might take and with that, we will recess into closed session. [gavel] >> tuesday, may 23rd. there's nothing to report on our closed session and no action items were taken. and with that, we'll recess our board meeting at 10:32, i'm sorry, we'll adjourn our board meeting at 10:32 and we are adjourned.

june 6 meeting of san francisco health commission. president bernalal is, way i am chairing the meeting today and secretary morewitz, call the roll. >> commissioner christian. >> present. where commissioner guillermo >> present wrchl commissioner green. >> present. combr commissioner chow. >> present. why commissioner chung and giraudo. >> present, present. yet member to call for opinion ment one digit off on the e mail i correct today it is on line i want to make sure i'm doing dill

jenls. member is 415-554-0001. access code: 2591 160 8939 ## chour will read the land acknowledgment. >> thank you. ramaytush oholone land acknowledgement the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the

ramaytush ohlone community and by affirming their sovereign rights as first peoples. sdwroo thank you. the next item is millions approval we have 2 minutes may 11 minutes meeting oi joint meet williaming health and plan and mi16 so secretary morewitz walk us through. you will have a vote for each item. am the public if they wish to and comment on each set of mentes. star with the may 11 minutes and if you were not in attendance you can vote on the minutes. why thank you. >> is there a motion to approve the may 1123 minutes minus corrections? >> move. >> second.

>> is there public comment y. if you would like to comment on the may 11 minutes raise your hand. i need to do a quick speech. or scriptful for each item members have an town to make comment up to 3 minutes the upon comment process input and feedback from individuals the press does noted allow questions to be answered in the meeting or members to engage in back and forth with the commissioners. commissioners do consider comments from the public when discussing items and making requests. note this each is allowed one opportunity to speak per item come individuals minot return one from others notable to attends. written comment sent to the healing commission e mail address. if you wish to pel your name you may in your comments about taking your time. >> city policy with federal,

state and low lupresent harassing conduct against employee and others and will not be tolerated. we will take it from individuals in person then remote. i have given each a code to peek and 2 received accommendation to begin prevent others from speaking. we'll hear from remote public comment from others. will be a time limit of 20 minute on the amount public comment heard from each item from individuals not received, commendation for disability. ja net, if you received accommendation raise your hand if you would like to comment if not wait to see who if there is a line. janet unmute the caller. >> mark gibbs [inaudible].

i want to speak to the minutes of the may 16th meeting, sorry. why hold your comments. we are doing this and the commission vote. hold and we'll get back to you. janet, that's okay. well is no public comment on these minutes. you are welcome to make comment or row >> questions or comments. can we take a vote. all in favor? >> aye. ja none. >> all right. minutes passed now the mi16, 2023 minutes. were there a few corrections. there were, thank you. >> thank you commissioner chow for pointing them out firead a book you will be my editor. you are the man. i believe on page first very left page the i forgot to put

the vote you all the action taken was that you voted unanimous low not to disclose discussion in closed session had is page 10. and then on page 8, several minor corrections commissioner comments on the b. page commissioner guillermo noting this it seems dph budget is deficit and instead of the word relay it should say rely on realignment to balance budget and commissioner green i read the sentence it should be stated ms. louie stated the state will cease, an added word coverage of those received special covid emergency coverage. those are corrections. >> thank you. >> are there other additions or corrections? >> is there i motion to approve minutes of may can'th? >> so moved. >> a second. >> we if to public comment.

janet unmute the caller. >> thank you, mr. morewitz. i enjoyed leading your, you should write another book. perhaps going in your service on health commission secretary for all these years would be interesting to read it. has for the may 16 meeting minutes, i was [inaudible] included my testimony on the director's report had not mentioned the laguna honda nursing home add administrator and nursing home provisions. i noted an updated organization heart showing the new reporting structure should be publishd and provided to the commission as a high priority. laguna honda's current chart updated last november showed

that the add administrator [inaudible] down from laguna honda ceo. since then it is clear that will [inaudible] because the home add administrator will serve concurrently as laguna honda ceo. i noted that i ideally the nursing home administrator should report to the director of public health colfax not report to the ceo of the san francisco health network. created to over seat neighborhood primary health care climate not to laguna honda. that was never mentioned [inaudible] and must be corrected. america, when are you going to get to writing another book exit volunteer to help be your proof

reader since i caught so many errors kind low point out to the e mill. thank you. >> >> all right. mute him. janet that is public upon comment. he points out many errors. where thank you to him. >> commissioners you are red for vote. >> all in favor of approval the minutes of may 16th. >> aye. go to the next item general public comment. >> okay. i am not going to read the script it is the same information this item is for public comment relate today items not on the agenda. if employees under the director's report states laguna honda is there, this is in the an accomplice to talk about luck lug recertification efforts. please raise your hand if you like to make general public

comment. why i see one hand. unmute, please. >> yea, so i'm not speaking about laguna honda recertification, so don't cut me off, please. i do say, however, that because the agendas are so long and the director's report is going to mention just a minor laguna honda hospital update, i want to encourage the commission to over the next couple of months at least include an agenda item on your agenda will [inaudible] and update report from the lhh ceo since she'll be serving in a new

capacity. you should feel from her that [inaudible]. not have buried at the director colfax's report is so long reporting on other news. aboutarctivities within the department. that laguna honda should be an agenda item on every commission meeting until and recert sifkz accomplished. >> thank you >> that was the only public comment for this item. >> thank you. so we will go to the next agenda yet the behavioral health service update. we welcome doctor hillary coonen the director of the dhs and

mental health san francisco. we look forward to hearing your report and your slides showed progress. you have the floor. >> good upon afternoon, commissioners. i am catching my breath. sorry. >> that's okay. should pop up. i unmuted you. >> yes. >> could you share your screen?

for the update. thank you. i'm pleased to be back. nice to see everyone thank you for having me speak about behavioral health services and

our work. thank you also commissioner for questions and i will try to incorporate them to the presentation and if there are ones i don't addressil circle back. next slide. so, just as an out line road map for the presentation share with you our vision and missionmented to share with you updates around our triannual audit of the mental health plan. some budget highlights and including opioid settlement and work around 5150 training. our care court update. some key initiatives are mental health sf update. and treatment on demand and cal aim and emic we have been busy in the next slide.

you can see -- on this sclied and this is a slide have you seen now last couple of presentations. hoping they are familiar and these are just to create the orientation come approach for our work. i wanted share with you an area of work that does not often get highlighted unless it does not go as well as we like. i want you to make you all aware of the extent to which we work with our state partners participate in audit had is the lafrngest in april participated in department of health care services, triannual audit for mental health plan. this is our role in the count tow be a par payor of mental health services as a managed care plan.

we have a large number of obligations under that. responsibility this is conducted every 3 years. the state monitors are compliant with state and federal law. through an extensive document review and 3 day on site evaluation. the state works closely with all of the mental health plans and the counties, we'll be expecting finding report soonful of note and what takes up a fair amount of our time we under go 8 audits per year. we participated in a program review of mental health service act funding. i know you hear about mental health services act programming annually in december, we had our what is called external quality review organization audit.

2 of those a year one for substance and mental health the next will be in september and november of this year. we continue, of course to incorporatein and feedback from audits. they have been successful low completed with some finding in areas of improve am. they are part of our bread and butter work to do 8 audits a year. i think that you are all likely to have seen with more to come announce am the week before last about proposed budget investment for mental health and substance unanimous the budget makes investment in some new approaches to some of our pressing behavioral health issues care court, wellness hub and continue the large number of existing programs mental health

sf, which we are continuing to implement over dose prevention, street out reach and treatment promise the behavioral health proposal will be included in the mayor's 2 year budget and submitted to the board for review and of course after -- after you have heard about the highlights. in the news the city's settlement with wall greens. . following opioid litigation the city attorney reached 230 million dollars settlement this is over a multiple years which is spreading out the funds coming in the city. and in the wall green's case 14 years. the vast majority of the settlement dollars in the first

years of the time period and that includes 57 upon admissible in the first year. funding is allocated during the current budget process priorities set by the city and the mayor's office. another update i wanted to share with you is extending the authority to initiate an involuntary psychiatric hold or 5150 to community paramedics. you are aware under california law there are specific people authorized to initiate an involuntary hold. includes peace officers and then also under the local behavioral health director, myself, extends

to, mental health and behavioral health professionals. so, we are pleased to be able to with the fire department train additional paramedics and the community paramedics who already have special training in behavioral health and deescalation and behavioral health occurrence. we train them now in this month and amount they will be able to execute rights 5150 order in july. already we have been have trained the captains and acting captains part of that division. and so they all already have been doing holds and we are participating with them and -- quality improvement work similar to all of the holds that we give authority to.

i think one of you asked i don't have who else i will take them together. i think you asked ideal out come. our main goal is to ensure a person in crisis is able to receive the most appropriate intervention. and and always voluntary intervention in time low a fashion as possible. so we are continuing to monitor the use of 5150 to see in total to see first of all if they are going up or down. and important low and i presented here before but without data. is what happens to somebody after a 5150, that is the

ultimate outcome. they have crisis, how is their health after receiving a 5150? and are they connected to on going care that will stabilize medical and behavioral healing conditions. so, we are setting up and have started the set up a connection to care tracker for people after a 5150 am able to do this or beginning toville idating the data and delighted share it witness we have that. for a subset of those and aiming to do it citywide not just for the parts of the health system is this dph is operating. also great interest is00 eye know in the press and amongst our staff is the newly

established program. care core. this was created under state legislation. the idea is to allow a broader range of petitioners or the legislation name reference. to seek assessment of people who have a very specific cest conscience as defined in the legislation. you can seat language there sits schizophrenia or other. it is done in phases. there are early aadopters of which we are one of 7 counties. and then a year and change later in december of 23, the all other counties implement. we are in the process of really designing the program procedural, we are collaborating with city partners including our

partners in the judicial system or in the housing system. and in order to estimate the number of potential care courts participates withhold be eligible. we have -- a staffing developed a staffing model and i think one of the questions here is includes the work flows moving from the court process. the care court statute creates reporting deliverables.

they include process measures importance upon participating drafk everdemographics housing place ams and so forth. our outcome measures that are of interest to the program and to ourselves include improve ams obtaining housing. reduction in nonroutine health care visits emergency department visits. reduction in law enforcement and incarceration. reductions in involuntary treatments. and retention in on going care. we also the state money that has been put forward part of the program of the city received

start up money with anticipated some amount of on going money that number is not known or clear. the state also the last bullet put out bridge housing grant. allocated by county and wave bohn put in a grand for wave one in order to help participates and others gain access to -- both short and longer term housing supported. that money is not on going motional it guess for several years and then -- we don't know yet. there will be 2 more waves of bridge housing fujdz coming out soon. and we will that money be competitive and will also be applying for those dollars.

don't know how much yet and don't know specifics there. i think -- i said all of this. i wanted to share a baptist update on and you have seen earlier each the projects. chooit excited share progress we made. we are and including myself participating in a behavioral healing leadership fellowship where we are gaining -- skills, and awareness of antiracist practices and -- thinking and

strategizing the way in which we as leaders can implement and create an equal work place.

the racial disparities among african-americans in the city we are aim to identify resources and tail ordstrategies including mental health service act monthey'll be dedicated to reaching the -- folks at the highest risk including black african-americans and over dose prevention and training you seat recent site wes are new to us as places to train. one of you also asked important questions about how we are addressing the need to increase acceptance of behavioral health

services among communities that may not have been able to accept service, one, i think community is the asian-pacific island are community. we have a number of service to all of you addressing the neateds with more always need. some examples are left year we awarded a guarantee to china town north beach mental health clinic and the asian and pacific islander mental health collaborative a division of the organization rams. to clan race in case management program to link monolingual immigrantses from asian countries to community resources. this is an interesting novel program. for example, rams provides

bilingual asian nonclinical case managers who are chinese, vietnamese. lotion and thai. a recruitment and connection to care strategy. we also launched a china town older adult out reach pilot. a mall team of 2 or 3 multidisciplinary health workers a behavioral health clinician and farm and or a pharmacist to roach tout to older adults with sxhl psychiatric needs limited mobility. we are excite body that program the team assess both medical need and behavioral health needs. we anticipate this holistic prop to care is promote for older

folk and a way to pull more people to behavioral health care. final low we than hiring and specific low competency is important. as part of hiring efforts, we have add to the way we hire with a notice of inquiry. someone aplies. job come up. send a notice are you interested in this job? we added notice of inquiry survey question about people's lived experience with populations at allowing us to. . try to recruit and hire for these needs. mental health sf.

so i know you all the know about this slide. mental health sf as you know was establish in the 2019. funded through prop c known as our city our home. theertsz 4 key initiatives. i wanted to update you on where we are with these. this is our now famous dash board showing the progress we are make to opening our 400 bends funded. as this shows we have opened 350 of the 400. i should say that some of the beds we opened out of county are intent to bring them back in county as we are able to identify cites. where we were able to return service part of the strategy

however, this was a way to get more services opened as quickly as possible. one of you asked a question about unused beds and using the beds we have been discussing publicly, we have a need and we are on track to do so for

exploring ways part of the next 50 additional beds that treat mental health with illness and substance use. in dual diagnose beds. we will plan to organism dedicated beds for age youth and our crisis stabilization unit in a new building will also still need to em. next slide. we announced we opened 70 new residential step down beds. this is known as recovery housing or sober housing. this is dedicated to people coming out of residential substance care might not have another accomplice to go.

this extends their time with social support. and in a living varment where people are working on recovery while enrolled in out patient treatment. another progress and change to mental health san francisco is the city under took a reconfiguration of street team in january. that affected the city street crisis response teams you see on this slide. our service behavioral health transitioned our troll provide a follow up and proactive response

on neighborhoods where there are folk in need of behavioral healing intervention. as of march, a couple months ago, initialled another acronym. something, best neighborhoods. bridge and engage am service team neighborhood. we started serving the following areas you see 7 days a week zeechl a team dedicated to servings clients outside areas. we have opportunity to grow the team as they get restaffed. any as we lost some staff in the transitional period. our goal is to enhance both near term will and longer term follow up support for people who may have interacted with the crisis response team and need health care. so this we don't lose anyone who

may have been seen boy a street team, may have been referred for something else on going care. we are ready to connect with them. that team that best neighborhood's team is now part of our office of coordinated care. we don't want to create a separate thing and want to connect folks back to our structures and ways zee to make referrals and make sure people retained in care. okay. treatment on demand.

provide adequate substance use disorder treatment to meet community demand for public loam funded treatment. last fiscal year 22 we enreasonable doubt more than 4500 people in treatment. of this i mean to meantime special care system. the licensed part of the treatment that happened. upon we think that is a very high number. only 10% of people with a

substance use disorder diagnose receive treatment. much of that is because folks get treatment or not interested in the moment. in of that 90% in the place they live or the insurance they have there is not access. the fact we reach 90% is good not this let's us rest easy. our wait times to access care are decreased compared to the year prior. we estimate we are able to get people this with drawl management or treatment for opioid use disorder or methadone program within a day and snat get people in residential care

within 4 days. on decrease from the year prior. we made additional interventions in the prior year. we established residential treatment. 80% who enter with drawl management admitted without the later residential this is a good important system intervention so we are not losing between levels of care. this is an example how we think about this within the substance use and treatment system 94% residential step down occupancy rate we report in treatment on

demand report. it was in our view too high. we out to see a loosening so we are able to get people in care quickly. >> of note, what i when we call special substance use treatment decreased over time a bad indicator. prescriptions in the city increased citywide year over year. what has happened initially and locally we created more path ways for people of seeing ups and downs in the sector i'm peeking and the primary care and

private sectors which are increaseingly offering it. in the federal context a special waiver or license to prescribe it has been lifted. it means more provide exerts prescene of the crimers enter and treat people with it that lifting of waiver means in california clinical pharmacists can offer it and treat with it. that is manage we are plan to take advantage of in the coming year. i offer as a main measure of retention and care of 143 days. one of the both difficult to measure parts of substance use treatment and impact is that after somebody leaves you don't know what happens to them. they are not in care. not funded or follow folks in

eternity not primary care where people come back necessarily. a main measure in substance use treatment is retention and care. we can see from our medical services our retention 143 days little less than 6 month system a good sign. we than is longer people are retain in the substance use care. the more likely they have a positive outcome. what is nice about our system of care is this we can follow people in administrative across levels of care. with drawl management, residential, step down. should those be the path way.

upon 70% self report and rugs substance use another major positive outcome from the work that we do. let me talk about this combreefl there are a lot of details. the impact of medical reform. cal aim in california is e mormous for behavioral health it is changing the way we offer and conduct services from assessing need and documenting what we do. and ideally purke us toward out

come that is the key things that i will highway light second from the bottom. is we are trying to take advantage of in of the ways which care is organized. one example is the best team i mentioned. which is part of the office cord nayed care. we are participating -- enhanced care management service. take vvenlth reimburse am structures for boshg we are already doing or planning to doch and another example drug sober center approved one of the funds service within cal aim, community support.

the next thing and left thing to mention is our upcoming transition to empic the health records. colleague in hospital used in primary care. this is i guess the largest expansion of epic electronic health records since 2019. i did not know that. so, we are preparing and preparing now for the launch

epic and reminding us all that will this affects dph run clinics and many, many contracted providers. for those of you who practiced in primary care or hospital settings as i have we are used to have learned and in my case to work electronic healing record that was built for physical health care. behavioral health where i worked and many of you have, organizes the care differently. focussed on treatment plans and to our traelth multidisciplinary team this is is a huge transexcision daunting one and exciting one. it means we will community in systems of care more effectively than we are done. and we really influence the way we practice part of the larger healing system.

a couple you have asked a question around confidentiality. and creating where appropriate protections for patient confidentiality. the building of our behavioral healing epic is guided by the requirements that we must and want to adhere to. and federal man days stop us from blocking information except at patient's request. substance use has protections. we understand that epic has a range of confidentiality tools that can address patient concerns and requests for data viewing we are trying to be very mindsful and patient centered about that. i think that may be the last

slide. thank you. why don't i pause i talked fast i have been running all day i hope not too fast. >> all right. commissioners check public comment. why folks on the line we are on item 4 the dhp behavioral health services update, would you like to make comment? press star 3. no hands. >> well are there questions or comments from commissioners. commissioner christian. >> i'm sorry. hands went up. i don't know what happened. so at this time wile start with folks received accommendation if you have not there are 2 people whom did i see 3 hands take your

hand down. and janet or jamie, please unmute the one hand that is up. >> okay. this is can you hear me? doctor palmer good ahead. i'm doctor palmer i know there is a number of patients at laguna honda that apparently no longer need nursing home care and mark for identification them are behavioral patients. there has been difficulty policing them. and what worries me is placements for people this have physical disabilities as well as behavioral healing problems, and as you know, there suspect a lawsuit going on about a man who was discharged to medical respite. who quickly died. in 22. and so i would like to be

reassured that of we are able to find place. you know one of the things that got laguna honda in trouble is the pressure to place people there who would not benefit, not be appropriate for nursing homeful and the need to create other types of accessible facilities in the community. thank you. i did not ask if people wanted to speak in the room. 3 hands go with 2 hands take the first. >> please. let us know you are there? hello, commissioners i'm norm. and i'm a long time resident of

san francisco and member of the [inaudible] cms will not recertify laguna honda [inaudible] using is the dest nigz for behavioral complex people care can be optimized in nursing home setting or jeopardize themselves on the other fragile folks in the nurgs home. if not corrected we can look forward to more citations and [inaudible] the public nurgs home. thank you very much. >> yea. this is [inaudible] [cannot hear speaker] dph recognizes [inaudible].

i have decided [inaudible] purke the idea street [inaudible] for novelty accepting services. when there are significant rates with large numbers of people having to have [inaudible] this is not a good sign. and in the similar way the city is not starting to go down the path of arresting drug users and recreating -- [inaudible] and again outlook for keeping [inaudible] laguna honda is nursing home is not bright. one way that it would be possible for laguna honda to be able to resist these trends is

that can remain independent to criminalize drug use and [inaudible] thank you. last caller. thank you. >> we'll go to question and comments. commissioner guillermo yoochl thank you. thanks for really encouraging report. a lot of changes. and lots of progress considering. the years lead up to this year when you are able to focus more on the foundations. one big picture questions i had in all of this is, because of the changes and the expansion of services and that. tuesday appear that this is

highly dependsant on able to fully staff with qualified and trained staff not within dph director services but with our community providers. and then related this is our seems we have an reliance on a few large providers. in this area. of service provision and so i get concerned about how are we going to be able to -- accomplish these innovations and great goals. even if there is funding are there the human resources and facilities available to continue the progress? that we are hoping for over time. i think those are 2 important

questions. everwe know a national and mroel grouch people to hire. it it is not a zero sum game. we have successful low done a bit of expansion. and brought in more people both to our own staff and community based providers. as well. and -- we are continuing to face vacancies. we have expandd and continue to expand. it is not as full or as rapid as i think remember there no workforce challenge. we are feigning to address

workforce and continuing as you know very open for ideas and new ways to address it. collaborate with human resource department. under the tenderloin emergency we were able to hire a large number of peopleful taken in a lot of the lessons learned. and implement them in when we call hiring of key conscience. there has been state investments in pipeline works.

the pharmacist angle on prescene of the criming an example of thinking how do we use the great number of healing professionals to support a person in their journey to wellness. another example incorporating pier workforce and people with livid experience part of care team usa a way to always recruit the pipeline and digital capacity. the other issue you raise about the number of providers in the space and the need to create opportunity for new providers to come in the space where possible.

having a rich tail ordarray of people provide and organizations living service system important. >> thank you. i think that i mean some point we have to face reality that san francisco is a difficult accomplice for people it come. and live. and work. and as we expand service, we need on recruit people in the city or close to the city. in order to be able to provide the service. and i do think that -- it is not just the department's problem to solve. but the reality is the more the service the more we need people. harder it it is to get people here. for a number of reasons.

rising costs. just transportation. of a range of things. i think this long-term thinking not just about service but how we get the resource to human resources to provide the quality service. got to be built in to the strategy. i appreciate the -- inventiveness in the learning from the past and other things. and also important to note that mistakes will be made and accept this not everything will be perfect. the long-term realities or mid term realities is that if the funged come the service might not be provided and the ideal way we would like. appreciate all your efforts. i think it would be appropriate and helpful for the commission to understand what the dynamics might be with regard to the need

for services the ability to funds them and the other resources. that are or not available to us in order to achieve those goals yoochl thank you. commissioner christian. building on commissioner garm over's question is so important and foundational. being able to pay people to live in the city or near somehow need to donings enable them on stay. whether it is housing. subsidies from the city and the state. whatever it it is but -- as commissioner guillermo noted if we don't have the clinicians the people to dot work then we are already lost so many peopleful so. it would be interesting to hear from the other city departments and from our department what the

collaboration is around those issues. not only of retaining people we lose now because too hard and are too much. upon the case load is exhausting them. butt pipeline from the young people growing up in san francisco already live here and could be bruin the simples i fwling up every meeting but critical when we talk about equity and allowing people and abling people to be allowed have a way to grow up in the community and stay and live and own a home or you know able to rent in the city. so important and -- really look forward to hear burglar this every time we get the grand opportunity to have you present to us. first i have a few questions.

i wanted know a bit about the universal were therapy president trump do with hrc a slide 11. can you tell mow what that is? yes , i may need get back with more. happy to testimony is a program that we developed with human right's commission with mental health services act dollars. they are state dollars in order to increase availability of private therapists potentially available to interested san franciscans who would otherwise not have access. it was aiming to try to create additional access. to people who may be under insured or uninsured. great. thank you for this. and on the whole you'veed culture initiatives to address racial disparities, fantastic

and so much looking forward to hearing the next presentation as well and as we know, racism is a detriment to health. black african-american people and people of color. die greater rate and senior than everybody else and different ways to approach the how dph partner with and that say public healing issue one our doctors

can't solve. that is something i'm hoping the department will say more as well. bestment >> so right and, mazing i want to congratulate the department and the mayor's office and the city on that because television is addressing so many needs and people. at the point where they need the attention and helping the neighborhoods. and -- helping to keep people out of jailsmented to congratulate and you thank you. >> thanks i will share that with the team who is behind all of that. thank you. >> amazing team. >> yea. >> commissioner chow >> thank you.

and thank you for this great update. and the enormous work you are doing and in spite of all the challenges. the fact you are able to hire and so fill so many positions it gives a chance to at least put in place your programs. following on commissioner christian's questions, i'm struck and had on my table here the slide on street response and care. my skrn not we are continuing to evolve but as we evolve, we lose the perspective where we were. and i hope we are able to seat range what is happening. that even the mayor's office reassigned and segregated out the different component parts of

addressing the street crisis, and we now have this part. and we have best for us to only get a report on best and not understand how many of the calls divert temperature how many get answered by the medical people where do they g. i'm looking at in our next presentation, that we get a picture of what is happening on the street. how successful we are. and how best that is to your program best i think. yea. playing its role and here is the success or challenge. that's my request >> great i appreciate that. and i agree. we'll aim to come back next time with that dataasm i think i want to acknowledge that program is

snivel evolution and the city our intent to have the same data you we have been sharing with you all as well as additional -- which we were starting to do follow up data, what happens after the street crisis visit. who come n. and then what happens after contact. of commissioner giraudo. >> thank you very much for your report and also i referred a number of people to the pipeline. to the intern help it has been helpful and successful. i want to question is -- do you collect data on those that have been offered mental health treatment and refused?

that was one of my questions. upon the questions i got and yours. we you know i wanted go back and did not have a chance to been this more deeply. we don't necessary low collect who declines krsz the board. one thing we have been interested in we think is important in programs like our street program. where we measure he is accepted or referral. and against the number of people we have seen we think are eligible for behavioral health treatment. we know about it in that way. and i think this we -- and imented to go back and see if we been it in other ways. for example. will someone gets made a refer exam does not show up is that considered a refusal.

we don't irrelevant know all the factor this is go in that. i wanted peek to the team about when we could dig up >> i appreciate it i guess the news media 16 were out of jail health. they were all xaufrs all refused. >> when we know back to the statistic i stated before nationally 10% of people with a diagnose received treatment. there are limits. i think when we and not you all know this also is this many people with an addiction or substance use disorder treatment are the behavioral change world.

not ready to making a change. including accepting treatment t. it is an on going process of engage export motivation. then again there is never the flip this you know how many. >> we offerd and people declined. just is -- frustrating in the information. >> if i can add the pilot program we are -- our within that shared collaboration, i

will talk more in director's report. am the number of people accepting and refusing treatment in that initiative, which is being spearhead under the mayor's purview, we are going to continue to collect this data. commissioner chow i have one follow up. i got carried away with the street program that commissioner christian was talking about and i forgot to thank you for responding to how you are asian community needs i hope we hear later how well some of these programs are actually doing in consideration of the fact that as we know, many. the clients to be clients and how you are continuing to intgrit that with the primary care services we have over in the china town center. i would appreciate that getting an update on this.

thank you. >> thank you. if there is timil have offer a partial response i appreciate the question and i think there hammer is in the become and we are very intent on describing how we bring behavioral health both integrate in primary care and special behavioral health. i think the extent to which we offer delivering service across the city and primary care is an important piece to this thinking broadly about how we engage people. in their own mental health substance use care and physical health. other thing i like to mention is to your point of how do we whon we are in our reaching. there is a need for population level data in the city. and it is on my to do list.

and part of our hiring approach to get fulfill up our analyst positions in order to get this population data that can give us targets and measure of need population level to know the extent top which we have unneed and which communities. thank you for this presentation on behalf everyone want to thank you and the staff, this is irrelevant encouraging progress. it is wonderful to hear this thinking and i think obviously behavioral health is a huge concern for the public at large. if we can learn more about how all of the divisions was steal work together on this huge probable and getting metrics.

for the community and for the department of we understands better when can be achieved commissioner jir odd over eluded to that. it is an extremely complex problem xu know we can tell from when you presented that you are going to lead the country in evaluating and initiating the programs and as long as we get the staff to dot work. it sounds like we have positive information to come in the future. thank you. >> thanks. the next item is office of health equity update. doctor bennett the director. hello noise toy see you it hen a long break. good to see you. and i am going to respect all of your time i have been warned i will stay in my 20 minutes. thank you for your attention again and i than you are all

very interested in this topic i appreciate you having me here to talk about it. this is our start i want to reminds us how long we have been at this. that's an old picture of san francisco general. and many of our staff from which really before i was -- longed that they work in equity. and we dom everybody sdchlt even when they don't have that intention. but what i want to level set with us all is what our work to deliver services to people is not the end. equity how we change the system and when we are doing we are participates in maintaining the inequityys and one of the few really players in the market of actually changing them. we have leverage.

we have 6 principles. angle areas i'm not going over the details of the updates i switched something in there. to tell you where the work is being done. what the intepgzs are the first is to reduce health deparities that is the primary goal and mission to make people healthier and across the board not in average. the next is there were some data from primary care. but have work happen nothing all parts of our service delivery. . authentic community relationships. you have to have the community and cooperation in their own care if we want to do it equal

loechlt and that is not an act [inaudible] it is also because the way in which we get people to access care and the way what -- i can move over. the way they accept care. the way we make care effective. need this information from community won't don't have. make sure money goes where it meads to go. a system tainable infrastructure the last are internal.

that means that equity moves to something part of our every day work but it is not there yet. somebody has to be in charge of paying attention. are you doing it. there to ask the questions. people who will learn the special skills and teach them to others. so we have to have an infrastructure that tells people this is something that is continuing and a priority. this is the space you ask your question and complrn all of those things have been built and have good information how that infrastructure is functioning. and the next culture this prioritizes equity. everyone putsum statements. what we need to do is have a system in which people see equity as a prior all the time they know the department is working on it and understands their job do find their roll in and something part of our

culture. we had in the past like all place times had it was unkwfrl for people to talk b. you cannot address a problem you are unable to name. people being able to say this is impactive race sxichl say this was not equitable and look at groups within groups and not to over with averages or feel like we are [inaudible] we mode to get down to details. last is your role. and others but is having accountability for progress. not have such a vague sense whf we are doing that no one can hold you to account we need goal and metrics and meetings and events and things people can hang their hat on. that the work is happening. presentationil give you divides in those areas. i can't talk about any of them there is a lot but i will give

you a sense how we are work nothing each domain to move the needle. i want to reorient us to ultimate healing disparity i came in the department because of work that was done on differences. this started the latest iteration of african-american health initiative this turns to something bigger. this languageefity deficit that many of our communities are suffering from. has not stopped. it is still quite there. and many ways worse after covid. that gap i show you in that in the graph is the 21 year gap from the 2019 data between asian women and black men. that means that there are groups

in the city who dprand fathers are unlike low it make it to 70s. which is wrong they are good years others are having the map is a longevity map. the darker is the longer livingch and you see that like everything else our legacy of geographic segregation plays out in this too and you can in most places. predict how long they live by which part of the city they were born in. buffer go on. native-american data you see there is from a different data set. and did not divide in men and women. that is partly because many times that group is small enough we don't track them at all. and we are tracking very hard to

not to do that and so i put them on there not quite in the same way from the same data med a note should be there that it is not it it is -- suffering from inequity bunkham i want to teletell ourselves that. a model had we hope to do in the small populations. we had 2 process in parallel. we have been having internal

planning group for over a year around of [inaudible] and priority setting and we had multiple recommendations out of community groups around the same topic the planning group i will not talk about everything but pulled kaiser. dph and ucsf in meetings and brought in community members. leaders, kaiser came on board. some from hsa we got social and health [inaudible] multiple health systems and community groups all together. that partner meeting will be in july. we are juneteenth messed we up a bit. and when we are doing is focusoth recommendations and the work this group with graphic study and the research and looking what are the drivers that we based on research based

on the study with black elders when should we focus? that is impacting people live and making them joyful and thriving? so those 2 things go together well. the communities was focused on many of the same things it is research and staff want to focus o. next slide. upon one way we present that recommendation that come out of that group and resxaefrpt community is trying to lay it out in ways the recommendations cluster. and many are around physical health and wellness. access to clinics and access to the help people are looking for their illnesses they already v. and the preventstive service we already deliver am behavioral health and joyful living. told not to focus on the negative. we had them together and they were discussed but partly

because of the opioid. is is environmental clean up and violence and things that circumstances in which people live we know well and workforce. a workforce we front research impactless on the way in which people accept care and has impacts on what care is offeredch and how that care is successful. having that will take things. whether or not loan repayment or solutions we as health system can work on together. we mead those people in the city or around the city or near the city. and almost does not matter at this point whether or not they

go to kaiser or dph we care but we need to work to finds a solution. from municipal and he others. that is the good we hope to launch example the behind this means we have to coordinate our work so there is work on black healing every wrchl we see to that throughout the department how do we make that collective and impact. how do we make it you know communal and reenforcing.

are community relationships we did working on that for the same amount of time. also base in the research done mapping out what is helping in the department already you see in this graph other things we were able to do you mean or happening in the department. and interview study with cbo lead torse ask the rep with the department and how that was functioning. those together difa road map of things that need to be worked on and set of themmings people are happy with and need to be sure we maintain >> we set up groups to learn about trauma systems not somebodying they would have may be learnod their own and how do we bring nain the citizen we serve that xroel continue on. we mode to work on our council and other things that may be need more help.

next. i will give you 1 concrete thing that relates to that work. much of when was said was about how much people value and really want greater connection with our staff and with our leadership. they are very comp lirmentary of the staff the feeling of whether or not the manager understands the community or the person understands the community is not as clear. we are starting in june. i think in 2 weeks. neighborhood tours our healing workers will do and once we figure out the role in resident and patients. and move happening around the neighborhood and looking at what are the historical things you should know? the health relevant grocery stores or other things resources or not. can we go to the wall greens and

see whether that is a place people use? than i start nothing bayview and do all 9 priority neighborhoods during covid and one to 11 going forward and finish the year. not understanding the context this is an important context to have. we'll take our doctor and nurses and staff out in the neighborhoods around the clinics they work in. and we will take leadership and managers. the staff from past have requirement of doing an hour a year part of the reason i put this so we could do these things that were structured time. so we will have our staff on the tours.

hopefully have the director and managers but not themselves getting a lot. and a bit more leadership hiring now use today several times having community panels to help interview people going to be executive or direct reports with the upon department we are getting a sense whether or not people have a sense of religion to the communities or they have that facility come equity statements and other things to get a sense of who can step in this work. next slide. our workforce acists are many. i'm not going all of them a progress report posted for the board. i want to talk about this one. the hiring and retention areas discipline are all behind mystery other work we have done.

done alegality in the areas. hiring guide lines. changes in recruit am. many things didn't reason they are at 50% is so much work is data department. and the data systems don't exist. they are just they are rolling out the first dash boards to say. whoech is coming in to the system. where are we losing them what is the way our process the time it takes are hurting us or not in keeping diversity. and that's the same for retention and discipline. those system are built and we will use them but until that happens many of those goals moving were impossible. next slide. talk the stuff in the areas

before i will move ahead. infrastructure grown a bit. there are of many more fte than there therapy is the chart for office of health equity. when i first, arrived i was a department of one for awhile there. that is excite fog seat areas which are community engage export questions of law improvement in service. many things will be moved this summer. many fte every area has staffing

should not be anyone who it is not have some line to member's job to make sure equity sehappening in their area. we assess the infrastructure every year and the infrastructure is -- several things. the basic you know -- equity your beyond. is it a priority. do you have training and are you staffed do you have a budget or doing activities that includes do you have metrics you are following. we have had the divisions rate every year the last 4. they -- rate themselves on 41 different items whether they

have it or not. whether it it is starting. and that means it is functioning and there for years. 5 would be the top of that scale. getting a 5 on average in every area without 15. we are getting close with the fte. we have had -- improvement in every area you see plateaus and -- wobbles there this is almost always related deployment or from staffing losses we had. i think we are further ahead you are not starting from scratch if you have an unstaffed program. there is progress. it faster because of resource.

it looks like what you expect over time. the first primary care i score still moving for at i'm almost then out of the 15. we got a lot of thing in place. next slide. almost done.

meant to be 2021 with butches because of covid. these other equity questions we asked overnight 2 time periods. we have seen improvement in every area. more are working on it. more say the department is working on it. we had a lot of fatalism from past failures and -- things our staff wanted. we are seeing improvements and a central metric for me whether or not it is work and whether people are working on it and the rest of us care. there were 45 questions to clinical care not all showed up to be real drivers somewhere

everybody scored the same on those. these are a few of those that were real drivers. my division is taking steps to improve racial equity. i feel comfortable talking about race in the work place and my department treat all staff. wloochl it it is about something that is equity or not but they are better then and there they were last time we looked. i picked the 3 they showium in this target was really about the jump in the staff's rating. consistent low the low they've is legitment. and the greatest improvements i hope this means some of this

work around improve treatment with staff and make sure everybody understands. and that we take it seriously born fruit. we will do much more effective work than we were when people were not sure. last is accountability. bring back to your resolution in 2020. this you did around health equity. and racism. there were 10 alleles meant to be getting done from that resolution. we have been cabbing them. done 5 them.

those are found alzheimeral things for the department. >> any questions? no mark. go ahead. >> and du want to introduce the new staff person you have. deputy director. why i have so many new staff people >> i'm sorry. i do have most of the staff is now to you. there are 2 my data manager anatasia and policy director and we got poth policy and data. jenny is still on. the corn upper the deputy director come of she is leaving for them as equity officer in

the add administrator's office in hayward and works here for years before she left to do that work and work in marine he is familiar and this is her work we are luck tow have her. thank you, mark >> sure. >> thank you. it it is a tremendous under taking and we welcome the new staff and the work you have done is clear goals are crystallized and the path forward is well defined. thank you. are there public comments. >> we have a person in the room. i will have a time exert when the buzzer guess this is time to wrap up your comments yoch robert from the san francisco black and jewish unity coalition. doctor colfax, commissioner and doctor bennett, thank you for

your reply to our presentations about staffing. life expectancy with black residence den and the rest population. continuing disparity in san francisco the worse among all counties in california despite the efforts you are marshaling to improve the health of black people of data coming in major new study from thes medical association. in california most of the economic burden racial and ethnic deparities by black african populations due to premature mortality. in the second study over 22 year period blk population in the united states experienced 1. 6 million death in 80 million years of life loss.

compared with white population. a period of progress stalled and got worse and a lot of that due to corid and heart disease. cancer. assaults, diabetes. vascular disease and black women maternal mortality ump must feel bad the left promise despite the situation is wrong. we made our request knowing about the programs you heard about today. electric at the numbers you came bawith. you say black african americans received covid vkzination in higher rates than else. how many died. 9.1% related deaths from the black population in a group 5% of the population thats the worse tally in the city's

population by relative population level in the city. we heard an important report about over dose deaths. in 2020, blks as a percentage of all the deaths 25%. 28% in 22. and in this year so far 33%. according to the san francisco medical examiner. remained the same the city's over all population black population decline. so do the numbers suggest a need for more inclusive prop of different care taking race and ethnicity in account. even more so than the numbers that you heard of from doctor coonin and you will hear in the sudden front budget property

>> wrap up sentence. >> we heard information today i'm sorry your time is up. >> in efloug we want to you consider this an emergency not just a practical program. something this needs attention. during the covid emergency. folkologist the line if you like to comment press star 3. e mail me your comments i can pass it to the commissioner. no hands on the remote. what about commissioner questions and comments. commissioner guillermo. thank you doctor bennett. y know it hen, while glad to

hear your presentation and help to see there has been progress this was anticipated begin the challenges. a couple project cal questions. i was wondering the data dependancey that you say is necessary i think is important part of this i'm glad to know you are being careful about moving ahead with program design and implementation until you feel comfortable with the amount data and the questions of law of the data awe are getting. one of the upon things i was curious about with the racial ethnic data are we capturing multirace data at population of san francisco is quite multiethnic and race. with the young are generation. there is also a different way they look at race and ethnicity than us involve said with equity issues for a long time.

i wonder, how that data is reflected when the nuance are nacome in play. as you look at dataeda and apply it to the design and service delivery. that is one question. the other question the workforce i -- go on and try to go on to the recruitment >> it is confusing. >> very. jot websites are changing. and then things they say forbidden you can't go on you don't know which website. . the sfhr website is okay but i don't see the equity and diversity efforts. the dph has and you talked about reflect in the this website. i wonder are there other ways to

get had word out? upon begin when we are doing and the leadership you are showing it is per the previous discussion with doctor coonen. recruit quality, skilled trainable folks that reflect the population we are concern body is critical. we didn't wait if you mean got

one of the dph announcements and clicked there is a link to a video this talks about how we care about equity and he faces of different staff talking about experience in the department and so that is atarrant countyed all of them. there is a statement about how we care about equity and how we approach it put on job announcements and as a statement before your interview temperature is infused through the process. it is not rising boost level of our individual announcements which is a problem this is a shared problem by us and other parts of the city the office of racial equity setrying to having shared goals with dhr on that. the first question on data, is interesting. it is interesting in state of art form equity. we had some research most move

nothing covid and locally about how to define groups and the way we have done as if they are static. is not useful for mall populations. if you do define pacific islander as anyone. the group is bigger and -- it looks differents in terms of whether people got vaccinated what covid rates were. the same for our native-american population. their population is birth then and there we say it is people's communities are not based on boxes you have a parent in a different grouch but you are with this group. how we do that.

what the -- agreed on rule so it is not chaos we are working on. that is part of what -- we will get worked out in the next need's assessment. my policy friends will help us write a new policy when we do and how we define and look differently and in addition to our gender identity policy. we'll be forced data matter and changes what the data looks like and probably a closer reflection when people are seeing than when we were doing before am i appreciate your sensitivity to this and manage you are more familiar with than i am and so i

appreciate and look forward to how you might help us also understand. those nondistinctions. and -- how they are impacting the policy the decision making that needs to happen. it is the future. i believe that the complications with identification continue on confound us. as we try to create the best solutions. one thing that i don't know how much the community is involved in helping you -- interesting to hear how those are they are defined and what are promoted.

set this as a model and touch base around what we have planned for you. >> commissioner chow. yes, thank you for this tremendous update. my comment which is related -- only as an example from life expectancy we were talking about the pacific islanders gives you a differents picture away from the arabians. we know the asian population is not homogeneous. for years we known well is a bimodal distribution through the social economic, and immigration and -- so -- there are also and

then went differents asian segments. if bow are going to do health deparities in the group it is important to do subgrouping of that group. it it is not just that everybody got x describes. describes is worse and a. and so as you are focussing on that you remember i'm trying to -- put this remind are back inform well tino is more within the east asian and south asian along with. >> i think we are there. i think what is needed you will see that. going forward. we are grappling with complexity

we try to get more effective we get close to reality that is more messy. and categories. divisions when we call black. those are not necessary low one community 91 are and health relevant some groups have different eating habit and treated different low than other parts of their group. i think we are there. in terms of the belief system i don't know in terms of agreeing on how to do that. and that it will help across the board. we are trying to get there. i think the next iteration of mystery data you see will show that. we are able to show it at least now because we do ask people not to fill out a box but tell when you say country and the more detail we allow them on check more.

the under lying data is there now what is missing is some really professional agreement between us about the need to do it and how so there is consistency. the fact we not the data is a giant first step. >> i think professional leave recognize and there are good examples went asian community in terms of working on diabetes and cancer. and this certain segments rather than hitting all asian groups it was clear it was not as important to work on -- that's how the pacific islanders got segregated out. would have been really an important a wrong message to them on bmi's and likewise. there are certain subgroups with diabetes.

noted hitting targets with best resources where the best, were. i encourage this if you are having trouble if a professional sustained point they should look at that and understanding why segregation really will actually be helping to no one where the best advantages are, best opportunities are in order to meet the disparities >> we have not unlimited resource. >> yes. >> more and more effective. we'll are to get close to when people are willing to do. >>you are right the data is important and i wanted to. >> ask the question. >> you can ask the question and someone can finds you about what that subgroup is doing. >> good to see you thank you for

your work temperature is so important. so, necessary so ground break. can you help me with slide 4 i want to make sure i understand the healing deparities black priority setting a model. on the right hundred side says review of commune input and the left side planning group of so i want to make sure i'm understanding what is happening here on the slide. the upon community input data the input from the community that lead to when you have done. >> no. nay were happening concurrently. some of it came to you in it came to director colfax. while we were in starting a process kind of a little bit more contained press we were going through research which is

may be not the largest group process. at the same time, there was a conversation starting in community so that megablack was putting them in budget and had a health section the reparation committee had a health section about black health. we were concurrently asking questions while they delivered input now we are trying to bring it together. activelies not us. we are trying to tick when we were already doing we were read thanksgiving this was manage this was an issue andmented be will involved in with when people were telling usch is the best way we have the prior and trying to understand the background. urn the planning group section where you say contracted the national research row view of

contributors to black lonefity and interventions. you have that review. we are it and share today and sent it to [inaudible] and the study the same thing a researcher who did a study of patients southeast healing center and rolling to the clinic and it did have some impact on how they're did pharmacy business and other things did another [inaudible] with blackelders with a different focus not the clinical the community sample and what were their health behaviors and lifelike and prior and how were they being healing competence joyful and it was ment to be

successful to hear. thank you, is there access to this research for the mount for us to have. >> we compensated a set of cbo's to bring people and did a couple events. we i'm i have not shared it widely partly i'm trying to get partner and now through the per in conversations to get pep on to this. yes, we should. i think it would be helpful and important to moving the worked for but in the community and enengage all of us to who live in the city on issues and see ourselves in these of problem.

i would like that town for the community at large and you know time allowing for commission. if there was a commune access we could attend that will be helpful. you will say we have been told by the parts of the community that people are tired how terrible things are and this they want us to tell them that one was good, one was bad and what we are doing about temperature that is part of the wait. i think it is a few months i want to tell people, yes that , is true. this is when we floon do to address this. i trust the priorities you are

setting and i think that this being be present in the a way not how bad but this is when we learned you read in the new york times that there is this -- weathering and loss of life. but looking forward to when that happens. and the way you believe it should. and thank you for all of it. >> i have one question can you elaborate on the collaboration with ucsf. i know they developed a lot of props so i wonder as we are trying to work throughout things commissioner christian is speaking of they have been published in the new england

journal. work used as an example for others to follow. how can we tap in our community resource include thanksgiving work there. we are partnering with a 2 heads of black health initiative one is the equity officer near ucsf health and the other is doctor butler a researcher. they are bring the 2 together to try to -- work with us and who we can get to the table to talk about how we each can play a role. how can we statement research they are doing. how can they shape their work the clinical service. what we are doing in community.

doctor youn and i figure out a way i think that they are -- trying to be a leader and trying to do manage we all want them to do look how does this benefit us. thank you for everything you have did and thank everyone in the office of health and all the equity champions. i will refer to staff meeting tomorrow this they are on the top of the group in terms of success. thank you. thank you all. next item is charity care report from mixture the senior health program planner.

thank you for your patience. mr. borrowa and partners. thank you secretary morewitz. good evening i'm max gara i'm a senior health program with office of policy and planning. today i will present on the fiscal year 2020/21 charity care report i draft was presented to the finance and planning on may second. i like to thank the members of the committee for feedback as well as other commissioners who had quotes report ahead of the meeting. we related the feed become in the report i will discuss. and i will address other question this is came up ahead of today's meeting. i'm joined today by several

hospital representatives who participated in the work group. i will provide background on the charity care ordinance and the land scape and go in the report. and provide information on citywide and hospital specific charity care trends and end with state and federal policy changes that may be impacting charity care [inaudible]. due to the opinion dem exhibiting emergency pregnancy by san francisco department of public health reporting process was delay exclude both 2020 and 2021 data are combine in this. [inaudible].

they it was passed by the board in 2001. this luwas the first in the nation. this ordinance helps to increase transparency and accountability around charity care requiring hospitals to report charity care data annually and notify patients free and discounted service. there are 8 hospitals required report did thea to dph and should note 5 ever required to report these are st. mayorys. francis and chinese hospital, cmnc vaness and mission. 3 hospitals data volunteer some report data on a fiscal and inical dar year data and the

analysis in this report covers a time that pans from july of 2019 through december of 21. with the 8 hospitals dph captures citywide charity care trends. regards to notification requirements every year dph staff visits each hospital to conduct comlines with the requirements and staff visited each the hospitals and all hospitals were found to add here to the notification requirements providing verbal notification at charity care policies to pashgd everpatients and signage throughout the hospital. >> i'm having difficult hearing you. i don't know the microphone?

next slide. thank you. birch start i want to highlight the events occurred since the passage of the ordinance impacted the charity care in the city. 2007 the healthy san francisco program was starred the city's health access program provides residents access to health care service. and in 2010 affordable care act and preparation conducted on the acts implementation. 2014, since benched increase in healing insurance through medical and covered california highlighted in previous reports.

from 2017 to 19 federal level under mine access. includes repeal on mandate penalty and changes to public charter rules. and -- in 2020 to 2021, we sought on set of the covid-19 opinion dem exhibiting new administration that result immediate a variety of federal and state policy changes the report presented covers data from the time period and i will discuss impact in religion to the city's health care system and trend in charity care. at the end of the presentationil discuss changes that could impact charity care to the report it provides over view of charity care for the city and show cases trends were experienced by 8 hospitals. data on healthy san francisco

and charity care parents. again traditional charity care is care provided to uninsured patient not in healthy san francisco had is a program created by oshs to make health care services available and affordable to uj insured residence. hospital representatives from all 8 institutions were engage in the discussing the draft to presents to the healing commission. i want to mention that due to covid the report combanes 2 years of data. this slide lights 3 main findings based on analysis i gallon through each providing more information. first we continued to see that charity care services uninsured and public and commercial coverage and those most like low

to experience healing inequities the report benched increase this charity care case and decreased in charity care patients for men during the reporting period. of we continued to bench healthy san francisco and the traditional chair care populations. so the next set describe who had is receiving traditional charity care. graph on the left shows residents of traditional care patients san francisco residents continue to be a major of charity care recipients data show a large number are homeless or unknown addresses 10%. i want to note the slide that peh is importance expert witnessing homelessness. the figure on the right a map of

charity care patients by supervisor district in dark are areas higher numbers of patients received charity care. in following with year's past a large number of patients from districts with lower than average house income. the neighborhoods have the highest emergency room visits and maps to the study map presented. health coverage and demographic data collected with all submitting data for patients the left shoes the racial ethnic break down in 2021. and comper seed over all population. data show that patients are like low to be hispanic or black african-american compared to the

city population when examed by coverage type in 2021, you 21% other than uninsured 78% had a form of healing coverage this includes medical, medicare and commercial insurance. this data supports this many receiving charity care are those who have coverage and unable to afford health care expenses. this data received a question regarding residency. we collect on residence and he status of charity care patient this is can't be cross tab laid but in the future we're trying to collect this data. stepping become those receiving chair care are those like low to experience the significant healing inequity and hes higher

medical need with homelessness, importance of color and importance with lower economic status this is not just uninsured being serviced by patients with in form of a health coverage. there was an increase in initial patients received charity care the left shoes number receiving charity care. between 2019 to 21 there was a 13% increase in the number of charity care patients the second on the right provides over view of patients by service type and the past 2 years the number of patients increased for each service type with patient counts for emergency and out patient service increase the most.

charity care and medical hor falls over the previous knife years medical short fall difference with expend tours for medical services and reimbursement received for service. hospitals will absorb this cost. between 20 then and 21 charity care increased by 19% medical remained similar year to year. the increase were driven by the hospital specific policy changes to end patience balance bill and covid driven decrease in hospitalization likely contributed to a stable levels of short fall we befshd among the medical short false. and i want to note another thing

ahead of this meeting was of that each hospital charity care costs provide this care not charged based on charge master. institution cost of charge ratios used to charity care charges. shows data on charitied care for hospitals during the reporting period. you see the over all increase in charity care patients driven by ucsf and these 2 hospitals represent 75% of charity care patients served in 2020 and 21 any changes at the institutions have an impact on city trends. and i want to note that st. mayorys experienced an increase.

in experience decrease in patients. mission bernal and chinese. kiez sxesh st. francis. they report data fiscal year the impacts of the change would not have been befshd until 2020. ucsf they began applying adjustments to parents qualified for financial assistance without an application from the patient and start in the 2021.

and this to increase patients receiving charity care at the hospital. there was an increase in the charity care patients befshd citywide 58 reporting hospitalings experienced decreases likely driven boy covid impacts the pandemic and health and economic affects had an impact on the health care system. result in the periods of decreased equalization decrease in emergency. and in parent service. and the graph is based on data from the state san francisco's among low average patient encounter for hospital services before and after the pandemic. note this graph is inclusive of charity care and noncharity care patients. decreases in ewile significant upon cant in 2020.

visits 20% below the 2019 baseline levels. the declines like low a factor in the benched decreases charity care cases i noted earlier. another driver for decreases is healing coverage increased in california due to policies in response to the pandemic. policies such as medical continue barred enrollment millionos medical and according to did thea 94% of californians insure in the 2020 the highest recorded from the survey inform san francisco 96.4% was insure in the 2021 the highest rates recorded. the increases may have contributed to over all reductions and asks for charity

care. ? this slide i'm glad this table is showing dropped in the previous meeting the table shoes each ratio of costs net patient ref now comparris to the state teenager it is a metric comparing each hospital's charity care contribution and the ratio all but 2 reporting hospitals are higher and which is the learningest provider had the highest at 14%. based on feedback from finance and planning add a new graph to the report showing the rit i don't the past 5 years. for each hospital or all hospitals we have data. and the data show that most hospitals seen increases in charity care cost and patient revenue ratios follows the state trend with most hospitals out performing the state during this

period. per qualify health commission we conducted a lit are tour review of other metrics to kwom pair hospitals. identified one other metric the ratio of ecpend tours to hospital operating expense and analyzed san francisco's hospital data use thanksgiving the analysis data showed that similar trends what we bench in patient ratios.

knelt patient ref mou does not capture uncompensated care hospitals with highway are levels of this service perform better using the metric to compare this is relevant when we are showing the charity care contributions of our safety net hospital provides high level of care. emphasize a large are proportion of care provided by safety net institution. moving forward weave will assess the use of new met tricks and used in the report. again traditional chair care, care provide to under and uninsured patient not in healthy san francisco the program making heck services visible to uninsure the san francisco resident and again healthy san

francisco is an important contributor to the hospital base the charity care landscape. hsf is not insurance. and commissioner to the question i received ahead of the presentation, regarding your hospital loss under hsf our healthy san francisco hospitals receive reimbursement for providing care to healthy sanning fran. but this it is not cover full cost service. and when we dive deeper in the data and compare to the populations of the cares there are difference i want to note. first is we see that benched increase in charity care patients driven by charity care healthy san francisco patients remain stable. this suggests there are pop lithes rely on healthy san francisco for accessing health care services likely ineli didn't believe for medical. and the proportion of emergency

care is grirt for traditional charity care patients compared to healthy tan san francisco population and the contention this healthy san francisco patients have greater access to preventative care service. can there are a number of policy changes. policy during the pandemic mitigate the potential negative impact on the health care coverage dp hymn pacted trends. with the end of the public health emergency the government is unwinding these. normal process for reeligibility medical in april of 23, and the state anticipates this change will lead to an estimated total of 2-3 million disenrollments the increase will has the potential to lead to increase in charity care patients due to

number of uninsured and under insured. additional low as we enter a new phase we expect health care equalization rates to decline and impact charity care. unrelated to the pandemic a change to medical to extend eligibility regardless of documentation status in may of twoot state allowed undocumented residents over 50 on enroll in medical and awful with low income regardless of immigration status will be eligible for medical. they are exampled to decrease over all enroll enemy healthy san francisco and charity care as well. 2 state law in 2022 and impact charity care reporting hospitals in future years they update notice requirements for chair

care and require hospitals to provide people without coverageage application for footage assistance or charity care. some hospitalings shared that the bills are likely to increase requests for charity care. san fran charity care ordinance enabled long history of data since 2001 this report marks 20 years of capturing dataasm president collection of dataal provide insight in the impacts of policy changes. and future potential changes we have seeing now. so this concludes my presentation i like to acknowledge our hospital partners are some of home on the call for participation on the work group and thifrng them for their support and like to acknowledge my colleague, on her work in the project as she lead

on electronic and review of each hospital notification and policy. thank you. why thank you that is an incredible amount of data to collect and analyze and we as commissioners would like to thank the hospitals for participation. a lot of work and it is interesting and a lot of information that makes sense. thank you. any public comment? folks on the line press star 3 if you have received an accommendation and ment on item 6. the charity care report. if you like to make remote public comment and not received accommodation you are welcome to being acknowledged. >> no hands. commissioners. >> come questions from commissioners. commissioner guillermo. too many g's in this room. [laughter]. thank you for your report.

i know we got a preview testify at the joint healing and planning committee meet and appreciate you updating per request made. as relates to the rit i don'ts of cost to the debt patient revenue. i think is helpful. are most impacted by charity care or taken another way which hospitals are likely to seat parents where charity care is -- more evidence. one of the things that might be more qualitative on this same upon vein is -- each the hospitals also provide a range of service some might lend

themselves more to the charity care costs that might be more prevalent then and there other services and specialities the supports have ed's and some don't. i can't remember in the full reportful but may be mark for identification this data could be provided round out the picture so it is not purely number or i know there is a description of service but manage more specific around the types of service and specialities provides gives us a bit more flavor?

i think this issor finest reports we created over the years and i think -- service the purpose for showing that all of our hospitals participating and the value of the hospital

services are it does also assist in answering the question when is the irrelevant chance of nonprofits in the city. thank you for this fine report wrchl thank you. i think all of us would like to associate ourselves with commissioner chour's comments thank you very much. >> thank you, commissioners. >> the next item is the director's report. >> director colfact. >> thank you. chair glean. a lot in the director's report i'm going to highlight 2 areas and then help to address questions you have about when i'm about to talk about or other written materials. to start off an issue has been in the press and not in the written director's report but time lowipmented to highlight for the commission.

the major's launching a -- effort to address drug dealing and drug use on streets. a command is establishes the drug market coordination center. of enhance efforts by treatment resource related reducing number of open air drug market and reduce drug use on the streets. to address drug use the pilot program with the police department detang highly intoks indicated in public and i danger to themselves or public or unable to take care of themselves. detained boy the sheriff's

office and they will decide when they'll be released. jail house service is part of dph will ensure individuals in the custody of the sheriff's office and path way for treatment. there will be no change for handling of medical issues for you the learning are program we are continuing to coordinate and more details will be provided as it is clear through the coordinating body and through the should have been and police

when that large are effort how that largey effort may be realized in physical pace and capacity. dph defined procedures for care and safety when a person enters for detention for the pilot includes when a person enters detention they have a nursing assessment if urgent or needs identified they are transferred to emergency department a person is detained the jail house services monitor intoxication and provides services had they are in the jail and the sheriff office has a discharge plan. dph supports that with connections to with draw management at the access center. dph offered substance use management or methadone upon discharge and also offer it while in jail and i think the commission is aware supportive of the sheriff we implemented distribution not that handily but nar can in the jails and upon discharge i wanted

prosecute void you with the status of the pilot program and make the commission, way of dph role it ensure this people in custody are offers services and when discharged with the sheriff as part of this plan by the sheriff dph makes treatment available. the second related laguna honda hospital. exciting news written in the director's report the first item which is announcing sandra simon the'd administrator executive officer for laguna honda. after a search dph announces that mrs. simon the new leader laguna honda hospital the serve the nha and chief executive

officer effective soon june 26. this transition to a licensed nh athe most senior position at laguna honda alines luck lug with top nursing facilities nationwide. she has the skills to lead laguna honda and serve. shoes chosen for manuscript to laguna honda's mission and over 20 years of successful experience as a nursing home add administrator. during her career sandra established success leading skill nursing facilities, assisted living, memory care program and learning multibuilding campuses with varying levels of care. held lerredship roles the chief administrative officer of the san francisco campus for jewish live and second learningest after laguna honda. and held roles as the campus director for the coal gate

center campus skilled nursing, residential care and independent housing as well as served the nursing home add administrator for the friendship health center. really delighted she returned to san francisco. xoit body her lead everybodiship and she will start june 26. i asurety commission that rolen pickins and his team will stay at laguna honda in work close low with mrs. simon as we move forward with recertification. the w that we'll will do at laguna honda. be under his leadership will continue with the same staff and mrs. simon an reenforcement through the recertification process. i want to share the good nows we have also have identified and

have offered positions to the deputy assistant nursing home add administrator. we expect those to be filled soon as well additional good news there. and on the another area of laguna honda update you on you will recall mr. pickens reported that -- coordinate care bedside initiative started. currently the team the neighborhoods we expect all then neighborhoods with the people am yesterday -- and cms surveyors arrive to commence with the third monitoring survey which

you recall is part of our seth am agreement. they are on site and we will continue to ensure the commission is updated with irrelevant van information we can share that survey commenced and the team is very bodies in terms of ensure the surveyors getting all the information they need and we are hopeful for successful survey. i will stop there and happy to answer questions about the items i went through or other written items in the report. thank you. sell there any public ment in >> yes. folks online let's start with accommodations. jaime or janet. unmute the callers and go from there. hi. its patrick can you hear me >> yes, please begin i got 3

minutes. laguna honda nursing home add administrator larry [inaudible] well -- vouch in 2004. shocking laguna honda decertification to hire a nursing home add administrator. but i congratulate sandra simon for being hired as the new nha perplex native american indian medicine woman. in june of 22, identified and -- nursing home add administrator necessary in november of 2022. prepared the first analysis for submission to cms on december first the facility does deposit

have a nursing home add administrator on staff contributes to the electric of knowledge to the nursing home regulations shameful taken 12 years to hire mrs. simon. cms [inaudible] laguna honda also.ed assistant nursing home add administrators on board rapidly. good to hear back doctor colfax it might happen soon passport my colleague doctor palmer written testimony she submitted for the dachlt new nursing home add administrator will not assist in failing laguna honda [inaudible] unless she is empowered act

independently if there are more -- they continue we will lose laguna honda. you need to empower her to act independently of mr. pickence until we certification is accomplished as the new ceo and nha should act independently -- who dragged their feet for over a year getting to a place where you might issue eligible to submit an application for recertification. thank you. we have one more much unmute. >> can you hear me. yes doctor palmer. >> doctor palm are aa.

retired nursing home dok i know about writing and following care plans. if you don't have enough of and staff to get to know the patienteds or move them around too much. there is no way that you can follow the care plan because they don't know the patient. and so -- the new add administrator is not going to be successful in avoiding immediate jeopardy unless staff is stable and deploy in the a stable way to different assignments. and so -- that is really worry some. the other thing is that if there are not sufficient behavioral for disabled people and laguna honda either cannot discharge

people or pressure to admit people to facilitate [inaudible] tell be the same old mess. has to be adequate behavioral treatment and care for patients who will not do well in a nursing home elsewhere in the city. and the -- the new nursing home add administrator has to be given the latitude to initial a screening program of the patients. so -- patients who are impossible low difficult for a nursing home to accommodate will not be admit exclude have other accomplice in thes community they are cared for. will she will given latitude and passport she needs to dot job right? or under the thumb of others in the system.

see laguna honda as a secondary facility. we have the 2 add administrators with offers out. is show encouraging. this is a positive develop and want i think the things that cms demanded part of the recertification program. woj thing that concerns me and i may not understand this is that i think we all concluded with the advice of the consultants

that the coordinating indicator bedside initiative was important. not only in order noimplement the actions that we have been able to accomplish but to sure comfortable with rule and regulations and their appropriate responsibles. you in the surveyors are here sooner. can you comment on where this leaves us and how we'll both address the surveyors as well as launch this critical initialive. >> thank you. chair green and i -- think that we went through the most recent survey successfully. and i'm optimistic with the team

and the work that happened that this survey am unfold we are help thanksgiving is the case understanding that you know there have been fining in the past that have been challenging for you to independent to and. you know is this unfolds we manage that. as we can. i think this the -- in mr. pickens and he is not here today learningly because there is a survey at the hospital and he and his team requires attention. just to -- the -- the coordinated care bedside initiative the goal in response to the findings that we have had both internal low in quality control and the other surveys. that set the initiative the goal of the initiative is to not only

get us as recertification but sustain that going forward. this is in the a matter of cross examining for the task this is a matter of moving forward and modernizing laguna honda to be the best going forward in the rowel and regulations. this is happening before this initiative has really it is just in 4 units. reflection of the survey will not reflect the efforts of that initiative. and so i appreciate you pointing out this timing. you know, we don't have control of when the surveyors come they arrive unannounced and we have mr. picken and his team executed and working with our quality improve am consultants to ensure

the right people are on board for the carrot bedside and for this initiate testify start as quickly as possible and this is again getting off ground we don't expect it to slow down and i said the staffing issues we expect all 13 neighborhoods to have that initialive staff executing that by the end of the happening month. we extend our gratitude to the staff for dealing with survey xors getting this important initiative off the ground. thank you. any questions or comments? commissioner chow. >> thank you for that report. so, i think that -- what you

said is that mr. simon is coming on as the add administrator and has to have herself, quainted with everything. >> yes >> and you are providing full support with mr. pickens remaining on board. in order to, sifting carrying out recertificationch so this this am bring on mrs. simon she will be the lead is this correct? . once oriented and luxury authority w width tome in this crisis mode that gives her that support. in order to do all the work that is necessary to be success envelope recertification that is how i'm understanding. that's right. there is a very dynamic

environment. and you know any system in learning it it is dynamic this is motor consistent care bedside is another example of things moving hap rapidly and efforts in investing improvements is an example of that. and yes. the mrs. simon gets the support she needs and a period of time where the team this is in place helps support her in the work going forward this is in the a time for us tosfgovtv. >> for over a year we need to enforce the work through staff and support of work and strengthen the hospital and then, you know. would anticipated and hoping successful recertification a more step wise transition to um,

having a laguna honda leadership team can sustain the work going forward as vinyl with oversight in mr. pickens as of the previous structure will be developed that is in the future um, and not in the immediate future certainly not before i'm hoping for a successful recertification. >> a when i was voted in at an appropriate time that feels comfortable to come and introduced to the commission will be really a very good idea for us to do- with a key person coming boarding. >> i expect had they arrives and mr. pickens arrives will be

really. >> thank you very much. art no, not comments or questions then we'll go to the finance and planning committee update mr. chung. >> hello commissioners to an is committee right before in commission meeting and we had um, a accepted one part of the report and it is (unintelligible) approval of the waiver a list of waiver (unintelligible) and this one is under the san francisco motivating code chapter woke up .42 and it is really not exactly but for our existing contract to feel that is the um, a gap, you

know. between the contractors so this is in front of you but wanted to direct your attention to the one of the providers on the list has been removed which is the oak children center because they're now closed. >> and it is all on the consent agenda. >> and commissioner. >> i - one other thing i did mention if you know one of the contracts in here is about like transports like to transport low income patients to diagnosing and because of like all the new policies around the environmental justice it is worth to have this conversation to make sure we see people that

contracted agencies use (unintelligible) or at least in the moving nuance turning them green. >> thank you there was a correction on the contracts reported i know you all i want to make sure the record is straight on the transport the new numbers for capital transit the proposed i'm sorry the prior annual amount without contingency should be $60,600,000 plus and the annual amount of hundred and 71 thousand plus and in the annual difference did have 265 is different than the spread shoot and the the definition of insanity is doing the same thing over and over and expecting a different result accepted this. >> all right. any public comment on this item. >> yes. there is. could you

please unmute the caller please. mr. mitchell. >> yeah. i'll do it. >> there we go i was can i start and yes, please you got three minutes. >> i testified to them the finance committee one wait a second with incorporated more the t implemented for online access to the will go to honda and to the board, i.e., that worked at laguna honda all the hospital policies were available online (unintelligible) and though a clearly error stated

the platform has a work up feature guide to any given proposal to refresh the clinicians memory on particular procedures i think the example used was one of our cap - clinicians need to add this need active to an online training on basic procedures like polar caps i was hospitalized for skin cancer and i wouldn't want my clinician who were certificate of preference for me to have to work up basic procedures at the last minute. and laguna honda clinicians (unintelligible) similar contracts with efforts

is shocking and it is extremely worrisome and laguna honda may hinge basic procedures um, tied to any given nursing policy and procedures it is really, really worrisome. thank you. >> any public comment. >> any commissioner questions or comments on this item? >> all right. thank you for the report commissioner chow and the consent agenda now the contracts you present on the consent agenda along with three policies and paradises will be approved at the jc c last weeks ago so i believe in the one- >> (multiple voices). >> one correction. >> yes. >> i move to adopt other consent agenda. >> second. >> go to allen.

>> all in favor, say "aye." >> aye. >> none opposed thank you for the consent agenda it is approved and the next item the joint conference committee i had the pleasure of giving this on the calendar so on may if we received a presentation about saving up staff experience and work place preservation and focused on to get the staff safe we have a complex patient population with the mental health as issues the progress is a excellence? the regulatory affairs and h.r. report the ceo and the it is investigations and places that the cf g but most of

issues we feel confident and no jeopardize or concerns about they - the h.r. department is going a great job of keeping the nursing the head of risk management did a wonderful job and it was brought to us a really wonderful organized department in the closed session we approved the report this is little item from the cf f g any public comment. >> you um, any comment press star 3. go ahead. >> any questions or comments great to the section item is order of business any other business? >> or public comment. >> no public comment. >> all right. we'll entertain to motion for adjournment. >> i moving to adjourn the meeting. >> all in favor, say "aye."

>> aye. >> thank you, everyone for this long but very for the meeting. >> thank you, sfgovtv for helping out [meeting adjourned] thanks you so much for coming today. welcome to the 13th annual nightlife and entertainment summit brought to you by the