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Here's how millennials could change health care

Jason Hidalgo
Reno (Nev.) Gazette-Journal
University of Nevada Medical School grad student Denise Reyes, middle, and undergrad student Heather Green work together in a lab at the Center for Molecular Medicine building in Reno on June 25, 2015.  Student Adam Kirosingh is seen on the left.

Daniel Martinez surveys the floor of a Reno restaurant on a Friday evening, his nicely pressed suit evoking the kind of sharp-dressed man that rockers ZZ Top sing about.

Surrounded by multicolored lights and the familiar din of slot machines, Martinez quickly handles multiple queries about kitchen operations and hotel room service without skipping a beat. As an assistant manager, efficiency and customer satisfaction are high on the 26-year-old’s list of job priorities.

Ask Martinez what would happen if a restaurant was run like the United States’ healthcare system, however, and the millennial gives a not-so-positive diagnosis. “Oh God, it would fall apart,” Martinez said. “It would be like, ‘You want pasta? Too bad, I don’t care what food you want, all I care about is making you not hungry.' "

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It’s a jaded assessment born from Martinez’s own interactions with a system he considers outdated, inefficient and ill-equipped to handle the needs of its customers. Martinez’s experience includes being told he could not see a dermatologist in Reno but could meet with one in a month about 30 miles away in Carson City.For someone used to quickly ordering products and services from the convenience of his smartphone or tablet and having them on his doorstep the next day, Martinez says the archaic structure behind the healthcare system just doesn't cut it. This is especially true for millennials weaned on the Internet age, he added.

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Danial Martinez stands inside the Cantina where he is the assistant manager at Grand Sierra Resort Casino on Jan 11, 2016

"We’re the instant gratification generation,” Martinez said. “I don’t want to wait two months for a delivery on a pair of shoes.”

With a presidential election fast approaching, healthcare is an issue that’s getting plenty of traction on both sides of the political aisle. For Republicans, taking down President Obama’s signature Affordable Care Act remains a red meat issue. Republican presidential candidates are also trotting out an ACA repeal as a key incentive for voting a member of the party into the Oval Office. Healthcare has been a key issue in the Democratic debates as well, with Hillary Clinton pushing back on rival Bernie Sanders’ plan for universal health care.

Amid all the debate, however, one group could prove to be the wild card. As more millennials interact with the healthcare system, the industry will find itself facing a more sophisticated and demanding group that won’t stand for its inefficiencies with the same begrudging acceptance of previous generations, said Kathy Hempstead, director of insurance coverage for the Robert Woods Johnson Foundation.

“Older people have sort of gotten used to interacting with healthcare providers in certain ways, even though the rest of the service sector has made all these improvements in customer service while the healthcare industry hasn’t,” Hempstead said. “I think millennials are going to give the healthcare industry more impetus to really improve the customer service part of what they do.”

Dr. Bayo Curry-Winchell poses for a portrait at her office in Reno on Jan. 27, 2016.

Dr. Bayo Curry-Winchell has an inside track on what millennials think about healthcare. In addition to having a background in family medicine, the Saint Mary’s Urgent Care administrator also happens to be a millennial herself.

“My generation is all about convenience and preventive health,” Curry-Winchell said. “We don’t want to see the doctor in person, which is one reason why we want to stay healthy.”

Although older generations such as baby boomers value person-to-person communication and cultivating relationships with their family doctor, for example, millennials are proving to be a different lot.

Growing up with video games, Google and the various trappings of the digital age, millennials’ perspectives are strongly shaped by having the World Wide Web and all its spoils literally at their fingertips. “If you look at the demands of millennials on our society as consumers, they are a group that uses services such as Amazon and the Internet who aren’t really used to person-to-person service per se,” said Dr. Ron Rowes, chief medical officer of Prominence Health Plan.  “They’re used to reaching out when they need something, getting instant gratification, moving on and only coming back when they have the need again.”

It’s a behavior that’s starting to make its mark on the healthcare field and is expected to lead to even bigger changes as millennials get older. At the top of the list is how healthcare is provided.

Daniel Spogen, who chairs the University of Nevada Department of Family Medicine, is already seeing a difference in doctors' relationships with patients. Older generations, for example, develop a personal relationship with their doctor, who they expect to be there for them 24/7 in case of an emergency. “My older patients will say, ‘Dr. Spogen is my doctor,’” Spogen said. “I don’t get that same kind of ownership as much with my younger patients.”

Meanwhile, a 2015 report by Salesforce found that nearly half of people age 18 to 34 do not have a personal relationship with their physician. Forty percent of respondents surveyed also believe that their doctor would not recognize them if they crossed paths while walking down the street. For some millennials such as Martinez, it is apparently a two-way street. “Honestly, if I walk down the street and met my doctor, I wouldn’t recognize him at all,” Martinez said.

Part of the reason is that millennials are  mostly healthy so they don’t need to see their doctors as frequently. The most pressing health issues for millennials usually involve car accidents, injuries and pregnancy, not chronic illnesses such as heart disease and diabetes, according to Rowes. Millennials also aren’t as tied to the idea that they must have one specific doctor be their physician. For standard checkups and consultations, some don’t even feel the need to see a doctor at all. Instead, many millennials are content with seeing a nurse practitioner or physician assistant.

“Part of it is that they’re healthier but it’s also how they consume goods and services in general,” said John Packham, director of health policy research at the University of Nevada School of Medicine. “It’s kind of consistent with them being the generation that doesn’t go to the malls but have Amazon Prime.”

The behavior is helping fuel the rise of quick service retail clinics from CVS, WalMart and Walgreens that are staffed by nurse practitioners and physician assistants. It is also cited as another factor in increased urgent care center usage, although doctor shortages and population play a key role in that as well.

A shopper walks past a Minute Clinic at a CVS Pharmacy in Sparks on Jan. 29, 2016.

Between 2006 and 2014, the number of retail clinics in the United States grew by nearly 900 percent from 200 to 1,800, according to the Robert Woods Johnson Foundation. By 2012, retail clinic visits also grew sevenfold to 10.5 million, which represents 2 percent of all primary care encounters in the country.

Although such services are used by consumers of all ages, millennials are posting the highest usage rate as a group. A PNC Healthcare survey, found that 34 percent of people ages 18 to 34 prefer retail clinics — about double the rate of 17 percent for baby boomers and 15 percent for older seniors.

For the "drive-thru" generation, the preference for convenience comes as no surprise. Rowes remembers having conversations with CVS when it was first rolling out the concept for its Minute Clinic several years ago. “It’s based on the theory that you don’t ask people to come to the office, you bring the office to where the people are,” Rowes said. “Unlike the TV show ‘Cheers’ where everybody knows your name … millennials only access healthcare for the most part when they absolutely have to and don’t see a need for forming a long-term relationship (with a physician).”

Curry-Winchell also sees a lot of millennials visit her urgent care facility. In the past year, one pattern especially stood out for the urgent care doctor. “One thing I noticed in a lot of patients in that age group is that they have not established a relationship with a primary care physician,” Curry-Winchell said.

Krysta Bea Jackson, owner of Sugar Love Chocolates, poses for a portrait at the old post office in downtown Reno on Jan. 22, 2016.

Tucked in the basement of a historic building that once served as downtown Reno’s main post office is one millennial’s labor of love that’s aptly called, well, Sugar Love. Opened officially in December 2015, the chocolate store features an assortment of treats such as vanilla fig, Americana, strawberry balsamic and French truffles.

Just before her store’s grand opening, 34-year-old owner Krysta Bea Jackson was brought down by something decidedly unsweet — a nasty cold that set back her store opening preparation a bit. It also reminded her of one of her biggest concerns as a small business owner: healthcare.

“Luckily, I’ve also been working at (the University of Nevada, Reno) for the last three years but I graduate in May, which is when my contract with them ends,” Jackson said. “I’m actually a little bit nervous about looking at health insurance.”

As someone who also does taxes on the side, Jackson has looked up insurance rates under the Affordable Care Act. What she learned is that it may not necessarily be affordable for her, but she also does not want to be without health insurance. Although millennials typically don’t go to the doctor as often as older populations, Jackson’s own history combined with the standard health concerns that come with being a woman makes health coverage important for her. She also exhibits one common trait shared by millennials about healthcare.

“Maybe it’s because I’m self-employed and have to pay everything out of my own pocket, but I’m extremely conscious of price,” Jackson said.

Although 8 percent of the U.S. general population asks for a discount on medical care, that number jumps to 19 percent for millennials age 25 to 34, according to a 2015 report by global auditing and consulting firm PwC. Millennials also topped a 2012 Deloitte survey as the generation that is most cost-conscious. It’s the group that’s most willing to switch doctors, use retail clinics and travel farther in order to save money on healthcare.

Hometown Health, the insurance of arm of Northern Nevada-based Renown Health, sees a similar pattern with its millennial customers. Unlike seniors who are more willing to pay higher premiums for lower deductibles, millennials typically prefer high-deductible insurance plans or health savings accounts where the premium is lower, said Ty Windfeldt, Renown Health vice president. “What we find is that millennials are more driven by saving premium dollars,” Windfeldt said. “They say, ‘I know I need insurance so I’ll buy it but I want the less expensive plan that you can provide me.”

One way insurance providers such as Hometown Health and Prominence are addressing millennials’ penchant for pinching pennies is by offering new tools that allow customers to do price comparisons for services such as laboratory work. Prominence, for example, is talking with a company called ClearCost Health, which allows customers to do price checks between health services via computer, mobile or even a call center.

Before that, however, there’s still the matter of addressing the archaic system for finding doctors and providers. Researching her coverage online remains a source of frustration for Sugar Love owner Jackson, who had an emergency one weekend and went to an urgent care center far away in Sparks because it was the one specified by her plan. “I just got my bill for that visit and found out my health insurance didn’t cover anything, which is just ridiculous,” Jackson said. “I could’ve just gone to the urgent care center closer to my home.”

Jackson’s problem is indicative of a wider problem that revolves around having a cumbersome system, said Hempstead of the Robert Woods Johnson Foundation. The current support tools for finding doctors, for example, were designed for looking at those within a particular plan but doesn’t provide much information outside of that, Hempstead said.

“Part of the problem is that people don’t have any information to use to find a new doctor,” Hempstead said. “It’s something that needs to change and I think it will change.”

Mike Soule poses for a portrait in his apartment in Reno on Jan. 23, 2016.

As an integration architect for Tahoe Forest Health Systems in Truckee, Calif., 24-year-old Mike Soule has a front row seat to the healthcare industry.

At the same time, the Reno resident also shares many of the same traits possessed by his fellow millennials. These include a preference for speed, efficiency and cost as well as a penchant for embracing new technology. “I really find that the healthcare industry as a whole is a laggard,” Soule said.

Backing among the workers within the field is especially important for any new endeavors to take root, Soule said. In his experience, if any new approach is not championed by the clinical staff, it basically isn’t going to happen. This is why it is important to get younger people who are comfortable with new technologies and open to trying new concepts in the field. Just as millennials can make a difference as patients, Soule believes they also can accomplish a lot as members of the industry.

Soule points to telemedicine adoption as a good example.

“Telemedicine is a great technology and we use it almost daily with the cancer center to talk to (the University of California, Davis) but it’s used rarely between patients and physicians,” Soule said. “Just getting more clinical staff to use these tools would greatly benefit the standard workflow.”

Rowes can relate to the potential disconnect between some clinical staff and technology. His 2-year-old grandchild, for example, knows how to use a cell phone better than he does, he said. Given the fast pace of change, not just with technology but also information, however, those in the field have no choice but to keep up if they want to stay relevant. Rowes expects technology in the works now that most people have not heard of being commonplace in a few years.

“When I first entered medicine, the turnover in medical knowledge was about five years and now it’s two years or maybe even a year,” Rowes said. “By the time the books are written, they’re already out of date.”

Even the healthcare industry, which can be notoriously slow to change, is adopting new concepts that benefit all patients but are an especially good fit with the younger generation. Earlier this year, Renown Health launched its Virtual Visit program and is also looking at leveraging apps for healthcare. Virtual Visit has been especially popular with millennials.

“We know some of our populations don’t want to schedule an appointment and wait to see a doctor in person, so this allows them to talk over a smartphone of the computer,” Windfeldt said. “We’re continuing to evolve and we’re seeing other companies across the country doing this as well … to better meet their patients’ needs.”

A file photo showing the outside of Renown Regional Medical Center in Reno. Hospital employees say scammers have been posing as medical staff and calling patients demanding for payment and credit card information.

The question now is whether millennials have the clout to force the kind of change that is being placed on the generation's shoulders. After decades of rising healthcare costs and worsening customer service with seemingly no improvement, it’s understandable to look at the influence ascribed to millennials as more pie-in-the-sky proclamations.

As millennials take over the workforce, however, they also gain something that any industry values most: spending power. In 2014, millennials accounted for a quarter of the U.S. population, according to a report by market research firm Mintel. By 2020, the generation as a whole is expected to spend $1.4 trillion each year, the report said.

High school students, from left, Steven Dash, Eber Moreno and Joanna Silva listen to a simulated heart beat as current medical student Nikki Heidt, right, looks on during an open house tour of the University of Nevada Medical School in Reno on April 11, 2015.

It’s the kind of financial clout that’s already making its mark on the healthcare sector as well. Once it’s clear that there is money to be made, even the slowest-moving industry will be sure to capitalize, according to Packham. Ultimately, the monetization of healthcare just might be what makes it more user friendly.

“Millennials’ expectations of healthcare are different than my generation and that will affect change,” Packham said. “The system might be a bit slower to respond, but I do think that the medical practices and healthcare providers that manage to resolve this will have a competitive edge.”

At the same time, some caution against being too caught up in the glitz of the latest new technology and conveniences. Although telemedicine and apps are great, there’s still something to be said about having a face-to-face discussion with your doctor in the same room — which still holds true even for millennials, Curry-Winchell said. The key is being able to strike a balance between adopting new technologies while preserving the advantages of a traditional patient-doctor relationship, she said.

“A lot of times with technology, a lot of things get lost in translation,” Curry-Winchell said. “There’s still no replacement for putting your hands on a patient and feeling their heart, which you can’t get when you’re talking on a computer.”

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