>> one question so once we approve those result studies it will be in the greater wellness program you'll have an update occupants the results. >> yes. >> okay. great. >> is there a - i'm ready to entertain a motion. >> i max make a motion. >> that's a second and third (laughter). >> any other discussion? comments? public comment r.c. sf president i'm hoping you can do something for workplace programs there are several programs where there are high rates of diabetes and prediabetes when i was at mta or muni i saw the drivers it was really difficult part of the problem getting the departments to really cooperate and hoping help give employees just like every hour 3 to 5 minute activity break a break from work or part of their state announced work break it helps them become nor active and not glued to their desks so i really hope that this program can enforced i'd like to see a happier and healthy workplace i want to add all my colleagues they're on a drug that has terrible side effects i hope there be a better drug that didn't impact in their ability to get to work on time this is a great program the retirees support it we want to see more of this we'll support the workforce >> all in favor, say i. of the motion as proposed i. >> opposed? the same sign or a different sign we'll move on the motion is carried we'll noting now move to action item 16 which the presentation of the strategic plan. >> dobd. >> the strategic plan is before you, you post the governance meeting yesterday we'll be adding some additional detail but probably the new sections are related to wellness and data analysis and itch of it it it did not sisters in terms of whether we can get technology funded but we remain committed to operation excellence the new initiatives are highlighted so there's a hope we'll be able to automate those and it keeps getting punched off maybe not until the second year the affordable health care we'll continue those and the new ones to identify inform mitigate to the excise tax to implement the database and to enhance opportunity to participate in research projects which will improve the well-being of our members and in terms of the that transparent governance our new initiative we'll continue the initiatives in place and we would like to consider implementing the distribution in the health service for materials and funding conferences for a commissioner to attend one per year and that can be changed and to insure that the i f e b and updates are available to board members in terms of goal 4 we would continue our ongoing initiative and new initiatives would include updating the website and increasing the digital communication with members that requires hurdle and continuing to engagement the departments at a greater level of cultural awareness and this becomes important so we've outlined the threats to success in each one we've talked about the opportunity and it moves all our goals along and adds wellness and data. >> are there questions from the members of the board? dobd made a high-level reference to our governance committee meeting the chair we kinthd it yesterday an international part of the work of will be quantifying which of those are milestones in 2015- 2016 talk about changing a reinforce going forward what is going to be accomplished if you will, during of the plan as i understand it we'll begin to combvent and talk about which year as we go forward after the plans adaptation >> are the questions from the board and i'm willing to entertain a motion. >> the health services i move. >> it's been properly moved and seconded are there any discussion from the board members further? any public comment? hearing or seeing none we're ready to vote all in favor, say i. of adapting the strategy plan as outlined and distributed please indicate by saying i >> i opposed? nay it's naming adapted thank you dobd and her team for the formulation so wife covered the required action items we can go to the regular order i'll call upon the secretary. >> yes. >> (inaudible). >> no, we have not addressed it now that we have time for a moment i'd like to do that. >> we're on number 8. >> well, i'm going to move to action item 10 while we have quorum begging the privilege of chair loans my council doesn't stop me i feel like i'm in control marginally okay secretary item 10. >> item 10 action item approval the stabilization policy. >> and . >> good afternoon. i'm an actual y in fact? the claim stabilization policy we would like to bring to your recollection that the plan has been added and hewitt's recommendation that the board accept the changes we welcome questions or comments. >> and the major change is doing what. >> the major change is to add the self-funded p po plan to the existing policy. >> thank you are there questions and so currently, the p po plan is on a yearly basis and if you're doing the raven for it goes for 3 years. >> yeah. we're doing yeah, we have the excess of premiums over expense in 2014 so we've got the stabilization funds in 2013. >> so they're using f it in the following year for the whole autumn. >> your surely right amp tied over 3 years. >> so for the next fiscal year and increase it for the following year. >> yes. >> okay. thank you that clarifies are there another questions? >> no and is there a motion on this item. >> i move to approve. >> is there a second. >> it's been properly moved and seconded we adopt the policy changes as indicated and described and discussed is there public comment? hearing and seeing no public comment we're going not ready to vote all in favor of the policy changes as described and discussed please signify by saying i it's carried unanimously is there any other items >> the only action. >> those were the only action items 11 we'll go to 11 since we have quorum. >> item 11 aforementioned item reconciliation of retiree shiners program funds am 11. >> amiably chief executive officer i'm make this really quick. >> thank you. >> okay this is the reconciliation that we need to do on the early retirement insurance program fund the end of the program this program was started with the affordable health care act to provide financial assistance to employer base cal plans and make coverage available to early retirees we have to all the programs - the program writers or requires that all funds received must be spent that i january 1st, you as you recall in june 2013, the boards approved distributing the funds bans a premium percentage paid to all members and also a policy that the funds will be applied to the maim paid by the member if the member paid zero premium they'll innovate receive fund in june 2013, the board agreed to stabilize the employee enroll let me see for units that agreed to the 2015 flat premium contribution strategy that led into the 83 and e e rp fund to submit sub decide the principle we've received it was two payment we received in 2011 totally $6 million well, i'm sorry $3 million plus over the period of time we earned interest prior to the well, actually to the end of the program of $112,000 plus for a total of 38053418 in terms of the expenditure we're giving you the subsidy that was distributed to all members and then the subsidy for the unions adapting the stream this was part of the overall payment it was 80 thousand 774 to total $3 million 805 for 18. >> and your recommendation adaptation? my recommendation to approve our report this is done in in accordance with an audit that occurs >> are there questions from the board. >> so we spent the whole early program do we have to do some reporting or subject to anti audit. >> subject to audit. >> the office the entity that animal this closed its doors. >> oh, and turned off it's lights so this is in the event that we are - >> all right. thank you other questions from the board about this item i'm ready to entertain a motion. >> that's the difference of the churns or insurance program. >> it's been properly seconded to adapt this as discussions hearing none we're ready to vote in favor of the motion please signify by i. >> i. >> all opposed nay it's so adapted thank you, commissioner for staying and giving me 5 minutes. >> thank you very much we'll see you next time. >> all right. so we're now ready to undertake any remaining items under the agenda we were at decision item 8. >> 8. >> we're going guilty of negligence gun on this item since it has my name attached to it we heard the controller and director of finance pamela talk about sing nicaraguans the budget with the general budget process to that he said i think any discussion of education or items for volunteering text evaluation should be incorporated into the 205 discussions and hence i am requesting that if at all possible between now and the presentation of the budget in february and if not then pam and dobd will give us guidance that a few minutes meeting be convened to discuss those matters toy come up with a fulsome recommendation to share with our city attorney's office for making sure we're clear about what we're recommending and if it's don't believe anticipate all of that to meet the requirement of 205 as described if our minutes and at the same time trying to accomplish a larger goal or effort here so this is really what i have to say about this item at this time i'll be more than happy to entertain questions. >> it's a very good idea we've talked about funding for education for almost ever meeting every annual when we've had the board or self-evaluations we've not gotten to it we had it when i came on the board did you that hadn't happened it is very important to look at it this and i'm interested in consulting money for the consulting firmly we can't get though the governance issue without their help so i think this is a very good idea we used to have budget and finance meeting more frequently i this years ago am i right. >> thank you very much commissioner that's my request that dobd and pam levin to come up with the principles of the finance committee that is myself and commissioner lim and sfooefrl and two out of 3 ain't bad we're trying to get that done we're ready to go on to the next discussion item. >> item 8 discussion item presentation of calendar for plan 2015 dobd. >> you have before you a revised calendar the addition are the dental vendors are up at the end of this year we're quickly looking at doing rfps for vision and dental not able to nail them when those will be ready hope is he we'll be able to do one in april and one in may that's not clear at this point. >> okay. is there any comment or question from the board regarding this. >> i remind all of those who are in our listening audience and viewing audience that the rates and benefits effort of board is done as a committee as a whole, however, there are any number of meetings that sometimes require members particularly the chair of the rates and benefits committee to participate along with the staff as they're having discussions with health plans o plan vendor and a artillery requires or i say vendor or health care partners and their representatives there's work that goes on between meetings as outlined on this calendar their innovate representing here and it's a lot of effort toe kind of get us to june we're able to say okay. here it is we had the great whisper and shrines by kaiser and i want to say that one more time and my hope is that working with all of our health plans we're able to accomplish the same resulted including the rfps with that having been said you don't know i don't have comments from other board members. >> so you you'll be the chair of the rates and benefits. >> until decided that at this point, i'm 2, 3, 49 first two hours of my presidentcy we'll see what happens so presuming another commissioner coming broad wherever that happens or the interests of other confirmations my hope as we do this work we can call upon others for their time and talent to get it done any public comment on that item? okay. if not we'll go to the next discussion item. >> item 13 discussion item 2014 health care survey ann hewitt. >> good afternoon barbara whatever likelihood this is a followup to a decisions we had in september of 2014 we presented survey data and you had a number of questions to follow up on there was it fell into two categories one questions about a couple of topics and the other follow-up on data i'm not able to still pull together the relevant comparable dalts you were looking to compare year to year trends on certainly materials we presented i'll still he trying to you pull that together but at this time i'm presenting one topic the topic of value based insurance and pricing the reason i'm presenting s it is there are questions about those concepts really meant the interesting part of about vail based is the words value based we're hearing a lot in health care katherine dodd and her team are working on a value based contract the concept about the value for the quality the cost for the services today, we're really talking about two topics that came up in our presentations the first one was the value based insurance design the concept of that is really about either spending more on a service or maybe spending lessen a service a health care service or a health service at sometimes in in this case it might be a strategy around trying to identify different health populations a clinical group trying to encourage behavior or courage use of centers of excellence and the value based concept the insurance design you encourage the behavior by changing the costs lower the costs to encourage people to go to a center or courage them to take a prescription by lowering the costs basic concepts of insurance design their driven by either service based or participation based and it is in simple terms it maybe we want people to use the center of excellence we know the quality is there wife done due diligence and we know that we might design the plan by lowering the costs for using that service or center a condition might be everyone would high blood pressure i'm an example everyone you change the co-pay on your bp meds to zero so that value based design is you encouraged compliance by lowering the costs and then participation based is something like that what we talked about smoking sensation maybe there's encouragement because we either make programs assessable or no cost or possibly some other kind of financial configuration so again, this terminology is in the marketplace and we wanted to provide some clarity to the public and commission next slide i will touch on slide 5 and again service based i want to point out that example this is an example of taking value based from slithering different angle maybe we've determined with the appropriate resources and data through different kwiefz resources that concern procedures are extensive active too many of them like emergency room utilitytion vitamin d testing and imaging services for low back in that case the position is this insurance design is actually make those services more expensive to discourage the high utilitytion of what is over utility listed the design can work from both angles as we move on from there i'm not going to go over the details but we provide information from data and research about what organizations maybe doing in eliminating this concept in their medical benefit programs like organize program employees and the university of michigan and so on so those are websites if you want to read information or like me to follow up with research on our on behalf of. >> is there any questions. >> commissioners any questions. >> thank you. this is a good presentation it is focused more on the value based design because it impacts how we design our programs facilities going thoroughly to 2008 and those steps will be coming so i think we need to go farther and research more. >> we believe the same thing i think the purpose is to as you said commissioner scott we need to make sure the audience understands little terminal i want to make one final comment on the other terminology reference based icing this terminology goes back in time dobd will know this the best probably with medicare about really setting a price on a service and saying this is what we're going to pay okay. so in simple terms that's the concept c sections we're going to pay $35,000 and anything offer that you pay for in real terms the way reference based pricing to used with planned designs organizations design and determine conditions that are appropriate for pricing and falls that can deliver the quality and care at a price point and they draw people there by essentially doing reserve deduct we pay it up front if you go outside the network you deal with that probably a really good example i apologize i did not bring the article but david the chief of the center at cal hearst recently pushed information they found dealing with their data warehouses they've identified the cost drivers and focused on where there's regional variations they if you do with arthritis knees and hips was 1/3rd the cost in that category over a period of 2005 to today it went up 39 percent they determined that knee and hip replacements were a good type of program for reference based pricing why? because there's great variation in the marketplace with similar outcomes okay procedure can be ske

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