the next week or two at the latest. the other highlights are given that go-no go decisions are critical path risks have been identified and mitigation activities are underway depending upon that decision. but we are also establishing and dhr governance structure that will need irrespective of whatever system we go to and we are also standing up in project management office to help manage the project. this, our second strategic initiative, number two, underwent a major revision in the alignment changing its original focus from implement the medi-cal 1115 waiver to its new focus on aligning care finances and clinical operations for

value-based payments. as we went through the process as honing and try to complete the a-three became clear as we questions just what it was we were trying to focus on, it became clear that the focus really was and just incrementing the waiver. it's really preparing our struggle payments hence the changing in and naming and the direction of the a-three. that being the case, we would all the major revisions is not quite complete weeks that to have it completed within the next month and oust chen is the owner of that a-three and she will not rest until it started i can assure you. her and as she keeps us all up in night that it is not done. finally, here is the status of our other three a's one strategic initiatives. initiative-initiative number

five stabilize finances. you see has a green dot. that a--three chart is complete and much of that information was shared with you last month by greg wagner when he presented the five-year financial overview of the department and greg is the owner of that 8-3. for initiatives three and four with the yellow dots, due to changes in leadership and staffing for example you know [inaudible] left zuckerberg as the ceo. she was the co-owner of develop our people we also change in the coownership of the right place, right time with dennis mcintyre the un medical director at zuckerberg's now been replaced by guttural as the co-owner of that there are five and. we need one more workshop to finish development of those

charters before they can move to the implementation and monitoring phase. commissioner [inaudible] asked about the two new sheets. this world want to remind you that those sushi to receive today are updated versions for the last two slides could so please refer to those and this presentation today actually does have the one that's been displayed has the right information. as you know, there is an ever increasing focus on measurement and outcomes in health care. as a network, we are learning how to create a more integrated organization given her wide scope of services which is a strength but also a challenge when it comes to equitable measurements across our various clinical divisions which do different types of work. as we mentioned before, were using to north as our overarching unifying framework to create a culture of continuous data

driven improvement. you can see the current status shows we have 55 total to north metrics across six dimensions. of those 55, 16 are on target. 11 are off target and the vast majority of the other 28 are still in various stages of progress in terms of data validation. the timing and collection and reporting of that data. it prime example would be many of our care experience metrics are based upon staff experience and we currently do the staff expense survey biannually within the department. so the last one was done almost 2 years ago and we will be doing the current one now and be able to report on that once we get those results. and, again, i talked about some of the education we read we

received from our roanoke consultants but the value of disability tools and here's another one of those two. this is essentially are to north metrics on one sheet, green shows the metric on target. red are the ones that off and great are the ones that are still in development. so that is my overview in the former presentation and am happy to take comments and try to answer questions at this point. >> ever seen no public comment request for this item. >> thank you, market any questions, commissioners?they also to be thinking at the moment commissioner sanchez >> i just want to say it was a really well-documented pertaining to ali areas where involving and also those that

we are successful in those that we are not at this point and those that are still ahead of us. i guess as we continue on though and there is going to be more cost-cutting throughout teaching hospitals and they are looking for ways to save money and of course one way they are considering is it and the effects of-is that going to if in fact as does come to be whether it be the five teaching hospitals that in the uc system, with that affect our -would that be a potential limitation for us or an area that we are going to plan b and plan c and is that does come to fruition? if in fact we do move forward on the totals. i know that's a long questionable what i'm saying because i guess this laundry thing hit me earlier and am thinking about

the departments [inaudible] sign centers are going to save money so the departments of radiology other radiology film went to india and was reviewed their was cheaper cost effective because many of the radiologist seven trained board-certified and you see hospitals are stanford or some of the other ones. so my question is, are we going to as we move forward, do we see any limitations where this might limit our ability pertaining to tracking our patients, both at the general follow-up and laguna honda. i guess i should not ask a hypothetical question i get some speaking from-it's happened before different ways, as folks and institutions you try to cut and save over a five-year period and many

times it's come back again and then they rehire it may retrain and they do whatever. does that make sense? >> i think so. from understand the question, please tomio, i think the question is, particularly with consolidation of it amazed if we do that is mise means of saving cockpit would that somehow that affect our ability to do some of the changes we are planning to have a more financially viable long-term horizon? is that >> right. >> i will try to answer that. particularly if your are you referring particularly to the phr or just in general? >> no. yes. i'm just try to save protector share with us as you work through as we work through this this is going to be an ongoing variable because i know that a number of staff in some different disciplines are already being reassigned and/or illuminated. in order to

save dollars because this is a very very expensive proposition for acting and teaching hospitals. and we are part of that. the department of public health and we made major commitments and we will follow those commands but we want to make sure the quality control is here. i noticed there was a governance units that is going to be considered. so this way we can have which is great. that really shows some good creative thinking as far as how we are going to navigate this. so it seems like we are well upon it. i don't want to get into the nuts and bolts. i just think that as long as we are aware and i think we are, i think we could come in with some alternate plans if necessary. so we are not my you know, i can misty was absolutely should governance is definitely a consideration that i think will be part of the gold though go decision as it

affects our long-term ability to really be self-sufficient and financially viable. >> thank you. >> commissioner pating >> first of all thank you very much again for the overview. i really feel like be strategic planning that you have been doing particularly with plan together to north metrics and the r5 and regionally, together. it's good to see all the hard work and but also all the drivers that are monitoring can i just run want to commend you. kind of reminds me on their driven a starship or enterprise but they always have those buttons and there was into control the whole shift from one keyboard. >> is coming together not quite as fast as i like but it's coming. >> you are getting. you'll get work speed in no time. >> well it's kind of steering the starship enterprise in a new direction. which is kind of hard. big ship to steer.

>> you are the captain, right? >>[laughing] captain roland pickens starship numbers start a number i can buy first question is in regards to the second a-three on value-based implement, it seems to me the definition of value is changing. i guess the question is, are we going to make up the value were defining the whole person metrics based on our own view of that? they really haven't ruled out a cms in a conference of weight yet and i was wondering your thoughts on it. i like the direction this letter off i couldn't three but the definition of what valuable tool person care, i'm not sure what how that works >> my personal opinion on that. my opinion is the value is twofold. value one first of all is the value defined by cms

because for the most part they are a major payer. so like it or not they get to assign the value. but also value comes from the point of the customer that can be either our patients in terms of the care they are receiving or are they getting better are the outcomes better? the value is also from our workforce could our staff. are they in environments in which they are thriving and want to be here and then therefore able to give better service to our patients and hopefully will increase their understanding of the value we provide to so i think it's both. what are the external organizations that are driving and who are determined with the value is, based upon national benchmarks, measures, other things but i think it's too full. both of payer value and the value from the perspective of the customer. >> i feel like that's a good approach. we definitely need to follow cms's lead in areas that

are not under cms's radar or that they are lagging we create our own measures in and we put forward her own in digby there's no reason we can't assert that we are providing our own measures to measure our sense of value and then just sell that to public payers or private payers as being credible. i think the question of how we prove it and so i like your answer. >> that's one of the good things about the medi-cal 1115 waived the prime program. there are 67-59 measures that all the public hospitals in california are being held to and so these -not all of them are ones that are sponsored by cms. again, depending upon the agency were the body we are being measured prolifically and we just-we are

under the gun to make sure we meet those pressures because it's now tied to our payment. so it's either meet them and survive or if not we won't. >> i'm really glad you're on the ship and we sent it away team to explore the planets. >>[laughing] the second thing is about the scorecard good i'm not really sure whether we should go into too much detail but i just want to call out a couple of early progress indicators that i think are significant first of all i like the scorecard. i'm wondering whether at some point in the future if we get more handles on this we should call out we should maybe like we do with the audience report to a narrative on things that are really significant achievements or significant deficits so that maybe we can meet out the bulk of the report and look at the red and green but things that either want to highlight as just needs working or this needs-this is a big improvement i think a narrative on this

would be useful in the future. although otherwise i'm a little worried you put data in front of commissioners is like me in front of dogs that will be all over this and may not leave much of the bone left. but i would like to know that you didn't throw this need to us throat a couple things. one, really pleased black african urban health initiative i just really really proud that were making progress with hypertension on the equity any quality initiative i think that stands out is extremely significant in our first equity marker that is turning. i also like the idea that we are increasing revenue through timely documentation you i think revenue capture for public health systems is him they were not always as good as because were always thinking as i can know not fee for service but you are doing significantly better than your 40% goal and up to 73% is significant. the

other one-i'm working from the back forward. that's under financial stewardship on page 3. i don't see much in workforce and care experience of the we do have positive care experiences at san francisco general which i hope will continue with a new hospital. the last two real ones i want to just call out is that laguna honda and the health at home program reducing staff injuries in such a short time from 11.6 per month or per interval, i guess, to 2.8 on both of those is just really a wonderful reduction in i know where justin staff injuries at san francisco general as well. so as i look across this those are really great early successes. the only one that had a question around with the health at home and the quality measure

division where we are-we went up on reducing emissions through improved discharge follow-up to 19.6 two 42.9. i'm just wondering i'm not actually sure what we are measured are we measuring reducing hospital admissions or discharge follow-up? that would be the one that i would be interested if you did write narratives in the future. >> absolutely. >> great scorecards. >> scrabble can give you that answer. >> okay. >>good afternoon vice president and director garcia and health commissioners. we will be our two n. metrics that are direct conference committee for november 8 and will be explaining to our joint conference commissioners our green and red areas for our

true north metrics. for the health at home metrics, as director dickens was saying, reviewing the data so that it matches what we have in the matches what cms has has been a challenge for us. when we are looking at the data based on our patients that we look at on a monthly basis it is very-the numerator and denominator are very different than what is posted from our from cms. so we are currently rectifying that and we hope to have the right data for you >> [inaudible] >> yes for the readmissions. these are medicare patients who have good we are seeing and working we admitted back to the hospital within 30 days. >> thank you very much. colleagues am sorry sparrow i

guess we do we are reviewing at the commerce committee's we don't need to review it twice. maybe what we should do again in the narrative stakeout some of the summaries that were really at the joint conference and then that we can just highlight-i'm just thinking that a future to make it simple so we don't have to go through the whole report twice. >> yes. i love to get your feedback because if you're at the laguna honda for zuckerberg jcc you will see it but if you are not then it's how do i struggle hadley keep the other commissioners inform. i'm happy to take your suggestions on how to make that happen. >> we were suggesting that to roland may be highlighting several of these areas and going in deep that some of the other commissioners are not at the jcc for the zuckerberg area that may have the highest concern for you or overall in

the network. he was sure. he was some of them might be quality bands around these numbers. like a standard deviation either plus or minus maybe those would be the ones that you report out. the ones in the middle where you're working on, we will just- >> you are right. i think i make sense of the deadly as beginning answers make sense of the ones that are missing and i think we easier for the ones more important wants to float up to the top. >> thanks. >> thank you. commissioner hayes-white >> thank you much for your report. i guess the question i really has to do with having its more general question and deep dive question like you just got. that has to do with when you say it's in progress or for example the improved emergency overdose response, that's in front. to be determined and is also in progress. i think that following along commissioner pating another statement would be helpful to understand what that means. if you have a timeline than that would be helpful as well. i don't think it's necessary