Navigating Generational Differences in Member Engagement

October 22, 2020 - Around a third of Millennials have a behavioral health condition, emphasizing a greater need for behavioral healthcare options and coverage as well as a new approach to millennial member engagement, the latest Blue Cross Blue Shield Association (BCBSA) report revealed.

“The report does a great job of highlighting the challenges that Millennials face, especially in the area of behavioral health. What the consequences are, especially in light of COVID and the pandemic,” Mark Talluto, vice president of strategy and analytics for the BCBSA, told HealthPayerIntelligence.

Not only do Millennials have a high percentage of behavioral health conditions but their rate of developing a behavioral health condition is rising by double digits. Over five years from 2014 through 2018, the prevalence of major depression rose by 43 percent, ADHD rose by 39 percentage percent, and psychotic disorders rose by 26 percent among Millennials.

Behavioral conditions are a precursor to chronic conditions.

Overall, Millennials with continuous behavioral health conditions starting in 2014 were twice as likely to develop chronic conditions. More specifically, Millennials with behavioral conditions are 2.7 times more likely to develop coronary artery disease, 2.1 times more likely to develop type 2 diabetes, and 1.9 times more likely to develop hypertension.

READ MORE: Payer-Provider Partners Tap Telehealth for Behavioral Health Access

These chronic diseases can be life-changing for patients. They also are financially burdensome for Millennials and their health plans. Heart disease and diabetes in particular are among the most expensive chronic conditions driving healthcare spending in the industry.

Poor health habits and substance abuse aggravate a behavioral health condition, the study added.

With the coronavirus pandemic mandating social distancing the likelihood that a millennial will develop or relapse into alcohol, tobacco, or opioid use disorders is much higher.

Over nine in ten Millennials reported that the coronavirus pandemic negatively affected their mental health (92 percent). Due to the pandemic, over a third of the participants reported increased alcohol consumption (34 percent), 20 percent said that they were smoking more often, and 16 percent stated that they had increased their non-medical drug use.

This trend of behavioral health conditions attending the pandemic is particularly dangerous in Black and Hispanic communities, for whom not only is the likelihood of experiencing severe coronavirus symptoms higher but also diagnosis of mental and behavioral health conditions is lower.

READ MORE: 4 Ways Payers Can Invest In Mental and Behavioral Healthcare

The pandemic led to Millennials missing 60 percent of their healthcare appointments or care procedures. Many have also lost their jobs or dipped into savings.

Preventing the behavioral health epidemic

What can health plans do to stop the undercurrent of a behavioral health epidemic?

Talluto and his colleague Brian Harvey, executive director of strategy analytics at BCBSA, emphasized that health plans have to know the challenges that Millennials face in healthcare and what Millennials want in terms of engaging with their health plans and providers in order to effectively deliver care.

There are four major problems or objectives that are a part of the millennial patient care journey.

First, Millennials are looking for multiple access points to care that work for them.

READ MORE: Patient Engagement High Priority for Millennial Patients

“Care that needs to be convenient and on their time, not on nine to five hours, but on their time,” Talluto shared.

Health plans have to recognize how unfamiliar Millennials are with their health benefits. It is increasingly important that payers educate Millennials about their health plan so that they can take advantage of their benefits to help protect their mental and behavioral health.

“Millennials really don't understand their benefits and what's important to them and how to access their benefits,” Talluto underscored.

“Plans are really going deep in terms of not only educating them about what their benefits are and how to access them specifically in the areas of mental and behavioral health, but what the impact could be of mental health and behavioral health on chronic conditions.”

Health plans also should be aware that while Millennials value developing a relationship with their primary doctor, many do not have a primary care physician.

Primary care is a perfect setting to integrate behavioral healthcare screenings and diagnostics, Talluto indicated. But first, health plans have to connect Millennials with a primary care provider.

“We found Millennials were significantly below the number of baby boomers and generation X-ers that had a primary care provider,” said Talluto. “That's critical because that primary care provider obviously is an avenue in a way in which that millennial member could at least begin to communicate and access to health care system.”

However, although they are not consistently seeing a primary care provider, Millennials and health plans have aligned goals on integrated care delivery.

“Millennials are going to use the system the way it makes sense for them,” Harvey summarized. “They're rejecting this idea of a primary care physician necessarily being at the center of their care. They want to have someone that is having a dialogue with them about all of their lifestyle choices, their mental health, their physical health. If they are going to have a relationship with a primary care physician, they want that primary care physician to be concerned about their holistic integrated health.”

Finally, as might be expected of the generation that experienced the evolution of the smartphone, Millennials value behavioral healthcare delivery and member engagement through digital and mobile apps.

“Digital apps that allow them to allow address their behavioral health challenges or behavioral health needs, but also their chronic conditions as well,” Talluto noted.

Digital apps also allow for greater customization, which is what drives much of Millennials’ engagement with the healthcare industry.

“Millennials—more than any other generation—don’t want a one size fits all approach. They want to have a tailored solution for their needs,” added Harvey. “We went to 100% telemedicine in the March-April timeframe and Millennials were the quickest to adopt it. Even though all generations had a significant increase, Millennials had an even higher increase than other generations.”

Engaging Millennials digitally

While Millennials are looking for tailored, personal member engagement, there are some overarching themes in the kinds of solutions that they gravitate towards.

“It's a mixture of both digital solutions, as well as brick and mortar solutions and retail centers or different types of clinics,” Talluto said.

He referenced a couple of BlueCross BlueShield company programs that are well-positioned to harness millennial member engagement to improve behavioral healthcare.

Some plans choose to integrate digital and in-person approaches to chronic conditions in order to help members manage or prevent behavioral conditions.

Blue Shield of California launched a program, Wellvolution, that mixes a digital platform with brick-and-mortar wellness programs that may target chronic disease prevention and management. The platform connected Millennials with a community of 30,000 brick-and-mortar institutions and 60 different apps.

Talluto remarked that the platform was particularly successful among Millennials. In its first year, the platform’s millennial participation rate more than doubled from 18 percent to nearly 40 percent, Talluto said. Most were enrolled for weight management and many participants also enrolled in type 2 diabetes programs.

The program was attractive to Millennials because it was “always on”—it provided chronic disease management techniques whenever and wherever Millennials wanted them. It was also personalized, matching members with providers based on member wellness goals.

“Always being on is showing progress in influencing Millennials’ ability to control their chronic diseases and conditions and also to address their behavioral health care needs as well through an integrated solution,” Talluto said.

Other plans leveraged a concierge-like service to streamline millennial member engagement and education about their benefits.

Premier Blue Cross partnered with a healthcare system to form an integrated health plan that caters to millennial member needs to have a health plan that is “always on.”

The plan rewards remote and in-home care delivered through online and home visits. It also offers a single point of contact, which functions like a concierge service and supports Millennials in understanding their benefits.

“Millennials might not understand their healthcare benefits fully, and that's totally understandable because they can be confusing at times—what’s covered, what's not,” Talluto acknowledged. “Pairing that concierge with them really allows them to better navigate the services and take full advantage of what's available to them.”

Finally, some plans have partnered with providers to ensure that behavioral and clinical healthcare needs are both met in the primary care setting.

Recognizing that behavioral and physical healthcare needs are intertwined, Blue Cross and Blue Shield of Kansas City created an integrated behavioral healthcare and primary care experience in its clinic.

Like the Premier Blue Cross partnership, this integrated model incorporates a care coordinator who can answer questions about both healthcare and customer service issues.

“It encourages preventative care and connects members to a customer service coordinator to help them understand not only their care, but also their coverage options,” Talluto explained.

Looking to the future, plans are starting to investigate how they can develop provider finders to fit millennial member needs.

“Millennials are hungry to have someone ask that next question and actually have dialogue with them about their holistic health. They want that,” said Harvey. “But there aren't enough of those types of providers out there to meet that demand.”

Millennials face unique conditions related to stress, depression, and gender identity. They want to form a relationship with a primary care provider whom they can trust on these issues.

If payers want Millennials to start seeing a primary care provider more often to manage their chronic diseases and avoid or manage behavioral healthcare conditions, part of the next step may involve reengineering their provider finders with more millennial-relevant information.