heartland 2050 meeting 3

Barry Cleaveland, Silverstone Group Director of Research and Development Commissioner, Iowa Department of Transportation

Richard Reiser, Werner Enterprises, Inc. Vice President of Government Affairs

Greg Youell, Metropolitan Area Planning Agency Executive Director

Research Team Steering Committee Members

24.1

26.7

19.8

22.8

24.5

21.6

19.8

25.5

0

5

10

15

20

25

30 M

inu

tes

Average Commute Time to Work

* 2011 American Community Survey

Presenter

Presentation Notes

The Omaha region sees better commute times than the national average. Our commute times are very competitive when compared to our peer regions

Congestion

Texas A&M Transportation Institute 2011 Ranking

– Denver – 8th

– Minneapolis – 25th

– Cincinnati – 27th

– Oklahoma City – 57th

– Kansas City – 68th

– Omaha – 79th

(101 Largest Metro Areas in US-. #1: Most Congested)

Presenter

Presentation Notes

Top 101 Metro Areas in the United States

82.3

75.6

81.5

83

78

82.6 82.5

76.4

Percent Drove to Work (Single Occupancy Vehicle)


Presenter

Presentation Notes

More people in the Omaha area drive to work than the national average The Omaha region is on par with most of our peer communities


8.8 9.6

10.3

9.2 8.7

10.6 9.9 9.7

Percent Carpooled to Work

Presenter

Presentation Notes

The Omaha region has a robust network of carpoolers when compared to our peer communities


2.4

4.6

1.4 1.2

4.7

0.5 0.9

5

Percent Rode Public Transit to Work

Presenter

Presentation Notes

The Omaha region lags behind most of our peer regions when considering public transit mode split

Roadway/Highway Inventory

National Highway System Mileage

+ The National Highway System (NHS) includes roadways important to the nation’s economy, defense, and interstate mobility.

+ Primary focus of freight traffic

+ MAP-21 includes all Principal Arterials

* Federal Highway Administration

398

568

231

482

657

164

361

0

100

200

300

400

500

600

700

Presenter

Presentation Notes

Note: Some figures in the chart include the new Principal Arterial System additions from MAP-21. The Omaha figure includes these numbers. Oklahoma City is currently appealing the addition of the Principal Arterials in their region to the NHS system, as is Denver.

Presenter

Presentation Notes

Congestion: This map demonstrates that there are existing congestion issues inside the Omaha-Council Bluffs Metropolitan Area Under idea driving conditions, limited congestion occurs on most major roadways. Traffic accidents and weather events can cause significant delay if they impact a major roadway (interstate/expressway system, dodge street, etc).

Presenter

Presentation Notes

The thickness of the white line portrays the amount of traffic on the roadway.

Ongoing Major Projects

+ Iowa + I-29/I-80 Council Bluffs System Interchange Reconstruction

+ US 34 Missouri River Bridge Crossing

+ Nebraska + US 75/Kennedy Freeway Reconstruction

+ Connection to US 34

+ N-133 Expansion to Blair, NE

+ Interstate 80/680 Expansion in and around Omaha

+ City of Omaha Signals Master Plan Implementation

Presenter

Presentation Notes

Major railroad reconfiguration in and around Council Bluffs during the System Interchange project

Railway Inventory

Presenter

Presentation Notes

This data is from Federal Highway Administration. They used methodology that is typically utilized to determine roadway capacity (based on existing traffic volume and facility design capacity) to determine a level of service. The green lines on this map display level of service A-C, the yellow is LOS D, the orange is LOS E, and the red LOS F. Below is a definition of what each of these different levels of service mean: Level-of-Service A can describe free-flow operations. Traffic flows at or above the posted speed limit and all motorists have complete mobility between lanes. Level-of-Service B describes reasonable free-flow operations. Free-flow (LOS A) speeds are maintained, maneuverability within the traffic stream is slightly restricted. Level-of-Service C describes at or near free-flow operations. Ability to maneuver through lanes is noticeably restricted and lane changes require more driver awareness. At LOS C most experienced drivers are comfortable, roads remain safely below but efficiently close to capacity, and posted speed is maintained. Level-of-Service D describes decreasing free-flow levels. Speeds slightly decrease as the traffic volume slightly increase. Freedom to maneuver within the traffic stream is much more limited and driver comfort levels decrease. Example of LOS D is perhaps the level of service of a busy shopping corridor in the middle of a weekday, or a functional urban highway during commuting hours. It is a common goal for urban streets during peak hours, as attaining LOS C would require a prohibitive cost and societal impact in bypass roads and lane additions. Level-of-Service E describes operations at capacity. Flow becomes irregular and speed varies rapidly because there are virtually no usable gaps to maneuver in the traffic stream and speeds rarely reach the posted limit. Any disruption to traffic flow, such as merging ramp traffic or lane changes, will create a shock wave affecting traffic upstream. Any incident will create serious delays. Driver's level of comfort become poor.[1] LOS E is a common standard in larger urban areas, where some roadway congestion is inevitable. Level-of-Service F describes a breakdown in vehicular flow. Flow is forced; every vehicle moves in lockstep with the vehicle in front of it, with frequent slowing required. Technically, a road in a constant traffic jam would be at LOS F. This is because LOS does not describe an instant state, but rather an average or typical service. For example, a highway might operate at LOS D for the AM peak hour, but have traffic consistent with LOS C some days, LOS E or F others, and come to a halt once every few weeks. However, LOS F describes a road for which the travel time cannot be predicted. Facilities operating at LOS F generally have more demand than capacity. Keep in mind that with the Rail application of this methodology some of the nuances in the LOS calculation are lost in translation.

Transit Inventory

Transit

+ Fixed Route + Metro Transit of Omaha is the only currently operating large scale

transit service

+ Metro operates inside the Omaha city limits under their existing funding structure

+ Contract services are provided to Council Bluffs, Bellevue, Papillion, and LaVista

+ 2012 boardings: 4.2 million

+ Demand Response + Services are provided by multiple entities outside of the Omaha

Metropolitan Area

Metro System Map

Weekday- AM Peak Service Frequency

Omaha Metro- Linked Transit Trips On-Board Survey Weighted Response

Presenter

Presentation Notes

Important to note that the major travel patterns for the transit dependent population are North/South Non transit dependent move more East/West

Freight Movement

Major Freight Corridors

Presenter

Presentation Notes

Our region is situated on two major freight corridors

Average Truck Speeds on Selected Interstate Highways (2011)

Presenter

Presentation Notes

Truck speeds through our region are very good

Aviation

Presenter

Presentation Notes

Commercial Service Airports Eppley Airfield 4 million+ passengers annually on six airlines American Airlines Delta AirLines Frontier Airlines Southwest Airlines United Airlines US Airways 75 daily departures to 16 destinations 138 million pounds of cargo and mail annually General Aviation North Omaha Airport Millard Airport Blair Municipal Airport Council Bluffs Municipal Airport Plattsmouth Municipal Airport Wahoo Municipal Airport Military Offutt Air Force Base Home to US Strategic Command 14,000+ employees

Regional Transportation

Issues

+ Funding

+ Infrastructure Condition

+ Reliance on Automobile

+ Transportation v Land Use

+ Air Quality

Opportunities

+ Freight through movement

+ Convenience of Eppley Airfield

Presenter

Presentation Notes

Potential for aviation based industry if the 16th Street (North Omaha) bridge is ever build Connections of the US 34/US 75/I-80/I-29 projects

Funding Challenges

+ Funding largely generated from motor fuel tax

+ Reduction in VMT and increased fuel efficiency

+ Status of Federal Highway Trust Fund

+ Increased cost of materials

$-

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

Illustration of Financial Availability

Total Revenue Total O & M Capital Funding Available

Questions/Discussion

Tim Burke, OPPD VP of Customer Service & Public Affairs

Todd Foje, Great Plains Communications Chief Executive Officer

Dave Johnson, MidAmerican Energy Business & Community Development

Amy Lindsay, MUD Vice Chair- Board of Directors Committee Resource: Doug Clark, MUD President

Research Team Steering Committee Members

Broadband

Presenter

Presentation Notes

Information provided by two state initiatives funded by the NTIA’s State Broadband Initiative (SBI)- Connect Iowa and Nebraska Broadband Capacity Building Program - Ongoing effort; gaps in data collection only fixed services; not wireless/mobile service providers data shown at the census block level areas in white area not served or underserved

Broadband Service Area Fixed Services

* Data sources: Connect Iowa; Nebraska Broadband Capacity Building Program

Presenter

Presentation Notes


Broadband Provider Coverage Map Fixed Services

* Data sources: Connect Iowa; Nebraska Broadband Capacity Building Program

Presenter

Presentation Notes

- Cox, CenturyLink and Windstream (IA & NE) cover the most amount of land area in the region. Cox and CenturyLink services overlap in many areas; many other providers overlap as well

Broadband Information

% Households with Access to Download Speeds > 10 Mbps

% Households with Access to Download Speeds > 25 Mbps

100% 99.7% 86.0% 99.3% 100% 95.4% 81.5% 74.2%

97.0% 93.0% 78.2% 41.8% 34.1% 0% 44.4% 0.2%

Cable DSL Wireless Fiber

% Households with Access to Technology by Type

91.5% 93.3% 88.7% 11.1%

96.6% 95.5% 95.3% 11.7%

53.2% 91.8% 100% 3.1%

81.1% 86.8% 4.6% 1.2%

0% 96.9% 82.5%

0%

36.7% 81.9% 99.8% 4.5%

44.6% 80.7% 73.6% 3.5%

46.5% 82.5% 70.9% 1.3%

Douglas Sarpy Pottawattamie Cass Saunders Washington Harrison Mills

* Data source: National Telecommunication & Information Administration

Issues and Opportunities

+ Inconsistent State Policy

+ Consumer Density/Service Gaps

+ Continued Expansion for Economic Development

+ Established Transport Network

+ Strong Enterprise Bandwidth Customers

Presenter

Presentation Notes

Issues Nebraska more progress with state Universal Fund Difficulty in filling service gaps with low pop. density; high cost to consumer for service Econ Dev emphasis on data centers and broadband dependent industries put pressure on expanding Transport Network Opportunities Well established Transport Network with support of strong private sector businesses

Electric

Presenter

Presentation Notes


Electric Service Providers

+ Total Customers: 309,516 (all sectors)

+ Generation Capability (daily): 3,208 MW

+ Operating Revenues: $1.05 billion

* Does not includes REC or municipal customers; does not provide service in Nebraska

** These generation and revenue figure s are for the State of Iowa

Omaha Public Power District

MidAmerican Energy

Rural Electric Cooperatives (REC)

+ 46,447 in Iowa region*

+ Generation Capability (daily): 5,343 MW**

+ Operating Revenue: $1.64 billion**

Municipal Providers

Nebraska Public Power District

Presenter

Presentation Notes

REC- Nishnabotna Valley; Southwest IA; Harrison County; Western IA Muni- Neola, Shelby, and Woodbine’; Atlantic in small area of west Pottawattamie

Electric Utility Coverage Map

Presenter

Presentation Notes

NPPD serves Plattsmouth in Cass County

OPPD Energy Sales: 2003-2012

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

18,000,000

2003 2004 2005 2006 2007 2008 2009 2010 2011

Residential Commercial Industrial Off-System Sales

Presenter

Presentation Notes

- MW hours - Most sector show steady/level sales; Off-System Sales showing growth

IOU 2012 Average Retail Rate / kWh

* Data source: Edison Electric Institute

$-

$0.0200

$0.0400

$0.0600

$0.0800

$0.1000

$0.1200

2013 MidAmerican-IA 2015 MidAmerican-IA 2016 MidAmerican-IA

* West North Central includes IA, KS, MN, MO, ND, SD and NE.

MidAmerican IA West North Central Region National Average 2012 $/kWh

Presenter

Presentation Notes

Comparison of IOU Companies - not RECs/Municipals/Public Power Districts

http://www.mudomaha.com/rates/pdfs/memphislightgassurvey.pdf

Presenter

Presentation Notes

Rates current as of January 1, 2012 Surveyed approximately 50 utilities that are similar in size to Memphis, Tennessee metro Primarily public utility providers Not all report for each category; Electric had 40+ responses; Gas, Water, Sewer had 30+ responses

Average Residential Electric Rates (1000 kWh)

*Omaha ranked no. 17

$77.75

$96.24

$222.79

$0.00

$50.00

$100.00

$150.00

$200.00

$250.00

Presenter

Presentation Notes

MidAmerican’s average is $88.10 per 1000 kWh (would rank 6th relative to other regions)

$0.00

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

$3,000.00

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40 kW @ 5,000 kWh Per Month 100 kW @ 10,000 kWh Per Month

.

Average Commercial Electric Rates (Tier 1 & 2)

*Omaha ranked no. 6 & 7 respectively

*Omaha ranked no. 6 & 7 respectively (again)

$0.00

$10,000.00

$20,000.00

$30,000.00

$40,000.00

$50,000.00

$60,000.00

$70,000.00

$80,000.00

$90,000.00

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500 kW @ 100,000 kWh Per Month 1500 kW @ 500,000 kWh Per Month

.

Average Commercial Electric Rates ( Tier 3 & 4)

*Omaha ranked no. 9, 5, & 6 respectively

$0.00

$1,000,000.00

$2,000,000.00

$3,000,000.00

$4,000,000.00

$5,000,000.00

$6,000,000.00

$7,000,000.00

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5,000 kW @ 1,500,000 kWh Per Month 20,000 kW @ 10,000,000 kWh Per Month

70,000 kW @ 50,000,000 kWh Per Month

.

Average Industrial Electric Rates

Presenter

Presentation Notes

OPPD- $102,100; $546,922; $2,372,022 MAE- based on average industrial rate, $64,500 (2); $430,000 (2); $2,150,000 (4)


+ Generation Capability

+ Transmission Lines

+ Competitive Pricing

+ High Customer Service Satisfaction

Natural Gas

Natural Gas Service Providers

Omaha Metropolitan Utilities District

+ Customers- 5,842* (IA); 4,352 (NE)

+Regulated Revenue: $ 659 million

MidAmerican Energy

Black Hills Energy

+ Total Customers: 217,103

+ Sales (MCF): 32,031,468

+ Operating Revenues: $226 million

* Does not include REC or municipal customers

Natural Gas Utility Coverage Map

Presenter

Presentation Notes

Map highlighting Omaha MUD gas service area.


Presenter

Presentation Notes

Rates current as of January 1, 2012

*Omaha (MUD) ranked no. 2

$118.66

$0.00

$50.00

$100.00

$150.00

$200.00

$250.00

$300.00

Average Residential Natural Gas Rates (200 CCF)

*Omaha ranked no. 3, 2 & 2 respectively

$0.00

$200.00

$400.00

$600.00

$800.00

$1,000.00

$1,200.00

$1,400.00

$1,600.00

$1,800.00

$2,000.00

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200 CCF Per Month 500 CCF Per Month 1000 CCF Per Month

.

Average Commercial Natural Gas Rates

*Omaha ranked no. 2 in both Tier 1 & 2

$0.00

$2,000.00

$4,000.00

$6,000.00

$8,000.00

$10,000.00

$12,000.00

$14,000.00

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5,000 CCF Per Month 10,000 CCF Per Month

.

Average Industrial Natural Gas Rates (Tier 1 & 2)

*Omaha ranked no. 3 in both Tier 3 & 4

$0.00

$10,000.00

$20,000.00

$30,000.00

$40,000.00

$50,000.00

$60,000.00

$70,000.00

$80,000.00

$90,000.00

$100,000.00

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50,000 CCCF Per Month 75,000 CCF Per Month

.

Average Industrial Natural Gas Rates (Tier 3 & 4)


+ Pipeline Capacity

+ Reliable Source and Supply

+ Competitive Pricing

+ Conservation is Stabilizing Demand

Water Service Providers

City of Omaha

+ Ave. Gallons Pumped to System (daily): 11.7 million

Council Bluffs Water Works

+ Total Customers: 201,580 (all sectors)

+ Ave. Gallons Pumped to System (daily): 86 million

+ Operating Revenues (net): $85.4 million

+ Local municipal providers

+ Private service provider- Regional Water Inc.

+ Individual well water

Additional Service Providers & Options

Water Utility Coverage Map Major Service Providers

Presenter

Presentation Notes

This map highlights the Omaha MUD’s coverage area. Those areas in the region outside the MUD coverage area primarily provide their own water services within the confines of their ETJ.


Presenter

Presentation Notes

Rates current as of January 1, 2012

*Omaha ranked no. 14

Average Residential Water Rates

$6.88

$19.87

$33.24

$13.76

$25.37

$49.85

$20.64

$32.50

$72.76

$0.00

$10.00

$20.00

$30.00

$40.00

$50.00

$60.00

$70.00

$80.00

5 CCF 10 CCF 15 CCF


$0.00

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

$3,000.00

Aust

in, T

X

Belle

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Clew

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, FL

Colu

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Dove

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Jack

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Jack

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Knox

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Lake

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, CA

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.

Average Commercial Water Rates

Presenter

Presentation Notes

1” Meter

*Omaha ranked no. 6 in water

Average Industrial Water Rates

$0.00

$5,000.00

$10,000.00

$15,000.00

$20,000.00

$25,000.00

$30,000.00

$35,000.00

$40,000.00

Aust

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WA

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Orla

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, CA

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FL

Water 7,500 CCF Per Month

.

Presenter

Presentation Notes

10” Meter Size Price at $0 = no date/unknown


+ Quality & Source in Rural Areas

+ Aging Infrastructure

+ Economic Development Capacity

+ Confident in Freshwater Supply

+ Conservation- Education is Key!

Sanitary Sewer

Sanitary Sewer Service Providers

+ Municipal Providers

+ Sanitary and Improvement District (SID)

+ Septic Tank Systems

SID Coverage Map

*No Data Obtained from Saunders County

Presenter

Presentation Notes

Douglas- 155; Sarpy-113; Cass- 10; Washington- 4 with 120 Rural Subdivisions; No data received by Saunders County at this time

*Omaha ranked no. 9

Average Residential Sanitary Sewer Rates

$5.44

$21.76

$42.30

$13.80

$28.26

$82.80

$20.70

$34.77

$123.30

$0.00

$20.00

$40.00

$60.00

$80.00

$100.00

$120.00

$140.00

5 CCF 10 CCF 15 CCF


Average Commercial Sanitary Sewer Rates

$0.00

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

$3,000.00

$3,500.00

$4,000.00

$4,500.00

Aust

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Belle

vue,

WA

Chat

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.

Presenter

Presentation Notes

8” meter size

*Omaha ranked no. 3 in sanitary sewers

Average Industrial Sanitary Sewer Rates

$0.00

$10,000.00

$20,000.00

$30,000.00

$40,000.00

$50,000.00

$60,000.00

$70,000.00

Aust

in, T

X

Belle

vue,

WA

Chat

tano

oga,

TN

Cinc

inna

ti, O

H

Colu

mbu

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Denv

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Detr

oit,

MI

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r, DE

Hunt

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Jack

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FL

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ville

, TN

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land

, FL

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cisc

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ld, M

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St. L

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MO

Talla

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ee*,

FL

Wastewater 7,500 CCF Per Month

.

Presenter

Presentation Notes

10” Meter Size Price at $0 = no date/unknown


+ High Cost Improvements/Expansion

+ State and Federal Mandates

+ Need to Upgrade Underserved Areas

+ Economic Development Considerations

+ Reuse Gray Water

Research Team Members

Douglas County Board of Commissioners

Mary Ann Borgeson

Alegent Creighton Health Mikki Frost

CQuence Health Group Mike Cassling

Presenter

Presentation Notes

Good Morning. I’m Mikki Frost, Director of Community Benefit and Healthier Communities at Alegent Creighton Health and member of the Health Care Systems Research Team, along with Mary Ann Borgeson, Douglas County Commissioner, and Mike Cassling, CEO at CQuence Health Group.`

Health Care as a complex system

* Source: Center for Disease Control and Prevention

Capacity factors actually account for comparatively small impact potential on health outcomes

Presenter

Presentation Notes

Factors such as those discusses in the previous slides are very important considerations, but they in reality have the smallest impact on health outcomes.

Health Care as a complex system

* Source: Center for Disease Control and Prevention

Demand-side factors such as access to routine care and contextual factors are the most significant determinants of health

Presenter

Presentation Notes

The greatest potential for impact is further down the pyramid – in prevention-oriented areas. These are the most difficult for health professionals to influence. Mary Ann Borgeson will now walk us through some of the chronic diseases and risk factors that illustrate this point.

Our Metro’s Health Care System

* Source: Nebraska DHHS, Iowa Department of Public Health

Hospital Locations

Presenter

Presentation Notes

We start out with a brief scan of our region’s principal health care system assets. We have thirteen full-service hospitals in the MSA, with at least one hospital per county, with the exception of Cass County, Nebraska.


+ 2.9 Acute Care Hospital Beds (2.4 U.S. average)

+ 17.4 full-time equivalent (FTE) hospital employees (14.0 U.S. average)

+ 4.7 FTE hospital-based nurses (3.7 U.S. average)

+ 185.2 physicians (202.0 U.S. average)

+ 68.1 primary care physicians (71.9 U.S. average)

+ 35.3 medical specialists (45.4 U.S. average)

+ 41.2 surgeons (41.6 U.S. average)

* Figures expressed as rate per 1,000 residents ** Figures expressed as rate per 100,000 residents. Source: Dartmouth Health Care Atlas

Health Care System Capacity*

Physician Availability**

Leading Indicators - Capacity

Our metro performs well in some measures of health care system capacity, but trails national averages in critical measures of human capital.

Presenter

Presentation Notes

Some leading indicators of capacity, sourced from the Dartmouth Health Care Atlas. Our metro performs well in several measures of health care system capacity, but trails national averages in critical measures of human capital.


* Figures expressed as rate per 1,000 residents

Leading Indicators – Peer Comparisons

0

2

4

6

8

10

12

14

16

18

20

U.S. Average Omaha Kansas City Des Moines Oklahoma City

Minneapolis Denver

Acute Care Hospital Beds

FTE Hospital Employees

FTE Hospital-Based Nurses

FTE Hospital Employees 14.0 U.S. Average

FTE Hospital-Based Nurses 3.7 U.S. Average

Acute Care Hospital Beds 2.4 U.S. Average

Presenter

Presentation Notes

Our metro area consistently outperforms peer regions on measures of health care system capacity, with only Oklahoma City having a higher availability of acute care hospital beds per 1,000 residents.


* Figures expressed as rate per 100,000 residents

Leading Indicators – Peer Comparisons

0

50

100

150

200

250

U.S. Average Omaha Kansas City Des Moines Oklahoma City

Minneapolis Denver

Primary Care Physicians

Medical Specialists

Surgeons

Total Physicians

Total Physicians 202.0 U.S. Average

Primary Care Physicians 71.9 U.S. Average Medical Specialists 45.4 U.S. Average Surgeons 41.6 U.S. Average

Presenter

Presentation Notes

Our region does not perform as well on measures of professional human capital. Our region possesses a higher number of surgeons relative to other regions, and a comparatively lower number of primary care physicians (2nd lowest in dataset), whereas larger peers had higher numbers of primary care physicians.

Access to Health Services

Asthma

Are

as o

f O

pp

ort

un

ity

Child & Adolescent CHNA

Injury & Safety

Maternal & Infant Health

Mental Health

Obesity & Nutrition

Sexual Activity

Substance Abuse

Heart Disease & Stroke

Maternal & Infant Health

Oral Health

Adult CHNA

Diabetes

Access to Health Services

Mental Health

Obesity & Nutrition

Sexual Activity

Substance Abuse

Areas of Community Concern 2011 PRC Community Health Assessment

Chronic Disease Adult Diabetes Rate

Presenter

Presentation Notes

Much of our region performs well compared to other metro areas in the prevalence of diabetes among adults.

13.4% 14.7%

8.1% 8.5% 7.5% 10.8% 9.1% 8.4%

12.2% 10.6% 7.7% 7.5% 10.1%

0%

20%

40%

60%

80%

100%

NE Omaha

SE Omaha

NW Omaha

SW Omaha

Western Douglas

Douglas County

Sarpy County

Cass County

Pott. County

Metro Area

NE IA US

Particularly high in African Americans

* Source: 2011 PRC Community Health Survey [Item 42] Covers Douglas, Sarpy, Pottawattamie, Cass Counties

Chronic Disease Percent of Population with Diabetes, Metro Area

Presenter

Presentation Notes

Yet these figures conceal disparities within our region geographically and demographically. (These and subsequent statistics come from the 2011 Behavioral Risk Factor Survey, covering Douglas, Sarpy, Pottawattamie, and Cass Counties).

Risk Factors Percent of Survey Respondents Reporting Chronic Depression

22.5% 27.6%

24.2% 28.1%

21.4%

43.7%

19.9% 23.1%

36.1% 36.5%

25.1%

0%

20%

40%

60%

80%

100%

Men Women 18 to 39 40 to 64 65+ Low Income

Mid/High Income

White Black Hispanic Metro Area


+ Both heart disease and stroke mortality rates have decreased in the past decade for Douglas County, Nebraska, and Iowa

+ However, significant proportions of adults still carry risk:

+ 67.5% of adults are overweight

+ 39.3% (of those screened) have been diagnosed with high blood cholesterol

+ 27.7% have been diagnosed with hypertension

+ 17.0% smoke cigarettes

+ 16.7% have no leisure-time physical activity

Chronic Disease Heart Disease & Stroke

Presenter

Presentation Notes

We have seen gains recently in rates of heart disease and stroke mortality. But, this risk factors are still there.

545.1

235.0

137.0

235.0

303.0 313.6

405.3

0

250

500

750

Douglas County 2010 Sarpy County 2008

Cass County 2008

Pott. County 2008

NE 2009 IA 2008 US 2009

Chronic Disease STDs – Chlamydia Incidence

Figures expressed as rate per 100,000 residents * Source: 2011 PRC Community Health Survey Covers Douglas, Sarpy, Pottawattamie, Cass Counties

Presenter

Presentation Notes

STDs continue to be a problem, particularly in urban core neighborhoods of the region.

Risk Factors Adult Obesity (BMI>30), Metro Area

Presenter

Presentation Notes

Chronic diseases are associated with a number of risk factors. One of the biggest risk factors for a host of chronic diseases is obesity. Between a quarter and a third of the population of all counties in the region are obese as of 2011.

32.8% 27.6% 25.8%

34.4% 33.2%

39.3%

27.8% 29.9%

40.9%

28.0% 30.3%

0%

20%

40%

60%

80%

100%

Men Women 18 to 39 40 to 64 65+ Low Income

Mid/High Income


Healthy People 2020 Target = 30.6% or Lower


Risk Factors Percent of Obese Adults (BMI>30), Metro Area

Presenter

Presentation Notes

Again, noticeable differences in obesity rates can be observed between population groups and geographic areas.

Risk Factors Childhood Obesity (BMI>30)

* Source: National Minority Quality Forum

Presenter

Presentation Notes

Our region also has slightly lower prevalence of childhood obesity compared to current national averages.

Risk Factors Childhood Obesity (BMI>30), Metro Area

In our region, zip code more robustly predicts childhood obesity than education level, income, or genetics. Property values are the best predictor of general obesity rates, too.

* Source: National Minority Quality Forum

Presenter

Presentation Notes

But geographic and demographic discrepancies persist here as well. In our region, zip code of residence robustly predicts childhood obesity, more than education level, income, or genetics.

Risk Factors Relationship of Obesity to Chronic Diseases

* Source: 2011 PRC Community Health Survey Covers Douglas, Sarpy, Pottawattamie, Cass Counties

21.5%

11.4% 12.1%

6.3%

0.8%

11.0%

2.9%

22.9%

15.8% 15.3%

9.9% 9.6%

13.8%

5.2%

29.6% 27.1% 26.1%

20.9% 20.8% 20.2%

8.1%

0%

20%

40%

60%

Chronic Depression

Activity Limitations

Arthritis/ Rheumatism

"Fair/ Poor" Health

Diabetes Sciatica/Chronic Back Pain

Chronic Heart Disease

Healthy Weight Overweight/Not Obese Obese

Presenter

Presentation Notes

STDs continue to be a problem, particularly in urban core neighborhoods of the region.

Risk Factors Physical Inactivity

Presenter

Presentation Notes

Our region has physical inactivity prevalence that is comparable to national averages.

Drivers of Risk

* Source: USDA Food Access Research Atlas

Food Accessibility

8% of African American residents live in Census Tracts with a supermarket 31% of Caucasian residents live in Census Tracts with a supermarket

Pink = Census Tracts where at least 33% of residents live greater than 1 mile (urban) or 10 miles (rural) from supermarkets

Food Accessibility is a major issue in rural parts of the region

Presenter

Presentation Notes

Moving a bit further down in the chain of causality, we are going to examine several drivers of risk. One very important driver is the ability to access healthy food, typically available at supermarkets (as opposed to other retail outlets, such as convenience stores or gas stations). Here, we see a map of Census Tracts where at least 33% of residents live greater than 1 mile for urban areas, or 10 miles for rural areas, from supermarkets.

Drivers of Risk

* Source: USDA Food Access Research Atlas

Food Access for Low-Income Residents

Green = >50% of Low-Income Residents more than 1 mile (urban), 10 miles (rural) to supermarket Orange = >50% of Low-Income Residents more than ½ mile (urban), 10 miles (rural) to supermarket

Presenter

Presentation Notes

The effects of poor access to supermarkets is magnified for low-income residents

Drivers of Risk Difficulty Accessing Primary Care, Metro Area

* Source: 2011 PRC Community Health Survey [Item 206]

47.3%

40.7%

28.9% 29.9% 25.0%

36.0%

27.3% 25.5% 31.5% 33.4%

37.3%

0%

20%

40%

60%

80%

100%

NE Omaha

SE Omaha

NW Omaha

SW Omaha

Western Douglas

Douglas County

Sarpy County

Cass County

Pott. County

Metro Area

US

Key informants in 2011 survey listed access to health care as the # 1 community concern

Presenter

Presentation Notes

Other drivers of risk include poor access to health care. Here, we see results of the 2011 BRFSS asking about difficulty accessing primary care in the metro.

Drivers of Risk Barriers to Access to Primary Care, Metro Area

14.5% 14.3% 12.5% 10.5% 6.6% 4.7%

0.9%

14.0% 15.0% 14.3% 16.5% 10.7%

7.7%

0%

20%

40%

60%

80%

100%

Cost (Doctor Visit)

Cost (Prescriptions)

Inconvenient Office Hours

Getting a Dr Appointment

Finding a Doctor

Lack of Transportation

Cultural/Language Differences

Metro Area 2011 US

* Source: 2011 PRC Community Health Survey [Items 9-14; 16] Covers Douglas, Sarpy, Pottawattamie, Cass Counties

Presenter

Presentation Notes

Some specific barriers to access cited by respondents to the 2011 BRFSS.

Drivers of Risk Gaps in Health Insurance Coverage


18.9% 21.7%

7.8% 12.2%

6.7%

14.5%

5.7% 10.0% 10.2% 12.1%

16.5% 12.6% 14.9%

0%

20%

40%

60%

80%

100%

NE Omaha

SE Omaha

NW Omaha

SW Omaha

Western Douglas

Douglas County

Sarpy County

Cass County

Pott. County

Metro Area

NE IA US

Presenter

Presentation Notes

Lack of health insurance coverage is another important risk driver, as uncovered individuals will be less likely to seek primary or preventative care.

Drivers of Chronic Disease Gaps in Health Insurance Coverage

12.8% 11.5% 13.8% 10.4%

33.8%

5.3% 9.2%

19.4%

28.0%

12.1%

0%

20%

40%

60%

80%

100%

Men Women 18 to 39 40 to 64 Low Income

Mid/High Income



5.3% of children in the Metro area have no health insurance coverage

Presenter

Presentation Notes

These health insurance gaps are most prevalent among low income populations, more often employed in occupations that do not offer health benefits. Of particular note is the fact that 5.3% of children in the metro area have no health insurance coverage.

Key Takeaways

+ Chronic disease rates and risk factors are on par with national averages for much of the region

+ These rates compare favorably to Iowa and Nebraska statewide averages

+ Statistically significant disparities exist between geographic and demographic markers of community (i.e. urban/rural/suburban areas, race and ethnicity, etc.) within the region

Presenter

Presentation Notes

Some key takeaways from this scan. I’ll now invite Mike Cassling of Cquence Health Group to discuss the economics of our health care system and future needs.

Chronic Disease Impacts On Health Care Economics

+ Chronic disease burdens our current health care system by producing

+ The most ED visits

+ The most physician visits

+ The most readmissions

+ The most post-acute care

+ The highest cost

+ The 14% of Medicare beneficiaries with 6+ chronic conditions account for almost half of all Medicare spending and 70% of readmissions

Chronic Disease Impacts

* Source: CQuence Health Group

On Health Care Economics

Presenter

Presentation Notes

This graph illustrates the distributional/equity issues associated with number of chronic conditions and receipt of Medicare benefits.

Chronic Disease Impacts


On Health Care Economics

Presenter

Presentation Notes

Another way to look at the same data

Implications for Health Care System


+ US spends more on healthcare than any other country + More cost per capita + A higher percentage of GDP

+ The US spends more per hospital discharge than any other country by $4,500

Ballooning Spending

Presenter

Presentation Notes

These conditions are going to cause a ballooning in health care spending nationally, much greater than other developed countries. The ballooning costs are eating a greater and greater percentage of our GDP.

Convergent Challenges Human Capital Shortages

+ Demographics are going to drive the need for more health workers + A new Medicare Enrollee every 8 seconds + Program will grow from 47 million in 2010 to 80 million in 2020 + Medicaid expansion and marketplaces (exchanges) will add another

29 million by 2019

+ Health Career shortages + The existing physician shortage will only get worse with the biggest

need in primary care + The nursing workforce has fluctuated between shortage and surplus

between 2005 and 2010 and will fall back to shortage + Patient-Centered Medical Home (PCMH) employs more mid-level

providers (PA, NP) to cover primary care needs

+ Alternative Programs to support + Growth of programs like non-medical home care have helped easy

the nursing need in home care + But there must be consideration given to other needed workers like

EMS and post-acute facilities

Presenter

Presentation Notes

As the demand for health care services increases, the human capital pipeline is growing stressed.

Overall Takeaways

+ Chronic diseases will determine the financial sustainability of the nation’s – and region’s – health care system

+ Chronic diseases have risk factors that are largely environmentally conditioned

+ Our region will likely experience greatly increased demand for and cost of health care due to convergence of demographic trends and chronic diseases caused by environmental factors

+ We are simultaneously faced with a current and projected shortage of health care workers in critical clinical areas

Presenter

Presentation Notes

In conclusion, the prevalence of chronic diseases will determine the financial sustainability of the nation’s – and region’s – health care system. Our region is not exempt from the national trends – we are aging faster than many other metros, and have a declining birth rate and family size. We can better control chronic diseases by moderating the risk factors, and improving the environment within which individuals make decisions about their health.

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