>> commissioner singer. >> commissioner melara. >> commissioner chow. >> commissioner [inaudible]. >> is second a team on the agenda is the approval of the minutes on [inaudible]. >> so moved. >> is there a second, please? >> second. >> all those -- is there any

corrections? all in favor, say i. e posed. the minutes have been passed. we'll go on to the next item, please. >> item three for the director's report. >> good afternoon. mayor lee presented his proposed balanced budget for 2015 and 16 this week. you will hear from our cfo details on our own budget, but i wanted to give you highlights on the overall city budget. the mayor really focused a lot on his investments and opportunities for all san francisco residents, including investment into affordable housing, service increases to make san francisco more livable, maintaining and improving or city's social net and you'll hear today regarding the takeback of our firsz year

community service cuts. the budget also continues to grow the city's reserves to offset the impact if an economic downturn does occur and the city's reserves for economic stabilization loss will grow over the next two years. the city projects to have a $234 million across its general reserve budget stabilization reserve and rainy day fund. the 25th anniversary of the he tie sis c virus looking back to look forward, our own doctor with the center for public health research has been selected to present on hepatitis c at the center for

disease control at their public health ground. he'll be speaking on steps toward ending he tie sis c in the u.s. and he's been working with us internally in looking at our own role in working with ensureing hepatitis c clients do get access to care. a really important that we've been very much involved in is that the u.s. department of health and human services lifts medical ban on sexual reassignment surgery. this is in response who is 74, a transjepder woman from new mexico. it's only for individuals age 65 and over and people with disabilities, private shurnts plans often look to medicare

for guidance on what should be considered medically necessary treatment. as a result the decision may put pressure on more insurance providers to cover this. we have our own program being developed within the department. this program has graduated over 70 families, chinese family graduation at ymca. [inaudible] and the san francisco boshd of supervisors presented certificates to honor the chinese we can campaign. we're really proud of the families and it's a wonderful

program that's a really comprehensive program for families in china town. and world refugee awareness month and since the mid 1970s san francisco's become home to and families seeking asylum status in the past year, over 250 refugees from over 34 countries have received services through the newcomers holt program and health centers health clinic. that's the end of my report. if you have any questions, i'm happy to answer. >> commissioners, any questions? >> i was going to comment that i had the privilege at being at one of the we can and in fact, they enthuse asically active living is really beyond just teaching the tricks of nutrition, they have everybody participating in physical

activity, which i think is often missing in many of our nutrition programs so i'm pleased the department is able to continue this program for the community. i also had the privilege of attending the mayor's budget address yesterday morning ing and i think we'll hear from our director of finance how positive it has turned out and the support the county gives to all public health. we are confident that that will continue to be part of how the board of supervisors looks at the budget. >> we have someone who would give an update on our recent labor negotiations. >> i think that would be fine. we'll have it as part of the director's report.

thank you. >> good afternoon, so we've concluded the negotiations with [inaudible] and we went with the city pattern, which is essentially 3.25% in october of 2015, 3% in october 2014 and then most of the agreements included a third year, which is between 2.25 and 3.25 and nurses agreement, the rn agreement does not include a three year, but a two year agreement for the rns. the only contract left in the city is the transit contract, the mpa, so now our contracts that with processed up to the mayor's office and the board of supervisors and we're putting together summaries and more detail in the upcoming director's reports, but the

actual negotiations is concluded. >> thank you. commissioners, questions again? questions to our personnel director? >> that'd be great that in addition to the summary you provide, but sort of integrate maybe with mr. wagner's office, integrate that raises to the budget expenses which we've been seeing for the years just so we can calibrate what kind of difference this is going to make in our spending. i realize a lot of things can change between here and there, but it would just be good to get an idea of how much we're talking about. >> the budget office helped us sort of look at those numbers as we went through bargaining and try to keep that down so they understand just how much that would cost. i'm sure he'll be happy to provide that. other questions? >> any other questions? thank you very much. congratulations.

we'll move on to the next item, please. >> item 4 is public comment and i have not received any requests for general public comment. >> okay. so the next item. >> item 5 is a report back from the finance and planning committee. and commissioner melara chaired that committee. >> yes, we had a couple presentations which was -- we had the primary care to optimizing access for primary care in san francisco health network. we also got an update on the ryan white plans and we also heard -- the monthly contract report and all your questions

were answered, doctor chow. >> i read that, thank you. >> but instead of requesting that we approve the consent calendar as outlined, i have asked that the contract with the san francisco healthcare foundation be voted separately because we couldn't vote on committee, only commissioners singer and myself are in the committee and i sit on the board of the foundation, so i cannot vote on it, so it has to be voted by the full commission. >> and if i may, because there's only four of you today, then that contract not to be taken out of the consent calendar because you don't have [inaudible]. >> right. >> okay. >> but the rest of the report that you voted on. a: okay. >> okay. so any questions to the

committee at this point? no questions, then we'll proceed to the next item, which is the consent calendar. i am therefore on the consent calendar, as i understand, we will not vote on the foundation contract, but you are recommending everything else? >> exactly. >> exactly from the executive secretary. >> yes. >> okay, good. >> and i'll move that we -- >> we won't need to do that because it's moved already on the consent calendar from the committee so we are prepared for further discussion of the consent calendar, which of course i must remove something from the consent calendar which we can then discuss individually. we're prepared for the vote of the entire consent calendar. no other comments. everyone prepared for the vote.

all in favor? all opposed? and that has passed. thank you. >> thank you commissioner. >> we are going to have change in the agenda timewise. we've been asked to advance the san francisco security update, the sfdph; is that correct? >> commissioners, we're waiting for the sheriffs to show up. i wonder if we should go ahead -- i can see them excitedly saying yes, but if we can go to the stra fee jik plan, if you don't mind and then -- >> sounds good to me. >> that would be fine. let's stay on the calendar until the sdsh -- >> i wonder -- okay, okay. what is your pleasure

commissioner, he's on his way. >> well, if the sheriff's walking across maybe with can take the san francisco department of public health patient rates, which should be a shorter item, without trying to break up the presentation that i think is very important in terms of the public health agenda so is that okay? >> sure. so what you have in front of you -- thank you commissioners. what you have in front of you is a proposed legislation. this is our annual adjustment to our patient rates. these are the formal rates that we set for our services. i always like to remind ourselves that there are -- majority of our patients do not pay these rates so for our

uninsured we're paying on a sliding scale or through healthy san francisco rates, medical pays those rates. these do set rates that allow us to maximize our reimbursement under our mental health division and some of our community programs. they are rates that are paid by, for example, privately insured patients who access services at san francisco general hospital. that's the basis of our user fees rates. and what you have in front of you is a proposal that comes from a report that we had done and are going to have updated in the coming year, but we had an analysis done by an outside consulting ing firm several years ago to take a look at our rates and advise us on how we

should adjust them and they determined we were low compared to the industry standards and advised us to move our rates up to bring them in line with standards so we've been, for the last three years, doing an incremental 10% increase on all of our rates to try to get caught up to where that consultant recommendation suggested that we go. so this will bring us closer on a cost to charge ratio to industry standard. we will, again, in the coming year, have an update to that study so i'll get a fresh look at where our rates are and we'll be able reassess and then take that information into account for future years. but again, this is an annual process that we go through. this legislation, if approved by the commission, will go to the board of supervisors as part of the budget process and

will be reflected started in the new fiscal year. bs >> what percentage of our revenue comes from people paying this rate? >> i should have known you were going to ask that and had it on hand . of our -- and don't stick me to this number, but it's a ballpark -- of our patient charges, not our entire budget, but of our patient revenues, i believe it is about a quarter to 30% comes from -- of our total revenue comes from commercially insured services at general hospital. although, if you look at the fraction of actual accounts, it's much smaller than that so it's in the single digits in terms of the percentage of

accounts, but it's a large portion of our revenue, but this is really a financial driver for us, it allows us to bring in rates from those privately insured accounts at the hospital that thereby help fill the gap on our uninsured patients and some of our lower paying safety network that we do for those patients. i can provide the exact numbers to the outline. >> yes. commissioner [inaudible]. >> how close does this bring us now to the industry standard? >> i think we're still going to be a little bit above our cost to charge ratio is still in the 30s if you look at a lot of what the others in the industry and in the bay area are is there in the mid 20s. last i looked we were at about 32 and so i think this will bring us closer to 30% so we probably still could go a little bit further on our charges to get us to kind of

the industry standards, but again, we'll know more precisely when we get that rate evaluation done over the coming year and they'll take a fresh look at where we are and we'll go rate by rate to determine where we are in lock with the average and where we're out of the norm. >> actually, you kind of preempted my question. >> on the professional component though is the study being done there also because i think i should return to private practice? >> on the professional

component at the hospital, those rates are determined and billed by the university of california so i'm not sure -- i can check with them and find out exactly kind of what the latest analysis they have about where they are, but that would not be included in the document that you have in front of you. >> so these are actually clinic rates for use of the xhinic and not the professional rates? >> correct. >> okay. so under -- just to clarify then, the differential between -- your difference between general clinic, which i know is at san francisco, but what about the primary cares that are community clinics and are we charging a facility charge on top of the professional charge? >> so for the primary care

clinics, the difference is less significant than it is for the hospital because we set our rate so that we can show what our comparison is and we can build that into our cost calculations for medical and others. so we do have rates for those clinics, but in terms of professional fees for our own doctors >> yes, that's correct. >> okay. so on the primary care side for

our own clinics, i would hope that the same type of study would be done so that we would stay within the parameters of the norm. >> yeah, and we will take a look at that and again, like i said, it's a little bit less of a central issue for the primary care because the bulk of our primary care charges were not receiving private commercial insurance for those -- >> even less, right? >> yeah. >> although in medical it still is a department of insurance rate because even though as medical has moved towards the [inaudible] or at least the next two years. 2013, and 2014, if they ever pay us for 2013. >> right. >> okay. commissioners, are you prepared for a motion to accept these rates? >> so moved. >> is there a second?

we have a second. any further discussion. all in favor say i. opposed? and so the rates have been accepted and thank you very much. >> so commissioners, i also encourage you to speak closer to the microphone. you're sounding a little timid today and i think it's because you're not close enough to the microphone. >> okay. >> we are going to move on with the public health division plan presentation. >> good afternoon. can you hear me? good afternoon. thank you for having us. we know you have a full agenda so we're going to be brief. we have a number of speakers we'll try to get it all in within 15 minutes. hopefully that will be the goal. so this strategic plan is the next step on our journey to

public health accreditation. we have completed the community health assessment or the chip. it is aur citywide plan to protect and improve the plan of all san francisco citizens. in contrast, the strategic plan the pop police station health division will one, contribute to the community health improvement plan, two, deliver the services of public health and three, become a community centered liability, high performance learning health organization. for us public heflt accreditation is about the passionate pursuit of results, equity, and accountability for community health. naturally we want our strategic framework, reach, for result, equity and accountability for community health. to ensure high performance we are focused on these results,

integrating health equity into quality improvement activities, ensuring accountability for continuous process improvements and practice based evidence. reach is focused on achieving aspirational results. although we are healthier than most regions in the united states, we still have room for improvement. we continue to have health inequities in san francisco especially with our black african americans and latinos. we have adopted a results based collective impact framework that is community centered, data driven and evidence based. our strategic plan will present result statements and headline indicators for our highest pry torety focus areas. reach is focused on integrating health equity into quality improvement. we have moved from the mission

and values statement to quality improvement practice. this ensures our efforts to inform public health practice, improve continuously and improve health outcomes. for example, we are partnering with our clinical division, the san francisco health network to improve health and wellness for our african american patients, clients and substance abuse systems. reach is focused on ensuring the accountability for continuous process improvements. achieving results is not sufficient if we are not investing in our work force or improving our business processes. we are investing in our current and future work force with leadership and quality improvement training and internship opportunities. finally, with support and technical assistance for centers for disease control and

prevention, we reorganized and integrated public health division. i'm going to have israel take us through the slides and we'll be introducing the other speakers. >> good afternoon commissioners. first let me say i am honored to meet you. i just want to remind you that we are here from your vision. we are here because you set three priorities for the health department, which is an integrated delivery system achieving public health accreditation and financial efficiencies. we're green in san francisco, we call this the tricycle. there are three prerequisites, a community health assessment and improvement plan. it has truly taken a village to achieve even applying for this and i want to thank the leadership of barbara garcia and car lean and her team who tuk us through the first two parts of this process with over 600 community and stakeholders

engaging in this, all of these visuals that you see in the hallway, we remind ourself that this was really about the community's voice for their vision for health in san francisco. we keep seeing this framework and i want to adjust it a little bit so you have a clear understanding. this is your vision for an integrated delivery system for san francisco. it shows you the two divisions. we've color coded it really to look at the public health accreditations categories so you can see where we're achieving governance, policy development and assurance and as you can see, many of us are matrix because we work together to align our efforts across to the health department. the first part of the strategic plan is actually divided into two phases.

it was also our strategic map with six priority areas also aligned to public health accreditation categories and performance measures that we want you to hold us accountable as we come to you. examples of that is an integrated delivery system for diseases. as you can see in policy 3.2 is not only for us to achieve public health accreditation, but for us to maintain it and as well as an example of definiting a centralized business office to maximize efficiency and use of dollars. those are just some of the examples we'll presenting throughout the years to you. i'm going to ask to present a larger framework and then our directors will all come up and provide you a little overview of where we're going. >> when we were doing the

reorganize, we borrowed from frameworks used nationally. what we did is that this is the framework we used where we became more functional and the idea is for us to be more agile, adaptive and responsive to emerging public health problems and so you can see our -- the areas there under healthy people, healthy places, diseases and disasters. the things i want to call out to you is we have a new office of equity and quality improvement and the other one i want to point out to you is the center for learning and innovation. those are two areas that are innovative and new and you will not find in most health departments. it's going to be these six high priority areas for our whole di viks, but they're cross cutting, but they crossed into the network and into the community. we do 100 things, but we're saying as a division, as the health department, we're going

to focus on these six areas. the first three come from the community health improvement plan and what i'm going to do is read those, i'm going to name the speakers all at once and then they'll come up one in a row. i won't come back and introduce them. so for the insurance, safe and healthy living environment, we'll have richard leaf, director of the environmental health branch, increase healthy eating and physical activity. we'll have tracy packer. under black african american health i will make a few comments under maternal, child and adolescent health. and then under health for people at risk in living with hiv, doctor susan phillip will make some comments. i'm going to go ahead and turn it ove