1. America’s Health Rankings ® What Does It Tell Us About the State of Our Health? Alliance for Health Insurers September 9, 2014

2. America’s Health Rankings® - Annual Report A Comprehensive Assessment of the Nation’s Health Longest running annual assessment of our nation’s health on a state-by-state basis Report identifies the driving health trends of the nation Report provides insights into the national health challenges on the horizon Report has evolved from a source of information to a robust, interactive tool that urges all populations and communities to act Under the editorial control of a scientific advisory committee based out of the University of North Carolina Chapel Hill Gillings School of Global Public Health Published by United Health Foundation, the American Public Health Association and Partnership for Prevention 25 th Edition will be released December 2014

3. 3 America’s Health Rankings® - Senior Report A Comprehensive Assessment of Senior Health  2 nd edition, updates the data we gathered for the 2013 inaugural report.  Offers a comprehensive analysis of senior health on a national and state-by-state basis across 34 measures of senior health.  Report seeks to promote discussion around the health of Americans 65 years and older while driving communities, governments, stakeholders and individuals to take action to improve senior health.  In compiling the report, researchers worked with a panel of leading public health scholars.  Report draws data from more than 12 government agencies and leading research organizations, including the U.S. Department of Health and Human Services, the U.S. Department of Commerce, the U.S. Department of Labor, The Dartmouth Atlas Project, the National Foundation to End Senior Hunger and the Commonwealth Fund.

4. Model, Metrics and Methodology 4

5. Measures of Health – Annual Behaviors Smoking Binge Drinking Drug Deaths Obesity Physical Inactivity High School Graduation Community & Environment Violent Crime Occupational Fatalities Infectious Disease (Salmonella, Pertussis and Chlamydia) Children in Poverty Air Pollution Public & Health Policies Lack of Health Insurance Public Health Funding Immunization—Children Immunization—Adults Clinical Care Low Birthweight Infants Primary Care Physicians Dentists Preventable Hospitalizations Health Outcomes Diabetes Poor Mental Health Days Poor Physical Health Days Disparity in Health Status Infant Mortality Cardiovascular Deaths Cancer Deaths Premature Death

6. 6 Behaviors -Smoking -Chronic Drinking -Obesity -Underweight -Physical Inactivity -Dental Visits -Pain Management Community – Macro -Poverty -Volunteerism -Quality Nursing Homes Community – Micro -Social Support -Food Insecurity -Community Support Policy -Low-Care Nursing Home Residents -Prescription Drug Coverage -Geriatrician Shortfall Clinical Care -Dedicated Health Care Provider -Recommended Hospital Care -Flu Vaccine -Health Screenings -Diabetes Management -Home Health Care -Preventable Hospitalizations -Hospital Readmissions -Hospice Care -Hospital Deaths Outcomes -ICU Usage -Falls -Hip Fractures -Health Status -Able-Bodied -Premature Death -Teeth Extractions -Mental Health Days Measures of Health – Senior

7. Ranking Model Construction 7 Behaviors Smoking Binge Drinking Drug Deaths Obesity Physical Inactivity High School Graduation Community & Environment Violent Crime Occupational Fatalities Infectious Disease (Salmonella, Pertussis and Chlamydia) Children in Poverty Air Pollution Public & Health Policies Lack of Health Insurance Public Health Funding Immunization—Children Immunization—Adults Clinical Care Low Birthweight Infants Primary Care Physicians Dentists Preventable Hospitalizations Health Outcomes Diabetes Poor Mental Health Days Poor Physical Health Days Disparity in Health Status Infant Mortality Cardiovascular Deaths Cancer Deaths Premature Death 2. Normalize using a z-score 3. Eliminate outliers 4. Multiple by weights 5. Sum weighted scores 6. Rank among states 1. Gather data

8. What Does It Tell Us About the Health of Each State? 8

9.  Visualization of the impact of all measures on rankings  Color indicates above or below norm  Size indicates magnitude of impact  For WI: http://www.americashealthran kings.org/WI/obesity?tabnam e=coremeasureimpact http://www.americashealthran kings.org/WI/obesity?tabnam e=coremeasureimpact 9 Core Measure Impact

10. Disparity Maps  Disparity by gender, age, race/ethnicity, education, income and urbanicity  Rates for smoking, physical inactivity, obesity, diabetes and high health status  Population affected in these subpopulations.  For Obesity in WI: http://www.americashealthrankin gs.org//WI/obesity?tabname=dis parities http://www.americashealthrankin gs.org//WI/obesity?tabname=dis parities 10

11. Trends  Trends for each individual metric over time are displayed for the state and for the country.  For obesity in WI: http://www.americash ealthrankings.org/WI/ obesity?tabname=tre ndstate http://www.americash ealthrankings.org/WI/ obesity?tabname=tre ndstate 11

12. 12 State Summary Ranks for all metrics Disparities discussion http://www.americashealthrankings.org/WI

13. Health in the Wisconsin & the United States 13

14. America’s Health Rankings - Annual 14  Hawaii has taken the title of healthiest state.  Americans made considerable progress in their overall health in 2013, driven by improvements in more than two-thirds of our health measures.  While we should celebrate the gains we made, a key challenge will be maintaining momentum.

15. 15 Change in Rank  Wisconsin varies year to year  The overall trend is a slow decline  Implication: Population health is not improving in Wisconsin as fast as in other states.

16. America’s Health Rankings Top National Trends 16 In the US, smoking has declined in the last year from 21.2 percent of the adult population to 19.6 percent. Wisconsin US Wisconsin rates are typically slightly higher than US rates for smoking.

17. America’s Health Rankings Top National Trends 17 In the US, obesity has leveled off, shifting from 27.8 percent of adult population to 27.6 percent of the adult population – consistent with other surveys. US Wisconsin 2012/2013 Editions used revised BRFSS Methodology Wisconsin trends bear watching closely. New data has WI at 29.8 %, slightly above US median of 29.4%.

18. 18 Binge Drinking  Wisconsin has highest binge drinking rate. –25.2 percent of population age 18+ are binge drinkers. –Among a cluster of high prevalence states in the upper Mississippi valley. http://www.americashealthrankings.org/WI/binge

19. 19 Pertussis  Wisconsin ranked 49 th for incidence of pertussis has a high prevalence of pertussis compared to neighboring states. –21.0 cases per 100,000 population. –high prevalence of pertussis compared to neighboring states. http://www.americashealthrankings.org/WI/pertussis

20. 20 Immunization - Children  Wisconsin does have a strong child immunization program –75.2 percent of children receive recommended doses of DTaP, polio, MMR Hib, hepatitis B, varicella and PCV vaccines by age 19 to 35 months. –Ranked 6 th –high prevalence of pertussis compared to neighboring states.  Adolescent immunization rate was 67.2 percent, a rank of 16th. http://www.americashealthrankings.org/WI/immunize http://www.americashealthrankings.org/WI/immunize_teens

21. 21 High School Graduation  Wisconsin has the second highest high school graduation rate –91.1 percent of incoming freshman graduate within 4 years. –IL is considerable less (81.9%) and MN is slightly less (88.2%) http://www.americashealthrankings.org/WI/graduation

22. 22 Senior Health Across the U.S.  This year’s senior report reveals some encouraging data related to senior health: –Seniors are significantly more active than last year. In the US, Physical inactivity decreased from 30.3 percent to 28.7 percent of seniors. In Wisconsin, it decreased from 33.8 percent to 30.2 percent of seniors. –More seniors than last year are pursuing preferred options for end-of-life care. In the US, the use of hospice care increased from 36.7 percent to 47.5 percent of decedents aged 65 and older. In Wisconsin, 34.5 percent to 47.2 percent. In the US, Hospital deaths decreased from 30.1 percent to 25.0 percent of decedents aged 65 and older. In Wisconsin, 25.0 percent to 20.9 percent.

23. 23 Senior Health Across the U.S.  This year’s senior report reveals some encouraging data related to senior health: (cont.) –More seniors than last year are avoiding preventable hospitalizations. In the US, the percentage decreased from 66.6 to 64.9 admissions per 1,000 Medicare beneficiaries. In Wisconsin, it is much lower with a smaller decline; 55.3 to 55.0 admissions. –Nursing home quality improved in the past year. In the US, the percentage increased from 42.0 percent to 46.8 percent of beds rated 4 or 5 stars. In Wisconsin, it is higher than the national average and it increased from 50.3 to 53.3 percent rated 4 or 5 stars.

24. State Rankings 24

25. America’s Health Rankings Overall Ranking 25 2013 RANK (1-50)STATEOverall 47Alabama-0.822 25Alaska0.275 28Arizona0.02 49Arkansas-0.893 21California0.31 8Colorado0.565 7Connecticut0.649 31Delaware-0.097 33Florida-0.21 38Georgia-0.315 1Hawaii0.919 12Idaho0.442 30Illinois-0.096 41Indiana-0.487 18Iowa0.317 27Kansas0.122 45Kentucky-0.716 48Louisiana-0.844 16Maine0.366 24Maryland0.276 4Massachusetts0.725 34Michigan-0.218 3Minnesota0.731 50Mississippi-0.894 39Missouri-0.373 23Montana0.277 2013 RANK (1-50)STATEOverall 11Nebraska0.46 37Nevada-0.294 5New Hampshire0.703 10New Jersey0.531 32New Mexico-0.175 15New York0.37 35North Carolina-0.247 9North Dakota0.557 40Ohio-0.407 44Oklahoma-0.666 13Oregon0.426 29Pennsylvania-0.022 19Rhode Island0.317 43South Carolina-0.635 22South Dakota0.284 42Tennessee-0.579 36Texas-0.25 6Utah0.695 2Vermont0.868 26Virginia0.259 14Washington0.403 46West Virginia-0.727 20Wisconsin0.313 17Wyoming0.355

26. 26 Senior Rankings StateRank 1 Minnesota 2 Hawaii 3 New Hampshire 4 Vermont 5 Massachusetts 6 Colorado 7 Utah 8 Oregon 9 Delaware 10 Wisconsin 11 Maryland 12 Connecticut 13 Iowa 14 Maine 15 Washington 16 Nebraska 17 Kansas 18 California 19 North Dakota 20 Michigan 21 Virginia 22 Pennsylvania 23 Arizona 24 New Jersey 25 Idaho StateRank 26Rhode Island 27South Dakota 28Florida 29North Carolina 30Montana 31Ohio 32New York 33Wyoming 34South Carolina 35Illinois 36Alaska 37Indiana 38New Mexico 39Missouri 40Georgia 41Texas 42Nevada 43Tennessee 44Alabama 45West Virginia 46Arkansas 47Oklahoma 48Kentucky 49Louisiana 50Mississippi

27. 27 Five Steps to Take Action 1 1 2 2 3 3 4 4 5 5 1.Click on “Take Action”Take Action 2.Select Annual or Senior 3.Select Measure to Improve 4.Click on “View” 5.Select your action from list

28. 28 25 th Edition of America’s Health Rankings  Celebrate 25 years of tracking the population health of each state.  Scheduled to be released in December, 2014  Feature perspectives on public health from public health thought leaders

29. Thank You! Foundation Shelly Espinosa shelly_espinosa@uhg.com 952-936-1889 Media Relations Scott Weier sweier@gpgdc.com 202-295-0170 Follow us on Twitter: http://twitter.com/ahr_rankings Follow us on Facebook: www.facebook.com/AmericasHealthRankingswww.facebook.com/AmericasHealthRankings Visit our website: www.AmericasHealthRankings.org Data Tom Eckstein tom@arundelstreet.com 651-222-5257 Data Sarah Milder sarah@arundelstreet.com 651-789-0699