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HSS opens talks with Kaiser on 2015 rates; unions and retirees push for transparency and quality reporting
Summary
The San Francisco Health Service Board reviewed early-stage negotiations with Kaiser for 2015 member rates, with staff outlining goals for funding structure, performance guarantees and fee-schedule stability. Labor and retiree representatives urged mandatory quality and defect reporting tied to utilization and suggested profit-cap guidance.
Acting Director Lisa Gottlieb updated the San Francisco Health Service Board on the status of negotiations with Kaiser over 2015 member rates, saying HSS has held four meetings and expects negotiations to continue biweekly through December with a board presentation in January.
Why it matters: the negotiations will affect premiums and benefits for active and retired city employees. HSS listed goals including evaluation of funding structures (self-insured risk-sharing versus fully insured), reconsideration of integrated care management charges, performance guarantees, incentive programs to improve care and fee-schedule stability.
Labor representatives and retirees used the board forum to press staff for stronger transparency and accountability. Larry Bradshaw of SEIU Local 1021 asked whether HSS will require Kaiser to report utilization tied to “defects in quality and safety” and whether HSS has a preliminary position on profit caps or limits on fee increases. Richard Roth, a retiree, asked the board to obtain a written report from Kaiser explaining differences between “observation” and “hospitalization” coding after a retiree incurred significant out-of-pocket bills.
HSS response: Gottlieb said staff will ask Kaiser for reporting on quality and utilization tied to preventable events and noted the board had discussed profit guidance at an earlier meeting. She invited further input from members and said the negotiation forum is the appropriate place to surface those recommendations.
Clinician input: Commissioner Dr. Schlain, a physician-member of the board, urged greater clinician involvement in negotiations, warning that narrow focus on price can miss incentive structures that affect care. Schlain proposed exploring alternative payment approaches such as “pay for engagement,” where providers are rewarded for patient participation and measurable outcomes.
What’s next: staff said vendors will be available to answer member questions during the negotiation sessions, and HSS expects to finalize renewal commitments for 2014 by Oct. 1 and to bring negotiated items to the board in January. The board encouraged members — active and retired — to attend the negotiation forums and submit written suggestions.
Sources: Statements and Q&A during the Health Service Board meeting, including public comments from SEIU Local 1021 and retirees.
