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t SOUTH r SAN FRANCISCO o p Mon r E tere CITY HALL i y Rd . G A r and Bl h g u o or stb We VISION

San Francisco is a healthy community for all. Message from our CEO As the San Francisco Health Plan enters our 22nd year of serving our members, this strategic plan for 2018–2020 focuses on striving to make San Francisco a healthy community for all. We will continue to build on our programs and past accomplishments, forge ahead to protect the gains we have made in San Francisco, California and across the United States in covered lives, thanks to the Affordable Care Act (ACA), and focus on a future that improves health outcomes of the diverse San Francisco communities through our successful partnerships. This strategic plan is the result of a collaboration with our leadership team and our Governing Board. The work reaffirmed our focus on our four strategic anchors: 1. Universal Coverage Through Partnerships - We will do everything feasible to work with the City and County of San Francisco, State and Federal governments, and our partners to ensure that all San Franciscans have access to high quality health care. 2. Quality Care And Access For Members And Participants - We will set high goals and track our outcomes and performance against quality measures, customer satisfaction and national accreditation standards. 3. Exemplary Service to Members and Stakeholders - We will never forget that, at the end of the day, what we offer is service to our members, providers and purchasers. This service must be of the highest level and of significant value to each of those key customers. 4. Financial Viability for SFHP and for Safety Net Providers - We need to ensure that SFHP’s financial future is secure so that we can weather the tough years, never limiting or capping our enrollment in the programs that cover the uninsured and low-income residents, while also helping to protect the viability of safety net providers, who offer access to care regardless of a patient’s ability to pay. We have seen many positive changes over our 22-year history, from achieving universal coverage of children, offering access through the City’s award-winning Healthy San Francisco Program for all uninsured in the City, successfully implementing the Affordable Care Act Medi-Cal expansion to childless adults, tripling our Medi-Cal membership in less than 10 years, a quintupling of our revenues, and being the highest ranked public Medi-Cal plan as determined by the Department of Health Care Services (DHCS) on quality measures for each of the last 10 years. This strategic plan sets forward the road map and path for SFHP in the next three years. We will use this plan to set our annual goals with the Governing Board, as well as adjust to the ongoing changes in our health care world. We are so fortunate to be located here in San Francisco, one of the premier cities in the world, where the Mayor, Board of Supervisors and community strongly support health care for all. We will continue to work closely with our partners at the Department of Public Health, San Francisco Community Clinic Consortium, local community providers and others to ensure that San Francisco is a healthy community for all.

John F. Grgurina, Jr. CEO, San Francisco Health Plan

1 MISSION

The mission of San Francisco Health Plan is to improve health outcomes of the diverse San Francisco communities through successful partnerships.

2 CORE VALUES

Our three core values are interrelated and serve as our compass; they guide our organizational behavior. SERVE WITH RESPECT We respect all those we work with, including members, providers, external partners, clients and each other. Serving with respect ensures we are accountable, courteous and responsive to a wide range of interests and needs. STRIVE TO EXCEL We strive for excellence in everything we do, from ensuring quality services to our members, supporting our provider network, running efficient operations, and acting with integrity. WORK AS A TEAM We work as a team within and across departments to ensure quality service to our members, providers and community partners.

3 WHO WE ARE

Established in 1994 by the San Francisco Board of Supervisors, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to improve health outcomes of the diverse San Francisco communities through successful partnerships.

SFHP is chosen by eight out of every ten San Francisco dedicated members of our community representing physicians, Medi-Cal managed care enrollees and our more than 145,000 health plan members, hospitals, labor, and community health members have access to a full spectrum of medical services centers. Although the San Francisco Board of Supervisors including preventive care, specialty care, hospitalization, appoints 14 of our 19 Governing Board positions, our Board prescription drugs, and family planning services through of Governors and SFHP are independent from the City and the Medi-Cal, Healthy Kids HMO and Healthy Workers HMO County of San Francisco. The Governing Board establishes programs. We also provide third-party administrative services organizational policies and oversees the general administration to the Healthy San Francisco and City Option programs, which of the health plan with an admirably consistent approach to provide health care access to over 13,000 uninsured adults, ensuring our members are provided with excellent services as well as premium assistance and medical reimbursement from SFHP. They are also committed to our principle to treat all accounts for over 345,000 San Francisco employees. of our providers in our network fairly and equally. We are a public, not-for-profit, NCQA Accredited Medicaid OUR STAFF - PERFORMANCE, HMO Health Plan that is committed to universal coverage. LEARNING AND STRENGTH Through long-standing partnerships with the San Francisco THROUGH DIVERSITY Health Network, the Department of Public Health, San Francisco Community Clinic Consortium, local community Our success in serving our members reflects our highly providers, and other community-based organizations, we help committed employees, who are passionate about our mission. ensure low-income San Franciscans have access to high-quality In turn, we endeavor to ensure our employees’ success by health care. providing a robust collection of learning and development options, and personal health and financial wellness programs. GOVERNING BOARD MEMBERS We provide employees with the opportunity to develop their SFHP was designed by and for the residents it serves, and technical and team-building skills so that they may advance takes great pride in its ability to accommodate a diverse their careers within the organization. Our highly diverse population that includes young adults, seniors, and people workforce ensures that we consider a variety of perspectives with disabilities. Our Governing Board is comprised of and allows us to make the best decisions for our members.

4 MEMBERS OF OUR GOVERNING BOARD

Chairperson: Steven Fugaro, MD - San Francisco Marin Medical Society Vice-Chairperson: Barbara Garcia - Director of Health, City and County of San Francisco Secretary/Treasurer: Reece Fawley - Vice President, Health Plan Strategy and Managed Care Chief Contracting Officer, UCSF Health Edwin Batongbacal - Associate Director, Community Behavioral Health Services Dale Butler - San Francisco Labor Council Eddie Chan, PharmD - President & CEO of North East Medical Services Aneeka Chaudhry - Senior Policy Advisor, Office of the Mayor Lawrence Cheung, MD - San Francisco Marin Medical Society Irene Conway - Member Advisory Committee Co-Chair Steve Fields - Executive Director, Progress Foundation Maria Luz Torre - Parent Voices, Member Advisory Committee Co-Chair Roland Pickens, MHA, FACHE - Director, San Francisco Health Network Emily Webb, MPH - Director, Community Health Programs, Sutter Health Bay Area David Woods, PharmD - Chief Pharmacy Officer, San Francisco Department of Public Health

EXECUTIVE TEAM Karen Andrews - Chief Operations Officer Sunny Cooper - Chief Information Officer James Glauber - Chief Medical Officer Kate Gormley - Interim Chief Human Resources Officer John Gregoire - Chief Financial Officer John F. Grgurina, Jr. - Chief Executive Officer Nina Maruyama - Officer, Compliance Regulatory Affairs Sumi Sousa - Officer of Policy Development & Coverage Programs

5 The majority of our members speak a language other than English as their primary language

English Chinese 49% 33%

Spanish Russian 14% 2%

Vietnamese 2%

SFHP QNXT Database 11/2017

MEMBERS: OUR HEALTH PLANS, MEMBERS AND PARTNERS BY LINES OF BUSINESS We serve members in our Medi-Cal, Healthy Workers HMO and Healthy Kids HMO managed care products. Our members include children, adults, seniors, people with disabilities, and In-Home Supportive Services workers and the 133,441 City’s As-Needed workers. Many of these individuals would not have access to other health insurance options for themselves or their families.

To best serve our members, we partner with San Francisco community organizations, hospitals, provider networks, and the San Francisco Department of Public Health to provide access to health care and support services for the residents of San Francisco.

The following information describes our provider network. The table below is only 11,357 the network.

PROVIDERS: MEDI-CAL, HEALTHY WORKERS HMO, AND HEALTHY KIDS HMO 624 4,630 5 Hospitals with Primary Care Providers Specialists 1,676 10 Hospital Campuses 493 52 979 Pharmacies FQHCs/Community Clinic Sites Behavioral Health

SFHP Membership Report 201712 12/2017 SFHP QNXT Database 11/27/2017 6 PARTICIPANTS: TPA LINES OF BUSINESS 345,392 SF City Option Employees 3,250 HEALTHY SAN FRANCISCO AND SF City Option Employers SAN FRANCISCO CITY OPTION

SFHP has worked in partnership with the City and County of San Francisco 13,587 and a dedicated group of providers to offer universal coverage to all Healthy San Francisco Participants 11/2017 San Franciscans, regardless of immigration status. Since the passage of the Health Care Security Ordinance in 2006 and the launching of the groundbreaking Healthy San Francisco program in 2007, SFHP has provided PROVIDERS: third party administrator (TPA) services for the Healthy San Francisco and TPA LINES OF BUSINESS SF City Option programs.

Healthy San Francisco continues to offer comprehensive health care services to uninsured San Franciscans that are ineligible for publicly sponsored 35 health insurance. While overall enrollment has declined since the passage Medical Homes for primary, specialty and behavioral health services of the Affordable Care Act, over 13,000 San Franciscans still rely on Healthy San Francisco as a regular source of care. Healthy San Francisco remains a critical safety net for the remaining uninsured of San Francisco.

The SF City Option program continues to grow and offer more services to its employers and employees. San Francisco employers can choose to 5 meet the employer spending requirement of the San Francisco Health Care Hospitals with Security Ordinance (HCSO) by participating in the SF City Option Program, 8 hospital campuses and SFHP has helped over 345,000 employees access their employer contributions. Employees of participating employers may enroll in one of three programs depending on which eligibility requirements they meet: the Healthy San Francisco Program; SF Covered MRA, which provides premium subsidies and cost sharing reductions for certain San Francisco residents; or 45 SF MRA, which provides a Medical Reimbursement Account (MRA) to pay for Pharmacies eligible health care expenses if they do not qualify for Healthy San Francisco or SF Covered MRA. 02/2018 7 8 STRATEGIC ANCHORS

Our strategic anchors provide the lens through which we evaluate decisions across our entire organization. Our goals and objectives align with at least one strategic anchor. Our Strategic Anchors are Universal Coverage, Quality Care and Access, Exemplary Service, and Financial Viability. Organizational goals are changes and improvements we intend to make within the next three years. With the uncertainty in the health care environment and potential changes to the Affordable Care Act, one of our top priorities is advocating for policies that protect services and benefits for our members and payments for our providers.

9 THREE-YEAR GOALS

UNIVERSAL COVERAGE QUALITY CARE AND ACCESS FOR THROUGH PARTNERSHIPS MEMBERS AND PARTICIPANTS

Support all efforts to maintain and improve Remain the highest ranked public Medi-Cal health insurance and health coverage in plan by the Department of Health Care Services San Francisco. based on aggregated quality measures.

Preserve the unique public-private Obtain at least 80% of available points for partnerships of the health plan. HEDIS and CAHPS when we pursue our NCQA Third-Year Renewal Accreditation in 2020–2021.

Improve access to adult non-specialty mental health services for Medi-Cal members.

We believe every adult and child in San Francisco should It is critical that our members and program participants have health coverage. Our strategic anchor of universal not only have access to health care, but also that the care coverage recognizes that the health plan alone cannot they receive must be of high-quality. We support a range of provide coverage for everyone. Therefore, we work in efforts across the organization that will assess and improve partnership with the public health system and community the quality of health care received by our members. providers to make providing health coverage a priority for San Francisco residents.

10 EXEMPLARY SERVICE TO MEMBERS FINANCIAL VIABILITY FOR PLAN AND STAKEHOLDERS AND SAFETY NET

Implement the appropriate infrastructure Optimize SFHP performance and provider support to obtain NCQA Renewal Accreditation reimbursements. in 2020–2021 and going forward.

Foster a culture of ownership, accountability and continuous improvement within SFHP.

We are committed to providing exemplary service and The fiscal environment in which we and our safety net support to our members, participants, purchasers, physicians providers operate is often in flux and uncertain. Therefore, and other health care providers, and each other. we maintain a strategic focus on the organization’s long-term financial viability and make decisions to support the economic sustainability of our safety net provider partners.

11 ACKNOWLEDGMENTS

This document was created with input and feedback from the following individuals:

GOVERNING BOARD MEMBERS Edwin Batongbacal, Eddie Chan, PharmD, Irene Conway, Reece Fawley, Steven Fugaro, MD, Barbara Garcia, John Gressman, Maria Luz Torre, Roland Pickens, Emily Webb, and David Woods, PharmD

EXECUTIVE TEAM Karen Andrews, Sunny Cooper, James Glauber, MD, MPH, John F. Grgurina, Jr., John Gregoire, Deena Louie, Nina Maruyama, Peggy McCrea, and Sumi Sousa

DIRECTORS Annette Angelini, John Dockins, Kerry Landry, Valerie Miller, Cecil Newton, and Van Wong

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