Heartland 2050 meeting 3

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Heartland 2050 meeting 3

  1. 1. Barry Cleaveland, Silverstone Group Director of Research and Development Commissioner, Iowa Department of Transportation Richard Reiser, Werner Enterprises, Inc. Vice President of Government Affairs GregYouell, MetropolitanArea Planning Agency Executive Director ResearchTeam Steering Committee Members
  2. 2. 24.1 26.7 19.8 22.8 24.5 21.6 19.8 25.5 0 5 10 15 20 25 30Minutes Average Commute Time to Work * 2011 American Community Survey
  3. 3. Congestion Texas A&M Transportation Institute 2011 Ranking – Denver–8th – Minneapolis –25th – Cincinnati–27th – OklahomaCity–57th – Kansas City–68th – Omaha–79th (101LargestMetroAreasinUS-. #1:MostCongested)
  4. 4. 82.3 75.6 81.5 83 78 82.6 82.5 76.4 Percent Drove to Work (Single OccupancyVehicle) * 2011 American Community Survey
  5. 5. * 2011 American Community Survey 8.8 9.6 10.3 9.2 8.7 10.6 9.9 9.7 Percent Carpooled to Work
  6. 6. * 2011 American Community Survey 2.4 4.6 1.4 1.2 4.7 0.5 0.9 5 Percent Rode Public Transit to Work
  7. 7. Roadway/Highway Inventory
  8. 8. 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 HighwayAdministration 398 568 231 482 657 164 361 0 100 200 300 400 500 600 700
  9. 9. 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
  10. 10. Railway Inventory
  11. 11. Transit Inventory
  12. 12. 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 MetropolitanArea
  13. 13. Metro System Map
  14. 14. Weekday- AM Peak Service Frequency
  15. 15. Omaha Metro- Linked Transit Trips On-Board SurveyWeighted Response
  16. 16. Freight Movement
  17. 17. Major Freight Corridors
  18. 18. Average Truck Speeds on Selected Interstate Highways (2011)
  19. 19. Aviation
  20. 20. Regional Transportation Issues + Funding + Infrastructure Condition + Reliance on Automobile + Transportation v Land Use + Air Quality Opportunities + Freight through movement + Convenience of EppleyAirfield
  21. 21. Funding Challenges + Funding largely generated from motor fuel tax + ReductioninVMT and increased fuel efficiency + Status of Federal Highway Trust Fund + Increased cost of materials
  22. 22. $- $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
  23. 23. Questions/Discussion
  24. 24. 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 ResearchTeam Steering Committee Members
  25. 25. Broadband
  26. 26. Broadband Service Area Fixed Services * Data sources: Connect Iowa; Nebraska Broadband Capacity Building Program
  27. 27. Broadband Provider Coverage Map Fixed Services * Data sources: Connect Iowa; Nebraska Broadband Capacity Building Program
  28. 28. Broadband Information % Households withAccess to Download Speeds > 10 Mbps % Households withAccess 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 withAccess to Technology byType 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
  29. 29. Issues and Opportunities + Inconsistent State Policy + Consumer Density/Service Gaps + Continued Expansion for Economic Development + Established Transport Network + Strong Enterprise Bandwidth Customers
  30. 30. Electric
  31. 31. Electric Service Providers + Total Customers: 309,516 (all sectors) + Generation Capability (daily): 3,208 MW + Operating Revenues: $1.05 billion * Does notincludes RECor municipalcustomers; doesnotprovide service inNebraska **These generationand revenue figure s are for theStateof 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
  32. 32. Electric Utility Coverage Map
  33. 33. 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
  34. 34. 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
  35. 35. http://www.mudomaha.com/rates/pdfs/memphislightgassurvey.pdf
  36. 36. 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
  37. 37. $0.00 $500.00 $1,000.00 $1,500.00 $2,000.00 $2,500.00 $3,000.00 Austin,TX Bellevue,WA Boston,MA Charleston,SC Chattanooga,TN Chicago,IL Clewiston,FL Columbus,OH Decatur,IL Dover,DE Evansville,IN Huntsville,AL Indianapolis,IN Jackson,TN Jackson,MS Jacksonville,FL Kissimmee,FL Knoxville,TN Lakeland,FL Lincoln,NE LittleRock,AR LosAngeles,CA Louisville,KY Manchester,NH Marietta,GA Memphis,TN MyrtleBeach,SC Nashville,TN NewOrleans,LA Omaha,NE Orlando,FL Pensacola,FL Peoria,IL Phoenix,AZ Richmond,VA Rosemead,CA SaltLakeCity,UT Seattle,WA Springfield,IL Springfield,MO St.Louis,MO Tallahassee,FL 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
  38. 38. *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 Austin,TX Bellevue,WA Boston,MA Charleston,SC Chattanooga,TN Chicago,IL Clewiston,FL Columbus,OH Decatur,IL Dover,DE Evansville,IN Huntsville,AL Indianapolis,IN Jackson,TN Jackson,MS Jacksonville,FL Kissimmee,FL Knoxville,TN Lakeland,FL Lincoln,NE LittleRock,AR LosAngeles,CA Louisville,KY Manchester,NH Marietta,GA Memphis,TN MyrtleBeach,SC Nashville,TN NewOrleans,LA Omaha,NE Orlando,FL Pensacola,FL Peoria,IL Phoenix,AZ Richmond,VA Rosemead,CA SaltLakeCity,UT Seattle,WA Springfield,IL Springfield,MO St.Louis,MO Tallahassee,FL 500 kW @ 100,000 kWh Per Month 1500 kW @ 500,000 kWh Per Month . Average Commercial Electric Rates ( Tier 3 & 4)
  39. 39. *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 Austin,TX Bellevue,WA Boston,MA Charleston,SC Chattanooga,TN Chicago,IL Clewiston,FL Columbus,OH Decatur,IL Dover,DE Evansville,IN Huntsville,AL Indianapolis,IN Jackson,MS Jackson,TN Jacksonville,FL Kissimmee,FL Knoxville,TN Lakeland,FL Lincoln,NE LittleRock,AR LosAngeles,CA Louisville,KY Manchester,NH Memphis,TN MyrtleBeach,SC Nashville,TN NewOrleans,LA Omaha,NE Orlando,FL Pensacola,FL Peoria,IL Phoenix,AZ Richmond,VA Rosemead,CA SaltLakeCity,UT Seattle,WA Springfield,IL Springfield,MO St.Louis,MO Tallahassee,FL 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
  40. 40. Issues and Opportunities + Generation Capability + Transmission Lines + Competitive Pricing + High Customer Service Satisfaction
  41. 41. Natural Gas
  42. 42. 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 notinclude RECormunicipal customers
  43. 43. Natural Gas Utility Coverage Map
  44. 44. http://www.mudomaha.com/rates/pdfs/memphislightgassurvey.pdf
  45. 45. *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)
  46. 46. *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 Austin,TX Baltimore,MD Bellevue,WA Boston,MA Charleston,SC Charlotte,NC Chicago,IL Decatur,IL Detroit,MI ElPaso,TX Evansville,IN Greenville,SC Huntsville,AL Indianapolis,IN Jackson,TN Knoxville,TN LosAngeles,CA Louisville,KY Memphis,TN Milwaukee,WI Nashville,TN NewOrleans,LA OliveBranch,MS Omaha,NE Peoria,IL SanAntonio,TX Springfield,MO Springfield,IL Springfield,VA St.Louis,MO Tallahassee,FL Washington,D.C. 200 CCF Per Month 500 CCF Per Month 1000 CCF Per Month . Average Commercial Natural Gas Rates
  47. 47. *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 Austin,TX Baltimore,MD Bellevue,WA Boston,MA Charleston,SC Charlotte,NC Chicago,IL Decatur,IL Detroit,MI ElPaso,TX Evansville,IN Greenville,SC Huntsville,AL Indianapolis,IN Jackson,TN Knoxville,TN LosAngeles,CA Louisville,KY Memphis,TN Milwaukee,WI Nashville,TN NewOrleans,LA OliveBranch,MS Omaha,NE Peoria,IL SanAntonio,TX Springfield,MO Springfield,VA Springfield,IL St.Louis,MO Tallahassee,FL Washington,D.C. 5,000 CCF Per Month 10,000 CCF Per Month . Average Industrial Natural Gas Rates (Tier 1 & 2)
  48. 48. *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 Austin,TX Baltimore,MD Bellevue,WA Boston,MA Charleston,SC Charlotte,NC Chicago,IL Decatur,IL Detroit,MI ElPaso,TX Evansville,IN Greenville,SC Huntsville,AL Indianapolis,IN Jackson,TN Knoxville,TN LosAngeles,CA Louisville,KY Memphis,TN Milwaukee,WI Nashville,TN NewOrleans,LA OliveBranch,MS Omaha,NE Peoria,IL SanAntonio,TX Springfield,MO Springfield,VA Springfield,IL St.Louis,MO Tallahassee,FL 50,000 CCCF Per Month 75,000 CCF Per Month . Average Industrial Natural Gas Rates (Tier 3 & 4)
  49. 49. Issues and Opportunities + Pipeline Capacity + Reliable Source and Supply + Competitive Pricing + Conservation is Stabilizing Demand
  50. 50. Water
  51. 51. Water Service Providers City of Omaha + Ave. Gallons Pumped to System (daily): 11.7 million Council Bluffs WaterWorks + 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
  52. 52. Water Utility Coverage Map Major Service Providers
  53. 53. http://www.mudomaha.com/rates/pdfs/memphislightgassurvey.pdf
  54. 54. *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
  55. 55. *Omaha ranked no. 5, 3 & 2 respectively $0.00 $500.00 $1,000.00 $1,500.00 $2,000.00 $2,500.00 $3,000.00 Austin,TX Bellevue,WA Clewiston,FL Columbus,OH Detroit,MI Dover,DE Huntsville,AL Jackson,TN Jacksonville,FL Knoxville,TN Lakeland,FL LittleRock,AR LosAngeles,CA Louisville,KY Marietta,GA Memphis,TN Nashville,TN NewYork,NY OklahomaCity,OK OliveBranch,MS Omaha,NE Orlando,FL Philadelphia,PA Phoenix,AZ Reno,NV SaltLakeCity,UT SanAntonio,TX SanFrancisco,CA SanJose,CA Springfield,MO St.Louis,MO Tallahassee,FL 100 CCF Per Month 250 CCF Per Month 500 CCF Per Month . Average Commercial Water Rates
  56. 56. *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 Austin,TX Bellevue,WA Columbus,OH Detroit,MI Dover,DE Hunstville,AL Jackson,TN Jacksonville,FL Knoxville,TN Lakeland,FL LittleRock,AR LosAngeles,CA Louisville,KY Memphis,TN Nashville,TN NewYork,NY OklahomaCity,OK Omaha,NE Orlando,FL Philadelphia,PA Phoenix,AZ Reno,NV SaltLakeCity,UT SanAntonio,TX SanFrancisco,CA SanJose,CA Springfield,MO St.Louis,MO Tallahassee*,FL Water 7,500 CCF Per Month .
  57. 57. Issues and Opportunities + Quality & Source in Rural Areas + Aging Infrastructure + Economic Development Capacity + Confident in Freshwater Supply + Conservation- Educationis Key!
  58. 58. Sanitary Sewer
  59. 59. Sanitary Sewer Service Providers + Municipal Providers + Sanitary and Improvement District (SID) + Septic Tank Systems
  60. 60. SID Coverage Map *No Data Obtained from Saunders County
  61. 61. *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
  62. 62. *Omaha ranked no. 3, 2 & 2 respectively 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 Austin,TX Bellevue,WA Chattanooga,TN Cincinnati,OH Clewiston,FL Columbus,OH Denver,CO Detroit,MI Dover,DE Huntsville,AL Jackson,TN Jacksonville,FL Knoxville,TN Lakeland,FL LittleRock,AR LosAngeles,CA Louisville,KY Marietta,GA Memphis,TN Nashville,TN NewYork,NY OklahomaCity,OK OliveBranch,MS Omaha,NE Philadelphia,PA Phoenix,AZ SaltLakeCity,UT SanAntonio,TX SanFrancisco,CA Springfield,MO St.Louis,MO Tallahassee,FL 100 CCF Per Month 250 CCF Per Month 500 CCF Per Month .
  63. 63. *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 Austin,TX Bellevue,WA Chattanooga,TN Cincinnati,OH Columbus,OH Denver,CO Detroit,MI Dover,DE Huntsville,AL Jackson,TN Jacksonville,FL Knoxville,TN Lakeland,FL LittleRock,AR LosAngeles,CA Louisville,KY Memphis,TN Nashville,TN NewYork,NY OklahomaCity,OK Omaha,NE Philadelphia,PA Phoenix,AZ SaltLakeCity,UT SanAntonio,TX SanFrancisco,CA Springfield,MO St.Louis,MO Tallahassee*,FL Wastewater 7,500 CCF Per Month .
  64. 64. Issues and Opportunities + High Cost Improvements/Expansion + State and Federal Mandates + Need to Upgrade Underserved Areas + Economic Development Considerations + Reuse GrayWater
  65. 65. Questions/Discussion
  66. 66. ResearchTeam Members Douglas County Board of Commissioners MaryAnn Borgeson Alegent Creighton Health Mikki Frost CQuence Health Group Mike Cassling
  67. 67. 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
  68. 68. 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
  69. 69. Our Metro’s Health Care System * Source: Nebraska DHHS, Iowa Department of Public Health Hospital Locations
  70. 70. Our Metro’s Health Care System + 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* PhysicianAvailability** 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.
  71. 71. Our Metro’s Health Care System * 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
  72. 72. Our Metro’s Health Care System * 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
  73. 73. Access to Health Services Asthma AreasofOpportunity 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
  74. 74. Chronic Disease Adult Diabetes Rate
  75. 75. 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 AfricanAmericans * Source: 2011 PRC Community Health Survey [Item 42] Covers Douglas, Sarpy, Pottawattamie, Cass Counties Chronic Disease Percent of Population with Diabetes, Metro Area
  76. 76. 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 * Source: 2011 PRC Community Health Survey [Item 112] Covers Douglas, Sarpy, Pottawattamie, Cass Counties
  77. 77. + 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
  78. 78. 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
  79. 79. Risk Factors Adult Obesity (BMI>30), Metro Area
  80. 80. 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 White Black Hispanic Metro Area Healthy People 2020 Target = 30.6% or Lower * Source: 2011 PRC Community Health Survey [Item 189] Covers Douglas, Sarpy, Pottawattamie, Cass Counties Risk Factors Percent of Obese Adults (BMI>30), Metro Area
  81. 81. Risk Factors Childhood Obesity (BMI>30) * Source: National Minority Quality Forum
  82. 82. 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
  83. 83. 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 HealthyWeight Overweight/Not Obese Obese
  84. 84. Risk Factors Physical Inactivity
  85. 85. Drivers of Risk * Source: USDA Food Access ResearchAtlas Food Accessibility 8% ofAfricanAmerican 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
  86. 86. Drivers of Risk * Source: USDA Food Access ResearchAtlas 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
  87. 87. 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
  88. 88. 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
  89. 89. Drivers of Risk Gaps in Health Insurance Coverage * Source: 2011 PRC Community Health Survey [Item 202] 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
  90. 90. 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 White Black Hispanic Metro Area * Source: 2011 PRC Community Health Survey [Item 202] 5.3% of children in the Metro area have no health insurance coverage
  91. 91. KeyTakeaways + 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
  92. 92. 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
  93. 93. Chronic Disease Impacts * Source: CQuence Health Group On Health Care Economics
  94. 94. Chronic Disease Impacts * Source: CQuence Health Group On Health Care Economics
  95. 95. Implications for Health Care System * Source: CQuence Health Group + 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
  96. 96. 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 millionin 2010 to 80 millionin 2020 + Medicaid expansion and marketplaces (exchanges) will add another 29 millionby 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
  97. 97. 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
  98. 98. Questions/Discussion

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