SFHSS' core functions are providing efficient and accurate benefits administration, managing cost-effective health vendor contracts, establishing annual rates and benefits via health vendor negotiations, ensuring legal compliance, maintaining accurate financial and demographic records,ensuring eligible members and dependents have access to quality healthcare, and educating employees and retirees about health and well-being benefits.
We remain steadfast in our commitment to constantly improve the quality of health care available to our members that are affordable, sustainable and in compliance with the legal requirements of the City and County of San Francisco.
The Communications division provides employees and retirees with accurate and timely benefits information, so our members can make knowledgeable decisions about their health benefits coverage. This includes designing and supervising production of all print, web and electronic materials, organizing informational events, and coordinating information among human resources professionals, unions and other groups.
In addition, this division ensures that information relating to benefits, Health Service Board proceedings, finance and operations are made available to SFHSS members, elected officials, the media and the public, in a timely manner, so the department adheres to high standards of government accessibility and transparency. Communications also reviews and approves SFHSS member communications issued by healthcare vendors and assists the employers served by SFHSS with benefits-related information as needed. Communications supports the annual Open Enrollment campaign, with dozens of communications pieces, mailings, enrollment materials and outreach content designed to ensure a successful enrollment process. Highlights include six Benefits Guides, four Benefits Booklets, customized suite of enrollment materials, web page content, Citywide emails, eNewsletters and artwork supporting open enrollment and educational events.
Carol Karimi, Communications Manager
Enterprise Systems & Analytics
The Enterprise Systems & Analytics (ESA) Division supports all the technical infrastructure for the San Francisco Health Service System from IT support to systems configuration and development, implementation of cybersecurity safeguards and project management. This division annually configures all the system modifications required to administer benefits for the plan year which includes the financial, benefit plan and enrollment components. ESA also provides production support for the benefits administration system and the eligibility and payment interfaces.
ESA leverages the All Payer Claims Database (APCD) to conduct analyses of the member population to evaluate quality of care, trend cost and utilization, and support plan design and population health considerations. Additionally, this division fulfils internal and external data and report requests. ESA provides data to support rate setting, budgeting, and internal/external audits.
Marina Coleridge, Enterprise Systems & Analytics Manager
The Finance Division consists of three units: Accounting, Budgeting and Procurement, and Contracts Administration.
The Accounting unit ensures the timeliness and accuracy of all SFHSS financial transactions, conducts the Charter-mandated 10-County survey, calculates annual premium rates, oversees the annual external audit of the Health Service Trust Fund, reports to the Health Service Board, and is responsible for developing and monitoring the Employee Benefit Trust Fund.
The Budgeting and Procurement unit is responsible for development and monitoring of the General Fund Administration and Healthcare Sustainability Fund budgets and management of the procurement of goods and services for the department.
The Contracts Administration unit manages the negotiation and execution of contractual agreements for the department, annual contract renewals, procurements and competitive solicitations, and contract performance evaluation programs, compliance and monitoring.
Michael Visconti, Contracts Administration Manager
Pamela Levin, Chief Financial Officer
The Member Services Division handles day-to-day enrollment transactions, provides benefits decision support to our members, coordinates premium contribution transactions with finance, and acts as a liaison between members and healthcare vendors as needed. Member Services is also responsible for monthly reconciliation of member data with plans and employers, processing births, deaths, leaves, new hires and retirements. Member Services staff answer thousands of calls and meet personally with members between 8:00am and 5:00pm. In 2017, operations staff answered 54,567 calls and assisted 14,840 members in person. Open Enrollment is conducted annually in October. During this time, the call volume and office demand increases significantly. Depending on the significance of the year’s plan and rate changes, the Member Services team manually enters data for approximately 14,000 open enrollment applications into the PeopleSoft system, in order to meet deadlines for data transfer linked to the start of a new plan year every January 1.
Siobhan O'Connor, Member Services Manager
Operations ensures compliance with city, state and federal regulations regarding protected health information, labor laws and privacy and records retention and IRS requirements for pre-tax benefit contributions. Operations advises the Health Service Board on the rules that govern membership in the San Francisco Health Service System, conducts ongoing eligibility audits and adjudicates member appeals. Operations assures service levels are met by our health plan partners, ensures service levels are met with our client organizations and advises on plan design and member contribution models.
Mitchell Griggs, Chief Operating Officer
The Well-Being Team helps our members (employees, retirees, and family members) feel, live, and be Better Every Day. We encourage and facilitate well-being by raising awareness, providing programs, services and tools and striving to create a supportive workplace culture. The Well-Being Division has several core functions: the Employee Assistance Program, Well-Being@Work, retiree services, healthy behavior campaigns and challenges, targeted interventions, and the Wellness Center. The Well-Being Team leverages existing well-being services offered through the health plans. With the support of the Well-Being Sponsors: The Mayor’s Office, Controller’s Office, and the Department of Human Resources, the Well-Being Team strives to transform the workplace into one that supports employee well-being.