Millennials shift primary care expectations

February 4, 2019

In an attempt to lure 20- and 30-somethings, physicians are looking to make everything from scheduling appointments to asking questions both quicker and easier for patients.

Martha Pietruszewski is at the age where friends are taking the leap from being on their parents’ healthcare plan to being policyholders themselves. Consequently, they’re turning to her for advice as a peer mentor and strategist for millennial women.

Pietruszewski says she isn’t sure who’s at fault, but the millennials she’s spoken with aren’t prepared to make decisions about their insurance plans. “It’s really stressful for them,” she says. “There’s a big [knowledge] gap.”

During the recent open enrollment season, the 24-year-old was fielding all kinds of questions from her robust network of Instagram followers on her account, @realmarthariley, about which options they should choose and how exactly deductibles work. Pietruszewski is working to become a mentor and strategist for fellow millennial women. Coaching peers through the health insurance transition, a rite of passage of sorts, is just one of many obstacles she helps them navigate.

Now that she’s sorted out her own health insurance plan, she hopes to act as life coach for her peers by sharing what she’s encountered along the way.

Millennials have been on their parents’ health insurance plans since birth. For many, having their own insurance plan marks the first time they are responsible for their own health. Millennials are also navigating insurance terminology, managing their deductibles, and learning about in-network care. That’s on top of student loans, first jobs, moving out, and maybe even new cars. Something’s got to give, so some millennials might let primary care slip at a time when they still feel healthy and invincible.

If the statistics bear out, millennials won’t likely choose a primary care physician once they’ve switched to their own plan. A recent poll by the Kaiser Family Foundation shows that millennials are less likely than preceding generations to have a primary care doctor. The poll found 45 percent of 1,200 random individuals ages 18 to 29 said they did not have a primary care doctor. That’s much greater than other population groups: 28 percent for those ages 30 to 49 and 12 percent of those 65 and older.

“Millennials are busy and cash-strapped, so they go where care is cheap, effective, and easy,” says Susanne Madden, CEO of the Verden Group, a consulting firm for healthcare providers.

And, as Pietruszewski points out, millennials might not have had easy access to a primary care doctor if covered by their parent’s insurance through age 26. That’s because in-network care through your parents at home in Ohio doesn’t always translate across state lines if you get a job in Florida. Rather than bother to look for a doctor, some millennials self-diagnose. As the Kaiser study pointed out, they also aren’t as apt to schedule that annual physical as other generations.

Doctors, in an attempt to capture this demographic at a time when habits are being formed and chronic conditions can be caught and treated early, are looking to make everything from scheduling appointments to asking questions both quicker and easier for patients.

“We’re all in 2019 now and relying on smartphones,” Madden says. “The difference is that the older generations are a lot more tolerant of not having that technology. Millennials, because they’re the connected generation, they’ve directed that change. There really is a groundswell demanding this, but millennials are just leading the charge.”

Great expectations

In 2017, Pietruszewski jumped around to five doctors trying to find a solution for a hormonal imbalance. She started by searching online and reading reviews for in-network doctors. Pietruszewski says she kept switching because doctors didn’t listen to her or gave what seemed like a one-size-fits-all answer.

Pietruszewski eventually settled on a physician she found through a referral. She appreciated that the doctor reviewed all of her symptoms to get to the root cause of her problem. The doctor didn’t have the ability to schedule appointments online. She admits she doesn’t like talking on the phone but says that didn’t deter her from making the call.

Millennials want to be seen quickly, and they want to get to the root of their problems-fast. In the past, Madden says, patients waited to be seen by their primary care doctor first and then wait for an appointment for a specialist their primary care doctor referred them to. Nowadays, many health insurance plans don’t require patients to see a primary care physician in order to access specialist care.

That means patients, including millennials, can go directly to a specialist for a problem they’ve self-diagnosed. Or, they can bypass primary care and go straight to urgent care. Madden says they’re also more likely to find online communities and seek advice from others with their chronic illness.

“They use Dr. Google first and read about what others have to say,” she says. “And they crowdsource. Reviews are king. Millennials tend to care less about where doctors did their residency and much more about what other people had to say about the practice or physician.”

The doctor will see you right now

Mott Blair, MD, was born and raised in Wallace, N.C., a rural community about 40 minutes north of Wilmington. He began working at his father’s practice before eventually taking over. He’s known his patients for decades, and he’s now treating the grandchildren of his father’s patients.

While North Carolina’s population is booming, the residents in his community mostly grew up there and stayed, going to work for one of the four major employers in the area. As a result, nearly one-third of his patients are millennials. While they might be unique in that they haven’t fled to a major city after school, their needs and expectations are on par for their demographic.

“We’ve implemented a lot of strategies to address and embrace this generation,” Blair says. Chief among them is open access appointments. Blair keeps about one-third of his daily appointment spots open for last-minute visits. “Millennials want to be seen right then and now. They don’t want to wait a week.”

He also uses the online patient portal platform MyChart. Another major component has been virtual visits. Blair says he’s embraced this technology because the practice covers 29 counties in North Carolina that are rural and far apart. Virtual visits became crucial during the recent hurricane when patients had trouble navigating residual flood waters for their appointments.

Next up: implementing a new scheduling software that will allow patients to book their own appointments online.

That’s also the next step for Matt Delgado, DC, a millennial with his own chiropractor practice-and plenty ideas of how care delivery could be improved-in Austin, Texas.

“If it’s more than one click away, you’ve lost them,” says Delgado, who would prefer that you just call him Dr. Matt, or even Matt.

Right now, his patients text his personal cell or his office cell to set up appointments-Delgado ditched the traditional office landline. In addition to texting for appointments, he also has his staff send text reminders of upcoming appointments and keeps the lunch hour open for visits, which makes it easier for patients who can’t afford to miss work to be seen.

“My approach is more casual,” he says. “I try to be humorous, light-hearted, and fun with all of my patients.”

Delgado says it works. About 2,000 of Delgado’s patients follow him on Instagram to see what he’s doing out of the office. That atmosphere and relationship, on top of his willingness to communicate on social media platforms, has made it easier for millennial patients to receive care. And catering to the roughly 50 percent of his practice comprised of millennials is easy for Delgado, who is 29 years old.

Delgado doesn’t accept insurance because, frankly, he thinks it’s a raw deal. Instead, he’s upfront about his pricing and offers payment plans. He says his millennial patients seem to appreciate that transparency.

“I’ve found a lot of millennials don’t have insurance but maybe they’re afraid to say it,” he says. “They’re more willing to utilize a different payment system, more so than older people.” Delgados’ patients use health savings accounts, and he’s looking to add Venmo as a payment option because so many patients ask if he accepts it.

Changing minds while healing hearts

Pietruszewski likes the primary care doctor she’s been seeing since she was born, but she’s not going to bother him for something like the common cold. She says his time is too important to be spent telling her to rest and drink plenty of fluids. She’ll see a healthcare provider if her cold lingers, but if she does she might head to the urgent care for a quick visit.

Just as millennials have forced primary care doctors to cater to their expectations, doctors are now looking to convince millennials of the need for a family doctor, someone who will take responsibility for the big picture of their health. And even those colds, too.

Primary care physicians still serve as an entry point into the healthcare system and a primary point of contact for patients. After all, specialists, urgent cares, and hospitals always ask for a primary care physician. They typically refer patients back to their primary care physician for follow-up, too.

“We have to reduce fragmentation of care if we’re ever going to have that kind of patient-centered care,” Blair says. “If you have a football team, you better have a good quarterback, someone to coordinate the play.”

The concept of a patient-centered medical home (PCMH) is one that physicians, including Blair, are promoting within their practices. The goal is to reign in patients who hop from specialist to urgent care to a second specialist while self-diagnosing and treating a potentially more serious problem. This could also be a way that physicians can convince millennials to return to primary care.

Madden says that while the concept is relatively new-the term was coined in the ’70s and ’80s but the National Committee for Quality Assurance began its push for it in 2008-the model is one that older generations already follow, as they grew up with different attitudes about physicians. And a different healthcare system.

The bonus of PCMH is that care delivered through this kind of network usually coincides with better use of patients’ insurance and can reduce out-of-pocket costs. If millennials find themselves a good PCMH, they’ll have much better health outcomes and a much different relationship with their doctor, Madden says.

Madden says that part of the problem is millennials are typically at the peak of their health and don’t have many chronic conditions. Until they’ve reached a stage in life where they need more care, they won’t likely see the benefit of a PCMH until they’re utilizing it to their full potential.

The good news? Madden finds that patients in their 20s and 30s are very conscious of their health. They exercise more and eat better compared to older generations. They see things like stress reduction and meditation as a form of self-care.

And they’re encouraging others to adopt good habits by sharing what they’re doing on social media. There are plenty of posts about their fitness challenge and trending diets. There are endless hashtags highlighting self-care routines that include everything from a good face mask to a trip to the dentist.

Rather than wait until it’s too late to convince millennials of the need for a primary care physician, it’s important that healthcare providers lean into the technology younger patients are craving now to bring them into the fold, so they have the tools to seek care down the road.

“We know there is a lot of benefit inherent in having someone coordinate care,” Madden says. “That helps with efficiency of care, effectiveness, and outcome.”

Kristine Gill is a freelance writer based in Naples, Fla.