Good afternoon everyone. Welcome to the Health ServiceBoard Meeting of march 14, 2024 and happy pie day to everybody. Would you please stand for the pledge of allegiance . I pledge allegiance to the flag of the United States of america, and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all. Thank you. Item 2, please. Thank you. Roll call starting with, president scott who is excused. Chair hao, present. Commissioner breslin is excused. Commissioner canning, present. Supervisor dorsey, present. Commissioner follansbee, present. Commissioner zvanski, present. Thank you. Thank you. We definitely have quorum. Item 3, please. Thank you. General Public Comment. An opportunity for members of the public to comment on any matter within the board jurisdiction on the agenda including requesting that the board place a matter on a future agenda item. Ill read our Public Comment instructions aloud. Remote viewing is available on sfgovtv and webex. Welcomes Public Comment during the Public Comment periods. There will be a opportunity for general Public Comment at the beginning of the etmooing and a opportunity to comment on each item. In person Public Comment will be first then remote Public Comment. Anyone in person you are welcome to approach the podium now. Each is allowed three minutes to speak. All Public Comment are made concerning the item presented. Caller may ask questions of the policy body but no obigation to answer or engage in dialogue. The Health Service board will hear up to 30 minutes of remote Public Comment for each item. Remote Public Comment people received accommodation due to disability will not count towards the 30 minute left. Members attending the meeting via phone can call by dialing 4156550001 and enter code 26604081402. When prompted press. You will be prompted to enter the webinar password, 1145 and again. Press 3 and you will hear the prompt. When the system message says your line is unmuted this is your time to speak. Your will be muted when your time expired. For those watching on webex click on the icon to be placed in the queue. A raised hand appears next to your name. Please select unmute to speak. Once you hear welcome caller, you can begin speaking. When your time expired you will be muted. Click on the raise hand icon to lower your hand. Members are encouraged to state name completely but may remain anonymous. When your three minutes ended i will say thank you for your call and placed on mute and unmute the next caller. Thank you to sfgovtv and media service. Well begin with in person Public Comment. No one approached the podium. Well move to our remote Public Comment and moderator will notify if there is callers in the Public Comment queue at this time. We have one caller on the phone line. Zero commenters have entered the queue. Thank you moderator. The board also received a written Public Comment. The member was ella lam and requesting the board add over the counter benefit to the Kaiser Permanente senior advantage plan. Next item, please. Thank you. Next item is approval with possible modifications of the minutes of the meeting set forth below which were december 12 Governance CommitteeMeeting Minutes and february 8 regular Meeting Minutes. Colleagues, you have questions or other edits you want to offer . I move approval of the minutes of the february 8 and december 12 meetings as listed. Second. Moved and second. Well take Public Comment. Thank you. Public comment is now open. Instructions are displayed on the screen for those watching on sfgovtv and webex. In person Public Comment is first fallowed by remote Public Comment. Press star 3 to be added to the queue. For those watching on webex, click raise hand icon to be placed in the queue to speak. Well move to inperson Public Comment and no one approached the podium and move to our remote Public Comment and the moderator will notify of any callers in the queue at this time. We have one caller on the phone, zero callers entered the queue. Thank you. Hearing no callers, Public Comment is closed. Thank you roll call vote please. [roll call] thank you. The minutes are approved unanimously. Next item, please. Item 5 is president s report. Discussion item and presented by chair hao. Thank you. I have a couple things. First of all, we have a very meaty agenda including two items in closed session, so we will be able to get through this, im hopeful that but we need to be mindful of the next commission who come in after us to use the room. One time we stayed way too late and they were a little grumpy. Lets make friends with other commissions. The second item i want to remind fellow commissioners that we have the form 700 due on april 1 as well as the required annual ethics training, so please dont forget to do that. I think there is a penalty for late filing of form 700 and again, we dont want to make the Ethics Commission grumpy about this. Thats it. I guess Public Comment on my comments. Thank you. Thank you. Public comment is open. Instructions are displayed on the screen for those watching. In person is first. No one approached the podium, well move to remote Public Comment and the moderator will notify of callers in the queue at this time. We have one caller on the phone line, zero callers entered the Public Comment queue at this time. Thank you moderator. Hearing no callers, Public Comment is closed. Thank you. Item 6, please. Thank you. Item 6 is directors report. Discussion item and presented by abbie yant. Good afternoon commissioners. Ill try to be brief to get through the meeting today. Reminder to the black out notice is in effect for all the health plans and rfp for the medicare product, so there is language if you are unclear. Speaking of which, the medicare rfp is on track. We are planning to deliver that to this board on may 23 and the panel is fully engaged, the process is underway, the documents are being submitted and reviewed and hats off to michael and mary from aon. It is a very robust process and taking a lot of their time and we really all appreciate that. I also wanted to point out we have been in negotiation regarding our lease some time now. As you imagine, Office Space Lease negotiations are a hay day of the Real Estate Department for city county of San Francisco now is and we are going to benefit from the lease negotiation. We are however as part that is vacating the first floor where we had the Catherine DoddWellness Center open in main of 2014. We are caring her Mission Forward where we are goingWellness Center is a gym space to where we prioritize invasion and collaboration with among the staff and or the departments. The shift aims to bolster operational capacity and cultivate a culture of senergy and invasion comprehensive wellbe. So, i think that is a fitting way to move that on. I spoke with catherine last week to let her know. She was very pleased and surprised to learn. That move is underway and right now the Real Estate Division is putting a package of leases together that will go before the board of supervisors in april and once that is done the team will commense with the work and preparation well underway and the gymnasium equipment we have according to rules we are following all the procedures to distribute around the city and all go to good use by city departments that are participating in different wellness activities. I think we have a really good plan in place and will be able to are locate the Employee Assistance program and wellbeing center to space on the second floor, which is much more habitable then the space on the first floor has been, so we are looking forward to that. The Health ServiceBoard Election is going to take place between may 17 and 31. We did a orientation for nominees a week ago, and the final slate will be approved after the form 700s are filed by april 11. That is the requirement, so let the campaign begin at that point. We will do the diva again this year, i think we mentioned before, it is womens history month. If you read the news letter, i did say a little about my own history with my mom and grand mother who served during the pandemic in 1918, so we have that in common. I also wanted to note that on the way over here today, the city, department of Human Resources opened a Career Center on the first floor and might want to stop by on the way out. It is pretty cool. The fact it is in city hall will help in a lot of ways, so we partner obviously every day with the department of Human Resources and recruitment and retention is a Key Initiative for all of us. And lets see, last but not least, the wellbeing programs, this month included renewed commitment to your own wellbeing and done a big campaign on sleep. Anybody with sleep issues i encourage you to take a look at it. With that, i think i will turn it over to the board. Thank you director yant. I also want to thank you for all the data you provide to us on a regular basis of the calls and other metrics that you are measuring in your department. Thank you. Well bring the annual report next month. Well flush that out in more detail for you at that time, so there may be more context to what you are receiving on a monthly basis. Thank you. If i can ask a question. About three weeks ago there was a hacking of the Billing Service for United Healthcare and my understanding is the Major Health Systems were not effected, it was small hospitals and individual providers. Has there been any impact on hss from this event as far as you know . Not that i know of. We did receive all the proper notifications and thats what we keep track of to make sure we are adequately notified and yeah, thats probably the biggest healthcare breach there has been and the feds are looking into it from what i understand. So, i do feel sorry for it the folks impacted. We are fortunate that it hasnt effected us that we know of yet. Big caveat. Thank you. Any other questions . Or comments . Im glad that you no longer have to report on the status of the ucsf negotiation with United Healthcare. Yes. Glad that has come to a end. Well take Public Comment. Thank you. [providing instructions for Public Comment] no one approached the podium. Well move to remote Public Comment. Board secretary, there are zero callers on the phone line and zero callers in the queue. Thank you moderator. Hearing no caller, the Public Comment is closed. Thank you. Item 7, please. Thank you. Item 7 is sfhss Financial Report as of january 31, 2024. This is discussion item and presented by iftikhar hussain. Good afternoon. Good afternoon. Yes, the result of the trust are similar to what we said last month. I do want to add one more bit of information in the claims running higher then planned, one of the reasons is the claims arepremiums are set on annual calendar year basis so the 10. 1 percent increase is not kicking in until january. A lot of reason you see the claims running higher are based on the older rates. Can you speak up a bit, because i didnt quite get all that . We talked about the decline in the trust balance because the claims experience has been higher then planned, and one thing i want to point out is the rate setting process is done on calendar year, so when we experience the higher claims, those rates were not adjusted until january of 2024, so a lot of claims is remnant of the lower rates. In january the rates were increased average by 10. 1 percent. The other thing i want to point out, we are seeing [indiscernible] 25 percent increase we expected last year. I havethis is notthe bad news is, the overall pharmacy expenses are quite a bit higher then, even with higher rebates. [indiscernible] Sustainability Fund is solid. The general fund we are expecting to be slightly ahead of budget because of the vacancies. We did do supplemental staffing during open enrollment to make up for some of the vacancies and we were able to do a surplus transfer to fund some of the expenses by taking salaries into purchase services. The net effect i think we are close to budget by the end of the year, and twl thereis one auditing process. Internal control process where they have given questions of the policies and they select sample of [indiscernible] so that is ongoing. Happy to answer questions about financials. Could we go todo we have the whole packet on we can look at . If we can look at your graph. In terms of it disparities between the claims and what we collected in the month and we see those curves sort of separating. If you can pull that up because i had a question. You may have answered it in part by talking about the application of the newthe first of the year. Application of the new rates. Rate. Yeah. So, i was looking at this and wondering if theit looks like thisobviously the expenses are always higher and revenues. But from month to month it looks like sometimesthat gap hasnt increased. In other words, it may have occurred earlier on, but in the last month or so and this plan and one of the others, the gap seemed to be about the same dollars. You see what im saying . Maybe thats the new rates. So, the gap between there lines on the bar are two reasons. One is stabilization. Right. So thats the two lines shown in the graphs. This is comuliative numbers. The net change in january we dont show. We show year to date but not the month. Did come down. If i subtracted revenues from the expenses in january it looked like that dollar figure was about the same as in december, so at least there wasnt a continuing increasing despairty. That was the rough calculation. I didnt sit down to that. What might explain that . The claims went down in january. Yeah. That was what i was asking. This is helpful. I wondering if it is useful to monitor this on a month to see what the month change is as well. We can see if there a trend of seasonality. We can certainly add that. Just curious, because obviously, to just watch month by month i throw up our hands is a little frustrating and i hope that the plans are getting the message that we are not just throwing up our hands and watching it carefully and they can do in real time rather then waiting for the new contract to sort of help whatever they think they can do would be great. Eel ill do that. I wanted to add to that dr. Follansbee, there is very extensive experience reports about the utilization of the health plans, so these are the big pillars how we evaluate dollars, but utilization drives the doctors dollars. The relationship between the spend and the utilization and the forecast is very important that we lay the groundwork for that and iftikhar presents on a mujtly basis to demonstrate the fiduciary responsibility to the trust and we watch this. Between[indiscernible] having a hard time picking up everything you are saying. I dont want to miss a word. The dollars is one way we continuously monitor the trust to make sure we got enough money to pay the bills, but what well look at starting today explaining the experience wree are seeing and the utilization trends are what you will be looking for as far as seasonalty and that type of thing is really looking why are people using services because in general we want them to use services, but when they start getting effected by pharmacy cost and other things, that may be news. Those are the type of things we continue to watch for and lays the basis for forecasting what the rates could and should be going forward. It is a very complex subject and we try to break it apart, but iftikhar presents to you as the cfo those reports letting you know as the board and fiduciary responsibility we carefully monitor the spend against what we projected. Thank you, any other questions or comments for iftikhar . Thank you. Well take Public Comment. Thank you. [providing instructions for Public Comment] well begin with in person Public Comment and no one approached the podium so move to remote Public Comment and the moderator will notify of callers in the queue at this time. Board secretary, we have zero callers on the phone line and zero callers in the Public Comment queue. Thank you moderator. Public comment is now closed. Thank you. Item 8, please. Item 8 the presentation of the 2024 rates and benefits calendar for