Americas Health Rankings What Does It Tell Us

America’s Health Rankings ® What Does It Tell Us About the State of Our Health? Alliance for Health Insurers September 9, 2014

America’s Health Rankings® - Annual Report A Comprehensive Assessment of the Nation’s Health • Longest running annual assessment of our nation’s health on a state-by-state basis • Report identifies the driving health trends of the nation • Report provides insights into the national health challenges on the horizon • Report has evolved from a source of information to a robust, interactive tool that urges all populations and communities to act • Under the editorial control of a scientific advisory committee based out of the University of North Carolina Chapel Hill Gillings School of Global Public Health • Published by United Health Foundation, the American Public Health Association and Partnership for Prevention • 25 th Edition will be released December 2014

America’s Health Rankings® - Senior Report A Comprehensive Assessment of Senior Health § 2 nd edition, updates the data we gathered for the 2013 inaugural report. § Offers a comprehensive analysis of senior health on a national and state-by-state basis across 34 measures of senior health. § Report seeks to promote discussion around the health of Americans 65 years and older while driving communities, governments, stakeholders and individuals to take action to improve senior health. § In compiling the report, researchers worked with a panel of leading public health scholars. § Report draws data from more than 12 government agencies and leading research organizations, including the U. S. Department of Health and Human Services, the U. S. Department of Commerce, the U. S. Department of Labor, The Dartmouth Atlas Project, the National Foundation to End Senior Hunger and the Commonwealth Fund. 3

Model, Metrics and Methodology 4

Measures of Health – Annual Behaviors • Smoking • Binge Drinking • Drug Deaths • Obesity • Physical Inactivity • High School Graduation Community & Environment • Violent Crime • Occupational Fatalities • Infectious Disease (Salmonella, Pertussis and Chlamydia) • Children in Poverty • Air Pollution Public & Health Policies • Lack of Health Insurance • Public Health Funding • Immunization—Children • Immunization—Adults Clinical Care • Low Birthweight Infants • Primary Care Physicians • Dentists • Preventable Hospitalizations Health Outcomes • Diabetes • Poor Mental Health Days • Poor Physical Health Days • Disparity in Health Status • Infant Mortality • Cardiovascular Deaths • Cancer Deaths • Premature Death

Measures of Health – Senior Behaviors - Smoking Chronic Drinking Obesity Underweight Physical Inactivity Dental Visits Pain Management Community – Macro - Poverty Volunteerism Quality Nursing Homes Community – Micro - Social Support Food Insecurity Community Support Policy - Low-Care Nursing Home Residents Prescription Drug Coverage Geriatrician Shortfall Clinical Care - Dedicated Health Care Provider Recommended Hospital Care Flu Vaccine Health Screenings Diabetes Management Home Health Care Preventable Hospitalizations Hospital Readmissions Hospice Care Hospital Deaths Outcomes - ICU Usage Falls Hip Fractures Health Status Able-Bodied Premature Death Teeth Extractions Mental Health Days 6

Ranking Model Construction 1. Gather data Smoking Binge Drinking Drug Deaths Obesity Physical Inactivity High School Graduation Community & Environment • • • 2. Normalize using a z-score Violent Crime Occupational Fatalities Infectious Disease (Salmonella, Pertussis and Chlamydia) Children in Poverty Air Pollution Public & Health Policies • • Lack of Health Insurance Public Health Funding Immunization—Children Immunization—Adults Clinical Care • • Low Birthweight Infants Primary Care Physicians Dentists Preventable Hospitalizations Health Outcomes • • 5. Sum weighted scores 6. Rank among states • • • 4. Multiple by weights Behaviors 3. Eliminate outliers Diabetes Poor Mental Health Days Poor Physical Health Days Disparity in Health Status Infant Mortality Cardiovascular Deaths Cancer Deaths Premature Death 7

What Does It Tell Us About the Health of Each State? 8

Core Measure Impact § Visualization of the impact of all measures on rankings § Color indicates above or below norm § Size indicates magnitude of impact § For WI: http: //www. americashealthra nkings. org/WI/obesity? tabna me=coremeasureimpact 9

Disparity Maps § Disparity by gender, age, race/ethnicity, education, income and urbanicity § Rates for smoking, physical inactivity, obesity, diabetes and high health status § Population affected in these subpopulations. § For Obesity in WI: http: //www. americashealthrankin gs. org//WI/obesity? tabname=dis parities 10

Trends § Trends for each individual metric over time are displayed for the state and for the country. § For obesity in WI: http: //www. americash ealthrankings. org/WI/ obesity? tabname=tre ndstate 11

State Summary http: //www. americashealthrankings. org/WI Ranks for all metrics Disparities discussion 12

Health in the Wisconsin & the United States 13

America’s Health Rankings - Annual § Hawaii has taken the title of healthiest state. § Americans made considerable progress in their overall health in 2013, driven by improvements in more than two-thirds of our health measures. § While we should celebrate the gains we made, a key challenge will be maintaining momentum. 14

Change in Rank Wisconsin - Overall 0 Overall Rank 10 20 30 40 50 1995 2000 § § § 2005 2010 Wisconsin varies year to year The overall trend is a slow decline Implication: Population health is not improving in Wisconsin as fast as in other states. 15

America’s Health Rankings Top National Trends Wisconsin - Smoking 35 In the US, smoking has declined in the last year from 21. 2 percent of the adult population to 19. 6 percent. US Percent of Population 30 25 20 15 Wisconsin 10 Wisconsin rates are typically slightly higher than US rates for smoking. 2012/2013 Editions used revised BRFSS 5 0 1995 2000 Edition 2005 2010 16

America’s Health Rankings Top National Trends Wisconsin - Obesity 35 Wisconsin trends bear watching closely. New data has WI at 29. 8 %, slightly above US median of 29. 4%. Percent of Population 30 25 Wisconsin 20 In the US, obesity has leveled off, shifting from 27. 8 percent of adult population to 27. 6 percent of the adult population – consistent with other surveys. 15 10 US 5 0 1995 2000 Edition 2005 2010 2012/2013 Editions used revised BRFSS Methodology 17

Binge Drinking § Wisconsin has highest binge drinking rate. – 25. 2 percent of population age 18+ are binge drinkers. – Among a cluster of high prevalence states in the upper Mississippi valley. http: //www. americashealthrankings. org/WI/binge 18

Pertussis § Wisconsin ranked 49 th for incidence of pertussis has a high prevalence of pertussis compared to neighboring states. – 21. 0 cases per 100, 000 population. – high prevalence of pertussis compared to neighboring states. http: //www. americashealthrankings. org/WI/pertussis 19

Immunization - Children § § Wisconsin does have a strong child immunization program – 75. 2 percent of children receive recommended doses of DTa. P, polio, MMR Hib, hepatitis B, varicella and PCV vaccines by age 19 to 35 months. – Ranked 6 th – high prevalence of pertussis compared to neighboring states. Adolescent immunization rate was 67. 2 percent, a rank of 16 th. http: //www. americashealthrankings. org/WI/immunize_teens 20

High School Graduation § Wisconsin has the second highest high school graduation rate – 91. 1 percent of incoming freshman graduate within 4 years. – IL is considerable less (81. 9%) and MN is slightly less (88. 2%) http: //www. americashealthrankings. org/WI/graduation 21

Senior Health Across the U. S. § This year’s senior report reveals some encouraging data related to senior health: – Seniors are significantly more active than last year. • In the US, Physical inactivity decreased from 30. 3 percent to 28. 7 percent of seniors. In Wisconsin, it decreased from 33. 8 percent to 30. 2 percent of seniors. – More seniors than last year are pursuing preferred options for end-of-life care. • In the US, the use of hospice care increased from 36. 7 percent to 47. 5 percent of decedents aged 65 and older. In Wisconsin, 34. 5 percent to 47. 2 percent. • In the US, Hospital deaths decreased from 30. 1 percent to 25. 0 percent of decedents aged 65 and older. In Wisconsin, 25. 0 percent to 20. 9 percent. 22

Senior Health Across the U. S. § This year’s senior report reveals some encouraging data related to senior health: (cont. ) – More seniors than last year are avoiding preventable hospitalizations. • In the US, the percentage decreased from 66. 6 to 64. 9 admissions per 1, 000 Medicare beneficiaries. In Wisconsin, it is much lower with a smaller decline; 55. 3 to 55. 0 admissions. – Nursing home quality improved in the past year. • In the US, the percentage increased from 42. 0 percent to 46. 8 percent of beds rated 4 or 5 stars. In Wisconsin, it is higher than the national average and it increased from 50. 3 to 53. 3 percent rated 4 or 5 stars. 23

State Rankings 24

America’s Health Rankings Overall Ranking 2013 RANK (1 -50) 47 25 28 49 21 8 7 31 33 38 1 12 30 41 18 27 45 48 16 24 4 34 3 50 39 23 STATE Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Overall -0. 822 0. 275 0. 02 -0. 893 0. 31 0. 565 0. 649 -0. 097 -0. 21 -0. 315 0. 919 0. 442 -0. 096 -0. 487 0. 317 0. 122 -0. 716 -0. 844 0. 366 0. 276 0. 725 -0. 218 0. 731 -0. 894 -0. 373 0. 277 2013 RANK (1 -50) 11 37 5 10 32 15 35 9 40 44 13 29 19 43 22 42 36 6 2 26 14 46 20 17 STATE Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Overall 0. 46 -0. 294 0. 703 0. 531 -0. 175 0. 37 -0. 247 0. 557 -0. 407 -0. 666 0. 426 -0. 022 0. 317 -0. 635 0. 284 -0. 579 -0. 25 0. 695 0. 868 0. 259 0. 403 -0. 727 0. 313 0. 355 25

Senior Rankings State 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Rank Minnesota Hawaii New Hampshire Vermont Massachusetts Colorado Utah Oregon Delaware Wisconsin Maryland Connecticut Iowa Maine Washington Nebraska Kansas California North Dakota Michigan Virginia Pennsylvania Arizona New Jersey Idaho State 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Rank Rhode Island South Dakota Florida North Carolina Montana Ohio New York Wyoming South Carolina Illinois Alaska Indiana New Mexico Missouri Georgia Texas Nevada Tennessee Alabama West Virginia Arkansas Oklahoma Kentucky Louisiana Mississippi 26

Five Steps to Take Action 1 2 1. 2. 3. 4. 5. Click on “Take Action” Select Annual or Senior Select Measure to Improve Click on “View” Select your action from list 3 4 5 27

25 th Edition of America’s Health Rankings § Celebrate 25 years of tracking the population health of each state. § Scheduled to be released in December, 2014 § Feature perspectives on public health from public health thought leaders 28

Thank You! Foundation Shelly Espinosa shelly_espinosa@uhg. com 952 -936 -1889 Data Tom Eckstein tom@arundelstreet. com 651 -222 -5257 Media Relations Scott Weier sweier@gpgdc. com 202 -295 -0170 Data Sarah Milder sarah@arundelstreet. com 651 -789 -0699 Follow us on Twitter: http: //twitter. com/ahr_rankings Follow us on Facebook: www. facebook. com/Americas. Health. Rankings Visit our website: www. Americas. Health. Rankings. org