FIVE-YEAR BUDGET TASK FORCE REPORT AND RECOMMENDATIONS

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Carmella McCoy
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1 FIVE-YEAR BUDGET TASK FORCE REPORT AND RECOMMENDATIONS Report to Health Commission Finance & Planning Committee October 4, 2011

2 Background Over the next several years, the Department of Public Health will confront several strategic imperatives, including the need to: Prepare for and implement federal Health Care Reform; Implement provisions of the Medi-Cal 1115 Hospital Financing Waiver, including the Delivery System Reform Incentive Pool and the Low Income Health Program; Implement electronic health records and a local health information exchange; Rebuild and open a new seismically safe San Francisco General Hospital; and In order to achieve the above initiatives, address the structural integration of DPH s health care delivery services. These initiatives come at a time of continuing cuts to State funding, pressures to reduce federal spending, and requirements to reduce dependence on local General Fund.

3 Background (cont.) San Francisco s Proposition A was passed in 2009 with implementation beginning in the coming budget year 5-year Financial Plan City projects deficit will increase annually from $283m in FY11-12 to $829m by FY15-16 DPH s corresponding projected shortfall is expected to increase annually from $144.4m in FY11-12 to $403.3m by FY year Budgeting 2-year rolling budget Goals Force longer-term thinking Avoid reliance on one-time solutions

In Billions DPH Historical and Projected Budget and General Fund Support 4 2.50 2.00 1.50 1.00 Non General Fund Unfunded Need 0.

4 In Billions DPH Historical and Projected Budget and General Fund Support Non General Fund Unfunded Need 0.50 General Fund - Fiscal Year * In FY DPH's budget included $185 M in one time revenues and expenditures for the Laguna Honda Hospital Rebuild **Projected

5 Budget Policy Implications for DPH Start early (now) Ensure consistency with 5-year financial plan Articulate policy goals and align them with budget

6 The Five-Year Budget Task Force Created in 2011 to help the Health Commission and DPH make budget decisions that are in line with clearly articulated priorities and goals. As part of that work, the Task Force: Is recommending the creation of the Five-Year Budget Subcommittee of the Health Commission s Finance and Planning Committee; and Is proposing for the Health Commission s consideration three budget priorities, a set of goals, and a work plan for the Subcommittee.

7 Proposed DPH Five-Year Budget Priorities Given DPH s strategic imperatives and the fiscal and policy landscape, the Task Force recommends the following three five-year budget priorities: Integrated Delivery System Public Health Accreditation Financial and Operational Efficiency

2011-12 2012-13 2013-14 2014-15 2015-16 PROPOSED FIVE-YEAR BUDGET PRIORITIES AND DPH STRATEGIC IMPERATIVES Integrated Delivery System Public Health Accreditation

Behavioral Health Services Capital Projects Meaningful Use of Electronic Health Records 1115 Waiver Low Income Health Program (LIHP) Heath Care Services Master Plan

8 PROPOSED FIVE-YEAR BUDGET PRIORITIES AND DPH STRATEGIC IMPERATIVES Integrated Delivery System Public Health Accreditation Financial and Operational Efficiency 1115 Waiver Delivery System Incentive Reform Program (DSRIP) San Francisco General Hospital Rebuild Primary Care/Community Behavioral Health Services Capital Projects Meaningful Use of Electronic Health Records 1115 Waiver Low Income Health Program (LIHP) Heath Care Services Master Plan Budget Planning 2-year Budgeting San Francisco Office of AIDS Renovation (SOAR) Project Budget Management Tool Development Community Health Improvement Plan Strategic Plan

9 Proposed Goals of the Five-year Budget Subcommittee In cooperation with the Director, evaluate and forward to the full Health Commission a set of uniform objectives that may be used as a common framework for Departmental planning; Review and approve strategies to focus budget decisions on improved health outcomes, sustainability, and program efficiencies; Reduce duplication of services and maximize the breadth and depth of the local health care system, which includes civil service, community-based, and private providers working in coordination; and With the Director, devise strategies to maximize federal, State, foundation, research, and private funds to expand access and enhance a sustainable system of care.

10 Proposed Work Plan of the Five-year Budget Subcommittee By September 2012, create a process to establish budget priorities Develop a tool or rubric to determine whether projects are consistent with these priorities. Questions the rubric will help answer: What are the elements of a sustainable system? Where do we want to be in five years? What services are DPH mandated to provide? What is the appropriate amount or level of service? Ensure budget reductions or increases are aligned with budgetary goals Apply these priorities and tools to the FY13-14 DPH budget Update the City s 5-Year Financial Plan to reflect this process

San Francisco Budget Overview

San Francisco Budget Overview Presentation to SPUR April 5, 2012 Overview San Francisco s Budget Current Year Status Projections for FY 12-13 and FY 13-14 4/5/12 San Francisco s Budget The only combined