Health commission endorses DPH budget package, approves submission to mayor; EHR plan would cost ~$183.7 million over five years

Greg Wagner, chief financial officer for the Department of Public Health, presented the department—s proposed rolling two-year budget for FY16–18 and additional initiatives for FY17–18. The submission folded in previously adopted base initiatives (primary-care expansion, new San Francisco General operating funds) and proposed new items including substantial behavioral-health investments, increased Drug Medi-Cal Organized Delivery System revenues, some conversions of contracted positions to civil service and modest population-health additions.

Wagner described the Drug Medi-Cal Organized Delivery System waiver (a Medicaid 1115-type pilot) that would increase available revenue for substance-use services; staff estimated about $6.5 million in new revenue in the first year growing in year two. The budget also includes additional realignment and MHSA-funded initiatives, and multiple civil-service conversions for services historically operated under contract.

The packet requested appropriation and spending authority to pursue a shared electronic health record (EHR) strategy, contingent on contract negotiations with UCSF Medical Center. Staff described a planning estimate of $183.7 million over five years for the EHR program (the bulk of costs in the first three years), and outlined a funding strategy that mixes existing appropriations, reappropriations, prior-year transfers and prospective philanthropic support.

Commissioners asked about line-item labels, bracketed savings, environmental-health staffing and the pilot transitional-food program (a partnership with Project Open Hand providing meals to congestive-heart-failure patients after discharge). Staff clarified that negative/bracketed numbers were reductions to general-fund requirements (savings) and reviewed the approach to minimize new general-fund requests by repurposing vacant positions and identifying revenue offsets.

After discussion, the commission voted to approve the budget initiatives and send the package to the mayor—s office for consideration and incorporation into the mayor—s June 1 submission to the Board of Supervisors. Staff committed to report back with more detailed implementation plans, FTE tracking and milestones as the mayor—s process proceeds.