Transcripts For SFGTV Health Service Board 20240713

Board commissioners, the Health Service system staff and members of the public. I wish to thank all the people who have worked many hours to make this meeting possible. Please note that our board secretary Natalie Ekberg and many of the Commission Secretaries across the city have collaborated to learn about these meetings. I also wish to note that our internal team has worked behind the scenes to provide the technical support, including marina coridge, Brian Rodriguez and others have stepped in to help manage our Public Comments today. I want to share my gratitude and thanks to all of you, as well as the Health Service staff who have helped make this meeting a reality. And finally id also like to acknowledge the Citys Department and Technology Staff of government tv for their time and energy into preparing our team. The staff and board commissioners appreciate all of your dedicated work, and i would like the board secretary to share her remarks regarding how to conduct ourselves in this Public Meeting in a virtual setting. Thank you. Thank you very much, executive director yent. Today the Health Service Board Meeting is being televised by sf gov tv. For those of you watching the live stream, please be aware that there is a time lag between the actual meeting and what the members of the public are seeing through the sf gov tv platform. If you are watching this via the sf gov tv platform and you wish to comment, please call into our conference line when that item is called. Again, please call into the conference line when the item is called on the agenda. And press 1, 0 to be added to the conference queue. For members who would like to make Public Comment, the phone number to use is 8888086929, and the access code is 5540616. This information will be provided to you throughout the presentation, after every agenda item there will be a Public Comment slide produced and shown so you can see these exact instructions to dial in and to get yourself in the queue. Please make sure when you do dial in that youre in a quiet location. Please turn off any tvs or radios, and if youre livestreaming the meeting via sf gov tv, that you mute the sound on that particular device, if its a phone, laptop or ipad. This will reduce any reverberations and noise so the Board Members and myself can hear you. You will have three minutes to make Public Comment. At the end of that Public Comment and the threeminute timer goes off, you will be muted and the next caller will be called. At the appropriate time during Public Comment, the chair will ask for the phone lines to be opened and there will be a 30second pause to allow for catchup from the members watching this at home from what was presented. If you wish to participate and comment on a particular item, again, please dial into the phone line and promptly press 1, 0. This will add you to the line and keep you in the order that you pressed 1, 0. The auto prompt will say to you on the phone lines that callers are entering question and answer mode. This is actually during going to happen during Public Comment. You will be queued up in the order in which you pressed 1, 0. Just another reminder. And there will be an automated voice which tells you when its your turn to speak. When your microphone has been unmuted, you will hear us ask you to state your name and to make your comments. I want to make a note that you do not have to state your name. You can remain anonymous if you wish. I will start your threeminute timer as soon as you begin talking. I will also say 30 seconds when you have 30 seconds remaining. When your time is up, you will hear a chime in the background and i will say thank you to the moderator and ask for the next caller. At that point, the moderator will put you back on mute and we will move to the next person. Thank you so much for participating with us today, and president breslin, this concludes my presentation on Public Comment. We can move to the next geagend item. Roll call. President Karen Breslin . Present. Commissioner vicepresident Stephen Follansbee . Present. Commissioner mary hao . Present. Commissioner wilfredo lim . Wilfredo, you may be on mute if you are on the call. I will come back. Commissioner randy scott . Is also expected. And if you called in, randy, you have to push star 6, please. Present. Im present. Thank you. Commissioner chris canning . Im here. Thank you. And supervisor dean preston . Present. Thank you. We have a quorum. President breslin, if you are muted, we do have a quorum and we can move to the next item. President breslin oh, sorry about that. Item no. 3, please. Item three is the approval with possible modifications of the minutes of the meeting set forth below, regular Meeting Minutes from march 12, 2020. President breslin does anyone have corrections to the meeting . Hearing none, i would ask for a motion to approve. Commissioner canning this is commissioner canning. I motion and move that we approve the march Meeting Minutes. Commissioner scott this is commissioner randy scott. I second. President breslin all right. Is there any Public Comment on this item . We will now begin Public Comment for the item. We will have a few moments to wait while members populate the queue via the conference phone line. Once you are on the phone line, please press 1, 0 so you will be added to the queue. Moderator, will you please open up the phone line for the first caller . The conference is now in question and answer mode. To summon each question, press one, then zero. You have three questions remaining. [indiscernible] Public Comments regarding approval of [indiscernible]. Hello, good afternoon. We are on agenda item no. 3, which is the approval of the march 12, 2020 Board Meeting minutes. Can i ask who we are speaking to . Derek cam. And do you have comments on the Board Meeting minutes . No, im just wondering if questions regarding the policy or the actual policy of the meeting, because im in regards to potential health care increases, and im wondering what item that is. All right, yes, youll have to wait until we get to the renewal portion of the meeting. We are currently asking for callers to call in regarding the Board Meeting minutes. Okay, sorry. No problem. Thank you. Moderator, can we have the next caller, please . You have two questions remaining. Hi, im also waiting for the period where we talk about copays. Okay, no problem. You can dial back in when we get to that agenda item. Okay, can i wait on the line . That is true, you can also wait on the line, yes, and then you have to dial 1, 0 again when we get to that item. Okay, thanks. No problem. Moderator, can we have the next caller, please . You have one question remaining. Hello, good afternoon. You are on the Public Comment line. Yes. [indiscernible] because i dont want the copayment to be increased. Thats all. Yes, you can stay on this conference line. Thats not a problem. We are currently approving the Board Meeting minutes from march 12, 2020. So if you dont mind, we will disconnect this Public Comment and you can dial 1, 0 when we get to the item number that youre interested in commenting on. Okay, thank you. No problem. Thank you. Moderator, can we move to the next caller, please. You have zero questions remaining. President breslin, we are concluding the Public Comment section for this item. President breslin okay, the minutes of the march 12, 2020, meeting have been moved and seconded. All those in favor . Aye. Aye. Aye. Aye. Aye. Aye. President breslin is there anyone opposed . Its unanimous. All right, item no. 4, please. Item no. 4 is the president s report. This report is given by president breslin. President breslin all right. On behalf of the Health Service board and San Francisco Health Service system, i would like to announce the San Francisco controller ben rosefields reappointment of randy scott to the Health Service board. Commissioner scotts new fiveyear term will begin on may 15, 2020, through may 15, 2025. The San Francisco Health Service system and the Health Service board would like to thank the controller for his reappointment of commissioner scott. Commissioner scott has been an articulate and respected voice on the Health Service board since 2010. He has provided excellent leadership in several areas, including governance, policy while serving as a committee chair. He continues to strengthen the advocacy and the morale of the board with every year of service. Thank you, commissioner scott, for all your work and we look forward to having you on the Health Service board for the next five years. And secondly, i would like to announce that mayor london breed has repointed dr. Stephen follansbee to the board. He has served since 2015 as a retired practicing physician. Dr. Follansbee has provided great insight into some of the more complex issues and questions that have come before the board. Dr. Follansbee has also served on the budget and finance committee. He is also serving as the vicepresident of the Health Service board. We are grateful that you will be serving another term on the board. And third, today is commissioner lims last meeting. Serving on the Health Service board is one of the most challenging and complex volunteer roles. Throughout your ten years of service on the Health Service board, you have consistently performed your duties with diligence. You are very knowledgeable of the San Francisco city processes and have always advocated in protecting [indiscernible] of the Health Service system trust fund. Commissioner lim has also served our members in the following capacities Health Service board vicepresident , finance and Budget Committee and chair, Governance Committee chair and rules committee member. Commissioner lim, the San Francisco Health Service system staff, our members, all four employers, the city unified school district, Community College and along with the Health Service board would like to thank you for your service. We wish you well in your future endeavours. With that, i will move through the directors report, please. Karen, we have Public Comment first. President breslin oh, im sorry. Public comment. Public comment on this item. And well wait 30 seconds before we start that. If you have any Public Comment on this item, please dial into the conference line and press 1, 0 to discuss the content of the president s report. Madam secretary moderator, we will now begin the Public Comment for this item. And there will be silence while youre on the conference line waiting for the members to populate your queue. Moderator, please open up the phone line for the first caller. You have three questions remaining. So my name is francisco da costa, and. Sir, if youre on the conference line, we cannot hear you. Can you please speak into your phone . And so i listened to you all from time to time, and you know that we are in dire straits because of this pandemic, and i would suggest. Sir, we cannot hear you i can hear myself. Sir, if youre still on the line can you please try again to speak into the phone. Okay, so i did say that we are in a pandemic and we are in dire straits and. Okay, fine. Madam secretary hello, sir. Are you still on the line . Sir . All right, moderator, can we please go to the next caller . You have three questions remaining. Its very hard to [indiscernible] with the delayed feed and so im hearing that. I would like to say welcome again to randy scott and to dr. Follansbee. We are very happy that they have both been repointed to the board, and thank you very much to for all of his service over his terms. He has represented members very well both and retired and we wish him well in the future, and we just want to say thank you [indiscernible] im not going to miss him. Im going to see him every time i go past his house in and out of the neighborhood, so definitely thank you, thank you, thank you, willy. You are so appreciated. I know its also greatly appreciated by local 21 sgiu tenderloin and all of the other active [indiscernible] and everyone youve represented in your term. Thank you so much, and thats the end of my comment for now. Thank you very much. Moderator, can we have the next caller, please . You have two questions remaining. Hi, im a registered nurse at San Francisco general hospital, and my comment is a comment, not a question, and i would just like to say this is the worst possible time for you to be raising the rates and raising copays. We need access to health care now more than ever, up to 20 of the people that are dying from this coronavirus are Health Care Workers, and we need to keep rates reasonable. This is not a time to raise them. Thank you. Thank you very much. Moderator, can we have the next caller, please . You have one question remaining. Yes, my name is richard glassman, and how am i do not see on the agenda general comments . Its usually at the beginning of the meeting. When can people make general Public Comment . I dont see this on the agenda and i want to know why it was taken off or not put on. How are people supposed to speak to the commission on items not on the agenda but under their authority . And why was it left off . And when will i get a chance to talk about my issues . Mr. Rothman, are you still on the phone . Yes. We can i can discuss this with you further offline. If you have any comments to give during the president s report or any other item that are related to your concerns, please feel free to dial back in and make those comments under those items. Well, theyre not under any items. Its under general comments. This isnt under any item on the agenda. Why was it taken off . I dont want to speak offline. I want the commissioners to hear me. Theres no place on the agenda for them to hear me. Why did they take that off the agenda . Mr. Rothman, this is the executive director. We have been this is our First Virtual meeting, and we were trying to make the meeting concise so that we could get through the business at hand. I apologize if that puts you in an awkward position. You are welcome to make your comment at this time or later in the meeting. Well, ill make it this time because its not under the item. Ill be short. One was a smile. Next month delta dental is going to make a presentation, and i ask that they make a detailed presentation of the smile program because i sure dont understand it, so [indiscernible] will make a detailed presentation in whats covered under the maximum and whats not covered. I kept getting different stories. And as far as kaiser, ill wait until next month. The only thing i want to say is i think we should set up an Advisory Committee to deal with issues that ive gone through and some of the other people, and the people i talk to at kaiser feel that this would be a good idea, and i hope the staff and the commission would agree that we could set up an Advisory Board made up of kaiser members and act [indiscernible] so we could deal with some of the issues that crop up. Thank you for letting me speak. Madam secretary thank you very much. Moderator, can we have the next caller, please. You have two questions remaining. Hi. I dont have a question but i have a comment. Im a registered nurse. I just want to leave a comment about kaiser distributing [indiscernible] masks. Right now were finding this pandemic and we dont know what kind of modes of transition this virus is going through. Theres a lot of nurses dying, and we nurses in south San Francisco have the highest, you know, in the region of positives nurses who are positive for covid. And bringing to the cdc reprocessed masks are not [indiscernible] decontaminating the masks are not a sure way of protecting us from the virus, and even the sva is saying that [indiscernible] kaiser is using a company to reprocess the masks, they have never been cleared or approved for the decontamination process. And so kaiser has not been transparent about how they are managing the situation or what number of [indiscernible] they have in their stockpile. So why dont they follow ucff, you know, allow us to use the new masks and then save the ones that will be surplus at the end. Instead of saving it for the future, like what theyre saying, there will be no need because all of the nurses will be dead. So im invoking the board of supervisors to please put pressure on kaiser, especially when they ask for rate increase, you know, to give the nurses and frontline workers the protection we need in order for us to take care of our patients. Because we as caregivers, we are not safe, and our patients will not be safe. We go out in the public, we will not be safe. We will be vectors of the virus, and so i ask your committee, your commission to please put pressure on kaiser. [indiscernible] at this time of pandemic they will increase their rates. Thats inhumane, and now more than ever our Health Care Workers and frontline staff need the you have 30 seconds remaining. And they need all the help they can have to be given in order for them to be given the protection and the health care that they need in this pandemic. Thank you so much. Madam secretary thank you. Also, anyone else who is still in the queue to make comments under the president s report, the kaiser item will be called. Its item no. Let me go down in my agenda, please. Its item no. 12. Its going to happen later on in the agenda, so if you are in the queue currently for Public Comment and plan to talk to the kaiser item on the agenda, please note that at the beginning when your line is opened so we can move on to the next agenda item, thank you very much. Moderator, can you please see if anyone else is left in the queue . You have two questions remaining. Hi, im a Behavioural Health commission at the merck and i want to speak about the kaiser plans to increase the premium rate. Hi, good afternoon. Im going to pause you right there. We are going to call this item later in the agenda. If theres any way we can have this comment made under the kaiser item, so we can move on to the next agenda item. We dont have i actually have to work and meet with clients, if its possible for me to be able to share. Go ahead, yes. I will start your timer now. Thank you so much. I do not believe the premium rate should increase due to the pandemic. Additionally, this has not been [indiscernible] and last i just dont feel its a good idea to put more stress on the frontline workers and their families. Thank you. Madam secretary thank you. Moderator, next caller, please. You have one question remaining. Hi, im president of ifeti local 21, and im calling to thank and congratulate willy lim for his service. Beyond the borders is a difficult thing to do. Its a lot of work and we really, really, really appreciate willys work, and he will be missed. I do have comments on the kaiser, but ill save that for the appropriate time. Again, willy, thank you very much. Thank you, bye. Madam secretary thank you, sir. Moderator, is there anyone left . All right. I believe this concludes Public Comment on this item. President breslin all right, item no. 5, please. Item 5 is the directors report. This report is given by the executive director, abby yent. Good afternoon, commissioners and members of the public. Thank you very much for working with us as we learn this new technology and this new way of working in the virtual world. A lot has changed since we met in march. I just want to go through the highlights in my directors report today, and first off i want to note that may is Mental Health awareness month. I think its worth noting that all of us are under enormous amount of strain and stress during this shelterinplace period in the pandemic, and so we i encourage all of us to take care of our Mental Wellbeing as well as our physical wellbeing during this time. To that end, we did worked with mayor london breed when she announced enhanced Mental Health resources, that we have now rolled out for city First Responders and have expanded mental Health Services for all of our frontline workers through our Employee Assistance line, which is now our three Employee Assistance Staff Members who have done a heroic job throughout this period, are now assisted by a 24 7 service that can provide needed guidance and assistance and counseling to any of us that need their services, and thats a Welcome Service since many of us know that these kinds of concerns and anxieties dont always come on a 9 to 5 basis, so its great to have 24 7 availability. We work very directly with our Public Safety department implementing a tool called cortico, which is a Smartphone Application thats designed by and for Public Safety workers. Its literally in the hands of the fire department, the police department, the Sheriffs Department and our 911 operators so that they have Services Available to them through their smartphone app. So do take care of yourselves as we go through this period and attend to your Mental Wellbeing as well. As i mentioned, our eap and our wellbeing services are really focused on these areas and have many resources up on our website. Please visit it if you have not yet done so. Also i will move into our departments covid19 update. We were able to move to close our office to the public effective march 16 with most of our workforce being able to assist remotely. We are abiding by the shelterinplace rules, and its been complicated. It was complicated from the getgo by the fact that we did have an archaic phone system that was not the best when we first had to shelter in place in that our members when they called us it went directly to voice mail and then we had to retrieve the voice mail and then call people back. We had around 2,000 phone calls that we did that with, but we got through all of them. On april 17, however, we finally did, with the assistance of the department of technology and our it staff within hsf converted over to the modern digital telephone system, and that went live, and that has made Member Services call answering much, much easier and more direct. So our members may not even may not even realize the technology that goes behind that call, but its been very beneficial, and as our board knows, its been in progress for some years, so were very happy to have it, have it live and in person. We are, along with all city agencies and other businesses, considering returntowork plans. They are very complicated, and we will update you on the progresses of those plans as they become clearer to us. We are, of course, doing them with Public Health guidance as we can imagine the safety is important as we learn new ways of working in this pandemic that will be with us for some time. Other updates in the directors report include announcing the new company altaes that has brown and as part of its business model. We are anticipating weve heard from brown tollen a couple of months ago about plans that they had to stabilize their business business maddel and the altaes partnership i think is a big piece of that. We will look for the benefits of that Going Forward. I have included in my directors report information from blue shield of california as an update to some of the questions that we have had about the implementation of the infertility benefits. That investigation and system improvements are ongoing with that carrier. We had planned on having an inperson update in april, our april meeting was canceled. The timeline has lagged this month, and so we are anticipating a june finalization of that report on their infertility benefits and what theyve done to correct procedural difficulties that exist, had existed. I also included in attached to my directors report today in lieu of doing a Financial Report we have included the Financial Report in my directors report. There is an executive summary on the first page that reads as if pamela were reading it to you aloud in the boardroom. And so i want to pause there and see if there are any questions from the board regarding my directors report. As i close my remarks, though, i do want to just state publicly that our staff has been absolutely amazing in their adaptability to this situation. They have been very, very engaged. We have continued to do all Staff Meetings and many special meetings using video conferencing, and im very grateful that our staff remained healthy and has remained very committed and dedicated to the work that we do on behalf of our members. Thank you. Commissioner canning this is commissioner canning. I have two comments and a question related to your report, director. Firstly, gratitude. I have heard from numerous members, particularly early retirees trying to navigate through the process of obtaining their Medicare Coverage with the effects of the pandemic, and your staff was extremely helpful, so i wanted to thank you and your staff for all of the help you provided, especially with the current pandemic situation. Secondly, another expression of gratitude for the eap benefit for Mental Health access to our First Responders. I realize its been rolled out, and i know that my department, the access is very much appreciated, which leads to my question about that particular benefit. There was discussion about it being available to retirees as well. Is that a component of that benefit that youre aware of . Yes, it is, and its uniquely so with this particular application because the application is very much coordinated by the department itself. So as you certainly appreciate, being a member of the police department, when someone leaves the force, they are still sort of considered family, if you will. So it is up to the department to determine who they grant access to or as to how they promote the availability of the application. So it is up to the department, and that makes it pretty unique. Commissioner canning thank you very much, and i assume that is the same for each department with access to the benefit for their retirees . Yes, and i cant say for certain at this moment that weve done a concerted effort to make that known. We really pushed us and corticoto the limits in bringing this online for four departments in less than a month. And a lot of kudos goes to our wellbeing team who helped coordinate that. But thats a good checkin point to see how were doing with the rollout and engagement of early retirees. Commissioner canning thank you so much, director. Those are my comments and question. Again, thank you to you and your staff. Commissioner follansbee this is commissioner follansbee. When i went through the agenda items, i had some questions regarding the infertility statement provided by blue shield of california, the update. Some of those issues were, in fact, addressed. And i thought that was going to be reposted, the clarification for some of the items, such as the definition of sme and also bullet point five, which dealt with the 17 cases that require additional review. So is that report, the response to that, those concerns, available or is that going to be held until the verbal report . Im confused. Yes, we did talk about that. I didnt include it in my update, but the s. M. E. , first of all, the subjectmatter expert, kind of insider baseball talk, i apologize for that, and then the cases themselves are i cant remember the answer to that question, off the top of my head. But i know that case review is still being completed, and that will be summarized and reported out in june. Commissioner follansbee my recollection on the response to the question on bullet item five was that the blue shield of california reviewed all 17 denials in the calendar years 18 and 19. The 17 cases that required additional review were the ones that were denied, and there were several that the issues were not covered in the current benefits, and so that left and some other issues around coverage, so that left the eight that required additional claims review. That is being done, my understanding is, by the s. M. E. , and we didnt have a preliminary report on those eight, and we will hear that i guess in the followup next month . Correct. Correct, and i think what youre describing is certainly the complexity of doing this kind of review and, yes, i think we will have the answers at our june meeting. Commissioner follansbee my understanding is that its one person doing who is acting as s. M. E. And then that person is doing the reviews, and again, well get much more detail on all aspects of this review. Yeah, and it requires an enormous amount of outreach to the member as well as the providers to get a full picture on what occurred and if there were issues and how to correct them. Commissioner follansbee thank you very much. Supervisor preston this is supervisor dean preston, and thank you, director yent, for the directors report, and i also want to thank you and your team for all of your work during this very challenging time and also to all the folks who have made us going online here possible and are making it possible today. I just wanted to echo dr. Follansbees, some of his comments and concerns, and appreciate the work thats been done around getting to the bottom of the infertility issues, and i realize as a newer commissioner this has been going on for a while trying to get a clear path forward and get some answers, so im pleased that were going to be getting a more complete report. Look forward to that in june, and thank you for all your work on that. I did want to ask, there was i saw a reference to a request from Public Records around this issue. I realize that those can be very challenging right now, but i wasnt sure if theres any status update on whether theres any Public Records to actually request pending or anything. I know someone has done quite a bit of advocacy around this issue. I appreciate her work and other advocates for surfacing this. I just wanted to check in on the status of responding to any Public Record requests on this issue. Yes, we are certainly in receipt of that request and have been working to call down the information that was initially requested. I think we had a 10 gigabyte load of information that could not be accessed remotely, and so we do have one or two members of the Management Team going in one or two days a week, into the office, which is for essential services, and so that has fallen under that, but its going a little bit slower than we would normally process because we had to take because it had to be done a, it has to be done in the office. B, it was a full load and we had to revisit on numerous occasions the algorithms to get to the information that would be made publicly available. We do manage a lot of phis, so we have to be extraordinarily careful when we process these kinds of requests. So we are on track, as i understand it, to have that completed this week. Supervisor preston great, thanks so much for the update. I appreciate it. Youre welcome. President breslin so is there anyone else from the board . If not, i will ask for Public Comment. Public comment on item no. 5. Madam secretary yes, im just waiting a few moments to see if anyones going to join the queue, and then i will call for it. President breslin okay, sorry. Madam secretary we will now begin the Public Comment for this item. There will be silence while we wait for the members to populate the queue. I would also like to remind those calling in on this item that this section of Public Comment is on the directors report content specifically. If you have any other comments on other items, please hold and either drop off the line and call back in when your item is called, and that will happen later in the meeting. We want to keep the agenda moving forward, and as this is being broadcasted to keep within our time frame. Thank you for your understanding. Moderator, will you please open up the phone line for our first caller . You have two questions remaining. Hello, quick question to the director, i see that the finance report that is attached is from february, and i was trying to listen very carefully, and i may have missed it. Are we going to have a more updated, like to end of march or end of april finances, or are we waiting until later . Im reading your comments about a Quarterly Report coming. Are we going to see more a more updated finance report soon . Or did i have the wrong finance report attached to the documents that were available to download . Thank you. Claire, as i understand it, our month end close allows us to report a bit in arrears. Not as current as one would think. So when we prepare this report, were preparing it on the close of the month, which for february so i dont know if pamela can help me out here if shes on the call, but i believe what we put together is the latest available reportable data because it has to be closed out before we can report it. This is pamela levin. Deputy director, chief Financial Officer. Yes, we have to go in arrears because labor and some of the revenues arent actually finalized in the month they occur until the following month, and so, yes, we will provide more updated information when we have our next meeting. Thank you, and happy retirement, pamela. Madam secretary moderator, can we have the next caller, please. You have one question remaining. Hi, good afternoon, commissioners. My name is theresa rutherford. I am one of the vicepresident s of [indiscernible] ten to one, and i just want to make a brief comment here. We are not in agreement with any increase in rates or copays by any Health Providers at this time. It is clear to sgiu and public unions that kaiser [indiscernible] large [indiscernible] profiting off the pandemic and frontline workers who are risking their lives. We are, therefore, asking the commission to stand up with unions and with all the frontline workers and to fight the corporate greed and the abuse of frontline workers and the public. If Health Care Workers are not protected, the public is not protected. We are all at risk. Please do not support any increase in rates or copays at this time. Please do your part as commissioners to protect workers and the public in this pandemic. We talk about an n95, that is a barrier. You are our barrier against these big corporate organizations who are making hand over fist money. Do not allow it. Do not support it. Do not allow any increases at this time. It is going to hurt us. It is going to hurt you. It is going to hurt this entire country. Health care workers who have to struggle to pay copays and to look after their families will not be able to focus on these important things [indiscernible] every one of you there sitting on that commission, your familys at risk as much as all of us. So please make that decision today and moving forward not to allow Big Companies to make miss, you have 30 seconds remaining. Thank you. Im done. Madam secretary president breslin, i believe we have concluded Public Comment on this item. President breslin okay. Very good. Now we are into our rates and benefits section. And i would ask you to now that im in this section, i think it might be a good idea, if theres no objection, to move no. 12 to the end of the agenda. It seems like theres going to be a lot of questions on that item, and i dont i think some of the members might not be clear on what was really presented there. So we do need to get through this because it is our rates and benefits, and we want to make sure everybody does have a health plan next year. So with that, i would ask for no. 8 no. 6, please. Madam secretary no. 6, item six is the presentation of the 2020 rates and benefits calendar for plan year 2021. This is presented by the executive director. Good afternoon, commissioners. The updated rates and benefits calendar is available in your packet. We are coming to the end of our rates and benefits cycle. Today before us are the three medical plans and several other items for action, and then in june we will be hearing the medicare plans and the dental plans. Are there any questions . Commissioner scott this is commissioner scott. Are we planning to have this meeting on the 28th . Of this month . Commissioner scott yes. That is still on hold. It depends on how things go here today. Commissioner scott all right, thank you. Madam secretary president breslin, you are muted if you are trying to speak. President breslin i should leave that thing. Anyway, yes, Public Comment on this item, please. This was item no. 6. Madam secretary that is correct. We will wait a few moments for the queue to populate and then we will begin with the asking of that opening of the line. We will now begin the Public Comment for this item. Callers, there will be silence while we wait for other members to populate the queue. Again, i want to remind everyone thats on the call line, this is for all Public Comment regarding the rates and benefits calendar, item no. 6 on the agenda for today. So if we can please keep our comments focused on the rates and benefits calendar, that would be very helpful to keep the meeting moving along. Moderator, can you please open up the phone line for our first caller. You have three questions remaining. Hello. Im calling on the benefits and rate plan. [indiscernibl [indiscernible]. Miss, your connection is cutting out. Can you please start over for us so you we can hear what you have to say, please. Yes, im saying that as a Health Care Worker too for my salary i can barely afford 20 for a copay. So will the copay increase . Or will the amount that they are taking out of your cheque increase . [indiscernible] hello . Yes, miss, your phone is cutting out. We can only hear part of what youre saying, if you want to continue. Hello . Yes, hello, can you hear me now . Madam secretary yes, i can. Go ahead. I wanted to know if the 20 copayment is going up or is it the fee that they are going to take out of our cheque every two weeks . Madam secretary so, miss, this time is for Public Comment. I cannot answer any of the questions that youre posing at this time. If you have any comments on the rates and benefits calendar that was just presented by the executive director, we can take those comments now. Okay, so thats my comment. My comment was that i could barely afford it on my income, so im just saying that, you know, Health Workers dont make that much money, so i was just wondering if they were going to raise the rates for the copays, but theres no if you can just make comments and theres no, you know, questions and answers at this time, then i guess thats it for me. Madam secretary all right, thank you very much. We appreciate the comment. Thank you. Moderator, before we open up the line, i want to remind callers who are in the queue, this particular item is on the rates and benefits calendar that we just presented regarding what is coming up on future agendas for june. If you have any comments on any other item, please drop off the line and call back in during that item so we can move on to the next item of your agenda. Thank you very much. And, moderator, can you please call the next caller. You have five questions remaining. Hello, i am calling in regards to actually, i was [indiscernible] president of our chapter. I just want to thank the Health Service board for your attention. We like to take the time to provide the details that its so important that were concerned against the recommendations of medical copay rate increases for any medical benefit program. In light of the covid19 pandemic and the major impacts to workers and the community, it has costs such as furlough, shelter in place, telecommuting, the dangers of still having to work in the office or [indiscernible] sites [indiscernible] or the [indiscernible], the need to sterilize offices, Office Locations daily, the stem of the public following the directive causing many to be infected [indiscernible] while maintaining distancing from staff and clients and the possible issues of layoffs in the future. We do not have time to wait for you guys to do a single pay. Thank you, your time is up and thank you so much. Natalie . Yes, president. And Board Members, i think that we will have to lim limit e Public Comments to one minute because most of these comments are not relevant to the particular agenda item and, job we have a lot of things to go through here. Next caller, please. Im against this and are you trying to take this increase out of my paycheck. Paycheck. Moderator. Operator you have four questions remaining. Hi. I dont have a question. I have a comment, as well. I think the majority of the working people working, im surprised theyre bringing this up right now, to decrease the copetecopay, this is really ous and i have to words to explain how we already feel as it is. And for you guys to be voting on something at this time in this crisis right now, we dont need the extra stress. Were already stressed to the max and the Economic System is very bad and will get worse. I would appreciate that you take this particular conversation im sorry, miss, your time is up and thank you for calling in. Thank you. Moderator, open up the phone line, please. Operator you have three questions remaining. Im a 1021 local union member and to address the hs committee and it was like, no, were dealing with too much as it is and for anyone to think about increasing our medical. Were struggling enough as it is. And thats all i have to say. Thank you. Thank you. Moderator, next caller, please. Operator you have two questionings remaining. Yes, i am working for hsa and i was shocked that the medical payment increased. I just feel that during this pandemic, its not supposed to be increased because i see a lot of people getting laid off and they are very stressed, so my comment is, to vote no for this medical payment increase, so please rely on commissioner to help out to support this medical copayment, not to increase. Thank you. Thank you. Moderator, can we please take next call. Operator you have one question remaining. Thank you for your time, everybody. I really appreciate it. I work at 1440 harrison street where we are constantly under pressure because we want to help out our clients. Wplease, we dont want to incur another copayment increase. Thank you very much for your time. To thanthank you very much,. Moderator, is there anyone left on the line . You have zero questions remaining. Thank you very much. This concludes Public Comment on item number 6, president. As for item number 7, im not so sure i needed a motion to change Public Comment to one minute instead three. I know ive seen it done at other meetings. Does anyone know if i need to do a motion for that . Lets just do it, karen. Theres no harm in doing it. Ive seen it did at other Public Meetings, but i dont recall them doing a public motion. This is commissioner scott and i would say that if were in the middle of a discussion item, that it seems to be a little bit offbalance, in the middle of that item and in the middle of that Public Comment to cut the time down, but i would say Going Forward as we proceed with this meeting, i would absolutely concur that we need to restrict Public Comment. Madam president , i just wanted to ask related to this, and just in terms of the order of hearing things, it seems we have a lot of folks calling in presumably on item 12 and i wonder if instead of limiting the Public Comment time, we might want to consider hearing item 12 sooner. I understand thats maybe the more controversial and longer one, but it seems we have a lot of folks on the line watching who want to address that particular item. And i think as we keep calling the earlier agenda items, well keep hearing from folks on that one. So rather limiting Public Comment time, perhaps we would want to take item 12 out of order and have folks speak to that item. How do the other commissioners feel about that . We have a lot of things to take care of. So that could take up an hour of our meeting. So how do the other commissioners feel about that . I think we need to understand our remind ourselves about the timetable under this agenda item. This has to go back to the board of supervisors at the end of june and i do think that if we are going to hold a discussion or recommend an alternative to any of the rates and benefits calendar items, because we have heard some addressing one health plan and others addressing all of the health plans that were considering today, then if we were to vote to hold the rates and benefits static for 2021, we wouldnt able to do that. We would have to go back to each of the health plans so we could hear what kind of services would be cut in order to accomplish that. And thats a point of negotiation from my standpoint. So i would want to hear more of a comment on that before moving forward. Because even if we move one agenda item forward, i think some of the comments have addressed all of the increases proposed to rates and benefits for all of the the different dih plans. So this is commissioner lynn and i agree with supervisor preston, i think, because if we move to item 7, 8, all of the comments will be related to item number 12 and holding up a lot of these items. So moving off of item number 12, hopefully when we go back to item 7 up to 11, most of the comments, most for item 12 will be done. So i agree to move item 12 right up before item 7. Well, any other comments . Any other comments from the director o . You know, i think its six one and a half dozen of the other because ive seen many of the Communications Come through earlier today and the messages are all similar and the public wants to speak. I think if we call the kaiser question now and let folks speak, i know youre considering limiting the comment to one minute, which would give us the opportunity to accommodate more callers because i know they dont want to sit on the phone either and that might be a good solution and well see how it goes. Ok, so are we going to move item number 12 up to our next agenda item instead of item number 7 . Is this a consensus and we limit the Public Comment to one minute . This is commissioner canning and one quick question. I think we should make a motion. Dr. Gant, moving item number 12, will the change in sequence affect the ability for us to understand the concepts that are likely involved in the previous five items on the agenda . If not, then i think there shouldnt be an issue with moving it forward. Commissioner, i think your point is well taken and that we have an overview of the medical plans that we could and its not an action item but to set the table for hearing the medical plan. We could defer and go directly into the plans and do kaiser first. This is commissioner howl anl and i agree. If we can take item 10 for the overview and then possibly take the kaiser item after that, i think that would give us a better context. Supervisor preston and i agree. This is commissioner kenning and we should hear item 10 first and then go into 12. So with that in mind, i would like to move that at the conclusion of this current item that we move item 10 on the agenda for an overall review and then after item 10, go directly, then, to item 12. This is commissioner scott and i second that motion. Ok. We making point comment one minute for the remainder of the meeting . Yes, of course. Im just asking, do we need Public Comment after this motion, which is usually what we have to do . This is supervisor preston and i defer to the other longstanding members that im not sure in terms of reorganizing the timing of the agenda that that requires a motion and i think that would be at the discretion of the president unless theres a unique rule on that that would require a motion. Ok. Then i am gobbin going to recomd that we take item 10 next on the agenda and after that, we will take item number 12 and, also, im recommending that we do one minute. So then we can go forward now, unless anybody has another objection. This is commissioner kenning and just for the record, ill withdraw my motion. Very good, thank you. Natalie, go ahead. Item number 10, leads. Please. Ill ask my producer to move forward to the item 10 slide. And then madam president , im going to wait about 30 seconds for the live tv foo feed to catp to what were doing. Ok. Out of order, theres item number 10 my apolog apologie, theres plan year for 2021 by mike clark from aon. Good afternoon, everybody. Im mark clark, actuary from aon. Before i commence on this item, i want to congratulate Vice President and mike scott and reappointment and commissioner lynn, congratulations for everything youve done and the entire community, thank you for your service and wishing you well in this last Health Service Board Meeting for commissioner lynn. So item number 10 is our health plan renewal summary for active employees and early retirees for the 2021 plan year and go to the next slide. So for the nonmedicare plans, these are for active employees and early retirees of the San Francisco Health Service system and this particular presentation summarizes the renewal actions that we are about to present for each of the three major nonMedicare Health plans and so the cycles renewal efforts into the 2021 plan year focused on understanding how plan costs in 2019 are impacting 2021 rating actions, as well as to enhance Member Support from sfhs support health partners. This table illustrates the rate change actions that are being proposed today. We show a beforeRate Stabilization adjustment column, which is the true actuary underwriting of the rate change for each of the four plans offered to active employees and early retirees and then because the blue shield plans and the United Healthcare plans are essentially selffunded, there is a Rate Stabilization fund set up for the blue shield and uhc plans and so, based on prior hsb approvals earlier in this rates and benefits cycle this year, we applied those rate stable adjustments which well talk about in each of the presentations to ultimately derive the recommended increases for blue shield and uhc that you see in the right side of the table. The Kaiser Program is fully ensure plan and there is no rate stable adjustment for kaiser. Next slide. Commentary on each of the proposed rating actions that well be reviewing with the Health Service board today, for the blue shield plans, the access plus increase is 3. 6 and the trio increase is 6. 3 . There were lower rate increases in the 2020 plan year, approximately 20 overall and these 2021 rate increases remain below expectations for access plus and are consistent with cost trend expectations for trio and are all derived from underwriting the 2019 health plan experience with associated fees and the programs forward to the 2021 year. For kaiser, a recommended increase of 5. 1le 5. 8 , followia 5. 9 rate increase that applied in 2020. The increase did include 1 for the return of the Affordable Care act in 2020. However, that tax is being eliminated permanently by the federal government now. And so, the underlying rate increase for kaiser based on the member utilization experience in 2019 would is been 6. 7 , but then removing the Health Insurer tax portion results in an increase overall of 5. 8 . We will in todays presentation present an alternative design renewal for Health Service board consideration that could potentially change two elements of kaiser plan design to match copayment levels now in the blue shield hmo plans. And then for the United Healthcare ppo, commonly known as city plan, we have calculated a 0. 9 aggregate increase across city plan and city plan not available which does reflect underlying trend increases from 2018 to 2019 and also reflects the portion of the rate increase 1. 5 of the 9 aattributable to stabilization by upping rates and how that applies from 2020 to 2021. Next slide, please. For grounding, this shows the distribution of the active employees and the early retirees in each of the Medicare Health plans offered b and you will se enrollment and 49 enrollment of the early retirees. Blue shield has most of the population with the city plan and city plan choice not available representing 2. 5 of active employees and about 14 of early retirees and these are figures that were included in the 20 demographics report presented to the Health Service board in february of 2020. Mexico slide. Next slide. In my final slide for this presentation shows the 2021 total monthly rates for each plan and these are shown in this exhibit purposes to the nearest dollar. Although rates are to the nearest cent, as well as how the total plan rates would distribute to employer contributions and member contributions and that is based on the city county of San Francisco active employee formulas and for early retirees receiving the full city charter formula employer contributions. And youll see in the footnotes, cpcna stands for city plan choice not available and these rates above are for a statusquo design, noDesign Change scenario and that concludes my presentation. President , breslin, to you are speaking, you are muted. Are there any commissioners thoughts on this . Otherwise, ill going directly to Public Comment. So it looks like we go directly to Public Comment. Again, as a reminder, we will be holding approximately for 30 seconds to allow callers to discuss this particular item. The medical renewal overview slides that were just presented. We will begin Public Comment for item number 10, the medical renewal overview slides that mr. Clark presented. This will be done in the next five or ten seconds and there will be silence while we wait for other members to populate the line queue. If youre on the line, press 10 to get to the cue. Moderator, will you please open up the phone line for our first caller. Operator you have five questions remaining. Hello. This is anna from dhs and my question is was this set up and youre voting on it now based on last years economy, based on what happened in the last two years . Because right now, this is not the time for that and for the poor working people to get that high amount and they wont be able to pay for this. They cant pay for medications now and they wont receive the healthcare because the payments will be high. Are you done with your Public Comment . Yes. I just wanted to say that im a Union Officer and im against the discussions that were having now. Can we talk about it and negotiate about it . Because you already made a decision that youre voting on it today and this is the first time im hearing about it. I appreciate your comment. Thank you very much. Thank you. Moderator, the next caller, please. Operator you have five questions remaining. Thank you,. inaudible . Why this is 7. 5 after stabilization . And im not sure i understood from mikes presentation why that is so high for city plan. As you see, theres a number of retirees in city plan and the number of actives diminishes significantly all of the time, but we have at least 14 and many early retirees vote into city plan for a thum number of reasons and a lot of them move out of the area. But given the situation thats going on, by the way, actives have been canceled, i understand. And when i look at these increases, 20 for city plan seems your time is up for the Public Comment. Thank you. Pomoderator, the next caller, please. And i want to remind everyone this is a oneminute Public Comment. Thank you very much. Operator you have five questions remaining. Hi. My name is debbie and im a San Francisco voter and civil servant. I implore you all to reject any and all items that increase rate for healthrelated benefits to public servants. We serve the public. We expose ourselves to everything. Were disaster workers and we should not have to of all people, we should not have any increases to our health benefits. So i implore you to vote against any and all increases. Thank you. Thank you very much. Moderator, can we have the next caller, please. Operator you have three questions remaining. Hi, this is deborah grabell with local 21 and i want to make a comment about the proposed increases on kaiser and the proposed design plans on the copayments, specifically utilizing more money more hospitalized in the time of covid19 seems outrageous and immoral, the same with outpatient surgeries. These are not things People Choose to have happen to them and even though kaiser is crying for it, they made millions of dollars and we dont think these increases should be passed on to working people in San Francisco. Pair operato please stand by we cannot afford that, and this should be an item that we all take, you know, very seriously and from working with works on the front line are those of us working at home. Again, i think it should have been avoided to allow the time to be the same or those who need treatment get what they need to pay. To put it down to one minute i appreciate your comment, miss, but your time is up. Thank you. Thank you. Madam secretary moderator, can we have the next caller, please . Operator you have four questions remaining. Hello. My question is this is a pretty quick turnaround for this price hike. Theres no i have not been given any jurisdiction for this. [indiscernible] actual doctors and staffing. That is all. Madam secretary thank you, sir. Moderator, can we have the next caller, please. Operator you have four questions remaining. Madam secretary hello . If there is someone on the call, can you please begin your Public Comment . Hi, yes, i am speaking as a resident of San Francisco. Given the current state of our national and local government, hiking up the costs for our most valuable Health Care Workers is totally unacceptable. Im asking that the Health Services board vote against any increases to Health Premiums for our most valued workers here in San Francisco. Thank you. Madam secretary thank you very much. Moderator, can we take the next caller, please. Operator you have four questions remaining. Hi, yes, my name is amy. I am a Mental Health human specialist at the San Francisco Behavioural Health center, and i do not agree with the increase for the copay for the kaiser, as well as for any insurance [indiscernible] people. Again, i agree with a lot of the folks who have been calling in about the rate increases. We have to protect our frontline people, and the city and county of San Francisco employees have been really diligently working hard to protect the community, and i think its really about time to really protect the Health Workers, community, and keep everybody safe. So please do not, do not vote to pass copays for any Health Premiums or copay with insurance company. Thank you. Madam secretary thank you very much. Moderator, can we take the next caller, please. Operator you have five questions remaining. Hello. Thank you so much to all of you for listening. My name is mary mcgee. I was a registered nurse with the department of Public Health for 32 years. I recently retired. I cant say enough good things about the staff there. I think its one of the bestrun departments in the city. I am calling because im deeply concerned about the possibility of rate increases. There is an article in the paper today about 3,000 City Employees being deployed [indiscernible] service workers. They are being thrust into jobs they have never done before, incredibly stressful, different shifts, different responsibilities, not a lot of direction or coordination in the midst of these chaotic times, so this is very much the last thing that workers need financially or psychologically, the increasing of rates. It will affect retirees and will madam secretary thank you, miss, but your time is up for Public Comment. Thank you very much. Thank you so much. Madam secretary thank you. Moderator, can we have the next caller, please. Operator you have four questions remaining. Thank you, operator. My name is derrick stan. Im an engineering associate, a union member and opposed to copay. Many businesses have had to make rapid cuts to meet the demands of the positions of sales. [indiscernible] are in positions that places them in direct potential risk all the way [indiscernible] delay. We have been uprooted, potentially placed in harms way and now [indiscernible] during troubles times like this is neither fair nor just and thats why i oppose the idea both as a worker and as a person. Again, thank you for your time. Madam secretary thank you so much, sir. Moderator, can you please take the next caller. Operator you have four questions remaining. My name is sophia alvarez. I oppose the commission taking any moves to increase any copay rate increases. Please listen to the nurses who are adamantly against this. Their voice [indiscernible] continued stabilized support from you against any Rate Insurance increases, the risks the Health Care Members that are delivering services, your Insurance Companies will, of course, continue to push for rate increases. Vote in the interests of the members and our community. The seniors are on fixed income. They cant afford any further increases. Thank you. Madam secretary thank you very much, miss. Moderator, will you take the next caller, please. Operator you have four questions remaining. Hi, my name is john seagrave. I work for the city and county as a technical engineer with public works, and i am a union member of local 21. Im very disturbed and concerned by any and all attempts to increase our copays now at this extremely critical time in the middle of a pandemic. As a worker who depends on my employerbased health care as part of a workforce that makes it possible for the city to fight covid19, its concerning and alarming that im told that i must pay more in case i get sick in the process of helping the public during this difficult time. I oppose this increase. Thank you. Madam secretary thank you very much, sir. Moderator, can we take the next caller, please. Operator you have four questions remaining. Hi, my name is aubrey karson and i work at San Francisco general hospital, and i absolutely oppose any rate increases at this time. Everybody is going through economic strife right now, and my family is also affected. My households down 4,000, and ive had to pull two children out of daycare and im having to work 20 hours extra a week just to financially compensate for what were going through, deferring as many payments as possible. This couldnt have come at a worse time, and i know my family isnt the only one thats affected, but to make a decision like this would be incredibly selfish and ill timed, and that is my comment. Madam secretary thank you, miss, for calling in. Moderator, can we take the next caller, please. Operator you have three questions remaining. Hi, this is president of local 21, and i want to echo with regard to so many of our members and members of other labor groups and nurses that this is not the time for the rate increase or for the increase to copay. Health care is critical at this time. This is not the time to make this kind of adjustment, and i ask the board to reconsider the motion, to vote against the motion, rather. Thank you. Madam secretary thank you, sir. Moderator, can we take the next caller, please. Operator you have two questions remaining. Hi, my name is theresa rutherford. I remember sciu 1021. Im one of the vicepresident s, and again, we urge you to vote no against rate increases and any increasing in copays. As my fellow Union Brother said, this is not the time for this. Its San Francisco. We are asking you to show the federal government, show the person in the white house what it is to lead. Please lead on this. This is not the time to penalize frontline workers who are doing the work, and their families and [indiscernible] by having [indiscernible] paying their bills as opposed to delivering the excellent service. San franciscos been leading. Please lead on this. Do not allow kaiser, blue cross and all these [indiscernible] to bamboozle you into supporting something that is going to harm us [buzzer] madam secretary im sorry, miss, your time is up on Public Comment. Thank you very much. Moderator, can you take the next caller, please. Operator you have two questions remaining. Hi, Rudy Gonzalez, San Francisco Labor Council representing 130 different unions here in the city. And among them, the 33,000 approximate city workers in our Public Employees committee. I think its important as you talk about this agenda item overall plan review that we remember that kaiser is a prepaid system. They lack transparency with regard to their rates for these systems. They have posted in the First Quarter of 2019 3 billion in net income, billion with a b. We have seen massive creases to their revenue increases to their revenues, capital planning. This is untimely and i think we need to distinguish kaiser, especially in this conversation, from the other selffunded plans. When they increase rate utilization, they are trying to deter people from using prepaid services. Its absolutely immoral, particularly with Public Health crisis in this unprecedented challenge we face as a city. Thank you. Madam secretary thank you very much, sir. Moderator, can we take the next caller, please. Operator you have one question remaining. Hi. I am so much opposed to this increase. Theres a lot of people hurting, a lot of families hurting, such as mine, in this pandemic. Have some compassion. The workers, everyone on the line [indiscernible] the workers, its time to protect the health care employees, and this is not the time to [indiscernible] please hear us. Please do not vote on this motion. Please have mercy and please with compassionate. Show your humanity. All of your voices and all of your City Employees, thank you. Madam secretary thank you very much, miss. Moderator, can we take the next caller, please. Operator you have zero questions remaining. Okay, we had planned president breslin okay, we had planned to take a break after item no. 9, but here we are down the road here, and i would just i guess everybody is ready for maybe a 10minute break . Madam secretary commissioners, would you like to take a break . Supervisor preston i have some questions related to this agenda item. Im happy to take them after a break or before, whatever is the pleasure. President breslin item no. 10 youre talking about you have some questions about . Supervisor preston yeah, just some clarifications for mr. Clarke, our director. President breslin why dont you do that now, and then well take a break, before 12, item no. 12. Supervisor preston yeah, thanks so much. So just in light of listening to the Public Comments, as well as my own review of this, i just want to make sure i understand whats before us here. So the clerk or the president could clarify for me, when we are talking about the rate increases that you showed us in the final slide, are any of these costs that would be borne or paid for by members, by the employees, or are these costs to the city . Mr. Clarke, you are muted. Youd have to unmute your mic. Hopefully you can hear me now. Madam secretary yes, we can. Supervisor preston and if youd like to clarify, im setting aside the issue of any increases to copays. Im just interested on the rate and premium issues you raised. Are any of those costs that employees would pay . Yes, so for both active employees and early retirees there are specified costsharing distribution formulas on how total rates are allocated between employer contributions and member contributions. For the active employees, they are guided by agreements between those employee groups and the employers. For the early retirees, those formulas are guided by city charter formula, and so as we go through each of the individual three presentations for kaiser, blue shield and United Health care, i will speak to the application of those city charter formulas provisions for the early retirees and the active employee contribution determination provisions, specifically for the city county of San Francisco employees in my discussion documents. But the other employers in San Francisco Health Service system, in addition to city county of San Francisco each have their own individual active employee contribution distribution formulas as well. Supervisor preston got it, thank you. And so well get into it i guess a little more with the individual items and look forward to that, but just more generally had a question, again either for mr. Clarke or director yant, typically in prior years is item no. 10 this overview usually presented to the board first and then at a subsequent meeting the various items in which we wrote to approve . And i fully understand that obviously in the last two months here we have all things have been turned upside down, so this is not meant at all as a criticism of these being all on the same agenda, but it just strikes me, and again as a newer commissioner, but it strikes me that its very helpful to get this presentation on item 10 and hear the Public Comment in advance of actually voting up or down on the rate proposals that youll be getting at later, and to the extent that that stragering is usually the way it would be done, i just for other commissioners benefit, i want to be upfront that to the extent that any of these future items were going to be hearing on the agenda impose any increases, whether in copays or in rates that in any way could be passed on to employees i would be hoping to continue those items so that we can digest that and get further comment. Has that been the practice in the past . Is it usually staggered in that way . Im happy to speak to that. Thank you for the question. So historically we present the nonmedicare rate renewal for Health Service board consideration in may and the Medicare Program renewals in june, and that timing is based on when the data becomes available from blue shield and United Health care for aeon to complete its underwriting and prepare the rates. So that typically finalizes the end of april. So may is the first opportunity to present for blue shield and United Health care. And then for the kaiser rates, we receive those from Kaiser Permanente usually around the middle to towards the end of april, and so again may is the first opportunity. This overview presentation that i just completed, item no. 10, is actually something that was introduced last year for the first time. Historically weve only just presented the actual rate renewal documents that im about to go through for items 11, 12 and 13. I credit executive director yant last year for suggesting that we also create this overview document at the outset of the presentation of each of the specific renewals. So for instance here in may we present this as a prelude to the specific renewal discussion document for blue shield, kaiser and United Health care. Well do the same in june as a prelude to discussing the two medicare renewals for Kaiser Permanente, senior advantage and the United Health Care Advantage ppl. I hope that helps to answer your question. It does. Thank you. Its very helpful, and i know were headed into a break. I never want to be the one standing between everyone and a break, but at the same time, i just just want to say, and you know, well get into individual items, but the comments from the callers very much resonate with me, and i think in my role on the board of supervisors i have taken a very strong stand around things like muni fare increases during this current situation. I think similarly the idea of passing on and increasing any of these costs right now on city workers and essential workers is one that does not really does not sit well with me, but i suppose we will take that up in the individual items that come next, and i appreciate the overview. Thank you. President breslin okay. Well have a break now, and no more i should say 10 minutes, this is commissioner hao, im here too. Madam secretary thank you all for confirming. Well wait another minute, president breslin, just to make sure everyones here. President breslin right. Supervisor preston supervisor preston, im on. Commissioner scott commissioner scott, im on. Madam secretary thank you, commissioners. President breslin okay. So item no. 12 then. Madam secretary item 12 is the review and approval of the Kaiser Permanente nonmade care rates and premium contributions for the active and retiree members early retiree member plan year 2021. This is an action item and its presented by mike clarke from aeon. Mike clarke from aeon, and if we could go to the cover slide. I am going to present today the Kaiser Permanente 2021hmo rates and premium contributions, active employees and early retirees. Next slide, please. This outlines the contents of the discussion. I will review the renewal and review two design alternatives, one that proposes changes to two copays to match those of the blue shield of california hmo plan designs and also status quo design for 2021 if no plan Design Changes were made from 2020 to 2021. Then well move to review of the rate cards and present recommendation for Health Service board consideration. And you can see the items that we have in the appendix that we may refer to during the course of the presentation. Next slide. So the preview the recommendations, approve a 5. 6 insured program increase from 2020 to 2021 for active employees and early retirees in california who are enrolled in Kaiser Permanente, which includes two changes in the kaiser plan design to match the copays in the existing blue shield plan design. I will also review what the status quo rate renewal looks like as well. And then to ultimately approve 2021 rate cards for the selected approach to plan design chosen by the Health Service board today. Next slide. The kaiser rates and premium contributions for actives and early retirees are included, as well as the active employee rate cards for the two most common employer contribution strategies as of the start of the year for the city and county of San Francisco employees. So commonly referred to as 939383 and 1009683, where the first figure is for the employee only tier, the second figure is for the employee plus one tier, or also known as twoparty. And the third figure is for employee plus two or more dependents. There are multiple employer contribution strategies for active employees across the employers who are participate. In this particular material we focus on these two employee contribution strategies for stoi county of San Francisco employees. Next slide. We should be on slide 118. Just one second, mike. Ill be right there in a second. Thank you. Thank you. So i will continue. So this page outlines the renewal summary without any plan Design Changes. The 2021 kaiser premiums for active and early retirees are increasing 5. 8 for the medical and pharmacy coverage, and like i mentioned earlier, this follows a 5. 9 rate increase for the 2020 plan year. The rate increase is being driven by kaisers claim forecast on a per member per month basis based on their underwritings from 2020 plan year to 2021 plan year, and there is a higher increase in the claim forecast than has been experienced from prior years. This resulted from higher increases in member utilization of the Kaiser Health plan by sfhfs members from 201819 than has historically been seen in kaisers data for sfhfs. The rate increase is helped by the permanent elimination of the Affordable Care act Health Insurance tax into 2021 after applied in 2020, so this creates a 0. 9 rating offset to the overall renewal, the rate increase would have been 6. 7 before considering this federal tax elimination. We have provided underwriting detail in the appendix that documents the 5. 8 status quo renewal in this presentation. Next slide. And we discuss an alternative plan design quotation for the 2021 plan year for two primary reasons. First, to lower the initial rate increase from 5. 8 and to consider plan design parity with the blue shield hmo plans in two areas inpatient hospital admissions and outpatient surgeries. For context, the Kaiser Permanente designs have remained at the same level since 2013. Due diligence is to periodically review the plan design relative to benchmarks, and we last presented design benchmarking to the Health Service board in march of 2019. We did not this cycle, just due to the april meeting cancelation, but those benchmarks have remained largely the same from 2019 to 2020, and i will refer to those benchmarks shortly. We make periodic recommendations ultimately in our recommendations to the Health Service board. It is ultimately the Health Service boards prerogative to either accept recommendations that the actuary makes or proceed with the status quo and the rate renewals that result from status quo plan design. If you look at this chart at the bottom of the change, the design value of the sfhfs kaiser hmo plan is substantially higher than the plan value in kaisers book of business, and this was a leading reason behind evaluating potential to consider plan Design Changes for the 2021 plan year. Next slide, please. So this alternative plan design would result in a 5. 6 increase for the kaiser hmo ending 2021 representing a 0. 2 reduction or 699,000 lower premium in total versus the status quo renewal, and based on the costsharing formulas alluding to the discussion in response to supervisor prestons questions earlier would allocate 72,000 members the 72,000 to members in the form of lower contributions from what they otherwise would be under status quo and 627,000 to the employers. Next slide. This is the sidebyside comparison between major plan design components showing the blue shield plan designs and the kaiser hmo plan designs, and again, with focus on the which plan design alternative presented in this discussion. Next slide. I alluded to benchmarking. This is benchmark data we reviewed in march of 2019 with the Health Service board looking at the plan design copayments for inpatient hospital and outpatient surgery for the sfhfs kaiser hmo plan today, the sfhfs blue shield hmos and benchmarks for government and national. Next slide. And this compares the copayment costs under both the present design and a proposed member copayment should they change relative to the average 2019 total cost per service incurred by sfhfs members in the Kaiser Permanente program. Where that average total cost of service, in total, for inpatient hospital was approximately 44,000 per inpatient hospitalization, and for outpatient surgery was 4,258. And so the percentages youll see next to the copayments show the percentage of these copayments in relation to the average 2019 total cost for service for each of these two services for sfhfs members. And at the bottom youll see the percentage of members reported to us by kaiser having each of these services in 2019, 4 of the covered members having an inpatient hospitalization, 18 of covered members having an outpatient surgery in 2019. Next slide. So next well talk about the rate cards. When setting the total rate card premiums for kaiser active employees and early retirees, we consider those fully insured plan premiums that are provided to us by kaiser, the basic plan vision premiums which are unchanged from 2020 levels as approved by the Health Service board in the march 2020 meeting, and the Health Care Sustainability fund charge of 3 per employee retiree which is unchanged from 2020. The rate cards include the employer contribution amounts based on the city provisions including the monthy county average actuarial difference and the employer contribution amounts, and we have prepared rate cards under both plan design alternatives for the Health Service board to consider, including the status quo, no change plan Design Change rate cards, as well as rate cards that would occur should the Design Changes happen. Next slide. So lets actually go to the recommendation page and then we can review specific rate cards based on questions i may receive from the commissioners. So the staff recommendation again is a 5. 6 insured plan premium increase from 2020 to 2021 for the active employees and early retirees in california and kaiser which would include the two plan Design Changes i spoke about earlier. And then the resulting rate cards that would result from those changes. The alternative should the Health Service board decide to recommend retaining the current plan design and not implementing copayment changes would be a 5. 8 insured plan premium increase from 2020 to 2021. And so anthony, if i may, ask you to go to slide 135 so i can show the Health Service board what the rate cards would be first for the early retirees and the 93 93 83 contribution strategy for active employees under a status quo plan design. And then page 136 would be the rate card for the early retirees and 100 96 83 contribution strategy for the active employees. And then, anthony, if i could take you back two prior slides to 133. These would be the resulting changes in monthly employee and retiree contributions in the first block, so monthly employer contributions in the second block, and the monthly total rates in the third block if the status quo plan design were to be adopted by the Health Service board today with no plan Design Changes. This specific page showing the changes for early retirees in the 93 93 83 contribution strategy, and the next slide. This would be for early retirees and the 100 96 83 strategy. So, anthony, if i could take you back a couple slides to the recommendation page, please. And with that, i have concluded my presentation. President breslin, feel free to ask the commissioners if there are any questions for me on the presentation today. Commissioner scott this is commissioner scott. President breslin, i do have a question of mike. President breslin go ahead. Commissioner scott mike, you say that theres been a higher level of claims utilization by members of the kaiser plan this year versus what has been the usual pattern, and my question is is there some sort of smoothing process . Did they just take one years activity and just move it and focus on this or did they take this over a period of time . In terms of their rates for this particular year . Thank you for the question, commissioner scott. So kaisers underwriting process compares calendar year 2018 data to calendar year 2019 data because this is a large membersized population, its what we call its an insurance term, but it is fully credible, which means that the plan experience for sfhfs forms the basis of the underwriting process that kaiser exercises as they review the changes and costs in member utilization from 2018 to 2019. They do so specifically in this particular renewal the largest portion of services that resulted in this rate increase were related to outpatient care, and so Services Like physician visits, outpatient surgeries, outpatient Behavioural Health care, laboratory and radiology. So those were the services that tended to contribute the most to this level of increase in the renewal followed by inpatient care, inpatient hospitalization was the second largest portion of the increase of the four Major Service categories. Pharmacy was actually a relatively modest increase from 2018 to 2019, so pharmacy figured least in the renewal increase, and then there are other services, such as ambulance, durable medical equipment, things of that nature that are also considered in the total evaluation of the cost and utilization comparison between their 2018 data and 2019 data for sfhfs members. Commissioner scott so were in a catch22. The practice of medicine here in the United States is being driven to outpatient settings for all kinds of procedures, and so youre saying that because it happens to be both the practice of medicine at kaiser that does these procedures on an outpatient basis and we have more of them, therefore were being charged more. Would they prefer that we go back to an inpatient setting for these procedures . Commissioner scott, excellent question. I would have to defer that to a kaiser representative. Commissioner scott but i mean its sort of like a zero sum game. And then lastly youre telling me that were just looking at a calendar year period. There is no over time look in terms of both the experience of claims and so forth. So they are saying that what they experience in the outpatient setting this year was unusual, but they dont want you to compare it to any other period. Yes, and i will say that certainly my role as actuary for the Health Service board and San Francisco Health Service system, i keep detailed records of plan utilization over a multiyear period, and we do discuss that multiyear of history as we engage in conversations about renewals with the Kaiser Permanente team. Commissioner scott well, i would say at this point that id like to hear more from them about this, and i am not persuaded that this oneyear change in these copays is going to be sustainable. It will be another its like toothpaste in a tube. We make this change this year, and the next year we got to do Something Else to try to lower the rate. Based on what youve just told me, thats not going to happen. Outpatient utilization is going to continue to climb because of the way medicine is being practiced at kaiser, and in these other health plan settings. So im not in favor of the copay changes in any way just to offset the premium reduction for this year. If were talking about practice and a longerterm view, then i might be persuaded to do Something Else. Thank you. President breslin any other comments from commissioners . Commissioner follansbee yes, i have a couple questions. One is could you i think you alluded to it in the past, but could you review health care is going up everywhere. Its not just Northern California. Its not just kaiser. Could you maybe review for us what the Health Care Costs are predicted to go up, you know, nationally and Southern California, Northern California in 2021 so we can put some perspective on this rise . Thats question number one. And then when i look at what are the components of the members contribution each month, theres a 3 Health Care Sustainability fund of 3 per person per month, which if we im not suggesting it, but im saying we probably should review in this meeting what that covers, because obviously if we just turn you know, we do have discretion to go to zero, and that would actually eliminate the increase for all the members in the ee and ee plus one category who have contributions. So maybe if those two questions could be addressed. Yeah, thank you, vicepresident follansbee. Im happy to address the first question and then would defer to the sfhfs team to discuss the Health Care Sustainability. So for National Trends at present, aon is seeing a National Trend figure, which means annual increase in cost one year to the next for health care, of 6 . So this is inclusive of both medical care and pharmacy, and both are increasing at a similar 6 trajectory at present. And in Northern California we do know that the average cost of health care in Northern California is unfortunately one of the highest of any market in the country. I know we reviewed last year with the Health Service board some statistics that demonstrated the position of the Northern California market relative to several others across the u. S. And in that particular discussion, Northern California was exhibited to have one of the highest per capita costs for health care of any market in the United States. So im happy to continue answering followup questions on that before we go to sfhfs for the questions on the sustainability fee, if you have further questions, vicepresident follansbee. Commissioner follansbee no further question. I just want to point out that as much as we would like to fix all health care in the country, you know, we are a part of this dilemma, and we need to take ownership to our part. Again, i think we cant fix the fact that Health Care Costs are going up everywhere across in both Northern California, Southern California and across the country, and we need to operate in that context. Good afternoon. This is pamela levin, chief Financial Officer of the Health Service system. The Sustainability Fund covers all of our communication to all of our members. It covers all the cost of open enrolment. It covers the cost of wellbeing programs that are offered to all four employers. It covers the cost of the all payers claim database thats used for collecting statistics on our membership and risk scores and helps determine and verify claims from the health plan. So elimination of that would essentially reduce the staff by three no, six people, and then we wouldnt be able to do open enrolment because theres no funding in the general fund. Ill be happy to answer any questions. President breslin any questions of pamela . Commissioner follansbee no questions of me. That helps clarify, just as we look at everything on the table here. Thank you very much. President breslin do any other commissioners have a question of aon . Commissioner canning yes, if i could almost piggyback on commissioner scotts questions, this is related to the method of measurement of mr. Clark. Are you aware if kaiser is consistent with their method of measurement comparing year to year . Or have there been any changes or modifications to how they are measuring their data . So my understanding so the underwriting methodology itself is consistent from one year to the next. I do know there were recent changes within kaisers systems on how they collect the data thats ultimately flowing through underwriting. I would have to allow a Kaiser Permanente representative to speak to specifics of that. Commissioner canning thank you, and then another followup question more broadly. As it relates to the utilization costs of the kaiser in particular, what has been some of the driving factors as to the result of their calculations . Yeah, so one thing in particular that we observed in evaluating the comparison of 2018 to 2019 plan experience for sfhfs is a higher utilization of behavioural Health Services that presumably have come from some expanded ability within the Kaiser Permanente system to deliver on those services. And so we did see both utilization as well as unit Cost Increases related to mental Health Services in the Kaiser Permanente system. So that was one particular aspect that we observed in evaluating the underwriting from 2018 to 2019 for Kaiser Permanente. Hi, mike. This is commissioner hao. How are you . Good. Commissioner hao i have a quick question also piggybacking on commissioner scotts last comment. Was there any kind of longterm sustainability thought given to the inpatient hospital and outpatient surgery copays . Yes, from our perspective we produced those recommendations on a couple bases. So one was in a relational comparison to the blue shield hmo plan design features. Again, noting that we suggested consideration for plan design copay increases for the inpatient hospitalization and outpatient surgery components of care but not the other components where there are differences today between Kaiser Permanente and blue shield, and there are others such as physician copays as an example. Also just in periodic review, and again diligence review to benchmarking data that both we produced from a specific copay standpoint that we reviewed in this presentation, as well as just the overall distribution of cost incurred by members in their copayments relative to the claims being paid in those plans as we looked at earlier in the chart in this presentation as well. So it was those multiple inputs that led to us suggesting possible plan Design Changes into 2021 for Kaiser Permanente as a possible way to lower somewhat the proposed rate increase that was originally proposed by Kaiser Permanente on the current plan design. Commissioner hao okay, so i think i heard a couple of things from you that jumped out. Utilization, also comparability with blue shield. And comparability to government and National Benchmarks that aon produces. Commissioner hao great, thank you so much. President breslin any other commissioners have questions or comments . Commissioner lim this is commissioner lim. Based on the ten years that ive been with the Health Service board, we have never benchmarked kaiser. So i mean, the copays, all the copays, we have never benchmarked it either to blue shield or United Health plan before or the city plan. Kaiser has always been, the copay has always been in the past i think my memory serves me that like on the sfhfs basis, the member before used to pay only 5 while on the blue shield the member pays 10 or 15, but we never benchmarked any of the copays to any other plans. And based on the presentation by mike, thank you, mike, the members that are utilizing inpatient hospital, at least its around 4 or based on the total membership of 55,000, thats 2,200 of members, the inpatient hospital admissions, the copays will increase by 100. And on the outpatient surgery, thats close to 10,000 patients, based on current utilization, who will be paying an additional 65. But in terms of premium i mean, the difference is the premium between a member will be paying 65 for outpatient surgery or 100 more on the copays for inpatient hospital admissions, but the difference in the monthly premium for the member only is only 8 cents, which is only 96 cents a month and then 9 cents or 1. 08 for a whole year for a member plus one or 55 cents for a member plus two. That would give the city 627,000. The members will be paying this now copay of 100, an additional copay for the outpatient surgery of 35, and all of the savings, its a the city will benefit for all of those, and its at the back of the members who are going to an inpatient hospital and paying 100 and all of the benefits, the increase will be to the benefit of the city. [indiscernible] i dont plan to vote on the plan Design Change for an increase in the copay. Thank you. President breslin any other commissioners . Supervisor preston yes, supervisor preston, and i strongly agree and really appreciate the comments of commissioner lim who i think laid out really well some of the problems with the attempt to lower the rates by increasing the copays, and i think thats highly problematic to at this time, and especially amidst this Health Crisis, which is going to be with us for a while, the idea of doubling hospitalization copays right now i think is not something that i can support. So i think, you know, certainly as with the two proposals laid out, you know, would strong i find myself rarely if ever, for whose who know me as a democratic socialist, i rarely say that i prefer the status quo, but the status quo design is far preferable, in my opinion, to the other. I do think, though, that, as i referenced earlier on when we were discussing item 10, i think there could be some benefit to putting this item over til the next meeting for a number of reasons. First, i think there are a few answers that are understandably outside mr. Clarkes areas he can speak on, and youve referenced that kaiser representatives would be better suited to answer some of those questions, and i think it would make sense to have kaiser representatives addressing some of those issues, some of those longerterm policy issues, at the next meeting before taking action on this. I have some additional questions, but again, i think are probably outside the scope of mr. Clarkes expertise, but are very troubling to me as were considering potential approval here around some kaiserspecific issues, specifically reports, numerous reports regarding the use the reprocess in 95, respirators for frontline Health Care Workers and the policies around that that are very concerning that i would like to have more information on from kaiser directly in terms of their policies and their provision of new p. P. E. To our folks who are on the front lines at kaiser in this crisis. So i have a lot of questions in that regard. I also have would very much like the opportunity to talk with representatives of the many folks who have been calling in, from our Public Sector Union Leaders and make sure that were all on the same page before moving forward to approve this contract that impacts more than half of the city workforce. So i dont know if it would be the appropriate time or if theres more discussion to be had, but would like to move to continue this item to our next meeting before taking action. President breslin any other comments from commissioners . Id like to make a comment myself. One thing i didnt like about this was matching copays with blue shield. Members need a choice, and if youre going to have the same benefit in each plan, then youre losing a choice. And blue shield is quite expensive in general, and especially for early retirees, and the i just to me, thats that idea of matching that. And then the idea of doubling the copay for the hospital and then tripling it for the outpatient surgery was really extreme to me. But i just didnt see any reason to match up with blue shield, or any other plan, since we have very few choices right now, you know. Basically you have kaiser and you have blue shield, and a lot of people cant afford the city plan because of other things. So our choices are very limited right now, and this kaiser as possible. I would like to ask our director about trying to continue these items since we do need to get this whole we have now only kaiser. We have blue shield and we have the city plan that we have to get through with our rates on in order to for june. So i would like to ask executive director yant to comment on that. Yeah, im hearing all of your concerns and share them because we do have a very hard timeline to meet to get the entire package approved at the board of supervisors in july. And so we do have a hold on the calendar for the 28th of this month, of may, that we could exercise to do some additional work on these approvals, because we do have the three medical plans, as well as some other products to approve. I defer to your request and how best to utilize the time we have today, and then i also, supervisor, would like to get very clear on the questions that you would like us to facilitate having kaiser respond to. So that would be helpful as well. Supervisor preston yes, and thank you, director yant. And i recognize the timelines are tight here and obviously the crisis Health Crisis has interfered with our ability to meet. So i appreciate that we will need to move that conversation along. I just feel, and colleagues feel, that as the one who will be carrying the package to my colleagues on the board of supervisors would really like to particularly make sure that we not only get answers on some key questions ive mentioned from kaiser directly, but also have had time to really review this in a little more detail with our labor leaders, and i would hope that we move forward with a package thats that they are on board for and we are all working together. President breslin the only other commissioner scott excuse me. This is commissioner scott. I think that im not im in favor of possibly delaying this, but i think that we should go on record today actively saying that we dont want to consider any of the copays so that that doesnt drag into another round of conversation here. So that would be my only condition if we defer this to another time, that we take that out of the equation today and do that as a unanimous consent, if you will, with this deferral so that were looking at the status quo design and issues around that, issues around the renewal process with kaiser, the other operational issues that youve raised, supervisor preston, but take out of this equation and further discussion any comparative to blue shield or copay increases or that plan design. Commissioner hao this is commissioner hao, and i hear the passion in your comments there, commissioner scott, and also president breslin, but actually as a consumer, for me its actually easier to compare features of Different Things when they are similar. So im actually open to considering the plan Design Change because particularly if it drives towards the end of providing highquality and sustainable plans for our Health Service members. Commissioner follansbee this is commissioner follansbee. Just a couple of comments. One is that, again, you know, were not operating in a bubble here, and theres been a huge move over the last several years to actually move primary care out of the emergency room in fact to the appropriate settings, and one of the ways to do that is to address the issue of the copay for emergency room visits. I remind everyone that the copay of 100 for emergency room visits is actually forgiven or not imposed if the member is, in fact, admitted. Now granted theres a 100 onetime fee for admission, but you know, again, in a national perspective, they are trying to limit the rising costs of health care to everybody. One of the moves has been to actually move primary care and urgent care thats not truly Emergent Care out of the emergency room. And the other thing that i wanted to comment on is if were going to ask [indiscernible] weve been proposed only two options to try to lower the burden of the rise in Health Care Costs, both to the members and to the city. And but most of the speakers spoke to zero rise in copay for the time being, and i guess if were going to address that, which goes across not only kaiser but all the health plans, we need to know what the implications of that would be in terms of service if we were to want to impose a zero rise in health care premiums, not only to kaiser, but across all the health plans. President breslin anybody else have a comment here . I would like to say that i agree with commissioner scott about taking the increased copays off the table and Going Forward if you need more information on the rates. But i understand that there might be needed some rate increase, but i agree with that idea. So if you would would you like to restate that motion to include that part of it, that we take that off the table and go forward with the status quo and get more information . Yes, thank you, president breslin. I restate motion to continue item 12 to our next meeting for consideration with with the item amended to exclude the Design Changes that would increase copays. I second it. Its commissioner scott. President breslin did i hear commissioner lim Say Something too . Commissioner lim this is commissioner lim. I second the motion of supervisor preston. President breslin okay. All right. All right, so now we need Public Comment on this item. Madam secretary so i want to apologize for everyone who is watching this on sf gov tv and participating today, but we are having technical issues with the at t conference line. We are assuming that there are so many people on the line that it has crashed. Currently i am working with dtsf gov tv and our moderator to get it back online. So i cannot take any Public Comment through the line at the moment because its not connected. We are working on that and trying to get it back up, but i cant give you an exact timeline of when the at t conference line will be available at this moment. President breslin eric, are you here . Our counsel . Yes. I am. Can you hear me . President breslin yes. Are we able to vote on this without being able to do the Public Comment considering the circumstances . No. Lets see where we are . I mean, i think you can obviously youre effectively continuing the matter no matter what, right, if you dont have a even if you didnt do a vote. You would be continuing the matter, by definition. Commissioner scott eric, this is randy scott. Given the fact that we now dont have a clear view of how we get Public Comment, lets take this out of the present motion and talk about the balance of the meeting. How do we proceed . Commissioner lim so eric, this is commissioner lim. I think the motion of supervisor preston is just to table this item to the next meeting. Right. Yeah. I dont i mean, you need we cant have this meeting without Public Comment. I assume its now is the public listening . I cant even tell. I mean, what does it mean . Its just the Public Comment function is off . Yes, based on what natalie just said, that the line is not operative, and she doesnt know when they are working on it, but she doesnt know when its going to come back into service. Yeah, i think we should wait a few minutes and hopefully it will come back on. But we cant take action on items without Public Comment. All right. So that then lines up with the consideration of the other items on the agenda, the Life Insurance, the other two health plans, the dental, et cetera. This is abbie. So the public can still view and hear the meeting, eric. Yes. But they cant comment, so could we proceed with the presentations . Okay, can you give me one minute to answer that question . Yes. Thank you. President breslin . President breslin, this is commissioner scott. President breslin go ahead. Commissioner scott i think that we should and i would, through you to the executive director, suggest that we begin our planning for the may 28 meeting. Okay, sorry, this is eric again. Hello, yes. So you can go forward with presentations. Im assuming that the public can continue to hear what we are saying and see the powerpoint and that we should go forward, it would probably be a good use of time to go forward with the presentations, and then at the end, assuming Public Comment is not fixed, we would just continue the meeting as randy and the executive directors direction. President breslin if thats the case, we could take item no. 7, which will be an estimational item, not an action item. Well, you can do presentations on action items as well. Youre just not going to be able to vote on them. President breslin right, but it might be good to get item no. 7 out of the way. I would defer to you on how you want to proceed. President breslin so abbie, do you have any preference on that . No, i dont, other than i think given the lateness of the day that we might want to get through some of the less controversial presentation, i. E. , the harper. President breslin yeah, and thats not item 7, though. Right. President breslin okay. Well, lets go to item no. 8 then. Madam secretary before i call the item, im going to wait for our producer to get to the cover page, and then i will call the item. And mike, youre ready to do this . Yeah, page 38. Thank you. President breslin, we could do items nine and ten. Well, ten has an action. President breslin ten we already did. Im referring to the delta dental stabilization. President breslin thats no. 9. Oh, i must be looking at the wrong one. President breslin no. 8 is hartford. No. 9 is delta dental. So we could do eight and nine are you saying, yeah . Yeah, the delta dental does have an action associated with it, but i dont think either one of those are going to need to be receiving a lot of Public Comment when we turn it back on. So it may go rather quickly for those two items. President breslin right. Okay. So we are on no. 8 then . Thats my understanding. There it is, the hartford, yes. President breslin natalie . Madam secretary yes, president breslin. Item 8 is the review and the approval for the Hartford Life and disability insured rate renewal plan for plan year 2021. This presentation is done by mike clarke from aon. Mike clarke from aon. If we can go to the cover slide. Today im presenting the Hartford Life insurance and longterm disability rate renewal for the 2021 plan year. Ill start with our recommendation summary followed by a brief introduction about these plans, a presentation of the insurance renewal rates for each of these plans, as well as the experience that we have seen through the plan year 2019 and overall renewal summary, and then our recommendation to the Health Service board for action. I will note that in the appendix there is information on the Hartford Life essentials Valueadded Services that are available to members through the hartford. I will not be reviewing them today, but they are available for viewing in the appendix. Next slide. Our recommendation is the Health Service board accept the renewal of all Life Insurance accidental death and dismemberment insurance and longterm disability or Ltd Insurance premiums that are included in this presentation for 2021 and a highlevel summary as the proposed rate actions by the hartford are illustrated below. This does include a proposed reduction to basic Life Insurance, even though 2021 is the second year of a threeyear rate guarantee with the hartford, and so as i go through this presentation, ill explain why we have worked with the hartford to arrange for this rate decrease on basic Life Insurance, even during this rate guarantee period. Next slide. So again, just introduction that for the city county of San Francisco, superior court and municipal executive population are made available, these basic Life Insurance, Ltd Insurance and supplemental life and adnd insurance plans for employees dependents. These insurances are not offered to retirees. Next slide. So the insurances have been in a threeyear rate guarantee from 2017 to the end of 2019 based on renewal that was approved in 2016, and the rate guarantee continued after the Hartford Life and Accident Insurance company or the hartford bought the Group Insurance business in late 2017. And if you recall last year, a new threeyear rate guarantee period was entered into for the 2020 to 2022 plan years with the hartford with the rate actions on the table below approved by the Health Service board during the june 2019 Health Service Board Meeting. Overall, there was a 12 reduction in aggregate premiums across all lines of coverage, but it did include a large increase in basic Life Insurance at the time, as well as rate reductions for the ltd and supplemental independent employee Life Insurance. Next slide. So this presentation will focus on 2021 specifically on the proposed rates by line of coverage. The rationale for why the basic Life Insurance rate is changing to a lower figure, and again, i referenced the appendix earlier. Next slide. As a backdrop, basic Life Insurance is 100 Employer Paid with five Different Levels based on eligibility by employee. In 2020, there was a premium increase from 8 cents per month per thousand of coverage to 11. 4 per month per thousand of coverage. That was approved by the Health Service board upon aon recommendation due to a higher level of claim experience that was being that was occurring in this plan in recent years relative to the premium charge. Aon committed to the Health Service board at this time to closely track the future emerging basic Life Insurance plan experience and report on that plan experience to the Health Service board. So we have our update today on the next slide. So recently, as exhibited in this chart, from 2015 to 2019 we exhibited high loss ratios, and loss ratio is claims divided by premiums. So for instance, the higher the loss ratio, the higher claims are relative to the premiums collected, and if its over 100 , it does create a loss to hartford in the plan. So those loss ratios, as you can see towards the middle of this exhibit, a middle row called incurred loss ratio, were very high in 2015, 2016 and 2017. That led to the high increase in basic Life Insurance rates into the 2020 plan year. But the loss ratios in 2018 and 2019 have now significantly improved, and that is the precursor for why we were able to work with the hartford to produce a lower rate for basic Life Insurance for the 2021 plan year. Next slide. So youll see that the rate will move upon your approval today from 11. 4 cents per month per thousand in 2020 to a revised premium for the 2021 and 2022 plan years, and there was a second and third year of the current rate guarantee period to 10. 5 cents per month per thousand. And based on the insurance volumes today, this will reduce aggregate premium by 135,000. Next slide. Transitioning to the other insurances, starting with longterm disability, ill quickly cover these. The rates will remain in rate guarantee for the 2021 and 2022 plan years after a 20 premium rate reduction occurred into the 2020 plan year. And this exhibits when you look at the net loss ratio on the very bottom of the page that the plan continues to run very well with low loss ratios that are justifying the 20 rate reduction that occurred for 2020. And please note that the premiums that are reflected in the exhibit are on the prior premium levels before evaluating based on the 2020 premium reduction of 20 . Next slide. Supplemental employee independent Life Insurance is fully member paid. These are the premiums by age with benefit options raising from ranging from 10,000 to 300,000. There was a 15 premium reduction for all rates, except for child life, that took place for 2020, and that continues with these rates through the 2022 plan year. Operator you may now resume the question and answer session. And you can see the enrolment at the bottom left of this chart of approximately 1,000 employees, and you can see the dependent and children numbers as well. Next slide. And this plan, as you can see in the incurred loss ratio from the middle of the page, continues to have favorable loss ratios as well, again, validating the rate reduction for the 2020 plan year. Next slide. And this is the dependent Life Insurance chart. Again, favorable loss ratios. Next slide. Supplemental insurance, these are the premiums. They did not change for the 2020 to 2022 period, and they will remain the same through the end of 2022. Next slide. And again, similar to what we looked at with the dependent and supplemental Life Insurance, favorable loss ratios in the adnd plan. Next slide. So overall these are the total premiums that are projected both in 2020 and 2021 based on the existing insurance volumes in these plans. Youll see the employerpaid plans at the top and the memberpaid plans towards the bottom of the chart. Again, please recognizing that many of these rates decreased from 2019 to 2020 and then now again because of favorable experience the last two years in the basic employee life plan, the hartford has partnered with us in discussions to lower the rate for 2021 for basic life, producing 135,000 savings i spoke about earlier. Next slide. So with this review of the hartford experience and rates, i ask that the Health Service board approve the basic Life Insurance longterm Disability Insurance and supplemental life and adnd insurance rates as displayed in this presentation for the 2021 plan year with these 2021 rates also holding for the 2022 plan year through the end of the current rating agreement with the hartford through december 31, 2022. So the specific actions i am asking from the Health Service board today are to approve the updated basic Life Insurance rate of 10. 5 cents per month per thousand for the 2021 plan year and approve the continuation of current insurance rates in the 2021 plan year for longterm Disability Insurance, supplemental employee and dependent Life Insurance, and supplemental adnd insurance plans as displayed in this presentation, and i do note at the bottom of the page that all premiums displayed in this presentation are net of commissions, which means there are no commissions included in the sfhfs insurance rate shown in this presentation. That concludes my presentation. I turn it over to president breslin. President breslin all right. If there arent any questions of mr. Clarke, id like to entertain a motion. Commissioner scott this is commissioner scott. I move that we accept the recommendations as presented by the actuary. Commissioner follansbee i second. President breslin very good. Okay. Public comment. Madam secretary hello and thank you for everyones patience. We do believe that we have this connected, and so we are going to try. The moderator and i are going to try to see if anyone is on the line, and well give it 30 to 45 seconds so people who are at home watching this get the message that we believe the line is open and ready for Public Comment on the hartford renewal. So please dial in on the conference line, press in the access code, dial 1, 0 and wait for your turn to speak. So im going to wait about 45 seconds so we can give the time lag so viewers at home through sf gov tv can also get back on the line, fingers crossed its working, and at 45 seconds i will call for the first caller. President breslin and make sure you remind anybody that it is on this item and to defer the questions to another item if they are asking about Something Else. Madam secretary yes, that is correct. This is for the hartford item. Operator this question and answer is session is now ended. To begin another question and answer session, press star 7, 2. Madam secretary you will hear all the announcements, just so you all know, moving forward. So this will be that point where we will take a pause and i will allow people at home to log back into the phone line and we will call for the first caller. Commissioner follansbee i want to second what commissioner breslin said and ask it be very specific that before we open up for questions and comments about the following item, which is the kaiser renewal, that you will read the motion that has been seconded so people can address that issue and not the broader issue necessarily. Madam secretary no problem. I will do that before people begin speaking. Thank you. Madam secretary all right. So moderator, we will now begin the Public Comment for the item of the Hartford Life and disability insured rate renewal plan where we just had a motion by the Health Service board to approve this insured rate renewal as it was presented to us today. Moderator, can you please open up the phone line for our first caller. Madam secretary at this time im being informed that no one is on the queue for this particular item. We have no callers, so president breslin would you like to conclude the Public Comment for this item . President breslin there isnt any Public Comment, right . Madam secretary there are no callers in the queue for this item, no. President breslin okay, the motion has been moved and seconded, so all in favor of the motion, signify by saying aye. Aye. Aye. Aye. Aye. Aye. President breslin are there any objections . No. Okay. This is unanimous. Now are we going to do nine or are we going to go back to kaiser . Finish it up . I think we should go back excuse me, go ahead. I think we should go back just to clarify that we were moving to table the kaiser item and without considering copays in that table. But according to what our counsel was saying, it didnt seem like it needed a motion, just that that was the action we were going to take. We were deferring it to the next meeting. President breslin okay. So lets supervisor preston, would you like to say that again . Supervisor preston yeah, i think, unless counsel advises otherwise we need a motion, and i think there was one on the table seconded, we just hadnt been able to get the Public Comment, so maybe we can do that. I dont know if ms. Ekburg wants to repeat the motion or if i would . President breslin i would have you repeat the motion. Supervisor preston okay, i have moved to continue item no. 12 to our next meeting with the provision that we would be removing the option that involved increased copays from consideration or further action. President breslin okay, now that was seconded before, right . Supervisor preston correct. By commissioner lim, i believe. President breslin okay. So now i want to go for Public Comment on this item. Madam secretary okay, and to accommodate people watching this on sf gov tv, were going to wait about 30 to 45 seconds from this moment so they can hear this as we are back on item 12, which was the Kaiser Permanente nonmedicare rate presentation to collect any Public Comment on this item, the kaiser item. So anyone whos at home, please dial back into the conference line, enter the access code and press 1, 0. We will wait about 45 seconds, and then ill come back to call. Commissioner follansbee but again, my understanding is that we, you know, would hope that the callers would focus on the motion hold on a sec. This is eric. Im sorry, if youre just continuing this motion, you dont need Public Comment. Lets just redo this the next time when we do this again. We are effectively just continuing the kaiser. Commissioner hao but eric, but its to continue the item without discussion on the plan Design Changes. That doesnt require a vote . Okay, give me one second. If you want to move give me one second, sorry. Supervisor preston i think it to be safe makes sense to have Public Comment. There may be Public Comments in light of the continuance choose to wait until the next meeting to weigh in, but i think its maybe prudent to have comments. Operator your conference is now in question and answer mode. To summon each question, press one, then zero. Each question will be asked in the order it was received. Operator you have seven questions remaining. Hi, id like to ask a question to the commissioners regarding staffing at kaiser. Were very concerned by the notion that the city might be willing to give additional funds to kaiser on the basis that there is increased utilization without getting guarantees from kaiser that they are going to ensure the clinics and hospitals are sufficiently staffed so that we can be assured that our city workers are getting the Quality Health care that they deserve and that kaiser workers are afforded a safe interaction at work. Madam secretary thank you so much for your Public Comment, sir. Thank you. Madam secretary president breslin, are you all right with me going to the next caller . President breslin yes, yes. Madam secretary moderator, can you please open the line for the next caller . This is eric again, im sorry to interrupt, but i want to be clear you can just vote on this and move on and continue the item. You do not need Public Comment, even if youre going to change even if youre directing sfhfs to change the presentation. Madam secretary i will defer this to the president and the commissioners preferences. We did fix the call lines, so im open to doing either option. President breslin this is your motion, supervisor preston. Supervisor preston it is, but i dont think its my call as to whether theres Public Comment. Im happy to hear from the public on this now or when the matter is, you know, heard at our next meeting. I would defer to the City Attorney and well, i just from an efficiency standpoint you would save having to do it twice, right . Youre going to have Public Comment and then youre going to be doing it all again, and given the time constraints the Health Service board is facing ensuring that rates and benefits get all passed by june and the limited number of meetings were going to be able to have, it might be more useful to try and get through maybe some of the other agenda items. Commissioner follansbee the people have been waiting online in order to comment on this, and so i guess i would ask them to exercise an option to either hang up, knowing they will have another opportunity for comment at our next meeting, or if they would prefer, since theyve been on the line, allow them to make their comment today. Madam secretary there are currently six people also waiting on the queue, so we can either make the announcement and wait 45 seconds to 60 seconds so they can hear it on their end, as well as the public hearing it on sf gov tv. I want to make sure that we are being transparent before we just move on. I would concur with what commissioner follansbee recommended, that we let folks know clearly that there will be another opportunity to comment on this when we hear it, and so folks may choose to get off the line with that information. But for folks who have been waiting now, some of them probably quite some time to comment on this item, i would be i would be happy to hear them. Okay. But you understand they may comment twice then . Well, my understanding is technically now theyre commenting on a continuance, right . Whether its required or not, and then they would be free to call again, you know, when we vote on or considering the action at the next meeting. Okay. Im not going to i assume theyre not waiting to comment on the continuance, that they are going to be waiting to comment on the item. President breslin i would think so too. May i suggest that we continue with the comments and we can just keep moving . Okay. President breslin yeah. Madam secretary thank you. Yes, again, callers, one minute per comment, and moderator, will you open the line for the next caller, please. Operator you have eight questions remaining. Hello, commissioners. My name is adam wood. Im a San Francisco firefighter. Thank you for continuing with comments. I want to support the motion to continue this without changing the copay rates for kaiser members. In our department, San Francisco, we have no covid positive members up to this point. We dont even have any members currently in precautionary quarantine. The way we pulled this off is by maintaining an intense focus every second of every 24hour shift about protocols on how we relate to the public, both healthy and unhealthy, and each other, so we dont get sick and become a vector infecting the public that we serve. There have been were making it work, but were hanging on by an emotional and mental thread. There have been a lot of comments over the last few weeks thanking frontline Health Care Workers during the pandemic, and we deeply appreciate it. But im sorry, sir, but your time for Public Comment is over. Okay. Thank you. Madam secretary thank you. Moderator, can you please call the next caller, unmute the next caller. Operator you have seven questions remaining. Hello. Madam secretary hello, you are on the call line. Yes, i am. Am i on the call . Madam secretary yes, you are, sir. Its your time to make Public Comment. Yes, thank you. First of all, id like to thank willy lim for his service. My name is larry griffin. Im a political legislative vicepresident for local 21, and i just hope that the commission thank you for putting it over and continuing it, but i think this is something that really needs to be looked at with this pandemic, with people losing their job, and City Employees are going to be losing their jobs too. For kaiser to raise its rate at this point is just unconscionab unconscionable. I was born at kaiser, been at kaiser for all my life, and i dont think ive ever been more disgusted with them than now. I hope you folks do reject this ultimately. Thank you very much. Madam secretary thank you, sir. Moderator, can you please open the call line to the next caller . Operator you have five questions remaining. Executive director of local 21. I want to speak in favor of the continuance and also on the second point about not raising the copayments and the rates. I think we all know that kaiser has made enough money the last two years off of our backs, and i think that, you know, we need the commissioners to stand with the city workers. Thank you. Madam secretary thank you very much. Moderator, can you please take the next caller . Operator you have four questions remaining. Hi, thank you for taking my call and taking comments. Im a miscellaneous member, and im in agreement with the other callers that ultimately hope that the decision is to pass on this increase, but i would even take it a step further. I think what weve seen in, say, the Car Insurance industry, how they have been giving customers discounts, my recommendation to my union is to fight for a decrease in our premiums that were paying. We saw what happened down in the south bay, Center Hospital recently, is now asking employees to take 20 pay cut because hospital visits are down 40 . So i just cant imagine that we are going to continue to pay this insurance and not get any services from it. I think that the commission should consider requesting a reduction in these premiums that employees are paying, because i have three children madam secretary thank you, sir. Your time for Public Comment is up. Thank you so much. Thank you. Madam secretary thank you. Moderator, can we have the next caller, please . Operator you have four questions remaining. I think what firefighter adam wood probably would have told you is our frontline heroes appreciate the designation as heroes, essential workers and Disaster Service workers really need your support, and that support comes in a number of ways, and in this context its this continuance and excluding the Design Changes and increases to utilization that have been proposed. So Labor Council weighs in support and favor of the motion and we appreciate the thoughtfulness and consideration that youre all making as commissioners during this difficult and challenging meeting format. Madam secretary thank you so much, moderator. Can you please open the line for the next caller . Operator you have three questions remaining. Im president of the california nurses association. It is unconscionable that kaiser will be taking this opportunity to ask for a rate increase. With the rate increase, members will not be able to come for their appointments, and with kaiser putting their frontline staff at risk by redistributing contaminated masks, its a total disaster recipe. I would invoke this commission to look at this very closely and stop kaiser from making profits on the backs of the members. And kaiser is a prepaid insurance. Whether we use it or not use it, they are making money. They are raking in money, and they have billions of dollars in profit. I would urge the commission to please not allow this to happen. We have enough stress as frontline Health Care Workers we do not need another stress to be put upon us, and i would suggest that kaiser should give us a discount madam secretary thank you, miss, for your Public Comment, but your time is up. Thank you so much. Thank you. Madam secretary moderator, can you open the line for the next caller, please. Operator you have two questions remaining. Hi, im from local 21, and im calling to speak in favor of the motion to have the continuance. Without the copay increases. Also i would like to thank supervisor dean for making the motion and commissioner lim for making the really great argument as to why it didnt make sense. Thank you both and well see you on the 28th. [please stand by] a. Ao thank you very much, sir. Moderator, can we please open the line for the next caller. Operator you have one question remaining. Teresa rutherford, seiu 1021, Vice President. Again, i want to say thank you to dean preston, supervisor, and commissioner lim, and then, i will continue to ask this commission to be leaders and to realize that youre not just leading in San Francisco with this decision, but youre leading all the way up to the white house. Take that leadership, use that platform, and do the right thing. Kaiser does not get a pass. They have made uber money off the backs of workers and clients for years and years. Its time for them to give back to these good corporate citizens and to understand that they are in a pandemic and they, as a corporate entity, need to step up, set examples, and lead. Thank you so much. Your time is up. Thank you. Moderator, can you please open up the line for the next caller. Operator you have one question remaining. Yeah, this is fred sanchez from protect our benefits. We monitor the Health Service for their 27,000 retired City Employees. We thank you for not considering the copayment increases in light of Rudy Gonzalez comment that kaiser made over 3 billion this year. Im willing to wait for the next two weeks to get more information, but i really appreciate supervisor prestons comments. We cant balance these things on the back of city workers. Theyre suffering too much now and dont need this additional stress. Thank you. Thank you so much. Moderator, can you please open up the line for another caller. Operator you have zero questions remaining. Clerk president breslin, that concludes Public Comment for this item. President breslin okay. Very good. So now, we have to vote on this item. We still didnt vote on this. Actually, president breslin, this is commissioner heil. Before we take the vote, i dont mind to push this over to the next meeting, but i hope we can talk about the sustainability of our health plans longterm, and whether contributions, as controversial as they may seem to be, play a role in that. I just want to put that out there for everyone. President breslin okay. All those in favor of pushing this to the next meeting without increased copays, signify by saying aye. Are there any opposed . Its unanimous, in favor. Clerk president breslin, which item would you like to move to . President breslin well, i believe we should move to item number 9, which is delta dental. Did you want to act on the hartfo hartfo hartford licensure . President breslin oh, we never did that. Does anybody remember who made the motion . I believe it was commissioner scott. Clerk and commissioner scott was required to leave the meeting. He was required to be at work, so hes not going to be present for the rest of the meeting. We still have a quorum . Clerk yes. In my notes, i have that we voted unanimous. Unanimous, yes. President breslin so we did vote on number 8 . Clerk yes. President breslin okay. I had it crossed out. So now, we can go to item number 9, or we can do blue shield. I guess we should do number 9 at this point. Clerk okay. We are here. Item 9 is a review of the delta dental of california selffunded employee preferred Provider Organization experience and the approval of the Rate Stabilization reserve for plan year 20202021. This presentation is done by mike clarke, aon. My name is mike clarke, and im here to do item 9. Our recommendation today is to apply onehalf of the available reserve as a stabilization buydown. As a result of the continued pattern of lower actual claims and fees relative to the premiums in the employee dental p. P. O. Plan, which i outlined in this presentation, a substantial Rate Stabilization reserve has developed, as well look at later. For the second consecutive year, aon is recommending to the Health Service board that a higher level of Rate Stabilization buydowns be applied to 2021 buydown than onethird per policy allocation. It will require the Health Service board to suspend the selffunded plans stabilization policy for the delta dental active employee p. P. O. Plan for this cycles approval. Our recommendation is a buydown in 2021 rates in the amount of one half of the available stabilization reserve or 5,663,000. This action would preserve or remaining carrie forward balance in the Rate Stabilization reserve are 562,000 for reduce in 2022 and beyond, and this compares to a 7,016,000 buydown figure applied in 2020 plan year rating. Next slide. Just some background on the stabilization policy as presented on this page. Its there to support the financial gain or loss of selffunded and flex funded plans, and creates a reserve that is amortized over a threeyear rating period. Todays focus is the delta dental act of employee p. P. O. Plan, and all other dental plan available to sfhhs employees are active reserve. This action is only on the delta dental active employee dental p. P. O. Plan for future reserves. At a future meeting, we will discuss our rate recommendations for all dental plans. Next slide. This is our exhibit of 2019 claim and fee experience as well as going back in time all the way to 201 in a 20 increa in 20182019 and all work attributed to a p. P. O. Dentist. However, were still concerned that Preventative Care is underutilized as one out of three employees did not have a dental cleaning in 2019, and we have included 2019 detailed experience in the appendix. I will not be walking through that in my presentation today, but it is included in the appendix for your review. Next slide. This is the history of the Rate Stabilization reserve for this plan. You can see that after the Rate Stabilization plan began in 2014, significant surpluses have built over time, given the favorable experience i just documented, and this did lead to our actuarial underwriting assumptions for 2019 plan year. Over the course of time, the amortization decisions have been to apply the policy in 2019, but as mentioned, apply one half of the new stabilization reserve, which, again, will be my recommendation for 2021. Next slide. This detailed chart shows the comparison of expected experience that was calculated in mid2018, forecast in 2019 versus what actually happened in 2019 in the right side column, and at the end of the day, 4,310,000 is added to the prior delta dental active employee p. P. O. Carrie forward Rate Stabilization reserve balance as a result of the favorable rate experience as pekt index the 2019 plan as expected in the 2019 plan year. And this is showing how the starting stabilization reserve balance as of december 31, 2018 flows through after the application of the reserve buydown in 2020 of 7,016,000, adding the recommended increase to the reserve based on 2019 experience, the 4,310,000 figure i just referred to, and our recommendation to apply half of the stabilization balance for rating in 2021. Next slide. So today, i ask the Health Service board to suspend the selffunded stabilization reserve policy on a onetime basis for the delta dental active employee p. P. O. Plan and approve use of one half of the december 31, 2019 stabilization reserve balance or 5,663,000 to be applied towards buydown across all rating tiers for the delta dental active employee p. P. O. Plan for plan year 2021. That concludes my presentation, president breslin. President breslin do the commissioners have any questions . Yeah, this is commissioner follesby. A year ago, we asked delta dental to come up with some recommendations for how to improve that. Do you have Historical Data on whether theres been any improvement in our members utilization of this important benefit . Yeah, thank you for the president , Vice President follesby. Y yes, we do. After our delta dental presentations, i believe its in may 2019 in the executive director report, it contained 2018 information on the escalation of Preventative Care, and then, were currently partnering to update all the statistics we showed, but we do have that information for 2019. The bottom line is yes, there has been this gradual, i would say small yearoveryear improvement in the small percentage of members that are using Preventative Care. I know weve talked extensively to delta dental to supported sfhhs campaigns communication campaigns about the importance of Preventative Care and other methods such as online and application technology. We continue that dialogue with delta dental today, but yes, we have seen small improvements year over year. I noted a 1 improvement in Network Dentist utilization. In the last year, there was a 1 increase in the number of employees using the benefit for cleaning in 2018. President breslin anybody else with a comment . Id like to ask, this has been going on a little bit now where the claims are less than the premiums, so are the members paying the premiums and the actives for the dental care . Do they pay any premiums . Yeah. What ill comment on is for the city and county of San Francisco employees pay 5 a month for employee only coverage, 10 a month for employee plus dependent coverage, and 15 a month for employee plus two or more coverage, and there are varying contributions for superior Court Employees and municipal executives. The this plan does not apply for the sfusd and the city college employees. Those two employee groups obtain their dental coverage outside of sfhss. President breslin so why wouldnt we lower the premiums if the claims keep being lower than the premiums . And when you say premiums, are you referring to the total rates or the employee contributions . President breslin well, i dont know, but the claims keep coming in less than what theyre paying for the premiums, so it would seem like the premiums are too high then. So i can speak to the total cost rates, i cant speak for how the employee contributions that are determined for employees, but for the total cost rates, this is why were recommending for the second year in a row that we use an elevated level of stabilization reserve or one half. Okay. Any other comments . This is commissioner lim, and i agree to use one half. Normally, we use onethird. I did receive some sort of flier or notification from delta dental about the list number of uses of the delta dental plan. With the Current Crisis and the shelter in place, my Preventative Dental care has been postponed until september. A lot of people will be doing only one cleaning this year instead of the normal two or three. President breslin commissioner len, would you like to make a motion . Can i just answer Commission Commission commissioner lims really quick . President breslin sure. Go ahead. We are definitely seeing nonutilization of services right now considering dental offices are closed. So to the extent that there are reduced levels of claims, that will be caught into the Rate Stabilization plan for future use. We are in discussions with delta dental of california to discuss the rating implications of what you just spoke about for the insured dental plans that are offered by sfhss, and therefore, we will plan to discuss that with Health Service board during the 2021 planned rate renewal during the discussion on dental plans in june. So appreciate that comment, and were actually in conversations right now with delta dental to discuss that impact on the insured dental plans. President breslin okay. I need a motion. So i move to suspend the [inaudible] on a onetime basis for [inaudible] this is commissioner canning. I second. President breslin okay. Public comment on this item . Clerk so im going to remind all the callers and viewers at home, we are only taking Public Comment on the delta dental rate premiums that we reviewed with mr. Clarke. I will ask you to hold your comment if you begin to speak on another item. So well give it about 30 seconds and pass it onto the first client. If you wish to speak on the delta dental premiums, press onezero. We will now begin taking Public Comment for the delta dental presentation. There will be silence while we wait for all members to properly populate into the queue. Madam moderator, will you open the line for the next commenter to speak. Operator you have no questions for this item. Clerk president breslin, that concludes Public Comment for this item. President breslin okay. All in favor say aye . Opposed . Okay. Are we out of time abbie, how much time do we have to finish up here . Technically speaking, we have until 9 00 tonight. President breslin oh, wow. We do have what i was informed of earlier, so i think its worth getting through as much as we can because you know were going to have a heavy lift on the matters that have been brought to our attention today. President breslin right. So how about then we would be down to item number 11, which is the blue shield. Clerk thats correct. Producer, can you please move to the slides. Item 11 is the blue shield renewal item. Were going to review blue shields flex funded contributions for active and early retiree members for plan year 2021. This presentation is done by mike clarke from aon. Mike clarke, aon. In this presentation, i will present the blue shield of california 2021 flex funded h. M. O. Rates premiums and contributions and rates for active and retired employees. Next slide. So i will start with a summary of the actions being proposed today, as well as the recommendations for 2021 with the rate cards and move to the recommendation for h. S. B. Action, and you can see the information contained in the appendix. Next slide. So today, we are recommending that the Health Service board approve first the blue shield access plus Health Care Proposal for a 6 rate increase from 2020 to 2021. Second, blue shield trio proposal for a 6. 3 increase for 2021, and the 2021 cards for the blue shield access and trio plans. We are presenting active employee rate cards for the two most common contribution strategies at the start of this year for the city and county of San Francisco employees, the 939383 and 1009683 strategies. There are multiple strategies for employees participating in the San Francisco Health Service system. Next slide. Next slide. Blue shield provided renewals for two flex funded h. M. O. Plans access plus and trio offered to sfhss active and early retired employees. As a reminder, what flex fund means is there are claims dollars that happen when services are sought in the blue shield plans, and so that, combined with other fixed cost elements in these plans becomes the basis for which rates are projected into the next plan here. We calculate these across all populations. No rate increases are being proposed this year for blue shield. Its 3. 6 for access plus, 6. 3 for trio, and when you combine those across all populations, its a 4. 4 increase. The Identification Cards ill propose is the 2021 pharmacy and medical claim cost, where pharmacy is net a Prescription Drug rebaits. Projected 2021 computation charges which includes a fixed cost per member that would include Physician Office visits, the Rate Stabilization service buydown that was approved in an earlier Health Service Board Meeting, the v. S. P. Plan premiums, and the sfhss Sustainability Fund charge, 3 per retiree and employee, unchanged for 2020. The overall blue shield plan expenses per employee and retiree per month increased about 7 from 2018 to 2019, which is slightly higher than the forecast trend i referenced earlier in todays meeting of 6 . The projected rate increases for trio are higher than access plus in part because trio saw a substantial increase in larger plan experience in 2019 than access plus. The stabilization and rates changed from a buy up in 2020 to a buydown, and so all else equal, that favorably impacted the end result for our projections by 1. 4 , and that aggregate 4. 4 rate increase for the blue shield plans on a status quo plan design basis is higher than the 1. 9 applied in 2020. Next slide. This chart illustrates the fixed cost components for fees from blue shield. The administrative fee is increasing by 2 into the 2021 plan year, consistent with prior years. The large claim pooling fee that applies as part of the flex funded feature as part of the blue shield plans in that any climb over 1 million per individual is insured and reimbursed back to sfhss. There was a substantial increase in these claims that exceeded 1 million in 2019 which counted for 9. 3 million versus 2018, which accounted for 3. 7 million, and that has led to an 18 increase in the large claim pooling for blue shield. And you will see the pcori fee is built in in this table. So the rate cards presented are shown for these population segments. The access plus plan for abtcte employees and retiree employees, and we also include comparisons of member contributions for 2020 to 2021 in this presentation, as well. Next slide. So this is the rate and contribution change on the right side of the slide, and the 938383 contribution for employees in the middle of the slide. And for access plus, we commented on the 3. 6 increase, and it applies on a proportional basis using the 938383 and the employee contributions in the active employee columns. And the rate changes then become distributed between the retirees and the employers based on the city charter formulas. Next slide. And this is a similar slide to what we looked at earlier. The only difference is this is for the 1009686 contribution strategy. Next slide. And this is the proposed rate card, where you can see all the elements of cost building up to the suggested rates and contributions that we built up on the next pages. This slide is 938383. Next slide is 1009683. On the next slide, we show trio. Same information, starting with rate and contribution changes 2020 and 2021 on a monthly basis. This slide for retirees on the 9383838 contribution root gee, where you see the 6. Contribution strategy, where you see the 6. 6 increase. Next slide contains the same information just for the 1009683 contribution strategy for employees. And then, the next slide shows the employee and 938383 active employee rate card proposed for trio. And the next slide shows for the 1009683 active and retiree employees. Today, i ask the Health Service board to approve the blue shield access plus plan renewal proposal for a 6. 3 rate increase from 2020 to 2021. Second, the blue shield trio plan proposal for a 6. 3 rate increase from 2020 to 2021, and the resulting 2020 monthly rate cards that you presented in this material for access plus and trio rate plans. That concludes my presentation. President breslin . President breslin any questions from the commissioners . No questions . Comments . None from me. President breslin okay. Blue shield is definitely very expensive for early retirees. I mean, theres, like, a 50 increase 50 increase this month for access plus, and a 75 increase for trio, so the retiree employees are paying 1,340 a month, which amounts to almost 17,000 a year. 17,000 a year is really a lot for a small family, say, like, maybe two children. I mean, are these rates that they come in with all the time . I mean, this has been going on a long time. Is there a lot of transparency . Can you just can you trust them, that these are accurate . So in working with blue shield that produces the 2021 rates, we are taking that information and using multiple different sources where we obtain information from blue shield to assure the information were working with and the underwriting projections is consistent. The actual determination of the rates is in part based on the plan and the associated fixed costs, but also on the city charter that determines how the retiree contribution rates are set, and also factors that are involved in how costs distribute between the retiree only, retiree plus one, and retiree plus more tier. Sfhss did post a presentation online last month where i discussed some of the historic and current perspective around rate setting methodology in all of sfhss health plans if that would be helpful for anybody to view. If you compare to the kaiser rates to the blue shield rates for a family, its like 6,000 more a year for blue shield. I mean, theyre two totally different plans, but it just seems that blue shield is really high now. Any other comments . And if not, well entertain a motion. This is commissioner lim. So i move to approve the blue shield rates and premium contributions and resulting 2021 monthly rate cards as presented. I second. President breslin we have a second . Commissioner howe seconds. President breslin all right. Is there any Public Comment on this item . Clerk people watching online, dial in and enter the access code, then press onezero to enter the queue. Well wait for about 30 seconds for everyone to call in and enter the queue. Okay. Members, we have opened up the Public Comment for this item. Remember, this is only for blue shield. Please comment only on the blue shield side. Operator, will you open up the line for the first caller. Operator you have one question remaining. Hello, this is napoleon. I am a city employee. Can you hear me . Clerk yes, sir, we can. Okay. Good. I am just i just would like to make a comment that the this is Uncertain Times for everyone, and these proposals are ensuring the continuity of the profit making of all the Insurance Companies, including the previous comments that was made, and that is not fair, and companies, particularly Insurance Companies, must pay their fair share. This is a continuance of all the previous comments you have been hearing. It is not only for members of the public, as it is coded often to pay their fair share or share the pain. In particular, corporations who are a particular money making machine should pay more than their fair share, compared to individual families. Clerk thank you. Your Public Comment time is concluded. We appreciate you calling in today. Thank you. Thank you. Clerk thank you. Moderator, is there any other callers on the line . Operator you have one question remaining. Hello there. My name is donna shear, and im an seiu 1021 member. The recommendations of potential health care increases to the board are due in june, and the city doesnt start the process until august. This process is being done backwards. I ask to table the discussion about any possible Blue Cross Blue Shield increase until after the city releases its budget in august. Thank you. Clerk thank you so much. Moderator, will you please open the line for the next caller . Operator you have one question remaining. This is Teresa Rutherford for seiu 1021, and again, we are asking the commission to not move forward on any rate increases at this time. This is not normal basis. This is not business as usual. We are going through a pandemic. Blue cross blue shield and all the other Insurance Companies must consider the nature of the pandemic and the serious impact it has had on the public. It is not the time for increases, it is time for them to give back to citizens as corporations that have made money off the backs of every citizens that have invested in these policies. It is bad economics to use a pandemic to determine a rate. Everything else looks at rates over time. Clerk thank you, miss. Your time is over. Thank you so much for calling in. Moderator, will you please open up the line for the next caller. Operator you have zero questions remaining. Clerk president breslin, that concludes Public Comment for this item. President breslin okay. That motion has been moved and seconded. All those in favor, signify by saying aye. This is commissioner follansbee. The comments are really germane because a lot of the comments that we got about the rate increase covered across the board. I think this is a bigger issue, although we certainly heard blue shield issues regarding a number of factors. I think we need to ask all the health plans the same questions regarding the current time, the pandemic, and their response, so i am proposing that we defer this to our next meeting, as well, asking all the health plans to address the sort of same general concerns that we heard today from multiple individuals in the community. President breslin i agree with that. I think its only fair. I dont know what any other commissioners have to say here. This is commissioner canning. I am in agreement with Vice President follansbee. This is commissioner hao. I think this is consistent with my concerns about longterm sustainability. President breslin okay. Who made the motion again . Clerk commissioner lim. President breslin would you like to withdraw your motion or modify i think the concern of commissioner follansbee is getting all the commissioners i mean, getting all the health lines answer questions about increases. Id be willing to withdraw this, but remember the timeline, although i wont be there for the next meeting regarding the renewal for next year. President breslin commissioner lim, you will be there for the next meeting in may. Clerk no, he will not, president breslin. His term ends tomorrow. Commissioner simanski would be there, as long as we get others sworn in. President breslin well, i think its fair if they have the same questions across the board here, so they could be done at the next meeting and dispose of this. Just some clarification, and i think mike would be able to help me on this one. Blue shield this is a flex funded plan, unlike kaiser. Its not an h. M. O. , where we pay a premium, and the flex determines whether its high or low, the process is the premium. This one is a selfflex funded plan, so maybe mike would explain more on that. Yeah, commissioner lim, happy to address that. So the vast majority of total cost in blue shield is the paid claims that occur when members use services. There are other components of cost in blue shield which includes the capitation expense, and again, capitation expense is a fixed employee cost to pay for Certain Services that physicians deliver, such as an office visitor inoffice services, and there are other defined types of Health Care Services that are part of that peremployee cost, but that is part of what the physicians are being paid to deliver Certain Services to members. So you have the claim costs, you have the capitation costs, and then, you have the fixed fees that i outlined in this presentation today that include the Administration Services costs, which are increasing 2 , the large claim pooling fees, which are increasing at a very high rate of 18 , but in response to the much higher amount of large claim expense, that blue shield reimbursed back to sfhss in 2018 versus 2019, and then, again, the very small required specific a. C. A. Fee, which is not influenceable, it is determined by the federal government. So i hope that clarifies the nature of the expenses that roll into the blue shield plans. Thank you, mike. So if its the consensus of the board to table it, im willing to withdraw my motion. I didnt think it would change month because these are based on projections and not fixed premium. Commissioner follansbee . I understand, but i think the bottom line is its a rate increase for our members, and they need to hear we need to hear, and they need to hear all aspects of this rate increase. And given the differences in the plan design, but still, we need to hear it. Okay. So ill withdraw my motion. President breslin okay. And then, were going to table are we going to table this to the next meeting . Is that the yeah, thats my recommendation, we table it to the next meeting, when we take up the next agenda items for the rate increases. President breslin okay. So then, we dont need Public Comment on that we already had Public Comment. Clerk thats correct. President breslin so we dont need to do that again. Okay. Im in agreement with that, so its going to be tabled. Is that it now . You have that down . Clerk or continued, right . Not tabled . Thats correct. Were going to continue it until the next meeting. President breslin all right. So we have we have item number 13 is the only action item left here, and we do have item number 7, but that is not an action item. Clerk president breslin, if i can make a note on the record, we would like to do item 13 next and then item 7 as we would like marina to present today. She is not available on the 28. President breslin oh, all right. Well, lets do item 13. Clerk okay. Mike clark, aon. This is for the United Health care plan, nonmedicare rates and premium contributions for active and retiree members plan year 2021. Today, staff recommends that the Health Service board approve United Health care city plan p. P. O. And the 2021 monthly rate cards presented in this material. The resulting aggregate overall rate increase for the combination of city plan and city plan choice not available, including stabilization adjustment for 2021, is 9 . Next slide. And with prior presentations, we present rate cards for the two most common employer contribution strategies as of the start of the year for city and county of San Francisco employees, and there are multiple employer contribution strategies for other active employers contributing and participating in sfhss. Next slide. Next slide. The recommended rate increases for the uhccp were recommended rate experience trended to 2021, the previously approved u. H. C. Rate changes in 2020, and the amortization approved in the march 2020 Board Meeting. As we go to the rate cards, Going Forward here, were going to talk through what the rate cards contain, 2021 fees, the change in the Rate Stabilization deficit, which is increased for 2021, inclusion of the basic plan premiums, and the Health Care Sustainability fund charge. Next slide. Overall plan experience for 2019 in the u. H. C. P. P. O. Was similar to the National Trend expectations, approximately 5 expectation increase for each employee and the plan. These fees are the plans plus the associated car for United Health plan, the selffunded plan. This tracks with our projected in 7 for prescriptimedical an drugs. If you recall, city plan choice not available was first offered in 2019 to help reduce the contributions paid by active employees and early retirees who live in geographies where the blue shield and kaiser plans are not available. Next slide. The early retiree u. H. C. P. P. O. Rating is the third year of a three year rate increase ras approved by the Health Service board in 2018 to achieve rate alignment for those u. H. C. P. P. O. Families. So in total, the aggregate rate increase projection for the combination of city plan and city plan choice not available is 9 , segmenting into an approximate 10 increase for city plan and the same 3. 6 increase for city plain choice not available which was proposed in the preparation for blue shield access plus. Next slide. The participants who were assigned a city plan choice not available as they enroll based on the zip code when it occurs [inaudible] and city plan and access plus are available but not Kaiser Permanente. This enables someone to be identified as a city plan choice not available participant. Next slide. So the Rate Determination for city plan choice not available for active employees are the same presumium rates, including all rate card elements including contributions as access plus for the early retirees, the same access as the city plan access plus, and this does lead to the higher contributions, lower employee contributions, and lower contributions for city plan choice not available. So the rate plans are presented for city plan and city plan choice not available for the two employer contribution models. As you review these rate cards, please keep in mind the monthly employer contribution increase for active employees paying member contributions in city plan is 3. 6 . This matches the employer contribution increase for the second highest cost plan offered overall to sfhss employees, which is the blue shield access plus plan, and the actual employer contributions for this highest cost plan, city plan, are the same and limited to the employer contributions for access plus. Early retiree family tier rates incorporate that final year of the threeyear migrags of city plan ratios to the retiree tier to match the ratios for blue shield. Next slide. So this exhibit shows for city plan the impact of the rate and contribution changes between 2020 and 2021 for early retirees and the active employees in the 939383 strategy. You will see that for active employees, the monthly employer contributions are the same dollars, same dollar amounts as we just presented for access plus in the prior presentation because of the provision that limits the employer contributions of the highest cost plan for active employees to be no more than the employer contributions for the second highest plan offered by sfhss. And for the early retirees, the rate increases include the adjustment in the family rate ratios for early retirees, and thus, that is why the monthly total rate increase is lower for families at the bottom right of this exhibit than for the retiree only tier. And then, the city plan or the city charter formulas to determine employer contributions are applied to the monthly total rates to calculate the monthly employer contributions for early retirees, and the difference becomes the monthly retiree contribution for early retirees. Next slide. This is the same exhibit, except for the 1009683 contribution strategy for the employees. Next slide. This is the resulting rate card for early retirees in the 1009383 contribution strategy for active employees. The next slide contains the 939383 contribution strategy for retiree employees. The next side is for city choice not available, and those rates are linked to the access plus plan in that they do not have access to the complete sweep of sfhss health plans. Next slide. And this is the 1009683 exhibit as well as the early retiree figures. Next slide. This is the rate card for the 1009383 employees as well as early retiree employees. And the 1009383. So today, staff recommends for Health Service board action that the Health Service board approve the u. H. C. P. P. O. And city choice plan and city choice plan increases available in this material and the resulting 2021 monthly rate cards presented in this material. That concludes my presentation, president breslin. President breslin any comments from the Board Members . This is commissioner canning. My understanding is that in the spirit of what we have decided with the other two plans, that the intent is for us to continue this, as well, to the next meeting. Is that correct . President breslin sounds right to me. Yeah, it sounds right to me, as well. I dont want to prematurely make a motion, but if thats the understanding, if there are no other comments, id like to make a motion that we continue this matter to the next meeting with the other two items that we continued. President breslin okay. Is there a second on it . Did i hear a second . Yes, second. President breslin okay. All right. And we dont need to do Public Comment on a continuation, as our City Attorney said earlier. Thats correct . That is correct. President breslin, this is commissioner lim. I just have a comment for mike. Thank you, mike, for the explanation on the employee contribution thats tied up with the second highest employee contribution, which is blue shield, and that answered my question that i sent to natalie. My suggestion is just on the glossary, on the notes, if you could add that explanation because the members wont be able to find that if its just in the footnotes if you could just add that, that would be more helpful. I will, commissioner lim. Thank you very much for that recommendation. Thank you. President breslin okay. The motion has been seconded to continue this item to the next meeting. All those in favor, signify by saying aye. Do i hear anybody else . Clerk that is everyone whos on the call, is that correct . President breslin commissioner lim, did you say oh, i said aye. President breslin okay. Its unanimous then. Is anyone opposed . All right. It is unanimous then. Okay. So the only thing we have now left is item number 7. Clerk that is correct. President breslin a presentation of the rate of risk scores. When our producer gets to that slide, i will call it, president breslin. President breslin pardon . Clerk were just going to wait for the producer to move to that slide, and i will then call the agenda item for you. President breslin oh, okay. Okay. Clerk item number 7 is the presentation of the 2020 he greggate diagnosis cost grouper risk scores report correlating costs to underlying illness burden population. This is presented by marina coleridge, enterprise systems and analytics manager. Hello, this is marina coleridge, enterprise systems and analytics manager for the Health Service system, presenting the 2020 risk scores for the h. S. S. Population. Next slide, please. The risk scores are just a likelihood of incurring expe e expenses in the current or future year. We generate our own risk scores so that we have insight and understanding into our populations risk thats distinct from what the health plans tell us. Aggregating the scores of individuals generates group level results that we can use to help predict future costs, assess performance, measure efficiencies and under the Disease Burden of our population. The concurrent model measures current illnesses, and this includes both acute and chronic conditions. So the acute is severe and sudden, and could be anything from a broken bone to an asthma attack. Its symptoms develop quickly and suddenly, and theyre typically brief episodes, so typically last less than six months. Age and gender are not important in this model because the aflexflictions are known. Chronic conditions are long developing conditions which typically have a slow onset and worsen over time. These conditions persist over six months and are generally not curable but are managed, such as diabetes or high Blood Pressure. For this model, members with no claims receive a score thats based on their age and gender. In order to have this report available in time for the rates and benefits cycle, the risk period is based on the cycle of october through september, and payment is based on a fulltime year. Next slide, please. Our analysis yielded that the largest percentage increases in both current and prospective risk scores were for active employees and their dependents, and the claims experienced from actives enrolled in the p. P. O. And Kaiser Permanente plans. In our early retiree population, those enrolled in the concurrent scores for those enrolled in the blue shield plans have decreased, and the prospective scores for the same population had a slight increase, and not surprising, the medicare population scores had higher scores in the period. We find that uhcppo, blue shield trio, and the access per cost are higher while the Kaiser Permanente adjusted costs are lower than expected. [inaudible] those that are driving the costs, again, diabetes, cancers, sepsis, heart disease. Next slide, please. If we take a look at comparing the predicted health risk to the concurrent or Actual Health risk, so, for example, in 2018, the prospective risk score thats represented by the green bar was 1. 059 with the prediction, and wz alook at the 2019 concurrent score in orange, we see that it was. 978, so our active population has performed better than the predicted scores. And we see the same thing in the early retiree population despite the slight increases in both the current and prospective risk. Next slide, please. Heres a look at our medicare population, and that concurrent score in 2019 of 5. 192 is considerably higher than the previous years projected score of 4. 758, and we tend to see that in this population, possibly as an exacerbation of the acute and chronic conditions. Next slide, please. Now weve taken those risks, and weve broken them out by the individual plans. Heres a look at our active and early retiree populations. The orange lines are the early retirees, and the blue lines are the active population. So for our kaiser members, the. 880 score in 2018, thats where its less than the average beneficiary represented by a 1. 0, and its better than the projected score for the previous period despite the expected and concurrent risk. The members enrolled in our blue shield p. P. O. Have the greatest risk of any of our prospective populations [inaudible] and the prospective risk score rose slightly. In the active population, we had slight increases in their scores, but the active population is half that of the early retirees. Here, we combined the active retirees in one population, and as we can see in three of the four plans, the concurrent score is lower than the previous period predicted score, and in our he nighted health care p. P. O. , heres where we see that the concurrent risk score higher than previous years prospective edition. Heres a look at our medicare population, so the prospective scores in our Kaiser Permanente senior advantage, higher than those in the other populations, those in the mediCare Advantage plan considerably higher at 5. 354. Were justi were adjusting these based on the risk scores, and we find that the blue shield plans as well as United Health care had higher costs higher than the expected value. Next slide, please. Here, weve taken our commercial population, and weve grouped them into risk b bands. So healthy patients include patients not in crisis, all the way to crisis and acute mobilizers having acute conditions. 2 of those acute members represented in red are driving 78 of the costs in the bar on the right there. Next slide, please. Now were breaking the same information out for you by the individual plans, so the all plans is the bar on the left, and thats what you adjust saw in the previous slide, and here, you can see the distribution of our population within the plans in those categories. Again, the end crisis to 7 of the population in those plans. Next slide. And theres a breakout of costs by those plans, so again, those in risk driving between 77 to 79 of costs. Next slide, please. Heres a look now at the top five conditions within those health bands, and as you see, musculoskeletal disorders are represented in every one of those categories, and its in the top four out of five categories. We looked at those that were continuously enrolled between 2017 and 2019 and looked at their Health Categories and what their category was then to now, and we found that 23 are in a lower risk category, 19 are in the same risk, and 29 are in a higher risk category. Heres that same look for the medicare population, and the conditions that are really prevalent are musculoskeletal, and also cardiovascular are prevalent. Here, we find that 19 of this population is at a lower risk than previously. 50 are in the same risk, and 31 are in a higher risk category than in 2017. Next slide, please here, were doing some additional risk adjusted comparison, and were using patients admit per 1,000 utilizati utilizati utilization metric. Here, were looking at the admits per 1,000, and the dynamic adjustment just takes the risk factor into account to determine what the admits per 1,000 should have been. So in the active population, even though trios performance is higher, no doubt, that number has increased over the previous period from. 9 to 1. 0. 1. 0 is still exactly where you want to be. Over in our early retiree, we have the uhcppo city plan at 1. 9, so here, its worsening the patient admitted were slightly worse than previously adjusted. Next slide, please. And heres a quick look at our cost and utilization within the relationship. It is the spouse and domestic partners that drive the higher utilization and costs. And heres a quick look with the medicare population. Here, its the retiree thats the higher driver of the utilization, again, costs not available. Next slide, please. And here is just a quick look at cohort by age and gender as well as the risk categories there below. For the increase in population, theyre at a 50 50 split. Next slide. Heres a look at our medicare population by hierarchal categories. For our roughly 29,000 lives here, you can see what the top ten categories are. Next slide, please. For the first time, were able to take the h. C. C. s and take a look at the population. Here, were looking by percentage, and we can see that end stage renal disease is the prevalent condition. Total population is just under 9 or 9 just over 9500 people. Next slide, please. And with that, this concludes my presentation of the 2020 aggregate diagnosis cost grouper and risk scores. Im sorhappy to answer questio president breslin commissioner lim . Thank you, marina, for all the hard work you did on this presentation. I also want to thank you. Its quite detailed and quite powerful, and i think the power were still understanding. I think my question, you prefaced we can go back and use this in terms of our rates and benefits cycles. Can you review how this information is shared and the response of the health plan, people to this . Yes, thank you for that question, commissioner follow ans b follansbee. This is the first time weve had the report ready in time for the rates and benefits cycle, and i think our cycle tends to be slightly different from what theyre using, but its consistent with what were seeing from the health plan. I think that maybe it would be use chl, since were asking the health plans at our next meeting to address each of their rate increase requests, if they can respond to the question themselves, as well, to to say where maybe there are discrepancies and what can be done to address future costs from our perspective in the Health Service system. Dr. Follansbee, yes. I think that was in our Strategic Plan that that is what we do on a regular basis, is we have very detailed review with each of our plans on their utilization. Keep in mind that the data that goes into the all paired claim database are the plans data, so we are looking at it at the same data, although we are looking at it perhaps differently. And while their claim database has the added list, if you will, from the i. B. M. Comparative tools, that were able to look at and see how we benchmark. But all of our discussions and i think this is important that we recognize that many of our members are not well, and they are utilizing services, expensive services, and this does set the basis for why were [inaudible] why rates do increase over time. Theres a fairly significant contribution to that by the very fact that we have members that use the services, and thats good. Its good that they use their services, but it does contribute to the rising cost of care, so i think thats just important to understand. And we do as i said, we do very detailed utilization review meetings and ask a lot of the questions that i, for one, learn from you and would be happy to continue to do that or invite you into any of the discussions as were able to. Yeah. I raise the issue in part because as a board, weve looked at musculoskeletal issues in the past, looking for ancillary contracts to try to help our members take control over musculoskeletal issues including, maybe not only well, including prevention. And i think that when we see the prevalence in terms of contributing costs across ages and etc. , its something we need to keep reviewing as a Health Service board. No, i understand, and its certainly a topic of special interest to bring to the board. This last year, we did a special presentation on cancer, and so were more than happy to move forward this year on musculoskeletal. For all the reasons you just saw, it is a topic to do a deeper dive to see if were providing the Optimal Services for our members that would help reduce their painful experience as well as the cost. Well, i, too, would like to thank marina, especially at this late hour for hanging in there, especially at dinner time. And anybody else have any comments here . Yeah, i just wanted to say, marina, this is commissioner hao, that your great analytical brain never ceases to amaze me. This is commissioner canning. I agree, as well. President breslin okay. At this time, im going to call for Public Comment. Clerk for anybody watching or listening online, were going to wait for 30 seconds to allow you to dial in with the access code. Well give that 30 seconds and then call for the line to be open. All right. We will begin Public Comment for this item. There will be silence for callers who are on the queue already, waiting for more to join. You have one minute to respond in Public Comment. Moderator, will you please open up the phone line for our first caller. Operator you have zero questions remaining. Clerk president breslin, that concludes Public Comment. President breslin wow. Thats amazing. Well if there isnt any objection, i think that we can adjourn this meeting, unless somebody else has some other comments that theyd like to make. I think were cooked. President breslin okay. This meeting is adjourned. Clerk thank you. Goodbye, everyone. We spoke with people regardless of what they are. That is when you see change. That is a lead vannin advantage. So Law Enforcement assistance diversion to work with individuals with nonviolent related of offenses to offer an alternative to an arrest and the county jail. We are seeing reduction in drugrelated crimes in the pilot area. They have done the program for quite a while. They are successful in reducing the going to the county jail. This was a state grant that we applied for. The department is the main administrator. It requires we work with multiple agencies. We have a community that includes the da, Rapid Transit police and San Francisco Sheriffs Department and Law Enforcement agencies, Public Defenders Office and adult probation to Work Together to look at the population that ends up in criminal justice and how they will not end up in jail. Having partners in the nonprofit world and the public defender are critical to the success. We are beginning to succeed because we have that cooperation. Agencies with very little connection are brought together at the same table. Collaboration is good for the department. It gets us all working in the same direction. These are complex issues we are dealing with. When you have systems as complicated as police and health and proation and jails and nonprofits it requires people to come to Work Together so everybody has to put their egos at the door. We have done it very, very well. The model of care where police, district attorney, public defenders are communitybased organizations are all involved to worked towards the common goal. Nobody wants to see drug users in jail. They want them to get the correct treatment they need. We are piloting lead in San Francisco. Close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. Our goal in San Francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention to address that population and the Racial Disparity we see. We want to focus on the mission in tender loan district. It goes to the partners that hired case managers to deal directly with the clients. Case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. I have nobody, no friends, no resources, i am flatout on my own. I witnessed women getting beat, men getting beat. Transgenders getting beat up. I saw people shot, stabbed. These are people that have had many visits to the county jail in San Francisco or other institutions. We are trying to connect them with the resources they need in the community to break out of that cycle. All of the referrals are coming from the Law Enforcement agency. Officers observe an offense. Say you are using. It is found out you are in possession of drugs, that constituted a lead eligible defense. The officer would talk to the individual about participating in the program instead of being booked into the county jail. Are you ever heard of the leads program. Yes. Are you part of the leads program . Do you have a case worker . Yes, i have a case manager. When they have a contact with a possible lead referral, they give us a call. Ideally we can meet them at the scene where the ticket is being issued. Primarily what you are talking to are people under the influence of drugs but they will all be nonviolent. If they were violent they wouldnt qualify for lead. You think i am going to get arrested or maybe i will go to jail for something i just did because of the Substance Abuse issues i am dealing with. They would contact with the outreach worker. Then glide shows up, you are not going to jail. We can take you. Lets meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. Bring them to the Community Assessment and Services Center run by adult probation to have assessment with the department of Public Health staff to assess the treatment needs. It provides meals, groups, there are things happening that make it an open space they can access. They go through detailed assessment about their needs and how we can meet those needs. Someone who would have entered the jail system or would have been arrested and book order the charge is diverted to social services. Then from there instead of them going through that system, which hasnt shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. They can offer Services Based on their needs as individuals. One of the key things is our approach is client centered. Hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take . We are not asking individuals to do anything specific at any point in time. It is a Program Based on whatever it takes and wherever it takes. We are going to them and working with them where they feel most comfortable in the community. It opens doors and they get access they wouldnt have had otherwise. Supports them on their goals. We are not assigning goals working to come up with a plan what success looks like to them. Because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. It is all on you. We are here to guide you. We are not trying to force you to do what you want to do or change your mind. It is you telling us how you want us to help you. It means a lot to the clients to know there is someone creative in the way we can assist them. They pick up the phone. It was a blessing to have them when i was on the streets. No matter what situation, what pay phone, cell phone, somebody elses phone by calling them they always answered. In officebased setting somebody at the reception desk and the clinician will not work for this population of drug users on the street. This has been helpful to see the outcome. We will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. First to push me so i will not be afraid to ask for help with the lead team. Can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. It is all part of the home reduction model. You are using less and you are allowed to be a viable member of the society. This is an important question where lead will go from here. Looking at the data so far and seeing the successes and we can build on that and as the department based on that where the investments need to go. If it is for five months. Hopefully as final we will come up with a model that may help with all of the communities in the california. I want to go back to school to start my ged and go to community clean. It can be somebody scaled out. That is the hope anyway. Is a huge need in the city. Depending on the need and the data we are getting we can definitely see an expansion. We all hope, obviously, the program is successful and we can implement it city wide. I think it will save the county millions of dollars in emergency services, police services, prosecuting services. More importantly, it will save lives. Tenderloin is unique neighborhood where geographically place in downtown San Francisco and on every Street Corner have liquor store in the corner it stores pretty much every single block has a liquor store but there are impoverishes Grocery Stores im the cocoordinated of the Healthy Corner store collaboration close to 35 hundred residents 4 thousand are children the medium is about 23,000 a year so a low Income Neighborhood many new immigrants and many people on fixed incomes residents have it travel outside of their neighborhood to assess fruits and vegetables it can be come senator for seniors and hard to travel get on a bus to get an apple or a pear or like tomatoes to fit into their meals my my name is ryan the cocoordinate for the tenderloin healthy store he coalition we work in the neighborhood trying to support Small Businesses and improving access to healthy produce in the tenderloin that is one of the most neighborhoods that didnt have access to a full Service Grocery store and we california together out of the meeting held in 2012 through the Major Development center the survey with the corners stores many stores do have access and some are bad quality and an overwhelming support from Community Members wanting to utilities the service spas we decided to work with the Small Businesses as their role within the community and bringing more Fresh Produce produce cerebrothe neighborhood their compassionate about creating a healthy environment when we get into the work they rise up to leadership. The Different Stores and assessment and trying to get them to understand the value of having Healthy Foods at a reasonable price you can offer people fruits and vegetables and healthy produce they cant afford it not going to be able to allow it so thats why i want to get involved and we just make sure that there are alternatives to people can come into a store and not just see cookies and candies and potting chips and that kind of thing hi, im cindy the director of the a preif you believe program it is so important about Healthy Retail in the low Income Community is how it brings that health and hope to the communities i worked in the tenderloin for 20 years the difference you walk out the door and there is a bright new list of fresh fruits and vegetables some place you know is safe and welcoming it makes. Huge difference to the whole environment of the community what so important about retail environments in those neighborhoods it that sense of dignity and Community Safe way. This is why it is important for the neighborhood we have families that needs healthy have a lot of families that live up here most of them fruits and vegetables so thats good as far been doing good. Now that i had this this is really great for me, i, go and get fresh fruits and vegetables it is healthy being a diabetic youre not supposed to get carbons but getting extra food a all carbons not eating a lot of vegetables was bringing up my whether or not pressure once i got on the program everybody o everything i lost weight and my Blood Pressure came down helped in so many different ways the most important piece to me when we start seeing the Business Owners engagement and their participation in the program but how proud to speak that is the most moving piece of this program yes economic and social benefits and so forth but the personal pride Business Owners talk about in the program is interesting and regarding starting to understand how theyre part of the larger fabric of the community and this is just not the corner store they have influence over their community. It is an owner of this in the department of interior i see the great impact usually that is like people having especially with a small family think liquor store sells alcohol traditional alcohol but when they see this their vision is changed it is a small Grocery Store for them so they more options not just beer and wine but Healthy Options good for the business and good for the community i wish to have lets do the roll call first, madam chair. I want to get over to that screen. Directo[roll call] madam chair you have a quorum. Should we move onto the should we have the comments under directors comments. We should be doing it now. Doing it now. Great. At this time, as i