new just asking. >> all right. thanks for bringing that up commissioner lee it is a good follow-up to a couple of months ago >> any other commissioners questions or comments if not any public comment on item this i don't see any the late item request for future items anything anybody want to bring up remind people our first meeting 40 in september a cancelled and the first in august hfa happens to be your anniversary party is it is not quite a meeting that will go to permit and sorry. >> doesn't we have an august. >> august 22nd. >> august 22nd is scheduled for our entertainment commission retreat for all of us the idea

we do strategic planning if you can get your thoughts going about - >> no. >> not yet we'll prepare that in the next couple of weeks. >> the date. >> august 22nd is a saturday, i building from 9 to one. >> do we have a location for that no. >> so we have a meeting on the 18 and the retreat on the 22nd correct. >> i just want to inform you i'll not be at the retreat i'll be at a wedding but i'll be at the 18 meeting. >> if we want to have our vice chair we'll have to look at another date okay. so it didn't seem like anything burning people want to bring up any public comment on this seeing none, that adjourns

our meeting have a good night. >> sdmirng commissioner chow commissioner chung commissioner sanchez commissioner karshmer the second item on the agenda is the approval of the minutes of july 15th commissioners the minutes are before you and a motion forceps is in order. >> so moved. >> second there is a motion and

a second are there any corrections to the minutes if not. >> all in favor, say i. >> i. >> opposed? of the minutes have been passed thank you. >> item 3 director's report. >> i want to welcome commissioner taylor-mcghee commissioners we are existing to share with you our port for a proposal for your review and approval to strengthen sorry health care security ordinance to insure continued health care assess and coverage i'm sure you're aware of the department is a long time supporter healthy san francisco prior to the ac a shows our ability to provide and insure that people in the community get access to medical homes that p and to healthy san francisco we the that and

another phase of how to insure that people are able to get a health benefit and today so you'll be hearing a proposal to modern motion to dismiss our security ordinance to insure that low income and moderate san franciscans have access to health care the increases the california plan for many san franciscans and maintain the healthy san francisco safety net for those who don't have another coverage opposed those improvements help more low income san franciscans fired orange county r affordable health care act while leaving the safety net in place may we announced his support on friday noting it keeps the health reform for all san franciscans you'll hear a more detailed report later this summer the centers for medi-cal and mcwill recognize ways in which medi-cal and

medicaid have transformed as we mark the investigating anniversary of medi-cal and medicaid we see the protection of the linebacker of families and the economic security those are life-threatening programs to commemorate camtc and heartache and san francisco general hospital and others are hosting an event on july 30th from 10 to 11:30 a.m. i'd like to invite the commissioner 50 years that president johnson signed the social security into law it was featured remarks from the health care experts how medal and medicaid help to build a smarter system i's conference of marries took place in san francisco and here the mayors passed the resolution

to support vision 2025 to eliminate traffic fatalities and severe injuries awhile increasing safety and health and mobility for all san francisco proud to lead the u.s. cities committed to vision zero and want to see more people and cities work towards this goal i want to acknowledge that sue karen retiree from central nervous system as a nurse and minority since 2009 this has helped san francisco generous quality is nationally recognized with stand up that he had risks and cancer and trauma and hiv and aids she's focused many safety initiatives in the department during your 10 you are but the san francisco

general hospital foundation they've got gifts and we've met in the san francisco general and the capital campaigns we want to wish many karen's the best and thank her for the great success in the department want to acknowledge laguna honda has hair medical annual retreat and medical leadership and those are listed in the report also just to thank laguna honda for attending the 2015 aids walk that happened july 19th we are really working and trying to support our dpw hiring ability and so we're doing a lion an improvement practice win our human resources department to really look at how we can streamline and improve our

hiring practice to get the right candidates so this will be an ongoing process for the next coming years and most importantly we've define work to achieve our ability to hire as quickly as possible also want to do a shout out to alice the class and institute health and scholarship the goal to strengthen the leadership of no matter oversees across the health care system and connect and desire to create new approaches for the health and well-being she's our chief medical officer and continues to look at innovations throughout the department we want to congratulate her on that appointment (clapping) that's the end of my report commissioners, if there's further questions.

>> commissioners any questions from the director at this point? you were so clear michelle obama i know we'll be talking about the ordinance we'll - i'll reserve my comments for that >> any other comments if not our next subject. >> item 4 general public comment not received any requests for general public comment at this time. >> so we move on to item 5 the health community public meeting and i'd like to report on today's health committee this is my first opportunity to take over at the chair i want to thank the previous chair in the past and turning over the good work on the committee community population public health committee is trying to look at the programs in the health division to see how they

integrate and fit into a network of programs to improve our overall city today, we heard programs of food and security of plat standard and tb control i'll give a quick run down paula jones heading up our task force food and security is endemic to san francisco it relate to health in so many ways without food you don't have health we need to think of food as medicine the board of supervisors recognized ♪ 2013 and xhiktdz a food security task force which was headed by dpw to address the food securities throughout the community about a quarter of san franciscans are blow the 2 hundred poverty level which is

where we begin to see incomes derotated into the security of less than 2 percent of poverty level 35 percent are designated as having tenuous food insecure status to the committee is looking at the health issues and tool based and health and food needs and food needs for seniors and they're doing quite a bit of work we heard a fraction of coalition of with program meals on wheels open hand dependent on aging, too many programs to name really come together together and bring the food services to the aide we ask that this program has it's who's also on the ground come back to us in january to present

some population based indicators how much progress since will 2013 and have indicators based on the survey we'll look at the initiative for 3 years has improved food skirt goal of this mission to reduce and eliminate food insecurity by 2020 so we can have 5 years to do that and check in on this january you'll hear more we'll expressed how relevant this issue is in san francisco despite our economic boom and the second class standards class is a federal requirement of all medicare funded programs 15 standards and the federal government office revised the standards for class bottom line is san francisco department of

public health is the population health division is meeting the class standards we're hundred percent meeting the services one the highlights was our governance and leadership bodies this agency including commissioner sorry director barbara garcia and her staff all 9 way down to our basic service workers are involved with training throughout the city this is improved to approved to be the culture change making san francisco culturally confident we heard about the tuberculous control we've had very good efforts on tb control in 19903 hundred and 34 cases of actually

tb and through case finding and screening we decreased to hundred and 14 cases of active tb last year and this is all brought under the department of public health tb infection control division so while we have this control the question that is being discussed where we might have a framework to eliminate tb or active tb in the city we're not quite there yet but possible hope when we get an electronic health record the writer use of screening techniques implementation of screening universally in our medical homes we might get a confluence of forces where the possibility of eliminating tb in san francisco becomes real so the department was not ready to commit to this

letting us know this is something we're thinking but with active treatment and surveillance and the public and private hospital this is a possibility we'll work on this in the department and perhaps come forward with a later on but we should feel secure that the control of tb is very well done in san francisco although in the as elimination which are two different things that's our report and i'll leave to any questions >> commissioners any questions? i have a question from our last report on the tuberculous i'd like to hear that that is not only me trying to understand how they try to reduce our portion of tuberculous cases so that state is no greater than the

national average if it can't get to zero >> well san francisco has becoming you know we're an urban population large immigrant population and a as well as there are always continuing forces that are bringing in new cases of tb one process our active screening under the affordable health care act has co-pamphlets to it one of the things that was look at what kind of funding to our system to reduce the barriers of people getting screening with regards to possible being at risk for tb while we're doing active screening the question is moving towards treatment that is foreperson under the

affordable-care act and another health insurance plans a matter of bringing the financing and the technology and applying this to some of our communities at risk those are the things that have to come together there say i think we were representative not a vision but hoping a possibility there's a way to eliminate tuberculous not just control which is what we're doing we're controlling it we're identifying cases and making sure those cases don't spread but making this go to zero is another issue does that answer your question commissioner chow. >> i was looking for that next step they're going to be taking and that it isn't just a wish on their part but that we ask there be a designated time they'll

come back with the food security issue and that they would then tells you the progress they're making towards doing that i think just as you said this requires breaking down the different population we know in the past when we have recorded to us there were the cases were coming in from those who were well those who are immigrant and also the reciprocal cases that happened to recess recurrent we had the fund they hadn't retreated to be positive and also then within the population that was vulnerable from weakness within chronic diseases or hiv that's the goal to try to reach vision zero really is the type population i'd like to see

more. >> commissioner chow and i spoke about that i'll be working with the staff on having an action plan towards the goal and one of the areas dr. chow worked with us the direct observation therapy to incorporate a better manner in which to improve our tb work and so we'll work with the staff and the next phase will think an action plan towards insuring that we're looking at. >> on the committee we were comfortable with the flow that not forcing this issue to come forward before it was ready we've presented ideas and a clear view of where the status is i don't want to get ahead of actually intents by a different

timeline and i think to hear that was being thought of and how to approach that is wonderful i'm appreciative that appreciative of the fact for a number of years we had to decrease our programs because the federal funding was not there and last year and this year we'll add city monies back into this problem this is one of the focused problems we need to and glad to hear the department is trying to work on eradication of tuberculous. >> i just wanted to add one point some of the discussions that happened during the committee we were looking at other commensurate diseases likehiv and eliminate that what are some

of the steps you know including the strategies that we can use i think that if we could break you know the preschools down to more granulated a details i think we will have a better strategy so i'm pretty confident we'll have more data. >> thank you commissioner chung so thank you very much for that presentation your presentation. >> i'll note no public comment requests for that item moving on to item six the laguna honda hospitalized gift fund expenditure for 2015-2016.

>> good afternoon, commissioners. and director garcia i'm the deputy financial office in the hospital center before i go over the detail of the proposed budget i'd like to go over give you a little bit of background of the laguna honda laguna honda maintains a difference for the purpose of the city donation contributions of money other than for the comfort of laguna honda in corneas with the admin code section 10201 so we think the laguna honda gift fund there are multiple gift codes not only identifying the donors intent and purpose but giving special recognition to some significant

donors they align with the worries about of the donors if the donors is not specific then the demons will be adopted into the grant code identified as miscellaneous for the confront of the residents and each the grant codes has a program monitor to plan budget and also supervisor the spending of the funds there is also a defund management committee that meets quarterly to review the expenditures and make recommendations for budget planning different committee members include the president of the residence council or a resident representative when the president can't attend and the hypothetical executive administrator and me the deputy

financial officer and other hospital executives so i asked the deputy officer on behalf of the committee also to provide quarterly updates of the different activities including donation and expenditures and fund balances to the laguna honda jc c in the beginning of the fiscal year each committee meets with the program monitor to plan for the expenditure budget for the upcoming fiscal year based on the residents needs and also the past year expenditures so that activities in the budgetary strategies can be recommended for approval by the health commission before others of every year that's why we're here today in did submitted gift fund budget for 2015-2016 you have a copy of the budget so the -

there on and on expenditures items from past f as well as new budget items from the different committees recommendation or from new donations overwhelming to go over some of the items that i think i might have questions or appreciative the details of that so the ongoing expenditures include funding for programs and purposes of ticket for giants games and musicians for the residents and funding for spiritual support other than religious events and newspaper and magazines sub descriptions and outings to parks and restaurants for residents barbecue and social hours for hospice residents, support of aids walk for positive and this happened last week and special cultural food for the residents

so what i mentioned was only a few works of the funded activities for laguna honda have enjoyed for years from the gift fund a couple of new items i want to go over the 9 months pilot program of latino boys choir recommend by the hospital social services department and the gift fund committee the program will have the choir director and the music company from san francisco music center to help us form a latino choir of interested spanish speaking residents at laguna honda choir members will practice sing and help to cooperate performances and perform in the community so not only there will this experience over enjoy and kraefltd and fund u fun and connection to its participants it will provide them with a

sense of belonging and responsibility pride and leadership and engagement and the second budget item i want to attention or mention is a new donation by dr. rosa former physician that made a generous $400,000 to the gift fund a few months ago to benefit end of life programs in the hospital we have created a new program on the last item on the budget list so the hero are some examples of the budget items that are proposed by the clinic leadership the lodging fund for that 9 members and a or families those at the end of life to be reunits with their loved ones during the last days and the

next it the comfortable the model that many hospitals provide end of life care that create a comfortable suit which is like a single room with home like decorations and couches for families and friends and comfortable chairs and soft latin-american the third example is the berealism support so the residents and families to remember those who have passed away in the past years so again we here by request the health commission do you want and exhaustive the laguna honda budget for the 2018 and i can answer any questions that you might have related to this fund >> commissioner karshmer.

>> thank you for presenting this and certainly we see the wonderful work this is bordering by this fund and the kind of really great activities that the residents get from this thanks for bringing up this before the full commission. >> commissioner chow. >> thank you for the presentation so i just want to find out a little bit the rational like increasing the budget for instance the one i'm looking at specifically the care programs and events you've budget $10,000 as of may 31st you know like the actual expenses to $849. >> so this yes ma'am item is a

new budget item a new program we recently strengthened the program had the monitors to propose some idea and role them into implementation fully in the coming fiscal year i know the first year we have not had a lot of expenses. >> the other one seems more logical you have a reception on the i know like the projected budget and yeah, so i was trying to get a sense of that. >> good afternoon commissioner and director garcia and dr. chow i wanted to add to what of the mentioned with the dementia program initially our dementia program was specific to 3 neighborhoods and looking at our painter population our re over 60 percent of our residents population have dementia diagnoses in impairment

diagnoses so we in the leadership have made a determination we can provide dementia programming and other residents outside of the 3 designated dementia neighborhoods have access to the program that are benefited from the gift fund that is the justification behind also the increase in the budget and as i participate in the budget management and the gift and that's the information i can share with you. >> so the reason why i ask is because you know that is unusual when you understand and you know, i appreciate our explanation thank you. >> commissioner sanchez. >> yes. i would say that a number of the fists particularly

the last 3 years have expanded more the opportunities and the need and how we are servicing those is really commendable another testimony to the quality of services and this one is the fact that some of our staff that have retired are disease themselves have made donations and continue to make donation to this very important activities which we don't have in our budget so it answers the quality of life and it is part the evacuation i'd like to move we approve the recommendation and the budget to get a second and have no more decision if you wish. >> i'll accept that motion. >> second okay. so further discussion - i

had one or two questions and most was related not so much to how well you described the different programs and although i saw the van at 21st century at - what is the total amount that is in this and therefore is this a percentage that allows that the funded will sustain goes back to a question when we accepted the last big gift and had them sold staff as recommended by the controller's office we were going to think as to how then we would make sure the fund continued to grow? >> john has the information. >> so we actually have been tracking the funding and

expenditures for the last 5 years i've been here so lucky the last two years we've seen two sizeable donations first one was the doctor the living trust was half million dollars and o the from another doctor we were able to maintain the balance of pretty much balance and consistent from year by year at the beginning balance of 2013-2014 we started with one if the $4 million in the total gift fund balance this included $700000 in the stock so we're going to the process of

the stocks been sold we actually the loading progress i've seen we actually be able to keep this a value from what we estimated last year and the balance stayed as 2.4 with the additional 4 hundred donation we are looking at we're going to finish this 2014-2015 year-end with a balance this proposed to have $289,000 annual and $2.8 million if no other donations will last more than 10 years but if we continue to get donations especially a big portion of the expenditures is reinforced by the friends of laguna honda so our team the hospital white program and the neighborhood money those 3 things are reimbursement as demons. >> in addition to this. >> it is including in the - and

it is included okay. >> commissioners any further questions if not, we're prepared for the vote. >> all in favor, say i. >> i. >> opposed? the fund expenditures is passed i assume no public comment. >> no public comment. >> okay. >> moeven to item 7 commissioners the draft dpw on naming the dpw facilities. >> good afternoon, commissioners colleen deputy director and i'm here with a short presentation on a proposed policy on the naming or renaming of the department of public health facilities the city charter designates to the board of supervisors and the department to provide the naming or renaming of the health department the department of public health have defined as any building owned and operated by the department of public health and the equipment and

rooms and internal or internal space you have a draft and this item is scheduled for the agenda for the next meeting for the final action not requiring a reduces resolution but in corneas with the city chapter you have designated the director of health as the sole dpw employee with the authority to provide you with recommendations for approval of naming and renaming of the department of public health facilities hospitals facilities you have the sole tort authority those are required with the health commission approval ambassador non-lease their owned by another parts of city require the board of supervisors so the pathway is from recommendations by leadership within the department through the director of public

health and the department of public health makes the recommendation to the health commission additional forwards to the board of supervisors for the final pathway that is true for the renaming of gifts to the department of public health so that guess the summary of the policy you have the draft it is by the city attorney and with the director of health and the leadership and you have it agendized for your action at the next meeting. >> thank you, commissioners because it is an important policy we're asking for your comments today and in the next several weeks no public comment at this point is there. >> no request for this item. >> commissioner karshmer. >> question is this changes from what has been the policy. >> we've not had a policy in

the past. >> this is the first time. >> yes. >> commissioner sanchez. >> i think this is an excellent summation what was in fact not policy has been in the city chapter that everyone extracts something and interpreted we were interprets it 24 the protocol from the process i guess the question i have once this is affirmed as our ongoing policy is there a time factor or are those as an example our various names are ready operational including our breast cancer center it was a major donation part ever library that has it's specific name, etc., etc. etc.

is this - does this apply to those or are we tenaciously a time variable we have to - >> to be fair to the history i think it is going forward we'll be looking at this policy and so i'm very comfortable leading the status of everything in place and moving forward with the new policy. >> this also as i read applies to the laguna honda. >> it applies to the entire department of public health. >> so anything in the future for the naming would come through this office and our next process. >> over the years i think people haven't said i wanted to say one more i see something coming down the pike. >> as an example we have the affiliation agreement when the

new research facility san francisco general health department campus which is being approved by the rent of puc is built on the campus so any naming rights in that facility we need to think about this as we move forward is that under our jurisdiction or up to the court regents of the state of california whatever they decide i know we have specifically factored in pertaining to the parking facility that is the city and county of san francisco so, i mean i want to make sure that we all understand as we move forward upcoming this is how we agree and precede otherwise we can get into problems and that's a fair question we'll take if that

through the city attorney. >> whether it is a city property. >> part of it is the agreement we'll work through that and we'll seek advice from the city attorney is a very good question it is pertinent. >> we'll try to get that answer back that is why we placed o that on the table such types of circumstances can be solved from the previous discussion also name or rename so i assume as the directors said everything is in place unless there's a reason to change the place of the name. >> other questions at this point? if not i'll discourage user encourage the commissioners to think about another circumstances they wish so have clarification and be prepared to

vote at the next meeting >> no public comment phone number for this item. >> item 8 is the resolution in support of naming the san francisco general hospital the richard h fine people's clinic. >> good afternoon, commissioners i'm rolling restraining order leaned the if he were in charge of the network i'm joined. >> by the professor of the food medication and chief of the division of trauma at central nervous system we're here i'm going to i'm going to turn it over to ask for your consideration of rename the general medication clinic at g h s >> when i stepped up to the plate into the central nervous

system san francisco general hospital persons i met was nike knew he was special i don't know how special he was until i worked with him over several years his post colleague dr. will share with you clips that talk about dr. fine and why we want our support address this resolution thank you. >> thank you, rolland and commissioners and director that is an honor to be here to present on behalf of the dr. fine this resolution to rename the general medication he clinton richard i'm a care doctor and i was the medical director of the general medication clinic many say the clinic it doctor fine founded

and mr. chinning chin was another deputy director dr. fine joined the family in 1969 which was the first year in which san francisco general had an oat patient presence if you were if you have diabetic come in a alu you'd be disregard to the home or so in the longshoreman or the morgue dr. fine was part of the movement to deputy e development those in that he had risks medication and surgery in 1970 he fount the medical clinic for mel complex adults not city and county of san francisco and since it's inception we've tooefrn over one

million patient visits dr. fine is currently in his final months probably he's age 75 suffering is from a terminal illness and has made multiple phone calls to me i think that is fair to say a dick that is what we goes by he wears a mechanics shirt to work saying dick that represents every man he is he is just like every man and woman in san francisco he played a visionary role to the underserved patients throughout the city and strengthened the general medication clinic by integrating the medical services council and help problems and

continuity of care and championed many programs from that clinic he's the champion for marginalized groups that spearheaded a lot of programs to help those who are otherwise disfrachd he co-founder it in patient jail unit if you were a jailed individual and illness i had no place to go other than the jail or elementary school those are focused on improving the health care for institutionalized people into through addressing their behavorial as well as physical health needs that are incredibly revolutionary during the time he called the jail a community and to get federally qualified health center and federal block money to take care of that very initiative in 1979 found the

health clinic at san francisco general hospital and from 1989 to 91 served as the chief of the medical staff at san francisco general hospital we believe that renaming it san francisco general hospital after dr. fine will not only honor his terrorism but terrorism of many of the health care workers who we collaborated with on any issues he didn't look for the lifetime light. >> let other people lead we believe that name it after dr. fine about cause our students and residents and trainees to ask why is it called the fine board of directors doctors clinic why are those people so fine then we can educate them about dr. fine and inspire

future generations to do the same so a couple of months ago we aired the world premium of a film about dr. fine and the city in which he lived and worked and was a film about the city and decades that he worked in the subjectivities movement and the crack and aids epidemic aisle all the major issues in san francisco and how dick harnessed them the movie is called bicer with a moral impose i has a impose we have a clip i don't know how to do the audio you guys have to turn around oh, you can see it in your computer great. >> was create at this hospital a plays for everyone.

>> director hicks role what 0 reminder the administration to remind - >> we need to do those things for a special program and into change those so things will eliminate - >> he's been a conscious. >> in the hospital let's just start over shaving shall we. >> dikdz legacy is what we created at the hospital for a plays for everyone to come to. >> director hicks role was a remind the administration and remind the other doctors we needed to do those things this is let's go forward. >> i speak and is a change so things emanate from him he's the conscious of san francisco

general hospital the remarkable thing about dick fine was his ability to see the importance of and role that outpatient care for non-communicable disease at an early stage. >> it is one clinic you hospitals liza patient wave good bye and see in the elementary school or the morgue. >> you would take care of the patients in the hospital and go disregard discharged to wherever. >> the patient that needed follow-up didn't get the care. >> director hicks dedication. >> what dick the. >> the law and the central traffic signal of a doctor for

an individual as opposed to others for an example of care the result of dick was what made this clinic amazing. >> health care being available to the mass dick cared about the narrative workplace the facilitates discretionary. >> dick had a major role of creating the medication and ambulatory care, he helped to change how people viewed the americans. >> dick committed his life to making sure there was something different. >> change and incorporating the nurses the residents solutions into a team that was dick promoting that doctor, nurse may or may not or patient relationship. >> many of the testaments of dick his original concepttion

that patient go home and disconnecting shaped the hospital. >> it wasn't always place because of progressive medication it is what san francisco general is really an extension of dick. >> you look at where 40 years dick fine ran those having shoulders above everybody else. >> the moral fine of san francisco general (clapping.) >> thank you. >> i'd like to close by saying that was my boys playing the music so - >> and commissioners just a reminder the resolution will be voted on, on the august 4th

meeting. >> and dr. do you want to explain why it is not called just the richard a fine clinic but the people's clinic. >> as i mentioned dick is not someone that likes the limelight he wouldn't want the clinic to be named the richard h fine clinic he sees the medical home as dr. chin mentioned i think that actually, the fine people's clinic is exactly what we understand about the people that come to our clinic many of the people that come to our clinic are seen as the most difficult challenging patients that nobody else wants to take care of so to suggest this is their people's clinic has a

certain power, of course that resonates with him and the practitioners at the clinic. >> thank you very much any further questions for dr. shilling gesture. >> commissioners that was place on the agenda for a vote and we'll take it up at the next meeting. >> no public comment requested. >> moving to item 9 to modernize the security and create a city wellness. >> the presentation is the paper copies in front of you. >> good afternoon again commissioners colleen deputy city director so as director garcia said i'm here to present a proposal about modernizing the committee fund san francisco has seen great second in enrolling

individuals since the prelims of affordable health care act but with the transient insurance coverage barriers to the health insurance rains on sfornz san franciscans our proposals to create a new employee wellness fund compliments the affordable health care act and addresses the affordability for many san franciscans so just a brief overview of what i'll coffer i'll give a summary of the proposal we're providing first and then a little bit about the impetus about the proposal and talk about the research and finding that occurred between the time we first start to think about this and today i'll give you a little bit of health security 101 about the proposal it relies on san francisco landmark health care

security ordinance i'll give a brief 101 on the health care security and talk about the detail and the expected benefits to san franciscans and the employers and the city overall so this proposal i'm sure you're aware of has two components the moneytion 23 appears in gray and blue and the creation of a new employee wellness funds that appears in orange this proposal messages existing infrastructure of the city option program and the new bridge to coverage feature in blue the existing city option comprised the reimbursement that remembers a provides health care to uninsured san franciscans we need the bridge feature of the city option program continues

san francisco's commitment to the ac a to 9 health insurance and make health insurance 2350r7b8 for 3 thousand san franciscans healthy san francisco affordability retains san francisco as awe our safety net for the people who the program is available now but makes it available for those who are unable to get affordable health insurance in orange here is the necessary employee wellness fund consist with the intervention and the with wellness will make initiative inform employee health care. >> so why are we here today san francisco as i said has seen

success in the affordable health care act over 97 thousand san franciscans have health coverage through the option and 46 thousand are medi-cal and others through medicare the uninsured are 44 percent and we have exceeded statewide enrollment and california has exceeded invading it is due to the healthy san francisco program that san francisco is able to make the progress healthy san francisco i'm sure you're aware of is a cooperated program for the san franciscans that are insured 80 percent of uninsured san franciscans were enrolled in 2014 that was easier to contact them of their options in ac a as a result san

francisco enrollment declined 50 percent busing plus in june of 2014 and those individuals have health insurance is far better than healthy san francisco the san francisco department of public health has promoted health insurance for those who have access i'm sure you're aware of the healthy san francisco is not health insurance but a cooperated health program for the insured health insurance provide people are for choices and also now required in the affordable health care act but despite it's importance some remain unable to take advantage some people are not eligible largely the up undocumented population as a others are exempt from the rest reasons and others unable to afford the options favorable. due to the affordability

concerns hltd in the mayor ed lee asked for a research and part of the health care council one the key finding part-time employees and low wage earners couldn't find health care the mayor made amendment to the health security to look at the affordability of the health insurance for san franciscans in addition to the citywide interest open affordability health insurance affordability is an our that is heard across the nation and state a recent survey of participant in california state health insurance called covered california found 40 percent are struggling to pay their premiums

the department of public health has 4 focus groups two of employers and two employees for the security ordinance we are heard the same thing employees cited the costs the chief concern of affording whether or not their insured or uninsured employers said they want to be able to over health insurance to their part time employees but not possible because of the cost or because the insures don't allow the employee employers plan to address those concerns the department of public health through a generous grant from the health affirmation engaged the university berkley center to present the proposal before you today the berkley was the created of

the cal model a model that is relied on by covered california and other state and policymakers that impacts the elements of the ac a we asked uc berkley to advise us on the numbers when is affordability exactly what are the tax up rates of models with the assistance we could offer how many people need assistance and how much revenue to support the program they were able to custom nays their model to have estimates for this report for h m a we asked for air perimeters we need help how much that will cost and how much revenue how to get the assistance and h m a helped us with this analysis they the a

operational analysis and made information for the benefit designs. so together they had a few major frntd from their works that informed our work for the proposal first, the high cost of living in san francisco it is estimated to the cost of living in san francisco is 49 percent than the national average second is that post ata that relies on cost schaffer those people from 2 hundred and 50 to 5 percent of passport are financially vulnerable the chart on the right shows the various income levels the household income that goes tarts premiums for an average 40-year-old person between 2 hundred and 50 percent of poverty and 5 hundred percent of poverty individuals are paying more than 8 percent

of their money on premiums this coupled with the higher cost of living in san francisco puts san franciscans at risk of being uninsured or under insured that was determined pie most viable for the proposal that will insure that all low and moderate san franciscans have access to affordable health care act now a a little bit of 101 on the health security ordinances impacted in 2007 it requires employers to make expenditures for health care on behalf of their employees so for for profit with 20 or more or nonprofit with 50 or more employees they make quarterly expenditures for employees they have many options those are the

months popular option by far the most is health insurance 85 percent of the employers according to the 2013 which enforces this ordinance about 85 percent of employers provide health insurance which is great about 20 percent provide reimbursement bktd i an employer reimburse employees and 20 percent provide the city option employers can choice one or any inspiration of those or other options to comply with the heartache ordinance about 20 percent as i said contribute to the city option who happened when a employer contribute the city once the contribution is made the funding is used to provide a benefit public benefit to the individual open who's on behalf of the contribution was made if the person is an

uninsured they are provide with the training and experience that supports their participation in healthy san francisco if they're not an uninsured san franciscan perhaps they reside outside of san francisco their contribution goes into a medical reimbursement account in the amount that the employers contribution in 2018 some changes lows people to transfer their money in order to save up enough in their accounted to afford health insurance when open enrollment became available so, now to the detail of the city option modernization proposal today again here the gray represents the city option program medical reimbursement accounts this

remains unchained for a person in an unbridged count and healthy san francisco in the gray remains unchanged for healthy san francisco on the next few slides i'll talk about the blue and the reimbursement account and the healthy affordability extension so first bridge to coverage who is global for bridge to coverage and what is it >> bridge to coverage is available for any san franciscan reside who employer contribute on their on behalf of 20 percent and their global to purchase health insurance on covered california and their protection is less than $59,000 in 2015 so this population what will they be eligible for for premium

assistance and cost sharing assistance to make health insurance more affordable so premium insurance a 60 percent of the cost of the lowest so premium costs will be covered by the program and cost sharing assistance would be insuring that people avoid under hungers that is denied as 5 percent of our income going towards the deductible so without premium assistance 60 percent of subsidies reflects the higher cost of living in san francisco than other places that is meant to address san francisco's higher cost of living cost sharing assistance is intended to addressed issue that the people between 2 hundred and 50 and 5 hundred are at risk because the deduct is more than 5 percent of the heartache plan

9 deduct is the first amount to pay towards the health care when that monuments to more than 5 percent of the income are at risk without health care so this graft shows an example of bridge to cover one of the development is we wanted to maximum all federal assistance before putting forward a local program so as you know the cost of health insurance varies by age and the federal subsidies by in case this is an example of a 40-year-old san franciscan hundred percent of poverty at the left all the way to poverty and a thank you right the full cost of health insurance is 6 thousand plus it is the same at every income level the

difference the subsidies available at each income level so at hundred 50 percent is 17 thousand plus a year 82 percent of the cost of the plan represented it in blue will be subsidized by the federal government the vast majority bridge to coverage feature for the medical reimbursement account subsidized 14 percent of the premium 4 percent left for the individual to cover those costs assume the individual uses the full deduct the cost of the premium bus the 5 percent deductible when you look at the 4 hundred percent and 5 hundred percent the last two bars on the right the federal government covers none the bridge covers 41 percent braus plus the deductible and the individual

discovers the rest the 59 percent the earlier graft between 2 hundred and 50 poverty the health care costs are the highest percentage this is lateral due to the significant incline to federal government subsidies that occur as income increases thus with the high cost of living in san francisco this is the population that most likely to be at risk without our bridge to coverage program so the brick to coverage benefit was designed to have a meaningful benefit to have the resources for the participants we estimate it the 3 hundred san franciscans that are likely to use this program 67 percentage will be less than 40-year-old

and 73 percent work less than thirty hours per week and 85 percent earn less than 17 thousand and the rest eligible for the subsidies it is entirely support by the contribution of the employers by the 3 thousand individuals each projection the 2016 and 18 projections are the projection in berkley studies and 3 thousand participant are estimate to participate in the program they will be associated with revenue of $8.8 million and the cost of the program would be $08 million total this is a $7 million benefits to individual plus one million dollar in administration so as you can see for all the program years the entire cost is

speeded to be covered by the employers when we designed this benefit we designed it so it will provide a meaningful benefit to the employees that made a defensive in the affordability of the health care and limited to the cost of the expenditures made on their on behalf of by the employers. >> so, now i'll move to the healthy affordability extension there are two key components as i mentioned none is eligible will be ineligible for san francisco after the implementation of the proposal there are two major changes we proposed here in the element of the proposal the first to increase the offer threshold of 5 percent of poverty i'm sure you're aware of we wanted to align with the affordable health care subsidy

structure but when we do the fundamental analysis up to 4 hundred people are issues with affordability we wanted to return there this back to the eligibility of every poverty second component to include the eligible san franciscans not able to afford the ac a option the state of california has approved that in 2014 and 2015 they called it the waiver we proposed to you and you approved that for a couple of reasons one people previously uninsured might not be awarded or aware of how to get the insurance we didn't want anyone to fall out of care and affordability concerns were raised from the out setting we didn't want to destable care with affordability concerns that passed by the health commission and to expire at the end of 2015 our proposal

to extend that indefinite as the affordability along with at components that include robust education and financial counseling for people trying to enroll in healthy san francisco but have another health insurance options available to them 0 overall it is largely the same still available for san franciscans age 18 and over the health commission recently the upper age limit was eliminated it is blow 5 percent of poverty and they've been urban insured for 90 days we don't tim displace people out of health insurance they can't be eligible for other programs like medi-cal or medicare that is one of the elements of healthy san francisco medi-cal is certainly no cost health insurance with the extension is more health

insurance to more people they also cannot be eligible for the bridge to coverage program i described and maybe they can self-attest their unable to have health care coverage or exempt from the ac a so what we want to do as part of the enrollment is really focus even more on the education enrollment assistance we provide already our enrollment assistance are able to enroll individuals in health insurance they're eligible for but we can include a more robust evaluation of their benefits of health insurance over uninsurance or the affordable health care what over and over those be eligibilities in terms of finances and weighing the benefit of paying a penalty other than healthy san

franciscan fees versus paying health insurance perimeter and the coverage you get for that we wanted to infuse that into our education and enrollment assistance and after all that will if an individual is still buildings they're unable to afford health insurance we'll allow them to maintain their eligibility in healthy san francisco we believe that this program addresses the potential coverage gaps by far the laerlth those not eligible ac a for the vast majority of healthy san franciscans and the mandate due to harding park or religion or other factors an exception for people that have offered employers supported shiners but that officer is too high and qualifies for an exemption under the law and the last one the no

option of the employers coverage still not able to afford purchasing coverage so financially looking forward what this means for the healthy san francisco the first column the 2013-2014 for healthy san francisco at the end of the year we had approximately thirty fussing thousand combreerlz and participation fees of individuals that participated in the program together that revenue totaled almost $29 million the experiences to be the program were hundred and $12 million leaving a general fund of 83 point plus million dollars this is represents the cost to the department of public health to the recommended by the the nonprofit hospitals or the clinics that pandered in this program so in 2014-2015 we estimate to

the are combreerlz will go down and stabilize lists by 15 thousand we believe that the revenues will go down and we'll reach a plateau in 2015-2016 and decline slightly by then and conversely they'll reach they're low in 2015-2016 and increase by the rate of medical inflation after that so the general fund contribution similarly has it's low in 2015-2016 and then increases by essentially the rate of medical inflation so the second component of our proposal is the creation of a new employee wellness fund the employee wellness in our proposal will recurs or

reinforce for qualified expenditures made and used by the employees in their businesses we are scheduling this one to commence later there are previous elements of the proposal the modernization we're proposing to roll aisle identity in 2016 that one roles out in 2017 creating a stakeholder progress that helps us design the projecting program elsewhere engage the employees and employees in a process to plan for the program eligibility for the 2017 launch as part of progress stakeholders will review the wellness examine health status and review the workplace interference in san francisco through this process we will determine employer eligibility and benefit design what is a qualified expenditures under the

program and make sure that are provisions for tracking and utilization and also make sure this is in alignment with the city community health improvement plan research has already shown there are clinton medical improvements that support the health of the employees that participate in the wellness and for employers that participate they have recorded dollars in health care costs and absenteeism and prosperity it contribute to the healthy san francisco overall the benefits will be designed to support the interventions for the health risks by san franciscans by reaching the population that might not be exposed to the efforts are overall population can be supported by the workplace healthy work style

so what are the expected benefits of the proposal certainly affordable health care act for all middle-income san franciscans this benefits san franciscans it benefits employer it benefits everyone to have everyone healthier but specifically for san franciscans we prioritized hundreds of dollars and little more we can do this makes health care affordable for many more san franciscans those who don't have the option and can't afford health insurance we'll be there with the healthy safety network and promote the healthy within if their with the bridge to cover increases the health insurance for they're low wage or part time workers as i said the focused group the employers

want to over the health insurance but had barriers because of the cost or the ability to obtain insurance for the part time employees 24 provides them with the opportunity this employee wellness is - by over and over the wellness program to their employees and to the city the bridge to kochlg is funded entirely through the employer contributions it is a way of reworking a benefit that the employees receive to make health insurance affordable the affordability extension and healthy san francisco enrollment trends that have been accounted for in the budget make sure we avoid the uninsured health care costs there was a significant reduction in the hospitalization by the participate without access to preventive and early

prevention care they use it at a higher rate when their unhealthy the employee wellness helps to improve the population health for all san franciscans. >> so finally i thought i'd show you a graphic of health care coverage and how to changed over time so on the vertical and assess the percentage of poverty and the horizon assess various categories of adults and how they're covered the portion shows 2018 so at the bottom you have adults the disabled and the blind adults on the far left the second column are the single adults that happy 80 happen to be low income and next the

seniors and city option employees next and those ingibld the undocumented and those unable to assess affordable health care act so the health insurance options were limited in 2006 age blinded and disabled were ineligible for this and seniors were eligible for health care everyone else in the light for a fee per service or charity or a fee clinic program in 2007 the health care security ordinance was passed it made san francisco health care it served 60 thousand individuals so for the first time adults who were single and what did you do children adults over hundred percent of poverty up to 5 hundred percent of poverty a

have access to the health insurance and this implemented the employees so the city option was created for employees who's employers contributed to the city option for low income that meant you had the city option you have medical reimbursement plus medi-cal and you have a reimbursement bltd for healthy san francisco so, now 2014 that's the implementation of the affordable health care act this provided actual health insurance not just healthy san francisco but for many, many individuals across the board at the bottom for all populations medi-cal is a available up to hundred and 38 percent of poverty and those disseminated are not eligible for healthy san francisco but the subsidies are

available for people are incomes hundred and 39 to above 5 percent of powerful and covered california is available for all adults and seniors if they wanted to they have medicare available to them nothing has changed for the city option for employees they have their opening statements available to them and those unable to access alice griffith affordable health care act they were able to stay on healthy san francisco during the transition period and finally twhaepz as a result of this proposalas a result employees are effected so it's that fourth column to the left those individuals have medi-cal in the city reimbursement accounted and above that they'll have covered

california with a bridge to coverage reimbursement nthsd making health insurance more affordable for them that concludes my presentation. i want to say this work really represents the work of many, many people and primary in that is the senior planner alisha chavez i couldn't have done that without here her and thank you to the director barbara garcia and the commission many of the heartache participates are here and may have comments our consultant cc berkley as well as health management society and many of the healthy san francisco providers were part of the universal consultants on this project our focus group and the san francisco health plan is here and the average office of labor and enrollment endorses the program is here as

well i don't know if i think the mayor's office is represented here as well and as i heard from director garcia they've embraced this program we're excited about as well you have before you process wise a resolution that we need to make a couple of small edits minor combroits for you later but for your k and action as you're following meeting on august 4th i'll be happy to answer any questions that you might have. >> prior to questions we have public comment if anyone was not turned in their slip please do so otherwise i'll call the following in groups of 3 each will have 3 minutes. >> first is stephanie (calling names). >> i'll have the timer when the

buzzer buzzes your time is up. >> i'm stephanie fishing the manageable that administrators the benefits for the employees so for the city and county of san francisco employees spend 50 percent of what we get health related choices what to eat for lunch or if i'm going to smoke or walk this brings full time and satisfaction or a cause of unmanaged stress the wellness makes the healthy choice the easy choice if their make them at work that's 50 percent of the time if they form healthy choices at work they'll take them home though help the quality of life for the employees and their family members at both home and work

and they're overall work satisfaction but the employee wellness program don't just benefit the employees we rely heavy on the gallop research 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 next month the proposal might be strengthened in two ways i will declare with chair showing you and commissioner singer it would be nice to run numbers an others worse case scenarios the bottom market drives done the u.s. market and you know facebook moves out of town and a bunch of bad things what's the worse case scenario of assurance i think that is one thing the second thing goes to the strength of this proposal i think this proposal is thank

you supervisor i have this discussion about whether the employee wellness fund is or not part of the modernization in the communication i got the sense that actually, it is part of the modernization if you knew then what he know could i is part of the expectation of this work so you - it is an ad on this respect in terms of the presentation of modernization i thought that was what it was about. >> it is their funded differently but it is part of the holistic proposal we're giving to you i think that commissioner pating said it it

relies on the shared responsibility that that component of the shared responsibility we're adding here but it is just the fund that is a little bit different. >> so in follow-up i'd like to understand that in terms of of then how you're the employer sector of our interviews looked at this even if were dollars or trying to develop it i royals it will take a year but in expect what you're looking at and how that might work and also how that actually then benefits the patient or the city yes. >> in terms of reduction of or improvement in health and restriction in costs for what you're thinking of in terms of it there is actually no quantify

summon maybe something you want to put if we need to come back with more data or have it as an element and prepared for a different budget year i think we need a little bit more detail on i mean at least more detail how we're intending to flush this out. >> commissioner taylor-mcghee. >> to my understanding so for is that we will have the what's that called the bridge. >> coverage. >> and the other options extension the two options for the residents of san francisco under a certain threshold and the employee wellness fund as

set up right now rely on the employee contributions to be part of that program it is only assessable to those who reside in san francisco. >> so the employer employee wellness fund is a general fund program it one of the criteria we thought we might consider for eligibility for reimbursements for the expenditures would be those who credibility to the city onyx it on behalf of the individuals who are using services not just offering by using wellness services not just having them offered we participated in dr. chow question is p is representation from the employees and employers and kougsal and hopefully others

who help us design a program that does many things that reviews the literature on employee wellness that look at the overall health status of city and the health improvements that we can realign the health services to encourage the workplace wellness that achieves the goals that we would also include outcomes and tracking miles an hour we wouldn't just provide the funds for a yoga teacher once a month but how many people are participating and measuring the improvements and health and use the tools it exist at the national level and report on those outcomes to. >> i get confused right now so if the employer is basing san francisco but thirty percent of the employees actually reside in

san francisco do all the employees quality. >> that is determined by the process we would determine who would be eligible how we will kwcht and track and measure. >> can - >> i'm sorry. >> but right now you know as it stands helping san francisco what about straightforward like if you have to add that element to it you know like i think yeah. it becomes a little bit more confusing you know you know and to separate the two programs would just make it cleaner. >> think about the fact we provide public health promotion and wellness in the public distinction all the time we've done that; right? this is targeting to a specific population within the city who have contributed and the employers that contributed mills and millions of dollars this was

a changing chance to look at the employees and think about how we can port the employers that are that concludes my report us in the project to provide a service that we always provide to promotion wellness throughout the city but it is really targeting a specific group we believe has contributed to the overall health of the employers for the employees for many years in this program so within an attempt to do the kind of work and help promotions within the public health of the department and target employee health within the employers. >> i think so that part but you know the promotion programs radio the beneficiaries. >> citywide. >> citywide in the neighborhood city but counties so if employees don't reside here i don't know how do we measure that that is confusing to me.

>> that might be one of the options it only for the employers we have to think about that as we develop. >> i then. >> it will other questions that come up are the equality why the employees so that's why i just want to look at that. >> why don't we make sense to develop exactly what we would like to do and then bring it back it doesn't i mean it would be just the way that they came across the other parts of modernization act with so thoughtful fully done and studied so specific in their recommendations and this seems you know in contrast not as bumentd adopt a contrast

things we approve things this earnestly or an appendage better on its own the i'm not convinced we stay connected to the modernization act we've not made the hard case it is connected to the modernization act. >> maybe i can recommend you allow us to explore that project and bring back that program before the process. >> i'm thinking within the resolution and as part of the modernization idea that that could be and you need to thrills what levels of authority you need to go and develop a program for approval rather than see whether we can have a program i'll go one step forward and see if if so that is

feasible. >> the plan in 2017. >> things like that you have a timeframe but the way it is written it says create we're expecting your coming up with a concrete proposal that is harder than what we are thinking from what i see the concept you've articulated that encourages employers inform really gives those in the employer situations where we are talking about smaller employers and so we know the larger are using it could be positive and helpful but that the word create seems to make that more concrete than perhaps your at right away right now i think that's what i'm hearing. >> my wish we wouldn't jet son but step back from authorizing i think we're authorizing the

dollars expenditure and the full commitment there are many reasons to add this to the ordinance both as supporting the employers and the role of healthy employee population i think the mayors weighed in on wanting to see that as an component we think that it may need a little bit of work we're supportive of the policy and then i would assume the working group or your leadership will meet with a series of decisions a plan and funding decision that may come back to us at a later point. >> a policy there are fundamental questions that i understand the dynamics of what you described with those employers paying for health care and dollars something we're

giving back to them their seeing come their way i'm partially incentive and prashl not in your society for better or worse we operate for employers tend to be responsible and they get tax breaks for providing heartache benefits to employees that's just the way our economic system works in the itself and task force works too the concept we've because they've fulfilled their obligation quay we're helping them; right? through healthy san francisco and some of the extension programs we therefore have an obligation to pay for wellness program like i'm not - i want to think about this a little bit more it's not as consistent with some of the other things a you've spoken about and highway patrol

feasible and laundromat or restaurant doing well in the programs that will show the results the randy study shows that large employers with stable populations. >> so i do think this is a fair comment i have to think, in fact, because of the special focus that we're reilly talking about within the idea of those participating within the city option that is really as you say not the larger but the smaller employers we have not had a change among those to offer something this might be a way in which the city my encourage this whether or not it is a readableable and helps the city because of the ability to get them the programs down to a

smaller employer level or apartment employer level as merit i think that all of the those can be looked at if we go on to the concept of developing it as part of this it is nice to take not simply the idea let's provide insurance because if gets them into those other programs or healthy san francisco an access program with you moves towards i think the your deputy director appointment the ac a was trying to go not simply singes care ensue wellness care i see this represents that this is another milestone within how san francisco is looking at skifrj additional healthy behaviors bull i'll leave that to us to discuss further at our next

meeting in terms of how we're able to see that this could be really part of our healthy san francisco or city initiative to continue to improve wellness i look forward to that. >> my discussions with the deputyity attorney deputy director i was mentioning i would be interested in seeing focus here i think that could go 3 of ways i don't think we're talking about a lot of dollars we could target small employers which is where this is going for public health tobacco or dental care that has overall population benefits we'll line up with our catnip program and look at the employers what are they operate economic issues back injuries scombrepgs or absenteeism they

have the reason to reduce the workers' comp we could by looking at the wellness programs for retention with small amazes amounts of dollars to figure out what wear looking at the small employer pools what are their principle needs and lion them with the county interests this is part of the conversation so it is not like we would need to get the $12 return like the study but to lfrj small amounts at the workplace as a new site of engagement and i hope that is part of the conversation that happens but it is not obviously you know those goals are not in the way it is opportunity in the resolution i think some of that needs to be focused to help us to be fully on board with

committing dollars in the future i think that is an important part find this initial and in the spirit of transparency i actually know you know that is assessable to. >> employees where they reside in san francisco or not we create a weird dynamic that was where i was going. >> that is for the wellness programs you're talking about. >> since we opened that can of wormgz might as well look at the percentage of their employees actually living in the city and the percentage that live outside the city for us health equality is one of the priorities for the commission i think that you know what we're doing is actually going through like improve health equality regardless of brown where they live i think we'll all support that that is my acceptance.

>> where you suggesting commissioner the subsidies for the non-residents. >> i'm not going to say that. >> through the chair yeah. yeah if i could through the chair i'm sorry commissioner taylor-mcghee and i to a point make sure i understand your question to piloting rather than implementing the full flush program. >> we should take that initiative 2, 3, 4 stages that blanks as a policy but flushing out and the deputy director to lead the phone call groups with the employers and figure out with small amounts of general fund monies to put them into the wellness programs where is the biggest employee pool that is partnering is it again in programs that reduce the overall health insurance and the reduce the workers' comp and the

workplace jurors or achieve all of them this is what we're needing as a plan that is not the proposal has the plan but i'm willing to sign off in the policy direction to encourage the department to engage once the policy is in place to come back. >> commissioner sanchez was next and i had two points as i heard in our overall presentation that was generally raising questions you'll be meeting with the small business groups and get they're thinking this is geneva you an additional configuration to generate input the other thing that crows my mind having working with the dr w y one of the major health care is the wellness programs for all

populations especially those that have limited assess was the folks we're talking about now they feel this is an integral part of health care is wellness wellness activities wellness programs it all part of the equation no longer point a and b here and there it is they're looking for creative activities they can fund in this area it is something we may want to look at at. >> yes commissioner chung so i know we talk about public health and we talk about like wellness and i you know i just wanted to make the case in the having an economic gang if you have healthier employees the prosperity goes up and the business will thrive if in their in the city the businesses

strife that means that traffic signals to more revenue for the city i think that is going both ways to really get a better picture to frame the narrative better to many betters by, yes. >> okay commissioners what an incredible amount of input to add to the work by the next meeting is there any other requests that commissioners may have? would you like to say some final word >> i appreciate your feedback and appreciated the opportunity to talk to many of i directly before the meeting. >> your questions and feedback made 24 proposal better i'm happy to work on the workplace wellness initiative and my comment to take what the commissioner sanchez said if you

could get some indication before going into a lot of focus the small employers could find that a useful comment. >> my presentation for the smaukts might help that and any other questions if not we'll go on the next item thank you very much for your wonderful work a robust decision and item 10 other business. >> commissioners other business? just 0 remind you of our planning meeting what date >> october 6th. >> october 6th. >> all right. so we move on to item 11 the joint conferee committee meeting laguna honda joint commission met on july 14th in open session reviewed the administrator's report we have a presentation on the groundbreaking lodged care program

we'll have a meaningful story about the legacies of care particularly particularly hiv and aids and hepatitis it was a compelling and quite informative about 9 work at laguna honda not for the city of san francisco we received the laguna honda metabolic youth in terms of the electronic medical records including a demonstration of the easy of the use of the those products and then we approved hospital wide policies and procedures and in closed session the report was approved i have a report from- >> wonderful could you let me know in the e hr demonstration what was. >>was a e clinic work >> it is the one. >> the in patient. >> they've adapted it for in

pafsht and in partial a patient only an at laguna honda all the services that was the only clarification why not precede with the other report. >> i h s we had a board meeting dart there were services provided at i h ss including the education and others programs but important to the commission there in the process of developing themselves as a nonprofit that would be able to then telegraph hill apply for grant funding with the fiscal on really what are the services that are needed for this population of people in the city and how can they help to leverage those services. >> i'll keep you updated. >> thank you that is

interesting. >> okay. any further questions to commissioner karshmer. >> our next item and item 12 agenda setting. >> i said what is needed. >> therefore we'll move on to i'll note no public comment for item 10 11 or 12 the next is the closed session vote. >> any public comment on the closed session. >> i've not received any a motion to go into closed session please. so >> >> all in favor, say i. >> i. >> opposed? we will go into closed session thank you very much the remainder of session we will have - >> should i leave and come back. >> why don't we have dr. gathering stay first and then mark with us to be to be finished.

>> so we're back in open session a motion whether to disclose or not disclose our closed session. >> not to >> all in favor, say i. >> i. >> opposed? that motion for adjournment is in order a >> all in favor, say i. >> i. >> opposed? this meeting is adjourned