Not invincible: free clinic in Michigan sees more millennials with chronic disease

Published April 24, 2019

City on a Hill is a free health clinic in Zeeland, Mich., about a half hour southeast of Grand Rapids. Since 2017, the clinic has seen a 27 percent increase in the number of millennial-aged patients. What’s striking about that increase, says clinic director Christine Plummer, is “that millennials are coming in with more complicated health problems – things you would expect to have seen in older adults.” 

Blue Cross Blue Shield of Michigan (BCBS Michigan) supports the clinic financially and has contributed more than $14 million to Michigan free clinics, including City on a Hill, over nearly 15 years. The reason for that sustained philanthropic focus, says Pam Yager, manager of BCBS Michigan’s social mission, is a recognition that people without health insurance might put off accessing care because of the cost. “And caring for the health of all Michiganders is part of our core mission,” says Yager.

Millennials not seeking regular primary care

“A lot of millennials,” says Plummer, “don’t think they have to see a primary care doctor regularly, because they’re young. Most come to the clinic for an acute problem like a cold or cough,” she says. “But when we take their blood pressure, there’s often this surprise. And we have to tell them, ‘You have a larger health issue.’”

To keep patients on track to better health, City on a Hill has a continuing care clinic for patients who need follow up. The clinic also offers basic classes on managing chronic diseases, getting active and nutrition.

Today, the health of millennial Michiganders and others across the country is more precarious than it was for prior generations at the same age. Data from a new Blue Cross Blue Shield, The Health of America® report finds millennials are more likely to have high rates of chronic disease and mental health conditions that their Gen X predecessors did at the same age. 

It’s a trend City on a Hill’s nurse practitioner, Alicia Wright, sees first hand. She remembers a patient who came to the clinic seeking an antidepressant.

Wright knew she had to address the patient’s depression. “But his cholesterol was high. He was overweight,” says Wright. “We came to find out there was so much else going on.” 

And she says she’s seeing more millennials just like this – patients with depression and unmanaged chronic diseases. Why? She has some theories. 

“Most people who come in for depression or anxiety want help for that specific issue,” says Wright. She believes that, for this generation, there’s less stigma around seeking mental healthcare. Her patients report feeling pressure to do more, to work harder, and, with social media, to keep up with peers.

“You see everyone else’s highlight reel on social media,” says Wright, adding that what you don’t see is their struggles. 

Multiple conditions make regular care even more critical

But some millennials visiting for the flu or lower back pain may not necessarily know they need help for anxiety or other serious conditions. And just 68 percent of millennials, compared to 91 percent of Gen Xers, have a primary care doctor monitoring their health over the long term.

What’s more, people with depression and other mental health diagnoses are also much likelier to have chronic conditions like diabetes. So Wright says she frequently finds herself counseling patients about mental health issues as well as basic lifestyle changes: exercising more, eating better. 

City on a Hill director Christine Plummer says her staff is committed to providing the best care possible for those with low incomes who are uninsured. But a community health worker is on hand to connect those who are eligible to affordable health plans, such as BCBS Michigan’s Medicaid plan, Blue Cross Complete of Michigan. Having insurance could make medications for chronic conditions more affordable and provide the consistent support patients need to manage those conditions.

Blue Cross Blue Shield of Michigan is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.