>> please silence any mobile devices that may sound off during these proceedings and when speaking before the commission if you care to state your name, for the record. and i would like to take the roll for the planning commission, commission president wu? >> here. >> fong. >> here. >> antonini. >> here. >> moore. >> here. >> richards. >> here. >> we do expect commissioner johnson to arrive at some point. >> and i will take the roll for the health. >> chow. >> present. >> singer. >> present. >> chung. >> present. >> thank you, commissioners and you have one item it your special calendar for case number 2012.0403 and this is a

joint informational hearing, and good morning, president's chow and wu, i am the assistant director of current planning today's presentation is a informational presentation on the california medical center with the development agreement for the 2013 reporting period. this is the first reporting period. today presentation, i am sorry, at today's presentation you will hear from the city staff on the compliance with the key components of the da that are relevant for the 2013 reporting period and as well as the updates on the compliance in 2014, following this hearing, the directors of planning and public health will determine if they are compliant with the 2013 obligations and issue the findings to that effect, a third party monitor will review the director's findings and inform the board of supervisors whether he agrees with the director's determinations and as you recall, the developing agreement is to build two new hospital and three new medical office buildings, with signs by the mayor in july of 2013.

since then, construction for both the hill hospitals have begun, they are on track for meeting the commitment to open the hospital within two years of opening the hills hospital. for the 2013 reporting period, there are eleven main action items up for compliance review as outlined on this slide. my colleagues will go into these in greater detail. >> in 2013, they were required to make 12 payments all of which they have paid. >> and with that, i will now it over to casey. thank you. >> oewdstaff, in san francisco foundation received the first two of three payments for force work training and improving entry level, employment for residents in a high priority

neighborhoods. the sf foundation received the first two of six payments to create the fund, which will grant the five community based healthcare organizations the parks and rec department and puc and sfmta. and the park, and around the cpmc, cathedral hill and the california campuses. and the mayor's office of housing and community development, received the payments into the city wide affordable housing fund for placement housing and rental assistance. sfmta received payments for transportation improvements including bicycle safety and

the brt and so our and we had two parts to our role in this dba the first one was hiring around construction. and you can see the goals and at least, 50 percent of the new entry level positions. and we have met that, and the goal, with cpmc and we have actually done quite well there.

a couple came through the office as internships and were placed there and very strong candidate and we have done quite well there. and then the next is for the apprentice program, which is how we with the city bill worked to get a lot of new folks in the pipeline there. and at least, 50 percent of the new entry level, apprentice ships which was our goal and we have met that and we have filled all eight in that, and

apprentice ship role and so when you go out on the sight, you can see our city bill efforts there and really paying off. and the, other thing that i would like to say, on the construction side that has been important, is that the staffing for the construction to make this happen, on cpmc side, on their contractor's side, was exceptional and that is how we have been able to exceed the goals and one of the staff that is working on this project, actually used to run our city bill academy and that really helped, because they understand our program and they understand the students, and that, that was a good effort. the next on the construction and the trade hours, which is the union journey man, and that was our goal and the apprentice that will be performed by the sf residents as of today and

the cpmc contractors reported and you can see the hours and so we have met that goal in terms of san francisco, residents, which was one of the concerns, when we got started on the project.

you can see where the other folks come from, 44 percent are from other areas in san francisco. and the in use jobs that have been a little bit more challenging and it has taken a lot more work to get it up and running. the intensity of this da from the first source perspective is different and unique from anything that we have done, the goal was to fill 40 percent of the entry positions with the system referrals meaning the referrals that come through our funded organizations, for workforce. and if the 40 percent is not met, then, whatever is not met, just rolls over into the next year. and you will see this is where we have struggled but i do feel

like we are making some progress. these were our priority neighborhoods that they were focusing on. they filled and you can see the different categories of jobs, housekeepers and security officer and patient registration and food service aid. of the six, five came from our designated areas. and so these efficiency or what has to rollover was the 13 entry level positions get rolled over into the next year. the other part of this was and

we have just got this part going was cpmc contributed $3 million to a workforce fund, the purpose of the funding was for removal and job training and the funding was to target educational institutions and non-profits. and the san francisco foundation has just released the rfp in the last two weeks and so that money is just now hitting the streets and i think that will help us a lot and it has gone out to a wide mailer of non-profits to compete for those funds to help with barrier removal, and any other issues, training, additional training, things that we now know can make and will need to get employed at cpmc. our initial failings, we have had a number of meetings and discussions with the community

group and cpmc and would like to talk a little bit where we stumbled and failed, coming out of the gate, and it took a bit of time to get the entry level job notices and so we actually knew what type of positions we would be hiring for it. and the projecting took different than when we initially put it together in terms of the types of jobs. and the initial hiring for entry level jobs is in the per diem format and it is not like a full time sc, 40 hours a week and it took the time for us all to understand the hiring system for cpmc. both of the cpmc and oewd also went through our own sort of

staffing for this project coming out of the gate. so, i can really speak from the perspective of my staff where we were extremely short staffed and needed to get the staff in place to really make this go and that is not to say that we can all do bet and her need to do better and you can see the improvements that we have gone to a daily, more frequent, and the meetings and cpmc has gone through their own sort of internal staffing to make this project work or this program work. and for us, a lot of our work is making sure that the job seekers are ready so to that end, we have invested additional resources, we received one million dollars in

resources separate from the 3 million that we just got to help the access centers be ready to get clients ready for the positions that are available. and so it has taken some time. and we have had conversations with the community and understand their concerns. we have had conversations with cpmc and the community, to try to get this to not make the similar mistakes and start this current year off in the better, stronger way. on the end use side particularly. the things that we now know are barriers for the people trying to get into these jobs, both on our shop and through sffoundation. and enhance our healthcare academies and now that we have a better sense of what the job

projections are and there was a focus on entry level healthcare and it turpd out that it was much more supporter services. and we have a hospitality academy, that we are bringing in to this mix, that when we originally got into this, we are more focused on healthcare and there is a system of up grades, both on the training of the cpmc side and training our staff and joint training with our community based organization and we didn't really have a data system in place and not a strong one to really track this. and then, understanding and monitoring the hiring trends a lot better. we also now have a system in place, to understand if we make referral and we have a system

in place that understand what is going on and why didn't they move on to the next step of hiring. and much stronger out reach and support. and we have gone to a more regular application, training process, of our cbos so that they know how to get the clients ready to apply. and we now do stronger hiring events and partnerships with cpmc. thank you. >> i am with the department of health and this slide is the summary of the 2013, healthcare commitments that were incorporated into the development agreement and i will go through each one. first is the base line, charity care commitment. the purpose of this was to insure that cpmc will maintain

their current level of service when they entered into the development agreement, and that any other healthcare obligations would come on top of the commitment, and that they were already giving to the low income residents of san francisco. serve a base line of 30,445 of patients each year and insures that everything else is in addition to what they did at the time that they entered into the contract and so for the prorated portion of the development agreement, they serve, 4421, unduplicated patient and they exceeded that by serving 5687, this provision, has been verified, and their compliance has been verified by an independent audit and one of the developments of the third party audit requirements. and so this represents care

across cpmc, san francisco campuses. the majority of the care to the low income is provided at the california pacific and the davis campuss that are reported together as one hospital, and saint lukes reports separately. and so similar, this requires that the community benefit be maintained at levels which was 8 million upon entering into the agreement. and the prorated share of this was approximately 1.16 million dollars, and cpmc then exceeded that by providing the community benefit in the amount of 1.5 million dollars. and also, the base line, charity care component requires that cpmc maintains the charity care and so that they can be no more restrictive and continue their financial support to the bay view, child health center. >> the second large component of the development agreement, related to medical care, was in

the medical beneficiaries and first to require that cpmc saw the beneficiaries was to maintain the contract with the plan which is the primary provider of medical services and insurance. cpmc did do that. as to the new medical beneficiaries are required to provide 54, and hospital care for up to 5400 medical beneficiaries. and there is no time line for them to meet the 5400, because, the new beneficiaries are and the time line is not in their control. as long as they stay opened to receiving new beneficiaries they remain compliant ask by the end of 2013, they were nearly halfway there by having, 2511 new beneficiary and my understanding from the discussions with the health

plan is that they have already exceeded the 5400 new medical beneficiaries in 2014. i want to note here that there was a double counting error that i will just decide in more detail later but it is essentially, it was just a math error and it was it does not effect the 5400 requirement. the double counting was a total and the 5400 obligation remains. and also, related to new medical beneficiaries 1500 will have to come from a partnership with a new tender loin survey, medical service organization and this organization has to be one that is able to do business in medical managed care and able to take on risk and do utilization management with the patient and track the patients and so on and it is a business model that goes beyond providing healthcare services. and the intention here of course, was that with the new cathedral hill hospital, the tender loin patients being new patient theres should be a

commitment to serve the low income patients. there is no new provider in the tender loin that is able to partner with cpmc to do the work and i will talk about that in a future slide. >> and another major component of the development agreement was the innovation fund, and this is a fund of 8.6 million dollars, that provided to the san francisco foundation administered by the foundation and in 2013, they were obligated to fund, 3.5 million of the 8.6 which they did. and the funding decisions by the innovation fund are made, by an innovation grant committee of the san francisco foundation and the department of public health and the cpmc staff, in 2013, innovation fund awarded 1.25 million, for the three pry mar projects, first

aca readiness for non-profit clinics and 40 percent of the funds went to support the klin clinics and the second was for people living with hiv and aids and approximately, 35 percent went to the san francisco foundation to support their new clinic in the castro and the third area was for the extension of the mental health services about 25 percent of the fupds went to the progress foundation to insure that their door and urgent care clinics could operate at full capacity 24 salt laker that is a clinic that is able to divert the patients from the hospital, if it is an appropriate placement for them. there were several additional provisions of the development agreement that are listed here and i will go through them quickly, the first is the subacute services and saint lukess that services either the nursing facility and the high need patients and those

services are expected to be eliminated by the time the new saint lukes opens. to convene a group to look at the need for the services in the future, we extended their deadline for providing us with some recommendations to june, 20, sorry, june, 2015 and those recommendations will come to the health commission and they have already initiate the work with the hospitals and on track to come to the health commission by june of 2015. staff integration, the commission asked that the health commission, that cpmc look to integrate the medical staff across all of the campuses integrated this is thus far are emergency medicine, and radiology and neurology and others and so they are making progress, and

it is important to know that these are independent physician organizations and not entirely under cmp c control. >> the community benefits partnership, this is a group of hospitals and health department and community organizations that partner to improve the health in the city, and the da required the continued participation in this group, and it does have a success or and it is called the san francisco health improvement partnership. culturally, appropriate, services. and so, the development agreement, requires cpmc to comply with national standards on cultural services and in

this area, cpmc submitted policies that it has in place to show that it is compliant with these standards. and we went back and asked cpmc for additional nfrg, including the metrics that they gathered to assess their own compliance and performance against the standards, and which they also provided. there is no partner available and that is true and no fault of theirs. the money went to support the community clinics to enhance readiness for aca and the funds

went specifically to see if the community clinics that come together and create that partnership to do business with cpmc. eight clinics came together and they hired an actualary and a consultant to look at the business end of doing business with medical managed care and at the conclusion of that process, they determined that that was not going to be a sustain able business model for them. so the clinics decided not to pursue that route. we are continuing to look at other alternatives, however, for cpmc to meet that obligation, currently there is a clinic in flux located in the tender loin that is looking to partner with the other providers. >> and one of those does do business with medical managed care and so there is a possibility that a partnership there could provide an avenue for them to meet 1500 tender loin life obligation and should that occur and we should know that in a few months, we have other plans in place to explore

other partnerships with the health department or others. it is possible that they will be short of the 30,445 base line commitments for serving unduplicated medical and charity care patients when we were notified the shortfall was projected between 3,000 and 5,000. and updated figures show that the projected shortfall is expected to be between 1,000 and 1500. so, this is problematic, i think, and they have the ability to make it up in a following year there is a provision called a two year rolling average that allows them to use the overage in one year to apply for another year and they have an overage in 2013, but i think that it is problematic for the terms of the da. and we are exploring other ways for them to help to meet this commitment and perhaps by

serving medical patients who are waiting at san francisco general for services and so it would reduce the wait for san francisco general and help cpmc and meet their own obligations and so we are exploring way to do that. >> and then i also mentioned that there was a double counting error on the total medical beneficiaries and this again does not effect the 5400 new medical lives or the 1500 medical lives, it was a mathematical error, and we knew that a certain number of people were transitioning into medical already and we didn't want cpmc to be able to use that number and we are meeting the 540 but that number was double counted, about 250 over. >> and so issues outside of the development agreement. i know that there still remains concerns about the lack of skilled nursing beds in the future plans for cpmc, the skilled nursing beds were part of an agreement that the health

commission had with the cpmc early on, and those agreements were the foundation of the healthcare elements of the agreement but in the negotiations, the skilled nursing facility beds did not make it through to the end and so that was certainly a concern of the commission and the commission recently passed our health commission passed a resolution, noting that the reduction of the skilled beds will be detrimental to the city but it is not an element of the development agreement and not enforcement under the agreement and finally the saint lukes diabetes clinics, we have received reports that there have been changes to staffing in the diabetes klinish at saint lukes that are effecting mono lingual women, the same number of people are being serve and we believe that there is concern about the level of

cultural come pentcy. while they have policies in place that support the class standards and the metrics to measure their performance there we have concerns about the actual implementation and how that effects the patients. so that concludes my presentation, and we will come. >> thanks, i am with oewd and thanks for your patience through this detailed presentation. i am the wrap up speaker so we are almost done i wanted to remind all of you how difficult and complex the process was for arriving at this development agreement. the staff believe that over all considering the short reporting period covered by this report, that the development agreement's provisions are working relatively well so far and the staff's recommendation to the director's of public hel and this planning are to define the cpmc in compliance for the reporting year and i want to

highlight just a couple of issues that we heard the concerns from the community and others. and you heard from her, the cpmc may miss meeting the base line target for the coming calendar, 2014 reporting period. we are glad that the discrepancy is not likely to be a large one, but we do want to say that we are surprised and disappointed that this key central division of the development agreement should be in doubt in any reporting year. and there needs to never be any doubt that this provision will be met and the city will continue to monitor and enforce this provision of the development agreement. and also, just to highlight on the tender loin, medical patients there was a central tenant of the agreement to try to make sure there is a way for the new facility to take care of the tender loin patients and the fact that that has not been managed to put together is not a fault of cpmc, i just want to reiterate that the city is committed to continuing to work to make sha