Singer, here. Chung be present sanchez, present. Karshmer, present. Second item on the agenda is approval of the minutes of the Health Commission heating of july 6, 2016. Motion to approve second any discussion . Comments . If not, all those in favor say, aye [chorus of ayes]. [closed session] all right, thank you. Item 3 directors report good afternoon commissioners. In your Commission Report today there is a article on the california rate increase in premiums with Health Coverage uncovered California HealthInsurance Exchange is vital 13. 2 next. In San Francisco the average increase is about 14. 8 higher than the statewide average. While rates for kaiser, which is largest proportion of San Francisco increase approximately 5. 3 . All other Insurance Plan 12 total doubledigit increase. As you know will be bringing forth to you regarding a project were working on in trying to assist some residence in providing some subsidies to them. Does seek to update the total of eight San Francisco residence of tested positive for the z got by this as of july 20 i would want to diagnose and the last week and just to note all patients contacted the by chris while traveling in countries with the z got virus is circulating. Theyre also continuing to provide information to providers and to the general public regarding the z got update. I want to talk a little bit about arts assisted outpatient treatment update. This is an active program. This is what some people call [inaudible]. Its been a very active program and for the first year of implementation we got 80 referrals to the program. Many of them do not meet the strict Eligibility Criteria outlined in the law but we committed them anyone calling would get a service. We have engaged 19 individuals in voluntary services and filed for court petitions. Most of these referrals made by Family Members in treatment providers which was the real focus for this program was really for Family Members. One Success Story is a case referred by a Family Member in this individual had extensive history of psychiatric crisis in attempting to engage in services. Prior to the referral, mr. White was homeless struggling with Substance Abuse and in 2015 at over 50 context of psychiatric emergency services. With extensive outreach and engagement by a program and extensive intensive Case Management team, i checked on this number is 634 and i checked it twice because i was pretty i just did not know it was true but basically he had one contact in that whole time. So 634 . Decrease in prices contact. Hes currently housed an independent house and i continues to be engaged with Mental Health providers. So, just want to and there. Any other questions you may have around the rest of the report. Any questions . Commissioners, there is a Public Comment request for this item. We can take that first. Because we can take that first. Yes, please be six dr. Kerr . Dr. Derek kerr. Your july 19. Meeting was canceled and today dir. Garcias report omits the log of medical staff appointments at laguna honda hospital at that was present in her july canceled reports. In the past this information would be shared at the Laguna Hondas joint conference committee, but no longer. Instead, it is only distributed here far away from the laguna honda community. Unless it vanishes when a meeting is canceled. What is remarkable about the missing laguna honda data is that two members of the medical staff were suspended in july. That is the kind of information that laguna honda administration should disclose to their approximate community to which they are accountable. Laguna honda relevant information should be shared at the laguna honda joint conference committee. Not doing so is a type of concealment that degrades and trivializes the joint conference committee. Thank you very much. Thank you. Any questions or comments on the directors report . Two questions . First of all, thank you for report. Certainly come i read it on paper around the rise in california rates and are alarming so i am concerned. However, i like to ask your thoughts on the impact with with regards to the rising rates on two populations,. One is our own Employee Base in the San Francisco county do dhhs and the second would be if theres any impact on the Health Network or managed medical enrollment. Would this increase in enrollment lower enrollment . Is there any prediction about these rates on those two populations . Some of the network probably can talk on this but weve not seen an impact on this increase could this is on covered california and presently we do not have a contract uncovered california so that has not impacted us did i know it is going to impact the city overall in terms of their negotiations because of these increases. We do not see that until october coming this year. So, thats for december start productive i have not heard ofi know the impact but i have not heard how to impact the budget on that thank you very much. The second thing with regards to the aot the outpatient treatment, i mean the rise of the one client reduction in services six and 30 is quite remarkable. Probably a person that did not want to seek treatment could i hope that we can take let some of the Lessons Learned what i hope will be a narrative of the Lessons Learned and applying some of our other populations that we are having difficulty engaging. Not just those with persistent Mental Health issues that are ending up in services but maybe some of our persistent street base substance users or maybe some of our Homeless Services as were looking at engaging in out reach. I mean theres something audience we are doing right and the aot program. It would be nice to see we can replicate that in some of the other highrisk groups yes. We replicated the work were doing in the department into the aot as well. In terms of looking at our how to utilize this wraparound services. As soon as we do that and we get a Background Service for high users, the costs go down exactly like this individual. Its a matter of the ability to have all the intensive services but it is something we are looking at and you have eight 1150 waiver whole person care model will, and share with you in the next coming months that i think that its the same model as well. But i think absolutely, youre absolutely right in terms of looking at the success. We just have to give a little bit more numbers to see what the real data looks like good right now its been 80 people we have seen. But the tricki mean the real commitment we make to having Family Members to be able to in the past they never have the ability because the status of their child and adult child. With this, this provides them an opportunity to engage in the system to call on their needs they have for their child and were able to respond to that. So, totally agree with you dr. Pating that we can learn from this program and see how this that applicable to other programs i like the idea of learning from the extension of services and wraparound but actually think there may be some subtle lessons in terms of the balance and care to encourage people to use the services so in terms of as much as the aot has some judicial force behind it, you know, what is it about how thats expressed that helps people to engage that previously with the same services and the same outreach maybe did not get engaged . I didnt i hope you will learn lessons how to balance those two ends of the pope absolutely. One program somewhat like that is our Collaborative Court when individuals needing jail and has an opportunity to come into our collaborative crooked as you know proposition 47 has taken that part of it from us in terms of people being arrested for drug use and so it is making a little bit more difficult in our court system but we do have sections for individuals that they come to our court system. It does play out in that manner as well. I had an opportunity to go and spend several hours in a Mental Health court last couple weeks and i was very impressed with the way the judge, the public defender, and the District Attorney and our clinicians were working well together for some of our most needy clients. So, i think we can learn from all of these programs that look at are mostly diagnosed individuals in our system and hardtoreach populations. That might be something i like to hear at a later time as an update in breaking. Particularly as one look at the Navigator Centers coming online and perhaps it is those that have someone court involvement. You know the second vehicle quarter extension of the behavioral courts. So, i didnt we are to be looking at an extension of the conservative ship court and were looking with the courts right now on that. We can give you an update in a couple months where we are with that development. We do have some staffing already budgeted that we be happy to provide that update. Great. Thank you very much any other questions . I had one. Dir. Garcia, how many people in San Francisco are getting insurance on covered california . Covered california i do not have that number in front of me. We certainly can follow up with you commissioner on that. I think this we interesting and we should give it some transparency at this level for everyone because this is a very complex situation. With the rate rises. We dont want a community where we have insurers pulling out. Thats not a good answer. We dont have community we can afford insurance. Thats not a good answer. Theres a large proportion of the population thats on covered california. It subsidized. So trying to figure out the exact impact of the rates on which populations other nontrivial exercise but i do think we ought to try and do it to get a handle on what is the impact here of that absolutely. Were working with you shortly on the new program we have outlook set help subsidize some these individual so we could certainly get that data point for you and ill make sure staff gets that when im actually worried about people be around from and to plan as you fall the lowest cost what providers that you go from one provider in one system but next year in changes because of those cost structures and they go to another provider and so you creating this discontinuity because of the changes in funding and fanning thing. It sounds like its going to be affecting less Health Network whether we are affecting us we are community and certainly around the margins we see people moving in and out of medical, into plans come out of plants. So youre going to see a lot of flux i mean to but the thing i know that i think in the past who knows what will be in the future, people tend not to choose the bronze land. They tend to choose the solar plan. And the tension on the one hand, theres this tension of people having it move around planned because the plans change. On the other its engaging the population in their health care in ways which previously people were unengaged. So, i mean, try and balance out the positives and negatives of that. I think it is early in this experiment. We will definitely calendar an update on that for you. All right. Were probably ready for the next agenda item. Sure. Item 4, general Public Comments. Im not received any request for general public, to get other any at this time . We can move on to item 5 which is a report back in the finance and Planning Committee meeting from today. Commissioner chung good afternoon commissioners. The finance and Planning Committee met earlier this afternoon and it was a short meeting. We had actually put recommended, the august 2015 contact report and one new contract with environmental logistic and in the amount of 1. 7 million dollars. Which covers from august 1, 2016 through june 30 2018. Its an eight year country. Those are two items on the consent calendar for the commission to approve. The item is before you ready for a motion. We are talking about items six consent calendar . Betwixt correct motion to approve second is there further discussion on this item . All those in favor say, aye speak [chorus of ayes] proposed . The item passes. We did thank you commission. Item 7 is the fiscal year16something approval request of the it ministration for the laguna honda gift fund. Hi. This is, from laguna honda. Good afternoon commissioners and dir. Garcia. I am here to represent the laguna honda gift Fund Management community to ask for your approval. The laguna honda resident gift Fund Proposed budget for this oh year 20162017. The provider list of the budget that we proposed, you can see we ask for total budget for the 201620 something in the amount of 297,000. Its about 2. 7 increase from the Previous Year budget of 289,000. Most of the line items are pretty much in line with what we had in the prior years. Except for one new item that is the last one on the list. Assistive technology. This is from the new donation from the donor Molly Flesher of the 100,000 donation which came to in front of this committee for a approval several months ago and it just went to the Mayors Office for their inspection last week. We budget for 10,000 donation dedicated to the purchase of assistive technology. Services for the laguna honda resident. So, one thing you might ask, why the budget was at 289 for last year and actually expenditures only 180,000. Numbers that were provided to me. These know that the Actual Expenditures at a time would wait some and this report because we are not quite close they get good its only for until the end of the may 30 2016 and so there were actually about another 5000 more expenses good its going to hit the final expenditure report. Also, a couple reasons why some of the errors we understood last year because the second fund to the bottom of the list is endoflife program was a new program. A new donation from dr. Rose last year. We do not get our final Mayors Office board of supervisors [inaudible] approval into the end of september. So there was a delay starting the project and also we spent some time to do the planning and also finding of trying to get a contract establish contact purchase order. So, theres a reason why we havent been able to spend the actual june what you see in this line item get weve about 2000 in expenditures. Still substantially under than what we budgeted but we will catch up next year. So, im ready to if theres any questions . For approval . On locus of Public Comment request for this item when we take Public Comment and then we will come back. Dr. Kerr . Hello again. Dr. Derek kirk. This budget for laguna honda this Patient Gift Fund was not disclosed at laguna honda joint conference committee. Its precisely the kind of laguna honda specific information that lh jcc meetings were designed to convey. Had it been presented at Laguna Hondas jcc meeting, someone would have noticed the remarkable decline in the funds allotted to the positive care aids program. If you just look at the budget, you will see that last year positive care was allocated 5500 from the gift fund and spent 4000 of it. So, how much is budgeted for this year . 3000. Out of 15 programs, positive care is the only one that is receiving less than it spent last year. This unique and unprecedented anomaly should be explained before you approve the Patient Gift Fund budget. Thank you very much thank you. Commissioner karshmer i just want to make sure i have this right. We have been guided by the City Attorney that this gift fund comes to the full commission for approval . If i can expand on that is because budget decisions are made by the full commission and not by any committee. So the City Attorney thought and guided us last year the second time this is happening it made sense to come to the full commission. Thank you. Any other questions . I had to. One, can you remind us the process that you go through to decide what the budget is for this so, we do have a gift Fund Management committee that consists of several executive staff at laguna honda and also on button. Also residents represented. We do meet every other month to go through not only the budget also the Actual Expenditures and the different programs suggestions. So, we typically closed to year end, will prepare the balance report and present to the committee exactly what you see here. Was last years budget, what was the expenditure, and what other new programs new donations coming in then suggestions of the based on the stork number of the budget and we tend to budget on the high side so that we dont have to keep coming back every time to ask for a new spending for the gift fund so that way we can provide better Resident Services and then have an effective way to be able to fund any of the new programs. So, once the Committee Approves and then i will bring the proposed budget back to the committee for their review again then bring it to