Editor's note: Katrina Lerman is senior researcher at Communispace, a Boston research firm.
The other night, I was taken aback when a haggard-looking Walgreens clerk handed me my change and told me to “Be well.” (Given that I had purchased only candy, I’d have been sure I misheard, but he said it to the customer in front of me as well.) Normally I’d roll my eyes at such a marketing gimmick but in light of my recent research, I couldn’t help but wonder if it signaled a deeper awareness among some brands of the pivoting priorities of today’s health care consumer.
Walgreens’ new new-agey farewell would seem to embrace the results of a recent multi-method study from Communispace that found an emerging set of health care values embodied by an increasingly wired, independent and self-reliant Millennial generation. Shaped by uncertain and challenging times, they resist following the traditional health care “rules” and, indeed, see wellness as equally important as health – opening up big opportunities for a wide range of brands to provide the support and tools younger consumers are looking for.
We deliberately chose to use multiple techniques, tools and samples to dig into this complex topic from as many angles as possible and to represent the voices of a range of Millennials. Millennials are a diverse generation, not just in demographics but – thanks to their constant connectivity and access to information – in experiences, attitudes and influences. We also knew that a range of interactive activities (all mobile-optimized, of course) would keep a Millennial audience engaged over the course of a three-month study.
To elicit personal stories, deep associations and interactive discussion, we explored health care topics with over 600 members (about half Millennial) of three private, branded online communities. Open-ended discussions asked members to share health care influences, past experiences and the various ways they use technology to manage their health. An EmotionCentric Explorer exercise uncovered deep emotions at the heart of health care decisions, while a metaphor-building exercise used images and storytelling to reveal strong associations with health care topics from insurance to providers. Finally, we had community members use a digital collaging tool to design their “health care app of the future.”
About midway through our community collaboration work, we fielded a survey to a separate, nationally-representative sample of 1,500 consumers (1,000 Millennials) from an online panel. These findings helped both to validate and quantify some of the themes we were hearing and to inform the rest of our community engagement.
Finally, we partnered with c2b Solutions, designer of the Consumer Classifier psychographic segmentation, a model that sorts health care consumers into one of five groups, each with its own motivations and preferences. This segmentation was administered to community and panel members and used as another lens through which to understand the diversity of Millennial health care consumers and how the unique characteristics of each group can help businesses connect with key segments.
Too much power
In our study, 37 percent of Millennials rated the current state of health care in America as “poor” or “terrible” and 49 percent said the government (symbolized by the Affordable Care Act, aka Obamacare) is most responsible for the problems with health care in America today. A full two-thirds of Millennials (and 71 percent of non-Millennials) believe that insurers have too much power and are often perceived as putting profits ahead of patients. Pharmaceutical companies are seen as greedy and deceptive, ranked as the least-trusted health care information source. Institutional-averse1 Millennials see the entire health care system as yet another dysfunctional collusion – and don’t see any of the major players as having incentive to change.
Regardless of their personal opinions about the ACA, most believe the law has done little to make our health care system simpler, cheaper, more efficient or better-prepared for the future. Millennials were slightly more positive than non-Millennials in their assessment of the ACA’s impact on themselves, those around them and the country as a whole, but when we really dug into their firsthand experiences, many had to admit that it was both good and bad. In other words, mixed reviews. The truth was, many knew people on both sides: those who had lower costs and expanded access to care and those who’d seen their premiums rise and care options shrink.
Millennials are disproportionately affected by the ACA yet they are more likely than older adults to say they don’t know enough about the law. Indeed, many young people we talked to agreed that much of the law’s bad reputation stemmed from poor implementation and communication – in short, a marketing problem. Similarly, Millennials were more likely to express hope that the ACA could lead to positive changes in the future. One young man summed up the pragmatic Millennial point of view using a weather metaphor: “Lightning can seem like a violent, damaging act which causes fire and destruction but it is also the sign of storms and rain, which bring about growth. Same thing with the ACA. Different people can make you see different things about it.”
That said, Millennials have a complex relationship with insurance that long predates Obamacare. In many ways, health insurance epitomizes the tension between childhood and adulthood. It represents so much that’s scary about being an adult – responsibility, complexity, expense, life’s harsh realities – and Millennials don’t want to grow up. Even those who have insurance are often hesitant to use it, for fear of getting lost in a confusing maze of co-pays, deductibles and prior authorizations.
An Emotion Centric Explorer exercise emphasized the often-contradictory emotions (fear and security, shame and pride) associated with buying, having and using health insurance. Similarly, the image of an umbrella – traditionally used by insurance companies to represent protection and safety – elicited both the expected associations and surprisingly grim sentiments such as, “Thinking about insurance makes me sad and seems depressing. It makes me want to stay home and not deal with it, like a rainstorm makes me want to stay home.”
Outside the system
Their disillusionment with the current state of health care, driven by high costs, shortage of care and an aversion to large institutions, has pushed Millennials outside of the traditional system. They have become fiercely independent, relying on their personal networks, niche resources and a wide range of products, services and providers to manage their health.
As shown in Figure 1, just over half have visited a doctor’s office in the past year, compared to nearly three-quarters of non-Millennials. By contrast, Millennials are more likely to have utilized a range of care options, from urgent-care clinics to emergency rooms to home remedies. Much of the stigma around alternative health care facilities seems to be gone; indeed, almost as many agree (31 percent) as disagree (33 percent) that care from a clinic is as good as that from a doctor’s office.
Nearly a quarter say they’ve sought medical advice from friends and family in the past year and 53 percent consider them to be a trusted source of information. Parents were often referenced as a “first call” for Millennials with a health concern and friends and family in the medical field are an invaluable source of guidance. Millennials are also more likely than older adults to self-diagnose (28 percent) or treat at home (36 percent) before doing going to a doctor.
The Internet has undeniably become a top tool in Millennials’ DIY health care arsenal, allowing them to learn from the experiences of experts and fellow patients alike as they research symptoms, conditions, treatments, providers and facilities. The idea that Millennials rely on “Dr. Google” is not an exaggeration but it’s important to recognize that they are using Internet resources as both an alternative and a complement to traditional medical care – a way to prepare for going to the doctor or to avoid having to go as often.
The trend towards self-quantification, enabled by wearable devices and health apps, has also transformed the ability of patients to monitor and improve their own health. In our study, adoption rates among Millennials were still relatively low (27 percent app, 8 percent wearable) but far outpaced older generations (12 percent, 4 percent). When we asked what they’d like to see from their tech-health tools in the future, the central theme was towards centralization – on both a private level, aggregating an individual or family’s medical data in a single, secure location; and a public level, integrating self-generated health data with a range of providers, insurers, brands and the larger electronic health record system.
Research has shown that younger consumers are increasingly willing to share all types of personal data, even as they fear the risks of fraud and discrimination.2 The potential for added convenience, personalization and incentives is simply too tempting. For savvy companies that can provide needed support outside the traditional system, the exchange of health data has huge potential to connect consumers more deeply to brands, products and services and help drive desired (consumer- or brand-intended) behavior change.
Less consensus around future-focused behaviors
Millennials are known for their YOLO (“you only live once”) attitude and this is generally true of their health care behaviors as well. While consumers across generations agreed on the importance of daily stay-healthy steps like drinking enough water, getting enough sleep and exercising, there was less consensus around future-focused behaviors (Figure 2). Perhaps surprisingly, less than half of Millennials consider getting regular medical (44 percent) and dental (45 percent) checkups or having health insurance (46 percent) to be part of maintaining their overall health and wellness; nor are they too interested in getting vaccinations (39 percent), performing routine self-exams (32 percent) or getting routine cancer screenings (23 percent).
Sure, Millennials as a group are young and healthy, so of course they’re not too worried about the future, right? Yes, the invincibility of youth certainly explains some of the generational differences we found. But looking at some of the other behaviors on our list, we saw that Millennials really do have a different, broader definition of what it means to be healthy and well. They view their health more holistically, trying to maintain balance on a spectrum from sick to well and in terms of small, everyday choices, not just the big ones.
For example, nearly half of Millennials consider maintaining a work/life balance (49 percent) and relationships with friends and family (47 percent) to be part of their health and wellness. Note that these are larger proportions than chose any of the above institution-centric behaviors. More than a quarter say organic, natural and non-toxic products are part of maintaining their health and may see them as alternatives to traditional medicine, signaling an opportunity for brands well beyond the traditional health care sectors.
Millennials have been dubbed the “most stressed” generation in history,3 so it’s no surprise that they recognize the importance of relaxation and mental health in maintaining long-term health; in fact, 55 percent agree that a healthy mind leads to a healthy body, not the other way around. As a result, they are more likely than non-Millennials to consider unplugging from technology, meditation, massage and talk therapy to be elements of staying well.
Wellness to Millennials is about more than not getting sick; it’s about all facets of life and in particular, how they are connected – from maintaining balance to controlling stress to cultivating positive experiences and relationships. Health care often feels like a gamble, cloaked in uncertainty and chance (i.e., even if you follow all the rules, you can still lose big), so instead of planning for the future, Millennials often focus on those things they can control today.
Health care without borders
For Millennials, health care is not a separate sphere, financially, emotionally or physically; it’s not about what happens at the doctor’s office, it’s happening all the time, everywhere. It’s happening in a discussion with a coworker over coffee, a Google search on the train, a lunchtime yoga class, a farmer’s market or an abuse survivor’s support group. It’s health care without borders.
The fundamental locus of control in health care has shifted from providers and big businesses to the consumer. Political and financial changes to the health care system have put patient outcomes front and center and behavior change is the name of the game. At the same time, competing financial pressures mean Millennials make direct trade-offs between health care spending and other purchases, leading them far outside the traditional system of care in an attempt to cut costs. Brands must meet consumers where they are to have a chance at truly moving our health care system from treatment to prevention.
Embracing the Millennial mind-set of institutional aversion and self-reliance means not dictating the “right” way to stay healthy. It means connecting self-reliant consumers with the resources, knowledge and tools to make better health care decisions and gently steering them towards treatment when needed. It means understanding the needs and motivations of diverse groups of health care consumers and keeping an open dialogue to understand ever-shifting priorities. And, for brands across other sectors, it means expanding their view of what health and wellness means and asking what their organization can do to support Millennials as they manage healthy life-styles.
Though just one of many, Walgreens is a great example of a brand embracing Millennial health care values through its products and services. The shift in customer-greeting protocol is very much in line with its other moves aimed to transform the drugstore chain into a full-fledged health care partner. Not only does it offer flu shots and physician consultations in-store (a practice now commonplace among drug, grocery and big-box retailers), but its Balance Rewards program allows customers to earn in-store credit – not just for Walgreens purchases but by sharing personal health and fitness data. This data can then be used to personalize messaging, offers, services and rewards to individual customers, further motivating behavior change and, naturally, strengthening their bond with the brand in the process.
Be well, indeed.
1 Pew Research Center (March 2014). “Millennials in adulthood: Detached from institutions, networked with friends.” Retrieved from www.pewsocialtrends.org/2014/03/07/millennials-in-adulthood/3/#chapter-2-generations-and-issues.
2 Lerman, Katrina (2014). “Beyond the bull’s-eye: Building meaningful relationships in the age of big data.” Retrieved from www.communispace.com.
3 American Psychological Association (February 2013). “Stress in America: Missing the health care connection.” Retrieved from www.apa.org/news/press/releases/2013/02/stress-management.aspx.