esearch that effects people across the country large employers that research demonstrates the wellness is associated with lower health care costs and fire scheduled days of time off and rates by the supervisors and combransz pursuit /* product. >> several years ago the mayor's office and department of human resources and the heartache services came together to sponsor the program the goals of the plan to improve the employee winging walgreens and handle the high cost of hedge funds it is a concept that addresses our choices and relationships and environment it included not only our physical but mental well-being it needs to take a comprehensive look at

the employees the city programs focused on peace of mind which isn't easy to describe did you incredibly important which is why i listed it first as well as the preventive care as the health service you're not addressing health unless i address well-being to work together through dpw and wellness thank you. >> thank you. >> next please. >> good afternoon, commissioners abby here representing the health in both of our hospitals st. mary's and st. francis memorial hospital our president was co-chair of the health council and sends his regards and happy to see the program continues to modernize

we're pleased to have been supported this all along and it is great to see the creativity and the innovation and research that is going gone into open about this post ac a world we're living in from the hospital operation we have seen a significance in the demand for services through h sf we see as a success and many patients have shifted into medicare and the systems are continued to enhance the medi-cal population but putting in this little very creative i think fix for dilemma we experienced in san francisco is really great thinking on the part of department and i commend their support for the research that went into this and lastly i

want to comment the wellness program we heard a nice prengs presentations is very much in line with the hospitals they're working with the san francisco health improvement in with the wellness program a manifestation how to work together is a terrific assess of this modernization act thank you. >> thank you following (calling names) those are the only slips i have if anyone else wishes to speak turn in a form. >> commissioner chow hospital council of northern and central california we're here to lend our voice and support of the staffs efforts to bring this ordinance to modernize is and to capture more in this program

during the presentation he couldn't help by wonder what a great job this city and department does in making this sort of adjustment that need to be ma made as we live in this ac a world that hospital contributes with your directors we're here to lend our support and hope you adopt this at your next meeting. >> you. >> i'm emily from the pacific medical center i'm happy to be here to lend our support for this modernization plan and say how thoughtful he think that is and impressive we are supportive both of the problems of the expanding insurance through the bridge to coverage medical

reimbursement account by promoting insurance through offering that extended benefit and modernizing healthy be san francisco to make sure it is the safety net program we intend it to be and also to say we're looking forward to continuing to work with dpw and the staff to make healthy san francisco a success we're supportive of the modernization plan and hope you'll approve it on august 4th. >> thank you. >> i have to adjust this good afternoon, commissioners i'm rosa i work with the acts or the statewide we're an advocacy organization also in support of the proposal that is before you we in the past i was not on board but in 2007 we were very active in support of the health care security ordinance as well

as healthy san francisco san francisco continues to lead in so many ways by definitely in terms of how it performs we're aware two other states vermont and massachusetts have taken additional steps to improve their program with the package of the affordable health care act we're protest of what the staff did in providing an updated proposal we have our own recommendations of things we'd like for you to consider are example the premium assistance should be available for san francisco residents as well as residents that don't live in san francisco our executive board director anthony was not able to make it because of a previously schedule board meeting no los angeles i

have a statement i'll leave with you we're in strong support thank you. >> thank you. >> so dhs. >> deanna from the san francisco clinic consortium we're here in strongly strong support of the city option i want to say you hear a lot of thing about the things happening in san francisco not great for the average san franciscan this is really supportive of the san franciscans we're proud of that i'm sure you're aware of san franciscans need clinic consortium we represented many clinics and serve about 10 percent of san francisco's population primarily the low income and moderate income population we've played a big role and as colleen talked about

the healthy san francisco enrollment has gone down most of the patients moved over to medi-cal or some covered california we are heard a lot of the same people in healthy san francisco also added on the ac a they wanted covered california but couldn't afford it are picked the brogues plan and not afford the services those are people that wanted to do the right thing they understood the goals and gooldz for in their own health, i want to applaud everyone in having a resolution i have a statement the women's community clinic want to say the vast majority of our clients are under 40 the clients over 2

hundred and 50 percent of poverty level repeat they're unable to afford the fund 24 will support those women and therefore having the access to care thank you for your support and we strongly support the modernization there are a lot of political rhetoric that pits fwroipz against each other one of the things we're doing in san francisco we're helping people that are eligible through 9 ac a and maintaining the programs so i think we are once again a model how this should be done. >> thank you very much. >> if i may commissioner, i said to acknowledge the work on this project she's made a difficult process into an important program so i want to acknowledge her she's acknowledged everyone but i wanted to be the one to

acknowledge here she's fantastic (clapping.) thank you director garcia. >> i was going to express the thanks for the commission to making a complicated proposal as simple as i think you could because even i can understand it (laughter) no that's correct it's clear the amount of work that's been done the background material this has been provide and the accomodation for creating and indeed able to support a program i think we've heard from public testimony will be helping more people commissioners we're prepared for comments or discussion at this point or additional suggestions

commissioner taylor-mcghee you i want to recognize stephanie's work on this. >> how many people today anticipate will enroll in healthy san francisco as a result of the extension it is my understanding it is subject to fines because healthy san francisco is not insurance and that's correct so when the health commission approved the extension in 2014 and at the end of 2015 we look at how many people were in healthy san francisco under that temporary waiver and there were 4 thousand people at the beginning of 2014 who were otherwise eligible for covered california insurance that number is 7 hundred today with declined and those who have health insurance have not come back to reenroll it will continue to go down to 12 hundred individuals

in 2016 the federal penalty for not having health insurance we the the maximum in 2015 individuals might not know the impact nail their tax return in 2017 but the maximum penalty of 2.5 percent in 2016 as that cost of the penalty blue healthy san francisco participation fees gets closer to the cost health insurance it might make that cost easier to move in favor of the health insurance. >> shirley. >> what's the reaction of employers and is there additional costs to employers under the new modernization. >> we had meetings on this with employers and labor representatives of labor organizations and from the

employee prospective i think that what we heard was this looks like a fine program it doesn't make any changes to what businesses are obligated to do in the health care security and the employee wellness fund they're interested in participating in a process that would create the wellness fund but they up we're neutral they thought it looked like a good idea but didn't change anything. >> they're not opposing it. >> not to my knowledge we're making a similar presentation to the small business commission next monday. >> commissioner singer. >> that's correct deputy city attorney and thank you for answering my questions in preparation for this i have a comment then a couple of questions comment is that we're living in

a time roadway where sort of everything goes up and to the right the level of employment goes up and even though wealthy in the city and unemployment goes down and therefore we can do things like that but especially with complicated programs it is reasonable to ask of it is a when we present those analyze the projected costs and membership there is so sort of scenario stressing so what happens and i know that greg wagner worries about this he present you it us frequently what happens when it changes but with you our eyes wide open what's the obligations we're taking on this is especially important with complex programs because the law of urban intended convinces will take

over my two questions are as follows i completely understand and support the thesis to plug the holes as we see them developing what i don't really understand is why we're not using this an, an opportunity to drive more people into the san francisco network it will become healthier and more vibrant at the same time, we have people in the competitive environmentalist triumphantly environment we're paying their insurance into their niblth or networks my concern a long term that the quality care in the city will suffer wool be out exceeded and this is a great opportunity to

think about that. >> we certainly looked at that as a proposal we wanted to putter before you it requires many things to be in place first, it requires us to have a contract with covered california if we're going to maximize all the subsidies and currently no pathway for covered california to choose the did you want as it's provider so right now there notice ability to do that we look at it with the eye towards a contract in the future what we looked at we are several options they were detailed in the report that h m a put together if you want them to comment they can after i'm done several things that raised concerns for different stakeholders in the process first was covered california ability to allow a plan on covered california to

contract with this kind of a program to offer something that is as federal eligible for federal subsidies to offer it to consumers in san francisco this creates an unlevel playing field and for the federal in terms of the ability to for us to contract with one qualified health plan in cost california in addition, we met with the h m a they have discussions and the plans had very little incentive to change any of their processes or procedures for the relatively small patient population we're talking about we're talking about 3 thousand combreerlz and 4 of the plans are invading plans so we focused our communication on the r without objection one local when you the

ability to make changes to account for a special program for the 30 thousand san franciscans we're talking about was not doable for them certainly in the near future but potentially not in the distant future looking at the timeline and those regulatory and legal barriers we didn't know that was feasible to do that at this time. >> this make sense i'd love to see a plan an outline how we will do it and when as we talk about you know - as the city spends moroni health care we have to think about the other spend we're doing if f there is a way to e rattle and get higher health care it is worst exploring the second question around the

wellness program partially what kind of employers are we targeting. >> we'll likely targeting of this is a special initiative not connected while likely target employers who contribute to the city option to comply with the health security ordinance those bike sharing tend to be sizeable businesses that choose a size limit or some certain features of that business to target the benefit towards. >> so the thing that strikes me not and we've talked about this the validity of those programs the question is really it doesn't make sense to me why it is part of this it seems like another different thing so if i had the mask 10 it wouldn't be in the modernization it

self-speak to the modernization apparently that the department so thoughtful fully prepared is trying to do it is trying to do something that is important maybe the employer should pay for it or the city i'm not sure it doesn't seem like it should be part of the ordinance. >> you're right the city modernization is specific to how we implement the health security ordinance and the wellness is a separate program what pulls it together with the alignment of the aeblth affordable health care act it had a investments in the wellness programs the report that i cite in the memo is actually commissioned by h ms and others by the randy cooperation corporations to support the affordable health care act on preservation so it

really incorporate our overall goals around population health and our citywide mission to protect and promote the health of all san franciscans in the framework of the affordable health care act so that's why. >> i was on the board when randy did that study you're right advertised compelling work i personally don't think that belongs in this program that needs to be evaluated in the context of what it costs us is it our obligation for the city or their obligation to do that and so this would be something i'd like the commission to consider. >> commissioners he raised a good question about the wellness and the wellness fund i'm reading maybe i need a clarification how this is funded so i thought it was

connected with the aco the security collection of dollars from the employers and this was. >> when would be a general fund budget. >> that's correct and it clarifies and what you're speaking to this was the thing i was worried about and so i think there were two questions other questions from the commissioners, i was trying to photocopy on commissioner singer on the thought of what would happen in the future and whether

or not even though right now it is infeasible to find the alternatives that are so well documented by the h m a report for the extensive report we're intending to have this available for 2016 and not create our covered california what is future in terms of what we're looking at for as this now films in how would we or considering to we consider maybe another city option i mean what are your thoughts. >> we've discussed that part of the reason that the health care foundation was interested the - we were looking at ways to leverage our own health care system to provide health care to

those and we'll absolutely do that. >> commissioners this program is worth a review after so many years by the commission to ask that question we will we can't predict what the future we can predict what ac a was happened but it is well porth or worth it to look at it and we don't know what the economy will look like we can fill that into the review. >> right it could go into the resolution. >> to be i think this is a reasonable idea that was not the thing i was a proposing i was proposing when we approve things like that or evaluate them we don't see one analysis look if unemployment goes to one percent

it is going to cost a lot less or 11 what is this is going to cost not that we wouldn't do it or understand and be responsible to the mayor's office and say hey here's what we're signing up for so noted. >> that's what i wanted to say and. >> i still like high idea and i think you're quite correct in terms of the analysis it is nice to understand and where are the limits of the dark side in a year if now all of a sudden something happens is that the type of scenario you're asking for the future. >> i just fell off maybe i'm not communicating as i listen to the presentation and look at the

charter six or eight years ago and you sort of see you know today in california we're ranked almost 50 accounting for the children and consecutively of care and we have a light house conference on the elderly aging in washington and noble the avoid with the federal guidelines but the factors there's providers and care and assess and follow-up everybody we have been discussing with the concept we try to aid those unique challenges for the city and upgrades e you know, i agree the measure options a can be great i can think of the industries and programs you name

most of large companies have fantastic programs for wellness for their employees because if their healthy and if part of program to creativity to have equate time for a new born baby for i mean all great things can happen but though in the equation it documentation reinforces what we're g about as the hunt those are good questions bottom line where are we today when you look at california and how we as a city are somehow measured as a sort of strategy we lead and through all those clinical trials but look at the who'll stay and the kids and the number of elderly it is sort of hits you and say thank god we're able to really

have some positive discussions with our businesses within our communities within i mean earlier we were thinking about dr. dick i was a general in 1969 how to provide the quality care for the people for the prisoners i mean let's do and thank god the late gentleman that helped people like fine to provide those great services but half the faculty what are we're going to do and here we are today as a city and still providing those services but it comes as a cost we need this type of dialog but it frustrating but sometime we have to bite the bullet and make a decision and i think of the greater good of who we serve and the humanity that makes san francisco in this case i too would like to see this

expanded to many of the employees we have who can't afford to live in the city by work in the city and don't have access to health care and folks that couldn't be here we hereto their notes how to address those issues pertaining to the 3 thousand plus clients we what is even though greater need today at stake than ever before i'm proud we have different ways of thinking but we're here discussing and talking about i'm so thankful we have essential stamping staff this is because of the trust and the fact we've been able to deliver as a public board

through the public leadership and the partnership to provide a little bit of difference if the quality of life and the patient care within the community or speciality clinics but - >> i understand the frustration. >> thank you commissioner sanchez commissioner pating. >> thank you very much first of all i want to congratulate and thank the directors director barbara garcia this is a beautiful and eloquent proposal and once you get over the shock of living in san francisco this proposal makes rarnl sense and provides expensive care in the systems leverages dollars and increases coverage it is very eloquent thank you for that with that said, before we hear and make the final decision