>> next public comment speaker. ~ i'm asking for continuance for the same matter but a different reason based on the sunshine ordinance. >> when that item gets called, then you can request the continuance. sure -- >> [speaker not understood] this is not an appropriate time to discuss the matter. okay. thea are going to be people who are coming -- >> sir, if this is about 480 potrero, this is not the time to discuss the matter. thank you. >> is there any other agenda public comment on items not on today's calendar? okay, general public comment is closed. next item, please. >> commissioners, it will place you under your regular calendar, item 6, case no. 2013.0360u, health care services master plan,

information public policy recommendations. >> good afternoon. is this on? >> did you want to use that one? >> i prefer this one. >> go ahead. >> thank you. good afternoon, commissioners, claudia flores, department staff. we are pleased to present to you the case services master plan which staff has been working on for over two years. in a few moments you will hear from [speaker not understood], deputy director from the department of public health on the background of this legislation and the inclusion of the plan. the first i would like to acknowledge there was [speaker not understood] by supervisor campos and his aide is here today and we will hear from her at the conclusion of the presentation. and also before we start, i'd like to mention this is truly an inter and intra-department collaborative effort. in our department, [speaker not

understood] have been working on the plan. and this health care services master plan and dph being the experts on health, soey [speaker not understood] on maternity leave and couldn't be here with us today as well as collene having been the primary city staff leading the preparation of the plan with the support of our director barbara garcia. also like to acknowledge members of the task force or of the public who may be here today who participated in the community engagement pro shes. [speaker not understood] truly informed the plan on where the key gaps and needs are. so, before i turn it over to collene, i just want to give you an overview of what you'll be hearing today, if i may have the slides. so, again, like i said, collene will give you an overview of the plan. and then we're going to talk to you about the key findings by assessment, the legislation required certain number of assessments and that was in your memos. and then [speaker not

understood] will talk about the recommendations and the determination process and it will be kind of less [speaker not understood] for the planning commission and how planning department staff will use this plan. and then we'll wrap up with some next steps on approval of the plan. so, i will turn it over to collene. >> thank you, claudia. and commissioners, it's a pleasure to be here before you today to talk about the master plan. this has been a long time we've been working on this plan for a long time. and i want to say that one of the greatest things about working on this plan has been our opportunity to work with the planning department. i know our director garcia and i both really appreciated that opportunity and it got us to be able to look at our city in a holistic way around health care services and the delivery of health care services in our city. so, we really appreciate the opportunity that this legislation sponsored by supervisor campos provided for us.

so, just a little bit of background about the health care services master plan. i think you all are very aware of the history, but i'll just be brief. ordinance 300-10 was passed in 2010 sponsored by supervisor campos and became effective in january 2011. and really the purpose was to identify current and projected need for health care services in san francisco and to make recommendations on how to achieve and maintain an appropriate distribution of health care services. the focus of the work that we looked at was on access to health care services for our most vulnerable populations. so, how will the plan be used? the process of deciding whether an application adhereses to the health care services master plan is called a consistency determination. and certain projects will be subject to a consistency determination. not all projects. there are five thresholds for any change of use to a medical

use that's more than 10,000 square feet and any expansion of an existing medical use that's greater than 5,000 square feet. this definition of medical use you probably don't need. this was prepared for our health commission which was quickly becoming more up to speed on land use terms. so, who will use the health carev services master plan? the planning department primarily, the primary audience for the plan was -- is the planning department. when they make consistency determination decisions on medical use projects that are before them. ~ also the department of public health and our health care stakeholders will use the plan for planning purposes. i'm sure when you reviewed the plan, you saw that the recommendations in the plan addressed policy issues as well as land use decision issues. so, that will be -- it will be essential for the work of our health commission and the health department. and then also other policy makers, the mayor and the board

of supervisors. the intention was that it provide information that gives an overview, a snapshot of the health care -- that health status and health care landscape in san francisco. so, a little bit about how we developed the health care services master plan. we really looked at qualitative and quantitative data. the quantitative side, the health department was working on some other health status projects which i'll talk about in just a quick second. but we had what was called the community health status assessment and this is indicators of over 150 indicators about the health status and socioeconomic status of our city. so, things on demographics, socioeconomic indicators, environmental health indicators, health and well-being. and we use those data to inform the work of the master plan. we also were -- performed the five assessments that were required under the ordinance. they are the health system

trends assessment, the service -- sorry, the capacity assessment, the gap assessment, the land use assessment, and the historical [speaker not understood] assessment, and we will provide a brief overview of this key findings from each of those assessments in this presentation. but equally important is the qualitative data that we received and our primary source of this qualitative data was the work of the health care services master plan task force. the task force met over about a year period. it had 10 meetings. four of those were in the community and it really not only provided the feedback of the [speaker not understood] task force, but also the individuals who came out to the community meetings to speak to the task force and have their voices heard. in addition to the task force work, we convened six population based focus groups and four neighborhood based focus groups. so, all of that data together informed the health department, the planning department as we put together the draft master plan that you have in front of you today.

so, just a little bit on the task force. as i said, this was really the primary source of our qualitative data for the master plan. the co-chairs were ms. rome a guy who was previously the chair of our health commission ~ and advocate in the community as well as dr. thomas aragon the health officer and population health division within the health department. this advisor body chose to focus on access to health care services, particularly for san francisco's under served populations. and it's with that line that they made a series of recommendationses to the health department and planning department in their final report that would inform the work that we did as we developed the master plan. the task force had 41 members that were broadly representative of the health care community and more, all hospitals and clinics were represented as well as business, physicians, consumers and others were represented on the task force. as i said previously, they met 10 times, four times were in

the community and specific neighborhoods that have the highest health disparities in san francisco. so, that was bernmission, addition, anbas point. we engaged more than 100 community members at each of these four meetings and i'm pleased to be able to have engaged so many folks in the development of the master plan. this is just a little bit about the work that we're doing as a health department and how the work of the master plan feeds into that. we have several projects going on in the health department that really senterra round community health assessment. ~ what is the health of our community look like and what can we do to improve the health of our community. i'm not going to go into all the details here except to say that this aligns with all of the other work that we're doing. the framework of the recommendations that you'll hear more about shortly follows the work that we've been doing to improve health community wide.

it falls under three health priorities that have been identified by our community as critical to moving forward. those are ensure safe and healthy living environments, increase healthy eating and physical activity, and increase access to high-quality health care and services. and of course by the nature of the master plan itself, it falls primarily under that third priority, increase access to high quality health care and services. so, as i mentioned earlier, there is a 5 assessments that were required by the ordinance. because we're doing all the additional community health assessment work, we include the first one which was community health status assessment which was the hard data indicators about the health and socioeconomic status of our residents. so, we'll go through each one briefly. overall, we found that all of the assessments together, we found the key take away there that san francisco offers many health care resources to residents.

that is the [speaker not understood] health care providers, sufficient dentists and others to the population is high when you compare it to other places in the state and in the nation. however, availability does not necessarily equal access. and we found that some populations by neighborhood, income, race ethnicity, [speaker not understood], struggle to access the health care services they need. we're fortunate that our providers have a long history and commitment to serving the city's diverse population and healthy san francisco has helped to engage our largest providers to together address the needs of our uninsured population. healthy san francisco has also better prepared san francisco for health reform and while we would likely fair better than our counterparts in other counties and states, health system trends specifically health reform will place greater demand on our health care resources. finally, given the existing

known medical use development projects in the pipeline, san francisco is in large part on track to meet residents' evolving health care needs. specific attention will continue to be needed for our most vulnerable populations. the community health status assessment is that assessment that involves more than 150 indicators along with 10 broad based categories. the key findings here are not surprising. san francisco is a culturally diverse and changing community. we have health burdens that are tied to social determinants of health, income, poverty, and education status. cardiovascular disease is among the leading causes of death in san francisco much as it is in other places of the country. and again, we have many health care resources available to our residents, but that does not always translate to access to care for those who need it most.

the health systems trends assessment was intend today analyze trends in health care services as they impact the city. this includes disease and population health status, governmental policy, disaster planning, clinical and communications technology, trends in reimbursement and funding, work force and other things. the major issues that were addressed in this paper, in this part of the report include medicaid waiver, health care finance trends, health information technology and innovation and the impact of those on health care delivery. connectivity through serve at thex through geography, transit, language, literacy and culture, disaster planning -- and disaster planning. one example of the impact of the most significant health system trend, health reform is 30,000 number that you see here. 30,000 folks currently uninsured in san francisco are

estimated to move into medi-cal in 2014. the ordinance also requires that we prepare -- for us to prepare a capacity assessment and a gap assessment. the capacity assessment was intend today quantify the current and projected capacities of existing medical institutions in san francisco, including emergency services, hospital services and more. and the gap assessment was intended to identify medical service gaps across the city and medically under served areas for particular services. viewing these components as complementary, we combine them in one assessment in the design master plan. the key take away is given its small size, san francisco offers residents better geographic access to services than other places in our state and across the nation. however, certain geographic areas in subpopulations struggle to access the care that they need. as an example, limited

transportation options impact access to care. again, it's worth repeating and you'll see this comes through over and over. we have many service providers relative to our population size, but gaps in service access still exist. and we have an aging population and we may lack sufficient long-term care capacity to accommodate our growing senior population. and finally, our diverse population requires access to culturally and linguistickly competent services in our community. ~ the ordinance also requires a historical role assessment. this is intended to take into consideration the historical role played if any by medical uses in the city to provide medical services to historically under served populations. this assessment tells us that san francisco has a robust network of providers who have a long history and commitment to

serving san francisco's vulnerable population. at this point i'll turn it back over to claudia to continue. >> [speaker not understood] mentioned, the ordinance also requires land use assessment and the [speaker not understood] the planning department took the lead on preparing this assessment. this assessment is intend today assess the supply and demand for medical uses in different neighborhoods in the city. [speaker not understood] we looked at square footages or supply and demand for actual physical space. not demand or supply of services. so, we looked at how many in our facilities are distributed throughout the city. this particular map in front of you shows where hospitals are -- which are the red dots on the map and where primary clinics are which are the blue dots on the map. we also looked at where medical uses are permitted -- not permitted and where required the conditional use. and in terms of to analyze [speaker not understood], we looked at projected job growth in the health service sector as

well as population growth to get an estimated square footage needed for demand for future physical space. the legislation also required a general discussion of potential impacts on land use [speaker not understood] medical uses could have on other uses such as neighborhood serving uses. going to key findings, as mentioned, san francisco does have many health care resources available for residents. many providers relative to population size, more hospital beds per population than the state, and [speaker not understood]. in terms of square footage, currently we have approximately 25 million square feet of medical uses in the city. this is approximately 10% of all the nonmedical uses -- i'm sorry, nonresidential uses in san francisco.

we also have approximately 2 million square feet in the pipeline. this includes large projects such as ucsf mission bay, cpmc. [speaker not understood]. it's also important to note the distinction between clinics and hospitals and private offices and this is because hospitals, for example, have a really large service rate. [speaker not understood], they may also be region also. we don't want to say that every neighborhood needs a hospital. you couldn't have that many hospitals. they tend to be larger facilities. we found out approximately there are 40 registered clinics in the city distributed throughout the cities, 11 hospitals, and more than 5,000 private doctor's offices. the clinics and doctor's offices are located and distributed in smaller buildings throughout the city. our demand analysis based on, again, population and job growth in the sector, we estimate that about 3.5 to 2 million square feet will be

needed by 20 35 to meet population and employment growth. as i said earlier, about 2 points of million square feet are already in the pipeline. so, we're looking at anywhere from .8 to 1.5 million need in terms of square footage. this is relatively small when you look at the 25 million square feet that already exist, and we think that this space is likely to happen mostly in clinics and private offices throughout the city. in the neighborhood commercial districts and other areas. these could be new construction, but it could also be new leases in existing buildings. however, we also think that innovation in health care delivery and technology could shrink that demand over time. just really quickly, this map shows where clinics are permitted per zoning. the green shows where they're permitted sf white. the blue shows where they're

permitted with a conditional use. and the take home is clinics can pretty much go almost anywhere in the city. of course, at certain places they're required conditional use because we need to see whether they are an appropriate use for, you know, in residential areas or in some of the smaller neighborhood commercial districts. [speaker not understood] map for hospitals, but because we thought that most of the additional demand would be met through clinics and smaller private offices, we are showing the map for the clinics here. and lastly, in terms of the key findings from all of this data, we think that based on the amount of existing space and the space in the pipeline, they were relatively -- in the relatively small demand for new space, we think san francisco is on track to meet its health care needs in regards to space. [speaker not understood]