1. Overview of Health Care Systems & Utilization Among Young Adults
Charles E. Irwin, Jr., MD
Distinguished Professor of Pediatrics
Project Director, Adolescent & Young Adult Health National Resource Center
Director, Division of Adolescent & Young Adult Medicine
Department of Pediatrics
UCSF Benioff Children’s Hospital, San Francisco
University of California, San Francisco
National Millennial Health Summit
Washington, D.C.
September 28, 2016

2. Introducing: The Adolescent and Young Adult Health National Resource Center
Purpose:
To improve adolescent and young adult health and address their health issues by strengthening the capacity of State Title V MCH Programs and their public health and clinical partners to better serve these populations (ages 10-25)

3. The Adolescent and Young Adult Health National Resource Center
Four-year cooperative agreement (2014–2018)
Project Officer: Trina M. Anglin, MD, PhD
Funder: Maternal and Child Health Bureau, Health Services and Resources Administration, USDHHS (cooperative agreement U45MC27709)

4. University of California San Francisco University of Minnesota
University of Vermont

5. Session Overview
Critical Health Issues of Young Adulthood Healthcare Challenges & Opportunities Healthcare Utilization: Pre- Post ACA Looking Ahead

6. Critical Health Issues of Young Adulthood
Motor vehicle crashes & drinking and driving.
Violence, including homicide, fighting & intimate partner violence.
Reproductive & sexual health, including STIs, HIV/AIDS & unintended pregnancy.

7. Critical Health Issues of Young Adulthood
Critical period for emergence of:
Mental health problems (e.g., depression, suicide and suicide attempts).
Substance use
(e.g. Tobacco/ENDS, binge drinking, and use of marijuana & other illicit drugs).

8. Mortality by Cause, Sex and Age, Ages 10-24, 2014
Rate per 100,000
16.8
Ages 10-14
Ages 15-19
Ages 20-24
Source: CDC Wonder, 2014

9. Past-Month Substance Use, by Age, Ages 12-25, 2014
Source: National Survey of Drug Use and Health, SAMHSA 2015

10. Past-Year Major Depressive Episode, by Age and Sex, 2014
Source: Center for Behavioral Health Statistics and Quality, 2015

11. Chlamydia—Rates by Sex and Age, United States, 2014

12. Session Overview
Critical Health Issues of Young Adulthood Healthcare Challenges & Opportunities Healthcare Utilization: Pre- Post ACA Looking Ahead

13. Healthcare Challenges for Young Adults
Access
Financial system emerging
No identified structure for care or provider, especially for males
Source of care is varied
Explanation of Benefits (EOBs) create confidentiality issues – dependent on the policyholder
Little focus on preventive care, despite evidence
Financial Systems
Public coverage varies more by state
Less likely to have employer-based coverage
About 18% of young adults (aged 18-25) are uninsured*
*Behavioral Risk Factor Surveillance Survey, 2015

14. Healthcare Challenges for Young Adults
Organization of Care
No identified organizational structure for care or provider for comprehensive primary health care
Females have reproductive health access to some extent
No identified provider for males.
Utilization of Care
Few have a Usual Source of Care
Sources vary more: More utilization of clinics, Urgent Care/ERs, and other sources

15. Have a Usual Source of Health Care, by Sex and Age, Ages 10-25, 2014
NHIS, Have a Usual Source of Care:
Definition: Usual place When Sick: place one usually goes to when he/she is sick or when parent needs advice about his/her health (no time frame)
Measure: Is there a place that you USUALLY go to when you are sick or need advice about your health?
Source: National Health Interview Survey, 2014.

16. Location of Usual Source of Care (of those with a USC), by Age, Ages 10-25, 2014
* Includes ER, hospital outpatient department, some other place, and don’t go to one
Place most of the time
Source: National Health Interview Survey, 2014.

17. Healthcare Opportunities for Young Adults
Increased focus on young adulthood (IOM)
Insurance Expansion
Medicaid Expansion
32 States including D.C. have expanded as of July 2016
Marketplace/“State Exchanges”
Dependent coverage to age 26

18. Healthcare Opportunities for
Young Adults
ACA Preventive Care Provisions
Provided by plans without cost-sharing
Required services drawn from:
US Preventive Services Task Force “A” and “B” recommendations
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents
ACIP Immunization Recommendations
HRSA-supported IOM recommendations for women’s health

19. Preventive Services for Young Adults
A comprehensive review of existing guidelines found evidence-based* recommendations in the following areas:
Substance Use
Reproductive Health
Mental Health/Depression
Nutrition/Obesity
Safety/Violence
Infectious Disease/Immunization
*US Preventive Services Task Force and CDC, Advisory Committee on Immunization Practices
Source: Ozer et al., 2012

20. Preventive Services for Young Adults
Why focus on the well-visit? It works!
Opportunity to provide evidence-based preventive services.
Young adults are more likely to receive preventive services if they have attended a well visit.
Source: Ozer et al., 2012

21. Session Overview
Critical Health Issues of Young Adulthood Healthcare Challenges & Opportunities Healthcare Utilization: Pre- Post ACA Looking Ahead

22. Receipt of a WELL VISIT among young adults, Ages 18-25, by Year and Measure, MEPS
* Rates significantly higher in
Source: Medical Expenditures Panel Survey

23. Receipt of ANY health care visit among young adults, Ages 18-25, Constructed Method by Year, MEPS
Source: Medical Expenditures Panel Survey

24. Preventive services received by receipt of past-year well visit among young adults, Ages 18-25, MEPS
* Rates significantly higher among those with a past-year well visit
Source: Medical Expenditures Panel Survey

25. Preventive services received among young adults with a past-year well visit, Ages 18-25, by Year, MEPS
* Rates significantly higher in
Source: Medical Expenditures Panel Survey

26. Session Overview
Critical Health Issues of Young Adulthood Healthcare Challenges & Opportunities Healthcare Utilization: Pre- Post ACA Looking Ahead

27. Looking Ahead: Improving Access to Preventive Services
Young Adults:
Focus on health literacy:
Inform consumers about the preventive services recommended for young adults
Inform consumers the preventive visit is free under every health plan
Develop tailored messages on the importance & value of preventive visits
Clinicians:
Educate providers about evidence for young adult services
Train providers on evidence for clinical preventive services

28. Looking Ahead: Improving Access to Preventive Services
Health System:
Encourage health care systems to expand opportunities for preventive services (e.g., scheduling, reminders) instead of acute care
Legal System:
Inform health care systems about state laws regarding EOBs
Educate consumer about how EOBs work