Like the Substance Abuse medical is the bridge to reform waiver as of 13 it is a demonstration waiver 1115 waiver called the organized Delivery System of medical waiver so the state amended the state plan and made a parole to cms approved this august to show it if they increased the Services Covered by drug medical that they could by organizing the system and having smooth trisz from levels of care and using evidence based practices they could improve the care and overall costs of medicaid would not go up you can opt in or not opt the community likes a demonstration waiver they should we we already do so were coming in and the bay area was chosen as phase one so there are several tasks for Substance Abuse services im in charge of one to have the implement plan with the timelines for everything and another one to set rates we negotiate with the state and make a new contract we want the rates to be realistic because if you compare grants the drug medal there is a huge increase in accountability and recordkeeping required for the providers as you may know Substance Abuse is contracted out and so the main task we already have in the orchid Delivery System almost all the services described it is just we have to document those things in different was including the criteria and so the main task weve been working on since 2013 when they started this job was to get our current providers who are not drug medical certified to apply for certification which is a long orus process so we have maybe five or six that have applied and maybe of in the next week or so including all the residential programs that have not burger to bill the drug in the short time so when they apply there is no retroactive payment no incentive in other words, the state didnt give start up incentives the programs are suffering how can i hire a medical director not had to have one before well so for we dont have the money to help you but in the future a steady stream of income maybe thats your incentives those are the things to provide our providers weve hired a instead of person that is wonderful and lead in our Substance Abuse department to help support people get certified and when they get those letters back every single application for drug medical hundred percent of them get a remediation laundry list of things to check off and get in form and that notarized so were working on that right now. Thats great, thank you. Commissioners, any questions . Do you mind, if any. I have a few questions for dr. Martin ive known dr. Martin for a long term wards to the fee waiver that is about expanding Substance Abuse for the medical program this is been the big effort part of this we didnt have a basic drug medical benefit so i want to thank judy for arguing on behalf of the county to get an extended benadryls do come without obligations and responsibilities so with regards to the demonstration it talked about 10 Community Coming online this is the first phase of the 10 county; is that correct. The 10 community were places theyve tested out things now most of the communities are opting in this is the actual implementation starting august 13th phase one is the bay area exultant that refers to bays montgomery and San Francisco bay area those are part of bay area counties and as far as i know theyre all opting in. As far as the services we have a full breath of services from residential to outpatient to medical services and it sounds like youre trying to bring enough providers on do we have enough provider to meet the needs of city and when will we be there having enough services for the patients. Im glad you, you raised that commissioner pating david was up on the Advisory Committee he had a lot to say how it is designed were missing some a became clinicians although we have care plans that are really busy in primary care physicians were discussing starting safety net oriented awe definition medication residency with the 486 we need licenses providers with health care who are licensed and connection may diagnoses right now a lot of the programs only work with certified xhounldz we need to bring the level of professionalism higher in the field and so, yes we need to have i mean right now such minimal payments are brought in by drug medical a lot of the programs suffer from entrylevel people interns and high turn over when i meet with the providers i had a staffing check with them and the theme is also we need more counselors weve lost them they come in and work for a couple of months on the one hand were training new people in sabs when they go on to other places on the other hand, it is a high stress for the programs to be doing that all the time. So the last question i guess is financial San Francisco has had a very whether we get reinforced from the state we offer the services for every person not treated end up in the longshoreman emergency room in the hospital so i think weve been ahead of the curve wards to the new funding coming in for the medical waiver will this change the Financial Plan at all will we get more money because we offer so Many Services there wont be new funds following or well be responsible for things not funded how will the match of u up for the medical environment. Yeah. I dont know that a clear picture it hadnt happened net i think this is a pioneer tax well pay in terms of not being dramatically able to reduce things like looerments visits we have those paid and the general fund the main difference well see is that maybe general fund can be used for something slightly different missing or not used at all maybe and the expansion has brought in a significant amateur of federal match hundred percent matched for the medicals methamphetamine clinic weve paid for assuring for the uninsured people now since 2013 a lot of those people are insurance particularly the methadone clinics have worked really hard to enroll their uninsured people into medicare to start billing. Thank you you have your work cut out for you and its exciting so maybe this effects the waiver in San Francisco. Thank you very much item 4 is there a Public Comment ive not received any requests. Item 5 a report back from the finance committee. Ms. Johnson. Good afternoon the finance committee met 3 oclock we went through the full contract and also the contract report it is all on the consent calendar and in addition the also have added you can romanced for the request from cat and this is for the medical respites and the reason for the relocation there is actually expanding and a. D. Another thirty medical records to their current bed coincidence all on the speaker cards and documents to be included should be submitted to the clerk. Calendar. We asked if anyone should be removed. If the commissioners want things for separate items. Shall we move for approval . Move to approve the consent calendar thank you a second. Second. All in favor, say i. I. All right. Thank you commissioners thank y thank you sxhaurn item 8 the San FranciscoGeneral Hospital bylaws good to see you before just to note commissioners these revisions have been reviewed and recommend for approval by the general cc. Maybe give us background why some come here and jc dont need to come here. The only thing approved by the jc are the minutes and the Financial Report and anything for confidential patient reports but policy comes to the full commission. Dr. Mash i have 3 the changes in the rex rules and regulations on the current rule limited to positions of the medical staff for the professionals Nurse Practitioners to the certified midwives pursuant to the standard dices procedure for the plan we submitted to the dph in response to the recent survey they conducted. So we do all those of a banish. Review them all and vote together unless theres an issue if you want to pull it out but i believe you can do it all at once. The next two are linked they relate to tightening up the process of temporary privileges are granted and so the first is currently, i grant the privileges for the chief of medical staff after the medical staff office valid day the medical licenses and training and letters of reference and service chief can request them to not go through the several month process for the people by conventional and it fournt were granting about 92 percent temporary privileges so thats higher than any other Health Care Organizations we want to tighten this up so thats what those balling changes the first action allows the criminal committee and medevac to hold a vote or business that is route wouldnt necessarily be limited but a necessary piece in order to get in time down the second is changes on the granting of the temporary privileges so temporary privileges can be granted to applicants that have clean packet it is defined as completed credentials are verified and not practice sites or missing in the packet its clean to share with the credible committee and credible committee holds an email approval for a vote and approve at which point if there is privileges needed before the jc c needs the chief of the medical staff can grant the temporary privileges that this tightens up, up not Credential Committee will approve with the chief of staff i hope to have the two email practices we can get most of the applicants to jc c and approve them and the temporary is used in the jc c has met in another month approval thats the changes in the temporary privileges. It would be reasonable to characterize those not the changing of credentials required. Right it doesnt consider that are required. The goal to reduce significantly the number of temporary privileges by getting packet through the Credentials Committee and after the jc c for regular approval and not possible at least the chief of staff is granting the temporary privileges on both packets seeing and approved by the credible committee and currently theyre not i see them and sign them. So the process is granted a reduction in a person has a significant reduction around ten percent. Any questions. I brought those they look standard and many hospitals do this to expedite new hirings and getting people in i think this is fine. Thank you for that comment on issues like this it is important to a licensed physician to Pay Attention to this so i really precious that. I should have said we look for best practices elsewhere and approval is very standard stanford as zero percent because they coffer that by email tests not possible so many things we can do by email now. Yeah. I wonder if you like just responded to a couple of things pertaining to the operational definition number one the we talked about the approval of straightforward and noncontroversial matters is there a working definition thats been you know disseminated and as an example i can think of things were there was concept called waiver for appointments, etc. But waivers are different meanings whether by the freds or state or university or medical staff a really, really comprehensive understanding i want to make sure that everybody understand what is straightforward means and theres a. Theres no change in the credentialing requirement their linked to medical they implemented revisecy theyre in Good Standing where they train theyre not significant metal malpractice grants ensue all the reference letters are complete and verified and none of that has changed i mean, the chair the credible committee does have some discretion under the definition of clean for example, how much of a malpractice settlement will constitute that packet not lean clean and sent to the Committee Members for a vote but if the chair did send it forward the packet will contain that information and any single Committee Members votes in the negative it has to go through the formal credible. Thank you very much the other one pertains to the temporary privileges 5. 2. 2 i was curious why the deletion of concurrence of the chief which i have officer on the staff i mean sometime pass there was the ceo and the associate dean or advice dean can you share with me why that would be this is 42. 2. Thats a good pickup because it shouldnt be that. Okay. Can you give us a letter so everyone can follow. 522 under the application it says the chief of staff for the ceo can grant temporary privileges i missed that i dont know the ceo and the current chief of the medical staff sign all privileges temporary. Okay. Thank you commissioner sanchez. Just wanted and great catch. There are no other questions well entertain a question. Disapprove of the all in favor, say i. I. Dr. Marks. Ill not no Public Comment for this item move on to item 8 did San Francisco heartache networ update. Good afternoon, commissioners im roland the director of the San FranciscoHealth Network ive come to you on at least two occasions previously to give you a formal update of the network you mean the network was launched when i was postponed in november of 2012 it took 3 months for the team to coalesce and condense the work between our integrated planning process and again with the h m a performance that generated over a hundred and 50 metrics and milestones that are identified in order for this network to be successful we need to the set and meet i came to you first to give a six months just want and then a one there update were happy to present our 18 months update a significant update that represents the culmination of our pin way forward mefgs those are the key metrics weve presented and you approved early on that guides the development of the network and so youll hear in 18 months an update where we are with the metrics and so other key medics with those with the Patient Experience i want to thank my Leadership Team deputy City Attorney and our chief medical officer that will take you through those metrics we hope youll get an idea of the work and get a picture of what we think we should moved in setting the next set of measures for the network and were happy to present this ill ask dr. Chin to come to the podium. Thank you. Good afternoon commissioners director garcia it is my pleasure to present to you today about the metrics so basically, what im going to do it is give a highlevel of the stream to the ends of the fiscal year and share thoughts e thoughts about what were learned and pivot and talk about how were thinking about selecting future metrics according to the challenges and importantly how our thinking in the true framework to develop a cohort set of metrics Going Forward this slide should look familiar those are the 10 measures their broadly categorized into 3 grownups and so namely being able to provide know asset to care and stewardship for the reality that our patient have a choice were going to be k350e9 with them and meeting to rain our own staff so those metrics came out that the engagement theyve served for 18 months, however, with the next time maturing we realized the framework are not what we need to move forward im walk us through and talk about how well be moving forward this is again, you this look familiar with a metric a star weve met or exceeded our proposed target a combra arrow up and down this is a favorable change with between the last database but there is another arrow where are in the wrong direction weve exceeded our target this is a testament to the work across the network this represents the Behavorial Health and speciality care a wide range effort ill give you more details ill go through to quickly im happy to field our questions so measures one and 2 in my mind represent our investment in primary care is the foundation of an integrated system our panel size is a one measure we made considerable process that is a lot of work and a lot of factors there and in terms of our second measure the support staff ratio while we technically dont have a green star weve pretty much met our goal and weve stated there no are the last two quarters measure 3 is about constitutional fill there are measures for Laguna Laguna honda it has pretty much hit its target every quarter and the last uptick San FranciscoGeneral Hospital is an prauchlt so the threequarters in particular attributable to the documents and care contributions are a hard nut to crack that is the larger social issues we lost 2 hundred units of boarding care by these that inhibits our ability to provide levels of care 4 around the fiscal stewardship this is while we do dont have the formula this is a close i have it well be getting a gastrostar well come back if we dont 5, 6 and 8 in some ways highlight our challenges with data and with what measures weve chosen so 5 is the workforce experience and in april we completed our very first dpw wide Satisfaction Survey the 19 percent were the percentage of employees when rated us a 9 or 10 with the best places to work thats compared to our National Benchmark of 28 percent the issue the next collection is slated for another two years in terms of Civil Service hiring youve seen the lead 7, 8, 9 is the highest in the city hundred and 90 days for sifrl positions theyre an annual cumulative methodology is the note amenable to the report hundred and 90 days from 20132014 and 20142015 is drops to hundred and 68 dazed there was an improvement and 8 was measuring the culture and engagement it is notoriously difficult thing to measure we took a stab at the intersection by having our sf h 50 do a web basis around the web network and answer questions it hundred percent you know response everyone got it right if you get a hundred percent the first time it is not something to formulate so going back to number