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SFGTV Health Service Board 21116 March 4, 2016

Commissioner breslin supervisor farrell commissioner ferrigno commissioner follansbee commissioner sass excused we have quorum. Thank you. Well take action item one item one approval and possible modifications of the minutes. Thank you item one action item approval with the minutes so forth the regular meeting the january 14, 2016. Are there any edits, amendments are comments to the minutes. Im trying to get open. I understand ill ask those of you who are new in the audience from the last minute we have new Technology Something called an i pad not on ipod and all of us have gone through training and the consultant with the city has been with us and we all have to take a manner to be patient. It is page 7. Page 7. I think the gentleman responded a twopart question whether or not the forms im still not there were available electronically you said no, i think thats my understanding include the answers towards the bottom of page ....

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SFGTV November 17, 2014

Of the overall population would not really matter. I just wanted to make that clear. You need to identify yourself. This is ann fulton with hewitt. Claim audit process. This is a review again from what we reviewed during our audit process. There were questions in our out of sample claim. This is an example, an emergency room claim if we identified an error in subsequent xray claim, that would be considered out of sample. We had a question on why we stratify our sample, the size really impacts the claim process egg processes utilized. The large claims have more control in place. You have administrators doing predisbursement audit and doing claim reveals and medical necessity reviews. The lower dollars are automated with the processes. We find that the side of the claim there are different characteristics as a result of the size of the claim. So we felt like we needed to break out and look at payment thresholds. That is why we needed to stratify the different claims in processing and we ....

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SFGTV November 13, 2014

Score. If you have a diabetic on the outpatient setting. They are totally counted. If you have a diabetic who is not managed well and goes into hospital you give them a higher risk score because i hate to say sounds like what you are rewarding is poor medical management. If you have a chronic diabetic that comes to the hospital, they come up as a higher score in the concurrent risk score because they went to the hospital. But if they do not end to the hospital on a concurrent basis and they are managed because they are not going to the hospital it lowers the risk point. Thats all im pointing out. Its very important for the audience to understand that if you have two people that are identical being treated in two medical systems and one is getting care that avoids hospitalization they will have a lower risk score. It does not mean in fact that they are less risky and of a less of a diagnosis. We should not read into these scores at least the way you are doing it, a definitive believe to ....

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SFGTV November 13, 2014

5061 for adjustment and recovery and are pending reimbursement. Is any of this provided to us in writing . Yes. Its included in ann hewitts report. Its not in the analysis what you told us in terms of how many claims and the dollar values. Is that included somewhere in it is. Its included in the last column in the tables pages 1112 estimated Group Financial impact. Its the column. And the na is because you have determined its annoy a systemic error. Thats right. Its an error that we did not agree with or an error due to process or which was not systemic repeatable. I just want to make clear if you disagreed you did not do a Financial Analysis even though our auditors continue to disagree with you. You just said is we dont agree and we are not going to show you the numbers. Correct. If we did not agree, we did not run a corrective analysis. We appreciate your opinion on t ....

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SFGTV November 15, 2014

Year, i had a cancer diagnosis, diabetes diagnosis and rb diagnosis. Those are the three diagnosis that were made at the hospital. Your point commissioner is we are not looking at the people who are well managed are and im saying, im repeating your point because we will revisit this issue with red request from the vendors that having a low risk score that you didnt get sent to the hospital. That was well said. That is precisely my point about context and application in this particular case and it needs to be a part of this if we are going to have this discussion annually, then we need to frame kind of why we are doing it, what it is and what the result is because that doesnt communicate year to year. Well walk out here today and i can guarantee you no member of the public or most of this commission will remember exactly what we said on this topic. So we need to talk about points of continuity. Im not talking about the result, im talking about the presentation in this particular case. O ....

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