>> good morning, ladies and gentlemen. i'd like to call this meeting to order. >> all right. thank you, sfgovtv, and ladies and gentlemen, want to welcome you back to another exciting meeting of the budget and finance sub committee. my name is malia cohen. i'm the chairman of this committee, and to my right is supervisor sandy fewer. joining us shortly in this

meeting will be supervisor safai. i want to thank jessie and michael for assisting us with today's broadcast. our clerk, of course is the lovely and talented miss linda wong. thank you everyone for joining us here today. madam clerk, are there any announcements? >> yes. please silence all cell phones and electronic devices. speaker cards and any documents to be included as part of the file should be submitted to the clerk. items acted on will be on the april 16 board of supervisors agenda unless otherwise stated. >> supervisor cohen: thank you very much. i'd like to call item number one. >> item one. [ agenda item read ] >> supervisor cohen: all right. thank you very much. supervisor peskin is the sponsor of this. i think we've got beth

rubenstein here who's going to be presenting from the department of public works, and i don't know if julia dawson is going to be here, as well. >> i'm here. >> supervisor cohen: all right. this item is a 240 day extension from jc decaux from public kiosk. thank you. the floor is yours. good morning. >> good morning, chairman cohen. we're here toed to ask for an extension. what we've been doing recently we ended up in a review at the historic preservation commission, and they asked us to step back and do some design evaluation. as a result of that we brought on beth reubenstein to help with the design process, and it's actually been going well, so i'd like her to come up and talk about what we've been doing with the design of the toilets and kiosks.

>> supervisor cohen: great. thank you. >> good morning, supervisors. thanks for hearing this item. so last year, sort of late spring, summer, and fall, jc decaux had an initial sort of draft design that moved through historic preservation and also the arts commission specific design and review, and they reviewed it, and it got stopped. they were concerned about i would say the utilitarian nature of the design. it didn't have the uniqueness and flair that we would hope for an important san francisco assets. these kiosks and toilets will be on the street for the next ten to 20 years. we wanted to step back and balance this contract that's really been beneficial for the city, so we'd like to get that contract completed as soon as possible. we'd also like the toilets and kiosks to be as beautiful a

possible. >> supervisor cohen: we got it. this is just an extension of the contract. supervisor fewer, any remarks? >> supervisor fewer: no. i think they're lovely, and i just want one in my neighborhood. >> and we talked. >> supervisor cohen: all right. well, thank you for the presentation. let's go to public comment. if there's any member of the public that would like to comment on item number one, seeing none, public comment is closed. all right colleagues, is there a motion? >> supervisor fewer: yes, i'd like to make a motion to move this to the board with a positive recommendation. >> supervisor cohen: all right. we'll take that without objection. thank you. madam clerk, could you do us a favor and call items two, three, and four together. >> clerk: yes. [ agenda items two, three, and four read ]

>> supervisor cohen: all right. so before us, we have three resolutions for concession stand leases in the international terminal in sfo. the best part about all of this is the combined leases will bring a minimum of $9.7 million in revenue to the city and county of san francisco, and we've got our friend, cassy widener from the airport to tell us all about it. >> good morning, chair cohen. >> supervisor cohen: good morning. >> cathy windendener for the s francisco airport. we are asking for three new leases in the international terminal a, with sfp america

for a manufacture food haul, black point coffee and boudin bakery. the length of time for the sfp america and boudin lease is ten years, and the black point coffee is eight years. all three leases have a ten year option to extend and are the result of a competitive proposal process. the leasees will pay rent either the greater of their minimum annual guarantee fore a tiered percentage rent formula. this will result in an annual rent amount over the initial term for all three leases of $9,570,000 at a minimum, although airport staff does expect that the leases will be paying on the higher of the percentage rent formula. the rent commencement date for each of the leases is either the earlier of the completion of construction of tenant improvements or 120 days after the tenant occupies the lease

space. the budget analyst's office has reviewed and recommends approval, and i would be happy toer answer any questions. >> supervisor cohen: thank you. i don't think we have any questions at this time -- oh, excuse me, supervisor safai. >> supervisor safai: just in general, and i understand i'm just sitting on the committee today, but i have a question. i look at the name of the people that apply. a lot of them are smaller cafes in san francisco, but when i get briefed from a budget and legislative analyst, it's always the larger businesses per se. you don't often see a small local san francisco based company that's often being chosen, so i'm wondering how you're putting your bids together and what kind of effort you're making to ensure the smaller mom and pops are really having a shot at san francisco airport. >> there are a couple of ways that we do that, and i'd be happy to get you further background, but just to answer

your question generally, there are cases in this -- in this lease right here, the lease with sfp does actually have a small business component. they partnered with marina's cafe who will be operating as part of this lease. i believe it's 35%, so there are opportunities for partnering. airport staff goes out into the community to try to get folks interested, and we set the annual guarantees purposely low -- >> supervisor safai: i guess i'm asking a different question. i know in the ferry building, once someone is a really established business, they're no longer allowed to be part of the lease. so when i say cafe roma on your scoring system score 56 points, and i see sfp scoring at 102, what i'm saying is how are you putting together your packaging in terms of your scoring; and two, do you ever consider not allowing some of these already

established businesses that have locations all over san francisco and allowing some of the smaller mom and pop businesses an avenue to get a foothold. because once you're in san francisco airport, that is a pretty lucrative opportunity, so that's what i'm asking. >> i can get more detailed information to you because i know that our revenue development staff does look into that and takes it seriously. we have pop up opportunities at the airport, as well, which has a $250,000 gross revenue requirement, which is low. >> supervisor safai: i get it. >> so we do try and do that, but i'll try and get you further information on outreach. >> supervisor safai: i'm fine, and i'm prepared to let this go. what i'm saying is when i'm in san francisco airport, i don't see it. i see businesses that are well established and they're all over san francisco, and i don't see mom and pop shops get that opportunity. that's what i'm saying. >> okay. thank you. i'll pass that along. >> supervisor cohen: all right. at this time, i want to pivot and hear from our budget

legislative analyst and hear what their thoughts are on these three items. good morning. >> good morning. i'm from the budget and legislative analyst's office. i think miss widener has summarized the leases pretty thoroughly. as you hear, the first year guaranteed rent to the airport would be about 990,000. it would be about $9.6 million over the term of each of the leases, and they do a percentage rent which would be higher than that amount, and we recommend that approval. >> supervisor cohen: all right. thank you. we'll take that recommendation under advisement. at this time let's go ahead and open up the public comment. any member of the public who would like to comment on items two, three or four please come up. seeing none, public comment is closed. thank you. i'd like to make a motion to approve these three items and send to the full board with a positive recommendation, and it looks like i can do that without objection. thank you, ladies and gentlemen. next item,

that's what i thought. okay. let's hear from the budget legislative analyst has to say. >> yes. as his alimiss alice pointed o these are the same that the board approved its two year fixed but jet in the last budget cycle. it's not in the report but i will respond a little bit to what was said in terms of the controller's office hoping to have more two year fixed budgets going forward. we did say two years ago in our report that we considered it

important for the board not to give up their appropriation authority and budget review every year. that was our finding two years ago. in terms of the four budgets this year, they are the same as the last two years, and we do consider this a policy matter. >> supervisor cohen: okay. are there any questions? no. okay. >> i would only add that there's nothing -- the board is not giving up any of their approval appropriation authority or review -- authority to review or appropriate a budget when you review two year budgets. so i think that's the substantive discussion or argument that we can have, but this doesn't do anything to change what comes before the board or how you may choose to review it. >> supervisor cohen: absolutely. i also want to remind that these are also the same departments as adopted in 16-17, 17-18, so we've got a

track record established. i'd like to open up the public comment at this time. my member of the public to come in and speak on item five? seeing none, public comment is closed. thank you. i'd like to make a motion to send this approved to the full board with a positive recommendation, and we can take that without objection. >> clerk: madam chair, would you like to send it as a committee report? >> supervisor cohen: i'll send it as a committee report. we can do that without objection. thank you very much. and colleagues, before we dismiss, i would like to make a motion to excuse supervisor stefani from attending today's meeting. can we take that without objection? all right. without objection. is there any other business before this body? >> clerk: there's no other business. >> supervisor cohen: all right. ladies and gentlemen, we are adjourned. -

>> shop & dine in the 49 promotes local businesses and challenges resident to do their showing up and dining within the 49 square miles of san francisco by supporting local services within the neighborhood we help san francisco remain unique successful and vibrant so where will you shop & dine in the 49 san francisco owes must of the charm to the unique characterization of each corridor has a distinction permanent our neighbors are the economic engine of the city. >> if we could a afford the lot by these we'll not to have the kind of store in the future the

kids will eat from some restaurants chinatown has phobia one of the best the most unique neighborhood shopping areas of san francisco. >> chinatown is one of the oldest chinatown in the state we need to be able allergies the people and that's the reason chinatown is showing more of the people will the traditional thepg. >> north beach is i know one of the last little italian community. >> one of the last neighborhood that hadn't changed a whole lot and san francisco community so

strong and the sense of partnership with businesses as well and i just love north beach community old school italian comfort and love that is what italians are all about we need people to come here and shop here so we can keep this going not only us but, of course, everything else in the community i think local businesses the small ones and coffee shops are unique in their own way that is the characteristic of the neighborhood i peace officer prefer it is local character you have to support them. >> really notice the port this community we really need to kind of really shop locally and support the communityly live in

it is more economic for people to survive here. >> i came down to treasure island to look for a we've got a long ways to go. ring i just got married and didn't want something on line i've met artists and local business owners they need money to go out and shop this is important to short them i think you get better things. >> definitely supporting the local community always good is it interesting to find things i never knew existed or see that that way. >> i think that is really great that san francisco seize the vails of small business and creates the shop & dine in the 49 to support businesses make people all the residents and visitors realize had cool things are made and produced in san

[ roll call. ] >> second item on the agenda is the approval of the minutes of the meeting of march 20, 2018, but i believe commissioner chow has something to say. >> commissioner chow: prior to that, i'd like to welcome our new commissioners. i believe mayor farrell has appointed two new commissioners for us, and i will ask each of them to introduce themselves. first commissioner dr. laurie green. >> commissioner green: hi. i'm laurie green. i've been living in san francisco since 1976 and practicing abat the time rick in san francisco since 1977.

i trained at the general, i trained at u.c., and i do a lot of other things. i delivered a baby an hour and a half ago. [applause]. >> commissioner green: a wonderful little boy, and i'm just delighted to be on the commission, and i hope some of the experiences i've had with ed many, many years ago and i hope some of the other things will add value to this amazing organization, this amazing city. >> commissioner chow: thank you. and commissioner tessie guillermo. >> good afternoon and thank you, dr. chow. i'm a lifelong resident of the bay area, a native san franciscan. the majority of my career has been focused on community health and public health, and i'm very, very gratified to have the opportunity to serve my hometown and the residents here and to be in the company of such august persons, so thank you very much, and hope i can do my best.

>> commissioner chow: thank you. we look forward to your contributions and thank you for the sacrifice that you're providing your time to the city. we'll proceed to the approval of the minutes. the minutes are before you for the march 20th, 2018 meeting. a motion is in order. >> move to adopt. >> commissioner chow: and there was a motion here i saw. are will any corrections? seeing none, we're prepared for the approval. all those in favor, say aye, all opposed? no opposition, and we can move onto the next item. >> next item is the director's report. >> good morning. i try to acknowledge students in the crowd. san francisco nursing students are with us today.

i want you to raise your hand and welcome you because you are the future of our system. [applause]. >> also, so let you know, this is public health week, so i just wanted to let you know we're doing a social media campaign. with that, we'll be highlighting our staff and program that's have made great strides this last year. we we vacuum sinuated 6800 people, and that was due to out breaks we've had in santa cruz. equity project, project pride, street medicine, i see barry -- dr. zevin in the room today. also our environmental health in the department of health and housing, hazmat, and food

safety. also, if you don't know, we do weathers and measures, so every time you go to the store and put something on a weight to ensure the number of pounds, we license those, and our massage programs in which we provide outreach to massage partners to ensure that they are within the law. we also are doing a lot of work around vision zero trying to have zero pedestrian fatalities, and our lead program is our assistance and diversion program for those who experience addiction. staff will be combined with a quote on what they do what they do, and we encourage everyone to follow on the sf dph facebook and dph twitter, so we want to make sure that we all celebrate public health week, april 2nd through the 8th. i also wanted to just acknowledge the fact that we are -- will be sending, as you

know, in september of 2017, we had a terrible hurricane in puerto rico, and one of the doctors isn't here today. he really made the point of what are we going to do this in response? it's taken us a while one, not to be a burden to puerto rico, but two, to provide some support. we are conducting a puerto rico relief mission. we'll conduct a medical relief effort in puerto rico to assist with the efforts in the wake of hurricane maria. a 15 person team made up of doctors, nurses, and workers will depart april 6th on a trip to the northwest island commonwealth. this is going to be led by the director of primary care for the san francisco health net work. we will assist a federally qualified health center serving

communities where the storm damage and health impacts are still very present. in hurtado, water and power have not yet been restored. the frisk team will split into two groups with one based at a clinic treating parents, and another going door to door in the community providing assessments, delivery and care to those who may not be able to reach clinics. as an example because many do not have electricity, as an example for diabetic patients, they actually deliver the insulin on a daily basis because of the fact that the infrastructure of those areas are still not impact. the storm as you know can exasperate and has exasperated chronic illnesses such as respiratory conditions, asthma, diabetes and high blood pressures. residents may be affected due to increased dust and mold in the environment. the macrorefrigeration for medications and difficulty accessing care are some of the reasons that we are going, and we also want to ensure that we are supporting federally qualified health centers and

also primary health centers in puerto rico. so i would like to -- our deployment team, our relief team to standup and so we can give you a round of applause. [applause]. >> and if i could, ask dr. hammer, come on up and give us a little bit of your perspective on this, and i really want to thank you, and we have a logistics team. why don't you raise your hands, because they really have been doing all the -- as you know -- [applause]. >> -- we go into our incident command system, which logistics is a really important part of it. but dr. hammond, thank you so much for taking lead on this. >> well, thank you so much dr. garcia. it's been so much a pleasure and an honor myself and i think for all of us to be called to action to use our clinical skills and our -- and other skills to support the medical

personnel. we're really looking forward to the trip. i really do want to appreciate and thank you for recognizing fiza delgado and tony liss who have been our primary logistics team. i anticipate about 50 people from throughout the department of health who have offered us their support to get us ready for this trip. so we leave friday night. we'll be traveling to hautillo and going out to the community every day starting monday, and we look forward to umm canning back and reporting on the work that we do there, as well as really trying to cement some relationships so that the health care providers there in the community health center that we'll be working with really know that they have a friend and support in san

francisco and the department of public health. so thank you so much for this opportunity. we'll be sending information back to you all while we're there, and i think we have a lot to learn, and a lot to bring back, so thank you. >> thank you, dr. hammond. let's give them another round of plauz. [applause]. >> i do want to acknowledge that we have behavioral health clinicians who are going, and as you know, behavioral health, mental health is one of our -- one of the issues that happens and people need throughout this process considering the fact that you don't have electricity or running water off and on for over a year. it does cause a lot of concern, so i just want to acknowledge both of our behavioral health clinicians, if you could standup, and we just want to acknowledge your work. both of these individuals work every day on your crisis response team. that's the end of my report. if there are any questions on any items of the recoport, i'l

be happy to answer any questions you may have. >> commissioner chow: thank you, and thank you, dr. hammer for leading this group. and we wish you god speed, and we look forward to your report when you are returning after the mission. the health commission is very proud. >> and just for one other comment. i did -- our health officer did put a quick report together on some of the health issues and impacts on puerto rico just for you to have some background. >> commissioner chow: okay. thank you. thank you very much, and we appreciate the work that you're going to be doing. thank you. commissioners, questions to the director on any of the subjects on her report or any other questions that we wish to ask her at this point in regards to our department? seeing none, we then will proceed to our next item, please. >> sure. i will note there were no public comment requests for that item. we can move onto item four,

which is general public comment, and i've not received any general public comment requests, so we can move onto item five, which is a report back from the finance and planning committee. commissioner bernal chaired, and if you could give a brief summary. >> commissioner chow: all right. commissioner bernal. >> commissioner bernal: yeah. so the finance and planning committee met today immediately before this meeting. we considered the monthly contracts report, as well as requests for approval of the new contract with kpmg for health information management consulting as part of the electronic health record project. both of those were approved by the committee and are on the consent calendar fore the full commission to consider today. we also received a presentation on the draft charity care report for fy 2016. as many of you know, the san francisco charity care ordinance was passed in 2001 and requires hospitals to notify patients about free and

discounted services and to report out on the charity care that they provided over the course of that year. so we reviewed that presentation, offered some feedback, and i believe that report will be coming back to the full commission in a future meeting. >> commissioner chow: thank you. commissioners, any questions to commissioner bernal on any of the items? otherwise, we will then proceed to the consent calendar. on the consent calendar and to explain to our new commissioners, items that the finance and planning committee have already recommended are on the consent calendar items. any of the items can be pulled out, including the contract report. contract report usually includes information on already existing contracts or modifications. the new contract before you has a summary of new contract

requests, and that's why it's in a more expanded format. any of these items can be pulled from the consent calendar, otherwise, we will vote on the entire calendar. is there any extractions? >> i'll also note that there's no public comment requests for this item. >> commissioner chow: thank you. there not being any extractions, we're prepared for the vote. all those in favor of the consent calendar please say aye. all those opposed? the consent calendar has been adopted. >> thank you, commissioners and congratulations, new commissioners, on your first vote. the next item up on the calendar is the whole person care update. >> hello.

good afternoon, commissioners. my name is maria martinez, and i'm the director of whole person care, and i have a side kick somewhere behind me. [ inaudible ] >> dr. barry zevin. i've been asked to come back and update the commission on the project called whole person care, and i know that some of you are new to this, so i'm going to try to give as much background as i can. i'm happy to answer any questions. so in 2016, the state of california department of health care services issued a waiver to medi-cal called whole perp care wi -- person care with the idea that there are a small number of people who are costing a lot of money using urgent or emergent care in california and not getting better. so they carved out i think it was $1.5 million for counties to apply what they deemed whole

person care, and only 18 of the counties applied for it -- the funds, and each county had the opportunity to target the special population. san francisco chose to target single homeless adults, and we started in january 2017. i came in, i think it was march in 2017 to update you, and i'm now coming back to say how far we've come along. so i'm going to talk a little bit about some of our -- our approach to whole person care and here in san francisco and secondly about our challenge of getting and keeping homeless people on medi-cal. this is a medi-cal waiver; therefore, we can only drawdown funds for people who are on san francisco medi-cal. i'm going to talk a little bit about the i.t. solution and a little bit more about our target population. dr. zevin will be talking about that, and then how we are

looking at our whole system of care here in san francisco. so san francisco, at the end of the day, has about $36 million of funds for this effort. half of it is matched through general fund. we have a two pronged approach. one is how do we improve the services and -- how do we stitch together a very complex system of care in a way that's human centered, and how do we use i.t. to help implement that idea? and again, we are targeting homeless single adultes. so we are looking at homeless single person care in three domains. we are looking at health services, obviously. the array of services that we have here in the health department are vast, but also, these folks need to have housing and they also need to have benefits in order to succeed. we are coleading with the department of homelessness and

supportive housing, c garcia and jeff kosinski of the department lead this effort. and then we have a number of departments, ageing and adult services, ems, both 9 health plans and community based organizations in this endeavor, human services as being the benefits. in terms of what we're trying to accomplish, this ends in december of 2020. it's not a lot of time to do the administrative lift of getting programs off the ground, getting them ready and actually implemented and evaluated. what i'm showing here are the met rick th metrics that the counties are committed to achieving. these are the health outcomes. they should be pretty straightforward. many of them follow the hedus

measures, and this is the homeless population that we would get for this measure. about half of the income that we get are going to services being delivered in the department of homelessness department of supportive housing. and then, we also have some items that we need to deliver on, and i'm going to talk a little bit more about those in a moment. those are the performance goals that we have for whole person care. in terms of the people that we have served in 2017, it goes by calendar year, not fiscal year. in the 12 months that we've been doing whole person care, we have served over 14,000 people who are homeless. about half of those people are only known to the health department, so they're not asking for services yet in the homeless department, going to the shelters, going into navigation centers, etcetera. so the health department is a

really important partner in addressing homelessness because that's where people come in to get services. and then about a quarter of the homeless folks, we actually share, meaning they're in both programs, and a quarter are only known by the department of homelessness. that same number of people, only about 57% of them have san francisco medi-cal. so one of our biggest challenges is trying to convert folks who are obviously can meet the criteria for income, to get them through the arduous process of getting medi-cal and staying on medi-cal. so this is just one picture of one of the services that we are billing for. this is called outreach and engagement services. it's a night in the navigation center or sober sheltering center.

so this shows month by month the number of people that are housed in one of those three centers. and you see that the bar, the line, rather, is the goal that we have for drawing down revenue from the state. so we're almost there in terms of people who have san francisco medi-cal who are in those. but if you were to add the people who actually utilize those services, who are not on san francisco medi-cal, we far exceed the numbers. however, we can't bill for that green block there, and that equals about 851,000 of under produced, unbillable services from the state. so we know that we have a bill challenge here, and we've been working very closely with the human services agency to try to improve the way that we get and keep people on medi-cal. and so one of the things we've been working with, on a design

for fjord, we've been working on two projects with them, and they doev into seeing what is the process of someone who is trying to get on medi-cal for the first time, and what happens? why are people falling off? about a quarter of the people fall off of medi-cal within two years, and why is that happening? first of all, identity is critical. i.d. is critical. homeless people don't get things in the mail. it goes to general delivery. the post office, it has like a three or four hour opening where everybody, all of rest of us can go eight hours on aymond through saturday, but homeless people only have this much time, and we know that they are worried about bigger things than getting to the post office for their general delivery mail. there's also no incentive for people -- very little incentive to go through the process of getting and staying on medi-cal.

it's the single standard of care. it's the way san francisco rolls. if you meet standard, you get the service, so there's no, i have to meet standard in order to get the services. there's a lot of confusion. what we are doing is implementing a benefit navigators pilot, and they'll be in the shelters, trying to help people in the shelters. talk more about that in a second. another finding that fjord found on us with us is you have the option of oughty renewing on medi-cal for up to five years. it has to be a box that the person actually checks off, and we can operationalize that. we can get people to do that. but then we found out at 12 months, the federal hub will spit out that application if they haven't done a tax return, and so how many homeless people do we know do tax returns? so it's an automatic, another, you know, rock to push up the

mountain there. so that in working with the human services agency to advocate for legislative changes there. another thing we have -- much of our medi-cal comes through emergency medi-cal in the hospital and behavioral health doing medi-cal conversions, so both of those are disassociated with the medi-cal office. so we are trying to work with the hospital base and the behavioral health base to improve that process of getting and keeping people on medi-cal, and then, there are just many myths and confusions, and we need to figure out how do we write about this process in a simple way, not only to homeless people but the people who serve them. benefits navigator pilot, which we are starting is not only getting people on medi-cal, but also getting them on food stamps and general assistance. we're training our hot workers to go into the shelters and to

get people to find the right people, get them onto medi-cal and its pilot. >> commissioner chow: maria, i'm sorry. could you explain what hot is to the new commissioners in. >> sure. hot is the homeless outreach team, and it's a program that we started here under dr. garcia 12, 13 years ago and now it's moved over to the homeless department. and so any way, we're targeting the people to help them get and stay on medi-cal, and it -- we are working together very closely with the assume service agency and the housing department and the health department to try to address this issue. in terms of the i.t. solution, we are looking at merging data from five different systems. in the dph right now, we're

moving toward he piepic. we have many systems that don't talk to each other. we are pulling together the health data, but we also need the homeless department's data, the department of ageing and adult services, and the department of human services for the benefits data to come in under one platform, integrated to create one record. so that's what we are working toward with gartner. it's a consulting group to help us design the future solutions. what we need at the end of the day is the ability when people are serving someone to have integration that comes from all these systems. tcs is our interim solution, but it can be faster and it can be better. table management, population health and invoice is, so this is the highlights. it's a very quick summary of a complex process that we're going to go through. happy to answer questions. at the end of the day, we need

a data share that is human centric that's at the right time, at the right level, isn't a lot of noise, is action oriented. we also are going to dpsh-we've agreed, all five of us, to create a universal assessment tool that in 15 questions can answer, should this person be fast tracked into housing, should they be fast tracked into intensive health care? we're going to share our care plans in a way that no matter what door they walk-through, the next right question or the next right action is known. it could be the shelter, it could be into the emergency room, it could be into intensive case management. so that's how we're going to share it on this platform. wither ae going to share this with each other and give each other alerts, and we also know from working with each other in the last 12, 13 years in an

interagency fashion, data doesn't really change anything, we have to learn how we use the data and hold each other accountable, so the system of care is going to have to adapt and adopt across these agencies. in terms of the targeted population, we know a lot about the homeless population through ccms. about 11,000 that we served in the last year that are known to me, the homeless department believes there's about 15,000 people. we've served about 11,000 people. whole person care between the two of them is almost so 15,000 people. we stratify our knowledge about these folks in two or three different ways. one way is are they using emergent or emergency health services? are they a high user of the emergency room, inpatient,

medical detox, so we know in the homeless population about 12% of the homeless population are in those high user categories, but they constitute about 75% of the dollars, so there's a small number of people who constitute a high cost, high use population. and then, we also look to see how long they've been experiencing homelessness. if they have over ten years of continuous or periodic homelessness, they're going to have a lot more complex tridisorder issues going on with them. one of the things that we're -- also have seen is there's an extremely high percentage of the long-term homeless who are avenue can america african american, so we know there's a pipeline of the

homeless people that's not associated with housing, so this is something we're going to have to look to in the system of care. and then there are other vulnerabilities, what would cause someone to have premature mortality, and they're predisposed to using drugs, etcetera. and now i'm going to turn it over to dr. zevin. >> thank you, doctor, and thank you commissioners and director garcia. just a comment on the slide because i get asked a lot of the time, how many homeless people are there, and why are there so many homeless people? and often there is a great deal of anger and often a great deal of anger at people experiencing homelessness. so this is what practicing health care for the homeless medicine in the san francisco department of public health since