 It's great to see the turnout here today, and I think that it's a good community health indicator of community engagement in what we're up to. I just finished my 17th year at San Antonio, and just a one minute reflection on how far we've come. My very first day in clinic in April of 1997 was in the Well Child Clinic. And after I had seen about the fourth or fifth kid in a row with a mouth full of metal teeth, which I had been in a lot of poor clinics of, mainly the Northeast where I was from, I had to leave the exam and go and find one of my colleagues and say, what is it with San Antonio and all these kids with mouths that look like James Bond villains? And they said, no fluoride in the water. And I said, oh, okay, now I get it. And so the fluoride quickly followed and started to solve some of that problem of the three-year-old with mouths full of metal teeth. But it was a great example of exactly what Charles was talking about, was the power of public policy and social determinants and doing things at a community level, rather than relying on people to do really simple things like fluoride one by one where parents have to go and buy drops instead of just being in the water. So we have equivalents of just being in the water for healthy food systems and healthy public spaces that allow people to be active in about 30 other policy initiatives that are on the road to enacting here in San Antonio. So it's been a really great trajectory. And I think the tendency of this morning reflects the path. So my task right now is to introduce Mr. Richard Perez, who's the president and CEO of the San Antonio Chamber of Commerce. He is homegrown, grew up in San Antonio, a product of the South San Antonio schools. He hasn't had a really succession of very responsible jobs, including being assisted to the city manager of Laredo and the Clinton administration that he was special assistant to the deputy secretary of housing and urban development, which is, for some reason, I'm thinking that's an organization we've heard a lot about recently. I can't remember why. He worked in the family business after that for several years, and then he was elected to represent the city council district 4. And following that has been now the leader of the San Antonio Chamber where he's led many initiatives, including Riverwalk Extension, a lot of business expansions of Parks and Library initiatives, PK for SA, Water Projects, and many, many others. He serves on a lot of local boards, and I don't want to take any more of this time because he has a very long bio, so I'm very pleased to welcome Mr. Perez. You all know this, but as the head of the Chamber of Commerce, the San Antonio Chamber of Commerce, of course, business and industry is what we're all about, and so I want to just talk a little bit about the industry itself. As you all know, one of every six people that work in San Antonio, Texas, work in the healthcare and biosciences industry. One in every six of you all are a special group of people, and you all, in fact, are part of the largest economic driver in San Antonio. Approximately $29 billion of economic impact on this community every single year, so the things that you all are doing to help people stay well and promote healthy lifestyles are very, very important, but it also includes scientists, it includes medical device development, research, all the doctors and technicians, so you put all that together, and it's about a $29 billion economic impact on our, I want to say that healthcare and biosciences industry is more than just jobs, and it can impact the economic impact on our work. We're here to talk about how this industry sector works with all other industries to build a healthier and stronger San Antonio. It's really about healthier people. I believe businesses must take the lead in our city's health initiative because our business leaders can have the most powerful impact on our entire community if we simply make it easier for our employees and our customers to be healthy, and we'll talk a little bit about that. Let me start by now talking a little bit about, I talked about how important healthcare biosciences, let's talk about some of the things that you all live every single day, some of the not so good numbers. As you all know, San Antonio's been named the second most obese city in the country by the Centers for Disease Control and Prevention with a rate of over 35%. It's worth noting, however, that we recently dropped that rate to 28.5%. In a recent survey by Gallup, San Antonio was ranked the second-fattest city in the country. San Antonio's rate for diabetes is 14% higher than both the state of Texas average at 10% and the national average at 90%. While the community has seen steep declines, the Bear County teen birth rate was still 46% higher than the national rate at the end of 2012. And in 2012, teen childbearing was estimated to cost nearly $60 million in Bear County alone. The rate of STDs in our community remains over two times the Texas average and over three times the national average. And in Bear County alone, over 260,000 people continue to struggle to get adequate nutrition. So why is health and wellness good for business? Well, a recent study by Iran, a non-profit research organization, charted the successful savings of companies that help employees manage chronic illness through health and wellness programs. In their study, companies saved nearly $4 for every $1 invested in health and wellness programs. Research is currently not an agreement on the true return on investment of everyday wellness programs, although employer studies and interviews have shown that these programs increase morale and positive production for employees. Companies will be able to increase incentives for employees who participate in workplace wellness programs as a result of the Affordable Care Act. And with an estimated 63% of businesses currently offering these types of programs, the terms of the ACA workplace wellness provisions is a hot topic with many community and businesses all across the country. So let's talk a little bit about how health and wellness is good for economic development. While the San Antonio continues to compete on a global scale to attract business and talent for our community, we are faced with the challenge to become a healthier, more transient and more connected city to cater to the needs and desires of young professionals. That is a challenge that we still have as a community, attracting young professionals to our community. If you look at Forbes' recent report of the 10 best cities for young professionals, you'll see communities such as San Francisco, Washington D.C., Boston, Austin, Denver, and others. All of these cities feature brands, their own brand, advertising for their city, a healthy, energetic, walk-a-vote, livable community. That's what they're all about. That's how they're attracting all this young talent. If you refer back to some of the lists I mentioned a little while ago where San Antonio ranks highly in unfavorable categories, the cities I just named often are significant competitors. They rank much, much lower than us. So that's where our challenge is, right? The perception and the reality of where we're at in comparison to all these other cities that we're competing with on a daily basis to bring industry and business. For example, Washington D.C., Denver, Boston, and San Diego all boast spots on Forbes' latest Healthiest Cities in America report. And it's no coincidence that these cities also rank as top destinations for talented workers across the country. As San Antonio continues to develop its urban core, and as we track initiatives such as the Mayor's Fitness Council and the SA 2020 goals, we are definitely seeing progress, but there is more that we can do together. So let's talk a little bit about what businesses can do and what businesses are doing. You know, your workplace may be the only positive role model for employees that has an opportunity to change habits. You know, I'm a Hispanic, a Mexican American, and I don't remember a single time at home, and this is no slide on my parents, but we ever talked about healthy foods. We just went to eat, my folks served food, and we ate it, whatever was there. Now, we always had an abundance of fruit and vegetables, so that was nice, but we all know that not all families have that. And so businesses are increasingly becoming the place for employees to learn about wellness, healthy food, and fitness. So I'm going to tell you a little story. At the Chamber, I have a staff member at the Chamber. By the way, there's 26 folks that work with me at the Chamber of Commerce. And I have a staff member that started working at the Chamber at the age of 16 years old. She started as an intern in our IT shop, and she's a fantastic, fantastic employee and just a lovely person. But when she came to the Chamber, it was pretty clear that she was suffering from several health issues. She was obese, she didn't get any exercise, she had no exercise in fact. She was a young mother, so she's a fantastic employee, but clearly she needed some help. And so I understood right away that the habits that she had growing up were habits that she learned at home. That's where she found all these things out. And so three years ago, we began a wellness program at the Chamber. The wellness program consisted of folks coming in to talk to myself about dieting, healthy snacks, choices during the day, different opportunities for exercise, low impact, medium impact, high impact. We did walking, we did jogging, we did Pilates, yoga, believe me, we did it all. And because we were trying to find the things that people liked the most. We didn't want to be one flavor for all, but we wanted to show that there's many different opportunities for people to begin a healthy lifestyle. So we began three years ago and this individual really got involved. And all of us started off very slowly, right? You don't want to put shorts on it for her. So it's a little embarrassing, but we're a family, right? That's her second family of work. And so we all got used to it and began to attend these classes regularly. And we did it in the afternoon and sometimes we did it over lunch. And everybody brought a healthy lunch. The idea was to bring a healthy lunch so that we could kind of show each other what we're doing and work off each other and play off each other. So she began to, again, attend regularly, began to exercise. And I'm happy to report that after about two and a half years, after really working very, very hard, this individual lost 80 pounds. She has, for the last two years, run in the rock and roll marathon and completed the marathon both years in a row. And right now she's training for a triathlon. Clearly, the ability that I had as CEO and to encourage all of my employees had a very direct and dramatic impact on this individual. And I can tell you we're all very proud of her. If you see a picture of her three years ago and what she is today, you would not believe it's the same person. Now she's taken that she's got a son. She's taken that home to her son. And her son now eats healthy snacks and is involved in sports. And so, again, my point is that at the office, the ability to impact people's choices and things that they do at home is very, very real. And so that's why I think that businesses have such an important role to play. The workplace is key. So this program didn't just transform this one employee, although her example is very, very strong. We now have an ongoing health wellness program at the office that many, many of us participate. We come in and out depending on the workload. But at minimum, we all go to these visits and talk and are involved in our wellness. And in fact, we now have cut out breakfast tacos at our offices in the morning. Sort of, sort of, sort of. That's a tough one. But so we're still moving to try to do that. But my point is that, and this program, by the way, is a program that was offered by the Medical Foundation's wellness program. It was a free program. They came to us and said, hey, we want to provide this free program to all employees, employers in San Antonio. Can you help us promote it? I said, oh, yeah. Why don't we start at the chamber? And it's been a fabulous success. And so my point is that there are programs out there, programs that you all deal with on a daily basis that are helping businesses or healthy employees. And they're carrying that home. And they're carrying that to their church. They're taking that to their children's schools. They're taking that to the PTA needs. And that's why businesses and the ability of business to affect people's lives is so important. But you have to have leadership from the top. And so we have other community partners like AGB, USAA, Valero. They have very, very well-defined programs that are very successful as well. But it's the smaller medium to small businesses like the chamber like not-for-profits that need all the help that they can get. And I can tell you that the Welles Coalition is there, ready to help. And we're happy to provide you with the information that we can. So in closing, let me thank you all for the fantastic work that you all are doing. The help collaborative is an amazing opportunity for us to know where we're at today and know where we want to go tomorrow. And so I'm very pleased to be a part of this morning's opening. I thank you for the opportunity to be here. And together, we'll continue to make San Antonio a better, healthier city. Thank you very much. Caballos San Antonio has been as the Secretary-Treasurer of the Public Caballos as the Chief Executive Officer of the San Antonio Hispanic Chamber of Commerce, which is America's first Hispanic business organization. It was founded in this role. He provides directional small business issues, international trade efforts, economic research, leadership development, education expansion, small business advocacy. His extensive background in economic development has uniquely prepared him for this role. He has served as the Director of Economic Development for the City of San Antonio during an unprecedented period of recruiting to Toyota Motors Manufacturing, Maximum, Microsoft, and I'm going to retain Rackspace, DPT Labs, and several others. He's also served as the Director of Research and Economic Development for the University of Texas Health Science Center, where he helped secure needed funds for the expansion of the Federal Arts and Research Center in the South Texas Medical Center. While I'm proud and proud of Levi Strauss, the Levi Strauss Foundation in Texas, Mexico, and Latin American region, as senior manager for the world, he's even owned his own communication company and advised companies such as AG&T, AG&T, and Maryland. He's also even taught economic development at the University of Texas. He's even had a role in public affairs serving as the campaign manager for Bayer County Judge Nelson Wolfe when he was elected Mayor of San Antonio. He's earned a Master of Public Administration degree from St. Mary's in San Antonio. He's a distinguished alumnus. It is my pleasure to welcome him here with us. As I look out, I see many familiar faces, many friends. Your work is powerful, and we at the Hispanic Chamber see that the best way to address healthcare issues is through education. As you all know, if you have an educated patient, if you have an entrepreneur that has the ability to have the key to open doors for their business or their employees to create wealth in their companies, that makes them people that can address their own challenges, their own employees' needs, and have the information to address many of the goals in your chip. We can't just measure goals. We need to find a way to improve and meet those challenges. And I wanted to share with you a few words about the work that we're doing to partner with you. A few years ago, we made an economic impact study on the bioscience and healthcare industry and as my great friend and colleague, Richard Perez, pointed out, one out of six people in San Antonio are employed in the bioscience and healthcare industry. As you all heard, I worked at the Health Science Center for a couple of years doing research in economic development and helping raise funds for the mark for Dr. Cigaroa and Dr. Brian Herman and the team over there. But it's very clear to me that if you look at San Antonio's history, it's a city that's almost 300 years old. But we didn't get our first graduating class from a medical school in San Antonio until 1970. And the class was a class of 20 people. And now, 44 years later, in that trajectory of 300 years of economic history, it is now the largest economic generator in our community. So this city is definitely on the upswing in the short time that we've had an institution like the UT Health Science Center located here in San Antonio. It's transformed your industry and many of you are individuals that were trained either at the medical school, the nursing school, or the School of Applied Health. But one of the things that, as I look out at the audience, I see that most of you all are women and our analysis a few years ago of the bioscience healthcare industry and the study also looked at other industries. And we formed about six years ago after I left the city to do economic development for the chamber, an institute called the Sa'ed Institute. You all know in Spanish Sa'ed stands for knowledge. But it actually stands also Strategic Alliance for Business and Economic Research. It's an acronym we partner with Dr. Stephen Evans at St. Mary's University. Who was my chief economist at the city when we were recruiting companies to San Antonio. And his analysis showed something very striking. He said, Amido, there are more women in the bioscience and healthcare industry, employed in the bioscience and healthcare industry than in any other industry. I said, well, that's great news, Steve, but thank you for that data point. And then he goes, but there's another industry that's the real estate and construction industry. And in that industry, more men are employed in that industry per capita than in any other industry. And I said, well, that's great to know, Steve. Anything else you need to tell me? He goes, well, it gets even better. I said, okay, this is an economist really trying to make an impact in the people. He goes, the healthcare and bioscience industry, not only are there more women in that industry, but it's the industry with very little turnover. These people, when they get a job, they keep it. And they're dedicated. And average wage for people in bioscience and healthcare in San Antonio, the largest industry, as Richard said, is better on average than other industries. So you're in an industry that's extremely powerful. It's an industry that generates great wealth in our community in addition to wellness. I said, tell me again about that construction real estate industry, Steve. He goes, well, it's mainly men. And the turnover rate is very high. So he goes, they don't keep their jobs as long as the people in the bioscience and the healthcare industry. And the average wage is not as strong as the bioscience and healthcare industry. So I said, so we tried to figure out what's the summary of this analysis? Well, we figured out, now we figured out why men marry women. Because women can keep their jobs and they make more money than men in the real estate and construction industry. And so I tell you that story because that's the type of data that is showing San Antonio's need to have a diverse economy. We need all industries, information security, information technology, aerospace, of course, bioscience, our tourism industry is great. Average may not be, wage may not be as high, but these are great entry level jobs. A lot of our young people get their first job working at a restaurant or at a hotel. And they graduate to bioscience and healthcare. So I'm very excited to be here today because I love what you all bring to our community. And let me share very briefly what we are doing at the Hispanic Chamber. You know, I worked at the Health Science Center a couple of years, and I can tell you that for me it was a blessing to see the work, how you alleviate pain in families, how you address healthcare disparities in our community. I worked for the Levi Strauss Foundation for six and a half years. And I was very fortunate to provide AIDS education and prevention grants in communities where we had a business presence focused on Latin America. I got to work from San Antonio, but I got to go into the barrio in Chinatown in Sao Paulo, Brazil. I got to go to Santiago Dominican Republic to do an audit of a contractor and provide grants to nonprofits in those communities. So I learned about really some amazing things that are needed in our community, and it gets back to education. And treating problems is not often the way we address them. In fact, one of our grants to a nonprofit in Mexico City was to a nonprofit that had been formed by working women in the inner city. They were prostitutes. They formed their own nonprofit to raise funds and grants for their needs. And the grant that the Levi Strauss Foundation provided was to provide condoms to women who had no access to condoms to address chlamydia and STDs, one of your goals here. And so we need to look at healthcare in a very fundamental and a very practical way. And it's not always the way we may think we should address the problem. Sometimes you address it by giving people the tools that they need to prevent the spread of disease. We all saw this week that we sent 1,000 National Guardsmen to the border to deal with the 70-year-old world and 51,000 other young people are here to try to get access to that American dream to get healthcare and to find their parents. I don't know that that's a very practical way to address the human problem that we as Americans need to address. So we need to expand Medicaid. We're foregoing billions of dollars of economic impact because of the opinion, again, of people in Austin that don't represent us. That's a tremendous lost economic impact. You heard from many earlier representatives that 40% of South Texas do not have access to healthcare. That's unacceptable. And oftentimes people trying to do away with the Affordable Care Act are people that have access to healthcare. And so we need to treat each other as neighbors, as family, as friends. And at the Hispanic Chamber we have taken a very strong position on these issues, on immigration reform, on Medicaid expansion, the Affordable Care Act resolution, is the law of the land and rather than continue to beat it up, let's make it work. And so again, it gets back to being fundamental and practical. We talk about access to healthcare but if people don't have cognitive skills or basic access to, you know, math and algebra, we were the only chamber in San Antonio that supported Algebra 2 being a requirement in all schools in Texas because if you take that away that right from a young person who doesn't know any better in high school, if they get popped out they're not going to get the fundamental and practical skills that they need to make wise decisions. And so that's another important thing. Getting back to my first point, access to economic development, to prosperity, to education will make you a healthier person and will also make you less likely to become a criminal in your lifetime and to have some of the social ills that we end up having to pay more money in the long run for than addressing them in the pre-K years. I'm very proud of Richard and the work he and many of our leaders have done on the pre-K for SA program. We were very much in support of that program and are very excited about the future potential for young people, everyone to have access to of course Head Start. It's not just babysitting, it's actually teaching our young people about health, about fruits and vegetables and eating well and you don't do that by just babysitting, you do it through actual education. So we are very aggressive with the expansion not just of Medicaid but pre-K for SA and five years ago we received a $250,000 grant from the AT&T foundation and it was focused on middle school kids in the inner city. We work with Harlingdell Southwest, Edgewood, Southsend and SAISD. We have 6,000 children a year, young people who we open their eyes over three days to the magic and the economic fun of science, technology engineering and that. We call it core four. We are entering our sixth year running core four STEM conference we brought in Dr. Bernard Harris who is the first African American astronaut who grew up in San Antonio Bob Ballard the first discoverer of the Titanic and of course Jose Hernandez who was one of the first Latino astronauts who was a migrant farm worker to talk to young people and on a weekend their families are open to go to UTSA St. Philips and Palo Alto during the expo and so if we can get more of our young people if we are 70% of the population in San Antonio we should be at least 70% of the educated workforce and at least 70% of the folks with an economic prosperity that is above the national average it's not just about raw numbers and so our core four STEM expo our sixth annual will be this November and we do that for 6,000 young people every year we are proud to be making our contribution to build that pipeline of workers for your industry and we give many of you all to come in and speak to us and most recently we also had our small business and healthcare summit with over a thousand people that met to learn about the importance of you know healthcare track in everything that we do in work we provided of course health screenings thanks to Baptist Health System we recognize Dr. Patrick Carrier the Children's Hospital again another thing that has been unacceptable for too long is not having a tier one state of the art Children's Hospital in San Antonio and they're beginning to address that let's give them a round of applause I want to thank Bilal Oaks for the leadership she provides we work with her for all of our healthcare summits every year I want to commend of course Methodist and the work that they've done with the Hispanic Chamber for many many years to help fund our conferences for her work Charlene Doria she and I worked together in the 90s on AIDS education and prevention efforts Charlene thank you for the great work you've done with the Ryan White Program for many many years and all of you I hate to single out people but each of you is special as I said you all keep your jobs longer I appreciate that you are a great economic generator for our community and at the San Antonio Hispanic Chamber of Commerce you know it's about substance and it's about making a difference and doing our small part to play a part in the success that you are bringing to making our city healthier and making our city more economically prosper so please have a great day and we're very honored to be here today to share brief remarks and our message about the importance of economic development thank you very much this was also the facilitator at that time and she's going to give us an overview and this is going to show us the design we would call informally now the dashboard but I want to call it something else at some point I think so Rose the format is Mr. Mendoza are you ready to change slides just say Mr. Mendoza will change good morning everyone so it has been my pleasure and my planning sessions that led to the document that you see on your tables and this has been a six month process we began in December of 2013 thinking about and reflecting on the 2012 chip and thinking about what we were proud about what still troubled us in the community what successes we wanted to acknowledge what assets we had in the community that we could mobilize and what we learned from the latest round of data collection and analysis from the community health assessment to tell us where we needed to focus and redouble our efforts for that six month period working groups which ranged in number from about 30 to up to 50 individuals meeting for three hours at a time over five sessions the working groups kind of ratified some elements and validated some elements of the previous chip but also updated that previous chip to reflect the changes in the environment and some of the new focus areas that we wanted to address so what I said and those of you who were part of the sessions cannot and say yes she did yes she did was that I always leave San Antonio more energized than when I arrived and being with this group of just incredibly committed passionate people month after month was just a very affirming and I want to give a hand to all of you before I start thank you slide we'll see how this works slide take this document in front of you the bound document this is the final chip and as was mentioned by our keynote speakers health is a really hot topic now and there has arguably never been a better time in our history to begin thinking about creative and collaborative solutions to some of the systemic issues and barriers that impact our ability to be healthy in our community and this is your plan the reason it's called a community health improvement plan is because it is created by owned by mobilized by and sustained by the community it is not a document for one entity to take on it is a document for everyone to use to think about ways that they can partner to think about ways that they can share resources to think about ways that they can piggyback their efforts on other efforts to really enhance the impact in the community so I hope that within a year's time these documents that you see in front of you will be marked up dog-eared pages have hanging off because it's a living document that you're referring to and that you're using in your day-to-day work in your day-to-day lives as you're beginning to make decisions about how to improve community health so we began as I mentioned in reflecting on some of our successes some of our ongoing challenges and then we went back to the vision of the previous CHIP and we really affirmed that this was the vision that we all wanted to hold for ourselves in this community the vision is kind of that overarching aspiration for what we're trying to achieve and as mentioned by the keynote speakers San Antonio will go from being known as one of the most obese cities in the country to being known as a very positive and healthy place to live with organizations that are working together to sustain improvements in public health and if you notice in each of the bullets of the vision statement there's some really key words that the working groups and those leading these efforts wanted to include as part of our conceptual elements that's the notion of aligning and coordinating the CHIP is not a replacement document it is an integrating document so the idea is to have this framework to align and coordinate our efforts to model collaboration to ensure access to health resources open access equitable access to create opportunities in the community where opportunities do not currently exist to support those who are working to support the environment and to sustain this work through conversations, through planning through sharing our metrics and through having events like these to really kind of come together and think about our community so this vision was crafted several years ago thoughtfulness and passion and purpose and it remains the guiding vision for the CHIP slide please we also felt that it was really important to affirm and reaffirm some of the values and operating principles that we hold as we develop the CHIP and as we hope to execute and implement the strategies in the CHIP so this is again that idea of integrating work and breaking down silos to transform our community in innovative ways to disagree with each other when we need to but to do that in a creative and productive way so that we can really move the needle to focus on results and on measuring those results and to really have a primary eye towards equity and integration so we spent a fair amount of time clarifying these values and these are the principles and values that are essential for building a shared understanding and shared leadership but also in supporting true collaboration slide please we also spent some time talking about this notion of the braid that came up with this visual graphic the idea that we recognize that we're all connected and we can't do our work well these are complex issues we're trying to address so we need to connect to work and integrate our work to be successful so these CHIP focus areas and there are five of them are interdependent and they have this common core of healthy communities and healthy systems to really kind of bind these elements together but this is the notion of the braid slide please again we were very intentional and very respectful of the idea that planning is a fluid process but we also want to make sure that our discussions mirrored other discussions reflected priorities and other plans so very intentionally aligned our discussions with SA 2020 but also as much as possible tried to bring other planning efforts, other initiatives other strategies already underway into our conversations with the CHIP so again we're not replicating we're not duplicating we're not replacing we're integrating and aligning next slide please here's the CHIP by the numbers for those of you who like these who like numbers there are 27 different objectives across this CHIP which is a fairly manageable amount across five priority areas these objectives are phased over the next two years and the focus on these objectives is really again what is actionable what is measurable and what is realistic so we really tried to make sure that our conversations were aspirational but founded in the reality of what we could accomplish and then across each of these areas you'll see the number of strategies associated with each of them next slide please and now what I'd like to do is just walk you through the elements very briefly the elements of the CHIP you'll see the great detail behind them in this bound document but we have five different focus areas for the CHIP they are the same as in the previous CHIP the goal statements have been slightly modified the objectives have been narrowed and made even more measurable and you'll notice that in this document we have target and baseline data points to help track and measure our progress right above each of the strategies that we're hoping to adopt so the first area that we're looking at is healthy eating and active living the goal is to support equity in healthy eating and active living and wellness to make sure community members can make the healthy choices that help them to lead healthy lives and if we look at page 16 of the document you can see a listing of the issues, those determinants that contribute to illness, what makes us sick including limited access to healthy foods the proliferation of fast food restaurants and physical activity levels declining despite the increase in resources for physical activity so it's next slide please as we look at the objectives across the chip there is an objective to establish a chapter for health and wellness in the city comprehensive master plan this is developmental objective and throughout the plan where an objective is noted as developmental it's an area where we do not have current data where we're looking to establish baseline data and then track progress over time so that's something to make note of you'll see a couple objectives here about increasing consumption of fruits and vegetables and increasing consumption of sugar sweetened beverages for adults and children a focus on physical activity for adults and children with the overall aim of reducing the percentage of adolescents and adults who are overweight or obese second area focus healthy child and family development the goal of promoting access of preventive health care across the lifespan to improve healthy child and family development we know that the well-being of mothers and infants and children is important for the health of future generations and preconception and interconception care are critical in ensuring health of future generations next slide please some of the objectives that we're looking here focus on prenatal care increased planned pregnancies to decrease the risks of closely spaced or unintended birth healthy weight pre-enduring pregnancy and increase in exclusive breastfeeding and an increase in preventive care and vaccine rates for infants safe communities we know that when we feel safe in our communities we're more inclined to make choices that are healthy this relates to sidewalks and lighting it relates to safe places to play it relates to our communities being crime free it relates to zoning and it even relates to the safety in our own homes so we have a goal to develop community to find safe neighborhoods by identifying and implementing local and global best practices through community empowerment the focus here is on reducing injury and promoting safety across the board next slide as measured by these objectives an increase in the resolution to 3x1 calls a reduction in the number of pedestrian crashes with automobiles a reduction in the number of family violence incidents and confirmed victims of child abuse and neglect a decrease in the number of bicycle accidents and a reduction in the violent crime rate next slide please behavioral and mental well being so we know mental health and substance abuse are related to how we think how we feel how we act and we know that stigma continues to be a barrier to accessing care the goal here is to improve and expand a comprehensive integrated behavioral health system to provide holistic services with access for all next slide please the objectives here decreasing preventable emergency room use due to behavioral health conditions ensuring a full range of behavioral health services in the community and we see a couple of developmental objectives here to begin to establish a baseline and monitor and track progress around strengthening access to holistic behavioral health services and increasing community awareness of issues and available resources next slide please and last and certainly not least sexual health the good news is that the teen birth rate is declining unfortunately the teen birth rate is still 46 percent higher than the national rate something that we need to confront and address the goal of sexual health is to ensure that all bare county community members in any sexual orientation or gender identification have access to culturally appropriate education and resources to promote sexual health next slide please if you look at the objectives for sexual health we have a developmental objective to increase awareness and use of the mobile app for sexual health so not only is it developmental it's technology based to continue reading along to decrease the teen birth rate and reduce the incidence of sexually transmitted infections including the incidence of new HIV infections so I hope you see that with the focus of these plans these are much more streamlined and measurable objectives the data and targets are included in the CHIP and I'm hoping again this will be a living document planning is a process it is not an event so the more conversations that you have the more that you integrate your work the better the process will be so thank you so much and Laura is Laura here yet but I want to tell you brief this process and not just to have a dashboard that said here is what we're doing and we check it periodically like once a quarter maybe once a year or when we meet you again here to see how much we've done but rather to have a site a portal in which not only do we reflect back what the data points are but how they're changing but who's engaged who is doing every day those things that make a difference in this community health improvement plan this is not just a plan as Rose said earlier we are here to talk about not a reaction to this plan but what action we're going to continue to take so you'll be hearing more about this portal this dashboard because we're going to be engaging everyone to come up with a name that really reflects your engagement so with that let me call the panel up so we can continue our morning and invite them to come up and as you see on your agenda it says that this is a reaction to the chip but it's really not a reaction because this community never just reacts it responds and that makes the difference this is a response to community I see Dr. McGeer and walking in the door so I'll let her tell you a little bit more about this portal that we've been talking about and come on up more I just wanted to talk to you a little bit on-line platform of some kind that will help us move this community forward on these indicators originally what we were talking about is an online dashboard or car a way for us to monitor progress over time and also see whether there were sub-populations, age groups, race and ethnicities, sub-county geographies like zip codes and census tracts from the chip participants very strongly with that they want some kind of online platform that will help them move the needle on these indicators which frankly as someone who's been doing also in San Antonio is just normal but changing the indicator for ourselves maybe we self-manage our own chronic illness or obesity there's a lot about the family tackling the neighborhood level and then also this whole thing is animated so originally it's not very strongly that we want real explicit focus on social economic terms in our built environment in our social and economic circumstances that determine whether we are vulnerable to or protected from certain health issues needs to be online needs to be mobile friendly so we're talking about a bilingual tool here content for different audiences they find valuable it's not necessarily the kind of thing that a neighborhood association president just to let you know a few things that came out of the design conversations we'll have it organized by goal and then by objective and Rose late those up for you just now we'll chart the objective trend over time and we'll also roll our progress on each individual objective into a summary status for that goal and we'll have each of the indicators individually or whether one counts for more just want to be able to turn on or off depending on your level of data to be able to see disparities by different sub-populations like different race and ethnicities and different age groups and we know that we want to see how precautions where you need to be careful how you interpret the data to help people understand what your initiative the chip is I'm sure you're all also aware of SA 2020 and then there's a child adaptator so some kind of deliberate effort to crosswalk so that we're not all just working in parallel with the initiatives making any explicit recognition that we're all tackling the key features we want to allow people to export and print the content so we probably want to have a print summary for indicator or for goal so they can just knock that out and hand it to someone right we want to be able to export the data for manipulation an agency that has it's a subset of the census tracts in New York County we want you to be able to dump straight out static integer or subscribe to notifications of changes to that indication on absolutely any sources for people easier for people to get together in an active collective area so resources for action at every level for ourselves so health related information and education the health and collaborative party has the community health bridge we could map the assets help people discover apps that will help them change their own behavior their family and neighborhood we want to connect people to each other if they're working on the same issue I think there's some possibility that we could fold in some user contributed content so that it's not just a one way flow of information I'm talking about something more substantive than a calendar and then maybe build in a communication platform to help people beyond that group that I just mentioned around conversation that weighs children's issue council which some of you may sit on or be aware of in that child largely the same indicators over time real time ish information about movement in child well being indicators and also support their ability to get together much the same thing as in 2020 is trying to do surviving is to do something about these indicators coming back to folks like that learn something that I absolutely love and that is what are standing ovations for a community who has just embraced healthy living and active they ask everyone instead of just clapping for the speaker stand up and do this more actively this is a response to organizations they're going to demonstrate how the CHIP strategies are already aligned with their efforts and what kind of opportunities they have for the participants in this community to engage and collaborate to bring about change in the health of our community families so I'm going to do a brief introduction of the panelists I'm going to begin with Andrea Ojarpo who is from Christa Santa Rosa she is the director of community health for Christa Santa Rosa and a doctoral student at the University of important San Antonio her work has been to develop community benefit strategies to increase access to mental homes and other health care services for uninsured adults and children of the use of the culturally competent community health Jensen is the currently the interim executive director for NAMI San Antonio previously she was the executive director for the department of psychiatry and Methodist Health Care systems in San Antonio and she has extensive acute and patient mental health experience with children, adolescents and adults and I don't see her up here when she gets here she will join the panel Carol Huber Carol Huber is the director of regional health care partnership facilitation of the University Health System in San Antonio, Texas under the Texas Medicaid 1115 waiver she leads the anchor responsibilities for the 20 counties in Region 6 serving as the ASON Commission and the 25 providers implementing 128 projects assigned to improve health and transform the care area as 20 years of experience working in the public health sector addressing community health improvement policy, environmental and systems change in her current position as the assistant director of community health of the San Antonio Metropolitan Health District this area provides leadership guidance to the community health section which include the chronic disease prevention division, teen pregnancy prevention project work, maternal child health case management head start dental health services the WIC program, the baby cafe which supports breastfeeding moms the mayors fitness council and school health collaboration and we have Ms. Rodrigos from SA 2020 Jessica Rodrigos has received her master's degree in biology at the University of Texas at San Antonio and prior to SA 2020 she worked at the University of Texas Health Science Center she's working towards her master's degree in public health and has done a tremendous job with this team in this part of SA 2020 so you each have 5 minutes to present what you're doing and how you align with this chip and how you can engage this community history in San Antonio we're here from our ministry our healthcare ministry the community coalition which is the community coalition which is the community coalition that is focused on maximizing enrollment in the health insurance marketplace this year SA 2020 is a big partner in rural America the health collaborative all the hospital systems we came together last year because we knew that we needed some strategies to enroll people in the marketplace we set a goal of enrolling 20,000 people I'm happy to say that we surpassed that and enrolled 76,000 people and even better than that I think is that we created the coalition created a best practice for enrollment we held some very large enrollment events to make sure that we could reach the most number of people and that best practice has been recognized on a national level the White House has recognized our coalition and asked us to share our best practices with people all over the country and so we're happy to do that and happy to represent San Antonio as a best practice for that so that is something that we're very proud of we're in planning for our next open enrollment which begins November 15 the US Congressional Budget Office estimates that more than 13 million people are going to enroll this year which is 5 million more than enrolled last year so that's a lot of work cut out for us but I think because of the people in this room and the hard work that we've done we're going to build upon that success and that relates to this improvement plan because obviously I don't have to tell any of you that access to health care only improves everything that we do in our lives and so it's going to contribute to the health of this community greatly other than that thank you for the opportunity to present this and I appreciate your time thank you for the opportunity to be here today and with these panelists I'm glad we're speaking from here and not the podium I was afraid I wasn't going to be able to see over the podium so I'm happy to sit here I have some slides there up on the screen this shows the 20 counties that represent region 6 of the Medicaid waiver we do have a table in the back if you have one information about the details of the Medicaid waiver but it's essentially a relatively new program negotiated between CMS and HHSC to transform care in Texas one of the programs embedded in that is the district or delivery system reform incentive payment program and that's what I'm here to talk about today our 20 counties there are 25 providers with 128 projects valued at a billion dollars over 5 years that are aiming to transform care and improve health in these communities our 20 counties there's some basic data there but I think it's interesting to note that geographically we're larger than 10 states and in terms of population larger than 15 so there's lots of good work being done here that's going to impact a lot of people university health system is privileged to be the anchor and we are coordinating among those providers and with HHSC in the delivery of care next slide these are sort of breaks down the types of projects that are being done and it was real interesting to hear the braid analogy just a few moments ago because that's essentially what we are doing through district and the Medicaid waiver and so you can see the different types of projects by theme and a big one for us is behavioral health and so that's what I'm going to primarily focus on for the rest of my remarks but you can see there's lots of work being done in a variety of areas next slide for each of the providers when they proposed projects they had to identify which community need was being addressed and we had identified six as a region and if you'll just click one time you'll see the community need number four is highlighted this is the one related to the need to integrate and provide greater expansion of behavioral health with primary care and so we have over 45 projects addressing that need in particular on the next slide you can see again what the providers are who are addressing behavioral health in this region and the one shown there currently are with Bear County and then just a few more clicks and you can see the other partners that we have out of the rural communities being the community mental health centers on the next slide we'll talk about the behavioral health learning collaborative one of the requirements we have as an anchor is to facilitate learning collaborative among our partners and individual partners and providers doing their projects although it sort of felt like that a little bit because over the last couple years it's taken a lot of effort just to get those projects proposed and kicked off as I've got two providers on the panel here who can probably speak well to that we've been very heads down and just getting things implemented and going but now it's time to really look up and look to each other and find ways to partner to share best practices and learn from each other collaborative through an effort to reduce preventable readmissions and through behavioral health we have a steering committee of partners who are helping to organize those events and those activities and we started out simply with some networking we called it it was a version of speed dating or what we call the district dash just basically saying who are you what does your organization do what is your district project all about shared and common problems and we have a great resource that I'll show you how to access in a moment but then we took this sort of actionable list and said okay what next what can we do beyond that besides just getting to know each other in the room and we said well we need to really help each other with some project challenges and one of which is workforce and how do we make sure that there's enough providers in our community to address the behavioral health needs and so we discussed that and shared some opportunities for improvement in our recent regional health care partnership summit that we had in May but even beyond that is where it's getting really exciting and our opportunity to partner with the health collaborative is through a common aim or common strategy that we as district performing providers and our colleagues and stakeholders can come together to work on and that's where we are finding ways to align here with the chip today which anyone who's interested in working with us to do this to give me your card we have a sign up sheet at the table in the back and attend our collaborative events as we work together to identify the impact we can make together to move the dial on these goals each of the hospitals participating in the waiver have to report on certain metrics which include readmissions and then some of those providers actually have monetary incentives tied to making improvements and things like behavioral health readmissions and you can see how things begin to align with the chip and so we are open at this point now to identify what those will be I imagine stigma will be a big one clarity child guidance center is a big supporter big partner for us and they have their one in five minds campaign if you're not aware of that I encourage you to talk to Rebecca and so lots of great opportunities out there for us to collaborate and we're happy to be here today and again my name is Jessica Rios I think there should be slides coming up pretty soon there it is thank you so much so you can go to the next slide so I've been with SA 2020 for about seven months so after seven months you know everything right? at least that's just what you tell yourself so SA 2020 is a common vision created in September of 2010 about 5000 people gathered together to say this is what I want San Antonio to look like in 2020 they decided you can go to the next slide they decided that they wanted a San Antonio to have 11 cause areas so just for example some cause areas our health and fitness safety and communities and neighborhoods better education just various things like that of course there's 11 but I only named a few of them in March of 2013 we became a nonprofit and in September we released our first progress report so again this September we'll release our second progress report you can go to the next slide so this is an African proverb that we live by in SA 2020 and as I've been sitting here listening to everyone speak I've heard Rose say it I've heard Andrea say it as well as Pilar that you know everything that we're doing it's so large and so great that unfortunately we can't snap our fingers like we want to but we have to grab people as we go and we all have to go together so next slide so again SA 2020 began as the community vision but has grown into a backbone of collective impact and so some of the services that we offer things that we provide are what you see on the screen so we guide the vision and strategy support collaboration measure progress engage the community advocate policy and mobilize funding next slide so just more about guiding the vision and strategy I'm going to brag on one of the organizations that I work with San Antonio teens for prevention pregnancy prevention collaborative they have come together so they're a large group they're private public they're not for profit they're for profit and no matter what they do and how they do it they've managed to lower the teen pregnancy rate and I'm sure most of you guys know their work are involved in their work somehow but together they have lowered the teen pregnancy rate so next slide so supporting some collaboration so we do that through action network some of our action networks are with talent pipeline access to parks and green space and roll a say next slide so we engage our community measure progress so some of the ways that we measure progress one of the ways recently was with the help of enroll say and we partnered with enroll America and together we measured the progress as Andrea said over 76,000 people got enrolled in health care this year and that was something that together we were able to measure and see how we can improve for enrollment period too next slide so engaging the community we do that through our blogs, our social media but we also do that in other ways so the next couple of slides that you'll see are different ways that people have engaged the community in health or their education so go ahead so the first one was enroll say where there was the community coming out to say hey I want to do something about my health and this second picture is destination college these are high school students who have filled out the FAFSA saying that they pledge to go to college and not just go to college but finish so next slide of course we advance policy next slide and of course we all need funding to do all these great things right so mobilizing funding is the last thing next slide so if you guys have any questions on anything I've just mentioned you can visit our website at www.SA2020.org next slide and again you know I just wanted to say as we've echoed out everybody plays a piece they're a piece of a puzzle of this large picture that we want San Antonio to look like and together we can get there so thank you good morning everyone it is such a pleasure to be here it's amazing to me to see so many familiar faces both the staff and team that I work with at Metro Health but also community members that we work with day in and day out so it's just great to see such a large group here I would like to encourage each of you to go ahead and open up your community health improvement plan again because I am going to be reflecting on the specific challenges within that community health improvement plan and share some of the initiatives that Metro Health is engaged in with many of you as partners and the things we're doing to address the objectives that were developed in the community health improvement plan next slide please so healthy eating and I have to say very wordy slides and I apologize I think that the next time I have an opportunity to present on the chip we can see the types of changes we've had in our community over the years right now I just got words but some of the things that we are working on that are directly impacting healthy eating right now we have a collaboration of over 20 partners who are working on developing a media campaign to reduce the consumption of sugar sweetened beverages in our community you all will be seeing that soon and many of you are already engaged with us in doing that we're also leading work sites and communities to implement policies that increase access to healthy eating and to healthy beverages maybe that's through our healthy vending policies through bringing farm to work or farm to community produce into food deserts so lots of work related to that we're also working with restaurants to expand our por vida program and hopefully many of you know about our por vida program and not only working in restaurants now but we're actually expanding that we're into work site cafeterias so that people who are at their work can access foods that they recognize or have been reviewed by our nutritionist and have that mark of this is a healthy meal for you we're working with a city to include nutrition guidelines and food procurement contracts now that sounds extremely boring but if you think about it in fact what types of food we are agreeing to have in the contracts throughout the city and the food that's provided whether it's through pre-k for SA or whether it's at our summer feeding program for our parks department you can really really have a large impact on feeding healthier foods to a lot of people we're coordinating with the YMCA to implement diabetes prevention and control programs that are here today Kathy Shields and Jeremy Beer and they can both provide you with a wealth of information if any of you have questions about those programs or would like to get more involved with them next slide please so in terms of active living I couldn't put active living and healthy eating on one slide because we're really are doing so many wonderful things we are working with the planning and mayors fitness council and the active living council to implement these considerations into the comprehensive master plan for the city of San Antonio so to be able to have an impact on the policies that they put into that comprehensive plan we think is going to be very impactful in the years moving forward we're working with the mayors fitness council and San Antonio sports to improve recreational facilities through spark park and implementing joint use agreements to make those facilities so that our schools are no longer locked up at 3.30 when all the kids leave but people and adults and families in the neighborhoods can actually use the tracks and the playgrounds to exercise in the evening and on the weekends we are collaborating with the parks department to improve infrastructure and resources to support physical activity so several years ago through the community is putting prevention to work program we're able to fund some fitness stations in parks well guess what it turns out that in the summertime those metal fitness stations get super hot and hard to work out at so we're funding shade structures to cover those so that people can use those fitness stations throughout the year we are also looking at bringing water fountains into our parks and some of our other areas in the community so that people have access to drinking fresh tap water and exercising so lots of efforts we are continuing to support Seaclovia hopefully many of you have either participated or know about it and if you haven't you should go to the next Seaclovia it's a fabulous activity we are working very closely with the mayor's fitness council we're sad to see our mayor leave but we're very excited I trust that Ivy Taylor will continue to support the efforts of the mayor's fitness council we're getting funding to translate the fitcitiasa.org website which is a fabulous website that shares not only partnerships and who you can work with in various areas related to fitness and health but also a lot of information the problem is it's been in English for the last few years we've got to have it be in Spanish so we're working on that happening we are supporting and working with our parks department on fitness in the parks FitPassSA and other important built environment initiatives Healthy Child and Family Development again I have both Kelly Bellinger and Norma Cifuentes in the room so if you have questions about some of these initiatives they can answer those questions after we're done we are helping pregnant women and families to make sure their babies are born healthy and stay healthy through the Healthy Start program and through the Healthy Families Network we're implementing the Baby Cafe which is one of our district projects which encourages breastfeeding and provides support to moms because breastfeeding is such an important thing not only to improve our babies health but to also reduce obesity there's a connection there we're serving women and children through WIC to ensure healthy moms and healthy families and we're working on creating mother friendly work sites so that women who have had a newborn feel comfortable breastfeeding or have a place that they can go to either breastfeed their child or pump so that they can continue breastfeeding for as long as they want to even after returning to the workplace we're also promoting and providing a case management services for teen mothers through an evidence based initiative to reduce repeat teen pregnancies to give young teen moms a better chance in their future by reducing the possibility of breastfeeding in the future and by providing a case management service to the teen mothers next slide safe communities thank you we're collaborating and this is a brand new project with the San Antonio Police Department to implement the cure of violence initiative it's an initiative that was implemented in Chicago and it's trying to reduce homicides and shootings through a disease prevention model that we're interested we are partnering with our office of sustainability to promote active transportation and bike and pedestrian safety awareness to improve safety in our community it is so exciting to me to see how many people are out bike riding there are more and more bikes on our bike lanes and on our streets every single day people need to be wearing helmets though and I'm not seeing a lot of helmets so we'll have to start working on that and policy perhaps to implement an ordinance that requires that we'll see our transportation and capital improvement to develop plans and designate resources for infrastructure and safety improvements and we have an initiative that fits in many different areas but I put it under safe communities we're working on community engagement it's so important to do the policy the built environment the environmental changes and the systems changes but we also need to make sure that we're engaging community members and that we're listening to them and that they are leading us to make efforts in the community and so our neighborhoods project again funded through the district is a district project is there to implement community-led health improvements and address health disparities next slide and my almost final slide sexual health if you look at that community health improvement plan there's some issues that are very very important to this community that we are trying to address and sharing with many to implement an evidence-based teen pregnancy STD and HIV prevention program to educate adolescents again I've got Mario Martinez in the room who oversees our project worth program and Dr. Anil Mangla who's another assistant director at the health department here who are working on these projects we're expanding access to affordable reproductive health care services for adolescents we are conducting clinical case management and case investigations for pregnant women to assure appropriate prenatal care and third trimester syphilis screening to prevent congenital syphilis cases and finally we're conducting education and outreach to local medical providers to encourage the adoption of third trimester syphilis testing among all pregnant women we've had a problem with the number of babies born with congenital syphilis we've got to bring that down to zero there's no excuse Mickey Maxwell is another person out there in the audience who doesn't like a lot of recognition but she's our school health liaison and supports every one of these initiatives that I've mentioned but the bottom line is this we couldn't do any of this work if we weren't partnering with the majority of you who are in the room and so I just this morning as I was thinking about this I thought of a couple of quotes one by Helen Keller some of you may have heard alone we can do so little together we can do so much it's pretty simple collaboration another one and my last one and closing remark is coming together is a beginning staying together is progress and working together is success Henry Ford said that thank you very much well thank you so much to our panelists and working together is indeed success it's time for you to we have actually put this in the agenda because we consider this piece so so important because we will have closing remarks at the end but for the next 15 minutes we want you to make sure that you look into your packets and you have a little survey this survey is very important to us notice it does not have a name at the top but if you answer question 5 would you like to be part of the chip workgroup in the future make sure that you put your contact information and when you finish the health collaborative people are wearing their shirts you can either hand it to them or leave it at the table as you walked in when you registered you can leave it there but make sure that you complete this form and then the other very very important initiative that we ask you to take today is to walk over to these tables these organizations that you have heard from and others and see how you can sign up to get your organization or you personally involved with the projects that you've heard about and get involved with your own others here that have other projects that are not here at the table but the call to action is really about how each and every one of us can continue to make that progress and make it happen because that is indeed success Jennifer for seeing that as a concluding remark for the action piece but I ask you now please fill this out and please visit the tables we will reconvene everyone in about 15 minutes thank you