may be recommended for incentives meaning favorably considered depending on the project's benefits. liz will talk a little bit more in just a second. address more operational needs for health system improvements such as collaboration and cost effectiveness. all of the guidelines are not highlighted as eligible for incentive illustrate the importance of broader policy recommendations to better community health and wellness i'm now going to turn it over to liz wadi. >> thank you claudia i'm elizabeth wadi i will now discuss how the plan's recommendation framework. some of the recommendations of the

plan are policy based and. while other this is where the process comes into play those projects that involve medical uses of a certain size will be subject to a consist see determination and the process is a requirement of the master plan ordinance previously adopted by the board. the consist see determination process will weigh project merritts and the task and encourage the development of needed healthcare infrastructure and without creating negative land use consequences. consist see determinations first incentives

this determination could apply to project on balance address the guidelines as being eligible for incentives. may be second the consist determination this would apply to those projects that positively impact health or healthcare access but don't specifically address the recommendation that identify eligible for incentives and lastly inconsist determination could apply to projects that do not positively address the guidelines and conversion ly projects that adverse ly effect access to healthcare may also receive this inconsist determination these determinations will be based on a balanced assessment of the project as a whole and will be made by the department of public health staff. dph will forward the recommendation back to the planning department

where we will post the recommendation on our website for 15 days as lori mentioned we're now at the end of a 3 year plus planning process and excited to move this plan to the board for final approval and this plan is required to be updated every 3 years to be sure it's consist with the city's healthcare needs and that concludes our presentation. we're here and available for questions. >> thank you colleagues and as you can see from this report there's a lot of data and information here and you can see that there's information not only citywide but also neighborhood by neighborhood so why don't we turn it over to some questions supervisor mar. >> i wanted to thank all of you for the great presentation and the 3 years of work and the tremendous community engagement of supervisor campos and

hillary a pretty amazing amount of effort targeted at great policy making that's equitable and in the best interest of the whole city and i want to say in looking at some of the maps not only the impacted neighborhoods that supervisor campos and others like the mission, be rna l and neighborhoods at least 2 hospitals with close access to kaiser as well but there's tremendous concern this process creates an equitable process or will help us but i want to ask about the incentive based system and how a consist approvals or consist see with

our values would have given more incentive to different projects and where an inconsist project might have been more challenging for the project sponsors and maybe you could use the original proposal saint luke's what would -- how would this process have looked at the original proposal to close saint lukes? and how would it have looked at the large 500 bed -- proposal. >> commissioner with the planning department at previous board hearings that same question was answered. but as a whole and said that project would be considered with this

master plan so i don't want to necessarily pull out saint luke's and she spent a lot of time looking at that question but the highlight of this process and importance of this process is that the planning department is not going to be making those determination it's going to be our healthcare experts along with the health commissioners that will analyze these projects there's more than one factor to any given healthcare project so it doesn't specifically answer your question about saint lukes but the project on a whole would have been considered consist with the plan. >> and just to add on your incentives question any project initially if they were to be inconsist they would have a chance by looking at what this plan did and looking at the recommendations and to become

consist and they know ahead of time what we're looking for so that they could achieve consist see and we could consider them for incentives. >> could you explain a little bit more the types of incentives that are used? what would the other incentives that are used? >> so far we'd consider expedite d review. there are other things that we're considering. i think because some some of these recommendations are operational in nature as opposed to actual land use it's really hard for us to give kind of land use incentives such as increase the ratio or anything like that but we're still exploring fee referrals requiring board legislation so

if that's something that the board recommend that the planning department pursue come back with legislation. we're also going to look at are they specific areas in the city where we can create smaller special use districts and ensure that we allow these uses at the right and that these special use districts may contain other incentives -- it's just really hard to say because different projects need different things to work. in the southeast quadrant they might need more parking so we're still looking at whether there's something land use or physical specific that would be helpful but for now priority processing seems like a good idea. >> can i just ask one last follow-up question? i think for miss cook and the department of public health, if there were projects or proposals

from within the department of public health like moving the dialysis unit or closing neighborhood health centers -- there's some kind of health impact assessment -- is that built into any of this if their project moves or potential closures that help centers -- does that fit into the master plan and how would that work? >> the determination is triggered by five locations so if the department of public health were to take a non medical use and convert to a medical use assuming it it would be subject to the health services master plan so the conversion of a non medical use to a medical use provided that

would occupy 10 thousand gross square feet or more alternative ly expansion of existing use a couple of things the medical use definition would have to be met a definition that varies throughout the planning code currently and we'd have to meet certain size thresholds so in terms of a determination those are the triggers that would trigger that comparison however i will also say that we at the planning department have invested a lot in the creation of this document so you can rest a assured that the values set forth here are guiding the work that we do. >> looking at the studies and other presentations even just understanding the asthma or death rates in other neighborhoods and if there's a

potential to close neighborhood -- but you are saying that it's only triggered if there's large changes of use of buildings and might not cover smaller changes within the department of public health. >> i think that's true but again we are guided very much by the values set forth in this plan so we'd take into consideration those certainly before making any decision. >> great thank you very much. supervisor yee. >> yes. thank you for the presentation and all the work that the task force or committee has done putting all this paperwork together. i'm just curious i didn't get a

sense ever whether or not when you ask for input and people came to these meetings were anybody or organization that came to the meetings to -- that come from the perspective of children and family in terms of what their needs are? i just couldn't tell. >> that's true. i think in the southeast sector specifically we got a lot of commentary in that regard and we also had one of our focus groups was focussed on the excelsior neighborhood and families so we did our best to capture that information to make sure we're capturing the needs of the

entire population younger and old. >> can you give me an example of their input reflected into recommendations? i just don't get a sense of this. >> right. i don't recall actually. >> well, i have one other question that i was going to ask you i think it references children for instance so one of the -- and by the way i think the challenge that i see with this is that there is so much information that i really want to make sure that we digest it and that policy makers actually know that this information is there because this is pretty impress ive information so one of the points noted here is looking at neighborhoods city-wide and neighborhood by neighborhood that if you look

at neighborhoods that are perceived to be unsafe, and i guess that's defined based on crime data and other statistics that 62 percent of children in san francisco who live in neighborhoods that are unsafe have no primary care medical home and then if you compare that to those neighborhoods that are considered to be safe, the number is inverse so in that case, in those neighborhoods, 61 percent of children actually do have a medical home. so 62 percent don't so 2 thirds more or less in those unsafe neighborhoods and in the safe neighborhoods it's the opposite so that's sort of an pam example of you know data that reflects what's happening to kids in these neighborhoods i don't know how that translates to the

recommendations but stood out to me. >> recommendations fairly broad but you have specific guidelines and i think claudia has an example here. >> yeah. just to follow up. they talk about prenatal care specifically for example in these neighborhoods where we identify those gaps. prenatal and primary care is important to children and the family. >> thank you. >> so if i may follow up on sort of those questions and again, you know, i think it would be really useful and i will be interested in sort of getting your thoughts on how we disseminate this information to all of the city agencies that are doing work that impacts the populations i mean all the populations in the city that are talked about here and so

i'm wondering if you can talk a little bit about sort of how you, you know, how you see sort of the dissemination of that information so for instance you know, one of the things that also -- another tidbit of information that was interesting was that there's a projection that the population in san francisco over the age of 75 will increase from 7 percent to 11 percent of the population by 2030 and of course we're talking about a population that has a higher need in terms of health services and so one question that i have looking at that, you know, data point is -- how does that change what we're doing in terms of, you know, the services that we're trying to provide to our seniors and

are we preparing for that increase before that happens? >> okay so claudia and liz may have a good perspective on conversations about disseminating information that have taken place over the last few months. anyone who has ever attended the master plan task force meeting send us an e-mail call us they are on our list anytime there's been a revised draft about the plan they have been contacted so they can keep up to date with the changes that have taken place and so forth so ever since this process began we've been doing our best to make sure that they are aware of the plan and the information it contains as you highlight it does indicate that we have very specific needs here in san francisco that need to be addressed and also the 41

member task force very much involved in senior issues we're doing our best to educate folks about information that the plan contains and claudia, do you have information about additional plans for communication? >> we don't have any plans at the moment but we want this to be a living document and not on the shelf so there's guidelines about out research reach and education we can prepare follow up steps. when we go to events in the community and talk about what we're working on so we can prepare a one page fact sheet or something. >> one thing i have in mind and maybe this doesn't make sense but for instance every city agency that does work with the senior population, that there should be something that

summarizes all of the relevant data about seniors and their healthcare needs today and in the future so -- we want to make sure that our agencies that are doing this kind of work with seniors have the data that's here in this report and with the hope that that data will inform some of the policy making. you know, the goal here was to have you know a better understanding of our needs and of course making sure that we tie, lanld use to that understanding and could be more useful and i think the same thing with any agency that does work with children i'm think of dcyf for instance the department of children and youth and their families they

should have at some point something that summarizes for them i'm looking here at another example -- the report notes that in san francisco the number of dentists per 100 thousand people is 219 which actually pretty high compared to the state average of 85 you know so and yet it points out that -- and this number has increased it was 139 in $200,0005. however, there are many people in this city who still don't have access to a dentist. so how do we use that information to inform, you know, where we invest and what decisions we make? so that's what i'm talking about. >> yeah i think that could be a good follow up item for us.

that is a great follow up item for us and i want to say while we talk about the master plan being a product of the department of public health and planning department so for example a lot of the data you see there did come from the department of children and youth and their families and aging adult services so we tried to do in this report not to ignore preexisting information that has come out of other agencies but intended to pull all those data sources together so i think you are absolutely correct but i want you to be sure that we've done our best to make this an incl u.s. ive report. >> the impet u.s. is on the agencies themselves i think you guys have done an incredible

job and now it's incumbent on us to make sure that all the agencies are as informed as they can be chances are they are because they were involved in this process and participated and shared information with you but i want to make sure that happens. supervisor mar. >> i was going to say the rapidly aging population and how critical long-term care and the planning counsel their work help s us understand for budgets for the department of aging adult services and like the long-term plan are critical i like how there's ethnic

breakdowns and other demographic breakdowns too so looking at obesity by ethnicity and neighborhood is really helpful and a lot of our revenue generating planning as well i did want to ask about the affordable care act i know you quickly mentioned that but can you quickly comment on what may happen when january 2014 hit and see how we're going to -- how many more people will be covered and the challenges with difficult to reach populations as well to make sure there's maximum coverage as there can be with currently un insured. >> i can get that but however the primary changes is we're going to have more folks who are insured. folks will now be in a more traditional medical home so we do have quite a

number of providers here but they will see more patients because they will be able to be reimbursed for that care, at a higher rate than previously. >> so even those folks not subject to the individual mandate or do not qualify for coverage under the affordable care act will have access to care if they choose to participate in healthy san francisco and folks transitioning from healthy san francisco into expanded medi-cal and we know more people accessing care through covered california the state's exchange and the poverty level will be eligible for subsubsidies under it as well and the department of public health has been working and preparing months and months and

months for this transition and pretty well positioned to accommodate the changes as they come come january 2014. >> actually i had another question about technology and i know the even just more online diagnosis so people don't have to come in directly but within the master plan was there a look at with technology change how that's impacting our healthcare service delivery system? >> sure. the health systems assessment and embedded in that assessment you will find a section on technology and there's a couple of different ways this is going to impact going forward. under affordable care act providers need to be using electronic records so

providers can easily share information across jurisdictions a as appropriate so that's one change that's certainly going to be happening and in addition to that so for example remote appointments with providers if you are not able to get there whether it's web based or phone based or something like that and to be honest i don't know about plans for current plans for expansion but that's something we address in the plan and seen as a promising opportunity really to increase access to vulnerable populations to make sure they get the care they need. >> great. colleagues any other questions? i think that there's so much information here i think it's just really impress ive and incredible and

i want to thank you for all the work you have done and for the outreach and the reason why we had a 41 member task force is because we wanted to have every possible group and segment of the population represented in some way and i think you know we managed to do that but that also made it a lot more difficult to move this forward so -- >> thank you for the exciting opportunity. >> on the question of the incentives i don't know if the board has an appetite for pursuing something like fee deferral -- >> great thank you very much and just a final question in terms of you know the two agencies that have a key role here the department of public health and planning commission

-- have there been presentations to those commissions and i'm sure they are aware of the key findings and recommendations that were made. why don't we open it up to public comment. seeing none public comment is closed. >> colleagues do you have any other comments or thoughts? supervisor mar. >> thank you for making the $200,000 page document and 3 year process digestible and even the changes that you are making -- it just really is helpful and i'm really impressed i know it takes a lot of time to do that too but i really appreciate that thank you so much. >> what i've heard from everyone including people who are not necessarily so thrilled about this legislation is that

a lot has been learned about san francisco and the healthcare needs of the city of the individual groups and individual neighborhoods and i certainly would encourage my colleagues to go through the report because you can learn a lot about how your individual neighborhoods are served and populations are served and when you look at the national picture, there is no jurisdiction in this country that has this level of analysis that we have so this really provides a road map in a way that no one else has so i'm very proud of that and again wouldn't have happened without the incredible work of the planning department and department of public health so colleagues can we have a motion to file this hearing? hold on sorrow y, it's actually a

resolution adopting the master plan and running and so can we have a motion to approve the resolution so motioned by supervisor yee if we can take that without objection thank you very much. >> mr. clerk if you can please call the third item. >> the resolution of the city and county of the city of san francisco's plan for 20 three. >> great and here we have a presentation from bill widimyer from hsa. >> good morning supervisors. the item before you is a