“OK, Boomers”: Will Millennials and Gen Z Young People Turn the Tables on Baby Boom Healthcare Leaders?

To what extent might intergenerational divergence and confrontation, which are already playing out in the broader U.S. society, come home to roost in the U.S. healthcare industry? A December 24 op-ed column published in The Washington Post provides some potentially tantalizing clues.

On Christmas Eve Day, the Post’s Karen Heller wrote, “This year it became ‘OK’ to be ageist. It became acceptable to digitally flick off your elders or young’uns on social media, to respond ‘OK boomer’ or ‘OK millennial,’ when, in truth, the people being addressed were often far from okay.”

Indeed, Heller noted, “While many people — though certainly not all — try to be more sensitive about race, orientation and heritage, ageist tropes ran rampant. ‘Age-based prejudice is the last acceptable form of prejudice,’ says New York University’s Michael North, who studies ageism in the workplace. ‘People are making age-based generalizations and stereotypes that you wouldn’t be able to get away with about race or background. Insert some sort of racial or ethnic group, or ‘OK Woman,’ and it wouldn’t go over too well.’”

Still she said, “People are getting away with it. This year, the baby boom was blamed for almost everything: the fate of the planet, Congress, college debt, plastic straws, the ending of ‘Game of Thrones.’ An entire generation was perceived to be operating as a giant monolith, mind-melded in its intention to make young people miserable for the rest of their long lives. Never mind that old people were once young, struggling, loaded with debt, facing a lousy job market, expensive housing, inflation. (Yes, there was something called inflation. It had to be whipped. Ask your parents.)”

And as engaged as some in the broader society might be, around inter-generational accusations, this entire “OK, Boomer” controversy—why the phrase is being said, by whom and to whom, and whether or not it is ever appropriate to say—inevitably makes one wonder how younger healthcare consumers will express themselves, when interacting more and more actively and frequently, with the U.S. healthcare delivery system.

Indeed, some industry analysts and observers have already begun to figure out what needs to be figured out. Earlier this month, the leaders of the Chicago-based Kaufman Hall consulting firm released a new report on the healthcare consumer experience, focusing on the needs and desires of millennials. “How Millennials Are Reshaping Healthcare’s Future,” by managing director Paul Crnkovich and senior vice president Dan Clarin of Kaulfman Hall, speaks to some of the challenges facing the leaders of traditional patient care organizations—hospitals, medical groups, and health systems.

As the report’s introduction notes, “For years, healthcare leaders have hypothesized about the changes the tech-savvy, instant messaging Millennial generation would bring to the industry—but the time for speculation is past. The oldest Millennials are well into their 30s, and already are driving significant change in healthcare as they make care decisions for themselves, their young children, and increasingly, their aging parents. Hospitals and health systems must act now to reshape their business models to address rising demands from this surging generation, particularly as it pertains to routine care. Born from the early 1980s to the mid-1990s, Millennials range in age from the early 20s to the mid- to late-30s, and recently surpassed Baby Boomers as the largest population segment at 73 million.”

Among the issues the report addresses: the unique characteristics of the millennial generation that are making it such a significant force for healthcare change; recent Kaufman Hall consumer research results that provide insights into millennials’ healthcare behaviors; and important steps healthcare organizations should take to adapt to changing consumer demands.

Demographics matter. As Crnkovich and Clarin noted in their report, “Millennials’ healthcare spending is significant and growing. Combined with other young adults, they make up about 34 percent of the population and contribute about 21 percent of total healthcare spending. While older generations continue to be the biggest users of healthcare services, Millennials are changing expectations across the industry with greater demands for improved healthcare access, value, and consumer experience.”

What’s more, the authors noted, “Millennials’ influence will only grow as they get older and comprise a greater proportion of healthcare demand. Look at the incidence of those with more than one chronic condition, for example, as these individuals historically are high healthcare users. While only 28 percent of those ages 25-34 have more than one chronic condition, the proportion steadily rises to 80 percent or more for individuals ages 65 and older.”

Here's one key implication from what we’ve already learned about millennials—they feel no hesitation about demanding that the healthcare delivery system serve their needs. And they will be far more impatient than the Baby Boomers have been, about the fact that the delivery system has until very recently been extremely provider-centric rather than patient-centric, consumer-centric, or people-centric (depending on what kind of terminology one might want to use here).

As Kaufman Hall’s Crnkovich told me earlier this month, when it comes to the concept of consumer loyalty in healthcare, “It’s morphing into different dimensions. Basic consumer marketing research looks at segmenting populations by attitude,” he said. “There will always be a certain segment of consumers who are loyal, but that’s changing. Most people are still loyal, if at all, to an individual doctor, and maybe a local individual hospital. So I think what you’re going to find is, as consumers are now responsible for a greater portion of the cost, and they also have technology and other options, loyalty will break into segments. For urgent needs for minor care, people will have loyalty to who can get me in and out quickest. I’ll give you a 10-out-of-10 net promoter score. So loyalty may be more towards a site of care or experience, as opposed to a specific doctor or patient care organization. And that’s something people haven’t quite figured out fast.”

Very importantly, Crnkovich told me earlier this month, “Our view is that health systems and providers will have to win on every transaction; it’s going to be a jump ball every time. It’s about what we call targeted brand value: for a given service, what are the most important elements for the consumer? For urgent care, it’s very clear that it’s, get me in and out fast. And if it’s a brand-name provider’s name over the door, maybe that might add a bit of perceived value, but if it’s going to be a 90-minute wait, forget it.”

That will be especially true, as millennials will have more data and information available to them than their grandparents ever had, and much more data than their parents have had until now. They will also be—as they already are—quite addicted to their devices and to technology in general. And while it’s unlikely that they’ll spend tremendous amounts of time digging through piles of data online if it’s not organized well or doesn’t tell a story, when it comes to issues like patient satisfaction and convenience, it’s hard to believe they’ll be passive.

Indeed, Crnkovich says, “I think we are getting to an inflection point where the traditional legacy providers have to rethink non-emergent care, that that’s going to have to be thought of as a completely different business, and it starts with looking at different segments of consumers. And you’ll have to be able to provide 24/7 on-demand care. Some of it you’ll do on your own, some through partnerships. But you’re touching most of the people most of the time, in the outpatient setting. And if you don’t have a consumer-centric network at the center, you’ll be losing customers. That’s going to be a requirement, and organizations will be moving at varying speeds to get there. I think the industry will move slowly, and some of those services will be pulled away by disruptors who are set up to deliver those services,” he told me. “Convenience, access, and other elements will be important. At the end of the day, it comes back to a two-part question: why is Consumer X going to come to you, and why will they come back? They’ll come to you based on access, on a variety of terms, and then they’ll come back, because you’ve satisfied their needs.”

Of course, there are layers of complexity here. As Michael Evans wrote in November 2018 in Forbes, in an article entitled “Millennial expectations Are Fundamentally Changing The Healthcare Landscape,” “When it comes to healthcare, members of the millennial generation are turning the traditional delivery model on its head. Born between 1981 and 1996, this tech-savvy generation of 75 million is about to overtake baby boomers as America’s largest age demographic. Millennials have grown up in a technology-powered consumer environment where transparency, rapid delivery, and convenience are the norm. They’re now transferring these expectations to the healthcare industry, which has profound implications for healthcare providers and care outcomes. But, while millennials’ expectations of efficiency and service may be a positive catalyst for a slow-to-change industry, their cost-consciousness in regards to healthcare may have significant negative personal health consequences.”

Part of the complexity here has to do with the evolving micro- and macroeconomics of health insurance coverage. Evans noted that “Millennial behavior also reflects general consumers’ growing tendency to avoid or delay care because of concerns about the growing cost of healthcare insurance and high patient deductibles. According to the results of a West Health survey published earlier this year, 44 percent of patients skipped necessary medical care because of costs. Other studies such as the CarePayment 20-20 study… show care avoidance to be much higher—a staggering 64 percent. Potential outcomes of these converging trends are higher healthcare costs for all and poorer healthcare outcomes for millennials.”

As Evans pointed out, “survey by the Kaiser Family Foundation that found “there was a pronounced difference among age groups: 45 percent of 18- to 29-year olds had no primary-care provider, compared with 28 percent of those 30 to 49, 18 percent of those 50-64, and 12 percent for people aged 65 and older. This shift is creating a dilemma for traditional health systems and hospitals: how to retain valuable patient relationships (and revenue) while maintaining the quality and continuity of care that differentiates their model from other, more consumer-friendly models such as urgent care and retail providers.”

So, we can posit that millennials, and their younger brothers and sisters, the Generation Z kids, are going to turn out to be the least loyal healthcare consumers in history; they will be demanding of tremendous convenience, responsivity to their questions and needs, and services that fit their schedules, and not the schedules of providers. And, as Kaufman Hall’s Crnkovich noted, there really will be no loyalty towards providers in the old-fashioned sense, no sentimentalism about the fact that one’s grandparents used a particular healthcare organization; instead, as he noted, it will be a “jump ball” opportunity every time.

And, with the senior executives of most patient care organizations right now being Baby Boomers, the generational gap between those individuals and the millennials, and eventually the Gen Zers—could become profoundly dangerous to the U.S. healthcare delivery status quo, at a time of high-deductible health plans, data-savvy younger healthcare consumers, and busy personal schedules for everyone.

And if the leaders of patient care organizations can’t figure out how to meet the needs of those millennials—and eventually, their younger brothers and sisters, the Generation Z kids born since the mid-1990s, who are just beginning to emerge into adulthood—they will face existential peril. It will be far worse than being told, “OK, Boomer”; the silence of millennials and Zers who turn away from traditional providers could prove deafening.