Measuring the Health of Adults Aged 18 to 64

in ColoradoDecember 2016

A Report by the Colorado Cross-Agency Collaborative

Adults aged 18 to 64 in Colorado are generally healthy individuals. They are active, have lower obesity rates when compared with the rest of the nation, are mostly employed and are more likely to have health insurance coverage.

In many ways, Colorado is trending in a healthy direction; for example, cigarette smoking and binge drinking rates have been decreasing. Yet there are some areas where Colorado needs to improve within the 18 to 64 age group.

Suicide and drug overdose rates are high and keep increasing in Colorado. In addition, certain populations such as adults enrolled in Health First Colorado (Colorado's Medicaid Program) and racial minorities, which experience persistent social and economic inequities, have higher tobacco use and prevalence of mental and physical health conditions, when compared with the overall Colorado population. These data highlight various health inequities in Colorado. Health is shaped by generations-long social, economic, and environmental inequities, which a�ect the morbidity and mortality of communities. These inequities can have a greater in�uence on health outcomes than either individual choices or one’s ability to access healthcare; they are a product of historical discrimination,non-inclusive policies, and the continual perpetuation of diminished opportunities. Reducing socioeconomic and racial/ethnic disparities through policies and organizational systems can help all Coloradans achieve optimal health.

The Colorado Departments of Health Care Policy and Financing, Human Services, and Public Health and Environment, strive to make Colorado the healthiest state in the nation through a multitude of initiatives that support the health and well-being of its population. In order to have the greatest impact on health outcomes in Colorado, the three state health agencies partnered and created a data alignment strategy. The purpose of this strategy is to identify and align pertinent measures that impact the health outcomes of Coloradans through available data at each state health agency. This initiative allows state health agencies to share a common list of metrics that help inform collaborative health improvement programs.

The data alignment activities are conducted by the Colorado-Cross Agency Collaborative (CCAC) workgroup, which represents every Colorado state health agency. Three previous CCAC reports identi�ed and aligned metrics for behavioral health, children, and adults aged 65 and older. This report covers adults aged 18 to 64 and is the last in the series.

In order to create a bigger impact and improve the health outcomes of Coloradans, the three state health agencies will collectively report, track and trend the aligned metrics in this report, thereby sharing a common area of focus to strategically leverage resources in areas of need.

*As of June 27, 2016, Colorado’s Medicaid program is referred to as Health First Colorado (Colorado’s Medicaid Program). Colorado Medicaid will be referred to as Health First Colorado in this report

Report Overview

About the Colorado Cross-Agency Collaborative

Source: American Community Survey (ACS), 2015

Source: ACS, 2015

Source: Department of Local Affairs (DOLA)

Source: ACS, 2014

Source: Colorado Rural Health Center, 2014

Colorado Demographics of Adults Age 18-64 years

Education level for adults 25 and older in Colorado

Bachelor’s Degree or Higher

Some College/Associates Degree

High School (HS) Grad./GED

Less than HS

37.4%

30.9%

22.0%

9.6%

3% Asian

70%

4%

White/Non-Hispanic

20%Hispanic

Black or African American

1% American Indian or Alaska Native

2% Two or more races

RuralUrban 14%

51%

49%

86%

Location of adults18-64 in Colorado

People who live in rural areas may experience a shortage of health facilities and community resourceswhen compared to urban areas, which can impact their health and well-being.

Colorado’s population is growing at a fast rate. It has beenestimated that by 2040 the population of 18 to 64 year olds will increase to about 4.6 million.

Gender distributionin Colorado

3,487,884

Adult 18-64 populationin Colorado

Race/Ethnicity distribution of adults 18-64 in Colorado

Colorado has one of the nation’s highestpercentage of adults with collegedegrees, yet has one of the lowestcollege graduation rates for individualswho were born in Colorado. This is, in part,because many of Colorado’s adults with collegedegrees migrated from other states.

Source: Colorado’s Elite College Access Gap, 2014

Source: ACS, 2014

Social/Economic Indicatorsfor Adults 18-64 in Colorado SUPERMARKET

PARK SCHOOLS

9%

10%

19%

18%Hispanic

Black or African American

Asian

$

White/Non-Hispanic

Percent of adults 18-64 who are living below the poverty level in Colorado, by race

Living in poverty can negatively impact health, due to fewer available opportunities and potentially greaterhardships.

Overall, 13.1 percent of people in Colorado are living below the poverty level compared to 15.6 percent nationally.

As these data illustrate, there are racialand ethnic income disparities in Colorado. For example, 19% of Blacks live in poverty. Only 4% of Colorado's population is Black, yet they represent 8% of adults aged 18-64 living in poverty in Colorado.*Sample size for American Indian or Alaska Native was

too small to calculate a representative rate.

UnemploymentRate

3.4% Colorado’s unemployment rate has been gradually dropping over the years. Similar trends can be seen nationally with the overall unemployment rate in the USA at 4.7%.

Public assistance programs protect individuals in our society who are financiallydisadvantaged. They help pay for bills, feed families, and ensure that individualshave a place to sleep. This assistance is vital for people who are in need of help so that they are given the right opportunities to reach their fullest potential.

SNAP

375,559 Coloradans (18-64) received food assistance in 2015

32,267 Coloradans (18-64) utilized the TANF benefit in 2015

Temporary Cash Assistance for Needy Families (TANF)

Colorado Child Care Assistance Program

18,268 Coloradans (18-64) received child care assistance in 2015

CO USA

383392

Incarceration Rate in 2014

per 1

00,0

00

CO USA

320

346

Violent Crime Rate in 2015

per 1

00,0

00

Colorado's incarceration rate was about 2% lower than the national average in2014.

As of December 31, 2014, the Colorado prison population was 20,646.

During the last 7 years, Colorado incarceration rates have dropped by 18%.

Colorado's violent crime rate was about 11 % lower than the national average in 2015.

During the past year, violent crimerates in Colorado have increased by 4.9%.

Source: DOLA , May 2016

Source: Colorado Division of Criminal Justice

Health Care Service Indicatorsfor Adults 18-64 in Colorado

*Colorectal Cancer Screening Rate for Colorado Adults 50-64

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2014

Source: BRFSS, 2014*Source: National Health Interview Survey (NHIS) 2014

58.9% 53.0%

Colorado Health First Colorado *Percentages include all individuals who metU.S. Preventive Services Task Force guidelines for colorectal cancer screening

Source: Colorado Health Access Survey (CHAS), 2015

Source: CHAS, 2013-15

Source: CHAS, 2015

Source: CHAS, 2015

Source: Medicaid Reporting System, 2016

Source: Medicaid Reporting System, 2016

Colorado *National

66.1% 54.8% 62.4%

Percent of adults 18-64 who hada dental visit within the year

Colorado’s uninsured

rate in 2015for adults

19-64

9.7%

*as of March 2016

20% Percentage of Coloradans

age 18-64 enrolled in Health

First Colorado

Colorado’s overall uninsured rate fell from 14.3% in 2013 to 6.7% in 2015. The expansion of Health FirstColorado through the Affordable Care Act successfully contributed to this downward trend in uninsuredindividuals.

741,000

353,0002013

2015

Number of overall uninsured individuals in Colorado

Access to care barriers :Doctor’s office not accepting patients due to their type of insurance, 2015

Barriers to accessing behavioral health care:

Individual Market

Employer-Sponsored

19.9%

12.5%

5.4%

Not all health professionals accept Health FirstColorado as a payer source. This can cause barriers to access in low-income communities where health care is needed the most. Individuals living in rural parts of Colorado mayexperience even greater barriers to accessing health care, regardless of insurance type, as theshortage of health professionals in rural communities is more pronounced.

Visiting your dentist at least once a year helps prevent tooth decay, gum disease, and even oral cancers. In Colorado, the rate of adults 18-64 who visited a dentist within the past year increased from 56.9% in 2013 to 66.1% in 2015. Health First Colorado members are still below the national and Colorado average.

Percent of Health First Colorado members Age 18-64 who have used behavioral

health services, FY 14-15

19%32.5%

Adults 19-64 in Colorado who did not receive mental health care, because they had a hard time getting an appointment, 2015

Health First Colorado

Health First Colorado

Health Behavior Indicatorsfor Adults 18-64 in Colorado

Percent of adults (18-64)currently smoking

Adults (18-64) whobinge drink

Percent of adults (18-64)who attempted to quit

smoking within the past year

Binge drinking is defined as 4 or more drinksfor a woman or 5 or more drinks for a man on an occasion during the past 30 days.

*Includes all ages. Source BRFSS, 2014

Source: BRFSS 2011

Source: BRFSS, 2015

Source: BRFSS, 2015

Source: BRFSS, 2015*Source: NHIS, 2014

Source: BRFSS, 2015*Source: BRFSS, 2014

Source: BRFSS, 2015 2008 Physical Activity Guidelines : https://health.gov/paguidelines/guidelines/summary.aspx

17.4%

18.2%

35.3%

20.6% 16.0%National*

17.1%

70.5% 65.9%64.5%

Adults (18-64) who consume fruits 2 or more times and vegetables 3 or more times per day

Adults (18-64) who meet physical activityrequirements per 2008 Physical Activity Guidelines

*National (All ages)

*National

Colorado

Colorado

Colorado

Quitting smoking is beneficial to health at any age, and cigarette smokers who quit before age 35 have premature mortality rates similar to those of persons who never smoked (CDC, 2015).

Overall, binge drinking in Colorado has beendecreasing over the years.

During 1965–2012, the prevalence of cigarette smoking among adults (aged ≥18 years) in the United States decreased from 42.4% to 18.1%, partly because ofincreases in smoking cessation programs. In Coloradosmoking rates have also been decreasing.

Colorado

12.6% 13.9%

Times per day

<1.51.51.61.7

>1.8

Median daily vegetable intake among adults in the United States

49.4%59.9%

Colorado

People who are physically active tend to live longer and have lower risk for heart disease, stroke,type 2 diabetes, depression, and some cancers.

Colorado is the second most active state inthe United States. (2016 Colorado Health Report Card)

Health First Colorado

Health First Colorado

Health First Colorado

Health First Colorado

Health First Colorado

Health Outcome Indicatorsfor Adults 18-64 in Colorado

Leading Causes of Death for Adults 18-64 in Colorado, 2014

Health Status of Adults 18-64 in Colorado

Source: BRFSS, 2015

Source: BRFSS, 2015

The leading causes of death for adults 18-64 are often preventable. Adopting healthier behaviors such as engaging in regular physical activities, eating a healthy diet, leading a tobacco free life style, and getting regular health screenings can dramatically reduce a person’s risk for most chronic diseases, inluding the leading causes of death.

The United States is in the midst of a drug overdose epidemic. More people died from drug overdoses in 2014 than in any other year on record. Deaths from drug overdose are up among both men and women, all races, and adults of nearly all ages. Colorado’s rate of drug overdose deaths climbed 68 percent between 2002 and 2014, from 9.7 per 100,000 residents to 16.3 per 100,000 residents.

555539.239.2

Percent of Individuals who had 14days of poor physical health in

the past 30 days

Percent of Individuals who had 14days of poor mental health in

the past 30 days

Colorado Colorado

10.0% 11.5%

27.8%23.1%

1 Cancer

2 Heart disease

3 Unintentional injuries

4 Suicide

5 Chronic liver disease Source: CDC, 2014

Source: CDC, 2015

Source: Colorado Vital Statistics, CDPHE, 2014

Rate per100,000

2.8 to 11.011.1 to 13.513.6 to 16.016.1 to 18.518.6 to 21.021.0 to 35.5

Age-adjusted rates of drug overdosedeaths by state, US 2014

Health Conditions* of Adults 18-64 in Colorado, 2015

*Survey respondents who reported that they had ever been told by a health care provider that they have the health condition. For asthma, this includes ever being told and currently having the condition.Obesity is calculated based on respondent's self-reported height and weight.

Asthma

6.2HbA1c

Diabetes HighCholesterol

LDLHDL

Hypertension

12279

12279

Obese Depression

Colorado

16.9% 9.0% 32.9% 25.2% 26.9% 42.1%

9.2% 4.6% 26.5% 19.7% 20.4% 20.2%

Health First Colorado members may experience a greater hardship related to socio-economic conditions, which can contribute to the health outcomes listed above.

Health First Colorado Health First Colorado

Health First Colorado

State Innovation Model

About the State Innovation ModelThe Colorado State Innovation Model (SIM) focuses on integrating physical and behavioral health care in more than 400 primary care practices and four community mental health centers within Colorado. SIM efforts will help address both the physical and behavioral health needs of Colorado’s population by creating a system that can provide efficient and effective health care. Integration of physical and behavioral health services will improve provider communication, reduce stigma for patients, and allow for better management of depression, anxiety, and alcohol.

ClinicalQuality

Measures

ClinicalQuality

Measures

Breast Cancer Screening

Colorectal Cancer Screening

Substance Use Disorder Screening

Influenza Immunization

Appropriate Asthma Medication

Obesity: AdolescentObesity: Adult

Depression ScreeningMaternal Depression Screening

Developmental Screening

Anxiety Screening

Hypertension Diagnosis

Diabetes: HbA1c Control

Diabetes: Blood Pressure Management

Fall Risk Screening for Older Adults (65+)

*Data for the SIM is currently being collected

Accessto Care

Measures

Accessto Care

Measures

Cost andUtilizationMeasures

PopulationHealth

Measures

PopulationHealth

Measures

SIM milestones

Cohort 1:100 practices

enrolled inSIM

Cohort 3:150 practices

enrolled inSIM

Cohort 2:150 practices

enrolled inSIM

February 2016

2017

2018 The Goal is torecruit 400

primary carepractices and

four communitymental health centers

SIM’s goal is to provide access to integrated physical and behavioral health care services in coordinated systems, with value-based payment structures, for 80 percent of Colorado residents by 2019.

Which includesmore than900 providers

SIM has selected the following metrics to evaluate integration efforts: