Clerk we have a quorum. Item 4 the approval with modifications of the minutes of the meeting set fourth below. This is the regular Meeting Minutes from february 15th, 2020. Are there any corrections to the minutes . Seeing none, ill ask for a motion. I make a motion that we approve the minutes from the february meeting. Second. Any Public Comment on this item . Seeing none. All those if favor say aye. Aye. Any opposed. It has passed unanimously. Item 5, general Public Comment from matters of the boards jurisdiction. Please come forward. I have a comment on the assistance dealing with this coronavirus and the healthcare and they have already got someone that had already got it and would not allow them to even be any lessons because the school and i went to in 200 200r this issue and what they did is that they bribed me and tried to make it work where everything was off base that other things that trying to teach me i was really upset about that because of the healthcare issue and they were towing it and because of the example that i am here we get through the coronavirus and this is serious and people, you know, see that. This is something ive always been through. To show an example, if the healing care issue and i shouldnt be ignored or anything in this matter. Thank you, very much. Next speaker, please. Hello, my name is alice mosley and im a retired teacher, although theyve asked me to come back parttime to help out. As of last july. Ive had a serious difficulties with getting my healthcare because i was not told i it not have when i went to sign up for the Social Security and i didnt know about medicare because i never had it before, that i required part a and part b and then i was told after i already signed up that i did not require part a because i it not qualify for premiumfr premium. I think the fshhs should tell all teachers because increasingly, you are going to find teachers who have not accumulated 40 quarters if theyve worked for sfusd because sfusd does not pay into Social Security, who are not eligible for premium free part a. Because i had signed up for it not knowing that, i was billed by medicare forever and ever and i was considered ta lin delinqud when i withdrew i dis enrolled from Medicare Advantage which are sfhhs has us to. Ive got 5,000 worth of bills because i it not find out until months after the fact so id love it if someone could advise me exactly of what the situation is. There is someone at sfhhs who is looking into it but i havent heard and ive got this i dont want my Credit Rating to go down many of its now been rectified but i still have bills for a period of time and i would never have gone to the doctor if i had known. I have medical supplies ordered on october the 31st when my new coverage kicked in on november 1st. I just didnt know. They need to inform teachers as we not paid into part a or part the 40 quarters for Social Security. Someone look in that, please. Thank you. Good afternoon, commissioners. Richard rothman, row tired city worker. Two items about delta dental. It says the maximum of dying knows and Prevention Services to not count towards the maximum. And then on the smile program, which my wife and i signs up for, i just paid my wifes premium but delta dental needs to put out a new flyer. Is this 100 coverage before . Is that included in the diagnostic coverage or is that except from the 1250 calender year all these that are listed on the page here . So maybe they could clarify this with a new flyer because i certainly dont understand it. Then i want to talk about kaiser. When you email kaiser, or their Member Services they come back with answers that really, i dont know, insult my intelligence. The last time i was here, i talked about why when they have contract nurses, they cant electronically communicate with kaiser and the doctors and i got an answer saying they cant answer the question. What kind of an answer is this . You know. And my doctor changed my wifes medication but how is the contract nurses supposed to know if they come out. But i want to talk about Saint Francis pavilion. This place, you should never send anybody, even your worst enemy there. There should be a provision when you negotiate the contract with kaiser, that no City Employee or retiree or any member of the Healing Services system should be sent to that location. That place was dirty, understaffed. He wont go into the details of what happened. Mitch can send you the letter. I just dont feel like it should be publicized. It was one of the most horrible experiences in my wifes and our, you know, years. It was terrible. And im still bothered by it. Why kaiser sends anybody there in the discharge nurse wouldnt eand talk to us and it was filthy. The bed was old style. When you put in the for a st. Johns fran pavilion. Ansanfrancisco pavilion. Clerk this report is given by president breslin. I wanted to mention i received a phony post regarding the coronavirus. Be aware of that. Its going to a lot of people. Instructions seem to be the same, wash your hands and stay out of large gatherings and stay home if well its very important. Our distric director said the ws up tated frequently regarding the virus so thats a go ahead place to lock for Accurate Information regarding the virus. Thats all i have to report. Any Public Comment on this item . Can i just comment, i think that you make really a good point about the information. Were all getting inundated and i think a lot of it is well meaning. I dont think poem are out there to enhance the risk but a lot of the recommen recommendations why look logical at face value are not really shown to have been effective as anti viral mechanisms avoiding ice and water, for example, which was in the message that you got. It was not shown to decrease ones risk of acquiring colds or influenza or coronavirus. And so, i to think the other side of this is that i think the advice that you can get by going to a websites that are monitored and screened and updated regular low, and often refer to so san flare says this. Sanford university doesnt provide healthcare, individuals do, doctors do. They are scientists and theyre physicians and nurses and all so to say stanford is saying this and organization should be suspect and it does to some extent when you start seeing all these different recommendations it doesnt undermine the good information that we can access and the good information because the message sub limb alley is well, why arent they telling us to avoid ice cubes . Why arent we doing told this from our own public Healing Department or the state or center of disease control. I want to reinforce your comment. Its well taken and i think we have a responsibility to help our family and friends and colleagues and under how to access information. Its really trying to cope with a very stressful information for every Single Person in this room and lots of people outside this romijroom, including in the wor. If i could echo some of that, obvious will he we wanobviouslye information. The updated friday directive from department of publicheal h Health Officer just to take it seriously. The recommendations around social distancing avoiding larger gatherings and less essential at the board of supervisors meetings, for example, weve the recommendations are around folks, you know, trying to be throthree or feet from other fos to prevent spread and weve an active in our district, things that bring people together, if theyre vulnerable populations, seniors, folks with Underlying Health conditions to be encouraging folks not to have those sort of Group Gatherings unless those are essential. I just think at every opportunity including for folks in the room or folks watching this on tv, its important for all of us to be making sure those recommendations are getting out there. Thank you. All right. Item number 7, please. Clerk item 7 is the directors report. This report is given by abby yant, the executive director. Good afternoon, commissioners. Thank you all for being here to the. And my directors report i comment on the covid19 19 and our citys Emergency Operation center has been up and running for eight weeks now. We have a department low low a. We are working to keep our members informed by updating the website regularly as chairperson breslin has commented, we have coordinated from the onset with our venders to be sure those micro sites, if you go on a general site you will see one thing and if you go on our site you might see something different. Those companies that we work with cover geographical areas different than San Francisco. We do direct links to our local department of publichealth. We dont do distric direct linky department. We advise those who live outside of San Francisco to connect with their local department of publichealth for local guidance. As far as operations go, at Health Service systems, we are preparing to telecomute where it makes steph and were preparing staffing models do you to the social distances directive or whether we have illness or exposure within our workforce so we have all of those plans under way. And are being very aggressive about working through all of that. Were very active on the covid19 and should any of the commissioners have any questions at any time please, let me know. Moving off of that, we are in a vendor blackout period. We are at the table with all of our major vendors right now and just an admonishment to all of us on the board that those kind of conversations should not take place outside of those renewal meetings. The Health ServiceBoard Election for this year, we did have one very qualified candidate who has submitted all the paperwork and was the soul nominee and she met all the qualifications, we have declared her the newest member of the Health Service board that takes effect in june and between now and then, we will orchestrate the wearing in ceremonies. So thank you and welcome, claire. I will say shes been very helpful in making sure our website is uptodate. [laughter] which i appreciate, its good to have that perspective from outside the organization. I did put in a small paragraph about the Infertility Services update. Were anticipating having on the agenda in april update to the board as we work diligently with blue shield to see we can address the questions brought before the board. Also the next item is the supper antitrust case as i put in here as the update from the Pacific Group on health. That care is still pending Additional Court action and so it is not finalized at this time and we will advise you when it is. We have continued to work on this Mental HealthProgram Expansion budget to the submitted to the Mayors Office and that will be completed some time within the next two weeks. The operation report i just wanted to call out a few things, one is jessica, she who wasnt able to come today is our new communications director, she just started this week, last week. And it seems like shes been there a while. She jumped in and is not shy about asking questions. Its a great addition to the team. And i it want to add to this that we did receive reluctantly the notice from sha von oconner who is in the audience and has been our Members Services manager for the last throw and a half years has rentered her renr resignation april 6th. With the modernization of sales force and the ecm and its just been outstanding. We will miss you and we thank you for your service. [applause] just a few other things to highlight as we continue conversations with the School District on how we can continue to partner with them offering benefits is pretty complicate and mitchell can describe it better but its a project that were interested in finding modernizing and helping and working with their newly modernized system in a way that doesnt disrupt the relationship that we have. The new telephone system is on our desk, turned on and well complete the conversion, i believe, were scheduled to awe over again and there was a question about met foreman. The doctor did find a very useful reference we have dig contributed that talks about the question of whether theres a cancercausing ingredient. This article states the fda has been involved in researching this question and at this time they have not determined if there is it doesnt contain it does not contain Dangerous Levels of this chemical and they have an Ongoing Investigation and its certainly a challenging question for them and because it is such an effective drug and theyre really arent alternatives for it its still theyre not recommending any re call here in the United States so i thank our member who brought that to our attention and its an interesting story. Well continue to follow it but at this time, we are following fda recommendations or our practitioners are following fda recommendations. So with that, i think im finished. My Public Comment on this item. Im sorry to hear that shavon is leaving and its the first number i have to help with our reccff members so i wish shavon well but i hope that we can find someone to fill her shoes, shes been invaluable during the time that she has been here and shes been very helpful and abby you cant leave either. Thank you, very much. I think shavon should stay and help us get more even with our healing care and you know, in the healthcare events and it could be more glad if you approve to make sure that lives will get too far in society with our to to whatever and this is worldwide and this already thousands and thousands of people, you know, that is going on and stuff. Better healthcare and in the age we can were putting things off and which we shouldnt have to for our healthcare. For our babies too. Item 8, i believe its Denise Rodriguez, the director of strategic accounts and the Public Sector presenting . Good afternoon. Denise rodriguez with kaiser perm ant tee and its a quiet room today. I wanted to come back this quarter to give you an update and ive committed to doing that every quarter. I know you are very interested in seeing how it progresses in terms of usage and as well as where were at with adding and wheelchair ban and coverage. Im excited to report that weve had 27 transportation requests and successful requests in the month of january alone and that was just with moderate communication. Ive got julie brady here with me, shes one of our medicare consultants that will talk about our plan to make sure people are using the benefit that you are paying for. I will have february numbers by the 16th so as soon as we have updated numbers for february usage, well share that with executive director yant and her team. In terms of the wheelchair van and gurney van, we recognize this is important we recognize the importance to this population we want to serve them. I shared with you the challenges with ragged this benefit so quickly this year and it had to do with cms compliance issues. Were still working towards adding it for january 1st, 2021. No further updates on where were at for adding it mid cycle. I did want to remind you all that you are not paying for that benefit that would include gurney van or wheelchair transportation. You are paying for it which is just the said an wheelchair transportation. Any questions or comments about that beforehanded off to julie to just over the Communications Plan . Thank you. Thank you. Hi, im julie brady. Executive Retiree Solutions manager with kaiser. I wanted to give you an update on the communication plan that we have in place to include out bound phone calls alerting them to the new transportation benefit and we also took that opportunity to remind them about the silver and fit benefit as well. We added the transportation. We created a transportation benefit flyer to outline exactly how they needed to go about seeking this service. That has been added to the kaiser site. We have shared with hss that same flyer so i would work with them it figure out where we can share that flyer if we post that on their website or if there are any upcoming news letters that we can send out to your members so they have the flyer there as well. We are in the process rit now of mailing out a letter to all of your retirees, all of your kaiser senior advantage retirees that will include both the transportation flyer as well as the silver and fit flyer designed to have stepbystep exactly what they need to do so they can get these benefits. We know many people dont necessarily lock at email or respond to phone calls so we wanted o mak to make sure we han a variety of methods. Were also we send aging kits when your members are turning 65 and weve added that transportation flyer to that kit so when they get that kit in the mail, it tells me about the senior advantage plan. It will also have the transportation anier. Also, the open enrollment kits so that will be later in the year. Are there any questions . Since weve coronavirus as come up several times but this is a population that should see itself at particular risk for the complications. Weve been getting lots of emails from bakery and all kinds of what theyre doing. So, does kaiser have a paragraph or a sentence or something that might reassure our members who would like to use this benefit about the sort of methods that are being used to show that these are clean vans or whatever . I would have to get back to you on that. Im sure our vendor has something and maybe we could potentially the letter hasnt gone out. I dont know if theres something that we can put in it although that information is changing everyday. Maybe we can at least post something on our micro site. For them to look at there. And then, would we should we take that back and get some more information to share with district or yant. Im not concerned about what theyre doing because as you point out the instructions and the procedures will change. Just that this is an issue that we address among the other issues about safety and all that. Just so its a generic issue that we include this in our concerns. I appreciate that. I work directly with the person who is overseeing this benefit and ill ensure shes working with the vendor so we got information how theyre managing and cleaning these vehicles. I was coming here today and theyre wiping the handrails down and i felt safe with that observation. Well certainly followup and close the loop with you on that. One more quick question. Of the 27 transports in january, to we know how the recipients were aware of the benefits if it was by a phone call or the email so we can target and i think if we dont have any information maybe its something that we can rehave you to find a more targeted approach to getting the information out. So we do not know how they were aware of it. Is that something we can potentially ask the vendor when theyre taking the calls to ask how the members heard about the benefit . Thats actually a really good suggestion because i think it would be helpful for us to know to be intentional in our communication so well ask it. The plan is to come back again in july and theres a different varieties of data the way they cut the data so im trying to understand that and see what is meaningful so we can bring it back to you all. And we can see if we can add that piece. Thank you so much. Ok. Thank you. Any Public Comment on this item . Seeing none, item number 9, please. Clerk item 6 the financial report. As of december 31st, 2019. This presentation is done by pamela levin, the chief Financial Officer. Good afternoon, pamela levin, chief Financial Officer. Sorry. I had to take a breath. Health service system. The report that is in front of you summarizes the revenue and expenditures for the trust and for the general Fund Administrative budget threw thrh december 31st as well as fiscal year and projections through june 30th. The trust ended the year last fiscal year on january 30th, 2019 with a balance of 92. 2 million. Based on activity through december 31st, 2019, the fund balance is projected to be 91. 8 million, which is a decrease of. 4 million or 400,000. Were projecting a decrease in the fund balance for the uhc ppo plan due to unfavor claim experience for access plus, the fund balance is projected to increase 11. 6 million primarily due to pharmacy rebates and favorable claims experience. For the tria plan were projecting a 4. 9 million decrease in the fund balance compared to last month when we came in it was 5. 8 so we continue to have unfavorable claims but things are getting better. Were projecting a 4. 2 million decrows in the fund balance for tell ta dental. This is intentional to stabilize the rates the healing Care Sustainability Fund will have a yearend balance of 2. 7 million. We expect a one million in montreal earnings although that may change. We wont really know until we get closer to june 30th. 300,000 in performance have been received through december 31st. We have not had any reimbursements under the adoption and surrogacy assistance plan and in december and were projected again to have have the 185,000 from the fund balance for reimbursement under the plan. The amount of forfeitures for unused spending which reside in the trust, until that time for the administration of the benefits. As of december 31st, we have 2 million in pharmacy rebates and the yearend projection is for uhc and ppo plan and trio which is consistent with the previous reporting and right now were projecting to end the year with a balance of 128,000. Theres been no instructions given out by the Controllers Office on any adjustment thats we would need to make in the budget given the effect of the coronavirus on revenues so that is kind of the thing im watching for and will let you know if we get that kind of direction. In prior years when weve had problems, we have in 2008 there were directions sent to departments. If you have any other questions thank you, any Public Comment on this item . No Public Comment. So now were going into our rates and benefits section. And item 10. The presentation of the 2020 rates and by is by the executive director. Thank you, is the rates and benefits calender and i will call to your attention that we do have a special Education Board meeting scheduled currently for march 26th at 1 00 p. M. Given the fluidity of the coronavirus situation we are consideringal continue tive ways of presenting that information. We are restricted current low under charter sunshine brown act on how we would do any meetings so wore taking that into consideration how we present those to the public and to the Board Members and this important understand the rates as you will see seeing them in the months following. So well keep you posted on that and i do want to acknowledge at this time that many of our vendors are under increasingly under travel restrictions our united team is not here due to travel restrictions and blue shield made it here today and kaiser made it here today, delta made it here today, vsp did not make it because of travel restrictions. I think thats kind of a sign of things to come and sort of all things coronavirus that were evolving and adapting on a daily basis so well keep you informed. Outside of that, just so you are clear that im clear, that we have a very important timeline to to to a meeting like that. Please, bear with us as we work our way through this very unique situation. So i just want to out the Educational Forum will not be held in this room, is that right . Did i see an email that said its changed . Yes, so we spoke as Leadership Team and i spoke to the Technical Team at my office and we are going to move it to the Wellness Center so we can stream it since its educationally based and theres no action items and commissiones can call into view the information. Its open to the public and it will be online. Well still have the meeting. Were still going to be the meeting but not here . Just not in this almost. I think Everybody Needs to be notified of that. Special meetings have a 10day notice requirement and at this point hold the date in the calender, please. Can i maybe expound on this. This seems germane because when you see all the recommendations to work from home and alternatives so if we could in the next few months a fact sheet about where those prohibitions and mandates through the charter and the brown act and how they entered our set of rules and regulations because it seems like its not very modern given the technology what were sort of forced to face by this problem but to be the future. It seems like its not very contemporary. Often, under stress we find new ways of being and changing the law can result from that but we are under current state of merge and this county and in this state so i dont want to speak for our attorney that is present but there are legal matters legal questions on how you go about doing these maneuvering in an emergency situation versus an ongoing one. If i could, just to add that there are some are state law issues and its discussion between the mayor and governor. My understanding is there was update to the governors executive order that actually just today that addressed some of the brown act issues that are state law issues. In some circumstances may prevent meetings that are not inperson like this so i too know if the amended order today directly effected our meetings but it is folks are much active in sac sacramento to make sure those adjustments can can be made to bring us no this september re whecentury. The brown act is a good thing. Open meetings its hard to visualize. Yep. Any Public Comment on this item . Ok. And on this, ive been in federal and issue and and and and one reason why i think its very take this and this is a health that were talking about and doing examples with that i can maybe byebye and thank you, very much. Ok. Item number 11, please. Item 11 a stop loss recommendation that is. Good afternoon, commissioners, mike clark and before i begin my presentations today a special thanks to mitchell gregs given our travel restrictions shal. Im glad to be here with you todays to present several presentations and were starting with the stop loss recommendations, this is an not youll review that we do for the Health Service board right around this time of the year to talk about the environment or stop loss reinsurance for the healing plans offered on a cell funded basis or a flex financedded basis by the San FranciscoHealth Services system. Our recommendation at the end of my presentation will be that sfhhs purchase stop loss pretext for the selffunded and flex funded healing care plans and ill present information as to why that is our recommendation. So on page 2, you see the programs offered today that are selffunded or flex funded, in other words, not full fullien id by Insurance Organization so the claim spenc experience flows thh the members. The United Healthcare for active employees and non medicare retirees, the blue shield, access plus tree owe hmos and active employees and the delta dental of california ppo plan for active employees. So some general commentary around stop loss reinsurance in order to obtain this coverage, plans sponsor would remit a premium to an enter tee who would then reimburse that plan sponsor when the claim cost exceed a certain threshold based on the insurance level purchased. This is an insurance product so when claims not excessive it may not pay out at all but, if the claim amounts are high there will be reimbursement. You expect, during the course of time, the premiums paid by organization would exceed the claims reimbursed otherwise the organizations would not be having a Good Business proppization. We also say at the bottom of page 3, dentsal plans are not candidates for stop loss insurance. Its limited via annual all service and lifetime oth don i i cadonicmaximum. There is a contingency reserve policy today as we note on slide 4. That for very large pools, this is a common approach to financial risk mitigation. Especially in a Public Sector environment and so there is a contingency reserve policy in place that does articulate this purpose for sfhhs and we discussed in january what the recommended contingency reserves were that the board approved as of june 30th. And then specific to the stabilization policy, which is another protective policy for sfhss it provides the ability to cushion changes in planned experience over the course of time to a threeyear amortization of those gains or losses. For instance, today i will present on the blue shield plan stabilization policy so its an added protection besides the policy that protects sfhhs. On page 6, you do have a reinsurance component or a stop loss component on the blue shield flex funded product requirements. As part of these programs, sfhhs is required to have a one Million Dollar per claimant large claim pooling provision which means that there is a premium charge today in 2020 and has been each year prior and will be Going Forward for which that pro voids a one Million Dollar year Access Protection so if a particular claimant were to go over 1 million in total medical and pharmacy claims in a given year, any amount over the 1 million is reimbursed back back to sfhhs well look at what that looks like as an example for 2019 when i present on the blue shield experience later today. On passenger 7, revisiting my recommendation as in prior years, we ask the Health Service board approve today the recommendation for sfhhs to not purchase external stop loss insurance for its selfand flex funded plans into the 2021 plan year and again noting the reasons why that include plan stabilization reserves, the fact that blue shield plans have large claim pooling, and the fact that for dental employer exposure is through the plan design. N any questions, i move that the stop loss insurance for flex funded healing care plans. Ill second. Public comment . All those in favor, aye. Opposed. Its unanimous. Thank you. Thank you. Item number 12, please. A presentation by mike clark from aion. Mike clark, before you is the San FranciscoHealing Services report for the 202010couldnt tee survey. I am presenting the information but this is information that is compiled by sfhhs and this is from those that compiled the information you see in this document. So, i will talk through the overview page and note after the overview page just a description of the information that is contained in the rest of the documents. So, as you can see, the over vow page is broken into several sub headings. The process, which is essentially describing how the city charter specifies the survey to be done for the 10 most populous country and to collect the amount contributed by the flier fo reply employee r employeeonly coverage. For certain, covered members, within the city and the plans covered by sfhhs certain members do have the employer contributions determined if part by the 10country amount. So you see Additional Information on the approval of the change rule in april of 2012 by the healing Service Board and there were in major changes chas collected for the plan. Its noted that while information is presented in the document included for the calpers design and the sfhhs designs, those organizations are not enclouded i inincluded in ty survey. You will see the description of the average contribution under the use of the 10county amount. Paragraphs in this page. And see how in june of 2014, the impact of the average contribution on rates was eliminated in the calculation of premiums for most of the act of employees. And you will also see on the right side of the page, at the very top, there will be circumstances where the citys premium contribution may fall below the lesser of the average contribution determined by this report or the premium itself so that the city would pay the difference between the premium m contribution and the average contribution. There are some plans for which the contribution is actually below the 10couldnt tecountyt because thats where the premium level sits. To get to the actual amount that i will ask you to approve today, you will see that under the result and observations section. We have cal could you lated a cd 729,000. 19 to be used in plan year 2021. This figure is 3. 3 higher than the amount in place in 2020 of 705. 92. We describe an example of and information on the method ole gougmethodology. If you turn, yo0 couldnt tease in order los angeles,al amir da, sacramento and fresno and in the right you see the 729. 19 and its an average in the counties represented in the study. The remainder of the information in this report, i will not go through it but its planbyplan premium information for the plans offered by each of these 10 counties as well as detailed plan design information. I go back to the figure on the overview slide, page 2, results and observations, and im asking the healing Service Board to approve a Monthly Contribution of 729. 19 for plan year 2021 item number 13. Clerk review and approve the Vision Service plan fingerprinted by mark clark from aon. Mike clark, aon. In it presentation, i am seeking the Health Service board to be plan year 2021 for the Vision Service plan vision plan offering that ill describe in this document. So as i indicate on the introduction page, there are two plan designs offered to active employees and retirees through Vision Service plan or bsp. There is a basic plan which is offered for many years and it comes with enrollment into any sfhhs medical plan and the premiere plan that offers a higher level of benefit than the traffic than and and members to wh difference between thepren total premium rates and ill show illustrations in a bit where you can visualize that and see what those contribution amounts are. There are sfhhs members who have access to a Computer Vision care benefit and as i stated at the outset, this outlines a recommendation forc for the rats many of at the conclusion of this presentation, on page 2, i will ask you to confirm today rates for the 2021 plan here that enclou include basic rates, premiere rates, Computer Vision care total rates and finally the premiere Plan Participant contribution rates that are over and above what they pay beyond the basic plan. Well go into the following page anpages so you can see those amounts and how Vision Service mandy arrive that given its a plan. So if we go back in time. Effect i have january 1st, 2017, sfhhs and Vision Service plan entered into a fiveyear agreement. The plan here im talking about today, 2021 is the fifth or last year of that fiveyear agreement and initially there was a decrease in rates for 2017 and no change for 20182019 and a provision it would not increase 2 over all depending on how plan experience derived for the plan based on the loss ratio which is the comparison of actual claim experience versus the premiums paid. What happened in year two was the premiere plan was added and it was not part of this agreement for 2017. It was added for 2018 and what is essentially happening, since foretells they elected the plan have benefited well from the parole plan but its also meant that the claim experience for the premiere plan is at a much higher level than the premiums that are being paid by the member. So loss ratio has exceeded more and the 2 not to exceed over all premium increase has kicked in for 2020 and 2021. Is on page 4, if you recall from last year we had a discussion from the Health Service board that led to a rate action with the 2 premium incres so having no change in premium rates for the basic plan of the Computer Vision care benefit because both of those insurance wise, are operating from a financial perspective versus the premiere plan which is the plan creating a very high loss ratio so basically loading the dollar value of the increase no the premiere plan. Were recommending the same for this year. Spreading the 2 increase so that theres no change to the basic plan rates, no changed to the Computer Vision care rates a 4. 1 increase to the premium plan rates so the premiere rates and this mathematically results in a 2 over all increase. I want to show you on page 5 that since the interrogation of the pre more plan, so we now have a third year of enrollment, as of the january 2020 open enrollment cycle, this plan is gaining popularity with sfhhs members. Started out with about 15 of total and it rose to 21 average enrollment in 2019 now a full 1 4, 25 enrolled in a vision plan are enrolled in the pro premiere plan. So while the majority of members remain in the basic plan, which again is part of medical enrollment, it is good to see that this choice that was added for 2018 is gaining popularity for members. So the specific rates on page 6 that im asking you to approve today are the cy2021 column. Cy standing for calender year. We illustrate next to that on the left of the cy2021 columns the current rates that are in place for 2020. And so, for the basic plans, again, you will see no change in the propose the rates. Rates part of the medical rate cards when we present those in may and john. For the premiere plan, you see the total premium rates for the over all coverage and then the total premium rate for premiere minus the basic plan rates become the memberpaid contribution rate and you will see rather lengthy foot note underneath but saying that its a difference in premium over and above just the m. O. , load into the rates that are part of the vision plan basic plan benefits. And then Computer Vision carrie maining at its current rate into 2021. That leaves us to page 7 where i ask the Health Service board to approve the vsp plan rating actions for the current plan dough signs fodesigns which ence change. For the Computer Vision care benefit and a 4. 1 rate increase from 2020 for the premiere plan with the paid contribution impact illustrated on the prior page and to point out before you consider that recommendation just page 8 is a onepage appendix showing the plan design comparison between basic and premiere if it helps you to visualize the difference in benefits. Any comments . Any questions . Well, i sound like a broken record. Year after year, referring to page eight which basically teases out members who cost, look, for other providers of eyeglasses who go to costco and get half of reimbursement and i know we withi went threw the wee calculations and i just do know this we have ever done this in the past, where weve teased out a provider of Healthcare Products either medications or devices and done this and so i guess at some point i would like to hear from our vision care people just how many what their average what percentage of their claims come from costco in each of the two plans and what their average payment may be, does it really justify such a different reimbursement rate. I know that some providers walk by on the stress they say, buy one and well send one street to somfree to aneedy person in cen. Thats great. The benefit of that to the world is incredible. Its one of the few things we can to that shows benefit in our giving. The people who cant afford it can can now work. Im not trying to penalize, you know, those programs but i kind of makes me a little i still question the issue. It wont effect my vote today but it would be noise to kno nia little bit more. I can provide a partial answer knowing that our Vision Service plan representative was unable to attend inperson today. Although i know theyre livestreaming so, any question im not able to answer, hopefully theyll followup with us quickly and we can report back next month. The costco relationship or vsp is relative low knew so it hasnt done Something Like go become in the history of vsp. At some point as more and more pressure came for vsp to consider a and thats what led to the alignment with the costco organization several years ago. Perhaps eight to 10 years ago. Because of costco buying power relative to the buying power of a typical vsp lower cost than a typical Network Provider so vsp constructed the frame allowances this way in order to close low a loin the total percentage of available frames that are available through a non costco Network Provider at or below the frame allowance to then be similar to the percentage of costco provided frames add or below that allowance and so for instance, based on information that it provided to me, probably this 80 allowance provides the ability for someone to purchase perhaps north of 60 of the frames available at costco with no cost sharing beyond the frame allowance and i dont have the specific figure but it just, thats a round about estimate and that is similar to an estimate now granted it may vary depending on Network Provider to Network Provider whether you go no vision provider a or b, et cetera. But the ideas to try to map the approximate percentage of frames someone could purchase in full given those allowances on page 8. We know the costco organization with the much dope deeper discog versus other providers in the vsp network. You raise a great question on what percentage of tole frames dispensed are coas costco that l be something that will last vsp to followup on because i do not know that answer. Thats helpful. Just to be sure im clear, vsp has a network of optometrist who provide frames so the member has to look, if they want to get this reimbursement they have to use a vsp provider thats available to them in a brochure or online. And you can secure benefits outside the network. You are just subject to much more cost sharing on your own for purchasing lets say a friendshiframeoutside of the nee its a retail price versus toes wholesale price that vsp has negotiated and vsps goal in working with the plan design. So for instance, this 150, 300 for non costco is a particular plan dough sign provision offered by sfhhs. Its not a universal approach for all vsp clients as an example. If there were a lower frame a lieuance there woulallowance, ir frames at a non costco without cost sharing because miz frame is under the allowance. Thank you. To i need an action item here . Yeah. I move that we approve the vsp re newell rate a renewal ra. Second. All those in favor say aye. Aye. Opposed. It is unanimous. Item number 14, please. Item 14 review and approve United Healthcare city plans prefer Provider Organization ppo administrative fees, presentation and this is done by mike clark ie from aon. So for your call last month, we discussed for the united healing care ppo city plan the 2019 claim experience and the Rate Stabilization recommendation. This presentation focuses on request for approval of the administrative fees that will be used by aon and the ratesetting process in a couple months for the 2021 plan year for the selffinancedded United Healthcare ppo city plan. This includes their Administrative Services only or aso fees and some fees ill describe and also, we build in the rate card for the city plan b healing care sustainability budget fee. And our aggregate are based on the january 2020 total active early retiree count of 1,857 and you will see fees expressed on what we say pepm so when you see the acronym pepm its per employee per retiree per month. Our recommendations in two areas on page 2, first, approve a 2 over all increase in the base Administrative Services coated by uac for 2021 and when we incorporate other elements of fee payments to united healing care for other programs, approved a total expense pupm figure were recommending for the 2021 plan year. Following pages providing information to support that recommendation. I will start with the base administrative fees. Again, 2 increase is the recommendation. Most of the enrollees in the city plan are cap interested ine two columns. We do have, as of the renewal presentation by united to us, 121 retirees that are captured in the medicare eligible map enrolled in medicare column. I know that sfhss strives to work with retirees to support enrollment in medicare when eligible but again, there are, as of the time of the renewal presentation by united to us, 121 retirees. The reason that the fees on the right side for the medicare eligible but not enrolled are lower, is that theres a presumption that someone is enrolled in medicare when the benefits are paid so just simply a lower amount of administration for those participants. And on page 4, there are Additional Savings programs that United Healthcare sponsors for sfhss that generate savings for the city plan but then also have a shared savings component or the savings are split between sfhhs and uhc. The first of those programs i describe on page 4 its called the shared Savings Program. What that does provide discounts to Service Rates for certain out of Network Healthcare providers that are not part of the primary ppo network, the main network of physicians and providers for you knitted healthcare but they do negotiate a smaller secondary discount with those providers and for that, sfhhs keeps 70 of the savings generated for these secondary Network Providers, 30 is paid back to United Healthcare as a program fee. The Second Program applies to a little bit different facility situation. It limits the planned financial exposure when care by a member is sought at a Network Facility but the treatment is provided by a Network Provider. Which we know from reading about Surprise Medical Bills is something that can occur. Or when an individual is treated to the non contracted facility for emergency care. And similar to the First Program sfhhs keeps 70 of savings generated from this program and 30 is cut by United Healthcare. And then theres a smaller program financially called valuebased contracting which pays financial incentives to certain providers who participate based on achievement of some pro set quality cost and efficiency metrics sfhss financedded thosfundedthose pay. On page 5 i describe a shared savings fee example. So, assuming someone incurs a procedure, 1,000 is the row tail cost and physician a might be a Network Provider and receive a 10 discount so the discounted cost is 500. And that is how the claim is processed. Physician b may not be a Network Provider in the primary network but has agreed to a 20 discount so a lower discount and its part of this shared savings. So that the discounted cost for the service would be 800 and then with the differential of 200, sfhss keeps 70 of that and pays the remainder back to uhc and program fee many of this is this is a example of how the programs work. There are typical in the industry. You can can see on page 6, up through 2019, these programs have generated 6 million of savings, 4. 1 million has been kept by sfhss, about 1. 9 million has been paid back to uhc as their fee. So, bringing everything together, on the uhc ppo administrative fees. We discussed the 2 incres there and again i note in the foot note that theres lower aso feed for medicare eligible but not enrolled. The shared Savings Program fee pepm estimate facility rnc and value based contracting payments are essentially developed by us based by aon on a best estimate of what we think those programs will produce for savings and then the shared component back to uhc and in 2021, based on the last couple of years of experience, and then you will see finally the fifth line item for the total fee administrative fee for the city plan is the 3 sfhss sustainability fee. So our recommendation to the healing Service Board today if you go to page 8, is to approve the 2021 United Healthcare base aso fee which is a 2 increase over the 2020 fee and then approve the total expense pupm figures we show on the prior page which represents a three and a half percent increase over the 2020 total expense figure. Questions . Its an action item. Yeah, this action is very clear. I appreciate the clarity of all of this. So just, so we pay a per member per month to blue shield to institute these programs. To united health. Im sorry, United Healthcare. So we pay on everybody. If they when theres a charge, then they apply they make more money we make money on this as well. So we pay them to do this and then they make more money when they find this. So, i guess, yeah, i just want to be clear on that. Im glad they do it and im glad they make money on it we make money on it it just seems wore paying twice for them to be successful because they should be hopeful low theyll be doing this for everybody, whether we pay for it or not because they could make money with the 70 30. And lastly, theres a discrepancy in terms of the per member per month charges between the three different programs and is there some explanation why the facility rnc went up so much when the others came down . Sure, what aon does, we lock at the most recent two years of Actual Experience in these programs to apply a trend factor to of what we think we will be translated on a per employeeper month basis. So as you can imagine, we have no idea this is a best estimate. Theres been, especially on the facility rnc program, for instance, there was a big increase in the last couple of years on how many dollars ran through that program so you will see so for instance on slide six, we do know each program carved out on its own but you can see in total as an example that your highest savings of any of the five years over all were in 2019 and for the program in 2019 relative to the past where the shared Savings Program intended to have a higher amount. So this it mean, as an example, when you go back and lock at the description of the facility rnc program, well it did mean that there was by having this program in place, cost exposure that would have been purely paid at a high retail basis, you know, unchucked so to speak, for use of an out of Network Provider when someone was going to a Network Facility or someone happened to go in an emergency facility that ended up not being a network. Those are the protections those programs have. Now i will say organizations like aon and our fellow consultants, we work very hard to troy to drive a higher percentage for the client and a lower percentage for the plan of these, special will he as more and more dollars flow no those programs. For instance, you used to be at a 35 share on the shared savings, we brought it down to 30 in exchange for a slight increase last year and that was a winwin for sfhhs because the amount you save in transition to united for this program more than offset the incremental ppm amount that was negotiated in return. I guess the observation is just that again, the frnc program, this is a big teal for members that they would go to a facility thinking that theyre going to get their professional fees covered and they find that maybe even the physician who they are using for the regular care who then comes in and who is contracted, on weekend, is covered by someone else who is not a member so are these arrangements increasing where theres a bigger discrepancy between the providers in that facility who are essentially credentialed to provide those procedures and care and were seeing this as a trend because it is a big jump. It is. And in general, we talk about an average healin healing care tret be 6 increase, the increase of dollars flowing through these programs is much highwa higher. While we appreciate the Health Plans Offer these, as a consulting organization, we encourage the plans to negotiate these particular providers to be in their regular network to the extent that they can achieve that and also encourage migration of the cost sharing where thats not possible. So that for instance, it may be at 70 30 this year but lets migratmigrate it next year to to combat the increase in dollars that are flowing threw these situations. A member has no control over this. The member cannot being exacted to understand when they are getting professional fees who in those kind of situations within a facility, who might be covered and who might not be covered and say no, i wont see cardiologist a today because that cardiologist is not covered by my plan. Ill wait until b comes around. And hope theres a b. Who is covered so this is really an unfortunate situation that we have to come up with fees for. I agree. Thank you, mike. In terms of dollar amount increase its very minimum but i got your point that maybe in the future we could increase or decrease the steering program to at least be able to minimize and increase no more than 2 if it happens in the future to be over 2 so we could negotiate on the shared Savings Program. Thank you. And approximate i will pick up and strive for that for next year. Thank you. I move that we accept the recommendations and to approve the 2. 0 over all increase in the uhc the plan expense per member per month for 2021 for active and early retiree ratings. I second the motion. Public comment . All those in favor. Aye. Aye. Oppose. Its unanimous in favor. Does anyone foal lik feel like a break or would you like to continue on . Im giving you the option. Id like a little break. Well have a little 10minute break at the most. Go ahead. All right. Item number 21. Yes, out of order, item 21 is to vote on whether or not to hold a closed session for the publicemployee performance for the sfhhs executive director presented by president breslin. I will node need a motion. I move we go into closed session for this item. Second. All right. All those in favor. Aye. Opposed. So now we are in closed session. Item number 23. Review and approve number 23. Worwore backwere back in open. Its 23. Clerk im sorry, my apologies. Possible report on action taken in closed session regarding employee evaluation presented by president breslin. I move we not disclose the proceedings of the closed session. Not the report. Yeah. Second. Any Public Comment on this . Seeing none. All those if favor. Aye. Opposed. Its unanimous not to disclose. Item number 24, please. Item 24 is vote to elect whether or not to disclose any or all discussion held in closed session regarding the Public Employee performance evaluation. Presented by president breslin. We have a motion. Ill resay it. This is the time i should be speaking. I move we not disclose that proceedings. Second. I mean the previous one is not the report. Its been taken. All those in favor. Aye. All right. So now we can go back to item 15. Clerk blue shield of california flex funded non medication claims presentation this is presented by mike clarke from aon. What you have before you is our experience document for the blue shield 2019 flex funded hmo plans. Two plans access plus and trio offered to active employees in early retirees. The access plus plan has been offered for several years to the sfhss employees and retirees trio was a new lower premium plan that was first available to members january 1, 2018. What you will see for trio is near two of the trio experience. The reserve increased by 7 on a retiree per moth basis from 2018 levels. This is just slightly higher than a National Cost trend increase. This compares to a total premium increase of 10 on a pepm basis from 2019 levels. If you will recall, the over all rate increases for these plans from 20182019 was 9 and then the incremental 1 has to do with some shifting of members that occurred from trio back in access plus so most trio populations for 2018 stayed in tremendous owe from 2019 but there was some migration back to access plus from 2019 and thats why thing aggregate actual premiums in this plan from 2018 to 2019 increased 10 . And just as a row fresher too, were focused on 2019 plan experience here but its just a reminder for the 2020 plan year, the over all rate premium increase was 2 as we presented at the may 2019 Board Meeting last year. This translates to a loss ratio for the blue shield plans of 95. 3 and the loss ratio was defined as planned expenses divided by the total premiums so another words expenses were lower than premiums by 4. 7 . Fair favorable to the plan and prescription were the most expense it stayed constant versus 2018 a lot of this is generated by a high Prescription Drug rate of use that actually so good news on the pr pre a, that was due in large part to an increase in claim dollars for very high cost claimants in 2019. There were eight victims who exceeded the 1 milliondollar pooling point i discussed earlier in the stop loss presentation versions only five members and 2018. So you will see, i constructed a table here at the bottom of this page 3 that shows what the and you can zizi that after the reimbursements the increase was 9 versus 11 before you considered those reimbursements. On top of page 4, part of the agreement that blue shield strikes with the physician organizations and other providers as part of these Accountable Care organization collaborations, includes incentive payments if they meet certain cost targets per employee im sorry, per member. In this particular instance for 2019, there was a incentive payment earned by the brown and tolland access of close to 1. 1 million after there were no provider collaboration payouts in 2018. We reflect that in this report. There was a slight increase in the over all projected ibnr incurred but not reported reserve so these are moneys on hand to pay for claims that are expected to be paid after a certain date where the services incurred before those dates and the case of us at hss we measure at the fiscal year, june 30th, and then there was a light decrease in the reserve over that period as well. So, on page 5, we show the over all change and experience 20182019 by line item. On a total toll ar basis, now you will see in our first bullet above the table that the average total number of employees and retirees decrease slightly from 2019 versus 2018. These are the actual actual toll dollars. You will see 10 on medical claims being a higher than expected number but then you will also see as you go down the page, large claim pooling. In 2019, there was over 9. 2 million paid back to sfhss on that Million Dollar large claim pooling representative of high cost claimants that included one claim over 4 million total and one claim over three million total and additional three claims that were almost two million or more and you will see the favorable Prescription Drug experience. You will notice the term capitation on this page. Its for certain Physicians Services that are offered. There are fixed dollar amounts per member that are paid to those physicians to provide an array of services. In exchange for the financial renumeration on a permember basis to those physicians. So while page five looks at total dollars on page six we do the math and divide by the employee and retiree members so those are expressed on a per employee or per retiree per month basis and because the head count change is slight, the percentage changes from page 5 to page 6 are similar just slightly higher on page 6 because of the slight reduction and head count. Page 7 is we break out the experience between active employees and early retirees and so the majority of individuals covered under the blue shield plans are active but there are 2800 early retirees in the plan as well. You can see how the experience premiums and the expense components and compare and the loss ratios at the bottom of the page for each of the two populations. So both finish with loss ratios under 100 , meaning the expenses were below the premiums collected. Page 8, just shows month by month dough tail of all the annualized numbers i just showed you so i will not go through that in detail. Page 9 shows the month by month dough tail for access plus. If you are interested in looking at the experience just for access plus, and page 10 looks at trio specific experience for 2019. One thing ill note, you see the correlation on trio to what chief Financial Officer pamela levin presented, you will see for instance, in five of the six months during this current fiscal year, july through december, read for the premium less expenses lyn loin on page , you will see how trio expense has been higher than forecast to bfor the last six months of the year but you will see in the First Six Months of the year more black than red meaning trio ran well so this is a calender year view versus the view from the Financial Reporting that is fiscal year. Then we just have last couple of pages an appendix and glossary of terms. I will be happy to answer any questions you have. Questions . So the ratio is below 100 . All the medical claims went up by around 7 . The paid loss is lower because of the 10 increase so it difference the the ratio below 100 . If we go back when we presented the rate increase for 2019, after a pretty low increase for 2018 with the interrogation of trio, i felt that a higher increase was warranted based on recent plan experience and what the increase was from 20182019 and our team will now take this information and start to work on our rating forecast for 2021 that will present at the may meeting. Any other questions . The only question i have, i think the difference between five and eight is small. Theres no way one it trend this or raise a siren or anything. Anything. How do we look at these high costs to see what was the care provided or issues. Was there a group of dying know sis we need to focus on as a Health Service or whatever. I mean, what happens to these high cost claims internally . Fourth coming on the agenda is our audit plan and we will audit highcost claims this year. I dont know if its been done in the past. It is of concerned and these numbers are so alarming and that we are obligated to do the audit and consider how that how the plan is managing these obviously highly complex cases and so, there are some very good questions to be locked a lookede wont do an audit on the large claims. All right. Accepts this is a discussion item, theres no action to be taken. Any Public Comment . Seeing none, move on to 16. Review and approve the presentation and this is presented by mike clarke from aon. Morning clarkeaon. My final presentation is to provide aons recommendation for the blue shield of california hmo plan Rate Stabilization plan action. You can see on page one this is based on the policy that requires the annual determination financial loss or gain for selffinancedded plans and any difference between expected and actual cost would then be added to the existing stabilization amount and amortized over a threeyear rating period. In the the third paragraph, ita surplus position as what im going to present today. For the first time in many years. So, december 31st, 2014. Its been indeficit for the last six years and i have a buy down of onethird of what is now a stabilization surplus balance for the tree owe plan and access plus. And this should preliminarily be expected to represent approximately a 0. 8 rating buy down when we present the 2021 premium rates in may. And that compares to what is now a 0. 6 buy up and the 2020 premium rates for the blue shield plans. So some history, last march, at this time, we presented a recommendation of a deficit balance. A the board approved and 1,886,000 as a buy out to 2020 active employee and early retiree premiums for access plus and trio which left the deficit Carry Forward balance of 3,791,000 and as i its rated on the last page, we have a surplus position. Page 3, so, in part this switches from deficit to surplus enable by the premium actions that took place and the blue shield plans from 20182019 it creates a flip to a surplus position. Page 4 illustrates a table that shows the comparison of the original expected claim administrative expense contribution and the shortfall or surplus of each plan for 2019 and we expected the revenue surplus of 3,162,000 and we ended up with a revenue surplus of 14,639,000 so that creates the favorable adjustment of 11,000,000. 04 had not 77,000 and what is currently a deficit balance but well flip it over to surplus. And you will see that on page six or five, excuse me. You will see the math behind the figures on the prior page as they cascade into the surplus position that we have calculated as of december 31st, 2019 of 7,686,000 and we take onethird of that and recommend that be a employed to 2021 rate buy down for the blue shield plans that amount is 2,562,000. In summary on the bottom of page 5, what i ask you to prove today is aons recommendation per their requirement of Health Service board approved Rate Stabilization policy that the surplus amount of 2,562,000 or onethird of the stabilization surplus balance be a replied towards buy down across tiers for the hmo plan applied per policy between active employees and early retirees. This will leave a remaining blue shield hmo plan carried forward surplus balance for your 2022 and beyond of 5,124,000. Questions . Comments . This is an action item. I move to approve the blue shield of california flexfinanced rates stability a reply onethird of the surplus for the premium premiums for 20. All those in favor. Aye. Its unanimous. Thank you. Where are we on this agenda if. 17. Well go to number 17. Reports and updates from the contracted health plan representatives. I have one more thing, you are not done with me yet but its not a presentation. So what i would like to do today is inform the Health Service board that on march 9th, 2020, three days ago, Aon Corporation announced intent to come together as an organization with will he iwillis towers watson, a Worldwide Consulting and Risk Management organization just as aon is, and so it is now in full announcement phase we expect that should all regulatory agencies approve the transacti transaction, it will take 12 to 18 months and requires Regulatory Approval from countries around the world. More information on thissance noment is contained on our website i wanted to inform you of this public announcement of my organization. So, the organization willis towers watson, in my starting out in the business, was known as towers parent and at some point they came together with the watheththe wyatt organizatiy came together with will is and watson. It was when i first started. It was my recruiting couldntecounterpart in 1989. I have one question. Weve got word of this and i looked it up online and this is i dont know about this whole field. Aon is a u. K. Company, right . Aon is in ireland but we have been a u. K. Company. We recently switched our Global Headquarters from United Kingdom to ireland but its in the financial district of london. When you say multiple countries have to a of this, how many are we talking about . At every continent . Ive been told 100 countries will need to weigh in on this transaction. Thank you. Again, i say statements today, please refer to our website. I speak to anyone, our website will have the official information that you should be following. Thank you. Good afternoon, Denise Rodriguez and i wanted to take this opportunity because coronavirus, covid19 is on everybodys mind. San francisco is quiet today. And i just wanted to rewind you all or just reassure you all that kaiser is really well positioned to manage this crisis right now and we have Business Continuity of plan, we have a command center looking at managing the situation with our employees and keeping them safe as well as treating the patients and weve been asked by the center for disease coal to participate in the first Clinical Trial for vaccinations and so were really being seen as leaders in this and im sorry, correct myself, National Institute of health. Were collaborating with cdc to help with the Health Infrastructure and respond to the systems to stop this spread of covid19. So, one of the things that kaiser is doing is weve made a donation to 10 leading publichealth organizations to subpoena or the this effort so were out there in the forefront. Additionally, i just want to assure you one of the strengthens of our model for many years weve been able to cover telemedicine which includes tele appointments as well as phone appointment and we have of course our advise line. We are really ramping up on this and theres been an uptick and its more critical that we utilize that service. Were reaching out for or vulnerable appointment appointmo change it to phone if its appropriate. Additionally, were looking at alternative ways to provide testing for covid19. We problem have heard in our medical centers weve had popup tents but its really a drivethru service. You call in and talk to a physician or nurse add vis and they direct you to go get the test. Were not ready to do testing because we dont have enough tests. No one does right now. They will be directed to go to a driveup testing ctstv. Co testi. Wore encouraging our members to go to the cdc as well as our web page for the latest updates. Were adjusting how we care and the cdc provides more guidance. Thank you for that clarification and drivethru testing because in the new this morning is kaiser is offering a drivethru coronavirus testing and i said is that offered to all the members. Thank you for the clarification. You are welcome. It wasnt a San Francisco journal a couple of days ago. We wanted to end on a positive note so im going to hand this off to my colleague to present something positive in our partnership with San FranciscoHealth Services system. Good afternoon. Debbie with the kaiser perm anent. I would like to provide you with good news with a Research Study between kaiser and San FranciscoHealth Service system. The collaborative study called comparative effectiveness of two Diabetes Prevention lifestyle programs in the workplace, the city and county of San Francisco randomized control trial was accepted for publication as an original Research Article and the johnal preventing chronic j. This is to evaluate the cdc Disease Prevention Program implemented in the workplace. We appreciate your partnership with your team. Director yant and fisher and todd over the years of the study and well work with the director to come back with another bored meeting to present the process result and outcomes. Any questions . Good news. Thank you. Paul brown from blue shield. I do also want to make a quick comment on covid19, coronavirus. We too are acting in support of governors request to provide access to care re lated to the coronavirus and we are removing all copays related to it for offices at out patient emergency room, inpatient care so theres no copays and were eliminating all utilization levers we might use for an inor out patient state to interact cease to i int you to be aware of that policy. Thank you. Anything else . All right. Public comment on this item . I would like to learn more about this. And you are speaking in this where we will have a more epidemic that costing any other, you know, with our children and our healing care issue, thank you. Any other Public Comment . All right. Public comment is closed. Item number 18, please. Clerk item 18 opportunity for the public to comment on matters within the boreds jurisdiction. All right. This is your opportunity. Seeing none, item number 19. The opportunity for the public to place items within the board of jurisdiction on future agendas. Any suggestions other than what we normally have . No . Ok. Were going in the Governance Committee matters. Since commissioner scott is not here today, i will be doing this. Which item is this on that you are referring to . This is your emotion policies that you worked really hard and i appreciate it. Thanks for, you know, for the property. Thank you. All right. So Governance Committee matters. Were the number 20. The review of the sfhss audit policy and the approval for the audit plan for cal ter year 2020 presented by president breslin. Are you going over this . I would happy to speak to this. As i mentioned earlier, we did develop a Health Service system and audit policy which is an administrative procedure for the department. What i did want to draw that to your attention where we need your approval, however is that we have put together an you had its plan and we looked at what we will be doing for this 2020 year. And theres a number of internal audits that are conducted by hss staff that are on the first page of the planned document including the Financial Statements things like that that you are familiar with. There are other things that you are not aware of and we take a robust Risk Assessment and look at best practice and standard of practices and have gotten good advise and council from aon and some of their subject matter experts. On the second page, its some of the external audits that we required external support and thatten clouds looking, theres a mandate to look at the Mental Health parity so well start with the uhc and looking at that. Were looking at the high claims with both blue shield and kaiser because that is a growing trend of concern and so were diving no that fairly aggressively this year. There are hip a Privacy Security audits and were weighing the city improves the standards as cybersecurity is more and more of a risk and there may be things that we are not regulated by the city that would bee hoff us to take a look at and its under consideration right now. The fraud waste and abuse audit, im sorry, this doesnt have on here but i believe were doing that with blue shield, am i correct . Blue shield and uhc. Thank you. So thats kind of a typo there. So well be doing that this year as well. And this is all presuming that current funding that we have available will continue to be available. These come at a price and all Things Considered its a wise use of our funds. Any questions . So money from this audit is out of where . Our budget. Its been approved . The funds are available. Any other questions . Any comments . We need a motion to approve. I move we approve the audit policy and schedule as presented and incorporated within the presentation. Second the motion. Second it. Any Public Comment . All those in favor. Aye. Opposed. Its unanimous. We are at the end of our agenda, i believe. Yes. So its confusing for me today too. I think this is about you did a good job. All right. This meeting is adjourned if theres no objection. 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 FranciscoSheriffs 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. It is a little warm for the mayor. Welcome, please come closer, my friends. I know we are going to get this started. Thank you so much. Thank you so much. Friends, colleagues, stakeholders, summer has started. It is always summer in in in th. This is a historic signing ceremony. Welcome to the signing for the right to return legislation authored by our leader and i present to you mayor london breed. [applause] thank you. It is so great to be here. I am so really excited about this legislation. I was happy to partner with supervisor walton on trying to put forth the policy we know was desperately needed, not just now but 20, 30 years ago because i cant help but think about my own experience and my mother lived here with my sister as at 1829 35th street. I used to spend a lot of time here. My experience in living with plaza east and the challenges that happened when people who were born and raised in oc and in potrero hill, the challenges that occur when you want to come home. Promises made, meetings. Community input. All of a sudden the Housing Authority is looking at maybe your back rent or your grandisonian his criminal history or some other things where they put up roadblocks and bear yours to allow barriers. It is a new day in San Francisco where we dont just try to tell the community what we are going to do and do what we want to do anyway. We are working with the community to ensure we support and keep the community intact. That is what this right to return legislation is all about. When we think about even the decline of the africanamerican population in San Francisco, there were a lot of africanamerican families living in Public Housing. My grandmother came from texas, my grandfather worked in the shipyard. Access to housing came through Public Housing. Public housing was my community. They are the people that raised me when we didnt have daycares. When we didnt have places to play. We had the kids in the community. Something has changed. People that used to be here are no longer here. It is time to change that. It is time as we move forward with rehabilitation of Public Housing that as we develop new properties that we are not doing it for the people who we anticipate are coming here, that we are doing it for the people who are already here andy serve to live in better conditions. Today is a glorious day. I dont want to go over. Some of the challenges of the conditions that exist i am excited the city is doing what it should have done a long time ago. It could have prevented a lot of things from happening in the first place. Here we are signing legislation that provides the security that people need to know that when we come into a community and say we are going to work with you and then you have a new unit and trust us, well, now here is the legislation to ensure that no matter who is the elected official, no matter who is running the particular department this legislation is about ensuring the safety of the residents and their rights to be part of the communities that they are born and raised in. I am really excited to be here today where we know it is always sunny and the views are always nice, but it is time that we do a lot more to bring attention and resources and support to this community. This legislation is just a small piece i think of hope to ensure the safety of this community and others including sunnydale, hunters point, places we are starting to revamp. We want to make sure we dont make the same mistake we did with plaza east and fillmore. We cant do things the same way and expect different results. If i could pass legislation that would allow everybody displaced out of San Francisco to come back from the past, that is something i want to work on. It has been tough. That is something i would love to be able to do. In the meantime this along with neighborhood preference and some of the other things in place they are going to be meaningful and now it is up to the community to make sure that we are doing everything we can to communicate to other people the laws that are going to help ensure access to opportunity for a community that traditionally has not been supported the way it should have in San Francisco. I thank you for being here for the signing ceremony. The legislation is intact. It is important to be here for the ceremonial signing in so people are aware this is important to us and it is going to lead to some incredible results for the future of residents of Public Housing all over San Francisco. Thank you all so much. [applause] thank you, madam mayor. Smartest woman in the building. Getting in the shade. As mayor breed mentioned this could not have happened without our fearless leader. I bring you our supervisor walton. Good afternoon. It is always a pleasure to be home. This is just a wonderful feeling today as i had a chance to walk into this and i used to attends here illegally. My aunt was director at the time. We named the infant child center after her. When my mom needed a place for me to go when i was removed from school for some reason or whatever the case may be, i would be here at cleo wallace along with other folks here in ph. Iit is good to see so many residents not from just from here but from other sites. This is important. We make sure we make our populations whole and communities whole, having the ability to bring people that used to live here that have been displaced is an important piece to make that happen. I want be to appreciate our then. Thensupervisor breed and cohen for passing the legislation to make it possible for higher percentages of our folks to win in the lot terry system that is detrimental to opportunity for housing for black people. I want to make sure that everyone knows and understands that we are going to continuously do everything that we can to make sure that folks have an opportunity to come back home. This is very personal to me. I used to live on 25th street with my aunt and cousins. My first job. I use to run the Family Resource center up the hill on top of the williams center. When we started having those conversations about hope sf and what we reenvision here in our community and i went to dcyf the work continues. We have the first building and continue to build more. Nothing is going to make that more complete without providing the opportunity for some of our families to return. I was excited to partner with the mayor on this legislation to make sure we do just that and bring the families back to San Francisco. I dont want be to belabor that amazing point. The mayor took my statements how beautiful it is and district 10. I make sure we highlight that. People need to know how beautiful our district is. People need to know why so many people are pushing us out and trying to come over to live in our places because of the beauty of district 10. Thank you all for coming out. This is historic legislation. Now we have to do our Due Diligence to get an opportunity to return back to these communities they help would build so many years ago. Thank you. [please stand by] just to say a brief word as to where we are. We are at the site of cross cultural, which is a facility that supports many of our people on potrero hill. Hope sf stood for a simple promise, that we would undo the harm on 2200 families, and this is a little bit about fulfilling that promise. This legislation is for that grandmother in hunters view. But not just that grandmother, but that grandson who goes to s. F. State university, so he can get good grades and come back to support his family. Its for that transitional age youth, that young person, whos at dillard university, working away, and he wants to come back to double rock, but theres no way for him to come back to his community. This is about real hope, real families, and hope sf. My name is theo miller, and i have the greatest honor to serve our mayor, london breed, in this partnership. When you think about who this package first in the nation, first in the nation. We are. Once again, leading this nation. It is as strong as this to prioritize, not just the sons and daughters and sons and daughters of the sons and daughters who used to live here. As we close in transition, i want to bring up one of those brilliant, brilliant, brilliant young mind who, as mayor breed and supervisor walton drafted this legislation, they had people like sealus in mind. I want to bring you up to the mic so you can share your story. Shaylas. Hello, everyone. I am a former resident when i used to stay in potrero hill. When i think of potrero hill, i think of barbecues, family time, and a Great Community family style living. Why would i want to move back to potrero hill . The view. The structure of the building making it more of a familystyle living. A new home is a new beginning for everyone. How this program can help others. Giving residents a new location and environment, letting people know its not where you live, its how you live, and last but not least, letting every resident know that there is hope and a Second Chance of new beginnings with the newhouse ho new household. My aunt valerie says they gave her a new place, a place thats safe for the kids, no mold, great views, and communitystyle living, as i mentioned before. Why is it important for me to live in this city . I feel its important for me and my child to live in this city, reasons being, great neighborhood, great programs, the Housing Programs are awesome, and not to mention the minimum wage is way more than a lot of cities that we know of. I want to say thank you so much for allowing me to speak today. I currently live at john burden housing, in a studio. I would love to have a chance to come back to my community, a chance to be a leader to other youth, a chance to show them that we have a chance to come back and be great leaders in our community. Thank you so much for having me today. [applause] thank you so much, shaylas. Were now going to move to that incredib incredible moment. If i could have mayor breed to come to the table, supervisor walton, other people who want to be involved in the photo op. Any residents in the building please come forward. Eddie cotrell is in the house. I want to thank supervisor cohen, former supervisor cohen, linda adams, daniel eelie, our city attorney, who drafted this thing, hope sf policy leader, jason lu, our Property Managers and service providers, thank you so much. And ill turn it to our distinguished leaders. The hon. London breed all right. Here we i lived in the Mission Neighborhood for seven years and before that the excel see your district. 20 years a resident of the city and county of San Francisco. I am the executive director of a local art space nonprofit that showcases work that relate to the Latino Community and i have been in this building for seven years and some of my neighbors have been here 30 year. We were notified from the landlord he was going to sell the building. When we realized it was happening it was no longer a thought for the landlord and i sort of had a moment of panic. I heard about the Small Sites Program through my work with the Mission Economic agency and at met with folks from the mayors Housing Program because they wanted to utilize the program. We are dealing with families with different needs and capacities. Conversations were had early in the morning because that is the only time that all the tenants were in the building and finally when we realized that meda did have the resources to buy the building we went on a Letter Writing Campaign to the landlord and said to him we understand you want to sell your building, we understand what you are asking for and you are entitled to it, its your land, but please work with us. What i love about ber nell height it represents the diversity that made me fall in love with San Francisco. We have a lot of mom and pop shops and you can get all your resources within walking distance. My favorite air area of my homes my little small patio where i can start my morning and have my coffee an is a sweet spot for me and i the hon. London breed hows everybody doing today . First of all, im london breed, mayor of San Francisco, and i want to thank all of the people who are here today to talk about Safe Consumption Services in San Francisco. Let me start by thanking glide. Just last year in this same space that we are here, glide hosted a mock, mockup of what a safe consumption space could look like in San Francisco and how it could potentially be an Incredible Service where it could save lives. And the fact is, i think the challenge that we face in this city and actually throughout this country is not having an honest conversation about people who struggle with Substance Use disorder. We know that its happening and playing itself out on our streets and people are complaining about it. But the fact is complaining about it and moving people from space to space to space does not solve the problem. If anybody has had a Family Member or their own personal experience with Substance Use disorder, you know its just not that simple to say here, heres help, or heres support or here are services you have to get better. People who suffer with Substance Use disorder have real challenges, and i think we have to change the kind of services that we provide to help people who deal with those challenges. Weve been lucky in San Francisco that we have incredible people and organizations that have led the way, including the aids foundation and the delancey foundation, haightashbury foundation, who have put themselves on the line for people that are struggling. And whats so amazing about the work that they have done, they help people beat the addiction that they have and get them back into full, productive lives. Thats all we want in programs like this, so today, we are here to announce what we are going to be providing in legislation. Myself, along with supervisor m matt haney, will be providing permits to organizations to allow them to operate safe consumption sites in San Francisco. [applause] the hon. London breed you know that ive been working on this for years, even when i was on the board of supervisors, and trying to inform people about what this actually means, what this could mean. And let me just talk a little bit about what it could mean, and ill introduce supervisor haney in just a moment. But the fact is, think about it. You see people who are basically out on the streets, injecting publicly. You see people using the foil and fentanyl and other things that are out there. Just think about them. Just imagining walking through this door and getting a space where theyre doing it inside, where theyre contained with people who are basically treating them with respect and making it clear to them that as soon as they are ready, we are there to help them. Thats what this is about. When they are ready, when they say the word, theyre getting the counseling and the services and they are immediately provided the treatment that they need to get healthy. Theyre not just going to do it because we say to do it. Theyre going to do it when provided an opportunity that they feel safe, that they feel comfortable, that they feel welcome, that they can trust the environment and the people that were working with. This is about not just the conditions that we are tired of seeing out on our streets, this is about saving peoples lives. The people out there are someones mother, somebodys father, somebodys cousin, somebodys uncle. They have Family Members, but they are struggling, and this is just a way that i think we need this is a direction we need to move in. Things are changing. What people are using is changing. We know the history, the crack epidemic in the 80s, the heroin epidemic, and now back to opioids in general and the trends around certain drugs and what happens, so we need to make some adjustments to deal with those challenges so that we can get people the help and the support that they need, and thats what this is about. And so as we know with all the challenges that exist with the federal government and the concerns, we know that those concerns are real. We want to make sure we protect the workers who are going to be on the front lines, doing the work, who are putting themselves on the line to help other people get the help and the support that they need. We want to make sure that the city is being responsible how they set up the permitting process for the agencies that are preparing to do this work, so this is just one step to get prepared for what were hoping could be an opportunity to open a safe consumption space in San Francisco soon. So thank you all so much for being here, and at this time, i want to introduce supervisor matt haney. [applause] supervisor haney thank you, mayor breed. I just first want to recognize and acknowledge your leadership, your steadfast leadership for Overdose Prevention sites and same consumption sites. Mayor breed safe consumption sites. Mayor breed, when she was a supervisor, she started the task force that looked into this issue and analyzed the sites in other parts of the country and other parts of the world, really, and came forward with a set of recommendations that this was something we had to do in San Francisco. So it was because of her leadership both as a supervisor and as mayor that were standing here today introducing this legislation. Its also because of the leadership of folks who do heroic work every single day to save lives on our streets, to provide care and outreach to folks who are experiencing Substance Use disorders, and those folks, i think, also deserve a great debt of gratitudetor what they do every day and for what they did to get us to this point. I want to acknowledge glide, the San Francisco aids foundation, the dope project, h. R. 360, r. T. I. , everyone who has been a part of this movement to deal with this crisis, this epidemic in a way that is evidencebased, that is compassionate, that is effective, and that will save lives in our city. We are facing the most deadly epidemic that this city has seen in a long time, and that is drug overdoses. This past year, in 2019, there were over 330 deaths as a result of drug overdoses in San Francisco. Thats a massive increase over 2018, and actually, the numbers expected to go up even higher than that. You can walk around this neighborhood and the neighborhoods that i represent and see people who are struggling, see people who are suffering, who are in need of support and need outreach and treatment, and above all, need to be in a place where they are inside and live and survive and have people that are there for them. We know that Overdose Prevention sites are not a radical idea. There are over 100 that operate in 65 cities around the world. And in those Overdose Prevention sites, not a Single Person has died from an overdose. Thousands of people have been able to enter treatment and care, and we know we need that in San Francisco. This will actually be able to save money. The task force came out that mayor breed was so effective in championing show that each Overdose Prevention site will actually save the city about 3. 5 million in health care costs. So this is the right thing to do, its the smart thing to do, its the compassionate, effective thing to do, and it could not be more urgent for us as we face this most deadly epidemic. This legislation will provide a permitting process so that Health Care Professionals can prepare to open one of these sites as soon as possible. We dont know what the federal government is going to do, but we know that they dont know, especially this federal government, doesnt know whats right for San Francisco. We in this room, the professionals who are doing this work, the mayor, the board of supervisors, the community, know whats right for San Francisco, and whats right is for us to move forward with these sites now. We were able to, just this past week, get positive news in philadelphia, where they have been in federal court and have won again and again, and theyre going to be moving forward. Its time that San Francisco move forward, as well. So we are going to be introducing this legislation together next tuesday. We are going to continue to push for the state and federal authority to do this, but what we need to do is move forward and prepare and be ready at that moment as soon as possible to open one of these sites because its urgent, its devastating our community, its deadly, and we know that this is a huge part of the solution. Its not the only solution. We also need to do a lot more than this, but it is a part, and its a proven tool that works. I want to thank andre and abbie from my office. Theyve been working on this for months, and this is a collaborative action, and we know that it works. Thank you all for being here. [applause] the hon. London breed thank you. When this idea of doing a safe injection site now, Safe Consumption Services did i get it right . All right. When it first was brought to my attention, it was brought to my attention by laura thomas of the drug policy alliance. She had spent so much time advocating and talking to elected officials, working with the community. She provided opportunities for people like me and others to visit vancouver to get a firsthand experience to understand what this could actually mean and how this could actually work, and theres nothing like seeing it directly to get an understanding and seeing it in use as to how it could potentially help people. I think i was on board before that trip, but i was more determined to get this done here in San Francisco after that trip, and its because of laura thomas and leadership. Shes now with the San Francisco aids foundation, and so lets welcome laura thomas. [applause] yeah. So im laura thomas, director of Harm Reduction policy at the San Francisco aids foundation, and as the mayor said, ive been talking to people about this for a very long time. But im really grateful for the leadership of the mayor in particular both when she was on the board of supervisors, as youve heard, and now as mayor for her willingness to stap up and say this is the right thing thing to step up and say this is the right thing to do. [applause] and im also grateful for the leadership of matt haney who stepped up and said what can we do about this . Lets bring this up now, and who has brought a sense of urgency to the overdose crisis and this issue, as well, so im ra really grateful for their leadership on this issue. Im also grateful to glide and this safe injection mockup that they put on. For people who werent able to travel to vancouver as the mayor did, but were able to come here and see what the concrete reality was, and i think that was a transformational Public Education effort, and im grateful to glide for that. I also want to thank the leadership we had for people who use drugs throughout this entire process. People who use drugs, theyve continued to be involved, showing up at the Health Commission and the board of supervisors to testify in support of this. And what weve heard over and over and over from people who use drugs is we do not want to be injecting on the streets in public view. We want a place where we can be safe, where we can be welcomed, treated with compassion, and where we can be indoors and be able to be out of view. We think thats important for us to remember as we think about this. You know, these are programs that can provide a bit of respite and dignity and compassion for people who often dont experience that in their daytoday lives. You know, i think its very clear that San Francisco meets these programs. When you see the amount of public drug use thats happening, we need these programs. As youve heard, these would save money, save taxpayer dollars. Theyve been shown over and over again to get people into treatment or correct them with sf with services, to reduce drug use. They dont increase drug use in the area, dont increase drug sales in approximathe area. Thats been shown in research in different countries, and i think its been clear from the scope of the Overdose Deaths that we need this. The San Francisco chamber of commerce, dignity, citybeat poll, has shown that well over 40 of people support these here. Other groups see just how useful these sites could be for us here in San Francisco. And finally, i think San Francisco deserves these sites. Weve long been on the front, on the cutting edge of, you know, following where the science leads, following where compassion leads us in order to do the right thing, even in the face of federal opposition. We know how to do these things in San Francisco, we know how to do them well, and im excited to be doing these things in the city, excited to have this legislation. We still need to get our state bill passed, and, you know, we certainly face challenges with this federal administration, but im confident that we have the leadership and the will and the the moral wherewithal to make this happen here in San Francisco. Thank you. [applause] the hon. London breed thank you. So i also want to take this acknowledge to thank the director of the department of Public Health, dr. Grant colfax, and the other folks who are helping spear head this particular process and are very supportive of this next step. They have just been invaluable throughout this process, and i want to thank the department of Public Health and its staff for their work and their willingness to do whatever it takes to help us get to this place. So as i said, we plan to introduce this legislation next week with the goal to prepare so that when we have the opportunity to open one of these sites, we want to be ready on day one. And so again, id like to thank supervisor haney for his leadership in helping to move this through the process as well as so many of the folks who are here, standing behind me, who have been doing this work for many, many years. They are the people on the front line, working with folks who are struggling with Substance Use disorder every single day. And their passion and their love for the clients that they serve is extraordinary and has led to so many incredible break throughs in peoples lives, and thats what this is all about, having a breakthrough so we can save people who are struggling. I want to thank all of you for being here today. Looking forward to the day that we can really get this Program Going once and for all, so thank you so much. [applause]