Safety, Housing, Education & Homelessness Committee - Regular Meeting

Welcome to the safety, housing, education, and homelessness committee of Denver City Council. The safety, housing, education, and homelessness committee begins now.

Pretty early to be this evening. Alright. Good morning, everyone. Welcome to our safety, housing, education, and homelessness committee. Today is Wednesday, May 7. Thank you all for joining us. My name is Serena Gonzalez Gutierrez. I'm I am your chair and also one of your council members at large. We have, I believe, one council member joining us virtually. And so we're gonna do introductions of council members, and we will go to our virtual, member first. Thank you, madam chair. Kevin Flynn, Southwest Denver district two. I apologize for the last minute, virtual. Appreciate it. You're good.

Thank you, councilman. And then I'll start over here to my left with introductions from council members.

Good morning. Darrell Watson representing Define District nine.

Good morning. Paul Cashman, South Denver District six, and I apologize for the last meeting person. Apologies there.

Good morning. Amanda Sawyer, district five. And I apologize that I am going to be on my phone for this entire thing because I left my computer at home today. So I just want everyone to know I'm not being rude. I'm using my phone as my computer this morning. Apologies.

Thank you so much. That happens to all of us. Yeah. So we'll have a couple other members that should be joining us soon here. And with that said, we have a couple of items on our agenda today. We have a an action item coming to us from regarding Roads to Recovery. And so we'll have you all introduce yourselves and provide the presentation. And then we have a briefing from Denver Health on the sales tax spending plan. So with that said, if you all wanna introduce yourselves, go ahead and proceed with your presentation, and then we'll take questions at the end. Do we have

go ahead. Go ahead. Lisa Lovely, director of real estate.

Tim Hoffman, mayor's office, director of policy.

Erin Atencio, director of Roads to Recovery.

So thank you. We are here today to talk about an acquisition at 4280 North Columbine Street for Roads to Recovery. So this request will be the approval of a purchase and sale agreement between the city and Correctional Management LLC for the property located at 4280 North Columbine Street. The red box depicts the building. This is in District 9.

It is a 13,000 approximate square foot building on a 17,000 approximate square foot lot. It can house 60 beds. The zoning is IA. The purchase price is a total of $3,700,000 $3.741875 But of that, the $241,875 are for improvements that the owner will make that are contingent upon us closing. Those are for life safety issues and some ADA upgrades.

I am sitting on this right now in real estate, CIP funds, so this will be from real estate, not from Roads to Recovery's budget. Will flag before I go to the next slide. This is a bit of a strategic acquisition right now. There's one other one besides this that is a former community corrections facility that has the appropriate zoning and use for residential care, that we know that between roads and certain other groups in our city, we do have that need. So I'm trying to be strategic where we can when the opportunity arises.

So this is a layout of the building. You can see that it has multiple rooms. The rooms are used more like as dorm rooms right now, which is how they had the number of beds. Conference space, office space, kitchen. Excuse me. It's kind of full service community space as well. It also has a little bit of a courtyard outside on the south end, so it does have some open space too. And then again, the owner will be making some improvements for us before we actually close on the property. This is an aerial picture of it so that you get a sense of where it is. There is newer residential north of it that was constructed while this property was operational.

To the south is more of the industrial. And with that, I will turn it over to Aaron and Tim.

Great. Well, thank you all for taking the time to allow us to chat with you about this potential real estate acquisition. I know this group is familiar with the Roads to Recovery program, but just wanna reiterate the goal of the program, and I think we've already seen some good amount of success with it, is to break that cycle that we often see of people who commit low level crimes. They go to jail for a couple of days. They aren't given the services they need.

They get out. They still have the underlying problems, either addiction, mental health issues or a combination of those two. They end up committing, additional crimes, and it's this, this cycle of in and out of the criminal justice system, and there isn't much of a, a concerted effort to break it. And so the Roadster Recovery Program has been focused on those individuals who are in and out of the criminal justice system repeatedly. We've had thousands of contacts.

I believe there's over 200 people currently in the program and some level of of intensive care. And we feel like this real estate acquisition gives us an opportunity to address an ongoing gap in our system. We have the aid center. We have other outside partners who really, especially during business hours, fill a lot of the needs for drop off and intake care. What we envision this Roadster Recovery facility to be is a 20 fourseven operation where oftentimes it's law enforcement or other entities who are connecting or contacting people at midnight, two a.

M, and there really just is nowhere to take them. And so to leverage this type of building, given the zoning, given the layout of the specific building, then get them into treatment, get them into some sort of triage to figure out exactly where their needs are. If we can go to the next slide. And Erin, if you want to touch on kind of where you see this fitting into the overall program.

Yeah, absolutely. So I want to start by saying that this is not like we do not have all the details figured out. This is where we are gonna be going, but we don't have, like, day to day ops. Like so I we don't have a ton of the in the weeds information. But the thought is that this would be a drop off placement for first responders, so that wouldn't be inclusive of an option for STAR for DPD.

But really, like Tim said, for these nontraditional hours where police or first responders are coming up upon someone, and at two in the morning, the option is, like, you need to move or you're going to jail, which are not always the sufficient or correct options for that person. So really giving these first responding teams an ability to say, can we get you indoors? Can we get you a meal? Can you, you know, have a place that you can rest? And then there will be supportive services offered to those provide or to the participants as well. So it'd be a drop off location 247. There would be staff on-site that would be able to triage into appropriate services, some similar to how Roads is operating now where we are able to say, here's all the options available to you. What would you like? How can we support you in finding stability? What is stability to you?

And really triage to appropriate service, have that on demand access. Our goal is obviously in real time, but, you know, sometimes it takes a couple of days to really make the right appropriate connection. So they'd be able to stay there until a bed at the next placement is open or until the reunification ticket is able to be, you know, executed on. And so it'd be a short term, very, very short term stay with the goal that we would connect them to a more long term placement.

And and to put a finer point on what Aaron was talking about, we're here today to talk about the real estate acquisition. This is not something that we would expect to have operational in the short term. I think there are still, as Erin laid out, the details that need to be sorted out, kind of recognizing the funding streams and trying to figure out how to get that piece together. But as Lisa can tell you, with the zoning that this building presents, with the layout and the the prior use, it present it presents a pretty unique opportunity for us to leverage it into a a facility for something like Roadster Recovery. And so we wanted to be aggressive about going after it when it became available because we could be waiting, you know, years until another similar property would come online.

And with that, are there any questions?

All right. Thank you so much. Well, before we go to the queue, I want to welcome Councilman Hynes and Councilwoman Torres. Thank you for joining us this morning. And with that said, starting off in the queue, we have Councilman Catherine followed by Torres.

Thank you, Madam Chair. Thanks for the presentation. Glad you're considering adding more capacity. It's greatly needed. Just a couple of questions. When the first slide said you envisioned 60 beds, I'm wondering, do we start from a number of whatever it is? We need 200 square feet for someone in in in a residential setup. Do we do is there a number like that that we deal with?

I will say historically, it's kind of a yes and kind of in terms of and I'm not going to have a number to quote. We can follow-up with you. But I know that certainly host uses one. I think of solution center where then there are best practices. And I think of this more similar to solution center where there will be some best practices for this type of service.

Thank is a you. The other thing is just so I understand. So if someone comes in at three in the morning, they're dropped off, there will be someone trained in behavioral health services to meet them if they're in crisis so they're not just kenneled for six hours till someone comes in?

Yeah. So all the staff would be trained. I would also say that if someone is in a significant mental health crisis that maybe solution center or another service might be more appropriate. This is not going to be a hospital setting. This is really going to be kind of like a place for people to come and just kind of decompress and stabilize. So in a situation like that, I would probably encourage a different placement at that point.

Gotcha. Thank you. That's all, Madam Chair.

Thank you. Councilor Buen Torres followed by Councillor Haines.

Thank you, Madam Chair. Thank you. So let me just pivot from that question there for Solutions Center. They've not been able to they only take folks who are in need of just mental health support, not also substance use. So if you've got both, where do they go if the mental health support might be needed in addition to the substance abuse kind of recovery side?

Yeah. So people will be trained there to handle if someone comes in with co occurring needs. If it is a crisis, we would have to find another placement. But absolutely, I mean, the thought here is that before everyone enters that there would be significant training done with the staff there to be able to handle everything from harm reduction approaches to behavioral health crisis situations where we could de escalate. But because this is not going to be a hospital or a clinical setting, that would also have to be trained with the people that are dropping people.

Okay. Thank you. I know you've been doing outreach and talking to folks now. Where do you take them

now? So right now in the middle of the night, we don't really have an option. So this is really gonna be filling that gap. But currently, we do have the solution center. We have the aid center. We have different community programs that are open nine to five, basically. And so during the day, those certainly would still be utilized. Yeah. We also have teams that are trained in the field to be able to do triage so that once we're doing proactive outreach, the same menu that would be offered here is offered to those teams currently in the focus areas that we are deployed into. And so we try and do kind of both from the street to an indoor placement that's appropriate, and this would just be a secondary option during nontraditional hours.

Okay.

Lisa, you mentioned the solution center process. And I think it's been one that the Sun Valley neighborhood has really appreciated. I think the solution center's monthly meetings, like there's regular check ins about what's happening. One of the things that keeps coming up, though, is how exiting occurs. And this is not jail. People are not confined to this space. It's not even its prior use as center? Well,

Well, it was the Family Crisis center. No, this location. Oh, corrections.

Community corrections. And so when people are exited, what happens? Where do they go? Do they just get shown the door and then they're out into the neighborhood? These are real questions that come up with the solution center. So just anticipating, I think, the conversations you'll want to have with the neighborhood of what takes place external to the building will be just advice on what to take on there.

And if I may say, we have not done outreach to the community for two reasons. One, again, because Rhodes is not at a place yet to be able to specifically talk about those details. And for the shorter term, where I'm looking at it to still try to occupy it, whether it's storage, some other city uses that are short term, things like that, I've already committed to Councilman Watson that we will work with his office to be able to work with the neighbors on whatever short term use we may identify. But that is the only reason why we really haven't done any outreach yet, but that's a good flag.

Okay. Thank you. Thank you.

Councilwoman, to bolster the point that you made, I think that that's one of the persistent problems that we have in the system is even if we've stabilized someone and we tell them, okay, you have an appointment in six hours, but we don't have that transportation. We don't have that warm handoff from point a to point b, especially with people who are dealing with either some sort of mental crisis or drug addiction. You you lose people in that transition and the transportation. And so I think part of why we're excited about the prospect of having something that would be open twenty four hours a day is that that transition and that transportation problem, which is basically a process problem, would be more solvable than it is currently.

Yeah. Okay. Thank you. Thanks, madam chair.

Great. Thank you. Next is councilman Hines followed by councilwoman Swire.

Thank you, madam chair. Thank you for for bringing this forward. This is currently a CoreCivic site. Is that right?

A former. Yes. Yes. It's it's their last one.

Yeah. So, so this is a conversation from the last council class back in. I want to thank you for hearing the concerns that the council had in 2019 about having private for profit companies determine someone's success. I I don't think that car incarceration really should be given to a for profit entity, and, obviously, counsel thought that at the time too. We also heard that that that we needed more time.

We couldn't just, you know, sever all ties immediately. And so this is taking a little bit longer than I was really hoping for, but but but here we are nonetheless. So you were talking about this is an opportunity that doesn't come along often. Will you talk a little bit about the the unicorn nature of these community correction sites? Because that was a big conversation we had five or six years ago that might be relevant for the people who are turning in to this today.

Sure. So again, it's a residential care. And unfortunately, without a CPD friend, I will not go too far because I know that I will misstate something by quoting distances. But in general, we have to look at the zoning first and then the use. The use is really critical, too, as residential care, right?

And you have to be x number of feet from two or three other or you can only have two or three within a certain radius, right? And so you can look for another building, but if it doesn't hit that sweet spot of being one of only two or three within a mile or two miles, then you have to keep moving on. And I will be honest, I may have one other one that I may bring to you as well. And it's kind of the last thing in the city, quite frankly. And so this is why I say, you normally don't see me here very often trying to be out in front quite in the way I am right now with these, which is why we're trying to still give roads time to work on their plan.

But it's because it is so hard to find something within that that meets all of the zoning requirements.

Yeah. So just adding a little bit of color, was hope I totally understand you don't wanna speak out of turn. I don't

I don't

either wanna miss misstate facts, but just that conversation showed how difficult it is to find a plot in the city where we can host community corrections. So I hear what you're saying that this is a you know, the current plan is a need that is not served anywhere as I so I'm but right now, the conversation about real estate acquisition, you have an idea in mind. Mhmm. I also I would support this also because even if that idea doesn't materialize, we also have this fallback idea in mind that also would be incredibly difficult to find elsewhere. So I I It

used a similar, so that is why this works. But that's why I say you may see me again here for that very reason because we still need to solve for that too.

Yeah. Exactly. That was going to be my next thought is we certainly still want to have community corrections. If we have ownership of one of the few parcels in the city that can do that, that I think that gives us a lot of flexibility. So just talking about the real estate transaction here, I think there's a a whole another reason beyond your intended your your purpose that you're sharing today that makes this for an unintelligent and prudent transaction. Thank you.

Thank you. Councilwoman Sawyer followed by Councilman Watson.

Thank you. Councilmember Hynes pretty much said asked the questions that I was going to ask. I was just the limited number of opportunities we have to purchase these sites from our former private prism providers just makes me wonder about the opportunity. Is there another location where we might be able to provide these services, which are very needed, especially the twenty fourseven, but without having to give up this potential community correction site

Oh, I see. Given how low the number of community corrections beds we have remains. So I may jump ahead, so I apologize. I think, again, as Erin and Tim shared, it certainly meets a need that would be now, right? Again, because I'm aware of one or two other opportunities, but they're not there yet.

And I don't know that the facilities would serve us. So that's the other thing is that we would without going too far down the road at the moment, I don't know that that would be quite the right direction, if you know what I'm saying. So I think the building still can lend itself for what they need. But I hear you. And again, I recognize we've got multiple uses within the city where we do need 20 fourseven residential care, whatever that looks like.

Yeah. Okay. Appreciate that. Just one more question that's sort of about the facility itself. I really appreciate that they are gonna be doing some ADA compliance and things like that in order to make it purchasable for us. But I'm curious when we get a little further down the road and we sort of know much more specifically what this facility or other facilities are gonna be used for, do you anticipate that there's gonna be additional capital costs in build out or any of those kinds of things? Or is this pretty much ready to go?

So I will say that it should be ready to go for a basic. But I think Rhodes, like some of our other I'm thinking host trying to be trauma informed, that there may need to be some modifications in the building to address those issues. So we don't have to gut it and start all over. But I do think that, yes, there will be at a certain point some discussion probably about some capital dollars to make sure that it better meets the needs of what the ultimate program is. Okay. Really appreciate that. Thank you.

Great. Thank you. Councilman Watson, you're up.

Thank you, committee chair. Thank you so much, Lisa. Thank you, Erin. Thank you, Tim, for the presentation. Thank you for the initial briefing and the commitment for community informed process.

Once Road to Recovery has kind of the end to end of really what this will be. I know today we're only focusing on this real estate purchase. I think the question that I think it was Councilmember Torres asked on for is there a similar program for folks that are overnight, if you have contacts with folks who have mental health or substance misuse difficulties and they are contacted, what is the option? It is from my understanding that that option may be incarceration without this step for overnight. And so my question to the team on kind of the and once again, I'm not going to want us to go into details, Aaron, because I want to give you all the flex time to be able to develop.

When you're looking at the iterative steps for 4,280 combined for support for folks going through, What would you consider to be just from top of your head, the timeline of care and support that your team are there different describe from just without having it fully formed, what are your thoughts as to what the timeline of folks, their stay within 4280? What would that what what should people consider to to to be an experience there?

Yeah. So from time to drop off, there would be we really try and do, a brief intake, figure out what the needs are. There would be, at an appropriate time I mean, if someone needs to sleep or eat, obviously, we wouldn't rush. But at some point quickly, there would be a menu of options and a conversation around what do you need? What's going on? How can we support you? And then the goal would really be within a couple of days. I mean, ideally, pretty short amount of time, but to get an intake done for that appropriate next step, to buy that reunification ticket to a family member. But really try and have that connection point be on-site at the facility. They can stay there until that next option is available and then be transported to that next option.

And again, this is really to help people find their stability. So short amount of time, really trauma informed, really asking the person to take the lead on what the intervention would be. And so within a couple of days.

And this doesn't preclude the solution center, the aid center, all of the other services provided. This would be an additive to that. So this won't become the primary space if these opportunities are provided.

No. I mean, this would be definitely a partnership. For example, if someone went to detox and then needed a sober living, but they needed like a day or two, this would be a great opportunity to say, hey, can they actually come to you, settle for those two days so we don't lose them, and have to exit them to the street? Same with the jail. Like, this person's ready, but the program isn't quite ready. We would be a next step that we could partner and say, yep, send them here so that they're indoors, they're safe, they have their needs met.

And one last question on capacity and ability for Roads to Recovery and the team to actually once this process begins. Is there a budget piece to this? Is it we're in budget season? Is there going be an ask for additional support for from the administration to support the the folks who are coming through? And if if there is, did you wanna maybe share a little bit as to what you're thinking capacity impacts of this solution?

Yeah. I mean, that's a great question and a really difficult question with budget coming up. This is something that we have been considering a DOAC ask for. And so really thinking this would be appropriate use, but trying to figure out the strategy there as well. We are comparing the level of staffing and intervention similar to solution center. Solution center, the 3rd Floor, the transitional shelter space. And so we are trying to figure out kind of what the number and what the budget ask would be, potentially coming out of our roads recovery funds. We're really thinking this would be a really good ask for DOAC and potentially caring for Denver alternatives to jail cycle next year. So we are still a ways out from that.

Yeah. And so on committee chair, I would say, I think there is sensitivity within the community on the types of services that dominate within globally or Swansea community. I know we're going to have a very proactive community dialogue and discussion. And so thank you so much for providing me the briefing and providing a background on the importance of this real estate transaction. Thank you, madam chair.

Great. Well, thank you all for coming and presenting this. It sounds like there's still a lot of information to come, and I look forward to learning more about what the program details will be, you know, whatever is determined following this. I do have just one quick question. When you mentioned that the staffing would be similar to the solution center, the 3rd Floor, but then you also had mentioned that there would be capacity or staff that are trained to help individuals that might be coming in that might be in crisis, which would then, in my mind, think of people who are on the Bottom Floor at the solution center, the folks that are providing those mental health supports, or maybe there's clinicians and whatnot.

Is it going to are you anticipating I know it's hard because you don't have all the planning but that you would have a mixture of both types of staff, both case management but then also clinical staff? Is that kind of a thought that you all are having?

That has been a thought, yes. But we are still trying to really get in the weeds. And we want to make sure that we're bringing the right people to the table to have those conversations. So I would say that everything is kind of on the table. But yes, that has been an option that's discussed. Okay. That's great. I have no definitive answer. Apologize.

I know. Sorry. It's probably a premature question also. So we'll probably get there when we get there. All right. With that said, this is an action item council members who sit on the committee. So I'll take a motion, moved by councilman Sawyer, seconded by councilwoman Torres. Do we need to take a roll call vote? Not seeing any and wanna just make sure councilman Flynn, make sure you get your Yes, Madam Chair. I am good moving this forward. Thank you. Thank you. All right. This will be moving forward to the full council. Thank you so much.

We'll just take a brief moment to transition for our next presentation. Alright. We are joined by some guests here. We'll have you all introduce yourselves, and you're here to today to talk to us about the two q spending plan. And so we'll just go ahead and have you all do some introductions, and then go ahead and proceed with the presentation.

And we'll have questions at the end.

I'm Donna Lynn, the CEO of Denver Health.

Stephanie Seiner, Government Relations, Denver Health.

Megan Prizzo, I am a director at Department of Public Health and Environment, and I'm supporting 2Q and the Denver Health Operating Agreement.

Great. Thank you. Can I begin? All right. Great. Well, thanks for the opportunity to present our spending plan. I'll make a couple of comments before that. First of all, you are all going to get and I think this is a demonstration of Denver Health's accountability and commitment to transparency on how we spend our money and what our outcomes are. So as you know, pursuant to the operating agreement, we produce a report to the city. Stephanie's got all the little packages we saved on postage.

So this gives extensive metrics around all the areas in the operating agreement, whether it's jail services, airport, etcetera, and trends over a three year period so that you can see that. And our commitment is as 2Q matures and we move into the environment we're into, that we will be providing that kind of longitudinal data as well. Is my favorite I call this my favorite slide. I want to point out a couple of things I think that are relevant. So the blue bar, as you properly recall, or the blue horizontal line represents the city's support.

That's from just from 2017 to 2024, but that bar would go back pretty much consistently to 1997, the little high $20,000,000 subsidy. Our budget, just for context, is $1,400,000,000 So we get our medically indigent payment of $30,700,000 from the city. That is separate from what I call the purchase of service arrangements, which are what's in this report to the city, so things like the jail. So the medically indigent payment was designed to recognize

the

fact that there are many patients that come to Denver Health for whom we get no reimbursement because they're completely uninsured, or we only get partial reimbursement through Medicare and Medicaid because they don't pay us the full amount of what our expenses are. And I think what we've shared with the council in budget hearings and others, there was a significant change after COVID that resulted in huge growth, both amongst city residents but also amongst out of county residents. When I came in in 2022, this line of out of county residents perplexed me. And I felt that it was important for Denver Health to try to level that off. You can see that that, in fact, has leveled off pretty significantly.

But the city share, so to speak, of our uncompensated care is still $110,000,000 Recognizing that there was no easy way to fix that because we take care of every patient regardless of their ability to pay, we pursued 2Q. And as you know, it provided us with what the city estimates is going to be a $65,000,000 infusion to Denver Health to deal with uncompensated care. There's a couple of things that I think you're generally aware of. One is that a lot of our reimbursement is Medicaid. It does not cover our costs, as I said.

And our increase for Medicaid beginning 07/01/2024 will be 1.6%. I think the average person on the street probably could say that's not sufficient to cover any increases that you see from year to year, whether it's it's for staff who we have to hire, medical devices, or pharmaceuticals. They typically go up three times the general consumer price index. So medical inflation tends to be in the four to 5% range. The second is something that while we celebrated on November 5, we also knew there were some storm clouds on the horizon.

The current Congress, as you know, is debating $880,000,000,000 worth of cuts over a ten year period to Medicaid. That will fall significantly on Denver Health, and we will be impacted more disproportionately than any other health care system because of the percentage of Medicaid patients that we have. So we've been doing a lot of work with our federal delegation, with the state, and also talking just to the mayor because we're trying to anticipate, although we don't even have a number yet, but we know it will be in the I would guess that if $880,000,000,000 actually trickles down to Denver Health in some of the ways it's being discussed, that it could have an impact of over $100,000,000 over the next five years. So depending on how they schedule some of these things out and the scope of what they do, ironically 2Q lets us breathe maybe for this eight month period in 2024. But we believe that by October, we will see, if not before, significant cuts from the federal government.

So we have a little breathing room. But let me tell you about how we're going to spend our money from 2Q. And I also want to let you know that as of last week, we did receive both our first and second payment from the city. So by April 30, I think, we got our first three months, January, February, and March. And then we just recently received our fourth payment or the payment for the month of April.

So we have in hand at Denver Health, we get about a little over $5,000,000 a month from the estimated sales tax revenue. And so we do now have four months of that revenue. We've been putting it in our budget all along as an item that we knew that we would receive. So our goals with this money and as you recall, and we're going to go through the five key areas where we are dedicating this money was to maintain our funding in what we call priority areas. So primary care, pediatric care, emergency and trauma care, and then substance use and mental health.

To try to reduce some of the burden that we experience, because we do take care of a lot of uninsured patients. I think you also know that we had a significant impact from the newcomer population. That has somewhat leveled off. But we were close to $40,000,000 in unanticipated expenses due to providing care either in our emergency room or in our clinics for newcomers. This gives us at least, as I said, a little breathing room when it comes to what we think might be happening on the federal level, although it could be very temporary breathing room.

And we'll work with the state and hopefully with you if there are even more significant impacts than we can anticipate at this point. You can go to the next slide. So to highlight, let's keep in your head 65,000,000 to $70,000,000 I think we're going with $65,000,000 from a payment point of view from the city, and there'll be an adjustment up or down depending on how the sales tax revenue works. So we have a spending plan that we have roughly outlined, and we'll be sharing more detail with the city and with you, to identify the areas where we think we will need to infuse this money. The first and the biggest is our emergency and trauma care, the most expensive, as you can imagine.

It covers things like transports to the hospital that aren't reimbursed at all. It was interesting listening to the prior conversation because many of the transports to Denver Health do come either from shelters or from other locations because we will take care of both the mental health and the substance use conditions that patients present. And just another fact to keep in your head, last year we saw 16,000 patients who did not have housing. And we take care of them in a variety of settings at Denver Cares, which is part of the operating agreement, where they do get up to 90 of housing in our emergency room, in our inpatient units, where we frequently can't discharge patients because we can't discharge them to the street, quite frankly. And as you know, we also now provide housing.

We have 34 housing units that often are filled by many of the patients, individuals that you just heard in your other presentation. So emergency and trauma care is very expensive. It includes paramedics doing work. I believe about a third of their calls are unreimbursed, often because patients refuse to be transported or they don't really have a serious medical condition. And many of those calls do go to shelters.

Primary care, I think as you're aware, are 10 community based clinics, are listed here, we will be allocating about $16,000,000 to those locations, about $14,000,000 for mental health services and in pediatric care, lower cost care, so only about $2,500,000 to our school based clinics and to our hospital based pediatrics, and then finally about $2,000,000 in alcohol and drug recovery. We you can go to the next slide. What we will provide as part of our annual spending plan is not just how and where the money is spent, but also what are some of the outcomes and the metrics. And so we're very focused on the additional patients that we will see as well as additional services. So I think I've covered a lot of what is on this slide.

I think the important thing are we try to balance what we need that the medically indigent payment doesn't already cover with some new services. So there are three specific new areas that we are putting some of the 2Q money into. We will open as you recall, I talked several times at the budget hearings about the 78 inpatient psychiatric beds that we have, and we only keep about 50 of them open. We are reconfiguring it and opening up 10 new, what we call, med psych beds that will take care of psychiatric patients patients with psychiatric issues who also have medical needs. Frequently it's usually just not one category.

That will open I allowed to say August. I think August. I mean, part of the challenge is whenever you open a new unit, you need, as you know, building permits. You need certifications from the state to be able to do this. These will be the only med psych beds in the entire state of Colorado.

So a really innovative way to deal with patients who have both issues. We have a new clinic site. And thank you to Councilwoman Romero Campbell because we've had some back and forth with two different landlords. But we believe before the end of the year, we will be able to open a primary care and specialty care site in Southeast Denver. Very excited.

It will have laboratory, radiology, pharmacy. And that actually is an area where we do not currently have clinics. And then finally, we have a new school based clinic. We will not spend the money on the new school based clinic this year because we have to wait for DPS to actually modify construction at Northfield. They got money in the bond, and so we will be able to spend that money in 2026.

We also were some of the money will be allocated towards increase in demand that we've seen in those five primary areas as well, just from '24 to '25, both increases in costs and increases in demand. And I think that's all I have. And I don't know if, Megan, you want to talk about your slide. And I assume we can go to questions.

Thank you. There's a lot of information here. We tried to keep this to one slide and as detailed as possible. Thanks, Donna. Excited about so much of what's in Denver Health's budget.

As you all might remember, according to the contract, the city has the ability to retain up to 1% of the sales tax revenue for kind of administrative work behind the scenes to support the sales tax. We don't know exactly what that will look like because this is new, but we have a sense of some of what it will look like because of other programs like Caring for Denver that have somewhat similar structures but not exactly the same. So for now, we have done our best, similar to Denver Health, to guesstimate what those expenses will be. This is an annual projection. So as you might imagine, since we're already in May, the idea of hiring folks and getting them through the door, getting an RFP out in a financial services contract, these things we will not spend the full 6 and $20,000 this year, potentially half of that.

If we're lucky, probably less than half of that. But this is an annual budget so you all can see the breadth of what we're hoping to accomplish this year. There are two positions. One is an administrator position that will handle all of the day to day nuts and bolts of this relationship. They'll be here regularly.

They'll be working with Denver Health regularly. They'll be the main point of contact for anyone in the city who has questions about 2Q. They'll be getting up to speed and sort of the subject matter expert on all things Denver Health at the city. We want them embedded in all things to understand and have a comprehensive picture of what's going on with the operating agreement, what's going on with the other contracts within the city, what's going on with the federal funding. And so it'll be someone who spends a lot of time understanding the landscape of the work of Denver Health with the city and how that relates to 2Q, how that relates to the spending, how that relates to our jobs of holding Denver Health accountable and supporting them within our city system for the sales tax.

For now, we've estimated a half FTE for a fiscal administrator slash contract administrator, someone who does both of those things within DDPHE. They'll be handling all the fiscal management, the contract management, the RFP if we, as we move forward with this contract services work. And so their job will to be process the invoices, make sure those payments go out on time, yada yada. So that's, right now, 50%. We, again, we don't exactly know how much time this will all take, and we'll be doing some assessments this year to think about what that looks like.

And then just some basic services and supplies to support those positions, some equipment training and travel if need be, and, office supplies and materials. And then the contracting services, you all may recall, Department of Finance historically has hired a firm Ernst and Young, who's done some analysis in support of the Denver Health financial system, helping folks within the city and us within DDPHE and the finance department to understand health care finance, understand some of the systems that aren't specific to the way the city does business from a financial perspective. So we're considering an RFP. We're drafting a draft right now of an RFP to help us find some external support and experience that will help us set up our systems from the beginning to understand and be built to help us hold Denver Health accountable to what we're understanding and seeing in the spending and also be a partner with Denver Health to say, as the federal funding landscape changes, what does that look like for all of us? How do we be good partners within the city to support those conversations and the the changing landscape?

So we we don't know. The last contract for that service provider out of finance was higher than this dollar amount. I don't have any idea what this will cost, to be frank. And so we tried to make sure that was high enough to get close to what the previous contract with Ernst and Young looks like, but not so high that, it was, first of all, out of our 1%. We may not spend, all of this this year.

We certainly won't spend all of year. And we don't anticipate that this is a contract we'll keep for the next dozens of years. We think this will be the upfront helping us set up systems to do a good job of this. This won't be something we put in the plan in 2027 and 2028 and 2029. This will be a near term consultant to help us really think through and understand the health care finance system better and set up some systems so that we can manage that on our own moving forward.

So I know this is super detailed compared to the 64,000,000 that Donna just presented, but we wanna be as transparent as possible about our thinking. We know this is a learning year, and we think that'll that learning will probably bleed into next year and really understanding what systems we need to put in place to support this. But this is our proposed plan. I guess the last thing I'll say is a reminder that in our contract with Denver Health, both DDPHE and Denver Health come back to you all kind of midyear before the August to get a check-in on how the spending is going, how this all relates to our spending plan, what progress we're making, what changes in the federal landscape look like. So both DDPHE and Denver Health will come back mid year to kind of talk through that with you all and give you a sense of were we right, were we off, where were we off, and what the landscape looks like financially.

And I think that's it.

And I think the attachment did have the actual worksheet for the annual plan. It should be in your packet as well. We just wanted to do the presentation very high level.

Thank you so much. This is great. Thank you for providing all this information. I want to welcome Council Pro Tem Romero Campbell to the meeting. And starting in the queue, we have Councilwoman Torres followed by Heinz.

Thank you, Madam Chair. Thanks, everyone. Good to see you all again. So one question for Denver Health and another for DDPHE. Just opened up the matrix document. So thanks for pointing that out. I think that gets to most of my questions around the allocation and whether it's covering personnel expansion of hours or if it's just covering an uncompensated care gap. Can you maybe clarify how that's going to be used?

Thank you.

So it's both.

We saw increases in our spending from '24 to '25, as I mentioned, things like staffing volume. I mean, we have, for example, in the primary care section, we are anticipating a 4% increase in primary care services. Some of those are reimbursed, but many of them are not. So it's a combination of the two. And when we see kind of

like an end of year or report out, we'll be able to see like $16,100,000 went to primary care. This is kind of how that was how we ended up spending that.

We'll see it by even as you can see, some of the categories, additional dental services, additional behavioral health services. So we'll break it down into all those components.

Great. And when I say we, I think it's

The the big way.

Right, yeah. The public. So I appreciate that. I think that'll be really exciting to see kind of the anticipated spend and then the actual. I also, Donalyn, appreciate your optimism in face of everything that you're grateful for an eight month breather window. Thank you for that. So then DPHE, so for that last slide so this doesn't seem like an accurate 2025 spending plan. If you're we're you're just potentially putting out an RFP now, you may not actually start paying that until '26. Right?

I think so. We've talked about maybe having a month or two of expenses hitting on that consultant at the end of the year depending on how quickly the RFP moves through. Same with the staffing, depending on how long the position, the administrative, administrator position is posted right now. So depending on how quickly, but we're thinking half a year instead of a whole year. So, yes, this is an annual spending plan. I'm happy to correct it for estimates for 2025. I think it definitely will depend on how quickly things move through the system.

Will we see from DDPHE the 1% spending plan on a, excuse me, on a regular basis? Or is this the only time that we're going to see it?

We'll come back in August with Denver Health, but happy to also provide more regular kind of updates to you all as needed for sure.

Dollars 600,000 for staffing seems high for like just anticipating the first couple years of this. So I would be interested in what that shakes out to be for partial year for 2025 and then real year in 2026. The other thing that I'm just a little fuzzy on is the administrator three role, one full time, but it's to every relationship we have with Denver Health, we're charging to two q dollars. Should it should it not be a partial charge to 2 q dollars because this this percentage was never meant to cover staffing for operating agreement and, like, all of the other things that are paid for through our general fund. Like, how how how did we arrive at a full person being paid for by these dollars?

Sure.

And I should be clear. When I'm saying this person should be sort of a subject matter expert on all things Denver Health, it's just in how that relates to 2Q. There will still be someone handling the operating agreement that is individual. And this individual will work with that person to understand how is the operating agreement MI payment or how is the relationship with anything happening in the operating agreement affecting 2Q spending or affecting what's going on with 2Q. So they will not be handling individually that work.

I think that it's critically important when we're talking about such broad category services across Denver Health and across I mean, I think just within DDPHE and I'm going to maybe get this number wrong, I'll get back to after the fact. But just within DDPHE, we have more than a dozen contracts with Denver Health individually outside of the operating agreement, outside of 2Q. And that's just DDPHE. Outside of that, there's another 10 or 20 or 30 across the whole city. And I think knowing how all of those relate to an additional $64,000,000 is crucial in my mind to making sure we're not missing our understanding of the entire work we're doing with Denver Health and how 2Q supplements that and continues to work towards getting services to folks that need it most while still understanding that there's another $70,000,000 for the operating agreement and another $30,000,000 in other contracts, I think, off the top of my head.

So I think just making sure we're really clear about that landscape. Dollars 30,000,000 is not the right number. I think it's closer to $6,000,000 But so it's it's definitely not handling all of that. Yeah. So okay. That's that piece.

That that helps me understand that a bit more because that didn't seem particularly fair Totally. On that piece. That said, one and a half staff people to manage just two queue. Like, it it might be helpful for me to have a better concept of the I can appreciate the fiscal administrator 100%. That's what I think of when I think of administering these dollars.

We've got sales tax dollars coming in. We've got to get them out on a regular cadence to Denver Health. The program management, we're not RFP ing to Denver Health to provide $64,000,000 worth of programs. We're paying them for the things that they're saying they need the money for according to the taxpayer approved sales tax measure. So it just feels like a little bit different. And for the another full time admin three, like, they will be doing day to day as it relates to 2Q is still a little fuzzy for me.

Sure. I get that. And we can certainly come back and provide information, and I can provide some more kind of upfront understanding. Right now, our caring for Denver administrator works,

you

know, forty plus hours every week on related things, and I think it's the most similar position that we found within the city, knowing that it is different, but still similar. And so I think, that's that's kind of the basis of where this administrator position came from. We're happy to be thoughtful about this. We don't want to we know these are crucial services. We know that every dollar that isn't spent in the city goes to Denver Health, and we don't want that to be, missed and lost on us. And so I think we will do our due diligence this year to make sure you all understand what is and isn't happening with these roles. And if it feels not right sized, happy to have those conversations and make sure you all see that in August and at the end of the year and moving forward.

So August is when we would be able to see, like, okay, if we're not gonna spend $300,000, that gets moved back over to Denver Health. Yes. Because we're not gonna fully spend out the 1%.

Yeah. And I can get you I mean, later this week or early next week, I can get you an updated plan that looks a little different than this and is an annualized. Okay. So I can get you that pretty soon, which means that some of those dollars don't remain at the city for 2025. For future years, for 2026 and beyond, this is a a a good estimate for us. I wanted you all to see that. And just to clarify related but, yes, we will come back in August and and let you know, like, we hired someone. This is what they're doing. This is what they've done for the first few week or few months of their tenure. And then just to clarify, you said 600,000 on staffing.

I think the contractor services will not be staff. We're not gonna hire folks to come do work for us, especially in the long term. This is just a consultant to help us set up our systems correctly in in the first year or two to to think about hospital metrics and health care finance in a way that we you know, that I don't individually know. And as much as we can hire someone with those skills, we just want to do that right and do that well. And that won't be something that is a staff member, it won't be someone who's on staff for years to come.

Okay. Thank you. Yes, Madam Chair.

Thank you. Councilman Hines followed by Councilwoman Sawyer.

Thank you. Chamber of Health, thank you so much for introducing the measure, for advocating for it, for spearheading it, doing all the work to make it become a reality

for an eight month Band Aid. I know it's

just kind of sad, the level of effort that and obviously, in November, we did not know. On the same ballot, there was another election. There were a bunch of elections. It was a really long ballot, but but that it would materially change the course potentially of of funding for Denver Health. And so I I I like that Denver Health and DDPHE are at the same the same table at the same time.

So thank you for that as well. When I hear that that the city is hiring con consultants to keep Denver Health accountable, I agree that we should have oversight. Y'all did all the hard work for it. And, of course, we wanna we wanna make sure that that you get the dollars that you're allocated and don't get the dollars that you're not allocated. But but I really hope that this is a partnership because you did the the the hard work to get the funds.

And so I hope that there are more partnership kinds of conversations instead of accountability conversations. So I just wanted to put that out there. Also we're talking about these dollars, but I and this it's not meant to supplant existing funds. That was

That's correct.

So 30,700,000.0 plus 65,000,000 gets us, if you go back to that first chart, 95,000,000. But that still is less than 7% of our budget. We presented, to your point and I think even Ernst and Young agreed that the average safety net in other parts of the country get around 11% of their budget from their local government. So $95,000,000 doesn't cover the 145,000,000 Or even if you took the city view, it doesn't cover the 110,000,000 of uncompensated care that we get. But I think to the eight month optimism, at least this year, we're breathing a little bit better and can really think about how we enhance services to the community.

Yeah. And so to counsel Torres' point about funding that entire FTE directly if it is for all programs, I think that would be supplanting some funding. So thank you for the clarification because my original thought was the same, that we were supplanting funding by having that particular role do more than just those funds. Nationally, obviously, we've got a conversation that is really scary for me as someone who's on Medicare and Medicaid. And nationally, have a conversation that I'm from rural Texas.

My mom just called while we're in committee. I don't know if she's watching. But she's not getting any younger. She's in rural Texas, and my heart jumped a beat. Like, she never calls during the day. And she called twice. And so I thought, woah, wow, I hope she's Okay. But the closest level one hospital is a three hour drive away She lives by herself. And so I can only imagine the challenge that rural Americans would have as well. And I think it's important.

In your chart, you have the non Denver residents. How many counties in Colorado do you serve?

62 of 64 counties.

So this isn't just a Denver thing. And our rural hospitals are doing what they can. In small town East Texas, Nagatoches, there were two hospitals. One declared bankruptcy, the public hospital. So the ones that would be accepting level four care for all, I think they're a level four hospital. Is that level?

Yes. There's, I think, one through five, right? Yeah. One through five. We are level one. We're the only level one in Denver. There are some in the metro area. I think to your point, too so two things. One, on the federal level, we have been talking to our entire congressional delegation because some of those representatives sent the community uses Denver Health. Shouldn't say they sent them.

The community uses Denver Health. And that's a federal law from when it's an emergency. And as you see, whether it's shootings or other things in the metro area, they come to Denver Health because we are, we think, the best in the state at saving people whose lives are endangered, or whether it's a stroke or a heart attack, etcetera. I think you bring up a really important point around the rural pace, which is as much as I talk about our vulnerability, they are more vulnerable than we are. And with days of cash on hand and maybe 2 figures we're in 2 figures, too.

But there are many hospitals that are Dozens of dollars. Free. Those rural hospitals, there's vulnerability. And then there's the what does it mean to the health of the people, like your mother, who might have to travel much longer distances even to get to a Denver Health or to a UC Health, etcetera. So I do think it's a city conversation, and it's a state conversation.

We did get, because we lobbied about that orange section of the chart, the $35,000,000 of uncompensated care from the state, the state did give us $5,000,000 again this year. So three years in a row, for the first time, we've been able to get the state to acknowledge they responsibility as well for the medically indigent that come from outside of Denver.

And so I'm working with the federal delegation as well to try to amplify my story because I believe it's an important story. I'd love to partner with you to share that conversation with the larger public if that's

possible. Absolutely.

Thank you, Madam Chair.

Can I

quickly respond? Yeah, if that's Okay. I think we have time. Yes. I I appreciate so much your comment about being collaborative and not only about account accountability.

And I definitely wanna speak to that because I think we've worked really hard over the last several months and with the two q contracting process to be as collaborative as possible and to really change the dynamic and shift away from kind of our historical relationship and really be better at understanding where there's tension historically. How do we overcome that? How do we be good partners? And so I do think it is DDPHE's role as the contract administrator to hold anyone under contract accountable and accountable to the metrics and the, you know, the dollar amounts. And, also, I hope that I can equally kind of articulate how much we appreciate this work and how crucial it is for the city, especially in a time like this.

Just that our commitment is 100% to be collaborative with Denver Health, and I think we've worked really hard for that. And you all were gracious in acknowledging that during the contracting process, and I hope that you know that we're still very much committed to that moving forward. And and just wanna say that out loud so that you all hear that and, know our stated commitment. And happy for you all to call us out on that if it doesn't feel like it's happening that way. But, thank you for saying that. Appreciate that.

Thank you. Councilman Sawyer.

Thank you. Thanks, you guys. Appreciate all that I have heard here today. I think that, you know, I I wish we had better news as it came from the federal side, but I'm so just honored to be any tiny part of the work that has been done that has come and the positive benefits for our residents that have come out of this changed, improved relationship with Denver Health. So really appreciate both all everyone involved, you know, who really brought us to a different place than we certainly were in when I started here in 2019.

So, really appreciate that. This is sort of a lot in the weeds, but I did have a question about the admin three position that you are, listing. Because what I heard you say the expectation or likely expectation of the job responsibilities will be and what the job responsibilities of an admin three position are are not the same. So I'm just curious whether you have really looked at that admin three position position description and responsibilities because I know this because we have an admin three position in city council, and we don't use it because the level of discourse that is required out of our staff members, particularly with the public, an admin three responsibility level and an experience level does not meet the needs of what city council members need in our offices. I'm just gonna say you're gonna have the same problem.

That is not an admin three rule. So this is, like, super inside baseball, but, that means and there are, I think, 11 admin levels in the city of Denver. So I would say you might just wanna take a look at that because you'll have to reprice based on if the job duties that you are talking about match to a higher level admin within our HR classifications.

Okay. I I appreciate the

It's Like I said, it's really inside baseball, but, like, we're talking about a a small amount of dollars here. Right? And it makes a difference. And the things I'm hearing you say this position will be responsible for, that is not an admin three job.

That's helpful to hear. We definitely went back and forth with HR. They they proposed admin two. We said not a chance. We we worked hard to make sure that we work with HR, to ensure that we were really clear about it. I, yeah, I definitely read through many different levels of the classification. I definitely, I worked specifically on the job description. I will say it's posted now, and we have some incredible candidates already. And we have a lot of them already. It's only been posted for couple of days, and,

we have

a lot. So, and if for some reason the candidate pool is not what we expect it to be or for some reason if the salary doesn't compensate the person we need to to do the job we're talking about, we can repost. We can reconsider, reclassify, and repost. I've been very pleasantly surprised by the candidate pool so far and lots of people stopping me in the hallway saying, guess who I know is applying? Guess what I know? So I think there's a lot of interest. I think it's a really unique position within the city. I also appreciate the inside baseball. So we will keep a close eye on that and definitely consider that if that's an issue.

Yeah. I appreciate it. And I will say we had a marketing aid position open that we're hiring for now. And we got well over a 100 applications and incredibly qualified people. It's really wonderful to see. But, also, we have to pay our people appropriately for the work that they're doing. Yes. And so I'm just you know, I I just will flag that for you because I do want every dollar we're not using to go to Denver Health because that's what our voters intended and that's where it should be. But also, I'm just hearing you say that there are going to be responsibilities involved that you're gonna need to look at a little differently, I think, helpful.

Thank you. Appreciate it.

Alright. Thank you. Yeah. I I'll just echo those same sentiments of, like, yeah, making sure. I know that in the conversations councilman Torres and I had during, you know, the process was making sure that as many dollars are going towards those services.

But with that, I do have a quick question on the slide deck, where it was talking about the services, the breakdown of the different buckets. I don't know if we could bring that back up. But the next slide after this, yeah, the pediatric care. I was just curious and I know, Stephanie, that you've been in some of the meetings around the WIC and kind of some of the struggles that there have been around funding for WIC and timeliness of when applications are submitted for people being able to get an appointment and then hopefully access those resources. Just curious if any of these dollars will go towards that effort, knowing the timeline, if you want to talk about that.

Mean, WIC funding is federal. So it is in other words, we provide WIC. It's housed within our clinics, but we aren't doing the funding. So where there's reductions in WIC, that's coming from the federal. Right? Correct?

But what about for staffing capacity? Because it sounds like part of the issue is that people are on a wait list. There's prioritization for people who are homeless or refugees. They are to receive information within ten days and then everybody else is twenty days. And right now, I think we're at sixty eight days that people are getting responses. And so I'm just curious staffing issue and if that is something that could be that that could get some help from these funds.

Thank Mike. Doctor Steve Adigo. I'm chief of government committee affairs. Thank you, madam chair. Thank you for the question. Thank you members of the committee for this rich discussion. I think you bring up a great question, especially around the need of a community. I think where we struggle a little bit is, you know, we've been thinking about these buckets as clinical services. WIC would be outside of that from the traditional understanding. To Donna's point, WIC is a we're a subcontractor.

We provide in kind support because we co locate them within our clinics. We think that's a great model for our patients. However, we've not traditionally funded them directly out of Denver Health dollars outside of the scope of primary care. So could we think creatively, perhaps through the operating agreement or through other alternative partnerships through the city to supplement WIC, I think, yes. I'm not sure that I would say 2Q would be the right way to do that, but certainly open to to a further discussion because the need is there. And I think in particular now, and I don't, to their previous discussion, don't see additional funding coming our way for that huge social determinant of health, be it food security.

Okay. Well, thank you. Thank you for answering that. I was just curious because I know that was something that was on our radar in my office and knowing we all, I think, can agree that nutrition for infants and children and, you know, nursing mothers, like, it's just really important to set people up and prevent a lot of other things. So thank you for answering that, and and would look forward to hearing any new developments in that space.

And we

do have an

update coming for you. We have been meeting internally to look at the budget and see what's happening with the federal circle and what the staffing looks like. And so I'm hoping that within the next month or so, we'll have an update on turnaround time and kind of what the next steps look like from the federal side. Great.

Well, thank you again. I really appreciate you all being here and providing this update. We look forward to getting the following updates and also with the operating agreement at some point in time. So I don't think Councilman Watson, I'm so sorry. I missed you. I missed you. No problem. I am so sorry. I had you on my list too. I'm really, really sorry.

I'll be I'll be very quick. I just

I got excited.

I'm sorry. Thank you, committee chair. CEO Lynn and Stephanie, Megan, thank you so much for your presentation. I want to say thank you for the transparency in what you all are providing as far as the 2Q spend. I mean, was a big win for Denver, a big win for the state, I would say, because we provide that support statewide.

The dialogue we had kind of pushed forward a discussion we're having on another contract specific to the DDPHE's holding for another service provider specific to medical care and something that Donna stated as far as the long term support for indigent care for folks who are unhoused and the psychiatric support you provide, the dental health support that you provide. I am very curious from your perspective as far as the outcomes of across the board medical health and support. How do you track the health support, the increase in physical and mental health support for folks who are unhoused that you are providing support for? Do you have tracking of that? And you don't need to have it today, but I have curiosity because that is a sticking point for me on on some of our contracts when it comes to medical support.

And I'm curious from Denver Health since you received those same residents, how are you tracking the outcomes from medical?

Stephanie could probably tell me the page, but it is because I know 16,400 unhoused patients. So we literally do track it. And I don't do any of my wonderful supporters here know what page we're on? I don't have it in front

of me.

But what I would offer is perhaps, particularly this committee, there may be a benefit of having a couple of our team members come and do a presentation outside of the funding about the work we do with the unhoused population, especially in the evolution of an ER visit, an inpatient stay, and a discharge, as well as our outpatient care because we do track housing as one of our components. So we have good data on the on, to your point, questions and process metrics around the unhoused and how they go through our system. It actually is relevant to the prior discussion on Roads to Recovery as well too. And we've been working very closely with the with the mayor's team, both through DDPHE and through Roads to Recovery on how we work together on both of those crossover populations, to be more efficient.

Thank you, doctor Federigo. Thank you, Donna. I know you all have the information. I just wanted to elevate that it's difficult for me to approve a $1,700,000 contract without outcomes for health, where Denver Health provides that to us all the time.

And we're working really closely on the ARPA dollars that you all gave us a million dollars with DDPHE. And our care management team has really been working on the high utilize high utilizers versus folks that are within the, roads to recovery. And we have some really good findings that, you know, I think we can come and share how that process worked, and how that partnership has developed over time. I think they have a really good path, and they're creating, different workflows and communication. How do we communicate with Roads to Recovery, but still protecting HIPAA?

Right? And how do we make sure that we're dealing with the folks that are spending a lot of money within our emergency room services and what services do those all in mile high sites need to provide in order to meet the care of those individuals? So we have some really good work that are in motion that I think in the next couple months, we could come and share the progress that we've made.

Thank you so much. Thank you, Madam Chair.

Thank you. And you know I'm relentless. Found it.

It's 28. Page 28. Literally,

we provided to you by county. And just to give you a sense, in Denver, in 2022, we were taking care of 7,200 homeless patients. And as I said, this is somebody gave me the number as of today, but almost 13,400 patients for 62,000 visits. Now I think you raise an interesting question that I'd love see, which is what are we taking care of them for? Are they getting are we integrating?

Again, back to the prior conversation, I think one opportunity Denver Health and the city have is, how do we we're taking care of the same people and in multiple venues. And how do we think about what's the right place to get them to? How do we measure success in a way that it isn't because we're not a housing agency. We're taking care of people who happen to not be housed, but who have a variety of different conditions. So I think it connects to the prior conversation, because they're not mostly people whose houses have burned down and are showing up at the solution center.

They're people with other medical and mental health conditions. So to the we should collaborate more, I would heartily agree on that one.

Thank you, CEO.

Sounds like we'll have a briefing or the suggestion from Doctor. Federico. We've taken a note of that. So we'll be reaching out to see about setting something up to talk about specifically that population and everything. So all right. Well, now we're done. I'm sorry, Councilman Walton. Like I said, I got a little out ahead and excited. But thank you, everyone. With that, we have some items on consent. Nobody has called those out. We have eight items on consent. Nobody has called those out. Those will move forward to the full council, and we are adjourned.

Thank you.