* This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting.
          [00:00:14]
          IT'S 
          [2. Presentation by Central Health on 2022 Demographic Report. ]
          [*A portion of this video is without audio*]
CONVENIENT TO LOW INCOME RESIDENTS. 
          AND AGAIN, GOING BACK TO THAT I 35 CORRIDOR, UH, WE ALSO LOOKED AT DISEASE PREVALENCE IN THIS REPORT. 
          AND, UH, FOR THE FIRST TIME WE LOOKED AT SPECIFICALLY WITHIN THE UNHOUSED POPULATION, PERHAPS, UH, UNFORTUNATELY, BUT NOT SURPRISINGLY, WE FOUND THAT, UM, THOSE, THOSE PATIENTS WERE ABOUT TWICE AS LIKELY TO EXPERIENCE CHRONIC CONDITIONS AS OUR POPULATION AT LARGE. 
          UM, WE ALSO FOUND THAT 40% OF ALL OF OUR PATIENTS HAD AT LEAST ONE CHRONIC CONDITION, UM, WITH AN AVERAGE OF TWO AND A HALF PER PATIENT. 
          AND FINALLY, WHEN WE LOOKED AT HEALTH EQUITY, UM, WHICH IS A FIRST IN THIS REPORT AS WELL, UM, WHAT WE SAW IS THE, UH, UM, THE DIFFERENCES, THE HEALTH AND EQUITY ISSUES PRESENTED MOST SIGNIFICANTLY, UM, IN EAST CENTRAL AUSTIN. 
          AND AMONG OUR, OUR BLACK PATIENTS. 
          HOWEVER, RACE ETHNICITY WAS MUCH MORE LIKELY, UM, TO BE A FACTOR IN INEQUITIES THAN LOCATION. 
          I HAVE A, A QUICK QUESTION, AND I'M, I'M HOPEFULLY THEY KIND OF PRE PREFACED YOU ON, LIKE, TO HAVE THIS MORE OF A DIALOGUE TYPE OF A CONVERSATION. 
          UM, FOR YOUR SECOND BULLET SAYS, AUSTIN IS THE KEY ACCESS POINT, RIGHT? UH, WITH THAT BEING THE CASE IN THE COUNTY WITH A, WHAT, 22 CITIES RIGHT? UH, WITH THE ETJ AREAS AND SO FORTH, UH, WHAT, WHAT IS CENTRAL HEALTH CURRENTLY DOING ALONG WITH ITS PARTNERS AND COLLABORATIONS TO OFFSET THIS SO EVERYBODY'S NOT HAVING TO, AS I SEE THIS SENTENCE, TRAVEL INTO AUSTIN FOR THE CARE? HI CHAIR. 
          DO YOU MIND IF WE LET THEM FINISH THE PRESENTATION SO WE CAN HAVE EVERYBODY GET A CHANCE TO ASK QUESTIONS AT THE END? 'CAUSE I THINK THEY WANTED TO DO THE 10 SLIDES AND THEN HAVE THE CONVERSATION AFTERWARDS, IF THAT'S OKAY WITH THE GROUP. 
          THANKS. 
          ANY ISSUES? ALL RIGHT, SOUNDS GOOD. 
          UM, SO THE BEDROCK OR FOUNDATION FOR THIS REPORT IS POVERTY. 
          IT'S WHAT THE, THE LENS WE LOOK THROUGH BEFORE WE START DOING A DEEPER ANALYSIS. 
          UM, SO THIS SLIDE IS JUST A QUICK DEMONSTRATION OF, UM, WHAT WE SAW IN 2022 AS WELL AS THE PROJECTIONS THAT WE DO LOOKING FORWARD, WHICH IS WHAT MAKES THIS REPORT UNIQUE. 
          WE ACTUALLY BUILD IN FIVE YEAR PROJECTIONS. 
          SO WE'RE ACTUALLY PLANNING FOR THE FUTURE AND NOT WHAT'S HAPPENED IN THE PAST. 
          UM, WE ARE PROJECTING BY 2027, UH, A A SLIGHT INCREASE ABOUT 1800 FAMILIES IN POVERTY THAT WON'T BE KEEPING UP WITH THE GENERAL INCREASE IN POPULATION. 
          UM, BUT IT IS NOT GOING AWAY. 
          UH, POVERTY WILL, WILL REMAIN, CONTINUE TO GROW, GROW AT RATE. 
          UM, AGAIN, UM, ALMOST THREE QUARTERS OF THE FAMILIES LIVE ALONG THAT I 35 PORT CORRIDOR FAMILIES IN POVERTY SPECIFICALLY. 
          UM, IF YOU LOOK AT THAT CHART UP IN THE TOP RIGHT, UM, WE'VE, WE'VE, THROUGH OUR ANALYSIS KIND OF DIVIDED THE COUNTY INTO THREE AREAS. 
          EASTERN TRAVIS COUNTY, THE I 35 CORRIDOR AND WESTERN TRAVIS COUNTY. 
          YOU LOOK AT THAT SECOND COLUMN, YOU CAN SEE ABOUT 17,000 FAMILIES IN POVERTY LIVE WITHIN THAT I 35 CORRIDOR COMPARED TO 4,300 EAST TRAVIS COUNTY AND ABOUT 2200 IN WESTERN TRAVIS COUNTY. 
          SO, UH, ONCE WE HAVE THIS ANALYSIS, UM, WE'RE, WE'RE LOOKING AT THIS GEOGRAPHICALLY BY CENSUS TRACTED. 
          THERE'S ABOUT 220 CENSUS TRACTS WITHIN THE COUNTY. 
          WE LIKE TO USE THIS BECAUSE IT'S MUCH MORE GRANULAR THAN ZIP CODES. 
          ZIP CODES ALSO CROSS OVER COUNTY LINES. 
          SO THAT DATA IS NOT USEFUL TO US IF IT'S HALF IN HAYES, HALF IN WILLIAMSON. 
          UM, SO WHAT WE DO IS WE LOOK AT WHAT, WHAT CENSUS TRACKS HAVE THE HIGHEST, UM, COUNTS OF FAMILIES IN POVERTY, UH, AND ESSENTIALLY DIVIDE, UH, THE COUNTY INTO FIVE DIFFERENT TIERS. 
          AND WE LOOK AT THE HIGHEST IN THE, WHAT WE CALL MODERATELY HIGHEST, THE TWO HIGHEST TIERS. 
          AND THAT'S IDENTIFIED IN THIS MAP. 
          AND THIS IS WHERE WE REALLY BEGIN TO FOCUS IN ON CERTAIN AREAS OF THE COUNTY. 
          SO WHEN WE HAVE THOSE, THOSE CENSUS TRACKS IDENTIFIED, WE, UH, WE, WE ESSENTIALLY GROUP THEM INTO AREAS WHERE IT MAKES, UH, GEOPOLITICAL OR GEOGRAPHIC SENSE, UM, TO PUT THEM ONE WITH EACH OTHER. 
          SOME OF THESE AREAS, UM, ARE MUCH LARGER AND ARE JUST ONE CENSUS TRACK, LIKE DELL VALLEY. 
          SOME OF 'EM ARE MUCH MORE CONCENTRATED, UM, BOTH IN, IN GEOGRAPHY AND POPULATIONS SUCH AS NORTH CENTRAL AUSTIN, UH, WHICH I BELIEVE AS EIGHT OR NINE CENSUS TRACKS. 
          AND THAT'S THE, THE RUNDBERG AREA. 
          UM, SO EVERY TIME WE DO THIS ANALYSIS, IT SHIFTS, WE FIND DIFFERENT NUMBERS, OBVIOUSLY. 
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UM, A LOT OF STUFF HAS HAPPENED SINCE, UH, 2020. 
          WHEN WE DID OUR LAST REPORT, UH, ONE OF THE PATTERNS WE SAW IN THIS, THIS ITERATION OF THE REPORT WAS, UM, WE FOUND ABOUT FOUR AREAS, WHAT WE CALL FOCUS AREAS NO LONGER. 
          UM, WERE IN THOSE TOP TWO TIERS OF COUNTS OF FAMILIES IN POVERTY. 
          WE DON'T SUGGEST THAT THERE IS NO NEED IN THESE AREAS, ARE THERE NO, ARE NO LOW, LOW-INCOME AREA RESIDENTS. 
          IT'S JUST NOT TO THAT TOP LEVEL THAT IT WAS PREVIOUSLY. 
          UM, THIS INCLUDES THE AREAS, UH, GOING CLOCKWISE FROM THE TOP RIGHT. 
          PFLUGERVILLE, MAINOR, ELGAN, HORNSBY, BEND. 
          UM, THOSE ARE NO LONGER IN THOSE TOP TIERS. 
          UM, AND DELL VALLEY HAS GONE FROM HAVING THREE CENSUS TRACKS SHRUNKEN DOWN TO ONE, AND LEANDER LAGO VISTA IS ALSO NO LONGER AMONG THOSE AREAS WITH THE HIGHEST COUNTS OF FAMILIES AND POVERTY. 
          SO ONCE WE'VE IDENTIFIED OUR FOCUS AREAS, UH, I'LL JUST GIVE YOU A QUICK PREVIEW. 
          UM, THIS IS WHAT WE REALLY DRILL DOWN ON, DOWN ON OR PART OF WHAT WE DRILL DOWN ON THIS REPORT. 
          UM, FOR EVERY FOCUS AREA, UM, WE LOOK AT WHERE, WHAT THE HEALTHCARE ACCESS IS, MEANING WHAT CLINICS, HOSPITALS, URGENT CARE CLINICS ARE WITHIN THAT AREA, UM, HOW MUCH AFFORDABLE HOUSING THERE IS, WHAT PUBLIC TRANSPORTATION'S AVAILABLE. 
          WE LOOK AT MEDIUM FAMILY INCOME, HOUSING COSTS, EDUCATION, EMPLOYMENT, FAMILY STRUCTURES, AND ACCESS TO TRANSPORTATION. 
          ON THE SECOND PAGE OF EVERY FOCUS AREA, WE ALSO DO COMPARISONS OF THE POVERTY STATUS, THE DEMOGRAPHICS AND THE LANGUAGE, UM, FROM DIFFERENT SUBSETS OF THE POPULATION WE LOOK AT, AT THE TOTAL COUNTY. 
          WE LOOK AT THE TOTAL POPULATION WITHIN A FOCUS AREA, AND THEN WE LOOK AT WITHIN OUR ENROLLED POPULATION, WE ALSO LOOK AT THE UTILIZATION DATA OF THE PEOPLE WE ENROLL IN OUR MAP AND MAP BA BASIC SERVICES. 
          UM, THIS INCLUDES WHAT LOCATIONS ARE THEY GOING TO ACCESS SERVICES, HOW MANY ENCOUNTERS HAVE THEY HAD, UM, HOW MANY, UH, TRIPS TO THEIR PRIMARY, WHAT PERCENTAGE ARE GOING TO THEIR PRIMARY CARE PHYSICIAN, WHAT PERCENTAGE ARE ENDING UP IN THE EMERGENCY ROOM. 
          AND FINALLY, WE ALSO, UM, AND THIS IS A FIRST FOR US. 
          WE'RE LOOKING AT THE PREVALENCE OF DISEASE AT A GEOGRAPHIC LEVEL. 
          SO WE CAN SAY, UM, IN BERG WE'RE SEEING, UM, HIGHER COUNTS OF SPECIFIC DISEASES VERSUS AREAS SUCH AS EAST AUSTIN OR OAK HILL. 
          AND FINALLY, UH, JUST WANTED TO GIVE YOU A KIND OF A, A SNEAK PEEK. 
          AGAIN, WE HAD NINE FOCUS AREAS, BUT, UH, JUST WANTED TO KIND OF HIGHLIGHT THESE THREE. 
          UM, AND THAT'S NOT TO SAY ANY OR MORE DIFFERENT THAN ANY OR MORE IMPORTANT THAN ANY OTHERS. 
          UH, NORTH CENTRAL AUSTIN, UM, THIS IS THE MOST POPULATED AREA. 
          THIS IS THE RUNDBERG AREA, ABOUT 52,000 RESIDENTS. 
          THE HIGHEST TOTAL FAMILIES IN POVERTY, TOTAL ENROLLEES AND TOTAL PATIENTS. 
          THIS AREA HAD THE LOWEST MEDIAN INCOME OF ANY AREA WE LOOKED AT. 
          AND, UH, ALTHOUGH WE ENROLLED MORE PEOPLE THAN ANYWHERE ELSE, WE ALSO HAD THE MOST UNSERVED, MEANING WE ENROLLED THEM, BUT WE NEVER, THEY NEVER PRESENTED AT A CLINIC OR A HOSPITAL. 
          UM, OAK HILL, THIS IS, UH, A NEW, THE ONLY NEW FOCUS AREA THAT CAME INTO OUR REPORT THIS YEAR. 
          IT'S THE ONLY, UH, AREA THAT'S WEST OF MOPAC. 
          UM, IT'S INTERESTING 'CAUSE THERE'S A SIMILAR POVERTY NUMBERS TO AREAS SUCH AS DELL VALLEY, BUT IT ONLY GETS HALF THE ENROLLEES. 
          SO THAT KIND OF TELLS US, YOU KNOW, THERE MIGHT BE SOME WORK TO DO IN AN AREA LIKE THAT. 
          UM, THE AREA ALSO EXPERIENCED A 4% INCREASE IN ITS TOTAL POPULATION, BUT THE NUMBER OF PEOPLE IN POVERTY INCREASED BY 21% VERSUS TWO YEARS AGO. 
          AND FINALLY, EAST CENTRAL AUSTIN, UM, THIS AREA, UM, HAS HAD THE HIGHEST PERCENTAGE OF FAMILIES IN POVERTY OF ANY AREA. 
          WE LOOKED AT, NOT THE HIGHEST COUNT, BUT THE PERCENTAGE. 
          UM, AND AGAIN, WE SAW LOWER THAN EXPECTED ENROLLMENT BASED ON THAT, UH, THAT RATE OF POVERTY AND ONE IN 20 UTILIZERS. 
          UM, THIS IS THE HIGHEST RATE OF ANYWHERE RECEIVED ALL THEIR SERVICES IN THE ED SETTING. 
          SO AGAIN, THAT TELLS US MIGHT BE SOME, UH, WORK WE'D LIKE TO DO TO, UH, GET FOLKS INTO PREVENTATIVE CARE. 
          SO OUR KEY FINDINGS, UM, THE NUMBER OF FAMILIES IN POVERTY WITHIN THESE NINE FOCUS AREAS THAT WE IDENTIFY IS GROWING FIVE TIMES OR FOUR TIMES, EXCUSE ME, WHAT IT IS OVERALL IN TRAVIS COUNTY, UM, WHICH IS WHY WE CALL THEM FOCUS AREAS. 
          UM, POVERTY AND ENROLLMENT DO NOT ALWAYS ALIGN. 
          THERE'S AREAS WHERE WE HAVE HIGH COUNTS OR HIGH RATES, UM, BUT WE'RE SEEING LESS, UH, ENROLLMENT THAN OTHER AREAS. 
          UH, SPANISH IS, UH, THE PREDOMINANT, 
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UH, LANGUAGE SPOKEN IN THESE FOCUS AREAS ABOUT DOUBLE WHAT THE OVERALL COUNTY RATE IS. 
          AND, UH, IT IS ALSO A MAJORITY LATINO IN THESE AREAS. 
          UM, THE HIGHEST PERCENTAGE OF BLACK ENROLLEES OF ANY OF OUR FOCUS AREAS IS IN EAST CENTRAL AUSTIN. 
          UH, AND AGAIN, NOT SURPRISINGLY, THE MEDIAN INCOME IS ABOUT $34,000 LESS IN THESE AREAS THAN IT IS OVERALL. 
          ALMOST HALF THE ADULTS HAVE A LESS THAN A HIGH OR A HIGH SCHOOL DEGREE OR LESS. 
          AND, UH, FOCUS PEOPLE LIVING IN THESE AREAS ARE MUCH LESS LIKELY TO HAVE ACCESS TO A VEHICLE. 
          UM, FINALLY, I WILL TOUCH ON THIS A LITTLE BIT. 
          UH, THIS IS, UH, MORE SARITA'S EXPERTISE, BUT WE'RE HAPPY TO RESPOND. 
          IF THERE'S ANY QUESTIONS WE CAN'T GET TO YOU, WE'LL RESPOND AT A LATER DATE. 
          UM, THIS IS LOOKING AT OUR, UH, OUR CHRONIC CONDITIONS AND, UH, DISEASE PREVALENCE THROUGHOUT THE COUNTY. 
          UM, ACCORDING TO A PH, CHRONIC CONDITIONS ACCOUNT FOR THREE OUTTA FIVE DEATHS OF TRAVIS COUNTY RESIDENTS. 
          UM, AND OUR ANALYSIS FOUND THAT ABOUT 40% OF OUR PATIENT POPULATION, WHICH REPRESENTS ABOUT 38,600 PEOPLE, HAD DIAGNOSIS OF AT LEAST ONE OF THESE CONDITIONS IN THE PAST THREE YEARS. 
          AND THE AVERAGE ENROLLEE HAD TWO AND A HALF CHRONIC CONDITIONS TO MANAGE. 
          UM, SO THIS CHART SHOWS THE RATES OF CLINICALLY DIAGNOSED DISEASE PER THOUSAND PEOPLE FOR NINE CHRONIC CONDITIONS IN DESCENDING ORDER. 
          UM, THESE WERE CONDITIONS WERE SELECTED BASED ON THE IMPACT TO THE POPULATION, AND THEY'RE CONSISTENT WITH OUR PREVIOUS REPORTS. 
          SO WE CAN START MEASURING OVER TIME CHANGES. 
          UM, CVD, WHICH IS, UH, YOU'LL SEE WHERE IT HAS THE HIGHEST RATE THAT REFERS TO CARDIOVASCULAR DISEASE. 
          AND COPD REFERS TO CHRONIC OBSTRUCTIVE PULMONARY DISORDERS. 
          UM, AS YOU CAN SEE, THE TOP FOUR CONDITIONS WERE CARDIOVASCULAR DISEASE, HYPERTENSION, BEHAVIORAL HEALTH, AND DIABETES. 
          AND THESE FOUR CONDITIONS ACCOUNTED FOR OVER 80% OF OUR CHRONIC CONDITION DIAGNOSIS. 
          UM, TO PUT THESE NUMBERS IN PERSPECTIVE, ABOUT ONE IN FOUR MEMBERS HAD CBD OR HYPERTENSION ABOUT ONE IN SEVEN HAD DIABETES OR BEHAVIORAL HEALTH CONDITION. 
          UM, AND AGAIN, FINALLY IN THE DEMOGRAPHIC REPORT, BOTH COUNTS AND RATES ARE REPORTED BOTH AT THE COUNTY LEVEL AND THE CENSUS TRACK LEVEL. 
          UM, COUNTS ARE IMPORTANT BECAUSE, UM, WE WANT TO BE ABLE TO, UH, PREPARE AND MEASURE FOR SYSTEM CAPACITY RATES ARE ALSO IMPORTANT 'CAUSE THEY CAN IDENTIFY WHEN THERE'S, UM, UH, NUMBERS THAT ARE, ARE SO FAR OFF THE NORM THAT WE NEED TO ADDRESS 'EM EVEN IF THEY'RE IN SO SMALLER SUBPOPULATIONS OR AREAS. 
          AND WITH THAT, UH, I BELIEVE WE CAN TAKE QUESTIONS. 
          ALL RIGHT. 
          SO, UH, APPRECIATE THE, THE, THE, THE LAYOUT OF THE COUNTY HOLISTICALLY. 
          RIGHT. 
          UM, I THINK MY QUESTION STILL REMAINS WHEN IT COMES DOWN TO AUSTIN BEING THE KEY ACCESS POINT BASED OFF OF YOUR REPORT, YOU HAVE IT BROKEN DOWN BY THE DIFFERENT GEOGRAPHICAL LOCATIONS, RIGHT? AND YOU ALSO HAVE IT BROKEN DOWN BY WHAT IS THE PRIMARY FOR EACH AREA VERSUS THE SECONDARY BY PARTICULAR POPULATIONS. 
          HISPANICS ARE NUMBER ONE, OR BLACKS ARE NUMBER ONE OR WHATEVER IT IS. 
          AND IN SOME OF THOSE AREAS, YES, THEY'RE STILL THE SAME FOR CARDIOVASCULAR OR HYPERTENSION, BUT IT'S DIFFERENT DEPENDING UPON THE GEOGRAPHICAL LOCATION, RIGHT? SO MY QUESTION IS MORE SO WHAT IS CURRENT PLANS OR EFFORTS TO, UM, EQUALLY DISTRIBUTE OR EQUITABLY DISTRIBUTE RESOURCES AMONGST NOT ONLY CENTRAL HEALTH, BUT THE PARTNERS AS WELL TO BETTER MATCH THE SERVICES THE PROVIDER WITH WHAT YOU'VE IDENTIFIED AS THE PRIMARY AND THE SECONDARY NEEDS? UM, 'CAUSE MY CONCERN WOULD BE IS THERE'S THESE CLINICS DISPERSED EVERYWHERE AND THEY'RE ALL PROVIDING THE SAME AMOUNT OF SERVICES VERSUS IF, IF ONE AREA IS HIGHER, UH, FOR HISPANICS IN A PARTICULAR AREA, YOU'RE TRYING TO HIRE MORE HISPANIC INDIVIDUALS WITH THAT SPECIALTY FOR THAT PARTICULAR AREA AS WELL TO HOPEFULLY NOT HAVE A CLINIC THAT YOU HAVE A WHOLE BUNCH OF PEOPLE ENROLLED, BUT THEY'RE NOT ACTUALLY UTILIZING IT TOO, WHICH IS WHAT YOU ALSO HIGHLIGHTED. 
          WELL, AND I THINK THAT IS LESS THAT. 
          SO WE USE THE DEMOGRAPHIC REPORT AND THE INFORMATION ABOUT DISEASE PREVALENCE AND CHRONIC CONDITION. 
          UH, THE DEMOGRAPHIC REPORT SUPPLEMENTED THE COMMUNITY HEALTH NEEDS ASSESSMENT, UH, THAT WE CONDUCTED THAT, UH, FED INTO THE HEALTHCARE EQUITY IMPLEMENTATION 
          [00:15:01]
PLAN THAT WE'VE, UM, ESTABLISHED IT ALSO, UH, COMMUNITY CARE DOES A COMMUNITY HEALTH NEEDS ASSESSMENT. 
          AND, UM, DR. RICE, UH, YOU, YOU KNOW, YOU GUYS I THINK ARE ABOUT TO HEAD INTO, UH, YOUR, UM, COMMUNITY HEALTH NEEDS ASSESSMENT. 
          AND I KNOW, SO ALSO THE HOSPITAL SYSTEMS DO, AND THEN ALSO THE CITY AND THE COUNTY WORK ON THE CHA CHIP THAT CENTRAL HEALTH ALSO PARTICIPATES IN. 
          SO AS WE ARE DESIGNING SERVICES COMPREHENSIVELY, UH, ACROSS THE SYSTEM FOR, FOR WHAT WHAT WE DO, WHICH IS REALLY FOCUSING ON THE, UH, MEDICAL AND HEALTHCARE SERVICES, UM, WE LOOKED AT, I THINK FROM THE LAST PRESENTATION, UH, WE LOOKED AT THE IDENTIFICATION OF MODERATE TO SIGNIFICANT GAPS ACROSS THE CONTINUUM OF CARE. 
          AND IN AREAS LIKE PRIMARY CARE, WE WERE MODERATELY GAPPED, WHICH THAT MEANT THAT WE WERE MEETING 50 TO 70% OF THE SERVICE NEEDS IN, UH, DIFFERENT AREAS LOOKING AT, UH, THE DIFFERENT POPULATIONS WE SERVE. 
          AND ONE OF THE THINGS THAT, THAT REINFORCED WAS OUR NEED TO OPEN UP CLINICS IN HORNSBY BEND, IN DELL VALLEY, AND NOW TO CONTINUE WITH THE DESIGN AND BUILD OF A COMMUNITY HEALTH CENTER IN, UM, COLONY PARK. 
          I THINK IN THE PAST YEAR AS, UH, COMMUNITY CARE ALSO, UM, YOU KNOW, GATHERS ITS INFORMATION. 
          THERE HAVE BEEN EXPANDED CLINICS IN, UM, VILLE AND THERE'S BEEN AN EXPANSION FOR, UM, THIS YEAR WITH, UH, COMMUNITY CARE AND THE BLACK MEN'S HEALTH CLINIC, UM, BASED ON THE IDENTIFICATION OF NEEDS, UM, FOR SERVICES FOR PARTICULAR POPULATIONS IN PARTICULAR AREAS. 
          UH, WE ALSO HAD IDENTIFIED THAT THERE WERE AREAS OF SIGNIFICANT GAP WHERE WE WERE MEETING LESS THAN 50% OF THE NEED FOR PARTICULAR SERVICES, WHICH IS ALSO WHY IN THE PLAN THAT WE'RE IMPLEMENTING NOW. 
          AND I THINK IF YOU GUYS HAVE ACCESS TO THE PRESENTATION THAT, UH, DR. 
          SALHA AND I DID FOR, UM, UH, VANESSA FUENTES COMMITTEE, UM, AT THE, UH, CITY COUNCIL, UH, THAT REALLY LOOKED AT THE, UH, SERVICES THAT WE'VE STOOD UP IN THE PAST YEAR, AND THAT WE'RE PLANNING ON STANDING UP THIS YEAR AND NEXT YEAR, WHICH IS REALLY FOCUSING ON SPECIALTY CARE SERVICES, WHICH ARE VERY SIGNIFICANTLY GAPPED IN A NUMBER OF DIFFERENT, UH, AREAS, UH, IN THE COUNTY. 
          AND, UM, SOME AREAS THAT ARE ALMOST A HUNDRED PERCENT GAPPED, LIKE RESPITE CARE SERVICES FOR PEOPLE WHO, UM, YOU KNOW, DON'T HAVE A SAFE PLACE TO HEAL OR PREPARE FOR HEALTH SERVICES. 
          UM, WE'VE GOT A 50 BED RESPITE CENTER THAT, UH, WE ARE REMODELING AND THAT WE'RE PLANNING TO OPEN IN 2026. 
          AND ONE OF THE THINGS THAT WE'VE DONE, UH, THIS YEAR IS COLLABORATING WITH, UM, WITH THE CITY ON, UH, HAVING ADDITIONAL RESPITE BEDS IN SOME OF THE SHELTER LOCATIONS THAT THE CITY OF AUSTIN, UH, HAS OPENED RECENTLY IN NORTH CENTRAL AND EASTERN, UM, PARTS OF TRAVIS COUNTY. 
          UH, AND THEN ALSO REALLY FOCUSING ON DIVERSION, UH, DIVERSION PILOT SERVICES, UH, AND WORKING WITH THE SOBERING CENTER ON EXPANDING, UH, SAFE PLACES FOR PEOPLE WHO HAVE DECIDED THAT THEY'RE READY TO TAKE THAT NEXT STEP AND ENTER INTO A TREATMENT TO HAVE A PLACE WHERE THEY CAN RECEIVE SOME, UH, MEDICATION ASSISTED HOLDOVER THERAPY WHILE THEY'RE WAITING FOR A TREATMENT BED, UH, TO OPEN UP WITH THE SOBERING CENTER. 
          AND THEN WE'RE WORKING TO MAKE SURE THAT INTEGRAL CARE CAN PROVIDE PSYCHIATRIC EMERGENCY SERVICES, INCLUDING PRESCRIBERS, UH, 24 HOURS A DAY, SEVEN DAYS A WEEK. 
          SO IF PEOPLE ARE IN A MEDICAL, MENTAL HEALTH CRISIS, INCLUDING NEEDING ACCESS TO A SUBSTANCE USE MEDICATION, THERE'S A PLACE WHERE THEY CAN RECEIVE THOSE, UH, EMERGENCY SERVICES ON A WALK-IN BASIS INSTEAD OF, UM, YOU KNOW, UNFORTUNATELY RECEIVING THEM THROUGH THE, UH, CRIMINAL, CRIMINAL JUSTICE SYSTEM. 
          SO WOULD YOU SAY, GETTING BACK TO THIS SECOND BULLET POINT THAT MOST OF THIS EFFORT IS HAPPENING IN AUSTIN, OR IS IT HAPPENING INTENTIONALLY IN THE COUNTY AREAS AS WELL? SO YOU DON'T HAVE INDIVIDUALS FEELING AS IF THEY ALWAYS HAVE TO GO INTO THE AUCTION AREA? I MEAN, 'CAUSE THAT'S BASICALLY WHAT THIS SECOND BULLET KIND OF READS TO ME, IS BASICALLY IF YOU WANT TO HAVE ANY SUITABLE HEALTHCARE, AFFORDABLE HOUSING, 
          [00:20:01]
WHATEVER, YOU HAVE TO GO INTO AUSTIN. 
          AND SO AS THE AUSTIN TRAVIS COUNTY PUBLIC HEALTH COMMISSION MEETING, THAT BULLET IS A LITTLE CONCERNING FOR ME. 
          SO THAT'S WHY I WAS ASKING THAT QUESTION AS FAR AS WHAT IS THE PLAN NOW THAT IF AUSTIN IS TO GO TO, HOW ARE WE NOW AT LEAST MAKING IT LESS OF A, I LIVE OUTSIDE OF AUSTIN, I HAVE TO GO INTO AUSTIN, WHERE ARE THE RESOURCES WITHIN MY OWN BACKYARD OR NEAREST TO ME, EVEN IF IT'S ON THE OUTSKIRT OF AUSTIN? SO, AND I THINK THAT'S ABSOLUTELY SOMETHING THAT, UM, CENTRAL HEALTH HAS TO TAKE INTO ACCOUNT IN ITS PLANNING FOR HEALTHCARE SERVICES. 
          I THINK IF YOU LOOK AT THE DEMOGRAPHIC REPORT, UH, IN HOLD, THIS KEY FINDING AROUND AUSTIN IS THIS KEY ACCESS POINT. 
          I THINK THAT IS MORE OF A BULLET POINT ENCAPSULATION OF WHY WE ARE STILL SEEING SO MANY PEOPLE GRAVITATING TOWARDS LIVING WITHIN THIS AREA THAT'S PREDOMINANTLY ALONG THE NORTHERN PART AND THE SOUTHERN PART OF THE I 35 CORRIDOR. 
          IT'S BECAUSE THE INVESTMENTS THAT COMMUNITIES ARE MAKING IN, UH, PERMANENT SUPPORTIVE HOUSING, A LOT OF THOSE INVESTMENTS WHERE THERE ARE, UH, WHERE THERE'S SIGNIFICANT DENSITY OF AFFORDABLE HOUSING, WHICH IS NOT SOMETHING THAT CENTRAL HEALTH IS, UM, AUTHORIZED OR ENABLED TO DO, UM, BY EITHER THE CONSTITUTION OF TEXAS OR BY CHAPTER 2 81, THAT DENSITY THAT, THAT THOSE SERVICES ARE PROVIDED MORE DENSELY IN THAT CENTRALIZED AUSTIN REGION. 
          I THINK ALSO, IF YOU LOOK AT CAP METRO AND OTHER, UH, AREAS OF INVESTMENT THAT AREN'T, THIS ISN'T NECESSARILY LOOKING AT HEALTHCARE SERVICES THAT CENTRAL HEALTH IS PROVIDING, BUT THE INVESTMENTS THAT ARE BEING MADE IN, UH, AFFORDABLE, UM, DENTS, LOW COST HOUSING, UH, YOU KNOW, WHICH I THINK THAT IS STILL BEING, UM, THOSE ARE PRIMARILY HAPPENING IN AUSTIN. 
          I DON'T KNOW, UM, YOU KNOW, PILAR, YOU GUYS MIGHT HAVE MORE INFORMATION ABOUT WHERE THE, UH, TRAVIS COUNTY HOUSING COALITION, UM, SITES ARE GOING TO BE COMING, COMING ONLINE. 
          BUT I DO THINK THAT MOST OF, OF THE RESOURCES ARE, YOU KNOW, THAT THEY'RE NOT, YOU KNOW, KIND OF, UH, FARTHER AFIELD FOR THOSE HOUSING INVESTMENTS. 
          THAT'S CORRECT. 
          UM, MOST OF, MOST OF THE, UH, SUPPORTIVE HOUSING WILL BE INSIDE STATEMENTS. 
          AND, AND I COULD ADD, I THINK, YOU KNOW, THIS, THIS FINDING IN THE RESEARCH AND, YOU KNOW, JUST PULLING THE INFORMATION TOGETHER AS A RESULT OF, YOU KNOW, AN ACCESS AND AUSTIN BEING A KEY ACCESS POINT, ESPECIALLY FOR AFFORDABLE HOUSING AND WHY WE HAVE STILL SUCH A HIGH CONCENTRATION OF LOW-INCOME PEOPLE IN AUSTIN. 
          YES, THERE ARE PEOPLE MOVING OUT INTO THE SUB SUBURBS, BUT I JUST WANNA USE AS AN EXAMPLE THAT THE CITY VOTERS HAVE PASSED A COUPLE OF AFFORDABLE HOUSING BONDS, AND SO THERE'S BEEN THIS, YOU KNOW, HUGE INVESTMENT IN AFFORDABLE HOUSING THAT HAS, YOU KNOW, KEPT LOW INCOME PEOPLE IN THIS COMMUNITY. 
          UM, AND, UM, AND SO JUST WANTED TO ADD THAT AS WELL. 
          NO, DEFINITELY. 
          I FULLY UNDERSTAND THAT AUSTIN TAKES UP PRETTY MUCH ABOUT 75% OF IT, IS IT RIGHT. 
          OF THE COUNTY. 
          I DON'T, YOU KNOW, NO, FULLY GET IT. 
          YEAH. 
          FULLY GET IT. 
          UH, ANY OTHER QUESTIONS FROM, GO AHEAD, VICE CHAIR. 
          GO AHEAD IF YOU WANT. 
          NO, GO AHEAD. 
          THANK YOU FOR THE PRESENTATION. 
          THIS IS IN REGARDS TO THE HOUSING CONVERSATION, AND THE, THIS IS WOULD BE BULLET FIVE WITH THE DISEASE PREVALENCE OF THE UNHOUSED. 
          UM, HAVE YOU, OR ARE THERE ANY SORT OF CONNECTIONS TO CBOS OR THE HOUSING AUTHORITY IN REGARDS TO LIKE GETTING INFORMATION AND ACCESS INTO THESE AREAS AND POPULATIONS? AND THEN ARE THERE ANY DISPARITIES IN THOSE COLLABORATIVE EFFORTS THAT THE COMMISSION COULD SUPPORT IN CREATING CONVERSATIONS THAT ARE GONNA BE EQUITABLE? SO THE CHALLENGE WITH, UH, THE CHALLENGE FOR US WITH THIS POPULATION IS THEY ARE BY THEIR NATURE, YOU CAN'T MAP THEM. 
          THEY ARE, UM, THE VAST MAJORITY OF OUR PATIENTS WHO ARE IDENTIFYING THEY SELF-IDENTIFY AS HOMELESS, UM, ARE MOSTLY STREET HOMELESS. 
          UM, WE DO WORK WITH, UH, HAKA AND SOME OF THEIR, UM, WE'VE CO-LOCATED WITH COMMUNICA CLINIC AT ONE ONE OF THEIR LOCATIONS. 
          UM, I KNOW THEY DO A LOT OF WORK WITH US TO, TO ENROLL PATIENTS IN OUR SERVICES. 
          UM, BUT SINCE THEY'RE SELF ENROLLED, UM, MANY OF THEM ARE SELF IDENTIFIED. 
          MANY OF THOSE, UH, FOLKS WHO GET INTO HOUSING MAY NO LONGER CONSIDER THEMSELVES UNHOUSED, 
          [00:25:02]
UM, VERSUS THE DATA WE GET FROM, UH, FOLKS WHO ARE LIVING IN THE STREETS OR ON COUCHES, UM, OR IN CARS. 
          SO YES, THERE IS, THERE IS ALWAYS COLLABORATION AND WORK, AND THERE'S MORE WORK TO DO BETTER. 
          AS MONICA SAID, WE'RE, WE'RE LIMITED TO PARTNERSHIPS AND BEING SUPPORTIVE. 
          WE CAN'T ACTUALLY DIRECT INVEST MONEY INTO THAT BY LAW. 
          UM, BUT YES, WE, WE, WE COLLABORATE WITH, WITH THOSE GROUPS, UM, CBOS TO, UM, A CERTAIN EXTENT WHEN WE'RE AT THE TABLE TOGETHER FOR THINGS LIKE THE CHA CHIP AND OTHER COLLABORATIVE FUNCTIONS LIKE THAT. 
          I DO THINK ONE OF THE THINGS THAT WE'RE WORKING ON IS A COALITION FOR, UH, HEALTHCARE SERVICES FOR PEOPLE THAT ARE MOVING INTO THE NEW, UM, PERMANENT SUPPORTIVE HOUSING THAT'S BEING DEVELOPED, THAT WE'RE WORKING WITH, UH, THE CITY AND THE COUNTY AND INTEGRAL CARE AND ORGANIZATIONS LIKE FOUNDATION COMMUNITIES AND COMMUNITY FIRST VILLAGE, AND THE TEXAS HARM REDUCTION ALLIANCE AND CARITAS OF AUSTIN AND SOME OF THE OTHER COMMUNITY-BASED ORGANIZATIONS, UM, TO DEVELOP A SERVICE, A HEALTHCARE SERVICE MODEL, UM, FOR, UH, PEOPLE THAT ARE BECOMING NEWLY HOUSED. 
          UH, AND WE'RE ALSO, UM, COLLABORATING THROUGH, UH, THE COUNT WITH FOLKS AT THE COUNTY AROUND, UM, HOW THE DIVERSION BOTH, UH, DEFLECTION, DIVERSION PILOT SERVICES, UM, WORKING WITH INTEGRAL CARE ON, UH, THE, UH, PSYCHIATRIC EMERGENCY SERVICES, THAT 24 7 EXPANSION. 
          AND THEN ALSO THEY'RE EXPANDING, UM, UH, KIND OF A LONGER TERM, 90 DAY, UH, SUPPORTIVE, UM, RE UH, THERAPEUTIC, THERAPEUTIC THERAPEUTIC. 
          IT'S ALSO THERAPEUTIC HOUSING SERVICES OFF OF 15TH STREET THAT ARE ALSO GOING TO BE EXPANDED AS PART OF THAT COLLABORATION. 
          I THINK CONTINUING TO WORK ON THE DIVERSION CENTER AND HELPING TO WORK WITH, UM, HOW, UH, KIND OF MEDICAL NEED IS TRIAGED ALONG WITH CENTRAL BOOKING AND HOW SERVICES ARE PROVIDED IN THAT TYPE OF SETTING. 
          UH, AND THEN ALSO JUST HOW AS CENTRAL HEALTH IS WORKING TO BUILD OUT, YOU KNOW, THIS, UH, 50 BED, UH, RESPITE FACILITY THAT ALSO INCLUDES SOME, UM, LOW ACUITY DETOX SERVICES, UM, AND THAT, THAT WILL BE OFF OF, UH, KIND OF 180 3 AND, UH, CAMERON ROAD IN THAT AREA AS WE'RE BUILDING TOWARDS THAT. 
          I JUST THINK, UM, YOU KNOW, THE COMMISSION CAN ALSO HELP BE SUPPORTIVE OF THE WORK THAT WE ARE DOING WITH THE CITY AND THE COUNTY IN, UH, EXPANDING, UM, SERVICES IN, UH, THE NEW SHELTERS THAT ARE COMING OPEN AND FIGURING OUT, UH, HOW WE BEST SERVE, UM, THE DIFFERENT POPULATIONS THAT ARE COMING INTO SHELTER. 
          UH, AND PROVIDING SOME SORT OF DEDICATED ACCESS FOR FOLKS THAT MAYBE NEED TO PREPARE FOR A HOSPITAL VISIT OR SOME SORT OF, UM, YOU KNOW, UM, A DIAGNOSTIC, UM, PROCEDURE LIKE A COLONOSCOPY OR FOLKS THAT ARE TRANSITIONING OUT OF THE HOSPITAL BUT THAT DON'T HAVE PERMANENT SUPPORTIVE HOUSING OR A SAFE, SAFE PLACE TO GO. 
          I THINK, YOU KNOW, AS SOMETHING THAT YOU GUYS COULD, UM, YOU KNOW, HELP WITH IS JUST, YOU KNOW, HELPING US AS WE'RE BUILDING OUT RESPITE OPTIONS AND PERMANENT SUPPORTIVE HOUSING, UH, SEE IF THERE'S A WAY THAT YOU COULD SUPPORT, UM, THIS TRANSITION FROM RESPITE TO PERMANENT SUPPORTIVE HOUSING. 
          UM, AND I KNOW WE ALSO HAVE THE CONTINUUM OF CARE, SO THERE ARE, YOU KNOW, IT'S THERE, THERE ARE A LOT OF FOLKS, UM, YOU KNOW, WORKING, UH, ON THIS PRO, UH, YOU KNOW, THE, THESE ISSUES. 
          BUT I THINK THAT'S SOMETHING THAT I THINK IS GONNA BE REALLY, UH, IM IMPORTANT FOR FOLKS BECAUSE YOU DON'T WANNA GET SOMEBODY IN RESPITE AND, UM, HAVE THEM, UM, THRIVE IN THAT SETTING AND THEN HAVE TO DISCHARGE THEM OUT OF RESPITE BACK TO THE STREET. 
          MM-HMM. 
          , ANY OTHER QUESTIONS? I'M NOT SURE. 
          YEAH. 
          OH, GO AHEAD. 
          I HAD A QUESTION AROUND THIS PHENOMENON IN NORTH CENTRAL AUSTIN WHERE YOU HAVE HIGH ENROLLMENT, BUT, UH, THE POPULATION IS UNSERVED. 
          SO CURIOUS IF YOU HAD AN EXPLANATION, IF THERE WAS A PROGRAM TO ENROLL A LOT OF PEOPLE, BUT THEN THERE WASN'T REALLY FOLLOW UP, UH, OR OTHER SERVICES TO KIND OF ENSURE THAT THEY WOULD CONTINUE COMING? YEAH, THAT'S A GREAT QUESTION. 
          UM, ONE OF THE INTERESTING THINGS WE FOUND WAS, UH, REGARDLESS OF WHERE WE LOOKED, THE, THE RATE OF UTILIZATION 
          [00:30:01]
WAS CONSISTENT ALMOST WITHIN TWO OR THREE PERCENTAGE POINTS EVERYWHERE IN THE COUNTY. 
          SO FOLKS LIVING IN RURAL AREAS VERSUS FOLKS LIVING WITHIN A HALF MILE OF A CLINIC, IF WE ENROLLED 'EM, THEY HAD ABOUT THE SAME PERS RATE OF ACCESSING SERVICES. 
          SO WHAT WE SEE IN NORTH CENTRAL AUSTIN, UH, RUNDBERG AREA IS JUST THE MASSIVE PROPENSITY OF LOW INCOME RESIDENTS LIVING THERE. 
          SO IT'S, IT'S REALLY JUST A MATTER OF VOLUME. 
          UM, THERE IS, THERE IS NOWHERE CLOSE TO RUNDBERG IN THIS COUNTY AS FAR AS, UH, LOW INCOME POPULATION. 
          UM, AS FAR AS THE NINE AREAS WE LOOKED AT, THEY DOUBLED THE NEXT HIGHEST. 
          SO, UM, REALLY IT'S, IT'S NOT INCONSISTENT, IT'S NOT ABNORMAL, IT'S JUST SUCH A VOLUME OUT THERE. 
          WE'VE GOT, UM, NORTH CENTRAL, WHICH IS OUR, OUR MOST ACTIVE CLINIC AND OUR ENTIRE COMMUNITY CARE SYSTEM OUT THERE, UM, LONE STAR HAS A CLINIC OUT THERE, AND THERE'S A, THERE'S A NUMBER ON THE PERIPHERY. 
          THERE'S STILL NOT ENOUGH TO BE QUITE HONEST WITH YOU, FOR THE, FOR THE NEEDS OF THAT AREA. 
          I THINK ALSO ONE OF THE THINGS THAT WE SEE IS, IS, UH, WE'VE, UM, MADE A POLICY DECISION TO ENROLL FAMILIES INSTEAD OF ENROLLING INDIVIDUALS. 
          AND I THINK IT IS JUST FIGURING OUT, UM, HOW DO YOU CREATE SUFFICIENT ACCESS WHERE IT'S CONVENIENT ENOUGH FOR PEOPLE, UM, THAT ARE, ARE WORKING, THAT ARE WORKING JOBS THAT DON'T GIVE THEM TIME OFF TO, YOU KNOW, TAKE CARE OF BASIC KIND OF HEALTHCARE NEEDS AND THAT ARE MAYBE WORKING MULTIPLE JOBS. 
          HOW DO YOU CREATE ENOUGH CONVENIENT ACCESS AT THE RIGHT TIME SO THAT YOU CAN, UM, ENCOURAGE PEOPLE TO ESTABLISH CARE EVEN WHEN THEY'RE NOT SICK? AND SO USUALLY YOU GET, YOU KNOW, A WHOLE FAMILY AND THE MEMBER OF THE FAMILY THAT HAS THE HEALTHCARE NEEDS AND THE KIDS, OR THE MOM AND THE KIDS USUALLY ESTABLISH CARE AND THEN, YOU KNOW, MAYBE THE DADS OR THE WORKING MOMS DON'T, UM, PRIORITIZE THEIR OWN HEALTHCARE NEEDS AS MUCH. 
          YOU HAD A QUESTION FOR, SIR? I HAVE A COUPLE QUESTIONS I WAS JUST GONNA DO VERY BRIEFLY. 
          FIRST OF ALL, I WANNA SAY THANK YOU SO MUCH, MONICA AND THE TEAM FOR TODAY. 
          THANK YOU SO MUCH FOR TALKING TO US TODAY. 
          SORRY. 
          AND, UM, I REALLY APPRECIATE THE WORK THAT YOU'RE DOING IN THIS REPORT, FOR INSTANCE, IS JUST, YOU KNOW, SO IMPORTANT FOR US TO UNDERSTAND AND FOR THE COMMUNITY TO UNDERSTAND. 
          AND, UM, SO THANK YOU. 
          THREE QUICK QUESTIONS JUST FROM MY BRAIN TO SORT OF GET A SENSE. 
          I WAS TRYING TO REMEMBER, IS THE OVERALL BUDGET OF CENTRAL HEALTH SOMETHING ABOUT A HUNDRED MILLION DOLLARS OR THEREABOUTS? I FORGET WHAT THE BUDGET IS, BUT WHAT IS THERE, WHAT'S THE GENERAL NUMBER? I'M NOT ASKING FOR A SPECIFIC, DOES ANYBODY KNOW? JUST, I JUST WANTED TO GET A SENSE OF IT. 
          THREE ISH. 
          YEAH. 
          THREE, THREE, MAYBE 350 MILLION ISH. 
          OKAY. 
          YEAH. 
          THANK YOU. 
          I JUST, I, I SHOULD JUST SAY I DO NOT KNOW. 
          WE CAN FIND THAT OUT AND GET THE INFORMATION BACK TO YOU. 
          I JUST, WELL, THANK YOU. 
          THAT'D BE GREAT. 
          I JUST, I WAS TRYING TO REMEMBER FROM SOMETHING ELSE WE'VE SEEN JUST KINDA WHERE THAT IS JUST AS AN ORDER BACK TO JUST TO UNDERSTAND IT. 
          SO THAT WAS ONE THING. 
          SECOND THING WAS, UM, YOU KNOW, I LOOK AT, AT THE LAST SLIDE, AND I SEE CVD, WHICH IS CARDIOVASCULAR DISEASE, AND, AND THEN I SEE HYPERTENSION, WHICH AS A PHYSICIAN, I THINK OF AS CARDIOVASCULAR DISEASE. 
          AND THEN I SEE HEART FAILURE, WHICH IS CARDIOVASCULAR DISEASE, AND WOULD SAY THAT IF YOU PUT 'EM ALL TOGETHER, YOU'D HAVE THIS REALLY HIGH COLUMN ON THE LEFT, WHICH IS REALLY HIGH. 
          AND I'M NOT GONNA HAVE ANY GREAT POINT THERE, BUT I'M JUST NOTICING FOR THOSE IN, IN THE ROOM AND AROUND THAT ARE LISTENING, THAT, UM, CARDIOVASCULAR DISEASE IS A BIG DEAL AND, AND, AND, AND, UM, YOU KNOW, UM, A PRIMARY CHALLENGE, NOT THAT THE OTHER AREN'T IMPORTANT OR WHATEVER, BUT, UM, IT'S, UM, YOU KNOW, IT'S A PRIMARY CHALLENGE AND OBVIOUSLY THAT'S NOT DEEP INSIDE, BUT I WAS JUST GONNA POINT THAT OUT. 
          AND THE REASON I GO THERE IS THAT POINT QUESTION NUMBER THREE OR POINT NUMBER THREE I WAS JUST GONNA MAKE OR OBSERVE WAS THAT, YOU KNOW, LIKE, LIKE ALL IN LARGE INSTITUTIONS, YOU'VE GOT A THOUSAND THINGS THAT YOU'RE DOING. 
          AND, AND THAT'S WHAT YOU'VE GOTTA DO. 
          OF COURSE. 
          AND I WAS TRYING TO THINK ABOUT, AS I LISTENED, I WAS LIKE, WONDER WHAT THE OVERALL GOAL IS? WELL, I UNDERSTAND THE OVERALL GOAL IS WHAT YOU SAID IN THE FIRST SLIDE, BUT, YOU KNOW, COULD THERE BE A THEME OR A GOAL, AND I'M GONNA MAKE THIS UP, BUT, YOU KNOW, I, ONE OF MY PET PEEVES ALWAYS IS THAT, I DON'T KNOW WHAT EXACT PERCENT, BUT PROBABLY AT LEAST HALF OF, OF THE NEED FOR KIDNEY TRANSPLANTS IS FOR PEOPLE WHO HAVE CHRONIC HYPERTENSION, WHO AREN'T WELL CONTROLLED, WHO CAN'T QUITE GET WELL CONTROLLED, AND THEY HAVE EVENTUALLY THAT PRESSURE ON THE KIDNEYS CONTINUOUSLY LEADS TO THE KIDNEYS BURNING OUT, AND THEY NOW HAVE NEED A RENAL, A KIDNEY TRANSPLANT, AND THAT WHOLE CASCADE OF THINGS OF LIFE COMPLEXITY. 
          SO I THOUGHT, YOU KNOW, AND I'VE TALKED ABOUT THIS BEFORE IN DIFFERENT FORMS, BUT YOU KNOW, ONE THING THAT'D BE GREAT TO SAY IS, COULD TRAVIS COUNTY HAVE A PROGRAM WHICH SAYS, OKAY, WE GOTTA DO EVERYTHING WE'RE DOING, CENTRAL HEALTH DOES, DOES, DOES, EVERYBODY ELSE DOES WHAT 
          [00:35:01]
THEY DO, BUT LET'S TRY TO WORK ON HYPERTENSION AND, AND LET'S HAVE A GOAL THAT THE WHOLE COMMUNITY COULD REALIZE THAT SAYS, LET'S HAVE THE LOWEST POSSIBLE RENAL TRANSPLANT NEED IN THE WORLD, IN THE COUNTRY, WHATEVER YOU WANNA SAY. 
          AND WELL, HOW ADULTS WOULD YOU DO THAT? WELL, YOU, FIRST OF ALL, YOU'VE GOT CERTAIN KINDS OF DISEASES WHICH ARE NOT RELATED TO HYPERTENSION THAT CAN CAUSE THAT. 
          SO YOU CAN'T FIX THAT MAYBE. 
          BUT IF HALF OF THE NEED FOR RENAL TRANSPLANTS IN THE TOWN IS RELATED TO HYPERTENSIVE HEART DISEASE AND HYPERTENSIVE, YOU KNOW, DISEASE, YOU'D SAY, WELL, GEEZ, WHAT COULD THE GROCERY STORES DO? WHAT COULD THE HEALTHCARE SYSTEMS DO? WHAT COULD CENTRAL HEALTH DO? WHAT COULD EVERYBODY DO? AND YOU COULD ALMOST LIKE, YOU KNOW, LIKE THE JOHN KENNEDY ASK, NOT WHAT YOUR HEALTH SYSTEM CAN DO FOR YOU, ASK WHAT YOU CAN DO FOR YOUR HEALTH SYSTEM. 
          AND THAT WOULD BE TO, IF YOU'VE GOT HYPERTENSION, GET HELP. 
          IF YOU HAVE, IF YOU KNOW SOMEBODY WITH HYPERTENSION, HELP THEM GET HELP AND EVERYTHING WOULD BE REVOLVING AROUND A THEME COMMERCIALS, THE MAYOR COULD SPEAK ABOUT IT. 
          EVERYBODY COULD TALK ABOUT HYPERTENSION, AND THEN MAYBE YOU COULD MOVE A NEEDLE DIFFERENTIALLY THAN WHAT WE'D HAVE NOW, WHICH IS IT'S ONE OF A HUNDRED NEEDLES AND WE'RE WHACKING 'EM ALL KIND OF THING. 
          AND YOU GOTTA DO THAT. 
          SO I'M NOT TAKING ANYTHING AWAY FROM THAT, BUT I, I WANTED TO THROW THAT OUT AS AN IDEA THAT WE COULD ALL MAYBE AT LEAST, YOU KNOW, CONSIDER AS A, AS A, AS A A WAY TO HAVE A SINGLE GOAL THAT EVERYBODY UNDERSTANDS WHAT'S THE GOAL, AND THEN MAYBE YOU CAN MOVE A NEEDLE DIFFERENTLY. 
          I THANK YOU FOR THE PRESENTATION, AND I THINK AS WE'RE KIND OF GETTING OUR SEA LEGS AS A COMMITTEE, THAT THIS, UM, REPORT COMES AT A GREAT TIME BECAUSE WE'VE KIND OF GOTTEN A REALLY GOOD IDEA ABOUT WHERE THERE ARE DIFFERENT ACTIVITIES OCCURRING IN THE COMMITTEE COMMUNITY THAT ARE ADDRESSING OUR PUBLIC HEALTH NEEDS. 
          BUT THIS REALLY, AS DR. RICE SAYS, REALLY DOES SHINE A LIGHT ON THE NEED FOR US TO ADDRESS CHRONIC DISEASE AND AS A COMMISSION, UM, IF YOU WOULD SPEND TIME LOOKING AT THIS PARTICULAR ITEM, AND AS, UH, COMMISSIONER RICE IS POINTING OUT, AND WE LOOK AT IT FROM A HEALTH IN ALL POLICIES APPROACH, THAT I THINK THAT WE WOULD GO A LONG WAY TO REACHING OUT TO PEOPLE THAT NEED TO HAVE THE EDUCATION, HAVE THE RESOURCES, UM, TELL US WHAT THEIR GAPS ARE. 
          UM, ALL OF THOSE THINGS THAT ARE PART OF ADDRESSING A PUBLIC HEALTH, UM, CHALLENGE WOULD BE ADDRESSED IN A REAL WAY, ON SOMETHING THAT IS IMPACTING CLOSE TO 80% OF WHAT'S HAPPENING. 
          UM, UH, AND THAT I THINK WOULD BE, UM, A CHARGE THAT WOULD REALLY SERVE THIS COMMISSION WELL, ABSOLUTELY. 
          NO, I APPRECIATE YOUR, YOUR COMMENTS VICE CHAIR. 
          UH, AND, UH, IT DOES, I KNOW I'M JUST RAMBLING RIGHT HERE, BUT IT DOES TIE INTO WHAT MY THOUGHT PERSPECTIVE WAS WITH BULLET NUMBER FIVE, UM, WHERE YOU'RE TALKING ABOUT THIS PERCENTAGE ACROSS THE BOARD, BUT WHERE IS IT HIGHER IN CERTAIN AREAS? MM-HMM. 
           THAN OTHERS? MM-HMM. 
           AND THEN REALLOCATING RESOURCES APPROPRIATELY WHERE IT IS HIGHER. 
          AND THEN YOU CAN TIE IN SPECIFIC MESSAGING AND SO FORTH FROM BEING ABLE TO SAY, BECAUSE THIS AREA FOR THIS PARTICULAR DEMOGRAPHIC POPULATION HAS A HIGHER CVD WHERE ANOTHER ONE MAYBE HAS A HIGHER HYPERTENSION, WHERE ANOTHER ONE MAY HAVE A HIGHER HEART FAILURE, RIGHT? WE'RE NOW LOOKING AT WHAT'S IN THOSE PARTICULAR AREAS, AND IS IT THE RIGHT SPECIALTIES? IS IT THE RIGHT PROVIDERS? IS IT THE RIGHT EXPERIENCE THAT NEEDS TO BE IN THAT AREA? PLUS IS IT THE RIGHT PARTNERSHIPS, COLLABORATIONS FOR COMMUNICATION TO HOPEFULLY GET MORE INDIVIDUALS THAT ARE ENROLLED TO BE MORE ACTIVE? MM-HMM. 
          . 
          AND SO THAT'S WHERE MY ULTIMATE QUESTION OF 0.5 WAS COMING FROM, RIGHT? BUT I THINK THAT OUR CHARGE IS, THE COMMISSION IS NOT TO GET INTO THE WEEDS AND THE DETAILS. 
          THAT IS THE, THE CHALLENGE AND THE CHARGE OF THE ORGANIZATIONS THAT ARE HERE TO REPRESENTED OUR CHARGE IS TO SUPPORT THEIR EFFORTS. 
          AND, UH, PARTICULARLY GOING BACK TO THE POINT THAT WAS RAISED ABOUT ACCESS BEING IN AUSTIN, I THINK THAT THAT'S A FINE POINT THAT NEEDS TO BE CLARIFIED. 
          THE HOSPITAL SYSTEMS ARE IN AUSTIN. 
          THE, THE ACCESS POINTS TO HEALTHCARE ARE THROUGHOUT THE COUNTY. 
          AND THIS, THIS DOCUMENT IS HELPING TO INFORM DECISIONS THAT ARE BEING MADE ABOUT WHAT'S GOING ON CURRENTLY AND WHAT WILL HAPPEN IN THE FUTURE. 
          BUT IT IS NOT OUR CHARGE AS A COMMISSION TO GUIDE THAT PROCESS. 
          THAT PROCESS HAPPENS AT THE SYSTEM LEVEL FOR HOSPITALS, UNIVERSITIES, CLINICS, PUBLIC HEALTH, CENTRAL HEALTH. 
          OUR CHARGE IS TO SUPPORT THEIR EFFORTS. 
          AND THAT, I THINK IS WHAT WE ARE HERE TO DO AND WHAT WE WILL DO VERY WELL BECAUSE OF THE GROUP HERE ASSEMBLED. 
          THE, THE ONE CAVEAT I WOULD ADD TO THAT 
          [00:40:01]
IS THE INTENT OF THE COMMISSION IS ALSO TO WORK WITH THE, THE, THE AGENCIES TO ENSURE THAT THEY'RE BETTER INTERCONNECTED, BETTER COLLABORATIVE IN ENHANCING AND EXPANDING THEIR RESOURCES AND ALLOCATIONS CAPABLE THROUGHOUT THE WHOLE COUNTY. 
          AND SO I THINK IT WOULD BE A DISSERVICE IF THE COUNTY, IF THE COMMISSION DIDN'T AT LEAST INQUIRE AND SAY, MAYBE THERE'S AN OPPORTUNITY FOR SUBCOMMITTEES, AS WE TALKED ABOUT BEFORE, OF LOOKING AT WHAT IS GOING ON EAST NORTH, SOUTH WEST, AS FAR AS LAYOUT OF THE SERVICES, WHAT ARE Y'ALL'S PLANS BASED UPON THE CHILD SHIPS AND THE SURVEYS THAT Y'ALL HAVE GOING ON BASED UPON THE DEMOGRAPHICS OF THAT. 
          AND IF THERE NEEDS TO BE RECOMMENDATIONS FROM THIS COMMISSION TO YOU ALL AS WELL AS TO THE CITY, UH, COUNCIL, OR WHETHER TO THE COM UH, COMMISSIONER'S COURT, WHEN IT COMES TO RECOMMENDATIONS OF, YES, FUNDING NEEDS TO BE ALLOCATED BECAUSE THERE IS A GAP AREA AND NO, NEITHER ONE OF THE PROVIDERS ARE IN THAT AREA PROVIDING THIS TYPE OF SUPPORT, OR THERE NEEDS TO BE MORE OF A SPECIALTY OR MORE OF AN EXPERIENCE, AND IT MAYBE IT REQUIRES SOME ADDITIONAL FUNDING TO BE ABLE TO BRING THOSE INDIVIDUALS IN. 
          RIGHT? AGAIN, SITTING HERE AND JUST LOOKING AT THE ASSESSMENTS, ALL OF Y'ALL DOING ASSESSMENTS, BUT SITTING AND LOOKING AT THE ASSESSMENTS AND NOT ASKING ADDITIONAL QUESTIONS OF, OKAY, SO HOW IS THE STRATEGIES ACTUALLY OFFSETTING TO COMBAT THE ASSESSMENTS? TO ME, THAT'S WHAT THE INTENT OF THE COMMISSION IS TO DO, IS TO BE ABLE TO LOOK AT THE ASSESSMENTS AND THEN ASK THE QUESTIONS OF HOW IS YOUR IMPLEMENTATION ACTUALLY COMBATING THAT? HOW IS YOUR IMPLEMENTATION ACTUALLY OFFSETTING THAT, WHERE YOU SEE THE BARRIERS, WHERE YOU SEE THE, THE, THE LACK OF CERTAIN RESOURCES AND PARTICULAR AREAS. 
          IT'S GREAT TO HAVE AN UNDERSTANDING THAT 80% OR WHATEVER IS CARDIOVASCULAR. 
          BUT AGAIN, GETTING DOWN TO THE NUTS AND THE BOLTS OF A BIG GEOGRAPHICAL AREA IS NOT 80% FOR THE WHOLE COUNTY. 
          SO ARE THE RIGHT SERVICES, ARE THE RIGHT PROGRAMS GOING INTO THE RIGHT PLACES IS THE RIGHT MONEY? IS THE RIGHT INDIVIDUALS GOING INTO THE RIGHT PLACES TO BE ABLE TO CHANGE THE WAY PEOPLE ARE ACCESSING THE HEALTHCARE SYSTEM? AND THAT'S WHAT I'M HEARING FROM THE VICE CHAIR. 
          THAT'S WHAT I'M HEARING FROM CERTAIN ASPECTS HERE, WHICH IS GREAT, APPRECIATE THE INFORMATION, BUT HOW ARE THE ORGANIZATIONS NOW UTILIZING THAT INFORMATION TO ACTUALLY INTENTIONALLY TARGET WHERE THOSE BARRIERS, WHERE THOSE GAPS ARE AT. 
          AND ALSO ENABLING PEOPLE TO HOPEFULLY UTILIZE THE SYSTEM MORE BECAUSE IT'S CLOSER TO THEM, IT SPEAKS MORE APPROPRIATELY TO THEM, IT ENGAGES MORE ACCURATELY TO THEM. 
          HOW CAN THE COMMISSION HELP YOU ALL TO DO THOSE THINGS? THAT'S WHERE MY QUESTIONS ARE COMING FROM. 
          THAT'S WHERE IT SOUNDS LIKE MOST OF THE QUESTIONS ARE COMING FROM, FROM THE COMMISSIONERS HERE. 
          UM, ANY OTHER QUESTIONS FROM COMMISSIONERS? I DON'T KNOW IF YOU HAVE A A, A QUESTION OR NOT QUESTION. 
          I HAVE A COMMENT. 
          GO AHEAD, CHAIR. 
          HOLLI, GO AHEAD. 
          UM, I THANK YOU FOR THAT INTERESTING PERSPECTIVE, AND I, I DO THINK IT'S A FINE LINE BETWEEN POLICY AND OPERATIONS AND I, I BELIEVE THAT'S WHAT DR. 
          WA WAS SPEAKING TO. 
          UM, IN THE UNIQUE POSITION THAT THE COMMISSION IS IN, OFTENTIMES THAT'S WHERE THE GAPS ARE. 
          POLICY AND RESOURCE DECISIONS, UH, I'LL USE COVID AS AN EXAMPLE. 
          SHOTS ARMS RELATIVELY EASY, RIGHT? LIKE, AND SO THE BOOTS ON THE GROUND ORGANIZATIONS KNEW THAT WAS, THAT'S WHAT WAS NEEDED, BUT WE ALSO NEEDED TO HAVE POLICY TO HELP ADDRESS THOSE BARRIERS THAT COULDN'T OVER BE OVERCOME BY JUST MORE PEOPLE GIVING MORE SHOTS IN ARMS. UM, AND I, AGAIN, I WANNA ECHO DR. 
          W'S COMMENTS. 
          THIS COMMISSION HAS A REALLY UNIQUE OPPORTUNITY TO FILL THAT GAP. 
          UM, THERE'S ALWAYS A FOCUS ON THE SERVICES BECAUSE IT'S MORE TANGIBLE AND IT'S EASIER TO MEASURE MORE QUICKLY OR MORE IMMEDIATELY. 
          UM, BUT I CAN'T HELP BUT THINK IF WE HAVE SOME REALLY CLEAR POLICY AND RESOURCE DIRECTIONS THAT, OR RECOMMENDATIONS THAT HELP AUGMENT WHAT THE BOOTS ON THE GROUND FOLKS ARE DOING. 
          LIKE, THAT SHOULD BE THE BALANCE, RIGHT? LIKE WE, WE KNOW WHAT, WHAT TO DO, WE KNOW HOW TO DO IT, BUT WHEN WE REACH THAT CEILING OF NOT, EITHER NOT ENOUGH MONEY OR THERE'S LIKE SOMETHING IN THE WAY AT A POLICY LEVEL THAT'S BLOCKING THAT, THAT'S WHERE WE NEED THAT LEVERAGE IN THAT BUY-IN, IN THAT INPUT, IN THAT VOICE. 
          UM, COVID IN THE BLACK COMMUNITY IS STILL A THING, AND WE THREW ALL THE MONEY AND THE PEOPLE IN THE WORLD AT IT, BUT WHAT ARE THE ROOT CAUSES THAT ARE 
          [00:45:02]
AT, AT THE BASE CAUSED BY POLICY DECISIONS AND HOW WE DEVELOP THOSE COMMUNITIES? AND SO THAT'S KIND OF WHERE THE, THE SWEET SPOT IS BETWEEN POLICY AND OPERATIONS, WHERE HOPEFULLY THIS COMMISSION CAN GET TO, BUT YOU KNOW, JUST 2 CENTS OUT OF A QUARTER. 
          AND I ABSOLUTELY, UM, UH, APPRECIATE ALL THOSE SENTIMENTS. 
          I THINK AS CENTRAL HEALTH, AS THE HOSPITAL DISTRICT, UH, DETERMINES HOW HEALTHCARE SERVICES THAT ARE SUPPORTED BY TAXES, UH, AND PROVIDED BY THE HOSPITAL DISTRICT, HOW AND WHERE THOSE ARE PROVIDED TO MEET IDENTIFIED NEEDS ACROSS THE COUNTY, WE, YOU KNOW, ARE, ARE EAGER TO COLLABORATE WITH, UH, THE CITY AND THE COUNTY AND, UH, THE COMMISSION AND SHARE INFORMATION ABOUT DECISIONS THAT, UM, OUR, UH, CEO AND UM, PROFESSIONAL STAFF HAVE PUT FORWARD WITH COMMUNITY INPUT, UH, AND THAT OUR BOARD HAS SUPPORTED AND, UH, APPROVED AS THE GOVERNING BODY OVER THOSE DECISIONS. 
          UM, AND WE AREN'T EAGER TO KEEP COLLABORATING. 
          I THINK, UM, DR. RICE, THIS IDEA OF THERE BEING SOME SORT OF COMMUNITY WIDE, UH, MOONSHOT, SO, YOU KNOW, FOR A PUBLIC HEALTH ISSUE, IT IS NOT ALL ABOUT HEALTHCARE SERVICE DELIVERY. 
          AND I THINK THAT THIS COMMISSION CAN BE VERY INFORMATIVE ON HELPING SUPPORT POLICY DECISIONS AROUND, UM, UM, THINGS LIKE, UM, FOOD ACCESS, HOUSING ACCESS, ACCESS TO ADDITIONAL SUPPORTIVE SERVICES. 
          WHEN YOU LOOK AT THINGS LIKE CARDIOVASCULAR DISEASE AND HYPERTENSION AND, UH, RENAL FAILURE, A LOT OF IT IS RELATED TO PEOPLE EXPERIENCING DIABETES. 
          AND SO HOW, YOU KNOW, YOU LOOK AT THIS FROM A MORE, UH, HOLISTIC PERSPECTIVE AND HOW CAN, UH, SOME OF THESE LARGER, UM, PUBLIC HEALTH POLICY INVESTMENTS AND RESOURCE INVESTMENTS, UH, SUPPORT THE HEALTH OF THE PEOPLE THAT ARE, UM, IN NEED OF NOT JUST BASIC HEALTHCARE SERVICES AND SPECIALTY SERVICES, BUT, UM, YOU KNOW, THAT, UH, POTENTIALLY SOMEWHERE DOWN THE ROAD, 10, 15, 20 YEARS FROM NOW CAN KEEP PEOPLE FROM GETTING TO THE POINT WHERE, YOU KNOW, ONE OF THE THINGS CENTRAL HEALTH IS DOING, THERE'S BEEN SUCH A LACK OF ACCESS TO SPECIALTY CARE IN OUR COMMUNITY FOR SO LONG, UM, THAT THERE'S A LARGE POPULATION, UH, THAT ARE ACUTELY IN NEED OF SERVICES THAT WE ARE HAVING TO FOCUS ON BUILDING OUT NOW IN A SLIGHTLY MORE CENTRALIZED WAY BECAUSE THERE IS A LARGE LACK OF ACCESS OF SERVICES. 
          I THINK WE NEED TO DO THAT ON A PARALLEL TRACK, WORKING WITH, UM, PUBLIC HEALTH TO TRY TO, YOU KNOW, KEEP THE GENERATION OF PEOPLE THAT ARE IN THEIR TWENTIES AND THIRTIES NOW FROM HITTING THAT ACUTE NEED 10, 15 YEARS DOWN THE ROAD. 
          UM, JUST CURIOUS REGARDING THE LAST SLIDE, AND THIS MAY HAVE BEEN SOMETHING THAT'S IN THE FULL REPORT, BUT LOOKING AT THE TOP THREE, UH, AREAS OF CONCERN, AND THEN ALSO THE FACT THAT YOU JUST SAID, YOU KNOW, RELATING BACK TO CARDIOVASCULAR DISEASE IS, IS LOOKING AT DIABETES. 
          DO YOU HAVE ANY DATA ON THE ROOT CAUSE, UH, WITH ALL OF THIS INFORMATION? AND I, WHEN I SAY ROOT CAUSE I TRULY MEAN WHAT IS THE ACTUAL UNDERLYING FACTOR THAT IS LEADING TO THESE PERCENTS PERCENTAGES, AND IS THAT DATA LIKE ACCESSIBLE TO THE COMMISSION? AND I HAVE A SECOND QUESTION, BUT I'LL GO, I'LL LET THAT ONE . 
          UM, THE WHY IS, UH, I BELIEVE WHAT YOU'RE ASKING, AND IF I TRY TO CHANNEL SARITA FOR A MOMENT, UM, THAT IS THE NEXT STEP. 
          AND NO, WE DON'T HAVE ALL THE ANSWERS TO THE WHY YET. 
          UM, AND WHETHER THEY ARE SYSTEMIC WITHIN CERTAIN RACE, ETHNICITIES, CERTAIN LOCATIONS, THAT'S WHY WE BEGAN TRACKING THIS DATA FOUR YEARS AGO, AND WE CONTINUE TO, SO THAT WE CAN START TO MAYBE COME TO SOME OF THOSE, THOSE BETTER INFORMED AS TO ANSWERING THOSE TYPE OF QUESTIONS. 
          UM, I THINK RIGHT NOW IT IS ESSENTIALLY ON A CASE BY CASE BASIS WHEN WE CAN GET PEOPLE INTO THE ACCESS THAT THEY NEED. 
          UM, BUT THEN YES, ASKING IS THERE AREA, IS THERE POPULATIONS WHERE WE COULD HELP INFORM THIS AT THE ROOT LEVEL WOULD BE THAT NEXT STEP. 
          AND I'LL ADD, I MEAN, IF YOU COULD, YOU KNOW, IF WE CAN GET COPIES OF THE DEMOGRAPHIC REPORT FOR THE ENTIRE COMMISSION, I THINK THERE'S SO MUCH INFORMATION AND IN THE LAST PAGES THERE IS ACTUALLY A BREAKDOWN 
          [00:50:01]
OF THE MAJOR, UM, CONDITIONS, UM, PER, UH, RACE AND ETHNICITY AND, UM, ALSO BY THE NINE AREAS. 
          AND I THINK THAT REALLY HELPS US BEGIN TO TRACK, UM, YOU KNOW, AT A MORE GRANULAR LEVEL, LEVEL HOW THESE DISEASES ARE, YOU KNOW, ARE EVERY TWO YEARS, ARE THEY MAINTAINING, ARE THEY GROWING, ARE THEY LESSENING? AND I THINK THAT HELPS US JUST BE BETTER INFORMED ABOUT WHERE TO FOCUS OUR ENERGY AND RESOURCES. 
          LOVE THE QUESTION. 
          UM, SOME OF THE ROOT CAUSES ARE THINGS LIKE TOXIC STRESS THAT'S BROUGHT ON BY POVERTY, UM, BY, UM, BEING, LIVING IN HOUSEHOLDS STRUGGLING TO MAKE ENDS MEET BECAUSE THERE'S LOSS OF JOBS, UM, LACK OF TRANSPORTATION, ALL THOSE NON-MEDICAL DRIVERS OF HEALTH. 
          UM, ALSO THINGS LIKE OBESITY AND TOBACCO USE. 
          AND WE'VE DONE A GREAT JOB OF SMOKING CESSATION IN TOBACCO FREE ZONES IN PUBLIC AREAS, BUT WE STILL HAVE, UM, SMOKING THAT'S OCCURRING IN, UM, CONGREGATE SETTINGS AND APARTMENTS WHERE OUR CHILDREN ARE, UM, SUBJECT TO HAVING ASTHMA EXACERBATION. 
          SO IT'S A GREAT QUESTION. 
          UM, AND THERE'S LARGE, UM, BIG DATA SETS ABOUT IT FROM A NATIONAL PERSPECTIVE, AND I WOULD, I WOULD CAUTION US TO NOT GO DOWN THAT RABBIT TRAIL OF DOING YET ANOTHER STUDY, BUT LET'S START TALKING ABOUT HOW WE CAN MAKE THINGS BETTER. 
          AND PARTICULARLY LOOKING AT TOXIC STRESS AS IT RELATES TO EARLY CHILDHOOD BRAIN DEVELOPMENT AND HOW IMPORTANT IT IS FOR US TO TAKE CARE OF OUR CHILDREN AND HELP OUR PARENTS TAKE CARE OF OUR CHILDREN BY PUTTING POLICIES IN PLACE THAT MAKE IT POSSIBLE FOR THEM TO THRIVE. 
          AND THERE WAS A POINT MADE ABOUT ACCESS, AND EVEN IF THERE IS ACCESS, THERE'S UNDER UTILIZATION. 
          AND SO TO GO TO YOUR POINT ABOUT WHAT IS IT IN THIS REPORT THAT'S, THAT, THAT TO ME IS A QUESTION WE NEED TO TAKE SOME TIME TO LOOK AT BECAUSE THERE ARE EFFORTS BEING MADE TO IMPROVE ACCESS. 
          WHAT'S THE DRIVER THAT'S KEEPING PEOPLE FROM HAVING THAT ACCESS? YOU HAD A SECOND QUESTION? YES, THANK YOU, CHAIR. 
          UH, SHIFTING AWAY FROM CVDI ON SLIDE, I DON'T KNOW, IT SAYS 25 IN OUR BOOK, BUT IT TALKS ABOUT SHIFT IN POVERTY PROJECTIONS AND KEY FINDINGS. 
          UH, DO YOU HAVE ANY OR, OR WHY OR WHAT CHANGED THAT THESE FIVE AREAS ARE, HAVE, HAVE SHIFTED? I THINK THERE'S A LOT OF FACTORS. 
          UH, I THINK COVI, UH, WAS A GAME CHANGER, AS WE ALL KNOW. 
          UM, IT WASN'T JUST THE LOWER INCOME, MIDDLE INCOME BRACKETS MOVING TO THESE SUBURBAN AREAS. 
          UM, THERE REALLY WAS AN EXODUS FROM A LOT OF FOLKS FROM AUSTIN, UM, WHO WANTED BIGGER SPACES, BIGGER HOUSES, THEY WERE WORKING FROM HOME. 
          UM, AUSTIN I THINK IS A, THE INITIAL POINT, YOU KNOW, THIS HAS BECOME, AFFORDABILITY HAS BECOME REGIONAL. 
          UM, SO AGAIN, THAT IS, UH, AS AUSTIN HAS BECOME MORE, MORE DESIRABLE PLACE, THESE PLACES HAVE THESE SUBURB SUBURBS HAVE BECOME MORE DESIRABLE. 
          AND NOW WE'RE TALKING ABOUT EXURBS, WE'RE TALKING ABOUT, UM, YOU KNOW, NORTHERN WILLIAMSON COUNTY, PEOPLE COMMUTING FROM, UM, UH, ALL OVER THE PLACE. 
          YOU KNOW, TESLA IS BUSING PEOPLE IN FROM OTHER COUNTIES. 
          SO I THINK, UH, ESSENTIALLY THE PATTERNS, UH, DISPLACEMENT THAT WE MAY HAVE BEEN TALKING ABOUT IN AUSTIN 10 YEARS AGO ARE NOW AFFECTING THESE SUBURBAN COMMUNITIES AS WELL. 
          UM, AND SO THEY ARE, IT'S NOT TO SAY THERE ISN'T AS MUCH, UH, THERE ISN'T NEED OUT THERE AND THERE AREN'T AREAS OF POVERTY. 
          IT'S JUST THE NUMBERS ARE JUST NOT AS SIGNIFICANT AS THE CENTRAL CORRIDOR. 
          UM, AND TO BE, I THINK TO SOME, AN EARLIER POINT, I THINK PERLA SAID, UM, THERE IS YET TO BE KIND OF THE, UH, THE MOMENTUM OR POLITICAL WILL AND OTHER THAN IN AUSTIN OR THE MONEY TO REALLY SUPPORT A LOT OF THESE ESSENTIAL SERVICES. 
          THANK YOU. 
          SURE. 
          THANK YOU FOR THAT. 
          I HAD THE SAME QUESTION. 
          AND SO THAT LEADS INTO MY NEXT QUESTION ON SLIDE 14. 
          WOULD YOU SAY SIMILAR TRENDS ARE THE REASON 
          [00:55:01]
FOR THE INCREASE THERE? ARE WE SEEING WEALTHIER PEOPLE MOVE OUT OF THOSE AREAS INTO THE SUBURBS AND THAT'S WHY THEY, THESE PERCENTAGES HAVE INCREASED? OR IS IT THAT, I BELIEVE LAST TIME YOU WERE HERE, YOU YOU TOLD ME THAT IT'S ALSO BECAUSE PEOPLE, YOU KNOW, COME FROM POOR FAMILIES AND THEY BECOME ADULTS AND THEY GET THEIR OWN PLACES, AND SO THAT INCREASES, YOU KNOW, PERCENTAGES AS WELL. 
          UM, ANY FEEDBACK ON THAT? I'M SORRY, I YOU'RE SIDE SLIDE 14. 
          SORRY. 
          OKAY. 
          YES. 
          UM, AND JUST SO I UNDERSTAND, YOU'RE ASKING WHY IT INCREASED IN THESE AREAS? MM-HMM, , UM, SO I CAN'T TELL YOU, WE HAVE IDENTIFIED KIND OF TWO AREAS WHERE THE LOW-INCOME RESIDENTS ARE LIVING, AND THAT IS LOW-INCOME, MULTI-FAMILY APARTMENTS THAT CAN BE SUBSIDIZED OR NON-SUBSIDIZED OR MANUFACTURED HOUSING COMMUNITIES. 
          UM, AND I CAN TELL THE AREAS HIGHLIGHTED IN THIS MAP PARTICULARLY HAVE AN ABUNDANCE OF BOTH OF THOSE. 
          UM, NOT A LOT OF SINGLE FAMILY HOMES, NOT AS MUCH AS THERE WERE. 
          UM, SO IT, IT, IT PUTS US, UH, AS A COMMUNITY, AS A COUNTY IN AN INTERESTING POSITION BECAUSE, UM, AS DEVELOPMENT INCREASES, AS THERE'S, YOU KNOW, UH, LAND USE CODES BEING LOOKED AT, HOW DO WE PROTECT THESE AREAS, UM, FROM BEING TORN DOWN, REDEVELOPED INTO SOMETHING DIFFERENT. 
          THANK YOU. 
          THAT'S HELPFUL. 
          AND THEN JUST ONE LAST THING. 
          ONE OF YOUR KEY FINDINGS WAS THAT ACCESS TO CARE CONTINUES TO BE A MAJOR BARRIER REGARDLESS OF PROXIMITY TO CARE. 
          THAT REALLY JUMPS OUT AT ME. 
          UH, SOMETHING I DO IN MY WORK IS TRY TO BRIDGE THAT GAP THERE. 
          UH, FEEDBACK ON THAT. 
          WHY IS, WHY IS PROXIMITY NOT A, A BARRIER, UM, NECESSARILY? YES, SIR. 
          I MEAN, I, I CAN'T SPEAK TO EVERYONE. 
          UM, IN THIRD INDIVIDUAL SITUATIONS. 
          UH, I CAN SAY THAT IF YOU COMMUTE OR IF YOU HAVE ACCESS TO A VEHICLE AND YOU GET AROUND AUSTIN TRAVIS KIND DURING THE DAY, UM, I THINK THERE'S ACCESS IS NOT A MAJOR BARRIER TO GETTING TO, UH, TO A LOT OF OUR LOCATIONS AND CLINICS. 
          UM, THAT BEING SAID, UM, THERE'S OTHER FACTORS I'VE CONSIDERED WHEN I'VE THOUGHT ABOUT THIS. 
          I THINK AMONG OUR LOW INCOME POPULATION, UM, A LOT OF TIMES, UH, HEALTHCARE IS, UH, MAYBE TREATED AS A LUXURY AND IT'S DEALT WITH MAYBE LESS THAN A PREVENTATIVE BASIS AND MORE WHEN IT'S NEEDED. 
          AND, UH, TO MONICA'S POINT, WE'RE ALSO ENROLLING FAMILIES. 
          SO WE MAY BE ENROLLING PEOPLE THAT, UH, UM, ESSENTIALLY ARE YOUNGER AND HEALTHIER AND MAY NOT NEED TO GO TO THE DOCTOR OR FEEL THE NEED TO GO TO THE DOCTOR EVERY YEAR. 
          UM, BUT AGAIN, I I, I, I CAN'T GIVE YOU THE, THE SILVER BULLET ANSWER FOR EVERYONE, BUT, UM, GEOGRAPHICALLY, THIS IS NOT A HUGE COUNTY OR AREA. 
          I MEAN, THERE'S SOME, YOU KNOW, YES, IF YOU LIVE IN A, UM, STEINER RANCH, SOMETHING THAT CAN TAKE A WHILE TO GET TO OTHER PARTS OF THE COUNTRY COUNTY, BUT UP AND DOWN THE I THREE FIVE CORRIDOR, UM, IT'S FAIRLY ACCESSIBLE. 
          THANK YOU. 
          SO, UM, DUE, DUE TO TIME, I WOULD LIKE TO SWITCH FROM DISCUSSION TO, UH, POTENTIAL ENHANCING OUTCOME FROM THIS DISCUSSION, UH, FROM THE COMMISSION. 
          UM, AND I BELIEVE EVERYBODY FROM THE COMMISSION, UH, AGREES WITH THE SENTIMENT THAT WE SHOULD NOT GET INTO THE WEEDS, UH, AND THAT IT SHOULD BE POLICY FOCUSED TO ENHANCE WHAT Y'ALL TRYING TO DO. 
          UH, I THINK ONE AREA OF ASK, ESPECIALLY FOR ME IS HOW DO WE SUITABLY COME UP WITH THE RIGHT POLICIES WHILE RESPECTFULLY GETTING INTO THE WEEDS TO UNDERSTAND WHERE THOSE POLICIES IN THE POLICIES WITH BEST IMPACT. 
          UM, AND I WOULD LIKE TO BE ABLE TO GO FROM HERE TO KIND OF ALMOST LOOKING IN A QUAD ASPECT, THE NORTHEAST, SOUTHWEST ASPECT OF THE COUNTY AS FAR AS JUST TRYING TO FIGURE OUT IS THERE A BLANKET POLICY OR THERE THERE, IS IT, DOES IT NEED TO BE MORE FOCUS AS FAR AS RESOURCES IN THE EAST NEED TO BE MORE THIS OR, OR WE'RE ASKING THAT THIS HAPPENS AS A POLICY MORE FOR THE EAST VERSUS MORE FOR THE WEST VERSUS MORE FROM THE NORTH. 
          AGAIN, OPEN, BUT I SUITABLY COULD NOT COME UP WITH A POLICY RECOMMENDATION BECAUSE I STILL DON'T KNOW WHAT, BASED OFF OF THIS, WHAT ARE SOME OF THE TANGIBLES THAT ARE CAUSING THIS REPORT TO HAPPEN, THAT POLICY-WISE, YOU WOULD 
          [01:00:01]
NEED A CHANGE FROM THE COMMISSIONER'S COURT OR THE CITY COUNCIL TO THEN BE ABLE TO MITIGATE OR ACT SUITABLY TO THIS REPORT. 
          ANY ANY THOUGHTS REGARDING THAT? IT MIGHT BE GOOD FOR US TO LOOK AT THE CHA, UM, BECAUSE IN THAT THEY'RE GONNA LOOK AT THE NON-MEDICAL DETERMINANTS, LIKE MAYBE IT'S SIDEWALKS, YOU KNOW, MAYBE IT'S BETTER CHANGES IN BEST ROUTING. 
          UM, I DON'T KNOW. 
          WE, WE WON'T KNOW UNTIL WE LOOK. 
          I DON'T KNOW. 
          WHAT DO YOU THINK? DIRECTOR STIR? I, SORRY. 
          SO DEEP IN THOUGHT, UM, I CAN'T SPEAK . 
          I THINK THAT THE, THE THINGS THAT THE COMMISSION CAN MOST DIRECTLY IMPACT, AND I'LL JUST SPEAK FOR THE CITY SIDE, IS, YOU KNOW, WHAT, WHAT RECOMMENDATIONS COME UP THROUGH THE BUDGET PROCESS. 
          AND SO IF, IF THERE'S A PARTICULAR AREA OF FOCUS IDENTIFIED FROM THIS CONVERSATION, YOU COULD LOOK AT WHERE'S THE CITY FUNDING SERVICES IN THOSE AREAS, AND IS IT, IS THERE A NEED FOR AN INCREASE IN THOSE AREAS? THAT'S NUMBER ONE. 
          YOU COULD LOOK AT WHAT PUBLIC HEALTH IS DOING IN THOSE AREAS, AND IF THERE'S A NEED FOR LIKE, RESOURCE SUPPORT AND MAKE A RECOMMENDATION THAT WAY, LIKE IF WE'RE TALKING ABOUT THIS FISCAL YEAR AND DOING SOMETHING IMMEDIATELY, THE BUDGET PROCESSES UPON US, UM, COMMISSIONS HAVE THE OPPORTUNITY TO MAKE RECOMMENDATIONS. 
          DON'T QUOTE ME ON THIS PROBABLY UP AND THROUGH MARCH THAT ARE THEN VETTED BY COUNCIL, BUT I'LL GET THE THE TIMELINE FOR YOU SO THAT YOU'LL UNDERSTAND HOW YOU CAN PLAY INTO THAT, THAT PROCESS. 
          YOU KNOW, I'M, I'M TRYING TO THINK OF THE THINGS THAT THE COMMISSION CAN MOST DIRECTLY IMPACT. 
          IT WOULD BE HARD FOR YOU TO DIRECT THE WORK OF OTHER NONPROFIT ORGANIZATIONS, UM, THAT DON'T EITHER HAVE A FUNDING CONNECTION TO THE CITY OR SOMETHING LIKE THAT. 
          SO THAT'S KIND OF WHERE MY, MY MIND IS GOING. 
          I DON'T KNOW, I, I, I'LL HAVE TO THINK ABOUT IT A LITTLE BIT MORE, BUT YOU'RE RIGHT, YOU PROBABLY DON'T HAVE ENOUGH INFORMATION AT THIS STAGE TO MAKE A CLEAR POLICY RECOMMENDATION. 
          UM, BUT MAYBE BY THE TIME THE BUDGET COMES AROUND, YOU COULD MAKE SOME CLEAR BUDGET RECOMMENDATIONS. 
          YEAH. 
          OR IT COULD BE SOMETHING AS SIMPLE. 
          IT SOUNDS SIMPLE ANYWAY, AS NO SMOKING IN APARTMENT BUILDINGS. 
          , SORRY FOR LAUGHING. 
          I KNOW. 
          I'M GONNA TURN MY MIC OFF. 
          I, I'M NOT SURE IF THIS IS SOMETHING THAT WE HAVE ACCESS TO OR IT'S BEEN CREATED, BUT ARE THERE ANY GAP ANALYSIS THAT HAVE BEEN DONE ACROSS ALL OF THE DIFFERENT ASSESSMENTS? SO THERE'S WHAT CENTRAL HEALTH IS DOING, THERE'S WHAT THE CITY'S DOING, THERE'S WHAT THE COUNTY IS DOING, BUT HAS THERE BEEN A GAP ANALYSIS TO SAY, YOU KNOW, HERE ARE THE AREAS THAT WE ARE, WE ALL AREN'T DOING THAT WELL IN. 
          AND MAYBE THAT COULD BE SOMETHING THAT THE COMMISSION COULD LOOK AT AND SAY, OH, HERE'S A RECOMMENDATION THAT WE COULD MAKE REGARDING POLICY. 
          HERE'S A RECOMMENDATION WE COULD MAKE REGARDING BUDGET. 
          HERE'S A RECOMMENDATION WE COULD MAKE REGARDING COLLABORATIVE EFFORTS OF JUST COMMUNICATION. 
          UM, SO I DON'T KNOW, I DON'T OBVIOUSLY PLEASE NOT LOOKING TO HAVE PEOPLE DO MORE WORK TO CREATE ANOTHER THING, BUT IF THAT IS SOMETHING THAT DOES EXIST OR IS EASILY ACCESSIBLE, WOULD THAT BE A POTENTIAL PLACE THAT WE COULD START TO SAY, HERE'S OUR SUGGESTIONS AND RECOMMENDATIONS. 
          SO I GUESS THE QUESTION WOULD BE IS ONE, DOES IT EXIST? IF, IF IT DOESN'T, THEN I WOULD PROBABLY RECOMMEND COULD WE TAP INTO LIKE A C, C OR UT OR SOME, OR, OR DELL MEDICAL OR IT IS THE CHILD. 
          OKAY. 
          SO WE DO HAVE, SO CAN WE PUT THAT ON FOR NEXT AGENDA? ? UH, UH, DOES ANYBODY DISAGREE WITH THAT BEING OKAY? YOU'RE SAYING THE COMMUNITY HEALTH ASSESSMENT, THE CHOP? MM-HMM. 
          . 
          CHA MM-HMM. 
           THE CHOP. 
          YEP. 
          AND THEN IT ALMOST SOUNDS BASED OFF OF WHAT YOU'RE SAYING, UH, IS THAT WE PROBABLY ALSO NEED TO HAVE A PRESENTATION ON THE BUDGET OR RECOMMENDATIONS FROM YOU ALL ON THE BUDGET FOR NEXT MONTH AS WELL, OR CA OR, OR WOULD YOU PERHAPS THE PROCESS THAT WE CAN SHARE WITH YOU, THE PROCESS. 
           SOUNDS GOOD. 
          ANYBODY DISAGREE WITH THAT? UM, IT SOUNDS LIKE THOSE ARE PROBABLY THE TWO MOST PERTINENT THINGS FOR OUR NEXT MEETING CHAIR. 
          CAN I ASK FOR ONE? OP. 
          OP, OKAY. 
          SO THE CHA IS, IT'S LENGTHY, UH, AT BEST. 
          SO WOULD THERE, I KNOW THERE'S GONNA BE SOME BIAS AROUND THIS, BUT IS THERE ANY WAY THAT MAYBE WE COULD HAVE SOME PAGE OP, UH, LIKE WE SHOULD CHECK THIS SECTION OF THE CHA OR WOULD WE NEED TO READ LIKE A 200 PAGE DOCUMENT IN ORDER TO BE PREPARED? I CAN TALK TO THE STAFF PERSON WHO IS IN CHARGE OF THAT PROCESS AND ASK HER TO PREPARE AN EXECUTIVE SUMMARY TO POINT OUT THE KEY. 
          YEAH. 
          [01:05:02]
UH, ANY OTHER QUESTIONS FOR OUR PRESENTERS? APPRECIATE Y'ALL COMING OUT AND BEARING WITH THE QUESTIONS I HAVE. 
          GO AHEAD. 
          ONE MORE THAT, UM, I THINK THIS HAS BEEN A GREAT DISCUSSION, SO I DON'T WANNA SPOIL IT WITH SOMETHING AT THE END HERE, WHICH MIGHT NOT BE SO GREAT. 
          SO THEN DON'T DO IT. 
          I'LL TAKE MY CHANCE. 
          , ONE OF THE THINGS I'VE, I'VE THOUGHT ABOUT AND, YOU KNOW, I'M IN THE HOSPITAL WORLD, SO WE HAVE, WE CONTINUOUSLY TRY TO, ARE FORCED TO OR INVITED TO MEASURE QUALITY, MEASURE EFFECTIVENESS AND THINGS. 
          AND SO I WONDERED FOR CENTRAL HEALTH AND FOR EVERY ORGANIZATION, CITY AND, AND COUNTY, ET CETERA, YOU KNOW, UM, IT WHAT ARE THE MEASURES OF SUCCESS THAT YOU USE? IT MIGHT BE LIKE, YOU KNOW, WHAT PERCENTAGE OF ALL PATIENTS GET A HYPERTENSION SCREENING ONCE A YEAR OR SOMETHING? I'M JUST MAKING IT UP. 
          I HAVE NO IDEA WHAT THE METRICS ARE, BUT, AND, AND THAT I DON'T LIKE THAT METRIC NECESSARILY BECAUSE THAT'S JUST A, A NUMERATOR OR A DENOMINATOR. 
          AND WHAT I'M REALLY INTERESTED IN IS HOW EFFECTIVE ARE WE IN DOING WHATEVER WE'RE TRYING TO DO AT, AT, AT, UM, AT CENTRAL HEALTH AND HOW DO WE COMPARE WITH OTHER CITIES THAT HAVE A SIMILAR STRUCTURE? ARE WE DOING BETTER OR WORSE OR THE SAME? AND WHO'S, WHO WONDERS ABOUT THAT, IS CONCERNED ABOUT THAT? OH ME ALL THE TIME. 
          OH GOOD. 
          OH GOOD. 
          SO YEAH, AND SERITA, WHO, I'M SORRY, UH, THE VICE PRESIDENT OF QUALITY ANALYTICS AND PERFORMANCE IMPROVEMENT, UNFORTUNATELY HAS THE POST, UH, HOLIDAY CRUD AND IS, THAT'S A TECHNICAL TERM. 
          THANK YOU. 
          LUCKILY NOT. 
          YEAH. 
          THIS IS WHY I'M NOT A CLINICIAN , YOU KNOW, BUT, UM, AND WE'RE GLAD THAT SHE IS, YOU KNOW, STAYING HOME TODAY. 
          ALTHOUGH IT'S UNFORTUNATE THAT SHE'S NOT HERE. 
          WE PRESENTED TO THE CENTRAL HEALTH BOARD ON ABOUT 20 KEY PERFORMANCE INDICATORS THAT WE ARE GOING TO BE MEASURING OVER. 
          UM, YOU KNOW, THE NEXT YEAR, TWO YEARS, WE'RE GONNA BE, BRING THAT BACK IN FEBRUARY OR MARCH TO, UH, MEASURE HOW WE'RE DOING ON IMPLEMENTING THE, UH, HEALTHCARE EQUITY IMPLEMENTATION PLAN THAT, UH, WE PRESENTED ON LAST TIME. 
          SO WE'VE SET UP, YOU KNOW, THIS PLAN TO BUILD OUT ADDITIONAL ACCESS AND SERVICES, ADDITIONAL QUALITY. 
          UM, IT, YOU KNOW, A LOT OF IT IS LOOKING AT, UM, HOW MUCH ACCESS BY LOCATION. 
          SO, YOU KNOW, TO YOUR POINT, UH, UH, CHAIR WALLACE REALLY MEASURING HOW MANY, UH, HOW MANY, UM, ROOMS ARE UP AND RUNNING IN THE CLINIC FACILITIES. 
          ARE YOU KEEPING THEM? ARE YOU PEOPLE SHOWING UP FOR APPOINTMENTS, THINGS LIKE THAT. 
          UM, LET ME INTERRUPT. 
          YEAH, I, I LOVE ALL THAT AND I'M GONNA CALL THOSE ABSOLUTELY. 
          PROCESS METRICS. 
          AND ONE OF THE THINGS WE TRY TO ALSO GET TO IS LIKE, YEP, OUTCOME METRICS. 
          DO WE HAVE ABSOLUTELY WE DIABETICS THAT HAVE ED VISITS OR FEWER MORTALITIES FROM, YOU KNOW, HEART DISEASE IN OUR POPULATION OR SOMETHING. 
          SO I WAS WONDERING IF THOSE, WE HAVE FOUR OF THOSE. 
          I DON'T KNOW WHAT THEY ARE TOP WELL ANYWAY, TOP OF MY HEAD, BUT I DO KNOW THAT WE HAVE THOSE. 
          UM, AND WE ALSO ARE, YOU KNOW, KIND OF ALWAYS, UM, LOOKING, BUT AT LEAST EVERY FIVE YEARS AT HOW WE BENCHMARK TO OTHER HOSPITAL DISTRICTS. 
          AND ONE OF THE THINGS WHEN I TALK ABOUT THAT, ARE WE MEETING, UH, 50% OR 70% THAT IS BENCHMARKS AGAINST BENCHMARKED BOTH AGAINST WHAT YOU WOULD EXPECT FROM OTHER HOSPITAL DISTRICTS IN THE STATE OF TEXAS AND THEN OTHER SAFETY NET HOSPITAL DISTRICTS. 
          AND MY POINT THERE IS NOT TO SAY THAT WE'RE GONNA GET TOO FAR INTO THE WEEDS, BUT IT SEEMS LIKE TO ME IN THE WAY THAT WOULD BE INTERESTING FOR US TO KNOW KIND OF HOW WE COMPARE AND WHAT WE THINK THE OUTCOMES MEASURES ARE SO WE CAN DISCERN IF THE COMMUNITY HEALTH NEEDLE IS MOVING IN THAT DIRECTION OR THAT DIRECTION. 
          YEAH. 
          DOES THAT MAKE SENSE? IS THAT NO, DEFINITELY. 
          AND I APPRECIATE YOU BRINGING UP THE METRICS PIECE AND I WOULD PROBABLY SAY IF IT'S SAFE TO SAY THAT WE'RE PROBABLY MORE, UH, OUTCOME METRICS ORIENTED, UH, WITH A LOT OF THE CONVERSATIONS THAT HAVE BEEN HAPPENING, NOT JUST WHAT IS OCCURRING AND, AND WHAT THINGS LOOK LIKE, BUT IS THE OUTCOME ACTUALLY IMPROVING? AND IF NOT, THEN WORKING BACKWARDS TO FIGURE OUT WHAT NEEDS TO BE MODIFIED OR CHANGED. 
          AND AS KIND OF ALREADY STATED, WHERE DOES IT NEED TO BE MODIFIED FROM A POLICY STANDPOINT BECAUSE IT'S NOT WORKING AT THE, AT THE, UH, IN THE WEEDS STANDPOINT, AND I THINK YOU GUYS REALLY LOOKING AT THE COMMISSION AT THINGS LIKE THE, THE CHA AND THE CHIP. 
          CENTRAL HEALTH IS ONLY TASKED WITH AND ONLY AUTHORIZED TO PROVIDE SERVICES TO PEOPLE THAT ARE LIVING WITH LOW INCOMES IN TRAVIS COUNTY. 
          UH, WE ARE NOT, UH, AUTHORIZED TO PROVIDE SERVICES FOR EVERYONE OR TO LOOK AT, UH, THESE HIGHER LEVEL, UM, OUTCOME MEASURES ACROSS THE COUNTY. 
          IF YOU LOOK IN A LOT OF THESE, UM, AREAS OF THE COUNTY, IT'S NOT THAT THERE'S NOT NEED, IT'S NOT THAT THERE'S NOT DISPARITIES, BUT IF THERE ARE DISPARITIES AMONG PEOPLE THAT HAVE INCOMES THAT ARE HIGHER THAN 200% OF THE FEDERAL POVERTY LEVEL, THEN THAT'S NOT SOMETHING THAT CENTRAL HEALTH IS GONNA BE, UM, REALLY, REALLY FOCUSED ON. 
          [01:10:01]
AND SO I THINK ALSO, YOU KNOW, LOOKING AND, AND YOU KNOW, WE FULLY PARTICIPATE IN THE CHA AND THE CHIP, UM, YOU KNOW, BUT WE ARE NOT, UH, ALLOWED TO, IT'S, IT'S NOT OUR MISSION, RIGHT. 
          TO MEET EVERYONE'S NEEDS. 
          NO, I APPRECIATE THAT SUMMARY. 
          UM, ANY LAST QUESTIONS BEFORE GOING TO ADJOURNMENT? I THINK WE HAD THE CONSENSUS OF THE CHILD SHIP AND UH, A PROCESS REVIEW FOR THE BUDGET FOR  FOR NEXT MEETING. 
          UH, ANY QUESTIONS? ANY, ANY QUESTIONS FROM OUR COMMISSIONER ON THE, ON THE, ON THE STREAM? NO, THANK YOU FOR ASKING . 
          ALRIGHT, SOUNDS GOOD. 
          I'LL CALL THIS MEETING ADJOURNED AT THREE 50. 
          JUST TO CLARIFY ON THE PROCESS, DO YOU WANT THAT FOR ALL THREE AGENCIES OR JUST AUSTIN PUBLIC HEALTH? ALL AGENCIES. 
          OKAY. 
          UM, AND I DON'T THINK YOU GUYS HAVE ANY, OH, WAIT, HOLD ON. 
          WHAT, WHAT CENTRAL HEALTH? SORRY. 
          JUST OKAY. 
          CITY. 
          OKAY, GOT IT. 
          DEFAULT TO, UH, THE WISE COUNCIL OVER HERE, . 
          ALL RIGHT. 
          I CALL THIS MEETING ADJOURNED AT NOW. 
          3 51. 
          THANK YOU ALL.
* This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting.