Well now have item 2, roll call. Thank you president scott. Our roll coloradoed to order is 103 p. M. And roll call starting with president scott, present. Vice president hao and breslin and canning is excused. Dorsey, present. Commissioner follansbee, present. With that, we have a quorum. Can we go to item number 3 . [multiple speakers] it wasnt his fault. Thank you president scott. Item 3 is general Public Comment. A opportunity for members of the public to comment on any matters within the boards jurisdiction that is fot on the agenda. Remote viewing is available on sfgovtv and online using webex. Welcomes public participation. There is a opportunity for the public to comment at the beginning of the meeting and each item. In person comment is first and then virtual. Each speaker is allowed 3 minutes to comment. All Public Comments are made concerning the agenda item presented. A caller may ask questions of the body but no obligation to answer or engage in dialogue. Will hear up to 30 minutes of remote Public Comment total for each item. Remote Public Comment for those who receive a [indiscernible] call in by dialing 4156550001. Enter access code 26607621309 and pound. You will be prompted to enter the webinar password, 1145 and pound. Press star 3 to be added to the queue and you will hear the prompt, you have raised your hand to ask a question. When the message says your line is unmuted this is your time to speak. For those watching on webex, click on raise hand to be placed in the queue to speak. A raise hand will appear next to your name. When you are unmuted request to unmute will appear on your screen. Select unmute to speak. Once you hear me say, welcome caller, you can begin speaking. When your time expires you will be muted. Members of the public encouraged to state name clearly, but may remine main anoninous. Anonymous. We thank sfgovtv and Media Service for sharing with the public. Well begin with in person Public Comment. No one approached the podium. Well move to our remote Public Comment before going to written submitted Public Comment. Moderator e will notify of callers in the queue at this time. Board secretary, we have one caller on the phone line. Zero callers [audio cutting out] thank you moderator. Ill move to our remote or written Public Comment. We had one submission for written Public Comment. The first comment was submitted by tim lee with sfmta regarding delta dental ppo. My childs dentist decided to leave the network. Trying to find a new pediatric dentist there are not many in network. Searching on the web there is similar result of dentist leaves delta dental ppo. Is there something the board can shed on the information or search i other carriers in the next open enrollment . End of submission. Thank you and we thank the member for the written Public Comment. I would ask that the executive director do review as well in terms of talking with delta dental regarding this particular comment. Thank you. Moving to item 4. Approval with possible modifications of the minutes set forth below from the november 9, 2023. Will be presented by president scott. Are there any edits, changes or additions to the meeting of november . Hearing none, im ready to entertain a motion. Move approval of the minutes of the regular Health ServiceBoard Meeting of november 2023. Second. Properly moved and seconded. Is there any board comment . Hearing none, well go to Public Comment on the minutes of the november meeting. Thank you president scott. Ill begin with a short intro. Public comment is open. Instructions are displayed on the vene can for those watching on sfgovtv and webex. [providing instructions for Public Comment] no one approached the podium and move to remote Public Comment and the moderator will notify of callers in the queue at this time. Board secretary, we have one caller on the phone line, zero callers in the queue. Moderator, i believe you said zero callers, so with that, Public Comment is closed. Thank you. We are ready to vote and have roll call vote. Scott, aye. Dorsey, aye. Follansbee, aye. Zvanski, aye. Motion carries. Item 5. Item 5, president report presented by president scott. There is a continuing question that has arisen since the board of supervisors made a change in their Public Comment process. As we all know, we had all inperson Public Comment prior to the covid pandemic. With that, when the pandemic hit we went to do it in online or in person or combination of both and we have maintained that until the most recent incident with the board of supervisors having what i would call hate speech time comments being made during Public Comment and they made a decision to discontinue the online or virtual Public Comment process. That again sent further ripples to the rest of the 165 commissions that we have in the city or 130 boards and commissions as to what we should do, and during the past several weeks the board secretarys of the commissions and boards that are present in the city have met around this issue. I understand the City Attorneys Office has been involved and the current state is that apparently i have the authority as the president of this board to discontinue virtual Public Comment. Im not going to do that. I rather going to request that this board make a decision about whether we discontinue or modify Public CommentGoing Forward and in the process is going to be as follows i requesting the executive director to review the usage and cost for virtual Public Comment for the last 6 months. I think i have a sense of how many people we had online during each of the past 6 meetings, but i like to have that in some type of written report. Im requesting the board secretary gather Additional Information from the other board secretarys regarding what other commissions and boards are doing. By now im sure there has been kind of iterative process. I was watching the planning committee, Planning Commission deal with this question a few weeks ago and they are going through the same process. Their council had a bit of guidance for them. The secretary of their board and said well, lets hold off make ing a decision at this meeting and do it later. That is what i like the board secretary to do. Requesting of the council that she provide the residing officer, whoever it happens to be with written guidance what to do if we have hate speech or that type of kind of situation come up during a Board Meeting and it would be disrupted by it. I think i know what i would do under my own Natural Instincts as a presiding officer, but i like to have Legal Counsel give me guidance, because i dont want to breach the free speech rights of members or callers or those who might be listening into these proceedings. I like to have some written guidance from that. And then lastly, the board will have this as a action item for its february meeting. Well hear the results of these requests and then take action on how we will proceed to have virtual Public CommentGoing Forward. So, with that, im willing to entertain any questions or concerns the board may have or any of the offices that i have requested these items of. Yes, commissioner zvanski. Thank you commissioner scott. This is a very serious issue as far as im concerned, because im very actively involved with retired city employees, and our members live all over the city, all over the peninsula, all over the state, all over the nation and all over the world, and our meetings are specific to their benefits, their issues and to this unique or select population, and i believe that it is essential that we maintain under those circumstances and with consideration of our specific and unique population or constituency i should say, that we maintain having remote and virtual Public Comment available at any and all meetings that we hold. It is a matter of respect for our members, it is matter of consideration and i believe it is a essential benefit that we need to provide because we have this unique constituency. Thank you for your comment. Are there other comments . I guess the only comment i would add mr. Follansbee. Thank you very much president scott. I think we had situations in the past where Public Comment either in person or online has been out of order. It is addressing other agenda items or items that have to do with the sort of goals and mandate of this commission, but i think we need clarity when the board secretary or the president or acting president can rule something out of order. If it doesnt fall within theand we need clarification on that so that kind of speech if there is a method to rule on that can be done fairly to all participants. Alright. Thank you commissioner follansbee. Just to add from the perspective of the board of supervisors, one thing that really plays out i think uniquely at the San Francisco board of supervisors is that Public Comment is something that plays out on National Television sometimes. You may have seen last week tonightthere isit has a National Audience and i think because of that theres people who were calling in directing hate speech in ways that were disrupted and we dont want to give a platform to, so there were unique situations that the board of supervisors faces as a high profile kind of government body that other i think disservice to the people we serve and in bodies like this. If that isnt the problem it may not be something we have to address. The other thing i think Legal Counsel can address better then i, we also have to make accommodations. We have to do that. I know when this came up before my committee, one concern i had because initially we considered this and decided to allow continuing Public Comment, it is little acward to ask people to identify themselves as having a disability or needing accommodation. There waswe didnt have Comfort Level of doing that. Only because circumstances kind of forced our hand that we didntant to give a platform to something that was disruptive for the good of open government and accessibility if we can avide that i think it will be better. Thank you supervisor. Any other comment . Hearing none i want to thank you for your comment supervisor, because i think it makes it very clear the board had no intention of this policy being extrapolated to other commissions or committees. This was in fact referring to the board of supervisors meeting and not a general recommendation or declaration to anyone else and i think that helps clarify that and thank you for that. Alright. There is no further board comment. Is there Public Comment on this item . Thank you president scott. Well open Public Comment. The instructions will be displayed on the screen for those watching on sfgovtv and webex. [providing instructions for Public Comment] no one approached the podium. Well move to remote Public Comment and our moderator will notify of callers in the queue at this time. Board secretary, we have one caller on the phone line, zero callers entered the Public Comment queue at this time. Thank you modraert. Hearing no further callers, Public Comment is closed. Thank you. Well go to item 6. Directors report. Thank you president scott. Item 6, directors report. This is discussion item and presented by executive director abbie yant. Thank you. Good afternoon commissioners. I would like to start by directors report welcoming a staff member, Member Service jolene rousseau who is in the room. Please stand. Welcome, we are delighted to have you with us and congratulations to planning to spend this portion of your career with us. Thank you. I also want to recognize in the room is carrie brusheers and her coordinator lisa not in the room but may be watching. She is pretty busy. They pulled off incredible event for the wellbeing awards event a few weeks ago and it was very well attended and they gave out lots of awards to many different city departments. I was privileged to moderate a panel of Department Leaders to speak to how they viewed wellbeing. T thapanel included the jada jurden from the department of public works. She was quite inspirational to listen to. Kelly dearman, Department Director within the Health Service agency and as well as City Attorney david chui, so it was a nice mix of folks and they were really very passionate about the wellbeing program and its just i think a testament to the work carrie and her team have done. A small team, but they have broad reach and it was very satisfying to see them being recognized as well. Thei had the opportunity to testify before the board of supervisors Budget Finance Committee november 15, where supervisor chan had as the chair of that committee had requested that we come and do some explaining about the rate increases in the environment we are currently in with the cost of healthcare. As a precursor to when we come before the board for the rates and benefits in july, we are under extreme time constraints and everyone appreciates that, so i do respect her forward thinking about laying the ground for what they may see in the coming year. I dont know if supervisor dorsey you were able to attend and did you have comments . Okay. Appreciate you participating in that. We also continue to pressure any way we can the relationship between the United Healthcare and ucsf medical group. We were notified yesterday by United Healthcare that they are resuming negotiations with that medical group. They had been stalled, so that was encouraging to hear. So, well keep everyone informed, but to date we are not aware of problems that have aprison because of this so while we understand the medical group has concerns about the situation, they havent made any practice changes that we are aware of and i would appreciate if they do make that decision any decisions along these lines that they keep us informed preferably in writing, but we have nt seen that yet. I appreciate the fact this item correctly identifies what the issue is. There a lot of misinformation out there and my next door neighbor or neighborhood [indiscernible] ucsf dropped by United Healthcare and i didnt bother to read it and dont want to get in conversation with neighbors across the city over misinformation. Clearly for whatever reason people are rather anxious about this and so i appreciate your efforts and efforts of your staff to make sure that a, the issue is clear, it is not ucsf medical center, it is medical group that practices at ucsf, and that you are monitoring any problems that might arise because of access both for primary and specialty care. I want to applaud your efforts in this regard. I appreciate it. We get an occasional call or email and there are people worried that something may go awry, but to our understanding, we havent identified a case that there is a problem. I do recognize the anxiety and like it clarified so hope fully will come to resolution on this. I want to remind the board the black out period notice issued november 9 and expect to go through june 24. If you have questions about that or are approached by anyone, please let us know and well walk you through the process. Also, cal prla, a hr professional organization has a annual conference in monterey. We did a presentation on the healthcare affordability and we have been able to do about it and i do appreciate iftikhar and mikes efforts in helping put this together and it was well receivedism. It was friday morning the last day of conference so a packed room. Commissioner hao presided at a meeting . She was the moderator and she encouraged us to apply, so very helpful. There were several people from our department of human resources, carol izen, [indiscernible] arden. Labor relations person. It was a excellent conference and pretty big event. We also i are wrote in here about a data breach weef were notified from blue shield. I will tell you that yes, there have been others. There was a big problem with the Data Warehouse called move it a couple months ago that seems to have touched tons of organizations and but we are finding that ourit is third, forth degrees breaches. Not from hsf, or providers it is more downstream so that is good and not good. What we are in the process of doing is working with [indiscernible] to create a web page where the information we have about data breaches would be available so if people are concerned they have a place to look it up easily, because sometimes we get these random phone calls about a breach that may or may not effect our membership, so that is in the works and well see something First Quarter next year. Also starting in january, we will kick off the Health ServiceBoard Election process. We have two Member Service positions that term out in 24. Captain chris canning and Karen Breslin and so we will need to replace those individuals and holly will help us understand the process and presentation that we will do at the january Health ServiceBoard Meeting. The Unified School District problems continue. They are grappling with what to do. They are considering yet another vendor so we just have to exercise extreme patience because there problems are many and each time they uncover one, it is another bolis of members we have to work with and problem solve and hats to Member Service team being so diligent and patient with both the members and School District. It is very troublesome, but we do get through it. Latisha harris is invited to speak in a actuarial conference talking about health and equity Action Planning and i think a number of things. One, it is wonderful we were invited to present, but also a very hallmark who has been working on the social determinant issue, it is amazing to see this in main stream and talked about and understanding how social determinants and various equity issues effect our membership. We are learning our way through this with everyone and think the conference will be very helpful and good that we have some experience in this area and can speak to that. I have talked here before about some of the external committees i participate in and boards. The integrated Healthcare Association is a 40 plus member board that has representation from pretty much all Major Health Systems and medical provider groups in the state and they really work on consensus to improve the Delivery Systems and healthcare. We are working on a number of things, not the least of which would be advanced primary care,b the equity issues, the cost issues, data issues et cetera, but it is a very rich group of people that are really forward thinking and there is a lot of compromise that happens there, which is quite impressive. They are very interested in and watching carefully the healthcare Advisory Board and its Advisory Committee that i sit on because they are charged with the legislation that Governor Newsom sponsored on the Health Affordability of healthcare. We are getting closer to definitions of total cost of healthcare and what the targets will be and those decisions will be made in 2024, so there is a cap in site, but not been clearly identified and it will be several years before it actually goes into effect. Latisha monthly writes very informative messages but health, Equity Diversity inclusion opportunities. Much appreciation and deep understanding how we are working in these areas. The divisional reports youll see throughout each division, i just want to comment on the contracts Division Lead by [indiscernible] with supportive Patrick Young and william and lots of folks from aon. We have a great medicare consultant working with us and they were able to successfully release the medicare rfp yesterday, wednesday, so that is a huge accomplishment. Much more work to be done. There was a real team effort in getting it launched, so much appreciation to the entire team for that effort. I think thats all i have unless you have questions. I want to go back to the United Healthcare ucsf medical care Group Medical situation and this board gave you full authorization abbie to pursue, prod, prompt, promote and encourage the parties to come to a resolution on that and i am very pleased you have exercised your prerogative where possible and i encourage you to continue to do so. Are there other comments . I want to applaud all your efforts once again for the department. You and the department on the Health Equity diversity inclusion. I think you are leading the way. There are misconceptions that sort of quality of benefits equals equity and it does fot. Equity is outcomes and we know outcomes for vaccinations and screening for cancer and dental care and all these things are different from a variety of social factors and so equity is the right word and at this board as well as hss been very interested from all the vendors how they address equity issues, outcomes, not just benefits, but how equitythe benefits translate to equity in all these areas so i want to again applaud you and the department for the work on these ish areas. This is very popular, but still misunderstood. The feeling, if everybody has the same employer and same access to benefits then what is the question here and there is a big question. The board recognizes that and affirm the work you and your department is doing. Thank you. Are there other board comments on the directors report . Hearing none, well now take Public Comment. Thank you president scott. [providing instructions for Public Comment which is displayed on the screen] well begin with in person Public Comment and no one approached the podium. Well move to remote Public Comment and our moderator will notify of any callers in the queue at this time. Board secretary, we have three callers on the line, zero callers enter the queue at this time. Thank you moderator. Hearing no further callers, Public Comment is now closed. Thank you. Well go to item 7. Item 7, sfhss Financial Report as of october 31, 2023. This is discussion item and presented by iftikhar hussain, sfhss chief Financial Officer. Happy to report our trust fund balance is stable. The results are similar what we had mentioned that year and this is after a year we had high claims and expenses, so we see the numbers stabilizing. The trust fund balance we roproject for end of it had year is 93 million. It is decrease, 11. 5 million, but that is due to stabilization and reduction in rates funded by the sutter settlement we got last year so we have to buy the rates down which causes the ending balance to drop. The net climes are running close to what we expected. We did receive pharmacy rebates in october, we are at 5. 8 million this year through october. We expect that to be 15 million by the end of the year, and interested consistent. Last year the Sustainability Fund we expect a net use of 1. 2 million. By the end of the year. In the general fund we are running ahead of plan. [indiscernible] and lastly, on the audit, the external audit is complete, and the benefit trust audit is ongoing. Are there questions from the board regarding the Financial Report . I would just commissioner follansbee, i urge everyone to look at your excellent graphics that are included in the full packet, because to me the net claims item to me is still very concerning. A, the fact that claims for dental care remain consistently low is not reassuring to me, because i do believe dental care is important and if this backfires and no doubt that poor dentition contributes to other issues. Screening for certain cancers for example, Heart Disease and gum disease are related, and so the fact that we net claims are zero out, because members are not utilizing dental is not a good sign to me. Likewise,b the fact our medical claims still exceed the revenues, still points to the ongoing and future problems and so everyone should be really familiar with these graphs and the fact the trends are not really changing to my mind at least to my review and maybe you can correct if im wrong, but the trends still seem to be in both areas in concerning directions. The medical claim [indiscernible] but it is for the running higher then what we expected, but the dental claim is pretty consistent trend. Are there other questions or comments from the board . Of the cheer Financial Officer . He survived the audit in good shape. [laughter] if nothing else from the board , well take Public Comment on the Financial Report. Thank you president scott. [providing instructions for Public Comment which is streaming on the screen] we will begin with in person Public Comment and no one approached the podium. Well move to online. Board secretary, there are three callers on the line, zero callers enter the queue at this time. Thank you moderator. Hearing no callers, Public Comment is closed. Thank you. Well move to item 8. Thank you president scott. Item 8, report of open enrollment activities for plan year 2024. This is discussion item. Presented by rey guillen, sfhss chief operations officer, jessica shih, communications director, olga stavinskayavelasquez, Operations Manager and carrie beshears, wellbeing manager. I would like to welcome the chief operating officer and his team back. They are still standing. They look well after open enrollment. No harm for all of the hard work that i know that he and his team have done during this past month to notp only get a report ready to do all the stuff you are going to outline today. It is very very intensive process and i marveled at the way you transitioned in this role. Thank you prez accident scott and commissioners. Again, rey guillen. Over the next several minutes, members of the Management Team and i will provide you with a summary of the activities from the just completed open Enrollment Period for plan year 2024. During our presentation, we will review the purpose of open enrollment, the specific objectives set for this year, reminder of the population we serve. Highlights from this Years Experience and project plan, communication efforts and the work performed specifically by our enterprise system analytic team. We will also provide a reportout of Member Service results, the result of some key initiatives, the success of our health fairs and flu clinics and preview some of the early enrollment results with you. As a reminder, the reason we hold open enrollment every year is to keep our planning and compliance with section 125 of Internal Revenue code. The cafeteria plan is what allows us to have active members pay for their Health Benefit premiums on pretax basis. However, the specific timing of open enrollment is set to allow our staff enough time to process all the plan changes submitted. This year we scheduled open enrollment for run for 4 week period from october 2 through october 27. Again, just as reminder, open enrollment is one time each year that members can enroll in, change or wave coverage and add or drop dependents without a qualifying life event. As this board is aware, certain portions of our retiree populations will experience significant premium increases beginning january 1, 2024. In addition to insuring we are clearly communicated impacts to our members, and also being prepared to handle a possible increase in volume of calls that may result, we set important goals this year. First, we wanted to improve accuracy and fortunately during the last open Enrollment Period there were a few errors in the communications that required us to send correction letters to some of our members. This year we want to strive to avoid the cost and effort required by such corrections. Given the Large Membership and limited staff rfx we want to drive our members to our website and to other Communication Channels to get questions answered and hopefully eliminate necessitate them to call Member Services. We always have the goal to reduce cost. Communicating to our membership and providing the assistance is huge undertaking. Membership exceeds 79 thousand subcribes and broken over 4 employer group, the city, the courts, the School District and the Community College district as well as all the retirees. Adding to complexity of it job is a variety of union agreements, pay status and pay roll frequencies. We just want to highlight before we get into details some of the outcomes and things that we were able to accomplish this year. One of the major accomplishments we are able to do is to reopen our office to inperson support and so we had a variety of our members join us in the office and we were happy to provide them inperson support. One of our overarching goals is always meet the members where they are, so we are aware that some of our members are not comfortable reaching out over the phone. Sometimes they have communication limitations, other times they just want to get something resolved face to face with our staff and so we happily reopened our office for the First Time Since the pandemic. Due to continued challenges with hiring, we did bring in the support with offsite call center to help answer member calls. In addition, we were still able to support number of inperson activities including 10 healthcare and 24 flu shot clinics. Answered over 6500 calls from our member jz also supported longterm viability of health net canopy care plan by helping increase the membership by 82 percent and well go into more details for each of the items in later slides. As this board knows, planning for open enrollment requires yearround planning. We also take into account a very detailed project plan to make sure nothing falls through the cracks. Brian rodriguez, our project planner was not able to be here today, but we do rely on brian to make sure that we are staying on track and make sure everything goes off without a hitch. This years project plan included over 280 with every division involved. We generally meet once a week to insure we keep on track and resolving potential issues as soon as possible. Next i like to introduce jessica shih our capable communication director to walk through this years open enrollment communication with you. Thank you rey. Good afternoon commissioners. Jessica. Yes . Could you bring the microphone just a little lower . There you are. It all most looks like you are trying to eat it. Good afternoon commissioners. Jessica shih, communication director at Health Service system and going to walk through our communication for open enrollment this year. I would say the bestif i had to choose one word to describe our communication it is really, transformative year for us. I think under our new leadership, rey guillen our chief operating officer observed inconsistency in our material, so we actually my colleague and i actually worked together to completely overhaul the communications. We rewrote the member guides. You will probably see completely different looking rate sheets this year. We have new envelopes and we combined guides because we realized the information from mea superior courts and csf were essentially the same, so we combined to one guide to streamline our information and we didnt actually increase the pages in the guide, because we were able to reduce some of the information. We looked at member call data and call drivers and made sure that we added clarity where it was needed to our guide and we reduced superilous information. I want to thank my colleague ryan klaus our graphic designer. Did an amazing job and inspired by Digital Access ability and inclusion mandate so brought a lot of icons into Design Elements of the guide and you will see throughout the guide. Visually people will understand this is a vision page and this is dental page, so we hope you were able to see the materials mailed to you. And as rey mentioned, we worked hard to improve accuracy in our print material and it seems a little counter intuitive, but we were able to accomplish this by increasing the number of letter templates we created. Last year we had like 22, which was already a lot of different letter templates for us to manage, this year we had 87 and what we did is we hard coated the rates on the back of each of the open enrollment letters. This way we didnt have to have more data provided through printers which cause errors. We didnt have to issue any correction letters this year. Im thrilled. And as always, i think we learned a lot during the pandemic and that we always want to meet our members where they are at. During the pandemic you remember we started doing webinars and Offering Health plan office hours and we continue that even thoughand of course now we are offering inperson health fairs and flu clinics and we like offering all the different avenues of support for members to provide education so they understand the benefits and make those elections. And as always our goal, we are all stewards for the environment so we wanted to reduce paper waste and print costs so this year we consulted with our City Attorney and determined what was really necessary to be in the mailers and for active employees they didnt receive booklets. Instead we drove them to our online web pages to have more comprehensive resource and information for everyone toand also we want to make sure they knew about the events happening and so what we learned is we didnt receive many requests for members saying i want my benefit guide. It seems the online resources was enough information for them to participate and learn about their benefits, so we might pilot it next year with our retirees. Would you repeat that . We are considering carefully contemplating removing the booklets and retiree mailers and now you have to remember, every member still has a right to ask for a printed guide and they are always welcome to call us and well mail one to them. Thank you. Having beenam a retiree of a very Large Organization in the state, i wish you every success in making that transition. [laughter] thank you. We will do our best to make sure that our retirees get the information they need to make the decisions they are best for them. Now i like to hand can i follow up on that . I realize im unique recipient of all these materials, because i have never been a employee or retiree of the city or any of our employers. I neveri dont find option to opt out of mailings so i get appropriate mailings and i was quite impressed with them, but i like to be able to let you know i like to opt out in the future and just get it online. Was there a box i missed to opt out or was that something might help facilitate transition as you include new groups such as retirees . No, thats something that we have been discussing internally is how we create a system that has a lot of information on the open enrollment letters is private data so how we create a secure system for people to access information. We are still working on that. But thats a great question. The followup is no, you havent missed anything. There is no opt out option. Do the employees who are not getting the printedall of them use the sfgov email address . Is that the way you guarantee confidentiality through internal system, whereas retirees dont have access to that . Is that part of the complication . My account through a different server may not be secure as what sfgov provides . Sfgov isnt all employee email addresses, there is usd which we dont have access to, puc, superior court. There are a lot of email addresses we dont have access to and when 80 consulted the City Attorney there was legal documents we have to guarantee sort of that members receive and one way to do that is to send it to them via u. S. Mail. Okay. Thank you. Thank you. Commissioner zvanski has a question i believe or comment. Thank you. Yes, i are like to know how you are going to inform especially our Retiree Group with regard to the fact that they wont be receiving the booklet . She didnt say wont be. I want to correct that. I want her to repeat what she said and would you repeat it again . We are considering piloting it. I understand that and i like to know how you anticipate communicating with this specific Membership Group with regard to that if you make that decision, because we have a lot of members who do not have email. They do not have wifi. They dont have a cell phone, and especially we have a number of retirees who are quite elderly, but many who are not technically savvy and i have great concern about this because i get a lot of those calls on a regular basis and when i go and meet with these various Retiree Groups i hear about it and so im very concerned that we have a good communicationthey get the opportunity to at least let you know how they feel about it or how they would get that information in advance if they dont have other options for electronicfor getting materials electronically. Thank you so much commissioner zvanski. That is certainly something well take into consideration and for those members well most likely continue to mail them the materials. Or they can always call us and request a full printed guide, in which case it will have more comprehensive information. Thank you. Are there any other comments or questions for communications . Thank you for all that you have done. Thank you. I like to turn it back to chf operating officer, rey guillen. Thank you jessica. Rey guillen, chief operating officer for Health Service system. Just to be clear, all members did receive a mailer in sent to them via u. S. Mail. They receive a comprehensive open enrollment statement that shows what their current elections are and what the premium cost for those current elections would be as well as the other options available to them for the next year. What we did remove from the active mailer for active employee was the shortened enrollment booklet which highlighted changes for the next year. What are seeing with the booklets number one, they are very expensive to produce as we try to keep up with the city mandates for use of recycled papers and things of nature. We found the vast majority of members want the current information of the benefits, what they cost now and in the future and dont rely on the booklets much at all. In addition in the mailers we also include what jessica was referring to is legally mandated notices we send to each and every member, so still a pretty comprehensive guide and booklet, just does not include the printed summary booklet we historically included but continued over the years to shorten, so now we have two printed materials, member booklet, which is summary and our full member guide which has all the information. We do feel that at some point a employee or retiree is making consideration to make a change they should refer to the full member booklet with all the relevant information in there so we are trying to point employees both active and retirees to the booklet as the Single Source for what their benefit options are in future years so well take that into account when we consider possible changes for the future. Going to back to esa, our enterprise system analytics efforts, unfortunately [indiscernible] our esa director is not able to be here today. She is performing her civic duty and on a jury the next two months so we are doing watt we can to continue on in her absence and giving her staff additional responsibility to build up the strength of her team. Esa is responsible for basically all the technology that goinize to making open enrollment run and it is a huge lift every year. Each year the esa team needs to update all our systems to account for rate changes and any changes in the administrative processes. Speaking of rates, there is over 3900 different rate calculations that need to be calculated every year and this is again due to the large number of employer groups we have as well as a variety of union agreements. Most of those rates in the past have needed to be calculated manually. Later in the presentation we are talking about Exciting New Initiative to automate that task, so stay tuned for that. In addition, esa worked diligently to work through both the technical connections necessary and both the Data Security protections that need to be put in place for our new offsite call center we utilized this year. Speaking oof the esa rate calculations, we are really excited to kick off a new project working hand in hand with our finance team to develop a new premium rate calculator using sequel server rin developed the data requirements to provide to the selected contractor to build a comprehensive Computer Program to hopefully calculate those 3900 premium rates each year. Once completed, we are hoping that there will be several benefits automating this manually intensive process allowing us to get the premium rates calculated earlier to aid in our communication efforts and probably most importantly decreases the chance of error. This year the contractor developed a program while our team calculated the rates manually. Hopefully to provide the side by side comparison to see where continued work needs to be done. Now i will turn it over to olga to go over our Member Service results. Good afternoon president scott, commissioners, olga, stavinskayavelasquez Health Service system honored to discuss accomplishments and challenges Member Service division encountered during open enrollment. Before we delve into details, lets begin with a quick summary of the member activities for plan year 2024. As we can see, we had a slight increase in members enrolling dependents to medical and dental plans. Appreciately 4 percent of members made adjustments to next year medical coverage and 3 percent made changes to dental and vision plans. We see constant with fsa enrollment with slight increase from plan year 2023. Member Service Staff play a vital role in supporting our members. They determine member and dependent eligibility, process paper applications over 900 during open Enrollment Period, validate thousands Online Transactions and provide support and plan selection to our members. During this plan open enrollment, Member Service managed 6571 calls with support of our offsite call center. They supported 291 members through virtual consultation which includes consultation for retirees that were looking to retire towards the end of the calendar year, provided virtical consultations for members looking for support on ebenefits and that platform for enrolling during open enrollment. Participated in multiple health fairs and assisted 470 members in person in the lobby. This was a change from last year and it was a Welcome Change as staff saw as a back to normal. Open enrollment related calls accounted for all most 30 percent of our total call volume with other call drivers remaining consistent from month to month. We were concerned with potential of increase in phone calls during open enrollment with the perspective premium cost increases, however, this concern did not get realized. In fact, we saw slight decrease in calls related to open enrollment overall from last years open enrollment. 2023 was a challenging year for Member Services. We experienced sig nificant loss in staff starting winter 2022 through september of this year and even though we are all most fully staffed by october, the new staff were not yet trained on all of the support that they would be providing to our members during open enrollment. To insure we are able to handle increase in call volume that happens during open enrollment we went through the Civil Service commission seeking approval to contract with a asneeded offsite call center. The idea is establish agents able to resolve simple open enrollment inquiries while the Member Service team tend today complex calls, support members in person and focus on work streams that are necessary for timely ly enrollmt. We contracted with offsite call center vendor, vsa. The vsa call center supported members with inquiries around documents received, request for document mailings and general eligibility and enrollment questions. Also supported with scheduling virtual consultation. As you see from the data, a significant number of calls during open enrollment were for inquiries that did not require processing with 4277 calls of our 6571 being routed to our offsite call center. The vsa support during open enrollment ramped up fast. Did cause challenges especially during the first weeks of open enrollment. However because we were in Constant Contact with vsa and able to review call data performance we made changes quickly. There is however a area where we were not able to create a resolution during open enrollment. One technical issue that still exists is the Call Center System integration which resulted in members on hold for significantly long time and then the calls disconnected. This was a major issue and did cause strain to the members and leading cause of unanswered calls we attempted to address it in several ways. Multiple mitigation strategies. Identified the calls and are they werethe team was able to call the members in those situation back within one hour to be able to reconnect and support them with their inquiry. The second strategy was for hss to reserve back two major queues, one for retirees and one for active enrollment so we reduce the number of calls. This did increase our total number of voice mails received but vsa was able to support in that as well by calling back. The goal is connect with the members kecking with us even though their First Experience was not fully completed. The third strategy in resolving the issue is a shared use agreement which put vsa and h is rks s on the same at t platform with understanding it eliminate the technical challenge. The solution has not been implemented, there are complexities with contractual review. We are still pursuing it. We will however be pausing our contract with vsa starting january 1 as is per our contract. But we want to attempt to resolve the issue before the contract end in the evend event we reengage vsa in the future. As we proceed to2024, our commitment continues to focus on process improvements with emphasis on Customer Service excellence and creating Lasting Impact on Operational Efficiency and satisfaction with service. I will pass on the presentation to carrie beshears. Before you do that, in case the are questions from the board. Absolutely. I have a couple questions. How were calls diverted between hss staff and vsa . After hours went to vsa so 24 7, accessibility or what was the mechanism . Great question. Vsa supported during our regular Business Hours and so the way that we divvied the calls, we identified three different queues that would be transitioned over to vsa. We identified queues that did not require processing while the hss team held to the queues that required more complex review of cases and actual processes of work. Vsa basically supported us with inquiries where members selfselected they were looking to confirm receipt of documents or they were requesting us to mail documents to them and general eligibility questions that otherwise would be answers would be of teams through the website or the member role. Hss we retain queues targeted towards making payments and access to care questions that members may have. So members have a opportunity to selfselect a queue. We also have divided into active and retire members to track volume from each. Can i followup . The slide that looks at the amount of time on the call with the two options, a couple minutes longer on call time. We suggest that maybe either they were not complexity was more then anticipated, took longer or the vsa staff had not been quite [indiscernible] to deal with thought to be simple questions or the members when they called didnt quite understand where their calls were going to go or had multiple ish sues. Sometimes you are asked to make a selection and have 3 issues. Were they misdirected . This is a complicated issue and appreciate your delving into it and hope for success in the future. The last question i have is, did members know who they were talking to . They were talking to hss or vsa staff . Members didnt know. We tried to make a seemless process for them so they knew they were contacting us because the trust is in h is rks s. We provided as much training as able to do for our offsite call center for vsa and they were always in contact with me should any additional questions come up that they may not havemay have missed training on, but it was a very integrated process in our communication and we supplied quite a bit of training for them so it is a seemless process from the member perspective. Okay. Not sure how i feel about that. I think it is a tough question dealing with vendors outside hss, not always knowing who won is speaking to or visiting the house. Are employees of the company visiting the house or vendors who dont have the same ownership to the issue so not sure how i feel about that, but ill leave that for staff to address in terms of transparency to make sure that all members get equal access to hss staff when appropriate. Absolutely. We did have a process to be able to do that. Should there have been a situation like you identified where members were calling about a issue that had multi items,b vsa transferred over to escalations to Supervisor Team or transfers to our team to be able to address. They had the opportunity or vsa team had the opportunity to triage and get them to the appropriate party. Thank you. Commissioner zvanski. Thank you. I agree with commissioner follansbee and the concerns. What i notice is there areshould i ask, did you track calls that were lost . We did track the calls lost. We had vsa call back the folks that were lost. Often times what happens when we are looking to reach out to them they are no longer available and we absolutely understand that was a challenge during open enrollment. Did you have in some cases where you couldnt call back because you couldnt access their numbers . A lot of times people have their phone numbers blocked. Understandable. Yes, that could have happened, yes. Do you know how many . I dont know how many were not called back . I appreciate when we do this in the future that we include some of that as well. It is good to know and it might give more options what else we might be able to do to get to those members. Thank you. Lastly, i just have a general question. This is the first time we used outside vendor to support this aspect. Do you think that it met minimally or maximally or kind of okay or no, we wont do this again or need to do further work . How would you assess the result overall . What i can say is we would not have been able to meet our members needs if we did not have this contract. Alright. Because of the low staffing at the time. Even though it might not have been the excellent experience that we are expecting to have for our members, we were at least able to connect with them and provide them with a level of support, so we would not have been able to do that without the vsa contract. Alright. Thank you. So, there is more work to be done and you are saying that you wouldnt have been able to do what you were able to accomplish during this open Enrollment Period without this vendor. Okay. Yes, director. I want to commend the team for putting the solution together because it was a big challenge to put it together and it was a great effort. We had a lot of support from the department of technology. Igist spoke with linda yesterday who is retiring from it department of technology, but she was very impressed with how this all came together in a rather short period of time and it did provide a service that was quite remarkable. In addition, there are many unintended benefits from that relationship and i think olga and her team have come together on understandingi liken to running a er. You got to be able to flex, got to be able to triage and get people the right place and right time and that way of thinking and doing business is now embedded in Member Service in a new way, so i think it has been a fabulous relationship. It did was not perfect, but the effort that went into it real time live, ongoing learning and put into place new procedures was remarkable, so i would really like to commend the group for being able to pull this off in a very effective way and i are just congratulations to the team. Thank you and the team for all that you have done during this season. Thank you. Carrie, please come forward. Good afternoon. Carrie brusheers beshears to talk about flu and Health Benefit fairs. First i want to acknowledge on my team, [indiscernible] she is the one individual that really spearheads up all these events. Naturally she has support from our team as well. I will highlight some things she did this season with our vendors, with our partners and some of the hours she put in herself to make this happen. So, i will start with highlighting that she manages about 16 vendors. We have 10 Health Benefit fairs and we have our flu clinics and there is partnership between many of those. Managing 16 vendors can be challenging but she pulled it off excellent this year. There was 35 communication materials that were developed just for these events which we partner closely with jessica and her team on. And then it is about 9 months of planning. We talk about open enrollment starting in january and not stopping and it does for us and also with flu and health fairs it is a very strong 9 month period in which jalisa tried to quantify her hours but at least over 1400 hours dedicated to making these events happen so i wanted to highlight that. Ill start by focusing on open enrollment events. Sorry, health fair events. Total of 10 this year. Maintain the same number year over year and continue to offer 2 clinics at the airport. One is a evening clinic that targets different population which we found very successful year over year. We alsoit isnt in the highlights here, we do also continue to offer benefit fair over at hetch hetchy. We find this very valuable and partner with the flu clinic and this we brought in vendors on site which we know is very helpful for that population. Some of the main focus areas in how we target is look where we are going to pull in the massing or pull in the people who naturally are on the ground not always in an Office Setting so often times we target those different maintenance yards or like hetch hetchy to gather in a lot of folks for these fairs so they get the information that they need. One of it best practices we started two years ago when we first started doing the benefit fairs was doing a preplanning call with all our vendors. It allows jalisa and our vendors to pget on page of what are the expectations, where they need to go, who are the site contacts so we continue to offer. This year we also invited some of our other partners to attend the events. Particularly we invited our external eapwho as you may know or heard have expanded service to First Responder departments but continue to serve our entire employee population. We also brought lighthouse, the First Responder wellness app we transitioned from a different vendor and also had some of our mhn partners specifically through health net attend these more specifically for the First Responder locations as well. And last, we had a partnertion with credible mind. Sure you may have heard us speak about it. It is online tool that provides a lot of resources around Mental Health and Emotional Wellbeing and they came on site to a lot of our locations. Ill shift to the flu clinic. We hosted 24 locations24 clinics at 23 location. We do two at department of Emergency Management to target Early Morning folks. 10 open clinics which anyone has the opportunity to join. No access issues. Generally open to the public but anybody can get in as long as they are a member. 14 restricted locations. We had one location we did not offer last year due to low participation. We have minimums we need to meet for our clinics so every year we assess are we meeting those, how far are we not meeting those so we brought back the puc sunol clinic. There was a lot of interest because they are further out and not so close to the city. We administered just over 2 thousand vaccines this year. I wanted to note, that is 10 and a half percent lower then last year. I wish i could say because we didnt offer the same number of clinics, the one clinic we didnt offer had very low participation so dont have a lot of data showing us why that might have happened. We know what we are hearing, which is really all over the map. Could be anything from people in hybrid schedule, not in the office that day. We have heard a lot of messaging around vaccination fatigue, so again we dont know exactly why but every year the goal is go up, up, up. This year we did not go that route. Sure among other factor is the fact there are more Vaccines Available in more venues then 3 to 4 years ago. Go to the drugstore, the supermarket, what have you, so people where we used to be Health Plan Provider or employer based as a primary source of vaccinations there are many more sites out there now and so that too may be impacting what you are seeing. Right. Which is a good thing. Yes. That may be the reason as well. Very much so. If i comment as well. There is a lot of Public Service messaging around flu season, but the [indiscernible] rsv and covid frankly is sometimes confusing to the public because you can only offer flu when people are somehow tuned into rsv because a vaccine is available for certain subgroups, adults for rsv and pediatric vaccine was short supply. This is very confusing to people, so i think some of is the low participation may just be not only vaccine fatigue and vaccination overload like how to prioritize this. I applaud all your efforts regardless. Thank you. Thank you. The good news we are getting people vaccinated either way so that is great. Some of the best practice we do continue to offer clinics to midnovember. We closed a little earlier isthe year and that was because it made more sense. We also continue to partner with Kaiser Permanente who over the last 2 years, now the third year utilized the third party vendor, albertsons safeway. A few new things is dr. Wilson our medical director officer for the city attended a couple of our events. She found this to be successful in some of the covid popups they were doing that it is like a ask the doctor and a lot of people were approaching her, asking her questions. We were not able to do covid vaccines this year with the flu so is it allowed her to answer any questions that could arise for both vaccines. A new change this year which generally impacted just our kaiser members is selfreporting. Generally in the past anybody who was a kaiser member, their flu Vaccine Information would be directly put into the medical record, anyone else has to take a image. This year all the participants who engaged wouldnt need to take a image in order to put that information into their own medical record. And that concludesopen enrollment benefit. Questions . Are there questions for carrie . Commissioner zvanski. Thank you. Because i know there have been a lot of shots available of both types in the communities that San Francisco has been very active and in the peninsula, east bay, where we have a lot of active members living as well, but a lot of retirees and i see it because i have been involved with some of those. Im wondering what am i wondering . Im wondering if we have beenHealth Service has been involved with any of those Community Options or if we know those are pretty much run by the communities and the pharmacies, because i think private pharmacies are still giving shots as well and having the Shopping Centers like albertsons and safeway available present many options for people as well. Have we been involved with others . Now, we do not do direct partnership with community locations. We do provide information through our materials and online for where someone can get vaccinated outside our work site flu clinics. It is selfreporting if that goes . Correct. Okay. Thank you. But i just wanted to mention that i think there has been at least in the immediate bay area great expansion of options available to get these shots and still ongoing and a lot of education going along with it, so thank you. Thank you very much carrie for all you have done during this period and your team. Thank you. Ill turn it back over to rey. Rey, guillen. Knowing we are presenting with much of the following information in our demographic and annual reports in the coming months, i just briefly want to share with you some information that we learned after processing our open enrollment transactions. First, open enrollment applications submitted electronically still remain very high, so currently at 88 percent all open enrollment application submitted through ebenefits or online benefit system. Well never to 100 percent because some transactions will not process through the system due to overlap in transactions, so for new hires for example, if they have a new hire event sitting out there, they cannot have a second open enrollment event open at the same time, so for those members we have to collect paper applications. Also for members transitioning from active to retirees status, similar situation where we will need to collect the applications via paper. Well never get to hundred percent, but we always strive to increase the number because it does reduce the complexity on staff processing those applications. When we look at the medical plan enrollment for our active employees, there were not major shifts with distribution between the different plans. The one notable exception again was with our health net canopy care plan. This year again we increased membership in that plan by 50 percent. Again, this is leading to more sustainable plan as long as they get that base enrollment up. Again, no significant enrollment. We do see increase in enrollment from last year the this year primarily driven by increase of employees during the reporting period. Again, for the preopen enrollment data that information is based on the data we pulled for open enrollment letters late august and so the postopen enrollment data we are looking at is after we process the open enrollment application which is midto late november and therefore we just had a number of new hires in the workforce during that period of time so increase is not indicative of anything other then the increase in the overall membership. If we look at the next slide it helps if we look at early retirees and medicare retirees. So, the one thing we wanted to keep an eye on was knowing there were significant increases in premiums for some of our early retiree members. We want to see if there was potential shift in enrollment due to that fact, however as olga alluded earlier, that did not come to fruition. Enrollment stayed pretty stable for our early retiree base coming out of open enrollment. Again, similar to thatback to that previous slide. Similar to the issue we saw with active employees, where we saw new hires, we do see overall decrease in the number of non medicare retirees, but again this is primarily due to the shift between the date we pull the data and for the preopen enrollment data and postopen enrollment datea. We have number early retirees aging into medicare over that portion of time and so again, the decrease in enrollment that you are seeing is primarily due to that issue. Enrollment stayed very similar. When we look at the medicare retirees, just opposite. You see we increased the medicare members, but again it is primarily due to those early retirees aging into medicare over that 3 month period of time. Enrollment in the plan even though we were fearful of potential decrease in enrollment due in the United HealthcareMedicare Advantage ppo, again, that enrollment did stay relatively stable. Here you see the positive enrollment in our health net canopy care hmo plan. We did see significant increase in lives for both when we look at it from a total subcriber base and total live basis and also subcribers or enrollee basis. We see significant increase in enrollment in that plan, again, after we experienced pretty much the same last year so very happy to see that in order to maintain the viability of that plan. When we look at dental, again you will see same thing as with the medical and increase in the accounts active. Attributed to the increase in employment during that period of time. The one thing that we are seeing when we look at both the data for active and retireees is a small shift from hmo plans to ppo plans. It is noted we have not had a chance to look into that for reasons, for that but we wanted to point that out. Next slide. Similar with vision, again enrollment stayed pretty stable and we do apologize, it looks like there is overlap in the data, but we did see when we look at the vision data, we do see a also a migration from the vsp basic plan to the vsp premier plan and again, the difference between the two is, there is no copayment for lens on the premier plan asual as there is a benefit allowance for things like frames and contacts every year versus every other year but we see members moving to the premier plan from the vsp basic. When whee look at retirees similar story. Enrollment pretty stable but see a slight move from the hmo to ppo dental plan. And again, similar enrollment change for the vsp plan for retirees, just members moving from that basic plan to the premier plan. So, with that, that concludes our presentation and we are here to answer any other questions you might have. Are there additional question from the board . Again, rey, on behalf of the board, we thank you and each of the teams in your department for the hard work and diligence that you displayed again this year in carrying out this process. I do thank you for that. It is truly a team effort. Every person in our department plays a very Critical Role towards the success of open enrollment from the planning on and so, i just thank the entire team for being team players through the entire process. Thank you. Thank you. If there are no further comments from the board, well take Public Comment on this item. Thank you president scott. [providing instructions for Public Comment which is displayed on the screen] board secretary, we have three callers on the line, zero callers entered the queue at this time. Thank you moderator. Hearing no callers, Public Comment is closed. Thank you. At this point, we are going to take a recess of 10 minutes. I often said, the mind can comprehend only what the end will ender, so well take a 10 minute recess at we are ready. Thank you. We are going to have roll call. Thank you president scott. Roll call starting with president scott, present. Follansbee, present. Zvanski, present. Now we move to item 9, which is board education. Thank you president scott. Item 9. Board Education Opportunities for future consideration discussion presented by anne thompson, senior account executive, aon, and mike clarke, lead actuary, aon. Good afternoon. Well be presenting today. Just as reminder, before we start just for background, this has been a ongoing education process throughout the lete summer and fall months and just reminder of what those 2023 requested topics were and how a lot of what well talk about today brings the last three discussions into focus for the future. And that is the title of our discussion today. Opportunities for future consideration. Well go through the just brief overview of the overall board education modules that commenced in august and conclude today as well as the Key Takeaways from the august, september and november discussions. The strategic goals are embedded throughout the duration of the discussion today, including conversation about driving high value in healthcare ann will go through, opportunities for future consideration that both ann and i will discuss and then anne closing with concluding thoughts on takeaways from todays discussion and preview of Health Service board education discussions that will occur in early 2024. Reminder of the modules commenced in august with broad review of the Health Ecosystem, and just preview of what transpired from september to december. September focusing on market and Health System invasion, november on benefit design benchmarks and plan design on plan use behavior and taking all that information talking through opportunities for future consideration today. Page 5 reviews some of the key take aways from those prior three modules. From a Health Ecosystem overview standpoint, certainly the complexity and everything that we see in healthcare and how those complexities drive up spend and how that spend increases with age and advancing needs for those with chronic conditions. That underlies a lot of what we see in our environment. Labor shortage in the healthcare environment, wage and supply cost, what is happening with Specialty Pharmacy and deteriorating physical and Mental Health. We pivoted in september to review Market Health consideration. Involving dynamic vendor ecosystem. Focus on unmet needs including navigation, wellbeing equity and affordability and a lot of [indiscernible] care delivery. For instance, the alignment blue shield will have starting in 2025 with the cost plus drug organization. The alignment of amazon with one medical delivering primary care as well as virtual care. And then last month we spent our time talking through benefit design benchmarking. Assessing plan des zines what we see in the broad employer marth place across the country and specifically in California Public sector and how that influences behavior. Copay based plan increase spend as prices increased significantly. There are differentials within the plan designs between the kaiser copayments which are generally lower then other plans. Research has not shown Significant Impact on behavior with increase point of care copays and coinsurance to some extent there. The member design features within the plans again align well with other California Public sector entities, but richer then National Public entities and how utilization is continued to increase as the population ages and those chronic care needs of members increase. So, as we think about the future, what kind of went into my mind is we want to drive high Value Healthcare and we chose those words very carefully. With we are not look frg the cheapest, we want the quality, which generally is the less expensive, but thats what is driving this at the end of the day, so we see there are 3 different components so the first on the left side improving Health Outcomes which we spoke earlier. Dr. Follansbee you talked about health ucwety and driving outcomes. This combines closely with the middle item reduzing member utilization and we want to do that through better Health Outcomes. The healthier the less you use the system or use the system when needed and that gets to making sure when care when needed is efficient and effective in the care delivery setting. How do be do that . On the next page we like i said combined improving Health Outcomes and reduce utilization and there are several areas we wanted to call out as key areas to address as we think about the future and so Preventative Care. We screen vaccinations which we have spoken several times about vaccinations today. Chronic condition management, wellness and wellbeing. Heard from carrie and her team all the work hss is doing and looking at pharmacy and medical device management. I dont think we have talked about pharmacy recently. Maybe last year, but we know theres a lot happening in that space so we want to really make sure we keep an eye on what is happening in that space and so again the ultimate goal is Health Improvement for better quality of life and utilization production. When you look at efficient and effective care delivery, again key areas primary virtical care, which we heard a lot from executive director yants and organizations that she participating with on primary care. [indiscernible] making sure that the right level of care is being sought. Something that can be done at your primary care, that happen s at primary care urgent care versus emergent care. This is ideal situation. We want to look at insuring the right side of care happening. We heard a lot 2 mupths about Technology Advance and invasion, so keeping an eye on that and how those things can teach us or initiatives we want to be involved in or engage in. Navigation. Accountability Care Organizations which you had in place for several years now and then fraud waste and abuse keeping active eye on that. Those are the key areas in the effective care delivery. As we think about the future, and we will then look at future opportunities. Leveraging high Value Healthcare, as we look at the future considerations certainly promoting use of high quality and low cost care is a big component and well go through little of information relate d to the current plans today. Addressing affordsability and sustainability. My passion as your actuary and anne will lead through ideas supporting Member Health and wellbeing and those with chronic conditions. On page 10 we do a lot to look at rates and cost and in our rate benefit presentations in may and june do side by side among the plans, but thes is interesting graphic and credit to anne coming up with this to look at the picture from a standpoint of both network size and level of Care Management where if you look at this, these are the plans available to active employ eoos and early retirees. The dollars you see are active employee only monthly total cost rates for 2024 and the size of the circle corresponds to the member enrollment size for the active employees within each plan. So, that success we see around delivering high quality low cost care comes from encouraging members or incentivize through a combination perhaps plan design variation, certainly member contributions to enroll in well managed plans. We look at Kaiser Permanente at the lower left, not the lowest cost in 2024, but historically they have been the lowest cost plan it just so happens in 2024 it is health net canopy care but that is largest population size and correlates to probably highest level of Care Management among the plans within hss and the smaller network simply because it is leveraged through the Kaiser Permanente medical group. You also see health net and trio plans fit that mode of high levels of Care Management. Within networks that are more focused on the providers that in this case health net through the canopy care platform trio through their selected network and blue shield environment are able to deliver the numbers. Access plus still delivering high degree of Care Management but the Larger Network size and ppo is there for individuals who want to select the ppo and certainly early retirees who live outside the bay area. It is its own plan, but you have a less degree of Care Management and certainly Largest Network available. Commissioner follansbee. When i saw the slide and materials i was confused by it, and the level of Care Management was very clear. The network size confused me a bit. Do we actually know the number of providers that are member c in health net verso trio versus access plus versus kp . Kaiser has a much more limited provider base and so the other plans sky is the limit of the ppo. When you look who our members are accessing, im wondering if this is accurate. Do our members in the ppo paying so much more access that many more providers then for example kp offers . Can you maybe elaborate . Absolutely. Starting with kp, not all care goes within the Kaiser Permanente medical group. Vast majority does but some care goes outside the network for complex care needs maybe kaiser isnt equip to handle and certainly members have the choice to go out of kp for emergency care. Thankfully and we do get this information on a quarterly basis from kp, i think well over 90 percent of emergency room visits are happening within the kp environment and from personal experience that isnt true for other california clients. With health net, the canopy platform or primary providers, so thinking health physicians, john muir, mare taj, the partners within health net, blue shield actually shares with us on a quarterly basis robust list of the percentage of members aligned with various physician groups in their network, so brown and tollnd and Hill Physicians are the dominant physician groups for your members within the trio environment. I think they account for probably 8085 percent of the membership. John muir is also prominent within that trio environment. When we look atthis was part of the discussion we had around the rate increases going into 2024 between access plus and trio were access plus had the higher rate increase, trio, nominal increase. Is there opportunity for access plus members to consider enrolling in trio . We saw from the Team Information earlier we didants see a lot of movement, but about 60 percent of access plus members leverage an ipa independent Practice Association so in other words a physician group, that is also available within trio. Now, the access plus also has i say about 1 3 of members affiliated with a Sutter Health or Palo Alto Medical Foundation physician where those physician groups are only available within the blue shield plans within access plus or the ppo but not available within trio. Does that help . It does help, but i think it begs the question about where our members are getting their care and are they getting their care with basically three times more providers then access plus then adjusted for the number of enrollees compared to kp. My gut feeling is part of the problem is that we may have more providers in the ppogo to the ppo. But when you look at only one or two or three providers per member and so when you talk about Care Management and trying to get messaging out, this is little misleading. Ppo, someone say look at the ppo network size is huge. I will spend the extra money, but where members get the care may not be that huge a denominator. That is what i was trying to get at. I think i totally agree. Part of the ppo network is hetch hetchy and sonora accessing care in out of state localities. I think within the bay area itself there isnt a great difference in the provider composition in the ppo for blue shield versus access plus. There will be then when you go access plus to trio. Alright. Please continue. Certainly a big focus the executive director yants and team is looking at alternative payment models and certainly as it relates to primary care and advanced primary care. Those alternative payment models are to look to shift away from just a pure fee for service. Pay for number of services to models that provide those financial incentives for equitable high quality cost efficient carement we see it today, especially within blue shield and health net environments through capitation, physician capitation for blue shield plans, capitation for all most all services in the health net canopy plan and value based payments with aco partners, Hill Physicians and brown and tolland. We look at future trying to link the payment models more to quality. They have been historically with brown and tolland but that is in the blue shield environment. The investment in those advance primary Care Initiatives and hss talking often to the blue shield team about how that is progressing within their key aco partnerships. Payment transparency. The Data Collection aspect. Looking at these variables which are fairly i guess new to the thinking of integrating them into the data process, and then integrating information on more real time actionable basis to support Population Health management. On this issue of payment transparency, there is a larger effort i think with center of Medicare Services around actually having hospitals and other i guess larger providers post their details of what things cost on a national website. Is that still moving forward to your knowledge . Yeah, so there are two cms initiatives around data transparency. Initially it started with hospitals and then broadened and it this week there was actually a piece of legislation that passed the house around more advanced data transparency and well see what happens as the senate considers. The history we are seeing in general is it data set is so large, unwieldy, while you may get compliance it may be more Technical Compliance but not necessarily with a mind tosay a system putting the information out there in a clear concise usable way, so there is definitely efforts underway by data organizations to i guess advance the technologies that allow us to have better insights from the data that has been released. Okay. It is still a project ongoing just hasnt yeah. It is good we have these regulations in place and it is continual work in progress to get to a point where we have more useability with the information that is required. Okay. Thank you. From affordability and sustainability. Last february we talked through some of the mitigation strategies that may be part of recommendations going into this rates and benefit cycle. These strategies, we think of them as ongoing and certainly in collaboration with the health plans that support the advancement of these aims and most recently we spoke in november about how those periodic plan design feature reviews is recommended to support the overall plan affordability and sustainability. Just a example, page 13 is a slide we shared with you last month just looking at the levels of annualized increase in Certain Services especially on inpatient hospital side, outpatient surgery side and brand prescription drugs. These are elements that require the least amount of costsharing for copayments. Just to give you a sense, this is what actuarys do, if we look at alternative plan design, looking at elements of the plan design today across various plans so you see the plans across the top and youll see examples of particular plan Design Elements down the side of the page. Just what if. What would it look like if we were to consider a particular increment and plan design feature for each of the given plans so that is what this is meant to do is show what that possibility is. For some it is a modest amount. For some it could be significant. Not saying all these are recommended and all brought forth to you, but just as a example, if all these increments were applied close to 18 million. There may be elements of this that we bring to you over the course of the winter and spring months. Could you pause. Are you on page page 14. That needs there you go. That needs to catch up. Page 14. To give a sense too, you see at the bottom of it page, if you look what transpired over time and hypothetically if you look to periodically index the copayment growth to something, think of medical cpi, a National Measure of increase in medical cost, it has grown 50 percent since 2009, so granted,ter is 14 year period here, but it would mean that a 10 copay in 2009 needs to be 15 for instance in 2023 to keep pace with inflation. And then again a recent slide to show examples of recommendations that i made to the board just looking at kaiser recommendations for both the 2021 and 2024 plan years. Again, just to get a sense what the Financial Impact would have been under those particular recommendations. Can i maybe make a comment . I appreciatea lot of this is rehashing the dat a we have seen and think it is very important. I guess that again, the concern i have in terms of our messaging is, when we talk about one of the early slides i bristled at the balloon that said, reducing medical utilization. I think that probably could be better worded. Maybe something like, optimizing healthcare utilization or something, because i think that this idea of minimizing medical utilization, the sort of concern is by minimizing early utilization we are increasing conditions that end up only managed by brand drugs or inpatient hospitalization or surgeries, and i guess where data transparency is important is can we really effect these three items by your later slide talked about, optmizeing preventive strategy and healthcare utilization early and this is where we see this gap. It looks terrible because in red, rx brand, they start cuttingasking to pay a lot more for my rx brand and that isntfrom my position on the board is to try to increase the screening and utilization early on so fewer people need the brand drug for the conditions that are so advanced that there are not many options or treatment may be much simplified rather then needed heroic drugs for the last 30 days of a persons life. I think this is a complicated area and appreciate you attempting to clarify, but donts want people to take away we increase copays for high cost as the only solution. It may be a solution in part, but there are other solutions we need to focus on in terms of early Optimal Healthcare utilization. Thanks for the comment. Im preaching. Sorry about that. I think we struggle [indiscernible] we understand and you have to get that message across. It is is great point and certainly not our intention and we struggled with the wording so wish you would have been in the room when we were doing that slide. Certainly it is not to reduce utilization because of needed care, it is to get upstream on the Preventative Care which we talked about earlier, the health and wellbeing. Those actions to ultimately reduce utilization but not in a punitive commissioner zvanski. Thank you. Dr. Follansbee, i heard my fathers voice ringing through with this, because he would look at his employer plan and also as he went into retirement and said, the goal is to really cut back so that weto get to the point we use fewer service and less and less expensive and the point we are try ing to make, if there is early utilization and preventive looking more at the preventive options, the end result is the savings on the other end, but again, how we present it, the minute i saw that phrase i wentmy god, hes coming back to haunt me. It sends a different message and i think what we want to say here is we want our members to be more prudent in their use of the benefits they have, because we know we have very good benefits, better then most, and we want to encourage our members to properly utilize those benefits so that they wont need as much going down the road and that we can keep our benefits Cost Effective as well, because we are locked into formulas that are preset. There is only so much negotiation because charter languages says this is what you pay and what you pay and that is what you pay and we are stuck with that and i think what we want is to optimize the opportunities for the best care and save us some money in the long run. Well have to work on our vocabulary a little bit. Thank you, because when you say opportunities, affordability and sustainability, those are key phrases, key words that we want to see and we want to present that to our members. Thank you. The last thing, the change recommendations when i look at opportunities on page 15, i think what we are trying to do is not have to make those changes, because the more we make those changes, the more it limits someones access one way or another. We may not be aware of it. Especially with retirees and those that are older and have low retirement benefits. They may not be able to afford going for from 35 to hundred dollars and may skip some of the preventive opportunities. Thank you. Thank you commissioner zvanski. Let us continue. On 16 and 17, we talk about the health and wellbeing program hss host and puts on with carrie and her team and i say will not read this to you, the key opportunity here is increase awareness and engagement. There is tons of great programs and we have great utilization, but lets get more in these amazing programs to really get at that upstream care. On page 18, ill jump to that. Not towant to acknowledge vendor programs. Just listed out a couple for each of these. Some could be quite long lists, but there are lots of programs within your health plan to also support health and well being so creating awareness and engagement in these programs. Page 19, getting to the chronic condition management. In support of those, we see three main avenues. Navigation, advocacy conditions specific support and value driven network. Some of the opportunities here we talked about i think in september was kind of digital care, integrated care, support navigation advocacy, continuing to [indiscernible] aco population you have focus on advance primary care, driving care to high quality providers and then last but not least, data [indiscernible] just because you send data doesnt mean the person get tg can use it. If you want to refresh on that, there is presentation from i believe august 2020. 2019. It was in person. In conclusion, a few take aways from today and really want to put this out there to establish the baseline of the great thing s we are doing and want to grow and development and if gauge further some of these initiatives and you may hear some of these as we move into read benefits in future years. Again, promoting use of high quality low cost care. We wont say reduce utilization. Address affordsability and sustainability. Health and wellbeing, getting upstream and supporting those with chronic conditions. That concludes the education part of our presentation. I will note on the next page sessions that well be hosting. Training in january with chris sears and february employer budget position that well hear from at that time. Just to clarify in the february session, we sent letters to the 4 employer entities this board serves and we asked those representatives to come and talk about the budgetary impacts of rising healthcare costs in terms of their operations, so thats the School District, the Community College district, the superior court, as well as city and county of San Francisco represented by its controller, and in the case of the controller, i took a point of personal privilege, because i understand hes leaving in february. I wanted him to also provide the board with council and guidance, lessens learns if you will, coming from his experience over the past several years with this issue and how it impacted overall the budget of the city and county of San Francisco. Well see how that goes, but it isnt just about their budget positions, but it is talking about the impact of increasing healthcare costs on their total operations. Alright. Thank you for your leadership in terms of this particulargetting to mike in a moment. Your leadership in terms of these sessions and also mike, your expertise in supporting the effort of reviewing these topics over the past several months. It is called board education but my hope is it laid a Public Foundation with what we are grappling with as a board as we go through the benefit cycle each year so thank you again. Any other comments from the board . I just want to reiterate what you said and just again, where the rubber hits the road when you look at the high cost areas, you talk about vaccination decreases absenteeism good for the employer and are decrease secondary pneumonia from flu or rsv or covid and hospitalizations and complicated sometimes very long hospitalizations and rehab that goes into that. The prenatal care, we spent a lot of money on very few cases, very complicated pregnancy and yet prenatal care can minimize that risk. Substance use, we spend a lot of time worrying and asking our patners to talk about Substance Use because we know uncontrolled Substance Use translatess to hospitalizations, complicated surgeries for drug users who end up having heart transplants or liver transplants and all that as well as high cost medications. These all factor into the same issues, which is early optimal utilization of these services whether it is Substance Use, vaccination, pregnancy et cetera. Again i want to highlight that we are all driving towards the same point. Not just trying to balance copays for those who are hospitalized. They dont want to be hospitalized we should have prevented that and we could have in some cases so thank you. Alright. No further comments from the board, well now take Public Comment on this item. Thank you president scott. [providing instructions for Public Comment which are streaming on the screen] board secretary, there are two callers on the phone line, no callers entered the queue. Thank you moderator. Hearing no callers, Public Comment is closed. Thank you. Well move on to item 10. Item 10,. Health Service Board annual selfevaluation and employee performance of sfhss executive director evaluation and timelines for plan year 2023 action presented by Governance Committee chair hao. This is action item. Thank you very much. I hope i have this right because i got notes here so thank you very much board secretary for preparing this as well. The Governance Committee had a meeting and reviewedtook a look at the materials for both the board selfevaluation and the evaluation for the executive director and made some recommendations accordingly and we set up a calendar with regard to when these activities are going to take place. Monday december 18 the board secretary will send the executive director performance Evaluation Survey to the Health Service board with director yants selfevaluation attached and there will be 4 weeks to complete the evaluation, and i just want to make sureit is the same with regard to the coo and cfo and thats again 4 weeks to complete the evaluations and then reminder well go from the board secretary to the board and the c orks o and cfo in december 27 and well be looking at that basically january 5. The responses will be due and there will be a draft that will be prepared for the Governance Committee to meet and take a look at those in january at some point, a date to be determined and the Governance Committee meets february 15, maybe. It is a proposed date with regard to the final recommendations and the report Going Forward. Not until march 14 that those items will come to the board in a closed session for our review. There is a number of steps that will be Going Forward with regard to these things. Also, with regard to our selfevaluation, there have been a number of changes the Governance Committee proposed. For example, they took out number 3, item 16, a term was removed from the policy that was stated. Item 24 and number 27, number 34. Those were removed and language changed in item 38 so instead of comment about the board engages in effective management succession planning, it would be where feasible the board may make recommendations because we looked at how the process works and what the board actually does. There were a number of modifications that were put forward in the Governance Committee meeting and those will go forward in the materials presented on those dates i listed. And i thinkare there any questions with regard to what the Governance Committee i like to move we accept the recommendations of it governance subcommittee visa vithe employee performance evaluation, the Health Service board selfeal evaluation and timeline, all three i move we accept these recommendation. Thank you commissioner. Is there a second . It is properly moved and seconded that we accept the report coming from the Governance Committee on the executive director performance evaluation, the board selfevaluation and the related timelines. And thank you commissioner follansbee for adding the timelines, which i didnt mention. Any other questions from the board . Hearing none, thank you we appreciate her work on this project as well. With that, no further board comments, is there any Public Comment . Thank you president scott. [providing instructions for Public Comment displayed on the screen] not hearing response from our moderator. Give one more second while i also support in the number of callers in the queue at this time. There two callers in the queue. No callers raised their hands so Public Comment is closed. Thank you. Well move to itemwe need a roll call vote on the item. Scott, aye. Dorsey, aye. Follansbee, aye. Zvanski, aye. Passes unanimously and well move to the next agenda item. Thank you president scott. Item 11, reports and updates from contracted Health Plan Representatives. This is discussion item and plan represents can move to the podium. Are there any Health Plan Representatives who want to make information comments or recommendations, edits, amendments . Anything at all . Would the health plan represents here please stand . I like to say to you and your colleague we look forward to a very happy new year and we wish you a very happy holiday season. Thank you for coming today. Alright. With that no discussion any discussion . There was no comment so no discussion and no need for Public Comment. Correct. I think i can aggregate it the process. The last item on the agenda is . Im sorry yes. I want to go back just a moment to a previous item and add a couple recommendations for future education for the board. I think we can do that in the solicitation of the board survey, which will be part of the board selfevaluation. Okay. Thats fine. Thank you. That way well address at that time. The item i see before me is the adjournment of this meeting. Hearing no objections, the meeting is adjourned. [meeting adjourned] in 201,755. 7 million passengers traveled through San Francisco international airport. We have on average 150,000 people traveling through the airport every day. Flying can be stressful so we have introduced therapy dogs to make flying more enjoyable. The wag brigade is a partnership between the airport and the San Francisco therapy Animal Assistant Program to bring therapy animals into the airport, into the terminals to make passenger travel more enjoyable. I amgen fer casarian and i work here at San Francisco international airport. The idea for therapy dogs got started the day after 9 11. An employee brought his therapy dog to work after 9 11 and he was able to see how his dog was able to relieve passengers jitter. When we first launched the program back in 2013, our main goal was to destress our passengers however what we quickly found is that our animals were helping us find a way to connect with our pang. Passengers. We find there are a lot of people traveling through the airport who are missing their pets and who are on their road a lot and cant have pets and we have come in contact with a lot of people recently who have lost pet. I love the wag brigade. One of my favorite parts is walking into the terminals and seeing everybody look up from their device, today everybody is interacting on their cell phone or laptop and we can walk into the terminal with a dog or a pig and people start to interact with each other again and its on a different level. More of an emotional level. I just got off an 11. 5 hour flight and nice to have this distraction in the middle of it. We look for wag brigade handlers who are comfortable in stressful situations. I like coming to airport its a lot of fun and the people you talk to are generally people who are missing their dogs. They are required to compete a certification process. And they are also required to complete a k9 good citizen test and we look for animals who have experienced working with other organizations such as hospitals and pediatric units and we want to be sure that the animals we are bringing into the airport are good with children and also good with some of our senior travelers. I think toby really likes meeting kids. That is his favorite thing. He likes to have them pet him and come up to him and he really loves the kids. Our wag brigade animals can be spotted wearing custom vets and they have custom patches. There is never a day that repeats itself and there is never and encounter that repeats itself. We get to do maximum good in a small stretch of time and i have met amazing people who have been thrilled to have the interaction. The dogs are here seven days a week, we have 20 dogs and they each come for a two hour shift. There is a lot of stress when people have traveling so to from these animals around to ease the stress and help people relax a little bit. I think its great. One of our dogs has special need and that is tristine. He wears a wheel around. He has special shoes and a harness and we get it together in the parking lot and then we get on the air train. He loves it. Little kids love him because he is a little lower to the ground so easy to reach and he has this big furry head they get to pet and he loves that. He doesnt seem to mind at all. Probably one of the happiest dogs in the world. Many people are nervous when they travel but seeing the dogs is just a wonderful relief. What i absolutely love most about it is the look on peoples faces, so whenever they are stressed and flying is stressful these days you get these wonderful smile. I am the mom of lilo the pig and she is San Franciscos first therapy pig. Lilo joined the wag brigade as our first pig. Wag brigade invited us to join the program here and we have done it about a yearandahalf ago. Our visits last 1. 5 to 2 hours and it does take a little bit longer to get out of the terminal because we still get a lot of attention and a lot of people that want to interact with lilo. I feel honored to be part of the wag brigade. Its very special to meet so many people and make so many feel happy and people that work here. Its been a great experience for me and a great experience for to toby. Its been an extremely successful program, so the next time you are here, stop by and say hi. Television. music . Hi, im welcome to the to San Francisco inperson a roundtable person about important topics were to be talking about maturing and aging retirement life really, really trying to speak with you all did i. Something that im trying to plan for and thinking about every year as im working everyday and hoping not to work anymore but go around and introduce yourselves and then let us