In the News: Research by Augustana Students, Faculty Examines Millennial Health Care

Millennicare story in the Sioux Falls Business Journal

The cover story for the Nov. 4 issue of the Sioux Falls Business Journal features research conducted by Augustana faculty and students. 


In a recent article, the Sioux Falls Business Journal examines the way millennials are shifting health care delivery.

Research by Augustana Assistant Professor Jaciel Keltgen and her "Health Care Marketing" class is featured in the story. Keltgen's research focuses on millennials working in healthcare.


Millennials Shifting Health Care Delivery

By Jodi Schwan, Sioux Falls Business Journal

For years, hospitals and health systems built big.

In Sioux Falls, multimillion-dollar buildings rose on both sides of town, designed for cancer patients, cardiac care and children.

Today, those same health systems are thinking about delivering care in a space the size of a smartphone.

Or in a neighborhood setting.

Or out of a grocery store.

"It's invention by necessity," said Dave Flicek, chief administrative officer of Avera Medical Group.

Much of it is being driven by the millennial generation – those born between 1980 and 2000 – who are in their earliest years of making their own health care decisions.

"I think this generation can be unique in that they're a young, healthy population," said Dr. Allison Suttle, chief medical officer at Sanford Health. "There are different strategies. It's very much looking at how do we use technology, how do we reach these populations in a different way."

What that sort of health care delivery looks and feels like is still being defined.

"The millennial question is a very vexing issue, and it's in every industry, but because health care is so large and all of us are involved to some extent, it seems even a larger issue," said Jaciel Keltgen, an assistant professor at Augustana University whose research focuses on millennial health care professionals.

"We're looking at a generation that hasn't even defined itself very well yet as consumers, but yet they're so important in the future. All of it is in flux. And health care is in flux."
Jaciel Keltgen
Assistant Professor, Augustana University

Measuring MillenniCare

Last year, Keltgen and her health care marketing class collaborated with Avera Health Plans on a study dubbed MillenniCare.

It looked at people in Sioux Falls age 26 to 35, who were no longer able to stay on their parents' health insurance.

It found the act of purchasing insurance "is tied to situational factors affecting millennials" such as financial stability and life choices including marriage and having children.

"Millennials report higher levels of debt, poverty, unemployment and lower levels of wealth and personal income compared to Generation X and baby boomers when they were at the same stages in their life cycles," the report said.

"At the same time, financially unstable millennials are often the primary target of new, individual health care plans."

Millennials born closer to 1980 probably have found health care through their workplace or have figured out how to sign up for it, Keltgen said, but younger ones "are thinking, 'I'm not worried about that right now.' It's just not a reality for them," she said.

Her findings said many millennials would "take the hit in their tax return the first year (health insurance was required) as they tried to figure it out, but by the second year the tax consequence would be more daunting," she said. "It seems like a lot of work, a lot of effort, a lot of hoops to jump through, and they're not sure how to get information because millennials, for the most part, ask their friends. And if their friends don't know, they Google it."

Engaging millennials in the health care system is about making it quick, easy and not too expensive, Keltgen said.

Both large Sioux Falls health systems are responding to those preferences.

They have introduced same-day scheduling to "meet them (patients) where they're at," Flicek said. "Let them come online and make the appointment, or we'll make it for them."

They also have introduced blogs and other online content to connect with Web-surfing millennials who try to self-diagnose before seeking care.

"So when the question does arise and they've never been in for health care, maybe when they do a Google search our blog pops up and they start reading our opinion on things," Suttle said. "We deliver content multiple times a week and have had great adoption."

Sanford reports its blog recorded almost 10,000 visits last month, and 81 percent came through a mobile device.

The more educated millennials are, the more likely they are to look at research and information, Keltgen said.

"They're not as susceptible to an advertised message," she said. "It needs to feel more organic."

Augustana's research found "scare-tactic" marketing messaging created the most drastic response as far as convincing millennials they need to seek care or coverage.

"It's more the realization it could cost you a lot of money even though you think you're invincible," Keltgen said. "If you have an accident, it could cost you a lot if you don't have health insurance. Millennials think they're healthy. They don't go to the doctor that often, and they don't think anything is going to happen to them."

Ease of access

When millennials do become consumers, health systems are aiming to make the experience as easy as possible.

Sanford e-visits involve filling out a questionnaire and getting treatment for certain conditions without having to talk to a doctor or come into a clinic.

"You can fill out the questionnaire on your time and get medical advice within an hour," Suttle said.

Avera and Sanford offer virtual visits through a computer, tablet or smartphone.

Sanford reports it has done 2,351 virtual care appointments in the past two years. That includes e-visits and video visits.

"What's interesting is it's a female most likely that does an e-visit or video visit, and the average age is 40," Suttle said. "We've had people in their 60s and 70s do video visits as well. Everyone has the need for convenient care. It kind of brings health care to their fingertips."

Making care more convenient also extends to how the systems are planning new buildings.

Avera's west-side clinic under construction at 28th Street and Marion Road will include the state's first freestanding emergency department as well as urgent care, family practice, internal medicine, obstetrics and gynecology, pediatrics, behavioral health counseling, a laboratory, radiology and an Avera Breast Center location.

A clinic with similar services opened last year at 69th Street and Cliff Avenue.

"That was our first departure from our typical family practice clinic," said Dr. Dave Kapaska, president and CEO of Avera McKennan Hospital & University Health Center.

"We felt we needed to expand primary care and get into neighborhoods throughout the city to be visible, accessible and responsive to people in those areas. We've been very pleased with the model."

Avera owns more land near its northwest clinic at 4011 W. Benson Road that could allow for expansion of services in that area at some point.

While the growth of neighborhood services relieves pressure on the hospital campus, it also adds to patient convenience, Kapaska said.

"It's important for us to be present in a solid way and serve the people as our city grows, and that's really what we're trying to do."

Sanford also has looked at adding clinics in the southwest and southeast parts of Sioux Falls as well as near its sports complex in the northwest, said Matt Hocks, executive vice president for Sanford Clinic.

"We've always had a strategy to put clinics into neighborhoods," he said. "I don't see us backing away from that anytime soon."

More unconventional approaches are coming, however.

The Hy-Vee Healthy You Mobile Powered by Avera debuted this summer. Billed as "a mini health fair on wheels," it's outfitted with two exam rooms to provide health information and screenings at events.

Hy-Vee dietitians and pharmacists will staff the vehicle and provide Avera-developed wellness information as well as information about Avera Health Plans.

That's in addition to small Avera clinics being added at several Hy-Vee stores.

"We have to get in those various spaces ... so we can meet them where they're at," Flicek said of millennial patients. "You're not going to see them in the clinic until they're sick, so how do we reach out to keep them excited?"

There are more advances ahead, too.

Both systems are considering ways for patients to enter their personal information electronically before leaving home for a health care visit.

Sanford is looking at adding more options for virtual visits and rolling out text alerts to trigger reminders when patients are due for shots or exams. At some point, patients might be able to take their vital signs at home and wirelessly send them to a health care provider.

"Millennials are kind of leading it, but a lot of the shift in technology and getting care closer to home can be good for health care," Suttle said. "It can improve quality of care. And ultimately that helps everyone."

Five ways millennials are altering health care

A survey earlier this year by PNC Healthcare found five trends that show how millennials are driving changes in health care:

  • Speedy delivery. Sixty percent of millennials surveyed preferred to receive care at a retail or acute care clinic.
  • Word-of-mouth marketing. Almost half of millennials reported using online reviews when shopping for a health care provider.
  • Kick the tires online. Half of millennials checked online information about insurance options, while older consumers preferred printed materials or talking to a representative
  • Good faith, upfront estimates. More than 40 percent of millennials are inclined to ask for and receive cost estimates before undergoing treatment.
  • Kicking care down the road. More than half of millennials reported delaying or avoiding treatment because of cost.