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 deputy city 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 adjournedúx

>> i have 2 job titles. i'm manager of the tour program as well as i am the historyian of city hall.

this building is multifaceted to say the very least it's a municipal building that operates the city and county of san francisco. this building was a dream that became a reality of a man by the name of james junior elected mayor of san francisco in 1912. he didn't have a city hall because it was destroyed in the earth wake of 1906. construction began in april of 1913. in december 1915 the building was complete. it opened it's doors in january 1916. >> it's a wonderful experience to come to a building built like this. the building is built as a

palace. not for a king or queen. it's built for all people. this building is beautiful art. those are architecture at the time when city hall was built, san francisco had an enormous french population. therefore building a palace in the art tradition is not unusual. >> jimmie was an incredible individual he knew that san francisco had to regain it's place in the world. he decided to have the tallest dome built in the united states. it's now stands 307 feet 6 inches from the ground 40 feet taller than the united states capital. >> you could spend days going

around the building and finding something new. the embellishment the carvings it represents commerce navigation all of the things that san francisco is famous for. >> the wood you see in the board of supervisor's chambers is oak and all hand carved on site. interesting thing about the oak is there isn't anymore in the entire world. the floors in china was cleard and never replanted. if you look up at the sealceiling you would believe that's hand

kofsh carved out of wood and it is a cast plaster sealing and the only spanish design in an arts building. there are no records about how many people worked on this building. the workman who worked on this building did not all speak the same language. and what happened was the person working next to the other person respected a skill a skill that was so wonderful that we have this masterpiece to show the world today.