Hello, good afternoon. We've got 2 .01, and let's get started. Welcome, everyone. We'd like to go ahead and call the Health and Hospital Committee meeting to order at this time.

I'm

Supervisor Otto Lee, Chair of this committee, along with my Vice Chair, Supervisor Margaret Abicoga.

And

with both supervisors present, we have a quorum.

Moving

to public comment, which is item number two, reserved for members of the public to address the committee on items that are not on the agenda, so that any public that would like to speak on an item not on the agenda today should request to speak at this time.

So,

how many cards do we have, Jess?

For

this item, we have one request on Zoom.

One,

okay. Three minutes, please.

Okay, we'll change the timer to three minutes.

Our

speaker is Parent.

We'll

open your microphone, and

you'll have three minutes to speak.

Yes,

thank you. Good afternoon to you all. I previously requested how... for my children to get a screening,

because

they're being sexually molested. My son has already confirmed that my ex -wife is letting a man in, and we raped him beginning at the age of 13. There have been unnecessary bathing with an adult and two of the children.

And

also, there was sexual contact between two of the children and one child

rubbing

his pelvic area against the rectum of another child, and I had to separate them several times.

It's

just, it's apparent to me that all of them, all four of them were being sexually molested. And I can't get a screening for my kids because my former attorney, she wants the sexual abuse to continue.

And apparently it's a conflict of interest with this county. And now this person is... She's threatening to kill my kids if I don't stop trying to protect them. And this person is completely deranged. She's caused me great bodily harm over this. And... I have death threats all the time, and I'm being stalked, and hacked, and... I mean, this woman is completely insane, and I can't believe that I can't get my kids a screening. I mean, she's threatening to kill my kids. I mean, you guys can see this. I forwarded it to Auto Lead, too. If you Google Valerie Houghton Shoes, and that's H -O -U -G -H -T -O -N, you'll see a blog called

Making Shoes. And I posted the links, the direct links to her thread, her threads, to kill my kids and make shoes out of their skin. I mean, she's crazy. This woman is crazy. I can't believe she's not locked up. She's done this to so many other parents.

I mean...

You can see what happened to a lot of different parents, and I'm not going to name the names right now. And... I just... I just... I beg you guys, please, is there somebody here who can help push a screening for my kids? Because, I mean, once a child says that you've been raped, I mean, that's when you go in and you do a screening. And especially when some crazy lunatic is threatening to kill my kids. I mean, you go and you do a screening. I can't believe that I'm having to come to this public meeting and beg you guys to help my kids.

Please.

Thank you for your time.

That concludes

public comment.

Thank you, Jess. The announcement I want to make is basically that California law does prohibit the disclosure of information relating to an investigation of suspected child abuse. As a result, we are not authorized by law to speak to the specific of any particular case or the results of an investigation in the case, even when the allegations are made part of the public comment. The law requires child welfare departments to immediately cross -report physical and sexual abuse of children to law enforcement and district attorney's office so that swift action can be taken. The public can be assured that our county do take these allegations very seriously. And this includes rapid cross -agency responses by the Department

of Family and Children Services, local law enforcement, the Child Advocacy Center, and the district attorneys. We also do have a complaint page providing information. This is provided by the California Department of Social Services that provide guidance on various avenues by which someone can make a child welfare -related complaint. When a speaker's comments also reflect concern of the family court, the complaint page provides direction on submitting a complaint when there is concern about a California judge's performance as well. All right. Then that's all we have on item number two. Moving to item number three, which is the approval of the consent calendar and changes to committee agenda.

I actually have one item to see if it's okay with you. I have two of my vice chair. For item seven, whether we can add that one, which is relaying to the public health department report on epidemiology grants and contracts for the care of STIs. Is that okay? To add that. To the consent. Oh, to consent, yes. Yes. Okay. All right. Thank you. And do you have any other changes to consent? No. Okay. First, let's see. Any public would like to speak on any consent items? Jess? I

just. Chairperson, I'd like to flag. I'm having trouble hearing you.

Oh, I'm sorry. I'll get closer. Thank

you. And I am confirming no request to speak on the consent calendar.

All right. Thank you. May I entertain every motion?

Yes. I'd like to make a motion to approve the consent calendar item 12 through 20 plus 12 through 20 plus seven. Plus

seven. Okay. Very good. And I will second that. Less to give out.

Vice Chairperson Abacoga? Aye. Chairperson Lee?

Aye as well. Thank you. Thank you. Thank you. And now moving to item number four which is receiving report relating to the role of Santa Clara Valley Healthcare as a safety net healthcare provider and fiscal review of SCVH. And Paul. All yours.

Great. Thank you, Chair Lee. Supervisor Abacoga, it's a pleasure to be able to speak to this item again. As you recall, back in January, we did have a study session for which we spent most of the time talking about the impacts of COVID -19. As well as talking about other implications within the healthcare market here in Santa Clara County.

As a reminder, Santa Clara Valley Healthcare is looking at a $1 billion shortfall in revenue due to HR1 when all of the provisions of HR1 are implemented. This year alone, Santa Clara Valley Healthcare was looking at $200 million. We came to the board at mid -year just for that. And I think it was recently for your board to approve budget solutions in order for us to get to year end on budget. But also to prepare us for the 26 -27 budget. In 26 -27, Santa Clara Valley Healthcare is looking at a $160 million shortfall. I think as reported by James Williams, the county overall is looking at a $400 and some million shortfall in terms

of the overall county budget. This is after the inclusion in accounting of the $330 million from Measure A. So as you can note, we are still confronted by some major challenges relative to our budget. During that study session, we did take the time to talk about how we are going to address the deficit in the shortfall. We are looking to maximize revenue as much as possible. The reality is that we are not going to do that. We are not going to cut ourselves to $200 million in shortfall in revenues. Nor are we going to address our shortfall in 26 -27 by simply cutting costs. So the $200 million that we presented to the board recently

represented about $50 million in revenue solutions. With the other 50 % coming from cost savings. As part of that cost savings, the health care system identified 218 positions of which 40 positions were filled. So we are at the point in time in which as much as we have attempted to look at vacant positions, we are now cutting into filled positions in order to balance our budget. The good news is that those individuals will have a place to fall somewhere within the budget. They will not be laid off, but they will be carrying out other functions within our health care system. So with that being said, what I would like to do is focus today's session

on two areas. One is how we are looking to adopt AI, artificial intelligence, to help leverage our technology and capabilities. But also talk a little bit about our revenue cycle process as we look to improve our revenue. Picture and portfolio going forward. So at this point in time, I'd like to introduce Khalid Turk, who is the deputy director with our technology services support department, who will talk about our work around artificial intelligence. And then we will turn it over to Vinod Sharma, our chief financial officer, to talk about our revenue cycle improvements. Khalid, I'll turn that over to you.

Thank

you, Paul. My name is Khalid Turk. And I'm here to present about the implementation of AI at Santa Clara Valley Health Care.

Santa Clara Valley Health Care, as we all know, uses Epic EMR. So our AI capabilities and AI enablements surround around our EMR. And they are categorized in three different buckets, if I may. We focus on the clinical workflows, patient access experience, and revenue cycle. Essentially, our vision here is, while working with the provider leadership and administrative leadership, to enable providers to maximize their efficiency and at the same time address the burnout where possible. From the patient access experience, we are using AI -enabled functions where patients can interact with their care providers more efficiently. And we're going to talk about that in a while. Then in the end is the third one. The third bucket is

the revenue cycle. And at the revenue cycle, we are utilizing AI both provided by Epic, naturally in the Epic EMR, as well as we are also exploring some external solutions, currently just exploring them to make sure that we can enhance our revenue where possible. Next slide, please. Since AI is a newer technology, we are making sure that we implement it the right way. And in order to do that, we have a very strong governance in place that comprises of the county council, the compliance, the privacy office, the technology, and the provider and administrative leadership. The way we undertake AI projects is to go through this funnel, as it shows on this slide. We make sure

that every time Epic or any other vendor presents a solution, we have to ensure that it aligns with our strategic roadmap, that we have developed working with the hospital leadership. And it has some measured ROI, not the AI for the sake of AI, but it definitely addresses the bottom line. And we also work with the privacy and security team to make sure that it meets our privacy and security standards. And we also have a generative AI governance committee, which is separate than the AI process that I'm talking about right now. So if any of the solution components comprises of the AI, the generative AI, we ensure that generative AI governance committee, or GARC as we

call them, has a view of that and make sure that the solution remains compliant. Once the AI solutions go through this entire process, we take on to the pilot. And based on the results from the pilot, we go to scale. Next slide, please. And I'll explain what I mean by scale. This is an implementation methodology. The previous slide talked about the governance for the AI. The AI enabled functions. Here we are saying that how we do that. Once the governance is approved and we have implemented and we conducted the pilot, at the pilot we collect the data, and based on the data, we complete the evaluations that did it really contributed to the provider efficiency,

saved time, contributed potentially to the revenue. And if there were some corrections to be made, whether to workflow or the technology, we go through the refined process, which will be different for every different solution. And once all of these requirements are made, then we go to scale. So maybe we started with 50 providers, and if all of these criteria are met, then we will go to the scale, which means that a larger population of the care providers can use it.

Next slide, please.

We bring one example here of the ambient AI pilot that we just conducted with 50 doctors. Ambient AI is where providers, care providers actually speak to the patients. This software runs on the mobile devices, captures the sound, and translates into the text, and eventually updates into the EMR. So all the time that is needed by the providers to type in the notes, that is reduced. Recently, like a week ago, we completed the pilot with the first 50 providers, and the results are promising, that what we have noted here on this slide, that per note, doctors are saving up to 20, 20 to 30 seconds, which doesn't seem much, but when you calculate over the entire

day, it's a significant time.

This solution is also contributing to reducing the so -called pajama time. That's the time that providers should be spending with their families, but they rather spend that on typing into the EMR. So the initial results based on the 50 providers have been promising, and currently we are still analyzing. I think the results, and as I was showing the process, that once the governance committee agrees that this truly is valuable, we will going to scale it to a larger population of the providers.

Here, Vinod, you would like to speak to this one?

Good afternoon, Vinod Sharma. This is a machine learning technology. What it does is it looks at all the denials, and for each denial, it looks at the probability of collecting. So it allows us to focus on those denials where the probability of collection is very high. And in one quarter, it has basically increased our efficiency or collectability by 5%. And the goal is as we implement more and more of it, and we have more experience with it, the gap between what was denied and what was actually received reduces to almost negligible. So in the sense that we collect almost all the denials that were initially made. So in a way, it looks at the probabilities

and allows us to do what we can in terms of collecting. So it's working well.

Next slide, please.

This slide shows the AI roadmap, what we have on a path to implement. As I was mentioning earlier about ambient AI, that pilot was just done. It's concluded. So we'll evaluate it and refine where needed and scale it. But in parallel, there are multiple projects that are currently in the test phase. If you look at this slide, some of the text is in the bold, and those are the modules or functionalities or AI -enabled products that are currently in the testing. The remaining are on the roadmap that will eventually come through the testing. And the processes are defined. We test them. They go through the pilot and then evaluate the refine and scale. So each

one of these will be going through the same process and under the governance that we talked about. So the compliance, the privacy, the security, every component has an overview of these products before they get introduced into the production.

That's all I had to cover, and I'm open to any questions, please.

Yes, Paul, do you have anything to add? So what we were hoping to do is first talk about AI and take questions before we get to the revenue cycle. If you have any questions, we'd be happy to respond to them. Sure.

Do you have any questions about AI?

Yes, thank you.

My question, or I guess comments and questions, I really very much appreciate

President

Lee for asking for this referral to have more information on AI. I think there's a lot of work being done related to the healthcare system.

And I think what's being done is impressive and going in the right direction. I think just in general, and I brought it up at our study session last month, is that the board has not discussed an AI policy. And I know there's work being done at the administrative level, but in addition to things like revenue cycle enhancements and the reasons for engaging with AI, the one area that I think that we often hear most about is how does this affect our workforce? And so that's the area that I think we need to discuss and come up with some policy on. So just in general, that is my concern around AI and that. I think we

just need to have more conversation about it at the board level and come up with a policy from

the board. But I did have questions, and it sort of ties to that, regarding how administration has been working with our staff and what kind of feedback or engagement have you had with staff on the implementation of AI? Thank you.

Thank you, supervisor. Just to comment on your first thoughts relative to policies. So what I can share with you, although there may not be an overall countywide AI policy or general policy, all aspects of the adoption of any tools follow the county process in approvals relative to protection of patient information, patient privacy. The management of data in a manner that does not present further risk to the county or to those involved in its use. So the team in terms of that governance spends a lot of time to ensure that we're following and appropriately managing the information that is used through AI technology. And I'm sure the county executive office and others will be working at

the board's request to develop a countywide policy. With respect to the users of AI and the adoption of that technology, we work very closely with those that are impacted. So staff, including physicians, as well as in finance, the finance team, to ensure that the technology addresses the core principles in terms of the adoption of artificial intelligence. Not only in terms of return on investment, in terms of dollars, but in terms of, as you point out, the way it impacts staff, in terms of making sure that it's addressing opportunities for improved efficiency.

In terms of their workflows, technology should be used to augment and support the workflows within any work environment, particularly in healthcare. And I think most people appreciate the fact, as time has gone on with the adoption of technology, we are at the point in which the adoption of AI can reverse some of the workload burdens that the original implementations created. A perfect example is we have a large amount of workload placed upon our physicians in their mailboxes, because people, people that utilize physician support services, in terms of trying to connect with their physicians, want to communicate directly with the physicians. And the question is, how do we more efficiently manage their time so that they're

actually providing the clinical care that they need? And so the adoption of ambient and other technologies will help us move in that direction. Great, yes. And

certainly that's, I think it's just that the intent should be to augment, supplement, enhance, you know, make more efficient the jobs that are being done. The, you know, and I'll just say it, like, I just want to be clear that, and this is what I think we need, or at least discussion about it, is to say that we're not, you know, the intent is not to replace humans, but to simply enhance the work of our human employees, our staff. So that's what I was trying to, I guess, get to, is that I just want to be very clear, you know, what the intent is. And I think in times like right now, when we are

looking at ways to reduce the budget, certainly technology is the way to, you know, help us do that. But longer term, I think we just need to have a, you know, policy statement that says that, that we want to, of course, you know, enhance the human aspect of the work that we do and the services we provide. So, and so then in terms of quality control, how are we determining whether the tools are at least maintaining current service levels and qualities of those services?

Carla, did you want to

go first? Yeah. Thank you. Thank you, Supervisor Ebicoga, for the question. I want to briefly address the previous one. I should have clearly stated that in AI industry, there's this term, human in the loop. It means that AI is assisting, not taking over. All of the workflows that we are implementing in the hospital, human is always in the loop. Human is in charge. And that also addresses your second question, that how we make sure the quality is there, because we are not letting AI run amok on its own. There's always human involved. And every time we implement AI, we carefully look at the data that is generated. Okay. And it is sampled against the benchmarks

that we have. We've been using EMR for 12 years, so we have data that how the data is captured and stored and processed. So that's where I was talking about the four -step process that we do pilot, evaluate, refine, and scale. Evaluate is the area of that process where we make sure that quality is met, are exceeded than humans.

Great. Thank you. And then what is the timeline, general timeline of implementation of these AI initiatives?

It varies from initiative to initiative. I'll just give a quick example of the ambient AI. The longest time it takes is in procurement. Once the procurement is done, then depending upon the complexity of the software, the implementation cycle will begin. In ambient, we can conduct a pilot, say, into four to six months. That will be the pilot time. Once the pilot is done, scaling is rather easier. There is not a steep curve in training individuals. Essentially, you need to know how to talk into that and what steps you have to take towards the end just to make sure that what you spoke into the machine is actually properly transcribed to some extent. Okay. So there

is no one timeline. There is no timeline that fits. Some of the workflows are easy to implement and the timeline is really shorter. In others, it takes longer to implement. And then you

actually touched on the last question I have and I think really important. It's the training, training of staff on how to use all these technologies and ensuring that they have proper training and probably continuous training because as technologies change, we have to keep up with that. So I'm assuming that it just... Is that a part of your implementation? Yeah,

that's part of the implementation process. Depending upon the complexity of the tool that is being used, training is provided accordingly. And

do you do, like, staff surveys, you know, to make sure that the training is adequate or sufficient for staff to be able to feel comfortable using those technologies? Yeah. I

believe that is more interactive, like asking the questions. I'm personally not aware of the survey. We will take the question offline and provide you the information on that.

That's fine. Great. Thank you. And,

Supervisor, I would just add, in terms of surveying the staff, ambient AI, for example, is something that our physicians are looking forward to. They've made it clear that they would like to implement it sooner than later, but obviously we have to go through the pilot process to ensure the quality control and the appropriate implementation of that technology. Great. But we do get feedback from staff in terms of its usefulness and effectiveness.

Good. Great. Thank you. Thank you. Thank you. Yeah, so

having many friends in the medical field, whether it's doctors, a nurse practitioner, one of the most biggest complaints that I've been hearing from practitioners is the admin red tape that they will have to do. They love doing the work. They love, you know, seeing the patients and spending more time with the patients. But due to those mundane... I would say the more mundane part of the work, the admin red tape, that they have to fill out the forms and write those things. And it sounded like the transcription process of ambient AI is attacking a good chunk of that work. Am I correct?

The ambient part only addresses one part, which is where the note needs to be typed into the EMR. Mm -hmm.

And that is associated with that. So the work that was generally done by typing into the system, that is being spoken into the cell phone device that gets transcribed.

Right. So, and so far with the pilot of the 50 lucky... Yeah. ...experimenters, I would imagine the feedback has been extremely positive.

Extremely positive, yes. Okay,

so if anything, I would say is whatever we can do, just be the process, because we have literally hundreds, if not thousands of folks out there waiting for this to be implemented. So I'll say, yeah, I understand we have to go through the process appropriately, not to shortcut the short change, but if it's that positive, it seems like this is a win -win. The number, sometimes I don't think it really shows how big a deal this is. When you talk about 20 to 30 minutes a day, right, if you add that up plus another 10 to 20 minutes per day after hours, and this, like you say, is pajama hours, these are very important. It's

a very important time that people can have for the quality of life. And it's a daily thing, right, number one. Number two is you multiply that by how many people that will be benefiting from this. And finally, I was going to say is this amount of time is not the most enjoyable time for any practitioner. This is not what they really want spending the time doing. So it's not only saving them time, but at the same time doing something that's mundane and not that, frankly, exciting, I think, is where I see this AI, that ambient AI could be extremely helpful. And clearly, it would improve efficiency and also the quality of the provider. So I'm

really ecstatic, very happy to hear about this development. So hopefully we have more of these type of measures that we could pilot out, and that's exactly what I'm looking for. The other thing you talk about is the denial of appeal letters, like trying to get the denial letters drafted. Again, trying to draft those letters is like an admin red tape that you don't really want to have to do it, but you really should do it, right? So if this could be made through AI's help to make those letters drafted much quicker, we probably will be able to draft more of these appeal letters. We'll be filing more bills, and by having more letters being drafted,

I would imagine our recovery will be better in terms of revenue. Is that a good way of putting it? Yeah. Yeah. Okay. So, yeah, I'm ecstatic. I'm very happy to see that these are some of the measures that we're doing, but certainly if there are more opportunities, let's do it. Thank

you. Thank you, Supervisor Lee.

Yep, that's all I have on AI. Okay. Yes, go ahead. Thank

you, Chair Lee. So I want to turn this over to Vinod to go through some of the revenue cycle improvements that we've seen as a healthcare system.

Good afternoon, Supervisors. Vinod Sharma, Health and Hospital System. The first slide we show is the total posted charges for the last 13 months. The first three months were before we acquired RMC. The average was about $700 million a month, and you can see post -RMC acquisition, our average is close to $900 million a month. That shows significant improvement in terms of billing. And if you go to the next slide, that shows the same thing on an average daily billing as to what we are doing. And from $23 million a day to about $30, $31 million a day. That's the net billing increase over the years, over the months. If you go to the next slide.

So this slide here shows our billing history going back to 2018. We used to be $345 million a month. In 2019, we acquired Verity, and 2020, it was $462 million. Last year, before the acquisition of RMC, it was about $680 million, and then it went up to $893, and then last month, we just reached the billion -dollar mark for the first time. And I hope that we stay in that category as a billion -dollar club for months to come. Here, I want to share something else. The efforts with the Revenue Guardian and Revenue Accountability Tool, which is an epic tool that allows us to identify missing charges or under -collections or under -billings, and then

coding gaps. As a result, in the last...

since 2024, June, when we implemented it, our facility charges or HP charges have increased 37 % per month, and the average for the professional billing has increased by 33%. This is also a combination of effort we did in terms of CDI training, the clinical documentation improvement training that's provided to the physicians, as well as the coding training providing to physicians, as well as to the coders. That is helping. And recently, we have established a denial management unit, which basically is going to be aggressively looking at all the denials and seek opportunities to convert them to cash. And that's where one of the tools that Khalid had shown about the AI would also help. So... Let's

go to the next slide. The next couple of slides basically show our monthly collections. And on an average, in 2018, we were collecting $60 million a month, and now we are close to $160 million a month collections. That's about $1 .6 billion of cash collections from the revenue cycle in a year. Do you have any questions for revenue cycle? Well,

thank you.

Thank you, Supervisor Lee. So at this point in time, we're happy to take questions, but just a general comment. And I've said this earlier in my remarks, which is, as a healthcare system, we have the ability to generate revenue. And we do that in a number of different ways. One is, of course, through our revenue cycle process and those improvements, but also through operational efficiencies. So as you well know, part of our initiatives presented to the board for consideration for the current year, but also which will be coming forward in fiscal year 26 -27, is really focused on throughput. In other words, our ability to see more patients, whether it's in the inpatient setting, outpatient

setting, regarding primary care and specialty services, ancillary services around diagnostic imaging, laboratory, other studies, if you will. Surgical procedures, whether it's inpatient or outpatient. All of those, if we're able to show some marginal improvement in terms of efficiency under the current cost structure, then our revenue picture looks better. So you can have a 2 -3 % improvement in our operational efficiency, and it can generate tens of millions, if not hundreds of millions of dollars. So that is an area that we are heavily focused on. I do have to commend the staff who have actually stepped forward and offered solutions around how we can be much more efficient in the delivery of care. So I wanted

to share that with you relative to our focus on revenue improvements as opposed to cost cutting. The other thing that I would mention to you, and you've heard a lot about this, is our ability to restructure service lines now that we're a four -hospital system. During the study session, we talked about cardiac care and not having multiple very highly skilled and high -cost services at each of the four hospitals, but rather folks that one facility will allow us to not only ensure quality in patient outcomes, but also to ensure that we're providing the most cost -effective care where it can be really efficient, expensive to maintain. We are looking at a number of other different

service lines, whether it be orthopedics, women's health care, et cetera, as we go forward into the coming years. And I wanted to once again reiterate the fact that none of this can be accomplished unless we have the engagement and the support of the staff on the front lines, including the physicians. And they have wholeheartedly accepted this challenge. And in a very short period of time, I think we've seen some remarkable success in our system relative to improving access, but also improving our bottom line around efficiency.

So with those remarks, I'm happy to take any questions, as well as those that are present here. Sure. Let's see if we

could have any public who would like to speak on

this item.

Giving it one second on Zoom. Jess, I think there's

some cards behind you. Oh,

these

are not for this item. So confirming no request to speak on item four.

Okay. All right. That will close the public queue on item four.

Vice Chair, do you have any questions on this?

No, actually, just a thanks to all of you. I very much appreciate the revenue generation strategy more than the cost -cutting strategy. We have to do both, but definitely I think, as you said, there's opportunity for revenue generation and the consolidation efficiencies. I think we're moving in the right direction and very much appreciate the hard work. I know this is quite a Herculean effort, and so I just really appreciate the hard work that's being done here. So thank you. Look forward to continuing to see the progress. Motion? Yes, I'll make a motion to receive the report. Thank you. I'll second that.

I do have a couple of remaining questions. So, Paul, we've heard you mention the importance of growing up primary care, and if you could explain to everyone why this primary care is such an important thing to work on.

I'd be happy to talk about the importance of primary care. As we all know, a primary care is really the front door to health care. It's the way in which an individual is actually able to navigate the complexities of health care in terms of individuals, individual needs. Our ability to grow primary care is critical to the system because it is focused on prevention and really around maintaining an individual's health and well -being. As we all know, that if you're able to diagnose early and care for and treat an individual, then it's much better for the individual's overall health and well -being, but also, from a financial perspective, it's much more cost -effective. And so, as

a public health, health care system, given the fact that we fully expect the number of individuals that are going to fall off coverage, in other words, as you well know, HR1 really targets those that are on Medicaid, and that represents close to 50 % of our patient population. So our interest is to ensure that those individuals, irrespective of coverage, maintain access to primary care for the reasons that I've stated. So that is a big focus of our health care system. I would add, and we have representatives from the Community Health Partnership Clinics, which also represents a large number of federally qualified health centers for which your public health care system is a party to. The

ability for us to continue to provide access collectively, and not just as a county system, but as partners with many of the community providers is really critical, given the number of people that we fully expect to become dependent on safety net health care systems.

And let me just say this. One of the things that people need to appreciate

about our county health care system is that it's an integrated system. It focuses on primary care, which is preventive health care, all the way through the full continuum of care, to specialty care, to hospital inpatient services, to emergency room care, all the way through to the ability for us to appropriately discharge and place individuals in the appropriate levels of care in terms of subacute, et cetera. That full continuum of care allows us to become much more efficient in the overall delivery of a person's care. And that is part of the reason why we as a public system is somewhat unique, because of that integrated system, we're able to take risk. In other words, what we

do as a health care system is not only bill fee -for -service and collect from third -party payers, but we're also able to take risk where we take capitation to manage a segment of a population. So the more effective we are in managing the health care of those individuals, the more cost -effective that care is to our community. So it's really important that we start with primary care, but it's the beginning of the full continuum of care that we offer as an integrated health care system.

Thank you, Paul. And that leads to the issue of PCAP, right, which is a primary care access program. I believe this will be coming back to us sometime in the fall on these issues. Anything you want to share with us, what you're thinking about in terms of the changes for PCAP?

Thank you, Supervisor Lee. So I think as most people, we realize, as I just mentioned, there is a significant portion of our patient population that potentially will lose coverage under the implementation of HR1. One segment of the community includes the unsatisfactory immigration status, the undocumented, of which we estimate there are around 75 ,000 individuals in our community that will potentially lose coverage. And as I point out, it's really, really important that those individuals maintain access to primary care, but health care in general, to maintain their health. And so we have PCAP, which stands for Primary Care Access Program, for which we are fully committed to, but we're going to have to

revise that program to complement the changes related to HR1. So what we do not want to do is disincentivize people to enroll into Medi -Cal, but we also want them to maintain their coverage. So we have to create a program that is complementary to all the other government options that an individual may have. And I will add that it's just not the UIS population that potentially is at risk here. There are many individuals that in our community, and we know this given covered California, for example, where we've already seen a 25 % plus, 30 % decrease in enrollment in covered California because of the tax credits are no longer there. And the cost of that

in some situations will exceed, in terms of premiums, close to, you know, 50, 60 % and in some situations over 100 % in terms of their monthly premiums. And so those individuals will have to have access to health care in order to maintain their health. And so we're going to have to create a program that takes into consideration all the impacts of HR1 and changes in the federal government in terms of enrollment in some type of coverage program. So we are looking to come back to the board sometimes later this year with a program that complements the needs of this community. Right.

And I hope that when these changes come to us, you would have had the ability to work with our community partners. Like you mentioned, the Community Health Partnership to come up with these changes to the PCAP program. Yeah.

Yes, we will engage with our partners. Good.

We, as you mentioned, the Medi -Cal type enrollment we know is going to drop given the changes of HR1. What would be the best way for us to shed this light so that we could be able to have the data carefully so that we could actually publicize this to let people know how HR1 is truly negatively affecting our programs in Medi -Cal and how this is hurting our community?

So, Supervisor, I think to your point, data and information is really important. And what we will do is in our subsequent reports to this committee, provide updates in terms of the Medi -Cal enrollment in the county. So we'll work with the Social Services Agency and others to make sure you get regular reports in terms of where that enrollment is and how things are projected out going forward. The other important aspect that we've all talked about is to ensure that individuals remain enrolled in coverage in Medi -Cal and also to ensure that those that are eligible actually apply for and get enrolled. I know there's some efforts underway. I know Family Health Plan and the Medi

-Cal Managed Care Plans are looking at strategies in supporting community organizations

to ensure that individuals stay enrolled. But to your point, we do have to take it to the next level. And we will probably convene a group that will include the Social Services Agency, health care providers, the Community Health Partnership Clinics and others to make sure that we have a very robust and strong strategy going forward. Great.