of uniformity i nominates edward cho. >> i'd like to second the nomination. >> all right. >> i move the nomination be closed madam chair hallway are there any other nominations due to close therefore let's move all in favor, say i. >> i. >> against? okay. the i's have it the next nomination is for vice president >> madam president i'd like to nominate you for vice president of the commission. >> did i hear a second and so second. >> are there any other nominations? okay hearing no one all in favor, say i. i >> against. >> all right. let's moved and

just for expedientcy. >> thank you. >> congratulations new officers. >> thank you. i'll thank you for the opportunity to make a brief statement first of all, i think all our commissioners commissioner melara thank you but in my two years of learning i'll be able to carry on our mission to support the commission of the department in the work we have to do. we're very fortunate to have your staff and its only apartment but we're going to ask him we ask each of our commissioners to tell us what

they want to serve on we've built a strong team in our committee structures the structures have matured where we hear indebted and have at the commission level the highest i levels of information we've received i'd like to have it continued and obviously our two large hospitals have joint committees we have our external committee so i'm going to ask mark to survey everyone to accommodate everyone. i'm hoping most commissioners will want to list their current assignments i believe they've gained in the information that we've been able to work with over the past two years and hoping especially our committee chairs a they'll continue to give us that expertise. so we are going to ask as traditionally for 3 areas that

you're interested in and try not to over tax no one and try to make the assignments by the next meeting. lastly i'd certainly like to challenge our department that has given us such important information and the changes have made clearer the lines of authority and the responsibility and help highlight the importance of both the i am congratulated system for our challenge in the chance of the entire country. we've made moves concerning that but this will be one of our most important challenges. the other parts that clearly

speak to the importance of the public health to closings one of my favorite routines u restaurants to the issues of public health accreditation. i know that the commissioner wants to thank and i thank director garcia. i see that we have accountable with 5 a's. that's where for this coming year we're going to conceive on items one is saenlt we know that ac a has increased that but at the same time has created a vision of affordability the second a we're dealing with that with a guideline that allows people in healthy san francisco to stay there in 2014 while we're able to see if we can make

california affordable to that group of people. we'll be following through to see how we're going to make health care affordable for all our residents you using both healthy san francisco and cover california and encouraging people who are eligible to sign up for medi-cal so. availability says we have to have geographically points of service with our clinic and consortium partners but they have to be valuable to the public and that is one of our challenges to make it available so it's not 6 weeks down the line to wait for a particular test. everyone is working on this we're not going to get to a end

point but remain a goal. our services and programs have to be appropriate thus speaks to the issue of cultural competent. we've said it before for years. we need to continue to integrate cultural competency into all our programs it's got to be part of everybody we've got a diversity that's greater than all it's not only racial and ethnic but a definition of income we have to fit all those people. and lastly we've got to be responsive to the public it's got to be acceptable to them. we have our challenges through the patient surveys we're

required to undertake for both regulatory and accreditation purposes. i know with sf general has been working with the program to improve our acceptability the entire system will be doing similarly and i look forward to having that happen in our deliver system. so those are the challenges we will be facing immediately. they're not things that happen in the coming several years were a lot of the whole host which things the commission has talked about from i t to pedestrian safety. and infect tuesday disease and asthma our african-american initiatives the need to face the tuberculous programs that we have here and make them more

effective. as the major city with the greatest number of tuberculous cases. so i thank my colleagues for the conversation they've placed in both myself and commissioner melara again and we'll be at our service speaker we're also amongst equal partners here on the commission and i really look forward to working with all of you there coming year >> thank you. we'll now go on to the next item. >> it's the long-term integration strategic plan.

>> okay good afternoon and congratulations commissioner commissioner chow to our new office on the commission and good afternoon to commissioners and director garcia. i'm ann the director of the aging and adult services services. i have my colleague here to share in the presentation i'm going to tube the who and why and i less than is going to get into the specification of the strategic plan that i believe all of you received both the copy itself and then i think i have a copy of appreciation we're doing today as well. the who. this work started under the long care council a 40 member body

that's appointed by the mayor. both the public health department and the department of aging services has seats on that body. in addition to that there are 4 other city departments that sit on it the hospital and the community nonprofits and u.s. part of it and consumers and advocates on that body as well. i be given the commission that i sit on you're all aware as any of us are that one of the things that older adults and younger adults with disables have in common is this real desire to live in communities and the institutional care but to live in the least recycle active environment san francisco has

had a public policy when you look at the community living fund or the integration plan or programs westbound the health department you'll see there are at about all out effort in your community that's different from most communities across the country to implement that which people want to help people who are in institutions to live in the community successfully and help people stay in their homes if at all possible. we also know and again, you as well our department and people across the community know that there's been this net to link health and social support sponsor those two things have to come together we're successful sometimes but not in the arena of long-term care. in the past 20 years there i was thinking under the 3 different

mayors to link those together better and now we have this opportunity under the the affordable care act the department and adult staff and the long term council you'll see later in the document on the oversight committee just how we framed all the work but again, the health department and others were involved in all the work. i'll have ilene talk about the work and i'll talk about some of the recommendations. you don't have a clock in the front so here's my watch to stay within the time >> thank you for the opportunity for the information for the plan.

i'm with the citizens health care and chair the group with another colleague. as ann mentioned it started with the initiative from the long-term care cooperate council but under the leadership of looking ahead with the ac a and the work in the state and how to better prop prepare for that with funding and support the coordinating group was created it's the long term services and support as ann mentioned we're talking about older and young adults with disabilities and when we talk about long term care integration we're talking about institutional and community based services.

in terms of the state initiative going on i'm going to spend time with the kworntdz care initiative it was introduced by governor jerry brown for california's effort to better coordinate care for californians. it's created with a lot of opportunity created by the affordable health care and how can better care b be coordinated and the cost savings. there's no - it effects quality and effects the cost of care so with the coordinated care initiative one part is called cal medical connect the dual particle is one of 15 states

selected by the federal government for some funding to create a pilot program to better coordinate care for dual eligible since medi-cal and medicaid nationally are two program that are aligned the rules don't fit well, with both programs those people that are dual eligible are people with seers health conditions and have problems getting the care they need instead of what is reimbursed some of the mississippi alignment drivers the quality of care and increased costs. the cal medical connect program is focused on dual giggles medi-cal and medicaid beneficiaries and to combine all

health services plus the two into a package it's through managed care. based on the traditionally medi-cal managed care plan and in addition the pace program is offered as an option because of the history of sgrath care through the pace model and through the model the plans the capital payment for the medi-cal and medicaid services. the long term services and support that are included include in home services and the services program and skilled nursing care. the adult services program is the new name for the health program and is already part of the managed care right now. as i mentioned cal medical

connect is one piece of the program and the other is for medi-cal beneficiaries who are maybe not medicare eligible or choose not to enroll they'll be required to enroll for the long term services and support so the second is called the long term support program. in terms of the coordinated cal program 8 county have been authorized to moved in this initiative. you see the list of county here in the bay area is alameda and san mateo and santa clara and los angeles and san bernardino and san diego and riverside. as part of the evaluation of readiness the centers for medi-cal and m.d. services have done readiness assessments to

determine whether the plans in the county are ready to move forward the earliest is april of 2014. at this point there's one county moving forward for april 2014 a that's san mateo but the other county are basically going to move forward bans they're readyness in he remembers of the health plans and the services for readiness. so for example, alameda county is scheduled to start in july of 2014 and sarah county is scheduled to start in january of 2015 there's a variety of start dates so in terms of menacing the enrollment process for the most part they'll be enrolled by

their birthdays so people will get before it their birthday they'll get a 90 day novs notice and a 50 and thirty day notice. they need to a choose a plan option or they'll be possibly enrolled similarly with people with disabilities what their enrolled their defaulted if they don't make a choice so communication is important in this effort. so it's the states intent to expand beyond the county and their goal is to expand the program statewide are there's certainly a desire and belief that better integrated care will be better quality for beneficiaries. so additional legislation will

be enacted and with that, the inclusive of san francisco county will be in 2006. there's interested in expanding to other counties as well. the managed care options available in san francisco include san francisco health plan is the public option and anthem blue cross those are the two plans that care in san francisco for a number of years primarily focused on families and citizens are medi-cal only and in areas where the programs are available the plans are available likewise. so to give you an idea of the target populations there are estimates of the population that

are dual eligible from 22 to 64 so there's in trouble in looking at the roll out of more people who enroll in managed care effect the significant number of population here. i'm going to turn it over to ann to a talk about the recommendation. >> the long term coordinating council have taken on other initiative and we've used a similar planning guide to do that first of all, it's convening an oversight committee or a design group and really determining who are the best folks to sit on that and then look critically at the information that comes from the various work groups so you'll see here not only do we have 3

different departments on it we have through the health plan we had some of the key community provides work in the union and consumer advocates and the mayor's office is involved as well. we broke this into at some .6 work groups 4 major ones we did data and finance services and a cooperation of services and an analysis of various information and so on this is a in the report itself. i wanted to move from who is looking at this to the what the recommendations were that came out of the group. the first one was for initiative run access for long term

services ease supports it was interesting for our department it stated that we should take a leadership role and create a door. he know with a no wrong door approach is very helpful many folks have relationships with community providers and they need to keep those relationships but we need a place for community providers to come together and seek out other information as well so having that balance of making sure that all the doors in the community are strong as they can be. and we've begun working on something like that we're expanding this work because of the work in this area. we're doing the transition from hospital to home and there are i think takes we do home delivery meals and it's a natural fit but

it was great to see come out of the community partners as a recommendation. you can really look at some of the other recommendations and their pretty well clear. i wanted to highlight a little bit related to training for caregivers and also the recommendation related to helms and dementia research that's another initiative that the county is undertaken. we've got a long-term strategic plan that relates to dementia in our county and other places have begun to use this for an example this data has found its way into the data this is a population that is growing rapidly.

for us we see consistency with the recommendations here as we've seen in other plans as well. backing up a minute you'll see a list of some of the items. that determined to be crucial elements of any long term car system the behavioral health and nutrition he know people need. the last i guess there's a couple of recommendations that we have been moving on. quickly because the opportunity presented itself and one of them was that there was a recommendation related to trying to make sure that nonprofit providers having had as much opportunity as possible to work

in the business world of managed care. so in this last year the administration for community living in washington, d.c. had a quest of proposals out they were will i willing to fund 9 community in the country and the idea was exactly what we put so what the plan if providers who are unaccustomed to working with the medical community or selling goods and services to people who are going to want to buy those items for their consumers and clients then people needed to be ready to do that. so it opportunity arose this last winter we accessed it and was selected as one of the 9 community and at this point are in conversation with the provider. another community several community providers in the southern california region are looking at doing some similar

and helping he easter each other to be successful in this area. the last recommendation you'll see in your packet you can ignore the resolution at the end of the packet this is the reason we're here that is there was recognition there needed to be an implementation body just as we needed an implementation body for the dementia program. it was recommended by this body that that implementation body would include the 3 departments dos and human service go agency and the health plan and in addition to the coordinating council. we're hoping to convene this group in may and dos will be

providing the staff to the group and we'll be in its first meeting determining who should be this oversight body it's was broadly put together. again, we will not be implementing this cc i will not be coming to san francisco but in 2016. what we've learned from other counties remember this work started two years ago it's taken the county to get to a place to implement something and only one of them is ready in april and hoping for too more in june. we believe as far along as we are in our collaborations with your county partners there's a lot of work to do to present. we believe that that work let's

say managed care and the cc i never came it will help to us better serve the people in san francisco. we see a lot in the plan we can moved on whether cc i comes or not. with that, we will entertain questions. >> was there any public comment first and there's no public comment. >> okay commissioner melara. >> yes. a couple of places ilene i'm familiar with the case by it would be good for the commission that don't know about this it's a great bottle to say in san francisco. >> the pace stands for the all inclusive care for the elderly it started in san francisco it

was started over thirty years ago and it really is designed to focus on individuals who are certified to be eligible to be in a nursing home but want to stay in the community as long as possible it begin with medical services and primary care services as well as long-term services and community services. i think that where it is kind of a blend a managed care program but also a provider because those programs operate their own centers and clinics where people come during the day it get a spectrum of services including home care. it is a complete package of medi-cal and medicaid services in addition to the services that the interdisciplinarian team and