1. Hali Hammer, Director of Primary Care 1 SFHN Primary Care Nurse Managers Meeting April 14, 2014

3. Integrated and Integrating Primary Care

4. 4 “ Way Forward” Increasing the Value of the Services Provided to Our Constituents: 1.) Patients2.) Workforce 3.) SF Residents & Consumers Performance Measures of Success - By July 1, 2015: 1.Achieve Primary Care Panel Size = 1,350 2.Achieve Primary Care Support Staff to Provider Ratio = 4.5 FTE 3.Improve by 5% over baseline, Patient Placement at the appropriate setting and level of care in Acute and Skilled Nursing Facility Institutional Operations 4.Meet or exceed budgeted performance in revenues and expenses 5.Improve by 5% over baseline Workforce Experience/Satisfaction Scores 6.Improve Civil Service Hiring, From Form 3 submission to start work date = 90 days or less 7.Improve by 5% over baseline Patient Experience/Satisfaction Scores 8.Establish a Unified Understanding of Staff Role in the Success of the SFHN by documenting Staffs’ ability to list 50% or more of the Adopted Performance Measures of Success 9.Achieve a 75% mammogram screening rate for eligible primary care clients 10.Increase by 25% over baseline, the percent of clients seen in a Behavioral Health or Primary Care Home who have established care with a Primary Care Provider (empanelment penetration)

5. Standardization of support staff ratios (data collection and clinic targets) Tool used to determine SSR for clinic-specific factor in new patient capacity calculation—so does not include 6M or PHP. DPHPC Support Staff Ratios STAFFING AS OF Mar 12, 2014 CMHCMHHCSAFHCCPHCOPHCPHHCSEHC TOTALS for COPC7CurryTWUHCFHCGMCCHC TOTAL PROVIDER FTE3.45 3.995.684.483.495.0029.531.959.1313.219.38 Provider FTE by active patients4.633.174.124.693.512.873.9026.901.123.7610.376.24 Provider FTE by weighted patients3.983.243.744.733.092.543.9125.221.483.9710.466.56 TOTAL NURSING SUPPORT FTE2.252.952.153.752.303.302.7525.601.501011.706.7 TOTAL CLINICAL SUPPORT FTE8.505.237.706.056.956.007.4052.502.507.0016.6811.40 TOTAL CLERICAL SUPPORT FTE8.755.907.655.805.606.536.7543.405.8012.99.806.2 TOTAL SUPPORT FTE (CLINICAL, NURSING, CLINICAL)19.5014.0817.5015.6014.8515.8316.90121.509.8029.9038.1824.3 P. Care Nursing FTE / Provider FTE0.6520.8550.5390.6610.5140.9460.5500.8670.7691.0960.8860.714 PC nursing support by active pt panel (0.9 target)0.4860.9300.5220.8000.6541.1500.7040.9521.3402.6581.1291.074 P. Care Clinical Support FTE / Provder FTE2.4641.5141.9291.0661.5531.7201.4801.7781.2820.7671.2621.215 PC clinical support by active pt panel (2.0 target)1.8341.6471.8691.2901.9782.0911.8951.9512.2341.8611.6081.827 P. Care Clerical Support FTE / Provider FTE2.5361.7101.9171.0221.2511.8721.3501.4702.9741.4140.7420.661 PC clerical support by active pt panel (1.6 target)1.8881.8601.8561.2371.5942.2751.7291.6135.1823.4290.9450.994 TOTAL P. CARE SUPPORT FTE / active patient FTE4.214.444.253.334.235.524.334.528.767.953.683.89 TOTAL P. CARE SUPPORT FTE/weighted patient FTE4.904.344.683.304.816.234.324.826.637.543.653.70 Active pt panel55613806494556274217344446853228513434514124417487 Weighted pt panel47793888448456703706305046923026917734758125557873 TWUHC and CSC old weighting; all others new weighting FTE staff needed to get to 4.5 Question is whether to use active or weighted panel size Staffing Targets: Nursing Support = 0.9 per Provider FTE Clinical Support = 2.0 per Provider FTE Clerical Support = 1.6 per Provider FTE COMBINED Ratio = 4.50 per Patient FTE

6. Monthly new patient capacity

7. Does integration help us achieve the Triple Aim of quality? Better Health Better Care TRIPLE AIM Lower Costs 7

8. Does integration help us achieve the Triple Aim of quality? Better Health Better Care TRIPLE AIM Lower Costs 8 Stable and Engaged Primary Care Workforce