Midwest Health Initiative (MHI), Missouri’s regional health improvement collaborative, is pleased to share with you its 2019 St. Louis Community Scorecard.

This Community Scorecard provides regional benchmark information to support our community in identifying opportunities to improve the health of our population. Additionally, it provides measures by which we can gauge our collective progress toward making St. Louis a national leader in the quality and value of its health care services.

The results included here are mostly from MHI’s database of approximately 1.6 million commercially-insured lives supplemented by information from other sources. To learn more about MHI, find available national benchmarks or submit ideas for future areas of focus, please visit midwesthealthinitiative.org.

ST. LOUIS MSA HEALTH STATS

AUGUST 2019

A Community Scorecard for Commercial PopulationsProvided by the Midwest Health Initiative

Linda BradyHealthcare Strategy and PolicyThe Boeing Company

Dave CookPresidentUnited Food Workers, Local 655

Joseph A. Craft III, MD, FACCCardiologist & MemberSt. Louis Metropolitan Medical Society

Frank D’AntonioPresidentAetna

Julie DavidsonChief Financial OfficerUnitedHealthcare

Tom Hastings, MDPrimary Care PhysicianEsse Health

Matthew HerzbergRegional Managing PartnerSenn Delaney Culture Shaping

Justin Huynh, MDClinical Leader, Engagement at HomeMercy Virtual Care Center

Karen JohnsonVP, Healthcare Insights & PartnershipsBlue Cross and Blue Shield of Kansas City

Jeff KarrenbrockDirector, Finance IntegrationCore & Main, LP

Marla LangenhorstDirector, BenefitsAmeren Corporation

Ron LaudelBenefit Plans AdministratorCarpenters’ Benefit Plans

Lisa MassaVice President HR, Global Total RewardsBayer

J.C. McWilliamsVice President of Managed CareBJC HealthCare

Lynne Nowak, MDPhysician, VP, Clinical & Provider StrategyExpress Scripts, Inc.

Beverly PropstSenior Vice President, Human ResourcesGraybar Electric Company, Inc.

Chad Sackman RN, BSN, MBAChief Operating OfficerSignature Medical Group

Ed StrouthDirector, Health & WellbeingBarry-Wehmiller Companies, Inc.

Randall Williams, MD, FACOGDirectorMO Department of Health & Senior Services

Amadou YattassayePresidentAnthem Blue Cross and Blue Shield, Missouri

John ZieglerSenior VP & Chief Administrative OfficerArch Coal, Inc.

Midwest Health Initiative Board of Directors

Physician Leadership CouncilDr. Bryan BurnsPrimary Care, Esse Health

Dr. J. Collins CorderPrimary Care, West County Medical Associates

Dr. Elyra Figueroa-EspanaAllergy and ImmunologyAllergy, Asthma & Immunology Institute of St. Louis

Dr. Beth GearhartOB/GYN, Private Practice

Dr. Christine HachemGastroenterology, SLUCare

Dr. Tom HastingsInternist, Esse Health

Dr. George KichuraCardiology, St. Louis Heart and Vascular

Dr. Paul SpeziaOrthopedics, Advanced Bone and Joint

Non-Voting Participants

Dr. Michael DurkinWashington University

Dr. Peggy PetraliaAetna

Dr. Jay MooreAnthem Blue Cross Blue Shield, Missouri

AcknowledgementsThis Community Scorecard is made possible through the support of MHI’s friends and its Champions for Health Care Value. MHI is grateful for their generous support of its vision and work.

• Aetna• Anthem Blue Cross and Blue Shield of Missouri• Blue Cross and Blue Shield of Kansas City• The Boeing Company

• Signature Medical Group• St. Louis Area Business Health Coalition• UnitedHealthcare

MHI Champions for Health Care Value

• Arch Coal, Inc.• Graybar Electric Company, Inc.

Friends of MHI

11.7%Decline (2015-2018) in patients readmitted

to the hospital in 30 days

21.4%Decline (2015-2018) in Opioid Scripts

Per 1,000 People

$4,833Total Annual Spend

Per Person

11.9% Percent of Medical Services

Paid for by Patient

14.2%Decline (2015-2018) in Total Emergency

Dept. Visits Discharged Home

7.2Rate per 100,000 people with

Annual Spending over $500,000

The Scorecard is organized in four domains: Population Health, Care Quality, Cost and Affordability and Utilization.

The indicators included were chosen and refined with input from the Midwest Health Initiative Physician Leadership Council and Board, including representatives from hospitals, health plans, employers, labor unions and the public.

Indicators 2015 2016 2017 2018 TrendDiabetes Care for Patients with a Regular Source of Primary Care

HbA1C 75.1% 79.0% 83.0% 84.8%

Kidney Test (Nephropathy) 79.5% 80.0% 77.7% 80.7%

Cholesterol Test 70.4% 68.0% 72.0% 72.5%

Blood Pressure Medications Refilled on Time 64.7% 71.0% 65.0% 67.8%

Women’s Health

Breast Cancer Screening 67.6% 67.0% 63.1% 60.9%Chlamydia Screening 37.1% 42.0% 47.0% 46.7%Cervical Cancer Screening 66.7% 66.0% 66.0% 60.9%

Patients Readmitted to the Hospital in 30 Days for Any Reason n/a 9.4% 9.1% 8.3%

CARE QUALITY

Indicators 2015 2016 2017 2018 Trend

Average Age of Population 37 37 36 36

% of Population with a Chronic Illness

Asthma & COPD 5.6% 5.5% 5.5% 5.2%

Diabetes 6.1% 6.3% 6.0% 5.9%

Arthritis 6.8% 6.7% 6.7% 6.6%

Hypertension 12.1% 12.4% 11.9% 11.9%

Depression 5.6% 5.4% 5.5% 5.7%

POPULATION HEALTH Commercially Insured St. Louisans 64 and under

Indicators 2015 2016 2017 2018 Trend

Generic Fill Rate 82.6% 83.8% 84.8% 85.2%

Scripts Per Person 9.7 11.1 10.7 10.6

Opioid Scripts Per 1,000 People 386.7 386.4 325.4 304.1

Professional Services 2.5 2.5 2.5 2.3

Ratio, Primary Care Visits to Speciality Visits 1-1 1.2-1.3 1-1 1.1-1.2

Primary Care Professional Fees as a % of Total Spending 5.8% 5.6% 6.0% 6.1%

Imaging Per 1,000 - OutpatientX-Ray 855.1 856.5 812.1 799.7CT 116.2 118.8 122.3 125.3MRI 80.7 81.6 83.7 83.4PET 4.0 4.0 3.7 3.7

% of Potentially Avoidable Imaging Studies for Low Back Pain

23.6% 29.3% 31.1% 26.2%

Outpatient Surgeries Per 1,000 107.1 107.7 102.0 97.3

Total Surgeries Per 1,000 Lives 159.7 162.9 152.5 160.4Heart Surgery: CABG Per 1,000 Lives 6.8 6.4 5.0 6.0Heart Surgery: PCI Per 1,000 Lives 2.0 2.0 1.7 1.8Total Hip and Knee Replacement Per 1,000 Lives 4.2 4.2 4.2 4.3Hysterectomies Per 1,000 Lives 6.6 6.7 5.1 6.3

Acute Care Admits Per 1,000 53.5 51.9 49.3 49.2

Acute Care Length of Stay 4.2 4.3 4.1 4.1

Total ED Visits Per 1,000 188.0 186.8 175.9 162.1

ED Visits Per 1,000, Admitted 19.8 18.7 17.4 17.0ED Visits Per 1,000, Held for Observation 18.2 19.6 17.3 16.2ED Visits Per 1,000, Discharged Home 150.3 148.5 140.9 128.9ED Visits Per 1,000, Among people with an established PCP relationship

102.5 102.3 101.1 97.1

Percent of Potentially Avoidable ED Visits n/a 15.8% 16.5% 13.6%

Urgent Care Visits Per 1,000 129.4 146.4 174.8 179.9

UTILIZATION

Indicators 2015 2016 2017 2018 Trend

Total Annual Medical Spend Per Person $4,380 $4,573 $4,681 $4,833

% of Total Annual Spend Paid by Patient 12.2% 11.8% 11.0% 11.9%

Annual Spend per Person as a % of St. Louis MSA Per Capita Income

15.1% 15.3% 15.0% 13.6%

People Per 100,000 with Annual Spend Over:

$50,000 975.8 1,068.6 1,033.1 1,051.0

$100,000 290.9 325.2 308.0 332.1

$250,000 43.7 50.4 48.9 51.6

$500,000 5.1 6.2 5.7 7.2

$1,000,000 1.2 0.4 0.7 0.3

% of Population with No Claims 22.7% 22.2% 22.7% 25.0%

% of the Population that Accounts for 50% of Annual Spend 3.5% 3.5% 3.1% 3.3%

% of the Population that Accounts for 80% of Annual Spend 15.1% 14.9% 13.0% 14.4%

COST AND AFFORDABILITY

MHI is a regional health improvement collaborative that brings together those that provide, pay for and use health care to improve the region’s health and the quality and affordability of its health care. The strength of MHI sits with the collective power of its partners, each working within their own spheres of influence to achieve change.

About the Midwest Health Initiative 8888 Ladue Road, Suite 250 St. Louis, MO 63124 314-721-7800 www.midwesthealthinitiative.org