that will allow them to capture payments on their end so they can, for the next two years, cover their projected cola increase. because we had budgeted an increase in the prior two years we can reduce that expenditure for saving. we're going benchmark for san francisco general to improve efficiency and patient flow, then we will actually see an increase in revenues and consequently they will qualify for a million dollar bonus payment in year 15, 16 based on 14, 15 performance. the second part of the savings is related to salary savings as san francisco general. right now it looks quite positive.

it won't fully correct all the problems in those areas but i think it's a start to true it up and allow managers to get a better sense of what they're managing around. i'll use $2 million of savings for that and apply $3 million of salary savings to offset [inaudible]. i apologize, i neglected to include initiatives b-1 which is on your summaries, but i forgot to include this as part of my presentation, but there is one regulatory initiative that's on your summary and it's not insignificant. it is related to electronic medical records and meaningful use, which is what bill kim just spoke about. it is $3.8 million and i think we've discussed that enough ,

but feel free to ask any questions. moving forward to our revenue neutral initiatives, we have an increase in behavioral health services that's supported by 2011 realignment funding. we're proposing to use this towards three areas, first is support the kda settlement complaints. again, kda is now a state mandate to provide additional mental health services for foster kids for kids who can -- who have actually qualify. dph is currently in the process of evaluating as many kids as we are familiar with to see what types of services they'll provide, but in addition there they be some kids we haven't seen or touched so this is a little bit of an unknown but we're putting investment to make sure we provide the services they need.

secondly we're going to use this revenue to support our mental health clinics by restoring our clinic directors and continue this initiative that we also had in the previous year. our goal was to restore a few over several years and so we're going to continue that initiative. and finally we are going to invest in our infrastructure support compliance and reporting, with just additional requirements for drug med cal, we need to support our providers to be able to handle the state's reporting systems and make sure we're billing accurately. this helps preserve our revenues and so that we don't get dinged on claims further down the road and will facilitate the process with providers to actually be able to bill more effectively and use the system in a meaningful

way. in addition to billing system, it has clinical data in it and we'd like that data to be as clean as possible so we can revisit that down the road. next is a change in maternal health funding. we got approval from the state to shift our target at management program to the state's maternal child health program. what this does is allows us to reduce some of the administrative burden because the reporting requirements for targeted case management was quite significant. in addition the reimbursement rate under maternal child health is a little more robust so it enables us to reduce our some of those public health field nurses to provide services under the nurse family partnership. and this is a more robust, intensive and preventive model of care where we actually do

more intensive case management and we work more closely with high risk clients. it's actually evidence based and we have evidence to show there's improvement in outcomes and so we want to sort of put our resources into that. we will still continue a lot of the field nursing work that we're doing, but we just want to be focus more on the outcomes for our patients. next at laguna honda rehab and home health we're going to make some changes to vacant positions to increase our productivity there and also help improve discharges from laguna honda. the new health clinic, we're looking at the possibility of renting a clinic space somewhere on market street. it's a centrally located area

and it's actually currently has primary care clinic and pharmacy in its location so if we were actually able to lease this space it would be turnkey and we could actually get primary care and pharmacy services in right away. what this will do is that it will enable us to reduce some of our panel sides at other clinics, particularly at san francisco general, and will actually -- and allow them to increase their revenues so they could pick up additional members at those sites. our hope is that we can come to agreement on this space and we think we can actually -- if we do, we would have the revenues to offset this expenditure, but if this plan would fall three through we wouldn't have the expenditure or revenue. the next thing is the services provided at san francisco general.

there's a number of ancillary services provided by ucsf that are billable so we're going to true it up based on actuals and request of $1.2 million increase in affiliation agreement offset by revenues. 11 is a pharmacist to support some of our patients who are anti blood thinners. you know, there cease on the significant on those medications and what this will do is have a pharmacist run a clinic that will help patients more understand the medications to review the dosage and ensure -- or try to minimize the number of hospitalizations for patients on this medication.

finally our fiscal intermediary conversions, a true of where we're seeing that there's some services that would be more effectively provided in house and more appropriate and we'll do a neutral conversion of reducing contract dollars to help pay for those services. moving on to the newer initiatives, first and foremost is the sf health network call center. this is a proposal to create a centralized call center that will support scheduling appointments and general inquiries for initially the primary care clinics. this was one of mm-mma's major recommendations and it's becoming standard for most health networks to have a centralized call center. our goal for this is to -- several things -- first to improve the productivity and efficiency of our primary care clinics because that allows us

to schedule optimally to make sure we can fill as many appointments as we can. secondly it will take the burden off existing clinic staff so instead of answering phones while someone's waiting to get checked in, they can move someone along and support their providers and not be on the phone all the time. and this will also help the patient satisfaction and because one, patients at clinics are actually going to be seen or could be addressed more quickly and that our goal with the telephone access is that phone calls be answered within three minutes and so they will actually be able to get a live person right away and this will also enable us to consolidate some of our language services in one call center so make sure that we have as many languages

available to our patients at one time. we'll do half our clinics in 14, 15, and the second half in 15, 16. the call center will be located at laguna honda and our goal would be to consolidate the appointment scheduling function with the nurse advice line and then upon successful completion of primary care scheduling we'd want to add mental health and specialty clinics down the road. the next four are related to it, the security enhancements that bill kind of talked about, the things that will support the implementation of new technology and technology

upgrades, the tell help upgrades and investment in information technology infrasfrukture so i won't go anymore detail about them. next is investments in human resources. you can't invest in all these initiatives, which does, you know, take a significant number of staff without actually looking at our hr. to ensure that we are filling our vacancies in a timely manner so that we don't lose any productivity and we continue to provide services, we need to invest in our hr department. this will add it is a medical

director for utilization management. it's a clinical operations director for ambulatory care.

we are no proposing at this time and they are fine with that. but what all our proposed changes it looks like we have some positive news in the first year and we have cost increases in the second year so basically we're about 14 million towards or $21 million target so we're about 7 million short but we've been working with the mayor's office and they're satisfy wd this proposal and are not asking us for additional contingency proposals at this time. while it does look like there's significant revenue growth, this does not include the realignment reduction from the state that we'll be reflected around budget. and just as a reminder there's

some other changes that are in our budget that are not included in our balancing plan. first is the community program's reduction that was approved in the 13, 15 budget process. we have an $8.8 million reduction in 14, 15 and it annualized to 17.7 million in fiscal year 15, 16. right now that still remains in our budget. i am projecting a potential $3 million reduction to hiv funding in the areas of brian white funding and cdc funding for hiv prevention. these are still projections at this time. we've gotten preliminary heads up that there's going to be a reduction coming, but have not received final notification so this is still a little bit of an unknown but it's possible it could be as high as 3 million. and lastly as we mentioned before, the 33.8 million in

state realignment reductions. so in terms of next steps, there's some corrections to these dates. our next health commission meeting will be on may 6 and then following that we'll actually have a hearing at the board's budget and finance committee where they want to hold a preview hearing for our budget. on june 1 the may or will have his balance budget commission and we'll start the board review process and the finance committee is expected to improve by mid july we expect approval of the new budget. that's all i have and i'm happy to answer any questions you guys have. >> is there any public comment? >> i have not received any requests for public comment. >> we'll go on to commissioner questions.

i'm sorry. if someone would like to speak, they can and just give me a card. i have not received any public comment requests. >> if someone has a public comment to make before the commissioners -- >> i'm sorry, i could ask you

then. okay, great, thanks, i just needed some clarification on that. thanks. >> i was curious about the san francisco general salary reduction and wanted to know how it's reconciled with past reductions and this sort of constraint on hiring. >> thank you commissioner, good question. couple of different things going on here. we have the salary budget and then we have our higher end initiatives and one of the

things we've been very focused on departmental wide and is one of the main strategic goals for the san francisco health network in its infancy is to improve our hiring. we have a couple of things going on and ron can fill in the details but we have had a difficult time getting our hiring pipeline going for the last six to eight months, but that is a big priority but we are trying to so the salary savings that are included here to put those into context, when in our current year financial statements we're showing a salary variance, positive, in

the financials. a lot of that hiring is coming online, but we've adjusted the salary budget to a count for what we anticipate we'll be able to hire by next fiscal year and so we can get up to our staffing model that's adopted. the other piece is -- and if you look at the initiative that was before the commission at the last budget presentation, associated with the new san francisco general hospital, we have about 100 fte's, in addition they're added in the san francisco general budget so in this two year budget you would actually see, despite this initiative, which is kind of seen in isolation when you look at it on presentation in front of you, you would see a significant increase in staffing proposed for san francisco general hospital as a whole in this budget proposal. >> so you expect that will take

place in 2015, '16; is that it? >> that's correct. that's when the hospital is anticipated to come online. >> okay. >> also just to add for the salary savings item, it is just a line item. we didn't tleet any budgeting, so basically it's just sort of a general salary savings assumed at san francisco general. >> commissioner, was that satisfactory? >> yes. i think so. >> commissioner er malara. >> mine is very small. i don't know if your date is when things are supposed to happen by, or the mayor is going to work on sunday, june 1, and the 17th is a friday and i don't know if the budget

committee >> the mayor is required to i think he does have until june 2 or in theory he could be ahead of schedule and submit it on the friday prior. and then the budget and finance committee is actually going to be meeting ing throughout the week in june so we do expect a decision on the final budget on friday, june 27. i apologize for the errors. >> that's fine. >> in addition, i do apologize for the memo and how it was -- >> that's okay. >> -- directed to -- not directed to commissioner chow. >> as long as the data is accurate and -- >> and the numbers are right. >> any other questions at this point? commissioner. >> i have a question about the call center and that new initiative which makes sense particularly with the adoption of making sure we have the

right languages, but how does that match with the discussion that we just had about the it integrated it and wouldn't -- aren't we looking at appointment making, for example, that we'd be able to make an appointment as a certain amount of time. >> yes, i'd like to speak to that. so as you know we have a lot of existing technologies and for now i'll call them legacy technologies, but before we get to the future state we have bridge products and solutions. we are, at this time, exploring, looking at using the legacy product and expanding the capabilities of it or more accurately utilizing the capabilities that we haven't used to fulfill some of the requirements that we have for the call center so it's not to

introduce new technology and to save money >> commissioner sanchez. >> to the chair, i just wanted to -- pertaining to the -- or sfgh protocol we've been discussing, and we've heard both in the joint conference committees and here, part of frustration of our staff and our department has been in reference to filling the vacancies per taning pertaining to number of departments including the department of public health

including all our units. i think as we heard the budget today and heard the budget presentation for human resource colleague over this past year, they are and are actually actively working to ensure that this timeframe, which is then astonishly unbelievable pertaining to institutional lag could be closed so we could begin to meet our unique patient needs and sometimes that really isn't deseminated because we have so many things on the radar. all we're saying is the department has been working on this actively and human resources is now getting -- has gotten additional people in order to ebb ensure we could expedite and begin to fill these positions that we have

wanted to fill, but because of the and nobody quality of care pertaining to the commitment of personnel and we've gone over this this is the first time we've really had some major dollars to say enough is enough, but we still have these other issues where we have to follow pertaining to our rules and regs between our different agencies and whatever and we are aware of that and the director and our hospital administrator and -- i mean, everybody is involved in this and we heard, like, an it, this is just one particular program, it's a system and that's what we're involved with now. how do we ensure that, you know, that basically the budget reflects these unique challenges we had.

a lot of these things are left blank because we don't know a lot of the impact based on the california state. we're involved in it and the communication is there but it's frustrating so -- come to the meetings, these are all public meetings and we should have some hopefully really positive outcomes pertaining to the quality of care that -- which is our major mission as a health department and as a hospital and the hospital of laguna honda, but i think this was an excellent presentation and gave us both the strengths and limitations and the fact that we still have additional challenges but we're working on them and are making a difference. just wanted to share that. excellent presentation. >> thank you. i appreciate those words. we have and will be continuing to focus on our vacancies. it's important for us to fill

those. ron and everyone from our hr director are focused on that. he has a shortage in his own department and that has been contributing to this so he's just hired new people and we're -- and i've also made a focus for him for san francisco general particularly for the nurses because that is important for you today and we will continue to focus on those areas as we try to get as many people on board as possible. >> commissioner er chug. >> thank you for the presentations and i don't want to repeat what commissioner sanchez has said, but i think that the affordable care to have something [inaudible] and, you know, and i really appreciate, i am assuming you've already made your best educated guess how it's going to influence some of these, especially with the medi-cal extension, some of the dollars that we used to spend on an

ensured patient might now become revenues so my question is more directed toward some of the other changes that you listed in the back, you know. are these, like, specifically past dollars that you're talking about or, you know, like, dollars that actually directly impact our delivery of services? >> i believe that commissioner is referring to -- >> so for the first item this was a reduction proposal that we had submitted as part of last year's buds jet. budget. if this cut were to remain there would be service that would be impacted. at the same time while we're implementing this cover i'm going to be rolling out an rfp for new services to align new services to affordable care act so we're not quite sure exactly how services would be impacted but overall in terms of financial imflakt would be $8.8

million in tact. if we lose a grant, we cut the expenditures along with it. historically that is, you know, that's what we've done, but we've also been back filled by the board so if this were -- this would feel like a $3 billion reduction in services. lastly the 33.8 billion that comes to the department. had we had to cover the short fall we would have had to come up with savings of some kind to offset it but the mayor's office is covering it as part of its definite sit deficit so we are not expecting any service impacts as a result of that last item. for all three of these items we've been working very closely with the mayor's office and board and