Partners in Transition
Adolescents and Managed Care, March 2000

Partners in Transition - 2000
This 68-page study provides a detailed vision of how health plans can improve adolescents' health and well-being.
Download (1MB)

Report Summary
It's no wonder that Americans think about adolescents almost exclusively in negative terms. Constant media exposure leaves us believing that most teens are engaging in high rates of unhealthy behaviors, such as cigarette smoking, unsafe sex and drug use. We hear all the time about adolescents who suffer from eating disorders, depression and a profound sense of disconnect from their families, communities and peers. We may be angered, saddened or troubled by this information but regardless: our outlook is negative.

This persistent negativity makes it difficult to consider adolescence for what it is: an exciting time of development when careful negotiation of complex situations can lead to immediate and long-term positive results. Teens have important developmental tasks to master, such as learning how to take risks safely, solve complex problems and negotiate new types of relationships. The foundation for this work comes from their early childhood experiences, and the results will guide their approach to their adult responsibilities. Adolescence is a challenging time with profound consequences.

Adolescents should not be alone in struggling to meet those challenges, but an alarming number are. Twenty-one percent of adolescent boys and 13 percent of adolescent girls report that they have "no one" to talk to when they feel stressed, overwhelmed or depressed. Caring adults must become engaged in ensuring that teens have the information, guidance and services they need to enhance their lifelong well-being. With this support, adolescents can fulfill the promise of their boundless energy, limitless ideas and heartfelt enthusiasm to become our country's next generation of parents, voters, workers and leaders.

Adolescence: A time for investment
Despite some positive trends, our society still feels the impact of adolescent health problems that are inadequately addressed:

• The cost to taxpayers of adolescent childbearing is estimated to be $6.9 billion each year for public assistance, health care for children, foster care, criminal justice expenses and lost tax revenue.
• The annual cost of gunshot wounds of adolescents aged 15 through 19 exceeds $20 billion.
• Relative to their population, an analysis of data from 1994 found that adolescents over utilized and improperly used emergency room services, while underutilizing office-based services.
• A 1995 study (in 1992 dollars) conservatively estimated that adolescents 11 to 21 years of age incur direct annual medical costs of approximately $33.5 billion--or $859 per adolescent--to treat selected preventable health problems.

With the dramatic projected increases in the American population of adolescents, we must devote ourselves to addressing these challenges fully. Health plans have a critical role to play in this effort: far from being "just another business," health plans have special opportunities, incentives and missions to promote the health and well-being of our nation's adolescents. Of course, all health care organizations have always had a unique role to play in promoting adolescent health and well-being.

But industry trends make clear that managed care has a particularly prominent place in the American health care system, and health insurance purchasers are increasingly looking to health plans to demonstrate their effectiveness in meeting the needs of their adolescent members.

Goals and Strategies

Children Now developed this report in order to provide the managed care industry with practical information about opportunities for strengthening their delivery of health care services to adolescents. The report is organized around two goals for health plans regarding their adolescent health services:

• The first goal, Facilitate Adolescents' Access to Health Care, focuses on policies and systems that can enhance health plans' responsiveness to their adolescent members.
• The second goal, Engage Teens, Parents and Community Resources to Improve Adolescent Health, demonstrates the benefits of partnerships to maximizing the internal efforts of health plans.

Managed care plans and purchasers of health insurance can consider these goals and strategies a "menu of opportunities." Each managed care plan will develop it's own priorities among these (and perhaps other) potential components of adolescent-friendly systems, with much dependent on the priorities of its administrative and medical leaders. Public and private health insurance purchasers also have the ability to influence plan policies and systems during contract negotiation. Children Now intends this report and each strategy to serve not as a ready-made program, but as a catalyst that may lead to the creation of tailored programs which may have the greatest effectiveness within a particular community.

Simply providing adolescents with health insurance is not enough to ensure that they receive the services they need. Health plans can take a range of concrete steps to facilitate adolescents' access to care. Of course, for many of these strategies to work, adolescents and their families must be familiar with them. Health plans that communicate through teen-and family-friendly materials can help ensure that the promise of their efforts towards promoting adolescent health is fulfilled.