savings proposal so that target and our general fund targets and 19 and looking out in to the following three years, we're saying ok after that adjusted total after we kind of do what we're going to do in this two- year budget what will the years look like and in those areas what we're doing here is the same thing that we did last year we're looking at the rate of growth in the general fund

revenues of those are the revenues the mayor and the board of supervisors have to allocate and this is the projection from the city's five-year financial plan and you can see i have circled down here that over the four years of this projection there's an average growth rate of about 3.5% and so we can change that or tweak that in terms of our growth assumption but if we use that number # we should be growing our support by no more than about 3.5% if we're not going to continue to exacerbate the city's deficit. so what that translates to is you take this 813 which is where we should end this budget process and grow it by 3.5% and end up at 842 and the same for the next year and the next year. so if our general fund stays within that constraints, we

won't be cutting services, but we'll still be growing but we won't be growing at a rate that is eating in to the increasing the deficit and eat north to everybody eels else share of the general fund. and then lastly, what can you do is if you take that rate 3.5% and compare it to our baseline projection it shows you how far off we are and how much progress we have to make to live with that constraint and that's the number down here in row 25 so you can see we've got our baseline projection is about 878 and we're seeing if we stick to that 3.5% we should be at 842 and that means we need to make up $36 million and that continues each year roughly at that same level in to the future

so that says to me is generally speaking, that should be the order of magnitude of what we should think about in terms of restraining our spending and increasing our revenues if we want to live within that constraint and most likely that will be something along the order of if this projection the city's projection stays looking relatively like it is, that we'll probably be the level of reductions that will be asked for some order of magnitude by the mayor's office. so those are big numbers but they are not that far out of line with the reduction targets over the past few years so again our year two target this year is $36 million and it's a big number but it's not something that is so far out of the realm of possibility i don't think we can tackle it with sound approach to our financial management and just to give you a sense of how we can move the

needle on our general fund support these aren't made up scenarios to give you a sense of how much you can move the needle with a 1% change but if we can increase our revenue by 1% it gets us $15 million so 3% growth in our revenue should be enough for us to keep within range of that $35 million target so that is clearly going to be one of our big financial planning strategies is looking at ever opportunity we can have to increase our earned revenue and increase our charge capture and look for other funding sources and work on opportunities to not have our medicaid drastically cut by the federal and all of those approachs and that will be a key piece in our financial planning efforts. other areas that we have that we can move the needle out without

a lot of pain in my view if we can figure out how to ex indicate and if we can limit the growth in our costs and those other areas so materials and supplies if we can do a better job our bulk purchases and limit over consumption of materials we can earn for each one percent we do that it's a million and a half dollars per year so that's another area for us to focus on. professional services again this is not reducing costs it's just saying let's slow the rate at which our ex pent attitudes are growing and we have of room to move the needle in the area as well and then lastly this is showing you if we do add f.t.e. s what it does to the projection and you can see it doesn't take much of an increase in our f.t.e. count to really push our general fund support levels up in those years.

so, let me just see if there are questions about that and i know that's a lot of numbers and a lot of acronyms. >> you actually are saying the way you've broken up your scenario and this target is not unreasonable that we have set last year and it continues to represent a good model to work with because it's probably close to the reality that they're going to need to work on. >> it's close to the reality that we'll need to work on and yeah i don't think it's unreasonable and what it tells me is that the job in front of us is we restrain our spending and be careful and we're not talking about making cuts and dramatic change in the economy and federal and we have to be

focused on a level of disappoint ment about growth in our spending and we do need to focus on increasing revenue generation and if we do those two things these are achievable goals they will take work and they will take discipline but they're achievable and reasonable targets for ourselves . >> the $36 million that we're looking at the projected gap or deficit includes the 3.5% city growth targets and does that also include the 2.5% mayor's budget cut or is that on top of that? >> so that would be that is correct would assume that we hit our 2.5 and our 5% target and so we make those reductions and then after we do that we're going to grow but we're not

going to grow at 5% we're only going to grow at 3.5% so we are still allowing ourselves growth but slower growth than if they just let things happen on their current course. >> besides the 2.5% caps we have to come up with an extra 36 so this is a total of 6% versus or is it a total of three and a half percent? >> yeah, yeah, you are totally making sense so if you looked at what our rate of growth is and this projection so let's see, equals let me just do this really fast because i totally understand your question.

>> so instead of growing at a rate of, you know, you can see from the numbers up here in most years we're growing at somewhere around $60 million we'll grow at a smaller number which is closer to $30 million a year or something of that order. >> so our cap is $36 million per year. >> so i guess it would be interested, we don't have to do it today but as we start looking ahead, the anticipated sources of that gap closure i assume that there's a lot of questions

still open and we looked at dollars at risk because of various number of reimbursements for h caps and sars and a prime with the big one and which hope medicate rates may go up and so i guess if we could just be kept abreast of the measures and the big financial drivers that would help us to look at that although we're looking at trying to improve a revenue collection by 1% and some of the things you listed. >> so you name the number of areas on the revenue and there are the waiver programs and built in to these numbers and our is assumptions how much we'll learn and the global payment program and it improves our performance compared to this

projection and another example is we've spent a lot of time focused on patients flow throughout the network and not for the care and we're not able to build for the optimum amount that we ought to be able to so if we can improve that flow we have fewer days at the hospital and we have fewer people in services that were not getting paid for and we can maximize our revenues there and those opportunities are in the double digits of millions with certainty and as we go in to the electronic health records project, that is a risk on our revenues also because you also see the often see when these things go live you see a decrease in productivity but at the end of the day, we should be able to see some improvement because of the discipline that the e.h.r. system will impose on

our charge capture and on our collection of data and that discipline should in theory and it's our intent and commitment to make it happen in practice and improve the rate of collection that we should see for each day in our hospitals, visits and primary care so that's an opportunity to just get ourselves paid more for the services that we are providing today. so that's a big area of focus for us as part of this e.h.r. on going effort. >> on the positive side i would look at the $36 million as being just slightly over maybe one and a half percent of our total 2.25 operating budget and on the scale of things, it's really -- it would seem to be within the normal business operational vary ance, 36 million so it

doesn't sound like a horrible hardship. >> interview: it's the way i look at it and it's still $36 million so it's a big number and it takes focus and effort and it's not like we're talking about in the really difficult times six or seven years ago where we had these very, very large targets that were we're trying to hit and we're looking at fundamental changes to services and i don't see us there and i see us in a situation where they will take work and they're manageable and especially if we start now and start now at an initiative that will payoff overtime including the revenue capture initiatives that this is something that is achievable and manageable. >> thank you. >> you know, one large block

here is the salaries, right, we don't totally control that and what is the over all city sense that this -- i'm sure each of the departments have similar things but we have the largest workforce that is under our negotiations and all and any of those could just blow these, i mean, it's not just 36 million it's hundreds of millions if which if we just had another one or two or three percent within the salary and that also somewhat goes with the work load and we run two big hospitals that have a variation of how much everybody is supposed to work and understanding the tensions and the needs for union s to represent correctly their constituents as they see

it and the will of the city would seem to be really important if not just this but the remaining 70% of the general fund and city budget is appropriately protected. >> yeah, you are correct. i mean, it's a driver for us and it's a better as a whole so there are going to be conversations that are not in our power as you said they happen through the central city agencies about what the wage increases and what the city contributions are to benefits like pensions and healthcare and those changes if there are changes up or down those do really drive the budget and i think the biggest thing though that really is in our control and that it really jumps out at

you like a sore thumb, is when you look at the impact adding and growing the number of f.t.e. s in the city if you went back in time and said for the number of f.t.e.s they added in the city over the last several years with that compound ing rate of growth in the costs per f.t.e., that really drives the expenditures side in a very big way so i think the thing that is under control and i think also the reason for the mayor's office instruction for the f.t.e. is the first thing that we can do is say we find something we want to do before we talk about adding an f.t.e. let's look and figure out there's within one our base that we can repurpose inform serve that function and keep our f.t.e. count stable but you are right that is kind of a structural growth in wage and benefit cost is a structural

driver of our general fund that is somewhat outside of our control. >> interview: any further questions at this point? >> no. >> all right. >> so i'll put that away and go back to this so again we talked about these but i think this will be the area of focus is limiting cost growth if we can just limit the rate at which we're growing and not saying cut we can really move the needle of especially in the out years object that cost growth and revenue and the biggest focus of our financial approach. the other thing that i'll say that i skipped over as we were talking about the principle of let's say and following last

year's health commission strategy session where we talked about this concept we've incorporated this approach in to our planning that we're doing through the lean process so our department of public-health lean planning and our san francisco health network lean planning so we're aligning the approach that we've worked through at commission with our process and with the city's five-year financial planning process so that all of those goals ar lined and we are everybody is pointing themselves in the same direction trying to say let's have a target for a constraining the rate of growth. so major initiatives, so i think this goes back a little bit comments dr. sanchez will the

future of big picture of where we're he had two year budget and five-year projection the story of our kind of 30,000 feet of where we are and we have gone through a period of recovery from what happened during the recession and we've done a lot of work on our operating infrastructure created the san francisco network reorganized the work and the work ahead of us and we have a number of significant infrastructure investments that will payoff for us for many years to come and the decade's long infrastructure investments and the good news is those are funded through the work we've done over the last

couple of years and through the city is capitol program and a lot of the effort that we're going to spend over the next five years is going to be on ex cuteing so the two biggest of those are obviously the electronic health records and our capitol program and so i'm going to talk about what those expenditures look like and those two items in and of themselves i think they're going to be enough to occupy the energy in the focus of the department for quite some time. so on electronic health records, the big focus is there are a lot of reasons we're doing the electronic health reports initiative as you know the big focus is from a financial perspective for us are going to be financial oversight of the project and so it's a financial imperative for us that we keep expenditures and time line under control because of the size of

that so that say big area of focus it's again on revenue cycle and risks and opportunities so how are we going to make sure when we implement d.h.r. we do it for all the clinical and service good it can achieve but also to increase the revenues that we're able to drawdown for the services that we're providing and preparing our people to be ready for the e.h.r. and these also align with the lein priority and targets we've adopted and so just to give you a sense this is going to be hard to see because of the way that this screen looks and i'm not going to go through this in a lot of detail because i want to

show you the top-line numbers as we go through the project. we will be by the way, completing the contract for the e.h.r. and we're on track to spend $52 million this year and in to the next year that gross and it's our big year where we're really focused on the go live so there are numbers and

the a huge portion of this so this will be getting our internal project teams ready and it will be for staffing back for training and for the people that are contributing to the project and it will be for replacing our infrastructure and getting our infrastructure in our operations upgraded and an even bigger part of it is spending on ourselves to make sure we're ready to use the system effectively and get the benefits out of it that we're going to need to make this thing happen. you can see that after the third year we level out and go in to a state where we're steady overtime and these are the costs

to operate that system and people to manage and maintain the system and for on going costs for the vendors and overtime you can see the estimates expenditure over ten years is about $330 million and these numbers are still changing and when we sit down with epic we'll get more detail on what this looks like and you can see this is big and this is a focus on our financial efforts for the next several years and probably limited bandwidth with big initiatives. through that you have across, we looked at some of the contracts today and the main contract going to really be most of that

86 million or what? are we going to continue to have a whole series of other contracts that you've been projecting and we need to kind of make sure that we're all in line just like you were saying with the lloyd project was such i mean how are we trying to shall without getting in to details of course, understand that they're fitting in and not all of a sudden a whole brand new group of contracts are coming in because this is autopsy a enormous -- such a enormous. >> there's a lot of contracts and as we go through this in look you saw the epic contract and then like you said today there are contracts for approximate project mappingment for implication and there are a number of contracts we have to get in to for the third party vendors and for modification and existing inner faces to existing system and so there are a lot of contracts and we are going to be

presenting those as a package to the finance and planning committee and our intent to approach this both with the commission and internal goods and management is that under each of these numbers so for example the epic implementation those are costs in the epic contract and then there are other lines in here for example, let's see, where is another one. see if i can find the -- ok, so, here is this first line addmin it's a contract you approved at the health commission for our administrative project management function and under

each of knees numbers, we have a separate spread sheet that is broken out by contract and by costs and so every time one of those contracts comes through our every time the request for funding comes through, we're taking them and comparing it against what is assumed under each of these numbers and we're saying either go or hold on a second that is not planned for and we need to re-evaluate and the intent with the commission processes to also do that so when we bring a contract to the commission we'll be able to say point to the line that the cost of that is included in and show you the budget for that line item and demonstrate it's part of the global budget that you've seen and that nothing in that contract is going to be expenditure in excess and cases like there were today where we had the deloitte and the nordic contracts with it gives us flexibility to chose between

vendors and we are going to be imagine age through the budget any expenditures again those contracts so we set up through our project where we're in the process of a project management office and our fiscal division and a number of controls foray approval of the invoices that everything that comes in we're checking it against the projections for budget and we're recording it and we're reducing the dollars available to spend so that will be a lot of our work and a lot of our conversations that finance and planning is keeping that management of these dollars in place and keeping the right controls in place to make sure we don't spend it. >> i'm just wondering if how we had tracked the generals progress in terms of expenditure of the dollars and you know and also the time line as being on schedule with a fairly simple

face and i think on the contract level it makes sense that the finance and planning seeing where these are from a commission standpoint i would think that we would want to see that the over all project of moving this way and here is where the expenditures have gone and here what we have kind of left or were halfway through something to the building does that make any sense. >> absolutely. absolutely. yeah, so as i know you've seen kind of an early version of that chart that shows you where the high level time lines are going to be mapped out for as we get our project management office up and staffed and then in addition as we actually have the epic

contract ready and we can start digging in to the detailed time line with our project management and with epic, we are going to have excruciateingly detailed project plans that we can share with the commission and give you updates as much as we had with the rebuild so we will absolutelying doing that and that will be part of the process that we're using as staff to manage the project and we'll report on that to the commission >> i think we need something like that and our responsibility to see we don't over run the contract of course but we also more importantly want to see it's on track and it's actually moving forward and without getting in to the micro management. >> yes. >> not going to get in to the bolts of the pluming. >> right. >> but yes we should absolutely we will absolutely be updating

you overtime on this status of the project and giving you some of those big metrics on time line and on the burn rate for the costs. >> commissioners, i just came back. we are modeling the report out like we've done with the capitol project for the d.h.r. because we knew it was a model that all of you were familiar with. >> yeah, commissioners are acquainted or feel comfortable with that and certain let us know you want a different way and i thought us tracking the general project really worked very well and they broken in to the key components and we understood probably more than we needed the power plant and likewise it was all, i think much clear tore all of us, so, if commissioners feel comfortable with that sort of model that would be one of the things we would look forward to. >> thank you. >> so we talked briefly at the

last finance committee we were told that they will be over 200 more contracts coming in so certainly with all those contracts it would be up to you and chair chung to keep the budget in order. [laughter] >> but the staff as they said it was a map provided about where the contract fit in and some were services and some were materials and some were hard cables and computers so there is a whole strategic map and before the contracts come to you you get the maps saying this contract fits in to this small little box and in which case your contract expertise and how is it a sign and whether the deliver rables look clear and outcome states and you talk about maybe a follow-up step is

looking at the performance issue of the contracts. >> i'm saying being able to follow the progress of the project like we did as this is a very concrete product coming out and not in the same sense but pretty much and in terms of the cost of a huge building already. >> so we're told several hundred approvals coming and they will pass through the subcommittee and am i correct? >> absolutely. >> and as they come through we will be packaging them and showing you how they fit in the context so that you have to take them all. >> it's enormous work. >> it's up to you. [laughter] >> just looking at the task of it. speaking of bricks and mortar,

the next -- >> that's the other kind of mega financial initiative that we're in the midst so again i think we're at a point where we've had a number of years of financial health and our focus is making in big investments where we'll be able to payoff for the next many years and we're in the midst of the proposition a from 2016 and it will be the sighs mick renovation of building 5 and it will be the expansion of southeast health center and maxime hall and castro mission and so a major capitol project and highly complex following up on the successful completion of building 25 and that will be a lot of work and focus over the next couple of years and director garcia has put process in place for oversight and

management of all of those projects and they personally as well as the rest of the executive team are very much on top of and the other thing is we'll have trying to think of when it is it's february that we have a capitol planning update coming from the commission so we'll be able to go in to some more detail about it at that meeting. shortly on the heels of that we have in the city's capital plan programmed $155 million up to 155 depending on the program in certificates of participation which are not a geo bond but a different debt paid with the city's general fund those are programs for fiscal year '18 and '19 so the upcoming fiscal year

and they will allows us to renovate building 9 on the campus which is the building on the south side at petraro on the south side of the campus which needs seismic retro fit to renovate the two old at laguna honda hospital if there's a need for space on the juvenile probation department to occupy space there so that will allows us to renovate the spaces and get some of our administrative support functions in to those buildings and that will allow us to get out of a lease facility and seismicly safe buildings we have following that we have another $300 million place in the ten-year capitol plan that would be another geo bond scheduled for november 2022 and that would be at the next phase in our program and the scope is

still yet to be defined and we'll have to work over the next couple of years with the capital planning process to nail that down but the next major item in line is the seismic retro fit and renovation of buildings 80 and 90 on the campus so when you look at how it fits together starting with the new laguna honda hospital building which went before the voters and the late 90s, bit end of this 10- year planning horizon we'll have done a tremendous amount of work and kind of once in many generations investment in upgrading our public-health facilities and the city so two hospitals and a number of seismic safety improvements for out patient facilities and our support facilities so stepping back this is a pretty remarkable time for our public-health system in this city.

the large strategy and we'll get in to this more as we go in to the details of the capital planning, but the large strategy is we have a number of our staff that are in seismicly unsafe buildings including this building, we have a large number of our staff that are in rented or city-owned facilities that are going to go away and so for example, we currently have staff in 30 vanness that building is being sold to finance construction of the city office building down at south van he is and mission and we'll have to get our staff out of that and we're also trying to look at our lease facilities so we have lease facilities some are which are knewer and older because we're in the facilities we're subject to whims of the real

estate market which is not a great place to be and in addition to that we're putting money in to lease facilities when we have a large amount of unfunded needs in our buildings on our campus and particular and so part of our strategy is let's get ourselves out of lease facilities and put our machine we own and investment and so that we have in facilities that are seismicly upgraded so over the next six to eight years will be exiting this building and 30 vanness and exiting some of the other small paces and civic center on to renovated. >> so that's a summary between the capitol programs and the e.

h.r. and our biggest financial issues from both an ex pendture point of view and from the point of view of how much bandwidth it will require as a focus for our finance temperatures and our operations and clinical functions. questions on those before we move on? so in your and there have been many about were going to go and and how or what percent of reality is well i will tell you and everything there are a lot

of dominos that have the fall see the complexity on possibility and complexity of all the pieces that are moving around within the system and each of those have dough pen den see of the peace before moving first so there's a lot of complexity we need to so one thing that i would say is that we in the capitol and we have the funding in place and there's a possibility of a the funding

in place so at this point in time we have a plan that is more thought out and more comprehensive than most that we've had in the history of the department and we're in a gook and projected and to and we're on good track. >> yes, commissioner. >> can you go, oh yes back to this diagram, you realize this looks like the digestive cycle don't you? [laughter] >> maybe these are kidneys. [laughter] >> i do want -- you are learning our language. maybe it's just conscious. >> commissioners, you've been with greg now for probably almost an hour and so i do want to recognize that the depth of

his knowledge of all of these areas and his leadership in this area and we've worked hard at ensuring the stabilization of the department around capital pieces it's a sharing economy in the department where we really want to focus on our service system so our patients and our staff will have safe building and we've also given up three times our ability to move this building to ensure that people here also have than opportunity so i think we're the closest because one of my jobs was moving out of this building when i first started over 20 years ago and again it's a volatile sometimes process and especially if the economy changes but i think we're very, very close for having this solid plan for this and i am very hopeful that we can and to all this planning we're doing but i want to

acknowledge all the staff who behind us are doing some incredible lifting and right after two hospitals being built wore back right at doing more capitol projects and we're getting better at the management of those and also really managing the financially so i just wanted to acknowledge greg 's leadership our c.f.o. regarding that relationship. >> it also does and i sit on the committee that reports out all of the city capitol projects and ace watch you know some of the departments we're very highly regarded of our ability to operate all of our capitol projects and getting them out the door so we hope it continues that reputation so that we'll be seen as an project to move on and having people in safe buildings is a real goal we all

have. >> can i follow-up with one last question, first of all, no rest for the weary but thank you so much and i really appreciate all the work and answering our questions and you've been getting us to this point with so many projects like the a.h.r. so with regards to capitol projects , how much are we at risk with regards to the operational budget if there are building capitol over runs are we responsible for the whole projector just the operational aspects of decan'ting buildings and the staff or if the building costs 10 or 20 million more than most does it come out of our general fund allocation because i want to know how much risk we have around the building. >> interview: so the short answer is we're not going to put ourselves in a scenario where we have to face that decision. it's a real issue and we learned that the regard way overtime over starting with the san

francisco general hospital bonds and we put a lot of oversight in place to make sure that we don't end up in a situation where we go out and borrow money through a geo bond and run out of dollars to complete the scope that we said we were going to complete so our approach and our policy now is that we make an investment up front to do the planning and the estimating and we appropriately size the geo bond if our ambitions are higher than the dollars available and the bond we scale back our ambitions and so the other piece that we have in place is we have oversight process and structure that i think is barely strong and we have executive committees barbara garcia herself chairs the a oversight committee and we have controls in place if there are changes to scope or to costs

for us to review those, we review those changes as they come in so we have a lot of controls around the process with the goal of not putting ourselves in a place where we hit that situation and where we're over budget and we have to deal with it. >> the risk to volume our department because there's d.p. w. involved and other divisions where they are the lead constituent or the lead interest. >> yeah, we worked very closely with d.p.w. so d.p.w. is our partner in delivering all the capital programs with us from beginning to end so we work with them very closely and in the event that we do get to a point where we have a challenge in the budget or we have an unforeseen cost that arises, ultimately the

financial responsibility for that would be what the department of public-health because d.p.w. is our implement er and we are the lead sponsor or the lead constituent as you say of the project so it really is on us to manage the projects from the beginning and as we foresee or as we experience problems as we go along for us to take ownership and manage the solutions. >> thank you, very much. >> just to make sure just to let you know we are starting quarter ly meetings with d.p.w. to ensue we're coordinated with them as well. our. >> saphia: is but executive level we will meet shortly for our first quarterly meeting with the executive director of d.p.w. >> yes, that's absolutely correct, i think we've gotten a

lot of experience both on our side on the d.p.w. side through this work with the vendors and how to hold the vendors to accountability so yeah it's a good point. >> i do think there was an example back when we were building laguna and it was commission that needed to listen to what was happening and then the department the directors and finance people and so fourth working with the mayor's office to workout what was going to happen and that day up with of the issues was steel of course and that drove the cost of the project far higher than project ed and there were a number of other controls that probably should have been in place but we've learned from that experience and did much better at the sfgh rebuild but

we did have to work i mean working closely with the city so it's not that you are responsible and cuts half the people off the clinics but how do we do this and the ultimate was to remove one time and it then butts it back within the budget and so it's a collaboration because city cannot just have you also default on the project nor could it actually want to sustain taking away patients' needs related to this but this is part of the -- i think the due diligence that we have to have to work with the department and with the administration to be sure that things do stay on budget and when they don't, then earlier rather than later the answers need to come a lot more

transparency which i believe the department has really come up with now over the years in order to give us the information and so that's why i'm looking forward to being able to do that and i think we need something similar on our capitol projects right because that is another bond issue we're following in terms of the seismic renovation at five and our other clinic buildings so we're model it similarly although not as complex as the e.h.r., right. >> it's interesting because when you look at what is under that building 5 program, there are -- the team here knows it from experience but there are dozens and dozens and dozens of moving parts different clinics relocate to go different areas so there is the bit of complexity to this

but we will continue to report to you with the kind of summarized version much like we did with the bond. >> ok. >> thank you. >> other questions commissioners on this particular part? sorry to make you keep going. >> the last slide on the marathon. [laughter] financial data nightmare. [laughter] so risks and uncertain tease this is the last subject that the commission requested that we touch on. so the two biggest as no surprise they have been for quite some time is the federal environment, the policy environment and state and the economic changes possibility so recognizing of course that anything that happens there could be big enough it really

changes the numbers that we projected out here in fundamentally changes the environment we've been looking at so we've been conscious of that and we've been talking about at this commission for most essentially the entire time i've been here and before but also at this city level trying to put ourselves in a position where when something happens we probably won't be able to mitigate it entirely but we can at least buy ourselves some room to deal with it so we're not kind of thrown in to react mode immediately when something happens so a couple of the initiatives that are core to that strategies the reserves on the d.p.h. the management reserve that we created we have $92.2 million that's built up from zero not so long ago so

that's a lot of progress and that is i think a big deal helping us sleep a little bit better at night and in addition in the budget that was adopted over the summer, there's a 50 million-dollar place that is in a central city reserve to mitigate impacts of changing to the a.c.a. or other federal cuts so that is helpful reserve if there's action again it wouldn't be enough to just make those a nonissue but it would be enough to help us mitigate the impacts and have time to develop a response to whatever may come. on the e.h.r. project i showed you that large project budget over ten years. we have been funding that in pieces overtime and we have in

the '18-'19 budget the the the last lump sum appropriation for the first three years of implementation so we have those funds set aside in a project budget and this is a question that has come up here and in other settings on the e.h.r. as how are we going to make sure that we have the funds in place to deliver it this is been our approach in our strategy and to make sure that we actually can execute and we have those funds that are segregated and a project they don't close out at the end of the year and it's a project that continues overtime so the funds will remain available and they have the ability to manage that project so we through the work of the last several budgets pre funded that project with we had good news and it's a good practice of saying when we have good news

let's put an end to investment that is capital investment that will payoff over the long run and lastly the general fund we talked about there is the city's general fund reserve and this has been the work of the city and the controller and the mayor 's office and over the last many years the city and the board of supervisors adopted the policy to increase the size of the city's general fund reserve it used to be $25 million total for the general fund and that reserve has grown overtime to about 8% of general fund revenues from a fraction of 1% that puts us in more of a standard range where we have re serves that are more proportion at to the size of the city's revenues so that should provide some question with one of these big changes.

and then let's see of course revenue generation is our other strategy for mitigateing any of these issues and the more self reliant we have on our revenues and the less we rely on general fund dollars or we're reliant on good news from the state or federals, the less susceptible to those changes so that that's got to be our policy for in sul eighting ourselves from the swings of the financial world so that is all i've got. [laughter] >> well, that was really very commendable. [laughter] >> recognize aside from having to stand. by itself it's difficult. >> it's good for my back. >> i mean obviously the work behind it in the way that you and jury staff has recognized it

as assisted the commission to understand where we're moving forward and ask the commission if you have thoughts now commissioner gardner. >> good. >> you have done a good job and he is at this point that this is a lot of money and it's going and you reached also and. >> thank you, very much and i just want to save the i've seen

a change in culture and ownership of the financial situation that has been pretty profound and we have if you look at our financial steward ship is an element and integrated in to the planning in the other areas so all of the leaders in the network and on the population health division and i think the leadership is really coming from the divisions to drive the changes that end up on my spread sheet so focus on financial management in the department outside of the finance division is really strong. >> i would ask add to the chair that the rights of