Community Health Needs Assessment Springfield, Missouri PDF Free Download

Community Health Needs Assessment Springfield, Missouri 2012

Contents Table of Contents Introduction... 2 Description and Basic Community Demographics... 3 Who was Involved in Assessment?... 6 Community Assessment Process.7 Primary Health Needs Identified... 7 Implementation Plans for the Identified Primary Health Needs... 8 Our Mission: As the Sisters of Mercy before us, we bring to life the healing ministry of Jesus through our compassionate care and exceptional service. Mercy Hospital Springfield Page 1

Introduction Mercy Hospital Springfield was founded by the Sisters of Mercy in 1891 when they responded to a call to help meet the health needs of the community. Mercy Hospital Springfield and the rest of Mercy continue to answer that call and to strengthen our community health assessment processes, partnerships, and program development. Community Health is a part of our tradition and core to our Mission. Mercy Hospital Springfield is located in Greene County, Missouri. It is a large comprehensive care hospital whose service area spans southwest Missouri and northern Arkansas. It is part of a six hospital North Central Mercy Community containing two general acute hospitals and four critical access hospitals. Mercy Hospital Springfield has 866 acute licensed beds (2011) and provides available outpatient services to nearly 700,000 individuals in the region. Mercy Springfield served 98,325 patients in the Emergency Department in FY12. As part of Mercy Health, the largest multi-state provider in the Central Midwest, Mercy Hospital Springfield has implemented a state-of-the-art, integrated and advanced electronic health record system to meet the demand for high quality health care services while controlling costs. Mercy Hospital Springfield services include: Level 1 Trauma and Burn Centers. Nationally certified Stroke Center. Heart Institute, Breast and Spine Centers. A dedicated Children s Hospital with a Level III Neonatal Intensive Care Unit and the region s only designated St. Jude s Children s Hospital Affiliate. Advanced Cancer Center including davinci surgery, Tomo therapy and Cyberknife treatment options, as well as a dedicated Community Cancer Resource Center. Orthopedic and Sports Medicine Services. The assessment of community health and associated needs is an ongoing process. We are committed to working together with our community to identify current and future resources and collaborations that will: Improve access to care. Improve health outcomes. Reduce the cost of care. Provide opportunities for disease prevention and health promotion. Partnerships and collaborations with the community and across Mercy boundaries will be directed at providing accessible and sustainable quality health care to all members of our community with special attention to individuals who are medically underserved and economically fragile. Mercy Hospital Springfield Page 2

The needs assessment process involved review of both quantitative and qualitative information to attain the full scope of our community s needs. This summary is reflective of our dedication to serving the community and documentation that Mercy Hospital Springfield is in compliance with IRS requirements for conducting community health needs assessments. Description and Basic Community Demographics Mercy Hospital Springfield is both an urban and rural community located in Greene County Missouri. Springfield had a city population of 160,660 (2011) and Greene County s estimated population in 2012 was 280,626. Mercy Hospital Springfield primarily serves a 13-county region in southwest Missouri and Carroll County in northern Arkansas which expands the population to over 700,000. The estimated Medicaid population percentage for Greene County is 13% while the Medicare percentage is 16% (Truven Health Analytics 2012). The 13 county primary service region has a Medicaid percentage of 14% while the Medicare percentage is 18% (Truven Health Analytics 2012). Missouri s overall health ranking is 42 nd out of 50 states (2012). Greene County ranks 38 th in health outcomes and 15 th in health factors out of 115 counties (County Health Rankings 2012). Prevalence of health factors exceeding national benchmarks in Greene County include: Adult smoking 23% (national 14% and 24% Missouri). Adult obesity 30% (national 25% and 31% Missouri). Children living in poverty 24% (national benchmark 13% and Missouri s 21%). The teen birthrate was 44 per 1,000 in ages 15-19 while the national benchmark is 22 per 1,000. Missouri is 44. Greene County consistently ranks high in Missouri for reported child abuse and neglect. Primary chronic diseases among adults (18+) within Springfield s 13-county primary service area are hypertension 30%, arthritis 25%, asthma 13%, diabetes 8%, depression/anxiety 12%, and coronary heart disease 5%. In addition, 3% have had a stroke, 4% have had a heart attack, and 4% are living with some type of cancer. (Truven Health Analytics 2012). Although chronic disease management and development of prevention strategies is a significant ongoing need, it was targeted only in specific areas from a community benefit perspective at this time. We have a highly developed Care Management team with Nurse on Call services addressing many of these needs and strategizing to better meet future needs. We work closely with Care Management in this regard with a focus on those with limited resources. Our increased aging population, their needs, and increased workforce development is an ongoing need and priority that we are already addressing on many levels. We provide multiple senior services to the community. We also collaborate with local and regional schools and universities to support the educational needs of nurses, advanced practice providers, physicians, occupational and physical therapy providers and other health care professionals. Mercy Hospital Springfield Page 3

Springfield PRIMARY SERVICE AREA MO The Springfield Primary Service Area (PSA) comprises 13 counties in southwest Missouri Mercy Locations Hospital Hospital (under construction) Clinic Urgent/ Convenient Care Outpatient Surgery Center MARKET OVERVIEW Springfield 13-County PSA DEMOGRAPHIC CHARACTERISTICS 2000 Total Population 2012 Total Population 2017 Total Population % Change 2012-2017 Average Household Income $50,168 $58,645 $67,315 POPULATION DISTRIBUTION Age Group 2012 % of Total 2017 % of Total Demographics PSA MO USA 2012 2017 % Change 607,370 5,595,230 281,421,906 Total Male Population 351,917 373,303 6.1% 719,777 6,056,620 313,095,504 Total Female Population 367,860 390,090 6.0% 763,393 6,258,528 325,256,835 Females, Child Bearing Age (15-44) 142,093 146,518 3.1% 6.1% 3.3% 3.9% HOUSEHOLD INCOME DISTRIBUTION USA 2012 % of Total 2012 Household Income HH Count % of Total USA % of Total 0-14 142,072 19.7% 152,170 19.9% 20.2% 15-17 29,292 4.1% 29,741 3.9% 4.3% <$15K 46,430 16.1% 13.0% 18-24 78,983 11.0% 81,697 10.7% 9.7% $15-25K 43,477 15.1% 10.8% 25-34 88,261 12.3% 98,042 12.8% 13.5% $25-50K 96,759 33.5% 26.7% 35-54 187,726 26.1% 181,929 23.8% 28.1% $50-75K 52,294 18.1% 19.5% 55-64 84,642 11.8% 94,191 12.3% 11.4% $75-100K 23,635 8.2% 11.9% 65-79 80,201 11.1% 93,771 12.3% 9.2% Over $100K 25,959 9.0% 18.2% 80+ 28,600 4.0% 31,852 4.2% 3.7% Total 719,777 100.0% 763,393 100.0% 100.0% Total 288,554 100.0% 100.0% EDUCATION LEVEL Age Distribution Education Level Distribution 2012 Adult Education Level Pop Age 25+ % of Total RACE/ETHNICITY Income Distribution Race/Ethnicity Distribution USA % of Total Race/Ethnicity 2012 Pop % of Total USA % of Total Less than High School 20,694 4.4% 6.3% White Non-Hispanic 659,958 91.7% 62.8% Some High School 46,209 9.8% 8.6% Black Non-Hispanic 10,484 1.5% 12.3% High School Degree 163,974 34.9% 28.7% Hispanic 23,519 3.3% 17.0% Some College/Assoc. Degree 141,264 30.1% 28.5% Asian & Pacific Is. Non-Hispanic 7,581 1.1% 5.0% Bachelor's Degree or Greater 97,289 20.7% 27.8% All Others 18,235 2.5% 2.9% Total 469,430 100.0% 100.0% Total 719,777 100.0% 100.0% Source: Truven Health Analytics, 2012 2 Mercy Hospital Springfield Page 4

MARKET OVERVIEW Greene 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 Greene County Error Margin National Benchmark* Missouri Rank out of 115 counties HEALTH OUTCOMES 38 Mortality 34 Premature death 7,824 7,451-8,197 5,466 7,981 Morbidity 47 Poor or fair health 17% 14-19% 10% 16% Poor physical health days 4.1 3.5-4.6 2.6 3.6 Poor mental health days 3.7 3.1-4.2 2.3 3.7 Low birthweight 6.9% 6.6-7.3% 6.0% 8.1% HEALTH FACTORS 15 Health Behaviors 19 Adult smoking 23% 20-26% 14% 24% Adult obesity 30% 26-34% 25% 31% Physical inactivity 26% 22-30% 21% 28% Excessive drinking 13% 10-16% 8% 17% Motor vehicle crash death rate 16 14-18 12 19 Sexually transmitted infections 296 84 438 Teen birth rate 44 42-45 22 44 Clinical Care 7 Uninsured 17% 15-18% 11% 15% Primary care physicians 1,003:1 631:1 1,274:1 Preventable hospital stays 54 51-57 49 75 Diabetic screening 88% 83-92% 89% 84% Mammography screening 64% 60-68% 74% 65% Social & Economic Factors 43 High school graduation 86% 86% Some college 65% 63-67% 68% 61% Unemployment 8.4% 5.4% 9.6% Children in poverty 24% 20-28% 13% 21% Inadequate social support 17% 14-20% 14% 19% Children in single-parent households 32% 30-35% 20% 32% Violent crime rate 509 73 518 Physical Environment 70 Air pollution-particulate matter days 0 0 0 Air pollution-ozone days 2 0 7 Access to recreational facilities 11 16 10 Limited access to healthy foods 9% 0% 8% Fast food restaurants 52% 25% 47% Source: County Health Rankings Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, 2012 7 Mercy Hospital Springfield Page 5

Who Was Involved in the Assessment? Community Members: The voice of our local community members is at the heart of our assessment. Mercy Springfield held community roundtable events in both 2010 and 2011 to dialogue directly with a variety of local community members regarding their health care needs, ideas and concerns. These discussions brought attention to local needs and also brought to light common themes throughout Mercy including the need for a greater emphasis on wellness and prevention, education and access. We also heard that a focus on children in the community is essential, promoting healthy habits at an early age. Concerns for the increase in our aging population and the need for health care workforce development were also expressed. Mercy will continue to listen to and engage the communities we serve with the 2013 community roundtable discussions. Mercy Mission Community Health/Community Benefit Team: Mercy Mission Community Health and Community Benefit Team co-workers lead our work with the community needs assessment as part of their responsibility for overseeing the community benefit/community health for Mercy Springfield. Input also came from Mercy Hospital leadership, Finance, Advocacy, Philanthropy, Mercy Clinic leadership, Regional leadership, and Marketing and Communications. Mercy Planning & Research: Provided analysis of both internal and external demographics, utilization, chronic conditions and heath status data. External organizations are also engaged by Mercy to analyze current utilization and future demand for health care services, as well as to assist Mercy on an ongoing basis in measuring and providing benchmark data on patient satisfaction of inpatients, ambulatory surgery and Emergency Department patients. Community Assessment Process 1. Review of existing community health needs assessments. Examine existing community health needs assessments. The needs assessment examination process included the collection and analysis of quantitative data available in State, Federal, and local community/public health resources. Mercy staff reviewed the following data within the past two years: - Community Partnership Annual Report to the Community 2011 - Community Health Status Indicators Report (CHSI) 2009. - Community Focus Report for Springfield/Greene County 2011. - City of Springfield Community Report 2011. - Springfield-Greene County Health Commission Report 2010. - Missouri Hospital Association Southwest/Southeast Regions Assessing the Health of Our Communities Report 2010. - The County Health Rankings for 2011/2012. University of Wisconsin-Population Health Institute/Robert Wood Johnson Foundation. - Springfield-Greene County Health Department Community Assessment Data 2011. - Community Data Profiles & Missouri Information for Community Assessment (MICA) 2011/2012. Missouri Department of Health & Senior Services-Bureau of Health Informatics. Mercy Hospital Springfield Page 6

- Issues in Missouri Health Care 2011 Assuring an Adequate Health Care Workforce in Missouri s Medically Underserved Areas. - Department of Health and Human Services Healthy People 2020 (Dec. 2010). - Data from Mercy s Health Information Systems Department 2010/2011/2012. 2. Listen to the voice of the community. Mercy-wide sponsored community roundtable events in both 2010 and 2011. These initial assessments were followed up by meetings with community partners like our schools and other nonprofit organizations. Continuation of the community roundtable process across Mercy begins in 2013. 3. Analyze and summarize the data. 4. Conduct an in-depth review of current community benefit activities. 5. Conduct resource assessment: internal and community. 6. Align assessment needs and priorities with resources and community benefit criteria. 7. Create an implementation plan with community collaborations. Community Resource Development, Connection, and Coordination. Primary Health Needs Identified After careful analysis of the community health needs data, multiple health needs were identified and the following priorities were selected: 1. Improve access to health care for uninsured and/or underserved individuals. 2. Improve access and health/wellness education and services for women and children. 3. Improve access to behavioral health education and services. Implementation Plans for the Identified Primary Health Needs Focus on disproportionate unmet needs, primary prevention strategies, advancement toward a continuum of care and programs that are collaborative. Consider measurable outcomes, existing internal and community initiatives and resources. The implementation plan will be posted by November 15, 2013 for all identified primary health needs. 1. Improve access to health care for uninsured and/or underserved individuals. 2. Improve access and health/wellness education and services for women and children. 3. Improve access to behavioral health education and services Mercy Springfield Initial Implementation Plans November 15, 2013 Upon identification of the Community Health Needs Assessment priorities, Mercy Springfield began working through its Community Benefit Oversight Committee (committee members and roles/responsibilities attached) to identify an initial implementation plan for each priority. This committee had a strategic planning meeting to review current community benefit programs and Mercy Hospital Springfield Page 7

to look at potential new programs. Subgroups were created with Mercy and community partners to work on implementation plans for the identified priorities. These subgroups are currently working to develop metrics and evaluation tools for the implementation plans. Partners include schools, other health care facilities, businesses, and others. Current internal and community resources are also under review with the primary assets under consideration being existing programs, community partnerships, other health care facilities in the community, engaged schools, businesses, faith communities, and nonprofit organization support. Please see the initial focus areas and goals below with detailed implementation plans pending. Community Health Needs Assessment Priority: Improve Access to Health Care for Uninsured and/or Underserved Individuals Access to Care Goal 1: Improve Access through Affordable Care Act Insurance Education and Enrollment Affordable Care Act Access to Care Program Description: In partnership with the Cover Missouri Coalition members including the Missouri Foundation for Health and other Missouri hospitals; Mercy Hospital Springfield will increase access to health care through education, partnerships, and enrollment assistance in the new health insurance market place made available through the Affordable Care Act (ACA). Access to Care Goal 2: Improve Access to Care through Patient Transportation Patient Transportation Program Description: Transportation will be provided to eligible patients with no other means to get to medical appointments or home from the hospital after an inpatient stay or Emergency Department visit. Mercy s courtesy van, wheelchair van services, and public transportation vouchers support patients without financial or family transportation support. This service also supports the needs of Mercy Springfield s skilled care facility. Access to Care Goal 3: Improve Access to Care through Medication Access Access to needed medication is vital to the health and well being of each individual. Without these medications, individuals are at increased risk for worsening health, sometimes to critical stages; as well as increased hospital readmissions and emergency department visits. Community Medication Access Program (CMAP) Description: As a member of The Springfield Greene County Health Commission, Mercy Springfield partnered with CoxHealth, Jordan Valley Community Health Center, and The Kitchen Clinic to design and implement a Community Medication Access Program (CMAP) in July of 2011. This community collaborative program assists uninsured patients in accessing free medications offered by various pharmaceutical companies Patient Assistance Programs. In January 2013, sponsorship of the program was transitioned from the Springfield-Greene County Health Commission to joint sponsorship by Mercy and CoxHealth, with additional support from Jordan Valley Community Health Center (FQHC). The program serves patients of Mercy Springfield Communities, CoxHealth, The Kitchen Clinic and Jordan Valley Community Health Center. Mercy Hospital Springfield Page 8

Community Health Needs Assessment Priority: Improve Access and Health/Wellness Education and Services for Women and Children Women and Children s Goal 1: Improve Health/Wellness Education for Children through School Health Education A. HealthTeacher Program Description: HealthTeacher is an online health education resource tool that includes lessons, interactive presentations, and additional resources to integrate health into any classroom. Mercy contracted with HealthTeacher in 2010 and began program implementation in Springfield public and parochial schools in 2011 at no cost to the schools. HealthTeacher s educational materials are designed for grades K thru 12 and meet state educational standards. This resource is used by teachers, parents, and students to address important health issues, including physical activity, nutrition, and social and emotional well-being. Program outreach educators assist in working with the schools. Mercy Springfield and HealthTeacher co-hosted health education conferences for local and regional teachers and school administrators in 2012 and 2013. B. Mercy Health Science Academy Description: An educational program developed in partnership with the Springfield Public School for 8 th grade students where classrooms are located in the hospital. Students will experience a full standard Missouri core curriculum, as well as the benefit of health care and health and wellness educational opportunities. This program is still under development and is anticipated to begin in the fall of 2014. Women and Children s Goal 2: Improve Health and Wellness through Safety Education for Children Mercy Injury Prevention Center Program Description: The Mercy Injury Prevention Center is part of the Trauma Services Department. This program prevents accidental injuries to children through education, research, advocacy, environmental improvements, safety device distribution and public awareness programs. Mercy staff provides education to children and families about safety and injury prevention through presentations at schools, daycare facilities and various community events. Educational program examples include seatbelt/car seat safety, drinking and driving, poison prevention, bike/pedestrian safety, fire and burn prevention. Community Health Needs Assessment Priority: Improve Access to Behavioral Health Education and Services Behavioral Health Goal 1: Improve Access to Behavioral Health Education and Services through the Behavioral Access Center and Behavioral Health Services A. Behavioral Access Center Description: The Behavioral Health Access Center is a Mercy department of psychiatric evaluation nurses who assess all psychiatric patients in the Emergency Department, as well as some of the patients in the hospital and at the evaluation center in the psychiatric unit. The department also includes a 24/7 call answering service where many psychiatric emergencies are handled over the phone. B. Behavioral Health Services Description: Inpatient Care Coordinators provide discharge planning for patients being discharged from the psychiatric unit while psychiatric RNs make follow-up phone calls to patients being discharged to assist in assuring compliance with their discharge plan. Medication and group therapy services are also provided. Licensed Clinical Social Workers provide individual/family/group therapy and also complete required biopsychosocial assessments for each patient admitted. This department also provides Intern and Practicum programs for Psychology students, Social Work Students, and Advanced Practice Nurses. Behavioral Health Physician Services include intake and hospital inpatient Mercy Hospital Springfield Page 9

care, consult services, adult, child and adolescent services, telemedicine, and neurorehabilitation care. Mercy continues to explore and evaluate behavioral health programs and processes that will improve access to care and utilization of resources. Next Steps: Subgroups will continue to work to enhance the initial implementation plans and to develop metrics and program evaluation tools. Enlist the services of specific topic professionals and community members, as needed. Continue to research and explore new or other opportunities in this regard. Groups will also work with community partners to share and maximize resources. Communication and Coordination within Mercy and the greater community. Mercy Hospital Springfield Page 10

Springfield, MO Community Needs Assessment February 2013

MARKET OVERVIEW Springfield 13-County PSA DEMOGRAPHIC CHARACTERISTICS 2000 Total Population 2012 Total Population 2017 Total Population % Change 2012-2017 Average Household Income $50,168 $58,645 $67,315 POPULATION DISTRIBUTION Age Group 2012 % of Total 2017 % of Total Demographics PSA MO USA 2012 2017 % Change 607,370 5,595,230 281,421,906 Total Male Population 351,917 373,303 6.1% 719,777 6,056,620 313,095,504 Total Female Population 367,860 390,090 6.0% 763,393 6,258,528 325,256,835 Females, Child Bearing Age (15-44) 142,093 146,518 3.1% 6.1% 3.3% 3.9% HOUSEHOLD INCOME DISTRIBUTION USA 2012 % of Total 2012 Household Income HH Count % of Total USA % of Total 0-14 142,072 19.7% 152,170 19.9% 20.2% 15-17 29,292 4.1% 29,741 3.9% 4.3% <$15K 46,430 16.1% 13.0% 18-24 78,983 11.0% 81,697 10.7% 9.7% $15-25K 43,477 15.1% 10.8% 25-34 88,261 12.3% 98,042 12.8% 13.5% $25-50K 96,759 33.5% 26.7% 35-54 187,726 26.1% 181,929 23.8% 28.1% $50-75K 52,294 18.1% 19.5% 55-64 84,642 11.8% 94,191 12.3% 11.4% $75-100K 23,635 8.2% 11.9% 65-79 80,201 11.1% 93,771 12.3% 9.2% Over $100K 25,959 9.0% 18.2% 80+ 28,600 4.0% 31,852 4.2% 3.7% Total 719,777 100.0% 763,393 100.0% 100.0% Total 288,554 100.0% 100.0% EDUCATION LEVEL Age Distribution RACE/ETHNICITY Income Distribution Education Level Distribution USA 2012 Adult Education Level Pop Age 25+ % of Total % of Total Race/Ethnicity 2012 Pop % of Total Race/Ethnicity Distribution USA % of Total Less than High School 20,694 4.4% 6.3% White Non-Hispanic 659,958 91.7% 62.8% Some High School 46,209 9.8% 8.6% Black Non-Hispanic 10,484 1.5% 12.3% High School Degree 163,974 34.9% 28.7% Hispanic 23,519 3.3% 17.0% Some College/Assoc. Degree 141,264 30.1% 28.5% Asian & Pacific Is. Non-Hispanic 7,581 1.1% 5.0% Bachelor's Degree or Greater 97,289 20.7% 27.8% All Others 18,235 2.5% 2.9% Total 469,430 100.0% 100.0% Total 719,777 100.0% 100.0% Source: Truven Health Analytics, 2012 2

MARKET OVERVIEW Springfield 13-County PSA Emergency Department Visit Estimates by Age/Gender Groups and Acuity Status (Emergent vs. Urgent) In the Springfield 13-County Primary Service Area, 59% 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 00-17 6,998 25,619 32,617 18-44 22,360 53,082 75,442 45-64 21,821 20,594 42,415 65+ 28,641 9,220 37,861 00-17 7,306 28,477 35,783 18-44 13,510 31,157 44,667 45-64 15,296 16,591 31,887 65+ 19,221 6,490 25,712 Total 135,153 191,231 326,384 The 18-44 age cohort account for 37% of all ED visits in the Springfield PSA Within that age group, the majority of visits (70%) are urgent (non-emergent) Source: Truven Health Analytics Emergency Department Estimates, 2012 3

MARKET OVERVIEW Springfield 13-County PSA Top ED Diagnosis Codes Diagnosis 3-digit ICD9 Volume % SYMPTOMS INVOLVING RESPIRATORY SYSTEM/CHEST 786 12,494 9.6% OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS 789 11,440 8.8% GENERAL SYMPTOMS 780 8,001 6.1% SYMPTOMS INVOLVING HEAD & NECK 784 3,597 2.8% DISORDERS OF URETHRA & URINARY TRACT NEC 599 3,101 2.4% SYMPTOMS INVOLVING DIGESTIVE SYSTEM 787 3,086 2.4% ASTHMA 493 2,988 2.3% OTHER & UNSPECIFIED BACK DISORDER 724 2,476 1.9% INJURY NEC & NOS 959 2,344 1.8% OTHER DIAGNOSES XXX 2,259 1.7% Diagnosis 3-digit ICD9 Volume % OTHER DIAGNOSES XXX 6,899 3.5% OTHER & UNSPECIFIED BACK DISORDER 724 6,495 3.3% ACUTE UPPER RESPIRATORY INFECTION MULT SITES NOS 465 6,453 3.2% GENERAL SYMPTOMS 780 5,716 2.9% OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS 789 5,264 2.6% OTHER CELLULITIS & ABSCESS 682 5,258 2.6% BACK SPRAINS & STRAINS NEC & NOS 847 5,204 2.6% SUPPURATIVE/NOS OTITIS MEDIA 382 4,963 2.5% SYMPTOMS INVOLVING RESPIRATORY SYSTEM/CHEST 786 4,855 2.4% ACUTE PHARYNGITIS 462 4,284 2.2% Source: Truven Health Analytics Outpatient Health Profiles, 2012 4

MARKET OVERVIEW Springfield 13-County PSA Chronic Conditions Identified Among 18+ Population in the PSA Prevalent % of Prevalence in Ages < 65 Prevalence in Ages 65+ Disease Cases 18+ Pop Count % of Total Cases Count % of Total Cases Pain/Aching of Joints 189,599 35% 136,244 72% 53,355 28% Hypertension 165,770 30% 99,053 60% 66,717 40% Low Back Pain 160,247 29% 125,142 78% 35,105 22% Arthritis 136,614 25% 79,897 59% 56,717 42% Migraine Headaches 81,829 15% 76,178 93% 5,651 7% Sinusitis 77,306 14% 61,353 79% 15,953 21% Asthma 70,392 13% 58,400 83% 11,991 17% Depression/Anxiety 64,715 12% 54,113 84% 10,602 16% Hay Fever 46,945 9% 38,797 83% 8,149 17% Diabetes 45,069 8% 25,342 56% 19,727 44% Hearing Impairment 37,091 7% 17,468 47% 19,622 53% Coronary Heart Disease 26,834 5% 9,839 37% 16,996 63% Chronic Bronchitis 26,204 5% 19,373 74% 6,831 26% Heart Attack 20,955 4% 8,138 39% 12,817 61% Stroke 15,898 3% 6,618 42% 9,280 58% Angina 13,813 3% 6,512 47% 7,301 53% Emphysema 11,660 2% 5,054 43% 6,606 57% Congestive Heart Failure 10,803 2% 3,777 35% 7,026 65% Ulcers 10,398 2% 8,429 81% 1,969 19% Weak/Failing Kidneys 8,922 2% 4,805 54% 4,118 46% Breast Cancer 8,749 2% 3,500 40% 5,248 60% Liver Condition 7,639 1% 6,288 82% 1,351 18% Prostate Cancer 6,347 1% 1,518 24% 4,829 76% Skin Cancer 4,936 1% 2,436 49% 2,500 51% Cervical Cancer 4,446 1% 3,796 85% 650 15% Colon/Rectal Cancer 3,281 1% 997 30% 2,284 70% Uterine Cancer 2,183 0% 1,190 55% 993 46% Lung Cancer 1,234 0% 351 28% 883 72% Source: Truven Health Analytics Continuum of Care, 2012 5

MARKET OVERVIEW Greene County, MO Chronic Conditions Identified Among 18+ Population in the county Prevalent % of Prevalence in Ages < 65 Prevalence in Ages 65+ Disease Cases 18+ Pop Count % of Total Cases Count % of Total Cases Pain/Aching of Joints 72,581 33% 53,512 74% 19,068 26% Low Back Pain 62,653 29% 50,126 80% 12,526 20% Hypertension 62,627 29% 38,602 62% 24,025 38% Arthritis 50,927 23% 30,569 60% 20,358 40% Migraine Headaches 33,159 15% 31,166 94% 1,993 6% Sinusitis 30,117 14% 24,455 81% 5,662 19% Asthma 28,102 13% 23,824 85% 4,279 15% Depression/Anxiety 25,791 12% 21,964 85% 3,828 15% Hay Fever 18,253 8% 15,386 84% 2,867 16% Diabetes 16,879 8% 9,796 58% 7,083 42% Hearing Impairment 13,738 6% 6,678 49% 7,060 51% Chronic Bronchitis 10,064 5% 7,631 76% 2,434 24% Coronary Heart Disease 9,755 4% 3,701 38% 6,054 62% Heart Attack 7,645 4% 3,081 40% 4,564 60% Stroke 5,955 3% 2,542 43% 3,412 57% Angina 5,059 2% 2,456 49% 2,603 52% Emphysema 4,216 2% 1,885 45% 2,331 55% Ulcers 4,083 2% 3,360 82% 722 18% Congestive Heart Failure 3,955 2% 1,429 36% 2,525 64% Weak/Failing Kidneys 3,398 2% 1,891 56% 1,507 44% Breast Cancer 3,243 1% 1,297 40% 1,946 60% Liver Condition 2,927 1% 2,451 84% 477 16% Prostate Cancer 2,230 1% 562 25% 1,668 75% Skin Cancer 1,796 1% 921 51% 875 49% Cervical Cancer 1,737 1% 1,502 87% 235 14% Colon/Rectal Cancer 1,211 1% 374 31% 838 69% Uterine Cancer 829 0% 458 55% 370 45% Lung Cancer 456 0% 132 29% 324 71% Source: Truven Health Analytics Continuum of Care, 2012 6

MARKET OVERVIEW Greene County, MO Child Health Indicators Children in poverty (Percent) 1990 2000 2007 16.1% 13.6% 19.6% Children under 6 in poverty (Percent) 1990 2000 2007 20.7% 16.7% 22.6% Children enrolled in MO HealthNet for Kids (Percent) 2004 2005 2006 2007 2008 41.3% 40.6% 35.2% 34.2% 34.1% Children receiving public SED mental health services (Number) 2003 2004 2005 2006 2008 2,180 2,367 2,411 597 490 Children receiving subsidized child care (Number) 2004 2005 2006 2007 2008 1,602 1,521 1,430 1,327 1,347 Percentage of Children receiving cash assistance (Percent) 2004 2005 2006 2007 2008 4.5% 4.3% 4.3% 4.2% 4.1% Children receiving food stamps (Percent) 2004 2005 2006 2007 2008 32.2% 33.4% 31.7% 31.2% 32.8% Students enrolled in free/reduced price lunch (Percent) 2004 2005 2006 2007 2008 36.3% 37.8% 38.9% 39.2% 40.8% Low birth weight infants (Percent) 2002 2003 2004 2005 2006 7.0% 7.0% 7.2% 7.0% 6.9% Infant mortality (per 1,000 live births) (Rate) 2002 2003 2004 2005 2006 7.8 7.0 7.2 6.9 6.7 Public clinic immunization (Percent) 2001 2002 2003 2004 2005 92.3% 92.3% 90.4% 87.2% 90.4% Births to teens, ages 15-19 (per 1,000) (Rate) 2004 2005 2006 2007 2008 44.0 46.5 46.9 44.8 41.0 Children in single parent families (Percent) 1990 2000 2007 18.2% 23.9% 31.5% Child abuse and neglect (per 1,000) (Rate) 2004 2005 2006 2007 2008 63.4 71.5 62.5 63.7 61.2 Child deaths, ages 1-14 (per 100,000) (Rate) 2002 2003 2004 2005 2006 18.9 18.5 17.3 16.1 13.8 Source: The Annie E. Casey Foundation Kids Count Data Center; Missouri Partnership for Children 8

Springfield, MO MO The Springfield Primary Service Area (PSA) comprises 13 counties in southwest Missouri Mercy Locations Hospital Hospital (under construction) Clinic Urgent/ Convenient Care Outpatient Surgery Center

UTILIZATION Mercy Hospital Springfield Top Acute Inpatient Discharges July 1, 2011 June 30, 2012 Note: Accounts for 22% of their total 34,191 Acute IP Discharges MSDRG Code MSDRG Description Inpatient Discharges % of Total Age Breakouts Inpatient Discharges < 18 % 18-44 % 45-64 % 65-79 % 80+ % 775 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 1,634 5% 48 3% 1,586 97% 0 0% 0 0% 0 0% 470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 1,164 3% 1 0% 20 2% 381 33% 554 48% 208 18% 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC 913 3% 11 1% 67 7% 253 28% 302 33% 280 31% 885 PSYCHOSES 759 2% 1 0% 473 62% 232 31% 50 7% 3 0% 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 693 2% 73 11% 144 21% 188 27% 194 28% 94 14% 247 PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC 517 2% 0 0% 20 4% 230 44% 190 37% 77 15% 897 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC 484 1% 0 0% 296 61% 160 33% 23 5% 5 1% 766 CESAREAN SECTION W/O CC/MCC 468 1% 4 1% 464 99% 0 0% 0 0% 0 0% 945 REHABILITATION W CC/MCC 395 1% 10 3% 70 18% 138 35% 130 33% 47 12% 743 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC 393 1% 1 0% 182 46% 167 42% 40 10% 3 1% TOTAL 7,420 22% 149 2% 3,322 45% 1,749 24% 1,483 20% 717 10% Source: Epic Hospital Billing Report 11

UTILIZATION Mercy Hospital Springfield Top Inpatient Admissions from the ED July 1, 2011 June 30, 2012 Note: Accounts for 29% of their total 21,987 ED Admissions MSDRG Description ED Inpatient Admissions % of Total ED Age Breakouts Inpatient Admissions < 18 % 18-44 % 45-64 % 65-79 % 80+ % Chest pain 3,049 14% 1 0% 378 12% 1,419 47% 879 29% 372 12% Pneumonia 917 4% 53 6% 71 8% 199 22% 316 34% 278 30% Altered mental status 452 2% 13 3% 73 16% 134 30% 115 25% 117 26% CVA (cerebral vascular accident) 371 2% 0 0% 20 5% 116 31% 124 33% 111 30% Syncope 323 1% 1 0% 32 10% 68 21% 126 39% 96 30% CHF (congestive heart failure) 284 1% 0 0% 7 2% 57 20% 87 31% 133 47% Dyspnea 276 1% 7 3% 18 7% 81 29% 97 35% 73 26% Abdominal pain 272 1% 31 11% 76 28% 75 28% 59 22% 31 11% Fever 265 1% 47 18% 25 9% 58 22% 88 33% 47 18% Fall 246 1% 6 2% 23 9% 40 16% 67 27% 110 45% TOTAL 6,455 29% 159 2% 723 11% 2,247 35% 1,958 30% 1,368 21% Source: Epic - Report ED0004: Inpatient admits from the ED (patient class includes emergency, inpatient, surgery, surgical OP/extended care, and observation) 12

UTILIZATION Mercy Hospital Springfield Top ED Visit Volume By ICD9 Codes July 1, 2011 June 30, 2012 Note: Accounts for 16% of their total 94,704 ED Visit Volume ICD9 Code Diagnosis Note: 3,634 (4%) of ED discharges did not list diagnosis Source: Epic - Report ED0018: ED Visit Reason ED Volume % of ED Age Breakouts Volume <18 % 18-44 % 45-64 % 65-79 % 80+ % 786.50 Chest pain, unspecified 2,581 3% 45 2% 860 33% 1,012 39% 438 17% 226 9% 786.59 Other chest pain 2,287 2% 30 1% 640 28% 1,003 44% 450 20% 164 7% 784.0 Headache 1,835 2% 114 6% 1,077 59% 429 23% 152 8% 63 3% 789.00 Abdominal pain, unspecified site 1,581 2% 199 13% 907 57% 291 18% 128 8% 56 4% 599.0 Urinary tract infection, site not specified 1,534 2% 147 10% 573 37% 255 17% 225 15% 334 22% 724.2 Lumbago 1,388 1% 24 2% 762 55% 415 30% 119 9% 68 5% 486 Pneumonia, organism unspecified 1,153 1% 262 23% 159 14% 252 22% 273 24% 207 18% 789.09 Abdominal pain, other specified site 1,000 1% 65 7% 574 57% 239 24% 86 9% 36 4% 780.2 Syncope and collapse 980 1% 81 8% 301 31% 225 23% 233 24% 140 14% 38.9 Unspecified septicemia 924 1% 4 0% 100 11% 239 26% 315 34% 266 29% TOTAL 15,263 16% 971 6% 5,953 39% 4,360 29% 2,419 16% 1,560 10% 13