Welcome to the Community Health Visioning 2017 Steering Committee Status Meeting

1. Welcome to theCommunity Health Visioning 2017 Steering Committee Status Meeting June 27, 2011 1

2. Welcome Robbie Roepstorff President, Edison National Bank Chairman, Community Health Visioning 2017 Steering Committee 2

3. Purpose Convene Steering Committee of the Community Health Visioning 2017 to review progress toward achieving recommendations and make needed course corrections. 3

4. Agenda Welcome, Introductions, Opening Comments Desired Outcomes and Part to Play Local Economic and Market Changes 2011 PRC Community Health Assessment – Lee County, Florida Break Progress Review of Eight Priorities Lunch Course Corrections Next Steps & Closing 4

5. Opening Comments Jim Nathan President, Lee Memorial Health System

6. Desired Outcomes, Agenda, Part to PlayBrad Pollins 6

7. Desired Outcomes Build understanding of about key local economic and market changes comparing 2007 with 2011 Build understanding about the findings from the market analysis completed by PRC Build understanding of progress achieved in the eight prioritized recommendations Share community achievements and lessons learned Identify any course corrections that need to be considered based 7

8. Eight Priorities Behavioral Health Primary Care Alternatives Electronic Medical Record Workforce Shortage Public Awareness of Services Preventive Healthcare Chronic Disease Focus on Quality 8

9. Part to Play 9

10. Audience Response System Practice Responding 10

11. Local Economic and Market ChangesRegina Eberwein 11

12. Unemployment – Lee County Past: 3rd in State for lowest; Now: 16th (out of 20 metros) Source: US Dept of Labor, BLS

13. Employment Growth – Lee County 43,000 new jobs 36,000 lost jobs . Source: US Dept of Labor, BLS

14. Employment Gain/Loss by Industry Lee County (2006-2010) 36,000 lost jobs in total Source: US Dept of Labor, BLS

15. Growth in Taxable Sales – Lee County Source: FL Office of EDR

16. Poverty Percentages – Lee County All Ages Under 18 US Census, SAIPE

17. Building Permits – Lee County Doubled in 3 yrs 95% Decline Source: US Census

18. Home Sales / Home Price – Lee County Existing Homes sold via Multiple Listing Service Home prices have fallen 60+% Source: FL NAR

19. Population Growth – Lee CountyPermanent Population 5.7% 5.2% 4.7% 4.0% 4.0% 3.8% 1.9% 1.1% 0.7% Source: UF, BEBR

20. Population Growth Components – FloridaPermanent Population 87% 55% 86% Migration as a % Population Growth Source: FL Office of EDR

21. Population Growth Forecast – Lee CountyPermanent Population 1.3% Avg Ann Growth Permanent Population; forecast BEBR-low Source: UF, BEBR-low forecast

22. Age Distribution – Lee CountyPermanent Population 65+ cohort growing 2.5x faster than overall population Source: 2010 Census; UF, BEBR

23. Non-Urgent Visits to Emergency DepartmentLee Memorial Health System 12% Increase in Evenings & Weekends 18% Increase in Mon thru Fri, 9 am – 5 pm Mon thru Fri, 9 am – 5pm is 39% of Non-Urgent volume Source: Lee Memorial Health System

24. In-Patient Commercial Payor - Lee County Hospitals% of Total Approximately 1/5 of In-Patient Cases at Lee County hospitals paid for by Commercial Payors Source: Thomson Reuters

25. 2011 PRC Community Health Assessment:Lee County, FloridaBruce Lockwood 25

26. Community Health Findings Lee County, Florida Prepared for

27. PRC Community Health Assessment Customized LocalPRC Community Health Survey The 2011 PRC Community Health Assessment consists of both primary and secondary data. Identical to the approach used in 2007. Secondary Data Key Informant Focus Groups

28. Telephone Survey • Stratified random sample of 1,000 adults • 250 interviews in each of four Market Areas • 153survey items; 20-25 minute interview • Lee County: ±3.1% maximum error • Each percentage of the total sample represents roughly 5,355 residents BENCHMARKING State BRFSS data (CDC) US Survey Data(PRC National Health Survey) Healthy People 2020 targets State and national vital statistics

29. Population & Sample Characteristics(Lee County, 2011) Sources:  Census 2000, Summary File 3 (SF 3). US Census Bureau.  PRC Community Health Survey, Professional Research Consultants, Inc.

30. Overall Health Status • Positive Health Findings • Overview of Community Vision 2017 Priority Areas • Areas of Opportunity • Access to Healthcare Services • Chronic Disease & Injury • Immunization & Infectious Disease • Maternal, Infant & Child Health • Mental Health & Substance Abuse • Nutrition, Physical Activity & Overweight • Overarching Issues • Q & A

31. Overall Health Status • Positive Health Findings • Overview of Community Vision 2017 Priority Areas • Areas of Opportunity • Access to Healthcare Services • Chronic Disease & Injury • Immunization & Infectious Disease • Maternal, Infant & Child Health • Mental Health & Substance Abuse • Nutrition, Physical Activity & Overweight • Overarching Issues • Q & A

32. Self-Reported Health Status(Lee County, 2011) 52.2% Excellent/ Very Good 17.4% Fair/Poor Sources:  Professional Research Consultants, Inc. PRC Community Health Survey. [Item 6] Notes:  Asked of all respondents.

33. Experience “Fair” or “Poor” Physical Health Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 6] ● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2009 Florida Data. ● Professional Research Consultants. PRC National Health Survey. 2011. Notes: ● Asked of all respondents.

34. Experience “Fair” or “Poor” Physical Health(Lee County, 2011) Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 6] Notes: ● Asked of all respondents. ● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.

35. Limited in Activities in Some Way Due to a Physical, Mental or Emotional Problem Predominantly age-related: most often attributed to musculoskeletal issues — back/neck problems, arthritis/ rheumatism, fractures or bone/joint injuries, or problems walking. Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 128] ● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2009 Florida Data. ● Professional Research Consultants. PRC National Health Survey. 2011. Notes: ● Asked of all respondents.

36. Overall Health Status • Positive Health Findings • Overview of Community Vision 2017 Priority Areas • Areas of Opportunity • Access to Healthcare Services • Chronic Disease & Injury • Immunization & Infectious Disease • Maternal, Infant & Child Health • Mental Health & Substance Abuse • Nutrition, Physical Activity & Overweight • Overarching Issues • Q & A

37. Selected Lee County Indicators Better Than the US: • Death rates due to: heart disease, cancer, chronic lower respiratory disease, stroke, diabetes, Alzheimer’s disease, cirrhosis/liver disease, pneumonia/influenza and kidney disease • Vaccine-preventable conditions • STD incidence • Osteoporosis • Seatbelt usage • Firearm prevalence • Physical activity • Routine vision care

38. Overall Health Status • Positive Health Findings • Overview of Community Vision 2017 Priority Areas • Areas of Opportunity • Access to Healthcare Services • Chronic Disease & Injury • Immunization & Infectious Disease • Maternal, Infant & Child Health • Mental Health & Substance Abuse • Nutrition, Physical Activity & Overweight • Overarching Issues • Q & A

39. Community Vision 2017 Priority Areas • Behavioral Health • Depression indicators are similar to the US, but the suicide rate is quite high compared to both the state and US. • While most reported high-risk alcohol and drug behaviors are close to national findings, the drug-induced death rate is worse than both the state and nation. • Behavioral health was the #1 ranked health priority among participants in the key informant focus groups. PRIORITY AREAS ADDRESSED IN DATA Behavioral Health Primary Care Alternatives Preventive Health Care Chronic Disease

40. Community Vision 2017 Priority Areas • Primary Care Alternatives • A relatively low proportion of residents have a “medical home,” and fewer than found in 2007. • Receipt of routine medical care has likewise declined since 2007. • A high proportion of parents report trouble accessing healthcare for their child. • Access to healthcare services, especially for low-income and uninsured populations, was the second top-ranked priority among key informant focus group participants. PRIORITY AREAS ADDRESSED IN DATA Behavioral Health Primary Care Alternatives Preventive Health Care Chronic Disease

41. Community Vision 2017 Priority Areas • Preventive Health Care • Three out of 10 school-aged children are overweight or obese, similar to what is found nationally. • Diabetes death rates are favorable, however, the prevalence of diabetes (those living with diabetes) is high. • More than one out four births in Lee County does not receive timely prenatal care. This is similar to the statewide proportion. PRIORITY AREAS ADDRESSED IN DATA Behavioral Health Primary Care Alternatives Preventive Health Care Chronic Disease

42. Community Vision 2017 Priority Areas • Chronic Disease • Two-thirds of Lee County adults are overweight or obese, close to the national proportion. However, obesity has increased since 2007. • Prevalence levels for diabetes and high blood pressure are both relatively high. • Nearly 10% of adults and children have asthma, similar to national findings, although adult asthma has increased since 2007. PRIORITY AREAS ADDRESSED IN DATA Behavioral Health Primary Care Alternatives Preventive Health Care Chronic Disease

43. Overall Health Status • Positive Health Findings • Overview of Community Vision 2017 Priority Areas • Areas of Opportunity • Access to Healthcare Services • Chronic Disease & Injury • Immunization & Infectious Disease • Maternal, Infant & Child Health • Mental Health & Substance Abuse • Nutrition, Physical Activity & Overweight • Overarching Issues • Q & A

44. Overall Health Status • Positive Health Findings • Overview of Community Vision 2017 Priority Areas • Areas of Opportunity • Access to Healthcare Services • Chronic Disease & Injury • Immunization & Infectious Disease • Maternal, Infant & Child Health • Mental Health & Substance Abuse • Nutrition, Physical Activity & Overweight • Overarching Issues • Q & A

45. Healthcare Insurance Coverage(Among Adults Age 18 to 64; Lee County, 2011) Private Insurance 61.0% Gov’t Insurance 18.5% No Insurance 20.5% Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 206] Notes: ●Reflects respondents aged 18 to 64.

46. Lack of Healthcare Insurance Coverage(Among Lee County Adults Under 65, 2011) Healthy People 2020 Target = 0.0% (Universal Coverage) Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 206] ● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2009 Florida Data. ● Professional Research Consultants. PRC National Health Survey. 2011. ● US Department of Health and Human Services.  Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective AHS-1] Notes: ● Asked of all respondents under the age of 65.

47. Lack of Healthcare Insurance Coverage(Lee County Adults Under 65, 2011) Healthy People 2020 Target = 0.0% (Universal Coverage) Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 206] ● US Department of Health and Human Services.  Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective AHS-1] Notes: ● Asked of all respondents under the age of 65. ● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.

48. Experienced Difficulties or Delays of Some Kindin Receiving Needed Healthcare in the Past Year(Lee County, 2011) • Barriers Tested: • Cost of Doctor Visits • Cost of Prescriptions • Appointment Availability • Trouble Finding a Doctor • Inconvenient Office Hours • Lack of Transportation Overall, similar to US 19.0% of adults did not see a doctor in the past year because of the cost (higher than US, an increase since 2007). Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 210] Notes: ● Asked of all respondents. ● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.

49. Had Trouble Obtaining Medical Care for Child in the Past Year(Lee County Parents of Children <18, 2011) Parents with trouble obtaining medical care for their child reported barriers due to cost or lack of insurance coverage, limited insurance acceptance, and lack of accessibility. Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 138-139] ● Professional Research Consultants. PRC National Health Survey. 2011. Notes: ● Asked of all respondents with children under 18 at home.

50. Have a Specific Source of Ongoing Medical Care(Lee County, 2011) Lower than US (76.3%), lower than in 2007 (76.5%) Again, access to healthcare services, especially for low-income and uninsured populations, was the #2 priority identified in the key informant focus groups. Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 207] ● US Department of Health and Human Services.  Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objectives AHS-5.3, 5.4] Notes: ● Asked of all respondents. ● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.