PowerPoint Presentation

The ACE LedgerThe Estimated Costs of Adverse Childhood Experiences for Adults in Alaska and What Targeted Reductions in ACEs Could Mean to Alaskans and their Wallets.1The economic burden of child maltreatment in the United States and implications for preventionKey findings:

The estimated average lifetime cost per victim of nonfatal child maltreatment includes: $32,648 in childhood health care costs+$7,728 in child welfare costs+$7,999 in special education costs $48,375

http://www.cdc.gov/media/releases/2012/p0201_child_abuse.html2Three Pronged ApproachPrimary prevention aims to prevent disease or injury before it ever occurs.Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effectshttp://www.iwh.on.ca/wrmb/primary-secondary-and-tertiary-prevention3A Way to Think about the Three Pronged ApproachPopulation EstimateOutcome EstimateACE Scores of 2013Adult Alaska PopulationZero194,275One121,950Two - Three135,398Four Plus94,134Total545,757CurrentSmoking14.4%18.3%24.1%34.5%PrimarySecondaryTertiaryACE Scores of 2013Adult Alaska Population who Currently SmokeZero27,901One22,298Two - Three32,564Four Plus32,481Total115,2444Population Attributable Risks (PAR) For Alaska Health Behavior or OutcomePAR%* Frequent Mental Distress60.1% Chronic Obstructive Pulmonary Disease, Emphysema or Chronic Bronchitis46.1% Health Insurance: Medicaid40.6% Physical Health Not Good 14+ Days33.2% Current Smoker32.0% Current or Former Asthma30.6% General Health26.8% Non-Gestational Diabetes23.7% Activity Limitation 14+ Days23.7% Heavy Alcohol Consumption 20.5% Ever Smoker19.3% Told Have Arthritis15.8% Insufficient Sleep15.5% Obesity14.3% Separated or Divorced13.2% Binge Drinking Risk Factor11.0% No Leisure Time Physical Activity10.2%5PreventionWhat is A Realistic Goal to Reduce ACEs inAlaska?6

Lets start with something thats doable.done somewhere else.Lets pick a state or two that are lower in ACE scores compared to Alaska.How about two states Vermont and Arkansas. Should we aim for their level of ACEs?7http://healthvermont.gov/research/brfss/documents/2010_data_brief_ace.pdfhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm

8What is A Realistic Goal to Reduce ACEs inAlaska?All ACEs?One ACE for Everyone?Two ACEs for Everyone?Something Else?9http://healthvermont.gov/research/brfss/documents/2010_data_brief_ace.pdfhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm

Not very realistic10http://healthvermont.gov/research/brfss/documents/2010_data_brief_ace.pdfhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm

Maybe someday but still too ambitious11http://healthvermont.gov/research/brfss/documents/2010_data_brief_ace.pdfhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm

This is really close but lets stay conservative12What about a Reduction in ACEs of one ACE for Half of Alaskan Adults?If half the people with one ACE dropped to zero ACEs and the other half stayed at one. and if half the people with two ACEs dropped to one ACE and the others stayed at two..etc.13http://healthvermont.gov/research/brfss/documents/2010_data_brief_ace.pdfhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm

14What impact on costs might be achieved by a reduction like this?

15The Alaska ACE Ledger

16Use of Adult MedicaidEstimated Alaskans adults who have used adult Medicaid Services 2012 53,800*

Number taken from DHSS annual Medicaid update (Age 20+)Costs of Age 20 + Adult Medicaid in Alaska are estimated at $860 million in 2012 - based on a DHSS document Long Term Forecast of Medicaid Enrollment & Spending in Alaska 201217ACE Scores of 2013Adult Alaska Population who Use MedicaidZero9,629One5,956Two - Three9,059Four Plus7,410Total32,055ACE Scores of 2013Adult Alaska Population who Use MedicaidZero7,329One7,192Two - Three10,847Four Plus9,127Total34,495ACE Scores of 2013Adult Alaska Population with ReductionZero255,250One101,002Two - Three113,081Four Plus76,425Total545,757A Reduction, for Half of All Alaskan Adults, of One ACEACE EstimateAlaskans With MedicaidAdultMedicaid3.8%5.9%8.0%9.7%In this scenario we would see a reduction of 7.1% of Alaskan adults who use MedicaidThis is a reduction of approximately 2,450 peopleThe average annual extra cost per person of have Medicaid is $15,985The estimated annual savings for Alaska are $39,000,000ACE Scores of 2013Adult Alaska PopulationZero194,275One121,950Two - Three135,398Four Plus94,134Total545,75718The Alaska ACE LedgerIssueNumber of AlaskansTotal CostsAverage Annual CostsTarget ReductionEstimatedSavingsMedicaid53800$860,000,000$15,9852422$38,715,670 19Current SmokingEstimated Alaskans Adults who Currently Smoke 2013 115,244

Calculate based on 2013 BRFSS SurveyCosts of Adult Tobacco Use in Alaskaare estimated at $576 million in 2012 - based on a State of Alaska Publication Alaska Tobacco Facts 2012 Update20ACE Scores of 2013Adult Alaska Population who Currently SmokeZero36,658One18,468Two - Three27,196Four Plus26,371Total108,693ACE Scores of 2013Adult Alaska Population with ReductionZero255,250One101,002Two - Three113,081Four Plus76,425Total545,757A Reduction, for Half of All Alaskan Adults, of One ACEACE EstimateAlaskans Who SmokeCurrentSmoking14.4%18.3%24.1%34.5%In this scenario we would see a reduction of 5.7% of Alaskan adults who currently smokeThis is a reduction of approximately 6,550 peopleThe average annual extra cost per person of Smoking is $5,024The estimated annual savings for Alaska are $32,300,000ACE Scores of 2013Adult Alaska PopulationZero194,275One121,950Two - Three135,398Four Plus94,134Total545,757ACE Scores of 2013Adult Alaska Population who Currently SmokeZero27,901One22,298Two - Three32,564Four Plus32,481Total115,244

21The Alaska ACE Ledger

22DiabetesEstimated Alaskans adults who have a diabetes diagnosis 2013 41,160

Calculated based on 2013 BRFSS SurveyCosts of Diabetes in Alaska are estimated at $450 million in 2012 - based on the Journal Diabetes Care The Economic Costs of Diabetes in the U.S. 2012

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23ACE Scores of 2013Adult Alaska Population with DiabetesZero15,139One6,728Two - Three11,506Four Plus6,441Total39,814ACE Scores of 2013Adult Alaska Population with ReductionZero255,250One101,002Two - Three113,081Four Plus76,425Total545,757A Reduction, for Half of All Alaskan Adults, of One ACEACE Scores of 2013Adult Alaska Population With DiabetesZero11,522One8,124Two - Three13,725Four Plus7,789Total41,160ACE EstimateAlaskans With DiabetesDiabetes5.9%6.7%10.1%8.3%In this scenario we would see a reduction of 3.3% of Alaskan adults who have diabetesThis is a reduction of approximately 1,300 peopleThe average annual extra cost per person with diabetes is $10,933The estimated annual savings for Alaska are $14,700,0000ACE Scores of 2013Adult Alaska PopulationZero194,275One121,950Two - Three135,398Four Plus94,134Total545,757

24The Alaska ACE Ledger

25Binge DrinkingEstimated Alaskans adults who currently binge drink 2013 98,152

Calculated based on 2013 BRFSS SurveyCosts of Adult Binge Drinking in Alaska are estimated at $545 million in 2006 - based on a Journal of Preventive Medicine Article State Costs of Excessive Alcohol Consumption26ACE Scores of 2013Adult Alaska Population with ReductionZero255,250One101,002Two - Three113,081Four Plus76,425Total545,757ACE Scores of 2013Adult Alaska Population who Binge DrinkZero40,868One17,294Two - Three22,138Four Plus15,961Total96,260A Reduction, for Half of All Alaskan Adults, of One ACEACE EstimateAlaskans Who Binge DrinkBinge Drinking16.0%17.1%19.6%20.9%In this scenario we would see a reduction of 1.9% of Alaskan adults who binge drinkThis is a reduction of approximately 1,900 peopleThe average annual extra cost per person of binge drinking is $5,553The estimated annual savings for Alaska are $10,500,000ACE Scores of 2013Adult Alaska PopulationZero194,275One121,950Two - Three135,398Four Plus94,134Total545,757ACE Scores of 2013Adult Alaska Population who Binge DrinkZero31,105One20,880Two - Three26,507Four Plus19,659Total98,15227The Alaska ACE Ledger

28ArthritisEstimated Alaskans adults who have a arthritis diagnosis 2013 132,136

Calculated based on 2013 BRFSS SurveyCosts of Arthritis in Alaska are estimated at $275 million in 2003 - based on a CDC document National and State Medical Expenditures and Lost Earnings Attributable to Arthritis and Other Rheumatic Conditions U.S. 200329ACE Scores of 2013Adult Alaska Population who Have ArthritisZero52,041One22,594Two - Three29,333Four Plus24,457Total128,425ACE Scores of 2013Adult Alaska Population with ReductionZero255,250One101,002Two - Three113,081Four Plus76,425Total545,757A Reduction, for Half of All Alaskan Adults, of One ACEACE Scores of 2013Adult Alaska Population who Have ArthritisZero39,610One27,280Two - Three35,122Four Plus30,125Total132,136ACE EstimateAlaskans With ArthritisArthritis20.4%22.4%25.9%32.0%In this scenario we would see a reduction of 2.8% of Alaskan adults who have arthritisThis is a reduction of approximately 3,700 peopleThe average annual extra cost per person having arthritis is $2,453The estimated annual savings for Alaska are $9,100,000ACE Scores of 2013Adult Alaska PopulationZero194,275One121,950Two - Three135,398Four Plus94,134Total545,757

30The Alaska ACE Ledger

31ObesityEstimated Alaskans Adults who are Obese 2013 156,660

Calculate based on reported Height, Weight, and Gender - BRFSS 2013Costs of Adult Obesity in Alaskaare estimated at $219 million in 2012 - based on a Institute for Social and Economic Research study published in 2014.

32ACE Scores of 2013Adult Alaska Population with ReductionZero255,250One101,002Two - Three113,081Four Plus76,425Total545,757ACE Scores of 2013Adult Alaska Population who are ObeseZero62,826One27,195Two - Three37,183Four Plus25,559Total152,763ACE Scores of 2013Adult Alaska Population who are ObeseZero47,818One32,835Two - Three44,521Four Plus31,482Total156,656A Reduction, for Half of All Alaskan Adults, of One ACEACE EstimateAlaskans With ObesityObesity24.6%26.9%32.9%33.4%In this scenario we would see a reduction of 2.5% of Alaskan adults who are obeseThis is a reduction of approximately 3,900 peopleThe average annual extra cost per person of being obese is $1,398The estimated annual savings for Alaska are $5,400,000ACE Scores of 2013Adult Alaska PopulationZero194,275One121,950Two - Three135,398Four Plus94,134Total545,757

33The Alaska ACE Ledger

34The Alaska ACE Ledger$111,393,551

35Eliminate Double Counting of CostsMedicaid100.0%Current Smoking 93.7%Diabetes63.7%Binge Drinking60.5%Arthritis 51.1%Obesity36.6%36The Alaska ACE Ledger$89,670,476

37The Alaska ACE LedgerEliminating possible double counting of costs we can very conservatively estimate savings to Alaska of $90 million from a reduction of ACEs of to the level of Vermont or Arkansas38What Does $90 Million Buy in Alaska?258 three bedroom homes in Anchorage (average price $347,000)

915 kindergarten teachers (wages only $66,384 + 40%) $97,938

846 police officers (wages only $75,672 + 40%) $105,941

518 mechanical engineers (wages only $123,600 + 40%) $173,040

339 pediatricians (wages only $189,000 + 40%) $264,600

Office of Childrens Services - General Funds 2016 Operations

All of the Behavioral Health State Medicaid Costs + $18 million

The General Funds for the Department of Commerce, Community & Economic Development + The Department of Labor & Workforce Development

103,307 Flights from Ketchikan to Barrow in July ($868)

Boeing 737-800 + $17 million for fuel and crew.

Pick One!

http://live.laborstats.alaska.gov/occ/alloccs.cfm#L398.9%3.5%5.0%4.7%6.6%4.0%6.7%6.0%403.7%10.4%2.8%10.7%418.9%7.0%7.0%42The Bad Metaphor SectionThe Balloon Animal Edition

43The ACEs Risks Balloon

44The ACEs Risks Balloon

ObesitySmokingAsthmaDiabetesSubstanceAbuseArthritisMedicaid UsageLow IncomeOther Issues45

The ACEs Risks Balloon

46The ACEs Risks Balloon

47Next StepsWhat are we already doing?Who is doing it?What works and what does it cost?What doesnt work?How can we be efficient with what we have?Do we need more resources?

48To learn more about Adverse Childhood Experiences and what Alaska is doing about them, go to the link at the bottom of this slide.

dhss.alaska.gov/abada/ace-ak/Pages/default.aspxPat Sidmore, Plannerpatrick.sidmore@alaska.gov