>> welcome to budget thursday. this is part two. this the regular meeting for the budget and finance committee and the budget federal committee i am supervisor melia cohen supervisor of this committee. in the chamber today we've got supervisor sheehy kim, and fewer. were going to be joined shortly with supervisor yee and supervisor tang. the clerk of the board is linda wong and john carroll today. i want to thank phil jackson an injury in

stark from sfgov tv for assisting us with today's broadcast. mr. clerk any announcements? >> yes. please, sounds all cell phones and electronic devices. completed speaker cards and copies of any documents been included as part of the file may be submitted to the clerk. items acted upon today will peer on the april 25 board of supervisors agenda unless otherwise stated. >> thank you very much. could you please call item one on the budget and finance select committee agenda. >> item number one a hearing to receive an update on the federal budget and any related impact to the city and request a controller's office and maters budget office. >> all right. thank you for hearing this item. several weeks ago we received an overview of federal funding-of federal funding to san francisco as well as any anticipated impacts or risks to our cities department. these are the risk they're going to be facing. it's difficult to anticipate the pace of how

quickly things can change at a federal level, but i believe it's incredibly important that this committee stay abreast and up to speed on the changes that do occur. that may have impact on our city's budget and financial health. this week will hear from the department of public health regarding the status of the affordable care act. what impacts and what impact the failed attempt to repeal the aca will have. with that i like to bring up pauline chawla, good afternoon pauline from the department of public health. >> good afternoon supervisors. thank you for having me. arlene joplin for the department of public health. i have just a brief overview for you on what is occurred since i was last here just about two weeks ago

related to the affordable care act. so primarily what i want to say is that the affordable care act remains in place. there have been no changes.. i think the most significant development took place the day after i was here last week, last month. on march 24, the majority leaders in the house of representatives canceled a key vote on the affordable care act on american healthcare act, that is, and this is really a win for the 133,000 san franciscans who've been benefited from the aca sponsored health insurance. when i was here last i talked about the american healthcare act which would repeal and replace the affordable care act. as i described to you previously, the american healthcare act would've repealed the individual employer mandate, would have repealed subsidies on the healthcare exchanges like cover california. would have reduced

federal medicaid funding to states like california and would have really restructured fundamentally the medicaid program. though the cancellation of this vote on the house floor is a reprieve the white house and congressional leadership have indicated their desire to continue with the repeal effort. in fact, i was in washington dc just last week with our community clinic consortium and we had the privilege of meeting with leader pelosi. the leader had indicated to us that the reason that the american healthcare act was so important to the leadership is because they needed the savings from the repeal and replacement to fund the tax reform package that there are intending to take up next. so that is among the reasons why it's still important for leadership and congress and in the white house

to look at some changes to the affordable care act. so it is unclear now what will happen exactly, whether the american healthcare act will pass, or, if it does pass it may look different than the current version looks now. in many details would be also up to the administration when she implements the legislation if it were pass. finally, whatever california does in response to federal action, will also be as important as federal action in terms of the impact on san francisco. so it's also important to note is a significant amount of administrative authority that can occur in the absence of legislation to rollback provisions of the affordable care act. so to highlight a few areas where the administration already has within its authority some power to change the affordable care act significantly. first would be around the subsidies that make insurance affordable for low income and middle income individuals. these subsidies are-one of the subsidies is a

subject of a federal lawsuit congressional republicans sue the obama administration and were successful in a lower court. the trump administration could-the obama administration appeal. the trump administration could take up the appeal or drop the appeal. if they drop the appeal, that means the subsidies could be eliminated for the lowest income individuals purchasing health insurance on the exchange. it could also allow state administration could also allow states impose restrictions on medicaid beneficiaries. what's being talked about at the federal level are things like work requirements. making sure that people on medicaid are working. this would be an allowance for states to opt into. the federal government could also without legislation we can the individual mandate. they could choose not to enforce portions of the individual mandate. this could result in destabilizing the marketplace because

individuals who rely more heavily on health insurance would be those more likely to enroll in those who don't rely heavily on health insurance would which would be more cost costly for health insurance and likely drive up prices on the marketplace. finally, within their current power redefine essential health benefits. right now, there's 10 categories of essential health benefits. they include hospital care, primary care, maternity care, prevention and things like that. while those 10 essential health benefits would have to remain there significant latitude within the admin stations power to change what comprises those essential health benefits. changing what comprises prevention or mental health or substance abuse care. so shifting a little bit to the presidents budget, i don't have any new information for you today. updating from a was last

available. the president had introduce what's called a skinny budget. a skinny budget means it pertains only to discretionary spending not entitlement spending like medicaid. in the discretionary budget the proposal was to reduce the budget by 18% for health and human services. the comment that most directly affects the department of public health. but specifically, specifics were not provided. the whole of health and human services area with two pages of narrative so i don't have more details than i did before. i will say, too, just as whatever changes to the affordable care act are taking up under the american healthcare act were administratively by the trump administration, how california response will be as important as the changes made at the federal level. so what does that mean? generally, funding at the federal level pass to the states not in all cases but in many cases medicaid is certainly one of those largest

cases. but, how to fund-if the federal government reduces medicaid funding, or changes requirements for medicaid, how california adopts those and whether california adopts those would be a significant question. how to fund and structure medi-cal in the event of changes at the federal level or, whether to take up certain federal options that the federal government gives to states to make the programs more affordable for them also would be of significant importance to the department of public health and the city. it's also important to know the california legislator is already considering other options. so there are legislative proposals afloat that would create a single payer in the state of california also, universal healthcare system not unlike our own healthy san francisco system. we are keeping an eye on those things, too. just an overview on what we are doing about all of this advocacy is our number one goal right now. i mention i'd been in washington dc and met with elected officials there. despite the proposals that are

pending at the state level, it still important we feel to protect the gains we have achieved under the affordable care act. so we are meeting with our delegation. meeting with the city's lobbyists and we are conferring regularly with her statewide and nationwide association. in the meantime we are tying to maximize all of the programming that we havethat were also in a lesson the impact of the proposals that are part of the public health. with that in mind, we are keeping at the forefront of course the care to the individuals we serve and making sure that we keep those principles high. that we want to make sure that healthcare access for our residents is of the utmost importance. so just

to leave you with a few key takeaways. a summary of my presentation. to say that nothing had changed despite all the conversation and everything in the news, everything is still the same as it was before. health insurance benefits remain in place and people should continue to use them. that federal changes still possible but the details and the impact remain unclear and we are continuing to monitor so that we know what the impact of the is as it is clear proposals come forward. even a clear proposals come forward, california has to act and how california acts will be of significant importance to the department of public health in the city and what's really at risk here is coverage for the 133,000 san franciscans who gain acas sponsored insurance. for those individuals health insurance could be reduced or lost. we want to preserve the gains that were made under the affordable care act and the addition of new insured san

franciscans and we want to make sure that we maintain continuity of care, not just access, the continuity of care in the very health systems across san francisco that serve these individuals. it's also important for you to know healthy san francisco remains in place. we continue to have a healthy san francisco program that will assist those who have no other options for health insurance. that is the conclusion of my presentation. happy to answer questions you may have. >> thank you very much. supervisor kim has a few questions >> thank you i want to ask about congresses passage in regards to title funding and trump p signing into law states ability to withhold federal funding from clinics that perform abortions and family care.. i know that is a state choice, but i want to know a little bit more about what the department of health is thinking about that. title x funding

>> right. i am not familiar. i should be formatted. i'm not summa with the actual executive order my investing around some of those decisions were in the american healthcare act and other places. but we certainly support reproductive rights and offer a continuum of reproductive health services at the department of public health. >> yes. i know that but february actually not sure it's an executive order. i think congress actually passed that. i know trump is signing that into law today or could've been executive you know. signing into law today so it's a legislation that would allow states to withhold federal funding title x funding, from organizations like planned parenthood that perform abortions. that was a lot obama had put into place. it would be great to get more information about that. i think it something we need to prepare for seeing that's decision is out of our hands. i doubt california would take that

option up but i'm very interested. >> will be very sure to try to get like the out other california rules i highlight i think were fortunate to be in a state where many the things are not likely to be adopted by our state likely being one of them. it's only something we need to pay attention to because the state has zero resources they need to make difficult decisions. >> thank you. >> thank you super visor kim. question for you. you mention in your report california roll and you [inaudible] california legislature is hearing a couple options one being single-payer and the other being universal healthcare. do you know where these piece of legislation are in the process? >> the single payer bill has been amended. i think just last week to include much more detail on what it's proposing. has yet to make it through the legislature. the universal healthcare proposal is one that has been talked about by the lieut. gov. but to my

knowledge has not yet been put into legislation. >> so okay it's being discussed. it has not been drafted or submitted? >> correct. >> thank you. any other questions? seeing none, thank you for your presentation i think we will go to public comment at this time. ladies and gentlemen you have public comments. you will have two minutes. your soft chime indicating 30 seconds on your time. if you would like to come up, please do so. >> good evening ladies and gentlemen, supervisors and audience. first of all i want to say who i am. i'm ace on the case washington. i'm not can go through the scenario i really do because this is a very important meeting. very important. first of all at the outset i want to say not only to make a statement but also trying to find out what in the hell is going on? if you don't know our city just edges, want

to know what somebody from the federal government here because right now, ace i'm on my way to washington dc. to find out what's happening. with trump i want to him to come to san francisco to tweet tweet tweet some of things he talks about in his campaign. what do you have to lose? i want him to come to san francisco and tell him to bring the new hud director to san francisco where this thing started out and find out he can tweet and tell the world was happening on fillmore street but as far as the city and county, the city by the bay, everybody needs to know everything is not okay. [inaudible] supposed to be doing. i'm not new to this. i'm true to this. let me take my hat off. i'm not just an ordinary citizen. i should be getting five minutes because i'm making a statement.. hope sf or whatever you want to call

it. i was there from the outset. nobody, none of you all, i don't see nobody around one hope sf was put together. [inaudible] lieut. gov. soon will be the next governor. i know him personally. i know legislators and i know a lot of people person to i know everybody before you got most of the people. that come from my community to the government now are executive directors of -and head of departments in san francisco. the city by the bay. where everybody thinks everything is okay. but i've got something to say. [inaudible / off mic] >> thank you your time is up. your time is up. [inaudible / off mic] mr. cook, please call the sheriff's department thank you. [inaudible / off mic] this meeting is in adjournments.

>> [gavel]'s >> [recess] >>

>> [gavel] >> calling someone to make a correction. the meeting with a german and actually we were in recess. one calls out of recess again and also want to acknowledge that at the beginning of this meeting i wanted to recognize that we have a full quantum, six members of the board of supervisors are here. three representing the budget select committee and three the budget finance subcommittee. so, i appreciate your patience. calling, she still here? i had a couple questions for you.

could you describe the difference between the functionality between the aca and healthy sf? >> so essentially formal care at did three things. required people to have health insurance. it gave them more opportunities to get that health insurance. then, he made some investments in public health and the opportunities to get health insurance, which included medicaid and private health insurance, are the expenses and health insurance which caused healthy san francisco to go down to healthy san francisco is essentially coordinate care program for uninsured health insurance did it looks like health insurance but doesn't uncover you out of the city. it doesn't cover [inaudible] it doesn't give you the entitlement picture you would get with health insurance. like the minimum level of coverage for certain things in a timely access to services. that's kind of a roundabout way to say health insurance is more of a holistic

program that's available across counties where you go it's portable with you but unlike healthy san francisco, which is just healthcare coverage within the city for uninsured individuals. >> all right. thank you. another question is, how much in federal dollars does san francisco receive for the winter 33,000 san franciscans in the expanded medicare program? >> i'm not sure i can answer that you do not to be to san francisco directly. it will be to the providers that serve them we serve about a quarter of the medicaid. the 93,000 got medicaid but the 43,000 got cover california they got their health insurance and other places. in the individual health insurance market. many of them have subsidies and those are federal dollars that come from the sub subsidies but doesn't come directly to the city of san francisco. >> okay. here's another question. the federal health dollars that could be lost, are they tied to other funding

streams, or, various funding streams? >> so if i think about medicaid,as the largest portion that could be lost, with the federal government was considering in the american healthcare act was changing the way states get medicaid funding. right now, it's in entitlements. if we spend money that is an allowable expenditure the federal government will give $.50 on the dollar for those expenditures. there's no limit right now. as long as we spend it on approved relations were approved services. under the american healthcare antenna with a want to do is change it to a per capita and say state of california, we will look at your previous utilization and previous enrollment and we will say you only get so much money per person enrolled in your program, and you have maybe some additional flexibility to use it as you want,, but we are only going to give you that

much money and you manage within that budget. that was seen as having a significant budget savings for the federal government and more for the federal government but moves that risk onto the state, which within move it onto counties. >> okay. last question. this is more on demographics, on trying to understand the profile of the persons that are on the expanded medicare population. so let me reword that. what are the general demographics on the expanded medi-cal population? >> the medicaid expansion we took up here in california had a significant impact on medicare enrollees. nearly doubled enrollment in medi-cal in san francisco. it meant that people who were at incomes between zero and 130% of the federal poverty level it didn't have any other qualifying conditions. i think previously people thought medicaid or medi-cal was a health insurance

program for anyone who is low income that wasn't true. if you are a single adult without connection to family or you're not aged or disabled, you do not have eligibility for medicaid. now it single adults between the ages of 19--64, you don't have disabilities, you don't have children and are in families eligible. it's a significant- >> thank you very much for your time and expertise. supervisor kim >> one quick follow-up question around colored california and the funding that comes from the federal for affordable care act. those in the medicaid population the 800 million that we talk a lot about, that would be-that comes from the federal government, that covers healthcare, that doesn't cover the c cover california clients. >> that's true. >> okay. the contribution to the federal government to our healthcare system is much larger than 800 million.

>> that is correct. >> thank you thank you for the clarification. >> thank you very much. all right. so colleagues, we've already taken public comment i don't see any other question. i would love to entertain a motion for item 1? supervisor tang >> [inaudible] >> i make a motion to >> a motion must be made one of the members of the subcommittee. >> okay. >> i make a motion to continue this item to the call of the chair. >> thank you. i will need a second. motion made by supervisor fewer and second made by supervisor kim. can we take out without objection or roll call

>> no roll call >> without objection the motion passes. >> [gavel] >> mr. clerk, any other business for the federal select committee? >> end of the federal select committee agenda. >> thank you very much. >> [gavel] >> now, mr. clerk if not mistaken will now go into our next agenda the budget and finance committee. is that right? okay please call the item >> item number one hearing to perceive a budget update from the recreation and park department for fiscal year 2017-18 and 2018-19 requesting recreation and park department to report. >> thank you. i want to welcome the general manager mr. philip ginsberg. >> thank you supervisors. we're gonna bring this down a bit. because it's a new budget committee and we have some new members of the board we were going to take just a couple of minutes to do a little bit of a broader overview of our

department before we dive right into budget. just a reminder about the breath of your fund it's truly one of the best urban park systems in the united states. the statistics on most proud about is very very very close to 100% of us live within a 10 minute walk of a part. that's an amazing thing. we oversee almost 15% of the city's land. about 4000 acres. we have 222 neighborhood parks with some new ones that have been acquired.our system is full of playgrounds and play areas could tennis and basketball courts,. [inaudible] swimming pools is call purses and stadiums and on the programs item i don't know enough people realize the breath of our summer programming and what we do. the breath of our recreation. over 77,000 hours of recreation programs offered each year

really, 500 summer camps touching every single corner of our city. everyone participates in a programs regardless of ability to pay. the last several years recreation and part apartment averaged offering over $1 million in scholarships based on the public school districts free and reduced lunch model to kids.. it's a system which people love which people really care about over $180,000 volunteer time in our system. our budget is very much a link to our strategic plan. i thought we would start there. you have a copy of this a strategic plan in front of you. our goal is that san francisco sparks connect us all to play, to nature, and to each other. we are really guided by our mission statement, our vision statement, are organizational values we talk about how we work and interact with the

public in our plan is really broken down into five core strategies which you see there. one is inspiring public space. our goal is to keep our parks safe clean and fun, to promote historic and cultural heritage. and to build a great parks of tomorrow. we want to inspire play by promoting active living, well-being and community for san francisco diverse growing population. we also want to inspire investment. whether that is treasure or sweat to community engagement advocacy partnerships. we want to cultivate more financial resources to keep our parks programs accessible for all. we seek to inspire stewardship by protecting and enhancing precious natural resources conservation, education, and sustainable lan and facility management practices. lastly, in our goodly most important, we seek to inspire our team. we are only good as the people that we are and delivering our services. so we encourage innovation and were trying to cultivate a connected and

engaged workforce that delivers outstanding service. these strategies are broken up into a series of objectives and over 80 different specific work initiatives that is in all of what we do but these are things that we are focusing on in our strategic plan. as you will recall in june the voters strongly supported and strongly approved proposition b. this was an important moment for parks. while voters have been very supportive of capital investment in our park system at the end of the day, sustainable operational funding is critical to our ability to care for it. and steward it. so proposition b provides a baseline of funding which grows very modestly and very incrementally over the years but nonetheless, protects the department from significant economic downturns and allows us to make sure that our parks and programs in our

neighborhoods continue to be served and continue to be well stewarded. proposition b was also a commitment by us to make sure we were capital and deferred maintenance. we've a very old park system. it's 140 years old. we have well over $1 billion worth of deferred maintenance needs in our system. this amount of money allows us to chip away at that but it is a pledge by us that this matters. we are basically taking $50 million a year which is much more than we've ever had before, and was really the benefit of some really good capital planning and work on capital planning committee and capital planning team and frankly, good economy that has allowed us to secure this amount for deferred maintenance. this measure also imposed to the good, very significant and thorough planning requirements.

calling for a strategic plan which were already doing but also calling for an operations plan, a capital plan, and very significantly, if i can find the slide, some equity metrics. this is what the language says. it asked the department to develop a set of equity metrics to be used to establish a baseline of recreational park resources [inaudible] compared to services and resource available to the city as a whole. so from the minute this measure passed and actually long before, we began to think about how we are going to do it. there's been a lot of conversation about equity in our city department's measure equity very differently. i can report after extensive research and that there are very few parks systems frankly, hardly any, actually doing this. i think we've come up with a way of measuring our service delivery that is an emerging best practice in the field. that is, we are using

[inaudible] the seven disadvantage population characteristics which include income, employment, linguistic isolation, presence of youth and seniors, asthma rates, low birth weights. i think that is the seven. measuring census tract by census tract compared to the rest of the city. what you see in this map here in the dark purple are all the areas in the city that are the top 20% of the census tract based on the aggregate presence of those disadvantage population characteristics. the light purple around it are parks within a five minute walk. of those areas. so we are now able to make service-level comparisons and look at how we are doing and how were delivering services and what we refer to as our equity zones compared to our services as a whole. we develop a significant height, a large number of metrics and frankly, over time,

as long as we actually have real data we can measure just about anything using this model, using this lens, but here are some examples of some core metrics that speak to our mission. which, i think i to make you feel proud of your park system. if you look at access to parks, inner equity zones, .47 parks are 1000 residents versus .22 in non-equity zones. our park maintenance, we were curious to see how we taking care of any parks better than others? 84% of our repair and maintenance requests were complete an equity zone compared to 80% in nonequity zones. park investment. this is under your leadership and under the maters leadership, there's been a significant amount in recent years a park capital investment in equity zone parks. we think were doing a half decent job of cultivating volunteerism and stewardship nonequity zone

parks. also, it is really the heart of a recreation program delivery. so from this, comes a budget these are policies, or values. now we take a look at our budget. our 16-17 budget was $208 million. of this, 154 of it is our operating budget and another 54 of it is capital. i want to note that our capital budget is lengthy. it doesn't look the same every year. it really depends on when we are issuing bonds and when we get grants and when philanthropy comes in. so we do -i cannot tell you we have $50 million every year for capital. it's actually very very widely in the counting is done it's a little goofy. your to smooth this out over a long period of time. where does our money come from? it comes from three primary sources. most significantly, the general

fund. our general fund subsidy. now, this is the amount that under proposition e we have some long-term stability. proposition b comes with a share of responsibility we are responsible for managing arlen increases in cost. to the extent where pay more for water or for salaries or for healthcare, or, for legal services or material and supplies, that is our responsibility to manage but it does provide a baseline. it protects the bottom from falling out like it did in 07-08 we had significant layoffs when we had to close cup clubhouses and things like that. that should not happen again. the second primary source of our revenue is our open-space fund. we receive five cents-i'm sorry 2.5 cents, i wish it was five, melissa it's 2 1/2 cents of every property tax revenue is set

aside in general fund dollars, but it set aside in our open-space fund. that open-space fund is a pretty important part of our overall financial model. lastly is the money we earn. this is very relevant. i will remind you every single park system in the country has an earned revenue spreadsheet. that is revenue from things being in small pr program fees. it's our concessions. it's outside lands. it's the parking garages which are beneath some of our parks and all contribute to our earned revenue. significantly, and importantly, earned revenue is where we have the ability over time to make more investments in our park system. our hope is that the open-space fund which is been doing well, because the increase in property tax revenue, but in some point it's expected to level off in general fund is really just-it's gonna stay pretty steady with minor incremental growth to the extent either cost significantly rise, or if you

would like us to make additional investments in our park system, it is that earned revenue bucket that gives us the flexibility to do that. where do we spend our money? you see those two pie charts here. they look at things in different ways. starting with the one on the left side of the slide, the biggest chunk of our support is for park maintenance. that is for gardeners, are gardner supervisors. our custodial teen . that is the biggest expense that we have. it slightly smaller for recreation and aquatic staff. we have a full-blown corporate yard at rec and park. we've electricians and plumbers roof workers and cement masons. that is a big chunk of our budget you will see that 93% of our budget includes directly into the [inaudible]. our administration, the

administration staff, we do a lot with a little. we are pretty lean. then, by type, and the shark probably should not [inaudible] than other city department. the business expenditure for us it remains salary and benefits. i think other things we do rely pretty heavily on the services or other department's and that's an area of cost containment that worries us a little bit. because we can't necessarily control what we do like over a large organization and because of the nature of what we do we do get our fair share of trip and fall and injuries in our park system. legal services. that's a big chunk. water, we are also very sensitive about material and supplies and equipment. those costs have continued to rise that's pretty much how we spend our money. i think, as you know, city departments we are given some budget targets. we were not as to make-we were not expected to

make a cut because a proposition b but we had to manage our own resources after we did the math on our 16-17 budget looking at all of our increase cost, we to $1.5 million base budget shortfall to solve. we are solving appeared with revenue. it allows us to make a modest amount of continued investment. >> supervisor yee has a question. >> can you backup just a bit. the base bun makes up 31%. my understanding is that the book that should be towards acquisition of a [inaudible] >> no. small pieces are reserved for acquisition. there's an acquisition fund is also a contingency reserve. it's funny that is supposed to be spent on development and maintenance. it's not for recreation. it's not for some of the other things we do. it augments our ability to care

for our 4000 acres of open space. there are specific carveouts in the charter where money set aside for acquisition and a significant amount of money is set aside for the reserve >> soi guess my question really becomes even within the categories you name, it doesn't seem to be reflective of your pie chart in regards to to the types of programs or whatever. your park maintenance there but- >> it's mostly in park maintenance, supervisor, that would go through again this is an operations budget not a capital budget. so acquisition funds, we would look at in the context of our capital plan we've all kinds of restrictions on sort of some funds but within our budget. i did not laid out in detail here. >> the pie chart i'm looking at is [inaudible] >> yes. >> how much money does pie chart represent?

>> it's a sum total of our operating budget, which is$154 million. >> the 154, i believe, the slide that showed that. >> the slide that showed what our operating budget is right here. they are not numbered. >> sfgov tv, the overhead, please. >> there it is, yes. okay the 154. got it. the budget is not reflected. >> not reflected there. again, the capital budget is a little bit more complicated and we do a capital plan and stay with a capital planning committee. then it comes to you but this is a look at our operations. >> i think i answered my own

question. >> again in 18-19 because this is a two-year budget plan, again our goal is to solve revenue allowing us to make some minor investments back into the system. again, preserving this $59 a year to tackle general fund capital to tackle deferred maintenance and related capital needs. so what are we doing with those funds this year? our budget allocations are linked to our strategic plan, which you saw earlier. under strategy one aspiring space, we are moving towards a preventative maintenance module that allows us not just to fix stuff when it's broken and when it's really broken we issue a bond, we want to get out front develop a preventive maintenance system and this requires a significant amount of maintenance planning to go along with just the folks that

have the substantive the skills to do the [inaudible] so were investing preventive maintenance planning services. we are adding staff to do some additional deferred minutes work. i believe that this is in our structural maintenance yard. i think a couple of cement masons where we've got some shortages and backlogs. and then related to more park cleanup and-which i'm sure you're all interested in, we are adding some labors to free up our gardeners to do more horticultural time where our labors can kind of [inaudible] custodial staff does stuff inside buildings and restrooms and were adding labors to help us with park cleanup on the outside space. this is a little bit of a highlight what that general fund capital budget looks like. by the way, the things you see in purple here, we've highlighted this is work

in our equity zones. equity -related work. just so you can kind of see how we have begun to use this lens to really think about equity in a variety of ways. i just want to pull up a larger chart here. not every bucket of our capital budget request is showing here. but general building maintenance, this is the stuff that pays the nuts and bolts of what our structural maintenance does every day comes out of that. we have money for camp mather. we are on a field revocation cycled with our synthetic fields. let me see. i think supervisor kim has welcomed a new replacement of a field at franklin square. i believe supervisor ronen has just welcomed the replacement of aesthetic turf field at garfield. i believe youngblood coleman and silver terrace are next up. crocker is in the loop. swifter plan these

fields. these have a shelf life of 10 years and we need to put money aside because they're big replacement cost. is also money for grass rehabilitation project as well. we are investing a considerable more in urban forestry for obvious reasons weaver hundred and 31,000 [inaudible]. we've got wild weather that we experience this winter we are seeing more tree failures meaning, tree maintenance becomes more and more critical and part of that tree maintenance work involves tree assessment of parks for doing over a cycle of time. court resurfaced things. these are the vascular courts and tennis courts, and asphalt in your districts we do categorize these. we look-we do a condition facility index and we try to tackle as many of the most critical ones that we can thanks to supervisor kim we have extra funny this year as a result of an agreement reached over a developing project. i

think san francisco save our sports is adding fun into the pot. it's not shown here but will allow us to tackle number of tennis courts and i think almost every district. then, - i'm sorry - and 17-18 we are leveraging some existing resources and capital resources, with this plan to tackle some park projects where there's been a desire for a scope that exceeds our budget. in these three equity zone parks. play. inspiring plate this more focused on recreation and this is a little sample. one of the programs that would love for you to know about that were most proud about is something called a tennis learning center. we are working on a major renovation of golden gate park tennis center which is really open it's the hub of public tennis in san francisco. it's a very expensive capital project. i think 80-90% of the

money is going to be philanthropic we raised were about halfway there but the program the vision is modeled after something in palo alto which is really beautiful. it's kids where kids from east palo alto comfort to stanford campus for a mix of tennis and high school tutoring and youth to bauman. it's a very very successful program with documented data driven outcomes we want to replicate that in golden gate park it the way we are starting this project is that three rec centers, one is at pellagra. when is at betty -and when is it hamilton we've been partnering with elementary schools were kids come over k-five and they are getting 45 minutes of tennis instruction and then about 45 minutes to an hour of swim work assistant my stop is actually working with the elementary schools and we know kids and were feeding them

and it's been really really successful. division here is the graduates from that program the kids most serious move on to golden gate park through middle school and so it's high school readiness and tennis. our athletic outcome is more kids of color playing tennis in high school. so we are investing in this program at the elementary school level this year. the it's going well. more program coordination for citywide sickness and citywide fitness and wellness i think we offer-i think now 35 free zumba classes per week there's one out right outside the civic center as i was walking in for budget these are all over the city in every district. they're very very well attended and were trying to do more of that but we need to be able to kind of scale this we need a little more investment in that and lastly, it's a small amount of money but i added it because i'm very proud of it. sam san francisco has become the help a

baseball for all movement national. that is giving girls the chance to play baseball. 100,000 girls before high school play little league baseball. by the time they get to high school is down to 1000. we hosted the last summer, we hosted the national baseball for all tournaments. this time a team of girls will be going to rockford illinois, the rockford teacher peaches to compete in the national torment against other girls and this is serious baseball. this is really extremely awesome competitive baseball. as a result, now our san francisco little league's have all-girls divisions and article girls teams. to invest a little more in that program. we are going to make-i'm doubling down but were going to increase our funding and civic center plaza. we are working with several other city agencies who know

about this. were bringing significant investment to civic center between the playground project and the zumba in america scores, and i think this is a space that just needs to be continue to be program. were working with a lot of community partners hunters point family, downtown street. the civic center cbd. we just feel like we need to do more in the space it's not just a plaza is 1600 new housing units go up around here it's also a neighborhood park. lastly, when you do a better job of telling our story a little bit, our history, our culture, and there some new awesome technology out and about. our technology is okay. it's not as good as i think it should be given that we are san francisco and this is going to enable us to deliver an app with a lot of interpretive services and also make people more aware of our programs. which we want to invest in. stewardship. we have a number

of investments in the strategy. we want to expand our green acres program which is currently at [inaudible] for those of you that don't know, these are high school teenagers . it's a nine-month program of environment all education and youth development these kids get a stipend.. they get funding for attendance and for doing certain things and they become environmental education it's volunteers and it's a great program we want to grow. supervisor sheehy, you in particular often though with our efforts and our leave no trace effort at dolores but we want to expand that effort a little bit, and a lot of what we want to do is do more outreach in equity zones and vulnerable communities to get him into our programs, to get them communities to volunteer, to form additional friends groups, supervisor cohen you been involved with that. we want to do more of that. then lastly workforce development.

we are adding i think you--three partnership gardeners. this is been an amazing program. i was at a-we had a ceremony last week called captains ceremony. where people gardeners became captains which is sort of like an assistant supervisor level. three of those captain started out as public service trainees. so our path when park made inside started as a public service [inaudible] which might be somebody who comes through downtown streets were hunters point family or any of our violence prevention programs that we are doing. some of those folks then going to be apprentices the premises become gardeners. the gardeners become captains. the captains become supervisors and we had three become captains who are pretty proud of our workforce to bauman efforts. i was just with director kelly and the mayor and the folks from local 261 with the city of phoenix is copycatting our garner pressure

program they are now the second city in the country to do it. they're also doing one in the park side with a waste sanitation services which they do more in house goes a proud moment for workforce development for san francisco. we do a lot of outreach. internal and external outreach and that's all i've got for you. >> supervisor kim >> thank you. i have a number of questions that manager ginsburg, thank you so much for the presentation and i also appreciate hearing hearing about the work you are doing in our district. it just demonstrates our communities commitment to the equity in outside metrics john avalos at the time and supporting proposition b which i know had questions about it sorry difficult to do a set-aside even when we believe in the value for the department like open space and park. because we know that ties our hands around

making budgetary decisions annually equity metrics i've a couple questions on that. before i get to that could you talk about the pse program? i'm curious how long did it take those individuals to get to the captain level and how many individuals are generally in the pse program? congratulations, by the way. that's great to hear. >> thank you. we work with human services pfts come to us through a variety of different ways. but i think what we are talking about is pre-apprentice. most of those employees come to us through the human services agency. frankly, given--we could use your help in thinking on this-wwe would like more.. there are real recruitment issues right now. trying to get people into these roles. but we have somewhere between 100-200 and a variety of different ways. currently >> currently? bs. not all in

the park maintenance space. their deployed in recreation. we have some and custodial. there in a variety of different park operations units. we actually have some-i've somebody in our partnership [inaudible] that start out as a psp. there's a variety of opportunities there. it took these folks who are now captains, i would say, probably -i don't know this for certain-i think probably three years. 3-4 years. so that would be let's call it a year as a pst the apprenticeship program is between a year and two years depending upon our hiring cycles. then there probably a rank-and-file gardener for a year or two and identified as potential leader. >> what is the-i don't know how you measure success of the program them up but i guess the percentage of the pst workers that end up getting permanent jobs with the city.

>> i think that's more of a question for director from the human services agency or the mayor's office of economic and workforce development. it's a good question. i mean, i think we've been very very open to receiving psp, pre-apprentice means there's a lot of life skill work that needs to go into these are folks that may or may not be ready for full-time work for a variety of reasons. it's been a good program for us. at the very least, even if they don't go on to city jobs, they've had a full year's worth of experience in our department and that builds a resume and helps maybe whether the city build in the private sector, or a variety of different pathways and we only have a narrow slice of this equation, but we've been very happy with it. >> okay. thank you so much. also, very happy with the work we are doing at civic center. it's even nice to see the

temporary playground get utilized in. today when i walked by a very excited about the helen diller i guess part three playground for the city. the court resurfacing and thanks for bringing it up the tennis clubs the debate club's commitment to running resurfacing it be great if we could get a list of the courts that are being planned on being resurfaced just to see how it's been distributed throughout the city. >> sure. >> my next question or request was more about activation of our fields. i know i'm going to speak for very district oriented perspective as i'm sure the other supervisors in may. i'm glad to see more activation of the [inaudible] park and i want to thank you for your hardship in our office of propping is activating this new park. does never club site on house but obviously, kitty corner has a rec center. it would be great to work with your office to figure out how we can utilize that baseball field even more

so it can be more utilize on the weekends and evenings i'm not sure how to do that but just more planned activities that we have in the park. [inaudible / off mic] siri found it. it would be great to be able to work with your office on that and i did not realize there was such a decrease in gross participation in baseball really appreciate rpd's connecting to that point. >> to that end, we are overwhelmed with youth sports in our field capacity doesn't-can't keep up with demand. i think i would probably need to go back into a deeper dive to understand how dmd in particular is being used. i know for example, there is a sf youth baseball team out of you pay, i believe. you and i have spoken about that >> and jean friend >> that is right that we do kind of when we can to minimize transportation barriers assign

fields closest to where the neighborhood is coming from. this is a blend that'll be really welcome the chance to work with you. we don't have staff to program every neighborhood where streak when it's not going to happen to what we try to do is use community partners and use organized sports to keep our particularly athletic spaces, programs. you been a great supporter. of organized sports that sense around the batting cages can be what it should be which is a ballfield. does not mean offers dog park means a ballfield. those things don't mix so well. we welcome other opportunities. i think there's also conversation to be had as you and i have also discussed about maintaining open time and access for our community and neighborhood to access space versus having permitted or program. there is a balance. both are right approaches.

>> no. i want to be sensitive because we all read about what happened in the mission and soccer fields. so it's hard for me to say, well this isn't a program. it be great to see more on that field. it's a good-i'm glad you brought up that point because it is true. we want to make sure there's that balance between community's that don't often access a rental system and that do. >> rental permit. it's just a -what it is, a reservation but it's for a particularly structured activity versus unstructured activities. those are different things. there spaces we do event spaces that we do rent,, but a baseball game my need to reserve the space because those teams that show up need to be able to count on the field. so-- >> that's a permitting process?'s bs. that's the balance. i'm excited to hear, we were together and figure out

strategies to activate [inaudible] more. the amazing part. i think it's more important in the neighborhood. that combined with some of the plan improvements to add capacity jean friend create an amazing recreation and open space help right in the heart of some >> i just want to commend your partnership with public works on the pitstops. it's been hugely successful. very sad to see marcus i think this was his last week. the neighbors already in love with him and our park is getting more utilized. by families and children because he is there on site. i know this is a tough discussion point but i do think it's important to have disposal boxes at parks but not to encourage people to use, just so there's a safe disposal site, and i hate getting reports that kids are seeing it in the playground. of course, what the activity and behavior to end but i just think having a safe disposal box will help at least that hurt some of

those needles into an appropriate location. >> it's a vexing issue in a vexing policy discussion. you should know we're not just sort of deftly ignoring the idea. we've had conversations with public health about it. for us, it's a simple metric. does it result in examples ivan i hate focusing on this because this is a small piece of the reality in our park system-but does it result in having this employee safety issue as well. so does it result in fewer needles in our parks on the grounds whether playground or grass or whatever. that is one bit of analysis. that i think needs to be a little more thoroughly tested and vetted maybe with a pilot or two or something, but --the other side of that coin is does it result in more unhealthy activity happening in the park. those are the

>> right. does it attract the behavior because the disposal boxes there?'s bs >> we have piloted safe needle disposal box in any of our parks? >> no. not in an authorized way. there's been unauthorized pilots. >> okay. so we don't have a way of understanding whether-he was weeping in some conversation with public health about figuring out an appropriate way to test that. >> that would be great. i'm sure public health and public works has data because all our pitstops with the exception of this one to have the needle disposal box. >> [inaudible]'s bs they're different. i want to distinguish that and i'm curious whether in their data they demonstrates that there's increased activity because of the boxes being on the corners,, or if it does actually help >> if it creates a cleaner safer and more in joyous park

then that is good. if it does not then that's bad and not conducive with the mission >> by the wway i'm agree with you i'm of the opinion that it may reduce the number of needles we see in the park but you are right, i don't have the data to prove that and so it would be like a department of public health or works to actually understand what the facts are. so it would be great to get to some type of conclusion and if the data shows that it attracts the behavior increases the number of needles outside of the box i'll support your position but if we were to get that information.. thank you. >> thank you. supervisor sheehy, i believe you are next. >> thank you. thanks for that great presentation. i have a few questions. one is, we are seen where a lot of trash gets generated. dolores park around [inaudible] and really, the summer weekend events, which i'm sure you are aware we both

probably get blown up over that. the recent weekend the first weekend of the summer. so i've a couple of questions around that. how will your budget include sufficient funds to handle this? then the other question is about coordination with ecology, may be dpw because for composting and recycling and getting the trash out but also from the surrounding neighborhoods because there's a lot of those kinds of spills out and the neighbors feel very confident this is can be an ongoing issue for the rest of the summer into the fall. >> so we've often said that the worst part gets love to death and we invest $2539 and created an amazing design that people love it even more. this probably consumes a higher amount of staff than energy and frankly, resources by myself than any other almost any other

single challenge, which is how do we inspire better behavior at the laurus. from a resource perspective, i don't have precise specifics. i do know our parks are not budgeted apart by park. there budgeted in park service areas. which overlap-they're not precisely based on supervisors old district lines. our parks are where they are so there's a little bit of a blend but dolores is getting very disproportionate share of the park services area, resources, we have added dollars for extra porter parties and things during the summer. are ecology built there is higher there than almost anyplace else and frankly, we bring more staff both on the part main inside to dolores and that we have a community campaign called love

dolores, were we have interns, some are paid some are unpaid, out there as you know you been out there every weekend with an umbrella spreading the love dolores.. we are trying everything we can. at the end of the day, we need people to behave better out there. packing in and packing out. to the grade, we are diverting are you a remarkable amount of compostable and recyclable waste because we have-we work with ecology on the eco-pop-up which is there during the weekends not just the summer but the spring spring through the fall the shoulder [inaudible] every time you can bring your compostable's and there's a place to put them right there on dolores street there's a place to put your recycling, and so we are seeing less trash into landfill, which is good, but a lot of people just are not doing it and they're leaving it. a lot of people ask but when i trash cans in the middle of the party becomes getting that amount of waste in and out is actually

very-is pretty challenging and there is data to show that trash cans invite more trash and more dumping and more litter. we are asking people to actually have the trash cans in the eco-pop-up all around the perimeter regardless on a busy weekend day it's another six-$7000 worth of overtime in additional staff costs in cleaning up. we do talk to re-ecology quite a bit and re-ecology has increased its garbage barrel with us pretty significantly during the summer you will see their bear three having four times a day enter emptying trash bins and doing a variety things to manage the problem we will not solve the central people stop treating the park like one gigantic garbage basket. they have to pick up their own trash. this is not a complicated problem in there something that is unique about that park and maybe some

of the parting happens but i can't quite figure it out it's not everybody, but too many people come to the park and just leave it. my staff worked so hard out there the weekends are brutal for them the truth of the matter is, the next morning it's always clean. but it's a hard one. >> have we thought about finding people? >> it's an interesting issue. public works has bar mental resource officers. are park rangers do have citations. i need to go back and look, whether we've issued citations for littering. we do a lot of education and a lot of warning i'm not sure how often we are actually finding people and maybe that is something after a warning that we might want to consider doing. >> yes. i mean those are my voters. but >> actually, they're not. the dolores park they may not be.

dolores park is a destination your people coming from all over the bay area to hang out in dolores park. big chunkof dolores park are your neighbors and voters, but people can come from all over to be in dolores park. >> but i do wonder if there is no consequences, sometimes we need something. >> at the last couple of years we've been trying to put on pressure and a little bit of community shaming.. we will see how that continues to go. >> might want to consider fines. >> thank you >> plus, i would give you some cost recovery. about equipment purchasing, i learn your department is some purchasing is delayed because of the thresholds have not been raised . like gardeners have shared devices like aerators [inaudible] have increased in price. so in the past, you would buy these immediately and

now the process is a more lot more complex. so i know were working with legislation on this topic so thank you for sharing your thoughts. >> thank you for having an interest in this rather wonky one. it's really important to our gardeners perform a little miracle every day. the things that really kind of try them nuts are the inability to actually procure the tools and supplies they need to do the job. some of these tools and slice got more expensive and i am not a purchasing expert, but i believe there is a $5000 thresholdthat has become really cumbersome for maintenance staff to operate on a i don't know the expense of other city departments, but it makes our procurement after 5000, there's a different process for procurement and it causes delays and a lot of aggravation for gardeners.

>> thank you. lastly, we have the eir bill on natural areas and there's two things have an interest in. one, i did want to inquire about additional staffing for natural areas. because now we have all the space i think maintenance is going to be more complex. then the other was to look at environmental management use of pesticides. i just was hoping we could prepare to discuss these items during the june 1 budget meeting. >> absolutely. >> thank you a much supervisor sheehy. dir. ginsburg, i appreciate the update. i particularly like the strategic plan and also the community report. my complements to your team that put this together. very helpful. i look forward to

putting it in our resource table in the office to collect him if there's no other questions, i think we will go to public comments. thank you very much. any members of the public that would like to comment on item number one, please, come up seeing none, public comment is closed >> [gavel] >> thank you. i would love to entertain a motion on this item. >> would you like a motion to call the chair or file >> motion to file >> is there a second? >> second. >> moved and seconded. without objection, please, note the house has changed.. without objection. thank you. >> [gavel] >> thank you director ginsburg item 2 >> item number two a resolution adopting the 10 year capital expenditure plan fiscal year 2018-2027 pursuant to administrator kate of code section 3.23 >> as our speaker comes to the microphone, i want to be that

we received an in-depth overview on the capital plan two weeks ago at this committee. we have not requested another formal presentation from the city administrator however, brian strachan is available for any questions. if there are none, seeing none, i think were okay mr. shawn. appreciate you. unless you have any burning remarks you have to get off your chest? >> no. thank you for the opportunity but i'm here for-- if there's any to follow-up. >> appreciate that. making yourself available for questions. any member of the public that would like to speak on this item, please, come up seeing none, public comment is closed >> [gavel] >> colleagues, motion on this item? >> i will make a motion to file this >> we need to adopt this intent of the full board with a positive recommendation.

>> i see. i will make a motion to with this out-of-court committee with a positive recommendation >> all right. we will take that without objection. supervisor tang made the second >> [gavel] >> thank you. please, call item 3 >> item three resolution adopting cities five-year information and community action technology plan for fiscal year 2018-22022. >> thank you. similar to the capital plan, we would received an in-depth overview on the plan this committee. so we have not requested a formal presentation from the city administrator's office we do have mr. jamie here of able to answer any questions. all right. seeing none, go to mother public comments. seeing none, public comment is closed >> [gavel] >> thank you very much. motion

for this item? >> i'll make a motion to send forth a resolution to the full board with positive recommendation in >> thank you. second? >> second. >> we can take that without objection. i'm sorry i want to note the house has changed. supervisor kim is not with us. without objection, thank you. >> [gavel] >> mr. clark, next item >> item number three adopting the cities five-year financial plan for fiscal year 2017-2022. speak great we've got the mayors budget director to join us and to make the herself available if there's questions on this particular item. i don't see any questions. so let's go ahead and go to public comments for anybody in the public like to comment on this item? seeing none, public comment is closed >> [gavel] >> thank you. motion and second on this item? >> so moved. >> second.

>> we can take that without objection. thank you. >> [gavel] >> any other business before this body?>> no further bu. >> working for the city and

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heredity disease that can run a million dollars a year. they also have significant side effects and so therefore they do require clinical management both manage the side effects and also to manage adherence and persistency on the part the member. what makeatize is a problem? first of all, it is high cost. only two to three percent of wrour members use it. it is expect today approach 50 percent the pharmacy trend come 2020. >> could you pause? we have a presentation today if you can bring that up. >> sfgovtv. we have a presentation. thank you. >> thank you. we are on page two. please continue.

>> and lastly, really at this point in time there are no replacements for them. the bio similar market while it is in process is slow to get approved. it will only represent about a 20 percent decrease in cost once they come online. so, some the strategies that you see on page 3 that employers have been implementing are trying to reduce and appropriate utilization and make sure the clinical guidelines that are being applied are appropriate. that, the medication is administered in the appropriate site. typically they start out being administered in the hospital setting or office setting. they have now been able to move home. they also-specialty drugs are hidden #13450i78s because some of the specialty drugs are found in the medical benefits about 50 percent of it and 50 percent of it is fon in the pharmacy

benefit and i see a frown and by that i mean someone that goes in the hospital and has cancer or oncology drug it is billed through the medical claim, but whereas once they get outside and continue the treatment on a outpatient basis it comes to the pharmacy side so that is why you don't fully capture all the cost in the pharmacy side. we also have employers have implemented a different tier for specialty drugs as well as ambulmented partial fills at the initial start so you get 10 days of the drug because as i said earlier the side effects are quite ramped. talked about the clinical side when i talk about who is appropriate to receive the drug. it is highly recommended that if there is a step therapy be applied and all

the drugs prior authorization. the two points i really want to make and then i'll turn it over to dean fredericks from kaiser, if you look at the history of the pharmacy spend what you see in 2011, 2012 that it is relatively stable in the sense that it is hiv, oncology, a few anti-inflammatory drugs but in 2013 that is whether the fda first approved two medications for system fib roses and the hepatitis c drugs came online and so what you see in 2014 is a incredible jump to 30 percent. while it has slowed down a little bit, what we are afraid of if you turn to page 5 is that you continue to see increasing costs for areas such as inflammatory diseases, such

as debeaties, ancology, ms and hiv and the problem here is this is-these diseases there are a number of individuals not one or two, but a number of individuals that will be required to take these medications and as that number increases either due to age, demo graphics, lifestyle perhaps, the cost will only keep ballooning. with that, ifem i'm going to turn over to kaiser. >> thank you, page. >> we have a presentation, sfgovtv. >> good afternoon. i'll eat the mic. >> thank you. >> i'm challenged as will. dean fredericks pharmacist with

kaiser, director of drug use management and my partner here is >> good afternoon. >> you have to come over, scott. >> good afternoon. scott yoma gujy, under writing for kaiser permanente. >> thank you for the time. so, we at kaiser are not immune to the rising drug cost and concerned and pay close attention in all the settings, hospital, clinic setting, outpatient drug area as well. i will tell you that we are ue nukely positions to address this and what we are doing. one thing i try to describe is that in kaiser we can act as one unit. we have the medical group physician and hospital and helt plan and pharmacy and contracting people and benefit said all lined up. we meet together to try to solve the problems to deliver the highest

quality most affordable care for our members. that is what we are striving to do. it is >> you describe that on page 3? >> yes. 2 and 3. i'll go to 3 in a second. i want to note our process is physician driven. that is very important to us and our members and our angle is three things. i trito describe how we manage is appropriate care, second is adherence, making sure the patient is taking the drug for the investment we make with that medication. all those to lead to the best outcome and we want to measure that outcome and make sure we deliver on that. slide here, here is detailed approach and want to highlight a couple things that tie with what page mentioned. in the upper right section, basically we start with experts internally to development the evidence and guidelines to apply what is called step therapy to figure what is the best way to treat our patients.

then in situations where we have opportunities where drugs may be equal efficacy we can hand those to the purchase department to nolesh negotiate the best price. we are able to shift market share so when we say we use one help c drug, har voney we use it at a high level and get negotiating power with manufacturers to negotiate with best price and that is what we do on a ongoing basis. the other point is around rebates. our philosophy is we dopet want to get into had rebate game and prefer transparency and want the lowest price at the beginning. we have very low level of rebates at this point in . time. >> the fact is you have volume? >> our volume isn't our volume that is the biggest

contradictor, it is shift in market share. if we say to a manufacturer we will move to 90 percent of your product or competitors product that is when we get their attention. >> market share- >> that the typical thought. we are only 3 percent hof market so it isn't really volume so that-the other piece we tied to is benefits so we have a specialty tier which you adapted and we use that to remain competitive in the market as a strategy as well. and then we internally do a bunch of work to basically what i call control the message. eliminate the manufacturer message to physician message and go with what the experts describe as the guideline jz best care and communicate to the doctors and that is what gets used in our organization to manage our patients. we also at the very bottom involved in advocacy arounds

rising drug price jz we have physicians and other team members going at the government level and coalitions and voicing our #34esage which is three fold. one is we want transparency in drug pricing, second, competition that drive priceess down, and third value which means if a manufacturer brings out a new drug we want to see added value if all is a price increase. we don't want to see drugs continuing to rise in price with no value. in slide 4, these are the tools and will let you read those. the one i want topoint out is bio similars. these are the gunarics for the bilogic drugs she mentioned. kaiser is being very active moving that agenda forward. we adopted the first bio that came and brought into the organization moved market share quickly and demonstrated

it is effective and want to continue to show over time we are irk withing on the second now to do the same thing. those are the strategys we applying at this point in time. >> thank you. >> thank you, dean. commissioners, we also want to share cost information and here we have on slide 5 the picture of the historical costs and cost trends for the hss membership conched with kaiser permanente. the top half of the page lays out the cost and presented on a per member per month basis for each wreer between 2012 going through 2016 and this is for your non medicare membership, so actives and early retirees but doesn't include the medicare membership. and then the bottom half of the page lays out the chaichck in cost so it connects to the bar chart above and shows the year over year change in each of the

categories. we have broken the cost out between the medical cost, the non specialty prescription drug cost and specialty drug cost in the charts here and just a few comments. you can see in the bar chart the specialty drug costs are still a relative lee small piece of the total cost, but have clearly been increasing at the fastest clip over the time period. at the bottom of the page in the trnd table we have shown the comp pound annual growth rate so average increase for the time period. average annual incraes and specialty drugathize grouth rate is 16.7 percent compare today a 2.7 percent overall compound annual growth rate. it isn't broken out in the slide here, where would note that the medications to treat hepatitis c were a clear driver in the specialty drug trend and

if you remove the hepatitis c medications the grouth rate for the specialty drug component would drop to about 8.5 percent. you would have moved from $8.52 sent in specialty to 2012 to $11.81 in 2016. that is the impact the specialty drug hepatitis c drugs impact. you have one additional slide. i sense urgency here. just to sum razz what you heard today, specialty medication and pharmaceuticalerize a challenge #23r the entire system and industry. at kaiser we have a comp rehensive program that demonstrated results ovtime. that program continues to expands squevalve to help keep

up and manage the specialty drug challenges. our strategy around drug management and specialty drug management is broader than the clinical component. it cont plates benefit design, procurement and puchs purchase and advocacy role but the clinical management programs and our clinicians are at the core of all of that effort and we believe that our ent grated model and integrated culture within the model are a key dif rinch knraiator. >> thank you for your presentation and what you are doing in the area and working with reporting on this i would just add in some detail. i attended several meetings regarding utilization so thaupg for the efforts. page, can you remind how many dollars per year we spends annually on

specialty drugs as a top level amount for the system? how many millions of dollars this is? can somebody answer that? if page can't i know our actuary can. >> i may not have it off the top of the head. it is quite significant. if kaiser represents all most half of our 40 percent of the membership and paying $16 a month, it is quite significant. >> i just like to have a ball park. >> we will get that for you. >> round for all of it not just kaiser. we have another presenter i believe. >> good afternoon. bouny hayes with optm rx. where are the pharmacy provider foru hc.

>> we have a presentation. >> just our slides are very similar and start out differently. but kind the same story you heard throughout the presentation. while we are wait frg sth slides you spend about $6 million for total pharmacy through about $7 million total pharmacy through optm rx and all most half is on specialty. >> thank you. >> so if we look that 4 year trends very similar, on the top is total per member per month cost and about 201415 is where we get the big hitter in and in the specialty, the blue bar is

specialty drug jz primarily the hep drugs. very small membership but about $30 thousand a month. typically the members are on for 4 months so for the plan it is about $100 thousand per therapy, however, one thing i like to point out is there is a offset of the cost on the medical side because these members are getting treated through the pharmacy and the great news is these new medications don't have the-doesn't make them as sick as it used to as well as there is a great success rate with them, about 95 percent. it is very expensive for the plans but there is great success with it. we are also seeing a decline in the use of the hep drugs. when they first came out doctors were anticipating they were coming out so so a big rise with them and the costs were really going high. we are seeing a drop now. not to say it still wont

continue to happen. the other thing on the slide is just to point out the 4 year period. the non specialty diabetics and high cholesterol there was a negative spend on that specialty is higher but for a 4 year period it was 4.3 percent trend. next slide breaks down- >> excuse me, is this specific to our system or is this kind of generic? >> this is specific for your plan. >> alright. >> absolutely. the whole-all the presentation is specific for this membership. >> thank you because the headers wouldn't seem tosuggest that and want to make sure everyone understands this is our experience. >> thank you, next time i'll clean that up. on slide 3, i like to show you this just because it points out the differences in the cost so

much. so on the left side is the utilization, the blue graph is your generic and the drugs around for quite a while. they are less expensive drugs. 80 percent of utilization is only driving 18.7 percent the cost. when we do our strategies and clinical programs we like to strive to get you over to the geneter drugs. they are $36 for generic versus $340 for brand so a lot of strategies are inclined to drive the member to the lower cost drugs. it saves the copay and the planism the other thing on the slide is only 3.4 percent of specialty utilization is driving 45.1 percent the cost. a little higher than what we see for other plans. most the plans now are about 35 percent. we do expect with a industry it will be 50 percent 06 the

cost in the next couple years so you are right there right now. i am seeing a little lower costs, so far at this point, so we are keeping an eye on it and have a lault of strategies and help in place to help with the costs. the other note on here and i didn't point it out, but just as a fyi, the generic utilization the drugs are lestz costly, your plan had a 1.9 percent in theginateic utilization which equate s to about $485 thousand savings so kudo tooz the plan to dribeing the members to the lower cost andnishatives you adopted. when we talk about the specialty pharmacy, i just want to quickly tell about brio. it is our specialty pharmacy and we don't only try to provide

help to the members because when you find you have ms or cancer it is very very concerning, very frightening and scare so have material available for the caregivers and family so there are websites they can go and get educated with that. the biggest thing is brio to life and that is you can face time as you getd your medication, you can do face time with a nurse or pharmacist that walks you through everything in the package and helps you understand how to inject it if it is a injection and helps you understand it and walks through it so this is a new offering we find very very valuable. then we also send if they need gauze or things we send that with it as well. just wanted to share quickly what we have with that. also when your members comcheers call in because we

have medical and pharmacy data if they have a need fl fr behavior health we can get them there. if we see they haven't had lab work done we can help with that as well. we do mujtly outreach to make sure they can compliant because when they start a medication you don't want them to not continue it. we also do outreach to the physician if we can't get a hold of the mb and do outreach after two outreaches. also, i talked about how we have medical and pharmacy data because united healthcare is at risk for over 8 million lives we want to provide benefits that provide the best care and support at the lowest cost, so we do. we do have some of the specialty drugs through the pharmacy as well as through the medical side. usually if it is influgz in the doctors office it is through the medical side.

those numberbs are just strictly pharmacy. the slide is rebates. we always want to negotiate for the best rates for you. the top 3 are the top drivers. there are no generics in these categories now. we do expect this to be changing because we there is new bio similar within the diabetes category called [inaudible] so we expect we will have movement there so next time when you see these numbers you will probably see a difference there. one thing i need to point out is a error on the estimates for rebates for 2016 i have a error. my apology. >> it should be 893 $893 thousand that is a substantial notation. not $89 thousand it

is $893 thousand. this is money coming back to us, is that correct? >> exactly. any questions? >> any questions by members of the board? >> i just have a comment. i recently tweent a conference where they were talking about prescriptions and the number one thing is they need transparency in all employers need to be a critical mass to demand it because the data is not there and they can't get it. another thing that came up is rebateerize a game. they just dharj charge your more and give money back, so-- >> we have price setting on the pricing so we try not to play that game and we do not put the highest cost drugs on the pdl for those rebates. i know that it is a tricky situation and there is a lot of discussion about it but we do not with our

formulary pdl we do not put the drugs on there that drive the rebates. >> are you participating in public policy forum snz >> always involved, yes. >> thank you. >> other questions from the board? if not, go to the next presenter. i attended that same conference and will make detailed comments in the president. i happen to be meeting with a representative of the national pharmacy benefit exchanges and he says there is a lot of stuff coming out and employers and people are going to be absolutely thrilled and pleased with these new drugs. we got 10 of them in the pipeline and every 1 of them will be $100 thousand per dosage. i said, i want you to know i'm absolutely thrilled to hear that. he upset my

breakfast terrible. within the next two years he said. you are? >> on that note, i am genet moan with blue shield. thank you for having me. >> delighted to have you. >> can you hear me? >> yes. >> much like my colleagues, scott and dean from kaiser, blue shield subscribes to much the same philosophy and practices. >> we have a presentation. thank you. >> thanks. thank you. so, i'm going through highlights. you heard a lot from two other vendors who we regard highly so don't want to review the same information you already received but will call out the item said that may differ. >> thank you, we appreciate your efficiency. >> sox on page 2 of the presentation i wanted to outline the similar patterns to what you saw prior that the

2014 a huge uptake in prescription trend. 23.93 percent with the largest tick we saw occurring in 2014. i wanted to also point out that of the specialty medications that were being administered, 3.59 percent occur in inpatient hospital setting. so that being reflected in your medical trend only, the 3.95 percent. moving to page 3, you can see the bar graph, you see the upward trend year over year from $19.61 to 27$27.56 to $34.82. the right is a bench mark and to the risk scores and how hss compares, there is a significant difference between

the risk score at least the risk score with blue shield of california, the population there compared to similar employers and the corresponding cost. a few statistics, the average for specialty drug is $6, 350 per month. the cost share is 20 percent but has a cap at $100 so that means the member cost share is 1.57 percent of the true cost. again, relate today there benchmark, hss cost is 14 percent higher than the benchmark for similar employers and hss specialty costs increased 26 percent year over year. we see a lot of this with the aco partners specifically brown and tol end

and the major focus is ancology medication and hiv and hepatitis which everyone saw. on page 4 we have our specialty prescription programs and much like kaiser, we are not focus on the rebate but the net cost and trying to avoid that game. we also focus like kaiser on ends to end integration where we are integrating our objective on the medical side with those of the pharmacy side so everything is related to the member and treated hol isticically. one difference i didn't hear mentioned yet and it could be based on the different models but there is a interesting phenomenon in the medical community there are many incentive and bet you learned about this at

thefernalacy pharmacy forum that some medical practitioners are incent vised to use higher costing drugs so we had to work with that and we have given incentives to use the low r costing drugs that we have tiered professional fee schedules and that is something notable. much like [inaudible] we have significant member intervention prioring to receiving medications there is a nurse support and practitioner support in advance of fills. the last item is short cycle program, often our members or patients are unable to take the entire course of a specialty drug prescription, so what the practice we started instituteest is first scripps are 14 to 16 days, the members copay is prorated accordingly

so there no waste and the poor patient isn't continuing on with something that is being rejected. does anyone have questions? >> questions for members of the board? alright. again, thank you for your presentation and the perspectiveoffs blue shield on this topic. >> thank you. >> page, do you have wrap-up comments you care to make? >> just in closing, one of the recommendations is we continue to look at developing a specialty formulaary and look how you want to tier if you should given the discripancy between the total cost thf drug and member out of pocket. one thing i highly encourage is you do partial fill frz the initial prescription. >> alright. thank you. this issue will come back to us as we are dealing with renewals as

we go forward. there are several conflicting items at this point i want to do. i know that one of our members may have limited time availability with us and wondering if we should take up the action item on the investment policy before we take a recess. the end can only comphand what the mind can inder or vice versa. i like to take the board action item on the investment policy as the next item. interrupting-we are now the board not the benefits committee. >> thank you. item 13, action item. approve san francisco health service trust fund investment policy. >> this policy came to us after a lot of work by our chair

commission sass a lot of involvement with the treasurers off with city and county of san francisco. we commend the work effort of our council eric rap aport leading the legal review to get to this policy statement and now here in our sweeping activity to get it down, however we left one phrase in the policy and what we are proposing to do today by this final action is to remove that policy provision. so, that is really its one edit in the policy is what we are making as a change. i'm ready to entertain a motion. >> move that we approve the investmentpologist as written. >> alright. as edited. it is moved. is there a second. >> second. >> properly moved and seconded we approve the investment

policy as finally edited. is there any questions or comments by the board? any public comment? hearing and seeing no public comment we are ready to vote. all in favor say aye. all those oppose snd ? it passed unanimously. with that, i would like to take a 5 minute recess. a 5 minute recess and we will reconvene as the rates and benefits committee and discussion itemsment . thank you. [recess] we are going to

reconvene in about 10 minute, so if you resume your seats.

[meeting reconvened]. having stretched our minds on both end we are now ready to proceed with discussion item 8 which is the rates and benefits committee meeting discussion itemfelt >> item 8, discussion iletm.

presentation on kaiser permanente multi-region plan. kaiser permanente. >> good afternoon. cindy green, senior executive account manager, kaiser permanente. >> we have a presentation. >> just lean forward if you would. thank you so much. >> thank you for the stretch break by the way. i have been asked to present information about the possibility of exploring kaiser permanente's addition of three con tracts in regions outside of california for the capability to allow early retirees and medicare retirees the ability to keep kaiser if they move outside california. today i'll provide general information about what that could look like. san

francisco health sunchs system receives many requests and have for years for kaisers members moving outside california and wanting to keep kaiser. kaiser is in other regions throughout the state and country so when someone moves to the the region and sees there is a kaiser there they wonder whey they can't keep it and still be affiliated with the city and count a. in order to offer kaiser permanente outside of california hss would have to look at adding three separate contracts on behalf of the regions we are interested in participating in. on slide three, those regions would be washington, oregon and hawaii. on slide 4, i list key statistics about those particular regions. we have existing member sp in those

regions currently. i won't go through every detail because we are tight on time but it gives information about the hospital, medical office, outpatient surgery centers and physicians in the areas. washington which is our newest region, we are affilicated with 49 hospitals in that area. on slide 5, are the amount of retirees that live out of the state of california in those specific regions. if you look at the top of the slide they are enrolled with united 198 members that live in oregon, 171 in washington and 55 in hawaii. the table at the bottom of the slide are individuals that live in the region where there is a kaiser service area but have waved coverage. they are not receiving any medical coverage

currently through san francisco health service. 54 in oregon, 36 in waux washington and 21 in hawaii. what the considerations would be in order to move for ward this process and the benefit to the member of san francisco health service system would be it allows them to have another insurance option outside of california and allow them to keep their kaiser coverage. it also would allow-excuse me, allows another choice for the retieees when they move out of state. in this situation the california based account team would remain your sole contract for any administrative contract needs and eligibility needs in the other regions so we would be your point of contact. it is not that you would have to deal with other account teams,

the california team is your sole contact. we are currently out to the bid process where we have taken this census information for these particular individuals i shared on the slide before and we are currently asking for rates and benefits, which we do not have at this time but in the bid process for that. we would be asked to align benefits as close as possible to the home region thrmpt are nuances sometimes in the other states based on the department of insurance in that area, which may prohibit from matching benefits exactly with the state of california under this arrangement, however the goal is match as close as possible. the retirees would need to complete a-go ahead. >> on the previous page allow members to keep insurance as a

active employee. is it active employee or letireee? >> it is early retiree. we can correct that. this plan i'm talking about is for early retirees and medicare eligible retirees. thank you for the clar ification. a retiree or early retiree would need to complete a new enrollment form if they moved out of california. they will not be able to continuously keep the same enrollment arrangement so that is the process that needs to be worked out on behalf if the new contracts were offered. >> could you explain why that is? >> under the cms regulations and guidelines right now the northern california region is considered your home region and so someone moving outside of the home region to another state is a requirement they need a new enrollment form. >> alright. >> part of this arrangement is

if it is decide to move forward is we are focus on the three regions to also evaluate the administrative burden or impact that such adding 3 additional contracts would have on san francisco health services staff and kaiser account management team and want to make sure we deliver the high quality service so there will be a evaluation process if we move forward on this. slide 7 listed some of the step squz nuances that need to be considered. again, i had already mentioned we will look to match benefits as closely as possible with the home region. the california account base team is your sole contact. you would have a separate eoc and custom contract in those additional regions. we do have the capability for electronic billing in the home region and it is to be determined whether

that same capability is available for a much smaller population in those additional regionsism we are also looking at the impact that would have on the current eligibility file, so currently all of the eligible employees in the state of california are transfer today kaiser electronically on one file. there needs separate files from those different regions. you also have different group numbers so now there is a group number for the north and south. there would be additional group number frz the regions we are referring to. as i mentioned the rates and benefits are determined. there would be different rates because we look at a different population in different state. there is also potential impact to the timing of rate availability. there is a for instance in our oregon a longer lead time to release

commercial rates than in california so there could be impacktd in the area as well as being able to meet your timing and that is one of the things we will look at and that would be applicable to medicare and early retiree. open enrollment occurs at the same time. no problem there. then from a data reporting i think kaiser currently provides robust reporting and data analytics on the california population and there is no reporting available on the small populations based on the size of the numbers that you saw earlier. based on that size we wouldn't be able to report on those specific populations in those three regions. our next step in this process is to continue the rate and bid process to provide that information when we gather that to san francisco health service system, answer questions on the previous slide on more of the

process, the timing and capabilities. this would be for the jan 1 effective date of 2018 and once we provide that additional information that will give them san francisco health service system the information they need to make a informed decision. >> thank you. any questions? >> this is a excellent idea. for years members have been asking totransfer to other areas. i notice other areas like colorado, do we have members there that- >> yes, there were members in all the other regions kaiser offers but we chose the three most populous regions and especially since this is something we want to evam wait the administrative impact we thought it is more fruitful to look at the three more popialist areas first and make sure we have this finetuned before we expand cht >> anyway, it is great. a long time coming. >> other question snz >> i have one more question. now, members who already in

these areas and have say united healthcare, medicare advantage because they had to sign up this year, they can transfer to kaiser? >> at open enrollment kaiser is a medical choice option for them. >> great, thank you very much. >> thank you. if no further questions any public comment on this item? hearing and seeing none-we do have public comment. dennis. sorry. >> dennis crurg active retired fire fighters and surviving spouses. this is great. commissioner breslin, basically piggy backing because my two questions she asked them. i like to add if kaiser could see expand to any place they have kaiser where we can accommodate our members that is a wonderful thing, but this is

a good first start. thank you. >> thank you. other public comment? >> age before beauty. um, actually i- >> you are? >> clar zuzonsky representing reccsf. i'm happy to see this. there are rumors about it and have been approached all the years i served on the board and all the time i'm serving with retirees i'm asked this all the time so these regions are critical especially hawaii and oregon. i think the numbers will increase over time and just recently got a inquiry from someone moving close toor the carolina area and asking about it as well and we had questions for members moving in georgia as well, so i think whatever we can do to help with this. i'm also hoping because

it is a small population that is mubing into a area kwr we are urmy retirees and retirees and tend to be looked at as a higher cost if there is some way to have our few members rated in a larger group, or as some like large group book of business kind of rating to keep those rates down, because those members are moving there because either families or the cost of living is different for them and lower for them and making this affordable is what is really important. if this becomes more expensive than for exampleu hc it presentss a significant problem and may in fact deter members going into kaiser and maintaining in most cases a long history with kaiser. all most avenue wn who asks has brin all most a life time member of kaiser and i think we need to consider that and hoping that kaiser does as well so they realize that this

is a continuation and those are patients who have already been well cared for by kaiser and they have a healthier lifestyle. so, that would be my addition to the comments that were made. thank you very much. >> thank you. any other public comment on this item? hearing and seeing none we move and thank you for the presentation. >> item 9, discussion itemism presentation of healthcare value initiative which compares blfts cross governmental and prive lt private sectors. aon hewitt. >> ann thompson and-in front of you you have a presentation on the health value initiative. we look adit this report several years in a row so in the interest of brevity i'll clip through this. on page 1 a reminder that we cull pair

your data against the very large database. there are 9 .3 million participants. your group represents about 1 percent when you compare the employee count between active population and the database. on page 2, we look at several benchmarks so we look at public sector industry which is government and education, organization size over 25 thousand, fortune 500, labor market which is san francisco since your active population is living nearby and a entire database which is the orange bar. looking at page 3 and annually healthcare cost you see you paid about $12, $268 thousand an nually and about 86 percent the total cost of the healthcare versus the benchmark and see for public sector at 5

7 percent all the way down to hvi at 65 percent. when we look at member share which is the pay roll deductions members pay 10.1 percent of premiums compared to 31.4 percent the public peer group. and then when we look at out of pocket cost which is plan design because members pay less at $612 versus average of $1441 for public sector. page 4 the financial induct we look that efficiency of the plan for demo graphics plan richness and geography. anything 100 percent or higher the more efficient. you are at 118.3 percent, which is quite high compare today the peers which indicates the plans are running quite efficiently. >> that trend is true for some

time if my memory serves that trnd is true some time. >> that is correct. the last couple pages dive into it details and numbers that went into the numbers that we just looked at. cost and head couts in total on page 5 and then by your three tiers of enrollment on page 6. if you want to see detailsism page 7 looking at the comparison from 2016 for yourself versus 2017 and versus the peers. all and all i think a positive message. >> questions from the commissioners on the hvi report? any public comment? hearing and seeing no public

comment, we thank you for the presentation. the update of the data, it will be posted on our website as part of the agenda for this meeting for fuper reference. thank you again. with that, we are now moving into our regular board meeting. transformative. >> item 10, discussion iletm. presidents reportfelt president scott. >> yes, as a discussion item we talked about the rfp process and i along with commissioner breslin had the opportunity to attend the integrated benefits institute forum held in san francisco on a scholarship program. we had members of our staff lee haighy who also attended on the scholarship program as a member of this to

this forum. how did we get there? the facts are that the wellness program under stephanie fisher's leadership, was considered for a enterprise health management and performance award and we didn't come out at the top organization judged by this group, but we came out very strongly. very good contender. don't know if it was number 2 or 3, but it is again a testament to what has gone on under stephanie's leadership over the past several years we worked at wellness. i found the forum to be informative, there was sessions that were somewhat repetitive. if one employer or vendor giving one perspeckive and go to another slightly different titled forum and it was kind the same

message but the integrated benefits institute is in existence for about 20 years and headquartered here in san francisco and it seeks to bring together from a employer perspective the issues of wellness, disability benefits and management and workers compensation and they are actively working at that and is a lot of benchmarking their do around these isues. i have done oergzal research and very large employers involved in it along with heth specialist and experts so i find it to be a very useful and informative period of time and commissioner breslin also attended several of the sessions as well and that's where i met the representative told me we got $100 thousand specialty drugs per prescription coming your way very soon in the next decade. beyond that it rfs

was a very good opportunity and commend it work of stephanie and her team for according the educational opportunity so thank you. so, with that i will stop and that is my report. i'll turn to discussion item 11. >> item 11, discussion item. director's report. active director griggs. >> good afternoon. mitchell griggs acting director. i have a few points on the operation report and director report but i will be brief. the first thing that i do always want to menshz mention is personnel and we have two benefits analysts that are open positions at the time and currently recruiting two interns. i lick to recognize we have a new staff member and her name is megan mc carthy.

>> megan, are you here? >> she was earlier. >> she was earlier. >> she did come. >> for the record the board welcomes you to the health services system. >> she is a 1406 administrateb assistance. this is temporary position we brought in into do scanning for the contracts. contracts how operations and member service is digitizing all the member files and said that looks like fun, so we are having all of those scanned as well. she is helping out with that. and as you know, catherine daud rr the last board meeting was last march and last day is march 14 and march 13 we had a retirement event. we asked what she would like and she asked to have in the wellness center instead of going out and having it anywhere else so the staff got together and we pulled off a

great event cht it fsh highly atepded about00 or so people and about 12 people voluntary got up and spoke about her service with the city and health service system. a great idea speaking of wellness earlier of the wellness staff was a honor since kathleen didn't want gifts to honor her service with the city and her devotion to bringing up wellness is to name our wellness center the kathleen dodd wellness center so that is watt we are doing and the plakes plaques are on order and there will be a plaque next to the door that says catherine dodd wellness center. i will segue into the management report and start with wellness because i will ask stephanie fisher to come up and give us a brief quarterly report on

wellness. >> we'll have a presentation. >> stephanie fisher, well-being manager working on our new term. but it still going to be the wellness center. thank you for enjoying the ici forum and definitely want to thank lee for drafting our application on my behalf. he put a lot of work into that. today i get to give a update on a web well-being program which is the larger program that we do tr fr all employees retirees and all our members and also a piece of that is the wellness center.

we like to thing where we pilot things and our home and shows we walk the talk and brings people into us but we aware it only serves a small portion of our population, so it is only part of todays report. so, early in march we had a large department head meeting. this is our third department head meeting where we introduce well-being and well-being assessment and had a call to action for champions and expanded the department this year. we had 41 attendees there and at that meeting we introduce thd new structure so in the past we have been working on assessing departments and letting them know how they are doing and providing programs to them and starting to get this grass roots movement happening. this year we introduced a structure

that is asking each to d department to have a plan and part of that is asking a member of leadership champion to support well-being at the department. that fts the ask of the department head meeting. as of the time of this report, we had 18 department leads and departments so far. i had 3 meetings that resulted in department leads today so that number will be growing quickly. we excited to see the departments are interested in personalizing this and making progress, so we couldn't be happier with that progress. as part the rerecruited champions. in the past you had to opt out and now we made them reopt in instead of keeping on champions who didn't bother to tell us they don't want to be champions

anymore. we had grown to over 200 champions and expected to be back closer to 100, 120. as of the report we are 137 and this morning at 151 so keeping the ones that were engaged and they are growing without much effort from us to recruit them so really excited about the infrastructure changes happening and thackt if is becoming mart part the culture. we implemented spot light awards and different resources which allow us to tell the story and analyze the program at the department level, so those pieces are coming in as well. we had our second campion training the year. the first one focused on the transition within the program, the second one focused oen our first campaign which is

around physical activity. the campaign is called, play your way and above moving your way and use the tool that works for you. in the past we had everyone tracking on the same app and website and there idea is there are so many different tools. some people like the physical activity tracking device squz some use their phone and some just use a friend to keep them accountable so making a challenge that allows people to be active and push them to be better each day. but also doing it in their own way. that the idea bethined campaign and has a 30 day challenge offered enmay. we trained just about 100 champions ovthe course of 12 trainings. that page is now live so if you go to my hss dautd org/well-being you can sign up and energ encourage you to do that. read the resource squz learn about tools that could help you. as part of that we are having like i

said that is our big program for everyone retirees family members, employee cz participate but the home at the wellness center we will have a play your way week april 24-28 to launch that really walking the talk having the activities we encourage the departments to do at the wellness centers so folks come in for instance recess to get a 15 minute break, physical activities class jz all our health plans dental and vision partnered to put together a fitness fair so from 11-2 wednesday of the week which is the 26 all our members can come and learn about the resources offered to them through their health plans, through delta dental and vsp as well as our fitness center discount partners and all our city partners so even the fact you can volunteer at animal care control to walk a dog,

they will be there offering that to show the diversity and what we mean when we talk about movement. the rest the report takes you through the data on the wellness center, usage around group exercise and on site activities so i'll let you read that on your own. if you have questions i'm happy to any questions that came out of the reports provided so far. >> questions from the brored? >> i asked a while back about how to measure whether or not any of these are working to make people healthier? you had said it takes i forget how long so wonder when you expect a report like that? >> some the indicators we have and can put toort a presentation on that is well-being assessment data we had in 20 freen 14 and 15 has

shown lower cost in the data. not just what the research said will happen but this is a true association in our data, so we have seen things along those lines already. each of these programs again tell a story we are starting to move people into different behaviors as you heard today there are a lot of things that empath our healthcare cost and health are not necessarily in our control, so having a direct correlation between those will always be hard. but we certainly have the data that shows that as we are improving well-being in our population we did between 14 and 15 we are seeing better healthcare outcomes and we are seeing lower costs. we chose to not assess in 16 and 17 because we spent ought lot of

money and time collecting data and not a lot of time helping people improve their well-being so changed our focus on programming and make sure we create a culture that will sustain that. yes, we need to assess again evaerch wale, but it is a very large investment and we wanted to make sure we had a strong program in place before going back to do that again and spending our budget othen programs. >> if you can plan on it maybe at the next quarterly report doing high level summary of where we started and where we are to the extent you have that supports that i think that will be use-foot. useful. >> certainly. >> maybe looking at this strategically we think about a 2 year cycle taking that measure rather than annually but that is your judgment. any other questions from the

board on this topic? again, stephanie thank you for all your efforts. >> thank you. >> any pubhook comment on that particular item of wellness? go back to the-yes. >> dennis kruger active retired fire fighters if you come early to the meeting and have a few minute on the north court 55 people doing exercises so from that perspective they would be outside eating lunch, instead they are doing something so i say the wellness program is working. >> alright. director. you have other items? >> yes. just to quickly go over the things in the other divisions within the health service system. in march calls increased by 20 percent over 2016. call volume mainly had been announce td 1095 were

due early march so people received those calling about those and wndering where they were. also, we are beginning work on our e benefits, self service part. we started meeting regularly and we are got a project plan and key members are working on bringing us to a point where october 2017 we can do a pilot the self services benefit so people can enroll electronically or change their benefits or change dependents. as far as data analytics is certained, we have at the time of the report we had 54 percent of our digitalization project complete but we are now we are over 60 percent. we have the opportunity to go down there to the vendor doing that which is called fmti and look at their

process and facilities near san jose and reasering experience how good they are and so we are already able to use our system and when i have a call from a member i can go electronically and see their entire file, what used it be paper file. i want to mention a important thing since after open enrollment and it was a busy open enrollment and things for at least member services we have a breather in april as far as calls but the data analytic team is still working on issues with open enrollment with the split area issue. when we move to united healthcare a medicare member the family any non medicare family can stay in blue shield and it was-they have been extremely successful but the amount of programs and code changing and we are still working on that mostly with the reporting currently. like i

said earlier, we completed the electronic-1095 paper reporting and completed early ahead of schedule the electron ics and upload the information to the irs. i also wanted to just briefly mention finance. they are currently going through a financial system project and i have to bring this up in front of the board and public it is a lot of work changing a financial system and so we are expecting i believe july 1 implementitation date so they will go into the change over at a very tricky time for all of us especially looking at our rates and they are moving from one system to a people soft system. it is difficult and challenging moving from one version of a people soft system to upgraded version which is what we did in august 2012 from

7.5 to 9.0 in the benefit administration side so going from another system to a new system and it is people soft so have sympathy for them and acknowledge it is a lot of work coming up. communications we continue to working with our new communications manager pamela johnson and work on getting her really informed on open enrollment material because in a couple weeks we will start tearing those apart and inserting the information we need to put out there for 2018. so, last but not least i want to talk about a meeting that i went to and report out the meetings and presentations we give and i had the opportunity to athend united educators of san francisco membership meeting in match and have to say that earlier i talked about things i like about my job and this is it,

engaging with retirees and retiree association because there is a big need for hss especially in the member service side to talk and find out their questions and this is again why we lead to the multi-reneen plan at kaiser. we engaged the retirees a lot last quarter last year because thechange in the medicare plans and i thought that was a helpful thing. i think we did 18, not saying we need to continue to do that many, but as many sessions and ujication sessions and opportunity to meet with retirees and those associationicize very important. i have to say too, after i gave a small presentation at membership meeting, the first question was about the second opinion benefit that is offered out there through best doctors so do think also when we review this next board meeting i believe enour communications and our education and training

we put out there during open enrollment we need to do that again. we put it out as new benefit last year so will continue that education because it is obviously big interest in that. we also were asked by the board to give updates on affordable care act and repeal and know what happened with the last attempt, it never made it to vote so we are still under the affordable care act status quo with that, which means we have a hit tax and still have a cadillac tax that is effective in 2020 which is very soon. i believe the position the president at the time when this didabout go through is we will focus on tax code reform, he switched that opinion and now repeal before the afford rbl care act is something he feels he needs to do before he goes through tax reform and that is because it

is difficult to pass trax reform with the trillion dollar taxes wrap udin the affordable care act. sorry. keep turning my head. sorry. so, it difficult because there is a lot of talk but nothing really for us to report on accept we are going back and forth but i wanted to make sure the board knows we will be regularly updating them every board meeting on whatever is happening at the time. >> thank you. any public comment on this discussion item of the directors report? >> [inaudible] i thought there was no more hit tax base odthen presentation on the last meeting or meeting before and you mentioned there is a hit and cadlic tax for 20 twebt with the aca. i thought it was proved through the dmhc at least one the plans no longer qualified for a hit tax.

>> that was blue shield. but the hit tax still exists. >> it exists but is it impacting our plans? >> it impacts the insured plans. >> okay. thank you. >> alright. any other public comment questions? we are not at that point yet. this is public comment on this item, the directors report. we are now ready to go to the next discussion item. >> item 14, discussion item. hss financial reporting as of february 28, 2017. pamela levin. >> pamela levelen chief financial officer helths serviceest system. we have now completed 8 months-end of february 8 mupth synchronize to the fiscal year. we have a projection for the fund balance in the trust for june 30, 2017

to be $73.5 million, which is 1.1 $1.1 million greater than the amount in february that is due to favorable claims experience both for the self funded city plan and delta dental. we received a pharmacy rebates in the amount of $140 thousand in february but the year end as projection remains unchanged because we anticipated that. as i mentioned the last month two applications have been received for surrogacy and adoption 6789 one applicant is deemed eligible for the benefit and we will issue the payment in the next couple weeks and then the other application is still under review. in terms of the general fund, we expect to end the year on budget.

>> alright. and can you tell us anything about the status of the upcoming budget cycle, just a cliff note where we are in that process? >> the budget is stim in the mayor's office and under their purview. i can tell you we have been successful in convincing them that we should not be cut and i expect that we will have a budget as we proposed it without the cuts when it comes out in june, but they can say everything is fine and you are finalized but there is still-until it is published it is still in their purview. >> alright. thank you very much, director levin. any questions from the board? >> i don't see the financial report in my packet but i just-you have been reporting

under the surrogacy but not reporting the performance guarantee amont is. what is geing in and out of it? >> performance guarantees- >> we are doing that quite a few mupths back but don't see it anymore. >> they rin here. the line for performance ganer teens we have not received performen ganen tees for this year as of this fiscal year. we are using the performen guarantees in the prior fiscal year sitting in the fund balance. we moved those $300 thousand-actually $150 thousand over to this special fund for fy 16-17 because it is 6 months so that is wlie it is $150 thousand and sitting waiting to be used for

eligible expenses set astd. >> hew much is set aside for sur gaes. >> it is one amount for surrogacy and adoption and it is it annual amount being a annually year, not this fiscal year, a reg yoorl is $300 thousand. this year because we report on a fiscal year basis and didn't start until january it is only $150 thousand we put in there. >> there is $300 thousand set aside for the surrogacy or $150 thousand? i'm still confused. >> in the report we report on a fiscal year basis so for the fiscal year that covers july 1, 2016-june 30, 2017 we only put

$150 thousand because the benefit didn't-isn't effective until jan 1, 2017. for 17/18 we will put aside $300 thousand. there is $300 thousand. but as i said we haven't paid out any at this point. i can tell you that the amount for the application that we have approved is less than $15 thousand, so- >> but aside from that what you are setting aside how much is in the fund? >> it is all in the fund balance. >> so are taking everything? >> no. i'm taking only a small portion of the fund balance- >> how do we know what the fund balance is? >> the fund balance is at the ends of june 30, 2016 was $68.6

million. >> in the performance guarantees? >> no, overall. >> i'm curious about the performance guarantees. >> it isn't segregated. we are not spending any money from premiums from any of our members to pay for the surrogacy and adoptions. >> any performance guarantee money we received at the time it is tracked and credit into the fund balance. >> correct. >> we have been doing that a number of years, is that not

true? and we have annual financial statements that attest to this, correct? >>iect. >> any other questions? >> maybe just a suggestion started fy 16-17 if you drop the performance guarantee from here on and how much of that amount was taken out to put into the surrogacy benefits. >> i do that but let me point out one thing, to the extent that performance guarantees are not used for the surrogacy and adoption, they are part of the fund balance is being unappropriated if you will fund balance. within that fund balance we always talked about how much money is available for any non obligated- >> understood, but the

surrogacy when we approved that it is taken out from the performance guarantee, so we just need to track from here on starting fy 16-17 how much we got for performance guarantee and how much of the guarantee was used for surrogacy and going to fund balance. just to track purpose. >> i do that. >> deputy if ia make nolet to do that. i don't want impression left we have level of income coming into the operation the system not properly accounted for and audited, we know they are. thank you very much for what you report today. discussion item 15. >> item 15, discussion item report on network and health plan issues if any. >> if there are any will any

plan representative come forward. >> kate kessler kaiser. wanted to let you know about a account management change. cindy [inaudible] >> don't tell me she is leaving. >> she is not leaving she is recognized for her work and been promoted in our organization so now the director of our strategic acoupt private sector department will not be mubing off ouf work wg you immediately but we do have a wonderful new account manager, patricia pervs who is here if she can stand. >> well come. we are delighted to sl you will us and have big shoes to fill. >> patricia is with us 20 years so in good hand and cindy and patricia will work side by side several months.

>> i like to add that i want to thank cindy and mary ann for their work. they worked with me probably the most during my time and want to say thank you. >> alright. thank you. any other network or health plan issues from plan representatives that we need to- >> i have a question of all plans. to let me know what your nutrition counseling benefit is now. what you provide for that and what you plan to add on since that was requested at 2 or 3 metings ego that nutrition counseling is included in the plans going forward. so, i haven't heard any kind of comment how that will work and to emoo that should be cost neutral. the savings i'm sure will outweigh the cost. we talked about

dibeatacy dibeatys is one of the highest cost. we still don't have #23450utrition counseling. >> to this point, we'll take commissioner brezlens request of each of the health plans and ask director griggs to please get consolidated report to the next meeting, a consolidated report from the plans not a individual report from each plan but consolidated report around this aspect of the operation and where we stand , what they do or don't do or planning to do going forward. thank you for the inquiry. >> i want to mention another thing, united healthcare, there required doctors referral for physical therapy in the medicare advantage plan and that was presented that we did not need a doctors referral but you do need a doctors referral i was told by a physical

therapist. >> is there a united healthcare member here. >> there is closed session and need to be out of 5. >> very conscious of the time. >> united healthcare. there should not be a referral, so if you have a specific member we can look into that. >> i had the form in writing where you required that from the physical therapist. i got there and they said they require it. >> for you specifically or a member? y can look into it. >> anybody in medicare. >> i request you follow up on that point. any other questions of plan representatives? moving to item 16. >> item 16, discussion item. opportunity to place items on future agendas. >> hearing and seeing none,

item 17. >> item 17, discussion item. opportunity for the public to comment on knhae meaters within the board jurisdiction. >> do we have public comment under any of the matter snz please come to the microphone. >> good afternoon. ann dawnlen the communication director at the san francisco superior court. thank you for the opportunity today to speak with you to make you aware of extremely poor customer service from ebs the city and county of san francisco benefit vendor. i lick to acknowledge and thank mr. griggs and mrs. o'connor for responding this week to my particular issues with ebs. i note with interest you have before you many customer service metricrix jz measurements for hss mpt i'm here to strongly urge you to do the same for ebs. this is a

lucrative contract and as such incumbent as board members to seek and obtain customer feedback from us, your customers and consumers of the many fine benefits you offer to ccsf and eligible employees like us from the court. my tortured experience with ebs demonstrated they have many strides to make to deserve your business. the simplest of tasks such as accurately arranging for pay roll deduction for inshurns products to making customer service representatives accessible, responsive and efficient at problem solving elude the vendor that is why i'm here to request you undertake and evaluation the companies performance to determine the level of customer satisfaction. has hss asked the customers to rate their satisfaction with the customer services provided by ebs? does their contract require they meet certain customer service benchmark ?

more than 9 years i worked for the corep i don't recall being asked for the quality of service provided. if you ever have engaged your customers to find out if you ever-if you never have engage your xhust customers to find out whether ebs should have our business i suggest it is time to do so. i'm a robest consumer of the money products you as board members decide to offer to us. i am but one person with a long list of documented service problemwise ebs, but you don't have to pake my word, a google search demonstrates that my consumer experience is not unique. here in my hand are the 9 ebs reviews posted on yelp. every one is a one star rating t the lowest rating on yelp. it is time to deman your benefit of the vendor and employ you to assure getting what the taxpayer squz employees are paying for. thank you for your time today and look forward to

accountability from you on this important consumer issue. >> thank you for your statement sphyou care to leave with the scaert you can do so. if you care to. any other public comment on any matter of the board jurisdiction? if not we are moouv toog action item, which is vote whether to hold a closed session or member appeal. >> item 18, action ite item vote whether to hold clodezed session. >> do i is have a motion? >> it is moved and seconded there be a closed session. is there public comment? hearing and seeing no comment all in favor say aye? opposed? the ayes have it and so ordered. we will be in closeed session.

[members in closed session]d

session. [members in closed session] >> i will entertain a motion for adjournment of this meeting, the regular meeting of the commission. >> i make the motion tew to adjourn. >> it is properly moved, is there a second?

>> we have the action to vote whether to disclose. so, we have item 20 action item vote to elect whether to disclose any or all discussion in closed session. >> i move we do not disclose. >> it is properly mubed and seconded we do notd disclose the result oz our deliberations in closed session. any discussion by members of it board? hearing none we are ready >> student vote. all in favor say aye. all those opposed? it carries. >> there is the report on action in closed session. >> move not to report. >> is there a second? >> second. >> properly moved and seconded we not disclose the actions taken in closed session. any discussion by the board? hearing no discussion by members we are ready it voted. all in favor say aye. all those opposed? so ordered.

now ready toentertain a motion to adjourn. >> make a motion to adjourn. >> so moved and will give approval by rising and leaving the room. [gavel]. [meeting adjourned].

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started as a intern guided through the process eventually one day a a deputy director or staying with the puc is where i love it >> i want to welcome everyone coming this evening. this is thend of women history month and thought it appropriate to get the department heads, female and male department headsfelt we have the police chief here supporting us, thank you. [applause] female elected officials, i know many are on break now because board of supervise r break but saw the sheriff here. there is supervisor fewer. thank you for showing up today. we had

had the sheriff here earlier. i thought it was pornlt we have a celebration to honor women's history month and the mayor disgussed this with plea a while ago. we had a successful 2016 women summit and one of the things the mayor said to me right away when he asked me to chair the woman's summit is make sure we have a womans summit that isn't just inspirational speakers that is important, but have a policy agenda and action items that will continue throughout the year following that womans summit. it was a very successful one and as a result we wpted to come today talk about what we have done over the last year and what we plan to do in the future. thank you mayor lee for encouraging myself and work wg myer schaaf in oakland and women here in government, in pushing forward all these issues that are not

just wumens issues about family issues and equal pay eshues so thank you very much. [applause] we'll have a panel discussion with some very dynamic ladies and the reception to follow. i want to have mayor lee come up to talk about some of the things that some of the pledges that the city committed during the 2016 womens summit and what we plan to do in 2018. want to turn it over to mayor lee. [applause] >> thank you naomeee and congratulations on your second

term of city administrator. [applause] um, you know when you have a good thing going and find talent you want to repeat it over and over again. that's why i'm really happy to speak here for a moment with a lot of our women's leadership, our leadership in the city. i was just laughing a minute ago because it was very symbolic when i had-when we saw francis hold thg ladder has the photographer was climbing up the ladderment that was pretty symbolic. it is a good week so far and i know that all of you have been paying attention to everything going on in our country and yesterday was yet another moment where we celebrated with our former candidate for candidate, secretary clinton at the professional business women's conference of california and that was a wonderful time to

see over 6,000 professionals come together and talk about what we need to do and do together. i'm very proud of what we are doing right here in san francisco and i'm honored to join all of you tonight to celebrate women's history month and i know that nayome said it was the end of the month, i think it is the begin ofg lot of good things we are doing and everything seems to be these days more of a renuns and beginning of more things to come and i want to also acknowledge how that the celebration is really happening in a different backdrop than past years and certainly since we met in 2016 as the bay area women's summit i was very proud of that summit and proud for the city because it got us committed to doing more. if there is any area we can

demore, it is promoting and advancing women's rights, family issues, more of our affordability for our city and certainly announcing more women heading up city government in the private sector as well. i know all you know the disappointment of last november is still with us and seems every day there is a new attack we have to deal with, whether attack on neighbors or families or friends or the values that the country is built on, but i also think something good is coming out and yesterday was yet another example and today is another example and that is that it given us the drive we needed to have. i didn't think anything good would come out of this, but i do and recognizing when we are challenged, the good of people all over our city and the country and region is coming out. coming out more

deliberately and intentionally and it allows us to fight together for the good things we believe in. i think our city certainly i bow our board is and i know supervisor sandra fewer feels the energy at the board level, it happens to be led by women so might be part of the reason it is so energizeed, but i also think our region and our country is being energizeed. people are looking for ways to participate, do what they can to make sure that our country moves forward and not backwards. in the bay area we know a thing or two about social change and led it way with guaranteedprintal leave and guaranteed sick leave, affordable healthcare for all and we certainly pushed up the minimum wage as quickly we can, highest in the nation and it

will really help working families and certainly mothers. we have been building our commitment to provide access to education and as i said earlier, i'm so proud of creating college savings account for all san franciscans right from the kinder gaerten all the way to college. that is one of the proudest programs i think this city has been on the map for and so many other cities are following that example. they were going from how did you do that, to we can do too. and this year of course we doubled down and very proud to have worked with supervisor kim making sure our city college is free to our san francisco resident that something that you will see a lot of benefit-you should see the ideas coming out of free city college. [applause] and i think all of you know here since our bay area women's

summit commitment dedicated $17.6 million to support san francisco families. including $6 million for subsidized childcare. $10 million to fight violence among women particularly for intervention programs out of that. [applause] and we are expanding our implicit bias all at the same time. knroe there will be a lot of tech companies that follow our example. this work goes well beyond just announcing new policies and funding. our region, our economy and our workplaces do benefit when ever we position women to succeed and we'll continue that by example, we'll continue that with programs that promote and advance women's equity, empowerment and opportunity. i'm proud to say this, that many of you in the room with your commissioner,

department head, being honored in the private sector or leading our non-profits, you know that 60 percent of our city's government workforce, that is 30,000 people work wg for the city and county of san francisco, more if you add all the non-profits that we contract with, 60 percent are led up by women in the workforce. that is a tru-minds example. [applause] so, i think we must have promoted women because yesterday was 58 percent in my notes. don't think i didn't notice that. public relations people. jumped up to 60 percent over night. [laughter]. must have hired a lot of people over night. must have been the fire department. [laughter]. but, i'm also proud that i lead by example because in our city

government and in the mayor's office in particular we are 61 percent women and so that city department is leading the effort. [applause] i get to go around promoting where our women are serviceing in leadership positions in the city. highest and most valued departments including our city administrator of course, our fire department, department of emergency management, health department, port director, department of environment, human rights, human resources. so many departments, occ, so many departments i'm proud of. 311, we are celebrating 10 years, right? it has been led for 10 years by a woman. i mean, these are critical important agency departments of our city and i'm very proud that they are beheaded by

women. of course i mentioned earlier, the first time in 21 years the majority of our representatives on the board of supervisors are women. of course led by president london breed. thank you for making sure women are leading that effort as well. [applause] so, in early march, i had the honor recognizing 8 women who are moving our city forward through the department of the status of women making history awards. these are of course leaders who are improving the quality of life for all of san franciscans, who made it their mission to advance equality and labor and business and just come down to they are fine human beings i'm giving the award to. they are great leaders in their own right. so i want to take a minute to

recognize the women by asking you to really help us by standing up when i announce you because you are doing fantastic things for the city, for the region and for the country. let's begin with kate kendell national center for lesbian right. kate's a good example. another good frnd. one i got the privilege working close with the last couple years because i'm trying to make sure she builds housing on sites as she leads some of the hardest working peepy in the city. olga mu miranda the president. in the private sector heading

up the venture partner at 500 starts up, monique woodard. thank you monique for being here. you are part of our recognition. the ceo of caravan studios marnie webb. thank you, marnie. someone i had a personal privilege work wg many many years if not a few decades in the city and now heading up the executive director haas family fund, pam david. pam. someone else who i worked with very intensely the last year but she's been working very hard for a few years as our police commission. she is now assistant chief

league council for the sheriffs department, suzy loftus. in chinatown we celebrate history as we also remind people and more and more it is more important to remind our national leaders about the history of many parts of our country and of course she heads up the chinese historical society as the director, sue lee. thank you sue. congratulations. and then you know, i'm pretty proud-i didn't think i would erfb say this but i'm kind of proud of lawyers these days because lawyers are doing it for us. when we need our viewpoints argued in court. when we need them to do pro bono work, need them to represent more people whether at immigration or in the courts, they have been there

and i'm very proud to have selected our executive director and general council of the bar association of san francisco, yolanda jackson. thank you. all of you from the background, from the titles from where you work, i'm very proud of each and every one of you for the outstanding work and your commitment to our city and to our communities. thank you all and i know that change does not happen on its own and i know it takes all of us working together and this is something that i had many discussion uzwith eech and every one of you. i never want you to work alone. the exciting thing working in san francisco is you get to work with each other. you get to work with people that you didn't think cared about what you do, whether in your department or in your commission or in your prive ate sector or non-profits. what i

think what we do the best is we break down those barriers, work more as a collaborative city and that's how we improve the conditions and opportunities for women in our city and women in our region. there is always more things to do. that's why i'm excited to announce that alongside last years-i joined libby schaaf to do the bay area women's summit. this year we will add in mayorlocardo from san jose and all three of us-[applause]. the whole region will be united. we have a date. we finally have a specific date and the date is for our next bay area women pchs summit is tuesday, june 19, 2018 at our own moscone west and i'm happy to announce the summit is in good hands. we have a date, we have two

co-chairs and i want to make sure you know them. of course city administrator naome kelly is coming back and debbie mezlow is joining as co-chair. we all know debbie, she is vice president of our commission on the status of women. long time senior advisor to the senator pamela harris. i think we have a senator coming. if not more than one. so, those serve as the 2018 co-chairsism i think it in great hands so won't have to worry about it. i know the 2016 was a success because we all came together. we all recognized the contributions people are making and we all wanted more opportunities for women and girls in our city and in our region. so, i'm looking forward to building on the

success of last year and discusing how to continue greater opportunities, having those critical conversations that we need to have to make sure that leaders, that we have more leaders to push for equality and pave the way for the rest of our cuntsry. more examples, more conversations just like we had which secretary clinton yesterday that was i think asperational and enthuse astic. this means there will be a lot of work ahead for all of us, but it is good work and we'll enjoy. tonight i want to join all you celebrating your accomplishments, keeping the city strong, making sure we are moving together and to know that you will have a mayor at least for the next three years and have department heads that we well placed. you have commissioners, non-profits that are helping but you have a

strong city that will back women's rights up, make sure we are family friendly, let's build more housing so people can get here as affordability. let's get more people not living on our streets and let's make sure that equality and opportunity and progress is made in everything that we do. congratuless, have fun tonight, let's celebrate and get to work together to make sure more opportunity are there. congratulations. [applause]>> thank you mr. mayor. up next i thought we would have a quick panel discussion with very dynamic ladies who i would like to introduce oo you. first is our moderator seriina who such a partner. she is head-coo of

womens foundation of california and put on the 2016 bay area womens sum mit and will partner get for 2018 so thank you for that seriina. [applause] why don't you come up. she has been the leader in fill philanthropic and non-profit social justice starts with local knhunty based pub lging in new england and shifting on array of social justice issues including womens right, lgbt sw human rights. next we have our panelist and one the mayor's awardees for womens history month, olga miranda and olga, please come to the stage. [applause]. olga is president of local 87, the janitors union in san francisco. she is also a secretary treasurer the san francisco labor coun m and

directed a collaboration with the labor community studies department at city college of san francisco. next up is panelalist catherine stifaunae, catherine come on up. catherine is an attorney who becan as a prosecutor in contra costa who serves as our own san francisco cinet clerk and served on the board of directors of homeless prenatal program and now the local chapter leader and spokes person for moms demand action for gun sense in america. and finally, but not least, buffy wicks, buffy please come on up. buffy is a political strategist and grassroots organizeer. serviceed othen senior staff of president obama's 2008 and 12 campaign and deputy director of white

house office for public engage ment. senior fellow at the center for american progress where she focused on public policy effecting women and families. buffy hosts a feminist pod cast called the riveter so check that out. i will turn over the panel who suvena who will moderate and looking forward to the riveting discussion. >> thank you so much. thank you all for being here. again, suree renea con, the ceo of womens foundation o california. so happy to partner with the city on the ecs inbay-air womens summit. proud partner for 2016 and can't wait for the next one. i'm particularly happy to bhee here tonight because the womens foundation of california got its start here in 197 ninel so all most 40 years old and in that time we granted out all most $40 million to organizations in the

bay area no across the state. we have grown to be a state-wide womens foundation but started right here in san francisco, so it is really a pleasure to be here tonight and to moderate this panel with this amazing group of people. so, our theme for this evening is civic engagement about how we can all think about getting more involved. we are really actually stairing at a moment in history in our lifetimes where we have the opportunity to engage more people than perhaps we have been able to. we have seen in san francisco in the streets and protests at sfo and across the country so it is a real opportunity to engage people. we want to build on what we did at the bay area womens summit. that was as you heard the mayor and naome kelly say that wasn't a one time event jpt to follow with policy initiatives. we

saw thousands of peep who attended make individual pledges and there were themes that emerged but how to get more involved. how do i get mentorship to get involved and make a difference. how can i resist-how can we protect the gains we have made and continue to make advancements particularly because we are here in the bay area and here in california and we have a opportunity to showcase hope for the rest the country because we well be able to continue making advancements for gender equality, for racial justice and economic justice and so it is both our responsibility and our opportunity. so, with that, i want to just ask-i want to start off on a personal note. i want to ask each of our panelist about what inspired you-who or what inspired you to get involved in a life of civic

engagement? i will start with olga. >> i think everybody heard of [speaking spanish]. the inspire image of [inaudible] that is my mother. she was a indigenous woman from [inaudible] she didn't know how to read or write and somehow she wanted something greater for her kids and she immigrate today the united states. not knowing how to read or write and didn't stop her fighting for fair housing and community being removed from our home. she helped a lot of latinos get elected in los angeles. our saturdays, our weekends were going out and walking and translating at city hall in los angeles and writing the letters that 8 or 9 year olds should not be writing to electeds why

we deserve fair housing. that has been always my inspiration. there is a lot of women in san francisco who's names we don't know but have done incredible things for all us here in the city and not just win labor but the private sector and i'm humbleed to be among all you. all you are warriors in your own respective way squz appreciate you all being here today. thank you. >> thank you so much. buffy, let me turn to you in terms of-we heard your amazing bio and many things you have done particularly recently and for many years, so how about you. >> so i'm from a little town called forest hill which no one knoze where it is. some may. i was living in san francisco early 2002 or 3 and moved into action during the lead up to the war in iraq. i was one of the women with the bull horn

leading people down the streets and shutting down the streets of san francisco. i'll tell a quick story that highlights i think my appreciation for organizing because my background is organizing. leading tupe the [inaudible] and drive toog work and a good friend and room mate at the time named tom called me and said i tested positive with hiv. can you pick me up to the clinic. i went in the clinic and sat down and learned about t cell squounts viral loads and thinks i didn't know much at the time. we left the clinic he was at and got in the car, i remember it was a cloudy day and he said, i don't have health insurance. in the biggest moment of need he was worried about insurance and not his health. this the week we started dropping bombs in iraq and got angry the direction our country was going. i decided i wanted to work on health reform

and have a seat at the table or close a seat as i could when we make these decisions as a country. that set me on a trajectory to get involved in national politics. shortly there after i made a state senator named barack obama and fight for wall marth healthcare workers. i movaled to chicago and worked for barack obama running for president. we pioneered-i was a field director for barack obama here in california against hillary back in the day where we took social movement organizing and apply to a electoral context. i worked on the campaign and in the white house and affordable care act so spent the first 15 months of the adminivation work ogen tha. i never forget march 2010 sitting in the roosevelt room with the president and

vice president and senior staff watching the votes come in on the affordable care act and when that last vote came in, i realized as the crowd erupted and everyone jumped up and the president started giving hugs my friend tom wouldn't be considered a preexisting condition anymore. and i also realized the power of organizing. that many spent decades working to get that bill passed through many different administrations and that if we worked together with the focus and passion and true understanding why we are doing the work we are doing we can achieve great things. >> thank you so much. [applause] thank you for sharing that, that is incredibly moving and so many people have healthcare thachcks to your work so really appreciate you shared that with us. i'm going to move to catherine now, our fearless

county clerk. you recently were active in starting the organization around opposing gun violence in schools and you mentioned it came from the tragedy at sanda hook and my home state of connecticut, so tell us whether it was that incident or what was it that inspired you in a life in civic and public service. >> thank you. i was always involved in the gun violence preedges vention since culm bine. i had a show called fl record on contra costa television and was so disturbed what happened at collinm bine i had a show called gun control and had someone from the coalition to stop gun violence and someone from the nra and at thatime i was flabbergasted what our laws were and went after the nra

person and realized i couldn't be a journalist because i couldn't be impartial. then [inaudible] and did pro bono work to prevent gun violence and coulden believe what happened an arara and the day of sanda hook i just dropped off snack tooz my sons classroom and i was in the classroom that morning and got in my car and drove to city hall, i worked for supervisor farrell and starting hearing reports of what happened. i just could not believe it and i knew in that moment that every day for the rest of my life i had to responds time and effort changing the lax gun laws in the country and thank god a woman named shannon watts started a facebook page called 1 million moms for gun control

and changed to moms demand action in america and what we wanted to do was become watt what the mothers against drunk driving did for our drunk driving laws for gun laws in the country. we have a chapter in every state, 3.5 million members, merged with mayor bloomburg and i'm the local group leader in san francisco and what we do, we resist, we persist. i think-insist. you real it is rhyme for change t. like a acronym. it stands for ripe. we enlist. we have grown our chapter so much 12 local group leaders and every day it is about what to do to push back the nra agenda for guns everywhere for anyone. >> thank you so much what a great start to the panel. [applause] so, we know there are many ways to bhee engaged

so want to turn to the audience and just ask some of you clearly are in public office, but for those of you that are not, have you ever-how many have been inspired or thought about running for office? if you can just raise your hand. okay. we got to work on that [laughter]. how many of you have been to a protest march? okay. how many have engaged in some type of policy adscrooeswhether calling a legislator or--terrific. okay. so, let me ask-you know, i'm sure all of you have been asked in-i have many en timeathize question of recollect i really want to do something after the november election i want to do something. i want to get involved. what can i do? how do i plug in? so, i'm sure

many of you have gotten that response too-that question and i'm wondering what are some of your responses? so, let's start with catherine. >> i tell people you caechbt give up. it isn't easy to get into a organization even when i try today get involved with moms demand action it was a young group and just kept trying and calling and couldn't make an event and kept calling and someone called back and got invited to dc and started to meet people in the organization and kept going back. i didn't wait for someone to ask me, i asked them and you just have to not be afraid to keep trying, to break into the organization you want to be involved with and not worry about what other people think. a lot of people say to me all the time, are you embarrassed or worried about all your advocacy on social media. i'm like, no, not at all. it is something i'm not

afraid to do so you have to go after it with all your passion. >> great. olga, you are a organizer. clearly you started very young in terms of organizing your community. that can be intimidating for a lot of people. they saw i want to get involved but dont think i can be a organizer. i want to get involved but there are so many different ways to get involved so do you have suggestions for people? some people may have time, some may have organizing skills, some people may have artistic abilities or extra money they can give. what are ways you think people can be involved? >> you know, the members i remember the workers i represent were shocked that results of the election but when you are directly effected you kropet the luxury to feel bad. a lot

example. the city is imp grnts, the city is about how women make the city run. i ask everyone of you to please join us. thank you. >> great. thank you, olga. [applause] burry, what is your

call to action. >> women are in the forefront of social change. on the obama campaign the core volunteers leader the campaigns 71 percent were women. when you look at moms demand action and you look at the muckters against drunk driving and resistance movement whault kicked off the womens movement the womens marcht. civil rights movement were leading it overshadows by the men. i have a lot of faith of the people in the room and my ask is pick the think you care most about, get involved, at a local laevl and commit whether the is choice or gun violence or clean energy, clean water, all of these things are under attack now with this administration and it is our moral obligation to stand up to this president. >> thank you so much. before we wrap up i offer my own call to action, i work in philanthropy so my call to

action is give local. find a organization that is local, that you care about and give to them and give toward gender equity because when the womens foundation started in 1979, only one percent of all dollars wnt to women and girls issues. now all most 40 years later, we moouved the needle about only to somewhere between 7 and 9 percent. that is not nearly enough for the inequities around gender. i ask you to be fill philanthropic and give to your local organization if you need help identifying one the womens foundation of california is here to partner and direct you to where you want to give. so, please join me in thanking our panelist and naome kelly and the city. [applause] >> wow, i was definitely inspired by all 4 of you ladies

and thank you so much. i mean, the call of action i was thinking what could we do and there is so much we can do right now and i love olga for america. i love opening the doors for department and commission heads andopethening door frz all the womens and families who come to our doors, lead by example and pick a issue and become an advocate for that issue. i love all that and give locally. love it. alright. so, one last thing, i will have debbie come up my partner and crime and close out remarks. for the 2018 womens summit, there are many many issues we could discuss so have back there john cal done and and jillgen johnson. if you have issues you would like to discuss and write them a note because we are taking all ur