I dont know how long the waiting list is. And you know, there are other things. Try calling durable equipment sometime and waiting on the phone for 45 minutes or a half hour. The other thing, my doctor ive seen for 30 years is cutting back. And the only reason i knew, because i was in to see him, but when you go online to make an appointment, you dont get him, you get apparently hes training the new doctor why doesnt kaiser send out an email saying he is retiring and you can see this other doctor, instead of looking online. If i went online, would have started calling up and saying why cant i see my doctor ive seen for 30 years . You know, kaiser needs to get down in the weeds and fix some of the issues before they start spending money on the warriors and the sharks. Thank you. President breslin thank you. Any other Public Comment . Seeing none. Now well go back to number 8. Back to the regular scheduled agenda. Item is the finance reporting as of june 30, 2019, and as of september 30, 2019. This is presented by pamela levin, the chief financial officer. Pamela levin, chief financial officer. Im going over the report for fy201819. The report in front of you i know is dense and long. This typically would be given at the same time as the audit results. Those are still delayed we think, as i understood from yesterday, that i thought they were going to be out in the middle of december, or next week, and i think theyre still going to be delayed. But all the data that im presenting is exactly the data that will come out in the financial report. They just havent finished all the work. So the trust ended fy1819 with balance of 91. 2 million, this is increase of 4. 7 million from the 17. 74 balance as of june 30, 2018. Ill discuss the increases against this 92. 1 million fund balance. The 4. 7 million increases because of 3. 6 million decrease in the trust fund associated with United Health care ppo plan, resulting from subsidizing the 1819 the 2018 and the 2019 rates from the stabilization reserve. And unfavorable claims experience. Particlely upsets partially upsets. Unfavorable claims experience is offset by the pharmacy rebates and the 3. 6 million decrease in the trust fund. For blue shield access plus, there is a 7. 1 million increase. This is several different factors are contributing to this. The first one is that we had a buyup in the rates to cover the 2016 and 2017 deficits that blue shield had. There are pharmacy rebates and favorable claim experiences. These are offset, these positive balances are offset by incent to payment to brown and toland for the 2018 year, plan year performance. For blue shield trio, there is a 5. 5 million increase in the trust fund balance. Its resulting from the buyup in the rates to cover 2016 and 2017 deficits. There is also pharmacy rebates and favorable claims experience. For delta dental selffunded plan, there is a 1. 2 million increase in the trust fund balance. Resulting from favorable claims experience. Which is offset by the use of the stabilization reserve to subsidize the 2018 and 2019 rates. We have a 800,000 increase in the trust fund associated with kaiser due to three factors. The first is the impact of the pay calendars through the School District and college district. When you have fiscal year ending and there is still a contribution coming from the entities. And thats the its just a timing factor. There is contractual provision governing the timing of the Premium Payments and also members are moving from active to retiree and from nonmedicare to medicare status. There is 100,000 decrease in the trust fund balance associated with claims payments for flexible spending accounts exceeding the payroll deductions as a result of the timing and the reductions. Its the same sort of thing. When the fiscal year ends, there is it doesnt necessarily mean that that all the payroll deductions are actually done. There is some timing issues. Weve always had that. There is 400,000 increase in the trust fund balance due to forfeitures for flexible spending accounts. As we discussed before, the irs allows forfeitures to be used to fund the administration of the flex spending accounts. The forfeitures reside in the trust fund and the expenses for the administration reside in the general fund. So a transfer is required at the end of the fiscal year. So on the chart that you have, at the beginning of the report, youll see a forfeiture is up 400,000 and then negative transfer for forfeiture, fsa administration. I want to note that we keep this transfer to the minimum required to fulfill our obligations in terms of our budget. And we dont transfer any more than what is actually brought in from the forfeitures. There is 500,000 increase in the trust fund associated with the Health Care Sustainability fund. The table that is in there shows budget versus actual, but at the end we have increase of 500,000. There is a 2. 9 million increase in the trust fund associated with investment earnings. This is considerably better than what we had several years ago. I think we can all remember those years. And there is 400,000 increase in the trust fund balance for performance guarantees which is net of the 100,000 dollars paid in 1819 under the adoption and surrogacy plan. There was 8. 1 million in pharmacy rebates received in fy1819. The end of the year, 92. 1 and for the fund balance, but there are obligations and reserves against that. So im going to go through those. There is 44. 7 million in future obligations against the 92. 1 million. Trust fund balance, they consist of 23. 5 million in contingency reserves, 16. 1 million in stabilization reserves. 3. 9 million for the Health Care Sustainability fund. 1. 2 million in performance guarantees for the adoption surrogacy benefit. And after that, the total is 44. 7 million in future obligations. Once that is netted out of the 92. 1, the fund balance is 47. 4. I provided a chart to look at where we are in terms of, you know, the fund balance and then the future obligations. And over the last five years and youll be able to see that the value of the future obligations and reserves has remained relatively stable since 201617. Turing now to the general Fund Administrative budget. There was a balance of 698,000 at the end of the fiscal year due to delays in hiring. After we carried forward 195,000 into this year, a balance of 504,000 remained. We went to the Controllers Office and Mayors Office and requested manual carry forwards. These are up to the discretion of the it requires approval by the Controllers Office and the Mayors Office. They have to be justified and we had 130,000 carried over into 1920 for professional services, materials, and supplies and work orders. You cant carry over surpluses or balances in salaries and fringes. So is there any questions on this report . Id like to take that before i go onto the next. The report for this fiscal year. Okay. All right. I turn to this fiscal year. So were giving a report that summarizes through september 30, 2019, and then a projection for the year end being june 30, 2020. In terms of the trust fund, as i just reported, were starting with a balance of 92. 1 million based on the activities through september. The fund balance is projected to be 89. 1 million, which is a decrease of 3 million. Were projecting no change in the fund balance for the ppo plan. For access plus, the fund balance is projected to increase 11. 2 million primarily due to pharmacy rebates and favorable claims experience. And i just like to put a caveat on all of this, this is only three months, july, august and september. So you know, the crystal ball is not fully developed until about may when we can tell you what well end up in june. For the trio plan, were projecting 8. 9 million decrease in the fund balance primarily due to large claims incurred in july, august and september. We have were working with aon and blue shield to dig deeper into this the large claims. Were projecting 3. 4 million decrease in the fund balance fort delta dental selffunded plan. And that is a result of subsidizing the rates and and when you look at this, its greater than the favorable claims experience. For the Health Care Sustainability fund, were projecting a yearend balance of 1. 8 million. This when you look at the projection in the chart, that is provided in here, budget versus actual, and the projection, were projecting 14. 5 14,000 left at the end of the year when you just look at the annual expenses and the annual revenues. Which obviously indicates that the expenditures, annual expenditures, ongoing expenditures are cripesing at fast increasing at faster rates than the revenues and well have to do something about that. In terms of investment earnings, were projecting 1 million. There are no performance guarantee payments received as of september 30. We paid out a total of 45,000 under the adoption surrogacy assistant plan through september. And we are projecting that we will use 200,000 for reimbursements this fiscal year based on Prior Experience in what were seeing right now. Just to right size this, when you went to approve the servicing adoption plan, we set aside a maximum of 300,000 would be distributed in a year. So were still staying well below, as far as im concerned, well below 300,000. The ammana forfeitures or unused spending account balances, which i described coming to the trust, that wont be known until july 2020 after the runout. And as previously described in terms of use of the forfeitures for the administration of the flexible spending accounts, currently there is a budget of 600,000, but as i mentioned before, well only transfer forfeitures up to the amount that the forfeitures come in and no more. So at the maximum, it would be 600,000, but as you can see from this year, it was 400,000. And in prior years we havent transferred anything at all. I have tried very hard to be fiscally responsible for the forfeitur forfeitures. No pharmacy rebates have been received this fiscal year, but we are projecting an 8 million balance based on prior years experience. The plan showing the expenses compared to the budget of premiums. The cumulative expenses are tracking higher than revenues for the uhc ma ppo plan and the expenses are tracking lower for access plus and delta dental. Again, three months into the fiscal year, well continue to work on that and see how that flows out and continue to monitor it. And then in terms of the general fund right now, were projecting that well end the year on budget. Is there any questions . Commissioner follansbee can you go back to page 4, the blue shield trio flex funded. You said there was during this period, 12 million decrease in fund balance due to unfavorable claim experience, what kind of claims are those, do you have any idea . So in trio, let me make sure i have the right report. Were talking about through september . Yes. Yes. So in the last three months, weve seen a peak in high cost claims. Those are claims over a Million Dollars. What happens with trio is that the correct me if im wrong, mike but in trio, the risk on the claims is born by blue shield. So while this is alarming, there it still doesnt present a really super i believe that at the end of the year, this will wash out. But we are we have a meeting with blue shield tomorrow. Were planning to ask questions. Were seeing their utilization where mike has been in contact along with me with aon. With the account Management Team for blue shield. And were really monitoring this carefully. All right. Mike clark, aon. When we started to see the uptick in the claim experience overall for the trio plan, july, august, september, we did reach out to blue shield, because my inclination is always to focus on large claims first. There is a reason why claims may be spiking one month to the next. But also we put a general ask, what are you soo eking in the data what are you seeing in the data . Theyre saying its isolated. Were seeing one high cost Chronic Kidney Disease claim that just rolled onto medicare, because thats one of the qualifying events, but it takes 29 months for that to happen. Highly unusual cerebral vascular events. But when we look at it over the course of the year, and look at where the claims have come in on trio, its really unusual to see the spike for july, august, september, that we frankly hadnt seen earlier in the year. Pamela commented on the favorability of trio through june 30 where we didnt see spiked large claim experience, but we did see it for july, august, september. Weve had ongoing conversations, just in general discussions around large Case Management with blue shield and how the partners are working with patients who are incurring large claims, so those discussions continue from a Care Management for those patients standpoint. But ill also say that sometimes you just see peaks and valleys and incidents of large claims. We have gotten Early Advance preview of, okay, what portrayed for october and november as well. Obviously not verified yet, but very early reporting, where we did continue to see a little bit of large claim activity in october. And to pamelas point, too, anything over a million does roll into blue shield responsibility because there is Million Dollars per individual for a calendar year on large claim in both the trio and the access plus plans. So part of what also happens, is when a claimant goes over a million, it will still play into the data that pamela has through a given period. And it may take a month or two then for the stop loss reimbursement, to vend that out in the experience. I think thats also happened when you look at data through september, versus some of the early information weve now seen through november. Thank you. Were on it. Any other questions . Thank you. President breslin any Public Comment on this item . Seeing none. Would anybody be interested in a break . Well be on a president breslin in session. Madame secretary, item number 10. Item 10, open enrollment report. Summary of the open enrollment Key Statistics and the member plan migration. This is presented by mitchell griggs. Mitchell, you survived. We did. Mitchell griggs, its that time of year again where were coming to report out about october. As i like to call it, our really big show. It takes a lot of work. Up to it and during that 30 days 31 days, whatever its going to be of open enrollment, and then after, its a lot of work, too. I always get fussed at by the Members Services staff when i say open enrollment is over october 31, because as you see it continues to go throughout the year. This is my 8th open enrollment and i do consider this one as one of the most successful and well get into why i feel that way. Just as a reminder, back in september i mentioned the size of open enrollment. We mailed out 76,000 packets this year. We brought in the county and Court Commissioners into selfservice this year. So that was a total of 36,000 people. We did do a pilot for selfservice for the School District which i believe was about 337 people. And we added more retirees for a total of about 6,000 there. 7,000. So last year we only had 8,000 actives and 4800 retirees. All in all, we had 42,000 people in selfservice. So we were anxious and excited to see how the adherence was. Im going to talk about that, but putting off, because im going to talk about that later. And talk a little more about member assistance. This year, the phone calls, we received 11,000 calls. Thats down 8. 5 . Last year, it was 12,000. We met all the Custom Service metrics. That was good, people waited average of 8 seconds for analyst to answer the phone. And inperson assistance, this is when people come in during the month of october, and the number there says 2158. That is last years number. It didnt get updated. It was 2900 this year. That was increase of 26 . Thats what we want. We want to be able to provide this assistance to people facetoface when they come in. We also go offsite. This year, we got 1800 members we spoke to. We have a lot of people who ask a quick question, grab a benefits guide. We dont necessarily count them, but i went to several of them and is looked like attendance had decreased a bit. This is not necessarily a bad thing. In the years where we dont have huge plan changes, some of that will decrease like the phone calls. But all in all, you know, its good to have that many offsite events. I did notice in looking at all the statistics, it was the lowest call volume in three years. Three years ago we implemented trio, which caused a lot of calls. And then in the last year, were still trying to figure out why we got so many calls. Its the way the planets were aligned. I think there was still after effect of trio. But this year, pretty steady. On slide 3, still about member assistance, we had upgraded and improved our website this year, earlier this year, i believe it was march. So for open enrollment, we looked through october and we had 27,000 individual users go in and check it out. As typical, though i wanted to look at this, everyone looks at it on october 1 and then everyone looks october 30 and 31st. There are few things in between. Some peaks in between that corresponds with our emails, our mass emails we send out to people. And some of them are actually, after the offsite events, people must go home and look at things. On the slide 4, speaking about our website, it appears that 25 , a quarter of the people actually access it through their smart phone, mobile phone. Which is good news for us, because we know there are employees out there who dont necessarily sit at a desk, not at a computer all day at work, but we do believe that most of them have a smart phone. So were glad that people are looking at it through their mobile device. And on the righthand side of this particular page, this is the top 10 pages that were accessed. We had 16 116,000 sessions. So if i were to go to the website three separate times day, thats three different sessions. Thats a lot of people accessing the website. And 40,000 of the top 10 pages were accessed and youll see number 2, the second highest, of course, the home page is always going to be the highest. Thats the first page everyone goes to, but the most visited outside the home pages were pages for ebenefits. Again, thats what we wanted. We wanted people to learn and use ebenefits. On page 5, how many paper applications did we receive versus people putting their changes through selfservice. Last year we got about 12,000 pieces of paper. When you do that, we have to manually review it. Someone has to manually enter it, check it. So its a lot of repetitive work, computer work for the benefit analyst. So people use selfservice, that helps us a lot. So this year we received 5,000 applications. That was a decrease by 55 . Which is the less paper that received since ive been there and certainly a lot less than last year. Then we received electronic changes and we received 8710. So the vast majority, 66 of all the changes, went in through selfservice and that was one of the success points that i was talking about earlier. We were hoping and thinking the unreachable goal would be 50 of changes. So getting that 66 is massive. And there was some reasons why, which well get into. But i just wanted to demonstrate here in this chart below those numbers is how many people submitted by ebenefits, broken down by employer, how many forms did we receive from the employers. So it kind of helps us see where we need to do work. The bar graph on the bottom is percentage of people who have access to selfservice. If you see on the first line, for example, the court, 68 of people that had access to selfservice didnt submit any change. 24 of the people that had access to selfservice actually submitted a change. 7 that had access to selfservice decided to send us a piece of paper instead. So not too bad. Last year, when our pilot, when we did about those numbers i mentioned earlier about 12,000 or so, when our first rollout. I think adherence was about 20 . Compared to todays 24 . So on slide 6, i think some of the things that helped us have success and the lower number of phone calls as well as e benefits is our outreach. Back in september, i told you we did improvements to our communication and i think it showed based on the feedback i got from the staff that speak to the members enough, that they were understanding our guides better. We did a lot of work on the inside improving on the graphic look, making it easier to read. In many cases, it worked on the copy without changing top of the actual meaning. I think this was a success too. Its the first time we were able to demonstrate that our communications improved the open enrollment experience. On the next page, continuing with outreach, just to go over the specific numbers of our direct Member Engagement. These are the offsites. You can see the numbers here. A lot more people show up to these things and we actually spend time with this, so those numbers are actually bigger. But i want to look at air here. Thats airport. Sfo. About 200 people. That was 11 to 2 or 10 to 1, two to three hours we were there in the morning. We also did a second shift, marina and i, went out from from 10 p. M. To midnight to speak to a lot of the staff that are starting the third shift. So marina did her advising on ebenefits and i tried to help everyone with the benefits, but it was a great experience and we saw at least 200 people from that time, 10 00 p. M. To midnight. A lot of good feedback. A lot of these offsites were health fairs where we included flu shot clinics and i didnt want to mention for carrie here, that we did increase the number of flu shots to 3. 1 increase from last year. So total of 4,482 flu shots this year, 204 being high dose. And thats just about 18 but the goal was 4500, so they missed it just by 18. Thats good to hear, its increasing 3. 1 over the year. On page 8, i want to talk about the outreach. Again, this is one of the reasons that i think we had such good success with ebenefits is part of the outreach. And a lot of that has to do with the fact that some marina, including marina went to the offsites and promoted e benefits. The benefits analyst had on blue shirts that San FranciscoHealth Service system and what i called the geek squad, had a note on there, saying ask me about e benefits. So i think that did a lot to promote ebenefits. We also had a howto video on the website along with the regular open enrollment video which was nice. We had codes. We pass these out, so its easy to access ebenefits are their smart phone. So i want to step into another category on page 9. Talking about the planned enrollment. In is looking at the migration of what happened, this is results of the open enrollment as far as plan changes are concerned. This is preliminary. There is a lot of work that takes into getting these numbers exact and looking at the reasons and thats why we present the demographic report in february. So there may be some more additional information, but just a few things. Comparing to 2019, and those orange columns, this is the variants. And some things that are a given, city plan pretty much decreased the most, with 14 employeeonly moving out of the plan. 12 employee plus one and five families moving out of that plan. But another thing ive noticed is that employeeonly and kaiser and blue shield trio, both decreased. Now there could be a few reasons for that, which were looking into, and this takes a lot of time, were working with peoplesoft. These could be employees only moving to family coverage or adding a dependent and staying with the same plan. I want to do a little more research, are they staying in the same plan, or migrating to a different plan. We have to keep in mind that diva happened in 2018 and some are putting spouses back on, because we only allowed them to perfect their claim for the dependent eligibility through september. So and then during open enrollment, they were allowed to put them back on for 2020 if they provided documentation. There was some of that going on, too. Also noticed that 85 people left waive, that means having no benefit and moved into some of these plans. Again, id like to see where they went and get a little more information about that. But that in general shows you overall, there was an increase in employ plus one of family coverage. So definitely some interesting things here that i think is worthy of us looking into and maybe having an addendum to this in february with the demographics report. On page 10, quickly, as many of you know, we have the split family situations for families that have one medicare member. They can be in United Health care, ma, ppo and then have one in city plan, they could be in blue shield. So we just look at a little bit of that migration, kind of the same thing. With a little bit more leaving trio this year. On page 11, this is our dental plans. I see a good number of people here to the far right, the variants, leaving what we all our dental hmos and moving into delta dental. I dont think thats too uncommon as those plans seem to continually be more unpopular. Then there are benefits weve added this year to delta and the rates have pretty much stayed the same. Then on slide 12, vsp, this plan is extremely popular. This is our premier plan, if youre enrolled in a medical plan, youre enrolled in basic, but you can double your benefit. You get glasses every year. Frames, allowance, 300, et cetera. So again, there is significant increases in here. We went from 15,000 to almost 18,000 for 20. And just for if you remember, when we first started this plan for the plan year, well plan year 2018, the enrollment was 10,801. That was the first year. As you can see, weve increased significantly. On page 13, weve also significantly increased, thanks to two open enrollments, of voluntary benefits that we initiated for all city and county a couple of years ago. You can see here that we increased by 1900 from november. And just so you know, or recall, we had a mid year open enrollment for these voluntary benefits around july. So we went up from july of 9,274 to 11,000. Our initial enrollment prior to july was just 5600. So quite a significant increase in voluntary benefits. I think the word is getting out and people are like can the benefits liking the benefits. Just a couple of comments on page 14. This is a snapshot of enrollment, these pages that i just went over. So you know, from january 1 to november, when we started looking at this. There is plenty of retirement. There are people who leave the city and new hires. So those change throughout the year. So this is looking at november. Whereas the demographics report will go from january to january. And that will be showing january 1st. I think thats about all i wanted to say, except for the fact, something new we did this year, we provided two surveys. One was to our own staff and Member Services asking them about their thoughts on their preparedness for handling open enrollment. And then we did a followup survey with the staff after that. We also surveyed the entire membership asking for their feedback on open enrollment. And we received almost a thousand responses on the membership survey. So i was going to add a little bit of that in this report. But i got so interested in it, that i wanted to provide a little more information in january on the results of that survey and followup items well be doing. But thanks to marina and her staff. She pretty much directed the whole plan of getting selfservice up on the past two plan years. Working not only with the department of technology, or not only the Controllers Office, but the department of technology and getting that going. And if you see three departments in the city working together that well, its unusual. I think it has a lot to do with her and her personality and to get everyone working together. Like i said, huge successful ebenefits rollout for the entire city. And again, the staff. The member Services Staff for taking all the phone calls and talking to those people and perfecting those enrollments and that type of thing. Our Communications Department that did all of the hard work. Care and ryan on improving those materials. And also finance. If we didnt have finance, we wouldnt be able to print those rates and talk about those rates correctly. Again, everyone really stepped up and did a fabulous job. It was a very good open enrollment. Any questions . President breslin just want to thank you for your dedication. Did i hear you went to the airport at 10 00 at night . Yes, we did two offsite events at the airport. Health fairs. We sat there and discussed president breslin thats great. And they werent flying out that night either. Taking a flight after . Yeah, it was tempting. [laughter] open enrollment wasnt quite over yet. Commissioner follansbee on behalf of the members and this board, i know every year this is a herculean effort for you and your team, youre to be commended and i thank you for your diligence, each and every one of you. Thank you, appreciate that. I would concur. This is spectacular in terms of the migration to ebenefits. Its something that makes sense in this era. I have a couple of questions. One has to do with the people who show up in the lobby on the third floor. Number one, do you have a sense about what their encounter time is . How long are they there to get their questions asked and answered. As awalked through, there are several terminals, i think. So are members able to complete their ebenefits there . Is there staff to help them so they can actually use the equipment in the reception area . I was impressed with the number of terminals and the possibility that could facilitate the learning curve and next year, you might have fewer facetoface encounters. Absolutely. We have some idea of the wait times in the lobby. It is right now the system that were using the sales force, the people log in when they come in and the timer starts there. And the timer changes time whenever theyre called in and then it changes time again when they leave. It rounds off to like an hour. So its very inaccurate. And were looking at more ways of gathering that information. But we do notice it. And it also depends on the problems, but the staff is really good of keeping an eye on because they can see through the sales force, how many people are waiting and most of the offices, you can see how many people are waiting outside. Did you want to Say Something about wait times . Okay. So what we did this year, we have staffed our reception desk in the lobby when you come in. There is always one that has been there for a while. We staffed reception desk and put some footprints on the floor there to guide people on how to sign it. Because it does get a lot of traffic. And footprints leading people to the terminals. The terminals are functional for them to look at the website, the health plan and access selfservice. That individual that was sitting at the reception desk is the desk top support specialist for those people. Encourage them to try ebenefits on the kiosks. Thats why theyre there. And when we start new hires, hopefully, by the first or Second Quarter of next year, the new hires come in, that will be there, using those kiosks. It reminds me to give accolade to the receptionist. I came in to pick up the ipad, so i didnt sign in, but she was right on it. Can i help you . She went looking for the right person. And i was not dressed i was dressed in street clothes. I didnt look like i was really important, although i think she did ultimately recognize me. But she was very personable and i think that really makes a big difference, because the visit starts as soon as you get off the elevator. And that really makes a big difference. I think it does, too. And we have lots of other times, other than october, there are times we have a lot of retirements or sometimes there is new hires, a lot of new hires at once for the larger departments, so its good to have the reception there and facetoface contact. It really does help a lot. So, mitchell, its amazing you went out to the airport at 10 00 at night. Are there other strategies for the 247 operations for other locations . This was our first one. Going outside of our typical Business Hours. With the exception of School District, we do go there until 8 00 at night, because a lot of the teachers are at many different schools throughout the city, and were at a spot with the School District benefits team, so we stay until 8 00. Right now for the 247 we dont have any. We tried this. And like i said it was very successful. And we got a lot of positive feedback from the airport administration. So we do want to look and do that more often. Because it showed me, marina and i there just there for two hours, and talking to 200 people, it showed the need, they definitely need Member Engagement. President breslin thank you. Any Public Comment on this item . Seeing none. Well move onto item number 11. Item 11, Market Assessment part 2. Sfhss Member Engagement presence. This will be done by both are you presenting by both heather imboden, principal communities in collaboration as well as shah nay hawkins. Id like to focus this on the Board Meeting that delivered indepth content of the rapidly evolving market place. That covered the impact of industry activities at a national and local level, defined the Major Players and opportunities in Todays Health Care ecosystem. Outlined a spectrum of health care design, explored factors driving health plan Market Assessments today and models for the San FranciscoHealth Service system. The opportunity to hear directly from members allowed them to give voice to their Health Benefit experiences. This process was an additional step in informing the health care Market Assessment. Following that in july, we announced plans with support from communities in collaboration, specializing in inclusive strategic planning, research and evaluation. We shared a comprehensive outreach plan with the Health Service board targeting diverse members, and adult dependents who could speak to Health Care Priorities for our member groups. They coordinated nine focus groups in San Francisco, san matteo, alameda, including the San Francisco police department, the San Francisco international airport, the public libraries, office of transgender initiatives, oakland public library, moccasin folks and the Health Service and at the Wellness Center here at the Health Services. At the end, we at the end of the day we had 117 individuals participate in the focal groups, representing 34 of the unique departments across the city. With that, id like to turn the mic over to heather and shenay to talk about the presentation of the core findings from this endeavor. Thank you. Thank you. Hi, commissioners, its nice to be here with you today. Im heather imboden, im with communities in collaboration. Were an oakland based consultant. We also do program evaluation. Im here with my colleague, shenay hawkins who also supported this project. Im going to breeze through the beginning of this presentation because abbie so thoroughly covered a lot of the introduction, so were going to talk to you about the work we did. Were going to focus on what we heard from members who participated in this process, both through the focus groups and also through an Online Survey that was made available for members who are not able to join us. And then well talk about the implications for hss and some of the things that hss is already doing to address the needs that were heard. So abbie covered the purpose of the engagement. Ill recap. It was to hear the experiences of members and understand their priorities, but also to test those Health Care Models presented to the commission earlier in the year. And understand what the questions and ideas that members had about those models might be. We targeted active members and retirees who are not yet eligible for medicare, primarily because those models were focused on nonretiree, nonmedicare backing up on members who are active and who are not yet eligible for medicare. Medicare eligible members have a different set of plans as you know. So we did not folk our efforts on those members, but we did have a number of medicare eligible retirees who participated and their input was certainly taken into account. As i mentioned, abbie went over the process, so i wont go into that here. We did hear from a great group of people. We wanted to hear from a really Diverse Group of members and so as we were receiving our demographic surveys from participants, we kept an eye on that throughout the process to make sure that we were hearing from different departments, different locations, people with different enrolled in different plans and other demographic factors. So we did additional outreach throughout the process to make sure we were really hearing from the broad diversity of members. So the meat of it. I want to talk to you about what we heard from the participants. And this is reflective of their personal experiences with their Health Benefits. So we tried to put this from their perspective as much as we could. I want to say at the outset that we asked a lot of questions about a lot of different kinds of care. And most participants were quite positive about their experiences. So im going to talk about some of the things we heard lots of good things about and then ill go into areas where we heard consistent messages about room for improvement. As far as primary care choice and access were really key for our members, as well as being able to stay with a provider that they trusted. One participant told us i would walk through fire for my primary care provider. That is a particularly emphatic statement, but when someone is happy with their provider theyre very happy. Access to specialists. Members really appreciated being able to get to a specialist quickly. And being having access to high quality specialists. Being able to be referred out of network when that was called for was also appreciated and making sure there was good communication between specialist and primary care providers. We asked about urgent care. And there were many members who felt very positive about urgent care because it was more accessible to them and they felt that the quality was very high. So that convenience of being able to access urgent care outside of regular Business Hours was really valuable to members and they felt like they were getting good care when using those services. We also heard a lot of positive feedback about apps and digital records, which are being used more and more by members. Again, there was the convenience factor that was very important to members. And knowing that their providers could see their records as well was very appreciated. One member said you can make appointments, email your doctor, lots of things through the app, its very easy. Going to skip and talk to medicine, because we heard something similar about telemedicine for members who appreciated not having to leaf the comfort of their office or home to access care. Sometimes it was easier to get an appointment over phone or video. And they felt that quality of care was there for those services, so that is something we heard theyre looking forward to using more in the future. And then dental care, again, really appreciating the ability to stay with a provider over the longterm. And trusting their providers and having friendly relationships with those providers was very much appreciated. One member actually told us they liked their providers because the provider laughed at their jokes. Its the little things, right . So there were three areas where we consistently heard messages of room for improvement. Where members felt like there was opportunity and needs that werent being met. One of them was in Mental Health and behavioral health. We already spoke about that a little bit earlier today. They felt that they had a very hard time finding providers who were covered within their networks. Even if they had a list of providers who were technically within network, they might not be able to find one who is actually accepting patients at that time. They wanted more robust coverage particularly for care before its an emergency. We heard from members who had crisis, Mental Health crisis within their families, they had good coverage and care when the crisis happened, but they felt if there were more robust coverage leading up to the crisis, the crisis might have been averted. We also heard that some members had trouble finding providers that met their needs as far as being a match and understanding their background. And the more diverse providers, so that was another area members were seeking more support. Another area where members were seeking more support was in wellness services. And they talked about that as far as fitness, as far as Nutrition Counseling and weight loss support and being able to access those things in some cases just being aware of the benefits that were available to them, they didnt realize were available to them. And if they were available, being able to access them outside of regular 9 00 to 5 00 working hours. We heard from some people with nontraditional working schedules who said, there is exercise at my office, but its from noon to one. If im a shift worker, that doesnt work for me. They were looking for more Robust Services outside of those traditional 9 00 to 5 00 hours. Then the last area where we heard pretty consistently a desire for support was in alternative medicine. Primarily chiropractic care and acupuncture. Again, finding providers who specialize in those areas was difficult. For members to find covered providers. And so members often were paying reported paying out of pocket or using their fsa funds to access those services with providers that they felt met their needs. And actually we heard that around Mental Health as well. There were members who had Mental Health care providers that they wanted to stay with and ended up using their own funds or fsa funds to stay with the providers because they were not covered in their networks. And with that, im going to turn it over to shenay who will talk to you about the feedback we received on the models. Good afternoon. As part of the engagement process, we