but i do see it here so i think that's really good and that's what i had a question about. so thank you. >> is there any other public comment on housing? okay. >> good afternoon. i really do not want to have -- i know excuse me, i know he's a very good driver but they are -- i

really do not want -- we want to have a place in this city everybody be calm and nice to other people. i know this is not about the strike nothing about that but and i want to say thank you for helping out the bart and bart was on strike -- >> i have to interrupt you i'm sorry in the interest of time we were talking about the housing resolution at this time. >> oh i'm sorry i didn't know. >> it's okay. we're past

number 3 but there's additional public comment later. >> oh i'm sorry i didn't know what number we were on. >> would you like me to keep your speaker card for later? it's okay. >> i didn't know what we were talking about. >> it's all right thank you. thank you for your comments. are we finished with public comment? councilmembers have any other comments? then we shall have a vote. the motion is on the table to approval housing resolution 13-1. shall we do role call? >> councilmember hair i wong?

>> approved. >> denise. >> approved. >> approved. >> approved. >> co-chair a del wilson? >> approve. >> councilmember roland wong? >> approved. >> thank you very much councilmembers and we'll take a brief break now and we'll be back. we're going to they heard you. can the control room put the powerpoint

presentation up, please, for mr. has kell. haskell? thank you. >> good afternoon councilmembers i'm happy to be here i'm the long-term care principal investigator and i'm also the facility facilitator i'm here today to present the long-term integration strategic plan for san francisco. this is the result of a great deal of work. i'm going to give you background information on why it was prepared and then tell you something about what the recommendations are to be accomplished in the next two years so this is background for you. information about what

the long-term care design group is recommending and a heads up about what's coming because this is a big deal. so let me start out. this is a presentation that ordinarily would be given by a long-term care design group member this plan was prepared by the long-term care design group members for the department of aging and adult services i am not on the design group i facilitated that work and i'm presenting it to you today. next slide, please. oh, it's me. next slide please. [laughter]. okay. what is the purpose of the long-term integration strategic plan? it's to prepare for the transition to long-term care integration in san francisco and to determine what is required to improve the

provision of long-term services and supports for medical eligible older adult and see adults are disabilities. this is targeting people who are what are called dual eligible eligible for both medicare or medical and medicare. what is long-term care integration? what does that phrase mean? it means the integration of primary and acute care services with long-term services and supports as well as institutional care. so we're talking about bringing the medical model together with the social services model, and they will both be provided by managed care health plans to this population, the dual eligibles, those who are

eligible for med ical and medicare so an older population as well as a population with disabilities as well as populations who are older so it's a mix. this plan was prepared because california has instituted a coordinated care initiative. in january of 2012 governor jerry brown introduced the coordinated care initiative. its purpose across the state of california is to improve coordinate and coordination of service delivery for consumer satisfaction of the groups i mentioned and at the same time substantial

savings so they want to shift where services are provided. i should tell you that the coordinated care initiative is tied to the affordable care act. this is an implementation of an aspect of the affordable care act in the state of california. the affordable care act is intended to reduce the overall costs of healthcare and 15 states, including california, are designing integrated care models while the coordinated care initiative is california's demonstration project under the ac a. coordinated care initiative requirements beneficiaries who

also qualify will be enrolled into managed care health plans for their medical benefits. i just want to review at a minimum, at a minimum. ihss, mssp the multipurpose senior citizens program and community based services and skilled nursing facilities will be included and provided through managed care health plans there will be many other services and supports as well but those are required mandatory. the goals of calmedi connect -- we'll talk more about calmedi connect just for a bit. to increase

access use a person centered approach coordinate benefit and see increase the availability of home and community based services. also to maximize the ability of dual eligibles to remain in their home and see homes instead of institutional care and preserve consumer's ability to self direct their care. so where is calmedi connect starting in california? in 2014 the first 8 counties or the pilot demonstration project in this statal alameda, san diego orange, san mateo river side and santa clara so those count ies are now getting

up to speed integrating medicare and medical funds for the target populations in those counties to be served through managed care health plans. alameda county is doing an enormous amount of work we're tracking those closely. in 2016 there will be 8 other counties included san francisco we anticipate will be one of those counties in 2016 so what we're doing now is to take this time to get ready to learn what's happening in the other 8 county ies so that we can do the best possible job for all of the people who are going to be transitioning to this demonstration project in san francisco. san francisco is

what is known as a two plan model. we have the san francisco health plan which some of you may have heard of which is the public option and we have anthem blue cross which is the commercial plan and we have a third option the pace program provided through on lock so those 3 options will be available for the target population that i mentioned older adults who are dually eligible and they will enroll either by choice or they will be passively enrolled. let's talk about numbers. the numbers of people we're talking about in san francisco the dual eligible medicare dual eligible

means medicare and medical over 10 thousand people the same population 65 and up so we're talking almost 45,000 people this is a lot of people who are going to be served through these managed care programs. primary and acute care and long-term services and supports so that's a lot of background. that's why this plan is prepared the coordinated care initiative was introduced in 2012, 8 counties getting started in 2014 it's coming to san francisco in 2016 and it's part of the affordable care act at the federal level so that's all background. what is san francisco doing to prepare for this? the department of aging and adult services in

collaboration with the long-term care coordinating counsel created the long-term care integration design group and that includes dos, department of public health, the human services agency the 3 health plans i mentioned, and a number of key community service providers. i should say although he can not be here today i wish he was -- but could not make it herb levine also on the long-term care coordinating counsel served on the long term care design group representing adults with disabilities. what we did in this process was build relationships that we didn't have before. we didn't know the san francisco health plan, the department of aging adult services staff didn't know them we didn't know anthem blue cross so this 12 month process

gave us a chance to build relationships which is crucial as we move down the road. people had their say we did what's called a swat analysis strength weaknesses opportunities and threats and how can we improve the weaknesses and deal with the threats so we have the strongest possible system. i'm going over now not in detail but an overview of some of the recommendations time doesn't permit me to go over 13 objectivelies and 25 recommendations in detail. joanna said i can't do it you can look at them later but i'm going over an overview of them. >> improved access to information. that's going to be crucial so older adults

across the city understand what's coming. better access to information about long-term service and see supports. what this plan recommends is that the integrated intake unit at the department of aging and adult services be the central door not the only door to get information about long-term services and support so anybody can call up and that can be the bridge to the health plans so that people can get the services they need. we want to continue to use and examine best practice models like the community living fund and the diversion and community integration program. are you all familiar with those two programs? a little bit? none. the community living fund is a program of the department of aging and adult services in the

baseline budget now i think it's about 2 to 3 million dollars used to help people move out of the institutional settings and back to their homes and communities. it's much the same thing a collaboration between the department of public health and dos and community based service providers where they take person by person by person and work out the details to make sure they are able to live in the community so we want to continue to look at models like that and take advantage of them. we want to have greater caregiver support we want to strengthen family caregivers we want to have strategies to expand supports for independent care providers people who are socially isolated and develop respite services for caregivers especially people who are caring for someone with

dementia and training for the caregivers and family members as well and it's important to know that we want to have crucial long-term services and supports incorporated into this managed care model. these services either should be provided by managed care health plans contracted with community based service providers or coordinated or purchased by so this next slide shows you the services we're talking about. home care care management adult day care medication management nutrition transportation social interaction protective services ombudsman services behavioral health and accessible and affordable housing so as we

move into this new arena there's going to be a change some of the providers that we work with are going to be no longer giving their services or training for free, the health plans will have to purchase those services and provide them so it's a new day in that regard. >> >> another recommendation is an improved ihss program you might remember it's one of those services going to be moved into managed care the managed care plans will oversee the allocation of hours to providers this is a very dice dicey and controversial topic. so the department of adult services should take the lead into managed care i'm sure there's questions about this.

i can't give all the answers because they don't exist yet but it's part of the requirements from the state. we also want more training and career development for direct care workers and want to retain the independent provider model and the contract modes for ihss service delivery. >> one of the things we're going to have to do as this begins over the next 6 to 9 months, is to develop clear consistent messages to consumers advocates service providers commissions and elected officials: after this we go to the health commission the advisory counsel on ages and a variety of other places but we were asked to start here so here we are. we have a communications plan and we have

messages and we will explain this under taking because this is just the plan. it's the implementation of this plan that's going to make the difference in san francisco so we're going to be doing clear consistent explanations to all of those groups. how will this all get implemented? well, the recommendation is for a long-term care implementation body to be formed that will include dos the human services agency the department of public health, the three health plans i mentioned and the long-term care coordinating counsel as an advisor but it's not set yet and i want to read something it says in our strategic plan -- the make up of the implementation body needs careful consideration and

consist of those that can influence the implementations of the recommendations representatives -- well it doesn't matter but there's a variety of groups. some of your organization may want to be on that body -- it's not set yet is what i'm trying to say. what will happen is that there will be implementation work groups below this body and they will be given charge for some of the recommendations and that's how the recommendations will be rolled out into implementation. so the state's goal is to expand calmedi connect project in the 8 counties. it will most likely come to san francisco in 2016 we have time now to prepare and

strengthen our delivery system and time now to answer questions . >> so we're really at the starting gate. we're really at the time to begin and i'll be happy to answer any questions that you have. before i conclude, this entire plan is available at that location, so you don't have a hard copy but you have an electronic copy if you would a hard copy, however, you can let car la know and we can have a hard copy mailed to you but you have an electronic copyright there. so that's my presentation. i'm completed with it and i'd be happy to answer any questions you might have. >> for those of us watching this

remotely can you go ahead and spell out that website for us. >> here it goes: http: forward slash forward slash www dot sfdass dot org forward slash asset forward slash seniors adults with disabilities -- all one word -- forward slash 2013 underscore ltci, underscore strategic underscore plan, underscore final dot pdf.

>> now, are there any questions? i want to point out i don't have all the answers. >> councilmember czar did a? zarda. >> thank you very much for coming here today with this comprehensive presentation. i was wondering if you could speak to the conference and what your take away was i know it's a lot but i really appreciate it. >> the conference that councilmember zarda is talking about was the california community of constituents

conference sponsored by the scan foundation funded a large part of the development of this plan there were some fantastic speakers from the state and federal government there i learned a great deal the roll out of the initiative and calmedi connect is a huge deal in the state of california and we learned a great deal about what's being planned at the state level and what's being planned at other counties and some of the challenges that we'll face and improving advocacy and organization skills helping family members there was a great deal of information and i guess that along was the next day which was a meeting of the regional coalitions of which san

francisco's long-term care counsel is one, we're really talking about a state of transformation here in california this is a big change. although it wasn't designed for this purpose but to redesign how long-term care and support is provided in the state of california so this is an opportunity we hope to take advantage of it and that's what i got from this conference. >> in one of the workshops there you had a chance to hear from the managed care providers, what did you feel about the relationship that's being built throughout the course of this process between managed care providers and community organizations and other stakeholders? >> i can tell you specifically in the development of this plan we built strong relationships with the san francisco health plan local option and anthem

blue cross and anthem blue cross is a commercial plan and these relationships depend upon the people that are there so as we move forward we'll build on those relationships to implement these recommendations i mean it's all about relationships i think that's crucial. however, that being said, what's important to know is that managed care health plans are very experienced in providing primary and acute care services the move toward providing long-term support is a new game for them. this is not in their experience tool kit so what we want to do is to educate them to train them and to have them take advantage of the best services and support that we already have in this city so that we're working in

collaboration with them so i think they are willing and able and i think they are the new kids on the block in terms of how to work with adults with disabilities and older adults so especially in chronic care managed support so we will see. >> thank you very much. any other councilmember questions or comments? >> i have one. thank you very much for your presentation. >> your welcome. >> i'm paging through here and i'm looking at the pictures and i don't want to be isn't snarky but one of our missions is increased visibility and incl u.s. iveness. >> in this full plan i think it got editing down and i'm afraid

some of my slides got editing out. i'm afraid they got cut out i'm sorry. i understand why you would be concerned. >> okay we'll move on to public comment on this item. and in the interest of time public comment will be restricted to one minute per person so please be concise and mr. shaw you are first. >> it's monette, sha w. i've attended meetings and they know me. you can not do long-term care without institutions such as laguna honda just not possible.