[0:05] this is a test.

[0:05] >> good afternoon.

[0:11] I'm going to call the May 15

[0:15] budget workshop to order.

[0:19] please call the roll.

[0:22] >> supervisor kniss, cortese,

[0:25] wassermann, vice

[0:27] President Yeager, President

[0:28] Shirakawa, you have a quorum.

[0:31] >> ladies and gentlemen please

[0:34] stand and join in the

[0:35] pledge of allegiance.

[0:35] >> I pledge of allegiance, to

[0:36] the flag of the united

[0:36] states of america and to the

[0:37] republic for which stands, one

[0:38] nation under God, indivisible,

[0:40] with liberty and justice for

[0:49] all.

[0:51] >> thank you item three is

[0:51] public comment.

[0:57] I have two speakers at this

[0:57] time.

[1:00] linda kincaid and richard

[1:02] calhoun come on up please.

[1:08] Give you a couple minutes to

[1:09] speak.

[1:10] Good afternoon.

[1:14] Hold on a second, is the mic on?

[1:17] Let's make sure the mic is on.

[1:21] >> thank you, my name is linda

[1:23] kincaid.

[1:30] I'm speaking on behalf of

[1:33] jazell. Notice of rights and

[1:34] file states unless the court

[1:39] has limited or taken the right

[1:41] of way, the conservative keeps

[1:43] right to receive personal

[1:44] mail.

[1:46] The court has not taken away

[1:49] her right to visitation.

[1:52] However, the public guardian

[1:56] has violated that right

[1:58] since becoming conservator in

[1:58] 2010.

[2:00] She was allowed to visit her

[2:02] son marcus for less than 2

[2:03] hours in the past two years.

[2:05] She is not allowed visitors

[2:06] from the community.

[2:08] She is not allowed phone calls

[2:09] and her mail is

[2:10] intercepted. She lost about a

[2:13] third of her body weight

[2:16] under the care of a public

[2:17] guardian.

[2:19] She needs new eye glasses.

[2:25] she is rarely allowed access to

[2:26] hearing aid.

[2:29] Her world is dark, silent and

[2:30] very lonely.

[2:32] She pray every night that God

[2:32] take her.

[2:37] I pray santa clara county will

[2:38] protect the public

[2:42] guardian.

[2:48] >> thank you richard calhoun.

[2:49] >> good afternoon.

[2:50] The public guardian spent about

[2:53] 45 minutes on the phone

[2:56] with me regarding my

[2:58] mother-in-law elder abuse case

[2:58] in

[2:58] southern california.

[3:01] They assured me that abuse will

[3:02] not happen here in

[3:03] santa clara county.

[3:05] it's happening under his direct

[3:07] control at that time of

[3:08] the conversation.

[3:09] That abuse happening in this

[3:12] county is worse.

[3:15] The county despite selling our

[3:16] house for $350,000

[3:21] recently -- she has to use

[3:22] toilet paper.

[3:26] she has to use toilet paper.

[3:27] Kleenex is not that expensive.

[3:30] We walked across the street and

[3:31] bought three boxes.

[3:37] There's something wrong.

[3:38] The pastor of westgate church

[3:39] should be able to walk

[3:40] over and visit.

[3:41] He was denied.

[3:42] I was denied visits.

[3:44] Everybody has the right to

[3:51] visits, even prisoners have

[3:53] rights to visits.

[3:55] But yet the guardian is not

[3:58] letting me visit her.

[3:59] That takes time in southern

[4:02] california, we got no

[4:06] citation approved for months.

[4:12] then you probably heard about

[4:13] it, there was conviction

[4:14] of bribery down there.

[4:16] We already have four about

[4:17] dozen investigations under

[4:18] way.

[4:20] There's probably about five or

[4:21] six here in santa clara

[4:23] county happening under your

[4:24] public guardian and you guys

[4:27] need to wake up and pay

[4:28] attention and find out we

[4:28] cannot

[4:29] visit our elders when they're

[4:31] under the care of guardian.

[4:32] That is wrong and it's abusive

[4:33] and it's a human right

[4:36] the violation and we should not

[4:37] tolerate it in this county.

[4:40] Thank you for your time.

[4:42] >> be richard, we mentioned

[4:43] before.

[4:45] We cannot engage on issues on

[4:46] this agenda.

[4:47] I don't want to gauge back and

[4:47] forth.

[4:50] for the record, our public

[4:52] guardian office does great

[4:54] work protecting those most

[4:54] vulnerable in our community.

[4:56] I understand there's issues out

[4:58] there in some of those

[4:58] homes.

[4:59] We're on top of it.

[5:01] >> I will say, we brought this

[5:03] to your attention two

[5:05] weeks ago and nobody

[5:06] communicated in any shape or

[5:07] form.

[5:09] I did hear from Mr. Cortese and

[5:11] therefore it's not

[5:13] happening. I'm sorry,

[5:15] vacations doesn't take priority

[5:15] on

[5:16] someone personal right.

[5:17] >> I understand richard, you

[5:18] will be contacted by

[5:20] staff.

[5:21] Thank you.

[5:22] Next item -- anyone else want

[5:24] to address the board?

[5:26] I have cards on other issues.

[5:30] On this item on the opening

[5:30] session.

[5:31] i see none in the room.

[5:35] Moving on to item four, vivre

[5:37] view and county executive

[5:38] fy '13 budget.

[5:38] >> Mr. President, members of

[5:39] the board.

[5:43] I like to give a little

[5:45] introduction to the proposed

[5:51] budget that we are starting to

[5:56] evaluate today.

[6:07] First slide.

[6:09] We've been discussing a

[6:11] maintenance budget for a number

[6:14] of months now and I would like

[6:16] to clarify maintenance budget

[6:18] does not mean status quo.

[6:21] What we focused on in this

[6:23] budget as we've developed

[6:26] it, is trying to not only

[6:27] maintain the services that we

[6:29] are

[6:31] providing but also change the

[6:32] style and process with which

[6:35] we provide those in order to

[6:37] reduce the cost for unit

[6:39] service.

[6:40] Then fundamentally rebuild our

[6:41] foundation which

[6:43] includes rebuilding both the

[6:44] physical and financial

[6:46] infrastructure of the county so

[6:47] that we can prepare for the

[6:48] future.

[6:51] We know that this year's

[6:52] budget, fiscal year '13, will

[6:55] give us a bit of a break from

[6:58] the more than a decade of

[6:59] reduction that the board has

[7:05] been asked to take.

[7:08] However, that brief relief will

[7:10] not last forever.

[7:11] We're preparing the

[7:12] organization for the future.

[7:16] i like to point out that

[7:18] concessions from labor had an

[7:20] enormous part in helping to

[7:21] balance this budget.

[7:24] As you remember, last year, we

[7:26] asked labor for

[7:29] concessions in the general fund

[7:31] amounting to $75 million.

[7:33] They were very difficult

[7:34] negotiations but successful.

[7:37] our partners in labor and our

[7:38] employees take great

[7:41] credit or should take credit in

[7:45] great part for this budget.

[7:47] You'll notice as you go through

[7:48] the budget, you won't

[7:50] see a line item that says $75

[7:50] million.

[7:54] All of those concessions have

[7:58] been successful and

[8:00] they're built into the object

[8:03] one cost of each department.

[8:06] As we look forward, we're

[8:07] looking at a new normal.

[8:09] There's been a lot of talk

[8:12] about in the economy lately.

[8:14] But not a new normal just

[8:17] because we don't see an

[8:18] amazing number of jobs

[8:20] returning to the nation but

[8:21] because

[8:24] at a county level, we can no

[8:26] longer rely upon state and

[8:27] federal revenue to keep pace

[8:32] with the need for services.

[8:35] Also, with healthcare reform

[8:41] changes, our hospital and

[8:47] clinic system, santa clara

[8:48] valley medical system, where we

[8:55] can no longer rely on lump sum

[8:58] supplemental payments.

[8:58] Next slide.

[9:04] we do have a bit of respite

[9:07] from deficits because in

[9:10] 2012 this board took the very

[9:11] thoughtful approach of only

[9:14] using one time moneys to solve

[9:17] one time problems and not

[9:18] putting them into ongoing

[9:21] deficits.

[9:22] That has stabilized our budget

[9:24] to great extent and

[9:26] we've also noticed some

[9:28] stabilization of the economy

[9:28] around

[9:30] us with some slight up tick in

[9:31] revenues.

[9:35] However those revenues are

[9:37] typically related to public

[9:38] safety realignment.

[9:41] we've had relief from

[9:42] reductions this year.

[9:46] As a matter of fact, you'll see

[9:46] in this proposed

[9:49] budget, we're actually adding

[9:49] positions.

[9:51] Total over 300 positions.

[9:52] I will point out many of those

[9:54] positions are funded

[9:56] from other sources than the

[9:59] general fund we've looked at

[10:02] each one closelily to make sure

[10:04] that next year, fiscal year

[10:07] '14, will not be faced with a

[10:09] situation of reducing those

[10:12] positions that we're now adding.

[10:14] We think they're all justified,

[10:16] we think they are all

[10:16] critical.

[10:24] we have utilized them to try to

[10:28] rebuild our foundation.

[10:29] However this brief respite will

[10:30] give us time to refocus

[10:31] our attention in the county on

[10:34] what our core mission and

[10:34] values are.

[10:39] The board of supervisors

[10:41] adopted this mission and value

[10:45] statement over two years ago.

[10:48] We have an opportunity now to

[10:49] make sure that it spreads

[10:51] throughout the organization and

[10:52] refocus the organization on

[10:59] the values that are critical to

[11:00] our future success.

[11:06] as I mentioned in the last

[11:09] decade, we have deferred

[11:10] many capital projects and much

[11:12] maintenance in order to

[11:13] continue provide services.

[11:15] This year we have the

[11:17] opportunity as the economy

[11:21] stabilizes to begin to rebuild

[11:22] and some of recommended

[11:24] budget invest in four key

[11:25] issues.

[11:28] Number one is the retiree

[11:32] medical benefits also called

[11:32] opeb.

[11:36] Gary will give you more

[11:38] detailed discussion on this

[11:40] budget.

[11:41] We also rebuilding our

[11:42] inspection technology systems

[11:45] putting some money into a few

[11:46] of the capital projects that

[11:49] have been on hold for a long

[11:51] time.

[11:53] We're recommending some

[11:55] reserves because of the

[11:56] question marks at the state

[12:00] level that have only gotten

[12:02] larger in the last day because

[12:08] of the May revise.

[12:09] Briefly, as I mentioned gary

[12:12] will give you more details

[12:14] later, but in recent years --

[12:16] >> President Shirakawa, can I

[12:18] ask a quick information

[12:20] question?

[12:24] Where you listed epic and the

[12:25] funding sources how they

[12:28] will be spent, within there

[12:29] somewhere is an incentive bonus.

[12:35] Are you going to mention that

[12:36] at some point?

[12:40] >> yes, we will mention that.

[12:43] >> is that another time?

[12:47] >> we'll get there.

[12:49] with regard to the retiree

[12:50] medical benefits, this is a

[12:54] very significant problem.

[12:59] A decade ago, this county was

[13:03] very forward-thinking and

[13:05] unfunded the light retiree

[13:06] health.

[13:08] over the decade of cuts of

[13:12] funding to that system has

[13:13] decreased.

[13:14] At this point we're

[13:19] recommending in this budget 75%

[13:23] funding to the normal cost for

[13:23] retiree health with a

[13:29] commitment to go up to 100%.

[13:32] Normal cost is a word used to

[13:34] describe essentially what

[13:36] would be equivalent to minimum

[13:39] payment on your credit card

[13:42] not really adequate to actually

[13:44] fund the unfunded liability

[13:45] in the long run.

[13:47] But certainly a minimum and we

[13:49] think you should commit

[13:50] to that.

[13:52] We need to develop further

[13:57] strategies in the future to

[13:57] deal with that.

[13:59] Information technology, we are

[14:01] recommending some

[14:02] significant investments in

[14:05] technology and as supervisor

[14:07] kniss pointed out, with regard

[14:09] to epic, one of the

[14:12] advantages that we have is that

[14:14] we are anticipating money

[14:15] from meaningful so called

[14:17] meaningful use which is federal

[14:22] money that will help defray the

[14:26] cost of revamping the entire

[14:28] core health information system.

[14:33] we have decided to issue debt,

[14:34] technology bond for

[14:34] $100 million.

[14:36] This is not a bond that needs

[14:38] to go to the voters, this

[14:43] is a bond we paid for based

[14:46] commitment from the meaningful

[14:47] use money.

[14:50] $70 million of that will go

[14:52] towards epic.

[14:54] $20 million will go towards

[14:55] general fund I.T. Project.

[15:01] $10 million for the cost of

[15:02] issuance and contingency

[15:02] fund.

[15:04] You can see that the total cost

[15:07] of epic that's budgeted

[15:11] at $68 million, most of that

[15:13] will be from bond proceeds.

[15:17] There also be will money from

[15:19] mental health services

[15:20] act.

[15:23] These are the list of the

[15:24] general fund I.T. Projects

[15:26] that we are recommending that

[15:28] you fund.

[15:31] You'll see that all of them are

[15:32] critical function.

[15:34] on the left are the ones we

[15:38] think we can fund with the

[15:38] bond proceeds.

[15:40] They are basic enterprise

[15:41] functions that are required

[15:43] for us to move forward.

[15:48] Things like public safety

[15:50] radios, sheriff's mobile

[15:52] computers, enterprise system

[15:56] called clarinet and our

[15:57] voiceover internet protocol

[15:58] system which helps with

[15:59] communications.

[16:02] We did not add all the I.T.

[16:07] System in here.

[16:11] These are just the ones that

[16:12] are absolutely necessary.

[16:12] Additional I.T. Projects which

[16:16] will not be funded

[16:22] through the bonds include the

[16:25] assessor system, modifications

[16:29] to kronus which is our time

[16:30] sheet keeping mechanism the

[16:32] cloud system and you can see

[16:39] also public safety radios.

[16:41] The next category that we're

[16:43] recommending for

[16:43] additional foundational

[16:45] investment is capital programs.

[16:48] I won't go through all of these

[16:49] capital programs.

[16:51] Again, these are actually small

[16:55] number of the programs

[16:57] -- projects that we need to

[16:57] accomplish.

[16:58] These are the most critical

[17:04] ones and totals up to

[17:07] $13.7 million.

[17:13] Terms of budgetary reserves, as

[17:14] always, your reserve

[17:15] we're keeping at 5% general

[17:16] fund revenues.

[17:20] We're recommending a funding

[17:22] $10 million for economic

[17:24] uncertainties from the state

[17:25] and fed.

[17:27] As I mentioned, the state

[17:30] proposal particularly the

[17:31] recent May revise has a lot of

[17:33] questions associated with it.

[17:36] At this point, we're doing

[17:37] analysis to try to decide

[17:39] exactly effect it will have on

[17:39] us.

[17:42] There are cuts recommended to

[17:45] medi-cal and safety net

[17:46] hospitals.

[17:47] Actually, it looks like to the

[17:50] best of our analysis at

[17:55] this point, those cuts will not

[17:56] have an effect upon us this

[17:58] year but it certainly will have

[18:01] effect upon us next fiscal

[18:01] year.

[18:03] However, don't hold me to that

[18:05] because there's still

[18:06] details we need to straighten

[18:07] out.

[18:11] As you watch the federal budget

[18:12] process, you remember

[18:12] that there automatic trigger

[18:17] cuts that are built into the

[18:20] federal process from last year

[18:22] so we're very concerned if

[18:24] congress and President Don't

[18:27] move ahead with effective

[18:29] budget or spending plan, we

[18:32] will end up with automatic

[18:34] reductions.

[18:38] We're also recommending a small

[18:39] set aside reserve for

[18:39] cash.

[18:41] This is not money we anticipate

[18:42] spending but this will

[18:44] actually help us with our cash

[18:46] flow issues which has been

[18:50] for the last two years, an

[18:51] issue.

[18:52] >> jeff, real quick.

[18:54] Last year we had extensive

[18:56] discussion on the

[18:56] contingency reserve.

[18:59] It's not all cash.

[19:01] just take 30 seconds to remind

[19:03] us again that the

[19:06] $96 million is not all cash.

[19:07] >> yes.

[19:09] >> we don't have to have the

[19:11] discussion again.

[19:14] >> the contingency is cash.

[19:17] It's an unspent allocation or

[19:18] appropriation.

[19:19] >> assets though?

[19:23] >> no, it's a budgeted

[19:24] allocation.

[19:27] It is equivalent to cash.

[19:28] >> what you're talking about is

[19:29] that we get the revenue

[19:31] over a period of time.

[19:32] We've allocated at the

[19:33] beginning of the year so we

[19:37] don't have a big lump sum

[19:38] instantaneously sitting there.

[19:41] >> how it was described to me --

[19:44] >> it's like buying on time.

[19:47] >> right, we also had some

[19:49] assets included in there.

[19:52] We had discussions about not

[19:52] being actual liquidable

[19:53] cash.

[19:56] I just want do make it clear

[19:57] because it's a different

[20:02] what we had last year.

[20:06] >> the fund balance is part of

[20:09] a fund balance.

[20:11] It's not 100% cash but it's

[20:12] tied into other assets

[20:13] which will convert to cash over

[20:18] a period of time.

[20:18] >> right.

[20:20] I guess that was my point.

[20:21] >> that's it.

[20:25] >> when you said asset, I was

[20:25] thinking you were talking

[20:30] about tangible assets as

[20:32] opposed to assets like

[20:33] receivable.

[20:37] >> the basic bottom line,

[20:38] there's not a lot of cash

[20:39] around.

[20:40] >> we had a long discussion

[20:41] last week.

[20:45] >> thank you Mr. President.

[20:47] May I ask one question page 7.

[20:56] On page 7, the debt issuance, I

[20:57] see the $70 million,

[20:59] the $20 million and $10

[21:00] million,ed needs for

[21:00] replacement of

[21:03] that debt, how is that

[21:04] happening?

[21:06] >> technology bond comes from

[21:08] the meaningful use money

[21:11] and it's also the general fund

[21:12] is committed to pay it back

[21:14] also.

[21:18] But it will come out of the 921

[21:19] budget.

[21:21] >> the $10 million jeff, where

[21:22] it says cost of

[21:27] issuance, I understand cost of

[21:27] issuance and contingency.

[21:29] What does that mean by

[21:30] contingency?

[21:33] >> it means basically that we

[21:35] have anticipated the cost

[21:40] of the infrastructure programs

[21:42] in a very rough way.

[21:45] We're not 100% sure those

[21:46] numbers are completely

[21:47] accurate.

[21:49] >> construction project, you

[21:50] got 10% contingency built

[21:51] in.

[21:54] Could end up with those moneys.

[21:55] Okay thank you.

[21:59] >> going back to page 11, a

[22:01] little bit about valley

[22:02] medical center and you'll hear

[22:06] a whole lot more later on in

[22:07] the day.

[22:09] You'll remember from mid-year,

[22:11] this year, this fiscal

[22:14] year, we anticipated about a

[22:16] $60 million current deficit.

[22:20] We look like we're on track to

[22:21] solve that deficit

[22:23] problem as was mentioned in

[22:27] health and hospital last week.

[22:29] We also had to commit $30

[22:30] million from the general fund

[22:34] in order to deal with that.

[22:36] Now, as we've known and

[22:41] mentioned many times in the

[22:42] past, the 921 fund, the

[22:44] enterprise fund is a very

[22:45] difficult

[22:51] fund to project because it's

[22:58] contingent revenue.

[22:59] Contingent on visits and mix of

[23:01] patients and lot of

[23:01] other issue.

[23:04] We have many billing problems

[23:05] associated with that.

[23:08] even though we look like we're

[23:11] solving this problem, we

[23:13] do expect some bounces back and

[23:16] forth over the next couple

[23:17] of months.

[23:20] You might see in the financial

[23:21] things going up and down

[23:23] but we think that in the end,

[23:28] we'll end up balancing.

[23:31] the recommended budget for this

[23:33] coming year, for 2013,

[23:35] we looked at very carefully.

[23:38] You'll notice that it does

[23:41] include significant

[23:44] projections of new revenue.

[23:46] The county execs office and I

[23:47] know the board has been

[23:50] concerned about the past about

[23:54] projecting new revenue.

[23:54] However, it is a revenue

[23:55] generating enterprise fund and

[23:58] that's a critical component of

[24:00] the -- patient care revenue

[24:03] is a critical component for the

[24:04] overall picture.

[24:05] We had to project something.

[24:10] we looked very carefully trying

[24:14] to come up conservative

[24:15] projections based on experience

[24:15] in 2012.

[24:17] We think they are justifiable

[24:18] and reasonable and we

[24:20] think they will be obtained.

[24:23] We also focused on work

[24:24] process changes, schedule

[24:25] changes and patient access

[24:26] changes

[24:29] in order to increase revenue.

[24:33] then the final comment, if the

[24:37] projections end up not

[24:38] being accurate, we will have a

[24:42] plan b to you which will

[24:45] actually decrease expenditures

[24:46] significantly.

[24:49] We plan this year on watching

[24:51] the revenue in the county

[24:55] execs office on a monthly basis.

[24:58] We will keep close track of

[24:59] those revenues and any

[25:05] projections that look off, we

[25:08] will address immediately.

[25:10] Again, to reemphasize the risks

[25:15] that are associated

[25:17] with this budget, there are

[25:18] always risks associated with

[25:18] any

[25:19] budget.

[25:21] The budget is really projected

[25:22] spending plan and

[25:22] revenue plan.

[25:25] The projections are based on

[25:26] assumptions.

[25:27] Those assumptions can change.

[25:30] We need to let you know what

[25:31] the risks are.

[25:33] In terms of healthcare reform,

[25:33] you know that the

[25:37] supreme court is in the process

[25:39] of reviewing healthcare

[25:39] reform act.

[25:41] It's pretty much anybody's

[25:44] guess what they'll do if

[25:49] they were to reverse the act

[25:51] significantly, that would

[25:53] definitely cause chaos and make

[25:54] funding really unpredictable

[25:55] at the local level.

[25:57] We also have our own local

[26:01] problems, which I just went

[26:03] through at vmc that essentially

[26:05] boils down to turning the

[26:08] entire organization into a

[26:08] competitive organization

[26:08] compared

[26:12] to what has been in the past

[26:15] which relied upon lump sum

[26:16] revenues.

[26:19] Other local risks, I mentioned

[26:19] earlier on, the

[26:21] $35 million that's built into

[26:23] this budget for labor

[26:23] concession.

[26:26] Remember that this coming year,

[26:29] 2013, is when the

[26:32] nurses, dsa and the district

[26:34] attorney investigators

[26:37] contracts open up and we

[26:41] programmed into this budget the

[26:42] expected concessions from those

[26:44] unions.

[26:47] If we are not successful in

[26:48] obtaining those concessions

[26:49] that will be a problem we would

[26:55] have to address with more

[26:58] reductions.

[26:59] We also are expecting increase

[27:02] retirement cost this

[27:03] coming year 2013.

[27:07] These retirement costs will

[27:07] come out of our general

[27:07] fund.

[27:09] We will not ask the employees

[27:12] to contribute to any of

[27:13] that.

[27:15] We will also have the risk of

[27:16] the retiree health which

[27:17] will be discussed in a little

[27:18] bit.

[27:21] I think I talked about state

[27:21] and federal issues enough

[27:26] so we can move on to the next

[27:27] page.

[27:28] >> supervisor kniss had a

[27:28] question.

[27:35] >> on this one in particular

[27:36] jeff, because, ken and i

[27:39] said on health and hospital.

[27:41] We spent substantial amount of

[27:43] time especially with

[27:43] washington consultants

[27:44] discussing the supreme court

[27:47] decision.

[27:48] You referenced chaos.

[27:50] I think more than chaos will

[27:50] ensue.

[27:54] I'm not sure that we need to do

[27:55] this right away.

[28:02] i think we should at least be

[28:03] very technical term,

[28:04] noodling what happens.

[28:05] It's a three part decision

[28:07] they're making.

[28:09] The first one would essentially

[28:10] not require states to

[28:13] have health insurance.

[28:18] That begins to alter the entire

[28:18] thing.

[28:20] That's one of the thing that we

[28:22] have been the most

[28:22] concerned about.

[28:25] Then as you know, the question

[28:27] will secondly be, can

[28:29] they separate different parts

[28:33] of the law and maintain other

[28:35] parts.

[28:37] I think you're right.

[28:39] It's a toss up at this point.

[28:40] It's probably up to one,

[28:43] believe it or not, probably up

[28:44] to one justice which is quite

[28:45] significant.

[28:48] I don't want us to lose the

[28:51] importance of that and that

[28:54] decision being made and also

[28:57] that there is a saying this is

[28:58] correctly as I can.

[29:01] There is a group in washington

[29:03] who very much had it as

[29:07] their goal to eliminate the new

[29:10] healthcare law should the

[29:11] administration change starting

[29:12] next year.

[29:16] Again, we can't be aware and

[29:21] ready for all

[29:21] contingencies.

[29:23] but at least, because I know

[29:26] that folks like gary are

[29:27] very good of kind of thinking

[29:29] ahead on this kind of issue.

[29:31] I hope that we're keeping that

[29:32] in mind.

[29:36] That will be a rather dramatic

[29:36] alteration for where we

[29:37] have been heading.

[29:40] It wipes out that meaningful

[29:41] use and dsrip whatever we

[29:45] will use for it.

[29:46] It's considerably alters that

[29:47] for the future

[29:49] >> yes, you're right.

[29:52] We have been noodling on it.

[29:57] Sort of standard logic in state

[30:00] of california has been

[30:03] that whatever the supreme court

[30:04] does, they won't invalidate

[30:06] the waiver and the waiver has

[30:09] been structured as a bridge to

[30:10] reform.

[30:13] However, we're seeing with the

[30:15] governor's proposal this

[30:17] year in the May revise, there's

[30:21] actually local effort to

[30:22] change the waiver.

[30:27] if the federal law changed,

[30:29] it's quite possible the

[30:30] state might change its mind too.

[30:32] >> as long as we're not caught

[30:33] off guard.

[30:34] I know you won't be.

[30:36] I think it's also important for

[30:37] us to say that in

[30:38] public and on the record that

[30:41] we are very aware of what

[30:44] those just what you call them

[30:49] risks and threats are that are

[30:51] out here.

[30:53] Cause us all kinds of heartache

[30:57] as a county.

[31:02] Of course, the $16 billion

[31:02] surprise I think it's

[31:05] sobering for all of us.

[31:06] Thanks george.

[31:09] >> okay.

[31:11] Page 13.

[31:16] We talked about restoration of

[31:18] personnel.

[31:21] There are issues having to do

[31:22] with bit rebuilding and

[31:23] financial infrastructure.

[31:25] You will see there are

[31:25] additions back to fleet and

[31:28] facility to deal with our

[31:29] increasing space.

[31:30] Additions back to employee

[31:32] services to deal with many

[31:35] of our workload issues and

[31:36] additions back to social

[31:38] services

[31:40] to deal with inhome supportive

[31:42] services and senior

[31:43] nutrition, which have not been

[31:44] performing as well as we

[31:50] would like without those

[31:50] resources.

[31:52] This is a summary of our one

[31:53] time funds.

[31:55] I won't go into it in detail

[31:59] but you can see basically

[32:02] that we're committing again to

[32:02] the 5% contingency.

[32:06] We have built in there the

[32:08] commitment to -- the

[32:10] repayment of loan from retiree

[32:12] health that was utilized to

[32:14] purchase the downtown clinic

[32:15] site.

[32:19] We built in here the sale of

[32:22] the children's shelter and

[32:25] we're spending that money on

[32:26] issues related to children.

[32:33] that will be on your agenda

[32:33] later on today.

[32:35] We'll give you much more detail

[32:37] about public safety

[32:38] realignment during the entire

[32:40] process but, I wanted to point

[32:42] out that santa clara county has

[32:45] been recognized across the

[32:47] state developing the most

[32:49] innovative ab109 plan available.

[32:51] we've been very successful in

[32:56] it at this point with

[32:56] reduced recidivism.

[32:58] We have not seen a dramatic

[33:00] increase, even significant

[33:03] increase in our jail population.

[33:05] Although there are mixed

[33:06] population and the population

[33:08] is changing a bit towards the

[33:09] more serious offenders.

[33:11] This budget assumes that our

[33:12] allocation will

[33:14] effectively be doubled.

[33:17] The formula has been in the

[33:18] works with negotiations

[33:21] between c sac and the state.

[33:22] We're seeing preliminary

[33:23] numbers which suggest that it

[33:30] will be at least doubled and

[33:32] we're therefore planning to

[33:35] spend on probation and public

[33:38] safety services commensurate

[33:38] with that.

[33:41] We're going to have a new

[33:42] population.

[33:43] We expect the state will

[33:45] continue with its commitment

[33:49] to fund our services to this

[33:50] new population.

[33:52] It is true that there is no

[33:53] guarantee at this point

[33:56] that this funding will come

[34:01] through without some more

[34:02] attached requirements.

[34:05] I wanted to highlight one part

[34:07] of the budget that we

[34:08] have relied upon for the last

[34:10] two years now.

[34:13] That is the center for

[34:15] leadership and transformation.

[34:16] We've focused on trying to

[34:18] change the way that we

[34:20] actually do business and we've

[34:21] had great success with

[34:22] empowering our employees to

[34:25] look at their jobs differently,

[34:30] to improve performance, to

[34:31] focus on customers and

[34:32] transforming the workforce so

[34:34] that people can lead from the

[34:38] middle as they say.

[34:39] So far, there are 39 teens

[34:40] currently working on

[34:42] projects which have saved us

[34:45] well over millions of dollars.

[34:47] You'll even see in your budget

[34:51] book, break out of all

[34:52] of those teams.

[34:54] these are the milestone dates

[34:58] for this budget process.

[35:00] We're currently starting the

[35:02] budget workshop.

[35:04] Last day for submission

[35:06] budgetary items will be the

[35:08] 29th.

[35:10] We're starting our hearings on

[35:11] the 7th.

[35:13] We expect to be done by the 5th

[35:17] and then our final

[35:19] meeting after that to approve

[35:21] the entire process.

[35:26] I'm open to any questions that

[35:30] you might have.

[35:32] >> so, just on this one jeff,

[35:37] the center for leadership

[35:43] and transformation is

[35:44] transformative.

[35:46] I wonder if we have looked yet

[35:47] at finding ways.

[35:50] I know I seen it mentioned

[35:51] occasionally but finding

[35:55] ways to let the public know the

[35:57] kinds of differences we have

[35:57] made.

[35:59] some of you know, I was in

[36:02] pittsburgh at the end of

[36:04] last week and it was a

[36:08] conference put on in order to

[36:08] talk

[36:09] about transformation.

[36:12] It happen to concentrate on

[36:13] pittsburgh where we were.

[36:16] Pittsburgh as in pennsylvania

[36:17] and not california.

[36:18] the transformation that has

[36:20] taken place there and I

[36:24] never been there before, they

[36:25] certainly showed a great demo

[36:29] of what it used to look like.

[36:31] Many of you remember in the

[36:33] past, the three rivers

[36:35] there will catch on fire for

[36:36] the incredible amount of

[36:36] pollution.

[36:37] Transformation is so powerful

[36:39] that it really turning

[36:41] that city around.

[36:43] I think you can make an

[36:45] argument for this in this

[36:48] county and let our employees as

[36:50] well as those live in the

[36:55] county know that we have done

[36:58] this because, if I'm going to

[37:00] accept all that you say as

[37:03] gospel and so forth, it would

[37:03] be

[37:07] great to see a series in the

[37:09] murk that talks about what were

[37:11] the differences that came about.

[37:12] We made substantial investment

[37:13] in this.

[37:16] We involved stanford at a very

[37:17] high level and I think

[37:21] it's a wonderful opportunity to

[37:24] show how we use county money

[37:26] in different way to save a good

[37:30] deal of money and also to

[37:32] motivate and transform some of

[37:34] our employees.

[37:37] Just a thought.

[37:40] >> well, in this year's budget

[37:42] message, pages 9-18,

[37:44] we've gone through all of the

[37:45] current projects that are in

[37:46] place.

[37:47] You're right, it hasn't gotten

[37:48] out as much to the

[37:54] public as we would like.

[37:57] We had a couple comments in the

[37:58] newspaper but and we

[38:01] put out a number of press

[38:04] releases that don't typically

[38:04] get

[38:05] picked up.

[38:08] We have this on our website

[38:09] both our internal website

[38:11] and our external website.

[38:12] This year, will give us a

[38:16] chance to refocus on getting

[38:17] the message out.

[38:21] >> a series was highlighted in

[38:21] some departments.

[38:25] some person putting a face on

[38:28] it, can be very

[38:29] influential.

[38:31] Whenever I travel, there always

[38:32] certain counties that

[38:35] stick out including yours.

[38:40] Fun to do that.

[38:46] >> perfect.

[38:48] >> supervisor cortese.

[38:52] >> page 11 of the slides, you

[38:54] went through this, that

[38:56] page closes talking about a

[38:59] plan b under development and

[39:04] possibly revenue materialize as

[39:06] planned.

[39:06] Under development, can you

[39:10] expand on that a little bit

[39:11] more?

[39:13] I don't know where is it at and

[39:15] when will we hear more

[39:15] about it?

[39:20] Presumably if we were going to

[39:21] have a contingency plan,

[39:23] woe would have it ready before

[39:25] the project develop and not

[39:26] after.

[39:27] I'm just wondering when is that

[39:27] going to be

[39:32] forthcoming.

[39:34] I'm also wondering if any of

[39:35] the thinking this board

[39:37] asked to have looked at in

[39:38] terms of areas where there can

[39:39] be

[39:42] a firewall between the general

[39:44] fund and the enterprise fund.

[39:46] i know we received some legal

[39:47] advice as to where we

[39:50] can't do that but we haven't

[39:53] seen anything come forward

[39:54] trying to make suggestions in

[39:57] the areas where we can do

[39:58] that.

[40:00] >> let me try to take those two

[40:02] questions one at a

[40:02] time.

[40:06] Number one, in terms of

[40:10] developing a plan b, we don't

[40:11] have that plan to the point

[40:12] where we would be prepared to

[40:16] put it out in the public.

[40:20] The only other approach to

[40:23] unrealized revenue is to

[40:23] reduce expenditures.

[40:25] There are a number of programs

[40:26] in the health and

[40:29] hospital system which are not

[40:30] absolutely mandated.

[40:32] Certainly not mandated to the

[40:36] level that we provide

[40:37] them.

[40:39] If indeed we were unable to

[40:41] meet revenues, we'd have to

[40:48] start looking at those services.

[40:51] They typically are specialty

[40:53] type services and other

[40:56] support services. That will be

[40:57] in significant reductions.

[40:58] Obviously, none of us want to

[40:59] do that.

[41:01] Therefore, we trying to project

[41:04] a budget here we think

[41:05] is very conservative and

[41:05] rational.

[41:08] In the midst of healthcare

[41:10] reform, it is not the time

[41:13] to be reducing services but as

[41:14] you well know, the budget has

[41:21] to balance one way or the other.

[41:25] We are in contingency planning.

[41:26] We will bring that forward when

[41:28] we feel like it's ready

[41:29] to be public.

[41:33] in terms of the second answer

[41:36] or second question about

[41:39] a firewall, as you know, the

[41:43] board does have constitutional

[41:46] obligations under 17,000 to

[41:47] provide healthcare for

[41:47] medically

[41:49] injured in the county.

[41:56] we provide far more than that.

[41:59] But, there is no legal

[42:01] structural way to actually

[42:03] prevent the expenditure of

[42:04] money on that program.

[42:10] It really boils down to setting

[42:11] up systems -- policy

[42:15] and commitments in the board

[42:16] policy area that will restrict

[42:18] how much money gets moved from

[42:20] the general fund.

[42:22] At this point, I know that

[42:23] county council has been

[42:29] working on some of those ideas.

[42:32] we are targeting in this budget

[42:36] trying to keep the

[42:38] general fund subsidy below the

[42:41] 10% range of the entire

[42:42] expenditure.

[42:44] I think you'll see that we are

[42:45] successful in that with

[42:48] some leeway.

[42:50] When I started 2.5 years ago,s

[42:53] general fund subsidy was

[42:54] about $220 million.

[42:57] This budget envisions it to be

[43:00] about $85.5 million.

[43:01] That's a significant reduction

[43:03] without significant

[43:05] reduction in services.

[43:08] I obviously can't take the

[43:08] credit for that.

[43:10] The hospital should take the

[43:11] credit for that.

[43:15] they done a fabulous job of

[43:18] improving their efficiency

[43:20] and effectiveness.

[43:24] That's a good step forward

[43:27] indicating that we are

[43:28] making significant progress.

[43:31] >> if you measure that by board

[43:33] presidency, we've all

[43:35] done well, President Shirakawa

[43:37] you just have $85 million

[43:38] more to go.

[43:43] [Laughter] I want to get this

[43:45] clear so it doesn't get

[43:46] -- probably will anyway --

[43:49] perhaps it doesn't get

[43:49] misprinted

[43:51] somewhere by some opinion

[43:52] maker. I'm not suggesting nor

[43:52] do

[43:56] i hear the board suggest that

[43:57] we do anything other than

[44:00] guarantee the 17,000

[44:00] commitments.

[44:04] When you present it to us last

[44:06] year, what the hospital

[44:07] system was spending money on,

[44:14] that piece of it is a less

[44:16] than 10% of the total hospital

[44:16] budget.

[44:18] It seem to me we can guarantee

[44:20] that piece and still

[44:23] have awful lot of attitude in

[44:28] term of where we prohibit

[44:28] ourselves moving money back and

[44:29] forth.

[44:31] I'm only suggesting under this

[44:32] plan b scenario.

[44:34] I'm coming into this process

[44:35] more than willing to

[44:41] support this plan at this point

[44:45] of half revenue solution and

[44:47] half subsidy solutions.

[44:51] Currently plan b -- we all have

[44:53] concern to have in

[44:54] place.

[44:58] i'm actually thanking you for

[44:59] that.

[45:04] >> you're correct on both parts.

[45:05] We do have more flexibility

[45:06] without reducing services

[45:10] to reduce our costs.

[45:12] We can actually increase

[45:16] services and reduce our cost.

[45:18] we're making progress there and

[45:19] that will be our

[45:20] directive.

[45:23] Like you say, if we can't meet

[45:25] it, we will then have to

[45:26] start thinking about what we

[45:27] can do without.

[45:31] >> to the chair, again, not to

[45:34] be misunderstood, I was

[45:36] joking with regard to the

[45:37] credit with the board President.

[45:39] i do agree that employees are

[45:41] the ones who have done

[45:42] this.

[45:43] There's no way five supervisors

[45:45] or senior staff can go

[45:47] out and manage an operation and

[45:52] bring numbers into alignment

[45:57] like that.

[45:57] That's understood.

[45:58] thank you.

[46:03] >> anyone else on this section?

[46:04] Thank you jeff.

[46:05] Item five is overview of

[46:07] funding status of the county

[46:11] retiree medical benefit program.

[46:13] >> george I'm taking my share

[46:13] of time this year.

[46:19] this is my last year.

[46:20] I get special privileges.

[46:22] I'm sitting here thinking that

[46:26] when I first got here in

[46:27] 2001, the budget was quite

[46:30] robust.

[46:31] You remember gary, believe it

[46:35] or not, they were called

[46:38] funds supervisors had to offer

[46:40] to their own district.

[46:43] The next year that wasn't the

[46:44] case.

[46:46] By 2003 it was dismal.

[46:47] It has been dismal for at least

[46:48] nine or ten years.

[46:50] It is amazing to be doing a

[46:53] budget where we're not

[46:54] discussing how awful it will

[46:55] be, how terrible the year will

[46:58] be, how many test we'll have to

[46:58] make.

[47:04] i think you're both to be

[47:08] commended.

[47:12] It seemed kind of jerky at

[47:12] times.

[47:14] Hard word, kind of a stop and

[47:15] start.

[47:18] Think we've gotten to an

[47:20] unusually good spot given

[47:24] where many other counties are.

[47:26] Where much of california

[47:27] doesn't enjoy the privilege

[47:30] we're having this year of

[47:31] looking at a budget that

[47:32] doesn't

[47:34] have as many challenges that it

[47:35] has before.

[47:37] I just don't -- it would not be

[47:38] there if we didn't call

[47:41] that out and say, good job.

[47:45] i can look back over 11.5 years

[47:45] at this point.

[47:50] It's been a lot of those times

[47:50] very rocky.

[47:52] I thank you and I'm sure whole

[47:54] board joins me in that.

[47:54] >> thank you.

[47:56] >> you better keep up the good

[47:57] work.

[47:59] >> well, we will.

[48:00] It's only because of fabulous

[48:03] employees and mary and

[48:05] leslie and gary and department

[48:10] heads who and all of their

[48:12] finance people who do yohman's

[48:13] job and they're here late

[48:15] nights and making sure

[48:16] everything adds up.

[48:16] Thank you for recognizing that.

[48:19] >> by the way, we are waiting

[48:20] until January for

[48:26] reinstated some of those funds

[48:34] from the districts.

[48:35] >> thank you Mr. President.

[48:38] We wanted to provide you with

[48:43] an overview of the issue

[49:05] of the opeb retiree benefit.

[49:09] First slide.

[49:10] The second slide -- I'm going

[49:11] to go through this

[49:19] quickly because there's a lot of

[49:19] contextual information.

[49:21] The important thing about this

[49:22] slide it outlines the

[49:24] benefit we provide employees by

[49:28] no means it's all retiree

[49:30] medical benefit, the most

[49:31] generous and no way that's the

[49:31] case.

[49:34] We only provide the benefit if

[49:39] you retire from the

[49:40] county, if you've met five up

[49:41] to ten year continue of

[49:42] service in order to get the

[49:43] benefit.

[49:47] also we only pay equal to the

[49:47] geyser premium.

[49:50] At the same time, that being

[49:55] said, this is an expensive

[49:55] benefit.

[49:56] Next slide provide you with

[49:57] some perspectives in terms

[50:02] of how things have changed.

[50:04] To give you some perspective,

[50:07] the county began

[50:11] prefunding this benefit in 1984.

[50:14] We wanted very few organizes

[50:15] that did studies to

[50:16] determine what we needed to put

[50:18] into this program in order

[50:20] to fully fund it.

[50:25] Since that time, there has been

[50:27] a variety of changes.

[50:29] 2008, new requirements,

[50:34] required the reporting of the

[50:41] unfunded actuarial liability.

[50:44] It requires dedicated assets to

[50:46] be placed in

[50:48] irrevokable trust.

[50:53] The county did open a trust in

[50:56] cal pers in indicate

[50:58] 2008.

[51:02] The board approved those

[51:04] funding. We ended up

[51:05] suspended contributions in 2010

[51:08] when we were really dealing

[51:10] with our cash flow crisis.

[51:13] That's the reason why in this

[51:16] year, we are recommending

[51:18] to increase our contribution to

[51:19] this benefit program.

[51:21] Also it's important to point

[51:26] out that beginning in

[51:29] 2012, we did negotiate, some of

[51:30] the employees contributing

[51:35] directly to the cost of retiree

[51:35] health.

[51:39] Next slide provide you with

[51:39] some definitions that might

[51:41] be helpful for you in terms of

[51:43] identifying how retiree

[51:44] medical benefits are funded and

[51:46] it gives a little

[51:49] description, pay as you go.

[51:51] Really only covers the current

[51:56] period cost for current

[51:57] retirees. The normal cost is

[51:59] pay as you go.

[52:00] Plus we're funding the cost of

[52:02] benefits for future

[52:03] retirees.

[52:07] This is referred tos a partial

[52:08] refunding, the arc,

[52:10] which is the annual required

[52:12] contribution is a normal cost

[52:16] plus we're also making payments

[52:17] on the unfunded liability.

[52:20] This is substantial amount of

[52:20] payments that ideally we

[52:22] can reach but when you see the

[52:25] figures, you can see what a

[52:27] challenge that will be.

[52:30] the next slide is a graphic

[52:33] representation of the value

[52:35] of these funding methodologies

[52:39] and as you can see, the arc

[52:43] currently is in the range of

[52:43] around $170 million, which is

[52:47] way above what we're currently

[52:47] funding.

[52:48] To the extent to which we do

[52:51] not pay for the unfunded

[52:53] liability, as you can see the

[52:55] trend will increase over time.

[52:59] These are annual costs.

[53:01] The next slide gives you a

[53:02] summary of where we are in

[53:05] the funding of this program.

[53:08] The amount that we have

[53:11] contributed to the irrevokable

[53:13] trust is $252 million opinion

[53:17] we are still retaining in our

[53:18] county funds $163 million.

[53:20] These are funds that were

[53:23] originally anticipated to be

[53:24] transferred to their

[53:24] irrevokable trust.

[53:26] We've hold on to them base on

[53:27] our concerns around cash

[53:29] flow.

[53:31] The retiree health trust fund

[53:32] is a major source.

[53:36] i think if you recall, we have

[53:37] about $250 million worth

[53:38] of play.

[53:42] I got amount of 160 is retiree

[53:44] health trust fund.

[53:46] During the 2009, '10 time frame

[53:50] when the economy was in

[53:51] a chaotic state, we felt it was

[53:54] very important to maintain

[53:57] that flexibility in cash as was

[53:58] discussed with the board.

[54:03] As time has moved on, we're

[54:04] feeling little more

[54:06] comfortable in starting to

[54:10] transfer funds out of the

[54:10] retiree

[54:11] health trust fund and that's

[54:12] went recommendations we're

[54:14] making in the current year.

[54:16] Now the number that's startling

[54:18] and of concern to us is

[54:23] in fact our actuarial accrued

[54:24] liability which is now

[54:25] exceeding $2 billion.

[54:33] Believe it or not, in 1999, the

[54:33] actuarial accrueded

[54:35] liability was $69 million.

[54:36] So it increased substantially

[54:37] based on a variety of

[54:40] factors that I will touch on.

[54:44] Again, the next slide gives you

[54:50] a since of how the

[54:50] unfunded actuarial accrueded

[54:53] liability has changed over the

[54:53] last 12 years.

[54:55] That growth has been

[54:56] significant as our

[54:57] contributions

[55:00] really have been limited again.

[55:02] We did that in order to really

[55:03] protect our services.

[55:04] It's a decision that was

[55:07] difficult but one that I think

[55:09] we stand behind because

[55:12] clearly, our mission is to

[55:12] provide

[55:13] service.

[55:15] I think looking back, it was

[55:16] the right thing to do.

[55:21] The next slide provides you

[55:23] with some more recent

[55:25] information about our

[55:26] contributions.

[55:29] In 2008 and 2009, we

[55:31] contributed 100% of our arc.

[55:32] That was possible because we

[55:33] utilized the retiree

[55:34] health trust fund in addition

[55:37] to what we budgeted to meet

[55:39] 100% of those costs.

[55:41] As our deficits grew and we had

[55:42] fewer and fewer

[55:46] options, we made the decision

[55:47] to reduce those expenditures

[55:52] and as you can see, the amount

[55:53] we contributed declined.

[55:55] So, at this point in time, one

[55:57] of the things that we're

[55:59] recommending is to increase our

[56:02] contribution in terms of our

[56:04] ongoing funds from 50% of the

[56:07] normal cost to 75% and then

[56:10] make up that difference to get

[56:11] to 100% gi beginning to

[56:14] transfer from the retiree

[56:17] health trust fun to the

[56:17] irrevokable trust.

[56:19] We begin drawing down reducing

[56:22] the amount in the

[56:25] retiree health trust fund by

[56:26] relatively small amount.

[56:29] We obviously will not go too

[56:31] far too fast because we're

[56:32] not 100% confident in the

[56:33] economy.

[56:37] The next slide provides you

[56:39] with again, a graphical

[56:41] representation about the

[56:42] estimated future unfunded

[56:43] liability

[56:45] based on the three funding

[56:46] mechanisms.

[56:49] Our goal is to again, reach

[56:50] that 100% of normal cost

[56:52] and then as possible, try to

[56:55] begin paying some of that

[57:00] unfunded liability depending on

[57:01] circumstances.

[57:03] the next slide provides some

[57:06] information regarding why

[57:09] the unfunded liability has

[57:11] grown so quickly. Retiree

[57:11] health

[57:14] is very sensitive to rise in

[57:14] health insurance premiums.

[57:17] That's a problem we face not

[57:18] only here but of course in our

[57:19] regular health premiums.

[57:21] We see substantial growth and

[57:23] even though they are not

[57:24] in the double didn't range as

[57:26] they had been in prior years,

[57:29] they are still growing

[57:29] significantly.

[57:31] The increase number of

[57:33] employees in retirees when we

[57:40] look at this from a actuarial

[57:41] perspective, has an impact on

[57:43] that.

[57:45] the funding strategy as I

[57:48] mentioned, the more we put

[57:51] into it, the limits the growth

[57:52] of unfunded liability and

[57:53] also the investment return rate.

[57:56] All of those things have been

[57:57] challenged by the economy

[58:02] over the last several years.

[58:05] the next slide provides some of

[58:07] the things -- some of

[58:09] the strategies that we're

[58:10] thinking about and certainly

[58:10] it's

[58:13] important to note that these

[58:14] are all subject to labor

[58:15] contract negotiations.

[58:17] These are not things that we

[58:19] would implement.

[58:21] Unilaterally but they will be

[58:23] part of our contract

[58:24] negotiations.

[58:25] things that we can do for

[58:27] instance would be to cap

[58:28] county contributions.

[58:32] We could reduce benefit

[58:33] coverage levels.

[58:38] Introduce a health saving

[58:38] account option.

[58:40] And on and on.

[58:43] There are ways in which we can

[58:47] address this obviously,

[58:52] mistakes obvious --

[58:54] this is something we have to

[58:55] address.

[58:58] The next step on the last

[59:00] slide, what we are suggesting

[59:02] we do is to create an

[59:03] administrative steering

[59:04] committee for

[59:08] the retiree health benefit to

[59:10] study best practices and to

[59:12] develop options for

[59:15] presentation to the board.

[59:18] Obviously we want to obtain

[59:20] input from our county and

[59:22] labor organizations.

[59:24] So that we can provide

[59:26] information and get feedback in

[59:29] terms of what this all means

[59:31] and how best to proceed.

[59:36] Our time frame is to study this

[59:39] in the upcoming fiscal

[59:41] year 2013 and to discuss with

[59:43] the board probably through the

[59:44] finance committee and the full

[59:47] board as we look at the

[59:48] budget for fiscal year 2014.

[59:50] Once again, we're making a very

[59:52] positive step this year

[59:55] in terms of getting to 100%

[59:56] normal cost.

[59:58] Our goal will be to try to put

[1:00:01] together a plan in terms

[1:00:03] of how we can address and

[1:00:05] approach these funding issues

[1:00:05] as

[1:00:06] we move forward.

[1:00:10] with that, I would be happy to

[1:00:11] answer any questions.

[1:00:13] >> supervisor cortese and then

[1:00:14] wasserman.

[1:00:17] >> first of all, thank you very

[1:00:19] much for including this

[1:00:21] as a major component of the

[1:00:23] study session.

[1:00:24] It's helpful and it's probably

[1:00:27] been on a lot of our

[1:00:28] minds wherever we sit here in

[1:00:32] the county in terms of roles

[1:00:33] given the conversation that's

[1:00:35] going on externally over the

[1:00:35] years.

[1:00:44] I know we were all aware of

[1:00:44] abstaining the funding

[1:00:45] effort.

[1:00:49] one of the questions I have is

[1:00:52] probably in the a real

[1:00:52] question per se.

[1:00:56] In the list of things that

[1:00:59] could be negotiated, there

[1:00:59] could be ideas.

[1:01:03] To what extent can we as a

[1:01:06] county given our capacities

[1:01:07] connected to the healthcare

[1:01:07] system?

[1:01:10] at least attempt to bargain to

[1:01:14] bring people into our

[1:01:18] own health plans in order to

[1:01:23] sort of mitigate what I would

[1:01:25] call a victimization of local

[1:01:26] governments by big insurance

[1:01:27] companies that we have no

[1:01:28] control over.

[1:01:32] i'm wondering if it's worth

[1:01:32] discussing?

[1:01:33] I'm not trying to bargain from

[1:01:34] here.

[1:01:37] I need to see it up there as a

[1:01:37] bullet point.

[1:01:39] I didn't know if that's because

[1:01:41] there's not much gained

[1:01:42] or because it's a collective

[1:01:44] bargaining issue.

[1:01:46] >> I would speak -- one thing I

[1:01:50] would say is there are

[1:01:51] limitations.

[1:01:53] i think that this is something

[1:01:54] that's been looked at

[1:01:55] before.

[1:01:57] In fact, was challenged and so

[1:01:59] there are limitations in

[1:02:03] terms of to what extent we can

[1:02:04] do that.

[1:02:05] I think that's about all I

[1:02:06] would say on it.

[1:02:09] >> I would add a little bit.

[1:02:12] last year we went forward with

[1:02:16] trying to make our

[1:02:18] internal system, vhp more

[1:02:20] attractive by expanding the

[1:02:23] network and making it a more

[1:02:24] attractive product for our

[1:02:25] employee.

[1:02:26] There's still we need to do in

[1:02:27] that respect.

[1:02:29] Gary is right, we can't really

[1:02:30] mandate that employees

[1:02:32] take one system or another but

[1:02:36] we can make it more

[1:02:37] attractive.

[1:02:39] We have seen significant

[1:02:39] transfer.

[1:02:43] I think it's up to 700 or 800

[1:02:48] or something like that.

[1:02:48] 1100.

[1:02:54] 1100 of people transferred over.

[1:02:54] That makes fairly significant

[1:02:56] dent.

[1:02:59] That helps us a lot because

[1:03:01] every dollar that we pay

[1:03:04] for health premiums it goes to

[1:03:04] vhp.

[1:03:08] Stays within the county system

[1:03:10] and allows us to have

[1:03:13] the flexibility to improve our

[1:03:14] health system, delivery

[1:03:14] system.

[1:03:16] Whereas, every dollar that goes

[1:03:18] to kaiser or health net

[1:03:19] goes outside of the county and

[1:03:20] helps them develop their

[1:03:22] system.

[1:03:26] >> it seems like that alone

[1:03:35] would be in a dialogue, an

[1:03:36] incentive or interest beyond

[1:03:39] just the product itself.

[1:03:43] In other words, if that's an

[1:03:46] organization, it helps us

[1:03:47] bring down accrued liability

[1:03:50] that end up impacting employees

[1:03:52] anyway. Trying to want if I

[1:03:54] that a little bit more.

[1:03:55] we're not asking people to take

[1:03:58] a hit for the team so

[1:04:00] to speak.

[1:04:01] But to the extent that people

[1:04:02] are attracted by the idea

[1:04:04] that we can reach a certain

[1:04:08] critical mass, it saves jobs,

[1:04:08] it

[1:04:11] freeze up dollars and wages and

[1:04:13] other things.

[1:04:14] I understand the collective

[1:04:14] bargaining session.

[1:04:24] i take note and other important

[1:04:27] thing is willingness

[1:04:31] convene early.

[1:04:34] My experience has been in other

[1:04:36] places, especially

[1:04:41] prior to coming here, that the

[1:04:45] lack or unwillingness of

[1:04:47] management elected officials

[1:04:49] and others to do that, really

[1:04:54] help lead to a lot of conflict.

[1:04:56] Like anything else, just like

[1:04:57] any balanced discussion

[1:05:00] with budget, there's a lot of

[1:05:01] questions whether accrued

[1:05:03] liability numbers are real.

[1:05:05] Are those numbers really where

[1:05:06] they should be.

[1:05:07] I don't dispute them but people

[1:05:08] need to understand that

[1:05:14] before they make commitments

[1:05:16] and secondly, what is the --

[1:05:18] how sharp does the trajectory

[1:05:20] need to be to get there from

[1:05:21] here?

[1:05:25] How much can we defer until we

[1:05:26] see how the macro

[1:05:28] economy changes and how

[1:05:29] healthcare reform May change

[1:05:29] things.

[1:05:32] I think those discussions are

[1:05:33] invaluable and maybe it's

[1:05:35] during those discussions when a

[1:05:37] little more sharing about

[1:05:41] how internal -- how vhp and how

[1:05:43] mechanisms internally might

[1:05:47] be able to help the problem.

[1:05:49] Sound like you're doing that?

[1:05:50] >> absolutely.

[1:05:56] The board action a few weeks

[1:05:58] ago to direct this to look

[1:06:00] carefully at a unified

[1:06:00] healthcare strategy is

[1:06:01] important

[1:06:03] component of this.

[1:06:06] It involves having a strategy

[1:06:08] to expand the commercial

[1:06:10] capacities of our local health

[1:06:13] systems so that we can make a

[1:06:14] much more attractive product

[1:06:16] for employees and for that

[1:06:20] matter, for employees of other

[1:06:22] organizations.

[1:06:22] >> supervisor wassermann.

[1:06:26] >> I wanted to thank staff and

[1:06:28] all of employees for

[1:06:30] being direct, being

[1:06:30] transparent, being

[1:06:31] collaborative.

[1:06:32] We're all working on this

[1:06:32] problem together.

[1:06:34] What I wanted to state here

[1:06:39] with something I stated in

[1:06:41] ledge committee,ly say it again

[1:06:45] now, at some point, I think

[1:06:46] somebody somewhere organization

[1:06:48] some individual needs to

[1:06:51] hold the medical industry

[1:06:52] accountable.

[1:06:53] When cost, supervisor cortese

[1:06:54] mentioned cost of

[1:06:59] insurance going up and up, they

[1:07:00] talk about premiums going up

[1:07:03] because the cost of the medical

[1:07:06] care is going up and up.

[1:07:08] I know I seen premiums.

[1:07:12] I seen in medical care.

[1:07:14] I'm just hoping somewhere

[1:07:14] washington, sacramento,

[1:07:17] somewhere somebody says why is

[1:07:19] medical costs going up 10

[1:07:23] times the cpi when we as

[1:07:24] employees are happy here when

[1:07:25] our

[1:07:27] salaries don't go down.

[1:07:30] The comcast go up couple 3%

[1:07:32] each year.

[1:07:38] The medical cost goes up 10 time

[1:07:40] s cip.

[1:07:43] it was double digit increases.

[1:07:46] When your cost of medical care

[1:07:49] or coverage insurance or

[1:07:52] whatever is estimating 10 and

[1:07:55] 20 percent and we're

[1:07:57] scrambling to try and find to

[1:07:58] be more efficient so we can

[1:08:01] set aside for money to pay for

[1:08:02] the insurance coverage of

[1:08:05] retiring employees, you got to

[1:08:07] ask at some point, why these

[1:08:09] costs are going this way?

[1:08:11] I appreciate the respect and

[1:08:11] collaborative efforts and

[1:08:14] between the administration and

[1:08:15] employees to figure out how

[1:08:19] we will pay for these expenses.

[1:08:25] sooner or later, we got to say

[1:08:27] these expenses are

[1:08:27] wrong.

[1:08:29] I don't know if we can throw

[1:08:29] out for further

[1:08:30] discussion.

[1:08:34] Gary if we have the right for

[1:08:35] justification of

[1:08:35] insurance premiums.

[1:08:38] I know there's a state

[1:08:39] insurance commissioner.

[1:08:42] I don't know who regulates the

[1:08:42] cost and what they

[1:08:44] charge for medical care.

[1:08:46] it's hard to be playing catchup

[1:08:47] all the time and you

[1:08:50] got this run away horse and

[1:08:52] somehow pull the reigns back.

[1:08:54] No matter what we do no matter

[1:08:59] with the epic, no matter

[1:09:01] with more efficient methods, we

[1:09:03] cannot keep up with

[1:09:07] escalating medical cost and

[1:09:10] premiums that are double digit

[1:09:10] each year.

[1:09:13] It's not a question of if or

[1:09:15] when.

[1:09:19] >> I think jeff and I can maybe

[1:09:20] both reflect on this.

[1:09:22] There was a time when medicine

[1:09:23] was not a business.

[1:09:26] it was looked at quite

[1:09:27] differently.

[1:09:31] It was a -- I don't mean to get

[1:09:32] carried away -- it was

[1:09:33] a laudable calling.

[1:09:37] Most of you know I have a

[1:09:37] nursing background.

[1:09:40] At that time, when people went

[1:09:41] into the hospital, there

[1:09:43] was insurance coverage but

[1:09:47] medicine was not the business

[1:09:47] it

[1:09:48] is today.

[1:09:49] There are, learning about this

[1:09:50] in pittsburgh, there are

[1:09:52] whole cities in the south that

[1:09:53] are devoted to healthcare.

[1:09:55] That's how people make their

[1:09:55] living.

[1:09:58] There's one city devoted just

[1:09:59] to dialysis.

[1:10:02] Dialysis is a very lucrative

[1:10:04] business.

[1:10:05] I hesitate saying things out

[1:10:06] loud but the more

[1:10:08] developed we have become in the

[1:10:09] healthcare field, the more

[1:10:13] ways there are to save people,

[1:10:17] to maintain them sometimes

[1:10:19] long after the quality has

[1:10:22] disappeared, the more expensive

[1:10:22] it becomes.

[1:10:26] That is one of the reasons in

[1:10:28] the aca there was a

[1:10:31] discussion initially which had

[1:10:33] a great dealed feedback about

[1:10:36] it about the dreaded word, what

[1:10:38] do I call that word instead

[1:10:41] of what it is.

[1:10:41] Call it options.

[1:10:44] Whether or not you discuss with

[1:10:45] people what they want

[1:10:46] the quality of life to be for

[1:10:51] them or for their family.

[1:10:57] I realize, I'm opining somewhat

[1:10:58] on this.

[1:11:00] We have become a very

[1:11:03] complicated country as far as

[1:11:04] healthcare goes.

[1:11:06] As we used to say, still do, no

[1:11:07] one every dies in

[1:11:08] surgery.

[1:11:11] they only die later because

[1:11:15] there is no way you can do

[1:11:18] that.

[1:11:20] Again, I am so sympathetic for

[1:11:22] families who lost

[1:11:23] someone who had that grief.

[1:11:25] There's also grief in families

[1:11:27] where someone lives far

[1:11:30] longer and as one of the women

[1:11:30] said earlier today, somebody

[1:11:32] who goes to bed praying,

[1:11:34] they'll be dead in the morning

[1:11:36] because it is so hard to

[1:11:37] maintain your life.

[1:11:41] It's a long answer mike but I

[1:11:42] really think the

[1:11:43] transformation that has taken

[1:11:46] place in healthcare and the

[1:11:48] time I reserved it is pretty

[1:11:48] dramatic.

[1:11:51] Probably why the aca did pass

[1:11:52] and even though it has

[1:11:53] its fault.

[1:11:55] I think there are a number of

[1:11:57] really good provisions in

[1:11:58] it.

[1:11:59] Longer answer than you you

[1:12:03] wanted but it has troubled

[1:12:05] me for years how insurance

[1:12:10] company have become such big

[1:12:11] business.

[1:12:14] their executives are paid

[1:12:15] extremely well and from time

[1:12:17] to time the system is misused.

[1:12:19] I don't know if you want to

[1:12:20] comment jeff or not.

[1:12:25] We have one nurse and one

[1:12:28] doctor on a board throughout

[1:12:28] california.

[1:12:31] Jeff you maybe the only

[1:12:36] physician ceo.

[1:12:37] I did carry on didn't I?

[1:12:42] >> I guess the question was who

[1:12:42] regulates this and

[1:12:45] there is some regulatory

[1:12:46] capacity that the insurance

[1:12:48] commissioner has but not

[1:12:48] complete.

[1:12:52] There also is regulatory

[1:12:54] capacity that the department

[1:12:56] of managed healthcare has.

[1:12:57] Again, not complete.

[1:13:01] I guess the fundamental issue

[1:13:03] is as supervisor kniss

[1:13:07] pointed out that in a for

[1:13:08] profit structure, somebody has

[1:13:08] to

[1:13:15] win and somebody has to lose.

[1:13:19] That's the way it no, our

[1:13:23] country today.

[1:13:27] >> to be perfectly clear so I'm

[1:13:29] not misunderstood or

[1:13:31] misquoted, I'm perfectly happy

[1:13:33] with each and every

[1:13:34] individual and organization

[1:13:36] making profitings. I don't

[1:13:39] begrudge that and it's the

[1:13:42] american dream.

[1:13:44] What I'm saying, I'm not just

[1:13:45] lobbying for government

[1:13:46] here.

[1:13:46] How government employees

[1:13:48] suppose to keep up with the

[1:13:50] cost.

[1:13:51] Private sector too.

[1:13:52] I was self-employed for 30

[1:13:53] years.

[1:13:54] Can't keep up with the

[1:13:55] escalating cost.

[1:13:56] We're in government now.

[1:13:58] I'm in government now, we're

[1:13:59] all in government, can't

[1:14:11] keep up with the cost.

[1:14:15] Something got to move more in

[1:14:15] parallel.

[1:14:18] i hope something somewhere

[1:14:19] happens at some point.

[1:14:20] Last couple years has been

[1:14:22] great.

[1:14:24] You brought that $220 million

[1:14:25] down to $80 million or

[1:14:27] whatever the number is, that's

[1:14:28] all great.

[1:14:33] But if cost go like this, and

[1:14:34] revenues go like this,

[1:14:39] like I said, it's a question

[1:14:39] when you break.

[1:14:42] Z

[1:14:42] break

[1:14:45] >> thank you supervisors.

[1:14:46] Anything else?

[1:14:47] Thank you gary and jeff.

[1:14:52] Item six is a recommendation

[1:14:57] relating to the sale of

[1:14:57] real property.

[1:14:59] Jeff I have one speaker.

[1:15:01] I think it's a question.

[1:15:06] Let me have her ask the

[1:15:12] question.

[1:15:14] Why don't you ask the question

[1:15:18] as presentation goes on.

[1:15:23] >> good afternoon lynn bradley

[1:15:24] from seiu.

[1:15:28] It talked about the shelter or

[1:15:29] receiving center where

[1:15:32] children will go.

[1:15:34] We have never been told in

[1:15:36] social services agency.

[1:15:38] we're curious where it will be

[1:15:39] moving one.

[1:15:39] >> staff?

[1:15:41] >> thank you Mr. President,

[1:15:43] members of the board.

[1:15:46] With me today, this is a

[1:15:47] familiar face, he's the

[1:15:48] interim acting director of the

[1:15:49] social services agency and

[1:15:52] responsible for the operation

[1:15:53] of a relocation assessment and

[1:15:56] intake assessment center.

[1:16:03] david and nancy weiner who is

[1:16:05] the founding and director

[1:16:06] of the silicone valley children

[1:16:08] fund.

[1:16:13] In the audience we have sharon

[1:16:15] pick assistant business

[1:16:18] manager for harker school.

[1:16:20] in conforming with the

[1:16:21] government code following

[1:16:25] direction on January 24th when

[1:16:26] you adopt resolution for

[1:16:28] offering to sale the former

[1:16:30] children's shelter.

[1:16:32] We subsequently opening sealed

[1:16:32] written bids on

[1:16:33] March 1st.

[1:16:36] We received four written bids,

[1:16:37] three at the minimum

[1:16:38] qualifying requirements.

[1:16:40] there was a subsequent oral

[1:16:44] bidding process at the

[1:16:46] closed of which harker school

[1:16:49] made the highest remaining bid

[1:16:56] of $25,505,000.

[1:16:57] Before recommend action to

[1:17:00] adopt the resolution accept

[1:17:01] highest bid approving purchase

[1:17:03] of sale agreement.

[1:17:05] It provides for 150 day due

[1:17:08] diligence period and a

[1:17:10] 30-day close escrow period.

[1:17:11] Following a successful close of

[1:17:14] escrow, the county

[1:17:16] would realize one time proceeds

[1:17:18] of $10.7 million and in the

[1:17:21] proposed budget there'sal a one

[1:17:23] time allocation of

[1:17:25] $3.5 million toward relocation

[1:17:27] of the intake and assessment

[1:17:28] center.

[1:17:32] But I think that those are the

[1:17:35] stark details.

[1:17:37] This really is a 20 year

[1:17:38] collaboration.

[1:17:51] there's been much cash --

[1:17:58] cachet.

[1:18:01] What we now see is prospect of

[1:18:02] beautiful facility

[1:18:06] entering new phase devoted to

[1:18:06] children.

[1:18:11] This partnership started out as

[1:18:15] a 50/50 joint venture

[1:18:19] between the private sector and

[1:18:21] the county and it ended up

[1:18:24] with 50% of the proceeds from

[1:18:28] the sale with the property

[1:18:32] being satisfied. Proceeds are

[1:18:35] split 50/50 with silicone

[1:18:36] valley children's fund.

[1:18:38] This afternoon I was also

[1:18:39] informed that city council of

[1:18:42] san jose played their part and

[1:18:45] took action to provide a

[1:18:48] process for lifting the

[1:18:49] affordable housing restrictions

[1:18:49] that

[1:18:50] were placed on the property at

[1:18:56] the beginning of the project.

[1:18:58] With that, Mr. Mavis.

[1:19:02] Anything you like to say on

[1:19:04] behalf of the fund?

[1:19:06] >> we would like to thank mike

[1:19:07] wasserman and his staff

[1:19:09] and also bruce for helping us

[1:19:12] navigate through this process.

[1:19:18] We're looking forward to

[1:19:22] wrapping it up.

[1:19:29] so thank you.

[1:19:31] >> I appreciate the opportunity

[1:19:32] to just make a few

[1:19:34] comments to all of you.

[1:19:36] Some of the familiar faces.

[1:19:38] I only want to correct one

[1:19:40] thing that bruce said.

[1:19:42] I was actually a 39 year

[1:19:44] employee of santa clara county

[1:19:46] and it was in that capacity

[1:19:49] that we formed the fund and

[1:19:50] developed this very unique

[1:19:51] partnership.

[1:19:54] Many of you know it was a model

[1:19:57] throughout the state

[1:20:01] for its community participation

[1:20:11] and for thed the model it set.

[1:20:12] I had opportunity to create

[1:20:12] this partnership.

[1:20:19] This gives me a chance to say a

[1:20:21] special thanks to

[1:20:22] supervisor diane mckenna who

[1:20:25] really did an amazing job

[1:20:27] with the cheerleader of this

[1:20:27] project.

[1:20:30] i think we ought to take a

[1:20:33] moment and thank the staff

[1:20:38] and our county supervisors and

[1:20:39] our county administration for

[1:20:40] the tremendous work that was

[1:20:41] done at the children shelter

[1:20:44] during all of these years.

[1:20:46] I am particularly appreciative

[1:20:48] of the very thoughtful

[1:20:52] process that has gone on at

[1:20:54] this point in time.

[1:20:57] I greatly appreciate the fact

[1:20:58] that bruce has been able

[1:21:01] and the county executive has

[1:21:02] been able to spearhead this

[1:21:08] project to place it in the

[1:21:09] good hands of harker who by the

[1:21:11] way contributed to this project.

[1:21:13] A group of kids from harker.

[1:21:16] That's a fun thing to note.

[1:21:17] I'm particularly appreciative

[1:21:19] that the fund will be

[1:21:22] able to use the donations that

[1:21:25] were given to this project to

[1:21:28] further the work because the

[1:21:29] real focus these continue to be

[1:21:31] to support and help the abused

[1:21:33] and neglected children of our

[1:21:33] county.

[1:21:35] I am very grateful for that and

[1:21:37] I thank all of you for

[1:21:38] the work you've done.

[1:21:41] I thank bruce for the work that

[1:21:43] he's done in carrying

[1:21:43] that forward.

[1:21:45] Thank you.

[1:21:46] >> thank you.

[1:21:50] >> Mr. President, I like to

[1:21:51] respond to lynn bradley's

[1:21:52] comment and question about what

[1:21:57] is the future of the center

[1:21:58] for social services agency.

[1:22:01] Comment that the employees have

[1:22:03] not been informed.

[1:22:09] I think the new shelter sale,

[1:22:10] pending sale is common

[1:22:11] knowledge as has been reported

[1:22:12] in the paper.

[1:22:15] The agencies continue to be

[1:22:16] seeking for alternate

[1:22:23] location for their scaled down

[1:22:24] operation.

[1:22:25] They received children for no

[1:22:28] more than 24 hours. We

[1:22:30] are in the process of looking

[1:22:34] for possibilities and we will

[1:22:37] definitely confer and consult

[1:22:38] our employee organization in

[1:22:39] the future of where the

[1:22:41] location is.

[1:22:44] There are other county partners

[1:22:45] whether it's pediatric

[1:22:47] center of vmc and mental health

[1:22:48] department and other

[1:22:49] department of social services

[1:22:52] agency that we will be

[1:22:59] consulting and conferring for

[1:23:02] either temporary location

[1:23:04] >> thank you, anything else?

[1:23:07] Thank you to all of you.

[1:23:09] Let me recognize supervisor

[1:23:09] yeager.

[1:23:14] >> I know all of this,

[1:23:15] appreciate all the work

[1:23:17] everybody has done to make this

[1:23:17] happen.

[1:23:20] For those of us following this

[1:23:22] very closely like I was.

[1:23:23] There was no guarantee we were

[1:23:26] going to be where we are

[1:23:29] this afternoon with everybody

[1:23:30] saying thank you.

[1:23:32] Having an agreement that works

[1:23:33] for everybody.

[1:23:37] this was very complicated from

[1:23:38] the very beginning.

[1:23:54] It took a lot of excellently of

[1:23:55] -- flexibility.

[1:23:56] i was excited that harker was

[1:23:57] the top bidder.

[1:23:59] It's going to fit very well

[1:24:04] with the surrounding

[1:24:04] neighborhoods.

[1:24:06] If I had to sort of choose

[1:24:07] where I would want public

[1:24:09] land to be used for school

[1:24:11] would certainly be at the top

[1:24:11] of

[1:24:11] my list.

[1:24:17] it was good to hear little bit

[1:24:17] about the history.

[1:24:19] We did have an obligation to

[1:24:20] make sure some of the

[1:24:25] proceeds did go to abused and

[1:24:26] neglected children.

[1:24:28] Nancy appreciate you giving a

[1:24:28] little bit of history and

[1:24:31] all the people involved in that.

[1:24:33] It was a magnificent project.

[1:24:35] When it started it look a lot

[1:24:36] of collaboration and lot

[1:24:37] of support and dollars and

[1:24:41] leadership to make it happen.

[1:24:45] Times changed and we all need

[1:24:47] to change with them.

[1:24:50] We did all of that obligation

[1:24:52] to the children that

[1:24:54] using that property to begin

[1:24:54] with.

[1:24:57] with thatly make a motion that

[1:24:59] we adopt this

[1:25:02] resolution.

[1:25:05] >> motion by yeager and

[1:25:05] seconded by wassermann.

[1:25:09] Supervisor yeager thank you for

[1:25:10] your work.

[1:25:11] Bruce of course you and your

[1:25:12] staff.

[1:25:16] Anything else on this board?

[1:25:22] please vote by light.

[1:25:25] That carries unanimously.

[1:25:28] Thank you everyone,

[1:25:28] congratulations.

[1:25:31] I think there's nothing before

[1:25:31] us for this item.

[1:25:34] We will move on to item seven.

[1:25:35] Supervisor cortese we are

[1:25:36] starting children family

[1:25:38] seniors committee.

[1:25:40] As a chair, I want to afford

[1:25:41] opportunities, if you want

[1:25:46] to say any word before we start

[1:25:48] with the child support

[1:25:49] services. Did want to say

[1:25:51] anything prior?

[1:25:54] >> only that we've taken a

[1:25:58] preliminary look at the

[1:26:00] committee.

[1:26:03] The budget items -- still

[1:26:06] opportunity for that to

[1:26:07] happen.

[1:26:09] Looking forward to the

[1:26:18] engagement of the full board on

[1:26:18] respite process.

[1:26:21] >> item seven is review of the

[1:26:25] department of child

[1:26:27] services.

[1:26:28] >> good afternoon.

[1:26:29] Adele hunter with the

[1:26:31] department of child support

[1:26:33] services filling in for ralph

[1:26:34] miller who has family

[1:26:34] emergency.

[1:26:41] i want to give you update of

[1:26:42] these department budgets

[1:26:43] since the recommended budget

[1:26:45] was published. Yesterday on

[1:26:46] the conference call from the

[1:26:50] state department of the child

[1:26:53] support services, it was

[1:26:54] announced there will be a

[1:26:55] reduction.

[1:26:57] At this point, the state is

[1:26:59] looking at options for ways

[1:27:03] to reduce that funding.

[1:27:04] We have no additional

[1:27:06] information and what the impact

[1:27:07] would be on santa clara county

[1:27:11] at this time is unknown.

[1:27:14] Once impact is known, and what

[1:27:15] our reductions are, we

[1:27:18] will be working oba to

[1:27:20] determine how to balance our

[1:27:20] budget

[1:27:23] and during the budget process,

[1:27:26] we will have more information

[1:27:27] for the board of supervisors.

[1:27:30] I'm available for any questions

[1:27:33] >> questions from the board?

[1:27:35] >> when you talk about the

[1:27:37] call, you referring to the

[1:27:38] May revise?

[1:27:40] There was a conference call

[1:27:41] dealing with the may

[1:27:42] revise.

[1:27:43] I just wanted to understand

[1:27:46] whether or not these are

[1:27:46] just additional proposals or

[1:27:47] something cemented?

[1:27:49] >> these are results of the May

[1:27:49] revise.

[1:27:51] >> so it's still up in the air

[1:27:52] at least.

[1:27:56] >> all right, thank you.

[1:27:57] >> anyone else?

[1:28:01] Jeff any other comments?

[1:28:04] thank you, appreciate it.

[1:28:08] Item number ability is inhome

[1:28:11] support services.

[1:28:14] Luke?

[1:28:21] Item eight now, ihss.

[1:28:25] >> sorry Mr. President, I was

[1:28:25] providing further

[1:28:27] explanation to --

[1:28:33] >> I know you were working.

[1:28:38] >> this is a my ihss support

[1:28:39] services.

[1:28:40] If you can confer with me, this

[1:28:41] is transferring the

[1:28:48] function to social services on

[1:28:49] the administrative portion?

[1:28:50] >> the transfer tax and

[1:28:51] responsibility will be

[1:28:57] transferred to social services

[1:28:58] on an administrative level.

[1:29:02] >> this has been historically

[1:29:03] been administered under

[1:29:04] the county executive office

[1:29:12] ever since the public authority

[1:29:15] was formed.

[1:29:21] >> questions from the board?

[1:29:26] >> I'll just point out that the

[1:29:27] governors May revise

[1:29:28] suggest more cuts when we know

[1:29:30] what's going on with that, we

[1:29:32] will come back to the board

[1:29:35] with modifications.

[1:29:38] >> okay.

[1:29:40] I'm thinking, it was difference

[1:29:42] you spoke of 11 years

[1:29:44] ago today and last years today

[1:29:46] it's a little different.

[1:29:48] I'm sorry I'm shell shocked and

[1:29:50] we had more discussions

[1:29:52] on some items.

[1:29:53] >> [Inaudible]

[1:29:54] >> thank you supervisor.

[1:29:55] Thank you luke.

[1:29:58] We will move on to item number

[1:30:01] nine.

[1:30:08] item nine is review of custody

[1:30:09] health services.

[1:30:13] >> I'll just make some very

[1:30:16] brief momentos keep with

[1:30:18] tradition, I guess.

[1:30:19] Thank you Mr. President

[1:30:21] shirakawa and honorable

[1:30:23] supervisors.

[1:30:27] at both Dr. Smith and gary

[1:30:28] described, the proposed

[1:30:29] budget for our health and

[1:30:32] hospital system fiscal year

[1:30:32] 2013

[1:30:37] reflects the direction to stay

[1:30:39] with maintenance level.

[1:30:42] It reconfirms commitment from

[1:30:47] the county mission.

[1:30:50] it continues and some cases

[1:30:51] accelerates the necessary

[1:30:53] changes to respond to the

[1:30:54] increasing challenges.

[1:30:58] As many of you noted, earlier

[1:30:58] discussion related to

[1:31:01] healthcare reform as well as

[1:31:02] the economic uncertainties.

[1:31:04] It's that purpose and with the

[1:31:06] county mission as well

[1:31:09] as our values in mind our

[1:31:11] executive leadership for

[1:31:11] adopting

[1:31:12] the following five major

[1:31:13] strategic priorities.

[1:31:15] First and foremost as you know,

[1:31:17] since this has been

[1:31:20] part of the strategic framework

[1:31:23] from the a&m work.

[1:31:24] The culture of accountability

[1:31:25] is very important for us.

[1:31:30] we can happens the monitoring

[1:31:32] of our system and also

[1:31:34] the manage performance of our

[1:31:35] health and particularly

[1:31:36] hospital system.

[1:31:37] System integration important

[1:31:40] for us as well in term of

[1:31:44] delivering better quality care

[1:31:47] and lowering cost.

[1:31:49] Position alignment is better

[1:31:52] for provision of care and

[1:31:54] strategic and decision-making

[1:31:55] process.

[1:31:58] Unified managed care in terms

[1:31:59] of happening reliability

[1:32:02] of safety net in more

[1:32:03] competitive marketplace as well

[1:32:03] as

[1:32:05] deliver the better and still

[1:32:05] support the critical functions

[1:32:09] of our health system.

[1:32:13] we added a tiff which is

[1:32:14] transforming communities.

[1:32:17] It's a challenge but also even

[1:32:19] more important to be

[1:32:21] within participations of both

[1:32:22] patients as well as community

[1:32:28] so we can continuously continue

[1:32:30] the health status.

[1:32:32] we think combining all of these

[1:32:33] five major strategic

[1:32:34] priority will position

[1:32:35] ourselves in a much better

[1:32:36] place in

[1:32:38] terms of reform.

[1:32:39] As you mentioned, our employees

[1:32:40] have done tremendous in

[1:32:46] terms of day in and day out,

[1:32:49] 7/24, 365 days out of year.

[1:32:51] Doing what we need to do to

[1:32:53] fulfill our mission.

[1:32:55] We want to make sure that we

[1:32:56] continue to protect and

[1:32:58] promote the health of residents

[1:33:00] in our communities.

[1:33:01] That includes all 1.8 million

[1:33:03] residents, that's part of

[1:33:04] our public health

[1:33:04] responsibility.

[1:33:06] Mental health will continue to

[1:33:08] treat and care the

[1:33:10] seriously mental ill in our

[1:33:12] communities on behalf of all of

[1:33:12] us.

[1:33:17] Custody health will serve

[1:33:18] incarcerated adult or youth.

[1:33:20] Drug and alcohol services

[1:33:21] department, will continue to

[1:33:24] serve youth and adults

[1:33:24] afflicted by addiction.

[1:33:26] Our community health services

[1:33:28] will continue to treat

[1:33:31] people with illnesses, that are

[1:33:38] risk to themselves as well

[1:33:41] as others. Certainly our santa

[1:33:42] clara valley medical center,

[1:33:45] we continue to provide care and

[1:33:47] treatment at your hospitals

[1:33:47] and clinics.

[1:33:49] Each of our department heads

[1:33:50] will now present very

[1:33:52] briefly the major highlights

[1:33:54] offer budget proposals and I

[1:34:02] will turn it over to mary yan.

[1:34:02] Maryann.

[1:34:04] >> let me recognize the chair.

[1:34:07] Let the chair say a couple

[1:34:10] words.

[1:34:16] >> just to say in general,

[1:34:18] welcome renee first of all.

[1:34:22] It's good to have you.

[1:34:26] Secondly, I'm not always sure

[1:34:28] that everyone understands

[1:34:29] what it takes to upgrade the

[1:34:32] health system in this county.

[1:34:35] Unless I'm wrong, we're usually

[1:34:35] running about

[1:34:36] $1.5 billion.

[1:34:42] Have we changed any this year?

[1:34:44] We upped it to 1.7.

[1:34:48] That is a third overall as we

[1:34:49] look at our $4 billion

[1:34:50] budget. It's very important

[1:34:52] service that we provide.

[1:34:56] i truly believe and I often say

[1:34:57] to people, this county

[1:34:59] has universal healthcare

[1:34:59] regardless what you might have

[1:35:00] in '

[1:35:00] county.

[1:35:03] We really do have that.

[1:35:06] There is absolutely no way that

[1:35:07] you could not get

[1:35:08] service in this county if you

[1:35:09] wish to get it.

[1:35:14] You can go to one of our

[1:35:16] clinics or partnership clinic.

[1:35:18] You can access our urgent care.

[1:35:19] You can access -- there are

[1:35:21] number of ways that you can

[1:35:24] get treatment in this county.

[1:35:26] We have had support from that

[1:35:27] from the public for a

[1:35:30] very long period of time.

[1:35:32] Right now, we're under way with

[1:35:34] a new building which I

[1:35:37] think still is on target for

[1:35:38] 2013, which is going to be

[1:35:40] certainly state of the art.

[1:35:43] Having said all of that, we

[1:35:45] really have struggled over

[1:35:50] the last few years, ken equal

[1:35:52] credit and I, to really put

[1:35:55] the hospital on a different

[1:35:55] track.

[1:35:59] because just as mike mentioned

[1:36:01] earlier that the rise in

[1:36:02] healthcare is phenomenal.

[1:36:04] It is also difficult when we

[1:36:09] now have so many issues so

[1:36:11] many new diagnostic test.

[1:36:13] So much is new particularly for

[1:36:14] patients not ask for

[1:36:14] those.

[1:36:16] If you go in with broken leg

[1:36:19] now rather than simply

[1:36:20] have an x-ray, someone will say

[1:36:24] you need an mri and ct scan.

[1:36:25] There's a lot of explanation

[1:36:29] that must go on between

[1:36:30] the provider and the user.

[1:36:32] It's become a far more

[1:36:34] complicated system that we use

[1:36:36] in order to provide healthcare.

[1:36:38] one that I think we have to be

[1:36:39] explaining to the public

[1:36:41] a great deal of time.

[1:36:43] Having said that, we still got

[1:36:46] great support in '08 for

[1:36:48] the bond putting up the new

[1:36:50] building. When we have gone

[1:36:51] out

[1:36:53] for public support particularly

[1:36:54] for kids areas, trauma and

[1:36:57] so forth, we've gotten that as

[1:36:58] well.

[1:37:00] i think the public truly does

[1:37:05] value this service that

[1:37:13] we provide in exemplary way in

[1:37:13] this county.

[1:37:17] This is not a whole new area

[1:37:19] for you but a different

[1:37:21] way to deliver healthcare.

[1:37:25] I really like to say thanks to

[1:37:27] ken because this is --

[1:37:29] these are long meetings that we

[1:37:30] have.

[1:37:32] We've spend a great deal of

[1:37:34] time.

[1:37:37] I spend a lot of time talking

[1:37:39] to jeff and linda

[1:37:42] particularly with gays and cfo.

[1:37:44] We are working with diligence

[1:37:48] to try to keep the cost

[1:37:50] down of that most expensive of

[1:37:52] our department.

[1:37:53] I really want the public as

[1:37:55] well as employees know

[1:38:03] that, I think we have had a

[1:38:05] concentrate effort in order to

[1:38:06] understand more completely

[1:38:07] exactly how the healthcare

[1:38:08] dollar

[1:38:08] is spent.

[1:38:11] I think we're making some

[1:38:12] progress.

[1:38:14] I'm going to turn this over to

[1:38:16] ken next year and lord

[1:38:18] knows he May save a whole lot

[1:38:20] more than we've been able to

[1:38:21] together.

[1:38:22] i really do want to show

[1:38:24] everyone that we have worked

[1:38:24] hard on this.

[1:38:28] It good to see you renee.

[1:38:30] You will be over seeing our

[1:38:32] umbrella of healthcare

[1:38:32] services.

[1:38:38] For all the other thing that we

[1:38:39] provide, we deliver

[1:38:40] kind of a sober message.

[1:38:42] if you don't have your

[1:38:44] healthcare and you don't have a

[1:38:46] way to get healthcare to help

[1:38:50] you through the problem to

[1:38:54] hopefully get better, there's

[1:38:57] no other option.

[1:39:02] many other things we can do

[1:39:03] without.

[1:39:05] When one's health is

[1:39:06] threatened, it changes your

[1:39:07] whole

[1:39:08] life.

[1:39:10] We're in a life saving business

[1:39:11] and hopefully we're

[1:39:13] also in a prevention business,

[1:39:16] which has been one of the

[1:39:18] areas that both ken and I have

[1:39:19] concentrated on through

[1:39:22] public health as we look at our

[1:39:29] great great grants come in.

[1:39:32] A rather long speech but I feel

[1:39:35] fairly passionately

[1:39:38] about this whole area and it

[1:39:40] certainly has been a

[1:39:42] challenging but very rewarding

[1:39:43] area to work with while I've

[1:39:48] been here at the county.

[1:39:49] Thanks.

[1:39:50] >> thank you very much

[1:39:51] supervisor kniss.

[1:39:52] You did ask a question in there

[1:39:54] that I feel compelled

[1:39:55] to answer.

[1:39:59] >> I'm trying to think where I

[1:40:01] asked the question

[1:40:01] [Laughter].

[1:40:02] >> you asked whether we're

[1:40:03] still on schedule for that

[1:40:04] building.

[1:40:05] the answer to that is no.

[1:40:12] With changes in terms of our

[1:40:18] interaction with osh pod

[1:40:26] as well as we modify our

[1:40:27] strategic planning.

[1:40:29] In addition, there's some

[1:40:30] issues around the design

[1:40:33] build and the relationship with

[1:40:34] the contractor.

[1:40:36] We are behind schedule and at

[1:40:38] this point, I can't give

[1:40:40] you an exact number but it's

[1:40:44] probably in the year range.

[1:40:49] i would not expect to be ready

[1:40:52] to open in 2013.

[1:40:54] >> heading at least to 2014?

[1:40:56] >> with our fingers crossed.

[1:41:00] >> one other thing I would say

[1:41:01] george, I think we've

[1:41:04] become much more realistic in

[1:41:05] our prediction of numbers.

[1:41:09] you're going to see that in

[1:41:09] here.

[1:41:12] Ken and I both follow an daily

[1:41:14] basis what the consensus

[1:41:17] is on the hospital.

[1:41:18] Almost no stone has been

[1:41:19] unturned if we track this.

[1:41:24] As you look at this here, you

[1:41:25] have noticed we have

[1:41:27] become far more realistic in

[1:41:28] our prediction which allow us

[1:41:29] to become much more realistic

[1:41:33] as we go through our budgeting

[1:41:35] session.

[1:41:41] That -- we haven't hit our

[1:41:42] target.

[1:41:45] I think it's more realistic and

[1:41:48] i think we have seen a

[1:41:49] number of improvements lately

[1:41:54] as far as getting toward that

[1:41:57] those actual numbers we

[1:41:58] allocated last year.

[1:42:00] >> thank you supervisor. Jeff

[1:42:01] anything else?

[1:42:05] Thank you renee and let's go to

[1:42:06] the unit form 14 grant.

[1:42:08] it was a long way to get to you.

[1:42:11] >> I'm happy to wait.

[1:42:12] Custody health services. From

[1:42:13] the highlights

[1:42:15] identified above, just like to

[1:42:19] quickly point out two of the

[1:42:20] highlights.

[1:42:22] The first the second bullet

[1:42:24] where we finalized

[1:42:27] agreement with the social

[1:42:30] security administration.

[1:42:34] This is really a critical

[1:42:35] piece, success reentry

[1:42:38] efforts for inmates back into

[1:42:40] our community I'm sure board

[1:42:43] members are aware May lose

[1:42:43] benefits upon incarceration and

[1:42:45] when they are released from the

[1:42:47] jail, it takes them three,

[1:42:49] six and more months to obtain

[1:42:51] benefits. This agreement will

[1:42:55] allow us to start the process

[1:42:56] three months prior to the

[1:42:58] release and the benefits will

[1:42:59] be available to them hopefully

[1:43:01] on the day of their release.

[1:43:04] We will be able to provide

[1:43:05] appropriate housing and

[1:43:10] other benefits for them.

[1:43:11] The last bullet I will point

[1:43:15] out 62% of our inmates

[1:43:18] receive medicare and equates

[1:43:19] about 2200 inmates. 22%

[1:43:21] receive mental health services

[1:43:27] and approximately a thousand

[1:43:29] inmates. As far as our request

[1:43:32] for funding, for fiscal

[1:43:34] year, the request is six

[1:43:35] positions.

[1:43:37] These positions are direct

[1:43:50] service care providers.

[1:43:53] i would be happy to answer any

[1:43:53] questions you might have

[1:43:58] >> maybe question and comment.

[1:44:03] We had discussions with

[1:44:06] possibly medical and that whole

[1:44:09] model.

[1:44:15] i think it was on page 463, the

[1:44:16] four positions and it

[1:44:19] mentions focus of care will be

[1:44:24] on primary prevention and

[1:44:25] chronic disease management.

[1:44:27] Certainly a good plan that

[1:44:30] rotate maybe one out of the

[1:44:30] six doctors and ga the

[1:44:33] community to do that treatment

[1:44:37] possibly and I've always

[1:44:39] advocated that the -- can you

[1:44:40] talk

[1:44:42] about discussions?

[1:44:46] >> the plan is that setting and

[1:44:49] primary care clinic at

[1:44:51] the reentry center.

[1:44:58] we want it to be a transition

[1:44:58] al center.

[1:45:01] We will be providing services

[1:45:03] until we can get them

[1:45:04] reestablished within the

[1:45:06] community with their primary

[1:45:06] care

[1:45:07] provider.

[1:45:10] >> we'll hear that five year

[1:45:10] plan.

[1:45:13] I'm sure you'll be there too.

[1:45:17] other questions from the

[1:45:22] committee?

[1:45:24] >> on page 460, on the right

[1:45:28] hand side three down, it

[1:45:32] says unfunded codes.

[1:45:35] i understand it cost center and

[1:45:37] it list 24 ftes.

[1:45:38] Can you explain what those are?

[1:45:40] Are they in the body of this

[1:45:44] and I didn't see it?

[1:45:46] >> the unfunded codes

[1:45:50] historically had a number up

[1:45:51] funded codes as I believe

[1:45:53] valley medical center had

[1:45:54] unfunded

[1:45:56] codes.

[1:45:57] Primary focus of those codes is

[1:45:59] they are all clinical

[1:46:01] positions. For-instances, we

[1:46:07] have clinical nurse position,

[1:46:09] nurse practitioner.

[1:46:11] They are used on individuals on

[1:46:12] a long term leave

[1:46:16] >> those are sort of like

[1:46:18] temporary health help?

[1:46:22] >> they are not temporary help.

[1:46:24] >> temporary contracts maybe?

[1:46:25] >> they would be.

[1:46:32] If we fill the position, it

[1:46:34] will be a coded position.

[1:46:37] it's a vacant position but it's

[1:46:38] unfunded.

[1:46:42] Funding will come from the

[1:46:43] position that -- let me see

[1:46:48] if I can back up.

[1:46:50] I can't remember when we last

[1:46:51] use them.

[1:46:53] We use it on in situations

[1:46:55] where we have a critical

[1:46:56] position within the

[1:46:58] organization to provide

[1:46:59] clinical care

[1:47:02] and we don't have the capacity

[1:47:05] to fill the position because

[1:47:06] people are on long term

[1:47:07] extended leave and we need to

[1:47:09] continue to provide the service.

[1:47:12] We would seek permission to use

[1:47:15] unfunded code.

[1:47:17] Let's say a nurse practitioner,

[1:47:18] we will seek

[1:47:20] opportunity to use unfunded

[1:47:22] code, hire someone under the

[1:47:24] code and they will be a coded

[1:47:25] employee.

[1:47:29] >> what jure saying, these are

[1:47:32] sort of your kinds of

[1:47:32] provided codes?

[1:47:35] You seldom use them but you

[1:47:39] need them in a just in case

[1:47:39] situation?

[1:47:40] >> that it correct.

[1:47:42] >> you you're saying you seldom

[1:47:44] use them?

[1:47:46] >> very seldom.

[1:47:48] I have to check with finance.

[1:47:53] I know we haven't used them in

[1:48:00] many years.

[1:48:04] >> employees on long term

[1:48:08] leave, we do not need

[1:48:09] unfunded codes. Historically,

[1:48:11] the unfunded codes in custody

[1:48:15] health as well as elsewhere in

[1:48:17] the hospital as mentioned are

[1:48:20] clinical positions.

[1:48:22] They mostly for the patient

[1:48:22] census.

[1:48:27] We build to the number of

[1:48:28] positions that maximumly

[1:48:31] going to be used. At times, we

[1:48:32] look at those unfunded codes

[1:48:35] to see if we continue to

[1:48:38] reflect that in the budget.

[1:48:41] >> anything else on that?

[1:48:47] >> I think you can understand

[1:48:49] why I was somewhat

[1:48:51] puzzled by those.

[1:48:53] I almost call them extremist if

[1:48:54] you need to pull on

[1:48:54] those.

[1:48:57] It's just a lot of codes.

[1:48:59] That what seemed unusual.

[1:49:04] thanks george.

[1:49:04] >> supervisor cortese?

[1:49:06] >> this is kind of a general

[1:49:09] question about the fte

[1:49:10] that will be seen throughout

[1:49:13] the budget in terms of ab109

[1:49:15] and the add ons.

[1:49:17] I'm not really clear.

[1:49:21] I didn't catch it in the

[1:49:23] overview or anything yet, as

[1:49:26] to what the bigger picture is.

[1:49:28] Obviously, the reentry program

[1:49:29] started in this current

[1:49:30] fiscal year.

[1:49:34] It started in prior calendar

[1:49:35] year.

[1:49:38] I don't recall how we factored

[1:49:42] in covering the cost of

[1:49:42] that.

[1:49:43] Obviously reimburses from the

[1:49:45] state.

[1:49:48] How we factored in terms of fte.

[1:49:50] How we getting by.

[1:49:52] There must be some strategy

[1:49:55] beneath all of this is is

[1:49:59] ramping up with the program to

[1:49:59] add fte.

[1:50:01] I do see the revenue coming in

[1:50:02] the documents I don't

[1:50:08] know what the methods to to

[1:50:10] the madness is.

[1:50:12] The way we receive it it's

[1:50:19] pieced in unit byunit.

[1:50:20] Maybe for the benefit for the

[1:50:22] rest of us, you can tell

[1:50:25] us how does that ramping

[1:50:25] working?

[1:50:27] I didn't really want to put

[1:50:28] that on one unit here.

[1:50:32] >> in the front of the

[1:50:36] document, there's a section on

[1:50:55] ab109 that 109 attempts.

[1:50:57] The department created a plan

[1:50:58] to how we approach this.

[1:51:02] The key factor is to recognize

[1:51:03] the fact since this was

[1:51:07] a major change, a change in a

[1:51:08] that we recognized there would

[1:51:13] be things happening where we

[1:51:13] have to adjust.

[1:51:14] It's a flexible plan.

[1:51:15] Over the course since October

[1:51:17] 1, we come back to the

[1:51:19] board on two different

[1:51:21] occasions to make modifications

[1:51:24] already to the plan.

[1:51:26] we attempting to -- what we

[1:51:27] seeing we given forecast.

[1:51:31] As we implement the programs we

[1:51:33] are adjusting based on

[1:51:34] the actual experience.

[1:51:36] It's not as if it's a hard and

[1:51:38] fast plan because we're

[1:51:40] trying to be flexible.

[1:51:42] As jeff mentioned in the

[1:51:44] introduction, we plan for

[1:51:48] basic. Getting a doubling of

[1:51:49] our resource and so what's in

[1:51:52] front of you in terms of the

[1:51:53] recommended budget, reflects

[1:51:53] that.

[1:51:57] There are an impact in terms of

[1:52:02] ftes in each the

[1:52:04] area, collection, probation and

[1:52:05] custody health.

[1:52:06] There's impacts more service

[1:52:07] and contract related drug

[1:52:09] and alcohol and mental health

[1:52:11] type of services. It's a

[1:52:11] combination.

[1:52:14] What we're trying to reflect is

[1:52:16] our actual experience

[1:52:17] in the area that is

[1:52:19] particularly clear to us as

[1:52:19] probation.

[1:52:22] We trying to keep a 1 to 30

[1:52:25] case load to make sure the

[1:52:28] over sight is very intense.

[1:52:29] Corrections is a little bit

[1:52:30] more difficult because

[1:52:39] we're changing the nature of

[1:52:42] our collection system.

[1:52:42] Previously, we rarely had

[1:52:43] people here only a year.

[1:52:45] We have to look at how we're

[1:52:47] going to manage that

[1:52:48] change in the geopopulation.

[1:52:51] >> is it fair to say we're

[1:52:52] extrapolating growth based

[1:52:54] on our immediate past

[1:52:55] experience, which only been

[1:52:57] about 6

[1:52:59] offer 8 months?

[1:53:02] In the formula over all seems

[1:53:06] to be a doubling of

[1:53:08] resources?

[1:53:10] sounds like there's nuances in

[1:53:11] each unit?

[1:53:14] >> their ramping up as we see

[1:53:14] more individuals coming

[1:53:16] out of state prison, we become

[1:53:20] more responsible for in terms

[1:53:20] of parole/probation.

[1:53:22] We also seeing increase in the

[1:53:24] number of individuals

[1:53:25] coming into our local jail

[1:53:27] system.

[1:53:29] these are known the 117hs that

[1:53:30] would have gone to

[1:53:30] state prison.

[1:53:32] You end up with this increase

[1:53:33] and then people start to

[1:53:37] be released and you end up with

[1:53:38] sort of a plateau effect.

[1:53:40] We have projections from the

[1:53:41] state in terms of the

[1:53:43] numbers of people we're getting

[1:53:44] out of the state prison

[1:53:48] system that would have normally

[1:53:49] gone to state parole.

[1:53:53] we know the individual that are

[1:53:53] being sentenced.

[1:54:00] I'm getting more detail here.

[1:54:01] There's changes in the way

[1:54:02] inmates are sentenced. Some

[1:54:05] are sentenced without any

[1:54:07] probation and some are split

[1:54:07] sentences.

[1:54:10] we have to take all of those

[1:54:13] factors into account to

[1:54:14] determine what's the

[1:54:16] appropriate level.

[1:54:18] We have the spillover in terms

[1:54:19] of custody health as

[1:54:21] more people are sicker and

[1:54:24] trying to manage all of that in

[1:54:27] terms of how we're allocating

[1:54:27] our resources.

[1:54:29] The other focus is making sure

[1:54:30] these people have the

[1:54:37] services that they need to avoid

[1:54:39] recidivating

[1:54:42] >> that's been a helpful

[1:54:45] overview.

[1:54:47] I heard bits and pieces

[1:54:53] depending on who office I was

[1:54:56] sitting on.

[1:54:57] I understand all that was put

[1:54:58] together by the teams

[1:54:59] that have been working on this

[1:55:03] and you brought it back down

[1:55:04] unit by unit.

[1:55:05] The board of supervisors

[1:55:09] ultimate question is, having

[1:55:10] done that, you then match those

[1:55:13] unit numbers up with the

[1:55:14] revenue.

[1:55:18] I don't want to call it new

[1:55:20] money.

[1:55:21] There's in general fund

[1:55:21] encroachment.

[1:55:22] I don't what keep asking that

[1:55:23] question.

[1:55:24] That's what I'm really after

[1:55:25] here.

[1:55:29] I need it understand the

[1:55:39] process, any time we see these

[1:55:41] ab109 ft es ramping up, that's

[1:55:44] going to come from the unit

[1:55:44] of that state.

[1:55:45] It's a wash.

[1:55:48] >> the dollars allocated for

[1:55:50] the ab109 expenses are

[1:55:52] 100% coming from the state.

[1:55:58] we tie them directly.

[1:55:59] There's no discretionary

[1:56:00] general fund impact.

[1:56:02] So far.

[1:56:07] >> thank you very much.

[1:56:11] That was one of the concerns

[1:56:16] that part $15 billion

[1:56:17] balancing act might pull the

[1:56:19] rug out from under us.

[1:56:20] I appreciate the explanation.

[1:56:24] I was just worried that these

[1:56:26] fte May not have been

[1:56:29] unit by unit balance against

[1:56:29] the revenue.

[1:56:31] If I was in the unit, I would

[1:56:47] say this is what I need.

[1:56:49] >> we're really managing the

[1:56:51] funding allocations from

[1:56:52] the county executive's office

[1:56:56] working closely with the ccp.

[1:56:58] The thing that is really

[1:57:01] interesting is that -- one of

[1:57:02] the things we will be talking

[1:57:04] about is that the preliminary

[1:57:05] formula or funding allocation

[1:57:08] looks like it's going to

[1:57:12] allocate more than we assumed.

[1:57:14] Recognizing the concerns that

[1:57:15] everyone rightly has with

[1:57:16] the state deficit increasing, I

[1:57:19] think it's going to give us

[1:57:21] an opportunity to reserve

[1:57:22] significant portion and hold it

[1:57:26] until we have more confidence

[1:57:27] that those allocations are

[1:57:28] going to be stable.

[1:57:30] Of course, one of the issues is

[1:57:31] going to be what

[1:57:31] happens in November.

[1:57:32] There is a funding guarantee

[1:57:35] that will be on the ballot

[1:57:39] for the ab109, the public

[1:57:40] safety realignment.

[1:57:43] >> we'll talk more about that

[1:57:44] on thursday.

[1:57:45] Supervisor wassermann.

[1:57:47] >> very quickly, I really

[1:57:50] appreciate the point

[1:57:51] supervisor cortese brought up.

[1:57:52] President Shirakawa you made

[1:57:55] about the rug coming out

[1:57:56] from under us.

[1:58:03] the reason if hasn't happened,

[1:58:04] they jumped to three

[1:58:04] days ago.

[1:58:07] The question I had was on page

[1:58:08] four, talking about

[1:58:11] custody health services

[1:58:13] highlight to fiscal year '12.

[1:58:17] it talks about two out of three

[1:58:19] inmate receive medical

[1:58:20] services daily.

[1:58:21] That's an astounding number to

[1:58:22] me.

[1:58:24] I learn more every single day

[1:58:29] while I'm in office.

[1:58:31] With the transitions taking

[1:58:31] place with those being

[1:58:33] transferred from the state to

[1:58:36] county, I imagine it's about

[1:58:36] the same.

[1:58:38] because of the nature of the

[1:58:40] individuals that were the

[1:58:44] state prison, I understand

[1:58:49] there's severity seriousness of

[1:58:51] crimes committed are the

[1:58:52] make-up the prisoners?

[1:58:57] I think it changes over time.

[1:58:59] will the medical needs increase

[1:59:00] greater still with

[1:59:02] those being transferred over?

[1:59:05] >> let me make a point of

[1:59:06] clarification, the inmate who

[1:59:10] within the jail system, the

[1:59:14] ab109 inmates, we are familiar

[1:59:16] with them because they've been

[1:59:17] incarcerated and gone through

[1:59:18] trial and they are sentenced.

[1:59:20] we believe in providing care to

[1:59:21] them.

[1:59:25] They now just in a new bucket.

[1:59:28] Now they are ab109 inmay notes.

[1:59:29] The inmates from the prison

[1:59:31] system who being released

[1:59:33] from the prison, we do not

[1:59:36] provide services to them within

[1:59:37] the jail.

[1:59:42] >> they're all probationary?

[1:59:45] >> yes.

[1:59:46] We would establish primary

[1:59:50] clinic center. We would

[1:59:54] have the doors open to them.

[1:59:55] >> thank you for that

[1:59:56] clarification.

[1:59:58] >> with respect do we

[1:59:59] anticipate that the healthcare

[2:00:00] needs essentially going to

[2:00:06] change this population, we do.

[2:00:08] In the past, although many May

[2:00:09] stay with us many years

[2:00:13] while they going through their

[2:00:15] trial, generally, period of

[2:00:18] time within the jail maybe 150

[2:00:20] average length of stay.

[2:00:23] we didn't necessarily need to

[2:00:24] provide services.

[2:00:27] For instance someone had a

[2:00:29] minor hernia, we would not

[2:00:31] support having that hernia

[2:00:33] repaired while they were in

[2:00:33] custody.

[2:00:36] It would be taken care when

[2:00:36] they were released.

[2:00:38] Now that they are going to be

[2:00:40] sentenced to the jail, we

[2:00:41] need to provide those services

[2:00:42] for them.

[2:00:48] In fact, we need to provide

[2:00:49] preventive healthcare

[2:00:50] services because they are going

[2:00:51] to be with us year after

[2:00:52] year.

[2:00:55] We do anticipate there will be

[2:00:56] very significant

[2:00:56] changes.

[2:00:59] >> I like to expand on that a

[2:01:00] little bit.

[2:01:05] it is also true that the

[2:01:06] inmates who classically are in

[2:01:10] prison or has been in prison

[2:01:14] tend to be less healthy than

[2:01:15] what has classically been in

[2:01:15] jail.

[2:01:18] That has to do with a lot of

[2:01:21] factors but when you

[2:01:22] figure that the vast majority

[2:01:24] of the crimes that are

[2:01:25] committed that result in people

[2:01:28] being in jail are drug

[2:01:30] related and violence related

[2:01:32] and people typically also

[2:01:37] taking their own drugs.

[2:01:39] We are much more able to keep

[2:01:41] people alive for longer

[2:01:42] periods of time.

[2:01:46] lots of people with chronic

[2:01:48] heart disease, chronic lung

[2:01:49] disease, chronic kidney

[2:01:53] disease, diabetes, all kinds of

[2:01:54] other issues infection, tb, hiv

[2:01:58] and various sort of things.

[2:02:00] As maryann brings out, now that

[2:02:01] we're going to be

[2:02:02] responsible for these people

[2:02:06] for a longer period of time,

[2:02:08] we're going to be responsible

[2:02:12] for things like transplants,

[2:02:15] dialysis, lots of very

[2:02:16] expensive procedures.

[2:02:18] >> you're saying they let

[2:02:20] health insurance lapse?

[2:02:24] >> we don't --

[2:02:25] >> I'm kidding.

[2:02:26] >> the question you are getting

[2:02:28] at, they're going to

[2:02:31] get more extensive and the

[2:02:35] answer is question yes, lot

[2:02:58] more.

[2:03:04] >> I wanted to ask board of

[2:03:07] supervisors so extend

[2:03:10] services to juvenile hall.

[2:03:15] They get visit one day a week.

[2:03:20] With 60% of the kids, have

[2:03:21] serious dental issues.

[2:03:25] It was also noted in the last

[2:03:25] juvenile justice report

[2:03:29] several grievances were filed

[2:03:32] by you because dental payments

[2:03:33] were delayed.

[2:03:35] We all know how much dental

[2:03:36] pain interferes with your

[2:03:42] ability to learn and behave.

[2:03:45] I know san diego is a much

[2:03:47] larger system but they have

[2:03:47] two full time dentist.

[2:03:51] We need to figure out how to do

[2:03:52] this because these kids

[2:03:56] -- they have so many issues

[2:03:59] with them.

[2:03:59] Thank you.

[2:04:02] >> any other questions on this

[2:04:04] unit?

[2:04:10] i see none, thank you.

[2:04:32] next unit is 417.

[2:04:34] >> good afternoon President And

[2:04:37] board members.

[2:04:38] I'm bruce copeley.

[2:04:41] I'm here to review our

[2:04:42] recommended budget.

[2:04:46] I would draw your attention to

[2:04:47] two elements.

[2:04:52] the first is a recommendation

[2:04:56] for authorization for

[2:04:58] $311,000 for two psychiatric

[2:05:00] social workers and a

[2:05:02] replacement of dollars lost for

[2:05:03] half time psychiatric social

[2:05:04] worker.

[2:05:07] These are individuals that are

[2:05:10] working at the park and

[2:05:13] adopted at the clinic to

[2:05:14] provide additional medical

[2:05:14] services.

[2:05:17] They will be providing

[2:05:19] screenings, consultation to the

[2:05:21] primary care doctors and

[2:05:23] treatment.

[2:05:30] The second is $401,000 that is

[2:05:32] for augmentation and

[2:05:33] enrollment of clients into the

[2:05:34] valley care.

[2:05:36] These are fees previously

[2:05:36] collected both from the

[2:05:38] county department as well as

[2:05:41] from our contract agencies.

[2:05:43] With enrollment of valley care

[2:05:44] that is eliminated to

[2:05:45] continue the capacity necessary

[2:05:47] to serve these individuals

[2:05:55] and to bring in enrollment in

[2:05:56] anticipation medi-cal

[2:05:57] qualification.

[2:05:58] We're recommending these

[2:05:59] dollars be added.

[2:06:02] The final good news is,

[2:06:03] approximately $2 million of

[2:06:05] additional 109 moneys that are

[2:06:07] recommended to be brought

[2:06:09] into the department to stand

[2:06:11] both outpatient services and

[2:06:11] residential services.

[2:06:15] currently we have a waiting

[2:06:16] list from ab109.

[2:06:18] It will substantially reduce

[2:06:19] that waiting list and

[2:06:20] allow us to serve the

[2:06:24] individuals that are now coming

[2:06:24] for

[2:06:25] into ab109 process.

[2:06:27] With that I'll take any

[2:06:28] questions or clarifications you

[2:06:32] would like from me.

[2:06:35] >> let me just start by saying

[2:06:37] thank you.

[2:06:40] Last year we talked about the

[2:06:41] gateway program.

[2:06:44] We all know people are ready to

[2:06:46] make that change and so

[2:06:48] appreciate that effort.

[2:06:49] You mentioned the $2 million.

[2:06:52] Hopefully it will free up this

[2:06:54] $2 million more services

[2:06:56] for others.

[2:06:57] That's a good thing.

[2:06:58] Supervisor wassermann?

[2:07:00] >> just a quick question, one

[2:07:01] way or another, how long

[2:07:03] have you been with the county?

[2:07:08] >> 24 years in another month.

[2:07:11] 14 years with dad and 10 years

[2:07:11] with mental health.

[2:07:14] >> it's probably a good time to

[2:07:16] think about, I know

[2:07:21] folks have talked previewed

[2:07:24] some kind of behavior health

[2:07:26] department from a dads merger.

[2:07:29] I know others out there talked

[2:07:30] about it.

[2:07:34] I'm just throwing that out

[2:07:36] there as a comment.

[2:07:38] >> I know that the issue has

[2:07:41] been discussed.

[2:07:43] I just met this morning with

[2:07:44] bruce.

[2:07:45] He's getting up to speed.

[2:07:49] We're looking at all of our

[2:07:52] options at to point and

[2:07:53] pluses and minuses to no matter

[2:07:55] what you do and nothing will

[2:07:57] be done without stakeholderrer

[2:07:58] input.

[2:07:59] >> it doesn't hurt to have the

[2:08:00] discussion for sure.

[2:08:02] That's all I'm saying.

[2:08:03] >> I understand.

[2:08:06] >> I don't have any other

[2:08:06] lights on thank you.

[2:08:11] We'll move on to the next

[2:08:15] section, unit 418, community

[2:08:25] health services.

[2:08:31] >> dave wright, directors of

[2:08:32] ambulatory care services.

[2:08:35] Our community health services

[2:08:41] is composed of two

[2:08:44] community health clinics.

[2:08:48] They also receive the unit and

[2:08:49] diversity award by the

[2:08:53] board of supervisors.

[2:08:59] our tb clinic and refugee

[2:09:03] clinic, they have the liest

[2:09:05] numbers coming from iran,

[2:09:07] burma, iraq and china.

[2:09:14] No budget changes are proposed

[2:09:22] for fy '13.

[2:09:24] >> I don't have any lights on.

[2:09:27] You're off the hook.

[2:09:30] Good job dave.

[2:09:35] Item 12, unit 725.

[2:09:40] valley health plan.

[2:09:45] >> hello.

[2:09:45] Greg price.

[2:09:47] Valley health plan has a

[2:09:48] commercial plan.

[2:09:50] We had a very successful year

[2:09:52] this year.

[2:09:53] We approach being 15,000

[2:09:55] commercial members.

[2:09:58] We also manage medi-cal,

[2:10:00] healthy kids healthy families

[2:10:01] for valley medical center.

[2:10:03] We're getting on to about

[2:10:06] 90,000 new lives and we're

[2:10:07] forecasting about 184 million

[2:10:08] next year in revenue.

[2:10:14] All of our positions for fy '12

[2:10:15] were paid for.

[2:10:17] We're in the asking for any new

[2:10:18] money.

[2:10:19] any questions about the budget?

[2:10:22] >> I don't have any lights.

[2:10:22] No, thank you.

[2:10:27] >> always a pleasure.

[2:10:31] Thanks.

[2:10:32] >> we still --

[2:10:33] >> we should mention at health

[2:10:34] and hospital committee,

[2:10:37] we discussed all of these.

[2:10:39] >> as a case with all the

[2:10:41] sections and committees

[2:10:44] either have or will have

[2:10:45] detailed discussions.

[2:10:45] Thank you.

[2:10:46] Supervisor wassermann.

[2:10:49] >> I want to mention that it's

[2:10:52] a pleasure spending

[2:10:54] hours going over these binders

[2:10:55] with staff and discussing and

[2:10:58] at the end hearing no new

[2:10:59] changes, status quo that kind

[2:10:59] of

[2:11:00] thing.

[2:11:02] Think you're all doing great

[2:11:05] work.

[2:11:06] >> thank you.

[2:11:07] Item 410.

[2:11:09] >> we'll start by going through

[2:11:14] our highlights for the

[2:11:14] year.

[2:11:18] Really a huge thanks to our

[2:11:18] board of supervisors for

[2:11:22] being progressive in adopting a

[2:11:23] number of health related

[2:11:24] policies. Just a quick

[2:11:26] refresher over this list.

[2:11:27] We adopted a comprehensive food

[2:11:27] and nutritional

[2:11:31] policies which a lot of folks

[2:11:31] worked on.

[2:11:34] Both the city and county passed

[2:11:37] a number of outdoor

[2:11:40] smoke prevention policy

[2:11:45] including tobacco retail

[2:11:45] licensing.

[2:11:47] We're in the line of to do the

[2:11:49] latino health assessment

[2:11:57] in the fall of 2012.

[2:11:58] The vietnamese community it in

[2:11:58] the bay area and become

[2:12:00] state and nationally recognized.

[2:12:02] as you will recall this time

[2:12:05] ast year, we were talking

[2:12:07] about a potential new vendor

[2:12:10] for our ems system.

[2:12:12] I'm pleased metro has been

[2:12:13] performing good or better

[2:12:14] than prior vendor.

[2:12:16] The response time is slightly

[2:12:16] better.

[2:12:18] All in all slight improvement

[2:12:22] in the system and kept

[2:12:23] the system affordable.

[2:12:24] now budget highlights.

[2:12:27] Much like my other colleagues

[2:12:28] our budget is essentially

[2:12:30] level budget for this next

[2:12:31] fiscal year.

[2:12:33] No additional county general

[2:12:34] fund augmentation request.

[2:12:35] I will quickly run you through

[2:12:37] where we're moving some

[2:12:39] money.

[2:12:45] we're moving essentially

[2:12:46] $247,000 from federal fund.

[2:12:49] I will start with accreditation.

[2:12:50] As I mentioned before,

[2:12:51] accreditation is a additional

[2:12:52] public health effort.

[2:12:55] We're going to be moving about

[2:12:56] $95,000 into that

[2:12:57] particular effort.

[2:12:58] The latino health assessment

[2:13:03] actually will cost us

[2:13:04] around $250,000 to $300,000.

[2:13:08] we need to move additional

[2:13:08] $75,000 essentially out of

[2:13:09] the administration in other

[2:13:12] areas and back fill that.

[2:13:14] Incidentally, we went out for

[2:13:16] bids to do the community

[2:13:18] neighborhood assessment for the

[2:13:18] latino health assessment.

[2:13:20] We got quotes as high as a

[2:13:21] million dollars.

[2:13:22] The fact that we're actually

[2:13:27] able to deliver hopefully,

[2:13:28] deliver an assessment during

[2:13:29] financial health week, it's

[2:13:30] quite an accomplishment for the

[2:13:31] amount of money we're

[2:13:31] working with.

[2:13:37] We like to propose to move about

[2:13:43] $30,000 into help

[2:13:44] promotion media.

[2:13:47] we were fortunate to have a

[2:13:48] full time position.

[2:13:52] We don't have a single dollar

[2:13:53] behind her code this is

[2:13:54] to recognize a small amount of

[2:13:58] money for that type of work.

[2:14:00] Public health preparedded, is

[2:14:01] an interesting idea.

[2:14:04] We never had any dedicated

[2:14:07] staff.

[2:14:07] This amount money coming from

[2:14:09] internal resources which

[2:14:10] fund a half time code.

[2:14:12] We'd initially hope to work

[2:14:15] with oes and faf to fund a

[2:14:16] full time position and we could

[2:14:17] have contributed half of

[2:14:17] that.

[2:14:23] We were not able to do this in

[2:14:26] this budget cycle.

[2:14:29] we have roughly $4 million in

[2:14:30] inventory in the

[2:14:30] warehouse.

[2:14:33] By the time full lease payment

[2:14:35] will be made, the county

[2:14:36] well invested well over $10

[2:14:37] million.

[2:14:38] This particular code and the

[2:14:39] reason I'm talking a

[2:14:41] little bit more about this one,

[2:14:42] is that this would be the

[2:14:45] one and only individual

[2:14:46] dedicated to nation sure that

[2:14:49] warehouse is on a ready-go

[2:14:50] status at all time.

[2:14:53] It's able to both receive and

[2:14:54] deploy goods in rain out

[2:14:56] of the warehouse in a disaster

[2:14:58] situation.

[2:15:01] The next item is interesting

[2:15:01] one immunization clinic

[2:15:04] staffing.

[2:15:06] We have 1.5 vacant codes in

[2:15:09] that particular code and we

[2:15:15] will be adding 1.5 1.5 vacant

[2:15:15] code.

[2:15:18] We're going to be deleting a

[2:15:23] vacant office specialist

[2:15:26] and a vacant clinical nurse and

[2:15:31] adding a full time office

[2:15:32] specialist specializing in data

[2:15:33] entry.

[2:15:34] Then the childhood led poison

[2:15:37] program, we are losing a

[2:15:40] state grant of just under

[2:15:41] $94,000.

[2:15:45] Therefore we're going to let

[2:15:47] go of a vacant position.

[2:15:49] This is cleanup from last

[2:15:51] budget year.

[2:15:55] We had lost grant last budget

[2:15:55] cycle.

[2:15:56] This is actually a cleanup that

[2:15:58] is to say that the

[2:15:59] services have not been provided

[2:16:01] for the full fiscal year.

[2:16:04] The child, health and

[2:16:04] disability prevention, we're

[2:16:09] going to be deleting a vacant

[2:16:12] public health nurse three

[2:16:12] code.

[2:16:16] That's due to the fact we're

[2:16:17] losing $110,000 state

[2:16:18] grant.

[2:16:20] That particular line item

[2:16:28] allows us to move $22,000 to

[2:16:30] general fund.

[2:16:33] we ask pharmacy to be very

[2:16:33] aggressive on object two

[2:16:34] cost.

[2:16:38] Really bringing down the cost

[2:16:39] of pharmaceuticals, we're

[2:16:42] able to move about $2000 of

[2:16:47] what's county general fund.

[2:16:50] Any questions?

[2:16:51] >> supervisor kniss?

[2:16:54] >> just some comments and a

[2:16:54] couple questions.

[2:16:57] One of the thing I like to call

[2:16:59] out is that with all of

[2:17:02] our employees, we happen to

[2:17:06] work particularly closely with

[2:17:08] dan peddycord.

[2:17:11] We came to me the other night

[2:17:11] with comprehensive plan.

[2:17:15] it was a challenging meeting.

[2:17:21] He handled it well.

[2:17:26] I want to call out that also on

[2:17:26] a national level, we

[2:17:29] have nose who play a major role

[2:17:33] and dan you're one of those.

[2:17:37] That would lead me into talking

[2:17:37] about the prevention

[2:17:42] fund which is part of the aca.

[2:17:46] One that naco and c-sac worked

[2:17:47] hard to protect.

[2:17:50] I had the health steering

[2:17:50] committee for naco.

[2:17:53] that is one of our top

[2:17:54] priorities.

[2:17:55] The reason that's so important

[2:17:58] that is where we have

[2:18:00] applied some time grants do

[2:18:02] come from other places. That

[2:18:02] is

[2:18:05] place where we can get grants.

[2:18:07] That is where some money can

[2:18:08] come in for just the kind

[2:18:11] of thing we talk about, led

[2:18:12] poisoning and so forth.

[2:18:13] There are issues that are

[2:18:14] looking for thousands of

[2:18:16] dollars and not for millions.

[2:18:19] They make a big difference in

[2:18:19] counties.

[2:18:23] It is a fund that is constantly

[2:18:24] in jeopardy that

[2:18:27] congress looks at it like it's

[2:18:29] a flush fund.

[2:18:31] Prevention doesn't have any

[2:18:33] great payback as far as

[2:18:34] they are concerned.

[2:18:38] It's a lot easier also if we

[2:18:38] put money into acute care

[2:18:40] and than it is to put into

[2:18:41] expression.

[2:18:44] It's one of areas public health

[2:18:46] keeps working hard.

[2:18:47] Marty is part of the national

[2:18:48] group as well.

[2:18:51] I just want to say out loud

[2:18:54] both marty and for dan, i

[2:18:56] so appreciate your service

[2:18:59] because we do get heard around

[2:18:59] the country.

[2:19:02] We are recognized being a

[2:19:05] county that really does do

[2:19:07] excellent work in the

[2:19:07] healthcare field.

[2:19:11] >> thank you very much

[2:19:12] supervisor kniss.

[2:19:14] By 2014 that fund is suppose to

[2:19:15] be about $2 billion on

[2:19:16] a national level.

[2:19:17] It represents the first time

[2:19:19] the federal government put

[2:19:20] some real financial backbone

[2:19:21] into prevention.

[2:19:23] We were the fortunate

[2:19:25] recipients through the

[2:19:26] community

[2:19:27] prevention work money for

[2:19:29] obesity that is reflected this

[2:19:31] that fund.

[2:19:34] Those funds seeming to come to

[2:19:36] an end here in our

[2:19:36] county.

[2:19:38] >> thank you having said that,

[2:19:41] we have a couple

[2:19:42] questions.

[2:19:45] We just talked about emergency

[2:19:46] warehouse position.

[2:19:47] Do we have any other department

[2:19:51] in the county that has

[2:19:54] any role in that warehouse?

[2:19:57] i only visited it once.

[2:19:59] >> we have a small presence

[2:20:00] there.

[2:20:01] The sheriff's office has a

[2:20:02] small presence there.

[2:20:04] We try to work with those

[2:20:06] partners to fill out the

[2:20:08] other half of the fte that full

[2:20:11] time code was justified for

[2:20:14] the amount of assets in that

[2:20:15] warehouse.

[2:20:17] they were not able to fund that

[2:20:18] particular request.

[2:20:19] Our proposal was to go forward

[2:20:20] at least with the half

[2:20:20] time code.

[2:20:23] >> thank you, I appreciate that.

[2:20:25] The other one regards the

[2:20:28] ongoing money for the phd

[2:20:29] accreditation, prep and

[2:20:29] application.

[2:20:32] Does it need to be ongoing

[2:20:32] situation?

[2:20:39] is that one to be a downside to

[2:20:39] one time money?

[2:20:41] >> we're looking at that level

[2:20:42] of commitment on ongoing

[2:20:43] basis.

[2:20:44] Once we reached point of

[2:20:48] applying, we will need to send

[2:20:49] in about $55,000 check. This

[2:20:51] that's good for five years.

[2:20:53] However, most department of our

[2:20:57] size are looking a the

[2:20:59] staffing 1-3 fte full time

[2:21:02] dedicated accreditation.

[2:21:03] What accreditation is

[2:21:05] instilling high level of

[2:21:06] quality

[2:21:06] insurance performance

[2:21:07] improvement across an entire

[2:21:08] organization.

[2:21:10] That takes small investment of

[2:21:11] human resources.

[2:21:13] >> so, I guess my question

[2:21:15] would be, because once we've

[2:21:17] gotten into ongoing, we tend to

[2:21:21] not look at it again as you

[2:21:21] know.

[2:21:25] You feel that's justified and

[2:21:26] something that we should

[2:21:27] include over the next several

[2:21:29] years?

[2:21:32] >> yes, I would very much

[2:21:33] supervisor kniss.

[2:21:38] We are moving other fte within

[2:21:39] the department to back

[2:21:39] our resource need.

[2:21:41] Rather than coming to you and

[2:21:44] asking for a financial

[2:21:46] augmentation for fte, we felt

[2:21:50] $95,000 if it stays relatively

[2:21:53] level should afford reasonable

[2:21:55] level of resource to sustain

[2:21:56] journey to accreditation.

[2:21:58] >> okay, thanks.

[2:21:58] >> besides supervisor the

[2:22:01] president announced on the

[2:22:02] state of the county.

[2:22:04] >> you know, george, you said

[2:22:05] it.

[2:22:06] It's got to be true.

[2:22:22] >> dan, just a couple things.

[2:22:23] When it comes to trauma and

[2:22:25] violence and injury and all

[2:22:26] of those issues, you guys are

[2:22:27] the experts I'm not.

[2:22:32] I can tell you, you come from a

[2:22:33] community of me -- I

[2:22:36] don't need to study, I don't

[2:22:37] need experts tell us the impact

[2:22:38] it has.

[2:22:45] we all know the impact of those

[2:22:50] -- obviously smoking

[2:22:50] thing.

[2:22:50] Interinterrelated.

[2:22:52] I want to thank you for your

[2:22:53] work and I know the

[2:22:57] committee will continue to have

[2:22:58] discussions.

[2:23:01] I think it was a one man

[2:23:02] discussion last time.

[2:23:04] I appreciate your efforts for

[2:23:06] sure and you can expect

[2:23:09] memo from supervisor kniss and

[2:23:10] I here shortly.

[2:23:13] Certainly finding someone to

[2:23:15] help coordinate some of

[2:23:24] those efforts.

[2:23:26] I just want to say that and

[2:23:29] thank you at this time and

[2:23:31] of course, some of the staff

[2:23:32] offline will ask you a few

[2:23:34] things to bring back in the

[2:23:34] future.

[2:23:38] Anything else on this item

[2:23:38] before the board?

[2:23:42] See none, thank you again.

[2:23:46] we're down to our last, before

[2:23:52] we recess, last unit,

[2:23:54] 412, mental health department.

[2:24:06] i see Dr. Pena making a way up.

[2:24:08] >> good afternoon.

[2:24:09] President Shirakawa and board

[2:24:10] of supervisors, nancy

[2:24:12] pena, mental health director.

[2:24:16] I am going to briefly talk

[2:24:18] about our highlights from

[2:24:19] this past year.

[2:24:22] We've been extremely busy.

[2:24:24] Thanks to really the support of

[2:24:26] the full board, mental

[2:24:29] health has been extremely busy

[2:24:33] and a very happy with our

[2:24:35] activities.

[2:24:36] School link services

[2:24:38] initiative, we are getting for

[2:24:38] the

[2:24:41] launch in fiscal year '13.

[2:24:43] Our older adult summit is also

[2:24:44] creating some

[2:24:45] implementation planning that we

[2:24:46] will also bring forward as

[2:24:49] we go into the next year.

[2:24:51] Certainly our partnership with

[2:24:53] ab109 and the ccp and

[2:24:55] all of the county departments

[2:24:57] that are participating in that

[2:24:58] has been extremely rewarding

[2:25:01] and we really look forward to

[2:25:04] the next year as we go forward.

[2:25:06] then as we do continue our work

[2:25:09] with the mental health

[2:25:11] services act and our interface

[2:25:13] with various innovations

[2:25:15] projects as well as

[2:25:18] partnership, we're extremely

[2:25:18] busy right

[2:25:18] now.

[2:25:21] One of the things I did want to

[2:25:23] note that isn't on the

[2:25:25] slides, it relates to the

[2:25:25] mental health services acts.

[2:25:28] This is an item that will be

[2:25:29] coming forward to the

[2:25:30] board.

[2:25:33] Probably in August once you

[2:25:33] return from the break.

[2:25:35] That's just because the timing

[2:25:38] for the mental health

[2:25:40] services act annual report and

[2:25:41] 30 day posting that to the

[2:25:43] public and then the hearing

[2:25:44] that we have to have through

[2:25:45] our

[2:25:46] mental health board won't

[2:25:48] happen until July probably.

[2:25:51] That means that we now have to

[2:25:52] come forward to you with

[2:25:55] our full plan for the mental

[2:25:57] health services act in August.

[2:25:59] There will be some items on

[2:26:02] there that we will be

[2:26:05] requesting in terms of ftes or

[2:26:07] funding for programs that

[2:26:08] you will see at that time.

[2:26:10] I just wanted to make sure that

[2:26:12] are aware of that.

[2:26:15] We are expecting with mental

[2:26:16] health services act to

[2:26:22] have about a 20% increase for

[2:26:22] fiscal year '13.

[2:26:23] That will pretty much pay for

[2:26:25] most of the items that we

[2:26:28] have funded with one time funds.

[2:26:29] we'll be bringing that forward

[2:26:32] and our budget for the

[2:26:33] mental health services act next

[2:26:36] year will be approximately

[2:26:37] $53 million.

[2:26:38] So it's a significant amount in

[2:26:39] the mental health

[2:26:39] department.

[2:26:42] Going on to the items that we

[2:26:46] have.

[2:26:48] The first item should be in the

[2:26:50] emerging issues.

[2:26:53] We are exploring the

[2:26:54] possibility of operating our

[2:26:58] emergency site services as a

[2:27:00] separate distinct stabilization

[2:27:00] program.

[2:27:04] You can operate these programs,

[2:27:05] these emergency psychs

[2:27:07] in two different ways.

[2:27:10] one is attached to a hospitals

[2:27:12] a an psych er the other

[2:27:15] one is a free standing crisis

[2:27:17] stabilization service.

[2:27:20] Both of them would be locked

[2:27:21] and contained and pretty

[2:27:23] much in compliance with title 9.

[2:27:27] We are really in the

[2:27:28] exploratory phases.

[2:27:34] we determine whether or not we

[2:27:34] will be feasible.

[2:27:37] If it is feasible, we will come

[2:27:38] back to you later in

[2:27:42] the fall with a proposal.

[2:27:47] I wanted to make sure people

[2:27:52] are seeing that we are

[2:27:54] operating off the vmc license.

[2:27:55] That is in the next fiscal

[2:27:56] year, we'll be coming

[2:27:58] forward with some plan about

[2:28:01] that or at least some reports

[2:28:02] on it.

[2:28:06] The second item relates to

[2:28:10] changes in the lives relates

[2:28:11] to special education.

[2:28:12] As aware the responsibility

[2:28:13] that the mental health

[2:28:16] department had and the counties

[2:28:19] had has changed this fiscal

[2:28:21] year.

[2:28:23] This fiscal year '12 to fiscal

[2:28:24] year '13 when the

[2:28:27] schools will be solely

[2:28:38] responsible for providing iep

[2:28:38] related

[2:28:39] service.

[2:28:43] We will continue to be involved

[2:28:46] as medi-cal

[2:28:51] beneficiaries are served

[2:28:52] through the health system he

[2:28:53] will

[2:28:54] no longer be the administrator

[2:28:55] of the program.

[2:28:58] Basically what this item, we're

[2:28:59] downsizing somewhat the

[2:29:00] budget that we have dedicated

[2:29:03] to that in general fund.

[2:29:07] Actually what we gend to do is

[2:29:09] redirect equivalent

[2:29:13] amount of two schooling

[2:29:16] services to help support our

[2:29:17] new

[2:29:18] schooling services effort.

[2:29:22] The next item really relates,

[2:29:23] we talked to you about

[2:29:25] this a little bit in this

[2:29:26] fiscal year, programs were

[2:29:29] transferred from dads to mental

[2:29:33] health.

[2:29:40] for the calworks treatment

[2:29:41] services. This basically

[2:29:42] moving the three administrative

[2:29:45] staff who are connected to

[2:29:46] those services from dads into

[2:29:48] the mental health department.

[2:29:51] The next item really is a no

[2:29:53] cost item but it does

[2:29:55] relate to priority of the board

[2:29:56] and certainly the county

[2:29:59] exec that we take a look at the

[2:30:02] high users in our county

[2:30:03] across departmentally.

[2:30:08] Particularly those who are

[2:30:09] homeless and chronically

[2:30:09] homeless as well as those who

[2:30:13] are involved in the criminal

[2:30:15] justice system and the health

[2:30:16] system.

[2:30:18] Those we consider most frequent

[2:30:20] users.

[2:30:21] And really looking at

[2:30:23] assessment of that population

[2:30:23] to

[2:30:25] see what we can do improve the

[2:30:26] services that we offer as a

[2:30:29] safety net for these

[2:30:30] populations.

[2:30:32] We also had some grant

[2:30:33] terminations ending of grants.

[2:30:37] we are picking those up in our

[2:30:40] medi-cal program or

[2:30:43] lihp, low income program.

[2:30:50] We do have 4.5ftes that we

[2:30:59] requested through the ab

[2:31:07] ab109 program.

[2:31:10] We also have a proposal here

[2:31:12] that really is done in

[2:31:13] collaboration with dads

[2:31:15] regarding the low income health

[2:31:15] plan

[2:31:19] and our continuing to move

[2:31:22] towards an expanded medi-cal

[2:31:25] program and benefits beginning

[2:31:27] in 2014.

[2:31:30] In will add some qi staff and

[2:31:31] health services

[2:31:32] representative staff to mental

[2:31:35] health that will be dedicated

[2:31:36] to dads.

[2:31:39] for the development more of a

[2:31:40] managed care

[2:31:41] infrastructure, getting ready

[2:31:44] for the future when there will

[2:31:46] be more individuals with

[2:31:50] medi-cal benefit who will be

[2:31:50] entitled to substance abuse

[2:31:53] treatment as well as mental

[2:31:55] health benefits.

[2:31:57] Finally, the last item is three

[2:31:59] contract staff.

[2:32:01] These would all be be paid

[2:32:04] through funding.

[2:32:07] We came to you earlier through

[2:32:08] the mental health

[2:32:09] hospital for these positions.

[2:32:12] These positions are desperately

[2:32:14] needed a we move into

[2:32:19] really processing close to 500

[2:32:22] either contract, rfps,

[2:32:24] mous we expect many for coming

[2:32:27] with school link services

[2:32:29] as we enter into agreements and

[2:32:31] our provides across the

[2:32:32] county to articulate services

[2:32:34] that we'll be delivering.

[2:32:36] These three staff are basic in

[2:32:38] our contract units to

[2:32:41] support the contracting process.

[2:32:45] With that, I will welcome any

[2:32:48] questions.

[2:32:49] >> any questions.

[2:32:56] I have one speaker.

[2:33:01] sparky, good afternoon.

[2:33:02] >> good afternoon.

[2:33:08] I wasn't sure if this belonged

[2:33:11] to you but it has to do

[2:33:12] with my concern with rap

[2:33:13] services.

[2:33:20] the reduction of services that

[2:33:21] emq and rebecca would

[2:33:21] have.

[2:33:24] If you've going to change

[2:33:24] providers, that's fine with

[2:33:27] me but I'm really concerned as

[2:33:29] you're putting this stuff out

[2:33:31] to bid, how you're going to

[2:33:31] transfer clients over?

[2:33:35] I know when I lost a grant that

[2:33:37] we had for 25 years

[2:33:39] with iop independent living

[2:33:40] program, the kids were suppose

[2:33:42] to transfer over and they did

[2:33:43] not.

[2:33:44] Because it was so tied to

[2:33:45] provider, they really did not

[2:33:48] want to transfer over to a new

[2:33:48] provider.

[2:33:50] Even though we tried really

[2:33:52] hard to do that.

[2:33:54] So my concern is that you

[2:33:57] really look at how those

[2:34:00] clients are going to transfer

[2:34:02] over sense they are most

[2:34:05] serious mentally ill clients

[2:34:06] and look attrition fund to give

[2:34:09] them time to transition out of

[2:34:10] emq.

[2:34:11] Another thought I have is

[2:34:13] something I know county

[2:34:15] department, how about

[2:34:16] encouraging new providers to

[2:34:17] hire

[2:34:17] those people that will be laid

[2:34:18] off.

[2:34:20] I can tell you right now what's

[2:34:20] happening.

[2:34:24] there's a lot of movement in

[2:34:25] nonprofit sector with

[2:34:27] everybody is changing jobs.

[2:34:32] We're all getting new contracts.

[2:34:37] We're all hiring each other

[2:34:52] staff.

[2:34:53] >> any questions from the board

[2:34:57] before we recess to

[2:34:58] 6:30?

[2:34:58] Jeff?

[2:35:01] Members of the boards, we will

[2:35:04] recess until 6:30

[2:35:04] exactly.

[2:59:41] >> we have our hands full at

[2:59:45] this time we do not have the

[2:59:46] financial expertise to handle

[2:59:50] these tasks at this time.

[2:59:52] Nor do we feel that the cross

[2:59:55] training is sustainable in the

[2:59:56] long run.

[3:00:07] And this will also relate to

[3:00:09] policies and procedures for the

[3:00:10] tasks.

[3:00:12] Thank you for your time, only

[3:00:14] financial experts can provide

[3:00:15] financial expertise.

[3:00:23] >> thank you.

[3:00:27] >> I am brett russell, and an

[3:00:28] am state administrator, and I

[3:00:31] have been worked in the office

[3:00:34] for 25 years and came in as an

[3:00:35] entry level position.

[3:00:39] I have worked myself up to the

[3:00:40] state administrator position.

[3:00:46] I was hired shortly after the

[3:00:48] grand injury admin strargz that

[3:00:51] held for the model was

[3:00:52] insufficient to protect our

[3:01:00] clients and the county

[3:06:28] incompetence and waste.

[3:06:36] >> good evening.

[3:06:40] So first highlights from fiscal

[3:06:41] year 12.

[3:06:44] We have increased hours of

[3:06:46] service at valley health center.

[3:06:50] we have reduced our diversion

[3:06:51] hours by 60%.

[3:06:55] Meaning that we are open to

[3:06:56] more ambulances arriving

[3:06:58] serving our community.

[3:07:03] We achieved our disrepresent

[3:07:05] milestones for the year, and

[3:07:07] collecting all revenue we could.

[3:07:10] And we have begun installation

[3:07:12] of the electronic record and

[3:07:16] scheduled to go live on that.

[3:07:19] We have formed a partnership

[3:07:23] for fciu to help in health care

[3:07:23] reform.

[3:07:25] We have seen increase in

[3:07:27] satisfaction over the last

[3:07:29] three quarters.

[3:07:31] And finally credited by the

[3:07:32] american college surgeons for

[3:07:33] burn care.

[3:07:35] Those are the highlights of our

[3:07:39] current fiscal year.

[3:07:45] We have 15 budget proposals for

[3:07:46] next fiscal year.

[3:07:51] We started with a deficit of 84

[3:07:52] million, once we based our

[3:07:54] revenue and the experience of

[3:08:01] the current fiscal year.

[3:08:03] The item that genders the most

[3:08:06] conversation is the clinic care

[3:08:06] volume.

[3:08:08] Some comments about where we

[3:08:14] are with that in this year.

[3:08:16] The projection for next fiscal

[3:08:24] year is a 15% -- 14% drop from

[3:08:30] the kurpt -- current year.

[3:08:33] we believe this is an

[3:08:35] achievable number.

[3:08:38] This is a sustainable number.

[3:08:40] We reduced our unused

[3:08:41] appointment slots.

[3:08:45] We have in our current clinic

[3:08:47] scheduling system the capacity

[3:08:50] to achieve this number.

[3:08:54] and it's managed to fill every

[3:08:55] appointment slot.

[3:08:57] Which we have many strategies

[3:08:58] to do.

[3:09:00] The inpatient volume increase

[3:09:03] is a result of down stream

[3:09:05] revenue from increased primary

[3:09:07] care volume.

[3:09:10] And increase enrollment in our

[3:09:11] low-income health plan that is

[3:09:15] a later budget proposal.

[3:09:18] It's simply a calculation.

[3:09:19] Revenue cycle redesign.

[3:09:21] We have four strategies to

[3:09:25] bring in that additional $21

[3:09:26] million.

[3:09:29] And as the board is aware that

[3:09:31] we brought in revenue

[3:09:32] collection.

[3:09:36] we are renegotiating some of

[3:09:40] our surance -- insurance

[3:09:42] contracts and working on

[3:09:47] collections of lab and dialysis

[3:09:47] centers.

[3:09:50] Reduction of vacant positions,

[3:09:51] these are positions that are

[3:09:53] not currently filled.

[3:09:57] that we don't intend to fill,

[3:10:03] for which we are not use are

[3:10:06] over time or extra help to get

[3:10:08] the work done and believe we

[3:10:13] can do without those 33

[3:10:14] positions.

[3:10:17] icpp-10 was delayed by cms by

[3:10:18] one year.

[3:10:20] But for the preparation of

[3:10:21] implementation, we will have

[3:10:25] some costs in the next fiscal

[3:10:35] year, approximately 2.8 million.

[3:10:38] Our core project for the

[3:10:40] medical record, we figure

[3:10:42] that's about 68 million, and I

[3:10:44] believe that jeff covered that

[3:10:46] earlier in the budget.

[3:10:47] Covered by technology.

[3:10:49] Is that correct?

[3:10:50] Okay.

[3:10:51] The cms incentive program.

[3:10:54] As I mentioned earlier, one of

[3:10:55] our highlights this fiscal year

[3:10:57] is that we achieved all of

[3:10:59] those revenues and goals as

[3:11:01] required in that program.

[3:11:04] We went back and looked at the

[3:11:06] possibility for next year.

[3:11:11] And we believe there is an

[3:11:12] additional $5 million we can go

[3:11:14] after and achieve.

[3:11:19] our managed care contract this

[3:11:22] is a renegotiation between

[3:11:30] santa clara health care.

[3:11:34] We have a different way of

[3:11:36] calculating valley health plan

[3:11:39] with transferring risk over to

[3:11:42] them that dmc has had in the

[3:11:42] past.

[3:11:44] But had no control of that risk.

[3:11:48] So this is more of an

[3:11:49] accounting transaction to move

[3:11:51] the revenue and expense to the

[3:11:55] appropriate place in valley

[3:12:02] health plan.

[3:12:05] Cap conversion.

[3:12:06] In the health plan, we started

[3:12:11] the year with 8,000 enrollies.

[3:12:14] And have a goal of 12,000

[3:12:16] enrollies by the end of the

[3:12:20] fiscal year, we are rapidly

[3:12:20] approaching 10,000.

[3:12:22] we believe this is achievable

[3:12:28] to bump that enrollment up.

[3:12:30] And our managed care contract

[3:12:32] featured service.

[3:12:34] A renegotiation of our future

[3:12:35] service, santa clara health

[3:12:36] plan contract.

[3:12:42] and thal bring -- that will

[3:12:54] bring an additional 7 million.

[3:13:03] we are currently in

[3:13:06] negotiations and we May be

[3:13:10] reforced to reduce our

[3:13:15] enicologists by 3.5 ftes.

[3:13:15] The contract position budget,

[3:13:20] in the past we used an outside

[3:13:30] firm care and we brought our

[3:13:33] physicians in and putting ftes

[3:13:37] back in the budget and this is

[3:13:48] cost neutral.

[3:13:50] We have assistance in opening

[3:13:51] the downtown location.

[3:14:05] they did not get guarantee this

[3:14:05] amount.

[3:14:13] We are bringing this next area

[3:14:17] in the custody health

[3:14:17] discussion.

[3:14:28] so questions?

[3:14:30] >> with information about

[3:14:32] gardener, I know at the hcc

[3:14:34] meeting I asked questions and

[3:14:36] didn't quite get clarification.

[3:14:38] I knew we had given the 550,000

[3:14:42] that we thought would cover the

[3:14:43] expense.

[3:14:47] but because they didn't get the

[3:14:48] additional dollars.

[3:14:49] Therefore we are covering it

[3:14:52] and it wasn't covered by the

[3:14:53] 550,000?

[3:14:58] >> I see that gary is reaching

[3:15:00] for the microphone phone.

[3:15:01] >> gardener's projection is

[3:15:03] that in the first year of

[3:15:06] operation, they require a

[3:15:07] 550,000 subsidy.

[3:15:10] The second year of the

[3:15:13] contract, they require a

[3:15:14] $300,000 subsidy.

[3:15:15] What happened here, we are

[3:15:18] being a little conservative.

[3:15:19] Because the original plan was

[3:15:21] for gardener to open earlier.

[3:15:23] So really what is happening,

[3:15:25] right now we are hoping that

[3:15:27] the downtown clinic will open

[3:15:28] on June 1.

[3:15:30] If we look at this on a

[3:15:31] calendar basis.

[3:15:39] Basically we are allocating

[3:15:46] 330,000 that is the amount for

[3:15:47] 2013 to 2014.

[3:15:48] The timing is a little skewed.

[3:15:52] But at this point in time the

[3:15:53] expectation is that what we

[3:15:57] were funding is a two-year

[3:15:59] program effect.

[3:16:02] And so the 550 is the first

[3:16:03] year and 300 for the second

[3:16:04] year.

[3:16:11] over two years it's a title of

[3:16:15] 850,000 subdiddys are --

[3:16:18] subsidy because they weren't

[3:16:20] able to acquire the federal

[3:16:20] funds.

[3:16:24] >> but we anticipated that they

[3:16:27] would and added that extra.

[3:16:30] >> adding the 850,000, our hope

[3:16:32] is that the amount they needed

[3:16:39] to open -- operate on a

[3:16:40] break-even basis.

[3:16:42] And with the clients and

[3:16:46] expenses results in a need for

[3:16:47] a 550,000 requirement in the

[3:16:48] first year.

[3:16:51] And because of a ramping up and

[3:16:54] seeing more clients, that

[3:16:56] requirement will decline to

[3:16:56] 300,000.

[3:16:57] Again this is based on forecast

[3:16:59] and we will be working with

[3:17:01] closely with them to see what

[3:17:02] their needs are.

[3:17:06] That at this point is what is

[3:17:07] funded.

[3:17:09] by allocating this 300,000, we

[3:17:11] will have funded them for two

[3:17:11] years.

[3:17:15] >> and we are anticipating

[3:17:17] gardener not receiving other

[3:17:18] grants that they were expecting

[3:17:20] and we would have to cover?

[3:17:22] >> at this point this is the

[3:17:24] maximum we expect to have to

[3:17:24] fund.

[3:17:27] >> okay, and also at our

[3:17:28] meeting, I had asked a couple

[3:17:31] of questions about the unused

[3:17:32] appointment rate.

[3:17:34] And maybe get a little more

[3:17:35] understanding about that.

[3:17:41] I know that the no-shows and

[3:17:42] the unused appointment rate.

[3:17:44] And maybe if you can talk a

[3:17:45] little about both of those.

[3:17:48] Where we have, I know we are

[3:17:50] trying to increase the number

[3:17:54] of patients that the dollars

[3:17:55] -- doctors see.

[3:17:58] And I assume that's the unused

[3:18:00] appointment rate, trying to get

[3:18:01] more patients in.

[3:18:04] And making sure, in a way you

[3:18:06] overbook, just in case you have

[3:18:07] the no-show.

[3:18:08] And can you talk about that.

[3:18:11] and as we look at that and

[3:18:13] reduce that, is that savings or

[3:18:15] additional revenue and how that

[3:18:17] will help the overall budget?

[3:18:19] >> sure.

[3:18:21] The unused appointment rate

[3:18:27] that we used in the budget is

[3:18:27] 6.25%.

[3:18:30] That's [Inaudible] Class is

[3:18:31] zero.

[3:18:33] There are physician practices

[3:18:40] out there that fill every

[3:18:41] appointment everyday.

[3:18:47] And we get an unused

[3:18:48] appointment rate daily.

[3:18:56] and since we have studied

[3:19:01] that, reduced our appointments.

[3:19:03] And appointments go unused for

[3:19:07] a variety of reasons.

[3:19:13] we don't include the no-snow

[3:19:15] -- no-show rate in the report.

[3:19:20] That's a different piece of it.

[3:19:22] An unused appointment is an

[3:19:24] appointment where the patient

[3:19:31] canceled in less than 24

[3:19:32] hours and we weren't able to

[3:19:33] fill that.

[3:19:36] Or it's a case where the

[3:19:38] patient demand wasn't there.

[3:19:40] Or the appointments we had

[3:19:42] availability for patient demand

[3:19:45] didn't match the type that the

[3:19:46] patient needed.

[3:19:50] Maybe we had three return

[3:19:50] appointment slots available.

[3:19:52] And this was a new patient.

[3:19:55] and we didn't have an

[3:19:57] appointment slot for them that

[3:19:57] day.

[3:20:04] So there is a tremendous

[3:20:07] science between managing of the

[3:20:08] appointment schedule system so

[3:20:10] every slot is filled.

[3:20:12] What I can tell about the

[3:20:15] budget, as compared to prior

[3:20:21] years, this year's clinic

[3:20:23] volume is based on what is in

[3:20:24] the scheduling system.

[3:20:27] We have a means electronically

[3:20:30] and by schedule to achieve it.

[3:20:34] And now it's as much about

[3:20:37] massaging the types of

[3:20:37] appointments.

[3:20:40] And you know making sure that

[3:20:42] there are very few unused

[3:20:45] appointment slots on a daily

[3:20:45] basis.

[3:20:47] >> yeah, I know this is a one

[3:20:49] part of a big puzzle we are

[3:20:51] trying to work with, trying to

[3:20:52] coordinate so many things in

[3:20:54] the hospital that we haven't

[3:20:56] been doing in the past.

[3:20:58] And my congratulations to focus

[3:21:00] in on that.

[3:21:02] And because so much revenue May

[3:21:04] be earned in addition, I am

[3:21:05] glad that everyone is focusing

[3:21:06] on that.

[3:21:08] And trying to tweak that

[3:21:12] schedule as ach -- as much as

[3:21:13] they can.

[3:21:15] >> thank you for the report.

[3:21:17] on your first page of

[3:21:19] highlights, I enjoyed seeing

[3:21:19] that.

[3:21:22] Second bullet from the end

[3:21:25] talked about patients

[3:21:27] increasing what would recommend

[3:21:29] the facility to friends and

[3:21:29] family.

[3:21:35] A couple of weeks ago I saw

[3:21:37] several graphs that recommend

[3:21:40] them to noise at night and

[3:21:40] cleanliness.

[3:21:42] And not thrilled where it

[3:21:43] showed that.

[3:21:48] But I am thrilled improvement

[3:21:51] of something, and when months

[3:21:54] go by and when you have

[3:21:55] measurements.

[3:21:59] i would appreciate receiving a

[3:22:00] copy of that.

[3:22:02] And where we are with our peers.

[3:22:08] I did this last year and I will

[3:22:10] continue it this year, thank

[3:22:14] you for taking a look at that

[3:22:15] funded vacant positions, and

[3:22:17] how necessary to keep them on

[3:22:19] the books.

[3:22:23] You eliminated 33 pots --

[3:22:26] spots and that equated to 43

[3:22:26] million.

[3:22:27] Thank you for looking at that.

[3:22:28] I don't know what the numbers

[3:22:32] are, still in the 700 range of

[3:22:33] funded vacant positions

[3:22:34] throughout the county.

[3:22:37] For a variety of reasons, some

[3:22:42] are brand-new and summon --

[3:22:45] someone leaves and retires.

[3:22:49] But when a department head

[3:22:55] takes a hot -- shot at this

[3:23:02] and it's instant savings to the

[3:23:02] country.

[3:23:11] >> probably the fluctuating

[3:23:14] to the department and this is

[3:23:16] an hour by hour science that

[3:23:18] goes on at the hospitals and

[3:23:19] clinics.

[3:23:24] >> siappreciate -- I

[3:23:25] appreciate that and every bit

[3:23:27] helpss and that's a big thing,

[3:23:28] thank you for that.

[3:23:31] >> thank you.

[3:23:32] Supervisor kniss.

[3:23:35] >> so I thought perhaps I would

[3:23:38] get a lot less grandular, even

[3:23:44] those are the things that made

[3:23:45] enormous difference.

[3:23:48] And I agree with ken asking

[3:23:49] about the clinics and unfunded

[3:23:50] positions.

[3:23:51] Those are what make the

[3:23:54] differences over the long run.

[3:23:55] But jeff, because I talked

[3:23:57] about this a little this

[3:23:57] afternoon.

[3:24:00] I thought maybe this time you

[3:24:01] could restate this.

[3:24:05] But I think in three years,

[3:24:07] while we haven't solved the

[3:24:08] problem, we have at least

[3:24:10] identified it.

[3:24:12] We have worked pretty

[3:24:17] successfully I think with the

[3:24:19] anm group that came in.

[3:24:21] And so I want to talk a little

[3:24:25] about what I think are some

[3:24:28] really good strides we made.

[3:24:30] And one might be far less

[3:24:31] subsidy than we have done in

[3:24:32] the past.

[3:24:34] And another might be far more

[3:24:36] attention to the numbers.

[3:24:38] As I mentioned before, I get

[3:24:40] the daily flash, I know what

[3:24:42] the numbers are all over the

[3:24:43] place.

[3:24:44] Which really helps.

[3:24:47] And you know, I think maybe you

[3:24:51] could toot your horn for a

[3:24:52] minute.

[3:24:53] It wouldn't be all bad.

[3:24:55] >> not my horn.

[3:24:58] >> it's been a tough two years

[3:25:01] to come in and make major

[3:25:02] changes in the health care

[3:25:02] system.

[3:25:06] >> it's not my horn.

[3:25:10] >> you can do gabrielle it is

[3:25:12] or anyonacy, just a horn.

[3:25:14] >> just like any other health

[3:25:18] system in the nation, vmc was

[3:25:20] faced with a total

[3:25:22] transformation in a short

[3:25:23] period of time.

[3:25:28] Going from a system that relied

[3:25:31] on med cal funding, that is one

[3:25:34] way of funding a system, to a

[3:25:37] system in the future that will

[3:25:40] rely on performance payment.

[3:25:44] and that's an enormous change

[3:25:45] in infrastructure and cultural

[3:25:46] approach.

[3:25:48] It means a lot of changes.

[3:25:50] And the team has done a

[3:25:52] fabulous job in the last years.

[3:25:54] Working towards that change.

[3:25:55] It's very difficult

[3:25:57] particularly at the same time

[3:26:00] that they are preparing for

[3:26:02] health care reform.

[3:26:09] and dealing with lip and

[3:26:10] medical expansion, everyone has

[3:26:13] a lot on their plate at vmc and

[3:26:14] health and hospital.

[3:26:18] And it's true, that in the

[3:26:21] past, we've removed little too

[3:26:24] much from the administratorive

[3:26:24] support.

[3:26:27] people are running around from

[3:26:28] one crisis to another at same

[3:26:33] time they are planning a

[3:26:34] long-term strategy.

[3:26:36] It makes it difficult to do and

[3:26:39] they have done an excellent job.

[3:26:41] The clinicians and nurses and

[3:26:44] doctors and technicians and

[3:26:47] everyone continue to do very

[3:26:48] high-quality work.

[3:26:49] And they are very proud of the

[3:26:52] work they do.

[3:26:55] And our job and the systems job

[3:26:58] is to get patients connected

[3:27:00] with the clinicians.

[3:27:02] In the riept time, in the right

[3:27:04] place and the right level of

[3:27:06] service and the right type of

[3:27:06] care.

[3:27:08] And we have proven that can be

[3:27:09] done and we are doing a good

[3:27:12] job of it.

[3:27:13] That all being sides.

[3:27:15] >> you still have a way to go.

[3:27:16] >> we have a ways to go.

[3:27:20] You don't change an

[3:27:23] organization of this size in a

[3:27:26] rapid period of time.

[3:27:29] particularly when the risk of

[3:27:32] rapid change is life and

[3:27:34] welfare of patients.

[3:27:37] You know, at any time it's

[3:27:38] certainly the highest priority

[3:27:41] to make sure that the patients

[3:27:44] are safe and cared for

[3:27:45] appropriately.

[3:27:48] and so change is not super

[3:27:48] rapid.

[3:27:49] But it's happening.

[3:27:52] And I am very proud of the team.

[3:27:58] And they are doing a great job.

[3:28:00] And individuals and the

[3:28:02] employees in the health and

[3:28:04] hospital system and the

[3:28:06] hospital system are truly

[3:28:08] committed to make sure they

[3:28:09] provide the best care possible.

[3:28:11] And they are all struggling

[3:28:12] with change.

[3:28:13] But they are doing a good job

[3:28:15] of it.

[3:28:16] >> I appreciate saying that.

[3:28:19] Because I think going from one

[3:28:21] system to another, as you said,

[3:28:23] from the dish and the system

[3:28:28] where money was really given to

[3:28:29] us.

[3:28:31] Without any measurable outcomes

[3:28:31] required.

[3:28:34] And that's a huge difference

[3:28:35] now.

[3:28:36] As measurable outcomes are

[3:28:37] required.

[3:28:38] And without them you will not

[3:28:39] get your money.

[3:28:42] And we will not get our money.

[3:28:44] We will not be able to continue

[3:28:45] to provide those services.

[3:28:48] And the one thing you didn't

[3:28:49] mention, jeff, the substantial

[3:28:52] decrease in the amount of

[3:28:55] essentially subsidy or general

[3:28:57] fund money we are using.

[3:29:00] It's down depending on how you

[3:29:02] look at it.

[3:29:03] Certainly 50% or more.

[3:29:05] And that's making a big

[3:29:06] difference as well.

[3:29:09] I think it's important, you

[3:29:17] know, we usually are saying far

[3:29:18] more inquisittive types of

[3:29:20] things, but it's good to hear

[3:29:22] that we are making good

[3:29:22] progress.

[3:29:25] And that we are not only doing

[3:29:29] that but paying great attention

[3:29:31] to how that progress can be

[3:29:32] made and reach those

[3:29:33] measurements.

[3:29:34] So far, so good.

[3:29:34] Thanks.

[3:29:37] >> thank you.

[3:29:38] Any other supervisors?

[3:29:40] I see none.

[3:29:44] >> thank you, Mr. President.

[3:29:47] >>> jeff, anything?

[3:29:47] Okay.

[3:29:50] Board we will recess until

[3:29:53] tomorrow afternoon at 1:30.

Board of Supervisors Budget Workshop

Agenda

Transcript