Steering Committee slides about Transportation, Utilities and Health

2. 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

3. 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

4. Congestion
Texas A&M Transportation Institute 2011 Ranking
– Denver–8th
– Minneapolis –25th
– Cincinnati–27th
– OklahomaCity–57th
– Kansas City–68th
– Omaha–79th
(101LargestMetroAreasinUS-. #1:MostCongested)

5. 82.3
75.6
81.5
83
78
82.6 82.5
76.4
Percent Drove to Work
(Single OccupancyVehicle)
* 2011 American Community Survey

6. * 2011 American Community Survey
8.8
9.6
10.3
9.2
8.7
10.6
9.9 9.7
Percent Carpooled to Work

7. * 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

8. Roadway/Highway
Inventory

10. 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

13. 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

15. Railway Inventory

18. Transit Inventory

19. 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

20. Metro System Map

21. Weekday- AM Peak Service Frequency

22. Omaha Metro- Linked Transit Trips
On-Board SurveyWeighted Response

23. Freight Movement

24. Major Freight Corridors

25. Average Truck Speeds
on Selected Interstate Highways (2011)

26. Aviation

28. Regional Transportation
Issues
+ Funding
+ Infrastructure Condition
+ Reliance on Automobile
+ Transportation v Land Use
+ Air Quality
Opportunities
+ Freight through movement
+ Convenience of EppleyAirfield

29. Funding Challenges
+ Funding largely generated from motor fuel tax
+ ReductioninVMT and increased fuel efficiency
+ Status of Federal Highway Trust Fund
+ Increased cost of materials

30. $-
$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

31. Questions/Discussion

33. 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

34. Broadband

35. Broadband Service Area
Fixed Services
* Data sources: Connect Iowa; Nebraska Broadband Capacity Building Program

36. Broadband Provider Coverage Map
Fixed Services
* Data sources: Connect Iowa; Nebraska Broadband Capacity Building Program

37. 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

38. Issues and Opportunities
+ Inconsistent State Policy
+ Consumer Density/Service Gaps
+ Continued Expansion for Economic Development
+ Established Transport Network
+ Strong Enterprise Bandwidth Customers

39. Electric

40. 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

41. Electric Utility Coverage Map

42. 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

43. 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

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

45. 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

46. $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

47. *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)

48. *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

49. Issues and Opportunities
+ Generation Capability
+ Transmission Lines
+ Competitive Pricing
+ High Customer Service Satisfaction

50. Natural Gas

51. 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

52. Natural Gas Utility Coverage Map

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

54. *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)

55. *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

56. *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)

57. *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)

58. Issues and Opportunities
+ Pipeline Capacity
+ Reliable Source and Supply
+ Competitive Pricing
+ Conservation is Stabilizing Demand

59. Water

60. 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

61. Water Utility Coverage Map
Major Service Providers

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

63. *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

64. *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

65. *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
.

66. Issues and Opportunities
+ Quality & Source in Rural Areas
+ Aging Infrastructure
+ Economic Development Capacity
+ Confident in Freshwater Supply
+ Conservation- Educationis Key!

67. Sanitary Sewer

68. Sanitary Sewer Service Providers
+ Municipal Providers
+ Sanitary and Improvement District (SID)
+ Septic Tank Systems

69. SID Coverage Map
*No Data Obtained from Saunders County

70. *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

71. *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
.

72. *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
.

73. Issues and Opportunities
+ High Cost Improvements/Expansion
+ State and Federal Mandates
+ Need to Upgrade Underserved Areas
+ Economic Development Considerations
+ Reuse GrayWater

74. Questions/Discussion

76. ResearchTeam Members
Douglas County Board of Commissioners
MaryAnn Borgeson
Alegent Creighton Health
Mikki Frost
CQuence Health Group
Mike Cassling

77. 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

78. 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

79. Our Metro’s Health Care System
* Source: Nebraska DHHS, Iowa Department of Public Health
Hospital Locations

80. 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.

81. 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

82. 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

83. 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

84. Chronic Disease
Adult Diabetes Rate

85. 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

86. 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

87. + 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

88. 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

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

90. 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

91. Risk Factors
Childhood Obesity (BMI>30)
* Source: National Minority Quality Forum

92. 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

93. 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

94. Risk Factors
Physical Inactivity

95. 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

96. 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

97. 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

98. 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

99. 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

100. 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

101. 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

102. 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

103. Chronic Disease Impacts
* Source: CQuence Health Group
On Health Care Economics

104. Chronic Disease Impacts
* Source: CQuence Health Group
On Health Care Economics

105. 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

106. 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

107. 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

108. Questions/Discussion