Thirty million U.S. residents lacked health insurance in the first half of 2020, according to newly released estimates from the National Health Interview Survey (NHIS). The report also found that compared with other Americans, the uninsured are disproportionately likely to be Black or Latino; be young adults; have low incomes, or live in states that have not expanded Medicaid. Yet, one report uncovered that the largest generation in the country, millennials, had the highest rate of uninsured individuals (16 percent). This group is also struggling with their mental health.
According to a 2019 Blue Cross Blue Shield (BCBS) Health Index report, of the top ten conditions impacting millennials, major depression tops the list. And of the leading ailments, six are behavioral health conditions. A more recent BCBS report reveals that millennial health continues to decline, driven by increases in behavioral health conditions. It shows:
- Nearly a third of millennials have a behavioral health condition, and rates are rising by double digits.
- Millennials with a behavioral health condition are at twice the risk of having a chronic physical illness.
Understanding that most uninsured Americans are millennials and the biggest health challenge facing this generation is behavioral health, how do we tackle this crisis? Below we list the barriers and behavioral care costs millennials face and reveal some long-term solutions to changing these statistics. Let’s dig in.
Uninsured Millennials: Barriers & Behavioral Health Care Costs
When it comes to millennials, the largest barrier to quality healthcare is money. In 2019, a survey found that 60 percent of millennials said cost was the most significant factor in their decision to purchase health insurance or not. A Transamerica Center for Health Studies report reveals additional barriers millennials face, including:
- Having less disposable income and are less able to afford prescription drugs.
- Relying on digital sources of health information than personal contact.
So how much are millennials paying for behavioral health services? The National Coalition on Millennial Health found 7.6 million young adults receive care for mental health conditions, costing $12.5 billion annually. Private insurance covers about 40 percent, and Medicare covers less than 1/3 – leaving a large percentage paying out of pocket. And out-of-pocket costs are significantly higher for mental health prescribers and therapists than medical specialty care. One national report reveals that eight in ten respondents had out-of-pocket costs of over $200 for psychiatric hospital or residential mental health care compared to fewer than six in ten for general hospital care. Another mental health report found that a patient without insurance with major depression can spend an average of $10,836 a year on health costs. So why is this happening? According to a CNBC health report, just 56 percent of psychiatrists accept commercial insurance. As a result, those seeking mental health care are over five times more likely to seek care from an out-of-network mental health professional than medical or surgical services.
One way to tackle and lower these high costs and out-of-pocket expenses? Provide accessible mental health diagnostic and prevention tools and programs to patients and providers. Providing better access to early diagnosis will reduce insurance costs, pinpoint effective treatment options, and reduce the likelihood of chronic mental health conditions. To do this, though, it’s essential to understand what millennials are looking for in terms of quality behavioral care.
What Millennials Expect Regarding Quality Care
To understand how to help this uninsured generation, we need to understand their spending habits and what they value most regarding their health. When it comes to the tenants of excellent healthcare, a Kaiser Health Foundation study reveals that millennials need their experience to include convenience, fast service, connectivity, and price transparency. An American Hospital Association article also shows millennials are more mindful of their whole health than other generations and are more likely to research integrative medicine options. The report also indicates millennials expect personalization. More than 80% of responding millennials feel that if their providers know more about their health interests, goals, and motivations, they would be able to serve them better.
Convenience, cost, and personalization seem to be at the heart of quality behavioral healthcare for millennials. With this in mind, many young adults turn to alternatives such as online telemedicine sites that offer virtual mental health visits. Unfortunately, these are short-term solutions to long-term problems. The real question to ask is, “How can we reduce insurance premiums, out-of-pocket costs and lower the likelihood of chronic mental health conditions?” It starts with prevention.
Better Mental Health Starts With Prevention & Personalization
Providing accessible mental health diagnostic screening tools and tailored prevention programs to patients and providers can be a gamechanger in reducing the cost of health insurance and preventing chronic behavioral disorders. Case in point, a recent review showed strong evidence supporting screening plus psychological interventions for mental disorder prevention in adults. Interestingly, most studies in the review consistently found that mental health prevention and promotion interventions were cost-effective or cost-saving. The review also uncovered that targeted prevention was more cost-effective than universal prevention. A Steinberg Institute article highlighted an analysis by the National Academies of Sciences, Engineering, and Medicine revealing that every $1 invested in prevention and early intervention for mental illness and addiction programs yields $2 to $10 in savings for health costs.
From Transactional to Whole-Person Care
In terms of personalization and prevention, to attract and retain patients, especially millennials, practitioners are ditching the “transactional” approach to patient care and are embracing new ways of running their businesses. Especially after the onset of Covid-19, many practitioners have rolled out patient portals and other digital tools that enable people to communicate with their doctors and make mental health appointments via smartphones, tablets, and computers. According to BCBS, doctors are also trying to embrace integrated whole-person care. This may include expanded behavioral health access and incentivizing doctors to provide whole-person care, including mental and physical care.
What does this holistic approach look like? Hospital divisions, like UMass Psychiatry, offer wellness resources to assist other medical departments and their patients. These wellness and prevention initiatives help patients increase physical activity, manage stress, improve nutrition, enhance general health, and become tobacco-free. Integrative care may also mean offering additional services, such as access to a broad spectrum of multi-disciplinary health care services and community programs. It may also include more personalized care, such as targeted stress reduction programs, offering personalized therapeutic assessments measuring cognitive or gut health, or providing a mental health treatment plan using alternative medicine and therapies such as acupuncture, meditation, or supplements.
By having mental health care practitioners and primary care doctors provide more personalized and preventative care, insurance costs and chronic mental health conditions may see a considerable reduction. Providing this personal touch may prove to millennials that their doctors are less concerned with making money and more concerned with partnering with them to maintain their well-being.