>> can you touch an one one of the things going on a while but pa focus has been to bring in part time recruiters we can't pull off every officer but have part time focus think not just women before you noting any other communities not thought about mrfrlz but question target areas like to point out (captioning is ending at this point due to the time limit provided for captioning)

next item, please. >> the next item is general public comment. this is opportunity to comment on any matter within the board's jurisdiction not on the agenda including requesting the board place a item on future agenda. we'll display the instructions on the screen and anyone can wait for any in-person public comment. i know there is a longer set of instructions so we'll wait

momentarily. i'm seeing we quite a bit of online participation, so i'll-with your acceptance, be able to move through in person and then i can read the fuller description. >> absolutely. >> we can anyone who is ready to do public comment, feel free to step to the podium. >> dennis krueger, active retired firefighter. good afternoon commissioners. director yants. after last week or last month discussion about dental care, i spent a little time just thinking about different things and what i came up, i went through a 3 year period where i had my teeth cleaned twice a year and

that was it. in those years delta dental rolled over my $1200 dental care into profit. i was thinking, is there a way that they can roll over that benefit till the next year. i know this is unheard of, but when you see $1200 disappear of dental care simply because you didn't neat it, and the next year when you need $3,000 worth of dental care, you have $1200. so, for a sake of discussion and before this board, i like to put that out there as a idea to be discussed at a later time and maybe through this other ideas will come up and we can strengthen our dental plan. and then on a sadder note, i personally will truly miss commissioner

scott. >> thank you. >> fred sanchez, protect our benefits. commissioner scott is devastating news. he was always approachable. he was professional. he had the institutional knowledge that cannot be replaced. the search for his replacement is going to be extremely dif ficult, but we are all saddened because he was extremely fair and just charismatic wonderful-person. thank you. >> i'll read the instructions for those waiting online. remote viewing is available on sfgovtv and online using webex. the board welcomes public participation.

there will be a opportunity for the general public to comment at the beginning of the meeting and opportunity to comment on each item. in person is first then virtual. anyone in person you are welcome to approach the podium now. we have-can come back if anyone wants to join in person. each speaker is allowed three minutes to comment unless the board president deems new time limits. all public comment is made concern thg item presenting. a caller may ask questions. the health service board will hear up to 30 minutes of remote public comment total for each item. remote public comment for those receiving accommodation due to disability will not count towards the 30 minute limit. call in by dialing 415-655-0001, access code 26613094155. then press pound.

you will enter the webinar password, 1145 and pound. press star 3 and you will hear the prompt-when your line is unmuted this is your time to speak. you will be muted when your time expired. those on webex click on the raise hand icon. a raise hand is in the corner next to your name. when your are unmuted a request to unmute will appear on your screen. select unmute to speak. once your hear welcome caller, you can begin speaking. when your time is expired you will be muted. please click on the raise hand icon to lower your hand. members of the public are encouraged to state their name clearly but may remain anonymous. i will give a warning when 30 seconds are remaining. thank you to sfgovtv and media service sharing the meeting with the public. we'll move to the moderator to see there are callers in the queue

at this time. >> [indiscernible] one caller entered the queue at this time. i will endicate when there no more callers in the queue and you will hear a brief silence. >> welcome caller. >> [unable to hear speaker due to quality of audio] he will be difficult to replace, and i hope this commission [audio cutting in and out] >> thank you caller.

moderator, please let us know if there are callers in the queue at this time. >> board secretary, no other callers entering the queue at this time. >> thank you moderator. public comment is now closed. >> thank you. next agenda item, please. >> item 4, approval with possible modifications of the minutes of the meeting set forth below. this is action item and will be presented by vice president hao. >> thank you. colleagues, do you have any questions or comments on the minutes? motion to approve. y >> move to approve the minutes. >> second. >> properly moved and seconded and we'll take public comment. >> thank you. i'll read the instructions allowed.

[providing instructions for public comment which are displayed on the screen] >> thank you board secretary. a reminder to all callers on the line, [indiscernible] you must press star 3 again to lower your hand. we have one caller in the queue who's hand remained raise d. there are other other additional callers in the queue. >> thank you moderator. i'll unmute in case the caller would like to add to this item.

welcome caller. hearing no response, i'll mute and with that, public comment is closed. >> thank you. next item. >> 5, president's report. this is discussion item and will be presented by vice president hao. >> thank you. i have one item for my report today, and that is our fair well and thanks to commissioner breslin for her long-term service to this board, and am-if you indulge me i'll read a resolution from the health service board. whereas, karen breslin elected to health service system in 2001 served consecutive 5 year terms until may 2024-that is a long time. whereas, commissioner breslin provided remarkable leadership to the health service bord and health service

system when assuming roles as the health service board president and chair of several committees, and whereas, commissioner breslin demanded budget support and member health benefits through dot com session of 2001, the great recession of 2008, the great resingilation of 2021 and covid pandemic and recovery era. and whereas, commissioner breslin strove to croul out of pocket expenses for all members maintaining and improving the overall quality of the member benefits, whereas, commissioner breslin tirelessly helped to pass two charter amendments that helped the health service system improve member benefits, propositions e and c. commissioner breslin continually advocated for benefits to support healthy lifestipe habitat and preventativedantal care and

whereas, commissioner breslin upheld her fiduciary responsibility to the health service trust fund and requested regular education for new board members and whereas, commissioner breslin demonstrated the value of persistence by demanding improvement indantal care aumgz and member education, and whereas, to that end, commissioner breslin recently urged contract agreements for member benefits to include access to the university california san francisco health system and whereas, karen breslin served the city and countsy y of san francisco as a employee of 27 years with the san francisco adult probation department and the health service board for 23 years. be resolved the health service board extends a profound thank you and appreciation to commissioner breslin for her devotion to the health service system and members and the health

service board along with the staff wish commissioner breslin much enjoyment and relaxation in her full retirement. >> thank you. thank you. i want to thank all the holly and everybody who has been so helpful. ray, call him up soon and it is done. the members, i could always rely on the members for that so we have excellent people to work with here and it makes the job easier. can't believe i have been on this board 23 years either. [laughter] i'm not that old. [laughter] yes, so it has been a quite run and quite a different thingz i have seen throughout these years, and it is nice to have abbie as our director and our board has changed continually throughout the years, so

everything all the time and commissioner follasbee has always been great. we are missing a few other people today, so--but thank you all the help you have always given me. appreciate it. >> thank you commissioner breslin. you were president when i first started and i was always very impressed with theficient ways you ran the meeting and the clear direction you gave to staff making sure our members were taken care of, so thank you. thank you for your diligence and looking after the system. >> i always try to remember my fiduciary duty. that is one thing a board member should always remember. >> absolutely. >> i'm going to read this now here. trustees are fiduciary of a trust in the concept is not well

understood. trustees don't have constituents in the normal sense of the work, they have beneficiaries. tustees but the population as highest priority. they must act for the sole benefit of their beneficiaries. i would like any new board members to-- and our director of course. fiduciary as well. thank you. >> can i comment? >> of course. >> i promised karen i wouldn't-i will get tearful over this as well. i have been on the board 9 years and i say, the resolution essentially-i'm always pleased when a resolution covers everything i know about the resolution and there is no stranger and

that resolution clearly covers all the strengths. we are a better board because of your tireless effort and always impressed the members enrollees felt so comfortable with you and reached out to you and constant participation so i want tothank you personally as well as from the president of the board, system and membership for your tireless services and thank you very much and sorry to see you go. >> thank you. >> karen, you taught me a ton since i started. starting in the interview i believe you were asking questions that challenged me quite significantly and some continue to challenge me quite significantly, but yeah, you have been

my gauge really on how well our team is preparing materials to come before the board. you read every word. you do your homework. you talk to other people. you really function high functioning representative of the members,x and i think it presents us with appropriate challenges that we are always striving to achieve and i tell the team that our job is to provide the board members with as much information as possible to make these awesome decisions that you are required to make. i do appreciate all the coaching and advising, debating that we have been able to do over the years to bring those products to you in a form in which you can support. that is our task and i think you have done a great job working with me personally as well as our team and you acknowledged member service and

we had great leadership there and continue to to and i think that is a very important function of our department is really serving the members directly on a daily basis. i appreciate your support. thank you. >> thank you. by the way, i have a charter of the city and county of san francisco from 1951. [laughter] at that time there were 9 members of the board of our board, so i'm leaving this with abbie's care. i think rin would really appreciate it. i was thinking about you. rin and i go back a long ways. when i first started even.

maybe not. >> sorry to interrupt but do we vote on item 4 or did i skip that or did i sleep through that? >> i am notorious for not voting so so sorry. >> i'm sorry, not being able to catch that so thank you commissioner follasbee. >> thank you. >> we can go back and vote on that. let's vote on the approval of the minutes. >> not listed on the agenda, a resolution can also have a motion for the board to have as a resolution before the whole board of karen breslin's service. which ever you like first. >> let's go back to number 4 first. >> okay. motion for the minutes? moved by supervisor dorsey and seconded by follasbee and now we'll take a vote. vice president hao, aye.

commissioner breslin, aye. supervisor dorsey, aye. commissioner follasbee, aye. with that, passes. >> thank you. now back to the normal programming. >> happy to make a motion to recognize resolution recognizing karen breslin for her long-time services on this board. >> i second that. >> moved and seconded and we'll have public comment, please. >> public comment is open. instructions are displayed on the screen those watching on webex and sfgovtv. [providing instructions for public comment which are displayed oen the screen] we'll begin with in person public comment. >> yes, first i like to start

by thanking chris canning for his service. i understand he is having a nice vacation, well deserved but i wanted to thank him for his service and karen breslin, there is a reason why she was elected for 21 years. she fully understood that she represented the membership. she was such a strong advocate always, so reelection was not an if, it was assured it would happen. her advocase for the early retirees was unyielding. she constantly tried because who speaks for them? they are kind of caught in between the active unions don't represent them. maybe early retire city county of san francisco, we try to, but it is just--they get a huge rate increase all the time and didn't matter, she was going to fight, fight, fight and she

understood her fiduciary responsibility. i know all of you understand that, but i mean, the last thing she talked about was fiduciary responsibilities. the good thing is, karen breslin isn't going anywhere. she will continue to council me constantly. i'll get the phone calls. what about this and what about that so karen breslin's presence will never leave these chamber s. thank you for all your help. >> thank you. >> with that, we'll move--excuse me. next-- >> hello karen. it has been a long time. i had the pleasure working with you and when i served here in 2013 i guess and 2018. that was the one term i served here. i had the pleasure working with you as well as working with randolph

scott. it was a very active time. i'm sure every year you worked here was a active time, but that was a particularly fun period. we worked together to bring abbie yant in as the director of hsh. we formed a panel to evaluate all the candidates and i think we made a excellent decision as we usually do as we all most always do, but it was really a pleasure working with you as well as all the other commissioners here and i just wanted to thank you for your service. >> thank you. remember rate relativety came up when you were here? >> excuse me. >> rate relativity. >> yes, rate relativity. [laughter] i think the united healthcare

contract was first entered in that period of time. very similar what we are looking at now with another possible change, but that was actually at the time i remember being fairly controversial and i think it was a tremendous amount of comment from the members and a lot of worry and concern about change, but it went quite well. it went very well. >> we were no longer eligible for the city plan and they started dividing people up. >> right. >> thanks again and i'm sure we will be hearing from you. i'm absolutely positive that. it is not good bye, but it is thanks for all your service. >> thank you. >> with that, we'll move to

virtual public comment. our moderator will notify of callers in the public comment queue at this time. >> we have 6 callers on the queue. zero callers entering the public comment queue. we have one caller who hand is still raised from the first round. just wanting to mention that. >> thank you moderator. we'll move to our next item and the caller can raise or lower their hand at that point. thank you. with that, public comment is now closed. >> thank you. now we'll take roll call vote on adopting the resolution. >> roll call vote, vice president hao, aye. commissioner breslin, aye. supervisor dorsey, aye. commissioner follasbee, aye. >> can i ask a question? >> yes. >> how many years did you say i was at adult probation? >> let's get this correct.

27. no! >> 22. >> 22. okay. >> i thought maybe i heard that wrong. >> it will be noted in the resolution. >> yes. >> the resolution to honor karen passed. please join me in thanking her for her service. [applause] >> next item, please. >> item 6, the director's report. this is discussion item and will be presented by abbie yant, executive director. >> good afternoon commissioners. >> just before we start,b i have gotten a note from the support team we

want to make sure all our mics-we are speaking closer to them. i adjusted the volume, but as a caution. >> can you hear me now? great. i do want to begin my director's remarks, again honoring health service board president randy scott. it is a heavy heart i share the sad news of health service board president randy scott. born april 7, 1944 and passed away april 17, 2024. servedoon the health service board from 2013 to 2024 and was appointed by ben rosenfield former controller. a rentless champion for health service system and members and deep lee saddened to lose our health

servers board president his spirit and kindless left a mark and will ender. for more information on forthcoming recognitions honor and services, please let holly know low the health-sfgov.org e-mail. as we know of events or opportunities to honor randy we will let you know. i will tell you, at this point we have not yet heard from the family what they plans are so we are respecting them to take the lead and so, it is as we several have already mentioned, it was a sudden occurrence and i think we are all a little still-i personally am still stunned that we lost him, but we are moving forward and that's what we

would want. he would want the show to go on, so here to do that. moving down my director's report, i do sit on the california department of healthcare access and information committee on healthcare affordability. i did announce the state announced that they have approved the target spending cap to be i think a graduated cap, from 3.5 to 3.25 to 3 over the three years of projected work. the base year will be 2025 and then the cap will be applied to the expenditures in the following three years. it is a long arduous process. how it will show up in our numbers, we haven't even had that

discussion yet, and as we begin to understand some of the details and implementation of these policies, we will bring--i think we'll need to do extensive education to the board and ourselves how that will work. the enable legislation has a lot of legs to it, including advancing primary care, integrated behavioral health, workforce issues and on and on and on. so, there is a lot of change coming down the pike and will impact us. how, when and where i can't say at this point, but we'll educate ourselves and the board as this rolls forward. i come back in a moment to talk about mental health awareness month. i do want to acknowledge two new staff members that are here today. if you wouldn't mind standing.

elizabeth lee and maricela sistos. welcome. i think we have a full complement of member services on our team. no? one more. one opening right now and that's a tribute to ray and the team for going through all the work to find and hire and train new staff, but it will position us nicely for open enrollment in the fall. the health service board election for two open seats is underway. i talked to severals who received their ballot. i have not. >> i got mine. >> you got yours, okay. vote early and often as they say in chicago. [laughter] that will be coming up shortly.

the dependent eligible verification audit is going along well. the team is continuing to learn how to do this in the most effective and efficient way possible, and we'll report out on those results as we come to a close. the staff did have a all staff retreat two weeks ago. seems so long ago. it was delightful. we went to county building next to the botanical garden jz we were able to enjoy forest bathing as they call it. it is therapeutic intervention for stress is spend time in nature, so we were practicing what we preach. and so with that, i want to recognize that it is mental health awareness

month. carrie beshears and team put together a lot of activities promoting mental health awareness and the highlight that activity is a video that was produced that was previewed among all city department heads last month with a lot of enthusiasm from the audience. they really thought the message resonated well with them so i like to take a moment. they are very short videos to air them. >> does anxiety impact-- does anxiety impacktd your wellbeing. >> are you consistently tired or experiencing low energy? >> feeling angier or more irritated them normal? >> have you thought of reaching out for help but haven't done it? it is okay to ask for help.

>> sometimes help can't wait. >> call the employee assistance program. >> don't wait, we are here for you. >> thoot that is first of two videos directed towards the first responders with the leadership of those departments participating. >> are you feeling overwhelmed at work or in your personal life? >> does an zitee impact your wellbeing? >> have you thought of reaching out for help, but haven't done it? >> are you finding it hard to cope? >> it is okay not to be okay. sometimes help can't wait. >> many people want to support you during this difficult time. >> we are here for you. reach out before you're in crisis. >> call the employee assistance program. >> don't wait. >> call eap.

>> dont wait. >> thank you. i think they are really fantastic videos. i misspoke. the second one was the first responders and the others--the eagerness of the department heads to be a part of the video was quite evident. we had no trouble filling the spots, so i think it shows a city wide commitment to encouraging people to use our many health benefits and programs the well being service provides to support their mental wellbeing. the last thing i like to acknowledge is the contract's team that worked diligently forward to bring forward the staff recommendation on the result of the rfp we are not going to discuss today, but i do want to

acknowledge the team in the room, because it has been a extraordinary lift and i know they are all very tired and ready to take a break, so i just wanted to publicly acknowledge the efforts that has gone on and we'll more about the specifics of the results that at a later date. i think that's all i have to report. any questions from the board? >> we want to welcome elizabeth and macela to the health service system. welcome to the team. we hope you enjoy a long fruitful career here. if no questions--question. >> thank you very much. i want to applaud you and human resources on the decreasing vacancy rate. i think it is fabulous and sure not only for membership but also for morale of the existing staff who have

been heroic trying to keep up with demands with so many positions unfilled and all that and i think they deserve a lot of credit as well. i am glad there was a retreat and sure it was successful as you pointed out. i want to also congratulate on the dependent eligibility verification audit. i remember how stressful it was the first time this rolled out a few years ago and i guess the fact there are over 10 percent of the 2100 audits revealed individuals depenedancy reviews and revised shows the success and need to do this. i think we all support the efforts going on. congratulate you and staff on this project. you have a vendor working with you as well and thank all you for that.

i think we-i have a question about the 2024 election. number one, i got my ballot in the mail and congratulate all three the candidates. they will have big shoes to fill, both for chris and for karen, and but their statements were quite inspiring. basically highlighting the concern about the quality of the services we continue to deliver and i appreciate that and wish them all the best and urge everyone to vote. i put mine in the mail. lastly, it does bring up the issue we found a tsunami of unfortunate events this month and i know it is driven by the charter and by periods of--i hope that hss and the board can come up with a way maybe to review this. you like to think the tsunami only happens once in the loss of village or board, but this has been pretty

devastating in terms of the ability to carry on the business of the board, because this postponing scheduling meetings and canceling them, scheduling agendas which we review and canceling it, because we can't get adequate representation from the board and feel this doesn't do the membership service to have this interruption and hopefully we can address that as a board and as a health service system for future consideration. >> i want to respond to one comment. we are not using a outsideveneder. this is institutional the practice and olga and her team have done a marvelous job. >> misunderstood. thank you. >> i think it is the right thing to do, just to find a way to embed it in our

usual practice, so there has been a lot of learning on how to do that and so, we are very grateful to have that efforts underway and i couldn't agree more to really look at the rules we have for the board. we have to look at all the rules for the board and how succession occurs and then the decisions about succession planning for the board i think is one that we can have in the near future. >> thank you for the correction. i really wanted to make a comment about randy scott as well. again, i think not enough adjectives in the dictionary to describe his strengths. but i would hope that his guidance and counseling and advice honesty

and stewardship has made be a better commissioner. i know it made the board a better board and thank him and send condolences to his wife who depended on him for her health needs. his large group of friends in his communities and want to again say how much we miss him. >> i could just add on to that. i like to also just express my condolences to randy scott's family and to those who knew him. i'm relatively new to this board, but i recognized him as somebody who just had a great and admirable temperament to lead a meeting and a board. it is something where i want to as a member of the board of supervisor do in memoriam to him and we are trying to reach out to his family. i want to differ to their wishes, but if there are stories or anyone

feels would be appropriate to mention in in memoriam before the board of supervisors, please feel free to e-mail me at matt.dorsey@sfgov.org and we can do that and adjourn as we do often for people we have lost who have done extraordinary work to serve our city. >> thank you. with that, we'll open up for public comment. >> public comment is now open. instructions are displayed on the screen. [providing instructions which are displayed on the screen] we'll begin with in person public comment. no one approached the podium. move to the remote public comment and the moderator will notify of

any callers in the public comment queue at this time. >> board secretary, we have 7 callers on the phone line. zero additional callers have entered the public comment queue aside from the hand that remains raised from the first round. >> thank you. public comment is now closed. >> thank you. next item, please. >> item 7, sfhss financial report as of march 31, 2024. this is discussion item and will be presented by iftikhar hussain, sfhss chief financial officer. >> good afternoon. >> good afternoon. adjust the mic. yes, the financial's are pretty consistent with the message and patterns and trends of last month. we expect the fund, the healthcare benefit trust drop by $12

million by the end of the year and that is really because we had stabilization and litigation built if to the rate we lowered for the current year. it is drawing down the balance. the claim experience over all is negative $6 million made up of higher medical claims then expected. dental claims are $2 million lower, but they are higher then our experience last year. the pharmacy rebates, 11.7 so far. we expect end of year about $16 million so pretty favorable. healthcare sustainability trust we are expecting growth of 1.4 million dr. because we had credits

reimbursement credits built in coming in this year related to expenses incurred in prior years. the general fund is ahead of plan and we are covering our mid-year commitments to the mayor for the budget cuts that they had targeted. the general reason for the [indiscernible] is vacancies that we gradually filled. the audit for the medical trust has started. we had preliminary meetings with there auditors and some of the board members i think are also scheduled to meet with the auditors, so that went well last year and hope to keep it up this year. the controller audit is in process, a annual process, process and procedures and we learn from their fiendings, so that is in process. happy to answer any questions on the financial's.

>> i have no questions accept that, it seems you are always under a audit. seems we are always under a audit. didn't we just finish mgo and starting one again? thank you. >> i'm not clear. dental claims are higher then prior year but lower then planned? >> yes. so, we-in the rate setting process, we do a projection of what the dental claims will be, and so that projection was higher then the experience last year, because we knew the utilization was low last year. even though we saw increase in utilization from prior year, it wasn't as high as we were hoping it would be, if that makes sense. >> thank you. >> any other questions or comments from the commissioners?

if not, we'll take public comment. >> [public comment is open and instructions are displayed on the screen] we'll begin with in-person public comment and no one approached the podium and move to remote and the moderator will notify of any callers in the queue. >> 7 callers on the line, zero callers entered the queue. >> thank you. public comment is now closed. >> thank you and thank you for your report. next agenda item, please. >> item number ath, the presentation of the 2024 rates and benefits calendar for the plan year 2025. this discussion item and will be

presented by executive director abbie yant. >> could i ask a question? why did we continue staff recommendation for request for proposal for medicare the next time? >> so, dr. follasbee asked a similar question earlier to have a fuller complement of the board present. i think at the june meeting we anticipate there will be 5 members of the board present i believe because we will be seating 2 newly elected members as well as mr. sass upon his appointment. go ahead executive director yant. >> sorry. trying to pull it up on the computer. the rates and benefit you have in the packet i pleev the significant change that can be noted is the may 23

meeting that we had intended to schedule cannot occur because we do not have quorum. that meeting is now canceled. the next regular meeting is june 13. given some of the circumstances, the structure or board is experiencing we may have to call a special meeting and announce 10 days prior as required. it is currently we don't have anything specific in mind, but it is something that we will need to consider i'm sure. >> could you give us what the window might be? >> our constraints are getting rates and benefit package delivered to supervisor dorsey to introduce to the board and i think we have until the third or fourth week in june to complete business to get it over there, so we do have real constraints this will not go on and on. it can't. we'll get it figured out.

>> but won't be on the 14th? we have [indiscernible] june 14th and is that still-- >> i don't think so. >> okay. it is on the calendar. >> yeah. to tell you the truth i haven't looked at the calendar this year, because things are so fluid and keep changing, but it still stands . we will have to poll the membership of inboard to make a selection so you will be involved in the decision making process. >> great. thank you so much. we'll take public comment please. >> public comment is open. [providing instructions for public comment which are displayed on the screen]

we'll begin with in person public comment and no one approached the podium and move to remote public comment and the moderator will notify of callers in the queue at this time. >> madam secretary there are 7 callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. item 10, please. >> item 10, health plan 2025 medical rx plans rates summary active employees and early retirees. this is discussion item and will be presented by mike clarke with aon. >> good afternoon commissioners and before i start on behalf of the entire health plan and community that servicess sfhss and health service board, commissioner breslin, congratulations on your long

service with this board. i think we can all say in the health plan partner community, your tireless work of the board, your advocacy made us all better in what we do to serve sfhss, the service board and the members, so congratulations on an outstanding board career and everything that you have coming forward next. >> thank you. >> with that, mike clarke, aon. we have several non medicare so active employee and early retiree recommendation that will go through. this is discussion item to bring a summary of what i will present with each individual health plan rate recommendation for 2025 after. as you can see, on page 2, we have again, most plans we are presenting

today, the kaiser hmo will be presented the june 13 meeting. when we look at the plan experience and if you go back to march when we talked through the 2023 plan experience for each of these plans, generally speaking, seeing at or below expectations relative to national trends. you'll see a little higher increases on the access plus and trio plans more, because of the impact of stabilization buy up, so that's why you'll see the higher increase after rate stabilization adjustment. the other funomnomhappening is there were significant dollars available through the sutter legal settlement for there 2024 plan year rating, so $15 million was able to be used as a buy down for the blue shield access

plus trio plan. there are still dollars left as presented and approved in the march meeting but only about $2 million. while it has been a benefit overall to rates in 2024 and 2025 with the sutter legal settlement dollars, the fact it is much less this year brings the upward pressure on some of there rates from before to after rate stabilization. and then going on page 3, more information on the blue shield hmo which includes the epo available for the non medicare split family lives. plan experience improved for 2023 relative to high claim year 2022. the headwinds with the sutter legal settlement buy down and stabilization action because we are still comparing 23 experience to 23 rates and 23 rate increases were very low for

these plans. there is a recommended shift on the blue shield large claim pooling level that we think will create savings overall to these plans and we'll discuss that in that particular presentation later today. health net canopy care continues to operate well from a financial standpoint, which we reviewed in march with the 2023 experience and then increase in the stabilization buy down helps create the slight reduction in rates that i will present next, and then for the non medicare ppo, 1.3 percent we saw favorable experience for 2023, and much that is due--we observed infusion of active employees in the ppo plan so retiree numbers stayed about the same, but more active employees in the plan it helped the overall risk profile of the ppo environment. on page 5 you can see the

membership distribution by plan. kaiser has the vast majority of the lives on the active employee side and half the lives on the early retiree side, fallowed by the blue shield hmo along with uhc split. and ppo plan as well. health net is gained enrollment over time, but still remains the lowest of the plans. and then, page 6 is just a exhibit, so perhaps you keep it available as we go through if you look to compare from plan to plan, but page 6 shows the projected monthly rates for 2025 where again i'll take you through everything accept kaiser today and the final page of the document is the comparison what is in place for today for the 2024 plan year. vise president hao. >> thank you. colleagues, any questions or comments?

>> once again, my regular comment. early retirees with any dependents with say two dependents is like $21 thousand all most a year. that becomes really unaffordable. blue shield islife that is less then the ppo plan, which was never used to be true. i dont know how that happens now that the ppo plan is cheaper. >> [indiscernible] >> sorry. the ppo plan is even cheaper then the regular blue shield access plus. once again, blue shield dominates the group here, so when is the last time we went out for a rfp for this group? >> 2020. >> that is about due next year. is it every three years?

>> we are learning as we go what the proper cadence might be, because there hadn't been a rfp on that product at all for i don't can know how many years. we'll figure it out. >> [indiscernible] >> somewhere in that three to five year range. >> yeah. >> we have to consider the whole book of business and-- >> blue shield taking over the retirees, medicare retirees as well. pretty soon you have nothing but blue shield--there isn't competition. >> the market consolidating the national level. >> i know. >> and so, that's part of the issue. healthcare consolidation, vertical and horizontal integration driving up the cost of healthcare everywhere. agreed. >> how about negotiations? are they drilling down on all the

charges? >> yes. yes. particularly the self-funded. we have visibility to those as well. >> when we do the blue shield hmo presentation, part of the discussion is adjusting the large claim pooling fee because i thought it was too high,b $1 million risk for value of the coverage so we were able to work with blue shield to evaluate alternative and part of the recommendation is that move to million 250 thousand dollars to lower the fee for the large claim pooling, and we think the fee reduction will more then off-set any additional claims and have to be paid for someone between a million and million 250 thon, so that is one area where we evaluated how can we deliver a projected lower cost just by changing insurance

mechanism on the large claim pooling. >> didn't reduce the retiree fee much. last year it went up $200, this year $134. per month. that's a lot of money for early retirees which sometimes does not make-don't always make these huge salaries. i think we need more competition, more choices. >> we added health net canopy care in the rfp in 2020, so we did add choices at that point and that plan is growing slowly, but growing. >> very slowly. >> thank you. any other questions or comments? let s take public comment, please. >> public comment is open.

[providing instructions for public comment displayed on the screen] we'll begin with in person public comment. no one approached the podium so move to our virtual public comment and our moderator will notify of any callers in the public comment queue at this time. >> board secretary, we have 7 callers on the line, zero callers entering the queue. >> thank you moderator. public comment is now closed. >> thank you. next agenda item, please. >> item number 11, review and approve the health net canopy care medical rx flex-funded non-medicare hmo plan 2025 rates and contributions. this action item and presented

by mike clarke. >> mike clarke, aon. each of these documents you'll see there is an introductory section that is pretty similar document to document just describing the different methods of health plan funding or in this case for instance, the health net canopy care is flex funded so combination of insured and self-funded elements. how the rate setting process occurs, which is essentially comparing projected total 2025 cost to rates and enrollment for 24 to determine the needed change percentage wise. page 6 shows our similar chart to what we just reviewed with the overall increases and then how that imp pacts the total rates on page 7 for all the plans. in terms of how total cost

distributed between the employer and members for most city county san francisco employees,ic it is all based on mou. the predominant or the 93-93-83 which is percentage of cost paid by the city and the other is the 196.83 for each of the tiers, there are varying strategies for school district, city college, court employees, and then for early retirees on page 9, the elements that make up the city charter defined contributions for employees is carried here based on the 10 county amount is a baseline, then the second element is the difference in the total rate between the early retiree only and active retiree only, which we labeled actual difference and then anything left over, half of which is the

contribution from the city as well. this is just a primer on how the underwriting process happens and distribution of the total cost by employer and members. this information is in every document. i wont go through that for the next two but just to reference that. page 11 for health net canopy care, the recommendation is for 1 percent decrease in the health net canopy care hmo plan rates from 2024 to 2025. going to page 13, the figures for health net canopy care are essentially then like i said, distributed active and early retiree rate cards and on page 14, seeing the added elements that come into those rate cards so the medical and pharmacy cost component

includes mostly capitation for the medical services, which is the canopy care model. plus pharmacy claims. and then the portion of medical that is also claims primarily behavioral health, the fees for the plan and then the basic vision premiums added in and then few meetings ago the approval to move the healthcare sustainability fund charge to $4 per employee and retiree per month and the rate stabilization buy down approved in april of $332 thousand played in. in termoffs the overall medical and prescription drug cost as you see on page 15, health net is projecting the same level of projected plan cost on a per member basis as occurred in 2024. certainly there are elements increasing faster. there is decrease elements to

that. for instance, the professional institutional and chiropractic capitation charges which include facility charges are projected to decrease about 6 percent, with the 2025 projections. that helps keep the renewal lower. there are some elements that are little higher in the renewal, such as the increase in fee for service claims which again is mostly behavioral health,ic and added demand for behavioral health service. pharmacy claims going up and see predominantly through all the presentations and we talked about that in march and administrative fees increasing as well. overall, the good news is no change in total projected cost, which is facilitating the ability to have rate cards with rates that actually decrease from 2024 to 2025. looking ahead to page 18,

you'll see about 1 percent reduction across the board for the total rates. the monthly employer contributions and the total rates, as a result of this proposed rating action. the 93-93-83 for the active is on page 18, $196.83 page 19 and early retirees on the right side and then the rate cards where you see the factors that build up to the total rates and distribution of the employer contributions starting on page 20 and cascadeed to page 21. with that, i'll close on page 23. with the staff recommendation that the service board approve the 2025 health net canopy care hmo rate cards.

vice president hao. >> thank you mike. colleagues, any questions for mike on this presentation? i have a question. certainly we welcome the rate decrease, that is always good news, but i guess my brain finds counter intuitive the capitation fee would go down, so under what circumstance would that decrease? >> i think-if you think about it the plan was first implemented in 2022, so the first renewal that canopy care really had information for on what was transpiring with the membership composition, membership experience was for last year's renewal so 2024. as we stood here for the 2024 plan year and what has been happening is growth in the plan continues to change the demographic make-up of the members in

the plan, and some that is also due to the relatively smaller size of the population is creating those dynamics where capitation is decreasing, but i view it as somewhat a function of how the plan is managing those costs, but also more a function of the just evolving population as more and more members elect the plan. >> okay. alright. thank you. >> that was a great question because i had the same issue, particularly since the fee for service claims have a 38 percent increase. is this--looking into the future, is this capitation number something that we can sort of not optimistically hope for in the future? is this a one time hit and then we see rate increases after this? pharmacy went up as well.

i was struck by the total projected plan cost was the same to the penny, and that was quite a coincidence or suggest some of this is encouraging, but i'm confused. >> i certainly questioned that as well, because actuaryies think we can project the future, projecting that way is near impossible. i couple things happening here. the capitation amount itself started very high initially because i think there was-health net during the rfp modeled the population as if it were the average sfhss population. average active employee and early retireeing and i think early on because of low enrollment itteneded to be individuals who were healthier, lower risk and certainly rin

will talk through risk scores for the first time with canopy care during the presentation later today. so, we have seen fluctuation in the capitation number over the first couple renewals. it did go up in 2024, but i think it was lower then 2022. my opinion is, i don't expect to see the level of demographic shift in aggregate now in future renewals now canopy gained a foot-hold, so i think the capitation element will be more stable going forward year to year. certainly the 15 percent increase on the pharmacy is concerning, but i think we are also in that environment where 12-14 percent seems to be the trend norm at the present. a lot of driven by glp1 increases and then i think the claim piece of this--when you break it down of

a lot of it attributed to elevated levels of mental healthcare delivery and mental health outside the capitation environment within the claim environment so i view that as more a function of the added services delivered to members, more so then any cost concern. the administrative fees certainly went up higher then we like to see them. percent increase in administrative fees coming outs of what proposed in the rfp and that was strictly a function of had lower enrollment then originally thought, even with increases that have occurred since the plan has been in place, so all most 2 and a half years , still lower, so they felt they needed to do adjusting of the administrative fees to represent the level of participation relative to what may have been anticipated as higher levels of participation by this time from

the rfp. this was the first renewal coming outside that initial three year lock-in from the rfp. >> i would like to move that we accept the staff recommendation and approve the 2025 health net canopy care hmo rate cards as presented. >> second. >> properly moved and seconded. we'll have public comment now please. >> [providing instructions for public comment which is displayed on the screen] we'll begin with in person public comment. no one approached the podium. move to remote public comment and the moderator will notify of any callers in the queue. >> board secretary, we have 7

callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. unless we have other questions or comments, we'll take a roll call vote. >> roll call vote starting with vice president hao, aye. breslin, aye. dorsey, aye. follasbee, aye. >> alright. it passes unanimously. i think now is a great time for a break before we launch into the blew blue shield portion so let us take a 15 minute break. i think commissioner scott would insist on at least 15, and so we'll see you back here at 2:40. [15 minute recess]

[meeting reconvened] [roll call] we have quorum. >> alright. next item, please. >> item 12, review and approve non medicare blue shield of california flex-funded hmo and united healthcare self-funded epo medical rx plans for 2025 rates and contributions. >> mike clarke, aon. this will be to review the rating recommendations for 2025 for the blue

shield hmo and united epo. and i will not go through the rate setting preface like i did last time, but just to note that the blue shield plans which are the majority, 98 percent of the lives are flex funded and the united healthcare split family plans are self-funded. so, on page 11, staff recommendation is for an 8.7 percent rate increase for the blue shield access plus hmo and united healthcare select epo plan renewal for trio, hmo and doctor epo, 11.8 percent rate increase and the rate cards that result from application of those changes to the rate cards. just to summarize what we see in renewal starting on page 13.

as indicated, this covers mostly blue shield covered lives and access plus and trio with the split family lives where one or more family members, medicare enrolled in the united healthcare ppo plan are included in the rates here as well. the table on page 13 shows the distribution of those both members of the employee and retiree counts as well as the total covered lives which include dependents across the various plans. overall, 2/3 of blue shield enrollment is access plus, 1/3 in trio and primarily dependents enrolled in these plans among the split family lives. the recommended rate increases take into consideration the 2023 experience reviewed in march that considers the

claim experience for medical and prescription drugs, the capitation costs for professional services, and the blue shield plans, the large claim pooling fees which again i'll talk about those a little more here shortly, and the other components like administrative fees. overall when you pull everything together across all the plans, recommended increase of 9.6 percent. one element that's impacting this on page 15 is the figure that we are using for the buy out attributed to rate stabilization reserve amortization has increased and again, this is because the 2023 rates ended up being a lot lower then the plan experience for 2023. if you recall access plus had a fairly substantial rate increase for

2024, so we don't anticipate this will be as much a driver of renewal as i stand here next year at this time, but it is a element of the renewal. the other element is the greatly reduced dollar amount being able to apply as a buy down for the sutter legal settlement reviewed in manch. at the bottom of page 15, one thing we look at every year is opportunity to lower some of the fixed cost elements of the blue shield proposal, and one in particular this cycle was what was a very high, very much increasing large claim pooling fee amount. if you recall last year the large claim pooling fee, after a high catastrophic claim year in 22, went up all most 50 percent so we asked blue shield to please offer alternatives to us where

we can consider increase in the pooling point away from 1 million, so it does bring claim exposure in the plan as you increase your stop-loss point, but the goal is to create enough of a reduction in the rate to actuarially off-set what you project the claim increase to be for those individuals. as we projected this out using 2023 large claim experience, which is more of the norm and what has seen, project that save $3.6 million when said and done for the 2025 plan year just by making that one move. we did see about a 7 percent increase in plan experience as we reported to you back in march. the medical--there was an

increase-big increase in 2022 in large claims. that came down but prescription drugs continues to escalate with the evolving world of specialty medications. as you recall, we talked how cancer and -predominant drivers of claims for the 2023 plan year. on page 17, these are the fees on a per employee per month basis for the blue shield hmo plans, the administrative fee is is increasing by 2.75 percent after a couple years of flat because again, this is the first renewal for blue shield since that rfp took place in fall 2020, wenter 2021 that locked fees for 22-24 so the fees are increasing, but we are seeing reduction of 24 percent in the large claim pooling fee with the move in

pooling points. overall, it is projected reduction in fixed fees of 11 percent. so, looking ahead on page 19 with the rate cards, again what is in this material is for the sit a county of san francisco employees with the two predominant mou, recognizing there are other contributions structures for other employees in the san francisco health service system. to look at year over year change and what's expected and what's projected with the contribution changes, on page 20, this shows the 2024, so current monthly rates and member contributions, member contributions at the top of the page, employer contributions in the middle and total rate. 8.7 percent increase for access

plus is distributed throughout. the reason why the member contribution increase is lower then 8.7 percent is because of the 9 and a half percent increase on the 10 county amount, so there is more employer money coming in proportionally into the plan because of the higher increase then year's past and 10 county amount, so that is seen in the data on page 20 and then page 21 is for 100-96-83 and the rate cards on 22 and 23 and transitioning to trio, little higher increase. again, we had a fairly low increase on trio last year, so some of this is the experience is tracking more with trend and you have headwinds with the higher buy up amount for the stabilization and the reduction of the buy down for the

sutter legal settlement, and so that creates an environment where because the rate increased higher then the 9 and a half percent, it creates higher contribution increases for the early retirees. certainly the retiree contributions are less then those for access plus. you see that for the members on pages 24 and 25. that leads to the rate cards themselves for the trio plan and doctors plan on pages 26 and 27. so, i'll close with the recommendation on page 29. the staff recommendation the health service board approve first, the blue shield access plus hmo and epo plan renewal proposal for 8.7 percent rate increase from 24 to 25. the blue shield trio hmo and epo plan proposal for 11.8 percent rate increase

from 24 to 25. and 25 monthly rate cards. presented this material for this plans. vice president hao. >> thank you mike. >> could you go back to access plus what they will be paying? >> access- >> access plus will be paying, i missed that. >> that would be the access plus contribution amounts, so page 20 would be the active employees and 93-- [multiple speakers ] >> the next page what the member will be paying. >> the top of the chart would be the member contributions monthly. on page 20. >> alright.

thank you. >> thank you. any other questions? >> yeah. getting back to the-i think we appreciate your efforts to reduce some of the fixed costs of these plans, including the catastrophic $1.25 million recommendation. i thought somewhere i saw the numbers for how many claims there were last year over a million, and maybe compared to the year before and i can't seem to find it now. when you did your analysis, what numbers did you use to come up with the $3.6 million figure we potentially will save, because with healthcare costs going up, it seemed it wouldn't take much in terms of getting into that 1 to 1.25 million group to add up to 3.6 million. just curious to know how the

numbers were derived. >> sure. first, the figure i referenced is on page 16. kind that second statement on page 16, that is $500 thousand. so, that's where you saw 49 individuals exceeded $500 thousand in 2022 reduced to 37 individuals in 2023. i believe that may be what you may have seen. >> yeah. >> so, we looked at the last three years of large claim data and candidly i track back to 2013 when flex funding started to be able to look at the total dollars that have been paid back to sfhss for large claim pooling for those who exceeded a million because the million dollar attachment point came with flex funding of access plus in 2013 and continued when trio was added

in 2018. for the $3.6 million estimate i looked at the claim experience over 1 million for each of the last 3 years, so i wanted to discount 2020. i didn't want to look at 2020 because of pandemic influences, and if i look at it, 2022 was really a extreme year for large claims relative to any in the past. there was year that came close to what you experienced in 2022 so i felt looking at two years typical, one year really high coming up with the assessment is what i wanted to look at, and so it was kind of taking average of okay, if this happened any of the last 3 years what would have the projections have been? for 2022 it would have been a slight additional cost under a hundred thousand for the other 2 years

multimillion in savings so averaged out to 3.6. i will say blue shield also presented us with options at 1.5 million, 1.75 million dollar and 2 million. to me, none of them made as much in my opinion financial sense as 1.5 but i was also concerned going up more then 250 thousand, because what you just said. there is a lot of uncertainty, a lot of unknown, so i wouldn't to put in a position to suddenly take on abundance of excess risk to try to lower a fee, so we actually recommending the least amount of increase that large claim pooling level of the 4 alternatives presented to us by blue shield. >> thank you very much. that was the statement on page 16. i was confused.

substantial increase in large claim exceeding 500k in a year from 2022, 49 individuals to 2023, 37 individuals. so, 49 seems higher then 37, but yet the statement suggests the opposite. i'm- >> it was my fault. i should have said decrease instead of increase. >> thank you very much. if we can correct the record on that. i do think confusing to anyone who is reading this. thank you. >> absolutely. >> thank you very much. >> i have a second question. staff recommendation request for proposal for medicare plan medicare advantage prescription drug and advantage ppo for--we haven't voted yet on-- we have want voted on that, so the one you are on right now would

also includes united care, but what if united care is voted off and blue shield takes on? >> sure. the rates would be the same, because there is very little difference in cost between the incumbent and any others being considered for the non medicare population. the difference is going to be a very nominal fee difference and with only two percent of the covered population being administered by united healthcare, it really has no impact on the rates we are asking to approve today for the plans for 2025. >> the only difference is the ultimatecaria will be? >> correct. for non medicare split family lives, the difference in projected cost for those individuals based on who would

administer those individuals, today it is united healthcare, is so small and then you consider only 2 percent of the people that we are talking about here, so i would not be recommending any change to the rates being presented today. if it were to come to pass that there would be a different administrator then who is now in place for the non medicare split family lives. >> thank you. >> there same for the next item too? >> and same for the next as well. it applies to the ppo as well. >> can i ask another question? doing research for the item we are not addressing today. blue shield of california changed its pharmacy service delivery and went from a pharmacy benefit manager contract to five contracts carving out various aspects, including specialty

drugs. i think they projected quite a savings based on this, but it isn't a year old. in fact, it was announced last fall, so it is quite--so, do these rates take into account their thoughts about how they are going to save money on prescription drugs through these five independent providers? >> they do. that change takes effect january 1, 2025 so coincide with the start of the new plan year,s and blue shield did factor projections into their renewal information they provided, so one end of the underwriter. primarily it will be increase in the pharmacy rebates available through the plan, so that was reflected. all the detailed underwriting behind this, there is a fairly substantial increase in the expected rebates, which act as a good guy and off-set

to total projection and they also forecast perhaps conservatively, but slight reduction in the trend for prescription drugs, with there new model versus what would have been in place before. those are the two elements that entered into the pharmacy component projected and the roll up of what you see with this recommendation. >> thank you. >> alright. any other questions for mike? if not, we'll take public comment, please. actually, before we take public comment, we have a motion for this recommendation? >> i recommend that we approve the 2025 plans outlined, including the rate cards for blue shield

california hmo, epo and for the blue shield of california-too many plans here. anyway, access plus hmo, epo and trio hmo and epo and rate cards. sorry that being so convoluted. >> you are referring to everything on slide 29? that right? >> i'm referring to--yes. >> okay. >> thank you. >> properly moved and seconded and take public comment. thank you. >> public comment is now open. [providing instructions for public comment which is displayed on the screen]

no one approached the podium and move to remote public comment and our moderator will notify of any callers in the queue at this time. >> board secretary, there are 4 callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. take a roll call vote, please. >> roll starting with vice president hao, aye. breslin, aye. supervisor dorsey, aye. commissioner follasbee, aye. >> it passes unanimously. >> item 13, review and approve non medicare blue shield of california and united healthcare self-funded ppo medical rx plans for 2025 rates and contributions. this is presented by mike clarke with aon.

>> mike clarke, aon. launches past the preface to page 11. staff recommendation is the board approve the non medicare ppo plan and non medicare ppo plan choice not available 2025 plan year monthly rate cards presented in this material. with the total rate increase for the non medicare ppo plan of 1.3 percent with the total rate increase for active employees in the non medicare ppo plan choice not available including stabilization sutter legal settlement tracking with the blue shield access plus increase of [indiscernible] [cough] again, the-this plan is the one plan that doesn't exactly follow a

percentage employer contribution because this is the highest cost plan and the mou's state that the employer contributions the highest cost plan are set equal to the employer contributions for the second highest cost plan, which happens to be the blue shield access plus and united healthcare select epo plan. so, just to keep that in mind, that's why you see higher employee contributions for this plan then you do for the other plans, including access plus. the early rate cards are developed based on it definition and city charter for defining the city contribution, the full city contribution amounts are what you see in this presentation. like we talked about with the hmo's, there are two administrators for the non medicare ppo plan, blue

shield of california is the primary administrator for most covered lives with united healthcare providing administration for the non medicare split family covered lives where one or more family members medicare and enrolled in the united healthcare medicare advantage ppo plan. you see the member counts and total covered lives, including dependents in this plan, which on the member side generally fall very similarly between active headcounts and retiree headcount. the rate cards themselves including the projection of 2025 medical pharmacy claims, based on 23 experience. administrative fees from both organizations. the buy down of the stabilization amortization where it was a buy up in 2024, so that's one element that is

really helping to lower this renewal. even though there is less sutter legal settlement dollars applicable in the plan. that helps to create a lower increase environment for 2025 for the ppo plan. thal plan experience, as we look in 2023 is favorable and i attribute a lot that to the increase in the active employee count in the plan, and then that help creates a environment where the stabilization deficit flip to stabilization surplus, so that's good. and then, if we go to the next page, the headcounts and distribution of members across ppo plan versus choice not available, which was initially created as a lower

contributions for members in the ppo plan who did not have access to any other hmo plan. think about a retiree outside of california or employee in hetch hetchy, they only have access to this plan within the sfhss environment. you can see more retirees are in this plan without access to others, most of the active employees in this plan do have access to the other plans, but there are 191 who live in areas who do not have access to the hmo. the criteria for determination of choice not available on page 14 is individuals who do live outside of service areas that have hmo access. so, moving to page 20, the rate cards again based on primarily the

mou for the city county of san francisco employees, again with the provision the employer contribution is no more then that for access plus, and then the non medicare ppo plan total rates are set to access plus for the active employees. so, the change in rates and contributions you see on page 21 for the ppo plan enrollees. for the active employees, while the contributions are still higher then they are for other plans, they will see reduction in contributions as well as for the early retirees, reduction in contributions because the amount of the 10 county increase 9 and a half percent with the total rates only increasing 1.3 percent. that benefits leading to reduction in the early retiree contributions for this plan from 2024 to 2025.

and so you see the 100-96-83 strategy leading to the rate cards for non medicare ppo plan on pages 23 and 24. and then on page 25, these are the choice not available so you see lower contribution amounts for the active employees and early retirees then you saw earlier for those who have choice of hmo. the increases for these plans basically map what you saw earlier for the access plus plan on pages 25 and 26. and then the choice not available rate cards are shown on pages 27 and 28. so, with that, i'll close on page 30. staff recommends the health service board approve the non medicare ppo plan and non medicare ppo plan

choice not available 2025 plan monthly rate cards presented in the material. the resulting total rate increase for non medicare ppo plan including stabilization and rating adjustment is 1.3 percent and total rate increase for active employees non medicare ppo plan including stabilization rating adjustment for 2025 follows the blue shield access plus hmo and united healthcare select epo rate increase of 8.7 percent. >> thank you mike. any questions or comments for mike? >> if you move out of state, you can only have cna, right? >> correct. >> but, then you go to another state where they dont take blue shield or united healthcare, how does that work? >> outside of blue shield

service areas for the hmo, the hmo's for blue shield and kaiser are in california only and not necessarily state wide either. rural parts of california won't have access to access plus trio and kaiser hmo so the plan is exactly the same, but this was set up several years ago to facilitate a lower contribution for the ppo plan for those who don't have a choice of plans. >> so they are in another state, you can go to whatever is available there and then-? >> national networks both with blue shield and united healthcare, so even though blue shield of california remains the administrator, they tap into something called blue card for national ppo provider access,

so i live in new mexico so there is a different blue cross blue shield plan in new mexico but i can access any provider part of blue cross, blue shield because they work together with the california blue shield plan to provide that national network access under the blue cross blue shield network. >> united healthcare is more priv lnt in other states? >> united healthcare is the same. national network, national provider network, so certainly a member would need to see who is available in network in that given market, but these are national networks for these employees and retirees. >> any other questions? if not, entertain a motion. >> i move we accept the staff recommendations approve the non medicare ppo plan and ppo plan

choice not available for 2025 plan year and monthly rate cards as well as the non medicare ppo plan--yeah. items on number 30. >> properly moved and seconded. we'll take public comment now, thank you. >> public comment is now open. [providing instructions for public comment which is displayed on the screen] we'll begin with in person public comment. no one approached the podium and move to our moderator to update oen the remote public comment. >> board secretary, there are 4 callers on the phone line and zero

callers entering the queue at this time. >> thank you moderator. hearing no callers, public comment is closed. >> thank you. roll call vote. >> hao, aye. breslin, aye. dorsey, aye. follasbee, aye. >> thank you. passes unanimously. thank you mike for your hard work. alright. item 15, please. >> item 15--sfhss 2023 risk score report. this is discussion item presented by rin coleridge. >> welcome back, rin. >> always a pleasure to be here.

good afternoon. rin coleridge, director of enterprise system analytic with health service system. here to present to you the 2023 risk score report. we are trying to get the-hf -[indiscernible] that's okay. i think this is--yeah. this is fine. but we got that thing. which i don't know--

anyway. we can still continue. you have in your packs both the actual report and i'm going to give you highlights for the presentation. i think i very much like to dedicate today's presentation of the 2023 risk score report to commissioner randy scott, because he would inquire every year why we do this, so just to review that. what we are doing is also calculating and reporting out these risk scores as a way to either validate or discover variances with the assumptions the health plans are using in terms of their rate setting processes and so it is a opportunity here to have more informed discussion regarding what we are seeing in these renewals. key items are population has not changed much year to year and

we still have those same top 5 conditions. number 1, risk contributors so when you look at a risk score and the conditions contributing to the scores and the scores are indication of future spend on the population and what we are seeing is, muscle and skeletal, neo plazm, 9 percent and cardio vascular disease, diabetes and mental health running around 9 percent of the contribution so those are top 5 conditions. as you look through the report we continue to see disparities based on race groups which is why again we absolutely firmly believe we must lead with equity in what we do so we'll continue efforts for target outreach and partnering with our health

plan partners around that. as we move to this next slide, thank you--what you are seeing on this page is our commercial plan performance. we do not have the financial's on the medicare population, and what this is doing is risk adjustments so looking at actual cost and adjusts for the risk and see what the expected cost would be so that is on this page here. on the bottom there is your expected pmpy adjusted for risk and then on your y axis it is the pmpy so we have kaiser lower then expected when adjusting for risk and blue shield ppo population, significantly higher then expected when you look at the risk, so for example we have a actual pmpy over 15k with expected running right about 11

thousand. a note, due to very small claim size we don't have in here your health net perfomance on a cost basis. looking at the next slide, whauts we are able to do is take the population and segment into risk bands that go from the healthy to in crisis. here we are looking for non medicare population so this is combined active and early retiree population and you do have 2 percent of the population that drives 36 percent of your costs. again, the percent risk contribution, we have given the same break-out but by each risk category that is msk, the larger contributor across all those risk band groups and coming on the whole population contributing to 15 percent of what goes into that

risk score. and on the next page, we are taking the same look with medicare population, again no financial's with the medicare population, so no comment on the contribution based on cost, but you can see by each of the risk band profiles the top risk conditions so looking across all of those risk band profiles, cardio vascular and muscle skeletal--here we are taking a look at those social determinants of health and again, why we do this is that there are other factors other then your clinical conditions that contribute to overall health, and so, we also know that some of the factors contribute to

inequities so part of our commitment here is to make sure we are capturing both quantitatively and qualitatively information we are then using to inform phase 2 of the racial equity action plan. you have seen letitia harris come to present to youp previouslyyyyy on our hss action plan. across all populations and in the graphic we have segmented by active early retirees and medicare retirees, but we do have the black members of our population having the higher risk across the population and you can see the break-down there.

here we are using the cms grouping so sdoh are looking from 5 areas so education, access and quality. healthcare access and quality. economic stability. your neighborhood and built environment

>> we will continue to see more and more data around this come through for us to look at. our next slide, i told you what the top 5 conditions were, so now we are taking a look specifically at those top conditions and w have broken out by race and ethnicity and seeing along those lines how that percent contribution is trend ing, so since 2020-23 and different and ethnicity. year over year the black population has higher risk scores but there is variability of contribution based on the conditions so i won't read all to you but that what you got on

pages 8, 9 and 10 just breaking that information down. >> 8 is 17 percent? for 2023 for white people? >> yeah. >> thats the highest? >> yes. they don't have the highest overall risk score as we talked earlier, that is our black members but when we look at a risk score and what is driving-contributing to your risk score, so my risk score may lower, but what is contributing to my risk score as a white member, the majority is muscle skeletal disorder. this helps identify some of the populations, but that is what this is telling you. >> [indiscernible] >> for example here, our black population, 15 percent of the overall risk score is coming from

skeletal disorders and trnded down, but if you look at other conditions for example, diabetes, it contributing to 9 percent of risk score, where in the white population only contributes 5 percent. that is the first time we brought that to you and looked at the data in this manner. again, this is a snapshot in time of the health of the population and it goes through service dates through september 2023 data, and our overall risk score hasn't changed much year to year so have a relatively stable population. keeping me honest. appreciate it. so, our focus we are continuing our efforts with mental health and

wellbeing like we offer the online classes, meditation boot camps, heart health and continued mobility and partnering with ymca with the diabetes prevention program to help with lifestyle changes and again, this is a report we are using to serve as a guide for how and where we should focus our energy and collaboration with our health plan partners and also solutions for our members. this concludes the presentation of the 2023 risk score report. are there any questions? >> thank you so much. >> i find the report fascinating. not much for changes because it seems fairly consistent, but as you point out where we can be targeting our energy. look at neo plazm curious to know what percent of the neo plasm might be influenced by early screening, because not all neo plazms can be screened for, so there are--so, likewise with

muscle skeletal disorders, i remember one point we looked at independent vendor to help role out self-care programs to members and i think we decided not to do that but i wonder er since it factors so high, if there is a way we could hone in on some of there diseases to figure where can we redouble our efforts to help effect change here? cardio vascular you alluded to that in the conclusions as well, but i'm still-some like nur logic disord, there isn't good screening other then taking family history. curious to know how we can help maybe lower these numbers and improve our cost per member per month by

getting some people out of in crisis category. >> right. i do think--in the report itself you she where we've got each of the categories for those risk categories and then the average age of them and the story says what the story is. as you age you end up--you know that probably better then i know that. >> as someone aging i know that. >> that is true. we have talked about how to delay onset and looked at on the cancer diagnosis, can we even like analyze when they first receive the diagnosis going back to your point about potential early interventions and i think some that is reliant on the clinical data. we are a bit hampered because we use claims data and so that's our partnering with our health plans with the lens that we have and working with them and we had some good collaboration previously and seeing it even

now with reporting and insights the plans are bringing forward on behest of abbie and h ss leadership. we are taking in that direction and you know these things move slowly. >> yeah mpts >> i just add to that we are probably past due doing a full report to the board on measurement plan and all the measures we are looking at. not us directly, we are relying on the plans to provide the data. we built in performance guarantees on a lot of things. we follow the federal u.s. prevention task force guidelines, the measures, there are lots of regulatory volunteer and involuntary organizations measuring a lot of stuff, so i think i think we need to come back to the board and let you know what all we are

looking at, but i can tell from being in the room, doing the reviews with our health plans, they got a lot going on, and so it is always a little--i know as a clinician it is easy to do a over-reach and tell the health plan how to tell the doctor to practice medicine. it is a arm length understanding and appreciation for what is improving over time and one of the biggest debates that is occurring now everywhere is focus focus focus. we have so much measurement and so much data that to really get systematic improvement you got to make choices about where your focus will be. so, i think for us, we stayed with us high cost high claim conditions and that seems to serve us well in the conversations with the plans, but we can plan in the some time over

the next calendar year to talk about the measurement plan and what we monitor and what the--and in partnership with the plans because they work with us on this. >> thank you. if no other questions or comments, thank you again rin. >> thank you very much. >> thank you. we'll take public comment. >> providing instructions for public comment which are displayed on the screen] we'll begin with in person public comment. no one approached the podium. move to remote public comment and our moderator will notify of any callers in the queue at this time. >> board secretary, there are 4 callers

on the phone line, zero callers entered the queue at this time. >> thank you moderator. public comment is now closed. >> thank you. next item, please. >> next item is reports and updates from contracted health plan representatives. discussion item and are presented by vice president hao. >> do we have any members from our health plans who have any announcements or information they like to share with us at this meeting? i see no one clamoring for the podium, so i think it is safe to say that we have no updates this month. that leads us to adjournment. so, thank you for attending today's meeting. we will see you next month. the meeting is adjourned. >> thank you. adjournment at 337 p.m.

[meeting adjourned] >> bring up person that [laughter]. for me it was we had neighbors growing up that were fold my dad he is raising me wrong for having me pursue the things that

are not traditionally female roles. and i think the biggest barrier to anyone in general is when you have cultural norms that make you feel like you can't do something that make you doubt yourself and make you feel you should not be there i don't belong. those other big efbarriers i think that is the thing to focus on the most is belong everyone should belong here. [music] >> wishing we trained women grow in production. and recording arts and so we have everything from girls night classes for middle and high school girls. we have certification academy

program. that would be women and gender [inaudible] adid you tell us. progress in the internship frm program where they are working in the studios. they are helping to mentor the youth in the youth programs and the job place am component. most of the time we hire interns instructors in our programs and engineer in our studios here. we have conferences we do all overnight country and we have concerts that we feature bay area women and gender artists. [music] [music] >> an education forward

organization. and so advocacy organization. dedicated to closing the gender gap and the audio and production industries. >> started out of the lead answer, why is there a critical gender gap in this industry that started at city college. why are there so few in this

class i was ashamed i did not have the answer being a feminist. why have i never thought of this i have been in the industry for decades and why have i accept today of all people. it was out of that and unraffling it. actually started the infernship last fall and just fell in love with all the things about women's oshg mission because we are diverse and so many aspects of audio i did not know and i feel like eyes opened up and i gained a lot of confidence in myself and other fells and queer people in the industry i felt there was more connection and community. ironically my time in the industry is all pretty good. i think what happened is i was raised by a father who is an engineer. i was comfortable being strounlded by men all the time in his lab i was used to technology. when i got in industry my mentors were men and i saw i had a unique importance that got mow in the place i could be fluent and navigate something difficult and it was the norm for me. what if it was not woman was createed provide it for

everybody. have this environment you are surrounded by technology and people that are going to support you and get you in this industry in a good way. i have been interested in audio i was never trained in music took piano when i was a kid. i never pursued it because not a lot of women doing that. and my family is not musically inclined. when i want to davis the first time i took a music class there were few females in the class. like a rodey for my dayed was load you will the mixers and monitors and the giant speakers and gigs and help run out the cables and take things down and set up mics i did all of that growing up and never occurred to mow that that was a field they could at all. and then one i could pursue i didn't nobody else was doing temperature my dad and then i go with him to studios and see --

the men in the studio. dj for 5 years now and comments you get like wow you are a girl dj that is crazy. that is wild. and i have great moments where it does not happen. and they treat me like easy. telling mow what to do they correct mow in ways that make me feel less i sprjs the opposite and i notice hand's on like you don't know what you are doing rather than asking me. not consistent times it happens. it is like when i talk to other females they are like say the same things it is like funny i know that nice men don't experience tht main thing triggers me when i experience different treatment and that happens a lot in the audio world.

industry is changing slowly. there is still that issue making the places that are places belonging for everybody. i don't think so. having a studio where it is not all run by white men like most studios. the studios are only in the word built and run by women. it has been super normalize thered are opportunity for girls and nonbinary people. you go in school and middle and high schoolers know that this is a field. this is a thing there are many jobs you can have in this field. some producing pod casts to setting up live shows. there are so many things you can do >> wee go in and teach the audio skills and give them equipment. i pads and then teach them how to make music and they get to

come in here and will getting the tools to people who don't have t. that is really important to me. that's why i was like wow. i want to be there for other fell and queer people who don't have the opportunity and also to be a mentor for them to really push them to experiment and not going to break it. does not matter if it sounds bad that is the point to try it. i think it is the goal to see confidence what they are doing and passionate and asking for hymn and excite body learning and excited about making music and it changed my life to realize i'm callented in the field i can make music without being trained to it it is amazing to be able to be part of that process and -- ushering women to the field. we can entirely transform how --

the technology part of what you hear every day. we can put xhg something in women's points of view in this every time. it affects the store and he messaging. think our best example is how we transformed an entire city. place that major artists on tour one of the men looks likeip don't get it there are woman every where i go and the person was like you are in san francisco. you like oh , you are right it is here. most venues have graduates we are grateful to the city for that reason because than i supported us at the beginning. following your curiosity and interest and don't let anybody get in the way what is presented to you, go for t. no matter what!

we are here for a reason. find what it is. don't let somebody else tell you what it is. you are the oldsmobile one that have been can know when you are supposed to do. go do it. >> come shop dine and play. taraval street is open for business. >> my name is mark recollect the owner of lou's cafe on taraval street. since 2010, my brother and tj and vince and mom [indiscernible] we used to sandwiches all the time. we said why not us.

geary boulevard in 2010. i figured i might to start in another location and when i opened the location in 2015. we treat each customer as family and we make our food with love and make sure everyone is happy. i recommend everyone come out to the sunset. >> take time for teraival bingo, supporting small business, anyone can participate. it is easy, collect stickers on a bingo style game board and enter for a chance to win awesome prizes. for

>> come shop dine and play. taraval street is open for business. >> i am a coowner at 19th. this establishment came about when me and my brother andy, coowner, we decided that it time for us to take a step up in the barber industry, and open up a space of our own. ory business is a community that shows their true artistic side of the barber industry. we are involved in teraival bingo so stop by, get a hair cut and when you do you get the barber sticker made just for us. i say in three words we are community, arts and here to help any way possible we can, so come by, visit at barber

lounge, 907 taraval in the sunset. you can find us on instagram. >> time for teraival bingo supporting small business, anyone can participate. it is easy, collect stickers on a bingo gameboard and enter a raffle event.

[music] >> san francisco is known as yerba buena, good herb after a mint that used to grow here. at this time there were 3 settlements one was mission delores. one the presidio and one was

yerba buena which was urban center. there were 800 people in 1848 it was small. a lot of historic buildings were here including pony express headquarters. wells fargo. hudson bay trading company and famous early settlers one of whom william leaderdorph who lived blocks from here a successful business person. african-american decent and the first million airin california. >> wilwoman was the founders of san francisco. here during the gold rush came in the early 1840s. he spent time stake himself as a merchant seaman and a business person. his father and brother in new orleans. we know him for san francisco's history.

establishing himself here arnold 18 twoochl he did one of many things the first to do in yerba buena. was not california yet and was not fully san francisco yet. >> because he was an american citizen but spoke spanish he was able to during the time when america was taking over california from mexico, there was annexations that happened and conflict emerging and war, of course. he was part of the peek deliberations and am bas doorship to create the state of california a vice council to mexico. mexico granted him citizenship. he loaned the government of san francisco money. to funds some of the war efforts to establish the city itself and the state, of course. he established the first hotel here the person people turned to often to receive dignitaries or

hold large gatherings established the first public school here and helped start the public school system. he piloted the first steam ship on the bay. a big event for san francisco and depict instead state seal the ship was the sitk a. there is a small 4 block long length of street, owned much of that runs essentially where the transamerica building is to it ends at california. i walk today before am a cute side street. at this point t is the center what was all his property. he was the person entrusted to be the city's first treasurer. that is i big deal of itself to have that legacy part of an african-american the city's first banker. he was not only a forefather of

the establishment of san francisco and california as a state but a leader in industry. he had a direct hahn in so many things that we look at in san francisco. part of our dna. you know you don't hear his anymore in the context of those. representation matters. you need to uplift this so people know him but people like him like me. like you. like anyone who looks like him to be, i can do this, too. to have the city's first banker and a street in the middle of financial district. that alone is powerful. [music]

>> [door opening] >> okay, kids. our next guest speaker for career day is the sheriff from san francisco. >> hi, everyone. does anybody know what a deputy does? >> they involve the law. >> you know what, let me show you what it takes to be a

deputy. ♪ [ music ] ♪ ♪ >> at the san francisco sheriff's office, we're looking for a few good deputies. ♪ [ music ] ♪ ♪ >> we need people who aren't afraid to push themselves. ♪ [ music ] ♪ ♪ >> who are willing to go the distance. ♪ [ music ] ♪ ♪ >> men and women who is up for a challenge. >> who love it as much as we do. >> [foreign language]

>> you'll probably drink coffee with us. >> [foreign language] keeping it real, this job is challenging. >> when one door closes -- >> we make sure another one opens. >> we protect san francisco courts. >> court is now in session. [gavel] >> helping justice to be serve. >> during election season, we make sure every vote is counted. >> we wet people where they -- we get people to where they need to go. >> and forward our city's hospitals. >> it's important we can keep you safe.

>> whether you're celebrating your quinceanera or getting married >> congratulations! >> we'll stand up for you so your voices can be heard. >> protecting your first amendment rights. [cheers and applause] >> (indiscernible) in uniform. [cheers and applause] >> go warriors >> we train hard to get to where we are. ♪ [ music ] ♪ ♪ >> [whistle] >> we offer a competitive salary. ♪ [ music ] ♪ ♪ >> and average of more than $100,000 a year to start. >> (indiscernible).

>> including great medical coverage. >> and a pension you can actually retire on. >> [foreign language] >> this folds really good. >> we're looking for those who think outside the box. >> and people who want to save lives. ♪ [ music ] ♪ ♪ >> for people who want to change lives. >> for those who want to serve our city. >> we need you. >> we're committed. >> you bring something to our team that no one else can. >> you! >> all right. now, who wants to be a deputy? ♪ [ music ] ♪ ♪ [laughter] >> three, two one. >> top notch benefits.

>> is that too much. [laughter] >> no. >> say your line, sheriff. >> your line, sheriff. [laughter] >> let me show you what it takes to be -- >> action. >> when one door closes -- [laughter] >> what did you say? ♪ [ music ] ♪ ♪

on behalf of the sheriff's oversight department oversight board, we would like to thank the staff at sfgovtv for providing technical assistance to broadcast and record this afternoon's meeting. you may view this afternoon's broadcast on cable channel 26. please stand to recite the pledge of allegiance. of the united states of america. for which it stands. one nation under god, indivisible, with liberty and world. dan, please call the roll member. mango. president mango is present. member