>> can we have the roll call? >> thank you president follansbee. call to order at 1:03 p.m. and our roll call. president follansbee? >> present. >> vice president canning will arrive later. supervisor chan? >> present. >> commissioner breslin? >> present. >> commissioner hao. >> present. >> commissioner scott? >> present. >> commissioner zvanski will be joining in a moment. with that present follansbee, we have a quorum.

>> if we can move on to item number 3, an action item. >> thank you president follansbee. agenda item 3, the resolution allowing teleconferencing meetings under the government code, this is an action item. >> so, we've had a chance to review this resolution. i'm not sure if you're going to project it, but -- >> i wasn't planning on it. would you like me to? >> it is pretty straightforward. every 30 days we have to update our resolve to allow teleconferencing. if there's any discussion from board members? >> this is commissioner scott. i move we accept the resolution. >> i second. >> thank you. so moved and seconded. with that, we'll open up for

public comment. >> thank you president follansbee. the public comment remote viewing access is going to be displayed and i'll read it. public comment is available for each item on the agenda. each speaker is allowed three minutes unless the board president deems new time limits. as a reminder, a caller may ask questions of the policy body but there's no obligation to engage with the caller. when i welcome you, you are encouraged to state your name clearly but may remain anonymous. after three minutes, the moderator will unmute the next caller. remote viewing is available. opportunities to speak during the public comment period are available by dialling the number on the screen. 415-655-0001.

use access code, 2498 558 9355. then press pound and pound again. you will enter the meeting as an attendee. dial star 3 to be added to the queue. when the system message says your line has been unmuted, it is time to speak. for those on hold, please wait until the system indicates you have been unmuted. we have a standing 40-45 second delay for viewers online. we'll allow the system to catch up and callers the dial in. the pause starts now.

the pause has ended and the moderator will notify us of any callers in the public comment queue. >> we have four callers on the phone line. zero callers have entered the cue at this time. a reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda

item. there are still no callers in the queue at this time. >> public comment is now closed. president follansbee, right on time, public comment is now closed. we'll want to make sure we can hear you. and we have had commissioner zvanski join the meeting. >> okay. moved and seconded that we accept the resolution allowing for telecommuting for the next 30 days. please say aye in favor. any opposition? it passes unanimously.

if we can move to item 4. >> thank you president follansbee. the approval with possible modifications of the meetings of the minutes set forth below. you will see two meeting minutes for the governance committee on december 2nd and full board on december 9th. >> any discussion from board members regarding the minutes of the two meetings? >> yes, president follansbee, this is randy scott, as chair of the governance committee, i would like to call the attention for everyone that throughout the governance committee minutes and calendar that were distributed for the meeting, we indicated we would be bringing forward terms of governance and policy document today for discussion at this board meeting. i want to first of all indicate that the work has been

completed. i thank very much our council, larry loo for his efforts from the finance and policy review standpoint. we didn't take into account a 10 day prior notification before voted on by the board. so as a result, it will need to be delayed until the february board meeting. it is all complete, all the work is done, we just need to do the proper notification so indeed it can be voted on by the board and we determined that would be at the next board meeting on

february 10th. >> great. any other comments on the minutes from the two meetings? >> the acceptance of the december 9th regular health service board meeting minutes, move acceptance. >> can we move acceptance of the governance as modified for december 2nd as well? >> we can approve minutes, it's just the document, right? >> that's correct. >> then i will amend my motion

to accept both without objection. >> second. >> thank you very much. so moved and seconded. now we'll open it up for public discussion. >> thank you president follansbee. instructions are going to be displayed while i read them. public comment is available for each item on the agenda. each speaker is allowed three minutes to comment. all public comments made concerning the agenda item presented. as a reminder, a caller may ask questions of the policy body but there's no obligation to engage with the caller. you are encouraged to state your name but you may remain anonymous. after three minutes, the moderator will unmute the next caller. remote viewing is available on channel 26 and web-ex.

opportunities to speak are available by dialling 415-655-0001. use code, 2498 558 9355. then press pound and pound again. you'll enter as attendee and dial star 3 to be added to the queue. for those already on hold, please continue to wait until the system indicates you have been unmuted. sfgov tv has a standard 40-45 second delay for those online. we'll allow 45 seconds to catch

up. the pause has ended and moderator will notify us of any callers in the public comment queue. >> board secretary we have four callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial star 3 now

for this specific agenda item. we will wait five more seconds and then close public comment. there are still no callers in the queue at this time. >> public comment is now closed. president follansbee, want to make sure we can hear you. i'm just going to support for a second. president follansbee, i'm going to unmute your -- president follansbee, can you hear us?

doesn't look -- we may have lost reception with president follansbee. >> i'm here. >> great. >> sorry about that. i'm trying to deal with an emergency here. okay, there were no public comments? >> no. >> correct. so moved and seconded that we accept the meetings of december 2nd, 2021, and meeting of december 21st. any opposition? it passes unanimously. thank you. sorry about the delay. if we can move on to item 5. >> item 5 is general public comment, an opportunity for members of the public to comment on any matter within the board's jurisdiction, including anything not on the agenda or requesting a matter on a future agenda.

i'll pull up our instructions. public comment will be available for each item on the agenda. each speaker is allowed three minutes to comment in length unless the board president deemed new public comments during the meeting. a caller may ask questions but there's no obligation to engage in dialogue with the caller. when i welcome you on, you are encouraged to state your name but you may remain anonymous. when three minutes has ended, the moderator will unmute the next caller. remote viewing is available. opportunities to speak during the public comment period are available dialling the number on the screen. the dial in number is 415-655-0001. when prompted, use access code,

2498 558 9355. then press pound and pound again. you will enter the meeting as an attendee and dial star 3. when the system message says your line has been unmuted, this is your time to speak. for those on hold, please continue to wait until the system indicates you have been unmuted. there's a standard 45 second delay for those watching online. we'll take a pause to allow the system to catch up and callers to dial in. it starts now.

the pause has ended and our moderator will notify us of callers in the public queue. >> thank you for transferring privileges. we have four callers on the phone line and one caller has specifically entered the queue at this time. other callers may enter the queue as public comment continues. i will indicate when there are no more callers in the queue and you will hear a brief silence as we transition between callers. elevating the first caller now. >> welcome caller. >> good afternoon commissioners. i'm a retired san francisco

firefighter and i continue to be part of the peer support team and critical incident response team. i spoke at your december meeting during general public comment to be placed on january's agenda to make a presentation for the san francisco fire department. it consists of 1700 personnel and we are looking to provide more treatment in behavioral crisis. we understand there are resources in place through the aep, compsych, creating the care bridge. we are starting to get more clinicians on board to support in a behavioral crisis. international association of firefighters, centers of excellence for behavioral and

health facility licensed for ptsd, trauma, substance use and other behavioral health challenges. we would like to give our members to have an opportunity to attend this facility and receive specialized treatment for behavioral health issues. the health service agency can contract as many other plans have done. the center of excellence all have a network access to insurers, most which offer ppo plans. in california, the two largest groups aside from cal fire are l.a. city and have access through anthem plans. the center of excellence is building near san diego, this treatment facility will be open at the end of 2022 and has another treatment facility fortitude specializing for other essential workers, police,

nurses, 911 dispatchers. in a behavioral crisis, the more resources, the greater the likelihood of seeking assistance and hopefully finding a treatment plan that works for them getting the care they need in a timely manner to recover quicker and return to living a productive life. this is a priority for the san francisco firefighters local 798 and i would like to be placed on february's hhs agenda. i have e-mailed my contact information and would like to set up a meeting with staff for further discussion. thank you. >> thank you caller. our moderator will elevate the next caller. we have zero callers in the public comment queue at this time. a reminder to all callers on the

line, you must dial star 3 now to join public comment for this specific item. we will wait five seconds and then close public comment for this item. we have another hand raised in the queue, elevating the caller now. >> welcome caller. >> board secretary, the call has been disconnected. there are no other callers in the queue at this time. >> thank you moderator. hearing no further callers,

public comment is now closed. >> thank you, this closes item 5. please call item 6. >> i would like to make a comment about the last agenda item. >> okay. commissioner breslin? this is on the director's report as well. if you want to hold it or comment now, it is up to you. >> referring to the member who just spoke. >> okay. >> and since he did recommend to be on the agenda before, i think it's a good time to put this on the agenda, not only for firefighters but all first responders. he did mention in his letter that there's also this place called fortitude, i wasn't clear on the facilities, if they were all in patient or out patient and i would like to know more about them. and he mentioned nurses, police

and dispatchers. especially during this pandemic, there's been a lot of extra problems and the police i know have really had a difficult time because of the negative stuff in the press, etc cetera. so, i think it would be nice to have an agenda item with this idea but maybe make all mental health services a little better since this is a big issue today. and i just -- actually i just asked my provider about a mental health provider not particularly for me but in general, she said -- united healthcare, this is ucsf and she said it is very difficult to get a mental health worker right now. it is a huge issue we have.

whether it is reimburse -- they say the lack of providers but on the other hand, it was mentioned in the original report that -- >> can i interrupt you. you have gone way beyond in responding to the call-in person and brought up another issue that we're continuing to deal with and will be on the agenda. can you focus on the response for the caller and move on. >> that is my response to the caller. >> provider reimbursement seems beyond the comments of the caller. do you have other comments in response to the caller? >> no, i think we deserve to give our first responders the best care we can. >> thank you very much. if there are no other comments, i close item 5. we'll move on to item 6. >> thank you president

follansbee. i will display our agenda. agenda item 6 is the president's report. >> i have no report. i'm going to close agenda item 6. >> okay. thank you. item 7 is the director's report, a discussion item and presented by executive director abbie yant. >> good afternoon commissioners. happy new year. and thank you for showing up today. we have in the director's report, i will provide some highlights. i think it is stating the obvious, we are still in the pandemic and dealing with the omicron issue. we're hoping that we're at the peak of this right now and that we may start to see the downward trends in infections in our

communities. we are all being super diligent. our workforce at hss is working from home again, we had returned to the office last november but that has changed once again and as all things covid, the virus is adaptable and so must we be. that's where we are. i do want to announce that our chief financial officer larry loo has accepted another position outside of our organization and will be leaving us tomorrow is his last day, ouch. i just realized that. and we were very fortunate to find a very well qualified replacement. mr. zang is on the call today.

we did a record in hiring civil service time to the credit of our personnel officer from the department of human resources was super helpful. we double teamed this and able to secure a well qualified financial officer in time to learn -- get the hand off from larry and learn our budget process, which is with us as we speak. so i would like to say thank you very much with sadness and fondness that larry is leaving us. he is going to be at the chinese community health plan. i'm sure we'll still see him. it is a small town. and welcome iftikhar.

>> i'd like to start. this is larry loo, outgoing chief financial officer. first, i want to thank abbie for really going through the process and allowing me the honor to serve the city during these trying times. it was an incredible experience and highly recommend it to anyone who wants to serve the city, it opens your eyes to what it takes to get things done. as i mentioned, as a city native, i was born at chinese hospital. i am a city boy through and through. and it was really just a great opportunity for me to help in any way possible to lend whatever experience and background i have had with the industry to help.

i want to thank the staff and finance and contracting area. to all those who helped and keep the financing for our trust fund active. and keep our procurements underway and help us with the general fund budgeting and sustainability fund. the numbers don't appear by themselves. so really they are a special team and they have also taken the extra step to come in to process checks. checks don't process themselves either. they made it through for lack of

mass transit to come in once every three weeks the make sure things were going smoothly. i want to thank mitchell griggs for welcoming me on board. that's all i wanted to say. >> good afternoon. it's a pleasure to be here. my background is on the provider side. i have worked with all systems, southern, dignity and el camino hospital before come together this position. i look forward to kind of

completing the other side of health insurance to make sure we provide affordable care and good quality. and then larry has helped in the transition. we've only had two weeks to work together but i appreciate the cooperation and help and patience he has given me. and also met the staff, so we have a good team here and i'm happy to be here and look forward to working with the board moving forward. >> thank you very much to both of you and best wishes larry. moving on, personnel changes, i did also write into my director's report kind of a well kept secret in that mitchell griggs is planning his retirement next year. so we are going through a

recruitment process now to fill that position. i'm not saying replace mitchell, we can't replace mitchell but we'll fill the position with someone else who is qualified to perform the duties of the chief operating officer. there will be much more to come as we go through the selection process and goodbye process with mitchell. i'm sure we'll have celebrations and farewell send off to him. he will have been with us 10 years next month. and has contributed a lot, i think, to the operations of hss. so much more to come on that. we did want the board to know. we are going through the recruitment process and hope to have what we have seen now twice, of various degrees, an overlap of outgoing executive with incoming executive, we find

that that ensures a smooth transition. that's what we're aiming for with the chief operating officer position as well. in other matters on my report, i know larry worked with aon and has provided some language in my director's report talking about how we're going about the rebate audit and so that is the approval process is underway, it does take some time. and then we'll bring the results depending on what they are, if they need to have a committee, we'll consider that as an option or the full board. the blackout period as you know continues. we are at the beginning of the 22 rates and benefits cycle to plan year 23. leticia harris has provided a racial equity action planning

update and that's in the report and speaks to the upcoming holiday celebrating the life of martin luther king. our work in that area continues and i appreciate her leadership and keeping us engaged and informed in the areas we are still learning. you did hear, again, from public comment on the disorder services. we -- i have spoken to mental health and particularly mental health with public safety to this board for the last two years. we were able to secure additional services starting in april of 2020. i believe i have commented on this almost every board meeting. it is an destroy in great flux. there's a great demand and the services are bouncing all over the place right now. the workforce is not adequate in

numbers and they're shifting as new employment opportunities present themselves within the service arena. we're keeping up with that with our partner health plans. we have spoken to them directly about these particular programs that this gentleman has brought to our attention. we are learning and considering what options can and should be available through our mechanisms versus other mechanisms. there are several models in the city on how the services are provided. we're keeping up with all of that, we've had a couple of really good in depth meetings and we'll be able to advise you on our ability to engage these services through our health plans. we're not inclined to do direct service contracts as you know. it is problematic for a lot of

reasons. so it is much better if all services are through the health plan, particularly with substance use disorder. one of the things i would ask the board to keep in mind is that the clinical assessment of a person prior to going to residential care is incredibly important because often the addiction is disguising underlining conditions that can be quite dangerous if not screened appropriately before going to a residential care service. on the flip side, when one returns to their prior life after leaving residential services, it is clinically very important they are engaged in the local care system. it is pretty serious disease that folks are often prone to relapse and so if they have a local resource to shore up their

services, it helps ensure a smoother stabilization period. there's a lot to be considered. we know that mental health is of interest to all of us and is a key factor in our strategic plan and a key factor in our work over the last couple of years. and we provided a transparency update in the report with the new regulations in place. this will -- this is kind of one of those things we'll have to see what really -- how that available data does change practices. so there's more to come on that. there's information about that in the director's report. holly provided the quarterly e-mail outcome report and the divisionle reports are embedded as well. the one thing i wanted to kind of pull out, i spoke at the last

meeting about being able to do our projects with help of an outside vender to help us on programming needs that we need. and our initial plan was to kick that off in april. that start date is now up in the air, we weren't able to secure through the process an adequate support service. we're looking at any and all options at this point, hoping to find a way to do some of the auditing this year. we think it is a very important business practice that not only may find fraudulent behavior but sends a message to our membership at large that that won't be tolerated. so, we're in the process now of kind of figuring out what the operating plan is to be able to do some -- to have a process that is embedded at the agency

and done on a regular basis. so more to come on that. i think that's all the highlights i have out of the report. happy to entertain questions. >> so i'll open it up to board members for comments. >> abbie, this is randy scott, could you provide a little more detail about the diva process. were we not able to get the venders we wanted, was it pricing, timing? i'm -- just clarify that a bit. >> i'm going to ask mitchell to respond to that if i may. >> thank you. >> so the timing of the audit -- >> the ability to secure the resource we needed to do the

diva. >> right. finding a solution, so right now, we are looking at -- if we do something like abbie mentioned, a lesser population, that will give us a little more time to work on the rsp and get specifics on what it is doing eternally. so, we're not really sure. this would allow us to do that and select someone and start that and get it going to do a full audit in 2023. >> so mitchell, i thought we did it and it didn't yield the results we needed. >> right. so we're doing another one. we're expanding.

they were not able to do based on the review of the rfp, there was only one response as i recall. they were not able to comply. >> i would just say i'm sure you are very aware we went for a long period of time prior to the last audit, this last process and i'm just concerned that we engage and follow through even on a limited basis to commit ourselves to do this in a best practice way. so, i just wanted to get a

little more background. thank you. >> yeah. happy to hear your support. that is precisely the conversation we were having this week. how do we keep that commitment going. i think we'll find our way. >> any other comments? i guess i'll take this moment to actually thank larry loo for really an incredible job in what seems like just yesterday when you joined us. there have been evident changes in the reports and with education to all of us on the board and membership at large as a result of your contributions. so your legacy will move on -- will continue on despite your moving on. i'd also like to welcome mr. hussein, as someone who moved

from the provider side to now the contracting side in my own professional life, i think you will find this position now both challenging and rewarding. and your expertise and background will be of immense help. mr. loo has set a high bar for excellence and i have complete confidence having seen your cv that you will meet the challenges and with pleasure and a smile which is important for all of us. again, thank you to both of you for your fine work and for taking on this assignment. >> i'm having video problems but i would like to make some comments as well. >> yeah, supervisor zvanski -- >> not supervisor but --

>> sorry, commissioner. >> thank you. i wish to thank larry loo for his service. i was incredibly impressed with his background and what he's been able to bring to our board and to the system for the time he's been here. it really speaks well for his background and i think the chinese health plan is very fortunate to get you as one native to another. but i think that i just want to thank you very much and we are very impressed with what you brought to us. and i want to welcome mr.

hussein. i'm going to practice your first name a little better. it sounds like you bring to us a special and unique background and we obviously need that because of the kind of work we do. i look forward to your service and the last thing i want to comment is that i think abbie, you pointed out how you have been speaking about mental health issues and services for the last two years and you're absolutely correct. there is a process. what i want the firefighter to understand, who has both written to us and now spoken, there are processes that we as a city agency must go through and we have made decisions overtime. i think there's no question that during this time, all of our emergency services are overtaxed and necessity for mental health services is huge. we understand that.

but there's collective bargaining, you have a bargaining process within your department, within all of our departments and also there's a process we have to go through in terms of rfp's and when we bring in programs and if we're going to decide to do any special contracting or work through our plans. and so, i just wish this colleague, this employee would understand that we would like to fit them into the process and consider the recommendations but we need to be consistent in how we do the work to bring what we hope would be the maximum services to all of our employees, especially our emergency service responders. i think all of us on this board value them and are very aware of their needs and service to the

city. but we have to stick to a process that is not to say no, we're not shutting out the recommendations, we're saying there are other ways to maximize having the opportunities available to the active employees who will need them. and also to those who then retire and take leave from the service for mental health reasons. we need to make sure that we can maximize the benefits that are offered. but there's a process to get there. and for this employee to respect that process and work within our system to make that happen. >> thank you. other comments from board

members? if we could maybe not debate some of the issues, it would probably be healthy for us. supervisor chan. >> i just really actually some of the comment already, to thank mr. loo for your service. also very pleased to hear you are going to the chinese community health plan. my mother, her first job in san francisco was a processer for chinese hospital and second job was with chinese community health plan as enrollment coordinator and my first internship in high school was office clerk filing papers at chinese community health plan office. so nothing pleases me more than to hear that you're going to

serve at chinese community health plan. i think we are going to miss you. here, i didn't have the good fortunate to get to work with you as long as some of my fellow commissioners have. congratulations on your new post and i look forward to also welcoming mr. hussein and so glad that we get to have you on board. so fast and be here with us and also thank director yants and just working over the holidays to really get and stabilize to make sure we have both outgoing and incoming cfo in great timely fashion. and want to thank you for working with our firefighters and making sure they will take the appropriate steps to get the care they need. i for one do not know the process, and really still

learning a lot more from you. sorry to hear that mitchell has to move on, i concur with you the fact we can't replace him. you can't replace the expertise and institutional knowledge of a decade. but i trust that all are well and all in good hands in your hands. thank you director yant for your hard work and thank you president follansbee for allowing me to make remarks. >> other comments from board members or questions or -- >> go ahead commissioner scott. >> go ahead. >> i will be brief. thank you mr. loo for all you

brought to the health service system and thank you for your commitment to all the lives that this system covers. so thank you so much. and best wishes at your next gig. and welcome mr. hussein. we look forward to working with you. i want to say as a public servant, i hope you get the public service fever and enjoy the work you'll do as a member of this team. >> thank you very much. i'll call on commissioner scott again. >> yes. mr. president, i would like to offer the following motion that the board commends and thoroughly thanks larry loo for his service and commitment

during his tenure as our chief financial office and wish him well with the chinese health plan. and we would like to welcome to the health service system, iftikhar hussain as our new chief financial officer and look forward to working with him. i present that as a motion. >> can you do that motion without it being -- >> second. >> on the agenda? >> yeah, why not? >> i think it's a good question. we need public comment on this. but i think you're right, there's no posting. >> it's not an action item. >> i would then defer that we adjourn the meeting with that accommodation. >> okay, that we can definitely do. assuming there's no objection to

that. >> i think that's a motion in order for any item. i think it's a good motion and i wanted to second it. >> can we ask our attorney to comment on the process at this point? >> yeah, i mean, technically, if you want to vote on something and take official action of the board it has no be notice as an action item, otherwise it is a discussion item. if you voted, it wouldn't be legally an official action of the board. if you -- if you want to characterize as a discussion and take a poll, that would be okay. >> so -- >> while adjourning the meeting. >> so commissioner scott, could

you withdraw your motion but reinstate your recommendation for accommodation to be noted at the end of the regular meeting today. >> i will do that mr. president, thank you. >> thank you very much. okay. thank you very much commissioner breslin for bringing that up. i think it's an appropriate question. any other questions or comments for director yant at this point? >> i agree with all the comments about mr. loo, although i don't think i ever got the chance to personally meet him because of the pandemic, face to face. i welcome our new mr. hussein. so i mean to be brief here, too. thank you. >> thank you very much. other questions or comments? >> i just want to say -- this is commissioner zvanski.

i apologize, i forgot mitchell, i hope there will be more time for us to talk about mitchell and commend him for incredible service. >> any other questions or comments? hearing none, i open it up for public comment. >> thank you president follansbee. i'll share the instructions visually and read them. >> each speaker is allowed three minutes to comment in length unless the board president deems new time limits during the

meeting. as a reminder, the caller may ask questions of the policy body but there's no obligation to engage with the caller. when your three minutes have ended, you'll be placed on mute and moderator will unmute the next caller. remote viewing is available. opportunities to speak during the public comment period are available by dialling the number on the screen. the dial in number is 415-655-0001. again, 415-655-0001. when prompted use access code, 2498 558 9355. again, 2498 558 9355. then press pound and pound again. you will then enter the meeting as attendee and dial star 3 to be added to the queue. when the system message says your line has been unmuted, this

is your time to speak. for those on hold, please continue to wait until the system indicates you have been unmuted. sfgov tv has a standing 45 second delay for the live broadcast online. we will take a pause to allow the systems to catch up and callers to dial in. it starts now. (please stand by...)

. . . >> thank you very much. we will now close agenda item number 7 and move on to agenda item number 8. >> agenda item 8 is hss report as of november 30, 2021. this is a discussion item. this will be presented by chief financial officer larry loo. >> thank you, commissioners. happy to present and some of the highlights of the financials for the san francisco health services system through november 30, the first five month of our fiscal year. and in the board commissioners packets and also available on the website to the public. we are five months into our fiscal year and important to note that the fiscal year starts in june and ends in july, but the plan year starts in january

and ends in december. so we're at the cusp of getting into the end of the first half of the year and rolling into the new plan year. having said that, and this is a reminder to the commission that the commissioners that we have several sources of funding. one major source is the trust and then also the general fund budget which serves as our really operational budget. and so in the trust and the balance of $123.4 million. as i mentioned in previous report, it is a little too early to tell exactly where we're at, but the first five months that is kind of where we are. but with regard to our funded plan, we are projecting to have

a variance of $77,000 to the fund balance that does include the projection of $8.7 million in the pharmacy rebate. year to date we received a little less than half of that already. and an additional source of revenue to the trust fund is from performance guarantee. typically we prefer to see it as low as possible. these are agreements that we have with our plan and administrators that if certain things such as the calls are not getting picked up in time to the extent we both agreed to, there are things to monitor. and we received $21,000 in the form of the securities. an additional source of funds includes the income from interest. that is typically posted by the

treasurer's office on the schedule. typically that happens closer to the year end and as the time of this report, there is no interest posted. with regard to the funds where we do build a budget and use debt for communicating our benefits, developing well being programs for all of our members and covered under sfhss and also creating initiatives to reduce the cost of health care, that fund is projecting a fiscal year end balance of $2.7 million. and then moving on to the general fund administrative, that is our administrative budget. we have that intended to be net neutral. currently we are showing a surplus of $492,000. we do manage that to have a no surplus, no shortfall position.

and with everything all told, currently projecting a fiscal year end change of a smidge above 0 or an addition of $3,000. >> thank you very much. and i open up the floor for questions or comments from whole service board members. >> i have a question and the point and what i see in these fluctuations are some of the figures going to and that works out.

and expected sooner in our fund. >> yes, that is the plan in effect. that is probably good opening salvo to the mrabing that is done for the rates and benefits. when the rates are set, there is a projection on where claims and expenses are projected to be on the funded plan. there are fund that are used from services in the past and the funds and decreases in the in the area. and building up reserves and a couple of points on that is pay attention to what utilization

which drives cost and then it will drive surpluses and expectations along those lines. and in the long term in the last several years, everything netted out to be on balance. in other words, no shortfalls or gain. on dental, however, there were surpluses on the self-funded side. and so there is a strategy to mitigate that. >> thank you very much. >> any other questions or comments for mr. loo? hearing none, we will open it up for public comment. >> thank you, follansbee. instructions for public comment will be displayed visually and i will read them aloud. public comment will be available for each item on this agenda and each speaker is allowed 3

minutes unless the board president deems new public comment time limits. all public comments are made concerning the agenda item that is presented. a caller may ask questions of the policy of the body but there is no obligation to answer or engage with dialogue with the caller. you are encouraged to state your name clearly although you may remain anonymous. i will thank you for your comment at tend of 3 minutes, you will be placed on mute and the moderator will access the next caller. opportunities to speak during the public comment time period are available by dialling the number on the screen. the number is 415-655-0001, meeting code 2498 558 9335. again, 2498 558 9335 and press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial star 3 to be

added to the public comment queue. when the message says your line is unmuted, this is your time to speak. for those on hold, please continue to wait until the system indicates you have been unmuted. sfgov has a standard 40 to 45 second delay. we will take a 45 second pause to allow the systems to catch up and callers to dial in. the 45 second pause begins now.

the 45-second pause has ended. the moderator will notify of us of any callers in the public comment queue. >> we have three callers on the phone line. zero callers have specifically entered the public comment queue at this time. reminder to all callers to dial star 3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed.

>> this closes item 8. let's move to ie agenda item number 9. >> thank you, president follansbee. mayor's budget instructions for the sfhss general fund administration budget for fiscal year 2022-2023 and fiscal year 2023-2024. this is a discussion item and will be presented by hss chief financial officer larry loo. >> thank you, commissioners. i am here to present the mayor's budget instructions for health services board as we are doing annually, we are building a budget, a general fund budget for the biennial period for

fiscal 2022-2023 and 2023-2024. it's an annual cycle that is driven by the mayor's office for all intents and purposes sfhss staff is treat as a department within the city's budgeting system, and this budget rolls up into the mayor's budget so that is why we have the instructions for this budget are important. the mayor's budget office released the instructions and on december 15. we'll pause to note that there was significant good news by the mayor's office. for the first two years there is a projected surplus of $108 million and followed unfortunately by some structural shortfalls, so this is incredibly good news and a significant turn around from the liability of last year when we were projecting significant deficits to the tune of about

half a billion or more. what's driving this is to point this out here and the newer sources and coming in greater than what was project bid the controller's office, and so that is driving one source of that. one of the drivers of costs include the liability for the retirement system and all the benefits that they must convey on retirees. and quite frankly, they had a record year in terms of returns on their investment. it was stated the return and their assumption was about .2% return on investment but their actual was about 33%. so what that does is reduce the future cost estimate for the

city as a whole. the other driver of better than expected income for the near term is the extension of the emergency relief dollars. and not necessarily a good thing because we are still in an emergency. however, there are dollars flowing into the system to offset some of the expenses. and the other driver to the positive view of the next two years is that the operating costs of the city's departments have been moderated. they were not clear ex-pend which you ares as quickly as anticipated. so with that in mind, it is very good news. and the cities and the mayor's office and the priorities going into this budget setting cycle to restore vibrancy of san francisco including public safety and street conditions,

most notable there is a lot of activity to insure that the streets are safe and clean. so that there is more commerce to be had in the city which, therefore, drives the revenue. the focus is also in recovering the local economy driven by returns of residents and tourists and even office workers like ourselves back into the office so that that drives the economy. n internally or at least more specific to city services, really wanted to reprioritize the funding to improve core services and what really is working and what is not really working. there is a push towards more accountability and equity in programs and services and the way that we account for that and the way that those are prioritized moving forward is also a priority for city. so with that there are some specific instructions that the department must abide by.

first, there is no mandatory reduction. so not only will it pause for positive comment there, but everyone who has worked on the budget at hss has experienced reduction targets every single year and this is the first year there is zero reductions. the flip side to that is no targeted enhancement, so we're not supposed to be putting enhancements into our budget. the focus should be going back to basics filling the funded vacancies in a lot of the departments. some of the savings that we have mentioned above include the fact that it's been tough filling some of the vacancies. and so there is a big push to insure that we complete the filling of vacancies that are budgeted and keeping this budgeted vacancy. and focus on programs that produce meaningful, ethical results. and quantifying that and our

other departments are focused on having those departments balance their budget within their own revenue projections for the non-general fund departments. what are the implications to sfhss? first, this kicks off the budget setting segment. we have worked with managers to identify what are the needs for the next two years. we will be developing the general fund administrative budget as well as the health sustainability fund budget on parallel tracks. we will have to have that go through the budget and finance committee and to the full health service board and are required to have two public hearings to ask for public input and to track that. and the most significant change this year is also that there is new budgeting software so that should make the process a lot

more efficient in terms of turn around times. however, with any new system, there are hiccups, so our staff and trained and provisioned to add software and we are ready to take on the challenge. with that, that concludes my report out on the mayor's budget instruction. i will take any questions. >> thank you very much. it seems encouraging and a challenge. i would like to focus on the priority of restoring vibrancy. i can speak from my position as the board that vibrancy is about people, and that includes our active employees in the employers that contract with us including the city as well as early retirees and retirees and their dependents. and so the challenge includes mental health, substance abuse, counseling and improving on that as well. i think we can meet this

challenge not only to restore, but maybe exceed vibrancy that we have been used to in the past. i think this is a great summary of what we're facing for the next two fiscal years. thank you very much. any other comments or questions from board members? i am glad there is an emphasis placed on accountability and equity and that is the past strategic plan and priorities as well as as well as the program that we have been putting in place for diversity, equity and inclusion. so i think that these priorities overall are not going -- we are

not going to be misaligned in the current and future thinking as a board around these issues. those are the strategist and goals we are about to put in place. >> a commissioner follansbee, i would like to support what commissioner scott indicated and also just to comment when i see no mandatory reductions on a budget year, i am so thrilled i can hardly speak. that was some of the best news and it looks like we will have

good opportunities going forward for the next two years. so that's great news. i think this will be able to maintain service and do what we plan to do for the next two years. thank you. >> thank you. other comments from board members? >> commissioner, larry, this is great news. i was a longtime san francisco public servant as well. so that you are able to fill all funded vacancies is like magic, and i guess that begs the question, how many unfunded positions do you have? >> we have about four unfunded positions actually. and one of the things with budget proposals and requests,

and will be trimming that out to look what we need going forward with all the programs we are trying to support. >> great. thank you very much. >> thank you. important point. thank you. any other comment from board members? i would also say the agenda item number 11 strategic planning process will have the chance to see the budget instructions incorporated into the planning process as well. hearing no other comments, would like to open this up for public comment. >> thank you, president. our instructions are being displayed visually and i will read them allow. public comment will be allowed and each speaker will be allowed three minutes to comment in length unless the board comment deems new public time limits.

you are encouraged to state your name clearly, although you may remain anonymous. you will be placed back on mute after the 3 minutes and the moderator will unmute the next caller. remote viewing is available and opportunities to speak are available by dialling the number on the screen. the dial number is 415-655-0001. again, 415-655-0001. when prompted use access code 2498 558 9355. again, 2498 558 9355. then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the public comment queue. when the system message says the line has been unmuted, this is the time to speak. for those on hold, wait until

the system indicates you have been unmuted. sfgov tv has a standard 40 to 45 second delay for viewers watching online. we will take a pause to allow the system to catch up and callers to dial in. our 45-second pause begins now.

the 45-second pause is ending. the moderator will notify us of any public callers in the comment queue. >> we have three callers on phone line. zero callers have specifically entered the queue at this time. reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no public callers, this is closed. >> this closes agenda item 9. i would like to move to agenda item 10 which we postponed from our december meeting and then i will promise everyone we will take a break after the

completion of agenda item 10. >> thank you, president follansbee. agenda item 10 is a board education item, health insurance portability and accountability act, hippa and is a training and discussion item and will be presented by rin coleridge, enterprise system and analytics director. i will be passing over the presenter privileges to you momentarily. >> thank you very much. good afternoon, commissioners. i appreciate your time today. and as soon as i get those privileges, i will share my deck and we will get started. >> it is coming through clearly. >> great. thanks for acknowledging that for me, holly.

so let's get started. rin coleridge with the health service system. and we are a covered entity and as such we must rely on the accountability and health information technology for economic and clinical health act, also known as hi-tech. the recent change that occurred last year is sfhss is designated a component of a hybrid entity, which is the city, along with other departments that fall under hippa requirements. for example t department of public health, fire department, city attorney, department of technology, and treasurer, tax collector. and that is an administrative construct to help simplify when we have to go out and do various legal compliance items. compliance requirements do

extend to health service board commissioners and in the presentation we're going to provide introduction to the sfhss privacy officer and that will as well as your role as commissioners and a general overview of hippa and the penalties and the practices to which we must adhere. i know many of you are conversant with hippa and so the details is in the latter part of the presentation because i want to focus the little time we have today to let you know about how does your role intersect with hippa and what you need to be aware of. hippa does not override state law and we are mindful of the state regulations that we have to comply with and so especially that are as protected of hippa and today we are focussing on

the federal regulation. we will let the privacy officer and a look at my credentials. i don't need to read them. the privacy officer is part of the hippa regulation and within that role i am a resource for you. so some of the requirements in that position are to deliver training so that is part of what we are doing here today. and also to develop our privacy policies and procedures to make sure those are implement and receiving and investigating and responding to any requests and logging disclosures and filing annually with health and human service. regularly monitoring our compliance around those hippa regulations. taking a look at the data we have and determining the classifications and that final bullet point, i want to stress that i function as a resource for any questions or concerns.

and really if you ever are unsure, ask a privacy officer prior to releasing information. and that is how we make sure we remain compliant and keep everyone protected. let's talk about your role as commissioners for the health service system. and on the health service board. i think one of your activities is that you receive, consider, and act upon member second level appeals. as part of this process a significant amount of protected health information is shared with the board. there are times that you are also receiving communication directly from our members outside of the apeels process and our membership does reach out as individually. and while a member can share any of their information, somebody is allowed to do whatever they want with their own information, but once you receive it, it is

govred by hippa because we are part of the covered entity and you are careful with that data and make sure you treat in it a compliant manner. it doesn't matter how you came to have that information. once you have it, you are bound by hippa. so one of the things like to share as a good takeaway for helping us stay compliant and protecting our members information is to always comply with the hippa minimum necessary requirement. essentially i am not sure a named person with rights to receive the information and we have ways to do that on our website in the privacy section. you will find all the hippa authorization forms that members can use to designate a third party be allowed to receive that information, but just being a commissioner does not grant you that permission to anything other than minimum necessary. an example might be follow-up

information on what happened for the members who contacted you or participated in the appeal process. and that is not necessarily a requirement for resolving the issue. so minimum necessary is really the minimum amount of information needed to either resolve the issue or complete a task or objective. that is what we mean by minimum necessary. we're always questioning ourselves with regards to me to answer the question do i need to share item a or are b and c also necessary. and fairly often you can really limit the amount of information you are sharing and still achieve the end state. and another activity as health service board commissioners is to be compliant with training requirements and i would like to extend mycin sere appreciation to all of you for completing your 2021 training by end of year so that kept us as a

department completely compliant with insuring we did that. and i do believe hss in terms of insuring the commissioners also have this information and practiced in cyber security. that is a little bit about what you are allowed to do. and that is local rules under hippa but the main are the privacy and the security rule. under the privacy rule, we are able to use and disclose phi for treatment, payment, and operations without having that explicit written consent that i referred to in the previous slide. but that did not mean, oh, hey, we all work for hss and are all on the board, so we can always have that information. no, it's really specific to, are you working on one particular issue? and so we see that frequently on member services and might have a

role in resolving an issue that doesn't involve a member of finance or communicationser to welding team. it is not an umbrella, hey, we are hss and deal with benefit administration and we all get to do this stuff. nope, it's very specific. you can always provide information to the individual who is the subject of that information. our members are allowed to have their own information. i did mention that for third parties the way they can be granted information is by obtaining written consent and we do have all those hippa forms on our website. and those are reviewed to the officer prior to releasing any information. there is some discretion they utilize in making a determination to release data under certain conditions and

finally, one of the ways that we release data is by de-identifying that data. fit's got on the a point where it is no longer personally identifiable, we are okay releasing it. there are two ways to do this with hippa. one is this scientific principles to make sure that we have reduced the data to a small risk to identify an individual. we do not use this data in how you define an expert and what are the scientific principals that you want to apply. we're going with something that is much easier for everybody not to deal with the data. you don't have to be an expert. this is accessible to everybody and that is the safe log-in method. we remove 18 type of identifyers and once we have made sure they are not in the data or information we are releasing, we

know it's being de-identified and that keeps us hippa compliant. we will look at the identifiers in a moment. here is some of the department practices for insurance and compliance. and that is the primary entity is always accountable for the protection of the information. so that is us. minimum necessary we talked about this but we limit the amount of personal information we collect, use, or share to only what -- to having a clear reason for why it's needed to take care of those activities. we do not discuss people and our members information outside of the treatment, payment, or operations. if we are discussing with within that realm, we do in it a secure manner. some secure mail. it is not in a public setting

whether it is an elevator or health service board meeting or break room and only to the individual who is have a need to know it so there again, you may find at different times as your roles as commissioners you interact with phi but your need to know it may vary at different times for the process. we do not put any phi or pii on our own computers. we keep that on secured servers that aren't something breaks into -- you have heard the stories and people leave the laptops in the car and sitting there with a coffee at a coffee shop and grab the laptop and runs. that is the world we live in. we do not put any phi or pii on those machines. pii is personal identifiable information. if we have hard copies of items that have to be shredded, we

have those and i have a compliant manner when no longer needed. phone communications is another area to be careful. we don't leave voicemail with specific information if we haven't actually reached that individual on the phone, we will wait for a callback because you don't know who is picking up the voicemail. essentially if we don't need the information, we don't store it. leaving that information around opens us up to risk. and there again, back to the privacy policies and forms that i have mentioned, there is the url for it which you don't have to remember. if you are on any page and you scroll to the bottom of that page in the footer you will see a link for our privacy policy. and of course, we must complete required training. we have done that already. and when we talk about no phi or pii on computers, we also have to be careful about hackers,

right? they can access our systems. and then get into maybe even the other systems that we've got more secure down. and that is why we are providing all of our health service board commissioners with laptops. and recently sent off by our executive director. abby. but this we find is a really critical piece as well because we want to make sure we can fully protect the systems with the end point solutions. cyber security integrates strongly with hippa because some of things that we can control like us learning about this so we know what we should and shouldn't do and there are the very capable threat actors and the items they can do to insure one less risk in terms of your

own personal computers and who you have using those personal computers. and what sites will using the secured provided hss labtops that you have for the protections on it and do remote support and making sure it's upgraded so you have to latest protections. those also are in the way. if you suspect any type of information about how to protect and go about securing it, please contact me. i am your resource. we want to make sure all the questions are being answered and empowering you before we do something we don't want to do. we went a little bit out of sequence, so let's quickly talk about hippa. what, why, how, boom. but it comes into use and

transfer of false information. iesz essentially is basis of this is to protect the continuity of care if they move from providers to specialists or to other hospital systems, so it's really both side of that coin is allowing the data to move but allowing and putting controls about how we do it so we know we are doing it in a way that helps protect personal privacy and what hippa applies to. medical, dental, prescription drug, long-term care, health and flexible spending care accounts. all of those are bolded because

those are items the hss admin registers. what it doesn't apply to, long-term disability, worker's comp, accident or life insurance. and so we have a little bit of those as well. and it does apply to covered entities which i have said we need that definition. and any of our business associates or subcontractors. so we work very closely with our contract team to have the proper legal documents in place before we share anything with our associates. and we all have a role in that privacy governance. so protecting members privacy and the security is just as important as assuring quality health benefits. i talked about phi so thanks for bearing with me if that was a new term for you.

so when you take a component and mary that up with health information, we have protected health information. it is considered any identifiable health information whether it's used, maintained, stored, or transmitted by a covered entity or our business associates in relation to the provision of health care payment or services. but it's not just past or present information or current that is aid. it is also future. it is also doesn't just have to be written or digital data. it can be verbal. it comes in any form. physical, electronic, etc. and so all of health information is considered phi when it includes any kind of individual identifiers. so back to a point i want to

stress with you because members reach out to you directly, it is phi and it falls under hippa and doesn't matter how it came to any of us. we have to protect and treat that data very carefully and who we're turning around and then sharing that information with really has to be only those that we have the protections in place that are for the treatment payment operation aspect but not just this is what i did at the office today. all right. let's talk about the 18 identifiers that i really like to use for making sure our data is accessible and you don't have to have any advanced statistical degree to be able to do this. you pull out all the items, names, geographic subdivision smaller than an estate, and any kind of dates. you can go with year and as soon as you have added a month to that information, that becomes

identifiable. phone numbers, email addresses, medical record numbers. any kind of account numbers. and you can see the list but url, internet, and so the ip address cans be traceable to individuals by a metric identifiers and finger, voice, and facial recognition as well. and number 18 is that catch-all. any other unique identifying number characteristic or code. so if we do need to share information outside of ppo, we render it as non-phi and to do that, we remove all of these items. frequently the zip code you can only do first three digits and no further down than that. as i mentioned earlier, there is a couple of components of the hippa and the privacy rule and the security rule. and so i briefly mentioned earlier that the privacy rule is

really about establishing those standards to protect individuals and medical records and other personal information. and the security rule is where we get into all sorts of layers of protection for that electronic phi and that gets subset further. we don't have time for that today, but into physical controls and that might be access to administrative controls and these are like pause words and log-ins and other technical solutions, such as when we equip information, for example, to keep that data confidential to make sure that the data is accurate so that is speaking to the integrity of that information and the people's information isn't changed in the way it should have been changed. it is available which means whether the members are requesting their own information or we need to be able to provide that information to the provider, we can get to it.

we haven't done so much locking down and the annual security service training is what helping you understand on a high level how to protect some of that information. and just a little note there are violations that you can encounter, so these violations are across four tiers. and they can go from tier one which you are looking at, like $100 per violation all the way up to a tier four which you are looking at $50,000 per violation and upwards of 1.5 million per year and i assure you we don't have that type of money to spend even though it sounded like a good budget report from the cfo. the difference between the tier one and tier four is really all about if you are completely unaware and maybe if you would recognize some due diligence, you might have known how we have

a risk here all the way to willful neglect meaning that you knew you had a risk and you had no effort whatsoever to correct that vulnerability, and so that is how these get assessed. but i want to let you know as well as the civil money penalties, there are criminal penalties that we can face, which include up to 10 years in prison. they could be lawsuits. it could be loss of a medical license. it could be employee termination and so these are significant. and at any time if there is more than 500 individuals in a certain geographic area affected by a breach, we have to notify outlets and the california attorney general's office and we want to make sure we are compliant with all of this information. and with that, i will bring my

presentation to a close so that if there is any questions, i am more than happy to take those. >> thank you very much, rin. it does complement the training that we have taken and the mandate to take yearly, so i appreciate that. with that, i will open this up for questions or comments from board members. >> this is the board secretary. rin, seeing that the presentation is still up if you were trying to take it down and screen share. >> is it still up? >> yes. >> i lost the nice bar that makes me stop doing that. >> mr. president, i would only add to your comment about this presentation supplementing what we have gotten in our training, and we speak to this in the

terms and governance provisions that we have talked about in terms of policies and regulations that apply to the hss board. and i particularly like the fact that, rin, you tailored some of the comments to our roles as commissioners. that was very useful. >> thank you, commissioner scott. and part of the reason for that as well is because in that hippa requirements we do have to do annual training and i know there was a couple minutes of hippa overview as part of the security training and this is requiring about our own policies and procedures. you use the third party tools, they are not talking about what we at hss expect. >> thank you. and if i could add to this, i think that two points. one is that the hippa rules are never supposed to interview with the actually delivery of care,

but we are not delivering care in our functions, hopefully that is not an issue. but as a member of the board f we get a specific issue from one of our enrollees who don't know where to direct the issue, it might be better as an intermediate step as to sort of send a jenin kwirry to the person we think might be responsible without forwarding the message saying i have an inquiry about benefits around the dental care or something like that. are you the one who should be dealing with this issue before we send off this message and it may go to the wrong person and department and technically that would fall into a violation if we said to someone who really should not have had that information and the wrong department and person and puts one more step in there if we are not sure where to forward a concern or complaint as a board

member, we need to ask generically and not specifically before we forward it. >> i would only add to that the first stop should be to abby and i would recommend as a board member and then certainly she can get it to rin or whomever. but i think that if we get those kinds of messages from members containing this information, the two of them should be kind of where we're sending that initial email. hey, i have received this. how do we want to process it? >> we have a pretty strong system set up for the board email and that was a risk and we shored that up so the emails come to holly, mitchell and i and we make a determination on who will address it. what we don't do is we don't tell the board what we did with it. because that is where the -- you

have handed that you have to us. we have to be super careful we don't get into specifics of specific cases. we will on occasion and you may not even know sometimes when we bring things forward that have been addressed and maybe affected more than one individual or something like that. and we have the responsibility to take affect and so we will come back and tell you about something new we are doing. and not necessarily tie it back to a single incident and that may indeed have been the instigator or something like that. we don't get into a discussion with a board member about how to manage a particular complainant. that gets into messy territory. >> again, just to alert board members sometimes members may have a personal email address for a board member through another route. and those are the times when our

system can't really triage that in a way and monitor that. so those are situations where either we send it directly to holly to deal with or send it directly to the director and not try to self-direct or whatever. i think that is a good -- the process is robust. and i think that it needs to be reinforced even if we get personal emails. we're trying to get away from that specifically. >> any other questions or comments? >> and this is commissioner and my original start date on the health service board was way back before hippa, so it's been interesting to see how things have changed over the years and rin, i want to thank you for this training and for the ongoing trainings in hippa because this, when it first came

about, it was a very big issue and a number of staff were sent to specific hippa training, but i think it's essential for those of us on the board as well in my personal experience and all the years that i have been involved with health service systems is a number of employees from all different classifications that will reach out. and either make a phone call or an email and when i have said, i don't need to hear all the details. these are projected, etc., etc., after hippa came in, what i find is that most employees because of their situation or condition or issue are incredibly willing to provide phenomenal amounts of personal information. they say, no, they're trusting you and willing for you to have

it. what i also find is that when i can call abby or mitchell and say here's an issue and can somebody call back or someone in customer service or whoever we want to deal with, when it is passed on, what i usually find is that employee will often call back and say this was resolved. it wasn't resolved. only this much could be and whatever and those employees are grateful for the assistance and very often easily relinquish what i would consider too much personal information. but they want the help and they are trusting of us. and so i think it is incredibly essential that we understand hippa and that we respect these rules and that we abide by them and we make sure that every

effort is taken to ensure their privacy. what i tell them is don't give me all the details in your email. i have don't want it. just let me know part of what the issue is and i can get someone who will call you back and deal with all those other essentials. but a lot of our members are just so desperate for the help and so trusting that they do share the information. so i think it's very, very important that we have this training and that we respect those guidelines and those boundaries, and that we work closely with our staff to make sure our members are protected. >> thank you very much. any other questions or comments from health service board members? >> i would like to comment that the line that keeps me on a narrow path and i would advise

commissioners to do as well is minimum necessary. so should you have a colleague or someone that you know who has an issue and handles hundreds of the calls very effectively, and please just take the minimum necessary information that will definitely protect you and is the right thing to do. so that we can promptly get to the concern of the member we need to talk to them directly. >> any other questions or comments? hearing none, we will open this up for public discussion. >> thank you, president follansbee. i will be pulling up the instructions.

i will be reading our instructions aloud. thank you for your comment. you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgov tv channel 26 and online on web ex. opportunities to speak are available by dialling the call-in number on the screen. the number is 415-655-0001.

415-655-0001. when profrmented use access code -- when prompted use access code 2498 558 9355. then press pound and pound again. enter that meeting an attendee on the public comment call-in line and when the system message says is line is unmuted, this is your time to speak. for those already on hold, continue to wait until the system indicates you have been unmuted. sfgov tv is a standard 40 to 45 second delay for viewers watching the live broadcast online. we will take a 45 second pause to allow the system to catch up and callers to dial in. i realize my screen is not being displayed. is that correct? >> yes. >> the instruction screen is not visible.

>> only says agenda item 10. >> i want to post that for anyone who may need that and just give me a moment. >> thank you for your patience. >> i will set our clock for our system and our 45-second pause will begin now.

the 45-stekd pause has ended.

we will wait for the moderator. there is still no callers in the public comment queue at this time. commissioner, hearing no further callers, public comment is now closed. >> thank you very much. this concludes agenda item 10. and what i would like to do is take a break now. it is 3:03. we will resume at 3:15 with a roll call and agenda item number 11. so a little break until 3:15 which is 12 minutes away. thank you. >> president follansbee, i wanted to make a note that commissioner hao did need to drop off for about 30 minutes and will return. and then i believe vice president canning has joined.

>> president: thank you very much. we still have a quorum at this point, but we will resume with another roll call. thank you very much. [roll call] >> thank you. president follansbee, we have quorum. >> i can call for agenda item number 11. >> thank you, president follansbee. i will be pulling up the screen momentarily. and agenda item number 11 is strategic planning process update and this is a discussion item and will be led by the

leticia harris senior planner and program lead. i will be giving the presenting privileges over momentarily. >> please pass presenter privileges to brian, that would be most helpful. the advanced strategic planning through 2020 to 2022 next slide

please. this slide provides a brief overview of our agenda and i will begin with the review of the perspectives with a profound and lasting process and discuss how the original strategic planning process framework has evolved over time. i will share a timeline of milestones with spotlights on tactical approaches and refresh activities linked to 2023 to 2025 planning cycle to seek input from the health services board and commissioners. next slide please. when we think about formative strategic plan perspectives, we are acknowledging our past, present, and future. what were we facing and thinking about when we put together our existing plan? what are the pieces of our reality in the current state and

has anything changed about the reality for which we need to adjust in the future. when we designed our strategy in 2018 health care perform was a driving factor fining a line on premium costs and affordable and carrier and provider consolidation and health and through the department and citywide and encouraging information among disparate partners. in addition to reducing cost barriers and simple i willfying membership and initial focal areas with opioids and maternity and fertility. in the pregnant day the covid-19 pandemic is a driving factor of market dynamics and keeping an eye on the pandemic's effect on employee turnover, not only for ccsf and provider retirement nationwide. over the last 18 months we have seen a virtual shift to care.

the key difference now is it is being provided by those who have historically performed only in-person care versus specialty tele medicine vendors and the stress of the pandemic and societal events increase and the number of members seeking mental health support and is responsive to this shift with the integration of well being and established citywide and emphasizing mental health and emotional well being. for the future we are aiming to link day-to-day work of organizational excellence and working to collect and leverage data driven insights around population health and also equity. building on the department's lean training to focus on employee engagement and member needs and continuous quality improvement and using pricing transparency to guide rates and advocate for providers to comply with rules and krinting to the growing body of knowledge involving health care value, cost savings and quality through our evaluations.

areas of focus include ageism and emphasizing mental health and care agent mth and tapping into the unique sphere of influence to the organization's goals. next slide please. as part of the strategic planning process we want to listen to the stakeholders and to manage, change, pivot and respond to member needs with the continuous improvement con cements noted in the blue arrow spectrum. for the 2023 through 2025 cycle and analyze the initial plan to identify successes and growth opportunities including what is driven and prohibited the

implementation framework when it comes to making decisions, changes, modifications or additions. to identify the progress over the life of the plan and conducting an environmental scan of the health care eco system to inform our go forward strategy. the strategy refresh exercise wills refine the quantity and scope of the business initiatives and measurable values to achieving mission and vision for 2023 through 2025. next slide please. this slide shows a timeline of strategic planning development milestones from the beginning of the timeline and milestones in blue which represent activities that occurred pre-pandemic. and back in july 2018 we had the innovation day to bring stakeholders around facilitated discussions to guide the strategic health philosophy and guiding principals and in august we engaged all staff around

discussions to develop the foundational principals with leadership and staff. by september our plan had been approve and endorsed by the board and in june and september we concluded a two-part health plan market assessment. the first part including analysis of health care systems models, friends, major players, contracting strategies and the second piece being an sfhss member focus group entitled your health plan options 2021 and beyond. we heard from many members in that feedback session and 34 unique departments clibt kribting to the inclusive strategic planning process. in the same month we are tapping our staff through the employee engagement survey to understand how we aligned with team growth, fit, voice, values and in october we solicited our members again for a premier open enrollment survey, specifically gauging customer effort and satisfaction using national benchmarks and our response

levels grew from the initial focus groups to gauge 1,000 responses from 49 unique departments. and as we move to the right-hand side of the screen, i want to indicate red post pandemic milestones to point out two previous strategic plan progress reports received by the board. one in november 2019 and again in march of 202. these reports speak specifically to the status of sfhss goals and business performance and key performance ind kaytors. in other words, how much of the plan is accomplished. i want to convey to the board that these previous reports are publicly accessible online and distinct from today's report which speaks to the methodology that is used to inform our planning process shortly after that preliminary report on november 2019 we leveraged the board's input and learnings and partnered with the controller's office to redefine quantity,

scope, and as we advance, we see in red the post pandemic milestones and think about the staff and the work force conversion they took part in extending the gratitude to them as we shifting to remote work environment and we want to acknowledge efforts of well being, finance, contract division that executed contracts in response to the mental health crises spoken to today. launching the app and customized wellness for first responders, current employees and retirees and our esa and member services work tirelessly to make member services e-benefits accessible to all sfhss members. in the communications division to lead a development of a comprehensive suite of webinars and with interdivisional support and health partners to acknowledge the gratitude to the board for the participation of the milestones in green and the

rfp for health plans 2022 plan year that concluded in february 2021 as well as our medicare rfi and that concluded in december 2021. this time reminds us of everything we have accomplish sod when we go forward, we will raise the bar and challenge the limits of our own capabilities. next slide please. enterprise systems and analytics is building an sfhss project portfolio that maps the rates and benefits timelines to interdivisional initiatives and annual reports, audits, sum system upgrades and the creation and manager of the portfolio will aid in the 2023 through 2025 strategic planning process. and this is because a tactical approach to project portfolio management involves the continuous process of selecting and managing the optimum set of project oriented initiatives with the portfolio management to

strategy and balances the resources to maximize the value delivered in executing programs, projects and operational activities. some of the benefits include greater visibility, to ground realities about resource utilization. realtime alignment of project timeline, increasing collaboration among the team members and reducing duplicative work and reimproving productivity and it helps to benefit governance and the portfolio helps to build structure timelines around reporting and project initiatives. this streamlines the evaluation of the progress and identifying barriers, interdependencies because we can use predictive scenario modelling that is mapped out in the timelines that the portfolio contain. and lastly, control. this tactic affords greater command of the strategic direction with day-to-day operation and strategic business having been clearly defined, refined and aligned through

project portfolio management. overall the portfolio management focuses the organization on achieving what is needed not merely on doing what is best but elevating performance and not just productivity. next slide please. we're always striving to convene multistakeholder experts to promote with and engage in unique sphere of influence as mentioned by the commissioners that involves a direct link between the budget and strategic planning processes. having met with the finance department, i can reassure there is a great deal of intentionality around meeting for the fiscal year 2022 through 2023 as well as 2023 to 2024 budgeting in anticipation of the february budget deadline with allocations for strategic planning and engagements of members, staff, and equity considerations. we are proposing another kickoff day and reminiscent of innovation day back in 18. this is projected for april of

2022. we want to bring together our stakeholders and have another meeting of the minds bringing together a broad set of thinkers and perspectives that help shape our current and future programs and services to best meet our population's needs. this is centered in between a preand post refresh exercise with our leadership which will take place in march and may, again, wanting to engage all staff at every step of the process and build a consensus around the implementation framework for the future. we want to assure the board that existing data around active and retiree member engagement from focus groups and surveys will be analyzed to determine whether new touch points and data points are needed to inform contracts, programs and communications. we aim to deliver preliminary drafts of the next strategic praft in june with the presentation of the final draft in august. our health care board secretary with the scheduling of exact dates and the distribution of calendar holds pending all covid

safety protocols in relation to meeting digitally versus in person as the pandemic is continually monitored. i would to thank the board for the ongoing endorsement of the strategic planning work and the high level planning is a preview of the strategic plan refresh activities and deeper level workshoping to come and i hope this overview is helpful to you. thank you for your time. >> thank you. this is a great presentation to get us really starts thinking about this in a real concrete way. i recall the kickoff meeting in 2018 and how robust that was and i am confident that that meeting that prow proposed will again address really the changing landscape and a lot of the barriers and successes and changes that have occurred in four years since we had that meeting. that is great. i look forward to that. with that, i will open up the

discussion and questions from members of the board. >> i would like to follow on the comments of president follansbee. this process has evolved over the it racingses of my tenure on the board over the last five to seven plus years in terms of where we started and in terms of the first effort and for strategic planning and got more sophisticated in the june 2018 every ra and now we have taken it to another level and the presentation today is a good road map to that, so i thank you for your work on this. i look forward to participating in april as we go forward to complete the plan. >> thank you. other questions or comments?

from any board members? >> this is commissioner zvanski. this is a wonderful appreciation. i appreciate it and a better focus and understanding of where we're going and look forward to seeing how this all plays out. i think it is very thorough and well organized report. thank you very much. >> thank you. >> other comments or questions about the presentation or the sort of timeline for the future. it seems ambitious, but i am thinking that, again, the board has been doinged in leadership at hss and the board has been doing a lot of the work in prep pags for this as we have implemented the last strategic plan, so i think that all this

seems quite doable and challenging and will be quite rewarding, i think. >> thank you to all the commissioners and president and the key objective to identify as you mention the important changes in the circumstances and our knowledge that we can use to keep our strategy relevant and refresh it. thank you all for the engagement. >> if there is no comments or questions from the board, i will open this up for public comment.

public comment will be available for each item on the agenda. each speaker will have three minutes. all public comments to be made concerning the agenda item as presented. a caller may ask questions of the policy body but no obligation to answer or engage in dialogue. i encourage you to state your name clearly although you can remain anonymous. remote viewing is available on sfgov tv and webex. opportunities to speak during the public comment period are available by dialling the number on the screen. it is 415-655-0001. again, 415-655-0001. when prompted, use access code 2498 558 9355. again, 2498 558 9355.

then press pound and pound again. you will enter the meeting as an attendee and dial star 3 to be added to the public comment queue. when the system messages says your line has been unmuted, this is your time to speak. for those on hold, wait until the system indicates ufb unmuted. with a standard 40 to 45 second delay for viewers watching the live broadcast online. we will take a 45-second pause to allow the systems to catch up and callers to dial in. the 45-second pause begins now.

the 45 second pause has ended. i will now check to see if there are any caller who is wish to make comment on this agenda item. we have three callers on the phone line. 0 callers have specifically entered the public comment queue at this time. a reminder to all callers to dial star 3 to be added to the public comment queue to be added for this agenda item and wait five second and close public comment for this agenda item. there is still no callers on the public comment queue at this time. commissioner, hearing no further callers, public comment is now closed. >> thank you very much. this closes agenda item number

11. i would like to call for eeg item 12. >> thank you, president follansbee. i want to know for the record that commissioner hao has returned to the meeting. we have quorum for all further action item. >> thank you. >> agenda item 12, delta den that quarterly report. this is a discussion item. and will be presented by a representative from delta dental. i will be passing presenter privileges momentarily.

good afternoon. again, my name is sharen stanek-lowe with delta dental. thank you for having me today. today we'll be discussing the quarter three, so q1 through q32021 report to the health service board. during q3 of 2021, our focus was in the following three areas. improve oral health, network, and member satisfaction. you may call in q2, we presented this dashboard that focused on sfhss utilization of the dental plan both sieve and retiree members and the focus primarily was on prevention and looking at

and pulling data for cleanings, the smile way program, online accounts and then overall utilization by type of service. i would like to go through each of these boxes to update you on the q3 numbers. so first in the upper left-hand corner, number of submitted cleanings and the teeth on the left-hand side, one cleaning, two, and three, pretty self-explanatory. but when we are looking at numbers if we look at the active column, those are the number of active members who have had at least one cleaning from january 1 through september 30 of 2021. for retirees that number is 11,702. and when we look at the total population of individuals that have had cleanings, 40.8% of the

actives and 35.2% of the retirees had at least one cleaning as of q3, 2021. 60% of our actives and 61% of our retire rear population have had a cleaning as of september 30 of 2021. this will become much more relevant as we move from 2021

into 2024 and a more non-pandemic view of the utility i willization. the positive information here is that as of right now we have q4 data to utilize the benefit and surpassed the book of business benchmark of 58%. and next our smile way program we have the total enrollment of 1,672. with the call out to the right explains the members receiving one, two, or three cleanings as well as the members that have received a root planing.

as that asterisk indicates, members can receive more than one benefit. there are six dental codes that encompass the smile way program and they could have a root planing as well as a scaling counting towards the number of utilized benefits. what is important here is that the smile way program is designed to allow and afford the members both active and retirees who are enrolled that third cleaning as well as the root planing at 100% if they are seeking services from a ppo dentist. this san added benefit and demonstrating that members are utilizing this benefit once they are enrolled. next our number of online accounts, why this is important is because this -- these members and actives and retirees have

given us authorization, delta dental, to be able to communicate and with them electronically. this will allow us in the future to continue to promote prevention type activities to drive more individuals to get cleanings and more individuals to enroll in the smile way wellness program. last but not least is our utilization by type of service. and there are three primary categories, dmp, diagnosic and preventive. basic and major services. this is both for actives as well as retirees. what you can see from this data and we are utilizing 2019 as a benchmark compared to 2021-2019, prior pandemic, so that's a more solid number base or database or

benchmark to utilize. when we look at the utilization for actives in dmpa slight increase as well as for the retiree population. and there is a slight decrease in both basic and major services for both actives and retirees. these are numbers we want to see. we want to see more individuals in the dmp category where we identify a situation, a dental situation and hopefully provide that prevention so it doesn't move into the major category. you might be looking at these numbers and saying, well, wait, dmp, 75.3% of activities and 69.3% of retirees use this benefit and up above when i talked about the cleanings and 60 and 61%, why don't those

numbers add upper to equal the same? dmp encompasses not only cleanings but it also covers exams, x-rays, and fluoride treatment with a little bit of a difference in the percentages when we look at dmp usage comparative to the cleanings up above. i will pause here for any questions. and then i will go on to the network slide if that is agreeable to the commissioners or i can continue. >> maybe the question i have -- this is president follansbee. the question i have is going to be addressed and i have to go through the presentation beforehand and in terms of, for example, the cleanings, do you have a breakdown in terms of whether the cleaningses are being provided and how provided

for h.m.o., ppo and out of network? because one of the concerns we have had along is around access to the hmo and ppo because of the out of network or members have a much higher share of cost in terms of the costs of the claims that may be billed directly back to the member. not reimbursed by delta. do you have a breakdown of that or is that coming up? >> it is not in this slide deck, so that is something that we can circle back with the information going forward as well as provide that to abby so it can be incorporated if she so chooses in the director's report next month. >> i would urge that and this is an important part of our understanding and both the positive side of this report but

also where we can focus our efforts as the health service system in trying to improve this as well. >> thank you very much for that feedback. >> i just have a clarification on this under the number of submitted cleanings and one cleaning is 30,000 something members. two cleanings is 13,000 members. so do you add these all together to get your 58% you said? >> the percentages. that is correct. 60%. and then the same for retirees. >> there is still only 40% have one cleaning, right? >> no, 60% -- you are correct. but overall, your population and

that one individual has had two or three cleanings, they have also had one cleaning already. we add those total numbers up. the 40, the 18, and the 9 to get the 60%. >> that is a little deceiving because the merge that has only had one cleaning is still 40.8%. and people that have had two cleanings is 18%. so they still need a little pressure for these people having only one cleaning. that is why we have this dashboard together to monitor this behavior and take action and i appreciate your input. i am being sensitive to the time and we might want to continue on. >> great. thank you. >> our next is the network and this is just a sampling of california counties. and this has this particular

information has really morphed and works with not only our actuary department and also with aeon and the executive team to really build a more thorough as well as informative slide and comparative to years past and why i say that is before what we would report on to the board is the number of dentists in our network and the numbers of dentists being utilized, added, termed and now this report is actually taking sfhss's claims data and the dental claim data and looking at how those dentists are being utilized. so when we look at the third column in, unique in network providers utilized by sfhss,

those unique in network providers and unique in network refers to our ppo and premier contracted providers. and then we're looking at specifically that top line alameda county. and there were 924 utilized dentists that are contracted with delta dental that were utilized by sfhss members. when we look at next column as of september 30, 908 of those dentists remained within our network. that change is a negative 16. they are 16 dentists that sfhss members were utilizing and are no longer on our network. and those can be reasons for the great resignation where they have decided to either sell the practice, retire or leave entirely and become a concierge

type dentist. and the percentage of the next one over is that percentage of change so what that 16 den cysts who have left the network, what that change is specifically to sfhss and the good or positive information is in total our network has grown in alameda county by 88 newly acquired in network ppo and premier dentist. and here january through september we have added 88 den cysts in alameda county to demonstrate counties that we have reported on in the past. and it's going to be a really great, useful tool in the future

as to monitoring any specific county where we might see a very high uptick of utilized dentists that have left the network and drilled down as to why and how it might have affected your population. so we're hopeful that with all of the work that so many partners have put into this that this is going to be a much. relevant and useful tool so sfhss and the membership. and that concludes my presentation. i am happy to sake any questions. so open up the floor again to questions and comments from board members. i would like to thank you for the last slide because this one is a very data driven provider

definition for us. and i think that where this conversation bebegan, i had at least the initial impression there was a large provider shift going on and going on. we can talk about which group they're in and all of that and this clearly demonstrates that the magnitude of this is not as expansive as the initial impressions might have been and without this type of data, and monitoring going forward, we would still be in that place of kind of guessing at provider changes there are. so thank you for this level of specificity. >> further questions or comments from board members? >> thank you. >> thank you, dr. follansbee.

i can't resist pointing out with relatively strong populations as part of the hetch hetchy system and employees and other remote areas. i think that speaks well so mu my concern is only this week i received calls from local member who is actually represent organizations of other members and they were talking about their only personal dentists in santa clara counties but the

comment was their dentists were complaining to them. and letting them know as long-time patients that they were no longer accept delta as the complete reimbursement and going to charge this regarding cleanings. and they were going to charge their patients the full billing rate and they would submit their invoice to delta on behalf of the client, the patient. but the reimbursement that would come would go to the client so that the dentist maintain the full reimbursement and the dentists complain they have been in practice a long, long time and were finding it extremely difficult to continue with the reimbursement rates and delta had not increased the

reimbursement for such essential services such as cleanings and close to five years. i was looking to see how many were leading and san mateo and santa clara and san francisco as well. and even contra costa because we have been getting a few -- or i have received calls from members in these areas and dentists have indicating they are leading delta because of reimbursement rates have not increased in a number of years. and the addition of in-worth network providers and we don't know if those are group practices where there are a lot

of new dentists so as long as the number goes up in the last column and gaining over losing 97 and i think you will need to look at that and be realistic about what it is the impact and they will have to pay $130 for a cleaning because the reimbursement from delta is too low for the dentists to make it worth his or her while. thank you.

>> thank you very much. >> thank you for your comments. commissioner breslin, is that you? sorry. other questions or comments? >> awe i am sure it is continuing. the cost of delivery is higher in the bay area and that they are in other regions.

>> and bringing new people into the network far exceeds and i do think part of the return level in such an organization. and to me that is a low number to have that little bit of turn. and where we're delta is help in helping us is these are the dentists that are serving our members. this is not a list of people we don't relate to. and getting into the relationship between delta and their dentist and the rate setting process is, i am not certain that is where we want to go.

>> it is a complicated issue and we have to acknowledge how difficult it is for the members who have been dealing with the data for sometimes years or longer to have to then seek out and interview new dental practices knowing that their own dentists are still in practice because it is and especially with inflation, everyone's costs are going up. we have to acknowledge the pain that this may engender for

people. [reading of instructions] when your 3 minutes have ended, the moderator will unmute the next caller. remote viewing is available on sfgov tv on channel 26 and webex. opportunities to speak are available on the number on the screen. and the number is 415-655-0001. access code 2498 558 9355.

press pound and pound again. you will then enter the meeting as an attendee on the public comment call line and add star 3 to be added to the public comment queue. this is your time to speak. for those on hold, continue to wait and until the system indicates you have been unmuted. sfgov tv is a standing 40 to 45 second delay for viewers watching the live broadcast online. we will talk a pause to allow the system to catch up and callers to dial in.

our moderator will notify of us any public comment callers in the queue. board secretary, we have three callers on the phone line and zero have specifically entered the public comment queue at the time. a reminder to dial star 3 now and you want to join public comment for this specific agenda item. we will wait five more seconds and close public comment for this agenda item. board secretary, there are still

no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you very much and thank you very much for the presentation and the discussion and feedback. that closes agenda item number 12 and we would like to move to item 13. >> thank you, president follansbee. this is a discussion item and will be presented by executive director abbie yant. >> you have in your packet the rates and benefit season. and we will update this and pre-present at each upcoming meeting. we put holds on these months for a second meeting.

and this just is what gives us space if things get complicated. and i think we have only had to invoke one of these one time. so don't stress about it too much. and our february meeting i think is pretty straightforward where we'll be looking at the hartford insurance policy that's the extra item that will be at that meeting and so on and so forth. so should -- and do pay attention to sort of when this is dated because as i said, it does change throughout the experience that you want to keep track and know you are on the right page and you will have to look at to put it at the top as of january 7. this is the plan. thank you. >> thank you very much. attempt to quell anxiety as well. and in these times. open this up for questions and comments from the board.

hearing none, we will open this to public comment. >> pibb lebron jamesing comment will be available for each item on this agenda. each teaker will be allowed three minutes to comment unless the board president deems new public comments and all public comments to be made concerning the agenda item that has been presented. a caller may ask questions of the policy body and no obligation to answer or engage in dialogue with the caller. you are encouraged to state your name clearly and you may remain anonymous. when the three minutes have ended, you will be placed and mute and the moderator will replace the next caller and available on sfgov tv channel 26 and webex. opportunities to speak are available by dialling the number on the screen. the dial-in number is

415-655-0001. 415-655-0001. access code, when prompted use access code 2498 558 9355. and then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the public comment queue to ind case this is a standard 40 to 45 second delay and the hah-second pause begins -- the 45-second pause begins now.

the 45-second pause is ended. the moderator will notify of of any public comment callers in the queue. board secretary, we have four callers on the line. zero callers have entered the public comment queue at this time. reminder to all callers on the line you must dial star 3 now if you want to join public comment for this specific agenda item. we will wait five more second and close public comment for

this agenda item. board secretary, there are no callers at this time. >> hearing no callers, public comment is now closed. >> thank you very much. this concludes agenda item number 13. we can move on to agenda item 14. >> thank you, president follansbee. agenda item 14, approve the june 30, 2021 incurred but not reported ibnr reserve and contingency reserve amount for self-funded and flex funded health plans. this is an action item and will be presented by mike clarke with aon. i will be passing over presenter privileges. >> thank you. good afternoon, commissioners. i will shortly share my presentation.

i will be reporting on the ibnr reserve and from flex-funded plans and today's discussion focuses on the first two. and the ibnr occurred and not reported is our estimate and actual estimate of the unpaid liability that would be expected for runout claims for the services are incurred.

these are calculated as of the end of the plan year, december 31, and we will be discussing stabilization reserves in the march time frame. there are these three distinct reserve policies that i just covered for the following plans. flex funded nonmedicare and hmo

plans and the self-funded dental ppo plan presented by delta dental of california. two important notes in the latter half of this page. first, we will not be talking about health net because the plan was not authored as of june 30, 2021 and in the future we will develop ibnr and flex reserves for 2022. and secondly there was the transition of the medical plan administrator and most participants and early retirees with uhs continued to administer

for non-retiree and noting the two elements that are not part of today's presentation because the measurement data is june 30, 2021. this presentation request and health service board approval today for the incur but not reporting and contingency amounts that will be displaced on the next coup of page. for the ibnr, this table where the top of the table is for the blue shield access plus and trio plans with the nonmedicare ppo plan administered by uhc and the self-funded dental ppo plan administered by delta dental. a slight decrease in suggested reserve for the blue shield hmo planned and substantial increases for the other two plans and as you see in my notes generated by the fact that on

the prior measurement data june 30, 2020, there were substantial covid-19 claim suppression impacts during the second quarter of 202 especially in dental, most pronounced. and what we're seeing for june 30, 2021 a return to more expected an typical levels for the incurred but not reported reserves relative to more suppressed levels for the ppo plan and the dental ppo plan that existed as of june 30, 202. in total, the overall ibnr reserves are projected to increase 1,800,274. and for contingency reserves we are seeing in total a near flattening of the suggested figure from june 30, 2020 to june 30, 2021 and though

certainly with variability by individual plan. a slight reduction in the calculation of contingency reserve for the blue shield plans and as you see in my notes at the bottom of the page, the more substantial increase for the mon medicare ppo plan came with a suggested change in methodology that we use for the calculations of cycle going to more of a large claim predictive modelling approach. we discuss this at length with chief financial officer lieu and the update to methodology was prudent since this ppo plan does not have stop los and the delta dental ppo plan to recommend a change in methodology that was

discussed and agreed upon by chief financial officer lieu knowing for dental the plan exposure is essentially catched on how much per individual the plan will pay versus medical where the participant exposure is capped through maximum out of together levels. the health service board policies are captured on the website within the governance policies in terms of reference

documents and with the web link included here in this presentation. and with the numbers that you see at the bottom of the page. and finally just to note the changes in contingency reserves will be a component of the december 31, 2021 stabilization reserve calculations that we start to present to you in march. so with that, i will stop sharing. commissioner follansbee.

i have one question and that is where i can understand and the concept to deal with this regularly in terms of the pandemic effects, is there any suggestion that there's been some delay in the actual mechanism of billing? and members are being seen or hospitalize and because of staffing problems and billing offices and whatever that we have not been getting more timely reports? in terms of reimbursement? or is it all just around the utilization that i can understand, but i am curious about the actual process of getting the charges to us.

thank you for the question. what is interesting is the calculations around june 30, 2021 and we were not necessarily observing any patterns of difference in the first half of 2021 and interestingly for many of my clients as we have done year end reserves and december 31, many of my clients and the fiscal year on december 31, and we have seen some instance with some carriers of longer lag times to process and pay claims. so it is something we will keep an eye on for us at sfhss to see if that may have impact on what to calculate as of june 30, 2022. and fantastic question. we just didn't necessarily see it as of june 30, 2021. >> thank you very much. so it's been moved and seconded that we approve the recommendations and any further discussion or questions before i open it up for public discussion?

hearing none, i will open this up for public comment. >> thank you, president follansbee. i will be pulling up the instructions to display visually and reading them aloud. >> public comment will be available for each item on this agenda and each speaker will be allowed to comment three minutes in length unless they deem new public comment items concerning the agenda item as presented. the caller may ask questions of the policy body and no obligation to engage in dialogue. when i welcome you on the the call, you may state your name clearly although you may remain anonymous. i will thank you for your comment and placed back on mute and unmute the next caller. remote viewing is available on

sfgov tv and webex. opportunities to speak are available by dialling the number on the screen. the number is 415-655-0001. access code is 2498 558 935 # an and wait until the system indicates you have been unmuted with a standing 40 to 45 second delay for viewer watching the live broadcast online. we will take a 45-second pause to allow the system to catch up and callers to dial in. the 45-second pause begins now.

the 45-second pause has ended. our moderator will notify of us any callers in the public comment queue. >> board secretary, we have four callers on the phone line. zero callers have entered the public comment queue at this time. reminder to all callers on the

line to dial star 3 now if you want to insure public comment for this specific agenda item.

>> item 15 is reports and updates. this is a discussion item. i am continuing with delta dental and still behind the scenes. but we have now been fully staffed both directors and v.p.s, national account manageers and so i officially will be handing off sfhss to the most capable jen and she will be spro deucing herself in the next

moment to give you her history. not to worry. i am in full support of her and full support of sfhss. >> sharon and ri in constant contact. lucky sharon. i am a manage we are delta dental and in the employee benefits industry for 17 years. all within the consulting world. i have started my career actually at aon. and i frequently say i grew up at aon and most recently i am coming from haze company. while i may be new to delta dental, i am not new to the

industry and throughout my career the data can tell us the story to make critical decisions and pinpoint behavior population and as well as identify critical opportunities to allow us the ability to better strategize and make recommendations as appropriate to the needs of your population. so with that i really look forward to working with the team and learning how we can continue to build on our partnership and city and county of san francisco

in the future. thank you very much. >> thank you. >> how long were you here? >> four years. >> any other comments? >> this is commissioner zvanski. all those days when i was off the board and we were sitting in the back couple of rows. the hearing room. and i will certainly miss the chatter and camaraderie back there. and you have been a wonderful representative for delta and thank you very much for your work. i am actually very happy to hear

that you will remain with delta. i want to welcome jen. i think it's going to be -- i am glad the hair color seems to be consistent so i won't get the reps mixed up but i want to welcome you on board and it is interesting you came out of aon and this should be familiar ground. i think you will find this is a good group to work with. welcome aboard. >> thank you. >> thank you again. any other comments? hearing none, any other reports from plan representatives? ? >> hearing none, i would like to open this up for public comment. holly? >> thank you, president follansbee. >> i would like to make a comment. >> yes? >> i would like to see what the

mental health reimbursement is for the providers, for the mental health providers from each plan if that is possible. probably not. but i know that it came up in kaiser representation. part of the problem is the reimbursement level for mental health providers in our plans. i think that could be a big issue because that is a difficult job. if that is possible, i would like to hear that in the future from our health plans. thank you very much. and any other comments before i open this up for public comment? hearing none, we will open this up for public comment. >> thank you, president follansbee. i will be displaying our public comment instructions visually and reading them aloud.

a caller may ask questions of the policy body but there is no obligation to engage with the caller. when the 3 minutes have ended, i will thank you for your comment and you will be placed on mute and the moderator will unmute the next caller. remote viewing is available on sfgov tv channel 26 and webex. opportunities to speak are available by dialling the number on the screen. the dial-in number is 415-655-0001. access code 2498 558 9355.

again, 2498 558 9355. and then press pound and pound again. you will then enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the public comment queue. this is your time to speak. for those already on hold, continue to wait until the system indicates you have been unmuted. sfgov tv is a standing 40 to 45 second delay for viewers watching the live broadcast online. we will take a pause to allow the systems to catch up and callers to dial in. the 45-second pause begins now.

the 45-second pause is ended. our moderator will notify us of public comment callers in the queue. >> we have three callers on the phone line and zero callers have enter the public queue.

>> public comment is now closed. as we approach item 16 which is adjournment, i would like to restate the unanimous commendation of the health service board and the city and county of san francisco for the work of larry loo during his tenure as cfo of health and human services. much appreciate and we all wish him the very best in his new position in san francisco. but not with us. again. thank you very much. with that, i would like to adjourn this meeting.

>> first of all, thank you for coming to celebrate this incredible milestone. i am really excited that she accepted. because i know what you often times may see is the fights between kim and i. what you don't know is about the

friendship and the amount of love and respect i truly have for her and her work ethic from the moment i met her actively engaged in labor in a way that brought the conversation to a different level around women and minorities and their role in leadership and labor. it is good to see more women step up and in fact, it is 125 year history not one woman has ever led the san francisco labor council and kim is doing that, which is absolutely extraordinary. [applause] and you are the first executive director of the labor council to serve on this work force investment board because i didn't want to appoint the others. just kidding. but in fact, you know, this is

so important. when i think about growing up in the western addition and the fights that we used to have to be included in the placements and job opportunities that exist in the city, i feel like we have come a long way but we still have a long way to go to make the real connections between people in many of the communities that many of you represent but himself the same people who want these opportunities, the new jobs that come to san francisco. not just the work related to construction and engineering but as you know there are even shortage of nurses. the work you have done with nuhw was extraordinary onever the years. how that played a role to make sure there is a real connection between people and the opportunities, through organized labor to make sure they get their fair share, the appropriate pay and benefits and

the ability to take care of themselves and their families. you have been doing this work for a really long time. i know that you are going to bring a really strong voice to this body. in the process you are going to make a lot of folks upset what it is you have to say, but i wouldn't have wanted it any other way because some things need to be upset. some things need challenged. in fact, i am not afraid of a challenge and not afraid of the conversations that need to be had to get to a better place that is what we want. we want a better place so people have better lives. you have dedicated your lives to public service. organized labor but public service because of the people that you know you represent. the people that you know are counting on autophytes for them and make the right decisions that are going to have an impact

onnary families and livelihood. regardless of disagreements at the end of the day the underlying message i know that is most important to much of you and i know is important to kill is the fact that we want to fight for better lives for the people we represent. that is why you are going to be serving on this board, and i appreciate and honor that you accepted this opportunity. i am looking forward to seeing something change for the better for workers throughout san francisco. with that let's debt you sworn in. (applause). >> i will put on my mask. covid is running rampant and we are close to each other. place raise your right hand and repeat. i say your name do solemnly swear that i will support and

defend the constitution of the united states and the constitution of the state of california against all enemies foreign and domestic that i bear true faith and allegiance to the same. that i take this obligation freely without any mental reservation or purpose of evasion and that i will well and faithfully discharge the duties upon which i am about to enter and during such time as i serve as a member of the work force

investment san francisco board for the city and county of san francisco. congratulations. [applause] >> here is a little city seal pen with my signature. i give this to all people i swear in to serve. ladies and gentlemen, the latest person for the board tackling work force in san francisco and making real change. [applause] >> thank you, mayor breed, for taking time-out of your schedule to do this. thank you to the leaders of labor here today, especially my board members, susan, mike,

charlie, debra, and my good friend karen. i want to thank you for taking time for the swearing in. it means a lot to me because i have always been really challenged by the fact there rvs and have notes in the work force, and i really want to fight overcoming making sure that everyone becomes a very. everyone has an opportunity to get a job and a wealthy job and to join a union if they so choose. that is my mantra since i was little. it is my mantra to this day. i will fight to make sure. that is what the labor council is about making sure there are opportunities for people and career ladders. that has always been what i have been about. i want to make sure that

happens. we have seen companies take advantage of people especially during strikes when they go into poor neighborhoods to try to recruit scabs. we knead to emphasize recruiting people to getting into them into construction and janitors and construction trades and up the ladder and nursing, healthcare. these are all opportunities they should all have. we want to make sure that the san franciscans that we all know and love have that opportunity and that is my goal for this. i really intend to implement a labor caucus to make sure that we are doing what we need to do to give every san franciscan the opportunity be to participate from our economic recovery from covid and overall economic recovery as we get on with opening up the city and making sure that people come to san

francisco. those the obstacles before us. i hope we overcome them altogether as we move along. thank you. [applause].

. >> chair mar: we're live? good morning. we'll come to order. welcome to the thursday, january 27, 2022 meeting of the public safety and neighborhood services committee. i'm gordon mar, the chair of this committee, and i'm