Transcripts For SFGTV Health Service Board 20240711

He seems to be unmuted. There were problems. Commissioner scott are you unmuted thank you everyone for being patient. Well cap up with our technology. Can you hear me now . Yes. I heard everyone in test mode. Steven, can you hear me . Yes. Thank you very much. As the board is aware we annually engage in a selfevaluation for the board of directors and also an annual evaluation of the executive director. The Governance Committee met a week ago to review both documents as well as a time line for both processes. As you know, we initiate the selfevaluation first and then follow that four weeks later or so with the executive directors evaluation once we received the executive directors selfevaluation. In reviewing both documents, we did not make any changes in the executive director document. We did modify in the board selfevaluation document a couple of questions. We eliminated one question and we modified the wording on another. So those changes are contained in the attachments sent out in preparation for this meeting. I would remind Board Members that if these surveys and the time lines are adopted, you are pledging to complete the process in in the recognized time line. We know this year well have consultative support coming from the department of Human Resources. Therefore our board secretary will be the action officer if you will, number one initiating to the Board Members and sending reminders and compiling respective reports. We had some discussion on this item on november 5 and everyone was supportive and shell be getting consultation from the department of Human Resources as we go along in terms of pili piling compiling the report but the majority of the work done by the board secretary. With that id remember to entertain a motion for this item. Commissioner scott, this is mary howell. I have a question. Last year we noted in certain circumstances the board was not able to observe or experience certain interactions or whatever and thought we should another rating of unable to observe. Has that been add . We discussed that at this meeting and felt it applied to only one item and around orientation process. There be be a change on that one item but the others we felt Board Members can comment on. All right. Any other questions . Commissioner scott may i make the motion to approve yes, please. I move to approve the selfevaluation survey and the survey with the executive director. And time line. Sorry, i was about to add and the time line as presented. Thank you, is there a second . Properly moved and second we had a prove the annual board selfevaluation and the executive director surveys as distribute and the time lines attached to each. Is there any further board comment . If not we will go to Public Comment. Thank you. Ill be reading instructions allowed. Public comment will be available on each item on the agenda. Each speaker will be allowed three minutes to comment. Both channel 26 and sf gov tv are streaming. Opportunities to speak during the Public Comment are available via phone by calling 4156550001. Entering the access code, 1466684910. Press pound and found again and then enter as an attendee. Before beginning Public Comment well take a pause to allow callers to time to dial in. After the pause if you dial in and wish to speak on the agenda item dial star 3 and its your time to speak for on hold. Moderator, let us know if theres callers who wish to comment on the agenda. Thank you. There are presently seven callers. A reminder to all callers on the line. You must dial star 3 now if you want to join Public Comment for this specific agenda item. We will wait five more seconds and then close Public Comment for the agenda item. There are still no callers at this time. Public comment is now closed. Commissioner thank you, were now ready to vote on the motion as offered. All in favor signify by saying aye. On the . Those opposed . The item passes unanimously with no opposition. Well go to item 7. Medical plan competive plans. Its a discussion item and presented by executive director abien. If i could before you begin, direct we had a robust discussion regarding the rfp process and how the commission could indeed be more familiar with the process as well as its role in terms of oversight and having some competence in the preparation of the r. F. P. , the administration of the r. F. P. , the implement of the r. F. P. , responses, etcetera. We convened a meeting november 5 and the direct brought to us in great detail how the process is unfolding, what is being done and what will be done going forwa forwa forward before the board is parent with a recommend in february. I believe commissioner breslin stated were satisfied with the process as well as the calendar and activities brought to us by the director. As a report out today its a high level review of what we reviewed and with that ill ask the director to begin. Can get the slooidz slides up, please. One moment. To compliment what commissioner scott said what about to present to you is high level process both a look back and forward on the r. F. P. For the medical plan. The key dates with the assessment and the first assessment was in july 2019. Que announced the decision we would not release the r. F. P. For plan year 21. We the medical plan would be through the competitive bid and that release has since occurred. Theres two sections of the r. F. P. And i know you all know at this point that that document is available and robust almost 100 pages on the hhs website and theres legalese you may not enjoy reading the two sections and provided the to the commissioners as well as is section 1 with the overview of the system. We talk about our interest in valuebased payment and talk about the Health Plan Market assessment. We talk about the results of the focus group that we did and presented the findings in i think it was november of 2019. The Strategic Plan has been a backbone to the entire process. The concept of even to consideration of doing competitive bids through the Strategic Plan and then we updated the Health Market assessment. And we are always looking risk scores and we dont have the healthiest population and that is of concern. And well be bringing them before the board on special determinates and be before the Governance Committee earlier this year. So the other section of the r. F. P. That i would direct us to and the presenters if you would take us to what is labelled slide 3 in the presentation to be on the same page. And the scope of the work of the contract go may i interrupt. Can you tell us what slides youre able to see right now. I can see agenda. This speaks to the scope of work and what i want to draw everyones attention to is this reads like a Health Service board agenda. All of the items that we list on the board were topics and a deep dive in the discussions over the last two years. Everything from Care Management to primary care medical homes, interoperability, several things on Second Opinion and Care Management and complex Care Management. As well as our own audit policy that we put into effect since last year and extensive training around rate methodology, a very complex subject of which hike mike clark helped produce four webinars on that because thats at the heart of the matter when we negotiate rate. Culminating with the utilization and quality dashboard we present to the Health Service board on a regular basis, all these inform the r. F. P. And as you review it you can see the work the Health Service board has done and how it informed the r. F. P. So that brings me to the time line. As you know we issued the r. F. P. On september 14th. We had our required proproposal conference calls. We receive the notices of intent to bid. We provide the responses all by september 30th. We have everyone involved and having a continued interest in the process have signed the disclosure statement and the proposal submission date is now behind us. We have now received all the proposals that we will be able to receive during this process. Going forward were in what we call the an lit analytical phase where were organizing the materials and responses and running the financials and disruption analysis and highly Technical Work and very complex given the volume of information that weve requested and have received. The materials will be prepared for the panel list who will receive them beginning first of december and have the month to complete their review with the scoring rubric that has already been prepared. Oral interviews will be taking place starting after the january 1 holiday. In order to develop our recommendation that we will bring back in a robust way to this board for a february 11 meeting. Understanding director, there you go. I was trying to get us on the right slide. Thank you very much. Its a little different than what i have on the agenda. So the time line is we are wrapping things up now and we are preparing for the written interview. The Health Service board will receive its information february 11th. We expect that to be a very robust dialogue with the board and well be well prepared for that and should the board have more questions than we can answer at that time and we request for the decision to be made at a later meeting, we have secured a second meeting date in february for that purpose. That will be february 25, if i recall correctly. February 18. Is that right . A week later . Yeah. Okay. That would be another Board Meeting open to the public for further discussion if necessary. Thats correct. Okay. Thank you. Director, thank you for the overview. Ill ask the Board Members if they have question the time line or the process at this point. Dr. Collins, youre right. The second meeting date is on february 25. All right. That is a thursday. So two weeks after the regular Board Meeting. We would have, if needed, an approval meeting of the medical plan selection if we are not able to accomplish that on february 11. So just for the record, its february 25. The 18th weve wiped out . Yes, the 18th is an error on the slide. It should be february 25. Are there any other clarifying questions or other other items described in the process and as outlined by director yant from the commission or board . This is president follansbee, id like to say this process as you already stated, chairman scott, has been well outlined and described i think to the Governance Committee as well. I think its consistent with the involvement of the Commission Board all along as im quite pleased having read the r. F. P. In large portions and read the comments that came in during the Comment Period and question period. I really want to compliment all the staff for both thoroughness and completement and in particular completeness and particular thoroughness for the Strategic Plan for 2021. I want to thank everyone for that. All right. Any other comments from members of the board . This is mary howe. I have a quick question. Who will comprise the panel for the panel review . Director, yant, would you speak to that . We will putting together a panel on subject Matter Experts including side employees and representatives from other county and entities. The identity of those particular individuals is confidential in order to protect them from undue influence. And Staff Support and other support as well. Thank you. And once we get the staff recommendation and the evaluation at the february meeting, a lot of the currently confidential information surrounding this process will be made available to the board and public unless as the proprietary information the health plans dont want divulged but the process and submission and all of that will be available to us at that time. And my understanding is that includes the members of the panel reviewing all the aspects of the r. F. P. Formulating the recommendation. Thats correct. Thank you. We took a formal process to selecting the panelists as ive described to others as if you were recruiting members for the governance board where you look first for the qualifications of individuals to have a rich diversity and subject Matter Experts. The health plan world is quite complex whether its someone with pharmacy, expertise or Government Contracting expertise. We started with that list of qualifications and then a small group of us that brain stormed and used our networks to qualify people that were willing to commit a significant amount of time to this process. I just have a question. Yes, commissioner breslin. So how do you you described how you pick a panelist but who pick the panelist . Who is involved in that . Our office, myself and mike vincente our lead contact in management. Okay. As for the City Employees, thats a Different Group than those who have expertise, right . City employees have various expertise as well. Okay. All right. Before we go into Public Comment i wanted to the great deal of admiration i have for director and staff and mr. Vissente and i had this responsibility before and i know the amount of time and effort that it takes to Staff Support to a process like this and i wanted to call that out publicly and thank them for what they have done to date. At this point well go to Public Comment. I have a comment as well. I mentioned im attending a meeting and it was a strong recommendation that every plan review and reissue r. F. P. S every three years. The appropriate and the timing of this appropriateness and timing of this and we are clearly in a very appropriate maybe slightly delayed time frame to review this. Im not suggesting we do this every three years but the recommendation by an expert outside of the city of san francisco. Id thank the advice and we on the board would be better to do a broader time frame if we were to do this in three years i dont know abby, michael or any of the other team members want to go through that that soon just as a matter of work flow. I agree. President follansbee, if i may jump in for the record and apologies ive been able to listen and view and have seen the entire proceedings but with technical problems and i was just able to join with the ability for you to see me during the presentation and i wanted to state that for the record im now able to participate fully. Thank you very much. Thank you, supervisor, welcome back. Thank you. Well now go to Public Comment, please. Thank you, commissioner scott, ill reading instructions. Public comment is available for each item on the agenda. Each speaker is allowed three minutes to comment. Channel 26 and sf gov tv is available and you can dial in by dialing 14156550001 and entering the access code 1466684910 well allow a pause for members to press 3. Dial star 3 to be added to the queue when the message reads its your time to speak, for those on hold please wait until the system indicates you have been unmuted. When i welcome you on the call youre encouraged to state your name clearly though you can remain anonymous. Moderator, ill pass you host privileges and let me know if theres callers who wish to comment on the agenda. Madame secretary, a reminder to all callers on the line. Must dial star 3 now if you want to join Public Comment for this specific agenda item. We will wait five more seconds and then close Public Comment for this agenda item. Madame secretary, there are no callers at this time. Public comment is now closed. With that, president follansbee ill turn the chair back to you, sir. Well move on now to item 8. Agenda item 8, directors report. This is a discussion item. Good afternoon, commissioners. I have a brief directors report for you but very important in that we had a very successful open enrollment in the virtual environment in our strange pandemic world. And that is a loaded statement. I cant tell you how impressed i am with mitchell and the teams for doing the heavy lifting to make this a good experience for our members. We didnt need to add to anybodys anxiety this year and think we did an excellent job of keeping things very manageable for our team as well as all of our members. I was crunching the numbers and well give you the color detail at the december meeting with lots of firsts weve accomplished with terrific support with our other department of technology and other support outside of hhs. Folks who have recognized the value and importance of doing this work in a Virtual World. We were well supported. Our Communications Team took a whole new took it up a notch or more quote, emeril, to make the information we had available with webinars and ongoing enhancements so the we have pages being able to monitor what information needed to be presented somewhat differently. And did an excellent job of keeping up with the face of the enrollment activity and so Member Services and the truth of coming through on the back end of this is that the clean up for the processing of the open enrollment transactions which is usually forcing us to be in a high operating mode for a number of weeks following the closure of the enrollment itself came to a halt pretty quickly as well which is another huge indicator of how smoothly the transactions did occur. Looking forward to seeing the all the numbers and my hats offer to the entire Operations Team for doing such an beautiful job on open enrollment this year under the current circumstances. Director, before you proceed, it may just be me but your screen is flashing your image. Either i have a seizure disorder maybe we can just see your name. It may save medical emergencies for the rest of your presentations if thats okay with you. Thats pretty darn funny. Thats a first. As the more like nausea. We dont need that. Okay. Just checking in too. I had noticed that as well and its likely a low bandwidth issue. Thank you, all. Reminder, i think it goes without being said we are very much impressed with the piece of the vendor blackout period is still in play. Our well being services has done an amazing job this year of adapting and transforming the Service Board and their being able to pivot and support the workforce through a Virtual World and with a huge focus and concentration on Mental Health and well being of our workforce its been remarkable. And continues to grow by leaps and bounds. Ill let carry report out to you in more detail next month but we had the opportunity to observe a champion event last week where we had over 200 champions across city departments that support well being in a very robust way and we had three key note speakers telling them how wonderful they were. It was very heart warming and well deserved because theyve been our web of support for city workers throughout also well being has taken it upon themselves to pivot. [please stand by]. They are leading that effort jointly and doing a marvelous job and we will be doing some more education with our staff in december as well. That combined with our focus on the social determinants of health we will bring to you in a joint presentation in december and in january to help understand what these terms mean to us as a Health Service board and how we can have influence addressing some of the inequities our members experience. We do have reports in my directors report, unless theres questions i wont go over them in detail, but the plans we are concerned we are at another period of time where we may see another uptick in our jurisdictions and certainly it is true across the u. S. It is good that the health plans are concurrently monitoring this and reporting to us. Our concerns mirror what the doctor said. In addition, we have concerns about testing available, which although it continues to be much more than it once was, were concerned if we hit a high demand period with an outbreak and or with schools resuming, that we will be again having to triage to get these resources. Thats what we experienced at the beginning of the pandemic, the testing resources were limited to those with symptoms. Now things are wider than that and people without symptoms can get tested for a variety of reasons. If there is a huge demand, that may be pulled back as well and we need to stay on top of that. We have followed up with requests for how to submit Public Comment. We have made the clarification and that is available on our website. Also, we have compiled a board email report and the board is aware of the emails and the resolution of the activities. So we have included that in this months report. Lastly, i would just like to say that we have as expected this time of year, there are issues that come up with the administration of the vaccine. There were a couple of questions that came up last week that kaiser had a response to on behalf of one of our members that wrote about it and experienced i think in the pfizer roll out where there was not available the highdose flu vaccine. To pfizer has offered an explanation. We can comment on that as well. So i will stop there. If the board has any questions, and dine you want to speak to the flu vaccine matter as well. If its okay, i would like to speak to the flu vaccine issue. I was glad to see this issue brought up with distribution and availabili availability. The high dose is recommended by the center of diseases control for anyone over 65. Its the same vaccine component as the regular vaccine which is available from multiple manufacturers. The high dose comes from one manufacturer. Its the same components, but the levels of the components are four times higher. As one can imagine does lead to a more robust antibody protection in those over 65. The vaccine was first approved based on antibody levels and not on any clinical efforts of increased efficacy or usefulness. That evidence is evolving, but it is clear that it prevents hospitalizations by about 24 . Its not four times more effective in preventing disease, but 24 more effective in preventing disease. That is significant, but what that says is the routine vaccine, if available is also very protective and very appropriate. The question arises, will they take the regular dose or a high dose . Historically there are studies that show that administration of a second dose of the vaccine is not as robust. So i cant tell you that taking the vaccine a second time does you any good and might just cause more side effects than benefit. I did check with the California Department of Public Health on flu statistics from around the state. From Early September there is one reported death from influenza and reports from sentinel laboratories suggest it is a low level. The occurrence at this point seems to be the low, the average over the last several years. That doesnt mean it will always be this way. What it does mean is there is ample opportunity at the present time to receive the vaccine if it hasnt been administered yet and expect a benefit because we do expect to see some influenza activity. We still have opportunity. I urge everyone to get the flu vaccine if, indeed, they havent received it and if it looks like the availability of the high dose may be delayed or hard to predict and if one wants to take advantage of the high dose, i would urge that as well. I want to make a brief comment about the covid19 pandemic because, director yee, you provided a detailed and remarkable account of what our health plans are doing, whats happening to our Health Service members. And i want to applaud everyone for their work at keeping this pandemic to a minimum in our area as best we can. These measures do work. As part of this Conference Im attending, there was a lot of discussion of benefits visavis covid. Its amazing to me the number of respondents attending this reporting a whole host of benefits or lack of benefits. The consistency with which were seeing in each of our vendors is impressive and its something that we need to acknowledge and applaud that everyone has steppedup to the plate. This is not the case around the country, despite directives and even legal sort of recommendations, et cetera. Some plans are getting bills for members that went outside freestanding testing sites, bills that go up to as high as 1,200 per test. I would urge all of us and our members, if one wants a test, start with your provider and the system. Number one, it can help interpret what that test may mean in your situation, whether youre worried about exposure recently, worried about symptoms, it should be interpreted in the way for each person. Again, i urge everyone to go through their medical provider. Does anyone have any questions or comments . I dont see any raised hands. Thank you. I just wanted to indicate one of our retirees said a bill of 60 or 70 was sent to kaiser on her behalf when she got a flu shot at one of the local pharmacies and she got that straightened out. But when you mentioned the bills going in for testing, i think its because in the community when we have these other options and theyre more convenient for a number of our members and we have people going to cbvs and walgreens. We need to consult on this. Thank you. Commissioner, do you have a comment or question . I do. Its regarding director yants report about the email. It said only nine people sent emails from september and october. Would that be correct . Yes. How can that be, nine people in an open enrolment . What . Only nine people sent emails in . Im sorry, what page are you on . I dont have any of that in front of me. When i looked through, i think it was i think what the nine emails represent are nine emails that may have been brought to the boards attention. It wasnt about open enrolment. The email report is sometimes we have emails sent as to the secretary addressed to the board of directors of the system. Thats the ones i think are contained in this report being referenced. Yeah were not offering a report on the number of emails we receive sine die. So youre offering a report on the emails directed to the board . Thats correct. Thank you. Commissioner bresman, did you have a question about the influenza vaccine . I absolutely do, but i was going to do that when item 11, contract and health representatives, because regarding the health plans, what are they doing. Okay. If we have to, well defer that until that item. Any other questions or comments from the commissioners . Seeing none, i think well go ahead and open this up for Public Comment. Clerk thank you, president. Ill be reading instructions. The Public Comment will be available for each item on this agenda. Each speaker will be allowed three minutes to comment. The dialin number is being streamed across the screen. Opportunities to speak during the Public Comment period are available by phone by calling 4156550001 entering access code 146 668 4901 and then pressing pound and pound again. You will enter the meeting as an attendee. Before we begin Public Comment, we will take a 30second pause to allow time for callers to dial in using information on the screen. After the pause if you dial in and wish to speak on this agenda item, dial star three to be added to the Public Comment queue. For those already on hold, please wait for the system to tell you, you are unmuted. Operator, can you please let us know if there are any callers wishing to comment on this agenda item. Operator we have eight callers on the phone line. Zero callers have entered the Public Comment queue at this time. A reminder to all callers at the time, you must dial star 3 now if you want to join Public Comment for this item. We will wait five seconds and then close Public Comment for this agenda item. Board secretary, there are still no callers in the queue at this time. Clerk thank you, moderator. Public comment is now closed. Chair thank you, director yant, and your whole staff for an incredible level of activity in the last few months. Before i call item 8, i would like to take recess for 10 minutes. It means that we will reconvene on my calendar by 2 28. Were going to have a very robust discussion on medicare market updates thats quite detailed. And i want us all to be fresh and Pay Attention to this as well because this is a fas mating topic for us to keep abreast of. [ roll call ]. Chair well go ahead and call item 9 which is a discussion item. Clerk agenda item 9, presentation of medicare market update. This is a discussion item. I just wanted to make a note that on our agenda it does have a representative, jon grosso from aon presenting, but mike clark will also be here. I wanted to make sure that jon is on the line and we can hear him. Jon, are you able to hear us . Yes, i can hear you. Can you hear me . Clerk yes, thats great. Super. Thank you. Hi, this is mike clark with aon. My colleague will be presenting the market update. We encourage this to be an interactive dialog on the topics well present today. I fully encourage questions as we review the slides during the presentation. With background, there are two plans available to retirees. One is the p. P. O. Plan to all medicare retirees. And then certain medicare retirees have a local Medicare Advantage h. M. O. As well. For about 70 medicare retirees there is also a kthmo Medicare Advantage in washington state, the northwest, which is the portland, oregon area. The purpose of todays discussion is to initiate planning as it pertains to the possibility of a request for proposal that could occur for the Medicare Health plans into the sfhsf plan. There are some questions we will be going through as we discuss the present state of the medicare market. The first is how has the need for medicare evolved in their offerings. What are some of the national and California Public sector Employer Trends that can be used to inform. And as we initiate this conversation today leading to a likely decision by june to determine whether to pursue a request for proposal for medicare plans for the 2023 plan year. What are those steps that hshsf will take. How do we assess if the plans today are meeting the needs of measures and are there any significant gaps that need to be thought through to think of Solutions Going forward to think of a possible r. F. P. With that, these are the agenda topics well discuss today. First leading with the medicare alignment. An overview of the Healthcare Market that includes coverage types. A National Statistical view as well as a county view looking at the offerings provided by the 10 counties that are part of the 10 county survey. And also other bay area counties that are not in the 10county survey. Well look at information for those counties. Well hone in on a Medicare Advantage point. Well close our discussion interactively with you to discuss next steps in the medicare future evaluation. We are not going to specifically review the appendix items today, but there are three robust appendices for this document. One is background of Medicare Programs, including the core medicare a, b, c, and d programs. More information that well review in the main portion of the document. And then also because healthcare is always fraught with many acronyms, there is a glossary of terms to help educate on the various terms that wont be discussed today in this presentation. With that, ill launch into a review of how medicare plans fit in the strategic goals for sfhsf. When we thin how the member plans play out, we need to think about copayment and say insurance. We need to think about how sfhss benefits the retirees. I cant emphasize enough the importance of the quality aspect of this by providing comprehensive and integrated healthcare. From an engage and support standpoint, the plans should work with the vendor partners to provide literacy and address Racial Equity and other negative social determinants of health. Before i talk through the next strategic considerations, any questions or comments about how we think about the medicare plans integration into these specific strategic goals . None from me. Michael, just before you go on, in terms of the affordable and sustainable, when you talk about contributions and plan designs, youre covering copayments and all those other deductibles, et cetera, et cetera, correct . Correct, that is [indiscernible] thank you. I just wanted to be sure that was embedded in that and we may want to clarify that in future presentations. Thank you for that suggestion. For the other two strategic goals, we realize the sfhss should think about the needs of members and provide a meaningful opportunity certainly from the Healthcare Plan itself and the vendor partner, the plan design element that we just spoke about, the copayment, the coinsurance, the affordability of member costs for services. And then in the Provider Network and Health System that are embedded within the networks of the medicare plan. And then the last strategic goal recognizes the plans to be provided by vorpeds who will support the ongoing wellbeing of activities and shifting sick care to health in healthcare and reduce barriers to care. In other words, addressing in a very targeted fashion the negative social determinants of health aspects. So we think about the potential to consider on r. F. P. For 2023. This is how were thinking about the integration of goals into the sfhss strategic goal platform. Excuse me, i have a question. In the prior slide. What does negative h. O. S. Mean . Im going to go to the prior slide as its more spelled out. Negative social determinants of health are those social determinants of health that may create a barrier to health or healthcare that may be a negative influencer to someone with the ability to access care to find the opportunity to sustain health. For example, you may hear the word food desert. Someones inability to eat Healthy Foods in their neighborhood to be viewed as a negative social determinants of health. Low income impacting someones ability to pay for services, for healthcare services, could be viewed as a negative social determinant of health. Well, everyone has the same opportunity and choices in san francisco. If you work for the city and youre a member of the plan, so im not quite sure how this is clear. There are cultural differences of what people eat and how they exerci exercise. That depends on cultures and ways of life, a little bit more than food desert in san francisco. Yeah, i know that youve obviously been leading the charge with sfhss. Id love to hear your commentary. It might sound good and goes with the program, but to me it doesnt make sense. We will be doing a robust presentation at the next two Board Meetings about Racial Equity and social determinants of health. One is on social isolation. We have a significant number of seniors in medicare that live alone and that is a risk factor as high as smoking is. There are others that do affect some of our members quite severely. Well be highlighting that in the reports that are forthcoming. I would add that even though all of us may have access to the same spectrum of services, issues like skin color make a difference in the ability of contractors weve designated to diagnose certain conditions. We have some responsibility to make sure that our vendors are assuring us that the vendors are well trained in certain issues such as skin color, this is just an example, on diagnosis of skin cancers. This goes beyond simply what was available in terms of services and also responsibility of vendors to guarantee equitable care as well. I would think any doctor would know that. I dont want to belabor the point because were going to have a presentation from the American Economy of dermatology talking about the challenges of knowing that their newly trained dermatologists are well trained across the country. I think any doctor is probably too broad a voice of confidence. And ill reserve my comments to the presentation that well be having in the ensuing Board Meetings. This is not only about care availability, but not only the cultural accessibilities and food and diet, but also preexisting conditions in certain populations that are also present in our membership. So its a much broader construct than some of the items weve talked about. And i think we need to be informed by those presentations. Thank you, commissioner. Ill shift gears to introduce the current Medicare Healthcare market. These are the available plan types on medical coverage. So the left side of this page starts with what we call traditionally original medicare. These are the programs that when medicare was first passed through the federal legislation in the mid1960s, these are the programs that were introduced, part a for hospital coverage and part b for medical coverage. Each provides a level of coverage, but with deductible and copayments and for part b coinsurance. It is funded primarily by the federal government with part a being earned with 40 quarters of employment over the course of a working career. Part b requires a member premium except for lowincome employees. This is the levels of coverage, not in a network, but it requires that physicians and providers accept medicare. The middle two are indemnity type coverages without reference to a network other than the provider is accepting medicare. A medical supplement is commonly known as medigap. This may fill in, say, the hospital deductible, other parts of the copayment structure. It could fill in the part b medical deductible and some or all of the 20 coinsurance that typically comes with the traditional medicare member. There is an additional premium that would increase as the fillins increase. With most states, there are 10 different approved benefit designs that vary based on the amount of fillins. A fulfillin is a coordination of benefits, thats the third column. Fully filled in those levels of medicare that would have the highest premium of any supplement coverage. Then the right side is the Medicare Advantage plan, otherwise known as part b or m. A. It provides coverage for both medical and Prescription Drug services, unlike the other three that are medical only. They usually have benefits for services. If someone is enrolled in medicare service, that plan becomes the coverage. It can be possible to obtain plans that are as low as zerodollar premiums as long as the member is eligible for both parts a and b. A distinction of member cost is found in the fact that you can have individual market plans that any medicare retirees could source via the market place or what is commonly known as group plans, Group Insurance, such as those sponsored by sfhss. The individual market plans tend to have lower market premiums, but higher copayments for doctor visits, description drugs, et cetera, at time of service. Group plans may have higher premiums, but typically much lower copayments for members. Some additional items related to the medical coverage. You see the additional potential Member Benefits are not there for original medicare, but supplemental Medicare Advantage plans may offer potentially benefits such as dental and hearing. More commonly and well talk about the prevalence of these shortly, some plans include added Member Benefits such as Meal Delivery and transportation coverage such as the sfhss and they plan to do today. A very important distinction in these coverages are the quality measures. There are no quality measures or original supplement c. O. B. Coverage. Well talk at length about those star ratings coming up later in this presentation. Also the care coordination, there is none for the original Medicare Supplement and c. O. B. Plans, whereas there is care coordination for member advanta advantage. This page covers the descriptions in the Prescription Drug coverage. The base level is available through the medicare platform. It was introduced through the medicare modernization plan in 2003 and part b went live for medicare retirees in 2006. There are four levels of coverage, based on how much Prescription Drug expense a member has incurred. At any point in the year it starts with a deductible. The first goes to insurance, the second layer goes to the donut hole. Once a staff member achieves the donut hole there is approximately 95 of coverage for the member at that point. Several thousands of dollars of expenses. The premium is paid by the plan members, but there is no automatic offering of this like the hospital part a and the standard part b do have the lowest premiums on the prescription plans simply because they have the highest level is at the time you purchase. There are no benefits. And there is no member care coordination. The middle column of the Prescription Drug plan, think of that as Medicare Part b plans with enhanced levels of benefits. So, for instance, they may create a greater level of fillins or greater level of member coinsurance along the way. Certainly a higher premium. Its common when any Medicare Beneficiary is purchasing a medigap plan or a coordination of benefits plan for medical on the open market, theyre also typically purchasing some form of Prescription Drug plan, or p. D. P. , as well to provide those Prescription Drug benefits. On the right side, Medicare Advantage, we talked on the prior slide how Medicare Advantage is integrated in the Prescription Drug plan. So the Prescription Drug coverage comes with Medicare Advantage. There is no requirement or need to purchase a separate p. D. P. Star ratings will talk about that shortly with respect to the medicare plans and the member coordinations. Any questions about these compare and contrast tables with respect to the variety of medicare plans available in the market place . None by me. I neglected to add a slide here, but there is also the ability to be covered by medicare under certain conditions of having end stage renal disease. Of all these medicare eligible individuals, approximately twothirds are enrolled in some form of original medicare and may only be parts a and b. Individuals could also purchase, like we talked about, medigap or other supplement plan and about 50 Million Medicare individuals do purchase some form of individual medigap plan supplements. The original medicare hospital benefits. We also know about 21 Million Medicare individuals purchase a part b Prescription Drug plan. As you can imagine, many people are among the 15 and the 21 million who purchase both. Those are individual counts, but there could be the same individual in both of those counts. Then about twothirds of individuals are enrolled in Medicare Advantage plans. 19 million are in the plan. About five million in groupsponsored medicare plans. You tend to find more in medicare market place plans because some employers have discontinued any form of medicare on a group basis. So sfhss is like other employers predominantly public sector, perhaps employers with significant retiree populatios. S there are groups who work for smaller employers such as retail or hospitality who do not offer employersponsored medicare plans. Those individuals would be the type of individuals to purchase Medicare Advantage plans via the individual market place. This could be h. M. O. Based or p. T. O. Based within that network of benefits. It can be local and regional. The last bullet we can glean from that statement is in california specifically, relative to the rest of the u. S. , there is a higher proportion of medicareeligible individuals who enroll in an m. M. A. Plan versus a flash supplement plan. That gives a sense of how populations distribute per employer. There are generally two approaches. You can see those in kind of the lightershaded blue ovals on either side of the page here. We say modified group strategy. These are Group Insurance plans guided by the employer working with health plans to offer these plans to retirees. Some of the evolution of these approaches happens through a combination of how healthcare reform has shaped the retiree market as well as employer objectives, like strategic goals that we discussed at the outset of the discussion. On the other side youll see the strategies where employers have eliminated their groupbased plans and gone to sponsoring and offering the individual medicare plans, whether theyre supplements, d. O. B. , Medicare Advantage, purchasing those plans in an individual market pla place. And some things in each of these strategies, for group base, typically Medicare Advantages can include coordination of plans, also Medicare Part b Prescription Drug pl Prescription Drug plans and Medicare Advantage, region and local as well as National Plans. Then from an individual plarktbas plarktbas plarktbasmarketbased needs, is are providing any funding or contributions, the individual marketbased plans are through a Health Reimbursement which provides Tax Advantages to both the retiree and the employer. These are typically amounts that fund into the Health Reimbursement accounts that are earned over the course of time, typically some form of age and servicebased buildup of account accounts. Some of the key issues, perhaps opportunities or challenges that are going to guide where the medicare plan market evolves from here, first certainly what impact the elections that transpired last week could have in the evolution of medicare plans. So well get a sense of how the federal government may look to evolve medicare plans. The outlook for medicare funding. The centers for medicare and medicaid is the agency of the department of human health and service sincere that orchestrates the Medicare Program and essentially determines the underlying funding that goes towards various medicare plans. The medicare access and Childrens Health Insurance Plan reauthorization plan is legislation that passed a number of years ago that is guiding the future of reimbursement methodologies for providers. Looking at how that needs to evolve over time as well as broader u. S. Social welfare progr program. Concepts we talked about earlier and longterm outlooks for the group. Knowing that for employers sponsoring Medicare Advantage plans, its very important to think especially about a national p. P. O. To provide the plan to retirees regardless of where they live across the u. S. Medicare supplement plans are inefficient. Theyre filling in some of the gaps for parts a and b, but theyre not necessarily providing any form of care coordination or any aspect that can be provided. Medicare standard plans that were first allowed in legislation that started in 1999, the big advantage is they provide them in tons of quality focus not seen in other types of medicare plans and have facilitate facilitates cost allocations. There are examples here of what are embedded in the sfhss plans today. Im not going to go through this in detail. This is the information on how original medicare compares to the Medicare Advantage across a number of different aspects of looking at the plans. The original medicare, a member can see any provider that accepts medicare, where noncomplying providers must collect directly from the patient. Or the h. M. O. Models typically only provide in that work providers certainly with provision for Emergency Care that may be thought of at work and p. P. O. Models can accept any medicare. The mavast majority of these listed do accept payment. As part of preparing for todays presentation, we know that retiree retirees have information on what other categories they offer. So we scanned both bay area counties as well as the remaining california counties that participate in the annual sfhss 10 county survey to understand what they offer to their medicare retirees. Highlighted in red is all offer one Medicare Advantage plan, some directly and some through an individual plan market place. When you look at the market place platform, youll see some are using the calper plan. Those employers may be providing some employer contribution for retirees to be covered. So four of these counties youll see leveraged calperes some way as the exclusive approach or for certain retirees that received covera coverage. Again, youll see kpsa predominant throughout these next few pages, as a typical bay area planned sponsor offering in Southern California as well, but youll also see that for group m. A. Plans, youll see others like your u. H. C. Plans being offered to retirees. There are some counties offering other group plans like supplements or c. O. B. But i will note in San Mateo County, to go along with their plans, they are adding a third Medicare Advantage plan in 2021 from blue shield california and eliminating the coordination of benefits plan after 2020 to replace it with the Medicare Advantage plan, which will be much more streamlined costs for San Mateo County as well as the plan members. For the remaining countries, three of the counties are represented in the bay area. These are the remaining seven. Youll see one m. A. Plan is sponsored by each of these countries. Kpsa in all instances spans a Southern California specific plan that is not available in northern california, but see is prominently offered in l. A. And orange counties. You will see some other plans that are offered and some of these other counties. And then some are available for retirees in riverside county. As i indicated before there is Additional Information contained in the appendix to this act. There are each of the 15 counties represented on these two pages. It would be helpful for me to know if theres any Additional Information that might be helpful for us to collect. So thinking about our 10county survey, we only do it for the purposes of determining the 10county amount and it does contain information on costs and plan designs. We could also start to seek information for each of these county counties or Retiree Benefits if thats something Board Members would be interested in seeing. Ill defer to my colleague who has her hand raised, but i would like to comment on this afterwards. Thank you very much. My concern is that while our issue issues including the surrounding area workers. When those folks retire, they send to remain in those areas because a lot of them have been living in those areas for many, many years. Some are employed in those areas because they were already living there. So while it doesnt pertain to the Financial Analysis that we do for the 10county supplement, i think its information id like to see for retirees in that area. And what ive also noticed over the years is that a good number of active employees from the bay area like to retire to areas that are around like senora and the twaleme area. It would be good to know whats offered to those employees. Thank you, mike. Absolutely. We can do that research. I think calpers may be the preferred conduit. We will absolutely do the research and funnel up with that information in a future Board Meeting. I was just going to say that as were collecting data or starting to think through plan design changes and so forth, i think it would be useful to try to find what benefit designs are present in some of these at least the 10 counties that we have traditionally compared to. I cant think of a particular feature, but certainly copayments, there might be any fo formulary issue. We should think about that Going Forward, particularly framing the r. F. P. Absolutely. And for starters, we can partner with kaiser to help us understand how the current plans compa compare. And then supplement that with additional research. I have a comment too. Nobody can see my hand i guess. Hello . Can you hear me . Yes. Go ahead, commissioner. So most of the counties or all the counties have the Medicare Advantage, but most of them have a p. P. O. And most of them have more choices than we do, especially for the medicare group. I never did like segregating our population. I think there should be one p. P. O. Thats open to both actives and retirees, which of course made it affordable at that time. So they have the Medicare Advantage, but also p. P. O. S in the mix. So they have more choices than we do. Thank you. And youll see that through these pages of exhibits that many of the counties offer multiple plans, more than just two. I have another follow up. May i go ahead . Yes, please go ahead. Thank you. One of my concerns was that previously when we had r. F. P. S going out, it wasnt split as it is today with the Medicare Part being separate. We actually looked at having presenters that offered both medicare benefits for retirees as well astivities and if they didnt have both, we didnt have them in the system. That was some years ago. My concern is primarily with blue shield are anybody who will respond to our r. F. P. S. Blue shield went out of the medicare business a number of years ago. Kaiser stayed in and are consistent with their offerings. Blue sheet, a lot of their contract providers didnt like the reimbursement, and basically we ended up with the c. O. B. Because they didnt want to be keeling with medicare. My concern is Going Forward as i see here, its a new day, blue shield is marketing to medicare and its back in business. Well, that back in business might have to do with medicare reimbursements and other issues with regard to what goes on in washington, d. C. I wonder if we have any sense of the reliability of a vendor such as blue shield to stay in and provide the services for no less than our contract. Going forward its difficult to change plans. A lot of our retirees are living in areas that are limited to start with. If they have a plan, it gives the best bang for their buck. Changing plans in the future can be very devastating especially as we get older. Im putting that out there and wondering can we trust among any of the other vendors, like blue shield, to be consistent in their promise to stay in the business and theyre not going to drop out if they dont find it beneficial. Thank you for the comment. Ill make a brief statement, but if i could ask paul brown from blue shield to follow me and provide a brief statement on your medicare offerings. I know in my discussions in preparation for today, that an example of the blue shield commitment was the coordination of the benefits platform to the blue shield benefit plan for 2021 that is available on a national basis. Paul, if youre available to provide more on this. Paul brown from blue shield california. Thank you for your question, commissioner. We never exited the medicare market. We have always had c. O. B. Plans or medicare coordination plans i should say in the group market. We have had in the group Medicare Advantage h. M. O. Area, the coverage in the past has been somewhat spotty because of our limited ability to get contractors to give the right rate to strike the balance between the medicare reimbursement and the rates. Since then and to my point, we have added a Medicare Advantage p. P. O. To our portfolio. It will be offered to San Mateo County starting january 1. There is some benefits about coverage. Those employees in the remote areas really do benefit from the Medicare Advantage p. P. O. So it spans coverage far beyond a county level. Its really a National Plan and it can accommodate those employees or retirees who like to travel, which is not always easy to get coverage outside the area. If i could just chime in. Again, we dont have an r. F. P. For medicare. I think the point of this presentation is not necessarily to add for responses for certain provincial vendors should we issue an r. F. P. , but i think its incredibly important and it was in the r. F. P. For the nonmedicare plans. If we can focus on the potential respondees in the future, we can get through all the comments. Anyone else have any questions for mike clark at this point . Otherwise, ill ask him to proceed. I think you can go ahead and proceed, mike. Thank you. On the market update, i mentioned earlier that approximately onethird of all retirees are [indiscernible] also there are numerous additional benefits in the various Medicare Advantage pl s plans. Think about how director yant spoke about the caregiver support could be the next generation of people supported. From a plan landscape, we talked about h. M. O. S that are in that work only. P. P. O. Plans in and out of network. The predominant style of plans are the p. P. O. Were seeing local and regional p. P. O. S take hold. This slide shows the predominance of the types of plans and carriers that are offering Medicare Advantage plans. United healthcare has the largest at the moment. Youll see two formations. Kaiser is fourth on the overall list. The bottom chart is the total m. M. A. Membership that is group based. So youll see that youre aligned today with two of the predominant m. M. A. Carriers in the market place. Mike, can you clarify, what is a pffs . Privacy for service plan. Thank you. And i talked earlier about star ratings and these are the foundation of quality measures that the federal government through the c. M. S. Entity uses to determine how a Medicare Advantage plan is performing. So for m. A. Plans, there are up to 45 different qualitybased categories that culminate in a rating that can vary from one star, which is the worst rating, to five stars, which is the best. They can include categories including how plans help members stay healthy through a bunch of screening tests. How members manage their conditions, plan responsiveness and care protocols. Also an aspects of operational performance. How many member complaints may be coming through. Members repeating services and customer service. Many of this feeds into the comprehensive star ratings that are produced by the federal government and theyre also determined by c. M. S. For the Prescription Drug plans, up to 14 measures for those standalone plans. Again, the good news for sfhss is if youre offering two plans that have high star ratings, over 600 member advantage plans excluding d. D. P. S were filed in 2020. Of those, about twothirds were rated. The National Star ratings is 4. 17. The goal is to at least make sure you have a plan four stars or higher. The satisfaction of the Quality Performance as well as the funding from the federal government, the higher the star rating, the higher the funding. Kpsa is one of only 20 contracts. Only 20 or 5 of those contracts received a fivestar rating for 2020 and that includes kpsa. National p. P. O. Plans have a more difficult time achieving a fivestar rating just because of the National Nature of the program and the need for information on Member Health and conditions to be known, which it doesnt always happen if members dont either see a physician in a year or in the case of the u. S. C. Plan get a house call. Any questions about quality measures for Medicare Advantage . Did i understand you to say that the reimbursement from the federal government to the h. M. O. Plans is somewhat improved by the higher the star for the same diagnosis or diagnostic group, they may get reimbursed a little better, you have five stars, as opposed to three stars . That is correct. The higher the star rating, the more there is the membership. The goal is to maximize what portion of that revenue is being generated through the federal p. M. F. Subsidies. The remainder is when i present to you on the premiums, that is after the federal subsidies from applied. Since a highlevel Government Official just accused the medical profession of fraud in their building, are these plans all subjected to the same antifraud activities to make sure that indeed the data they provide that generates the fivestar information is, in fact, valid . One of the deep dives we plan to do is into the quality because when we talk about valuebased payments, that is what were talking about, the whole shift of payment mechanisms is shifted away from fee for Service Outcome and the instruments are important on that. Certainly the federal government has a very large Compliance Division that looks very carefully across the board on all c. M. S. Charges that come in. Thank you. I have a question about that. Just go ahead. If the doctors have a plan to get reimbursed by the government, as youre saying, does that mean the doctors get more for their services . Because part of the problem as i see it is, yeah, they offer all these coordination of cares, but now theres a shortage of primary care doctors because theyre getting paid so poorly. And i think were at an Inflection Point where that is starting to change, where Physician Practices to local i. P. A. S are very much working in the direction and were building that into some of our contracts is their ability to perform by quality measures, some of which c. M. S. Is asking and some of which are the institute for Healthcare Association and in california, this is a heavy lift to move the needle to go in this direction. C. M. S. Has taken the lead to determine what those Quality Metrics are and determining their ability to comply and over time this trickles down the system. I have an example and when i saw what they got reimbursed, it was sorry. I dont even know why they would take the plan. It was 24hour care and people right there all the time. And to see how little they were reimbursed was kind of shocking to me. We have to be careful and this can be part of the discussion. All the federal government can do is reimburse those using electronic billing better. But the federal government cant monitor quality from individual providers. The reimburse for these providers and e. R. S and all of that is something that is negotiated not directly with the federal government but with the various health plans or insurance companies. Is that fair to say . Yes, i would like to ask my colleague if he can comment. Sure, mike. Can you hear me . Yes, we can. So the general rule, the health plans, the Medicare Advantage plans, are going to reimburse the providers something close to what traditional medicare would pay the providers directly. So those reimbursements from a Medicare Advantage plan can be below medicare, at medicare, or above medicare, but they tend to hover around the fee schedule and not deviate too significantly from the base line that is accepted by the provider community. Well, what i have seen in my personal doctors and physical therapists, which is a big deal for me is that they will accept medicare and not Medicare Advantage because Medicare Advantage is reimbursed so poorly. Ive seen this, where the doctors will not accept Medicare Advantage for that reason. Thats not surprising here. There are different specialties that can be reimbursed differently for various reasons by Different Health plans. I think what youre saying is not surprising. We would absolutely agree that that happens. By and large if this plan is used as the base line, and they may pay a little bit below or above. And there will be chances for bonus reimbursements for data sharing, for certain positive outcomes as determined by the Medicare Advantage plan and as governed by c. M. S. This can be a complicated area, but were not surprised there will be anecdotes out there. This is the reason most wont take an h. M. O. , the wellqualified ones. Thats the way it is. Maybe, mike, you can continue with your presentation so we can stay on schedule a little bit. Commissioner scott, did you have a question or a clarification . No, nothing at all. Go right ahead. Thank you. I will proceed. This chart highlights different types of Medicare Advantage plans. We discussed them, a combination of local, regional, national pp. O. S so you can see the distinction on these plans from the spectrum of low to high on the left side to the level of Care Management and restrictions which are highest for h. M. O. S and juxtaposed with Cost Management opportunity, which is higher in terms of an overall opportunity on the national p. P. O p. P. O. S. Just some further information on these programs. Building provider relationship and improving member help. Plan sponsors who commit to this advantage should consider this approach. What we often find is those competitive business can result in 20 to 50 savings relative to lets say if current plans are supplements or c. O. B. Type of plans for these reasons listed in this chart. [indiscernible]. We have one page on covid19 impacts. The revenue for 2021 came in slightly lower than expectations, just unrelated to covid. The Health Insurance tax relieved some of the pressure. We saw that under u. M. C. Renewal. What is expected Going Forward is in the short term there may be a lowering of premiums versus what they otherwise may have been and weve seen that in the u. H. C. Renewal, a decrease for 2021, a very small increase for 2022. The importance here is how the riskers are sustained. Well be keeping an eye on the covid impacts as we see how future c. M. S. Forecast may affect 202 and beyond rates. So where i want to close is talking you through considerations in the 2023 plan year. Thats where we started and certainly welcome any feedback, based on what we talked through here today and any early commissioner thoughts on this concept, engaging an r. F. P. Next year for the 2023 plan year. Today we want to accomplish a review for the medicare offering. We want to discuss general medicare offerings and provide Key Information on the different counties. We want to talk on expected covid19related pandemic impacts. For my final slide, just reinforcing that todays discussion will guide the consideration coming up from now to the main june time frame of next year. Thank you for your interactions and your comments throughout. Ill turn it over to you, president. Chair thank you very much. I see there is a question or a comment. In the interest of time, i want to make sure that the questions or comments deal with the broader issues and a particular vendor or something. My question is do we have any sense of how the hearing before the Supreme Court with regard to the a. C. A. Will impact any of the presentations that weve had so far . Can we speculate or not . I prefer not to at this time. Im not really prepared to make those remarks. I think there are a lot of questions about the age or eligibility for healthcare may drop to 60. I think we should leave these questions to see what happens on the political agenda side, but the issues that are important will have to be built into our fees how they adapt to the change in the National Political scene on the medicare question. But that is an important question, but it needs to be deferred. Thank you. Chair any other questions or comments . Hearing none, we would like to go ahead and open this up for Public Comment. Again, this is an information item. Thank you, president. Ill be giving instructions for Public Comment. Public comment is available for each item on the vend. Each speaker will be allowed three minutes to comment. The dialin number is streaming across the screen. Public comment is available by dialling 4156550001 and entering access code 146 668 4901. Again, 146 668 4901. And pressing pound and pound again. You will then enter the meeting as an attendee on the Public Comment. Before we begin, we will take a 30second pause to allow callers to dial in using the information that is on the screen. After the pause, callers, if youve dialled in and wish to speak on these items specifically, please dial star 3 now to be added to the queue. When the system says youve been unmuted, this is your time to speak. For those already on hold, please wait until the Commission Says you have been unmuted. When the commissioner says welcome caller, you may speak. Moderator, i will pass you the host privileges. Please let me know if there are any callers who wish to comment on this item. Operator thank you, board secretary. We have nine callers on the phone at this time and zero callers have entered the queue. A reminder to callers, you must dial star 3 now if you want to join for this specific agenda item. We will wait for a few second and then close Public Comment for this agenda item. Clerk Public Comment is now closed, seeing no callers in the queue. Chair i want to thank you for your presentation. Still lots of unanswered questions. I want to thank everyone who is listening in on this to continue their own education about this market, that you are an important component to these reflections as we move forward. So i want to thank all of you for listening in on that. With that, i would like to call the next agenda item. Clerk thank you. Agenda item number 10, report on blue shield infertility and pharmacy benefits process improvement. This is a discussion item. This will be presented by Shawn Lovering, and i will pass over presenting privileges now. Thank you. Is good afternoon, commissioners. Im Shawn Lovering and i have responsibilities for the Services Account at blue shield of california. Im here to provide you an update on the infertility processes that were presented on in june. So as we talked about back in june, through our research we discovered we had several operational gaps around benefit interpretation and the authorization process. Effective 1112020, we streamlined the process. We removed the authorization and requirement of a diagnosis of infertility. We felt this would greatly improve access to services, remove administrative barriers for members and physicians, and allow members to Access Services according to their cycle and timeline, not ours. So by removing all these barriers, members will enjoy a much more streamlined process and not having to have the headaches of prior authorization and getting their services in the given time that the authorization is effective, and be able to have a much more streamlined process. We also engaged our provider partners to ensure accurate benefit interpretation and compliance. Weve ensured that the benefits and Services Related to fertility are culturally compassionate and are in alignment with the Health Services goals. Weve created access to an internal subject matter expert. We continue through our Concierge Services to continue navigating and advocating for patients. Weve also processed all claims of telephonic outreach to members who had their claims erroneously denied. On the medication part, the infertility access issue, when we looked at this and found the medications were covered under the medical benefit that caused a limited access to a select number of providers and patients had to either pay the full cost up front then bill blue shield of california. They were sometimes offered a lower price if they paid cash, so there was inconsistent pricing and they had difficulties getting their medication. What we did to alleviate the concerns is we moved the infertility medications and they are now covered under the pharmacy benefit. This helped the patients obtain them at any pharmacy. We now have stable pricing with greatly improved discounts and we removed the prior authorization requirement for medications related to infertility, again to help streamline the process, make sure that members have access to the medications that they need at the times that they need them and dont have to wait any longer for their medications and they know up front what theyre going to pay. When we looked at the drug cost shares, what this means is infertility medications are still covered as a 50 coverage, simply because that is what the infertility meds are designed to be paid at according to the infertility underwriter currently in place. These medications now have access to a. W. P. Pricing through c. B. S. Specialty pharmacy, which greatly improved member access and cost share. Weve done a soft transition to the pharmacy benefit coverage, beginning 111, and we have anticipated retirement of medical benefit coverage in 2021. So well now have members will have a greater stass, theyll have greater discount on their medications. And thoseaccess, theyll have greater discount on their medications. And those with greater benefits through Freedom Pharmacy and the limited other areas they could obtain those locations will now be grandfathered over to the pharmacy benefit effective 112021. For those members not currently in a accessing their drugs through the medical plan, effective 111, they can now access those through the pharmacy plan. So we are very excited that we were able to work out this deal with c. B. S. Specialty and provide additional access for members in this area. Now i would like to answer any questions you may have. Yes, commissioner. My question is when you indicate that you reprocessed all denied claims, how far back did you go in terms of benefit [indiscernible] we went back to 112018 when the enhanced rider went into place. Thank you very much. Any other raised hands . This is commissioner scot. I would like to thank blue shield for taking what i think was a transformative step based upon member concerns, the issues raised. We had to go back and look at our board policy in this area. I thank you for your partnership and diligence over the last several months that has brought us to this place. Thank you, commissioner sc t scott. Chair if there are any other questions or comments that was a clear presentation and i also commend you because i think it takes people to respond to this in each of our health plans. And i think you were key in this. I think the whole Health Service system appreciates the responsiveness of key individuals. Thank you. Any other questions or comments . Shawn has been a key person in creating organizational change. We all know how hard that is to do. Thank you very much. Thank you for adding that comment. Chair with that, i would like to open this up for Public Comment because it is an information session as well. I will read out the instruction for Public Comment. Public comment is available for each item on this agenda. Each speaker will be allowed three minutes to comment. You need to dial 4156550001, again 4156550001, enter access code 146 668 4901. Again, 146 668 4901. Then press pound and pound again. You will then enter the meeting on the Public Comment call line. Before we begin Public Comment, we will take a 30second pause to allow callers to dial in. If you wish to dial in and speak to these items, please remember to dial star 3 to be added to the Public Comment queue. When the system says your line has been unmuted, this is your chance to speak. Please wait until the system indicates youve been unmuted. Moderator, could you please let us know if there are any callers who wish to comment on this item. Operator we have seven callers on the line and one caller has entered the Public Comment queue at this time. Other call irs may enter the queue. I will elevate the first caller now. Welcome, caller. Good afternoon, commissioners. My name is erica may down and i come as a humble employee. I brought an attention an [indiscernible] of looking into and understanding the issue. While i think we were all thinking this experience was isolated, it became clear that this was experienced by a subset of members. It was also clear in addition to supporting members, that the policy change required in order to ensure equitable access. Im truly grateful for the work and dedication of director yants, the staff, and you, commissioners. This is true when i was relentless in my advocacy. To all the commissioners, this is priceless in terms of getting the policy closer to the finish line. For me, this has always been about the policy and the moral obligation of equity. I want you to know the decisions made on the policy have measurable impact and for some it will mean a difference between having a family or growing a family or not. This last july i welcomed a daughter and will share this as part of her story. I am proud of the commission and our city, that you will continue to work to ensure employees have equal access to benefits. I was unable to determine the new costs [indiscernible] but i also think its important for you to know the impact of your work on this decision. Last year i spent 6,500 on meds alone and this was 100 an outofpocket cost. Overcoming infertility is not a sense of [indiscernible], but you need to know that the changes youre supporting will save members thousands of dollars and for some it will mean fulfilling the dream of having a family. My most humble thanks to you, commissioners, for hearing me out, prioritizing, and for not giving up until the issue was addressed. Thank you so much. Chair thank you for that summary. Thank you also to the rest of the commission to articulate the issues at every step. We didnt go too many times into the blind allies. You really helped address this issue for yourself and all Health System members. Thank you for that. Are there any other comments in the queue . Clanchts we have seven callers on the call line and no additional callers have entered the queue. We will wait a few more seconds and officially close Public Comment for this item. Good morning, everyone. And welcome to this beautiful monday. The meeting will come to order. Welcome to the november 9th, 2020 of the rules committee. Im supervisor hillary ronen, chair of the committee. With me on the Video Conference is Catherine Stefani and rules Committee Member supervisor gordon mar. Our id like to thank sfgov tv for staffing this meeting. Mr. Clerk, do you have any announcements . Clerk yes. Due to the covid19 health emergencier and to protect Board Members, City Employees and the public, the board of the supervisor legislative