a way to connect with our pang. Passengers. We find there are a lot of people traveling through the airport who are missing their pets and who are on their road a lot and cant have pets and we have come in contact with a lot of people recently who have lost pet. I love the wag brigade. One of my favorite parts is walking into the terminals and seeing everybody look up from their device, today everybody is interacting on their cell phone or laptop and we can walk into the terminal with a dog or a pig and people start to interact with each other again and its on a different level. More of an emotional level. I just got off an 11. 5 hour flight and nice to have this distraction in the middle of it. We look for wag brigade handlers who are comfortable in stressful situations. I like coming to airport its a lot of fun and the people you talk to are generally people who are missing their dogs. They are required to compete a certification process. And they are also required to complete a k9 good citizen test and we look for animals who have experienced working with other orgorganizations such as hospits and pediatric units and we want to be sure that the animals we are bringing into the airport are good with children and also good with some of our senior travelers. I think toby really likes meeting kids. That is his favorite thing. He likes to have them pet him and come up to him and he really loves the kids. Our wag brigade animals can be spotted wearing custom vets and they have custom patches. There is never a day that repeats itself and there is never and encounter that repeats itself. We get to do maximum good in a small stretch of time and i have met amazing people who have been thrilled to have the interaction. The dogs are here seven days a week, we have 20 dogs and they each come for a two hour shift. There is a lot of stress when people have traveling so to from these animals around to ease the stress and help people relax a little bit. I think its great. One of our dogs has special need and that is tristine. He wears a wheel around. He has special shoes and a harness and we get it together in the parking lot and then we get on the air train. He loves it. Little kids love him because he is a little lower to the ground so easy to reach and he has this big furry head they get to pet and he loves that. He doesnt seem to mind at all. Probably one of the happiest dogs in the world. Many people are nervous when they travel but seeing the dogs is just a wonderful relief. What i absolutely love most about it is the look on peoples faces, so whenever they are stressed and flying is stressful these days you get these wonderful smile. I am the mom of lilo the pig and she is San Franciscos first therapy pig. Lilo joined the wag brigade as our firs first pig. Wag brigade invited us to join the program here and we have done it about a yearandahalf ago. Our visits last 1. 5 to 2 hours and it does take a little bit longer to get out of the terminal because we still get a lot of attention and a lot of people that want to interact with lilo. I feel honored to be part of the wag brigade. Its very special to meet so many people and make so many feel happy and people that work here. Its been a great experience for me and a great experience for to totoby. Its been an extremely successful program, so the next time you are here, stop by and time you are here, stop by and the San Francisco Health Services board will now come to order. Please stand for the pledge to the flag. All right. Madam secretary, roll call, please. Roll call. [roll call] we have a courtroom. Okay. Item number four. Item four is the approval of possible modifications of the minutes of the meetings set forth below. The regular Meeting Minutes from september 12th, 2019. Are there any questions corrections to the minutes . I move the minutes from the september 12th, 2019 meeting be adopted. Second. Any Public Comment on this item . All those in favor of approving the minutes signify by saying aye. Aye. Any opposed . It is unanimous in favor. Will all right. Item number five. Item five is a general Public Comment on matters within the boards jurisdiction. Do we have any Public Comment this is the time to come forward if you have any questions or concerns about something. Please come forward. Hello, my name is jason and i am from ucsf. Currently vaping and ecigarettes are still widely used and there are many programs in place that offer Preventive Health care screening and Mental Health care consultations. What are your thoughts about implementing or expanding the Tobacco Cessation program . That is a good question. Could i ask our director about that . Im sorry. I have only heard part of what you were saying. Yes. What are your thoughts about implementing Tobacco Cessation programs . There are many preventive screenings currently in place, but there is none for tobacco use. We do have Tobacco Cessation programs, correct . Through the health plan. Yeah,. Through the wellbeing program . What was that . Maybe you could come up and say something. She is mentioning that the newer Tobacco Cessation Program Addresses vaping in particular. Let us do an assessment with the health plan on whether that is currently the case. I imagine that it is but i can affirm that with the health plan , but, yes, tobacco is one of the leading preventive measures that we can do and we will take a look at that. Thank you. Thank you for bringing that to our attention. Thank you. Any other maybe we could find out if our own Wellness Program that we operate deals with tobacco or not. I heard you say no. I am not clear that is the case. Yes, currently we have Tobacco Cessation programs through our health plans. We currently do not have anything that we offer directly through the wellbeing program. We used to when we had one of our counsellors here probably about five years ago who went through a particular training, Tobacco Cessation training that she did offer to city employees, however, when she retired a few years back, we did not actually supplement that by getting an additional person trained because we felt, at that time, the health plans were able to meet the need. It wasnt tobacco specifically, but as abbey indicated, we have to do an assessment on the vaping case. What im worried about fake being is is it the same addiction or different addiction it is also an addictive disorder. There is a collective concern about the uptick of teenage utilization which is exactly what the sales of Tobacco Products target. Then you get someone who is addicted for a long time. I think it is a very valuable thing for us to check into and report back on. I think with the report back weekend maybe assessed if there is something that needs to be enhanced within our own program and to our own employees that we can assess that when we hear what the health plans are doing. Okay. I just read that another person died from it in california here. I think it was around this area or something. All right. Okay, any other comment on this item . Seeing none, Public Comment is closed. Item number six. Item six is the president s report. This report is given by president breslin. I have nothing to report at this time. We can move on to the Governance Committee issues. Item seven is the approval for the initiation of the Health Service board annual selfevaluation process regarding the fiscal year of 2018 through 2019. This will be presented by Committee Chair scott. Thank you. The Governance Committee met earlier this week to review both the Health Service Board Evaluation form, as well as a timeline that is proposed working in strong cooperation with the department of Human Resources, which is really the administrator of this survey. After reviewing the survey itself, we agreed that the survey that was used last year should be used again this year, and that the timeline would start this friday with the notification to Board Members or the selfevaluation and to continue on for about two to three weeks to allow members to complete the selfevaluation, and then we would come back in january with a the report of the results. So that is a broad timeline. It is outlined in our terms of governance that we do this annually, and this is, i believe , the fourth year we have conducted a selfevaluation of board activities. With that, i would like to move that the recommendation of the Governance Committee, that for the selfevaluation form and timeline be adopted. I will second that. I have one question. During the Governance Committee meeting, somebody brought up the issue of being a unable to assess the new Board Members. I dont believe we ever added on an extra item for that. Did we . I will defer a bit to the secretary, but my understanding is that we have not done that. We have tried to maintain consistency with the prior administrations survey, and that Board Members who are not able to assess any particular item or area of the survey are asked to complete that in the comments section of the form. That is correct. I have the same concern, particularly around the orientation since most of us have not be reoriented since the last survey. So if we dont answer the question, then is the survey not complete . We have to answer the question in the comments and say, please ignore my response to question number whatever and whatever . Essentially, there are further guidelines that will be emailed to you all tomorrow, but we are asking every question be answered. If you select neutral because you feel as if you do not you cannot answer it in any other accurate way, we ask that at the end of the section for that grouping of questions, you explain the neutral responses in a sentence or two sentences to give context. And then the neutral will be discarded . No, it just basically is ensuring every answer every question is being answered. We still have the same number of questions from last year without altering the survey completely by giving six response questions we did not want to alter the survey. We may have to cook to may have to consider the results as we start and not compare them to the previous years. I can tell you, speaking as an individual, if im going to change my answers to some questions because of the neutral option where i feel there has not been anything that applies to me in that question. So there will be some changes, but you will just have to contend with the account if you are not going to ignore it. But you will also have an opportunity to comment about your neutrality or why you didnt respond. They are doing the analysis. Okay. So it has been moved and properly seconded. Is there any Public Comment on this item . Hearing and seeing no Public Comment, we are ready to vote. All those in favor of the item as presented, signified by saying aye. Aye. Opposed . It passes unanimously. All right. We are back into regular board matters. Number eight, please. Item eight is the directors report. Thank you, good afternoon, commissioners. I would like to begin my directors report by acknowledging the passing of the c. E. O. Of Kaiser Permanente. Im sure many of you have read the many accolades of bernards contribution contribution to healthcare. I know i didnt have the opportunity to work closely with him, but i know many who have, and people who worked with him since he was a medical records clerk all the way back. So he is a very revered and, as i said, the accolades i dont know in my memory of ever seeing a Healthcare Executive receiving the types of accolades that he has upon his passing, and it just speaks highly to his contribution. I did want to acknowledge that. I know their archives a representatives representatives here that may have additional comments. Good afternoon, i am from Kaiser Permanente. I thank you for the opportunity to say a few words about our very highly esteemed chairman and c. E. O. Of Kaiser Permanente bernard thyssen. I come up with a heavy heart. We started our careers around the same time. He was with us for over 30 years and has been our c. E. O. For the last six years. He was passionate, a passionate leader. Not just for the people, but also for our members and in the healthcare industry. He was an advocate for a lot of change around pharmaceutical companies and challenging them on some of the costs, so he was very active and really believed all people should have access to healthcare. And very committed to the wellbeing of the community. So reaching out and trying to help the communities that we serve to be healthier and have a healthier lifestyle. He was an amazing visionary. I can tell you, being an employee of Kaiser Permanente, what i experience. It was a visionary with a really big heart. If you ever had the opportunity to talk with him, you felt that. He always felt like he was a friend. We are going to miss him greatly we are confident with our interim c. E. O. , greg adams, who worked very closely with bernard he has a lot of experience inside and outside of kaiser. We are very confident that his work will continue to move forward in this organization. I will share with you there will be a viewing of his body that is open to the public on sunday in oakland. It will be from 11 00 a. M. Until 3 00 p. M. For anybody interested it will be at the oakland rotunda, 300 frank all applause in oakland. Thank you for this opportunity. Thank you. If i can make one comment as well. Having been in my professional career at Kaiser Permanente, this is to remind the audience that kaiser is a three like its tool. It is a Nonprofit Health plan and a nonprofit hospital and it is a medical group. He was the c. E. O. And head of the Nonprofit Organization which was the health plan and hospital system. Speaking as a physician, one can see throughout my years on the board some of the tensions that can occur between physicians and health plans and physicians and hospitals. I would say that he was a true partner in working with the medical group and furthering goals, so i know that the physicians share the extreme fondness and loss of the leader of the other two thirds of the stool. But to make sure everyone is understanding that this partnership, as you can tell from the press, is always tense in healthcare delivery. He managed to really show that there is a way forward. And for that he could also he should also be recognized and modelled in all health plans and medical groups. I would only add to that the reason why i am in San Francisco is that i was recruited by bernard to serve as a Vice President for h. R. In a prior structure at Kaiser Permanente called the golden gate service area. I also have a personal relationship with him through a professional mens organization that he and i are members of. Both from a professional and personal standpoint, he was and had been a friend of mine throughout my early career here in San Francisco in Human Resources until my leaving kaiser in 2001. I will miss him personally and professionally. Thank you. Thank you. Turning to the directors report , in the packet it highlights the highlights included are the decision not to release a request for health plans for plan year 2021. As the board knows, we have been monitoring the marketplace and it continues to evolve. There are one of the things that has occurred since we last met was the announcement of the settlement with sutter, and that settlement will not be public until late february, early march of next year. It is possible that it will have impact on the market here in San Francisco. So that is one that we are anxious to see what the settlement entails. We are also continuing to serve the development of the can be product and watching the sutter product develop. We will be coming before the board again in december to talk about the member focus groups that we did throughout the month of october where we did a significant number of listening sessions with the members to understand their current experience and to get their input regarding their questions and concerns about possible models. Going forward it was very informative. I have reviewed the polemic area results and have the draft final report on my desk unread at this point. I am anxious to call through it go through it and make the presentation to the board in december. We are also in the process of updating the Strategic Plan based on the activities that have occurred over the last year and, again in december, plan on reporting out in the form of the annual plan and Strategic Plan update simultaneously, since they are so interlinked. We are anxious to do that. We have done some initial assessment about accomplishments for this year, and as always, when you take the time to do a look back, is always amazing how much you get done. We are pleased about that and we will be looking at those areas that perhaps we didnt accomplish and understand why. It could be that there were dependencies or sequencing that we needed to recognize or give more time to the Strategic Plan. It was written over a threeyear period and was quite ambitious in the number of activities that were suggested to accomplish some of the goals. We will be reporting that out to you in december. I will, at the conclusion of this directors report, stand at the podium and give to you the results of the Employee Engagement survey. I will defer on that for now. Also as a followup to an earlier meeting when the care coordination presentations were done, we had a breakdown in communication with kaiser and have given them the opportunity to put together a presentation on complex care coordination which be which would be more comparable from what you heard from the other plans. That is in process. There have been some investigations into some of the issues that some of our members are experiencing. We want when they choose to buy a concierge service, but it is not required to be a one medical participant and it is precluded from positions to charge an extra fee, but it is considered an ad on option that members may choose to charge. As we become aware of any of these situations, we are better able to investigate. We have heard it mentioned that there was some issues with some providers. We have communicated to them at large. But as most of us know, it is very difficult to correct a problem when you dont really know where it exists. I really do encourage the members to advise h. S. S. When they have questions or concerns about their plan coverage. We do hold that information, the privacy of that information and would protect the member from any procedures and retaliation that they maybe fearful of. I would encourage people to talk to us. Can i ask . Yes. Two questions. I guess there are two parts to this topic. One is that the one medical. So when you just walk into one medical, because they are everywhere, the front windows now say they are associated with dignity and the healthcare system. There is one in west portal that i walked by. So our potential patients given a sheet that alerts them upfront what the fee schedule will be and that they are, maybe at risk for paying those fees depending upon their health plans . I dont know how this works. Someone is nodding yes. So they are given one they walk in the door. It is my understanding, at least from their website, that you can join and pay a fee on the website. What is not clear is we have done some secret shopping and tried to understand where the confusion might be. I think one medical in their general marketing practices do advertise a membership fee and they state it is for their extra attention and concierge Type Services and receiving appointments. What our plan is, particular with the ma p. D. Is prohibitive if you are under contract. I dont know how every one medical Office Brooke operates in as far as informing members, but it is important that if you are a member that you dont have to pay the fee. Okay. So that is evident to our members, how . How do they all remember this day today when theyre walking down the street . It is fairly to folk typical. Once they determine youre not there for an emergency, the next thing they ask is for your insurance card. Again, we need to continue to ensure that when medical is following these procedures and assists the members should they require assistance. Okay. The second item has to do with tolling. We have talked about these additional fees on other occasions. So what i understand you to say is the board is clear on this. Sometimes, and maybe other health plans positions who are also not as clear on this or members are not as clear, this is prohibited. This is clarification that when we get these complaints there is followup with medical groups or health plans . Yes. Along that point, if i may, would be possible to communicate to membership perhaps on the website or through members that have healthcare plans that would like to be able to shop around for physicians to give them a heads up to look out for these extra fees that may not necessarily be covered . I think we can take a look for our Communications Team as to what the information is that we give about the plans and on our website, and we can talk with the plans to see what they are staging stating. Thank you. I am still not clear. If they charged us fee, will we pay it . No. Okay. My understanding is that we have to pay this fee in order to belong. It is my understanding that that would not that would violate the contract. Is that correct . I am with united healthcare. So with the Group Medicare advantage p. T. O. , they are prohibited against their contract. If their conch if theyre contracted with our network, then they cannot charge the fee. Somebody can be on an individual Medicare Advantage plan and be charged the fee. It is their option to choose it or not, but there is no protection on the individual medicare advanced plans, but your group plan is definitely protected. So they can charge this fee, but it is not it is not against the law. Is up to the member to opt to pay that and it comes along with the fee. They can choose to pay the fee and take advantage of those additional services. It is prohibited if the provider is contracted with the healthcare. Second thing i hear you say, members may be telling them that are medicare options. They maybe saying medicares primary. It is hard to say. There are so many different insurances that these front offices manage. So to ensure that they have a clear understanding of the differences is a big challenge for them, but that is their business model. I think we have to hold them accountable for their contractual obligation. Having been in this service practice, it is possible that one medical is from a business standpoint but asked somebody to pay upfront and say that if you want us to bill medicare and see if we get anything back, then we will reimburse you. But of course, they wont. They certainly wont if they belong to the p. P. O. So members have that option, but usually lots of other providers charge that office the upfront. So you run it with cash or credit card or whoever you want to pay and then hope to get reimbursed by somebody. Yes, and this is a little bit different. To the general public, they pitch it as a membership fee. Right. I think what i need to do is have a conversation with one medical to be clear what the practices are and what they are doing to meet the needs of our clients. We need to look at the plants plans as to how many members we have under those that are using those services. It could be we do a direct outreach to those. You go there and you have your Medicare Card and it shows what your coverage is and what your copays are. Why would they be confused . Because they may be trained under the membership fees to be adjusted for everyone. This may be an exception. I dont know how any exceptions they accommodate. We were able to hire a whole bunch of folks to help us with open enrolment this year and other agents of services. I would like those that are here today to stand so the board can recognize. With open enrolment we have. With our Member Services team we have. [calling names] [applause] and we also have hired a new assistant health educator. There we go. [applause] thank you. We are very adequately staffed for open enrolment this year which is really great. It is like a trial by fire for an orientation for the team. Welcome aboard and thank you for helping us. The next item on the directors report is responses that marina wrote a very generously to a couple of technical and difficult questions, and one i wanted to highlight was the member feedback that Grady Ellison who is letting the Board Members know. I think we have deputized him as an investigator on the team. He was he has really worked closely with us to help identify some problems early on with our electronic enrolment. He was very helpful. It was a very hectic time for the department of technology, but we all overcame those barriers and it was really great to have a member so engaged with us in our services to identify issues early on and get them corrected for our membership. I thank him for that. I also, marina wrote a pretty robust response to some technical questions that you had that the phones be on the dashboard. I hope that we answered your questions. And thirdly, from the report, i will ask her to step up to the microphone. I just want her to read it into the record so the individual can hear it on the recording
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