Claudia Covello, executive director of University Health Services at the University of California, Berkeley helped me understand the challenges and opportunities of serving almost 28,000 students who fall into the millennial age range with a full array of services including medical care, mental health care, urgent care, lab, optometry, immunizations, radiology, pharmacy and social services. The students face their own set of challenges, with almost 40 percent of them on Pell Grants (i.e., they come from low-income homes). For more than half of them, English is a second language. These are similar to the challenges faced by many health care organizations in the U.S.
Covello was reluctant to make generalizations about millennials but tentatively offered a few for our consideration:
“Different from prior generations, they want us to continue to stay in the parental role,” she says. “While they don’t want to be treated like children, they want to be guided.”
“Don’t assume anything,” she also says, “even how to make an appointment, how to choose a doctor or when to seek counselling.
“We have learned that talking about seeking health care is probably the most boring topic for students, so we engage them by talking about what they want to talk about. When talking about topics like sexual assault, alcohol abuse or stress, we weave in the health services that can support them.”
Even though all services are within a few blocks’ radius of campus, the students tend to ask questions about how they will they get to them. “They want high levels of customized care and immediacy,” Covello says. “Self-directed” services, where students can pick up standard prescriptions, manage pre-existing conditions or go in for routine care have been a huge help to them.
Mental health is one of the major issues on campus and keeps growing in importance. Since mental health is still somewhat stigmatized, the university’s health services has placed a psychologist and social worker in academic departments with drop-in hours. “Creating easy access in a nonthreatening and nonstigmatizing venue has proven to be wildly successful,” Covello says.
“Another major initiative we are adopting is an integrated care or collaborative care model,” she says. “Much like what hospitals and health systems are trying to do, we have added clinical psychologists, social workers and health educators and are piloting adding a clinical social worker.” For example, a student may make an appointment with a physician for a bodily ailment; but after listening to his or her history, the physician might prescribe some short-term meds and also do a warm hand-off to a psychologist. “Students love this approach — particularly having access to all providers in one visit.”
When I asked for Covello’s advice to hospitals, she gave me three tips:
- Millennials should be invited to offer feedback on a provider’s website and encouraged to comment on its ease of use and interactivity.
- Providers need to learn a new way of communicating. While these younger patients may be smart and well-informed, they need more follow-up and specific instructions than others. “Don’t take anything for granted,” she says.
- To learn more about the millennial generation, conduct satisfaction surveys and ask open-ended questions.
To that end, leaders at many health care organizations have been working to understand and serve the unique needs of millennials. I spoke to three leading health systems in California: Kaiser Permanente, Sharp HealthCare and Sutter Health. Some common themes emerged about listening and learning; expanding digital solutions; improving access and convenience; delighting the customer; and communicating and connecting.
Listening and learning
Asking questions of this group and understanding its needs is crucial. In a Kaiser survey of millennials, the system found that health care coverage was important to them — “and they were willing to make trade-offs for this,” says Christine Paige, senior vice president for marketing and digital services. They also describe what “being healthy” means in terms similar to those of older Kaiser members — that is, “eating right,” “not being sick or injured” and “being at a desired weight.”
“Decision-making should follow based on your patients’ needs and not staff or provider demands, although it is easier said than done,” says Steven Green, M.D., chief medical officer for Sharp Rees-Stealy Medical Group. “Old traditions and norms are hard to break. Something as simple as reading survey comments can provide you with valuable ideas you may not have thought of.”
Expanding digital solutions
Understanding that access and convenience are top of mind not only to millennials but to all of its members, Kaiser has been working to improve access through email and telephone visits. In fact, email and telephone together make up more than 56 percent of all “touches,” says Paige. The health system is moving aggressively on this front and adding more video visit options. (See my “Three Approaches to Virtual Office Visits” from the July 16, 2015, H&HN Daily.)
At Sharp HealthCare, the patient portal MySharp launched in 2010 for similar reasons. “Instead of having to call, leave a message for your doctor and wait for a reply, patients can email us with detailed questions (rather than playing phone tag) — and get a much quicker response,” says Green. Much like Kaiser's electronic health record, lab results are available online to patients, along with educational information about normal ranges and other factors. “Not only is this more convenient,” says Green, “but it offers greater privacy — not having to talk to your doctor’s office from your cubicle or classroom.”
“Mobile is really the way to go,” says Kelly Faley, vice president of digital marketing for Sharp, “and if you aren’t there yet, this is where you need to focus. As we well know, health care tends to be behind the curve in technology, and we need to catch up.”
Improving access and convenience
“It’s our experience that millennials place special emphasis on convenience, customer service and cost,” says Sutter Health spokeswoman Karen Garner. The system has established Sutter Walk-In Care clinics that are open seven days a week, from 8 a.m. to 8 p.m., and offer amenities including charging stations, free Wi-Fi and complimentary refreshments. Fees stay consistent, so visitors know what charge to expect every timel. Walk-In Care locations are also stand-alone storefronts in shopping centers, which means they are a part of the neighborhood landscape and next to businesses like the local grocery store or dry cleaner.
While Sharp also offers extended hours, it has same-day appointments, early morning and evening hours and weekend appointments to accommodate all schedules. Kaiser, too, has been trying some fresh approaches and is piloting in-store clinics at Target stores in Southern California.
Delighting the customer
For decades, The Walt Disney Co., The Ritz Carlton Hotel Co. and Nordstrom have been talking about going beyond mere service to delighting the customer. Unfortunately, “service” and “customer” (or consumer) have been concepts adopted by health care with some difficulty. The introduction of more self-directed health care purchase options has made customer delight all the more important today.
“Millennials expect an Amazon experience, and we need to move to more modern ways of engaging with them" says Faley. "As avid users of Yelp and similar rating sites, millennials want quick and easy access to information about their doctor or hospital.”
In fact, Sharp is launching its “star ratings” based on Press Ganey surveys on doctor profiles, which will include patient comments. “We would much rather potential patients look at our own site for credible information based on our patient comments,” says Green. “We are proud of our physicians and want to share the robust information and ratings we have gathered.”
“At its core, health care is personal, so let’s get the administrative functions out of the way and let our caregivers focus on the care,” says Faley. “If we can check in for our flights and choose our hotel rooms on our phones, why can’t we make appointments, check in for our doctor’s appointment and pay our copay the same way?”
Communicating and connecting
Getting “eyeballs” with members of the millennial generation in their cluttered multimedia world can be challenging, to put it mildly. To that end, Sutter Health launched a digital partnership with Vice Media, a leading youth media company, to debut a health-focused channel named Tonic. The channel allows Sutter to reach this audience with its brand while offering a new, creative canvas for its clinical experts to be featured in original documentaries and other editorial content — in a place that millennials trust.
Sharp’s Faley says it has established a customer media room that monitors activity on Sharp's social media channels to look for problems and try to address them in a timely fashion. It also is trying to keep constituents engaged by pushing out at least two stories a day on social media, which it has found to be a success.
What I gleaned from all these conversations is that, while millennials may be at ease in the digital realm, they do want a personal relationship, support systems and someone taking an active interest in them. Their needs may be the impetus for pushing us a little harder to rethink our care and delivery systems — like creating new technologies or more convenient access. The outcomes of these adjustments, modifications and new approaches not only serve millennials but improve life for all of us. What could be better?
“The rewards and gratification of being a part of molding these young lives and setting them on a path to healthy living far outweighs any challenges,” says Covello.
And I certainly wish them every success.