retired employees in the city and county of san francisco. one of the things i'd like to mention we didn't hear this was going on until a few weeks ago (captioning is ending at this point due to the time limit provided for captioning)

unitedhealth provides also, i don't want to have claims denied and blue cross has a notorious record for doing this, and it could be life or death for people who are retired or even active. so please keep united health and think your decision very carefully. you know, lives could be hanging in the balance.

thank you. thanks, herb. thank you. caller. i'll unmute the next caller. welcome, caller. yeah, my name is joseph asaro, a retired city employee. and i just when i was looking at your presentation, i found it interesting on your on page 21 where it shows your final scoring chart, that if you eliminate out the item for premiums and you look at all the all the other items that they rated, which deal more with the quality of care you united health care scores 84.02 and blue shield scores 61.97. it's about a 28% difference. so i guess it's fair to say that if you're dealing just with quality care, you would stay with united health care, rather than blue

shield. thank you. thanks, joe. thank you. caller i'll unmute the next caller. we have four callers with raised hands. patrick monaco i hope board members have read the written testimony i've submitted. blue shield submitted an unrealistic. i believe you have an echo from your device. i'm going to pause. you 10.2% rate increase in drug formulary changes. cost increases in 2017 legislation. can't hear you. speaker one if you avoid this contract cola, you're going to have to pause. there is an echo 25. it will suddenly raise its rate. caller if you stay in the queue we can unmute you. but i'm going to move to our next caller. and that's a reminder to anyone who is using remote public comment

to make sure you mute. mute alternate devices that may be close to you in wherever your location is. i'll unmute the next caller. welcome. hello. good afternoon. hello. can you hear me? yes, caller. go ahead. yes please keep the united health care. as you know, they get the highest waiting for quality care. the low bid from blue shield is a bait and switch, and it should send up a red flag if the bidding is lower . much lower than the united health care. again, quality counts. it saves lives. why did blue shield not provide its guaranteed rate increase caps for the years 2627? this should send up a red flag again. bait and switch. wait till you get the bill at the end if you're alive. it seems that this is a political interference move, since blue shield is a heavy donor to the gavin newsom campaigns. if blue shield is not transparent, what do you think

that they're going to be as good providing any type of medical service you have to fight for what you get with blue shield i and i'm old now. i only have so much fight left in me. don't kill me by giving me blue shield as the only alternative, and i don't appreciate whether it's silencing breslin and 70. thank you. let the commissioner speak. we have five callers remaining on the line. i'll unmute the next caller. welcome, caller. hi hi. my name is olga ryerson. could you hear me? yes coming in. clear. hi, i'm retired from city and county of san francisco in 2015. i had blue shield before i turned 65. a year and a half ago. and so i went from

blue shield to united health care. i really, honestly have to say, i didn't have any problems with blue shield. my husband is also on united health care. we are both on, and they've been okay. but and you know, i'm nervous about changes. i am and i, i, i hope to god that you guys look into this good. but i trust whatever you guys do. i don't think we would have problems going back to blue shield because it is a medicare advantage program, from what i understand, and it will just go from i imagine it will be the same, you know, so thank you. thank you for the work. i know a lot of work went into this. and so thank you guys, and thanks to the health service board, thank you. and i'll place you back on mute. thank you. we have six callers on the line. i'll unmute the next caller. welcome, caller

. hello caller your public comment can begin now. i'm going to mute. seems this caller does not want to speak. i'll move to our next caller. welcome, caller . can you hear me? yes yes. would you please stop silencing breslin and zemansky when they want to have conversation with the other commissioners so that they can ferret out the different opinions that are being heard? please keep united health care, please. there's no transparency with blue shield. why did they lowball it? it's bait and switch. as was said before. i think again you need to look at quality of care for the elderly. if blue shield comes in a year later and starts

raising fees, who's going to suffer? it's not going to be the employees that are active. it's going to be the elderly and fixed incomes. is that what we deserve at the end of many years of service, i hope that the commissioners will vote against this move. and by the way, why do we have to have a change? was that ever transparently presented to anyone? i don't know about this health care administration that is in that are managers. if you want to save money, get rid of the managers that don't do the job for the people they serve. thank you, thank you, thank you. caller we have three callers with their raised hand. all unmute the next caller. welcome, caller. hello. welcome, caller. why do we have to have a change?

was that ever transparently presented to anyone? caller we can't hear you very clearly. health care administration that is that is caller you can try to call back and raise your hand again. we have three callers on the line. i'll unmute the next caller. welcome, caller. caller you've been placed in the queue. you're unmuted. hearing no response. caller you can call back if you'd like to contribute to public comment. a place you're on mute. we have two callers with raised hand. i'll move to the next caller. welcome, caller. commissioners,

this is fred sanchez, president of pob. i mean, i understand the economic condition of san francisco, but it's the board of supervisors who will ultimately have to close the gap. there's other areas in the budget that aren't going to affect our most vulnerable population. these people who put in over 30 years in their career, their let them, you know, there's 600 nonprofits that are usually i mean, commissioner dorsey knows that he has the opportunity to cut other areas of the budget. it doesn't have to be done on these people who have provided the best service, for some people have died in their line of duty. i mean, i urge you, please do not cut united health care. it's too vital. these people have fought hard and deserve the

best. thank you, thank you. caller placing you back on mute. we have three callers with raised hand. i'll move to the next caller. welcome, caller. hi. yes? can you hear me? you may need to speak a little louder. nope. okay i, i'm a retired nurse from the city and county, and i'm currently getting cancer care at ucsf, and i'm really concerned that ucsf may not take blue shield, i'm really happy with united health care. it has covered everything i needed and i would urge you to vote no, but i would also like you to be very clear about what health care systems in the area will be covered by blue shield. if we are forced to make that change. good point. thank you.

thank you caller i'll place you back on mute. we have three callers with raised hand. i'll move to the next caller. welcome, caller. caller you've been unmuted. yes. you can proceed. yes. this is, martha hawthorne. i'm a also a retired nurse from the city and county, and i'd like to urge a no vote on this proposal. we have no explanation of how blue shield can charge less for the same services. i can't believe that no matter how much you cut this, it is a major disruption. even people who are healthy, like myself, i don't have one provider. i actually have 3 or 4 keeping me healthy. physical therapist endocrine ologist, gyn. and at 70 years old, i

spent a lot of time on the phone and there is a staffing shortage everywhere. i called one provider, she said, yes, we'll take blue shield, the other said all our phones are sound and ucsf actually said to me, well, we think we'll take it, except i think your share of costs will go up now, they may be wrong, but that's not an excuse for this change. now when there is so much confusion already, united health care has worked for us. i as a nurse have been an advocate and blue shield is very difficult to deal with as a patient. i found it very frustrating. other people have spoken to that. so please, please, even with an outreach team, this is not going to work. any delay in care results in e.r. visits that are going to cost more for the system, more for us, and out of pocket. absolutely. more hospitalizations when care is delayed. your comments. thank you. please urge a no vote. thanks. thanks, martha. thank

you. caller we have two callers in the queue. and they may be returning callers that we were not able to hear before. i'll unmute the first caller. welcome. i urge you to vote no. i urge you to vote no on switching to blue shield. they're notorious for being hard to deal with. also, i urge you to review patrick shaw's letter. it's very detailed and very accurate as to what you need to look at before you take a vote. and i don't know what's behind this. why do we have to make a switch? why is staff pushing something that doesn't work? they've done this before and we paid for it. now we're too old to live out whatever errors they make for us. please vote no. do not accept blue shield. let us keep united health care. thank you, thank you, thank you. caller placing you back on mute.

there's one more caller who may be trying to rejoin again that we were not able to hear before. i'll unmute the caller. the caller is muted themselves. there's one other caller in the line. i'm going to unmute to see if they can come through this time to. welcome, caller. holly, this is red santa. okay. thank you. you've already talked. yes. thank you. i'll give a reminder. there's no raised hands. right now, but for anyone on the call, we have 19 callers. i'll give a five second pause for anyone who may want to raise their hand and

conclude any remote public comment for this agenda item. no callers have raised their hand in the remote public comment at this time. we can move to our final portion of the remote public or the of public comment, which includes, as commissioners have stated, the written public comment and we want to read those names into the record. there were two two written public comments, voting or urging the board to accept the staff recommendation, which was michael paganini and alex tucakov. i'll go through the remainder of the list, which is around 180 callers or written responses voting no, stating their names for the record, jaclyn d'amato, irene burns, janet pond, karen held, william neal, loretta najarro, howard

polonsky, larry pacetti, william welch, armond pellizotti, bob finzi, carles pessoa, john. berkeley, nadeem. tota, michelle mcdonnell, leanne dordick, leah. colombano, lynette. hugh, charles. keown, george and hillary aldoff, lois. perilli, john. murphy, john. stance george. carrington, augustine. larue, lawrence. wright, patricia. wright. fogarty, brian. d'arcy jim. castro, patrick. sabia, john. rogers, teresa. adkins, donald schleper, dave. b'rit, mark. mahoney, roger. battaglia gary. wilson, william. burney, mike. becker, anna. brown, tim. shanahan kenneth. carino, lori. warner, joe. collins, richard. warner, gary. martini lorraine. lou, sandra. fuentes gerald and

ramona. killoran, tom and sarah. harvey, vicky. quinn, raymond and victoria, edmund. garcia, ronald. artillery. david and phyllis. sieber, david. berti, brian. boyd, elmer. carr john. goldberg, george. calfskins, james. guerrero, charles. terry, steve. lynch, robert. lopez, concha. castro, william. cali, bob. mazzola, john. grizzle renee. la prophétie, robert. quinn, james. taylor, fran. luken, eugene. callanan john. shine, maureen. damico, william. forrest, benthos, james. harrington, jim. belsham, julia. hasley lewis. braunfeld, joe. makowski, mark. solomon, david. pollitt, william. moe, brian.

delahunty, richard. barber, michael. yellen, patrick. logan, margaret. parente, greg. lynch, james. hall rich. dalton, dalton , stefan. goodell juanita. stockholm, william. konig phil. phil. fitting, lawrence. zumberacki martha. boyle, john. harrington, bob. daris, vicki. gross, stefan. bosshard maria. josé. josé, margie. favro patrick. shaw, kelvin. wu daniel. jacob. meyer david. sager, ron. barney, michael. hobel gerald and kenleigh, and shirley, donna. lopez, gary. s-sit, patricia. conestee, robert mcallister, gail. goff dennis. bonacci, christopher allocco, carolyn. lucas, edmund. cota melvin. manu, sally.

dehaven, cynthia markopoulos, joseph. péraldi richard. tong, valerie mcgrew, elena. simonian, mike. favetti, lodi. ju, pet. mario. excuse me. pete, mario. balassi joe. cuff, patricia. keller, susan. mae. hammer, mara. baldacci mary. ann. scanlon, marlou. reyes, philip. takai, luis. vicosa, robert. gillespie, james. jones, lois. scott helen. motley, tara. ivey, ronald. martin, leslie. adams, nicholas. sikora, francis. williams. miller, mark and rosalie. johnson, george. pig, joseph. gutman daniel. lineham, terry. wallace, patricia. lineham pat. gutman, jerome. palluzzi william. long, kai.

aspelin, sarah. coe, john and elaine mendez, elaine. crystalline. tellez, john. skidmore tim. nolan, lennie. pond, leland. pond george. pig, margaret and james. novell romero, amelia. scott, noreen, eric. patrick mclaughlin, patrick. munchetty, calvin. nutmeg these are all the entries for written public comment that were forwarded to the board yesterday by the 5 p.m. deadline and with that public comment is closed, thank you and thank you everyone who provided public comment. and thank you for your patience. i know that's sitting here for three plus hours is, it is not is quite a feat. so thank you again for coming, so colleagues, do we have further discussions or questions before we take a vote? yeah, i'd like to just, express my appreciation to, staff and to all of the

presenters today. ian included, and also just compliments to, fellow commissioners for some excellent questions that were, i think, helpful for all of us to understand this. i similarly want to express my appreciation to everybody who who sent emails and who reached out, you know, obviously there's going to be there will be disagreements in this. to the extent i know, fred, i appreciate fred's sanchez reaching out. i will generally speak for myself on the board of supervisors, but i think i can confidently say that i don't believe that there is any member of the board of supervisors who is looking to the health system to balance our budget. i and i think in, in much the way that i respect the roles that they have on other boards and commissions, that is going to be a different obligation on what they have as a supervisor. whatever else, my job is in this building. when i sit in this chair, my duty is to

the trust that is my fiduciary duty. and what i would have to see in this. and i committed to keep an open mind in this process, and maybe this is just a perspective that's informed by most of my career being in the city attorney's office, where i was a colleague of jennifer donelan's just respecting a process. now, i think that can allow for the possibility that this process may have been errant or or wrong, or there's something that we're not seeing. and i think there were some excellent questions in that. as commissioner forlenza said, when we were exploring, trying to tease out where are the achilles heels? if there was a showing of that or if there was a sense that i had that, that was there, then i might be inclined to not, vote for the staff request, but i did not see that finding. i, also really appreciated the background on the meticulous

detail of the process that, again, as somebody who grew up in the city attorney's office, i just appreciate and respect. and then even though i am relatively new, having only been on this, this commission for a year, i do have a long time, you know, a couple dec two and a half decades, i guess, of confidence in the san francisco health service system about this department's commitment to the quality of our health care, so i am satisfied with the staff recommendation, and i will be supporting it. thank you. supervisor dorsey, any other comments? i would just like to sort of echo, your comments about appreciating so much the work of everyone, abby, her staff, mike, his staff, in the completeness and the robustness of this process, i have to say

that i still have unanswered questions. it has nothing to do with the process. it has to do with the fact that there are just questions that are unanswerable, quite frankly. and that does give me pause, because , you know, we are in the midst of many crises, not just as a health service board and health service system, health care in the united states, financial system in the united states. and so but i want to again applaud everyone's efforts and appreciate everyone's efforts for really, attempting to answer to the best of their ability in a transparent way and an honest way. all the issues that this complex rfp arose. and i again, thank everyone. thank you. and i want to echo, echo, my thanks. without being repetitive, i do think that this is a very weighty topic, and i think it's been several years of slow and methodical discussions. and so and i do appreciate the fact that we can have hearty discussions and not agree and

have questions and but still hopefully make the best decision that we can. so, commissioner sass, oh, no. so with that, i think that if there are no more questions or discussions from the board, we can go ahead and take a roll call, vote. just just one one brief comment i appreciate i appreciate the public comment. i understand the feelings of the members, i also have a very good understanding of how a medicare advantage plan works, and that blue shield is administering something they are not. they are not approving, and they are not, you know, or disapproving or negotiating or stalling with anything. the, the claims is that the service will be provided by all the providers that are currently supporting our retired members. they will submit their claim for service to just to a different payer. but and they will be reimbursed with the medicare rates that they have come to expect. and

they will get the blue shield has. blue shield has no reason to delay or stall, but that said, that doesn't change the fact that there's a tremendous amount of anxiety about change, i too didn't, intend to, to support this motion because i believe that, again, i respect the process that the department has done. i also i worked in as a cfo for the department for several months, in addition to being a health service commissioner. so i actually know the people in that office very well, and i work with them just like everyone else. does it open enrollment to get my health plans enrolled? they do an outstanding job and i have the full confidence that they will work very closely with blue shield to make certain that any of the concerns that that may have existed in the non-financial areas are addressed and worked for the next seven months, so that by the time they start, we theoretically should have most

of those put away. and i think i believe that blue shield can certainly manage a medicare advantage plan. thank you. thank you, commissioner sass. so let's proceed with the roll call. vote a roll call vote, starting with commissioner kremen. nay, commissioner. supervisor dorsey. aye commissioner. follansbee. nay commissioner howe, i, commissioner. howard. nay commissioner. sass i and commissioner. ziminski. no that's four no's and three ayes. yes so based on that vote, the staff recommendation is not adopted. thank you, thank you, thank you. may live to regret

it, but such is life. all right. thank you, everybody, for attending our special meeting, we are now officially adjourned. adjournment at 5:30 p.m.

>> thank you. i have the privilege of reading the land acknowledgment today. the san francisco commission acknowledges that we're in the unseeded homeland of the ramaytush ohlone who are the i object hab ants of the peninsula. they have never seeded nor lost nor forgotten their responsibilities as care takers of this place as well as for all people who reside in their traditional territory as guests, we recognize that we benefit from work anding living in their traditional home lands. we wish to pay our respects by acknowledging the ramaytush o hlone. the next item in the agenda is approval of may 21, 2024.

commissioners we have before you the minutes of the meetings, are there any additions or corrections? seeing none, we'll take, we'll take a vote? >> clerk: motion. >> motion to approve these minutes. >> speaker: so moved. >> is there any public comment on the items? any public comment on this item, item 2, there is a hand remotely, before we do that, i'll read a quick script, members of the public will have an opportunity to make public comment for up to three minutes. it's designed to provide impacts from individuals. however the process does not allow process to be permitted in the meeting. the commissioner do consider comments when discussing items. individuals may not return to

read statements from other members. the commission dphs we will first take public comment from individuals attending in-person and then we'll go to remotel folks. there is one remote person. great thank you. you've got three minutes. >> caller: these minutes include my testimony during the april 10, quality conference that continuation of llccbi program is the key component of

nine steps sustainability with cms regulations into the future. but l.a. change has not been presented a sustainability plan for the health commission review yet. why hasn't a sustainability so members of the public can see what the plan entails? why was that sustainability plan presented to a national conference of cms but not presented to this commission? for that matter why wasn't submitted for the review for the quality confidence? and was that sustainability plan submitted prior to ending its contract that was scheduled to last until august 31, 2024. with them no longer, what happens to sustaining the ccbi program that they complained about? thank you. >> all right, that's the only comment on this item.

>> all right we'll take a vote all in favor of approving the minutes, say aye. >> aye. >> thank you, the next agenda is general public comment and once again, secretary has a statement to read. >> the script is a little different for general public co. at this time members of the public may address the commission of items of interest to the public that are within the jurisdiction but not on this meeting agenda. and then the rest of the information, i already reviewed. is there anyone in the room? give me a second to pass out. >> speaker: good afternoon, and thank you for allowing me to speak again. last meeting, i'm christopher klein, last meeting there was a

presentation about ethic, ethic health so i did a little research and it runs parallel about the things that i've been talking about the last couple of months. 1400 people trained in san francisco that uses this system but there is 300 million health records that epic health owns. that's not just in san francisco california that's across the street and other countries. you're going to see university linked to ethics, university of san francisco and michigan pennsylvania but there are other universities at our link. in san francisco there were more than two people that worked in san francisco. and when they left, they took everybody's whistle and one person went down to l.a., his name is mitchell katz used to be the director of public health here in san francisco and then took all the records

from l.a. from l.a. to san francisco to new york. i don't want anybody in new york accessing my health records and dictating my health. that's one of the major concerns, so i'm going to put a power point presentation to explain this in very detailed information so everybody can understand, it's a lot of information and technical. but that's technically what happened, it's a cloud con paouted, they get your position from you about your health record. so on, there is a lot of people working on this, i reached out to the department of defense, office of inspecting general, they're helping me guide me through this, it's not just happening here, it's happening everywhere. it's causing the protest because with it, you can send

messages to protest and get them upset and riled up, so there is more to come, there is a lot of people working on this, and, right now, the best thing that we can do is just, ask questions. ask questions to director:fax within human services agency and we'll go from there and again i'll put that presentation together, i should have it within the next three weeks. thank you. >> thank you. >> let me check remotely, is there anyone that would like to make public remote public comment? i see no hands. >> thank you, the next item on the agenda is the director's report. >> good afternoon, commissioners and members of the public, we have, i have an extensive reporter's report here. much of it very exciting. i'm going to go through the items and i'm happy to take any

questions and i'll try to be both comprehensive and mindful of time. so there is a new san francisco program that uses night time tele health to provide immediate access to preparation medication to start recovering from opioid disorder. provieeding unhoused people with immediate medication preparation at night in a safe place to begin their recovery. under this pilot program, they're providing realtime connection with a doctor for those ready for treatment and other opioid use disorders. medications from opioid use disorder highly affective and reduce the rick of dying by at least 50 percent. to use prescription is filled and medication is taken, the pilot provides a safe place to sleep at night. the caseworker is provided

along with stabilization in certain cases. in the first 8 weeks, more than 55 people started medication for disorder residential treatment program under in night time program. in total 173 people, and 134 percent people prescription issued with 33 percent of the prescription filled. nearly 1,000 people entered treatment. the program is in partner with the community health center, the san francisco department for homeless and sub board nat housing in four teams. the team which is out on the street from 7:00 p.m. to 3:00 p.m. was noticing and these were funding by dph were noticing that people were interested in starting treatment and we had very limited sevensers available at those times and of those pilot

program we tested the hypothesis which is people protalked to a provider at night and offered a place to stay while they wait for the prescription to fill and you can see from the first data, we had a great number of people fill their description and start their recovery. so we look forward to reporting more on this program. again for the people out in the street at night in this area under this pilot, there is a truly treatment on demand, so i just want to emphasize that. so item 2, city of san francisco encourages m pox and we want people to take care of their sexual health by vaccinating for m pox, which is also called monkeypox. we're continue to go encourage

people at-risk for m pox to get two series vaccination. i have rio hond o personnel update. so laguna update remainses sustainable, surveyers from the centers for medicare and that should be medicare and medicaid were on side for a survey for the december 2023, medicare certification in 2024 and preliminary findings indicate related to the medicare sert if --certification. laguna honda continues to work with regulators to report incidents and anonymous

complaints. on may 30th, surveyers returned for one-day to resolve two plans of correction. we are pleased to share they exited with zero find fgz. laguna honda also was to announce--cherry brings a wealth of knowledge including most recently nurse manager and assistant director of san francisco, a general care a cute care hospital was a distinct nursing facility and second in size only to laguna honda in san francisco. so we continue to our journey to certification as you can see we continue to bring in, leadership to, to help us continue with that journey. i have an additional department wide overdose response workup date in addition to the program

that i started with to reduce fatal and non fatal overdoses with the focus on the black community and people living in permanent supportive housing. existing programs to create a database to reduce drug overdoses in san francisco. our coordinator response has made progress towards our goal of increation the accessibility and affective and treatment and strengthening engagement social support for people at-risk of overdose. they have partnered with department of supportive housing to implement a boxing program at all housing sites and drafted is assembly bill that increases access to methadone by allowing clinics to dispense methadone for up to 72 hours, not that they're open for 72 hours, but they have

72-supply of methadone. create a new pages for over use disorder and distribute more than 50,000 cards described opioid services through the city and community programs. that's the last month in addition to the program that i talked about. moving on to the next item, very pleased to announce the new chief financial officer, brings experience within the city and county of san francisco. from 2016, he has worked with dph finance and controller for the department. prior to dph worked with the controller's office. and initial prior will include

financial planning through what is expected to be a challenging to maximize revenue and maintain financial stability for the department. next item with regard to the 46 annual carnival, the dph group was excited to announce that they successfully coordinated over 30 to support the carnival on saturday march 27th in the mission district. this is the second year that staff has come out to support this event and there was widespread where they, volunteered and engaged in community in participating with the event and made people aware of our health and wellness service sxz that we're open for care for every one. next item is vsfg received a baby friendly did he go

designation and received a friendly designation after a rigorous progress conducted by baby u.s.a. provieeding that supports breast feeding of all birthing people that make decisions for themselves and families and this is just another indication of what strong program for maternal health they have. cfg department and emergency nurses recognized during medical services week which was may 19th through 25th. the city celebrated all the great partners in emergency medicine and other professionals save lives everyday. during the award ceremony which i was able to and happy to

attend, we recognized the emergency teresa sandwhole who was awarded the hospital provider award in recognition of her incredible contributions. there is a lot of detail to call out staff who worked for many years including, dr. earl recognizing jenny trend, who served dph for 35 years, that's 35 years. and richard find people's clinic and other clinics across the hospital. and recognized teresa del rio, i'm sorry, delian a physician

leader who--and she is an experienced leader and chief of service of family medicine. i can say she is an outstanding leader. next item, the population health division has been closely monitoring avian influenza a, h-5n1 and there is a full review of the local developments. i will just go through the san francisco update and happy to answer any other questions but that specifically in may of 2024, dph was informed about a positive h5 avian flu test result on two a systematic chickens and a live bird market in san francisco. this testing was conducted as

part of food and agriculture testing program of live markets. dph responded to protect the health of market employees and completed the health of employees who are in close contact with the live chickens. the employees monitor did not report any symptoms, no members of the public were exposed and the market has safely reopened. the infectious across the uflt states has recently begun waste water at the timing for h11n1 due to the live bird market detection in may, waste water scanned their new avian flu in san francisco waste water and fragments of the material were detected. we're the only municipality with a avian flu detection.

multiple other jurisdictions across the country did have detections. more resent testing conducted in the latter part of 2024 did not detect the waste water. it is possible that the genetic fragments originate from the birds or other animals through the san francisco sewer system that collects storm water in the same network of pipes. still remains a low risk to general public, there have been no detection of avian flu among patients investments that have been poured to a laboratory. dph is working to increase the number of patient respiratory specimens for a lab for testing. we continue to work closer to their partners to monitor h5 a 1 activity and update public if

there is any action taken to protect health. budget update there is an attached memo that i'm happy to respond to any questions in regards to the budget and then you have the covid-19 update report and i'll stop there and see if commissioners have any questions, thank you. >> first of all, thank you for the report and of course our dph and population of division is all over following this avian flu issue and we really appreciate that, and it's always so wonderful to hear about the recognition that work in the department, you see this and besides the people in this room are so so talented. testament to leaders and lead so well. i know there will be a lot of

questions because we covered so many different top ixz on the direct's's report but we'll start with public comment. >> all right, is there any public comment in the room? all right, i see one hand remotely. if you're unmuted, let us know that you're there mr. menshaw. >> speaker: i am but it says i'm muted. >> you are unmuted, i'm speaking to you right now. you have three minutes. >> speaker: this is patrick. first i would like to offer my con --congratulations. i met ms. grados when i was admitted for meeting hospitalization for cancer mass on my right cheek. the jewish home before i was allowed to return home.

i had some intersections and found her to be responsive to patience's concerns and had a terrific bedside manner. sadly with the consultant company saag no longer around, it's troubling that they had to return to l.a. change to correct two of the plans correction that resulted in two severity actual harm citation. having read the details on the form 25-67 it's worrisome that without consultants, had trouble preparing the trouble of correction and had the return op site to pocs, this director reported the surveyor survey revisit on may 30th will not lead to another delay looking to delay to see if there are actual findings from that survey.

will that contribute to more delay? thank you. >> that's the only public comment to this item. >> are there any commissioner questions or comments? okay, i just had two very quick ones then. one is is there a, it sounds so encouraging the night time tele health and accomplishments to date. is there an end date? and if so, what would be the next steps? it sounds like it's going to be very successful? >> dr. just arrived, and we'll be providing a behavior update. i just went through the highlight program.

president green was asking if there is an end date. there is no end date, we're actually looking to see if we should expand it. we can come back and report, they can give you a few pointers about a few keep points about how we're working to expand the program in the future. >> thank you, and i can see other things and this is both for my identification and the public, do we know if people that have gotten their two m pox vaccine how long immunity will last? do we have any ideas? people lose their immunity to other viruses, i'm wondering if there is any update. >> i snuck up upon you commissioners. that's a great question, right

now cdc and i are aligned that people if have received both of their doses no matter if it was in the first year or just recently, they are considered fully vaccinated for the purposes of m pox protection. we donough that people can still get infected but the evidence is suggesting that it causes a more milder disease and we think that is good. so if people have received two doses, they are fine and our--please get a second dose. >> thank you, thank you for clarifying that. because with the shingles vaccine, if you don't get it within six months, you need to reboot. great. thank you. >> thank you. >> any other questions or comments? oh, commissioner girando.

>> i'm hoping, i read an alcohol about the alcohol reduction program which i thought was a good article too, you know, on yes, it's harm reduction but it's all working and it was positive. if in fact, dph's media folks, i know i'm always on the soap box, but good parents, night time tele health and overdose response work together and get it on the local news and in sf gate, because this i think is such positive work and we need more information out there. >> yes, i appreciate that and there have been a couple of pieces that have received coverage so we can call the

commission attention to that as well. and you're reference to u.s.a., what is in sf gates. so it was today. that won through the data and science, with regard to the manage program and the staff that by our estimates it's saving the taxpayers 1 and a half million dollars a year in terms of costs and keeping people off the streets and emphasizing that no taxpayer money is being paid for by alcohol. >> thank you, and i may be incorrect it may be the u.s.a. today article but it was in the san francisco foundation paul rose's blurp. >> thank you. >> thank you, the next four

items volve resolution to see recommend to the authorization of dpa to accept and expand a series of gifpts from the foundation and we'll take them one by one but greg will present each one and we'll see if there is any questions in both reach. >> thank you very much,? in discussion with the board, board of supervisors. so in discussion wz the controller's office, the coerl's office has asked about amendment be made to line nine of the health commission 23-14, with the line accept to expand a gift of cash to department and donations to better reflect the nature of the gift.

we ask the commission to approve this amendment. >> so, let me get, we have the resolutions numbered here, is this resolution 24-07? the one-14. >> okay. >> with the previous resolution approved bit health commission. and when we turn to the controller office, they want us to show that it was a donation of cash and in kind donations to the department. so that is o7. >> thank you, thank you for the clarification.

and i'll let commissioners to look that over. >> i so move to approve 24-07. >> is there a second. >> there is no public comment in the room, is there public comment remotely on this item? no hand. >> everybody in favor of approving number 24-07, please say aye. >> aye. >> aye. >> okay, now we'll move 24-08. >> this is similar issue at the controller's office looked through this motion that was approved which was 23-09, and said that, they would like to amend the line which says the public has been a gift of cash to department to accept a gift of incline donation instead, if

there is donations for supplies that was given to the clinic, we humbly ask to approve the amendment of this resolution. >> all right, once again, we'll take a few seconds to look at 24-08. is there a motion to approve. >> is so move to approve. >> second. >> any public comment on this item? >> is there public comment on this item remotely? there is nothing in the room. i see no hands. >> all right, all in favor of approving 24-08 please say aye. >> aye. >> aye. no. wonderful. 24-09 and please speak up, enunciate. >> they're donating to the public health food in the amount of 367,187 thousand of

food to go support the food pharmacies at dph clinics to address nutrition and security. we humbly ask the committee to approve this resolution. >> thank you, that sounds wonderful. is there a motion to approve. >> can i ask motion first. >> public comment. >> sorry. >> is there a second? >> second. >> we'll take public comment. >> public comment on this item remotely? no hands. >> okay, now commissioner comments, commissioner girando, sorry. how many food pharmacies? >> unfortunately, >> this is gregory can you all hear me? >> yes, is it possible to turn your camera on, dr. gregory? >> yes. >> did you hear the question?

>> ye, i'm the director of primary care. and thank you for your question. so i don't want to tell you the exact number without knowing that i have it right. we do not have to you shall every one of our clinics but we have them at a handful so if it's okay, i would like to give the specific number as a follow-up, it's less than half a dozen. >> thank you. is there any thought even with this funding of adding anymore? >> yeah, we are very motivated to expand the program it's been really successful and well received by patients. we're in the process right now of doing a deep dive into the model using a lien to analyze it and figure out how we can

optimize it. we just want to make sure that we get the model right and understand the best delivery possible before we spread it to other locations. >> thank you, any other commissioner questions or comments? okay, we'll take a vote, please says aye. >> aye. >> aye. >> and our final resolution is 24-10. >> this is going for the fiscal year 2025. the health foundation is donating to the health gift 368,000 for the food. and previous resolution goes to support food pharmacies and dph clinics to address nutrition and security and provide

patients with healthy food. i humbly ask that we approve this resolution. >> all right, is there resolution to approve resolution? >> so moved. >> is there a second? and is there any public comment on this item? >> is there any public comment on this item? we're on item 6. no hand. >> commissioner comments and questions? >> yes, thank you mr. wong. did you say that this is for 2025? >> yes, fiscal year 2025. >> which would begin in july. >> it will be beginning in july, i'm sorry i didn't explain that, the resolution could be for the 23-24 which is coming to a close but we're trying to get this resolution approved so we can get it. >> because like in the resolution itself, it didn't have any references that year.

so, so that's why. thank you. >> all right, seeing no other questions or comments, all in favor of approving resolution, please say aye. >> aye. >> aye. >> thank you very much. appreciate it. the next -- ~>> actually commissioner if we may, director colfax asked me if he's able to read part of the budget memo from the director's report, he feels it's important. so we'll do that. >> absolutely. >> thank you, commissioners and i just thought to read into the record, i know the budget was pretty challenging this year, i want to thank louie and emily gibbs that were here earlier and seriously across with many people across the department to provide the mayor's office with the mayor's asked for in terms of putting her budget out which will go to the board of supervisors. so i wanted to read the

introduction to the memo, that the mayor introduced for the fiscal year and 2025-26 on may 31, overall proposal by about 47 million dollars or 1.5 percent to over 3.2 billion and includes similar funding. the budget fund contribution declines from the community year to about 135 million before increasing fiscal year. includes update made during labor negotiations aligned projected, we anticipate some of these changes in reduction to some dph programs can examine in that regard, there is a hearing scheduled before the board of supervisors on

june 25th at 3:00 p.m., so you'll have other numbers and other details in the memo but i just wanted to read this into the record. thank you. >> thank you so much. >> we can go back to the item. we welcome our dph director, and she is going to give us a behavioral health services update. thank you. >> hi, everybody, good afternoon, commissioners, i'm really happy to be here, next five. and thank you also for your questions in advance. so for today's update, i wanted

to just remind us about phs mission and vision speak about prop one the recently passed state law is in epic migration update and update on the office of coordinated care, cultural green care residential care and treatment and finally overdose response, so this is a little bit of a hudge pudge that we wanted to make sure that you were all aware of. next slide. as missioners know, well being and participate meaningfully and across life spans and generations and to accomplish this vision our mission is to provide questionity and substance and promote

behavioral health and wellness among san franciscans. you can see our key tactic below our mission and vision to improve access to care and increase, awareness of where and how to get help. and i believe the presentation you'll see will focus on these areas. next slide. i wanted to update on proposition 1, the state proposition 1 was approved by california voters in march of this year. prop 1 changeses a number of different things. first, it substantially revised the services act. this was an act passed by california voters in 2004 and

the focus of the changes has or will be on how many under this act can be or should be allocated by the counties. the act is also changing the name. this includes substance use related care and what is allowable. so, a part of proposition 1 is to allocate money in particular ways. right now it's not in align with proposition 1 future allocation. that by the way does not need to go into affect until july of 2026. so we have and we begin

embarking now is a planning period in order to fully understand what is and isn't an alignment and how we get to be an alignment. i should also say that the full guidance from the state about what is allowable in each of the categories, has not been started yet. so we're waiting for guidance on what counts for each of the services, behavioral house supports and housing. i think the other has been and likely continue to be volatile. it's based on tax collections that happen at the state level and it goes up and down and anticipated to have some declines in the coming years.

comprises about 13 percent. the other pieces important pieces of prop one is that it approves a 6.4 billion dollars bond that is state wide money. from what we understand is that the state will allocate applications the request for funding, we expect to be coming out in july and then, we apparently have until november to apply for the money and then it will be awarded next spring. so we are awaiting what will be eligible and what will be applied for and we'll make an application. the last change is changing and integrating the way behavioral health has to report up to the

state right now, as i think i've related to you all, we report, we have many reports and many things we do and it's divided by mhs a by substance use, mental health, health plan and many have multiple parts. so it's a lot of reporting which takes a lot of staff time and energy and we are hoping although again, no guidance, is in our hands yet that this will rationalize and streamline some of our reporting, hopefully, next slide. this is a state issue slide with a full go slide in july of 2026, next slide.

epic migration has launched last week as of may or two weeks ago, may 22, we and behavioral health on our mental health services side joined the san francisco health network on health records, you can see, on the picture in front of you, is max rocha, marco lopez, imo momo our vhs leaders, marla simmons is here in the audience about to present, this was and is still herculean, preparing for the day, the many many

behavioral health staff who learned the electronic health record coaching staff to change workload to change the way we're doing business. every one is very excited and op mus tick and also experiencing the very real challenges of this kind of enormity of change. next slide, and i'm going to try to answer questions as we go. so thank you, both commissioner je ra do and green, so will health record be available everywhere. so the answer is yes, when the patient is available when the healthcare providers who are providing care to the patient

when the health record is shared as you all know. it occurs by an electronic change. under care with the client's consent, so it's really exciting and will change meaningfully how healthcare can be coordinated. commissioner green you had a complex section about disorder and mental health issues and as commissioners know, we elected at this time to not move our sud services with the federal confidential law, that has

implications about high low that we're continuing to work on, what that means and there is many different, different implications when a person may be getting care in primarily care, it's not concerted 42 protected information so it can be shared in the record. if a patient discloses to a non 42cfr covered entity and that entity like me as a primarily doctor puts it in a medical record can be shared as epic in the routine. but it's providing are providing care in outpatient clinic that those records will not be part of the routine epic record.

and again maybe this is too detailed but it's because of la protections and you can probably deduce my point there. so this is a bift a busy slide about the office of coordinated care. this office has done extraordinary care. i'll acknowledge marla's image for whom this was a brain child before mia rival, we in the city did not have capacity to really have properly and follow

people from setting to setting where and when needed. and our care coordination function that is the ability to not only get people in the front door but to move with them across sites when they are at high-risk for not making it to the next level of care or service. what we're start to go do and have been able to do is track data, that office did launch an epic to they were early doctors and have shown up some of the things that is doable and epic.

so you can see, we've been, through april of this year, and to business had gotten steady by november of 2023.

the next slide depickets what we're following as teams. to make it an appointment or housing appointment or something else that they need. the green is our best neighborhoods team, these are the street base teams specifically working on people who may be encountered in the street. they get refers from other teams from neighbors, from from

coming in from 311, with the hot team, the homeless out reach team. and these are folks that follow people, longitude overtime to try to connect them to further service. and then finally, we have a team focused on the shelter and providing and supporting shelter behavioral health working very very closely. and you can see that there is steady large number of referrals dating since november. and we'll continue to come back to you. i know one of you had a question about the percent of referral meaning of people who we hear about or know about, how often are we able to connect and make some forward

nation. we will come back to, i think that's exactly where we want to head in terms of data. i think that's where we want to go in addition to how things happen to folks. and retain gear which is ultimately about trying to improve their health. okay, next slide. we will come back with more specific updates, part of what

we're focused on behavior health is trying to deliver appropriate care as we have come to term congruent care to specific folks. we have one program for black african-american communities. these programs are now implemented in four of our our own dph clinics, they're using, both practices that have been adapted to the black african-american using techniques like storytelling and management and therapeutic intervention. this is one of the programs that has been funded under mental services act as part of

the project that we're very eager to see live on. maternal mental health trying to tie together mental healthcare and that will soon be implemented. next slide. so switching gear again, a very important part of the system as i've spoken to a number of you is what is happening in our residential care and treatment programming. and i wanted to these slides are actually drawn from an update that we provided to the board of supervisors and wanted to make sure that you were all aware of these as well. next slide.

so this fiscal year, we have access to 25 residential care and treatment beds. why is this an estimate? this is an estimate because in some cases, we own the beds, we run the bed, it is only for san franciscans or if it's somebody else is there, by permission or special case. we also contract that is we're in an arrangement with an organization that does not reserve the bed for san franciscans but is available for us to place the patient and we might assess the person and say, call up a particular providers will you accept this client or not? there may be and reasons that

they may accept or not, that include space importantly and competing over space resources. and i'm about to tell but substance abuse care because they're regulated differently. we separate even though a lot of what is happening does volve the other diagnosis or the other challenge. so on the mental health side, we have 114 beds. with most being in county and they offer range of treatment plans intensity of care.

for kunzed of new beds that we believe we still need. we believe we need between 55 and 95, what are called sub acute or mental rehabilitation center beds.

the next slide. the really higher medical complexity beds that we don't

really have access to in san francisco and we're working on strategies to figure that out. we also need more sud residential step down beds. these are beds that are not specifically treatment beds but these are sometimes called recovery housing. transitional recovering housing or sober living. including a good analysis by brand institute that confirms that we know people waiting but we don't have the data to

analyze flow and inside, next slide. some of the difficult beds. we're anxious to see this happen and anxious to have a time line. i also know that you heard from dr. leaer' from pdf, and he raised some of the challenges around shelter which we obviously don't control and that the coninfluence of

housing needs with behavioral health issues is together a city problem. but the shelter problem is not under dph. i don't have specific numbers around what levels of care, of folks need coming out of pef, i will say that tr*, in my conversation with dr. leaer' with whom i worked very closely, there was an awareness that a lot of what is needed is connecting people and helping them to get into care is a mainl or part of what we have been working on together including with the particular office coordinated care. one more section, moving on to overdose. when i come before you to talk about overdose and you heard

from dr. coalfax about our program with tele health. we as awe department i think you know, are really aiming to strengthen our efforts, laser focus on fatal and non fatal overdoses and to reduce overdose death disparities in san francisco. we're aiming to do these five things align and coordinate existing and new approaches to maximize our impact. we're really focusing on equity and reducing racial disparities. particularly analyzing assessing gaps and existing intervention sxz who we are not reaching. we are working closely with community partners, we are also really pushing on local state and federal policy and i'll

circle back to that and then strengthening our data capacity. next slide. are key objective are on the slide in front of you and i'll talk specifically about the first key objective, we're aiming to improve access to and retention in medication treatment for opioid use disorder and the evening tele health gets at that issue, if we can get to people in the moment that they want help and this is the bedrock of what it means to have treatment on demand and get people into care in the time that they're ready and this is what that pilot program represents. we also know that it's one challenge in the city and in the country, is it that methadone treatment and i think i will get there, which is highly regulated makes it more difficult to have the kind of

flexibility patient centered that we know is ideal so that is why the policy work is very important to take advantage of any flexibility that is available. our next key objective is around community engagement and in particular we're focused on building and supporting capacity of black african lead organizations to address overdose in the communities that they serve. and then, secondly, we know that over death deaths are over represented and we are working really aggressively with the providers and shs to find way to see expand access to treatment and overdose prevention. we are also want to go raise awareness, helping people identify resources when and where they need it. so i'm going to speak briefly

about methadone and share can you three data slides. we, the landscape for methadone treatment in the city is as follows. we fund and provide methadone by a six clinics and one mobile van, you can see them in front of you. the o top award 93otop van services run out of zuckerberg, the remaining program in the case of ford help and bart are national methadone programs that are part of a large for profit system. dave view hunter's point and black serving methadone program and non for profit. and each in the situations, there needs to be different approaches in order to expand access like intake, like retention and care like flexible services. i'll just point out and we've

talked about a lot about staffing shortages and workforce, and in some cases, workforce really impacts the hours of operation for new patients, their ability to do and see as many new patients as we would like and they would like. so this is an on going project for all of us. i want to share three data slides, next slide. and just again, make sure that you all are aware of the data that we now are able to follow and be able to share with the public to track how we are doing. what we know on the last is the annual numbers those come out from the office of chief medical examiner and i'm just showing the finalized numbers

in front of the screen. we do make available monthly fatal overdose and i think you all know we're doing monthly press conferences after the ocme releases the monthly data. on the right, what this slide does, is compare since january the month to month vaie aiblt. so we're not seeing an increase in the way that we did in 2023 it is still far too high. but we are i guess hopeful that some of the work that we and others are doing are beginning are flattening the curve this year.

we're tracking the number of people receivinging methadone and morphine in the city, most affective forms of treatment to prevent overdose. so in the slide that you see in front of you, we're able to see a number of san franciscans at a city level, that we have received morphine and i hope by next presentation, we'll be able to receive nepanophine, this data come from the state with a very long, as you can see, lag time. and next slide. and finally, we're able to track a number of people receiving methadone in the city. what you can see in front of you is, a loss from 20 to 21, very similar to the rest of

healthcare, followed into 2022 with an up stick in 2023 and what you're seeing is 2024 is the first three months of the year. so we're expecting and hopeful that we will see a big increase ideal, because of our many efforts and as we attract and hopefully retain more people in methadone treatment. okay. i'm going to stop there. >> thank you so much for a really wonderful and very extensive presentation and of a thought and analysis that has gone into this, as you said the night program has been innovative idea and it will be a wonderful addition to trying to address this huge problem, is there any public comment on this item? >> there is no public comment,

i suspect going to be some commission. >> thank you so much for answering most of any questions, and this one i did not write down but i'm going to throw it out anyhow. in the presentation about the beds and it's all adult, and i totally understand that, but i'm also wondering, and i know, i believe it's next year that at csfg there will be another 14 beds available for adolescents. for kids who are not in that age range, there is only four beds available at edge wood that are crisis beds. is there any thought of expanding that number.

i experienced this out yesterday with a ten-year-old figuring out and my best bet was in the east bay. i don't know if that's my question is. >> let me, i would like to bring up part of the team and i always appreciate you bringing up kids. and i know we spend a lot of time speaking about adults. for everybody what commissioner girando is referring to is a very large stake grant that we received to set up in patient unit for adolescent at zuckerberg which goes in enormous way to see filling out a big gap in the city while not perfect. let me bring that back to to the team for the below adolescent population.

as you know, regulations about who and how, different age group can be treated and had aing and manage that and i appreciate that question. i'm still concerned with the under 12. >> under 12. thank you. >> thank you. >> commissioner christian. >> thank you, president green. it is thank you for this presentation, very rich and helpful as always. in the slide behavioral health residential needs and you spoke

about, prim --preliminary recommendations, can you talk about the 9 percent does it include people who are higher needs? how do you balance that out? >> so i knew as i was reading that that that was, it was a statistical maneuver. the average wait night and waiting to go below zero. so inclusive of the difficult. i don't know what the term, the most complex folks, because we don't want a situation where we're mostly placing every one except what we see already some very long stairs and i know you're aware of those folks.

we want to build services that will take that, that we're not finding as it is sometimes now, the most difficult place. so the 95% was really for statistical and i appreciate what you're asking. >> thank you, i knew you would. and so of course, as you know better than i do, the people who are, have a more difficult time finding appropriate places for, is that in part because of the unusual nature or the not usual nature of a residential facility having the expertise for let's say forensic clients who have a series history of violence in the community? >> yeah. so first, let me also say that this is not a san francisco,

exclusive san francisco problem. and if you read, the rand rater that i referenced, be really it described the same situation that we are challenged by. and i think it is that residential care, the majority, the many residential care providers are not always staffed or willing to take on some of the challenges that turns out many california counties are sending. i think there is a well intentionally, our well intention finding care placement for as many people as can be in your, as you're asking diverted from forensic

karsral settings which every one is on board with and having the mix match expectation that's there is homes in behavioral treatment for them and i think what this really highlights is cultivating whether it's new providers, new services, building it together, with a potential provider to try to solve for this. people are not left behind or left out. >> thank you, and when you, speak to the powers that and

the funders at all levels, is this something that would profitably be emphasized to them? >> meaning? >> that there is a need, everybody in your situation knows there is specific needs always, but this specific need is one of them that is crucial for a lot of when we're having this conversation this is part of what we're saying and negotiating and conversing with providers about. >> as much as you think that it is useful i think it would be helpful for that to be emphasized in a public way when you talk about these beds and these facilities, you know, again to the extent that you fill it could be useful. >> absolutely.

you noted in some of our comments that we had the pleasure of having dr. at the jcc meeting and he and dr. jarlet noted that there is about two shelters that are, focused or able or willing to take people who have behavioral health needs. talk about whether it takes any sense for dph for the city, for the state to have department health having shelter beds that are specifically for people with behavioral health needs, not just one or two that may take. they obviously have some that's like two beds or something like that. >> yeah.

>> commissioner, just to clarify, those are two beds for all the hospital for everybody, they're not specific to behavioral health, two shelter beds in all the hospitals in the system for 24-hour period. >> okay, thank you for that clarification, i appreciate that. even worse. so does it make any sense for there to be any move towards creating specific more specific facilities or beds under the supervisor of whatever entity is appropriate, whether it be public health department or the hsa or whoever does it. >> i know that the issue of shelter in san francisco is so, you know, obviously for shelter is needed than we have. and i think that the design i'll just offer the design of the program and what really is a, the right model, the wrong

model, i would just sort of offer the faith as we're hearing two shelter beds, across the system beinger it's hard to even go where you would like to go which is really what is the right design of a particular shelter when we are still work withing very few beds. i will say differently from what you're describing, one success in the last couple of years, has been the opening of what we have been calling psychiatric beds coming from valencia that is a discharge destination. i know we have spoken about sometime discharge destination for street teams and i would frame it as morality na tiff to emergency department. we are obviously, and you all know working on a crisis what

we have been calling the stabilization unit which will be alternative destination to the department. so i think where behavioral health has been really working is thinking about some of the lower barriers sites that both can stabilize people in lieu of emergency department and also offer psychiatric res pid. >> thank you for bringing that up and thank you for this very meaty yet clear presentation on a lot of amazing work that you've been doing. thank you. >> can i just ask doctor, i think we're also for the 24-hour, for the night time treatment program, we're essentially proving the

hypothesis that if you give people a place to go they will most likely go on treatment. this is related to the conversation. >> so as part of the evening tele health pilot that we implemented, we have identified some hotel rooms that we can tie medication with hotel room. we find when there is a hotel room with next day follow-up with a navigator folks have a pretty high rate of filling a prescription continuing with the prescription and with their medication and we've been able to provide hotel rooms for 7 days, 7 nights while we're working on next placement and next steps. so i think this is a really good example as dr. colfax just

mentioned and thanks for reminding me to prepare the shelter with the health intervention. >> that is a fantastic idea that is now a reality, so thank you. >> team. >> not surprised. >> so i guess, and thank you so much for this. can you clarify one thing, you got the slide that talks about shelter behavioral health. how does that correlate with what we're talking about with shelter beds? because you've so well explained that entry and moments of engagement is critical and that's part of what this night time tele health is going to do. but just curious to know how that relates to this challenge of two beds for the city per night. >> so the shelter behavioral

health team which is part of our office coordinated care is the team working with, within dph with our physical shelter team to work with people in shelter who have been identified as having behavioral health needs. sometimes that work is around coaching the housing case manager, sometimes it's meeting with staff, the problem solve, it's somebody that needs care or maybe somebody just having disruptive behavior. and to try to work with either the client or the shelter team to problem solve and get the person the care into the care they need. so this is not about navigating people into the shelter, this is where people already in shelter.

in as - >>. thank you. >> the next item on the agenda is calaim medi-cal and have our sponsor and bernadette our sponsor. >> hello, everyone good afternoon. i'm marlo for the bus transit district services been a while since i've been here we're going to have a presentation and joined by the director for the behavorial health network and we're happy to be here to do a presentation very briefly our next item. very briefly we're going to give a brief remainder and talk about

the leadership role in the medi-cal san francisco and share data about the impacts we're seen so far. and next slide. so calaim as a remainder for the commissioners is really a significant um, transformation by year transformation of medi-cal system in california and huge deal one to three california on the medi-cal system in san francisco about 200 and twrief thousand people that eligible for medi-cal and a speaking overall goal is outlined four about looking at people more holistically from trying to bring in a more comprehensive set of services and improving the quality of services trying to address some

disparities to be more efficient. and seamless and they're doing this through a number of components and really overall feasibility study introducing new benefits and found gaps in available services and streamlining and improving the coordination and non-traditional support and help to address the health barriers providing incentive funding to really drive a lot of change and help the systems have the possibility of overall increasing strategies to um, rile help folks enrolled and can benefit from medi-cal in all of this. next slide, please. so the um, calaim has a lot of

components. we don't have to do a presentation we think of - but wanted to i'll talk about the behavorial health transformation work and all of the initiatives and multiple things happening and a couple of things i want to highlight on this slide one is the wheel to the right here really highlights a how many county level partners are involved and justice departments and institutions and community-based organizations, and level of coordination happening is really unprecedented and calaim pulling the partners in many cases in the city of fresno this is very helpful i wanted to give an example of one of the initiatives the justice involved

work that is happening and obviously a high priority population what calaim is doing it is among striving screening for folks they come into the jail and supporting them to get enrolled and paying for services 90 days and doing a lot of things on the discharge and really mandated connections and into the community care and ben detective will talk about what those services look like but an example of one of the initiatives happening. and. next slide, please. one thing it is focused on medi-cal managed care and so in san francisco we have three

medi-cal and san francisco and blue cross blue shield and next as you all also probably remember the dph operates two spltsz medi-cal any member of the public wish to speak on this item care and the mental health and the drug medi-cal operations and so this slide is showing the research from the dph into the managed care plan and ultimately for providers san francisco health net is a big procedure if mix as well as dph and other of our dph contractors providers and then ultimately serving the members and another thing just on the managed care fund prior to calaim were about thirty percent in the medi-cal numbers were not enrolled in and now

approaching the high 90s a model of care and what was? >> yeah. i made the point and a lot of the fund going to the medi-cal managed care plans and so we are working closely with them to make sure the services are 2k3wr5g9d in the dph systems and next slide, please. so again, i won't go into all the details on the slide but calaim tries to provide services for populations that are focused and it is, you know, the same population the dph has tried to prioritize populations that we know have a lot of different health disparities and district access to care and not having the same outcomes we want everyone to

achieve and calaim benefits all calaim and people in the system really falls out to specific individuals you've hear that from ben detectives comments. next slide, please. and i'm just given time not going to i want to highlight which talks about someone is ongoing challenges 51/50 households and have treatments and in this situation paid for with the intent happened to someone from our office in cal management and the services allow times for people to engage not having treatment but build relationship in this situation and, of course, over time will

build the trust and up more stable and for the emergency services and. next slide, please. hand to over to ben detective and back in a couple of slides. >> thank you i'm bernadette and i'm here with my executive sponsor. next slide, please. and excited to share with you about the way that pedestrians impacts dph you but the city and county of san francisco and residents of san francisco and currently 5 vacancies across the city and county of san francisco. who are leading the inches and san francisco is leading the way an example dph has provided the critical

infrastructure and contracting fenton street for two city agencies and hsh. to be able to provide enhanced care management and community support and as well as leveraging their network so the stark contrast to be able to having their own infrastructure for the contracting and direct operational management for them and examples of the hsh and being able to give me with calaim the efforts are provided coordination for clients for laguna honda hospital with our relationship and workload of hsa and calaim supports that foundation for hsh to be able to scale their support. additionally, we have our dph

jailhouse services team leading this initiative i understand that is two folks were here sharing an overview and since this is close cooperation with our sheriff's department and hsa and many other agencies and community-based organizations and care plan, our special programs is leading the planning for we believe reentry for laguna honda and that's, of course, with the initiatives and two additional city agencies operation and ihss are leading the application systems for the initiative. and in general our partnering and our cbos leading to cross agencies and data sharing and design and

implication and scaling the medi-cal enforcement and re-entry services. next slide, please. some additional examples of cross coordination is calaim helps to streamline the workload and help with the experiences and one example a community support modification. community support of programs that has been defined are cost effective such as entering room or hospitalization and so considered. >> community support example of home modifications are like you see in the photo so that plans throughout this in the background setting have a feature set up for the mobility

and risk of - and as we been preparing to luncheon with the community support we understood that an exercise are all providing services consistent with the modifications and so we brought our key stakeholders into the room to discuss what it is and just by getting stakeholders into a room together we learned there were significant duplication and by diving into the current states we have the place of streamlining to resonate the processes and especially important increases the team members experiences next slide, please. and a little bit about the hsa so really

focused on the role of b h s with the mental health plan and has a number of initiatives over multiple years and on the top highlights two of biggest shifts happened in the system first is the adoption for mental health. and what this is done to the healthcare system modernized and streamline how we get to this getting us away from the healthcare and moving towards health risks and working to support our providers to spend a lot of time with the clients and less time with the charge and things are complicated to this has been a welcomed change you can only imagine a huge lift for

uses of care and services about the changes. and payment reform is another significant change ongoing and really had is happened over the reform the state is paying is some different - and moved to services model and then that trickles down and will change how we pay our providers but moving our providers over the next couple of years to service structures and i know a lot of it is happening change will really roll out and one managed care plans color together with a speciality so now about the collective use with the same training tool to identify the specialities services for they

belong with the non- specialities with the mental health services and shared way we're um, using the transition to share that information and we are also implementing the health care management and benefits of the programs that bernadette talked about and have expanded management which is really the only evidenced treatment available for meth men and one last a huge lifting for us, we currently have two contracts with the state and those contracted have separate reporting and those we go separate audits and over the next couple of years and coming

together we'll have like top one is mental health services access and behavorial health services and have one integrated health plan in san francisco and the state ultimate goal so have all the managed care plans work together a ways away for us but a lot of change happening next slide. >> so we have the benefits of care coordination talked about that quite a bit this afternoon and talked about the healthcare management for the team through this calaim benefit. so enhanced care management is a medi-cal benefit under the managed care system and what it is a - it is really a high attach person-centered program whereby

a client is soifrnd a case management and community health working with the clients experiences and can be a registered nurse and social worker and that meets the needs and functions within the environment with a collaborative approach and with a air traffic controller how to help them have a successful um, and under calaim in 2021 a new function for the staff we identified courage care equipment team were perhaps in the general fund and providing services that were aligned and converted to the medi-cal requirements. and we are also able to add our organization and develop new

teams examples for the medicine team and the brand new discharge team that are be lodged this summer and our teams are embedded into the health systems of care and community so a our led case management are in hospital and taking emergencies and primary care in our housing department and shelters in the neighborhood to might the clients and opportunity for our am to help those individuals to truly so the highest clinical issues. next slide, please. . and so in regards to our case manages to meet people where they're at this is a in his

visible to show you where our clients are extremely located in san francisco next slide, please. as you can see the d c m enrollment is bigger than 2022 our method for increasing enforcement includes expanding the care team and workloads and close partnership with the management plan our d c m enforcement is 50 percent compared to the average of 25 percent we are very proud of our enforcement rate and attribute it to having community health workers that have exercise and supporting the enrollment and

into our demographics is more details we can really understand the disparities and our methods were about outcomes and so we're starting to understand what is the age range of our clients and what is the reason as is clients we're serving and we're planning to significantly dive deeper into this work. by better finding the breakdown of the processes we outreached and enroll persons with the disparities and looking ethnicitys and. next slide, please. and another one of the calaim initiatives community support we found to provide a foundation to

allocate because of prior steps by the care programs we found we launched 4 community supports are supporting hsh and the today and the medi-cal billing and adoption and reporting requirements into our existing program. and some of the programs have become calaim support includes centers this is you see here. and both are care and respite and the programs and our housing navigation and transition and we found those practices providers and leaders are required to follow up are including the data driven and linkages to care and providing an ongoing data revenue source.

next slide, please. another initiatives within calaim a large umbrella is the population of the management initiatives and medi-cal is requiring a plan for the population of management initiatives and concentrated in the holistic approach to improve the um, of the individuals and predominately through the data storing to provide services to provide members with the right services and support in the population. we have either begun the implementation of the two key initiatives under the population health management umbrella and one of them is called population needs assessment our population division is leading those

efforts and leading those efforts whereby the management care plans now under calaim are required in our community health and holistic assessment and so for several months our population health division with the network representation and our three managed care plans for san francisco come together to look at data sharing, and what the goals of the population health management and our addressing one shared goal over the next several years those goals is to improve the percent of children to - decrease disparities and - this work will continue over the next years and one additional initiative over

time indeed so we have talked about providing medi-cal coverage and about disparities that claims the frustrations. and so i want to share some data how medi-cal coverage is provided to the clients in incarceration and so prior to calaim individuals who became incarcerated lost their medi-cal status so under calaim not only is there a requirement to scale up insurance screening with the pedestrians application support but clients no longer are incarcerated actually get their medi-cal and soft their incarceration they get released the majority of them do and have gaps if health insurance and hsa

does the medi-cal conform and data sharing about the release that medi-cal conform will be unsuspended and have access again in the community. so, so currently our plans to the county jail are screened in the past that was objective question so uniform more reliable - and for the support clients uninsured in their time for medi-cal scaling up and then um, we talked about this suspension and unsuspension i wanted to respond to one question that i received that i didn't have enough data on this morning but this average with our partner with ihss and questions about the juvenile health since are

leading the applications in juvenile hall and shared with me is that the applications they received for medi-cal the vast majority finds the plans they have medi-cal so up stream that is not recognized earlier think in the process but that results is that seem to agree and the plans not having medi-cal um, are special programs for the team and agencies team shared that unfortunate they're finding that the plans that the parents are not responding very much to their efforts to help the client get on medi-cal. so - i'll also share that, you know, this work is that set up to provide the entry services