Transcripts For SFGTV Health Service Board 20240713

We do have a change in our supervisor. Rafael nadal him and will no longer be part of our board and we will have mr. Dean pressed things preston starting next month in february. We have a quorum. Item number four . Item four is the possible modifications of the meetings set forth below. Regular Meeting Minutes from december 12th, 2019. Are there any corrections to the minutes . I move adoption of the minutes for the december 12th meeting. Second. Any Public Comment on this item . All those in favor of approving the minutes signify by saying aye. Aye. Any opposed . Its unanimous. Item number five. Number five is the general Public Comment on matters within the boards jurisdiction. Happy new year. Im sure you are tired of hearing from me, but i want to let you know that i genuinely appreciate all of your time. I wanted to say that last month or the month before when you made the recommendations for the memo, i really wanted take to get to hard. I especially thought about what you said, commissioner as the only md on the board, that you felt confident that a memo and not a change in the policy in that implying up a luminary diagnosis would be sufficient. I really thought about that, and that maybe standing operating procedure in the field of medicine in internal medicine or h. I. V. Or in many other fields of medicine, but that was not my experience. I was not given april luminary diagnosis, and none of the people who received denials were given preliminary diagnosis, otherwise they would have been approved. And so what we are expecting is for clinics to do something that may not be Standard Operating Procedure for all clinics, that members are able to find this memo that exists. A memo that is pretty wonky in its rating and doesnt even use the word preliminary diagnosis, which to me, is not someone from the medical field is clear. Expecting members to advocate to their doctors, something that may not be Standard Operating Procedure. I have been told that blue shield has someone specifically assigned to help members navigate when they received denials. I have worked with the person. They are wonderful. However, how are the members supposed to find this person . I have been connected because ive spoken here. Denial letters are form letters. They do not say a specific person to contact. It is like an 800 number. It is reasonable to expect somebody to call concierge on their card. So is it reasonable to expect the hundreds of people that answer these phones for a concierge to know that this one person exists . I think that is disingenuous. If a person is able to find this employee to help navigate, that would be amazing because she is great. However, is it in her Job Description to be proactive and ensure that no one else is being denied . I am tired and wanted to basically give up on this, but i was contacted by someone in Public Safety whose job it is to protect and serve our public and our lives and what this person told me was identifies the Lgbtq Community and was worried about getting denials. This is not what this body or this board wants. The department mentioned both here and that the budget and finance meeting with the board of supervisors last year is there looking into specifically those agencies that cover fertility benefits. I havent heard any updates. I dont know if you have received any updates. I know the budget is due to the Mayors Office next month and im curious if there are any recommendations being made for the turning over of the budget when it is given to the Mayors Office. Thank you. Thank you. Any other Public Comment . Good afternoon, commissioners and happy new year. I was here last month and i talked about whatever i said about [indiscernible] i cant understand them. Apparently they cant, in the computer system, cant tell who is in the smile program. All i know is they havent fixed my wifes bill since the last meeting. The rep has been nice, but she didnt even know we were in the smile program until i told her and then she found it out. I dont know what is going on there. I wanted to come and talk about kaiser, you know, last month i was here. Somebody called me, but nobody ever got back to me about the issues i raised. But i want to talk about an incident that happened maybe two weeks ago. I was near kaiser at the San Francisco facility and i still hadnt heard about the shingles shot, so i decided to go to the Injection Centre on the sixth floor. I couldnt believe what the nurse manager told me and why there is a shortage. I understand there is a national shortage. They came out with a new shot. That i understand, but what i dont understand, what blew my mind is what kaiser does with the shots. Apparently they distribute them to each facility on an even basis and dont, you know, distributes them proportionately to the members. So my friends who go to kaiser outside of the safety got theirs right away. People in the city, which i assume are a lot of retirees have to wait. I waited over a year. And then she told me they have lists, but they dont have a consolidated list. I asked her where i am on the list, which is a valid question and they didnt know because she says we have multiple lists and we need to consolidate them. That really just blew my mind. So she took my information. So i left and a few minute later she said, richard, are you near to the medical centre and i said , yeah. Long story short, i got the last shingles shot a current apparently in the building. My wife still needs one, but this is just really outrageous. We are one of kaisers biggest customers. And i think when we start negotiating next year, you know, we need to get them on the ball. The doc the doctors are great the medical staff i have no problems, but their bureaucracy i think we need to put some pedal to the metal and get them to change this bureaucracy there thank you. Thank you. Any other Public Comment . All right. Item number six. Item six is the president s report. This is given by president breslin. I have nothing to report at this time except happy new year to everyone. Is there any Public Comment on this item . [laughter] we will move on to item number seven. Item seven is the directors report. This is given by the executive director. Good afternoon, commissioners the directors report is brief this week, or this month, but to make it clear to everyone, we do have a seat open on the board that is currently filled. We he will be stepping down when his term expires in may. We will be conducting an election and those official election practices begin in january, january 10th, to be exact, where we will be distributing the nomination forms and looking forward to having eligible candidate step forward for this role. The nominations will be accepted through february 14th and then the election process will ensue, assuming that we have more than one qualified candidate. Were looking forward to that. The second highlight in the directors report is the centre antitrust case. There was a settlement that was announced on that in december. Much of that is still being discerned and considered and will be made public in february. There is both a financial compensation award that will go to eligible employers, unions, and public entities covered under the class action and legal fees, and importantly there also a number of practices that centre had had in place that will be changing. Those are highlighted in your directors report. And as we learn more specifically about how h. S. S. Will be impacted by this decision, we will bring that information to the board. There is a lot of discernment underway as we speak. We look forward to having a clear understanding of the impact in we will notice the board in due time. Also out of washington there was some good news regarding healthcare taxes in that the cadillac tax, which had never been actually implemented, has now been completely appealed. There it has also been a repeal on two other taxes, one on the medical devices, and that one we solved indirectly through our providers. And then the Health Insurance tax, which has been the subject of much discussion at the Health Service board. So we look forward to having that eliminated in the next round of the negotiations because it is effective 2021. It does not affect rates go into effect in 2020. But it will impact next years. So theres more detail on that in the directors report. The other healthcare tax that was extended is the quarry, which is the Patient Centre Outcome Research institute. It is much smaller in dollars. That will continue. That is the only tax that came out of the a. C. A. That will continue. The others have been illuminated operationally, i think everyone is recovering from open enrolment. It went really well. Mitchell will shortly tell you about some of the evaluation mechanisms we were able to put in place this year to help us improve. We are looking forward to getting a new telephone system installed. February is the target at this point. It will be a pretty nice and good change for us because we have been concerned that our current telephone system is pretty old and we have been worried about system failure, but we are just around the corner of getting this new system installed. Hopefully february unless something delays us from moving forward. The equipment has all been purchased. We are moving along at a good clip. That will afford us a lot of opportunities for automating a lot of services over the phone that we dont currently have that opportunity for. First thing is first, will get the hardware installed and learn how to use it and navigate a new phone system and then we will see how it can enhance Member Services. I just want to follow up on the r. F. P. For First Responders. Did you find any more out on that as far as im scheduled to meet with them this month. I have actually spent some time trying to identify best practices around the bay area people and how they have worked with Employee Assistance programs and where people are at we are taking a look at what that might be and then we will be meeting with the First Responders this month. So this r. F. P. , though, is outside it has nothing to do with e. A. P. . Not directly. It is an Employee Assistance program. Police has had it in place for some time in fire want to do something. They want to seduce do it in partnership with all the Public Safety agencies. Would this be and the Union Negotiation issue . I suppose it could be. I dont know that it has been in the past, but, you know, that would serve outside my purview, but i think understanding how we assess what the needs are and where and how we implemented those and how they marry up to our benefits are very important questions that we continue to look at. I havent met with them yet. It is early january. I intend on doing that this month. Okay. Thank you anything else on the directors report . No. That concluded my report. Questions . Any Public Comment on this item . Good afternoon and tapping new year, everybody. I am an active and retired firefighter. The start of this r. F. P. Came out of contract negotiations that it would be explored. It was in the last contact and they are now getting around to it. One of the things in talking to the president of our union, all the stresses all the stress is a cumulative. It continues on and on even after you retire. So as part of this r. F. P. , i hope they are exploring at least the same as we can claim other injuries from the job after we retire, it goes five years. That would be a nice number to start with to treat these people as part of this r. F. P. Thank you. I definitely think this is true, especially with the First Responders group. Many retire early, not because they want to, sometimes because they have to. So the challenges of the job or injuries or something. That makes it worse too because they are retiring when they would like to still be working. I think there is a lot of real issues about the retiree group. Thank you for bringing that up. Any other Public Comment on this item . All right. Item number eight, please. Item eight is a San Francisco Health Services post open enrolment 2019 survey report out this will be given by the chief operating officer. Good afternoon. I believe i mentioned last month in our open enrolment presentation that this year we did something new under abbeys direction. We developed and gave out some surveys. Not only to membership members receiving these benefits or that are active and open enrolment, but also staff and their preparedness. The first survey that i do want to talk about on page one of your presentation, is a survey we presented to our employees and staff. The Member Services staff are the employees that have the facetoface contact with the members on the phone, interaction with members, processing open enrolment applications and perfecting those enrolments. Basically Customer Service as well. This survey was designed to followup on the 29 Employee Engagement survey. That is employment, the Employee Survey that we did in earlier 2019. And the two surveys were to measure the readiness, specific to open enrolment and to inform us on what we can improve and what we can start doing now to improve processes and any other things about open enrolment. The first survey was given pre open enrolment right before open enrolment to see how they felt prepared as they were getting ready to start open enrolment, and the second survey was done post open enrolment after october 31st. All in all, there were 25 responses. Probably 20 of the 25 employees actually responded, but a total of 25 for those surveys. In the preopen enrolment survey, it gave the staff access to knowledge and resources and how supported and heard they felt within their departments. And what our opportunities they had to collaborate with other agents divisions. The post open roman survey consisted mainly of open ended questions. It means they could type in their responses and not select from prepared responses. Basically these questions were learning what additional knowledge and tools to they feel were needed for the future and what types of team support they received during open enrolment. In addition, what questions were asked most frequently during open enrolment as they were interacting with the membership. In general, looking at both surveys, we determined that stuff really did agree that overall they had knowledge. The knowledge they needed and resources they needed in general for open enrolment and were confident in their own ability to successfully engage members. Staff did express a desire for more collaboration. For more collaboration opportunities with other divisions and more training on selfservice and benefits and peoplesoft components. Both of these surveys, something we heard a lot about was selfservice. It was very exciting for the membership, exciting for our employees to work with, and there was a lot of positive feedback. A lot of recommendations on what to do. It is new and its always good to hear from other people. I didnt include the survey itself in the presentation because its a small crew and a small response, and to keep it, to keep the anonymity of the survey, i didnt put it with the presentation, but i will make a few more comments that are not on the presentation. Some of the questions that were asked, for instance, specific questions that were asked, asking if they felt supported in discussing both positive and challenging professional experiences openly and honestly within the department. Most people agreed, they agreed on that particular question. Another question that was asked was the hard work that they do and preparing for open enrolment is valued. That motivates them to do their job to the best of their abilities. So there is strong agreement with that question. One of the more Fun Questions was how do you prepare for open enrolment mentally and physically . This was an openended question. A couple of my favourite responses were, i sleep more the night before and another response was they prepare by conserving their energy and prioritizing. That was the preopen enrolment survey. The post survey, some of the questions that were asked were open ended questions. What type of support did you receive from your team and from experts of your department during the period . A lot of them felt they were very they worked very cohesively and it was a team effort. Our Business Analyst who filled in before natalie came as board secretary was mentioned in several of these responses about how helpful he was in helping the benefits analysts was selfservice and explaining selfservice or providing support for selfservice. That was really good to hear. What is the most common concern or question that members ask . We knew what this was, but its always good to have it documented. The number one question is, if im not making any changes, doing need to do anything . Just a few examples of questions before i go on to the member survey, do you have any questions about the Employee Survey . And ass a couple questions . Thank you very much. This is really encouraging and i particularly like the response of those surveyed that they were interested in selfservice. I saw that is something that i think is a big benefit for our members and for the staff in terms of their efficiency and use of time. But to be sure i am clear, how many employees were eligible to fill out both surveys . So i got the impression there was maybe 25 and so the total of 25 responses meant that the number of responses could have been 50, so i guess the question is, what exactly are the numbers , into the people who do you have a sense of people who fill out the prealso pull out the pope fill out the poster was as this a scatter . At the beginning of open enrolment, we had 24 employees working. We had 16 responses to the first survey and to the second survey, we had a total of nine. Probably a little less than half the stuff staff responded to the second one. Im not really sure how many of those, because it was anonymous, im not sure how many of those were the same people. It was 16 in the first and nine in the second. Its interesting. You might want to set focus on ways you can increase encourage people to respond to it post because that is where, you know, the openended questions like how do you prepare for this . Will how will the sleeping the night before work . And so it might want to focus on how you can get a better post participation. Absolutely. This was our first time in doing this. We are setting the baseline. It is important, you know, not only on our interpretation of what we can do, with the staff realizing, you know, that if they do something, if they do participate, things could be for the better. Has staff received this feedback from both of the surveys . Has that been internal discussion about the general findings . Yes. They will be. We have sent some comments out in the presentation is available to them. They will be a more indepth meeting and we will discuss this when everybody comes back from holiday vacation and some people out for illness or whatever. We want the majority of staff there for one of our thursday meetings. It will be coming real soon. Thank you. If there are no other questions, i will move to the membership survey. Again, this is the first time we have produced one of these surveys to distribute electronically throughout the membership. We were able to send it to all active employees that we have actually all active employees because we have email addresses for all active employees. Either their business address or personal address. We were able to send it to retirees that we have on our mailing list, our email mailing list. We dont have a lot of personal emails for retirees and were hoping selfservice corrects that as we further along role that out. This survey went out on novembe. We wanted to give a few days after enrolment, will before confirmation letters came out so its still kind of russian peoples minds what their experience was. We had just under 1,000 responses and 49 unique city departments responded. The department of Public Health and munimobile and Human Service agencies, they are our biggest agencies so we had the most respondents for them. However, just a note, the department of Public Health outnumbered m. T. A. By three times the number of responses. They definitely wanted to provide their feedback. So what you do with these types of surveys and how can you measure that into industry standards . The taoiseach, i dont think is there she is. She did a lot of research and a lot of help on providing these types of scoring for Customer Service. Again, this was our first time doing it so youre setting baselines. On the fourth bullet here, the three benchmarks that we use are calculated based on the responses. One of them was a Network Promoter score. The other one was a Customer Satisfaction score and customer effort score. Like i said, these are evidencebased measurement tours tools that are widely used by Service Oriented organizations to gauge client satisfaction, experience and loyalty. This was the first time we did this so we are setting a baseline. I tried not to worry too much about the comments, but there are a lot of positive things, too. On the next page, page three, presenting a lot of the questions and some of the scores that went out that were calculated. Based on the benchmark on the left row, the customer effort score, this is a score that tells us whether we were successful in reducing memberships effort to resolve their problem. We were resolving their problems or helping them to do this more quickly. The actual question was, did h. S. S. Make it easy for me to handle my open enrolment needs . This is one of the indicators. So the score was one through seven and we got a 5. 9 out of seven, which i think is pretty good. [please stand by] the question is how likely you be to recommend sfhss to a colleague. This is based on members being more likely to discuss negative interactions than positive. So we wanted to know where we were with that. That score was 32. Anything above 0 is good. 50 and more is excellent and 70 and above and considered world class. Our score right now is good. We also included quite a few openended questions. These questions were varied based on things like accessing ebenefits, et cetera. So looking, there were potentially 1,000 of these responses to look at, but overwhelmingly the response about selfservice was extremely good. Everyone was so happy to get it to do it electronically, they liked it. What i also liked was they were very appreciative and they said, could you do this or that in the future. There were several comments or concerns about moving to electronic only and not having paper again. A few questions about communications materials. A lot of it was positive, but asking for other things, clear comparisons, and that type of thing. But overall, every comment that caught my eye was mostly about selfservice and being able to access it this year. Retirees that responded were hoping that they would have access to it next year for those who didnt. And i just also included as an example on the next page, this includes all the questions on the survey and the numbers of responses and, you know, kind of what they looked like on a graphic. Its kind of small i realize, but the questions themselfves ae pretty much large enough to read well. Again, dph, by far, was the highest responder. So any questions about the member reports . Regarding let me go back for a moment, excuse me, i had it here. Its on page 4. You have kind of what the benchmark or the score for that particular Network Promoter score. I was wondering do you have similar kind of data or standard embedded in the Customer Service efforts score and the Customer Satisfaction score . In other words, what are their benchmarks, finding out what they scored relative to the answers we were given and what would these organizations say is good, better, world class, what have you . Right. Well, with the score background and calculations included in the second row, for instance, like the mps, you know, 0 is considered good above 0 is considered good. I think we do have that compared to other organizations. We do have that, but not readily available. With the Network Promoter score, and this is one thing i had to wrap my mind around, we were talking about any kind of Customer Service. You answered about your service and your Cellphone Service and how likely would you recommend that particular company. So it is a broad question. Something we would like to do and should do is go back and look at similar types of benefits, Administration Employee benefits, organizations and the types of Customer Service scores they have received. Thats really what i was getting at. I recognize youre doing this score here, and its great that youve done it, but it would be great to see if there were similarly described organizations using some kind of composite and see how we compare to that. That might provide a pathway for what youre doing and you do it well or here is an area we might want to improve. Hi. Along the same lines, i was wondering were there specific industries that you guys used for the benchmark data. Was it other sort of Public Agency or Customer Service providers and how did you mark that . Was it region or nationwide . With all Customer Service organizations, i dont believe these were limited to just one organization. They are just benchmarks that are used specifically, you know, its the broad range. All of these are national. So all of these are national. So it wasnt looked at in a specific area of Like Northern california or Something Like that that they are national scores. Then do you have any idea about the size of their Customer Base that you measured against. It would be all size, small or lornlger. Thats a good comment too. We can certainly look for future surveys of drilling down to the specific industry and similar maybe Public Sector or california west coast type of thing. I think whats important is we have used validated survey questions and standardized polls. What i think is very helpful about this is it gives us an objective way to measure the quality of our Member Services. We know we have areas of needing improvement. So as we put those in place, say the phone system or what have you, we would expect to see an impact on these scores going forward. So its a brave thing to do is to put these kind of scores public. So i commend the team for consenting to do it. Moving forward i do think it will give us a nice way to be objective about some of the objectives were doing and it was a good time to do it when we made a radical change of going to selfservice. The scores are in part reflecting the fact that for sure as i consider coming to this job one comment i got from everyone in the city was, please dont make me go down there anymore. I think weve met that demand and we can continue to improve it and expand the access for others that dont yet have it. Theres many things we can do throughout the year. Member services stays busy all year long. I think theres other activities we can do to improve. This is my fifth year on the board, and i have to say this is truly impressive and i want to commend you and all your staff, not only for the work they do in the participation, but also for participating in the Employee Survey as well, which i think moves everyone forward, particularly the services to our clients. I think thats really fantastic. Im very impressed. Thank you. Yeah, i echo that. Thank you, harvey and mitchell, for the good Job Well Done during the open enrolment. And positive comments on the open enrolment. Most of the members who participated in the openended enrolment were happy. Just on the Customer Service benchmark on m. P. S. , when i take that survey, i put the low score on the m. P. S. Score because i took it literally. How likely would you for you to recommend it says to a colleague. How could i recommend that because only these people could take part in h. H. S. , unlike if you have a credit card, you want to open a new one. I think thats the comment too that i got from some of the members. Most of the City Employees are in s. S. S. Thats why im baffled by that question. It is a standardized question. So it could have been differently worded i think. I mean, the services that youre getting, how likely are you or something related to the services, but to recommend h. S. S. To a colleague from outside of the city, they cannot get it anyway. Our hope with that question is people would take it as you know, we know that employees talk a lot amongst themselves about open enrolment and whats happening. We found that out when we introduced three or four years ago. So we were hoping that if they would take the question as if a fellow employee had some type of issue with their provider or issues with the open enrolment, they should contact h. S. S. , i did, it was great, or that type of thing. So we and thats a good point, something we had a long discussion about that particular question internally since it was a standardized question, i cant change the wording too much. It would be worth looking into a different benchmark and perhaps developing a question that would gear people to that thought. Any other questions . Any other comments . No. Thank you. Very good job. Any Public Comment on this item . Seeing none, item number 9, please. The San Francisco Health Services reporting as of october 31, 2019, this is done by pamela levin, chief Financial Officer. Good afternoon. The report provided to you summarizes the revenues and expenses of the Employee Benefit trust fund and the budget through october 31, 2019, as well as fiscal year projections through june 30, 2020. In terms of the trust projection, the trust balance on june 30, 1, was 19. 2 million. Based on activity through october 31, the fund balance is projected to be 90. 6 million june 30, 2020, thats a decrease of 1. 6 million. Were projecting no Material Change in the fund balance for uhcppo plan. For the blue shield access plus plan, the fund balance is projected to increase 11 million primarily due to pharmacy rebates and favorable claims experience. For the trio plan, were projecting a 6. 7 million decrease in fund balance, primarily due to large claims incurred in the First Quarter. When we report next month, we will report a decrease in the medical claims, but due to better claims experience. However, we did so i had the advantage of being able to see things that occur in november and december where this just reports through october. The reason we dont do a report directly after the month end is because the entries continue to be put in and hit the trust throughout half of the month. So were looking back through october. I can see in november that claims dropped about 50 . And then in december, they went up again. We are continuing were working with blue shield to understand why theres such a fluctuation. We do know that for that First Quarter this year, there was claims that were paid from prior years due to they were highcost claims, catastrophic claims, that were from a prior year where there was an incorrect presentation when the member went in, they gave a Medicare Medicaid card rather than their blue shield card, and it really is a blue shield claim. Therefore, it took a couple years for everything to get straightened out. We are looking very carefully at the largecost claims because that continues to be an issue that requires due diligence. When we do report next time on the trio, we will see a little better claims experience. Were projecting a 4. 3 million decrease for the delta dental plan. The reason its a decrease in Fund Balances is the amount that was used to subsidize the rates is higher than the favorable claims experience. The healthcare Sustainability Fund is projected to have a yearend balance of 2 million. We project to have 1 million in investment earnings by june 30, 2020. We did not have any performance guarantee payments in october, so you wont see anything in there. There were no reimbursements under the surface see and assistance plans in october and the fund balance is projected to decrease 200,000 due to the disbursements under the plan at the end of this fiscal year. The amount of forfeitures for unused flexible spending accounts which is in the trust wont be known until june 2020. Thats because while the spending accounts and december 31, you still have three months run out to be able to put in your claims for the prior year. We dont see anything until closer to the fiscal yearend. As we mentioned in last months report, we use the forfeitures and the flexible spending accounts for administration of the accounts, which is pursuant to i. R. S. Rules. The forfeitures are found in the trust. The expenditures for admin straiting the flexible benefits is found in the general fund. While theres a budget for the transfer of 600,000, well only transfer the amount that is actually collected for that year. Its a little confusing, but it is its allowable and best practice. As october we received 2 million in pharmacy rebates, and the yearend projection is 8 million based on the prior years experience. We continue to put graphs in the there. We are showing the cumulative expenses compared to the budgeted premiums. The cumulative expenses are tracking lower for the uhcppo plan, a funded plan. In terms of the general fund budget, at this point expenditures through october 30 were projecting to end the year on budget. That concludes my report. Are there any questions . None. Thank you. Thank you. Any Public Comment on this item . Seeing i couldnt even, item number 10, please. Item 10 is the mayors budget instructio instructions presentation for fiscal years 20192020 and fiscal years 202021, general Fund Administrative budget. This presentation is done by pamela levin, the chief Financial Officer. Pamela levin, chief Financial Officer. There is an error on the agenda because its for the fiscal years 202021 and 20212022. We do a twoyear budget process. The instructions that i will go over today only apply to the general Fund Administration budget. The instructions that the mayor put out were a response to the deficits that are projected in the fiveyear Financial Plan which covers fy 2021 to 2024 to 25. For 2021 its expected to be 224. 1 million. They do the estimations based on current levels and staffing revenues. Years ago when and ive been here almost 20 years. The deficits during a period of time were in the 400 million a year. So these deficits are alarming in the second year. I anticipate that in the end the deficits will go down when they do the reporting in march. The local tax revenues are projected to grow in the short term, but there is an decrease in expenditures that outpaces revenue growth. This is what we see every year. This is primarily due to voted mandated initiatives set aside, such as the money thats set aside for park and rec, the Parks Department. The reserves, we have very high reserves, which is good for if theres a recession. The cost of salaries and benefits. Most of the unions negotiated a threeyear contract this last year. There are some outstanding unions. Then were always dealing the city as a whole is always dealing with the investment earnings in the pension fund. They can, depending on how that is, it affects the pension budget along with the cost of health benefits. The areas of impact include the labor negotiations for 202122, the risk of economic recession, and state and federal budget impacts. The mayor is focused on addressing the growing deficits and the challenges of people struggling on the street. The mayors budget decisions will emphasize accountability and an outcomedriven budgeting in order to prioritize discretionary funding and particularly shes looking for providing housing shelter and services for those in need, promoting safe streets for everyone, and fostering healthy and vibrant neighborhoods. Im going to now talk about the key themes in the budget instructions. The first is to focus on accountability and equitable outcomes. In terms of accountability, the Mayors Office is looking for a demonstration in the effective use of city funding, tracking and monitoring meaningful and measurable metrics, and achieving outcome and goals based on Performance Measures and project deliverables. All of these things are what were doing now as a department and what is in the strategic pl plan. Theyre also looking for equitable outcomes. Providing City Services to reflect the value that each person deserves and an opportunity to thrive in a diverse and inclusive city, and prioritizing Funding Initiatives that serve residents with the highest need. And then theyre going to require from some departments accountability and equitable outcome plans. This is not something that was required from us, but these are the goal is to track your outcomes. You know, have measurable metrices in terms of what it is you want to achieve and report how youre achieving it. Now getting down to the actual budget instructions. So the first thing is departments propose ongoing reductions equal to 3. 5 of the general fund support, and the reductions in 202021 must be ongoing reductions. That means what we reduce out of the budget in 202021 needs to stay out of the budget when we submit the 202122. And then theres another 3. 5 that is in 202122. So over the twoyear period were supposed to submit a budget that cuts 7 . The value of each year is 126,000. So its 126,000 in 202021. Keep those and add another 126,000. This will be difficult for our departme department. That message has been given to the mayors budget office. When i got the news, i said this is going to be tough because weve taken a lot of cuts over the years and were a small department. The second is for the department to propose solutions that increase sufficient and effective use of general fund dollars. They want us to look for revenue options, review and consolidating Service Contracts for potential savings, streamlining programs and operations using the lean principles that this is a program that is being used in our department right now. And then pilot Creative Solutions that reduce costs. And then the instructions say the department shall not add new positions in their budget submissions. However, they do say that after the budgets are submitted to the Mayors Office, there can be discussing on new positions if they align with the mayoral priorities. The next instruction is that we must demonstrate the effective use of existing city funding, including tracking, monitoring, measuring outcomes to achieve and deliver on Core Department functions and citywide principles. We you know, as you can tell from the reports that you get attached to the directors reports from the functions that we provide, we are a department that cares about demonstrating what we do and how we do it in terms of data. Departments budget proposals are also supposed to reflect the goal of achieving equitable outcomes for residents. This says that departments are to submit budgets that seek equitable outcomes across the city, focusing on communities most impacted by economic and social inequities in serving residents with highest needs. Excuse me, but i dont think we need to go over every one. I dont know how everyone else feels. There are a couple more that are important. We dont have to go over all of these. I understand. The one thing that the city, the Mayors Office, and the board of supervisors Work Together on, and thats developing a new way of doing budgets, and its in terms of transparency. So we have to hold one Public Meeting to consider the departments proposed budget by february 13 ours is february 13. Then theyre going to centralize all the documents into a single website. So people from you know, our members, other people that dont attend these meetings can actually see what the budget proposals are. We also put them on our website, but this is a broader would that be our budget and finance meeting . Budget and finance meeting is on february 13. Then the budget gets submitted to the Mayors Office on the 21st. The meeting that were talking about, yes, is on the 13th. Okay. Right. And then, you know, we should consider anything that people have looked at in our department and found deficiencies or things we need to work in. Those are reviews and audits. So to wrap up, on the 13th of february, as we just mentioned, the proposed 202021 and the 202122 will be presented to the budget and finance and board for approval. And at that time we will be providing the 202021 and 202122 budget. The instructions and salary savings any salary what . They usually ask for a salary savings like 5 . No. They basically are saying that you are so theres no layoffs. You could keep positions vacant in order to get salary savings, but theres no particular instruction that that must be done, at least for our department, for the larger departments thats a way that you save money. Thank you. So just one comment on the focus and accountability and equitable outcomes. For number 3 it says it will include outcomes of important communities. We are saving money, but we are not being rewarded for any of the savings we give the city. So in terms of outcome, were overperforming almost all other departments and saving the city millions and millions of departments, but every year there are some instructions that we only use to cut our budget and all the amount is under 126,000 in terms of presentations for smaller departments, thats a big deal. I mean, big departments could easily absorb some small dollar amounts, but for agencies, 100,000 is still a lot of money. Thank you. When we submit the budget, we always emphasize the cost savings of the board to the city as a whole in terms of the health rates. That is one of the arguments we have not arguments, but thats one of the real kind of armor we go forward to the Mayors Office, saying it doesnt make sense to cut our budget, its small, its tight, and we produce savings for the city. So thats a very good point. Any Public Comment on this item . No Public Comment. Item 11. Item 11 is the presentation of the audited Financial Statements through june 30, 2019. The presentation will actually be done by g. Walid from kpmg instead of lisa avis. Im pleased to introduce chi walid. She is a senior manager over our audit. We worked with her for several years. Its always been a pleasure to work with her and she will be presenting the required information to you as the board. If you could just make this high end, just the important points. Great, thank you. Thank you, everyone. As you probably have in your audit package, its a copy of the presentation. I will go through, assuming you had the opportunity to read through them, i will go through high level some of the key points. On page 2 and 3 2 to 4, this is kind of like a summary of the required communications. I do want to highlight that the scope of the audit was the Financial Statement for the year ended june 30, 2019. Kpmg did issue an opinion on the Financial Statements as well as a report on the internal controls in accordance with government auditing standards. Both were, i would say, unqualified opinion, which also means a clean opinion. So there were no audit or corrected misstatements or internal control deficiencies noted as part of our had Financial Statement. And then on page 4 there are no matters to report to the Board Committee. Same thing with page 5, no matters to report. Everything worked really well this year. Page 6, this is the report that relates to the various communication topics, as it relates to illegal acts, noncompliance, subsequent events. Page 7 im not going to go into in detail, but these are the required increase that we performed with management. I did want to bring this to the members of the board just to keep these questions in mind as you think about the Financial Statement audit as well as if theres anything that has become alarming to any of you, please feel free to reach out to the auditors and discuss with us. The next slides are very high level. We wanted to show you there is no changes to management policies as it relates to significant accounting. There were no exceptions noted. We did our substantive test work, and there were no issues report reported. Page 10 this is a significant accounting estimate that we noted during our audit, and this relates to the reserved for the selfinsured claims. We paid a little bit more attention to it because it is an estimate that derived by the actuaries. So we did a little bit more due diligence, such as involving our actuaries to review the claims. We did our underlying data testing, as well as just to look in at the reconciliation between the claim triangles and the general ledger. As a result, there were no exceptions noted. We found that the assumptions and the inputs to be reasonably reported. Okay. And then on page 12, this is a significant risk noted in our audit. It relates to the management overrider controls. This is a presumed risk across all entities, so its not specific to h. S. S. , which assumes some level of all entities there are some levels of risk. These are the procedures we performed. We looked at general entries, postclose entries, and inquired of management any unusual transactions or any kind of accounting estimate aside from what we had already presented that we should be made aware of. I think page 13, this is just like one of the accounting standards that would be assessed in future years that could have an impact on management. This is something that were still talking to management about and whether there would be an impact on future Financial Statement disclosures. Would you in a thumbnail, through the president , give me a summary of what this fiduciary activity is, what its trying to cover, its scope, its activity. Yes. So i think in the current indicia right now, theres not really a standard guidance in terms of how to report fiduciary duties. So the purpose of this standard is to provide some consistency and comparabilities for all Government Units to be able to identify and report any relevant fiduciary activities. Okay. If you defined it using the word fiduciary. So, for instance, we are the board here. Will there be some aspect of this standard that would engage this board . No, no. In this way . No, it would not be. It would just be the Financial Operations of the system as represented by our chief Financial Officer in that department and the city and county of San Franciscos Controllers Office . Correct, correct. If i may. So 84 is mostly for reporting purposes, the fiduciary trust fund, its mostly a reporting. Its mostly a guideline on the reporting side. Thank you. When i say that, my ears go up because we are the fiduciaries of the system. So if were going to have to do something differently than were doing now, then i think we need to know that or prepare for it. No, it would be involved more with pamela in management and the city controllers in terms of the Financial Statement disclosures. Thank you. And i think on page 14, this is just more disclosures defining like what kpmgs responsibilities are. The purpose is to provide an opinion on the Financial Statements. We do not have a responsibility to opine on the effectiveness of the internal controls, but if we do see internal control deficiencies then we would have to assess it. We did not find any internal control deficiencies. And then the next couple of pages are the appendices. Its detailed and lays out the responsibilities held at Management Level as well as the Board Committee responsibilities. Questions . This report is remarkably similar to last years report and the year before, which is always reassuring. Since kpmg did read over the minutes of the board, are there any comments about maybe not the level of deficiencies, but interaction or things that the board might be paying more attention to, even though there is not really a deficiency, just to ease my anxiety as well . No, we actually did not identify any sort of i would say issues noted, like working with management or even the work itself. I think that it was a pretty clean audit. Of course every year we do come in with a fresh lens and make sure our Risk Assessment is appropriate for the current year. Its been a pleasure working with pamela as well as her team to be able to get this out before the holiday break. This years audits seemed to take longer than prior years. Could you comment on that. Yes, i think its still the effects of gazo 75, which is the oped standard. While it does not directly affect h. S. S. , a lot of their data do come from h. S. S. And that was the delay or issues noted when working with the Controllers Office. I would say its not any of h. S. S. Like Management Level that caused the delay. I just wanted to have that on the record because i know that pamela stood before us about a month ago saying this is coming, its coming, and theres some systems changes and delays in the process. Thank you for that clarification. I just want to acknowledge and commend pamela and her staff for giving an unqualified opinion and also acknowledge the great Operations Group and management for a Job Well Done for a clean audit. Thank you. Thank you. Any other comments . This requires an action. So i will need a motion here to approve the audit. I move that we accept the audit as presented, a commendation to our internal Financial Team and their role during the past year in not only working with our auditors but the general financial of our Financial Systems at h. S. S. Second. Okay. Any Public Comment on this item . Seeing none, everyone to vote. All those in favor . Aye. Any opposed . Its unanimous to approve the audit. Item 12. Approve the resolution ordering that 2020 health Board Election for one term and authorizing the staff to proceed with the election. This is presented by the executive director abi ian. I spoke to this during my directors report. There is a resolution regarding the election in the packet and the announcement about the process that will ensue. So i think its fairly straightforward. All right. Questions about the process . We did go through this just last year, so i think its fairly familiar to the board. All right. We need a motion then. I move that we accept the endorse the resolution as presented, and with one qualifying comment on my part after the motion is adopted. Second. All right. Public comment on this item. Go ahead. Seeing none, all those in favor of adopting this, please respond by asssaying aye. Aye. Any opposed . Its unanimous. My only qualifying comment is im regretting that my colleague to my left is not planning to be with us in the ensuing cycle. You mean to the right. To my right, my left, your right. So were now into our rates and benefits section of the agenda. If anybody would like a break, let me know, otherwise we can probably get through this without too much more time it looks like. Should we just go ahead on this . Anybody need a break . Okay. Good. Item 13, please. Item 13 is the presentation of the 2020 rates and benefits calendar for plan year 2021. This is presented by abbie yant, the executive director. Thank you. We have inserted into our packet the rates and benefits calendar as we know it today for the ensuing season. Please note that we did as we had last year put additional holds on this room should we go beyond our normal meeting requirements. If Board Members would please take notes of those dates. We will be i guess at this point we can cancel the january 23 meeting. So we will take that on a monthbymonth basis. I think thats all i have to say on that. Any questions or comments. I just want to note, i did make all the start times at 12 30 and i have that confirmation for next month, if we want to start early we can. Also month by month we can adjust the start times to be 12 30 or 1 00, depending on if we need the extra halfhour. Is that okay . Yeah. Im just trying to read the board, whats the preference of the board, whether we have a fixed time and stick to it. I would prefer 1, but if we need a longer meeting, it is there. I would request when we have a variation from the 1 00 start time that we really highlight that to us as Board Members. I would not want to change our ongoing time from 1 00 to 12 30. Youre just talking so well keep the regular meetings at 1 00. But these are all rates and benefits so these will be at 12 30, this whole january and through it from now on . Thats what im trying to clarify here because whats the preference of the group, to do a 12 30 standard time for all meetings for rates and benefits . Well, how does everybody feel like about that . I prefer 1 00. I do too. Given the time for those ones that end, unless we anticipate that the meeting would go longer than 3 30 its fine, but my preference is 1 00. I agree with that to the point that half an hour early means we dont have to meet on another date, i would prefer a halfhour early rather than scheduling a second meeting. Okay. My understanding now then is that we will keep the 1 00 time for the regular meetings. If we see a need to add time or add a meeting, we will notice yourselves and the public. Yeah. Okay. So this calendar is going to change. Ill keep it for next month. Yes. Well keep the room reserved for the extra meetings. But change the others to 1 00. Yes, that is correct. All right. Thats fine with me. Any Public Comment on this item . Seeing none, item 14. Item 14 is the approval of the june 30, 2019, incurred but not reported and the contingency reserves amount. This presentation is going to be done by tom hicks from aon. Good afternoon. Im one of your actuaries, tom hicks. I appreciate the next hour and 30 minutes i have for this presentation. [ laughter ]. So were going to be talking about your ibnr contingency reserves today. If we go to slide 3, just as a quick reminder, the incurred but not reported, or ibnr reserve, this is a required reserve you hold that is meant to value any outstanding claims as of a certain date. If your plan were to shut down as of june 30, how much money we have to set aside for money to pay the claims bills as they come in. That is the goal of that reserve, the reliability of the runout claims. The second reserve well mention is the contingency reserve. This is in effect sort of a rainy day fund. So we do work to specifically determine the amount of variability in the claims payments and forecast a confidence interval of how much money you should set aside in case things dont go the way that we plan. That is june 30 as well. The third reserve is the stabilization reserve, and that will be addressed in future meetings as we assess each plans funding for the upcoming year. So well move to slide 4, which is a summary of the incurred but not reported reserves as of june 30, 2019. These are the reserves you heard from the auditor that they tested and didnt have any exceptions. So overall we saw very minor changes in our estimates for 6 30 2019, versus the previous year. We saw an increase of 74,000, or 0. 3 . Highlevel observations, blue shield, we did see some trend increase in the costs per employee or member per month. We are refining our models as weve separated out the access plus and the trio populations. But really, you know, a fairly minor increase there and then United Healthcare and dental both showed a 4 decrease, which is in part coming off of claims changes and in part recognizing that our 12 30 2018 forecast ended up being higher than was necessary. So we had a bit of extra margin based on what was actually paid has runout as at june 30, 2019, that weve now lowered that and taken that out of the equation. On slide 5 ill pause. Any questions on the incurred but not reported reserve . On slide 5 were going to switch to the contingency reserve. Minor changes, 5 increase overall. The number that will jump off the page to you will be the United Healthcare city plan, which increased by 600,000, or 10 . This is really being driven by the retiree portion of that plan, where we saw a lot of claims volatility, especially being driven by large claims. The way this reserve is being calculated is a function of the magnitude of the claims on average being paid per member per month, the number of members, and then the stability of the monthtomonth estimate. If we see spikes in large claims during our measurement period, that is going to reflect in higher risk and volatility, which will produce a little bit of a wider confidence interval. Thats what were seeing some spikes in claims have driven up the volatility estimates requiring a higher reserve. But on the whole, 2. 5 increase for all plans combined. Any questions on the contingency reserve . Questions. All right. I guess we need a and this will be and the contingency reserve and ibnr will be included as part of the rates, as far as part of the ratings when we go to the premiums . Yeah, so the contingency reserve is a component of the claims stabilization reserve calculation. So that number, the increase by plan that you see in the table will come back as a line item it got integrated yes, youre absolutely correct. Thank you. Any other comments or questions . All right. This is an action item. We need a motion. This is june 30, 2019, incurred but the not reported and the contingency reserve amount. Second. Okay. All right. Any Public Comment on this item . All those in favor, signify by saying aye. Aye. It is unanimous. We are finished with our rates and benefits section. Were into our regular board matters. The timing is looking very good. Okay. Item number 15, please. Item 15 are reports and updates from contracted health plan representatives. Come forward, please. Happy new year, everyone, sharon stanilo with delta dental. On the man who spoke earlier, we have been in communication about his wifes claim. I do have access, but it is not my primary job. It did take me a minute to go to that screen to see that him and his wife were enrolled in that plan. I did say i would have further conversations with him later tonight or first thing tomorrow morning. Thank you. Go ahead. So last night i got a call from a retiree who is a member of United Healthcare. He got a card from blue shield, and hes asking me how come im getting a card from blue shield, where im United Healthcare . No, its a day before yesterday. And he said when he called blue shield, blue shield said this is the list we got from Health Services system. So im not sure if youre aware. Mitchell is taking note, if you would have a conversation with him after the meeting to let him know who, he can follow up. I mean, there were more members that received a card from blue shield although they are retirees. One is a member of kaiser advantage and the other one is United Healthcare. Yeah, these are the types of issues that the Member Services really relishes resolving for our members, so please let us know. Any Public Comment on this item . Seeing none, item 16, please. Item 16 is the community for public to comment on matters within the boards jurisdiction. Good afternoon again. Dennis kruger, active and retired firefighters and spouses. I too got cards from blue shield for my wife and i, even though we are both in United Healthcare. I have reported it to the main phone service, and i was told to disregard it. Then they sent me another statement showing me what my benefits were for the year and who was carrying me, but i did get a set of cards from blue shield. I have another question regarding our carriers. What is the policy on experimental drug studies and tests as far as people participating in them and how much aour insurance carriers wil support them and pay for what comes up . Is there a policy regarding that or is it individual and individual insurances. Through the board to any of the people in the audience who represent companies. The reason why i ask, a person contacted me. Theyve been recommended for a cancer study, and they wanted to know if the parts that they were responsible for, if the Insurance Company would cover it because its experimental or its in the testing phases. We would definitely review each one on a case by case basis in the event that member had some sort of rare condition that required an experimental procedure. The sponsor of the study and the health plan, so no one should be denied, or should not have access to emergent or urgent or routine care just because they are in a clinical study, but the same the investigator said, you need the following 23 tests that would not be part of routine care, that i think most of the Health Providers and most of our health plans would probably say, you know, i would not be normally ordering this soy cant really authorize this. Its very individualized. Okay. Individual basis then. And the last thing i want to reiterate in the directors report regarding the r. F. P. , i might have not been clear in what i was saying, but i believe that for everybody active, First Responders, should always be available, but i also believe that even after departing, that same r. F. P. Should cover them for a number of years after the same as if they are covered for heart conditions or lung conditions which is usually five years. Which is what i would want to say. The service i was talking about it was workers comp. They cover that going beyond, but this r. F. P. Is specific to First Responders and i would just hope that that would also cover the ongoing employee beyond employment. That is all. Thank you. In light of the issues that the commissioners and weve heard in terms of cards going out to people, i dont know if there is a root cause, but in dealing with this, which is easy to just rip a card, but if we could maybe explore why cards are going out inappropriately and get some sense about is this the tip of the iceberg . Were there more cards that we havent heard about and was this some sort of computer glitch a violation of confidentiality or something. This is the time that we learn of these issues. Because the cards have been mailed so people have received them. We will take a look at what the underlying issues are. Did i hear it wasnt only blue shield was also a cars or person that received . We will look to see how much of an issue it is and certainly address it. Thank you. Any other Public Comment on this item . Seeing none, item 17, please. Seventeen is opportunity to place items in the board boards jurisdiction on future agendas. All right. Does anybody have something they would want to put on the agenda here all right. Not seeing any, Public Comment on this item . All right. We are on number 18. Do i have a motion to adjourn . I dont think we need to second that. I move we adjourn. This meeting is adjourned. We spoke with people regardless of what they are. That is when you see change. That is a lead vannin advantage. So Law Enforcement assistance diversion to work with individuals with nonviolent related of offenses to offer an alternative to an arrest and the county jail. We are seeing reduction in drugrelated crimes in the pilot area. They have done the program for quite a while. They are successful in reducing the going to the county jail. This was a state grant that we applied for. The department is the main administrator. It requires we work with multiple agencies. We have a community that includes the da, Rapid Transit police and San Francisco Sheriffs Department and Law Enforcement agencies, Public Defenders Office and adult probation to Work Together to look at the population that ends up in criminal justice and how they will not end up in jail. Having partners in the nonprofit world and the public defender are critical to the success. We are beginning to succeed because we have that cooperation. Agencies with very little connection are brought together at the same table. Collaboration is good for the department. It gets us all working in the same direction. These are complex issues we are dealing with. When you have systems as complicated as police and health and proation and jails and nonprofits it requires people to come to Work Together so everybody has to put their egos at the door. We have done it very, very well. The model of care where police, district attorney, public defenders are communitybased organizations are all involved to worked towards the common goal. Nobody wants to see drug users in jail. They want them to get the correct treatment they need. We are piloting lead in San Francisco. Close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. Our goal in San Francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention to address that population and the Racial Disparity we see. We want to focus on the mission in tender loan district. It goes to the partners that hired case managers to deal directly with the clients. Case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. I have nobody, no friends, no resources, i am flatout on my own. I witnessed women getting beat, men getting beat. Transgenders getting beat up. I saw people shot, stabbed. These are people that have had many visits to the county jail in San Francisco or other institutions. We are trying to connect them with the resources they need in the community to break out of that cycle. All of the referrals are coming from the Law Enforcement agency. Officers observe an offense. Say you are using. It is found out you are in possession of drugs, that constituted a lead eligible defense. The officer would talk to the individual about participating in the program instead of being booked into the county jail. Are you ever heard of the leads program. Yes. Are you part of the leads program . Do you have a case worker . Yes, i have a case manager. When they have a contact with a possible lead referral, they give us a call. Ideally we can meet them at the scene where the ticket is being issued. Primarily what you are talking to are people under the influence of drugs but they will all be nonviolent. If they were violent they wouldnt qualify for lead. You think i am going to get arrested or maybe i will go to jail for something i just did because of the Substance Abuse issues i am dealing with. They would contact with the outreach worker. Then glide shows up, you are not going to jail. We can take you. Lets meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. Bring them to the Community Assessment and Services Center run by adult probation to have assessment with the department of Public Health staff to assess the treatment needs. It provides meals, groups, there are things happening that make it an open space they can access. They go through detailed assessment about their needs and how we can meet those needs. Someone who would have entered the jail system or would have been arrested and book order the charge is diverted to social services. Then from there instead of them going through that system, which hasnt shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. They can offer Services Based on their needs as individuals. One of the key things is our approach is client centered. Hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take . We are not asking individuals to do anything specific at any point in time. It is a Program Based on whatever it takes and wherever it takes. We are going to them and working with them where they feel most comfortable in the community. It opens doors and they get access they wouldnt have had otherwise. Supports them on their goals. We are not assigning goals working to come up with a plan what success looks like to them. Because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. It is all on you. We are here to guide you. We are not trying to force you to do what you want to do or change your mind. It is you telling us how you want us to help you. It means a lot to the clients to know there is someone creative in the way we can assist them. They pick up the phone. It was a blessing to have them when i was on the streets. No matter what situation, what pay phone, cell phone, somebody elses phone by calling them they always answered. In officebased setting somebody at the reception desk and the clinician will not work for this population of drug users on the street. This has been helpful to see the outcome. We will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. First to push me so i will not be afraid to ask for help with the lead team. Can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. It is all part of the home reduction model. You are using less and you are allowed to be a viable member of the society. This is an important question where lead will go from here. Looking at the data so far and seeing the successes and we can build on that and as the department based on that where the investments need to go. If it is for five months. Hopefully as final we will come up with a model that may help with all of the communities in the california. I want to go back to school to start my ged and go to community clean. It can be somebody scaled out. That is the hope anyway. Is a huge need in the city. Depending on the need and the data we are getting we can definitely see an expansion. We all hope, obviously, the program is successful and we can implement it city wide. I think it will save the county millions of dollars in emergency services, police services, prosecuting services. More importantly, it will save lives. As a society weve basically failed big portion of our population if you think about the basics of food, shelter safety a lot of people dont have any of those im mr. Cookie cant speak for all the things but i know say, i have ideas how we can address the food issue. Open the door and walk through that dont just stand looking out. As they grew up in in a how would that had access to good food and our parent cooked this is how you feed yours this is not happening in our country this is a huge pleasure im david one of the cofounder so about four year ago we worked with the serviced and got to know the kid one of the things we figured out was that they didnt know how to cook. I heard about the Cooking School through the Larkin Academy a. Their noting no way to feed themselves so theyre eating a lot of fast food and i usually eat whatever safeway is near my home a lot of hot food i was excited that i was eating lunch enough instead of what and eat. As i was inviting them over teaching them basic ways to fix good food they were so existed. Particle learning the skills and the food they were really go it it turned into the is Charity Foundation i ran into my friend we were talking about this this do you want to run this Charity Foundations and she said, yes. Im a cofound and executive director for the cooking project our best classes participation for 10 students are monday theyre really fun their chief driven classes we have a different guest around the city theyre our stand alone colas we had a series or series still city of Attorneys Office style of classes our final are night life diners. Santa barbara shall comes in and helps us show us things and this is one the owners they help us to socialize and ive been here about a year. We want to be sure to serve as many as we can. The San Francisco Cooking School is an amazing amazing partner. It is doing that in that space really elevates the space for the kids special for the chief that make it easy for them to come and it really makes the experience pretty special. Im sutro sue set im a chief 2, 3, 4 San Francisco. Thats what those classes afford me the opportunity it breakdown the barriers and is this is not scary this is our choice about you many times this is a feel good what it is that you give them is an opportunity you have to make it seem like its there for them for the taking show them it is their and they can do that. Hi, im antonio the chief in San Francisco. The majority of kids at that age in order to get them into food they need to see something simple and the evidence will show and easy to produce i want to make sure that people can do it with a bowl and spoon and burner and one pan. I like is the receipts that are simple and not feel like its a burden to make foods the cohesives show something eased. I go for vera toilet so someone cant do it or its way out of their range we only use 6 ingredients i can afford 6 ingredient what good is showing you them something they cant use but the sovereignties what are you going to do more me youre not successful. We made a vegetable stirfry indicators hed ginger and onion that is really affordable how to balance it was easy to make the food we present i loved it if i having had access to a kitchen id cook more. Some of us have never had a kitchen not taught how to cookie wasnt taught how to cook. I have a great appreciation for programs that teach kids food and cooking it is one of the healthiest positive things you can communicate to people that are very young. The more programs like the cooking project in general that can have a positive impact how our kids eat is really, really important i believe that everybody should venting to utilize the kitchen and meet other kids their age to identify theyre not alone and their ways in which to pick yours up and move forward that. It is really important to me the opportunity exists and so i do everything in my power to keep it that. Well have our new headquarters in the heart of the tenderloin at taylor and kushlg at the end of this summer 2014 were really excited. A lot of the of the conditions in San Francisco they have in the rest of the country so our goal to 257bd or expand out of the San Francisco in los angeles and then after that who know. Wed never want to tell people want to do or eat only provide the skills and the tools in case thats something people are 2rrd in doing. You cant buy a box of psyche you have to put them in the right vein and direction with the right kids with a right place address time those kids dont have this you have to instill they can do it theyre good enough now to finding out figure out and find the future for San Francisco recreation and Parks Department offers classes for the whole family. Rec and parks has a class for everyone. Discover what is available now and get ready to get out and play. Henri matisse. Frida kahlo. Andy warhol. Discover the next great artist. Get out and play and get inspired with toddler classes. Experience art where making a mess is part of the process. Classes and the size the artistic process rather than the product. Children have the freedom to explore materials at their own pace and in their own way. Talks love art, especially when they died into the Creative Process dive into the Creative Process. At the end of the classes, they have cleaned and washup. Of. Com great way to get out and play. For more information, visit sfrecpark. Org. That out and play and get into the groove. Rec and parks offers dance classes for seniors. Firsttime beginners or lifetime enthusiasts all are welcome. Enjoy all types of music. Latins also, country and western. It is a great way to exercise while having lots of fun. Seniors learn basic moves and practice a variety of routines. Improve your posture, balance, and flexibility. It is easy. Get up on your feet and step to the beat. Senior dance class is from sf rec and park. A great way to get out and play. For more information, i would like to call the commission to order. Ill take the roll. [roll call] the second item on hello, everybody and welcome. The second item is the approval of the december 17, 2019 minutes. You have the minutes before you. I would like a motion to adopt these minutes. So moved is there a second . Second. Comments or questions from the commission . All those in favor say aye. Aye thank you. There is no Public Comment for that item. Item 3 is the directors report. Good afternoon, commissioners. Grant colfax, director of health. Happy new year. Of aofi have a few things to highlight. Very exciting news with regard to medy cal expanding coverage to undocumented immigrants up to age 26. This is an expansion that Governor Newsom authorized as part of the states 2019 to 20 budget, including full scope medical to eligible adults ages 19 to 25 regardless of immigration status. Statewide this is expected to have a wide impact, covering 90,000 people, and enrollment started the first of the year. We have to make that expansion will apply to about 1,000 to 2,000 individuals in San Francisco. And we have been working with the Human Services agency to notify eligible san franciscans, including transitioning those who qualify from healthy San Francisco to medical. This is also an important opportunity to remind residents about the available of medical, that immigrants are not pen liesed when they apply for a green card, and there are no changes to the public charge rule as the courts issued an injunction and the federal government cannot implement or force the rule indefinitely at this time. Obviously, the Health Department just to remind the public, and the commission that we will continue to provide Health Care Services through our clinics and hospitals in the San Francisco network, regardless of immigration status or lack of insurance. Everyone is welcome, and we encourage all San Franciscos to get the care they need and deserve. Last year, december, last month, mayor breed issued budget instructions to Department Heads to guide the budget process for fiscal years 2021 and 21 22. The mayor directed the Department Heads to prioritize identifying funding to help people suffering on the city streets and to target deficiencies in their budgets. The city is projecting a budget shortfall of 420 million over the next upcoming budget years out of an annual budget of approximately 6 million. And i think that important for the commission is that the mayor has indicated that a priority for the coming year is providing shelter, housing and services for people struggling on San Francisco streets, and this includes opening new shelter beds and expanding Behavioral Health coverage and services for people. So we will come back to the commission as we do every year, several, a couple times in february with budget proposals that of course you will review and help us modify and hopefully approve. So looking forward to that process with our staff and with your guidance and leadership. I also wanted to to highlight the fact that given our vast network of services and all the work we do every day in delivering those services, that we are improving Health Services at three neighborhood clinics, serving more than 12,000 san franciscans. We are this year, we will be working on improving clinic facilities in three primary care clinics including the Health Center in the western addition, the Castro Mission Health Center and southeast Health Center in the bayview. And im a big believer in how care is delivered and the quality of care is also reflective of the environment in which it is delivered in. That care environment, that physical space reflects our value as providers and as communities and having worked in several of these clinics, a number of decades ago, they certainly, and the staff and most importantly the patients and the community deserve the renovations that are going to go forward. And im hopeful it will also improve our ability to provide a topquality care. So thats my summary today. I stand available for the commission to answer any questions or Additional Details of things i have covered or not covered. Is there any Public Comment . Not receiving Public Comment for this item have not received Public Comment for this item i have a question under the topic Health Department educating the public about mobile vendors and food safety and the need to have the current inspection. Does that apply to the food trucks that are wandering the streets . In terms of current inspection, whether they require them . Do the food trucks have inspections . Yeah. So im getting an affirmative from some of our team that led on this. Is doctor here . Do you want to fill in . I believe they do, right . Require the defaults . So this has to do with food vendors that have trucks, carts. The hand trucks . Correct. So they are permitted. But what happens is we have people that come from other areas that have not permitted, and theres always tension, theres always tension on how we deal with people who are not permitted, because its really hard to deal with that situation when it happens. The carts should be permitted. What happens is some come that are not permitted, and how that gets mitigated has been one of our challenges. My question is not the pushcarts. Its the food trucks. Those are also permitted. So all the food trucks that are every single one. That everybody has to be inspected . Absolutely. And have a decal . Im not sure they have a decal but they have documentation inside the truck that they are permitted. Those are absolutely permitted. We have times when they have violated a permit we have shut down some of those trucks as well. Thank you, mr. Coal max. Item 4 is general Public Comment. We have one request. John edmond abraham. Yes. I have a timer in my hand, and when the beep goes off, please know that is your time to stop talking. Some people would say this is the time to stop talking. Good afternoon, commissioners. And my name is john edmond abraham. And it is easier to call me mr. Abraham. Im here to for a couple reasons. Mainly to let you know of the deplorable condition of the way people in charge, small businesses, the aids foundation 50 plus at the aids foundation, others open house that are there to support old, gay men and women fall far short of the goal and also the whats now called the h. I. V. Care council, the h. I. V. Community council. Everybody is dropping the word the acronym aids out of the equation. The effect is out of sight, out of mind. They think this thing is over. And i just lost a friend two months ago to a. I. D. S that ive known and theres this huge hole. Every other thought is about that person, and our lives, not together, but we were not lovers or anything like that. We were partners in a lot of ways. We came from new york. And i used to say, believe it or not, that the new york city opera and the metropolitan opera, and here, this man was a former eye surgeon, and when he got sick with aids, he couldnt do that anymore, and when i aim out here and i got sick sic with aids, i stopped singing. Is that i should shut up now. How about you finish okay. I just want to give you my telephone number because i know this is going to take some time. And this is not anecdotal. This is strait on from my experience. Please take out your pencils, everyone behind me and everyone in front, 4159216211. We can do lunch or some other way, but i need to communicate the truth of my experience here. Finish your statement, please. That is it. Thank you. Commissioners, item 5 is the finance and Planning Committee report today. Good afternoon, commissioners. The finance and Planning Committee met earlier today to consider a contract report and also a new contract. The contract report has one item on it and it is for the request to approve the total contract amount of 2,296,793. And this is like due to new Grant Funding in the amount of 120,511 annually from the California Department of Public Health for overdose sponsoring nizers. This is funding going to the Harm Reduction coalition. The new contract is a contract in the amount of 107,250 with a 12 contingency. This is for realtime survey services to patients and physicians of the Emergency Department of zuckerberg General Hospital as well as the primary and specialty care, and the term is from january 1, 2020 through december 31, 2020, and both items have been added to the consent calendar for your consideration. Thank you. Any questions, commissioners . Questions . Commissioners . Item 6 is the consent calendar. It contains two items that commissioner chung just noted from the finance and Planning Committee meeting. Oh, im sorry. Is this better . The consent calendar contains the two items commissioner chung just noted in her report back from the finance and Planning Committee. Prepared to take a vote on consent calendar. So moved. Signify by saying aye. Aye. The motion carries if there is no Public Comment, item 7 is a resolution honoring winon a mindolovich. President loyce, commissioners, it is my honor to present a resolution to you this afternoon honoring winonas 21 years of Exceptional Leadership with the department of Public Health. Its a bittersweet moment for me as she is retiring at the end of the week. As you have come to know her over the past yea and most recently with her work on our transition formational Electronic Health program, i have come to see she leads with a great sense of compassion and puts her patients and clients at the center of her work which i think has defined so many of her successes here. She leaves us with a great legacy of diversity, inclusion, and diversity im sorry, equity, in the work that she does, by having supported and inspiring so many women to join the Information Technology field, both here and at other areas where she has been involved. I would just like to add that my initial work with her was not here. I have known her for several years. The first time i remember meeting her is the feeling that i got and the sense that i received was warmth but also just a dogged tenacity to get the work done. And it is that that im going to remember most about you in that you just do not let it not get finished. And im just moved by that, and i hope that i can carry on as you have after you leave us at the end of the week. The resolution is before you. And if you have any questions, im happy to answer them. Thank you, commissioner loyce. I want to express my gratitude personally and across the department for your leadership. We werent able to Work Together that long, but the time that we had was so incredibly valuable, both from what i learned from you and the integrity that you brought to the work. Your perseverance was epic, and i think its really key to remind ourselves that it got launched during a time when the department was undergoing a lot of transitions, including in leadership and the tremendous progress that was made and the effort that you invested and your attention to detail and the support of the team that actually executed on the august 1, right . August 3, sorry, how could i forget . But really the leadership that you showed, the tenacity and the fact that you have built a leadership team, i think one of the key marks of a great leader is the team that you build, the team that you mentor, the transition to ongoing leadership is so important, and you have done that. I want to thank you for making a commitment, especially over the last couple years, to staying with the department, seeing this epic transformation be successful and go through, and we will continue the work, and your legacy will lead on. So thank you so much. Thank you. Commissioners. Commissioner bernal. Hi, winona. First of all, i share the observations of the director and him. I would add on top of tenacity, your enthusiasm was infectious this whole time. When you were making presentations, you couldnt help but be on board what you were talking about. My favorite moments were when something moved from red to yellow or yellow to green. At the top of the like a great victory. You always shared the credit with your team as well, which is admirable because you had a great team. So thank you for seeing us through that whole period of time. We are deeply grateful, so thank you. Commissioner chow i also want to add my thanks. Having followed the episode of the birth of dhr from its conception, shall we call it, and the term during its gestation and the real question whether it could be carried off because of the challenges of transition, i couldnt imagine that came off not only on top but as well as it did. And its got to be from your leadership. So i want to echo that not only i know for the many years that you have been working here but particularly for that project, which weve been watching so carefully your shepherdship of it, your stupidship of it, and bringing it through your stewardship of it and bringing it through is by itself a credit to all you do here. Thank you. Commissioner i would like to echo everyone else. They call it epic for a reason. It was an epic task. I remember sitting here being through an implementation, and you would present these objectives and key results, i thought they were beyond stretch goals, i mean how many people you were going to train. I couldnt do the math. Yet you did every one of them and got the team on board, and its not easy working with epic, i mean people out of the corporate offices, and yet you obviously pulled the best from them and the best from our department. And your leadership was just incredible. I was so happy to see. I couldnt even believe those things were going green as quickly as they were and as on time as you were able to accomplish them. Thats fantastic leadership, and we are grateful, and i wish you would stay. [laughter] you are in good hands. I would like to add my compliments to you as well. I remember a couple of presentations you made for us. I think the compassion, the warmth and care about patients is very important, but i also think bringing a sense of humor and that smile when you were presenting, i always knew you were right on point and that if i listened, i might learn something. So thank you very much for your service. The resolution is in the hands of the commission. Can i have a motion to adopt the resolution . So moved. Second. All those in favor, signify by saying aye. Aye i want to say a couple words to president loyce and commissioners and a few of you i have worked with in finance committee side of things and director colfax and secretary, its been with our support that we were able to accomplish this over the last few years and it indeed was an epic journey. There were many contracts and amazing number of contracts bringing to you so with your support and listening to me with my many yellows and greens and our status, and last time presented to you it was before we went live, so i knew we were going to make the date, but it isnt because of me. I had a fantastic team, many of which are in the audience and the leaders in dph, it has been an absolute pleasure to work with this group of people over the last 20 years and just to do the work that we do and serve the population that we serve has been an absolute pleasure for me so thank you very much. [applause] thank you. Commissioners, after you shake her hand, you can join her for a picture over by dr. Colfax and i. [indiscernible] [applause] thank you, everyone. Ill note there was no Public Comment for that item. Item 8 is the office of compliance and Privacy Affairs annual report. I would like to note that mr. Chatfield has been here three times. This is his third time. Twice he had to be canceled due to a meeting having to end so can we thank him by a rand of applause a round of applause . [applause] thank you. Can someone help me with that . Sure. No worries. Okay. Good evening, commissioners. Thank you for having me tonight. My name is chatfield, im the acting director for the office of compliance and Privacy Affairs. Im here to give you an update and annual report for the fiscal year 2018 2019. Just an overview, it was established to help mitigate the rest of the department, both financial and reputational in four general areas, one being compliance. This context, we are talking about fraud and abuse, financial compliance with the services that we get paid for by medicare and medical. Privacy, of course, to protect patient privacy and data security, making sure when we share our information with our partners and members that its done legally and appropriately, and then of course to investigate complaints that come to the office either to the program or directly to us. And not just with compliance and privacy, but conflict of interest rules, misuse of city resources and things like that. So we try, as a general overview, we try to educate staff on responsibilities by doing annual training, providing newsletters and advice to departments. Making sure our policies they understand what is appropriate and required of them, assess risks throughout the department to make sure we are doing the things we are meant to do, and then of course look into wrong doing and come up with corrective actions to correct that if we find something that needs to be corrected. So quickly just organizationally, how we are set up, the director reports to the director of health. The director currently has been reassigned to home and hospital at the moment. Theres currently two Compliance Officers that are in each hospital as privacy officers and two vacant positions as well for Compliance Officers. We have an auditor and an investigations officers for whistle blower and then theres three privacy investigation positions, two of them currently are vacant, which we are recruiting for. Thats sort of the nonBehavioral Health side. The Behavioral Health side, we have more of a beefedup team. We have an obligation to the Mental Health side to ensure the providers are doing the right thing. So we have many more auditors in there where we look at what they are doing and making sure they are complying with the rules, providing them guidance and assess their work. So these laws, im not going to go into detail. I just wanted to make sure you are aware of the general universe we operate in, the first being the false claims act. Theres a federal verse and state. That does deal with fraud, waste and abuse. Our claims, our services, making sure they are appropriate when we go to get reimbursed for them. There are antikickback statutes, not prefers or profiting off that, the reduction act for medical and that with the Affordable Care act had a lot of compliance requirements in there to make sure that as an organization we have mechanisms in place to mitigate the risk thats inherent in such a Large Organization like us. And then of course dealing with patient privacy, and then theres a california equivalent called california medical information act, which is a little stricter than hip pa in hippa in some regards. A quick overview of some of the things we did accomplish in the last year. We developed a new Compliance Training module that is on onlie and interactive, a vast improve the over the last powerpoint slide presentation we had. This requires the users to interact with the program, answer questions along the way, click in the modules that they are actively engaged in it. That was the help of our Compliance Training requirements to show we are providing meaningful training and not just go ahead and read this. We also improved our monitoring efforts at the two hospitals. It went up from 14 projects at the end of the fiscal year prior to about 25. [please stand by] are they flowing through properly on the clinical side. Quality of care, audio compliance, they go handinhand we want to make sure we are not delivering substandard care and if something is falling below what is required, that we then look at that because it affects our claims as well. We want to make sure we are sending claims out for Quality Service we are doing. Making sure our documentation is okay, complete and accurate in supporting the services we are sending out. And then most importantly, expanding our exclusion screening. The federal government has stuff to make sure that everyone we do business with, including employees, are not excluded, meaning they cant receive federal money. Because we do receive federal money, we have an obligation to check that. We do check some employees, not all. We are working to get that process more streamlined. On the privacy side, for the privacy program, it was set up primarily to make sure our clients, our patients, our residents that are with d. P. H. , their information is protected and we are doing everything we can to prevent any unauthorized exposure or use of that information. We investigate potential breaches, we look and see what happened, to determine whether or not it is a reportable breach its something that meets the definition of a breach and we need to notify the state and federal government that it has occurred. We provide advice to all of the divisions on their best practices, we encourage people to come talk to us before they do something so we can advise them and guide them the best way that we can. And we also issue a newsletter every other month about the privacy policies. We do focus on information. We have noticed in the last fiscal years an increase in the number of incidents that get reported to us. I it hasnt necessarily correlated with the breaches that we saw before, however, we think we become more culpable and we make ourselves the awareness of staff they are more likely to tell us it is going on. Although we are happy to see these go up a little bit, we would rather look at a lot of issues and determine where there is problems that we can help mitigate any potential breach. The more we looked into things that might be near mrs. , we put systems in place to stop this from occurring. We have seen that go up. I dont have the numbers for this specifically. With that, it is one of our areas to watch. With the vast information this has, it has allowed people to have vast information. So there are chances for people to be looking where they shouldnt. We are setting up programs to make sure they reject that they check that. Handling people are records, we want to be careful as we transition away from paper that people dont become cavalier or careless. And they continue to treat it with the same level of care that they always have. We dont want people getting the wrong slips or things like that. And then, of course, making sure the people who are looking at records have a reason to look at that record, not just because they are curious. What we do here is make sure that when we are sharing our information, our Health Information with vendors and partners that we have a legal way to do so and that is secure. The data sharing side, we have a data sharing officer. They look at these agreements to make sure everything is in place and they have their own security protections in place. It is important that we do share this information with our partners because we want to make sure care is carried out. We want to make sure we had a bit of an uptick in the last meeting. In the last fiscal year, a lot of those specifically were focused for care link, which is one of the ways our partners go into it. They all got approved in this fiscal year so they dont show up here, but we do get routine requests for this all the time and review this information. The program is something we do and work in conjunction with the Controllers Office. There are two ways we can get complaints. One is through the Controllers Office program or directly to us there is a hotline which is 24 hours a day or in person. We will investigate the compliance and privacy, but a lot about the whistleblower investigations involve our misuse of resources, nepotism, and Improper Conduct. We are always looking at these things from an ethics side to make sure that our staff understands they have obligations under that as well. The results of these all go back to the Controllers Office if they were referred to us from them as well. Looking forward to this fiscal year, as we continue to strengthen our programs, one of the things we are doing is developing a d. P. H. Level Compliance Committee. Currently there are separate Compliance Committees that live in the hospitals and the reporting doesnt hasnt gotten filtered out to the executive staff. They can understand what the risks are within the department. They can help allocate resources and also identify risks that they may see. It is important we get that structure. We already did have our first meeting and we will have our next meeting in february. That is already happening. We do plan on hiring our Compliance Officer for laguna honda. Currently that position is vacant. The Compliance Officer is covering that for the minutes. Were close to getting that filled within the next month or so. We are happy about that because then we can go ahead and get primary care the Compliance Program that we want to get established there. I mentioned about epic. One of the things that we have started doing is dedicating our staff to monitor for inappropriate use. We have tools now that allow us to do this much easier than in the past. We are looking at the reports to see who is accessing it. Is it appropriate what they are doing in there . We also want to develop a protocol for putting an Auditory Service on records that might get flagged as confidential highprofile, Something Like that, so we do this, but would like to have a routine way of deciding when these get flagged so we can look at who is looking at these records. And then to increase our live training, although we do to the annual computer training, what we are looking to do is targeted topics so that there is an area or division that wants us to come talk about something that is specific to them, or there is something we feel people should know about, then we would add that to that. We are continuing our education efforts. That does conclude my presentation to you. Im happy to answer any questions you may have about what i discussed. There is one Public Comment. It is Public Comment. Good afternoon, commissioners i am a whistleblower. The d. P. H. Is coping with the biggest compliance and privacy failure in laguna hondas history, yet todays Compliance Report seems oblivious to that scandal. No explanation for why the Compliance Program and its whistleblower hotline missed dozens of patient abuses over three years. No suggestion for how the program could improve to detect future privacy and safety violations. How could it better deal with a culture of silence . We are not told. There are two reasons why decent employees do not report wrongdoing. The first is that they believe that nothing will be done, and the second is that they fear retaliation. Neither of these barriers was addressed today. Note how todays presentation only shows the number of investigations without disclosing the outcomes. The message is that nothing was done or that nothing was substantiated. That discourages employees from reporting misconduct and it promotes silence. Therefore, investigation outcomes and substantiation rates should be reported. Similarly, complaints of retaliation arent mentioned. The message is that retaliation is being ignored even though employees know that it happens and fear it. A Compliance Program that ignores whistleblower retaliation, promotes a culture of silence. The program should report retaliation complaints and what it did to address them. Time. Unless the compliance and proxy program explains what it could do differently to prevent future abuses, it should not be expanded. Lastly, please consider more frequent Compliance Reports. Once a year leaves you in the dark. Thank you. Thank you. Dr. Colfax, did you want to make a comment . I wanted to acknowledge the progress that has been made. This year has been a challenging year. One thing i want to emphasize is that garrett really stepped up in this role. He is acting director and maggie who is our compliance director was recently at laguna honda and has built a lot of the foundation you built today. I want to acknowledge garretts leadership. You are on the job a very short time in this role. We were very excited to be able to have him not only join the team, but bring in the leadership here. And the fact that we are really focusing on developing a d. P. H. Wide Compliance Program. I thank you saw the evolution in the summary, but i want to emphasize that. Having executive level Compliance Committee really signals in a very meaningful way that the d. P. H. Values compliance and we need to expand that work across the entire department with executive level oversight going forward. I really want to thank garrett and his team and acknowledge maggies leadership in developing it up to this point. We look forward to 2010 tito 2020 which will be a year of expanding our compliance and oversight of the department. Inc. You. Commissioners . I have a question on one of your risk areas to watch, which was quality of care that you have brought up. How do you monitor, measure the quality of care . Do you have specs specific variables . How is it measured . Our compliance primarily focuses on the the quality side of things. We work with quality to understand what they are looking at. We attended their meetings to understand what they are doing. What we look at to see is if quality issues are to the point where we shouldnt be claiming for the services that we are providing. I cant give you a measure at this point because quality, we dont do a Quality Assessment in compliance. We work with them to try to understand what they are doing and what we are trying to do is focus ourselves to Pay Attention to that so that we are aware of what is happening on the quality side. I guess my question and concern is, if, in fact, they have a metric that they are presenting to you for compliance is there such a thing . I dont have that for you. Im sorry. Commissioner ciao . Yes, thank you for the presentation. This is one of the times were normally where we begin with a slide that shows where your office is. It would have been helpful because i am trying to understand where Compliance Reports to, which i think is very high up, and number two, if i remember the old chart, and when the Office Organized itself into this manner . Is it a recent organization or is has it been there for 10 years in the structure you are showing . I apologize for that. Is my first time with you. Next time i will make sure i will have it for you. That is why i was wondering. We have not actually i dont think recently we have seen this type of overview. So that is why i am wondering, is this also part of the build out of compliance to make it and privacy, trying to make it more robust. Sure. I will answer in order. The director for the Compliance Reports directly to the director of health. That is where it sits in the organization as the division under the director. Part of the reason for this overview and the executive level was to make it more robust, provide reports to on a more regular basis. We do intend to report to you more then annually so that you are aware of what is going on, along with d. P. H. Leadership and make sure that that is happening thank you. If i can, i wanted to hear the followup question. I did look at your interactive compliance module, which i thought was extremely comprehensive and wanted to graduate the department on it. I was stressed by the fact that there was so much information, that i was wondering, was there a means for that to actually be more easily obtained by users . That its employees might think, i remember there was something about privacy but i cant remember what it was and what i can do. While i know we dont really know the number that is very nice. I guess i am asking, if resources are available beyond that module, that makes it easy because you have done a lot of work and have a lot of resources and secondly, more specifically, i found the code of conduct extremely detailed and it would seem to me that it really should be a valuable thing on our website. Is it on our website . Like here are our objectives and here is our code of conduct and the way that we do our business. The code of conduct is on the website. We do try to reiterate what we talked about in the training through the privacy policies in the compliance matters that we issue to try to bring more detail to them. Part of what we discuss is expanding the education so that we can either buy invite or by concern of an area, we can present topics in a little more detail. We do really want to encourage people to understand that all of these things are to be part of their daily work. It didnt just happen on the idea about patient privacy and making sure we are acting with integrity and reporting issues. We do encourage that. Those are some efforts we are currently doing. If i were an employee step working in the living room and i wanted to review, because now i remember [indiscernible] is there a way they can do that without going through the whole thing . Sure. As far as the training, that is a good point. I think there isnt a way at this point, once a training is off the platform, it is off the platform, but that is a good point. I think its something we can look at and see if that is something we can leave off. Our policies are available in the website so we can look at the policies that are behind all the trainings. That is a pretty good point. Right. I was fascinated by the fact you do have risk areas you are watching, which means this is sort of your work plan for 20 years. You have given us a preliminary data. It does go back to the question of, from the data, then what did we learn and where do we go from it . Which i would anticipate in your next reports we would start seeing. You will. I think particularly in areas we obviously have heard of data breaches and we get we get those reported as they happen, but it would be nice to see these in a report coming in and looking at the history and then understanding what we are doing in order to and here are the things. Just like you did very impressively on the issue of decreasing disallowance is on incomplete clients. We knew that was a huge problem in terms of not properly documenting or inappropriately diagnosing for a large number of reasons, sometimes under diagnosing and so forth. And to move that out in this type of way is a wonderful outcome of this. I think we would like to see some of the others where you are showing that we either have decreases or increases of reporting. And i know that for specific units, sometimes we get to look at that. I think it is at the at the department, this would be helpful. And then the lessons learned. We have this program in place. We think it is really meaningful that we then become much more aware of what is happening and we can articulate to our public that is often asking us because it shows up in the papers, what are we doing about this. Certainly we can provide you with that data as we move forward when we report to you. Thank you very much. Thank you for your presentation. Very impressive. You really cant under overstate the importance of your offices work to protect our patients and our resources. And as you said to try to prevent issues, that are particularly challenging an environment that is changing and often uncertain. Looking at your organizational chart, there are 14 positions and four of them are vacant. One of them is being reassigned and another has been reassigned internally. That is a lot of vacancies or people doing work that is not there core work. How much of a barrier is that to the work you are doing and how is your progress in filling those positions . It is a barrier because people are doing work that is not their primary responsibility they have all done it willingly and i commend them all for doing it. The positions are moving through at the pace that they do. We do almost have the laguna honda position filled. The other positions are moving along slowly behind there, but i am trusting that the h. R. Process is doing what it needs to do to have that happen. To be perfectly frank, its a challenge because there are people doing a lot of work and doing the best they can in a very, like you said, challenging and changing environment. Kudos to them for their great work. We hope you will get the staffing you need soon. Also, just two other quick observations. As commissioner chow had said, im wondering what would you attribute in the disallowance is for incorrect claims . Its an 80 reduction over two years. What would you attribute that to there was a big payback with the mental Health Services earlier and that the former Compliance Officer overall over there did develop a very Robust Program and that really did help. That was a lot of it. We do hope that this continues, although i would never make a guarantee on that because you never know what can happen. We do like to see that happening and assume a question when youre looking at the whistleblower program. It looks like there has been a 50 to 60 reduction yearoveryear in investigations for Improper Conduct in fate and favouritism. What would you attribute those decreases to . It is not really meant to show a reduction, it is really just the number we looked at. During those two years, it was about 83 in the first fiscal year and 63 total and the other one. This really was to show the areas that we look at the most. Thats all that was. It wasnt a comprehensive chart of reduction necessarily. There were 20 less cases. The Improper Conduct one from 36 to about 17 or 18 the next year and also under favouritism, it went from 16 to about six. I couldnt tell you what caused that or because that reduction. It could be we just got less complaints around that. At some of that be due to not having a full complement of staff as well . Yeah,. Certainly we only have one person doing this so we handle them as quickly and as best as we can. Thank you. Commissioner green . Thank you for this. Its very exciting all of your plans for the coming year. Given that they are so extensive , you shared with us four of the goals or metrics that you have been following today. If youre going to expand the program, do you have any sense of what other objectives or metrics you might incorporate, and also what the actual numerical changes you might be targeting . We have seen that in other areas , for example, at hospitals im wondering if youre doing any analogous work in these areas and when we might have access. I think the corlett his gigantic have you gotten a sense of how you might best utilize it and where you might focus . We have this resource, but without knowing exactly what you want to extract from it and what our goals to that information is , it is hard to assess where we are making progress. Will you expand some of these and how will epic be a part of it . When will we be able to get report . Definitely before the year goes by. I dont know when. That is part of having the executive level committees so we have more regular reporting and we can bring that reporting to you. We do plan to look at disallowance rates in the various areas and using that as a tool for that. You are right. Epic is new and we are still learning how to use its reporting functions and that is our learning curve to be able to look at what is going on there and figure out, okay, what is trending as a problem within their . Which is why we are going to do that Risk Assessment early this year to see what might have a chain change in that environment. We can provide you with information on what types of breaches are happening, as well as if they are increasing or decreasing. That sort of thing. Is that it . I just wanted mr. Pickens to loop back on the question i was asked about the intersection of quality and compliance because i felt like there might be some more information that could be provided in response to the commissioners questions. Good afternoon. Im director of the Health Network. I want to add to garretts presentation, particularly your question about quality. In terms of quality of care. Quality of care sits directly within the Delivery System. Most of our Delivery System is within the Health Network with a small component also within ph. D. , mainly our city clinic and tuberculosis clinic. Within the network, each of our units, laguna honda, zuckerberg, the various units of ambulatory care all have quality departments and staff that actually report on the quality of patient care. If you sit on those zuckerberg j. C. C. , that is where quality is presented. Similarly for laguna honda. Recognizing that we are this vast network