All right, so good morning, everybody.

Happy Monday morning, October 27th, 2025.

Clerk called the role for the health committee.

Supervisor Tam.

Present.

Supervisor Miley.

Present.

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All right, thank you.

So our first item this morning is an action item, Measure C, Children's Health and Childcare Initiative, Pediatric Health Care, Account Safety Netflix update.

Quite a title.

Good morning.

So I am back to present some updates on our safety net recommendations for Measure C.

Next slide.

I don't, do I have the slides?

Oh, okay.

So this is what we're going to be covering today.

We're going to do a review of the proposed allocation plan for the Measure C safety net fund.

And we're going to do some follow-ups.

Some additional health committee guidance from the September 8th meeting.

And focusing on two areas: the additional revenue allocation for the violence prevention strategy and the stipends for the oversight committee participation participation.

And then a requested action to bring the recommendations to the board in November.

And then just a reminder that all of the presentations from our last two health committee meetings are in the appendix in the back of the of this deck for reference.

So as a follow-up from the September 8th Health Committee meeting, you requested information on allocating annual revenue beyond the projected annual revenue to the violence prevention strategy.

And you also wanted to see a plan for providing stipends of up to 150 per meeting for members of the Measure A, C and W Citizen Oversight Committee.

Slide.

And before I get into those information about those recommendations, wanted to just recap how we came up with our recommendations.

So we're uh proposing allocating the accrued and the annual revenue to maximize the impact.

So that's that six million annual projected and as well as the 30 million in the reserve or the accrued revenue.

And we want to establish a proven reserve and a three-year funding cycle starting this fiscal year, 25-26.

And this would be this would be allow us to you know support that regular review of strategies and also align with the measure A cycle.

And we want to support our strategies that leverage existing infrastructure within our system and build on existing assessments and plans.

And we're supporting we're providing a mix of in the recommendations of county and CBO contracted programs, and we're prioritizing strategies that support cross-sectional and holistic support for our priority populations.

And so this is the budget that you've seen before, but there's one change to this proposed three-year allocation, and you'll see it highlighted in yellow, which is the violence prevention strategy.

We've increased that line item again by approximately one million from approximately two million to three million.

And everything else, all the other um allocations on the right remain the same, and then you'll see that the reserve fund has gone down a bit after that increase to violence prevention.

So now we're at about six million.

Oh, that's fine.

I was just gonna say that the year one spending would be approximately 17 million and year two and three about 13 million.

Next slide.

So now we're going into the recommendations regarding the use of annual revenue beyond that project, the projected $6 million for the violence prevention strategy.

So uh we are we are recommending um that to allocate measure C the sales tax revenue received in the safety net fund in the excess of six million for the annual projection to the violence prevention strategy at year end, up to an additional one million per year.

Um and that's recommended for the full three-year cycle, but it will be reevaluated for the next cycle.

And anything that's above that additional one million would go into the reserve.

So it's up to one million per year.

And this is consistent with the September 8th Health Committee recommendation.

And this is this is regarding the stipends.

So Supervisor Miley proposed a stipend of up to $150 per member per meeting for all the committee members.

We did a bit of research around how we would do this and just considering this recommendation.

And we found that the measure A, C and W committee members do not currently receive stipends, and we're recommending not to provide stipends at this time.

And lastly, our requested health committee action would be to improve.

And this is just the timeline here that we're anticipating.

If that uh approval goes forward, um today is the you know, the follow-up presentation to the Board of Super Supervisors Health Committee, and then November 18th would be the request for approval for the expenditure plan.

And then in fiscal year 2627 is when the Citizen Oversight Committee would begin to review both measures A, C and W expenditures for fiscal year 2526.

And lastly, our plan is to have the Citizen Oversight Committee provide updates to the Board of Supervisors Health Committee on all these measures annually.

And then these are this is just the appendix.

Okay, thanks for the update.

I'll start with um Supervisor Tim.

So she has questions and comments.

Um thank you, Chair Miley.

Uh appreciate the presentation and the follow-up from the September 8th uh health committee meeting and the responsiveness on the um the violence prevention strategy.

Uh do we have an idea which uh CBOs in particular might um be part of that uh augmentation?

Yeah, that's a good question.

Um, our plan is to develop to go through a whole RFP development process.

So we can't we don't really know for sure which CBOs would apply for that and then receive the funding.

Um I would imagine it would probably be some of the CBOs that are maybe already receiving our funding.

But yeah, there's no we don't know for sure which CBOs will be partnering with us.

Um because several of them uh obviously receive some one-time grant funding uh to do studies.

Uh I was just trying to figure out like where like ceasefire program would potentially fit in all of that effort, and would they have to go through an RFP process?

Yes, they would they would need to go through that RFP process.

But I but I just want to say that I think the oh go ahead, Anika, you want to I was gonna say I think uh ceasefire is a city of Oakland program, right?

And so Kimi might also be aware a little bit more about this, but we've been having conversations.

Um our Office of Violence Prevention is connected with the city's Office of Violence Prevention and talking to them to make sure that we're aligned in our strategies and and what we're putting forward.

So that one may be a slightly different route than the the full right, okay.

Because it's a partnership with the city of Oakland uh, and obviously one of the reasons we we asked for this is because uh gun violence is a public health concern, particularly with uh certain demographics uh, and just one other thing I'll add is that you know, so Lisa noted that the previous allocation for violence prevention was at about 2 million, so that was about 50 percent for our office uh and and staffing needs and 50 percent for uh uh community uh RFP, you know, community investment.

Um so now that community investment is at about two million, and then we think that with the additional uh one million, but the one million is retro at the end of the year, and so each year there could be about three million dollars available for um external-facing violence prevention work.

Okay, that's helpful.

Um, and then with respect to uh Supervisor Miley's proposal on the stipend.

Um I know that like the Measure A committee and well now C and W, they they do a look back.

It's to see whether they were compliant with the terms of the ballot measure, and the ballot measure actually called for uh these committees to do um the citizen look back.

Do you know uh do you expect that they'll meet only one time a year?

Because we only get reports from them on an annual basis.

No, I believe they meet seven several times a year.

It's quarterly or monthly, Anika.

Do you do you recall?

It's I think it's monthly at this point.

Yeah, it's monthly.

So they meet regularly uh regardless, and so um over the last couple of months we've done some briefings with them on what the additional measure W responsibilities might be as well as the measure C responsibilities.

Um, and uh, you know, our our recommendation to not move forward with the stipend at this time is really just about needing to do some more coordination both with CAO and auditor's office to see um potential impacts in other places, and so that was the reason.

Okay, the the reason I asked about the frequency of the meetings is because um most of our boards and commissions and even the advisory committees, I think they get some uh stipend, right?

That's part of uh the broader landscape that we wanted to take a look at.

Um we had assumed that measure A was also getting it, but they were not, yeah.

Measure A did not, but the the ballot measure doesn't preclude them from receiving a stipend.

So I I think we should um try to find out if we can accommodate a stipend for them because um this level of work and and trying to appoint people to these committees is something that's not always uh easy because we see vacancies from other board offices.

Okay, thank you.

If if we can get uh some of that sorted out before the November board letter, we'd we would include it in that.

Okay, thank you.

Otherwise, we'll bring it back.

So Supervisor Tim has some excellent questions of which I was gonna, you know, um chime in on.

So I'll start in the reverse.

I think the fact that uh all three of these are mandated set them apart from normal boards and commissions that maybe aren't mandated.

That's the first thing I would and you know the county administrator uh knows, and maybe Supervisor Tam is aware of this as well.

We've been waiting to have a report on the boards and commissions we have, which ones um are duplicative, which ones are no longer um uh necessary because we're also establishing new uh boards and commissions.

In fact, here's two more coming on right now, but it's gonna be combined with measure A.

So I really do think I agree with uh Supervisor Stamp, that analysis needs to be done and it needs to get back to us.

Because I I too just gives me a bad feeling in my stomach to know these folks have got to do this level of work, potentially monthly, and not get a stipend.

Oh, the when they meet, is it an hour meeting, two-hour meeting, three hour meeting?

Do they get refreshments?

What would what what I'm seeing?

Okay, you get refreshments.

I know that's serious.

What's what what's happening there?

It's it's a 90-minute meeting.

90 minutes.

There are refreshments.

Uh it's usually in the morning, and so it's a whole breakfast spread um with fruit snacks that people can take for later.

Um there uh the way the meetings are usually structured is that um you know they go through presentations from uh organizations that are funded by measure A.

So there's a schedule, so for example, AHS gets Measure A funding, which is, you know, not directly out of the county's portion, but the separate portion.

So they do regular updates.

Lisa's team gets measure A funding, and so they come to the group and say, here's how we're spending the money.

And the committee's uh role is to ensure that they're spending it in ways that are consistent with the with the measure.

Um so that's what we're working with them on is to see how we can build in C and W.

C and W, because there will be some overlap with the organizations, but there might also be ways for us, like as an agency to help uh streamline some of it.

So for example, public health receives measure A funding that they then give out to CBOs.

And so instead of, you know, each CBO having to present, maybe there's something we can do to um to streamline it and do some pre-work so that it's less onerous for the committee.

Yeah.

So now they've got to do two additional measures, C and W, on top of A.

I'm not saying it's gonna triple their workload.

I've seen it might double it uh in terms of uh the meeting time, um, but the meeting time now is an hour and a half, it might go to two hours, it could go even longer.

I just really think um we need to this is gonna come to the full board on November 18th.

Yeah, I really need to have the agency drill down with the county administrator's office, and and if and if you need to talk to the auditor to do this to get this resolved.

Um, you know, I personally think a hundred dollar stipend is a good amount.

It's an incentive for them to want to do the work.

I mean, they're gonna do the work anyway, but it's an incentive um for them to participate in this level of scrutiny.

The um, you know, um the planning commission, they receive a stipend.

Um the MAX, they receive a stipend.

Um the municipal advisory councils, I'm not sure uh what other boards and commissions potentially receive stipends.

I know there have been certain boards and commissions that have asked for stipends and we haven't provided it.

And I think one critical component would be is that board and commission mandated?

Is it required under federal law, state law, ballot measure, whatever, and if it's required, then I think that gives a different level of responsibility and accountability.

Because for instance, the MACs, um Supervisor Tamman are very familiar with the MAX Peninsula Advisory Councils, we've got um a number of those.

They aren't required.

We created those ourselves to help us do a better job of of um of providing public service uh to the unincorporated uh communities, and we provide a MAC, I mean we provide a stipend to the MACs.

Um so that's kind of I think a separate uh category just because the county is the is the governmental body that oversees uh responsibilities, uh municipal responsibilities in the corporate area, and so having the MAX really helps us with that.

So I can see while that might be carved out for a stipend, even though it's not mandated, but I do think one major criteria would be is it mandated?

Um and if it is, um, is a stipend uh warranted based on the the workload um that we are expecting from that particular uh board and commission.

If it you know if it meets monthly, oh I mean excuse me.

If it meets annually, maybe not semi-annually, maybe not, but you're telling me this body's meets monthly unless unless it's canceled.

I mean, I just I it's not yeah, it's not right.

So I I would suspect if you haven't come if on the 18th, if you don't come in with an answer to this, uh Supervisor Tam and I might, you know, raise it with the full board.

Um, and you can remind the county administrator, she knows the study that was done on boards and commissions was done four or five, six years ago.

It it's put the information, I don't know if it's stale, because at one point she uh updated it, and and I know when I was president the last time I tried to get this um managed, but I wasn't able to get it done because it keeps kind of going down to a lower level of priority based on all the things we've got coming at us.

You know, there are people calling Friday meetings and you know uh 12-hour meetings on Tuesdays and all sorts of stuff.

Um so we this is kind of sunk into a very low priority, but it would be nice if we could get that wrapped up.

Um, and if we can't get it wrapped up, at least advance this piece based on this criteria.

Yeah, so I know I've said a lot.

I'm glad Supervisor Tam spoke first and uh felt that this was um something of important because I didn't want to jump out there ahead of her.

So you're hearing from the committee.

Um and ultimately the you know the board supervisors, we've got the fiduciary responsibility, and if we think these folks need to get a stipend, they need to get a stipend.

Um let's go back to the violence prevention.

So uh there'll be an additional million, and then there could be another million if there's um funding uh that comes in uh greater than uh the six million uh projection, up to a million dollars.

Yeah, it won't go above a million, and then anything.

If let's say uh we bring in eight million annually uh one year, so that's two million extra.

So a million would go to violence prevention and a million go to the reserves of that two million.

Okay, and just one other thing I'll note on the reserves is that you know we're wanting to um just for fiscal prudence have a reserve, but then also because a lot so much is shifting in the the funding landscape, um, you know, we may need to pull on that reserve to support other things that might be happening that we're just not aware of right now.

So that's why we're being a little bit conservative with it.

And it is the three million reserve uh presently starting at six million.

Oh, is the is the reserve presently starting at six million?

Yes.

It's over bill from there.

Yes, exactly.

Yeah, we're about approximately six million.

Okay.

And then with the violence prevention, uh the will uh public entities be precluded, will public entities be precluded from uh responding to an RFP for violence prevention money.

For instance, suppose Hayward wants to respond, or or Oakland or some other jurisdiction, school district, whatever, will they be precluded, or is it just for CBOs?

That's a good question.

I'm gonna let can you take that one?

Good morning, supervisors.

Uh no, cities would not be precluded.

However, generally we work with our cities differently, and so we would want to be in conversation with them for other pots of money like Measure A, for instance, we do fund um the city of Berkeley.

That is not through a normal kind of procurement process as they're a public health jurisdiction of their own.

And so we would approach it somewhat differently rather than an open competition along with CBOs.

So there, let's suppose you've got um you've got three million and about 500,000 is going to administration, so 2.5 million is going to the actual program.

So you might carve out, I'm just theoretically throwing out a figure, um, a five hundred thousand dollars uh if a city were interested in trying to do something around balance prevention.

We would work with them on.

Yeah, we would take a look at which, you know, where there are existing efforts, where there are concentrations of uh community organizations that they are already pulled together.

We have been in communication with the Department of Violence Prevention with the City of Oakland, but are also looking to establish those kinds of relationships with other cities that have growing efforts of their own, um, so that we can work better together.

I don't think I can actually say exactly how we would go about doing this and which organizations would get funded, but what I can say is that I don't think it would be appropriate to use the typical procurement process with with cities that we would use with CBOs.

Okay.

Now I know um and I think you've you've had um conversations with the mayor's office, the mayor of Oakland, uh, because she's spoken to me, and I don't know if she's spoken to Supervisor Tam about the summer youth job program as a violence prevention strategy.

Have you had any conversations with her with her or her violence prevention people about that?

So I have not had conversations personally, I have not had conversations with the mayor's office regarding their summer um the youth summer jobs program.

However, we have worked with that program in the past, the public health department has.

Um we have had several conversations and meetings with the chief of the Department of Violence Prevention around the organizations that they currently fund, and we're also looking with them at which organizations they maybe are no longer funding, what part of the continuum they are focusing on, and we want to make sure that what we're doing is complementary and not duplicative, and that we're paying close attention to the things that might be falling through the cracks, but no, we have not specifically spoken about the jobs program.

Okay, all right.

And I know Oakland's pretty much the the city that's and that I think from the from the data we had, I think we're gonna get a follow-up on that.

Uh we were drilling down to see um uh at one of the reports on violence prevention, maybe um uh where a lot of the um concentration was coming from.

I think we're uh were you giving that report?

I can't remember who's giving that report.

Was it you, Kimmy?

So the public health department did partner with the District Attorney's Office to produce a gun violence report, and as part of that process, we also, and just a part of the Office of the Violence Prevention work, we are looking at the data and have prepared um some data that we shared with the staff of your offices, and we are looking to come back to the joint public protection and health committee to do a more complete presentation.

But we do have some data, we don't have as much as we would like, but we have some of the data by city.

So we have uh gun violence by city, we have homicide by city, we also have suicide by city.

Um, so we really are trying to focus on the four types of violence that we're focusing on right now.

Um so we have two of the four by city.

What are the other two?

Intimate partner uh and hate-motivated violence.

Okay, good, good, good.

Okay.

Because I think uh we need to have some criteria and efficacy around, you know, this is the reason why we're focusing so much of our um violence prevention resources if it is with the public sector in that particular jurisdiction.

That's right.

The data indicates that's right all forms of violence.

That's right.

Or you know, whether it's partner, whether it's gun, whether it's this, that, or the other, it is here.

Yeah.

That's right.

Yeah, that's right.

And we are looking forward to working more closely with our law enforcement partners who often hold the data to be able to have more information about the other two forms, but we do have some type of data right now in terms of where the concentrations are greater.

Um again, we have it for all of Alameda County, all cities.

Okay.

And then, no, I'm spending a lot of time on this because you know, this is a passion of mine.

Um the entities that receive funding, be it a CBO or if we're partnering with the city, uh, it's all based on results-based accountability.

We have metrics, we have outcomes, we're measuring, because for instance, I don't want to see us give money just to fund a recreation program because they say, oh, this is gonna stop violence.

Right when there's no, you know, there's no efficacy or metrics associated with that to see, you know, we're just funding a recreation program that the city should have been funding anyway.

Right.

Right.

So yes, as is consistent with other programs that we have within the public health department across the agency.

We are still following your board's direction around results-based accountability and are using that frame with community-based organizations.

I will say that this first round of funding that we put out through ARPA, we really try to get things established and get things moving.

I am not certain what framework is used, not yet.

We will know soon what framework is used by the city of Oakland to evaluate other subcontracts.

But we would be expecting that from any organization, including city, that we fund.

So yeah.

Okay.

So I'm just speaking for myself.

I'm not speaking for the Supervisor Jam, but I can give you a little grace on the ARPA, in terms of, you know, we want to get the money out there and help folks out and this, that, and the other.

But when we really start looking at this much more carefully, I'm gonna, I'm not gonna be easy on you.

So you know, I've been involved in this type of work.

I mean, it's like I'm a jack of all trades and ace at a very, you know, a few things, and this is something I do know a little bit about.

Yeah.

Um, understood.

Yes.

Okay.

So I think you'll be very pleased with when we come back and provide the report in terms of the work that's happening and the uh foundation that we're setting to be able to evaluate effectiveness.

What we are looking to be able to do eventually is to narrow in on a smaller set of interventions that we know work.

There are two operating in our county that have been uh evaluated very rigorously, the hospital-based intervention as well as ceasefire.

We would hope to be able to lift up a few more interventions that we know work really well here in Alameda County and be able to fund a fewer set of interventions, but fund more deeply so that we can get the impacts, and we're hoping that our partners, both in the community and jurisdictions, would be supportive of that approach so that we can get the impact that we're all looking for.

Yeah.

No, you mentioned hospitals, James, sitting behind you.

I know Yeah, Youth Alive, you know, because you know, I talked games about Youth Alive and that so and I know you're familiar with Youth Lives.

I yes, they are one of the uh entities, Youth Alive is one of the organizations that is funded uh currently um within the Office of Violence Prevention.

Uh so yes, we are well aware.

Now, what about school districts?

I'm not suggesting they'll want to um look at any of this funding, and I know we only have so much, but would do you do any interaction through the also violence prevention with school districts?

Currently, um school districts are not funded under the Office of Violence Prevention.

However, we do work with, and this is where uh Lisa Erickson um and our department work really closely together um to take a look at what funding they have currently, and we are in conversations with the uh Department of Violence Prevention right now with the city to really see which what kind of funding they were giving the schools are giving the schools to do what kinds of things, um, and so we're still in the middle of that analysis, but currently we don't fund them under the Office of Violence Prevention.

Okay, so um so uh when Lisa comes back with an updated report, hopefully we'll hear more about the work that you're doing with school districts around violence prevention.

Okay, uh Supervisor Damn, you have any any qu any more questions of Kimmy?

Okay, um now back on the funding allocations.

So I'm particularly interested in REACH.

So this additional million dollars, so has does this alleviate the District four office of its obligations to reach in terms of financial obligations to reach, or do you still need the District 4 obligation to continue in some form?

We would love to continue to have conversation with you about that, but this we we do think that it alleviates a large part of the structural part of the structural.

So, I might be able to reduce the amount and uh provide those resources to like YU or some other entity.

Okay.

And so you'll keep you'll be talking to um, I guess Aaron and Bert, and we'll figure this out.

Yeah, as we head into the MOE process, um, you know, we'll have some more details for you coming up soon because I reaches another one of those programs that um, you know, in addition to the structural deficit, it also relies on like Prop One funding and I'm sorry, not prop one, MHSA funding, and so we're trying to figure out where there's uh you know if there's gonna be any shifts in there.

Okay, great, great.

Okay, thanks.

Okay.

So let's see.

Do we have any public speakers on this item?

I have no speakers on this item.

No speakers, okay.

So at some point, uh, you know, I meet with Anika twice a month if I can.

Uh and at some point, uh Nika's gonna have you and I and aaron on a meeting together, and Kimmy and I and Anika in a meeting because I like to.

Sounds good.

A little bit more hands-on with some of your stuff.

Yeah, because I used to be um a frustrated social worker when I was working in the social services committee, but now I'm a frustrated, you know.

But the health health analysts or whatever it is, that I'm on this committee.

Okay.

Thanks.

Great report.

Thanks, President.

Okay.

Okay.

So, since that was an action item.

Oh, okay.

Let's have a motion.

There's an action item.

Okay, so I will move uh the expenditure plan and the recommendations to the full board uh with the exploration of trying to get a stipend uh for the um measure A, C and W.

Commission members before it comes to the full board.

And I'll second that.

Supervisor Tam.

Aye.

Supervisor Miley.

Aye.

Approved.

Okay, thank you.

And this will be it before the full board on November 18th.

Okay, so let's go to our next item.

Alameda Health Systems Fiscal Year 26 budget update.

And we've got the Alamini Health Systems folks in the house.

Good morning.

Um I'm gonna start off and then I'm gonna turn it over to James Jackson.

So I'll start with the financial update.

Um, so this is as of August, so it's only two months into the fiscal year.

We're pretty close to budget.

Um, a couple of highlights.

We're seeing more discharges.

Uh we had 168 more than planned in the first two months of this year, and our length of stay has gone down.

So those are two positive things seeing more patients, uh, a lower length of stay.

Uh and our ED continues to be very busy.

It's uh all last year we beat budget.

This year, it's also very busy.

Um, if you look at the financial statements there, we have a net income of 4.7 million for two months.

We're off about 800,000, which is you know, pretty close.

Um, our FTEs are still over, but our volumes are up, so that's not necessarily a horrible thing.

Um, but our labor costs are exceeding budget, and this is closer than we've been in the entire last 12 months.

So a lot of focus and effort on labor costs.

Next slide.

As a result of the big bill and H1, uh, we decided we needed to do a multi-year planning.

Um we're currently implementing software strata to do that for us.

Right now, it's all manual, but as part of it, we have the cash flow here, which is concerning.

Uh I want to make a few comments about it.

Uh, to start, you can see for the last four years, we have not been pushing up against the NNB ceiling.

You can also see that at the end of each fiscal year, we were in a receivable situation.

If you look at the current year with our budget, we are expected to get all the way to the ceiling of ninety-five million on 630 26.

That's problematic because there's a cycle, and the cycle is indicated by the dotted black lines there.

Those are the high points, usually Q2 of each fiscal year.

And because we're starting at the max, we are projecting to exceed the NNB by 74 million in September of 26 next year.

This is without any intervention.

This is if we do nothing, right?

This is what our current budget indicates.

So a lot of work is happening.

James is going to talk more about that in a few minutes.

We're also working with the county where we would like to amend the permanent agreement to have some more flexibility with the NB.

And again, as I said, we're now looking out five years because the big bill implications get bigger each year.

For the next two years, this next June 30 and the following June 30.

We think we'll be pretty close to the max on the NNB because our revenues from supplementals come in in the spring summertime.

So it's it's this cycle that's bringing us way up, and even slightly more than normal because of repayment of the HPAC realignment funds, some usually about 40 million, 42 million.

This year we're paying back from two years ago, and we're also not earning it this year.

And the reason for that is although QIP and EPP supplemental funding increased, we don't get paid that money for two years, but it's in the formula for HPAC.

So it's delaying cash flow, and it's definitely having a negative impact on our cash situation.

Next slide.

This is the same information, it's just in a table format.

I'm not gonna go through the whole thing with you, just a couple things.

One good thing that happened is EPP funding got advanced, and you can see FY27 Q2 75 million, significantly more than what we got in the previous two years because they've accelerated, which is great news for us because you see the AB 85 realignment there, the HPAC amendment.

We have to pay back the 41.7, and we're not getting any new money this year at all, and we're not expecting to get it next year.

So that is uh definitely uh having taking its toll on us.

Next slide.

This is St.

Rose.

Um, not a lot has changed.

We did, we are still waiting to get licensed as a subacute unit to take care of Medical and Medicare government patients.

Right now we have mostly Kaiser commercial patients in there and has a very low census.

We're hoping that will get fixed soon.

Uh St.

Rose is bringing their budget to the St.

Rose board tomorrow.

It's at about break even, which included IGT funding of 36.9 million.

We're still working on, you know, generating the local share to drive that max down.

It's not currently in any of my numbers.

Um the good news there here though was with the 30.3 million IgT for this last fiscal year, they were able to pay AHS off completely the line of credit, and they're actually ending the year with a small profit.

So that was very positive.

Next slide, or do you want to ask some more questions there?

I'll let you look.

You know, we'll let you finish, then we'll ask some questions.

You're Kim Miranda, right?

Say that again.

You are Kim?

I'm Kim Miranda.

Okay, yes.

Wanted to make sure you introduce yourself okay.

Oh, thank you.

My apologies.

So this next slide is the uh bill big bill impacts.

Um, John Minut Schwartz on our behalf of our organization has been doing a lot of education on this all over with all kinds of constituents.

And you can see in 2026, the impact to us right here at 7.8 million is not significant.

It does grow substantially.

One of the things that Alamina Alliance has informed us is that they're projecting about 30,000 lives to be disenrolled from MediCal.

And they're telling us that the cost to care for those patients last year was 350 million dollars.

And I don't have any of that additional care under HPAC or any other arrangements in my projections.

I guess at this point we're wait and see.

They did lose 4,000 lives last month, but in the month of July, they actually picked up lives.

So we're still kind of waiting to see how this plays out.

We didn't expect to see anything until at least January, and then minimal impacts until next year.

So that is one risk I wanted to bring up here.

Next slide, please.

I thought, you know, in light of all this, I should spend a couple minutes on some, you know, notable achievements from a financial standpoint.

So if um if you don't mind, I'd like to just spend a few minutes talking about it.

The first one is GPP.

You can see back in 2015, 16, 17, we were getting about 100%.

And then it dropped off, and then during COVID, we would have been quite low.

Um, but because of the pandemic relief, we were able to maximize at 127%.

But you can see we're now projected 24 to get 100%, and we think that we can continue, and you can see the slope of the line is increasing.

So our reporting is getting better.

Um, that is not only just AHS, it's also the county reporting.

Um, it's it's good news.

We are partnering and we are able to claim the points that we are entitled to.

Next slide.

This is pay for performance with the Alameda Alliance.

This is something we've been working on.

We want to improve our quality, uh, and you can see we earned 58% in 2024, uh, which is over a million dollars, and it has increased substantially uh over the last several fiscal years.

Um at the bottom, I just summarized some of the some of the metrics that are are really strong.

Breast cancer screening 100%.

Um follow-up after an ED visit for mental health.

I mean, this is something we've been really focusing on from zero to 75%, between 23 and 24, also with child and adolescent welfare visits up to 75%, and look at member satisfaction.

We are working on making sure patients can access our system and have a better experience.

50% improvement in one year.

Next slide, please.

This is our uh collections.

Uh we went live in Epic back in uh the 2019-2020 range, actually October 2020.

You can see how low our collections were, especially that first year.

I should have put adjusted patient days on this graph to show you that our volumes have not really changed pre-COVID.

They're up a little bit, they are a couple percent, but look at our collections.

Um we are doing year over year quite well, up to 942 million and 25, 26 were projected to exceed that as well.

Uh next slide, please.

This one is uh John George.

Um we were struggling getting all the information into the county billing system correctly, and we were able to improve this substantially from 2,323 and 22 unmatched information down to 450.

So we really um put some focus into this to make sure that the county and AHS can be paid.

Uh next slide, please.

So here's uh the John George maximum contracts amount in 23 before Cal AIM was 72.1 million.

The maximums for 24 and 25 went up 73 to 74.

However, this is a time of high inflation, and this is also when the county was converting to smart care.

We actually billed out 89.8 million in 24 and 93.6 million in 25.

So we feel that there is opportunity, probably in the terms of you know, 15 to 20 million if we can get information real time, fight denials, get payment, and this would then directly help our NB position because that would increase cash flow.

So this is something we're pushing on to try to improve more, and those are kind of the highlights.

I could probably go on and on and on, but those were the ones that I wanted to share with you today.

In the at the previous health committee, um I didn't a lot of this is um uh I would say a little outdated since this was approved June 11th of 25 without any of the big bill or H1 impacts, and this was before we did our cash flow projection and we're working on the multi-year planning.

Um, but I'll just spend just a couple minutes showing you where what the board approved for us.

A break even budget.

You can see in the middle column there, budget 26 at a loss of 228,000, which is basically breakeven.

If you look at this, you can see the biggest factor that's driving our cost situation is labor.

Um as I mentioned, uh inflation was uh really big in the 24 time period.

You can see our labor costs went from a million uh five.

And we're still expecting it to go up another 54 in this year's budget at 4.7 percent.

We have fought hard to keep the rest of our costs down for an overall increase of 2.8 compared to an increase of revenue of only 1.8.

So this is the strain, this is what's hurting us, and this is why we need to get our cost structure down.

Next slide, please.

Um, this just goes to Avida, which is basically our cash flow bringing in 22, I'm sorry, 33 million.

We try to always have about 30 million for capital.

That's been our our budget to keep you know all of our equipment um able to care for patients.

Next slide.

So this is basically the same thing I just showed you in a different format, although this is a little older data.

And you can see that we need to use some one-time uh supplemental funding to make sure that we stay below the 95 million on June 30, which we're projecting to do.

We need to use it next year too.

It'll be a little harder to get there, but this is with no intervention.

So our our board approved this budget, and they said you must come back to us and tell us how you're not gonna let us get all the way to the maximum of the NNB.

And of course, we want to have those conversations with the county about an adjustment to the permanent agreement and the NNB ceiling.

Next slide.

It's in the deck.

That multi-year planning, we think that's so important, and we are purchasing and implementing strata to help us do multi-year planning.

Again, our budget was approved before the big bill or H1 in July, so we didn't have the impacts of that in it, although they weren't significant in our projections for this year.

Um, we always have continuous approvement, that's what we call grit.

We had 26.8 million of continuous improvement in our budget, and we are tracking to achieve that.

We didn't do anything with tariffs, we just didn't know.

And uh again, at the very bottom there, I mentioned CalAim and the transition to smart care and our need to really understand what those denials could be and how we might be able to mitigate them is important.

And the next slide is my last slide, and this is uh planning for St.

Rose.

Um, so the potential IGT funding is 36 million.

We plan to use the 7 million from Measure A funds from the county.

We had some contributions back in June from Eden Health and the city of Hayward, and we needed an additional 9 million.

That appears to be 10 million now, which AHS at this point has not approved in the budget, but we are taking St.

Rose budget to the St.

Rose Boys Board tomorrow and to AHS in next month.

So that will all need to be factored in.

But at this level of funding, we expect that St.

Rose will be at at least a break-even position, and that's what they're bringing forward to their board.

So that was a lot.

Any questions I can answer for you?

Well, thank you for this very comprehensive presentation.

I'm sure we have questions, and I'll start with Supervisor Dan.

Yes, thank you for that presentation.

I basically have three broad questions.

Um, the first is Saint Rose.

I just need some clarification.

So the um the ITT funding that was received in May of 30.3 million dollars.

Um, that was part of that was used also to pay back the loan through the line of credit of 11.09 to AHS.

Is that what happened?

Well, not exactly because um they did receive the IGT funding, which they need for operations.

It just all comes at one point in time.

So the way our line of credit goes is that you know, whenever they have cash, they can pay us, pay it down.

Um, so it's kind of more of timing than that, but the Medi-Cal losses at St.

Rose require that IgT funding.

And if with that IGT funding, they're at about break even and they don't need our line of credit.

Okay.

That's helpful.

Um, when you looked at the $10 million that's to be determined that's going to the Board of Trustees.

Um how are you proposing or to the Board of Trustees to fund that for St.

Rose?

Um, so uh James is gonna talk about the Center for Operational Transformation.

So what I've showed you is if we have no intervention, so I'll I'll let uh James talk about our plans in regard to reducing our cost structure so that we can afford to give to help St.

Rose with the local share uh and also um plan for the big bill cuts.

Yeah, that that's kind of where my second line of questioning is.

It's so uh your projections on the big bill or HR1 and the impacts is gonna be phased out in 2026 and 2027, and St.

Rose is like 90 percent of their patient bases Medicail dependent when uh you received the information from the Alliance on the disenrollment, the 30,000 disenrollment potential.

Does that capture the whole system that includes Saint Rose and the potential deficits?

So that information came to us from the Alliance, those were their projections.

They haven't given us details as to exactly you know these specific patients, their specific needs.

Um there is a group that's meeting to kind of talk through what this means, but that's the latest information I have from them.

Okay.

Um well since we serve on the Alliance board we'll we'll find out we'll drill down.

The uh the last question is um so the NNB or the line of credit comes from the county's general fund and you're you're showing obviously some offsets that will be needed to be where you need to tap into the NNB.

Are we I guess this is more a question for Anika for from AC Health in terms of the whole idea around moving to the five year plan with measure W on the central county services are we planning on making some accommodations with the backfill with measure W on the medical offsets.

Yeah thank you for that question supervisor.

It's one of the things that we'll certainly be considering but as you know that that essential services component of the Measure W fund is about 34 million a year.

And so certainly not enough to backfill all of the impacts at AHS at the county with the clinics just for the healthcare system overall.

But some of uh you know uh Kim mentioned health pack earlier that's one of the areas where we're looking at to see what can we leverage and really at the agency level we're looking at how can we be most efficient with the resources that are available to us.

And that will need to be done in partnership with our uh you know certainly with AHS and the FQHCs and certain other partners as well.

So it's it's kind of we're still in this space of trying to figure out what funding is going to the different providers to do what things and you know when the impacts are hitting and what's gonna happen but that that data on you know as people start to lose coverage and and exactly where we're feeling those impacts is it's gonna be really crucial.

Yeah we we know that we cannot backfill uh all these cuts in the future it's just that I I this is something I'm gonna impress upon Supervisor Miley and my colleagues on the board is that um when we look at triaging that means we can't just keep spending future money like we did last time at the board work session where we are throwing funds without any uh specific details because that affects our ability to do these offsets in future years so I I'm thinking that you will be coming back to that joint committee between health and social service to provide um some grounding on what this might look like because there's several factors that we can't see in totality right whether it's coming from AHS whether it's um what we're seeing in our federally qualified health clinics whether which is all kind of wrapped around with the alliance.

Yeah I I appreciate that so I think as we um it kind of transition into uh those regular meetings with the joint structure we those are exactly the types of things we want to bring to you is like here's the impacts that are known um and then of course being cognizant of budget timelines and other things that are coming the governor's budget will be out January 10th and I think that'll also be a good indication of what we can expect the state to be doing but you know again from our perspective we're taking a look at uh the various funding streams so measure A, Measure C, Prop one, there's going to be a lot of shifts and and things that are going to have interdependencies on on the organizations that serve um but we'd like to bring those policy uh pieces back to the to the joint committee okay and and I know that as you pointed out in your financials, as with any hospital, actually uh labor costs is a big part of the fixed costs.

And seventy-five percent for us.

Yeah.

So do we have any thoughts on how that might be affected with the forecast on impacts with HR1?

So we're we're working through that now.

We're doing a lot of contingency planning, and James is going to talk to you about the Center for Operational Transformation, which is all about us getting more efficient, and there is labor implications.

Okay.

Thank you.

Thanks for all those questions, Supervisor Tam.

So I've got a few questions as well.

So when we were talking about the net negative balance, and some of the stuff Supervisor Tam was kind of talking about.

So the a joint committee of Health and Social Services, we're going to be moving forward with that.

Okay, all right.

Because I do think that's a good structural approach to this.

I also feel first of all, really appreciate the report.

I've been around for a bit, I haven't been around maybe as long as Jeanette, but I've been around a bit.

I always like to tease Jeanette.

But so I've seen a lot with HS before it was HS, you know, before I got here when I was at the Oakland City Council, et cetera.

So I mean I think AHS is really um, I mean, it's just remarkable how well it's being managed and financially and delivering services and stuff.

And I really do feel your success is our success.

So we need to address that net negative balance.

And you know, I've said that publicly, I'm continuing to say that.

I'm hopeful that uh the conversations with the county administrator, the auditor, uh Alameda uh Health, Alameda County Health, uh will uh prove um uh fruitful.

Uh and and I and I'm and I'm not sure based on this, when do you need to have an answer?

Well, it's uh we're expected or projecting to go over the NNB limit in September of next year, so almost a year.

Okay.

And again, like I said, we have a lot of plans, you know, to try to reduce our cost structure, right?

Um, but um we would like to have a target and an agreement on what we're gonna do and what the county will do with the N and B so that we can plan accordingly.

So, yeah, so clearly you need to have all this nailed down before uh your trustees adopt a new budget for the for the next fiscal year.

Yes, for sure.

Okay.

Yeah, hopefully before that too, so that we can not hit that max and make sure we can stay below it, whatever the new max might be.

And do we know when the next joint meeting of the Board of Trustees and the Board of Supervisors will occur?

Because I think that'll be a good check-in to see where we are with this.

November 18th.

November 18th.

Really?

That's the same day as a board meeting.

Oh my, we're going, not gonna be another long day.

Okay, okay.

Um, because that's gonna be another good opportunity to check in.

And I really do think too um some of the conversations that are taking place around HR1, the net negative balance, other budgetary implications.

I think because Supervisor Tam is on the county's budget committee and is really you know monitoring all these aspects very carefully.

I'm hoping that you know uh she and her office are intimately involved in the all of these conversations moving forward.

Because I know I feel she's right on point.

I really do.

I feel she's right on point.

Um I think if if we can um satisfy Supervisor Tam's uh concerns, I think, you know, I'll be a bit more easy about this.

Because you're right, we are spending, you know, we're we're we're making decisions and not really putting the context of what what's what our projected needs are going to be and implications here and there and it's like some people are just spending money because they see it it's like well wait a minute and you don't know we got some maybe some major concerns we're gonna have to address and we're not gonna have enough money to address all these concerns and I really do think you know if we adjust the net negative balance you know the county's gonna have to you know absorb uh of that and that's another hit on in HR one and so yeah I really feel so I just want to uh emphasize that I think it's important that she and her office be very much in the loop on conversations around all this stuff.

Then let me see here.

Appreciate the notable accomplishments um particularly the piece around um John George with Cali will that be impacted by HR1 well um the behavior health funding um as far as I know um it's just a matter of if medical membership drops that could impact it because then it could become indigent versus getting paid so we don't I don't have any specific projections on the behavioral health population on that but maybe that's something we need to look at as well.

Yeah because I appreciate I really appreciated the you know the fact that you're now you're down to now 450 as opposed to a high of 2300 yeah that was great.

If I could just add something on that so CalAim is a uh there is a big behavior health transformation in it that's some of the stuff is dependent on federal waivers and some of it is not um but the state at this point is planning to uh so CalM itself the 1115 waiver components of it um are due to expire at the end of next calendar year um and so they're you know at this point the state has said that they are planning to renew the waiver but we don't think that there's a lot of support at the federal level for that um so we'll see and then with in terms of the John George uh piece uh we've had some initial conversations with our our teams our respective teams with HS and behavioral health um and we'll continue to do more but some of that is also caught up in um our uh transition to a new billing system so it's been uh you know a payment not ongoing but like last year we did it as a part of the uh final budget so it's a it's a timeliness issue as well okay.

Let me see here there's a couple other things I wanted to ask about um with the with the capital budget are there any capital needs we need to be concerned about yeah our our capital budget was approved for about 29 million this year.

We typically don't spend the full amount but there are a lot of projects that are in play right now.

Right now that's one thing one lever we could pull is is not spend as much on capital so that we don't drive up the NNB as high.

So that is a lever we have at this point our board has um went ahead and approved a budget right around the 30 million mark.

I didn't put the the what we're purchasing with it in here but I can bring that back to you if you'd like to see the list.

Do we want to see that or we don't need to see that do we no okay yeah but I was just curious about that so I know that's in the mix so yeah and I know there's delegate balance between whether or not to move ahead with those capital um matters uh because if if you don't then there's implications there but trying to see whether or not any of that could offset some of the net negative balance you know might be another exploratory, you know, matter.

Yeah.

Um some good news in regard to capital are um our board has uh asked us to report on how we are doing at achieving the industry standard for care, which involves equipment.

And um we've been listening to reports now for some time, and overall, we are we believe we are providing the standard of care equal to our any other organization in this area.

So that was, I mean, really positive to see and hear from our teams.

My last two points, comments, questions, whatever.

I know taking on St.

Rose was a you know is a major lift.

And I think once again, I think that's why the county uh we need to be as supportive of HS as we can.

Because you know, if AHS hadn't done that, we'd still have the the matter of how are we going to address St.

Rose.

Right now, it's under your umbrella, but your umbrella is, you know, uh connected with the with the county, so we need to be supportive there.

And if that is creating creating um a financial uh const um constraint that's not being effectively addressed, what what more can we do to try to ease that in terms of the overall picture financially?

Thank you for saying that.

Yeah, AHS did donate um 12.2 million last year, and I think our board is going to approve 10 million this year with for that local share.

Um, and that's obviously very difficult to do with with our current projections of the NNB.

Yes.

Oh boy, man, so many things.

And finally, with labor, you know, labor is but labor is.

Um Alameda County is a labor county.

So talking with the bargaining units and letting them be very uh aware of the constraints that we're dealing with.

Uh AHS is dealing with the counties, dealing with, etc., I think is going to be really important because you know they aren't unreasonable, um, and we just need to try to figure out some type of accommodation.

So as you continue to try to work on your end to bring down some of your costs, which is really fantastic, and you try to get support, more support from the county.

Labor needs to kind of look at all that in the context of how we can be, you know, how they can be supportive of all this.

Uh, because once again, uh, you know, we will get through this at some point.

It might take two, three, four years, but we you know, we will get through this, so maybe things need to be projected out over the course of you know five years as opposed to you know one or two or three years.

Yeah, we we have um uh meetings with our labor partners to educate and also just to discuss, you know, all of this.

And um, you know, we have Jet Chapman now that James has brought in, and she's an expert, so um we'll have we will be having I'm sure many conversations with our labor partners.

Okay, well, thank you.

Thank you for this report.

Um, I think James is gonna come up next, but before that, we're gonna take a five-minute recess because whenever a supervisor leaves a committee and there's only one of us here, we have to recess, right?

Yes.

We county council told us that.

So yes, so we're gonna take a five-minute recess.

Okay, thank you.

Uh, supervisor Tam.

Present Supervisor Miley.

Present.

Okay, we'll continue with item two, HS um update.

Just for the opportunity.

My name is James Jackson.

I'm the CEO of the Alameda Health System, and um really grateful for the chance to come today and to share a few things and to obviously answer any questions that you have of me or or my team.

I'd like to start off by just endorsing what uh Director Watkins Tart said earlier regarding violence prevention and funding, or excuse me, focusing the funding on quality versus quantity.

I think are coming about going deeper and not being as diffuse.

Um I'm paraphrasing, but I think that was exactly right.

And so um at the Alameda Health System, we look forward to continuing to work with Alameda Health regarding the hospital-based interventions.

I did also want to acknowledge and express appreciation for your comments regarding the Alameda Health System in general.

Certainly, we have uh it's been a journey, but your tenure, although it's not quite as long as Jeanette's perhaps, but I know you've seen a lot of a lot of changes over time, and um I think that um we are creating standard work and being consistent, and so your remarks are are well received.

So I'm just grateful for that.

Um and Jen, that's gonna make me pay for that later.

Um, so my presentation, if you have it, please.

I would just say, all joking, Jeanette and I have probably been around for about the equal amount of time.

So yeah, yeah, because we go back to the our days in at the Oakland at Oakland City Hall.

Sure.

So good times indeed.

So it you do not have the CEO report.

So they came together, I thought.

Um, and it's that's unusual.

Okay, well, I will I will go verbally and supervisors.

I apologize um that we don't have the visuals, but if you don't mind, I'll talk through what I have.

And um, if the report is found, we'll get it up as soon as possible.

So um my report starts with a reflection, and often these things we we talk about, um, it's somewhat sterile, and we forget that there are people involved.

And so I was starting with a reflection because one of our staff actually sent a note to me recently, and I'm just gonna quickly read it to you.

And she noted, I wanted to take a moment to express how honored I am to work in the obstetrics midwifery and gynecology department, which is also known as OMG, which is kind of fun.

But her note is being part of such a dedicated and compassionate team is truly inspiring.

The commitment to patient care and the support we provide to families during such significant moments in their lives is both rewarding and fulfilling, and I'm continually amazed by the professionalism and the experience of my colleagues, and I am proud to contribute to our shared mission.

Thanking this hardworking team for their leadership and dedication for fostering an environment where we can thrive and make a difference in the lives of our patients.

Thank you.

I am forever grateful for such a job and space here at the Alameda Health System.

And um, so I think these are the important moments to share because certainly at a high level, we often forget about the individuals who are giving so much of themselves to to do this work and to have an individual like this.

Her name is Holly Woolridge, and she is a scheduler in our surgical schedule at an OMG.

And this is kind of what what drives me, frankly, is helping folks like Ms.

Woolridge um do the important work of the Alameda Health System.

I use the pillars of our organization for my presentations, and so the first pillar is the quality pillar, and I am going to while we're waiting for the president to come up, I'll just quickly talk.

There's something called Beta Heart, and Beta Heart is a program that is um sponsored in collaboration by the Beta Healthcare Group, and they collaborate with the hospital quality institute, and they acknowledge healthcare organizations that successfully build and sustain a transparent and a reliable culture of safety.

And so this goes back to providing excellent care.

Um that's why we use the resources that you know the county provides for us to make sure that we're providing the best care possible for the constituents that we all serve, and so um it is of note that they recognized that AHS has achieved validation in all five heart domains.

Um and heart is an acronym, and it stands.

Let's see if I can find that.

Oh goodness.

Um, I'm I'm not seeing the exact definition of heart, but in essence, um, we achieved all five domains, and one of them is Obi Quest, and that's obstetrics and uh gynecology, and an improved safety and quality in obstetric care, as well as the ED quest, which enhances safety and patient care in the emergency department um at Highland Hospital, at Alameda Hospital, and at San Leandro Hospitals.

And so we are really proud.

We are actually the only public health system that beta has acknowledged has achieved all five domains of heart.

And so again, they work across the country.

We are the only public system that has achieved all five domains, and so um I it's a pride point for AHS, the entire country.

Yes, the only public health system to have achieved that.

And so really it's an acknowledgement of how important we believe that quality is for our organization.

Quality is job one.

Our board has made that emphatically clear to me, and I believe this is a testament to the fact that we are providing good quality care.

Wanted to move to the sustainability pillar, and CFO Miranda referred a bit to some of the elements that I wanted to touch here in regards to HR1, the big bill, and what we believe the impacts are going to be.

We believe that over the next few years it can be over 100 million dollars per year reduction in the revenue that we'll see as an organization.

We also are concerned about the potential elimination of disproportionate share hospital funding.

And pardon me for AHS, that could result in over $60 million per year over the next three years that we might lose in the DISH funds.

For St.

Rose, they will also be impacted.

We think that's about 1.3 million dollars a year over the next three years that they could potentially lose as well via DISH.

And the reality is the state also is impacted by HR one.

We believe that they may impose additional cuts.

And there was conversation earlier about the potential budget implications that the governor may be announcing coming up very soon.

So we're watching that very closely because obviously it has ramifications for what we do.

And then the Alameda Alliance and Supervisor Tam, you noted it, we're on the board there, and so we I think have a good line of sight on what are the ramifications of HR one.

But as people drop off of enrollment, and again, that number is at a minimum 30,000 that they're projecting it could it could be higher, and that could mean well, the cost of care for these individuals was over 350 million.

And so as they drop care and they move to HPAC, obviously, that has ramifications for us as a healthcare system.

And then Supervisor Miley, you said something a moment ago, and I was very grateful.

You mentioned labor, and labor, they're our partners.

We must work with them.

And so we've set up a series of meetings where we're going to be bringing them in, talking about HR1, what we see as the direct impact to the Alameda Health System, and then really trying to engage them in a fruitful conversation about how do we work together to make sure that we mitigate the impact because you said it, Supervisor TAM, over 70% of our cost structure.

Kim is always very clear it's 75%, but at least 70% plus, is in labor.

And so we are gonna have to make changes to our labor structure, our cost structure, but we want to do it in partnership as you alluded, not just kind of unilaterally.

And so those are the conversations that are gonna be happening very soon here.

And I think my presentation is coming up.

Yes, all right.

So I think we're on slide six now.

And can we go back to please?

Because supervisors, I do want you to on the one regarding beta heart.

There's a link there, and so um I would just, if you are so inclined, I would urge you this one.

And so at the very bottom, you'll see beta heart validation recognition program.

I think it might be interesting reading for you to just um check that hyperlink and really go there and really see um what are the criterion that beta's using, but we think that it's an objective assessment of quality.

With and by virtue of that, AHS has seen is really doing um good quality.

And so we think we're doing good call quality, and it's great to have beta endorse that.

Um can we move on?

And your heart acronym is healing, empathy, accountability, resolution, and trust.

It's the top of the page.

Thank you very much, Supervisor Tam.

All right, reading is fundamental.

Um, so we can go forward two slides, please.

Uh and I just talked through this one and at the very bottom acknowledged we will be meeting with labor leadership.

We have three meetings scheduled to make sure that they have adequate opportunity to interface with us to understand what we see coming, and then to be a part of our planning as we move forward.

Uh, next slide, please.

Uh, wanted to talk a little bit about a little more about St.

Rose.

Um, we have a number of projects, and I don't want to belabor um the elements of this, but you know, in that you asked earlier about St.

Rose, I think it's important to talk about the fact that we are making investments in St.

Rose to make sure that they are remain viable and they're performing well.

Really pleased with what's happened thus far.

We're not seeing the increased volumes that we'd hope for, but we are seeing a renewed interest.

We have some very interesting and promising conversations happening with our community partners about partnering with us at St.

Rose, and so really looking to bring the same confidence and quality that now people see with the Alameda Health System to St.

Rose as they fold more completely into our system.

So the first one is core switching replacement and high availability project, kind of a word salad there, but the purpose is to replace end of life core switches that serve as the central control point for our network access across that campus.

And what that's going to do, it will improve the network reliability, reduce the risk of downtime, and enhance readiness for future clinical expansion.

So we are looking to push certainly clinical care there, but also we heard from our clinicians in that community.

A lot of the reasons they don't use St.

Rose for the ancillaries for diagnostic imaging for the lab is because they can't get access to the results because they're by and large on Epic and St.

Rose remains on Meditech.

And so we're trying to expedite getting EPIC to St.

Rose so that we can have the local clinicians avail themselves of the resources that are available right there in their own community.

So excited about that.

The second one is the results integration for lab uh rad and lab referrals.

And again, this goes to integrating lab and imaging results from referrals originating in the Newark and the Hayward Wellness Centers, which are part of our system, having them transmitted directly and in real time from Meditech into the Epic system.

And so this will allow again clinicians to quickly be able to see the results from the tests that they're doing so that they can make better clinical decisions.

And we are absolutely looking to scale this up so that we can make sure that we're driving more and more business to St.

Rose.

Next slide, please.

Moving to the staff and physician experience pillar.

Next slide.

Many of you know this individual.

Um Jet Chapman was the um chief human resources officer most recently at Alameda Health.

Sorry, Anika.

And um, she has come on board as our chief human resources officer, and there is a pretty comprehensive assessment of Jet and who she is and what she's done, and I will just to overuse the colloquial statement.

She's a five tool player because she's well versed in labor relations, she's a known and respected entity with our county partners.

She knows AHS intimately as a former trustee for AHS, and she has extensive chief human resources officer experience, and finally, she's an Oakland native.

And so we're very excited to have somebody with Jet's experience and the respect that she carries in the community joining us as our CHRO.

Next slide, please.

Moving to community connection, next slide.

Um, wanted to take a moment and talk about an individual who we are extremely proud of, and that is Sambo Lai.

Sambo is the director of interpretive services for AHS, and our that department um offers access to on-demand remote interpreters of over 300 languages.

And so this department continues to innovate, and they recently introduced iPads that allow patients to have clearer conversations with their providers.

So Sambo was profiled on a very uh compelling story in the local media here.

And again, the hyperlink is there, and so if you have a moment to hear Sambo's story, that would be fantastic.

And I just wanted to leave you with one quote from Sambo.

Um, I know from my own experience that having a language barrier is an invisible disability.

Once I had the opportunity to work at the Alameda Health System, I saw an opportunity to give back to my community.

Um, and I'm honored that this work has been recognized by KPIX, and I want to recognize my dedicated co-workers in the interpreter services department who provide compassionate language assistance to our patients and make a difference in their lives every day.

Next slide, please.

Um, this month is Philipino American History Month, and we celebrate diversity, we celebrate all aspects of our system that make us the unique entity that we are.

Filipino Americans are the second largest Asian American community in the United States, and they're the third largest racial group in California.

Their contributions to the Alameda Health System and to our communities are exemplary, and their achievements are recognized and they're celebrated throughout our system.

Filipinos and Filipino Americans are an essential part of our workforce and their unique culture and background, strengthen the care and the service that we provide our patients, our communities, as well as our co-workers every day.

And so our message simply is this month we celebrate you, your expertise, your professionalism, and the compassionate care that you provide to our patients, our residents, and the communities that we serve.

Next slide, please.

This is a fun one.

We know again that we are providing great quality care, but it's great when outside objective entities acknowledge that as well.

And recently, all of our acute care post-acute care facilities were recognized on Newsweek's America's Best Nursing Homes 2026 list.

Previously, some of them have been on the list, but this is the first year that all of them have been recognized on the list.

And so I have to lift up Richard Espinoza, who is our CAO for Post-Acute Services.

And our facilities have been ranked among the best five times now.

And Richard attributes this to the compassionate team members who care for our residents, like their family, and our strong, reliable, and effective practices.

And so, supervisors, I just wanted to commend this to you again as evidence of the quality of care that's being provided by the Alameda Health System.

Next slide, please.

And one of the um the proof of that point is we volunteer regularly at the Alameda County Food Bank.

And so we were there most recently in September.

Um had a huge turnout.

As you can see, about 25 people came out and spent the morning bagging meals for those in the community.

Um one in five people are experiencing food insecurity.

And so we believe that it's important that we proactively are trying to do the work necessary to make sure that folks know where their next meal is coming from.

And so this was evidence of that.

Next slide, please.

More of the candid shots there.

Um next slide, please.

And so the participants included our Black Employees Affinity Group, also known as Bean, Latinos Unidos, and our LGBTQIA Plus and Allies Affinity Group.

And so I'm really wanting to make sure that AHS is embracing and inclusive because again, we're stronger together.

Next slide, please.

Finally, we had most recently a community health fair.

It was in the parking lot at Alameda Hospital, and you can see the various components of that, including emergency preparedness training, stroke prevention, and free flu shots and bike helmets.

And so trying to, you know, make sure that we are being good community partners.

Next slide, please.

That's it, supervisors.

Um, happy to take any questions or provide any clarifications as you wish.

Right.

Supervisor Dam.

Thank you for that report and um congratulations on the beta recognition acknowledgement.

That's definitely um quite an achievement.

Thank you.

Indeed.

And um I especially appreciated the highlighting of the interpreter services because the medical terms are very difficult to translate into other languages.

So having that um is it's gonna be very critical.

Um the questions I had surrounded um St.

Rose.

So we we had talked in the past about um the cost factor when it uh when we have to provide EPIC right, as part of their system.

So from their meta-tech system right now, are we is there um is there still a need to completely overhaul their system, or is it something that we're just making do between Medic uh Meditech and Epic?

So we are going to replace Metech with Epic.

And so that is work that we had projected.

I thank you for bringing it up.

We had projected that was probably two to three years down the road.

We really don't think we can wait that long.

And so um Christine Yang, who is our chief information officer, has led an effort.

We've been able to drive down the cost that we believe it will um require in order to make that transition by about 50%.

So we've really decreased the cost of implementing Epic there.

And so we have issued an RFP um to identify the vendor that will help us activate EPIC at St.

Rose.

And so some of the things that I shared were prelude to our activating Epic there.

And so we think we may be able to go live with Epic in the next 18 months or so.

How did you bring it down by half?

I am, you know, I can certainly come back with the specifics of it, but it was really um the frankly, the the people power that was gonna be required.

And because we've done some of this work before, we think that we will not have to start from scratch, if you will.

And so we were able to drive down some of the the people power overhead, and then really streamlining the process because we have implemented via community connect, we've implemented Epic with health care for the homeless.

We are in talks with other entities, and so frankly, we've developed some muscle memory around how do we go about implementing Epic in other facilities.

And so Christine, I think has done a really nice job of taking our experiences with pushing Epic to other elements of the community, and that's what's um informing how we're gonna be able to drive it to St.

Rose.

Okay, uh that's helpful because I I just remember it was very chaotic even at Alley Hospital when we have to go through that transition.

Um in terms of like uh where is St.

Rose at with respect to their likelihood of being able to provide for Medicare patients and getting that reimbursement.

I know there's a certification process that's underway.

Yes, there is, and so we were told initially, and I believe it was the spring when we were told it was anywhere from a 90 to a 120-day window within which uh CMS would get back to us.

We have since been told that because of the shutdown that is delayed um for a period of time that they will not project for us right now, and so by rights we should have heard by now.

Um we have been in touch with um uh some of our electeds, including um Congressman Swalwell, they he's trying to help, but because of the shutdown, it's kind of unknown when we will get the definitive answer, and so we continue to push, but it's somewhat out of our hands.

Where was it before the shutdown?

Was it like on the verge of no exactly where it was?

Um, it's at CMS, and so it's some, you know, frankly, it's something of a black box.

We're not told exactly, you know, at what point it is in their process.

They were reviewing it, was our understanding, and again, we had that 90 to 120 day window, which has expired.

We're beyond the 120 days now, but because of the shutdown, we are not um clear on when we will get a definitive answer.

Is that a fair?

Yes.

Okay, thank you.

Of course, thank you.

Appreciate you asking, and obviously, we're very anxious as well because people need that care, and that facility is sitting somewhat fallow because we cannot um bring them in and get paid for it at this time.

So thank you.

Okay.

Yeah, thanks for the uh the presentation.

I know in terms of the shutdown work that you're doing to help the food bank continues to be important.

You know, shut down the fact that people might not be receiving SNAP benefits soon.

It's just gonna heighten, you know, the sense of um, you know, a crisis when people can't even um uh get the necessary food that they need.

And I know, you know, our social services committee and agency is taking a look at that to see what what we can do to ease some of that burden, but that's that's an issue.

Um, and then I'm glad Supervisor Tam asked about Epic, because you know, my big concern is linking everything under Epic.

Uh and I'm just hoping Alameda County Health gets everything linked up.

Our jail, HS, our clinics, you know, everything on EPIC, so that it's it's all seamless, so that our personnel, our clinicians, and others can provide better care and um so I I think the um the director of the agency is kind of hearing hearing me.

I hope so.

I just I think the director of the agency is kind of hearing me.

The interim director of the agency is kind of hearing me.

I'm not going to even look over there.

Um, that epic continues to be extremely important.

Thank you.

I agree.

Did you want to say anything?

Just that we uh definitely agree with you, and as I shared at a previous health committee, um, you know, the so the a HS, the clinics, uh most of the provider community in the county already is on EPIC.

Um, and so the sooner that we can bring on behavioral health in the jail, um, you know, the system can move some things a little faster.

Okay.

And then let's see.

Um, yeah, it's good that you're kind of um not being modest about heart and the other accolades, because to be, you know, that recognition uh is the only public system in the country.

I mean, that's that's really fantastic.

Um, so thanks for bringing that to our attention.

Um, I'm confident that uh the Board of Trustees they're aware of it, and they are um, how should I phrase this equally um impressed and um uh what's the word appreciative of what you and your team are doing.

I appreciate you saying that.

Supervisor Miley, I believe the answer is yes.

Certainly, their expectations are high, and I I don't shy from that.

I believe that their expectations are well founded.

And um, to your earlier comment, I think AHS is as viable and as vibrant and doing great work as it ever has.

Um I'm I'm really proud of what we've accomplished.

Um there was a recent media report where it was implied that AHS was a struggling system, and I would just frankly um with respect disagree.

I think that what we've shown you this morning is that far from struggling, we have had a sound last fiscal year.

We're tracking appropriately this fiscal year, and we're doing the work necessary to make sure that we're ready for what's gonna come as a result of HR 1.

And so I think that's seeing the iceberg and making the appropriate corrections in advance of that.

And so I think characterizing AHS as struggling is just incorrect.

Yeah, I'd agree with you on that.

I would certainly agree with you on that.

Um, and I'm trying to recall if there's anything else from your presentation.

I wanted to comment on other than Epic and the um uh the shutdown and the and the food insecurity.

I think that was about it.

Um, once again, I would just say, uh, in all sincerity, you know, I like to look at things in the terms of sports analogies.

So you've put together a winning team and you continue to have, you know, a good solid season.

Uh you've had some good seasons and you're preparing to deal with the uh the um the challenges associated with the future as well.

So I just want to make sure we here at the county are doing what we can do to try to um ensure the success of uh AHS.

I am grateful for that.

Um I'll take a moment of personal privilege.

January will mark five years for me in this capacity, and um one time flies, but two, I am any success I've had has been because of extraordinary support from the board of Supervisors, um, excellent partnership with Alameda Health.

Um, the interim director, Chaudry has been a phenomenal partner.

Um also the Alameda Alliance um working very closely with Matthew Woodruff and his team.

Um we are stronger together, and so I'm grateful.

My board has been fantastic, very supportive of our initiatives while still pushing me and my team to to be better, as they should.

So with your continued support, I'm confident that we can we can win.

Okay.

Now the only drawback, the only thing that I think I would criticize, is in your presentation, I just didn't see a slide dealing with September 25th, 2025.

You know what you know what that date was.

I pulled that slide out.

Um we we had a slide, I believe you're referring to the OPIC event.

Is that oh no?

September, okay, September 25th.

What?

September 25th, 2025.

How could you forget that?

At the Oakland Zoom.

Oh, good gravy.

The Healthy Living Festival.

The Healthy Living.

We were there.

I know.

Yes.

I know.

Okay, that's a demerit.

I get a demerit for that one for not acknowledging that.

Back to the partnering and working together and helping people see pro Thank you, Aaron.

Um, working together to make sure that folks know what resources are available to them.

And so thanks to your office for making sure that those sorts of events happen, and we're happy to be partners in that.

Now I embarrass myself because I mentioned the OPIC event, and that's the Oakland Private Industry Council.

Um, and they um recognize me as the son of Oakland and for the work that ostensibly I've done, but it's really AHS.

And so I did not put in the presentation because I felt like that was kind of self-aggrandizing, and that's not what we're here for.

But I do recognize on behalf of AHS how important it is to receive those kind of accolades for our system because that's not always been the case.

But thank you for the reminder about September 25th.

Yeah, the Healthy Living Fest.

We only had about 3,500 seniors from all over the county, over 100 vendors of which you know HS is one of them, and people got flu shots, COVID shots, screenings, all sorts of information.

Had a great day, and you know, it's yeah.

Well, to use a sports analogy, my bad.

Um, yes.

Okay, thank you for your attention.

Yeah, see if there's any um public comment on this report.

I have no speakers on item two.

Okay, thank you.

So let's see if we have any uh public comment on non agendized items.

I have no speakers for public comment.

Alrighty, great.

So the health committee for October 27th is now adjourned.

Thank you.