work and meetings and a lot of conversations so with that i also want to thank in my office hillary ronan who has been working on this for many years and i think that in years to come this is one of those things that we'll look back and be very proud of the fact that we started this comprehensive planning that outlines the healthcare needs not only of the city but of individual neighborhoods and groups and i think that this is something that will serve the citizens of san francisco for many years so i'm very proud of that so with that i'll turn it over to the presentation about the healthcare services master plan. >> thank you very much supervisor campos that was an elaborate introduction we'll just go for it my name is lori

cook i'm here representing the san francisco department of public health and i'm here with my colleagues from the planning department how excited we are to be here today to present you with a plan we've worked on this plan for 3 years now and i want to thank you for the opportunity and the directive really to have a comprehensive look at healthcare in our city so we see this as an opportunity and we're grateful to be here today. preview of coming attractions. you will be happy to know that we've summarized the findings into one slide we'll see how that goes and welcome any questions and in addition recommendations that were largely developed by the master plan task force as

well as public comments received at those meetings and subsequent ly our public comment meeting on the draft. we'll close by giving you a sense of where we've been in this process and where we're going to begin with the overview but before i do i want to point out the pictures that you see here to the left of the slide community participation in the 4 meetings we held throughout the city we wanted it to be a quantitative and qualitative process and we really appreciate the community members who gave life to the numbers we presented throughout the plan. ordinance 3-10 outlaid a 2 fold purpose to identify the current and

projected need for healthcare services in san francisco and secondly set forths forth a series of recommendations and appropriate distribution and the primary use of this plan will be for the planning department and they will be reviews project applications against the plan to determine consist see and as supervisor campos mentioned it goes far beyond what was written in the legislation the board of supervisors will certainly have this document to reference in the future as will wee in the department of public health it's an extraordinary collection of information and i think it's going to guide a lot of wonderful healthcare processes going forward so we took a 2 fold path to this

master plan first of all our first push was for quantitative information and we initiated that process by looking at more than 150 quantitative indicators to complete the health status assessment and a parallel process going on in the department of public health a community health improvement plan so this was an excellent compliment to that process and to see a snapshot of the residents among different populations and neighborhoods and quantitative information and the five assessments. but in addition to that we didn't want to get bogged down in the numbers we wanted to provide the information quantitative ly but also to give life to those numbers by collecting quite a bit of qualitative information as well and we did that for the 10 members i believe we had

more than 100 community members participate and give their voice giving life to what we see in the numbers and 10 different focus groups to the plan you see before you today and you take all that information and the department of public health and the planning department have created the master plan and this document is over $200,000 pages long so foregive me if this slide -- we in san francisco are extraordinary ly lucky to have a rich a array of healthcare in this city for example i might live next door to a dr.'s office but i might not be able to seek care there. next we know that the demand

on healthcare resources are going to be pushed to the brink actually but in san francisco we're probably better prepared than many other municipalities because of the healthy san francisco program and other programs that have existed in the city for a long time. there are certain populations that have higher rates of health disparities in our city so hoping it will guide the right kind of health facilities to those that need them and we have a diverse population here and providers who have been providing care to our -- in terms of land use projects of a medical nature it looks like san francisco is on track to

meet resident's evolving health needs. now i'll turn the presentation over to claudia florez planning department. >> i'm going to cover the recommendations components of the plan in which came out of the data analysis for which lori gave you the highlights. the recommendations align with the work that the department of health is already doing and the structure presented in the plan mirrors the values of the health improvement plan er chip which was finalized in december 2012 as lori mentioned. not only made stronger work and the hospital needs assessment projects but also helped bring everyone together so that all of these projects working from the same foundation of

information and on the same health priorities. these 3 are the community the 3 communityies identified and under which the master plan recommendations are lined up. in the plan each recommendation is followed by a serious of guidelines that detail specific areas. i'm not going to go into that level of detail but it's included in the plan as well as the executive summary of your plan. it's illustrated by the recommendations on this slide the plan goes beyond strict focus on land use and acknowledge the health and wellness and integration of services and neighborhood characteristics. as such recommendation 1.1 about social and environmental factors.

health promotion and disease prevention. refers to things such as urban space and healthy design. the next set of recommendations 3.1 through 3.5 under health priority number 3 focuses on increased access to vulnerable populations and those with high healthcare needs. under health priority number 3 you will find guidelines eligible for incentives those that can potentially be addressed by individual development projects subject to determination by meeting these plan identifying needs just to give you an example, there's a related guideline 3.1.4 that states

increase the availability of prenatal care including but not limited to black african american residents. development projects that meet one or more of these guidelines 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