Transcripts For SFGTV Health Service Board 81116 20160816

Please stand and join and stay with me the pledge of allegiance . [pleage of allegiance] i will now ask our secretary to call the [reading ordinance] [call of the roll] scott lamb Breslin Farrell excused, ferringo expected, follansbee sass. We have a quorum. Thank you. With that we will undertake action item number one item 1, action item approval with possible evocations of the minutes set forth below. Regular meeting of june 9 22nd special meeting of june 21, 2016. Are there any comments or clarifications by members of the board rregarding the minutes of these two prior meetings . Again i commend those who do the translation of all of this stuff given the volume of Public Comment on some of the complexity of the details of the proposals we were considering but generally on the june 21 meeting. Any comments from the commissioners . Ready to entertain a motion i guess were doing both sets . Both sets, yes it there is seconds . Moved and seconded. Any Public Comment . Seeing none, we are now ready to vote all those in favor signify by saying aye [chorus of ayes] opposed . [gavel] speak so ordered. It is unanimous. We are now going to overtake discussion on item number two. Item 2, discussion item. [reading ordinance] is there any Public Comment on any matter not appearing on the agenda . Yes . If you would please identify yourself . My name is sylvia alvarez. Although the scheduling and dedication is not on the agenda regarding the distribution of our new health plans im requesting a consideration of instructing the Healthcare System director ms. Dodd to bail out to act each active employee further to be able to make intelligent comparisons between health plans being offered. Last year the active group provided a onepage letter informing them no health plan information will be mailed and this in the 29 years that was 28 years i never had this done. Instead, we were to look at the information on computers are dropped into the offices and make decisions. There is a problem with this. With this scenario, as expressed in my email to all of you, and let me give you a copies sent to each of you, of which i did not receive a reply, and i am going to give these copies to your secretary right here. Thank you. What happens is theres a class issue here. Theres three transit operators the laborers, the bluecollar trades, plumbers, bus drivers, truck drivers, dont have a computer or printer. Readily available while they do their jobs. Most of them commute because San Francisco is too expensive to live engine to be able to take their time away from work when youre doing with 39,000 employees, this is not feasible. Nor is it fair. I has a clericalyes i sit at a computer i have a printer i can easily access the information i wanted but not those bluecollar workers. Also, it seems every year we hear fewer healthcare options. Theres a minimal competition issue here. Before when i start with the city, we were given at least six of their plan options. They were competitive and health going to me was the best and the worst in my experience was kaiser. Napa county readily, right now, is getting their employeesand heres a copy to the Commission Secretary to distribute to you10 Healthcare Plan options. We are in workforce of 39,000 employees in over 20,000 employees could not help retirees mightve been included only gets to pick from to. With our clouds, without power of money, i think we can do better. If ms. Dodd needs assistance with that i think you should give your the resources she needs to have a more competitive presentation for employees for the so they can consider other Healthcare Plans not just to, not just three. Thank you. Thank you for your comments. Is there any other Public Comment on items not appearing on todays agenda . Seeing none, we will go to discussion item 3. Item 3, discussion item. President s report. Ill reserve my comments to a later agenda item. Item 4, discussion item directors report. Director dot. Thank you. Commissioners that you have my report in my packet but i ask the indulgence of the chairusually i sleep through it but i did want to highlight some things since its been two months and then a very very busy two months. I would like to start by introducing two new staff people. The first is our new contracts manager Michael Scott to get michael, would you stand up . Michael comes to us, he is a native san franciscan and he came to us during contracts with the airport good is an undergraduate degree in economics from ucla and Legal Training from American University in washington dc. He is already putting contracts in order so we are grateful to have him. Then, next the haiti would you please remain standing . Lee comes to us also from washington dc and he is filling the Research Assistant position. He served as a Human Resources policy advisor for the office of the deputy mayor in washington is did he served under three different mayors in washington dc. He has a jd and mba from hostile university in new york and were thrilled about both of these positions filled with such capable people. Well on behalf of the board id like to welcome you both to the Health Service system. Your backgrounds seems to made you more than qualified to undertake the duties that have been assigned to you. We do profoundly welcome you and wish you every success in your career endeavors at this stage of your career. So, thank you for deciding to join us. We also had two additional interns with whom i dont believe our. Wellness interns. There Public Health students and their special classification within stephanie managed to hire to really bright young women. One is doing evaluation of the wellness program. So she is working with statistics and the other is helping on the program itself. We still have our Member Services manager position open and we will be interviewing tomorrow for that position. So, we are very excited. The of seven candidates finally came through and met all the qualifications. So its been open for a while and working to fill it. The other personnel issue is the Employee Engagement survey was completed and you will hear later from dr. Lynn where item number 10 on our agenda, i believe. In terms of operations, operations and communications, and finance to some extent and myself have just been working full steam on open enrollment materials and preparing for open enrollment. In terms of the mundane, all of our Customer Service levels were met. Commissioner sass raised a question about why the resume any terminations in june and mitchell grays Operations Manager pointed out that you had three paid or not. By the time the people got their second letter there have only been a paid period and a missed another one. So, that will happen to two months of the year when there are three paid. Well hear more about our work with United Healthcare in terms of preparing for the new city plan implementation and mitchell has been consumed with getting ready for implementing voluntary benefits for this first time. We will be offering eight voluntary benefits to all city county and court employees. It would be a test of my memory to list them off, but they are life, pet, longterm disability, Deputy Director, would you help the director out . I got four. Mitchell greg chief operating officer of the Health Services and were not heard voluntary benefits and we do have an update next month on the agenda about that. Weekly, supplemental life, of two 100,000 guaranteed issue. Pet insurance, shortterm disability, Accident Insurance critical illness, and did i say pet insurance . Yes so that is six. I thought it was eight . Six will get a complete report next month with the details. Thank you. Supposedly administered by ebs currently administers the benefits. Its very exciting and as youll see in the medications report we had over 2000 responses to voluntary benefits questioned in terms of what would be most important to you. The idea of being able to get Life Insurance with no physical exam no evidence of coverage requirements, is really a onetime plus for all of our employees. In terms of the Data Analytics cannot you remember Enterprise Content Management System where we are going to digitize over 200,000 paper records that programming is complete. Staff training has begun. So, we will hopefully be have a whole new room available to us at this time next year. Maybe, to do more exercises in meditation. We did successfully submit all of the 1094 and 1095 forms to the irs by the filing deadline and the irs is currently processing corrections probably for everything oh employer in the country. Finance, i will just point out, they worked on those two contracts as well as the branding contract and met with doctors in operations to work on scope of work for doctors. The finance report is in your packet and you will hear market in terms of given occasions, i think if you didnthavent look at the deck, its important to note, there were 1085 clicks on the choosing wisely tab in terms of whatwhen you should get checkups. You will recall choosing wisely presented us at the november for and the board instructed us to begin the rollout choosing widely. So people are interested in getting information about taking more control over their healthcare. There were also 1200 clicks on the Health Service board. The most clicks the Health Service board has ever got. Communications is immersed in open enrollment materials and getting things ready and to the printer and we are also working with two different agencies rolling orange, which is a web strategy project, and with the red company which is a brand and style guide company. These are 12 week projects. If you would, say up a little bit more about what they result is briefly . We see it in the packet but youve identified thus far, what the new logo will look like can i just do that at the end were comes . Okay stephanie will be here later to go through some of her wellness reporting but i just want to point out 83 retirees at the retiree meeting were engaged in wellness activities and exercise at the last meeting. That she has them. Championing training and retraining throughout the city and that weve completed the recruitment for the Diabetes Prevention project and we have 156 participants and this is, again, a First Research project with kaiser looking at how to prevent diabetes and people are really excited about it. So, we will let her shine on what she wants to point out to you. I willi would be remiss if i did not point out the are expecting all of you to be 18 in getting fit on route 66. I pointedi said, i do not know what route 66 was having never driven across the country. Sorry. What . I know theres a song about 66 per one now going to get fit on route 66 clicks the mother road. So youre all expected to sign up. Maybe you can be will get a couple of the commissioners to compete get more active on route 66 did is taking the place of what weve had for several years to shape up walking challenge. In terms of my specific activities, i attended both the health positions aco meetings and will point out from the first time in a long time brown and tones numbers have improved. So, that is exciting. I mentioned earlier i spent a lot of time working on the open enrollment materials and like last year, we will be sending out a quests which have a letter in them that says this is what your current coverage is and theres a booklet with all the new changes. And because there are so many pages of benefits in order to get to those you do have to go online or you can call the office and we will mail you a hard copy booklet were saying being unders of thousands of dollars not to mention trees, by not printing and mailing booklets. Killing all those booklets are about five dollars each. So, those booklets will be mailed out again midlate september. We begin open enrollment on the first floor to my first of october. The retiredretirees and anyone who is going to turn 65 will get retiree booklet with all the information in it intending to mail to retirees. All of our information is available on smart phones and we are working to meet all the key deadlines. I participated in a meeting with you, chairman scott and commissioner breslin and browning and United Healthcare to make sure the be no disruption for the brown and tony hhs retirees as we move to the new city plan. We have spent a significant amount of time with best doctors to get exactly what is available and to make sure we market that well. I participated in the puc Public Employees Council Meeting and people are very excited about the best doctors benefit. We met with kaiser permanent date and we do this we jamie. Commissioner scott has attended some. I will they produce and credible utilization reports. These are details that they can get because theyre integrated system get we can get these from our other vendors. But i just want to point out that we started out by talking about in the kaiser system, for us, the average age is 47. 6 number which is 5. 7 years older than the kaiser regional average. Thats the average scriber age but when you add into the families the average age is 37. 4. Again, three years older than the regional average. Our average family size is two. The regional averages 1. 9. But what really hits you, and i think this is reflective all of our members is that 23. 6 of our members have chronic conditions and that uses 61. 4 of our premium dollars. 23. 6 percent of our people spend 61. 4 of our dollars. They go through the different, by prevalence, they go through the different chronic conditions. I think obesity, diabetes, and depression are ones that we all are flagged on them but i was going to pass thisi have two of these i believe. Yes, i have two of these and i was going to pass them around if people wanted to flip through them during the meeting or if you want to take it home and bring it back, but its a tome of information that really provides guidance to our Wellness Department that really tells us where we need to work. I also met with kaiser about setting up is there an executive summary in the document . I just gave it to you binding written . No. That was series telling you she has an executive summary. No, there isnt but i cannot kaiser to do that in the future that might be helpful in a mighty a summary of the highlights in that way could be not only shared with the board but with the system out large. Okay a mighty avengers. Right a summary means no more than five pages. Thank you. I met with kaiser and we arethey are setting up workshops at hhs which we held on september 15 from 121, 5156 15 pm on advance Care Planning. Then, two weeks later, they will have a counselor of able all afternoon to help people finish completing their dance care directive and no also have a notary available if people want to get it notarized and ready to go. So, thats very exciting. To shield them at the same time, is rolling out advance Care Planning Information Program here in without members but also throughout the country and to be sending out around thanksgiving time a six page click on what an advance directive is and how you talk about it and what should be in it and who should sign it, and so we are we will have reached all of our membership one way or another in terms of advance Care Planning. Kaiser, of course, has monthly times you can go and get that information. I met yesterday to the Business Leaders and health with the speaker was steve pamela with deposition kind of a father of pellet of kid. I know its a issue commissioner breslin is. Where is the pellet of care benefit in our evidence of coverage and it reallyit is in kaisers and the impact had people change plans because they wanted Palliative Care but steve just said there are not enough pellet of care practitioners. That california trains about six positions a year in that specialty between uc irvine, ucsf and uc davis. So what they are working on is trying to get curriculum out to primary care practitioners to do some of apple when you do get sick and need serious symptom management, you need a specialist. So, it is something he said that you are the consumer of demand. We will push that demand and we also need to get better medicare reimbursement for it. So i promise to work on both of those. Again, issues that affect members that were working on in different ways. The finance department put in incredible amount of time and at our last meeting we had just got the report documented Budget Analyst Office did attempt to take one of our positions and assigned to a attrition savior we were successful getting that position reinstated and am grateful to supervisor farrell and the other members of the finance committee. The executive team met with dr. Where to review the salt results of the engagement study, which is a illustrative and we meeting again to talk about activities we can take. I spoke at the quarterly retirees meeting and we had a meeting with aetna to go over life and disability results and i thought there was some interestingi said i think you should present this to the board. In terms of the brand and website on the second to last page of my report, we kind of the sped up the part of the Brand Development because we needed to give blue shield and United Healthcare the logo so they could put it on the back of the cards and print this month. So, we looked over lots and lots of departmental brands as well as other brands. Since hhs serves the unified School District, San Francisco city college, and the San Francisco superior court, as well as city and county employees, we felt dropping the city and countyis it not on the back of blue shield . [inaudible] they asked for the brand logo. That was part of it. I logo is okay because its in spanish hull. Not city and county of San Francisco. At any rate, we are dropping the city and county of San Francisco. I also brought pre2004, we covered up what was the content of this letter to mobley used that Health Services system them a division of the department of Human Resources, city and county of San Francisco. So, when the proposition passed that separated us out would begin help Service Systems city and county of San Francisco. I brought that toi brought that just so you be able to look at it. At any rate, we wanted to differentiate because we get calls every day asking if or the Health Department because Health Service system. It sounds like we are the Health Department. So, we asked to add a tagline, which either can be used or not and so you can do it with or without the tagline. So those are the bottom of that page, and then the next page shows you some of the other departments in the city who have removed the city and county of San Francisco section of their logo. Theyre both large and small. We often have trouble getting things onto one page because our logo takes up so much space. So this is a nice clean small logo. It will be rolled out without 2017 open in womans materials and everything will be switched by 2017. Right now, were just getting stuff right now ready for open enrollment. With that, i think that concludes my reports. So, what we are going to this point then, what we are going to see in terms of this branding, at this juncture, which is on page 6 of your report, as i safely recall this as phase 1 of the branding process and theres more to be developed around it including maybe some nomenclature because beneath it as shown on page 6 of your report . Yes,. Theyre also doing its branding and style guides could it will say what font will consistently use, same font instead of all having different fonts. We had just been given a Color Palette to pick colors good i feel like im decorating. So, its an entire package. Were also talking about voice and what kind of voice do we want our materials to have. We want to say, go to this page to enroll in voluntary benefits or do we want to say, lets go to this page and enroll voluntary benefits . So we are working to a lot of different branding and style issues. Then, we will want to in some way differentiates wellness because wellness is either with different icons currently they have four icons. Were talking about using those potentially other icons. They will make a wellness message clearly from the wellness part of hhs. So San Francisco Health Services wellness or wellbeing. Were still going back and forth on those two. Although, wellbeing is in our mission statement. Are there, done the directors report . What is accosting for these contracts for these two people to do this . Pamela . This is from last years budget that you approved. Pam 1120 Financial Officer Health Service system. I believe that they are under 10,000 each. How much . 10,000, under 10,000. Okay i just cant figure out this is necessary. Im still trying to figure this out. When im looking at the good with the brand look like before spewing it is San Francisco Health Service system city and county is given. If you look at the top of your current agenda thats the logo if you will i was looking at the hhs San Francisco employees retirement system. I would think somewhere you would have to have San Francisco employees Health Service system otherwise it looks more like Public Health department to me. I mean, i can understand wanting to divide between Public Health around because thats always been confusing but i think this gives any distinction. Because that is the only difference is that we dont serve the public. We serve people working for the city and county of San Francisco. I mean, thats what i see as the distinction. Well we serve more than just San Francisco employees. We serve the School District the Community College district in the superior court right that spelled out in the charter and city and county of San Francisco employees are separate person or separate group. If the city and county of San Francisco San Francisco unified School District. Sf superior court. So, in the charter it has those four different groups that we serve. But, how do you distinguish a believe i believe the charter only has the city and county of San Francisco and the unified School District. It has that and sf superior court. The sitting county of San Francisco is mentioned throughout the charter almost all the pages whenever it refers to the city. So, i am just kind of trying to figure out why if you want to make it look different than Public Health department, i dont think this is doing its. The purpose of making it look different from the Public Health department is adding the tagline below that says affordable quality benefits. I know thats different than the Public Health department. [crosstalking] if i look at that i would not know a different this is not coming back at a later stage once you a further development on this topic . No. Not on this particular stage of it but as you complete the work and the next phase no, this portion of the work was completed first because we needed i understand. And im saying as you go beyond this you say youre having him do font and other type of work. Is that not yet to be developed . That is yet to be developed. The logo is not going to be further developed. I just think this is less descriptive than what we had before. Part of this there was a time constraint in terms of trying to get, here, a couple of the providers together materials put together and all that. Maybe the report in the year of confusion so you can say theres been confusion in terms of phone calls and all that. Maybe you can report back in terms of the sense your department is getting . I understand the thrust of this not only to be for printed materials but also the web itself . This would be the logo on the website, the web strategy is completely different contract that is moving us out of the html web which is kind of antiquated now if you could believe that to what is called [inaudible]. Its much easier to update and drop things into and we met with other departments, the Assessors Office is already working on that. This is not mean we will not have read on our website get we probably its probably a 12 month project but first you have to map out all the Different Things you want website to have and we want to be able for it to have interactive things. We want to put up animation that shows people how to do things. Excuse me, and we want to be able to update it easily. Since more and more people go to the web to get their information. But, all this rolling orange web strategy vendor doing is mapping out all the different layers. Its really remarkable how much information there is, but they did for mta which is even more complex than we are and theyve done it for the assessor, so were following along. The we and otherwhat do you do with all the paper and the letters you send out and whatever . All that will have to be changed must be right . Because my spirits when the department changes headings you have to change everything so thats a big cost another big cost. We dont have large supplies of anything with the logo on its. We kind of order as we go. Thats one of my concerns, too. I will guarantee commissioner breslin will not waste any paper. Glad to hear that. We dont drink excessive amounts of paper. We communicate largely online and dropping this logo into a template or into the template for your decks, you see at the bottom here, its electronic function of cutting and pasting. Its not that expensive task. Well anyway, i cant see were makes a better distinction than it did before. The other one was actually longer i dont see how this is any better. Any other comments on the directors report or questions . If not, we will move to the next discussion item. Public comments. Thank you very much commissioners. Present number re ccsf and Vice President of seiu retirees. I want to address the issue of the branding. Started while i was an active employee and which ive always felt takes us away from the idea that we are Public Employees and public agencies. It doesnt remind the public that we are working for them. It makes us look like we are private entities and i think that doesnt serve us well in the long run. But with this branding, thank you commissioner breslin. My response was that it should say serving employees and retirees. Because this says are we helping helping San Francisco, who are we . I did were losing our identity as serving a discreet and unique group and that people do a Search Online theyre going to find this and that were going to get a lot of disruption from the public that maybe we have not had before. I know traditionally for many many many years in all the years i served its always the problem with department onto Public Health, blah blah blah. We would say, no, we are Employee Benefit system. I think we should have something thats as serving employees and retirees. So that we know that. I do appreciate the fact where updating things and if you look at wheat 66 it was like a really cool tv show with the court that. Anybody remember that going down with 66. Some people are doing that in their old age. But, really i think we like to see some of that acknowledges the fact this does serve employees and retirees i lost my other train of thought. I apologize when i think of it all be bad. I know what it was good i appreciate the conversation that youre having a pure. It gets lost their voices go down and it is lost in the back row. I excellent hearing and i my hearing test and i come out at the very top but its very low in the back and it would be nice if you remembered that there are others here and we are trying to hear what youre all talking about. So, please pickup and into the microphone. Enqueue for those comments. Any other Public Comment . Commissioner breslin as to the prior Public Comment but anyone called and asked for a book that they can get it. Is that correct . Absolutely. I know last year they ran out or something. So i want to make sure somebody is looking did we run out of booklets last year . [inaudible] maam, if you are going to speakwere passed Public Comment but im inviting you to come to the podium and make your comments. Please, identify yourself i apologize, sir. Actually, my last years expense was a little complicated because was a first time i did not receive as an active employee the materials to be considered for my review. And to pick a very good plan for myself. So i called in i asked for the booklets. I received them two weeks after the Enrollment Period had stopped oriented. The other issue is, i was not clear whether ms. Dodd agreed to sendit was not clear because i could not hear whether she is planning to send the activists information on the various health plans that we can consider tupac . Thank you for that question. I never got an answer just a moment. Thank you for your question and the comments. The first question was, did weyou may resume your seat and we will respond. Director, did we run out of booklets last year . For the benefit guides, theres two things. Theres the booklets we met with the open enrollment initial enrollment does go to everyone and that is the specific you plan your changes, rates, the plans offered any other changes we are doing good so thats included with a letter. That fits your current plan, current rates, whatever union you are and what the rates will be for the other plans for the following plan. The benefit guides, is the larger booklets that typically used to go out that also includes regular employment stuff for new hire information. Does it do go out to new hires. So, last year we did not run out of guides to send we still have some in stock and the booklets went out with everyone with every mailing. The booklets do not run out either. They went with a mailing thank you for that response. The rector dog, would you repeat which her attention is regarding the distribution of open enrollment materials that you made as part of your report, please . The booklets which have information thats required by law for us to send out and which have what has changed, what is new from the previous year, will be mailed out around september 20. Thats what we are shooting for. The guides, the handbooks that are 48 pages long, which also give you a lot of other information about cobra and about how to stay healthy and any number of things, those guides will also be mailed out to retirees who are 65 years and older and retirees who will turn 65 during this fan year. Plan your so theyll not be mailed to active employee . Correct but they are available by making a phone call they are available by making a phone call and will review the process by which those get mailed out and they are available when you come into the office good they are also online . There are also online but theyre available you come into the office and during that last week of october, we have all the vendors there. Is a great time to come into the office and talk to the vendors about what choices you might want to make your thank you. Any other questions on the directors report . Any further Public Comment . We are going to move to discussion item 5 item 5, discussion item [reading ordinance] stephanies on route. So id like to move to at the privilege of this year to discussion item 6 which is the financial reports. Since Deputy Director levin is it. Item 6, discussion item hhs Financial Reporting as of may 31, 2016 as you come to the podium, the director, i again want to thank you and your staff for your diligence and your persistence through this budgetary process this year. I know there were many twists and turns and i think my board colleagues are also making their views known to the respective reviewers of the budget during the course of this prosecutor thank you again. Thank you. Him 11 chief Financial Office officer Health Service system. The report you have in front of you summarizes actual revenues and expenses of the Employee Benefit trust fund and the general Fund Administration budget through may 2016 as well as the fiscal year ending projection through june 30 2016. The projected fund balance in the trust is 69. 4 million, which is 2. 4 million less than the amount reported in june. The primary reason for this decrease is attributable to the blue shield flex plan due to unfavorable claims experience. There are no significant changes in the other line items. The projection for the general Fund Administration budget is to end the year with eight 400,000 balance. Just to reiterate, in terms of the 1516im sorry1617, and 1718 budget requests we were able to navigate our way through and i believe the reduction that was finally made was around 5000. We did not raise any secular we dont have to keep any more positions vacant and we were able to keep our contacts together and not have cuts so, i appreciate all the positive statements that youve made towards myself and my staff, and we look forward to having another successful fiscal year. The audit by kpmg is underway. It will produce the Financial Statement which are issued in october but will presented to you in your december meeting. We dont anticipate any material findings. We dont anticipate any difficulties in getting through this audit. Your completed an internal audit with the Comptrollers Office earlier is that correct . . Yes. They on an annual basis come to us and asked for various items including not just whether or not we were processing entries into the Financial System correctly and have a backup. They also look at our policies and procedures, our internal controls, and they want us to do a more detailed policy or depth procedure for processing our journal entries, which we are doing as we go through and ending the year. But there was no material findings there either, correct . No. There are no material findings. You are correct. Director dog i just forgot, as are seattle pointed out, we only have a 5000 budget and i forgot to thank the Retiree Organization because they generated a lot of support for our budget and said a lot of nice things about our staff. I want to say thank you for that thank you. Thank you. Are there any questions by other Board Members to Deputy Director levin . Any comments from the board . Is there any Public Comment . Thank you commissioner. I just want to reiterate the support for the staff and the recognition that Deputy Director performed and it just fantastic its the best budget results that i recall from my time on the board and in recent years given the budget constraints. So come i think theyve done a yeomans job and we should acknowledge that and continue to support them. So, from the retirees, we thank you very much. Because thank you. Ill make a footnote that this system is returned to the city and county of San Francisco in the last five years but over 100 million dollars. As i said to someone in one of my notes, there shouldnt be one of father and taken from the system for any of the Administrative Expenses that it takes to run the system. But 5000, ill let it go. So, Deputy Director levin . Chief financial Health Services. I didnt want to mention that because we are ending the year with a balance it goes in the general fund, we are not transferring any of the forfeiture revenue over to the general fund. So, that leaves us with roughly 165,000 that would have been transferred via the budget but we are notwe assayed is because we have attrition have not been able to fill but we do get some relief from that. All right. Thank you for the clarification. We will move forward on our agenda with the other item on wellness being deferred sort of discussion item 7 item 7, discussion item update on blue shield of california. You will recall catherine dodd, director, youll recall concerned about being clear to our membership that they could opt out of having their Data Collected by an independent organization that isntthats not part of blue shield cofounded but not part cofound. Paul brown shield of calvin. In your work packet is the letter that is the process of being mailed to approximately 19, 600 subscribers. Within the blue shield plan. The letters are being staged over a couple of weeks to give some bandwidth to the folks at cal index the will see results in flux of calls in result of the mailing. We then work with several months with cal index on the content of the letter and were happy to report its going out at the expense blue shield as requested. Any other comments or observations by members of the board . Commissioner jankowski i appreciate the hard work. I still feel the letter is sort of glosses over many of the concerns that were expressed at least from this board and those include the fact this is a fact should be voluntary. In fact, its not voluntary unless they opt out. Number two is that it was unclear even by going to the website which i did, whether the data is still being collected. Its not just disseminated spirit if a member of blue shield enrollees opt out he or she doesnt get permission for the information to be shared with the data is being collected and lastly, i think the letter one of the concerns, the enrollees have no way to find out what has been collected. The website does say that. When you look for it. But, i think these are all issues that are could have been maybe highlighted a little bit better in the latter including the confidentiality which you did a nice job of these promising without sort of describing the mechanism, but that is okay. It really falls short good i hope we get some feedback on the outcome of this letter in terms of the number people who opt out so we can maybe talk about it again. We will be happy to provide feedback ot sort of opt out we receive as a result of this. Absolutely commissioner breslin i agree with dr. Follansbee because in the future will they be able to opt out before the put into the system . Thats the most important thing to me it will remain an opt out process. It should be voluntary. You dont automatically put somebody in. Thats the whole point i think that was the complaint from the beginning. You are basically saying its not been modified . Its not been modified at the big complaints. Welcome i know you cant speak for cal index nor would you want to at this point correct i asked dir. Dog to, please seedling get some representative from that organization to come to our fault for them so we may have a rather robust discussion about what it is they are doing what indeed they do intend to do and how they will be moving forward. But we can hold you accountable for that other than helping to create this thing, but beyond that, i understand its a separate entity yes, yes that is correct and sure they will be happy to thank you. I know you have borne the brunt of our higher but i would not say deservedly so. Not you personally but the process i dont take it personally. Thanks. Any other comments from commissioners . Commissioner sass one additional question. If someone offered out last year do they have to opt out again or remain opted out . You remain out until you choose to opt in in the future could be dick so its prominent whats you make the choice . Yes. Thank you. Any other questions from the commissioners . If not is there any Public Comment on this item . Thank you commissioners. I notice in the letter right in the middle it says why join cal index in this is a letter regarding opting out. So i think its very confusing i hope theres more work on this letter because theyre not being asked to join. Theyre being asked to opt out and i know that its confusing enough for practice but, old boy, is it really confusing for retiree members and you will have a lot of early retirees in this pool. So i hope we review the letter and look for any language that is confusing like it. Thank you. Thank you for your comments. Any other Public Comment . Seeing none, we will now move to discussion item number eight item 8, discussion item update on h hss hss adoption and surrogate benefit plans. Mitchell gregs chief operating officer of Health Service system get in the april Board Meeting the Health Service board approved adoption benefits. Adoption and surrogacy benefit in the amount of up to 50,000. Part of hhs response ability after that was to develop a Plan Document for employees who may claim that benefit. So with some superior work by our new contracts manager michael biscotti as well as Pamela Leben Rcf oh, we put together a document reflecting not only large employers, what they are doing, these days as well as these types of benefits, but as well as researching qualified expenses with the irs because for the adoption benefits, its exempt from personal income tax on that on payments. It was a collaborative effort. I think was very well done. So, this is a discussion item for this meeting. Im what you go through some of these things. If you have questions, i certainly can bring back answers and maybe apply some changes at the next Board Meeting this would be an action item to approve the that was heavy my question about prospect youre asking to review out today and the next meeting we would be not only reviewing it but acting on it . Acting on it, that is correct thank you. So, in this plan. Info perception is the purpose and then this benefit will be effective january 1, 2017. Its to establish the Terms Conditions and requirements for reimbursement of qualified expenses incurred by an eligible employee in connection with an eligible adoption were eligible surrogacy. Under this plan the city shall offer onetime benefits of a reimbursement up to 15,000 to an eligible employee for qualified expenses incurred in connection with either eligible deduction or oh will jubal argosy. The next section gives definitions on eligibility. Weathers eligible employee or eligible child that would be adopted the eligible adoption and eligible surrogacy and surrogates. So, to be eligible for this benefit in the very first definition under eligibility, the employee has to be a member of hhs. No words have to be eligible for benefits through hhs and our employment has to be at least for one year. And in eligible child would have to be a child that is not attained age 18. And eligible the option would be an adoption that has been finalized or terminated. And eligible surrogacy it defines a few of the different types of surrogacys that currently are in use today. Then, the eligible surrogate, im sorry, and eligible surrogacy also explains a couple of the surrogacy processes that are practiced today. In the next section, the adoption of surrogacy expenses might it just lists the qualified expenses to be able to claim on these two benefits. Pretty adoption, which is a first paragraph these are also qualified expenses under Internal Revenue code. If i may suggest something in terms of the layout, i reckonedthe first paragraph applies to adoption. The second paragraph applies to expenses. Why wouldnt you put the titles by the paragraphs . I think would be easier to read just a suggestion right. We can certainly do that. Just an example, some of the following expenses production are eligible. Would be related to Attorney Fees and costs. Other expenses directly related to and for the principal purpose of the legal adoption. Of an eligible child. Adoption expenses are not eligible for reimbursement until an eligible adoption is finalized or formally terminated. A point here. Is this list exhaustive . Is this the total list of every possible variant . I would suggest to you it could not possibly be that this probably some other thing out there that somebody would have that might be determined not eligible. So, i would suggest the not covered is on the next page. But you have in eligible expenses, the following expenses are not eligible. I am just suggesting anytime i see a big list like this frequently, theres something that somebody forgot. So, i think you might want to put a conditional sentence or two on the front end of the paragraph leading into this. Just to say these are its illustrative of but not exhaustive or whatever. Just so people understand there could be some other things that as we read the plan and begin to execute it better maybe things in eligible. You could determine that in some way. Right certainly. Then the next paragraph they ghosted expenses eligible for investment under the surrogacy portion of the plan which includes agency fees, screening and background checks expenses gestational surrogates conversation and in vitro realization transfer payment. Donor compensation Attorney Fees and costs, and license and social worker fees and other expenses directly related to having the eligible surrogacy. So, page 2, we start going through defining some of the in eligible expenses. Something thats causally pointed out to us, these are very expensive procedures, adoption and surrogacy, and probably have plenty of eligible expenses before the people start trying to do anybody in eligible expenses. But i want to go through the entire list but as you can see there pretty well defined as what some of the expenses that could be out there that would not be notable under this benefit. In sectionsorry . May i ask a question. I think its implicit, but i am not clear because under ineligible expenses, surrogacy expenses incurred outside the United States is included. That is clear. I know theres an application regarding the surrogate about which includes the residency status of a us citizens or have visas, i guess. But it wasnt clear under the adoption of surrogacy expenses well, i guess the section before under eligibility, eligible surrogate, does that include they must be a us resident or citizen or something . It looks to me like were excluding people who contract with services in india, which is probably a good thing to be excluding but i was not clear if that was, in fact, inherent . And eligible surrogate that they must be somehow usbased . Its not listening here as a under the eligible surrogate they must be a us citizen and that is something we have discussed. That could be a clarification that we should put in there. To have some legal status. Not paying for expenses outside the United States. There should be some legal status within the United States i would think whether their citizenship or visa or whatever. I guess the only thing committee documented residents. Because yes. Something gentle enough to recover ourselves for the ineligible right. I understood. If you make note of that as well. The turks right. So under section 4 on limitation expenses, we reimburse expenses under reimbursement of expenses limited to 15,000. Theres also a limit of one adoption or one surrogacy under the plan per eligible employee. So that would mean if you submit 10,000 once you only get 10,000. You cannot submit another 5000 lay. It has to be 50,000 and only one claim. Up to 50,000 and only one claim. I just have a question commissioner breslin for adoption, it would not apply to a child to the doctor from another country . For adoption, under the adoption child from another country would be covered. It would be spewed the turks it would be yes is just none of the expense would be paid for the service if they paid out of the country . At is correct under the surrogacy. All right. In section 5, it describes the process for application in reimbursement for adoption to apply for this reimbursement the eligible employee must omit all the following information to hhs within 12 months. The finalizing the adoption. So, below that is a description of you know what they have to do in order to claim that if theres a reimbursement form documenting all payments and fees and costs and other documentation under section 3. Under section 6, application for reimbursement for surrogacy and kind of the same process here. We are explaining the surrogacy has to be claimed expenses for the surrogacy has to be claimed within 12 months of the birth of the child. Also, if this is documentation here that is required with the application. Then, the reimbursement procedure will be issued in accordance with the eligible employees payroll Reimbursement Policies and procedures determined by the city Comptrollers Office. Then the last section indicates hss is the Plan Administrator for this benefit is the appeals process within here, under item 9, is consistent with what we stayed in other provisions of our plan . Right. Its the same process that we process anything under hss rules all right. Other questions from the board . Commissioner lamb so this is an active employee that covers also retirees it is active employee only. Thats the way was presented because it was a benefit plan. Is that how it was . Is there an age limit . Aside from surrogacy i meant [inaudible]. Adoption, i thought it was we didnt limit this to employees for adoption . At the board presentation i think we gave 15,000 per active employee but if we want to i mean we can look and see the back and see exactly what the decision was, but we can add retiree as well. There is nothing that prevents us from doing so while youre probing the surrogacy weapon adoption benefit under active employee . No. [inaudible] surrogacy benefit no. The adoption surrogacy came at the same time. There was no there was no adoption benefit prior to this time in our plan. Prior to this prior action, i mean right is there an age limit . There is no age limit and i do think the retiree should be included in your people with partners that are much younger than them sometimes. This is the way it is. So i do think we be discriminating if we dont but i think would be nice if there were an age limit but there i think its 55 for the fertility benefit. You know, has anybody thought about part of this kind of an age limit for surrogacy . For surrogacy, we do not consider an age limits. Anymore thinking on adoption i mean you have families or husband and wife or active employees and as soon as they retire, they did not have any children at the time before they retired but now its time to consider having children. And they adopt one. Yes. Commissioner sass can you remind me with the funding is coming from the . My recollection from this it was a relatively fixed sum of money to fund this that is not employer payments. It is not in the premiums. That to some extent be sent to the benefit the number of people that might be able to draw down this is ultimately limited by the availability of funds. Is that true . It is true we are not being paid from the premiums from employer contributions were employee contributions. This comes from the funds we have for performance guarantees penalties. And i checked with our cfo, pamela, this past disclosure, 1516 those halfmillion dollars for that year and so at 15,000, that would be 34 claims in a you. Period. Thats good. Ultimately a limitation of the funding thats available. So, extending it to more individuals expanded to retirees in addition would potentially set up a situation where we would run out of funds sooner. Right commissioner ferringo i know where you are coming from inside the Education Fund with the city allocates some money and whether gets there first there first and i think you have to be clear in how you articulate it i do think there should be an age limit, to im hearing an age limit and whether it should be applied to retirees is two points for further consideration. Commissioner follansbee visavis the age limit, you utilize some of the gameplay or packages, already. I dont know how many you look at and whether age factored into any of the other packages that you reviewed in preparation of this . The ones have looked at did not have its limitations. I dont know nothing on hand that says you recall. The one that pbc age sent yesterday in one of them and have an age limit but i would suggest we bring this back, not just for discussion but for discussion and action at the next Board Meeting and give options that the board can shoot. You want an age limit or not and you want an age limit on adoption . Age limit on surrogacy . Do want to retireesjust make those discrete choices yes i will bow to the director on that point. I appreciate commissioner follansbee one 50,000 per other option or surrogacy. If a married couple among both were employees or one employee and retired if we extend this, is the benefit applied than simply to the individual so that presumably a married couple would get 2 adoptions were one adoption and zurich see because each adult gets one . The way the policy is written out it would be one benefit per employee family. Family family, that is correct are you employee family if i have benefits for just me and then i married somebody or had a relationship with somebody and have their own benefits because youre not signed up as a family are signed up as an individual . I think legally you need to have this done attorney weigh in on this and also surrogacy are they can and perfect and is in a work out what juncture do you side to get this. Theres a lot we have worked with the City Attorneys Office on this and we have gone back 34 times with the attorneys office. As well. Do you know the estimated cost for surrogacy is by any chance . They can be all over the board but its much more than 15,000. Part in the . Is much more than 15,000 orchid betwixt the range for medical care for surrogacy not just the legal was over 35,000 just for mmedical usc sections have been the way to go into the birth this in the future to be one of the ways to go instead of giving birth to your own children. I have no crystal ball in terms of birth trends. Deputy director levin, you came to the podium, please pim 11 chief Financial Officer. Health service system. The 500,000 mentioned at performance guarantees that were perceived in 1516 were from blue shield. We have over the years had additional performance guaranteed money that has been sitting in the fund balance just like the 500,000 and so, there is more available money than the 500,000. I think that what would behoove the board is that once we get through a year, that we come back and tell you with the volume is. What the average amount that weve given out, so then there can be more discussion on the impact, but i believe that thehaving available money for 33. 3 rounded 234, is will be sufficient for at least the first year and longer. All right. Thank you for that. So, at the suggestion of the director, if you can come back with those options as we are planning to take, undertake discussion and action on this. I think would be edifying. In addition to the other suggested i presume michael was making notes or somebody was makingor you will see it in the minutes. Regarding some of the suggested edits. All rights. Any other board questions . Is there any Public Comment on this item . Thank you commissioner did i was going to let it go but i say listen to commissioner lamb breslin and commissioner ferringo and what i see is i think you need that menu to choose because there are many retirees and early retirees that have long younger spouses and also what i wondered when you talk about age limit are you talk like the surrogates or the member . Because that in situations where there have been what we would call grandmothers who have agreed to take the surrogacy and to bear the child for a daughter for a youngerfor a daughter. Despite the fact that that person may be in her 60s were so is willing to do that. So i think when we look at the age limit am i think we need to keep an open mind with regard to this because we dont to find family units in San Francisco. I spent time on the committee that worked very hard to really open the definition of family units and the city adopted that policy more than 20 years ago. I think we should really take a look at that with a very open mind and also i think sometimes the surrogacy situations can go well over 150,0002000 hours. They get very expensive so this is a modest benefit. The other thing is my think we should separate this and understand we have rules in our system that allowed for adoption so were already covering children of even if they come to adoption. We are i understand this is really paying for some of the expenses for that process or for surrogacy so that there is an option and a choice because in some cases members cannot or unable to have children on their own. Please, dont eliminate the retirees from consideration because again, we define families differently in San Francisco and we should be open to that. Thank you then much thank you for your comment. Any other Public Comment . I am going to exercise the privilege of the chair. The mind can only absorb what the pen can endure. So im going to call for a recess of 10 min. Of our Board Meeting. , correct . Preciousnes time. Im going to claim the privilege of the chair and move an agenda item specifically the agenda item that deals with the Employee Engagement survey, number 10 to the next discussion item. I appreciate the presenters patient and going through all this other stuff this afternoon. So, mdm. Sec. , if youd read that item . Item 10 discussion item presentation of hss Engagement Survey results. Dr. Wherefrom integral Talent Systems director dodd do it make any introductory comments about this . A point out this concludes the request from the Governance Committee and board that we do in engagements of survey and much was put on the questionnaires in a variety of other things, the survey went quite well and i think you be interested in the results. Where are we . Discussion item number 10. While that while were getting set up, and she is getting ready, page 142 in the materials, i want to again by this podcast, thank those Staff Members who actively participated in this process. Its profoundly important that, as an employee, your voice be heard. I hope the Management Team, and i know they willwell take these findings seriously and begin to engage in the process that will follow and will europe a little bit about those today as presumably as well. Dr. Well, please thank you. Can you have someone assist in driving your presentation moving your slides and you can talk from the main podium i can phone . Thank you when where ceo integral Talent Systems where Talent Management consulting form based in mountain view. Thanks. I am here today but with megan riddle the project manager for the employees survey. So thank you. I want to start by appreciating the opportunity we had to work with hss they been a great group to work with and we will be reporting the results from the survey that was done earlier this year. So, our agenda today we went to cover what the initial purpose of the survey was, what the methodology was, what the survey results were by survey scale, which are the different categories that all the survey items roll up to, the things that came out of the survey, what some of our recommendations are, and to propose next ask for you. So, the initial purpose of the survey was to look for ways to improve the overall engagement of the hss staff group. Employee engagement is defined as peoples willingness to go to the extra mile to serve the organization. Their intent to stay with the organization, as well as the persons emotional feeling of belonging and tried to work with the organization. So, i do want to mention that every Employee Survey we have done as an Organization Since 1999, as well as other consulting firms like ours but do these types of surveys, every survey shows the different strands Employee Group has as well as it looks for areas in which people can improve. So, we are really looking at a dual purpose for the survey. So in terms of the survey implementation, the survey was actually conducted for to wait period from june 6june 17 we had 49 items that had onefive rating scale which all the fine in just a moment. We had a double rating scale, used in the survey which asked employees for each item how effective they think a particular item is happening in the department as well as how important it was to them. 40 3 40 employees responded, which is actually 90 Response Rate, and that is a very high Response Rate for us. Its in the top 10 of all the organizations that took the survey, which for us is an indicator people felt enough trustworthy organization to actually respond to what we were asking. So, these items that were asked on the survey roll up into actually six scales, with Employee Engagement been one of the outcomes. So, the other five scales are all the different actions that happened within the Health Services system group to drive or detract from Employee Engagement and we will go over which each of these skills mean. So, in terms of results for overall Employee Engagement, the effectiveness on onefive scale, was 3. 70. This is a moderately high, as far as engagement goes. If you look at three as the middle of this onefive scale, its about the average score that you would see on Employee Engagement on this type of a survey. This is actually looking at the persons job fits. It is how well a person is selected into the organization, what type of fit they have with the type of work they are doing. Not only from his skill and experience standpoint, about how motivated they feel during the current job for themselves. So that was fairly high, one of the higher scales on 4. 05. Alignment is all of the items related to the employees belief in the mission and vision of the organization, the meaningfulness of the work they are doing, i. E. , the service to the Employee Groups that this group serves, and the alignment with the objectives the organization is trying to achieve, the goals. Worth reporting 88. Team, is exactly what it sounds a. How well the groups are working together and also across functions. That was rated on the average of 3. 46. Valuing, which has to do with exactly how valued people view. How much they feel they are recognized for work that they do that is good work, not necessarily the war, but recognition both by the organization as a whole by their managers was 3. 33 and growth has to do with the employees feeling of how much opportunity they have for them to develop in their role within the department and the group they are in. That was actually the lowest rated of the different scales at 3. 19 were going to go into more detail on that. So, looking at Employee Engagement as an outcome we have an index and as i said earlier, this measures the extent to which people feel passionate about their job, committed to the organization, etc. Also, their willingness to refer other people to work within the group. So, of the number of people who responded to the survey, 63. 25 mark is either for or five. So you will see the key, below, that is the red, yellow, and reading squares showing you on the rating scale anyone who marked the item related to this scale 12 would be unfavorable, three was neutral, so the person either work agrees or disagrees and 45 is favorable. Someone who is agrees or strongly disagrees. So while you sleep, the name of the game is to try to get as many people in the green zone as you can could have never seen any organization that has that rating in all the years weve been in this. So, its like i said, its a fairly moderately engaged group. That doesnt mean there isnt room to improve as there is for eddie every organization. Okay, so fit. Another way to look at the data, 79 of the employees responded, mark these items between 45 alignment, the extent to which the organization believes in and puts efforts towards the organizations mission, values and results was 72. 11 favorable. Team, 55. 33 favorable. Valuing, 51. 93, so over half said they agreed they felt valued by the organization and growth being again the lowest area, the extent to which employees feel supported to advance in their career or develop personal skill sets within the organization. So, with any survey like this its important not to get focused in on individual items thats why we are reporting this by the scales, but we do look at the overall themes in terms of what actions to take. So what we see here with the staff group with hss is an organization thats very committed to the mission and goals of the organization is chartered to achieve and as visitors have heard of this today in the first hour of the meeting. So it was also reflected in the survey. Employees also recognize the value of their work to the city and they care about the results of the Organization Achieve that is to the alignment rating we looked at earlier. Employees are well placed in the jobs they are doing. So whatever Selection Process is being used and fits into the type of work people argue are doing on a daily basis is good. They had expressed a desire, the employees, to receive more and different types of recognition. So they can better understand what is valued and recognized within the group. They are also requesting more development and opportunity for growth, which you will see and a recommendations is part of what we want to work on from a standpoint of what is growth and development really mean to the Employee Group because there may not necessarily be a lot of places for people to be promoted or advanced just because of the structure of the organization. So, how does hss defined Development Opportunities for employees . We need to look more closely at that. They also have expressed through the responses on the survey that they would like to improve communications between the departments so that work is not done as sideload is maybe they feel it is a mode but more opportunity to interact across the Department Plan will Work Together and to communicate with management about feelings they have about the project and so forth it more input is something that was requested. So come on the we are looking at the overall summary from the survey. Again, as i said earlier, the stunts that this organization has are largely have to do with the passion and commitment people feel to the purpose of the organization. They care about the departments achievements and meeting the goals you have set out for the group they feel passionate about the type of work they are doing and theyre very aligned with what theyre supposed to be a calm pushing as a department. The opportunities are that any career Development Opportunities need to be made more visible that is both within the department as well as some discussion about what we would call in ids, career governance, whether or not moving to different parts of the city as far as during your career with city and county of San Francisco is this something we want to look at and promote . Employees like supervisors to be more involved in career discussions and discussions around skills. They would like to develop they would like the projects in the department to be more coordinated across the groups. So again, input into projects and goals that are people are working on together could they want access to more Skill Development and growth opportunities. There was some discussion about new projects or skills happening in the course of daily work. For example, when you learn a new Software System but employees not necessarily recognizing that was an opportunity. They are already learning new skills they might have recognize that as a Development Opportunity as it is for example. And employees wanting more recognition for what they consider to be good performance. Or even effort towards performance. So, as far as recommendations and next steps, what we will be doing as ms. Dodd mentioned earlier, we will be meeting with the Management Team to do the actual Action Planning and communication of the results and we want to look at ways in which on a daily basis and also maybe some more formal programs, the valuing and recognition can happen more visibly in the group. We also want to look at how development is defined for the employees in the in the staff and how they see opportunities and what they need to feel motivated around their careers to my and also opportunities for the teams to collaborate across the silos more effectively. Those of be the three areas to focus on is far as the results of the survey are indicating. So, for the next steps, this is our recommendation as a company, ids, for all of our clients. Its just not for hss but the typical process is that we would like the group to prioritize and plan for at least two departmentwide initiatives. We say to at a minimum. Really, the maximum is about three because you just cant make a lot of change in a year or so time effectively. Its a matter of focusing on getting the followthrough and the actual results in a few key areas of the employees are prioritized for us through the survey. The results need to be shared in whatever communication vehicles already exist or other staff meetings, newsletters, email, etc. And we would like to be available to support the team, Management Team, and any Employee Group thats involved in this rollout to make sure that the results actually are improved in the areas that were identified for hopefully next year. So, there should be a way to check in through administering this survey and doesnt necessarily have to be in 2017. It could be even later. It just depends on when the crew feels that the actions have been taken and results are going to be different than what weve measured the first time. So, this survey really acted as a benchmark to get kind of an existing state of what is going on and hopefully through the actions that are taken we would see improvement the next time we do the measurement. So, any questions . Speed tricks to fix any thank you for your presentation. Any questions from the board . I will start with commissioner sass to questions and an observation on slide six of two columns 1 effectiveness and oncall importance. What is the importance . What do these two important but in particular importance . Great question. What the importance is that for each survey item we asked the employees, how effective do you feel this is happening in your organization. And they were rating out 15. We also asked them how important is this to you. So, one item, for example, might be my manager is aware of my career aspirations. So they are going to say, well, i agree but thats really important to me. Okay. The second is, when you go into the favorability percentages have you come up with those percentages . I dont see the relationship between this chart and those percentages. Is there a map . Its a different way of viewing the data. On slide six, this is just the average score on 15 scale, the average of all the people that responded to each survey item. On the favorability rating, thats the percent of employees who waited the items in that scale 45. So, that would be considered favorable because were trying to get everybodythe way this survey is structured, you want people to break each item hi. Auo 3 of the people rate it at four or five . Correct to be clear the favorability is a based on the commendation of questions and a subset of questions in that pituitary will go to a value of valuing . Correct theres 45 questions the roof of dialing in the survey . Correct to that in those areas people responded favorably thats how you do the calculation . Correct. That is correct to the extent that expanded . Yes. To that thats difficult these types of surveys from an hr standpoint. Dr. Follansbee a couple mechanistic question. You have a sense of abandonment rate people who start out the fill out the survey did not finish that . 43 employees respond. Does that mean for three employees answered every single question . Could you close the survey and ignore certain questions . Thats a good question. So, each item on the survey also has an and a choice. They do have to respond to each item that you can say not applicable. You can do that. I dont think we didnt count on that, did we. We dont have that Data Available but if it was important we could get that to you im just curious because going back to the favorable, if a certain percentage of people will lead to my second questionthat said and they would did not answer it you can still you could not close one could not employee could not close the survey if they did not answer a question 33 and 37, either with a number or na. Each survey item can require a response. The only way we get the survey data is if someone goes to the end of the survey and actually clicks submit. So, we dont know of the i guess it was five people, of the five people who do not respond, we dont know how many of those mightve abandoned the survey a lot of us the second question is, are used to seeing distributions of answers and so when we see an average we think the majority were just below or just about. That the ones and twos were really low. Was that the case . Do you think were there some, maybe a few number of employees who answered many questions in very unfavorable category from a disgruntled employees, or whatever, who might not only affect the results but might need special attention in any kind of plan . It thats kind of a touchy issue because we did promise employees confidentiality. Right its hard at this point to go back. We be making can speak to the percentage of people that may have fallen into the category you are asking about, but i think its hard to go back now and say, okay, so and so said this could i was not asking that. Okay. Do you want to hot hello. Megan little. As far as the data when we cleaned it for allies. If there were any specific individuals answering all one all and eight, all fives, they were in consideration for the data. In general, there was a variation between responses. If anything looked odd we did take that into consideration within calculating our results. So, just to followup on commissioner follansbees question, sometimes by identifying subsets of answers within certain categories, i. E. , fit or what ever, those can be correlated to attrition or projected attrition in the organization. Does this survey, or do you type do that type of analysis . And attrition analysis if you will spirit we could do that. To look at how certain scores on items could predict attrition. Its the kind of on not asking if you do im just wondering if you do that everything . Yes, we do that everything think. Commissioner breslin the board received an email concerning you do not allow the staff to comment on management in an unfiltered manner but i think that the only way to do that would be the way to have comments which i think sometimes our self identified correct in this survey did we have in the survey we did not have open comments that was a concern that was in any way expressed. Yes. That was a decision that was made all right. Any other comments from the board regarding the survey . Commissioner sass is the information given to dr. Dodd more detailed than what were given here . I appreciate this is highlighted i could not come up with any kind of a plan to respond to this at all based upon this amount of information we dont have to we dont have to but there is more detail available the one yes, for each item, yes. Thats what we would be working with with the Management Team on that all right. Thank you. Any other questions from the board . If you would just up aside from the microphone, will entertain Public Comment at this moment thank you. You may be called back so dont leave the room. Yes, Public Comment, please herbert weiner. As someone who is experienced harassment and bullying on the job, i am wondering if there is a way of surveying routinely in the survey because i think thats very important respect to employee morale. So, i think its important for any employment survey, anywhere anyplace anytime, throughout the world, and i think it should be part of the survey and i offer this as constructive suggestion thank you for that comment. Any other Public Comment on this discussion item . If not, i will say, thank you for your work in support of this effort. Im very clear that director dodd and senior Management Team are committed to following through and working on this or we would not have begun the process. So we look forward, i hope, to another review of an updated survey at your were so for now. Thank you very much for your time. With that, we will now go to discussionnegotiators stephanie could discussion item on wellness. Item 5 discussion item ages as wellbeing Program Updates. Stephanie fisher stephanie fisheron this Program Update this is item number six is it . Item 52 think it just to be clear for those taking notes. I have a presentation. Sfgov tv, there we are. Thank you. Today we are here to talk about a lot of things. We been doing a lot on wellness and help reported out so i apologize for the quantity of material received all at once. The colorful choices report talks about our Healthy Eating campaign. The first thing the assessment we did in 20142015 showed us was that the area of wellbeing we stored the lowest and was Healthy Behaviors. Of the behaviors are primarily made up of Healthy Eating physical activity smoking is also in there. Drinking. Some other Healthy Behaviors for the primary driver is on our your Healthy Eating and physical activity and in that report we learn of a percent of our population doesnt consume enough fruits and vegetables. The nice thing about addressing fruit and vegetable consumption it is something as much on every diet and any recommendation you would have regardless of conditions. With some modifications. It incorporates a lowfat diet, low sodium diets, things along those lines. We try to take a Healthy Eating topic that would be appropriate for the masses. With that, we chose the colorful choices challenge. The challenge is one aspect of the campaign. The Overall Campaign was called eat better, feel better and was really a compilation both of the online challenge but also championship in activities at the worksite. Educational presentation, coaching, just cultural events. It was a really nice event coming off the Employee Engagement survey at the Comptrollers Office where they actually got people together to talk about what they have been doing on vacation they had a salsa tasted it was an opportunity to share, recognize, spend time together but also bring up this idea of Healthy Eating. Those are the types of things we train the champions on and do for any of our campaigns and the challenge is the way to get data. Also, the way to encourage people are ready to make a change to commit to making a change. Not everybody is ready not everybodys quick to participate even those that you might not make it all the way through. But it does give us a sense of how interested people are in addition to the champion survey feedback just what were hearing along the way. I would say, my team would echo, this is kind of the thing we did that started to tip the scale. The first couple years of the program theres a lot more of us try to convince people this was a good idea and with the better feel Better Campaign the champions got excited and apartment got excited and they started coming to us is the bus having to call them so much. It was a really nice shift. The report goes into also today. Its really interesting to us and really helped us is moving forward into the get fit on route 66. It showed us things like a lot of people registered but then they didnt all track. We had only about 54 of people who registered actually follow through with staying with attractive. Theres a couple factors that go into that that will change in this next challenge to try to make sure that people are actually staying on top. We also got comes back like yes, you did not type but i was aware and eating so much more. It is and always if they do not type they do not change. Type of correlation. Something we learned was that people didnt download the app. We tried to make it as easy as possible for them working i have it on my version and app version but only under 10 of the population actually downloaded the app. Does the types of things will change and again in the route 66 promotion that happening right now. Those are the big lessons learned. Im happy to answer any questions but i was really going to speak to how it is influencing our upcoming challenge. Unless theres something in the 20 some odd pages you would like me to go through . Questions from the board . You be talking somehow in the future whether this is having an effect on our health of our population . Is that part of a plan . Will be looking at what happens. Will we ever be able to use this challenge in this moment that changed this Health Outcome is probably not. Its a compilation of everything we are doing is going to change the different people are going to need Different Things and will continue to offer Different Things to appeal to those people get but we do hope to show that both the individual challenges themselves have some change on behavior and as we start to change behavior and culture we are seeing changes in peoples wellbeing scores changes in peoples engagement in Different Health activities as well. The price issue, which always bothers me. It always seems to me you might just want the [inaudible] and to be doing what they say to get i know nobody would do that people get very excited about prices. But in general, we keep the prices very low cost and theyre always at a raffle. So theres no promise of if you do this then you get this. It is if you get this you get entered into a raffle and you might do this. The prices for colorful choices not even came to get. Theres a whole bunch of him sitting in my office did it was in the primary driver for those folks. We try to use it as a way to call out the behaviors we want. So, you will see it get fit on route 66, we changed the prices to emphasize people tracking because that accountability that checking in each day actually doing it has been proven to show he change his behavior. We also reward people who have made progress toward the goal. We dont expect everybody to go from zero physical activity to 30 min. Five days a week but theyre making progress towards that thats another area we call out by you be entered for a raffle. We also provide incentive sometimes to get information back. Another one is please take a poster because that posters tell sbs questions like what is your current work climate around Healthy Eating or physical activity may ask you again at the and the cnet change is valuable so we can see the champions what theyre doing is having impact on the culture. Sometimes we provide prizes to encourage participation in surveys that give us valuable data and help us actually improve the program moving forward. Oscar basket of fresh fruit or fresh vegetables would be a nice price to the ashley all the teams that one prize thats what they got it i got a basket of fruit on us. Boxes. We do about measuring spoons. We gave out all of the things that encouraged continued Healthy Eating. Or physical activity. We do not give them a stake or fried chicken. Or tell them to slices of tomato under power birder no. That was not what we did okay. Are there other questions from members of the board . Commissioner follansbee yes come i think dr. Dodd did challenge us as a group and to enter so i looked at the program and thats as far as i got. Oh, no im retired and economic to type so i am i looked at it. I guess the question is, when you talk about getting feedback on tracking in a postsurvey, do does your department administer all this human is not administered by the champions. The champions are just there as coaches to encourage people but then the results for improvement sort of like employee satisfaction. Not all employees want their diet habits shared with their colleagues. Im a little confused about how this is operationalized . The role of the champion is to spread the word. We tell the champions is whether job when i percent of the people they represent to know about it better, feel better and thats the campaign right now and these are the things we have available to support them in that. So, when i percent of people, no, not when i percent of people participate. Sometimes we set goals we want at least participants from every department, things are along those lines the retail hundred percent of people you get somebody from every department but the champions come in terms of the survey feedback, all people who register for the challenge took an initial survey as part of the registration process and then they were all asked to take a survey at the end of that. We do sometimes as the champions to remind people to take the survey but we dont in any way have the data coming back into the champions. We then survey the champions, though, and ask the champions how did it go . What did you do spirit what can we improve . Especially people who do not participate, will talk to the champions so thats how we found out how people are not participating, why not. Because thats important, too obviously other questions . There still more so you might want to please, proceed sfgov tv theres a presentation. I have alluded a lot to get fit on route 66 and ill leave it at registration, the first day is monday. You can try again dr. Follansbee to register and do something to get this one is about physical activity. Stay tuned. We have tried to improve everything that we learned from choices. We will see how that goes. So, champion support. We trained 100 champions and 11 different trainings to push out the move more feel better which is the physical activity campaign. The exciting thing here is were starting to go offsite and do the trainings at the champions and were starting to great communities of those champions. Thats been a big change. It takes a lot of effort. We were out training 11 times, two hour training. It takes a lot of work but its completely worth it to be on the ground with the champions and having them Work Together. How do you become a champion . How you pick a champion . Theres a lot of inroads becoming a champion but the initial ask that upon has to identify someone that was two years ago, last january, we did kind of a refresh like a champions, do you want to stay on. We asked you to do this about 16 months. Your 16 months are up. Some stayed on some identified other people. Some just dropped off. People hear about and get excited and therell asked to do it. Theres always a process would have to be approved by their supervisor to participate. Because we do ask that there given 48 hours a month of work time to be a champion. Okay. The Diabetes Prevention program is one of our targeted interventions that we partnered with Kaiser Permanente and a division of research on. Its done so weve officially recruited all our subjects for that program. So that six year and year and data will start to roll in the first site started in late september of 2015. So, that we finished their Yearlong Program this september and the last site was required this july. So we will get the last bit of data a year from now. We have reframed how we are marketing eap to be really clear. That there are services for employees they traditionally think of as eap as conducted so really think about your oneonone counseling, for either personal or workrelated issues, but we want to expand the message to really make sure that managers and supervisors are aware of all the prevention and engagement type things that eap can help with. So, part of that was creating a separate brochure for them but advertises the trainings the seminars, managers and supervisors can bring on second it talks about if there is a loss of the employee eap can come out and talk about that. So, really targeting the population that eap has brought in more frequently and not just thought of it as when youre in a crisis anyone a talk one on one that their scope of services is definitely more broad than that. That also can help us keep efficiencies with only a team of three people to serve the entire city. The Wellness Center is booming. We try to open up the 1 pm timeframe to be open use were people could just commute to the Wellness Center and we have to offer exercise classes 4 5 days because her swelling at noon to such an extent. Both an interest of topics but also just in size. We had our First Official cap on a quest worry actually have to turn people away because we cant fit them all in from a safety standpoint. It. Its exciting to see so many people coming any interest in difference types of class. We are not just doing zuma and yoga and the total body conditioning classes and tai chi and things like that are really growing. On the flipside, were struggling to get people to come to seminars. The other great seminars in every once in a while we have a gym to get 25 people but we can get people to come anytime for Group Exercise or the other side of the house the educational side, having to get more creative on. We just had a great week were we did combo, and learn and we were able to get some more interest but we are definitely needed to continue to be creative with how to provide health education. However, we did do a partnership with department of Public Health on back safety and we had a lot of hss staff trained because we do a lot of listing of open enrollment books and things on those lines so it was a nice opportunity bring a valuable training to protect the healthy and safety not only all city employees, but really helps a good number of hss please. We continue to support the meetings with health and wellness activities and have opened up both the colorful choices challenge and get fit on route 66 two retirees. The update is not huge but it doesnt hurt us in any way to include them in for those it helps, it helps. We will continue to learn more about what their retirees need as we continue this journey. Anything else . Thats it. Thank you. Questions from the board . Well i for one have admired your work and persistence and your enthusiasm over these past two years this twoyear period of time. It was really kind of the league in fate but you have brought a greatyou and your team have brought a great deal of skill understanding an effort to this and i think the results are beginning to show. So, the fact that you do not have to our reach as much people were seeking you is a testament to that. So, thank you for all you are doing. Thank you. Are there any questions from the board . If not standby because of Public Comment. You may be called back. Thank you commission. This has been a Wonderful Program for our members. Our members get very excited at each meeting when Margaret Sullivan is there and the prices are fun. People are happy to talk about their experiences and the changes in their life with regard to the programs that were being offered. So, i see this is very positive for retirees because the worst thing we can do is basically sit all day in the back room at a meeting and not move a lot. But some of usi know actually, and one event is that at the retirement board instead of clapping, we did this. We got our exercise as well as let the board note we were happy. I want to thank the wellness staff. They are just really fantastic. A lot of our members like to come down to the classes as well. I think it is really an outstanding program. The one thing i want to add is, yes, it has always been an issue very much an issue for me when i was an active employee and member of this board that eap is woefully understaffed. They do a phenomenal job with just three staff with all the needs in the subject i think we haventwe have just cracked the surface with the amount of work they could do and for the counseling on a number of issues the other thing that occurs to me because i had a supervisor like this would take the information for this persons own personal interest, whether its with regard to what the eap does or any program like this, not sure with employees. I see this as something that they got what they would actually work to make sure that the employees under them did not have these benefits, or, in this case when youre asking for several hours a week to be devoted to this program that some of those supervisors dont really see this as a value and wouldnt grant employees who requested the opportunity to spend the time. I think we have to do a little more education with management with middle management to let them know this is actually a plus and at the other end of the greater production and there will be better morale and that actually will improve the workplace and suppressing those employees is not really the answer. These are the kinds of programs that make a big difference. I saw you need drivers in my years at uni. I saw people in my the traits that suffer from a lot of physical maladies because they didnt have these opportunities and we need to work harder with those specific employees groups anymore activity sitting here at the desk all day is not. Or even driving around in a car for half the day. Not good. We need to expand this and thank you so much for having this great program. We all really enjoy it. Thank you thank you for your comments. Any other Public Comment the one if not, again thank you stephanie to you and your team. We will now pick up with item numbersecretary, tommy item 9, action item. Approval or revisions of Health Services system membership rules. Mitchell briggs chief operating officer of Health Service system. Every year Health Service system has the board to review any membership will changes we have put into our membership and rules for fact that following plan you. So these are summarized on the first page in your deck. The first change to review is section or hotel, page 21 in the rules themselves. In regards to entitlement to medicare. This reflects Operational Policy Group but equally, for 2017 when we had to Medicare Advantage plans being offered for medicare enrollees. Excuse me what do you mean by reflects operation policy . Images were already doing it and this is been done to comport with what we are doing . Work this is something we intend to do . Is something we intend to do for 2017. Because of the family set up next medicare in romans, one being it could be retired employee. Its not on medicare but has a spouse is already reached medicare age i understand the effects operational policy means i could interpret that to being we are already doing Something Like this and we are now conforming our policy to do what we are operationally doing. It just my reading. Right. So, for this particular pool change, i will read what we have changed in section h page 21 would be added section 6. If retired member or dependent becomes entitled to medicare the number of dependent will need to transfer to another planet were to maintain hss coverage of no Medicare Advantage or Medicare Prescription Drug plan is available in the premedicare plan. So again its about families that have one medicare in romans and another member of the family not medicare. So, in section k, page 2425 of the rules, it currently read that Medicare Advantage and medicare Protection Program participation is required from medicare eligible retiree numbers independent of enrolled in the plan administered by hss. The previously read in apd plan for student drug plan, for instance, that would have been blue shield, medicare plan that was in the 65, plus Medicare Advantage that would have been access plus which had the pdp as well as the original selffunded city plan had a medicare sponsored pdp plant. Now, we are restating where theres only one offered and thats a Medicare Advantage work in apd plan, for retirees eligible for medicare. The last change is appendix a which is a change we have to do every year and that is changing all the coverage periods for the plan year. So, these are the periods based on our seven the premiums by payroll whenever we get that payment this is the coverage or not thats been covered. So, that is all the changes for the 20 1710 year. Are there questions by members of the board . You know i know its written in the rules retirees who fail to enroll in medicare will be transferred to the city plan 20, is that still there . That is still there and thanks for reminder me thats actually page 25. Okay, thank you get any other questions . If not is there any Public Comment . Im ready to entertain a motion that these plan changes be adopted. So moved moved and seconded. Is been properly moved and seconded these plan changes be made as described in the item. All those in favor say, aye. Any Public Comment on a motion . Know. Im out of order here. All those in favor say, aye [chorus of ayes] opposed . It passes unanimously. [gavel] next item item 11, discussion item update on aetna life and disability utilize asian. Karen hill. Edna. Thank you so much for your patience. No problem. I learned a lot today. So im karen hill. On the Group Insurance account executive with aetna. I met with director dodd and mitchell previously to go over the outcomes of the longterm disability in the Life Insurance that we manage for ccsf and was invited to come and go over those results with you. So im going to talk about the longterm disability as well as the Life Insurance. I have a presentation. And there it is okay. If we could go to slide four, please could. Great. Who is covered. This just gives an overview of the two different plans for longterm disability in which unions are covered under those specific plans. So, the one plan has a 60 benefit to 5000 monthly and it has 180 day illumination period. The other plan is 66 2 3 benefit of 7500 a month with a 90 day illumination plan. So, key findings. I have a few slides below that will review the outcomes for claimant activity diagnosis and duration them a days close claim activity claim distribution by top eight diagnoses and claim resolution. Just as a point of understanding, the majority of appeals filed were upheld. One was overturned, and so basically when there is an appeal, not to change somebodys mind about a decision but rather for the claimant to bring Additional Information so that we have more information to look at that may impact the decision and change is but truly the majority were upheld as denials you adjudicate your own claims . Views served as the appellant body . Aetna, does, yes but theres an appeal unit at aetna which is totally separate from the claims in. So, the different folks, different sets of eyes what remedy two people have if they wish to pursue this matter beyond your appeal process . After appeal the next option and is only one appeal allowed x option will be litigation litigation, okay, thank you. Just looking at some benchmarking information ccsf had a higher percentage of claims than aetna. Group and aetna business. So, the following category had a little bit high. Skeletal and group of diagnostics is always the top one with every client ive ever worked with. So youre running a little bit higher than a book of business than the pure industry. Neoplasm, injury poisoning, those were the ones running just a little bit higher than the benchmarking that we looked at. However, you had a lower percentage of claims and at the pier and book of business for mental disorder. That would include things like anxiety, depression, those kinds of things. That was a good outcome. Does this comport with our pharmacy analysis . I dont think it does. The good news is you got lots of folks that have those issues are not moving into longterm disability. I see. The drug therapies are working now. Exactly. Thanks. All rights. The highest percentage of claims was age range of 5059 and thats kind of where we see that happening industrywide. 62. 2 of claims were for females. We could do a claim Satisfaction Survey and the results show 80 were still under the category of excellent, very good or good. So, we had we actually surveyed 100 of your claimants midpoint and end point of the claimant and we tried to surveyed 153 individuals. Only 45 people responded so thats what youre getting there with respect to the survey. Okay. So, this slide is just giving you a picture of the openclose denied and pending claims. For the period there were 37 open closed and denied impending claims compared to 113 four 2013 and 106 in 2014, but longterm Disability Data lags, so youre going to see much different outcome when we look at this time period later on this year or at the end of this year because bucks more claims will come into it there were 34 claims out of 23,000 people covered . That were open during this time period. All rights. The most common reason for denial is noncompliance, which generally means that they didnt respond to the requested information that we needed in order for us to make a decision. Sometimes noncompliance could be somebody has diabetes or anxiety or depression or that kind of thing and are not taking the medication. We can check this to Pharmacy Records and those kinds of things. You could actually have your claim denied for not taking your medication. So those are the kinds of things you see with noncompliance. This slide talks about the diagnostic and average duration of days. Again, you see must go skeletal disorders at the top of the list. For that disorder, it has the most total days approved its overlooking out when the claim became effective and what timeframe it was approved through. But, you see under your logic disorders, it has a higher average duration. This next slide kind of highlights the average duration by month by location. These locations on the right of the slack to margot department of Public Health, municipal transportation agency, the department of human services, and superior courts. So the average duration months or 2014 was 8. 5, compared to 11. 8 in 2015. Then, the superior court had the longest duration. That was the division or area that had the longest duration. This next slide is just showing the closed claims and the top reasons. So the secondhighest closure for is returned to work which is a good outcome. Right. Thats what we want we want people to get healthy and back to work and is better for everybody. Its petty for employers and for the claimant. So, thats a really good results. Our next slide, this is a claim distribution this was taken for the entire period of one [inaudible] 2015 and you can see that the top diagnoses are the malignant neoplasms, must go skeletal it just a different way this diagnostic group is defined. I want to just highlight that when i met with director dodd she was curious about the cancer because its a pretty significant portion of the claims related to cancer. So, she asked me to dig in and see there related to smokers and with respect to the disability, we look at all active claims theres actually none of the claimants that are doing with cancer due to smoking. The highest percentage are breastcancer and then you have prostate and cancer. Thats where they are. Theyre not due to smoking. The next slide is talked about claim resolution. The good news here it is 63 of the claimants return to work. Again, very very good outcome. The next slide is showing some statistics on our Social Security disability integration. So, we have an Advocacy Firm we work with and we look at every claim to see if we can assist with getting them approved for ss the act and so there have attorneys. They do things like help the claimant fell out claim forms, do all of this omissions and communications with ssd i am working at those claims approved. Its at no cost to the claimant. Something we do as part of a value added service. So, you can see out out out of all the claims we manage for all these years, there are eight that are greater into years duration, meaning they had not been approved for ss di yet and its not in common. Sometimes it takes a very long time to get it through and approved. But we continue to manage those and work with the claimants as well as ss di. The next slide im going to be talking out of the Life Insurance. As you go through this, if you could summarize some of the more detailed slides on claims status and so forth . I mean as you go through. Dont have to hit every slide. We have the data in front of us got it. Okay. Were almost done with the presentation. That shows you who is covered and what he is benefits are for each category. The next slide is just the key findings. The top causes of death were cancer and Heart Disease. Of the total claims 25 were for males among 19 for females. So on and silver. If we just take a look at slide 16 canasta question yes, dr. Follansbee is at the top causes of cancer were cancer, 50 and that 25 of the claims were males for cancer and 19 were for females with cancer. So when i had those two numbers up thats only 44 . Just kind of curious what am i missing . White director dodd assets in question were actually looking at all the claims. Not just look at that cancer claims. If im looking at all the claims for mail males and 5 of the male claims were for cancer. The other 75 for mail claims were different probably would be clearer if you stated that so we can get a sense of the demographics. Very good. Very good call out. I will change that. Okay. Thank you. Okay other questions . So this slide gives you a visualization where the slides fall. You can see cancer and Heart Disease are the top two. Not uncommon thats pricey with the majority of my clients. We love you that you are value added. Thank you. Think good other questions from the board . Yes, dr. Statistics show mortality rates are Holding Steady at 100 . [laughing] thank you for that. I agree. Very good point is there any Public Comment on this item . Seeing none, thank you very much. Director dodd i know you want to slip through the value added but this is a slide we want employees to know about. People dont read their Life Insurance contracts and their Legal Services available. Its really valuable service from a Life Insurance company. Payroll planning and care at a busy yes. Id like to add im working with mitchell and ebs on a Communications Campaign and we are going to really do all we can to highlight those Value Added Services thank you for saving that because were going to these other benefits that were talking about this would be of great educational points. Yes that will be the carriers for the voluntary life thats going to meet new 1117 so doing lots of the medications around that all right. Thank you. Any Public Comment . My curiosity has to do with any coordination with retirement system that handles disability benefits and i was looking at the ssi but not everyone who goes out on a disability retirement through the city is on ssi. It seems to me this would be valuable information for carmen as well but im just carries out any coordination here. Thank you thank you for that comments. Any other Public Comment the one if not, we are now ready to move to item number 12 12, action item appointment of Health Service Board Committee chairs and members for fiscal year 20162017. Pres. Scott there are, under our new i should not say new. Its been were into the second year. The newly revised terms of governance we have two Standing Committees at this board. Finance and budget. And governance. Could you for we have rates and benefits as a separate committee. As i tried to say time and time again, when we deal with the rates and benefits we do so as a committee as a whole. So, after much reflective thought and a great deal of arm twisting, ive come up with the following recommendations for this boards approval. For finance and budget, who has the responsibility for oversight of the financial oversight of our system, including oversight of audits in the budgeting process, requested the following members serve. Commissioner sass as chairman, commissioner ferringo as member and commissioner lim as members. For governance, established to assist in developing and overseeing governance policies and practices of the Health Services board and its committees, including the Board Evaluation and the directors evaluation, executive directors evaluation, i asked the following numbers to sir. Commissioner breslin as chair. Commissioner involves the as number and myself as a member of that committee. I am ready to entertain a motion on this item i moved to approve moved and seconded. That we establish the committees on finance and budget and their membership as well as governance and its membership. Is there any board comment . Is there any Public Comment . Seeing none, hearing none, Public Comment is closed. All those in favor say, aye opposed . It passes unanimously [gavel] item 13 discussion item update on the new city plan and Kaiser Permanente medicare Retiree Benefits educational session. At this point is that are coming, this is where i wish to make my comment. This board undertook to make, take a decision on 21 june two, the board majority, to undertake a new plan. At that time, i said that to the new vendor partner, uh see, we would be having a high degree of accountability and by that i meant that we would be reporting and discussing this item every Board Meeting through open in romans and following open enrollment. So, i know the staff over the past month has engage in a great deal of planning and Work Activity and i want people to be aware of what is going on around the planning and activity of this effort. There is going to be wide ranging series of retiree and other meetings around this topic and im encouraging strongly members of this board five, and their schedules to attend one or two of these meetings so we can hear what is going on at a ground level. We are eating going, again, as always, to [inaudible] i may be able to do that trick myself. Im not sure coming back from a College Reunion but i may be able to do that. In any event, my hope is that through all this effort, both communication here during the course of the meetings concerns and issues will surface. We have a very clear commitment from you hc to try to respond to these questions as they come. We can only note was questions are if people put them forward. But its equally incumbent upon this board as it has opportunities of the members thereof, we have opportunities to talk to people about this change that we accurately do so. So, that is really my plea and my encouragement as we go through this process. With that, deputy breaks and others mitchell griggs. Today we have with us from United Healthcare shannon hostage account executive of our medicare groups. She is going to give a presentation of the implementation of taking this migration expected migration from the original selffunded city plan coronation of benefit plan and also the members medicare members from blue shield. We have also been working ever since the decision was made every week the same project manager and team from United Healthcare as we did last year bringing the National People ppo with United Health to. I think a very strong project Management Team we have with United Healthcare we also brought in kaiser into our meetings with implementation for the educational sessions. With that alternate over to sharon. Chairman house United Healthcare. Could you pull the microphone down just a bit . There you go i have a presentation you need to bring it closer to you if you can and talk directly into it. Okay today ill be talking about our Implementation Plan which will focus on retiree communications, educational meetings, as well as how united Healthcare Plans good so assist hhs responded to retiree questions. The first slide is the communication overview. Ill start at the top left. Across. First, we have the announcement of the plan changes as well as the roman material that with it hhs sent out the retirement benefit guides. That is targeted to be the last week of september. Within a few days of that mailing, United Healthcare will mail out their 2017 plan guides that will go to all medicare eligible city plans, blue shield members as well as anybody who is turning 65 and aging into medicare in the 2017 plan year. From there, in december following enrollment and after cms approval of the enrollment retirees can expect to receive their confirmation of enrollment among their id cards as well as a welcome packet from United Healthcare. Going down to the educational meetings those will begin the last week in september and go through the third week in october. We will be mailing meeting invitations on september 12 which will include all the dates and times for the available meetings. Yes . Dr. Dodd is commander with United Healthcare in kaiser . Yes to all talk about that on another subject we have more ongoing education so, for now and even after the open enrollment or not will do our reach as needed. Currently were teaching in a targeted outreach to those providers we know have not historically accepted the plan. Were doing that proactively. At the meetings, we will have a member provider guide to care flyer. Its a twosided flyer. One side addresses the retiree on the other side is for the retiree to take to their provider and helps educate them on the plan offering. Then, later in the fall, we will send a retiree postcard reminding retirees that they can contact us for help with outreach to their providers to make sure that theyll accept the plan or help them find a provider if they so wish. As of september 6, our call center will be ready to start answering questions on the 2017 plan year. Then, as far as the website goes, we are in the process this month to want some 2017 highlight changes on the website. Next slide talks about the educational meeting good we are partnering with kaiser to host 18 in person meetings and five teleconferences to help retirees understand the new plan offering and get any other questions answered. We will have a reservation line that is going to be managed by you hc, so that we can make sure there is enough Seating Available for those who want to attend and then address any special accommodation needs. While that line is managed by you hc, the messaging on the line is generic or so, thats kaiser members can also call in. Then, we will be tracking the summary of the meetings the attendance and any issues that come up and like you said, report it back to the board. The next slide is a county map of where the meetings will be held. These counties were selected based on the highest retiree populations and then we also added to the budget sheet retirees. The next slide is a calendar of all of the meetings, so this includes the meetings that hhs is also setting up a grade you on an annual base. Those meetings are highlighted in blue and all of the nonshaded dates are the ones that we are hosting with kaiser. October 10, that is you said San Francisco correct that San Francisco south San Francisco Conference Center but thats not in San Francisco. Sma looked at it they might think its in San Francisco. You might want to put the word south San Francisco we will correct that. Thank you. Then, there are two updates to this calendar since it was published for the board. October 12 the time for the our ecs Health Care Meeting is from 1012 pm and then hss has added an additional venue on october 19 41 s. Van ness health fair from nine4 pm. The last couple of slides talked about how were going to support hss and also respond to retiree questions. We will create a frequency frequently asked questions document or database so that we can make sure that you hc as well as ages hss benefits analyst are responding consistently to those retiree questions. We have a uht Service Account manager we refer to as a sam. They will actually be onsite at hhs the first week in january and if needed longer than that. The sams are available from 85 pacific time mondayfriday to answer any escalated questions. The same district we email . It is email and resource for hss. The retiree can call our Customer Service line if they dont feel like they got their questions resolved we will contact hss and hss is would refer those calls to us. Because theyre not all email ready . No. Its a partnership between ages as of hss and uht. If its okay then, for any questions hhs as does refer to a sam were committed to respond to those with at least a status and knowledge meant within 24 hours. Its our experience the majority of those issues are resolved within those 24hour period. Again, we will provide reporting to hss twice weekly basis as well as reporting summarize information to the board. As far as retirees, again, retirees should be contacting Customer Service at first that we do have a dedicated hss San Francisco hss phone number for them to call. Its the same phone number that we been utilizing the ppo plan and beginning september 6 they can call in with questions regarding the 2017 plan. They should be able to get most of the questions if not all answered through that long. Again, if there is any need to escalate it or have a deeper hightech individual service, they can contact each ss and again they would refer those to our sam. New for 27 in, we worked with hss is to implement a standardized template. The benefits analyst will be working with them to implement that process. Though complete the form for us which is in your appendix. No email it to the sams mailbox and go from there. We will also have hard Copies Available at all of the educational meetings in case retiree does not have time to wait for someone to talk to them oneonone. We will collect those. We will fill them back at our office and somebody will outreach to that retiree. The lead sam will maintain the log of questions. Again, for our reporting purposes. Then, we will be poured back to number and types of questions we are getting to the board. As far as expected questions, its been our experience that two most common types of questions are, does my provider except the plan and all my prescriptions covered. For the provider questions, we take down the provider information. We compare that against our list of providers who have historically accepted the plan and if they are not on our list will do a knowledge to the provider and educate them on the plan and explain how they can about accessing the plan. Once all the research is done we contact the member back and let them know the outcome. Its on this point that he was the subject of a meeting between myself and director dodd and representatives of you hc and brown and tolan and commissioner breslin attending and talking more explicitly about the physicians participating in this plan. It was a commitment made at that meeting that there will be at least monthly, but if its needed more frequently contact between these two organizations to ensure every brown provider has a clear understanding of what the plan provisions among reimbursements and changes are. So, again, as your reporting back on everything else, we like to hear a report some commentary on how the process is working as well. Okay. As far as i can thank you. Thank you as far as prescriptions we take up the list of the prescriptions the retiree is taking can we compare that against our formulary list and get them their coverage and their benefits explain that to impute if theres any need to contact their doctor to get a new prescription we also help with that. Then, the last is just again the new template. We are creating. Attached again be a onepage template. It split right now between what we consider to be preenrollments questions and going four for post in rome and get the top section is just the demographic information of the retiree and again whether the questions provided related or prescription related and going forward, we expect to also have questions concerning claims or authorizations either on the prescription plan or the medical plan. All right. Thank you for your presentation at either questions from the board . I dont know here the one to ask this or not, it came out at one of these meetings that anybody, any doctor that doesnt take medicare member would not be reimbursed for. That was it was also said that was the same as the present ppo plan present city planned with that is not accurate because presently in the city planned as long as you see a licensed doctor youll be reimbursed in the medicare level. I talked to eugene about this we been extensive research. Right now, there are four members who currently seen on medicare providers. Were looking at each of those individual cases and determining how best four members in the city planted it novel city plan. That would be over for medicare, right b1 correct but there seen on medicare providers. So what is the plan to deal with those. Were looking at each case individually and working with hss to determine the plan of action for each of those matters. Because that is what they were promised. Going into this that everybody basically it was if you like your doctor youre still can see him. If that sounds similar to anybody. Yes, but that really was not exactly the way its turning out i dont think. Right lets be accurate. You are following up on it and you have a process and were talking about for instances. Correct . Correct one of the underlying themes is that the provider must be must accept medicare understand and youre working on it . Correct and you come back and tell us what has resolved or what have you. Thank you so, if the person has only part b is not outlook we do have a part b only. Were implementing the second group number if you will go before part of avalon. Originated city that a and b but now we have the two options. If there is city planned to go into the ppo plan if that blue shield to . Bill going to the ppo or b plan only when did this change . Its probably been i believe at least a month ago. Because theres quite a few widows i think this point the issue theres a lot of staff work that is going on with the intent of trying to make sure this process and to implement this decision as smoothly as possible. So, as issues arise, i believe the staff is trying to address these things serially. So there might be changes that are happening today, tomorrow and next week and were going to hear about them. Again next month. So, i want everybody to be on notice this is when to be a regular part of our process through open enrollment and changes or new information will arise at each of these meetings. It will be captured fully in the materials thatll be distributed. So nobody will be surprised at the end of the day as to where this came from or what was done. That was our intent from the beginning of the time of making this decision. Please, proceed any other questions. Any other questions . Yes. People not out of the United States they stay on the city plan . If they permanently reside outside of the nine states, correct cured they stay on the city plan okay. Because i told people they have to have their offer and b. Thats not right, i guess. Okay. Then there was some question you said you had a list of 801 providers yet to come along. To fix 800 . To fix it on. That was at the june meeting us about the figure in the minutes to fix that was the target providers. How are we doing . Were doing mailing out regime are doing a phone outreach as well. I have Something Else but is not related to this exactly. To fix if we need to stay on this topic for the moment. Okay i have a question about the item question template on your appendix. That i guess youre the member would fill out if they had a question. So, the intent of it is for hss to use it. However, as a special circumstance for the educational meetings we are going to have a hard copy at the meeting. If a retiree can Stay Together question answered or they dont want to wait to speak to someone they can complete it we will collect those and bring them back to our same to respond back to each number individual. So this is not an ongoing sort of question template. This is people at the time of enrollment stephen is ongoing for hss to use so they can refer questions to our sam to do that higher Touch Service with a member. It is shortterm for the educational meetings whether retiring would actually completed so hhs hss staff will have eight better bit of instructions about how to fill this out correct. Reagan about training for them you can just list just say brief discovery of december the drug is. With the communication was because a lot of times drugs may be approved for one indication but not for another. All the staff will have the information is required for this form . Correct cured today hss us does refer questions to us that its to create more standardization between the benefits analyst so that we get consistent information coming in. Whatever information hss staff theyll put it on the form and usually we take that we research to our ability to a lot of things make in our reach to the member talk to them directly to see the specific concerns are. I think that was my concern about the standardization of the information being transferred. There would be less upsetting to the member or enrollee as well as our staff, to know in advance what is going to be required in that box. So that there is not further outreach or questions back to either or repetition or repetition judge if everyone had the same sort of destruction this is the minimal amount of data you need in order to cement this form and to make sure the staff has all that cured maybe they do. Event the question is about coverage or prescription drugs please provide the names of the drugs and the question and the reason theyre being prescribed. Whatever you need in order to make a decision i think, the minimum should be also used the diagnosis and the reason for prescription. One drug for noncovered reason or nonlicensed reason and that is your reason for denial than it needs to be stay with the reason really was right. We are again doing training with hss that in september so will blow that out a little more sober getting to it not to lose sight of the reason. You are trying to get a constant clear stream of information that is somewhat a way you can process it, deal with it and respond to it correct thats what were trying to get at here. So, this form after you used it for a while you may decide to come back and modify it, correct . Correct retirees without a and bo how many theres about 114 b only people without a or b . There are some oldtimers still. I dont even know how many are left but there was i guess i would assume stay in the plans . To fix though stay in the current plans. Theyre not in a medical plan with the blue shield were grandfathered. We call them grandfathered where they would say in the city plan you know how many are left . Its a very small small number would you bring that back so we have that on the record and what your response was if you could let the secretary know. Well inserted in the minutes in the spot. Its 10, 20 or 30. Their plans will not be disturbed. Is that what im hearing you say . That dont have a or b that is correct if they dont have a or b. We are on the record date. Any other questions from commissioners . Following commissioner breslins question would that be communicated also to the members butler b only without amd is our plan to communicate to those members their coverage will not they still have the option right. So, the open in rome at its euros they get applied to plan are eligible for. But we will take an extra step because particularly blue shield extra step and working with them and making sure they understand nothing scorn to change for them any other questions . Commissioner moonreynolds just a comments. Thank you. Dr. Dodd, thank you for working with high speed about this is the start i think this answers a lot of questions that were asked during the previous meeting get so, thank you. [inaudible] thank you very much. Any other questions or comments from commissioners . If you would stand by, there may be Public Comment that would require your support. Is there any Public Comment . Thank you commissioners. It has been really wonderful in the interaction that ive had with eu 8c thats in trying to do what we can to our organization to really make this information that distributed to make it work i have a friday deadline for an article with regard to this and i cant remember dodd if youre writing network i was writing that claimed. [laughing] thats what i thought. Thats okay. Because i written this out so many times arms can assign you the electronic version of the flyer. Yes, thank you there is a bit of a shared responsibility we are coordinating here, obvious. Through news and views are publishing deadline is friday. We are writing up as much as we can. Doing two things. One is to put it in our newsletter which will be distributed toward the end of august but im also doing an email blast to all of our members so that they get some advanced operation and knowledge because im hearing different rumors out there that are people upset as you can imagine. So, either trying to dispel a lot of that and the idea is that members will get an email blast that will tell them what their options are, what they can do and hopefully i will get the Customer Service phone number and that sort of thing. Really encourage them to go to all the meetings. What we find at a regular meetings for example, are healthier and october many of the members who attend do not have computers or emails. They come to our meetings so that our newsletter is really critical. That is how theyre getting its good at about 140 that i personally mailed the newsletter to because they dont have electronic service. So, we are aware of that and working with you 8c with all service, with everyone to make sure that everybody gets as much of the correct information as possible. So i want to thank everybody on all sides for the assistance and also to understand the whatever else we can do to help with this information and will retirees feel comfortable about the information and their options we are here and ready to assist you to, thank you thank you for the comment and your offer for supports the work youve done to date. Is there something from kaiser on this point . Is there a kaiser represented here . Yes . Anything you care to offer at this point . On this topic . Kaiser permanente. I just want to thank hss for allowing us to collaboratively work with United Healthcare. Its actually been an enlightening process. Its kind of unique to both vendors on this together but we are coordinating and working so that we can let people know that they do have a choice of Kaiser Permanente in addition to the blue shield number in addition to that United Health to. And its going well . So far its going extremely well, yes. They have been gracious thank you. I just want to get that on the record publicly. Okay. Other Public Comment im sorry for that one could get there are some blue shield people were being referred to specialists that we been told are not accepting not medicare that has some exceptions to that. So i think its more than just of four people within the city planted think we have to aware of who else might be in blue shield might have special considerations to be addressed and also our big message to all the kaiser people is that nothing changes for them and that kaiser is an option. If you have any specifics would you please refer those folks into the staff or followup. Any other Public Comment on this item . Hearing none, and seeing none, we will move to the next item item 14, discussion item report on it work in health plan issues. If any commissioner breslin i the question for many represented from United Healthcare. I talked to jane perrone the other day about the medicare new plan for pain doctors call the macro and she said she dont say she was going on vacation but i was curiosity is how this going to affect members . Was a lot of concern may be a lot of doctors would not take medicare people anymore with this new medicare reimbursement plan. Its complicated. Theres a lot of questions and answers. I got 34 inquiries dr. Dodd, can you shed any light on this . The macro regulations have not been finalized. I reviewed the comments Pacific Business group forwarded regarding the regulations. Macro is designed to reimburse for quality so that there is a mip fund which is an Incentive Fund that if you meet certain Quality Standard the physicians actually get more money. There have beeni did a literature search after i saw you are email, commissioner breslin, and thereve been no articles that have projected that physicians will leave medicare because of macro [gavel] good morning today is july 29, 2016 welcome to the local Agency Formation commission my name is john avilas i am the chair of the commission i am joined by supervisor crews and supervisor mar and supervisor campos. Mme. Clerk would you please call the first item. Item 1 is the call to water and [roll call vote] which weve arrayed done okay item 2. Item 2 is approval of the lafco minutes from the meeting of june 13, 2016. Do we have any Public Comment . Unless there is a ghost in here than i dont think they were going to have any Public Comment. I will close Public Comment. Can i please have a motion and a second . We have a motion and a secondthe minutes of july 13, 2016 are approved. [gavel] mme. City clerk please read item 3. Item 3 is that Community Choice aggregation activities report by barbara hale and jason fried. Good morning, barbara hale. This is the lowest topdown rate that we have seen so far. Great, do you know any reasons that people do opt out when they do . We have had a lot of interest in the program and we are seeing a lot of commitment to it. The super green participation is also good. The rate of participation in our super Green Program is currently 3 . We are continuing to promote the super green offering that is the 100 renewable offering and we will send out a notice soon to our existing customers to encourage our friend and neighbors to join the super green portfolio as well. And, we will be doing an Advertising Campaign in the fall to specifically promote the super green sign up in our next enrollment in districts five and eight. So, speaking of the next enrollment we have 561 customers that have signed up for august enrollment. Most of those signups are residential. 78 is super green and 28 have signed up for our super green offering. We are finalizing our notice for our next renewal period you may recall that when we previously surveyed the city that districts five and eight were areas that showed a 500 renewable product and when they start the product they will start there instead of having to start in green and make a second step to super green. Please sign up for this enrollment please sign up for this enrollment cleanpowersf. Org by august 1. We have launched a