Transcripts For SFGTV Health Commission 51716 20160521

Are there any corrections to the minutes . Hearing none or seeing none, all those in favor of the minutes please say aye. The minutes have been approved unanimously. Thank you, commissioners, item 3 is the directors report. Good afternoon, commissioners. Yes, please. Were so happy to announce that San Francisco General Hospital and Trauma Center has officially been licensed and is ready to receive patients. We want to thank all of the people who worked so hard to make this historic mile stoeb possible. I know our ceo is in the audience and just want to let her know how lucky she is to move into a brand new hospital this weekend and i know she will be working hard along with many. Also, just to let you know, we have have 24 7 it teams ready to support the new hospital. They will be on call for a whole week and then of course they will stand down if things look good in terms of any issues. So i think that is one of the best news. Also mayor lee did announce his department of homelessness and housing. The new department is expected to have about 110 staff members, many of them transferring from the department of human health and service agency, we will have a budget of about 165 million, jeff costofsky will be leaving the department as he has been the recent director of Hamilton Family services, which is serving homeless families. So we really want to welcome him and ill be working very closely with him in terms of our job, which is to provide the Clinical Services for all of the homeless, housing as well as the needs. Homeless individuals that they serve. Also just want to recognize our deputy director, coleen chala, who worked closely with me in the development of our able project. We are partnering with the San Francisco police department, bart police, public defender to launch a program that would allow Police Officers to divert drug offenders to treatment rather than arrest. This is modeled after a successful Seattle Program and basically under the Program Officers who have probable cause to arrest someone possessing drugs will take them directly to the Public Health intake site where they can be connected with treatment services. We have had similar programs like this and we can tell you at least 50 percent of the individuals do take us up on the pee tension of being able to access services. This is also one of our initiatives to ensure that people get opportunities and every opportunity when they engage with the police in terms of seeking treatment. Want to acknowledge the fact that alice chen is to be honored by the San Francisco clinic Consortium Event and she will be honored for strengthening the citys safety net and improvements she has made to access to High Quality Health Care for all San Franciscoans. I will stop there and any questions the commissioners may have regarding the report. Commissioners, questions to the director . I could ask the first one, which is related to your report on the climate and Health Program of 2016 im wondering if we could have that reported also. Absolutely, we can do that. I was wondering whether you can expand on the issues of sentinel . We have talked about it here at some length, it just seems like happening. Absolutely. We have a whole group of individuals in our Department Working with all of the other providers to ensure that our Provider Network knows the issues. Also this is a Different Community that could be using these, it looked like narcan, it looked like xanex or narcan. Good afternoon, commissioners, so we have first of all i think whats interesting is that we often hear from our providers in the Community First when these things are out and we have a great communication with our syringe access providers. We have a process thats not unlike our Emergency Response system so we develop a health alert when its up for review and core provider review and we get it out to all of our providers that would be engaging with drug users of any kind, people on the street. They have photos of the drugs that are safe, for lack of a better term. To followup, what about with sfusp we have our mailing list, we have the pios at all of the inaudible and, yeah, we actually work directly with the School Districts because the initial information a few months ago was in marin county or i forget which county it was in the high schools. Yes, actually it was it was east bay. Further questions . Well keep you updated on some of the activities. Thank you, i think also the commission would like to welcome dr. Alick, its nice she got such a nice gift as the license so she has a hospital to operate. Were pleased you are on board and to thank dr. Alice chen for her work, nice that the consortium recognized that. Further comments from the commission at this point . Id like to take a moment to again thank everyone who has been involved with getting us to this point. Really acknowledge that on the 21st we will move our first patient into the new hospital, is that the intention . Thats right, they start at 7 00 am and they anticipate being done by 2 00 pm it is such a big deal as both a city and as a Health System and Even Commission giving kheers, this is just a really wonderful moment for all of us to actually move the first patient who will get the, i hope, the penthouse suite to the new hospital is really a major accomplishment. So i would like to take a moment to thank everybody for your hard efforts and the wonderful success of this moment. Thats very nice of you. I do want to also acknowledge we have everybody from it to outfit the whole system and inaudible done an incezible job. I assume there will be cameras there . Yes, there is a media vepbtd and when we hear about the branding and marketing raifrp he will can talk a little bit about that, she has a whole plan with them as well. We had to do a couple little changes this week, we had ambulances that were practicing, there was a little bit of curb issue and this weekend they fixed that and im sure there will be Little Things that come up, any time you move into a new home or anything else theres always things they have to fix as they use them so we anticipate that and i know staff is ready to respond to those in good fashion. So well bring you an update as well from our next meeting as to how well that went down. Good luck and good sailing. Commissioner sanchez. I would just add, pertaining to the opening for patients on the 21st, this is really a unique challenge not only for our hospital, for the entire department. And i think what has impressed me the most, having been there when the other hospitals opened a number of years in the 80s is the fact that there was a whole network involved. It isnt just our core staff, rowan had to do multiple things, barbara led a whole different intervention, we have people from our different institutions, it, you name it, we were involved. It was a real, real commitment to not only the department of Public Health and the city of San Francisco, to the Health Department and sfgh will continue to be a flagship of excellence in patient care but getting involved in the funding because weve already talked about the foundation and others who have given major major dollars that no other Public Hospital in the nation has ever got. When the rubber hits the road on saturday and ongoing, weve been through some Clinical Trials and underway with reference to all these advise itds from csn, from the state, from the feds, whatever, that will continue. But we know that we have the confidence and the excellent staff and the collaboration and the network that we never had when we had the other, quote, hospital bill, we know that for a fact and i really think that were setting a whole new pattern of involvement and leadership pertaining to Public Health, county hospitals, and excellence that no one that hopefully other cities will be able to duplicate if they have the resources to generate it and more importantly to maintain it. Thats our real commitment, to sustain it and to ensure that Due Diligence and leadership is in facting there as we continue to focus on our unique needs of sf general. Well done for everybody but again it was a really unique pathway ive never seen before and ive heard many, many excellents from so many people from industry, from the community, from other academic Science Centers saying, wow, this is unbelievable. Yes it is and we as a department, and the city, its a commitment we have as a city and the leadership we had the last years to make sure that it is a flagship of excellence and it will be a flagship of excellence. Thank you. I might just note for information that the completion of the rest of our campus in terms of being able to use our new, the vacated buildings, five in all, is on the ballot for peoples consideration. Further comments . No, but in the spirit of commissioner singer who asks how we celebrate things, can we applaud the staff of the staff at the general for all their efforts and wishing them well. applause . Thank you. Item 4 is general Public Comment and i have not received any requests. Are there any at this time . All right, we can move on to item 5, which is report back from the community Public Health committee. Commissioner. I was joined by commissioner chow today on the Public Health committee. We heard two reports, one is a Technical Report in order to prepare us to present to the full commission. This was on San Francisco Health Network primary care implementation as a medical waiver or the 1115 waiver. It has two parts. First of all the waiver was implemented beginning january 2016 and we are already into may. The specifications for the waiver are dribbling out, so this is a process in which we are kind of catching up with the bus, running, and this waiver will run to 2020 and will probably be the last of the 5 year waivers that we receive. This was the prime waiver that replaced the waiver that we had for hospital integration over the last 5 years. Im just going to give you a quick outline of what we heard. Its both a funding and quality set ever mandates under prime, which is Public Hospital redesign and incentive in medical, and it also includes Global Payments and program reform. The best way to think about it is moving us through pay for performance to become an Accountable Care organization. Its money, about 200,000 that will be at risk through medical with the goal of meeting certain outpatient performance standards and the department has picked three areas in three domains they will be targeting as their primary initiative. One is the million hearts initiative, reduce hypertension and cardiovascular disease. Another is the chronic malignant Pain Management initiative and a third one is resource stewardship involving high cost of pharmaceuticals. So these are initiatives that will drive towards performance and based on how we meet them, certain medical dollars will be at risk. Theres also a second performance, thats the prime component i just described called global payment reforms. These are new rules by medical that will allow Flexible Funding for services, for example telephone visit nursing appointments and other kinds of nontraditional visits that previously we know effectively improve service but may not have been able to be billable. So these are really good things. Implementing them will be a large challenge and the department has given us an outline and will come back over the next couple years with a more detailed timeline of the plan, how many dollars are at risk and this will all be hopefully presented to the Health Commission consortium. We heard the overview of that and were just kind of getting a summary. The second core report we heard was on the Food Safety Program and is our annual review of the Environmental Health division. We had director Stephanie Christian present. The Environmental Health division, as you know, oversees everything from air quality, waste management, housing, health, sewer protection, Hazardous Waste and our allimportant food safety. They have a total of 143 inspectors which, interestingly, are highly cross trained. You can start out as a food safety inspector and get on the job training as a toxic waste inspector and then go and inspect massage parlors and its a very fluid and multitalented staff, but its one of the efficiencies and strengths of the department is that by being flex i will and moving their staff around theyve been very efficient, very nimble, and very employee friendly workplace. One of the other highlights of this position is that Environmental Health is embedded in our Population Health and Public Health department. This allows for collaboration, for example, around food safety or even massage parlor safety to link up services, for example, when we were looking for trafficking issues and some of the illegal massage parlors and making inspections. This is actually unique to our county. Not all counties have the joint units. But we got the impression that the Environmental Health unit is meeting its needs and meeting expectations and then we heard specifically on food safety. We have 35 inspectors looking at food safety, 7500 restaurants and food trucks and hot dog stands that they go and inspect a year, giving all the ratings and very High Satisfaction rates from both the community as well as the restaurants. And i think the most important thing is they go out in a multi cultural way in chinatown and then the mission and give detaileaining on how to provide safe food. And its really building capacity which goes beyond and helps with prevention rather than being strictly a licensing or permitting division, which really makes our Food Safety Program really unique. So these are two things that we lerd. I think that we inaudible do what they do and part of our annual review of Environmental Health. Thank you, commissioners, questions to commissioner pating . Seeing none, was there any Public Comment . There is no Public Comment request feir this item. Item 6 is a resolution in support of vision zero and automated Speed Enforcement. The resolution was introduced at the april 5, 2006 meeting. Thank you, commissioners for having us back. My name is ana validzic and i am with the Community Health equity and promotion branch. As you remember we gave a presentation on april 5 on the status of vision zero in general and with the specific request for the Health Commission to support a resolution for a technology called automated Speed Enforcement because this is currently not legal in the california Motor Vehicle code and we are asking for local support to urge sacramento to make a change in that law in order for us to pilot this. And your request was it strengthen the resolution because you thought this was so great, thank you so much. So i believe you got a marked copy inyour packet, i just wanted to highlight that wae made some 4 major areas of change. We added a lot of language on the more data on the general traffic injuries here in the city. We added more language on the exact problem of speeding here in San Francisco, we added more language specifically on automated Speed Enforcement, including a lot of reference to the controllers report that was issued about six months ago on automated Speed Enforcement and how effective it is, and those are all in the whereas clauses. And then we added a clause in the resolve section to address the privacy issues that some people bring up, saying that we really only support these, the data that is collected from the cameras can only be used for this purpose of this program and not for any other purpose. So that should address a number of the privacy issues. So im happy to give more detail or answer any questions if you have them. Commissioners, we have the revised resolution before us. Was there any Public Comment on this . There are no Public Comment requests on this item. So we can have discussion, further discussion, on this and or a motion for the resolution. Can i just clarify . Theres no sponsored legislation either locally or in the state at this point, this resolution would move forward to recommend to our Government Affairs for the city to sponsor legislation by the state . There are two local resolutions on record here in San Francisco. One is passed actually by the board of supervisors urging our representatives in sacramento to take this on and make that change in the Motor Vehicle code, and theres also the commissions for the San Francisco county Transportation Authority have also passed a resolution. So we have two local resolutions. We did not get a sponsor for this legislative season, but we are, the city is laying the ground work to reach out to the people, the organizations that have initiated concern this summer so that we would be able to address those and go to our policy makers, assembly man ting, assembly man chiu and whoever wins the senate race and ask them to introduce a bill in the next cycle, which that groundwork starts in the late fall. So this resolution would be in support of that effort. Thank you very much. Thank you. Commissioner singer. I just want to express appreciation for strengthening this and rewriting it and as this unfolds in the fall, keep us posted. Absolutely. Any further comments . A motion for acceptance of the resolution is in order. So moved. And is there a second . Second. Is there further discussion of the resolution . If not, all those in favor of the resolution before us, please say aye. All those opposed . The resolution has been adopted unanimously. Thank you very much for your work on this. Thank you, commissioners, item 7 is a resolution in support of the 2016 Community Health assessment. Again, this resolution was introduced it at the april 5, 2016 meeting. Thank you. Good afternoon, commissioners, my name is Michelle Kirian and im an epidemiologist with the Community Health assessment impact unit with the Population Health division. Im here today to provide a brief update on the 2016 Community Health assessment. As discussed on april 5th, the Community Health assessment was completed in collaboration with the San Francisco Health Improvement partnership and the assessment not only fulfills the Health Departments accreditation requirements but also the nonprofit hospitals irs requirements. To more fully align with the hospitals needs we changed the name of the assessment from the 2015 Community Health assessment to the 2016 Community Health Needs Assessment and this change is reflected throughout the rest of this presentation. In april, commissioner chung voiced concern another on the lack of data describing health trend in residents. While due to Data Availability and quality we were unable to provide better statistics for this population, we did add information regarding our limitations and our work to reduce those limitations in a new appendix titled using this report. To this appendix we also added language clarifying how data are presented for different racial and ethnic groups. For both the section sex and gender we referred to the respective guidelines published by the department of health for guidance. Commissioner chow noted that use of data might be complicated and how the overlap with the zip codes. Again we were not able to put both the zip codes and neighborhood data on one map and maintain readability in one report so instead we added a zip code map to the main report. Additionally in the using this report appendix we added boat the zip code map, the neighborhood map as well as two tables cross referenced between the two and a link to an online interactive map of San Franciscos geographies. Over the past month there were various errors that were corrected and while the majority of them were sifrp typographical, grammar, spelling, formating errors, im not going to present all of those. I will just mention two. Among the errors was a mislabeling error of the asian and Pacific Islanders on page 14 of the report and in the demographics section and that was corrected. We also replaced the annual amllosis and pertussis with more data. Both form a basis for the collaborationings with the nonprofit hospitals and other San Francisco Health Improvement Partnership Member organizations. An additional whereas statement was added to the resolution to better place the Community Needs Health Assessment in this context. And during the april presentation the commissioners voiced a number of thoughts and concerns for the Community Health Improvement Plan process which follows the assessment. These concerns including commissioner pings presentation to the Health Commission on how the goals and outcomes are going to change with the update and commissioner chungs concerns that diverse language needs be addressed were both passed on to the San Francisco Health Improvement Plan Partnership backbone who are working on the plan. This concludes my summary of the changes to the 2016 Community Health Needs Assessment. And i thank you for having me present today and ask if you have any questions. Is there any Public Comment . There have been no requests. Commissioners, questions . Commissioner singer. Thank you for this pretty important work because it lays the foundation for a lot of the work the rest of the department does in allocation of resources. So my question is really to director garcia. Give us a sense of how you think about using this information to inform kind of how we decide our priorities back at the department and allocation of resources and how you check to see, you know, did daily activity and urgent matters kind of take us off course from the fundamental plan of the Needs Assessment and how do we get back, give us some insight into how things operate. We really, this is a new process for us for this, particularly as we brought all the parties together and so i think this is a very comprehensive report. And we do recognize and its a longestablished where our issues of equity are and the need for equity in the department. I think as you look at the annual report you can see how weve really tried to focus in, as an example, on our black African American health initiative. So we will use this as part of our Strategic Planning for the future and nepb look at it again as it comes to be again because this, again, is a relatively new document as we move together in terms of the groups and use it as our Richter Scale and use it in terms of our promotion, but this is how were trying to look at Population Health data and its delivery. As you saw in my directors report, we hired dr. Anya bennet, we can manage our Delivery System and then influence the rest of the Delivery System as well. There document is great and provides us some real informed information particularly in the direction we need to go. Its not just the department but how we move the entire city system of care in a new direction. So i think, looking back, we can definitely use this and look at 2017 and then give you a report how well were doing. We think that would be an excellent exercise for us to do. Commissioner karshmer. Thank you for this. It is really quite comprehensive. I do think it helps conceptualize the scope of the work of the department and as you were saying next year a report, a comparison of what this shows and what that shows, but it also strikes me that this is a way that might help organize our work in the commission, that it could be sort of a check i dont have this fully formed, but the idea it could be a way for us to make sure we are addressing each of these in some way over the course of the rhythm of our year. So perhaps we can think through how this could be a road map for us in terms of looking at the work of the commission, the work of the department and the updates that they want. Just to give an example in data, if we dont have the data for a particular population, how are we going to identify their needs . So we have a tricounty Pacific Islander community that has really been concerned about not the data doesnt target its needs because we put it under the api area. To really take that and use Pacific Islander as specific requirements for us to check on our Data Information will give us a Better Health status for that population. I thought commissioner chungs information about transgender needs and, as you know, we are about ready to look at a transgender Business Plan and that kind of information to really inform the direction we are going. I think its a great idea to look at how the commission can also look at their work and im sure planning director and our secretary can really think about how we can structure that. Commissioner pating. First of all i want to thank you very much for including my comments, to me thats really the link, saying how this assessment impacts what were doing Going Forward. I think what happened is like a plan to act cycle, last years plan and based on our assessment influences next years plan. Im looking forward to when next years plans will come out and presentation how you will link those two. I want to thank you for including. My second question or comment is when is that plan going to happen, when should we xegt, now that youve been through the assessment when will you come up with what the next steps will be . Thats actually what i think the commission is following is implementation of the plan, not necessarily assessment, although assessment is an important part of it. Im not actually on the group working on the plan but i do know they are actively working on it now with a due date around the milds middle of this year. Okay, great. With regard to assessment the data is so valuable not only to the commissioners and the department but i actually think it has such public relevance as we try to build Community Collaborative that it would be wonderful, maybe not this year but next year to get this data realtime and on the web where people can go, see it in there and have a solution and the data gets them there, that would be really wonderful. I dont know what the cost of that would be, but that would be realtime web based date ta reflecting the complexity and the thoroughness done in that assessment report. As i told you, i keep a copy by my bedside and literally i delve into it every night, which part of the city has trees and which part of the city has no stoplights, i should avoid those corners, its all there. I didnt know salmonella, i learned how to correctly spell it as well. I do believe its also in pdf format. Yes. You could actually read it through your i pad. Okay. Before we go further, i did want to followup on the question on the Community Health Improvement Plan because i believe thats also what commissioner karshmer was asking about. I think does anyone, can anyone today tell us what the time frame is because it says here on your last presentation, next was going to be, and i appreciate that you put in the Community Health Improvement Plan within our whereas, it says. This is the assessment and then were going to have our proven plan. Im just trying to get a time frame so we can be sure we arent going to lose track. Colleen cappa as michelle stated the summary there is the plans deadline. As you might remember, the Community Health Needs Assessment or Community Health assessment is really the compilation of many efforts. As dr. Pating said, the foundation of a lot of work thats being done not just in the Health Department but across the county. So this Needs Assessment is really the foundation for hospital and Community Benefits plan and the Community Health Improvement Plan will inform the community plan, it will also inform the Strategic Plan for the Population Health division, as well as the Health Care Services master plan. So were all working from the same foundation of data to make the same conclusions to move toward health citywide. Youre saying by the end of the summer. Thats the expectation. Its being moved largely through the San Francisco health inaudible . Commissioner sanchez. I would just say this is, its an exceptional comprehensive report. The first time we have a comprehensive base line to look at the parameters and the subsets, as you reported here, outcomes, findings, et cetera, limitations, all the challenges coming up. Its really an exceptional document and it keeps Getting Better and better for the documents our department is producing. Astounding. Could be published. A motion is in order. So moved. And is there a second . Further discussion . If not we are prepared for the vote. All those in favor of the resolution for supporting the Community Health Needs Assessment report please say aye. All those opposed . It has been adopted unanimously, thank you. Thank you, commissioners. Item 8 is the San Francisco Health Network update and just to note there is no action on this item, this is just a presentation. Please silence all phones in the audience. Good afternoon, xhirs, roland pickens, director of the San Francisco Health Network. It is my pleasure to share with you an update on the network and in todays presentation well focus on providing you first an update on the development of the Strategic Plan for the network. Next, a description of our youth of a toyota Production System lean Management System in developing and monitoring and reporting on the status of our Strategic Plan, and then finally to provide to you an update on the development and implementation of a strategic outreach and communication activities of the network and that presentation will be done jointly by rachel kagen and patty verbiglia who has joined us in the last year as a mayors fellow, recruited to bring us her expertise in the area of marketing and communications. You will recall that when i last presented to you in october we had just completed a twoday strategic visioning session in september. That session lay the groundwork for the development of the Strategic Plan that were going to review today. During that twoday strategic visioning session we developed consensus on our vision, mission and true north for the network. Armed with the mission, vision and true north we were ready to use the tools to guide development of our Strategic Plan. In march we did that, facilitated by consultants greg cruz and vera romy, who you met at your last planning says, they helped facilitate what you see in this picture which is one of many Breakout Sessions in march of this year during a twoday process of Strategic Planning, also known as ocean connery. We discussed what it means and what it would take for us to meet our mission, vision and true north. So in sum the product of our two day strategic visioning session, followed by our twoday Strategic Planning session, is summarized in the document you see before you known as an x matrix. The x matrix is designed to provide a visual description of our high level Strategic Initiative, including our mission and vision, and our accountability mechanism anticipated outcomes and how it all ties to our true north. Our current version of the x matrix is still in draft but approaching final format as it will continue to be refined throughout the month of may in what is referred to as a3 clinic, in lean terminology. Well talk more about the a3 clinic in a minute. Id like to spend a few moments just reorienting you to the x matrix document. First, on the far left are 6 true north, which weve previously presented, which are safety, quality, work force, care experience, equity and financial stewardship, represent what we blaefrb to be the longterm goals of the network. As i mentioned this visual was previously shared with the commission and when you look at the box for each one of those, it provides more detail of what each of these true north means at the Network Level. For example, safety, the goal is to eliminate harm in all forms to both patients and staff. The next portion of x mate trex is the Strategic Initiative portion. That session that i mentioned was a process where we looked at all the various initiatives throughout the network and there were almost a hundred different activities that were being worked on across the divisions of the network. Going through the lean process, we narrowed that almost hundred list of projects down to initially 8 but really 9 Strategic Initiatives that you see presented and they are presented in rank order. No. 1, titled right information every time, everywhere, that was originally entitled implemented network wide ehr, but through our iterative process the group determined a better title was right information every time, everywhere. The top left corner depicts how these measures align with our true north measure. Green in the color indicates a high coloration, yellow a moderate correlation, and white either very little or no correlation. The performance measure section of the x matrix obviously will provide information on how we are doing meeting our initiatives. As background these were developed and first recommended in our twoday session and as we are going through the a3 two day process, we started in april and will end and will end in may. And the key leader section reflects those who are important in achieving these key initiatives. Its important to note we formerly formed five a3 teams for the first five priority rate projects because thats where we will be focusing our efforts over the next year, on the first five of those nine. The next section. X matrix is the true north outcomes. Typically in a health care Delivery System, the organizations x matrixes have financial and other operational metrics for the outcomes and weve identified some of those in our network. However since, as you know, our network encompasses a wide range of Clinical Services, everything from outpatient to inpatient, acute rehab, home health, Mental Health Substance Abuse, it was important that we identify measures at the Network Level that offered the greatest amount of flexibility across this wide range of Clinical Services so as to account for the fact that a metric chosen for one type of care Delivery System wouldnt necessarily apply to another. So, for example, in the Skilled Nursing facility arena, hospital tracked pressure ulcers is a great metric and is being used there, but obviously that wouldnt apply, necessarily, in an outpatient Substance Abuse center. So again weve therefore gone to electing to use a composite of the true north from all the various divisions of the network. The network goal is to have 70 percent of our divisions meet their true north goals. For example, if we have 10 total metrics for safety, our goal is for 7 out of the 10 metrics to be met. Again, this allows divisions to select the metrics that are relevant to them and their specific clinical offering. The use of a Network Level composite allows for alignment across all our divisions by setting up minimum standard metric to which each division is expected to achieve. Its important to note the only metric that is not a composite roll up is the financial stewardship metric in true north, which, in consultation with greg wagner and jenny lue we decided to express as less reliance on the general fund. Since the march session the development of the a3s for each of these initiatives has been happening throughout the department. This a3 development represents a significant contribution of work from the leaders of the network and across the network to really build consensus around the improvement activities that will be necessary for each of the Strategic Initiatives by defining the target and milestones and establishing accountability mechanisms. And finally, this slide shows lean work is happening across the network and at different levels. Some division are further in their laepb journey than others, but they are all coming on board. We know sfhg was an early entrant and honda has also initiated lean methodology. We implement, develop and monitor our Strategic Plan. That concludes my part of the presentation and i defer to you if youd like to ask questions or make comments on my part before going on to the Outreach Communications part or go forward. Commissioners, any questions at this point . No, then we will. The first thing id like to do is say congratulations to you for the move to the new hospital. You were thrust into additional responsibilities in the milds of the project, it was late and you got us back on track and i think were all super appreciative. Group effort. Thank you. Yes, but you would have been in front of us if you hadnt met it so we should give you the credit. So i want to ask you some questions that have more to do with outcomes than process. And i realize that youve described in detail how were doing on many processes so that we get the outcomes we desire, and thats kind of a precondition to do that, but i also think its worth sort of touching on a couple of those. So i guess the first is what is the Key Performance metrics of the network that you are obsessed by . I know you have hundreds of them and you look at them carefully, but what are the ones that you kind of use in your head as, okay, this tells me how were doing. Obviously the most readily available ones are the financial ones. Are we meeting our budget, are we performing within budget and if not is that appropriate . If we have an issue with fuller costs to network it may be appropriate that we are out of budget in terms of lower level of care placements. So finances is one important measure i monitor. The other is appropriate measure of care, how many patients particularly at laguna and as csfg how does that impact level of care. I know were talking a lot about the details of that. My next question was managed care is 14 percent instead of 153,000 or so of the patients in the network. Is that number going to increase, that percentage going to increase and whats 14 percent of the 156, is that going to increase and what implications does that have . The expectation is certainly that it will increase. The question becomes by how much more. I think were over the hump in terms of the medical expansion adding new members to our network. Well continue to see, i think, some more of that particularly as we come to conclusion on the covered california contract that will again allow us to have a few additional patients but again we expect most of those to be going back and forth between covered california and medical. The expectation is that it will increase but, frankly, weve already gt a little over a hundred thousand patients within our network and in terms of our current capacity we dont have capacity to really add a whole lot of additional ones. So i think our goal really is to make sure were optimizing access to the patients that we currently have already in our system, including the ones that are assigned to us and have still not yet even come in to receive care. But we can only expect capitation to grow, thats the real purpose of prime to expect us to survive with alternative methods of payment with capitation being the backbone of that. Do you expect 20 percent in 5 years or 50 percent, what should be our expectation . I would say probably 20 percent, i would say, would be the most we might expect. Again, we are staying true to our core mission of being that underserved medical managed care provider, thats our bread and butter. But were also exploring ventures into targeted commercial contracts that make sense for our capacity and for the stability of our Trauma Center. So we have to balance all those things as we look forward to our future plans. And you said in your discussion that your goal was to reduce the amount of money from the general fund. And im curious by how much by when is your goal. So we one of our 9 initiatives is financial stewardship and were actually developing those goals right now. So greg wagner is the team leader for that one, that group is actually meeting now to set what the ending of the general funds would look like. By the end of this month we will have a more final document with goals and targets identified. Just to level that, what is the draw from the general fund for the Network Today . Ill have to let greg. Commissioners, greg wagner, chief financial officer. I dont have the exact figure off the top of my head, but its around 550, 575 million dollars. So we have our Public Health general fund is a portion of it, the bulk of it is in the network and i can give you the exact figure as soon as i go to a file. Also in response to your earlier question, the targets and what were doing for our true north and our response to it is one of the things well be talking about at the retreat, the Planning Session we have scheduled this fall. Were trying to develop the strategy and the goals and then tie that into both our lean process and the citys 5 year Financial Plan so thats one of the things that well be looking at is some of the variables and some of the options for how we bend that cost curve and what realistic targets are over 5 years. Thank you. Would you like to proceed, then, with the remaining. Going the wrong way . There we go. Hello, thank you, rowan, thank you very much for this opportunity. My name is rachel cagen, director of communications at the Health Department. Id like to present my copresentor, patty verbiglia she comes to us with a wealth in expertise in marketing, in change management and in working with organizations on strategy internally how to create capabilities for organizations so they can meet their strategic and business goals. Shes going to give the bulk of the presentation because shes really been leading us in this work and already dived in and is doing a fantastic job, but i did want to start with a bit of a vocabulary item. As you can see were calling this the Patient Communications update. Previously you had asked for marketing update and branding update and certainly those activities are within Patient Communications, but we have learned as we have delved into our organization to see what our capabilities are that this is a patient communication function and we need to build so we are talk to go patients we currently have, in reach, as well as outreach it attract new patients. A lot of this work has to do with looking at our own systems and how our staff understands the network and how our staff speaks with patients so its broader than sort of a narrower marketdriven marketing branding project so we have named it to reflect that. Before we talk about what were doing now and where we are going i wanted to remind you of some of where weve been and our short history in Patient Communications. The hma engagement ended in the spring of 2014 and reinforced our decision or codified our decision as an organization to create a Health Network with our care Delivery System to meet the challenges and demands of the Affordable Care act. So as you know we did that and in july of 2014 we had our internal launch of the Health Network and that was the first time we really had a coordinated effort across our entire care system to inform our staff what the Health Network is and to embrace some of the early branding efforts that we had developed at that time. So thats when you saw things like the bridge come into shape and the tag line, the development of our newsletter, business cards and templates to start to look like the Health Network and to name ourselves that. We also have an internal news letter called the bridge and have launched a web site for the Health Network. Those are significant steps that we took before we launched further into the outwardlooking patient dmupxes and branding and Marketing Efforts that we are now undertaking. In the fall of 2015 we had great incentive to work very specifically on the hospital branding effort. That was, a lot of that had to do with timing, the hospital ribbon coming in november, the gift we received from the zuckerbergs which created the need for the name change and created expectations for the gift to do branding work for the new hospital for the new name. Were so fortunate that we had that opportunity because that really allowed us to get into a professional branding exercise that we had never done before and doing it for the hospital was our first necessity and now we look forward to taking that same effort and expanding it into the network and we are looking always, even in the hospital branding, how it relates to the network. We hadnt had that opportunity before, the zuckerberg opportunity. Our approach is threefold in this effort. The first is really that need we have as an organization to develop a longterm plan for our strategy around Patient Communications and marketing. However, we didnt want to only be planning in the abstract and so our second element of our approach is to be doing some very specific projects now, case studies or pilots, if you will, both it get work done now and to make use of this great opportunity we have with our mayors fellow so our planning is based on some experience we have on what works and what doesnt and we have chosen our specific projects you will be hearing about very carefully, both as projects that are doable but also projects that help us with our business or Service Goals and may be scalable into templates as we move on to do other projects in the future. The third element has to do with Patient Research and branding and im sorry commissioner chung isnt here today because i know shes quite interested in this area. We havent started the formal brand definition and branding work yet. We do plan to issue an rfp very san to bring in consultants to help us with that work and do it at the same professional level we were able to do with the hospital, but we do see that as an essential third piece of the endeavor. Just to sort of bring it all together our priorities, as i said, are to introduce it, build the blaef both internally and externally in what were doing and who we are, to begin our ongoing Patient Communications to retain and attract patients. There are many, many examples of Patient Communications in our organization now but there is really no one patient communication sort of program or a standard way that we do it and we also have never had to or had the experience of doing it with the goal of retaining or attracting patients or it meet business goals. So thats new for us so were developing that as well. Related to that we want to make sure our patients know what the services are they have available to them in the network and how to use them. We have learned in our Patient Research weve been doing m patients dont know they are in a network, which is understandable rblt i dont think weve really told them and its a new phenomenon. What happens is people use the network socalled wrong, in quotes. For example going to an emergency room thats not zuckerberg general so its out of network. But the patients havent been told that and it hasnt been part of our practice in terms of how to identify with them. We want to fill that in terms of patient behave or but also more importantly that patients know what the services are that are part of this network and that they have access to. In order to do those first three things, we need to build capabilities in our organization which we havent had before. Im not going to go over all of those but highlight the Brand Strategy and messaging, which is we know is he essential. Without doing that we will not have successful Patient Communications because thats what people relay on to hear from organizations. In just a moment ill turn it over to patty to give more information about our projects as well as our longer term and Strategic Planning but i wanted first to outline what the projects are so you have a feel of whats to come. The first project thats already been touched on several times in this meeting is the opening of zuckerberg San Francisco General Hospital, which will happen on saturday. This is a great opportunity to raise the flexibility of the hospital and of the network it assure patients that this hospital is for them and that if you are a network patient, this is your hospital and to make use of both the resources and experience that we have available to us in the hospital branding and marketing that weve never had before, so using that opportunity to promote the hospital but also to enhance our Patient Communications for the network. Related to that were laufrpbling launching the new Family Birth Center at the hospital. This is such a great project to be working on for several reasons. Its the First Service line we have ever really promoted or marketed. We havent done that before. We know and anyone in the business knows that births are business that you want and we also know theres a lot of daufrp tition for them so if we are going to continue to success in our fantastic birthing service that we provide, we need to engage in marketing that service. It is also a service line that is stellar, probably the best in the state, best in the city, anyone would want to advertise it, anyone would want to be able to back it up so its a great first one to start with to really provide quality care and the information about that to our patients. And finally its an Excellent Way to bind and unify the hospital and the network because of course birthing starts in the prenatal setting, pie marry care. Primary care. As a Pilot Project its one that has everything you would want and we hope to learn a lot from it and move on to other service line promotion in the future. The third project is the chinatown service line project which is a primary care project. We know right now when patients enroll with us through the San Francisco health plan in this case to chinatown Public Health center, they dont hear from us again. Its up to them to reach out. That is not a way to retain or attract patients as far as we can tell. We have many patients that have enrolled but not been seen by us. Chinatown is our first study to see if we can create and then refine Patient Communications tools that will be effective. Thats sort of the overview of where we are now and id like to ask patty to come up and talk about these projects and our larger strategic picture and well be happy to take any questions that you have. Im a little shorter. Thanks, racher, thanks, barbara, roland, ellis, ive been working here about 7 months now and its an amazing introduction to Public Health in the bay area. Ive lived here 20 years, ive just not been introduced to the amazing work this team does. One thing we are starting, well be sending it out next year, is a welcome mailer to over 90,000 members in the city, those are our members, to let them know the hospital is open, the hospital is for you. Continue to go to primary care when you need it but when you need Emergency Care or specialty services, this is your hospital. We realized this was important for a couple reasons. One is that a lot of our Network Members didnt realize they were Network Members or this is their hospital so were just reinforcing that. Secondly, when people saw the new hospital there was some concern that it was fancy or private and not for them. So we really wanted to reinforce the message that this is your hospital. So that will be the first mailing that weve done out to all of our members. Excited about it. The other thing you will start to see in the coming weeks is advertising in media quluing press around the city. So youll see outdoor ads and this is just one example, this is a 95yearold patient from chinatown Public Health, cancer survivor, recovering hip replacement patient, so were the focus of this campaign is called bredth of care. San francisco general is very well respected and known for trauma and were trying to expand that reputation into p other services. What you will see are providers and patients from different areas focused on birth, hiv care and eldercare, helping to change the perception of the hospital to the full bredth of services that we offer. Next sunday make sure you grab the chronicle, there will abdomen 24 page tab insert, lots of different stories including an ad for the network so connecting again the network and the hospital, they belong together. Thats the first attempt were making at connecting that for people in the city. A lot of these ads will be in language, they will be in chinese, they will be in spanish, bus shelters and busses are placed strategickally in naipbds where our patients live. If you are spending a lot of time in certain neighborhoods you may not see them, but come to the mission, come to the excelsior, thats where were concentrating our efforts. Of course the media will be in full force on saturday so we have a lot of media stories coming. Finally were updating the web site, over the next few months you will see continued updates to the web site to transform the Patient Experience and transform it from less of General Information to more of a tool for our patients to use. The way were measuring the efforts of the hospital opening is looking at the awareness of the hospital among San Francisco residents. Were working with a Health Care Research firm called nrc who does Perception Research ongoing throughout the year so well be able to measure how well we are doing in improving awareness and perception around the general. Related but separate is the launching the new Family Birth Center which rachel talked about. One of the reasons we selected this as a pilot was we had some drops in birth at the hospital and this was a challenge to the department and we saw we were not getting the patients from the net board of corrections. Our own patients were going elsewhere to give birth. We wanted to upbltd what was happening there because we know our hospital is second to none in the city in terpls ters of quality of maternity and birth care. So we did a number of focus groups with moms and people who gave birth to us, people who gave birth with us, how they choose a birth center. Right now were accumulating the stories and brochures, video, it will object social media but really the outreach is the most important for us on the birth center. So were working with Health Network clinics as well as consortium clinics to make sure we are prointroducing the birth center. We have this time to go say our birth center is brand new, as gorgeous as any of the city, and the quality of our care is second to none. Another thing i mentioned up there was patient tours, which is very important. For women going elsewhere the experience of touring and getting comfortable with their facility is important to them. We have a patient coordinator who will be leading tours through all the different clinics Going Forward. The way were measuring that is the fupler of burgts throughout the hospital and will also be looking at the number of clinicians that was able to train and operate within the birth center. We worked closely with the primary care team, even the Call Center Team was involved talking about what will it take to get patients who are enrolled if here for their first appointment. We are launching a pilot this month using dregt mail as well as phone followup from the clinic and well be looking to real estate dues the number of enrolled but not yet seen patients and also increase the number in that population who call for their first appointment. Thats really the outcome were looking for. So i wanted to share those 3 projects with you before we went into the overall plan because i wanted to stress the approach that were taking, which is learning by doing. It seemed like when i came in to spend the bulk of my time here strategizing without really getting into the system and understanding how it works. We might not get the result we wanted at the end of the year. So we had this great opportunity with the timing of the hospital to jump in and start to figure out how this could work. Now ill back up our mission is not changing. Were here to provide High Quality Health Care for all San Francisco residents. But what were thinking about in the changing landscape is what will it take for people to choose us and stay with us throughout their lives. With the Affordable Care act people have more choice than ever before. We are serving a lot proportion of medicare patients. It was an incredibly large population. We have more than 40 percent of the share of those managed care members either being served through our primary care clinics or at consortium clinics so thats the difference between the 67,000 number and the 93,000 number, but the 93,000 number are also assigned to San Francisco general for Specialty Care and Emergency Care. So to better serve our patients in the future were going to expand beyond medical. From a business perspective what were thinking about is maintaining share, converting people to medical or covered california when possible, working to get contracts so we can add covered california members. That number on covered california doesnt seem so large, 35,000, but when you understand the situation that theres this flux or this churn where people move in and out of jobs throughout their lives and they go from covered california to medical, back and forth, in order to keep them through their lives as patients and have continuity of care you need to have coverage in both places. So thats why were working to get contracts in place and then expand contracts with the city or cph and others. So when we look at the Health Care Landscape today, we have had an influx of patients through the medicaid expansion. So our enrollments are up. Our uninsured patient days in the last 2 1 2 years at the hospital from declined from 30 to 7 percent, which is wonderful. What it also tells us is that a lot of our patients now have insurance and they have more choice. So when we were doing a great job, we have patient advisories up at all the clinics, we have them at the hospitals, the pie marry care team and the hospital have really improved our listening. When we listen we learn a lot and what were learning is that patient expectations are rising dramatickally. So i included a quote from a patient to point out in the past we might think underserved individuals are not online and they are not digital. We might have also thought that our older patients were not online and not digital and neither of those are true. We have a curry patient saying its about time they try this, with texting. People want to be connected a lot with their provider and with their health care. Given all that, we want to talk a lilgt little about our strategy. Any questions so far . Should i pause . We are starting with one premise, which is navigating health care is one of the most confusing things any of us have to do. Regardless of what our Health Care Coverage is, when we realize we are sick or our daughter is sick, we want to take better care of ourselves, we go into a series of questions where do i go, do i ask my mother, is it on google, what was that billboard i saw, is there a place in my neighborhood and then more questions from there. If you look at our Patient Population they are grappling with two or three jobs, they are grappling with language, how urgent is it, do i have to go today . Which job do i have to juggle to go, how do i get there, is there going to be a bill . This is some of the angst our patients good go through every day when they are sick or healthy. Our job is to bring patients into the San Francisco Health Network. We blaefrb our opportunity is to help patients navigate health care with easy. That may seem simplistic. I think it would be an enormous win for our system in terms of helping patients in our population navigate with ease, it is far easier said than done. But when we can accomplish that we will create a healthier San Francisco by ensuring people get regular preventative care. That will mean people know they can understand and access the Services Available to them at our hospitals and clinics. They are going to the right place, we are listening to them and responding to their needs and ultimately what all of us in the system want is that patients become engaged and involved in improving their own health. We believe when we can help our patients navigate health care that we will become the provider of choice. We all believe and know that our dare quality care quality is very high but theres a disconnect right now between the quality of our care and the quality of our communications in how were helping our patients navigate the system. If we can get those closer to the, we actually believe the per perception of our care system will rise with it. I will share a couple challenges with you. Almost no one, including our own teams, wae dont know what what the San Francisco network is. Its a competitive noisy market. Nearly everyone points out to me that nearly 50 percent of the advertising you see is from the health care market. But that presents an opportunity we feel strongly about. This brand is ours to invent right now and we feel we can create a very compelling story for both our internal and external audiences. We are focused on San Francisco like no one else. We are in your enable, we are in language, we are champions for our patients wherever they are in their life so this is a great opportunity for us to differentiate in this market. So when i come into a situation, sort of try to assess i come from a marketing background but as we said i think the challenge here is communications. The early questions are always what should we do, a brochure or is it a web site, how digital is it . But the way i like to think about it, what is it that we as an Organization Need to accomplish . So in my early meetings as i was getting out and meeting all the great people in the network i was having a lot of conversations with people about the different silos. Oh, i work on the web site, im in primary care marketing, i work at the birth center, were working on the ambulatory care call center. As you know theres great advances being made in each of these places, whether it be around the nurse hotline capacity, everyone is moving forward with great progress in this system. The challenge is because were still communicating in silos it doesnt make a lot of sense to our patients. So whats important from my perspective is that we find new members and we help them find us, that we enroll them into our system and we then serve people throughout their lives. I think once you have that system and framework in mind then wook talk about the programs. A lot of what i showed you earlier around the hospital advertising and changing perception of the hospital is really about reinventing how we think about Public Health so its a system we would choose, not a system of last resort. When people go to the health plan to enroll, this is medical patients, not the population of the city, approximately 20 percent choose us. I think we could do much better than than. Second is moving people from enrolling to serving and we talked a little bit about that already with chinatown. Once they are enrolled we dont proactively communicate to introduce them in, so that leaves us with over 10,000 patients in the system who are enrolled but not yet seen. Were going to need to see those patients, bring them in, when you do see patients its clearly documented they are less likely to leave. So you are more likely to retain patients who you have built a relationship with. In the serve for their lives, we have limited Patient Communications about Available Services and the connection between clinics and hospitals. Again, the birth center is a pilot in this area. When our patients go elsewhere for services such as emergency, birthing, eldercare, when they go elsewhere for one service we often lose them from our system. So we dont just lose the delivery of the baby, we lose the mother care, we laz the baby care. This will give you a first draft at our goals. I know we talked a little bit about metrics earlier. A couple that are important to us are maintaining the number of managed care members and primary care patients, decreasing attrition and appropriate use of Hospital Services for key services. I will close on reiterating the priorities of the foundation. Thank you. Any questions . Thank you. Commissioners, questions . Commissioner singer. Thanks, super helpful and super impressive. Weve come a long way since this idea of the network kicked off and were beginning it kind of engage and that feels good. So congratulations on all that. It would be great to see page 32 again with actually in the future with actual numbers to measure these things by. Absolutely, yeah. I dont know if you have them or not but what do you mean when you say this and how do we figure out what were doing . The second thing i think, and weve talked about it a lot at the zsfg sorry, you guys know what im talking about the zsfg we often assert how good we are in quality of care but our metrics are ambiguous. And i think, i mean theres a lot of attention to that, theres increasing selfrealization that that is a fact, there are a lot of people who are crazy focused on getting the metrics back where we assess ourselves wanting to be, which is great, but i give you a little bit of caution in asserting that too strongly in a world where people are going to increasingly ask, what do you mean we have high quality care . What do you mean about readmission rates, what do you mean be about h cap scores, how do we compare . The work started but i think we got to be a little careful right now with that assertion. The second thing i was going to say is that we have a huge we have two huge advantages. One is that as a system compared to most other counties and municipalities and cities and such we are actually organized in a totally rational way. Its all in one department with the ability to really be thoughtful about that. The second huge advantage we have is that San Francisco to date is ground zero for people trying to think of new ways to engage patients, to change behavior in the Health Care System at large. So theres an enormous soup of creativity here. Some of the ideas seem great and will be terrible and some of the ideas seem to be bizarre and will turn out to be genius. So i encourage you it tap into whats going on here because youre beginning to behave like other actors in the health care ecosystem. I hope your mobile site will have the ability to have someone look at it in a language they understand because the current site doesnt have that. I know the mailings are starting that way. Theres a lot of learnings going about this. To me its exciting that were here and we can tank advantage of that. Thank you. Commissioner karshmer. I think this is terrific. When you look at the timeline and its been two years, its a lot of moving forward in two years, so kudos to everybody involved in that work and really it doesnt just network, whats a network . Actually i understand why you did some of the things you did, the internal communication and then the external communication. And there are some things that i resonate with about dealing with the members, the folks who are our patients, differently and giving them for credit for what theyre looking for. This beautiful new hospital and to leverage that into this opportunity that this is an attractive way to seek health care in this very crowded space i think is very important. I do think that just as you think in terms of these metrics, you used the example of perception and awareness of being run one of your key measures, which is okay, but you also have tied directly to one of the priorities which is right place right time which would be the natural metric for that particular initiative they are doing. Its not just the awareness, did the awareness sink into the people that they chose the right so i would urge you to make sure its more than just awareness as you do this. I also think its great that you are doing things as you are Going Forward because you will learn, oops, that wasnt a very good idea. And the less mushy that one is, for instance, roland has to have that for his true north so those are all linked together. Thank you. Commissioner pating. I just want to thank you both for a wonderful presentation. What i really liked a lot about your presentation is that you have placed the patient at the center of all the communication, which is so important as a brand, not only your communication but how we really want to shape our whole Health System. So i really want to thank you for correcting us because we asked you for a branding plan and you gave us a patientcentered communication plan. I think thats a very significant shift. I also want to ask that you would followup with parts of this later on with the commission at the Population Health committee. I think this affects the communication and the patientcentered care affects who we serve and then what services we provide which will impact a lot of areas of the network. I think under the community Population Health it would be nice to look at how they intersect, not just a plan but the issue of providing services to meet the expectation of this patientcentered aproef. Thats just fwo rr wishes. But then i want to make 4 comments if i could. Page 22, the mission, i visited part of the work group that came up with the Mission Provide High Quality Health Care that allows all San Franciscoans to live vibrant quality lives. I want to call out the word vibrant, i think its a special word not found anywhere in our documents but i think its a special word that calls out the affect of our Health Care System. Have a lack at that word and see what spins out of it because i think theres potential uses. Not every Health System is vibrant and not every Health System achieves or wants to aspire to that. I think thats a special word in terms of branding. My next comment, sorry about this, is no. 24, page 24. So key to being vibrant is knowing what services you are going to provide and who you are providing them to and these four sirb 4 circles for me are your key mission. Once you noi who you are treating then you can provide services well and in a vibrant way. I think this particular diagram needs a lot of work. I have been asking for really the last year now who is the Health Networks key client, what is the vision of what they look like and what services do wae want to provide. I think were still stuck in the problem. This is not anyones fault but i think we need to think about it more. We are still providing on the one hand capitated care, thats the model, medicare, Affordable Care, id like to see how you move between the various circles with capitation but where does the safety net fit in and provide this capitated model, they Seek Services in different ways as we know and as we are learning. I think it relates to some of the questions mr. Singer is asking about. How much of this will be capitated and how much will be safety net because a really relates to what we do. As best i can gather were probably going to be at a 5050 mark, were going to be half capitated, how does that affect the brand name and service delivery. Does that make sense at all . This diagram is fine for now but in the future as we move forward with the business strategy, how are you going to get from the 152 to adding hlty San Francisco and adding covered care. Lets start here and figure out where we go. Sorry about this next comment. Page 37, this is in the appendix, you didnt show us this, but theres a lot of meat here that i think many of the commissioners would be very interested in. You went through a whole process, i dont know how many days you did this slot analysis but im looking at several weeks or month of work you must have done to come up with this slot, strengths, weaknesses, as a commissioner i would really like to understand this because this would help me to be close to the work you are doing and the whole work at the Health Network to understand in detail the slots and so i would be interested in hearing more on this at the population Health Commission subcommittee but im wondering whether it would be worthwhile spending a little time on this at a later point. This is not just the brand name khal challenges, i dont think weve seen it as clearly laid out and this is a good place to be able to support the work you are doing. I want to commend the work you are doing and call it out. This is a lilt long, this is my last comment. Page 41. Youll go into this and see actually why dont you go to 40 first. You have learnings from other Health Systems. So you have ole health, Cambridge Health alliance, kaiser permanente, then you have us, San Francisco Health Network. I still think we might need to look at our name and what is a network and how does a network relate to my care . I understand its a collection of clinics kind of brought together but im wondering whether theres again one way we can capture the vie braepbs of the name of our system. I dont know what i want to submit, maybe we find a big donor who has a big name and put the name on our network for the right billion dollars maybe that would be worthwhile and we would capture that as the vibrant network of our name. But i think one of the issues is how to sell the network as a basic network and the concept of it and getting past it. I mean the zuc is the zuc, its the general. You know where it is now and getting that Brand Recognition for the Health Network, how it differs from the Health Department or the San Francisco zoo or the San Francisco department of transportation. Its kind of in there as whats unique about the Health Network and id like to call it the garcia network or Something Like that, or the Garcia Health plan in honor of our. I challenge that a little bit. You know, kaiser . Yeah, i know. We dropped the permanente. I get you on that one. Thank you, thats excellent feedback. Those are my comments, wonderful, wonderful job. Thank you for really guiding us and putting patients first because thats a message that i think we want to send out in all directions, the most vibrant Health Network in the city. Thank you. Thats coming from dr. Pating, we wont tell your employer. I also want to commend your report. When dr. Pating was asking in terms of more detail, certainly the committee that should work with you in terms of areas that you would like to explore a little further, in further depth. We can get that agenda. As we also have regular reports back from the San Francisco Health Network which gives us the overview and then we can select, as you have today, certain areas that you would like to also be able to go further into and remembering also what commissioner singer had proposed, that there be more detail on what might be the criteria for success that are in some of the objectives that you have. Id like to point out, though, i think that commissioner singer really pointed out a very unique aspect of the city here and also our mix of population that could in fact perhaps go and not necessarily might not even need funding, i suppose with all the innovation going on here, weve got a population which i just added up, probably half of which have a different language than english. And be this has been a real challenge trying to get this information that you are talking about being patientcentered and being able to even access through the webs or patient opportunities for conversing back to their providers because of language. And thats been one of the big problems already with patient interaction with the hrs, for example. And i think you have a wonderful opportunity here to really experience how we can actually answer that need and that the city probably could well be that vehicle, that experiment, that really is able to do it. And there are people out there who may well be available and perhaps some sort of an interaction between what we need and what is available in terms of thinking because once that happens and you are able to actually have multiple languages that are accessible, this is something almost everybody is looking for and nobody really has that, that i am aware of. And i think that is really a great opportunity. Also i recall part of the grant from the zuckerbergs was it look at how to strengthen our branding, if you want to call it, or even our outreach into this and that might be another area where you might work with the foundation is to see if some of these new different ideas really could help, that certainly everything you have in here has to be done. But here is really a great opportunity and it could be, you know, a new app today that really all of a sudden starts opening up avenues for patient care that we cant do today for those who are nonenglish speaking. Nonenglish speaking and in a safety net relationship, which is certainly a very major need. I think the other area that i would ask is that as you are looking at the types of population that you are looking to want to bring in, that i dont think we should ignore the medicare pop place. Its a senior, a growing senior population. We have a wonderful facility to be able to take care of these people. We have a highly trained staff and there isnt a reason be why we shouldnt also have that as part of our now, i understand that part of the Medicaid Managed Care might well include medicare, but that is a separate segment of the population really because what does medical managed care is i think that youve listed is that area that at the moment does not include the due eligibles but as you age and the due eligibles become medicare principlely, it becomes another segment we should be concentrating on, may even become more important than commercial because a lot of our commercial is tied up with Large Companies or already Group Contracts and all. We could become a provider but your opportunity at being the primary care for a medicare recipient i think is even higher. But those are just some ideas. Thank you. A wonderful presentation. Commissioners, are there any other comments . Yes. Commissioner sanchez. I dont want to, i think everything said i think is really right on, but i would underline again youve done an exceptional job and really presenting before us the number of whats been done, more importantly, some of the challenges coming up. Just one little footnote i want to add because it was discussed again, quote, the safety net. The department of Public Health and sfgh have always been the first to respond to any emergency, especially in latin america whrx it be the earthquake, whether it be the earthquake in nacaragua, now we have the destruction of hospitals in brazil and argentina. Sfgh has been some of the prime movers in having professionals come and train here, in diabetes, orthopedics, you name it, the whole gamut. Theres a network here that is still ongoing including a cohort of latino physicians who are here but cannot practice because of the number of restrictions but more importantly because they are still involved in many of the things affecting latin america today. And maybe some of you have read the tragedy going on in venezuela particularly because thats the latest on the radar i can think of at least four postdocs who trained to go back, sister city, had resources, training grants, whatever, and to see whats going on today is just a tragedy. But we wont forget that San Francisco general is an important city and weve always had communication and links that sfgh has always listened to and i hope will continue to listen to as either we step up and Work Together with some of the different organizations as needs come in, but it affects also patients and one of the highlights i really enjoyed in your presentation was we listen. It isnt just, quote, the undocumented, per se, its human beings families that have always used the general and many of the outstanding clinicians, nurses, staff, because they were able to understand, they were able to provide the quality of service and work with different agencies and institutions. Thats part of our challenge also to market. I cant think of anything more important than having a couple of our venezuelan ball players talk about the importance of this hospital, what it was in the past an what it continues to be, as we continue it provide the highest quality of care for those who have come here and want services. Its something that has been constant for over a hundred years. That is part of the challenge rs thats part of the safety net and hopefully we will continue to step up, i know barbara as director of Public Health has worked with a number of resources in our latino population. What im saying to where there will no longer be any Health Services within central and south america in so many of these places where we have had, as i said, a continuum of training and postdocs and docs, nurses, train here and then go back. Now they are in great crisis and they are asking, will be asking for additional help. Thats it. Thank you, well done . Oo. Great context, thank you. Public comment . There have not been any requests for this item. I look forward to your work. Thank you for the input . Oo . A item 9, San Francisco department of Public Health fiscal year 201415 annual report. There is no action item for this report, it is just a presentation. Good afternoon, commissioners, i am sneha patil with the office of policy and planning and today i will be presenting an overview of the fiscal year 20142015 annual report. As required by city ordinance, the purpose of the annual report is to highlight the department services, programs and achievements from the previous fiscal year. This years report opens with a message from director garcia which highlights key achievements in our efforts to proat the time and promote the health of San Franciscoans which is the theme of this years report. This message describes the departments response to the Ebola Outbreak in west africa, our on going work to address Health Disparities between San Franciscos African American residents and the historic donation of 75 million from Mark Zuckerberg and priscilla khapb. Our Population Health division which provides core Public Health services for all residents. This letter also recognizes the many generous donations to San Francisco General Hospital, which is opening this week, and affirms the commissions commitment to providing a Sustainable Health care Delivery System and Public Health services to meet the needs of San Francisco residents. The next section of the report provides an yofr view of our two maipblg divisions that help the department fulfill under the circumstances mission, as well as an organizational chart to help orient the reader. This fiscal year our Population Health division moved closer to Public Health accreditation through the development of a Quality Improvement and Work Force Development plan and the San Francisco Health Network, our integrated plan, worked on many Strategic Initiatives to become a provider of choice. Some of these initiatives include the acquisition of an Electronic Health record, the development of the Business Intelligence unit and the expansion of the Networks Call center. The next section of the report provides an overview of the Health Commission structure, commissioner bios and fiscal year 20142015 resolution. So based on some of the feedback that we heard from the Health Commission last year, this year we have streamlined some of the contents of the report, ultimately making the rrt a little shorter compared to previous dwreers years and a little more readier friendly. One of the ways we did this was by choosing 3 achievements to feature and organizing shorter highlights around the theme of protecting health. The first feature in this years report is the response to the Ebola Outbreak in west africa. This fiscal year dph activated its Departmental Center and over 100 staff the Department Also monitored 113 travelers returning from ebolaaffected countries. This demonstrated we are able to successfully respond and protect the health of residents and visitors. This year dph, in collaboration with the San Francisco Health Improvement partnership, introduced the oral Health Disparity plan to improve the oral health of children of San Francisco. Goals include increasing access to dental care, integrating oral health into primary care and introducing oral health into African American communities. The first group is focused on collective impact by addressing Health Disparities in clinical outcomes for African American clients in the San Francisco Health Network. The second group is focused on increasing cultural humility across the department and the third group is focused on Work Force Development and this year the groups met quarterly to prioritize their work activities. The next section of the report is our fiscal year highlights, which describe the departments key activities and accomplishments to protebt and promote the health. I will talk briefly about a couple of things on the slide. In an effort to protect the health of individuals at risk for hiv, the San Francisco Health Network developed a prep program that increased access to prep and developed Clinical Management guidelines for more than 30 primary care providers at our networks clinics. Aligned with our efforts to poe mote health by ensuring residents have access to health care, this year dph developed a plan to provide health care for all low and moderate citizens. This will increase access to health care for 3,000 residents as well as maintain San Francisco Health Network for those who do not have access to other health care opposites. This section provides information about december grachks such as race ethnicity, race, gender and patient payer source. We made one formating khaifrpg since you all received the rrt page 24. There was a little bit of a field covering up the data so we made the change since you received it. This yaer we also included a section highlighting programic activities which include safe and Healthy Living environment, access to finally provides information about the revenues and expenditures for the entire department. The last section of the annual report is a map of our dph Service Sites and affiliated partners as well as a list of all dph contractors. I also want to thank linda accosta in our Communications Department who did a lot of the work on the design and layout of the report. The final report will be posted on our web site shortly and as required by city ordinance, the link will also be sent to the San Francisco Public Library and posted there as well. Thank you. Thank you, commissioners, you have received the report. Dr. Sanchez. I just want to say its excellent. You have really done an outstanding, everything is just it really shares what in fact were involved with, in particular when you cite Services Available, ive been walking by some places on Mission Street i always thought there was just a group of psychiatrists there and i find out theres at least 5 other units will and they have been operational and they are doing fantastic things. As we take a look at the bayview, the mission, excelsior, everything is very much quaul litative and really shows us our outreach and services we are providing in the report so well done. Thank you. Commissioners, any other comments with your permission then we will also send a copy of this to each of the supervisors and the Mayors Office as we have in the past with cover letter. Its actually required by the Mayors Office to send supervisors. Them and the thank you. Thank you very much, the graphics are also outstanding and i think the ability you have been able to shorten and yet the succinct and yet comprehensive is very helpful. Thank you. All right, commissioners, moving on to item 10, which is other business. No Public Comment . No Public Comment. Other business. I just wanted to make a request for a future agenda item. Two things were touched on today, one was the appointment of the new head of the homelessness department, im sure its called something else, of that department and that there would be things leaving the department of health. I think it would be informative for us to hear about what that is and the timing of that and the second thing is coming in, understand theres some thought to bringing back to dph some of the Regulatory Oversight that relates to emergency services. And i think its probably, be good to understand that and maybe give us a tutorial on how actually all these things fit in the city and what our responsibility is and what other people and what the transition plan is, how you are thinking about it, what are your concerns about it, et cetera. Very good. We will definitely look into that, commissioner. Okay, thank you. Any other comments or requests . If not we can move on to our next item, please. Item 11 is the joint Conference Committee report back and weve got april 26. On april 26 we welcomed of course dr. Erlich as our new ceo of the hospital and during the meeting discussed quality management, Regulatory Affairs report and heard an update on the new patient closed strategy between pes and the emergency department. We also reviewed the in patient psychiatric Core Measures and mary thornton, our consultant be who has been there for several years, indicated that they were on course and our Compliance Officer there also indicated that the last 3 audits of the units charting met regulatory requirements. Weve corrected that problem. As youve heard, we are ready to move into the new building. There was also a discussion of the hospital diversion rates contributing to this. Of course is also the high number of patients needing low levels of care who are not able to be diskharpbld discharged from the hospital, how the flow from the system would assist in decompressing this and how at least a short Term Solution as we move into the new building the number of slots that are available within the emergency room will be increased considerably over what we have now so that diversion hopefully would then go down. We also then discussed the patient Care Services and the hr report showing that were on schedule to be able to staff the hospital. During the medical staff report we did approve the radiology Clinical Services rules, regulations, cidp, policy, controlled substances utilization review and evaluation systems mandate and in closed session approved the credentials report. If there were any questions from that, otherwise you also see those in the minutes that will be distributed. Now commissioner karshmer can get an update from the may 10. Laguna honda joint jcc met and discussed the administrators report, heard presentation on the rehab and psychiatry presentations. The committee encouraged laguna honda and the San Francisco Health Network to continue to explore ways to earn revenues through the hospitals Rehabilitation Program and excellent outcomes and also discussion about how laguna honda hospital will work with dffg during the movein process. In closed session the Committee Approved the credentials report. I also just have a quick report from ihhs committee on which i sit, and just to announce that they have relaunched their Mentorship Program to prepare both providers as well as their consumers and they are working closely with the laguna Hospital Transition Program personnel. Thank you. I have not received Public Comment requests for this item. Good, go on to the next session. Item 12 is adjournment. I would like to draw attention to the master calendar for everybodys own calendar, we are currently scheduling a Community Meeting in september and at the same time we discussed at our last planning meeting we will be also angendizing a Planning Session on finances, budget and our longterm plan. So please look at the schedule and be sure to keep those dates available. If there is no other business before the commission we are prepared for a motion for adjournment. So moved. And a second . Second. All those in favor please say aye. All those opposed . This meeting is now adjourned. meeting adjourned . Good afternoon everybody and welcome to the regularly scheduled meeting of San Francisco board of supervisors for tuesday may 17, 2016. Please call the roll. Sfr visor avalos, present. Supervisor breed, present. Campos, present