Provider first impressions matter most for millennials

Healthcare providers keen to keep their millennial patients had better impress them on that first visit.

Millennials pay close attention to office appearance, cost, customer service and the quality of products used during a visit, according to a recent survey conducted by the Health Industry Distributors Association, whose members distribute and manufacturer medical products. The organization's survey of 1,009 patients included 319 millennials, the largest response of any age group.

Providers are closely watching the millennial generation, which unlike previous younger generations have the option of visiting urgent-care clinics, which have sprung up across the country and are located in many pharmacies. They no longer have to wait for a traditional appointment with a primary-care physician, which can sometimes mean weeks of waiting for an existing patient and even months for a new one.

There are nearly 80 million millennials in the U.S., and they spend roughly $600 billion each year, according to consulting firm Accenture. The insights on millennials' healthcare desires contained in the HIDA survey follows a wider survey released last year on the impact medical products have on patient satisfaction.

The survey emphasizes the importance of first impressions for millennials. The survey found that millennials are more than twice as likely as older patients to research providers on websites such as Yelp, Consumer Reports and Angie's List. A third of millennials said they have switched providers when dissatisfied, 12 percentage points higher than that of other generations.

Millennial dissatisfaction arises from a variety of factors, though cost was highlighted as a major issue for 60% of millennials. Cost was the top reason for millennials switching providers, with 41% saying they postponed seeking care because it was too expensive. About a fifth of millennials said they have a high-deductible health plan, a number that is just under the national average.

Millennials are big fans of alternative, retail-style care sites, with 43% reporting they've used an urgent-care center in the past year, and 23% saying they've used a retail health clinic in that time frame. “Millennials are looking for convenience and customer service, and they're not necessarily looking for a long-term in-depth relationship. It's a pretty big paradigm shift,” said Dr. Halee Fischer-Wright, CEO of the Medical Group Management Association.

The millennial generation appears to be particularly concerned about provider wait times. One-third of millennials said they waited too long to receive care, and 38% said a provider failed to meet their expectations because they were unable to get lab results during the visit, something that is now technologically feasible and is more often available at urgent-care facilities.

The jury is out on the health impact of millennials' shift toward urgent or retail care. But providers need to be cognizant of the changing shape of demand if they intend to compete with quickly growing retail-style competitors. “I think the mistake is holding to our conventional practice behavior and expecting patients to shift back as opposed to moving forward with our consumers,” Fischer-Wright said.

Millennials may not understand the higher costs that come with urgent-care facilities due to their longer hours and advanced services such as imaging and on-site diagnostics. During her time as chief medical officer at St. Anthony North Hospital in Westminster, Colo., Fischer-Wright said she received a lot of complaints from patients who used urgent-care centers and didn't realize they'd pay higher co-pays or out-of-pocket costs.

Urgent-care centers claim they provide competitive pricing and are generally transparent about what patients have to pay. Operators understand that, in a retail-style environment, they have to deliver more amenities to millennials beyond quality care, in order to justify a premium service, according to Steve Sellars, CEO of Premier Health, a Baton Rouge, La.-based chain of 41 urgent-care centers.

“You expect that the doctor is clinically competent,” Sellars said. “A lot of people are looking for a little something extra: great service, friendly service, follow-up calls and a patient portal to pay their bill online and access their records.”

Now the real work begins. The new law doesn't include specific guidance on how social determinants of health should be measured and modeled into quality reporting. Determining SES risk adjustment for readmissions will be a significant challenge and remains the open, $500 million question for hospitals.

Of note, the Cures Act calls for creating cohorts of hospitals that care for a similar socio-economic mix of patients—in this case, focusing on patients dually eligible for Medicare and Medicaid. The intent is to compare hospitals with a large percentage of low-SES patients against other hospitals with a similar patient profile. There are a few challenges with this approach, including determining what cutoffs will be used to determine the penalties assessed to each cohort.

Besides cohorts, the CMS should include other demographic factors in determining SES. Evaluating ZIP codes served by a hospital and refining with census data and street addresses would offer greater insights into SES. Another proxy of SES is penetration of school lunch vouchers.

Other factors not currently captured by risk adjustment but influencing readmissions and correlated with low SES include health literacy, proximity of grocery stores with fresh fruit and vegetables and access to public transportation.

No model is perfect, however. Even if a hospital provides proper discharge instructions, ensures medication availability and aftercare beyond a seven-day window, factors outside of a hospital's control begin to have a much larger influence over outcomes. Changing the readmissions measurement period from 30 days to seven days would go a long way to level the playing field for hospitals and better reflect quality of care. The need for socio-economic adjustment would also be minimized.

As the CMS begins developing formal guidance on accounting for SES, we look forward to working with the agency to help steer this much-needed improvement to quality measurement.