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Michael Tarkoff, Lead Decision Support Analyst, Highmark Inc. Consumer Engagement and Analytics
Whether it’s their supposed love of avocados or disdain for chain restaurants, differences between millennials and other generations are always making headlines. But getting beyond the superficial overgeneralizations, who are “the millennials”?
According to Neil Howe and William Strauss, who are credited with coining the term in their book Generations, millennials are people born between 1982 and 2000. Other definitions vary slightly, but the Pew Research Center and others agree that millennials are now the largest portion of America’s workforce.
Millennials — including me — have spent their entire adult lives in a post-Y2K world where the use of technology expands by the day. In 2018, about one third of U.S. millennials used a wearable device, such as a smart watch or an activity tracker, at least once a month. This “always-on” communication — text messages and emails straight to your wrist — can change expectations and potentially increase stress. Persistent job insecurity inspired by The Great Recession of 2008, and the pressure to pay off unsettling amounts of debt from skyrocketing college costs, are also common experiences.
You can see why there might be concern for the wellbeing of my generation. When you dive into the data, it turns out that the concern is justified. The Blue Cross Blue Shield (BCBS) Health of America® report series studied data from the 55 million millennials in the U.S. who are commercially insured. Specifically, “The Health of Millennials” report focused on adults who were 21 to 36 years of age in 2017. Among the findings: older millennials (ages 34-36) had higher prevalence rates for nearly all of the top 10 reported health conditions than did members of Gen X at the same age.
Surprisingly, the same report found that 83 percent of millennials considered themselves to be in good health, so there seems to be some discrepancy between perception of health and actual wellbeing.
To learn more about their health challenges and how they would like to see the health care industry evolve, we gathered 25 millennial health plan members for a two-hour, in-person listening session. Below are some key themes that stood out for me, along with video segments from the discussion.
A chart comparing the health of Gen X with the health of millennials, as published in “The Health of Millennials,” part of the BCBS Health of America® report series.
According to the BCBS Health of America® report, 68 percent of millennials have a primary care physician (PCP) — compared to 91 percent of people in Gen X. Why is there such a significant gap?
A member of our listening session noted she didn’t have a PCP simply because she never took the steps to choose one after aging out of her pediatrician’s care. That is probably true for many millennials — taking time to research and find a PCP is not necessarily the highest of priorities while juggling everything else involved with starting a career and living on your own. That’s where a time-saving digital tool like DrMatchQuiz can help. Busy millennials answer a few questions about what they want, and the tool instantly shows nearby care providers who will be a good match.
Similarly, millennials in our session mentioned the inconvenience of not being able to book an appointment with a PCP in a timely manner. For sick appointments, some said they instead rely on an urgent care or a walk-in clinic that offers convenient hours and allows them to be seen quickly. Online scheduling, same-day appointments, and tele-appointments all received positive feedback for being helpful to those who feel as if they can’t take time out from busy work schedules and lives.
Penn State general surgery resident: I actually don’t have a PCP, but I’ve been lucky enough to not get sick. I’m one of the general surgery residents at Penn State. I wouldn’t be able to go to office hours at a PCP anyway. Even if I could, and I got sick, I would have to then make an appointment or show up and hope someone can see me, rather than these freestanding urgent cares that aren’t exactly emergency departments, so you don’t have the wait, you don’t have all the fees that are associated with an emergency department visit. Some of these places will accept insurance, some of them are just cash payment, but I know I can go in, get seen and get out.
Rachel Borowski: Online scheduling is so much more helpful than having to go step away, go into a break room, go outside, to take a phone call and talk to the doctor about your symptoms. I will put something off just because I have to make that personal phone call at work. So the more health care providers can do online scheduling the better.
Young Woman: Every single time I have had to call a dcotor’s office for a sick care appointment it is never ever the same day, it’s always, “we can see you tomorrow morning.” Which, that’s not what I want. If I can do online scheduling and I can see right upfront that there is an appointment I can just book, then we’re good. If I can’t do that, I’m just going to assume my doctor can’t see me and I will go to urgent care, or do telemedicine. I’m actually waiting for the next time I get sick so that I can have that entire sick care appointment at home on my couch.
Penn State general surgery resident: When employers sponsor employees’ health insurance, there is a certain reliance of the employee on the employer to provide the best plans. I think that says a lot about the employer’s expectations, and the employer’s investments in their own employees. When employers go above and beyond and promote health and wellness and have fitness classes or discounts when you can meet certain criteria, I think that says a lot about the kind of employer and whether or not that affects your loyalty to them.
In the BCBS report, major depression was the health condition that had the biggest increase in prevalence when comparing millennials with Gen X. Our group indicated that this could be partly due to greater willingness to report mental health concerns, as millennials seem more open to discussing mental health issues than previous generations and 71 percent of millennials recognize that physical and mental health are intertwined.
Despite that awareness, heavier reliance on digital media, especially phones, may be another factor impacting mental health. Millennials are the first generation that, when bored, could turn to video games, the computer, AOL Instant Messenger and other digital options for entertainment. Similarly, this generation now often relies on texting and emails instead of communicating in person or by phone calls. Numerous studies suggest that too much reliance on digital media can create a sense of isolation and loneliness, and contribute to more serious mental health concerns.
Participants in our session also pointed to the impact of social media, including the struggle to avoid comparisons to peers. One participant noted the tendency to only show positive information and hide the negatives on social media, which can create unrealistic standards and feelings that one can’t live up to expectations set by others.
Young woman: People are probably more open nowadays to come forward and seek help from a mental health professional. That could be a reason why with major depression too, because we actually see them more now and it’s more talked about. Also, we are kind of in a generation where social media is a huge thing, and you have this sense of being criticized all the time, and maybe that can cause a little bit more stress, I believe.
Young man: We’re all talking about our comfort with sharing, and yet, social media, people filter out the things that are most difficult to talk about, and I think there is some gap there again between what real life is and what social media portrays. So I think there’s been a series of studies that have shown that people that use or look at social media feeds more often have a greater prevalence of depression and I think that probably explains a fair chunk of that.
The role of diet is hard to ignore when looking at three other conditions where “The Health of Millennials” report showed higher prevalence in millennials than in Gen X: Type 2 diabetes (22% higher), hypertension (16% higher), and high cholesterol (12% higher).
Our listening session group acknowledged the correlation between physical health, mental health, and diet, but expressed concern about the lack of easy access to healthy foods and the financial burden of choosing to eat better. Some pointed out that farmers’ markets, high-end grocery stores, and options that offer a broad array of fresh produce, organic food, and healthy choices were far from home. For millennials who may not have the desire or time to cook, take-out meals — including through delivery apps like Uber Eats and GrubHub — are often the quickest, most convenient, and most affordable options. Unfortunately, take-out often includes the kinds of foods that can contribute to conditions like type 2 diabetes, hypertension and high cholesterol.
Rachel Borowski: I also have to wonder too in terms of access to healthy foods, I think that some millennials that are living in cities that maybe have a Whole Foods and healthier food options, and are in a walking city, are more likely to be healthier than more rural communities or suburban communities, where you’re driving everywhere, and there’s McDonald’s, there’s fast food, you can maybe get Uber Eats. How often are millennials relying on unhealthy options when there isn’t an access to healthy foods.
Young woman: I live in a very rural area and the best place for me to get healthy foods is to drive 20 to 45 minutes away to a farmer’s market that most likely just sells imported fruits and vegetables.
In a survey from Securian Financial Group, 52 percent of millennials said they were struggling or knew someone struggling to pay medical bills despite having employer-sponsored insurance. Participants in our listening session postulated that one explanation for this was the trend toward incentivizing employees to select high-deductible plans. Although some in our group were unfazed by the idea that they might have to pay a couple thousand dollars under a deductible over the course of a year, others worried about how an unexpected medical cost could affect their already tight monthly budgets.
Our dialogue raised an important question: How well do millennials — or people of any generation — really understand what “high deductible” means and what services they will have to pay for under their plan? People may choose a high-deductible option because of the lower monthly premium or employee contribution costs. That choice can backfire if they end up spending more over the course of the year, because they have to pay for certain tests or services until they reach the deductible amount.
Even those in the health care industry sometimes find it difficult to get a clear picture of what coverage entails. Participants in our session were eager to see definitive answers about what would be covered and what they would need to pay out of pocket. For care decisions, they understood that cheapest isn’t always best — but pointed out that it helps to get straightforward information about when tests or procedures will be the same regardless of cost, and when quality or other factors should take precedence over price.
I’ll add that information concerns were more about better clarity and easier access, not more detail. In fact, the group suggested that there is sometimes too much information to sort through, whether online, in printed publications, or by phone. They wanted clear, digestible information on health insurance websites with easy navigation — in a digitally focused world, brevity is part of ensuring clarity and understanding.
As they age, millennials will have an increased effect on the U.S. economy, including workplace productivity and health care costs, so it is critically important to understand how best to support their health. My overall conclusion from our listening session is that millennials want easy access to tools that can improve health and wellbeing — whether it’s more convenient doctors’ appointments and scheduling processes, simplified health insurance and billing information online, or an app to help support healthier food and lifestyle choices. The good news is that the entire Highmark Health enterprise has been moving in those directions to help realize our vision of a world where everyone embraces health.
As a lead analyst of Consumer Engagement and Insights, I have been involved in a number of initiatives to leverage the vast amount of data Highmark collects in order to make informed decisions. One personal and professional highlight has been collaborating with transition teams to identify members most affected by the changing health care market.
Before joining Highmark, I worked as a statistician for the Department of Health, designing surveys to monitor population health. I have a bachelor’s degree in mathematics from Dickinson College.
Blue Cross Blue Shield is partnering with Moody’s Analytics to forecast how the health of millennials will impact the economy, with results highlighted in a future report and a national summit on the health of millennials in Philadelphia in November 2019. To see all BCBS Health of America reports® and a wide range of data-driven insights to improve the health of all Americans, visit www.bcbs.com/the-health-of-america.
Highmark Health and its subsidiaries and affiliates comprise a national blended health organization that employs more than 42,000 people and serves millions of Americans across the country.
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Need to find info about providers, prescriptions, coverage, claims, ID cards, or health spending or savings accounts? If so, your Highmark member site is the place to go. (It’s separate from this blog.)