SFHSS pilot dependent‑eligibility audit removes 19 dependents; staff reports ~$86,000 annual savings

San Francisco Health Service System staff reported results from a pilot Dependent Eligibility Verification Audit (DIVA) focused on retirees. Chief Operating Officer Ray Guillen said the audited population grew to 634 retirees; 601 members completed verification, 14 were removed from the audit for updated family status documentation, 19 resulted in dependent terminations and the estimated annual savings from those terminations is about $86,000.

Staff said the process generated heavy member contact: 668 inbound calls and 331 outbound calls tracked during the pilot. The audit relied on mailed letters (up to four reminders), phone outreach, fax and mail submission, and a multimedia hub with recorded webinars and instructional videos. Staff said the lack of an integrated, automated upload and Salesforce‑linking capability increased manual workload and led the department to plan a new RFP to find a vendor to integrate document uploads with member accounts, which would make future audits at scale feasible.

Board members acknowledged the savings and the workload and asked about selection criteria and future audit frequency. Staff recommended future audits cover roughly one‑fifth of the membership annually (about 5,300 members) rather than an annually targeted one‑third, and said an automated technical solution would be required to sustain audits at that scale.