Community Health Needs Assessment Mercy Hospital St. Louis 2012

Transcription

1 Community Health Needs Assessment Mercy Hospital St. Louis 2012

2 Table of Contents Introduction..2 Description and Basic Community Demographics 2 Who was Involved in the Assessment.2 Community Assessment Process 3 Primary Health Needs Identified..6 Implementation Plans for the Identified Primary Health Needs..6 Our Mission: As the Sister of Mercy before us, we bring to life the healing ministry of Jesus through our compassionate care and exceptional service. Mercy Hospital St. Louis Page 1

3 Introduction Mercy Hospital St. Louis (MHSL) is a 979-bed hospital located in St. Louis, Missouri. The hospital is the only Level I (highest) trauma center in St. Louis County, and is one of only two hospitals in the state of Missouri to have a Level III (highest) neonatal intensive care unit. The community health needs assessment (CHNA) process involved review of both quantitative and qualitative information to attain the full scope of the community s needs. This summary is documentation that MHSL is in compliance with IRS requirements for conducting community health needs assessments. Description of Community Mercy Hospital St. Louis is located in west St. Louis County. The hospital s service area is comprised of fourteen regions (194 zip codes) and includes both rural and urban settings. Fifty-eight percent of MHSL s total discharges in FY2012 were residents of St. Louis County. For its CHNA, Mercy Hospital St. Louis has defined its community as St. Louis County. St. Louis County Demographics Population 998,694 Median household income $57,052 % of population under % % of population 65 and over 15.0% % of population with Medicare* 16% % of population with Medicaid* 10% % of population uninsured* 8% % of population below poverty level 10.6% % of population unemployed 9.2% Source: Missouri Department of Health and Human Services (MDHSS). (2012). Social and Economic Indicators Profile St. Louis County. Retrieved from ty=071 *Mercy Health, Truven Insurance Estimates, Who Was Involved in the Assessment At the center of involvement in the needs assessment were the people of the community. In April of 2010 and again in October of 2011, Mercy held roundtable events to dialogue directly with local community members about their needs, ideas, and concerns related to health care. Common themes included the need for a greater emphasis on wellness and prevention, education, and access. Barriers identified included economic/financial resources by some, access to physicians and services, and general apathy for good health. A focus on partnerships, education, and technology were cited as ways to improve health and wellness in the community. Mercy also heard that a focus on children in the community is essential, promoting healthy habits at an early age. Follow-up roundtables are being scheduled in Mercy Hospital St. Louis Page 2

4 To continue the dialogue begun at the community roundtable events, online community advisory panels were formed. These individuals are routinely surveyed to assess need, evaluate program/service ideas and provide feedback. Members are continuously added to the advisory panel. New MyMercy users are invited to join the group and a public invitation/form is located on the Mercy.net website. Mercy s Planning & Research Department provided internal and external demographic, utilization, chronic condition, and heath status data. The consulting group Sg2 was also engaged by Mercy as a partner to analyze current utilization and future demand for health care services. Professional Research Consultants (PRC) assists Mercy in measuring patient satisfaction through personal phone calls and surveys. The St. Louis County Department of Health (SLCDH) serves as the primary community partner for Mercy Hospital St. Louis in both the CHNA and community health improvement plan (CHIP) processes. SLCDH is utilizing the Mobilizing Action through Planning and Partnerships (MAPP) model, bringing hospitals and agencies across St. Louis County together in a collaborative process. MHSL also works closely with the St. Louis Regional Health Commission who serves as a vital facilitator in bringing together key partners to address community need. Community health co-workers in the Mission department of MHSL coordinate the CHNA process as part of their community health and benefit responsibility. A Community Health Council is accountable for ensuring community benefit meets mission, compliance, and IRS guidelines. The council is led by the hospital president. Members include co-workers from finance, care management, philanthropy, Mercy Clinic Mercy s integrated physician group, mission, and other key areas. The chief medical officer as well as a MHSL board member are also actively engaged members of the council. How the Assessment Was Conducted The needs assessment process involved the following five steps to attain the full scope of the community s needs. 1. Examine existing community health needs assessments (Step 1) The needs assessment examination process included the collection and analysis of quantitative data available in community/public health resources. Mercy staff, supported by Saint Louis University Master of Public Health students, reviewed the following data: St. Louis County 2011 Community Health Needs Assessment In December 2010, the St. Louis County Department of Health contracted with the University of New England s Center for Community and Public Health (CCPH) to conduct a countywide CHNA that included an extensive report with data broken down by sub-county regions. The assessment was released at the county s first Public Health Summit in December HealthNeedsAssessment_1.pdf Progress Toward Building a Healthier St. Louis 2011 Access to Care Report St. Louis Regional Health Commission Each year Mercy s JFK Health Center is cited throughout the report as a major provider of care for the uninsured and underinsured in our region. Mercy Hospital St. Louis Page 3

5 Decade Review of Health Status for St. Louis City and County St. Louis Regional Health Commission This report focuses on change over the past decade in fourteen leading health indicators and disparity metrics in St. Louis City and County. County Health Rankings This is a new resource that was unveiled in March It is county-level data that will be updated annually by the University of Wisconsin-Population Health Institute and the Robert Wood Johnson Foundation. Community Data Profiles & Missouri Information for Community Assessment (MICA) Missouri Department of Health & Senior Services-Bureau of Health Informatics This resource provides some of the best community health assessment planning tools available including community data profiles on 115 Missouri counties, thirty health indicators, and the capability to create customized tables Children s Mental Health & Substance Abuse Services Needs Assessment for St. Louis County St. Louis Children s Service Fund This resource identifies the characteristics of met and unmet mental health needs, service gaps, utilization and capacity, and the barriers to utilization of mental health and substance abuse services. dren%27s%20service%20fund%20- %202012%20Needs%20Assessment%20FINAL%20REPORT.pdf Data provided by Mercy s Planning & Research Department Data from Mercy s internal records was used to assess the needs of the community. Community health assessment and planning is an ongoing process at Mercy. As community/public health data is released, plans and programming are adjusted. 2. Obtain qualitative information from community members (Step 2) In an effort to dialogue directly with the community and include qualitative data, input from community residents, individuals served by Mercy and also those with expertise in public health were included through: Community roundtable events Online surveys SLCDH focus groups SLCDH provider interviews SLCDH household telephone surveys Mercy Hospital St. Louis Page 4

6 3. Analyze and summarize the data to prioritize needs 4. Review community benefit activities in place 5. Create an action plan in partnership with the community Analyze and summarize the data to prioritize needs (Step 3) Health Needs Identified The St. Louis County Department of Health s 2011 Community Health Needs Assessment Report was a key deliverable in the initial phase of the MAPP process. The report not only provides data for the entire county, but further subdivides the county into four study regions: Mid, North, South and West. While continuing to participate in the MAPP process, Mercy s Community Health and Benefit staff reviewed this report, along with other available data, and identified community health needs critical for Mercy Hospital St. Louis to address that align with Mercy s mission and community master plan. Public health data for lifestyle issues such as obesity, tobacco use, and substance abuse paralleled with internal hospital data. Age-adjusted cancer incidence rates in St. Louis County for colon, breast, and prostate cancers, although declining over a ten year period, remain higher than rates reported for the state of Missouri. Cardiac-related disease, diabetes, and asthma, along with those seeking treatment for behavioral health needs, remain critical issues when assessing the health of St. Louis County. Lack of prevention strategies and poor behavioral choices continue to contribute to decreased quality of life, avoidable hospital admissions, and higher health care costs. St. Louis County also has several underlying socio-demographic characteristics that impact the health of its population and cannot be ignored. The county has what is described as an aging population. Older populations utilize more health services creating increased access demands on the health system. Another significant finding is variation at the sub-county level in income, employment status, and health outcomes. North County, for example, reports significantly lower income levels, higher unemployment, increased risk factors, and overall poorer health outcomes. Disparities such as these must be taken into account when addressing community need and creating health improvement plans. Community Assets Identified The St. Louis community is fortunate to have two major universities/medical centers that include two schools of public health, St. Louis University and Washington University. There are also many other hospitals, universities, schools, churches and religious groups, and health and social service agencies, including a strong department of health. Additionally, the St. Louis Regional Health Commission is involved with the business community through the Business Health Coalition. County government, Civic Progress, and a variety of other community groups and forums serve as catalysts for community development and improvement. Mercy Hospital St. Louis Page 5

7 Summaries: Assessments and Priorities To set priorities, criteria focused on identifying disproportionate unmet need, primary prevention strategies, advancements toward a continuum of care and a program that is collaborative and involves the community. The following priority needs were identified: Next Steps Access to Care Mental Health & Substance Abuse Health Literacy/Lifestyle Issues Tobacco Use/Chronic Disease Injuries Intentional & Unintentional Review community benefit activities in place (Step 4) Using Lyon Software s CBISA tool, a review will be conducted of current community benefit activities and what Mercy is presently doing to meet identified priorities. In addition, the community benefit activity of others in the community will be reviewed. Create an action plan (Step 5) Mercy Hospital St. Louis will continue to partner with the St. Louis County Department of Health and area hospitals/agencies to develop a Community Health Improvement Plan. Hospital representatives will participate on appropriate action teams that are being formed during the summer of 2013 as a result of the SLCDH s MAPP process. MHSL s Community Health Council will oversee, guide, and support Mercy s involvement in this collaborative approach. The implementation plan will be posted by November 15, The following Community Health Improvement Plan for Mercy Hospital St. Louis has been developed as a response to the priorities identified in the Community Health Needs Assessment Access to Care, Mental Health and Substance Abuse, Tobacco Use, and Injuries-Intentional: Domestic Violence. Health Literacy concepts will be incorporated throughout the plan. Access to Care Mercy Hospital St. Louis (MHSL) will focus on two primary initiatives to improve access to care: 1. Cover Missouri Coalition In partnership with other Missouri Mercy hospitals, Mercy Hospital St. Louis will increase access to health care through education, collaboration, and enrollment in the new health insurance marketplace made available through the Affordable Care Act (ACA). Partners Missouri Foundation for Health, Cover Missouri Coalition members (75+), other community organizations Short term goals Secure funding from the Missouri Foundation for Health (MFH) Expanding Coverage grant opportunity August 2013 Form internal Mercy ACA implementations teams across Missouri August/September 2013 Mercy Hospital St. Louis Page 6

8 Identify community partners in each Mercy community October 2013 St. Louis partners through MFH led by the Community Action Agency of St. Louis County (CAASTLC) Additional community partners Develop communication plan for internal and external audiences October 2013, ongoing Develop implementation project plan; hire, train, license Certified Application Counselors (CACs) September/October 2013 Open toll-free call center; begin hospital-based and outreach programs October 2013 Provide outreach and education to a minimum of 9,000 individuals statewide October 2013 thru March 2014 Assist 4,000 individuals in enrolling in the health insurance marketplace October 2013 thru March 2014 Continue to advocate for Medicaid expansion through participation on Cover Missouri Coalition ongoing Long term goal Support the Missouri Foundation for Health goal to reduce the number of uninsured in Missouri (currently 17%) to 5% in five years 2. Integrated Health Network In partnership with the Integrated Health Network (IHN), Mercy Hospital St. Louis will connect patients in the emergency department with a primary care home and coordinate critical support services regardless of ability to pay. Partners Integrated Health Network (includes 16 Federally Qualified Health Centers), St. Louis County Department of Health Short term goals Receive approval for IHN/Mercy Community Referral Coordinator (CRC) Program July 2013 Form IHN/Mercy Implementation Team August 2013 Create job description, work flow, patient engagement strategy and finalize contract August thru September 2013 Develop implementation project plan; hire, train, and orient CRC September thru October 2013 CRC to serve as primary point person in ED for Mercy Project Access with initial focus on uninsured patients with the following chronic diseases: heart disease, diabetes, asthma, hypertension and chronic pain ongoing Develop metrics surrounding encounters, referrals, readmissions October/November 2013 Long term goals Increase the number of patients connected to a medical home who receive quality primary/preventative care Shift patient use of the ED for non-emergent situations to appropriate levels of care including urgent care centers and physician offices Decrease cost per case managing care outside the hospital when appropriate Mercy Hospital St. Louis Page 7

9 Mental Health & Substance Abuse Mercy Hospital St. Louis will improve access to mental health and substance abuse services. Partners St. Louis County Department of Health, Behavioral Health Network, Mercy Clinic and community physicians Short term goals Develop a regional approach to mental health and substance abuse through Mercy s Community Master Planning Process July 2013 Increase access/inpatient capacity at MHSL from 72 beds to 85 (13 bed gain 10 adult, 3 child/adolescent) November 2013 Increase the number of integrated, regional providers for child/adolescent psychiatric services MDs: 2.75 to 5.0 FY13; 1.6 budgeted growth FY14 NPs: 1.2 in FY13 RN triage: 1 in FY13 Decrease new appointment wait times from 4-6 months to 4-6 weeks for psychiatrist; from 2-3 months to 3 weeks for NP Increase the number of integrated and non-integrated adult psychiatric providers Build on Mercy s present relationship with the Behavioral Health Network through participation in the Hospital Community Linkages Project and the Emergency Enhancement Project November 2013 Participate in the St. Louis County Department of Health s MAPP Mental Health group Fall 2013 Explore with Humedica & IPD (Integrated Patient Delivery) Key Initiative Team baseline data for Depression Screening follow-up for Mercy Clinic St. Louis physicians Develop metrics to measure short and long term goals March 2014 Long term goals Continue regional approach including growing inpatient and outpatient services in surrounding counties and expanding child/adolescent services Explore a centralized approach for intake services for Mercy s East Region Increase number of MHSL/Mercy Clinic patients connected with quality behavioral health services Decrease use of ED for non-emergency treatment Tobacco Use Mercy Hospital St. Louis will increase awareness of and access to smoking cessation services. Partners American Lung Association, Wellcoach, Mercy Clinic and community physicians, Healthification Short term goals Continue to strengthen Mercy s Tobacco Cessation Team identifying a physician champion to be actively involved March 2014 Establish a budget March 2014 Mercy Hospital St. Louis Page 8

10 Work with Humedica and IPD (Integrated Patient Delivery) Key Initiative Team to determine baseline data and establish targets for Mercy Clinic St. Louis physicians Provide smoking cessation group classes 3 times a year Begin new one-on-one telephonic cessation program (Wellcoach) January 2014 Further evaluate current efforts with the Healthification team and identify opportunities on which to partner March 2014 o Build on the internal Healthification communication plan adding an external/community focus Develop metrics to measure long term goals January 2015 Long term goals Increase the number of individuals who are screened for tobacco use and are provided follow-up interventions by Mercy Clinic physicians Increase smoking cessation success by adult smokers Injuries Intentional: Domestic Violence Mercy Hospital St. Louis will increase awareness of domestic violence and access to services. Partners ALIVE (Alternatives to Living in Violent Environments), St. Louis County Family Courts Short term goals Secure seed funding from Mercy Caritas for initial HOPE (Hospital Order of Protection and Empowerment) Project training July 2013 Form collaborative committee with ALIVE partners July 2013 Improve screening of domestic violence victims by including a scripted question in EPIC for all patients Develop staff education and training materials to increase identification of the signs and symptoms and how to respond to a patient who discloses experience with domestic violence Assist victims of domestic violence who are seen in Mercy Hospital St. Louis s ED in filing orders of protection (HOPE Project) Provide community education and special events to increase awareness of domestic violence Obtain additional community/philanthropic support Develop metrics to measure short and long term goals March 2014 Long term goals Continue with above objectives Share and expand the HOPE Project to other Mercy facilities and adapt legal path to their court system Mercy Hospital St. Louis Page 9

11 St. Louis, MO Community Needs Assessment January 2013 Prepared by Mercy Planning Research

12 MARKET OVERVIEW St. Louis 14-Region PSA DEMOGRAPHIC CHARACTERISTICS Demographics 2000 Total Population 2012 Total Population 2017 Total Population % Change PSA MO USA % Change 2,609,130 5,595, ,421,906 Total Male Population 1,325,544 1,354, % 2,740,910 6,056, ,095,504 Total Female Population 1,415,366 1,441, % 2,796,632 6,258, ,256,835 Females, Child Bearing Age (15-44) 554, , % 2.0% 3.3% 3.9% Average Household Income $67,146 $58,645 $67,315 POPULATION DISTRIBUTION Age Group 2012 Age Distribution % of Total 2017 % of Total HOUSEHOLD INCOME DISTRIBUTION Income Distribution USA 2012 % of USA % of Total 2012 Household Income HH Count Total % of Total , % 544, % 20.2% , % 114, % 4.3% <$15K 124, % 13.0% , % 257, % 9.7% $15-25K 111, % 10.8% , % 361, % 13.5% $25-50K 293, % 26.7% , % 743, % 28.1% $50-75K 227, % 19.5% , % 373, % 11.4% $75-100K 143, % 11.9% , % 291, % 9.2% Over $100K 195, % 18.2% , % 111, % 3.7% Total 2,740, % 2,796, % 100.0% Total 1,095, % 100.0% EDUCATION LEVEL RACE/ETHNICITY Education Level Distribution Race/Ethnicity Distribution % of USA % of USA 2012 Adult Education Level Pop Age 25+ Total % of Total Race/Ethnicity 2012 Pop Total % of Total Less than High School 66, % 6.3% White Non-Hispanic 2,027, % 62.8% Some High School 137, % 8.6% Black Non-Hispanic 518, % 12.3% High School Degree 504, % 28.7% Hispanic 75, % 17.0% Some College/Assoc. Degree 581, % 28.5% Asian & Pacific Is. Non-Hispanic 64, % 5.0% Bachelor's Degree or Greater 545, % 27.8% All Others 55, % 2.9% Total 1,835, % 100.0% Total 2,740, % 100.0% Source: Truven Health Analytics, 2012 Prepared by Mercy Planning Research 2

13 MARKET OVERVIEW St. Louis 14-Region PSA Emergency Department Visit Estimates by Age/Gender Groups and Acuity Status (Emergent vs. Urgent) In the St. Louis 14-Region Primary Service Area, 63% of all ED visits are considered urgent. On a national scale, 62% of ED visits are considered urgent and can likely be treated in different care settings. Female Male Age Group 2012 Emergent Visits 2012 Urgent Visits 2012 Total ED Visits , , , , , , ,920 82, , ,463 33, , , , , , , , ,174 67, , ,080 21,892 78,972 Total 461, ,319 1,246,328 The age cohort account for 39% of all ED visits in the St. Louis PSA Within that age group, the majority of visits (73%) are urgent (non-emergent) Source: Truven Health Analytics Emergency Department Estimates, 2012 Prepared by Mercy Planning Research 3

14 MARKET OVERVIEW St. Louis 14-Region PSA Top ED Diagnosis Codes Diagnosis 3-digit ICD9 Volume % SYMPTOMS INVOLVING RESPIRATORY SYSTEM/CHEST , % OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS , % GENERAL SYMPTOMS , % ASTHMA , % SYMPTOMS INVOLVING HEAD & NECK , % SYMPTOMS INVOLVING DIGESTIVE SYSTEM , % DISORDERS OF URETHRA & URINARY TRACT NEC , % INJURY NEC & NOS 959 8, % OTHER & UNSPECIFIED BACK DISORDER 724 7, % BACK SPRAINS & STRAINS NEC & NOS 847 7, % Diagnosis 3-digit ICD9 Volume % ACUTE UPPER RESPIRATORY INFECTION MULT SITES NOS , % OTHER DIAGNOSES XXX 34, % GENERAL SYMPTOMS , % SUPPURATIVE/NOS OTITIS MEDIA , % OTHER & UNSPECIFIED BACK DISORDER , % BACK SPRAINS & STRAINS NEC & NOS , % VIRAL & CHLAMYDIAL INFECTION IN CCE & SITE NOS 79 22, % OTHER CELLULITIS & ABSCESS , % ACUTE PHARYNGITIS , % OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS , % Source: : Truven Health Analytics Outpatient Health Profiles, 2010 Prepared by Mercy Planning Research 4

15 MARKET OVERVIEW St. Louis 14-Region PSA Chronic Conditions Identified Among 18+ Population in the PSA Prevalent Cases, Ages < 65 Prevalent Cases, Ages 65+ Prevalent % of % of % of Disease Cases 18+ Pop Count Disease Cases Count Disease Cases Pain/Aching of Joints 702,364 34% 526,896 75% 175,468 25% Hypertension 649,118 31% 423,478 65% 225,641 35% Low Back Pain 593,177 29% 479,838 81% 113,340 19% Arthritis 501,293 24% 315,398 63% 185,895 37% Migraine Headaches 313,313 15% 294,289 94% 19,024 6% Sinusitis 291,121 14% 238,715 82% 52,406 18% Asthma 272,016 13% 232,252 85% 39,764 15% Depression/Anxiety 256,636 12% 221,486 86% 35,150 14% Diabetes 180,946 9% 111,333 62% 69,613 39% Hay Fever 171,631 8% 146,101 85% 25,529 15% Hearing Impairment 124,820 6% 63,621 51% 61,199 49% Chronic Bronchitis 95,932 5% 74,406 78% 21,527 22% Coronary Heart Disease 95,132 5% 41,101 43% 54,031 57% Heart Attack 73,885 4% 33,227 45% 40,657 55% Stroke 61,224 3% 28,954 47% 32,270 53% Angina 48,278 2% 25,449 53% 22,829 47% Ulcers 39,418 2% 32,415 82% 7,003 18% Congestive Heart Failure 39,323 2% 16,319 42% 23,004 59% Emphysema 39,039 2% 18,898 48% 20,141 52% Weak/Failing Kidneys 35,656 2% 21,009 59% 14,647 41% Breast Cancer 30,712 1% 13,709 45% 17,003 55% Liver Condition 29,001 1% 24,740 85% 4,261 15% Prostate Cancer 21,948 1% 6,271 29% 15,677 71% Skin Cancer 15,552 1% 8,327 54% 7,224 47% Cervical Cancer 15,053 1% 13,073 87% 1,980 13% Colon/Rectal Cancer 11,645 1% 3,942 34% 7,703 66% Uterine Cancer 7,464 0% 4,412 59% 3,052 41% Lung Cancer 4,739 0% 1,735 37% 3,004 63% Prepared by Mercy Planning Research Source: Truven Health Analytics Continuum of Care,

16 MARKET OVERVIEW St. Louis County, MO Chronic Conditions Identified Among 18+ Population in the County Prevalent Cases, Ages < 65 Prevalent Cases, Ages 65+ Prevalent % of % of % of Disease Cases 18+ Pop Count Disease Cases Count Disease Cases Pain/Aching of Joints 268,319 34% 195,153 73% 73,165 27% Hypertension 258,153 33% 163,408 63% 94,745 37% Low Back Pain 222,846 28% 175,660 79% 47,186 21% Arthritis 196,882 25% 119,178 61% 77,704 40% Migraine Headaches 115,327 15% 107,488 93% 7,840 7% Sinusitis 110,124 14% 88,383 80% 21,741 20% Asthma 102,383 13% 85,786 84% 16,598 16% Depression/Anxiety 97,172 12% 82,444 85% 14,728 15% Diabetes 72,948 9% 43,683 60% 29,265 40% Hay Fever 64,273 8% 53,733 84% 10,540 16% Hearing Impairment 48,781 6% 22,974 47% 25,808 53% Coronary Heart Disease 38,529 5% 15,845 41% 22,684 59% Chronic Bronchitis 36,433 5% 27,489 76% 8,943 25% Heart Attack 29,759 4% 12,676 43% 17,084 57% Stroke 25,029 3% 11,285 45% 13,744 55% Angina 19,147 2% 9,591 50% 9,556 50% Congestive Heart Failure 16,080 2% 6,398 40% 9,682 60% Emphysema 15,385 2% 7,039 46% 8,345 54% Ulcers 14,924 2% 11,952 80% 2,972 20% Weak/Failing Kidneys 14,367 2% 8,127 57% 6,240 43% Breast Cancer 12,497 2% 5,356 43% 7,142 57% Liver Condition 11,063 1% 9,307 84% 1,756 16% Prostate Cancer 8,992 1% 2,390 27% 6,602 73% Skin Cancer 5,947 1% 2,964 50% 2,983 50% Cervical Cancer 5,470 1% 4,649 85% % Colon/Rectal Cancer 4,744 1% 1,487 31% 3,258 69% Uterine Cancer 2,961 0% 1,673 57% 1,287 44% Lung Cancer 1,974 0% % 1,274 65% Prepared by Mercy Planning Research Source: Truven Health Analytics Continuum of Care,

17 MARKET OVERVIEW St. Louis County, MO County Health Ranking *National Benchmark = 90th percentile (i.e., only 10% are better) Note: Blank values reflect unreliable or missing data Source: 2012 County Health Rankings provided by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute Prepared by Mercy Planning Research St. Louis County Error Margin National Benchmark* Missouri Rank out of 115 counties HEALTH OUTCOMES 20 Mortality 16 Premature death 6,700 6,509-6,892 5,466 7,981 Morbidity 45 Poor or fair health 12% 11-14% 10% 16% Poor physical health days Poor mental health days Low birthweight 8.9% % 6.0% 8.1% HEALTH FACTORS 6 Health Behaviors 7 Adult smoking 18% 16-20% 14% 24% Adult obesity 29% 27-31% 25% 31% Physical inactivity 25% 23-27% 21% 28% Excessive drinking 19% 17-22% 8% 17% Motor vehicle crash death rate Sexually transmitted infections Teen birth rate Clinical Care 2 Uninsured 11% 10-12% 11% 15% Primary care physicians 658:1 631:1 1,274:1 Preventable hospital stays Diabetic screening 83% 81-84% 89% 84% Mammography screening 72% 70-74% 74% 65% Social & Economic Factors 15 High school graduation 88% 86% Some college 74% 73-75% 68% 61% Unemployment 9.4% 5.4% 9.6% Children in poverty 14% 12-16% 13% 21% Inadequate social support 18% 16-21% 14% 19% Children in single-parent households 34% 32-35% 20% 32% Violent crime rate Physical Environment 105 Air pollution-particulate matter days Air pollution-ozone days Access to recreational facilities Limited access to healthy foods 4% 0% 8% Fast food restaurants 53% 25% 47% 7

18 MARKET OVERVIEW St. Louis County, MO Children s Health Indicators Children in poverty (Percent) % 9.3% 12.9% Children under 6 in poverty (Percent) % 10.7% 17.2% Children enrolled in MO HealthNet for Kids (Percent) % 27.0% 24.2% 25.8% 25.8% Children receiving public SED mental health services (Number) ,858 4,163 3,941 2,802 2,768 Children receiving subsidized child care (Number) ,812 8,995 8,875 9,318 10,216 Percentage of Children receiving cash assistance (Percent) % 4.0% 3.6% 3.6% 3.4% Children receiving food stamps (Percent) % 22.3% 22.3% 23.7% 25.3% Students enrolled in free/reduced price lunch (Percent) % 35.8% 36.4% 36.7% 36.9% Low birth weight infants (Percent) % 8.7% 8.8% 8.9% 9.1% Infant mortality (per 1,000 live births) (Rate) Public clinic immunization (Percent) % 93.8% 94.7% 92.8% 94.7% Births to teens, ages (per 1,000) (Rate) Children in single parent families (Percent) % 23.3% 31.9% Child abuse and neglect (per 1,000) (Rate) Child deaths, ages 1-14 (per 100,000) (Rate) Source: The Annie E. Casey Foundation Kids Count Data Center; Missouri Partnership for Children Prepared by Mercy Planning Research 8

19 St. Louis, MO MO IL The St. Louis Primary Service Area (PSA) comprises 194 zip codes in east central Missouri and west central Illinois Mercy Locations Hospital Clinic Urgent/ Convenient Care Outpatient Surgery Center Prepared by Mercy Planning Research

20 UTILIZATION St. Louis 14-Region PSA Top Acute Inpatient Discharges July June 30, 2012 Note: Accounts for 37% of their total 42,720 Acute IP Discharges MSDRG Code MSDRG Description Inpatient Discharges Age Breakouts % of Total Inpatient Discharges < 18 % % % % 80+ % 775 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 3,725 9% 45 1% 3,677 99% 3 0% 0 0% 0 0% 885 PSYCHOSES 3,215 8% % 1,580 49% % 212 7% 94 3% 766 CESAREAN SECTION W/O CC/MCC 1,810 4% 8 0% 1,799 99% 3 0% 0 0% 0 0% 794 NEONATE W OTHER SIGNIFICANT PROBLEMS 1,654 4% 1, % 0 0% 0 0% 0 0% 0 0% 765 CESAREAN SECTION W CC/MCC 1,316 3% 8 1% 1,303 99% 5 0% 0 0% 0 0% 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 1,009 2% % % % % 89 9% 470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 983 2% 0 0% 18 2% % % 95 10% 774 VAGINAL DELIVERY W COMPLICATING DIAGNOSES 751 2% 6 1% 93 12% % % % 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC 751 2% 11 1% % 1 0% 0 0% 0 0% 603 CELLULITIS W/O MCC 697 2% % % % % 81 12% TOTAL 15,911 37% 2,598 16% 9,618 60% 1,942 12% 1,183 7% 570 4% Source: Epic Hospital Billing Report Prepared by Mercy Planning Research 10

21 UTILIZATION St. Louis 14-Region PSA Top Inpatient Admissions from the ED July 1, 2011 June 30, 2012 Note: Accounts for 25% of their total 26,228 ED Admissions MSDRG Description ED Inpatient Admissions % of Total ED Age Breakouts Inpatient Admissions < 18 % % % % 80+ % Chest pain 2,490 9% 1 0% % 1,191 48% % % Depression 896 3% % % % 45 5% 20 2% Pneumonia 845 3% % 88 10% % % % Abdominal pain 772 3% 64 8% % % 99 13% 67 9% Syncope 382 1% 0 0% 51 13% % % % CHF (congestive heart failure) 276 1% 0 0% 8 3% 54 20% 89 32% % Altered mental status 267 1% 3 1% 33 12% 65 24% 75 28% 91 34% Acute appendicitis 254 1% 53 21% % 68 27% 12 5% 4 2% Cellulitis 227 1% 9 4% 72 32% 74 33% 42 19% 30 13% Dyspnea 221 1% 0 0% 17 8% 63 29% 82 37% 59 27% TOTAL 6,630 25% 419 6% 1,665 25% 2,204 33% 1,353 20% % Source: Epic - Report ED0004: Inpatient admits from the ED (patient class includes emergency, inpatient, surgery, surgical OP/extended care, and observation) Prepared by Mercy Planning Research 11

22 UTILIZATION St. Louis 14-Region PSA Top ED Visit Volume By ICD9 Codes July 1, 2011 June 30, 2012 Note: Accounts for 15% of their total 81,227 ED Visit Volume ED % of ED Age Breakouts ICD9 Code Diagnosis Volume Volume <18 % % % % 80+ % Chest pain, unspecified 1,854 2% 65 4% % % % 105 6% Abdominal pain, unspecified site 1,692 2% % % % 83 5% 43 3% Other chest pain 1,332 2% 17 1% % % % 99 7% Headache 1,262 2% % % % 77 6% 22 2% Urinary tract infection, site not specified 1,115 1% % % % % % Pneumonia, organism unspecified 1,040 1% % % % % 96 9% Head injury, unspecified 1,014 1% % % % 83 8% 74 7% Other and unspecified noninfectious gastroenteritis and colitis 984 1% % % % 37 4% 18 2% V Surgical or other procedure not carried out because of patient's decision 892 1% % % % 52 6% 19 2% Unspecified otitis media 872 1% % 61 7% 8 1% 4 0% 0% TOTAL 12,057 15% 3,253 27% 4,356 36% 2,648 22% 1,093 9% 707 6% Source: Epic - Report ED0018: ED Visit Reason Prepared by Mercy Planning Research 12