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A New Way to Think About Healthcare Consumerism

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With the Boomers rapidly nearing peak retirement age and the even larger Millennial generation making hard pushes for change in care delivery, the morphing face of American healthcare consumerism is very much on the minds of hospital executives, physicians, underwriters and policy wonks alike. What will the consumer healthcare landscape look like over the next 5 to 10 years? What generational insights could providers employ to increase effectiveness in their marketing and patient engagement efforts?

First, let's take a look at each generation's unique circumstances. We'll compare and contrast their views and begin to think about ways your organization can tailor service lines and engagement efforts to maximize impact on members of those cohorts.

Then, we'll examine how healthcare providers can look through Boomer and Millennial lenses to focus the messaging in their marketing and provider-to-patient communications.

Boomers face serious health challenges.

The generation born between 1946 and 1964 is projected to be, overall, one of the longest-living generations in American history. That doesn't mean it's by any means the healthiest.

According to the Centers for Disease Control and Prevention (CDC), the percentages of Boomers who suffer from metabolic syndrome-related conditions — high cholesterol, hypertension, obesity, diabetes — have been steadily ticking up over the last decade, even as life expectancy for members of most Boomer-aged demographics has increased (low-to-middle-income Caucasian Americans excepted). Where the number of deaths attributable to heart attacks, strokes, cancer and dementia fell from 2003 to 2013, the number of people living while managing recovery or aftercare for these obesity-associated diagnoses are expected to rise right along with the obesity epidemic. Simply put, modern life-sustaining treatments are allowing the Boomers to live sicker, longer.

Unless drastic lifestyle and care management changes occur, aging Boomers are probably going to need more acute care than their predecessors. They're going to need more frequent short-term and more extended long-term rehab. Many seem to have difficulty self-managing, so they'll need home care and case management. And the nation faces a critical lack of incoming primary care physicians and geriatricians.

The Boomers are going to tax our care delivery systems like no generation has before.

Boomers are in poorer financial and emotional states than preceding generations.

For every generation in American history, quality of life improved. Until the Boomers hit retirement. Many are woefully underprepared after a lifetime in which they borrowed heavily, consumed much and saved little. And when they began to hit retirement in and around the 2008 Great Recession, those chickens came home to roost.

Boomers are under increasing amounts of stress. As Time reported, the percentages of individuals aged 55-64 who reported suffering from mild to serious psychological distress grew, between 2003 and 2013, for members of households at every income level below 400% of the Federal Poverty Guideline (FPG).

For the topmost income levels, there was no discernible change in stress rates — the proportion there held steady at 4.6%.

Despite overall gains in the number of covered individuals realized by implementation of the Affordable Care Act (ACA), Boomers somehow seemed to have bucked the positive trend yet again. From 2003 to 2013, the percentages of covered persons ages 55 to 64 actually fell for income levels below 400% FPG.

Although Medicare entitlements more than make up for the difference, by some estimates the real cash value of Social Security benefits taken is already at, or below, lifetime pay-ins for single males and single females. In essence, even given cost-of-living adjustments, for some Boomers, Social Security represents a losing lifetime investment.

Compounding the issue, many Boomers dipped into their retirement savings during the Great Recession and 2008 mortgage crisis. Others were laid off, or saw their employers welch on pension obligations. So, already-stressed individuals are approaching retirement with less health coverage and less income security. Many Boomers are rightfully afraid for their future.

Millennials have much to fear, too.

In some respects, Millennials face even less financial surety than Boomers do. The Millennials also have little faith in a Social Security system that faces reserve depletion by 2034. With no expected population rebound to prop up entitlements with additional revenues, many adults born between 1980 and 1995 are beginning to assume that those entitlements will be reduced or unavailable by the time they reach retirement. Many have no idea how to begin planning an alternative.

Although Millennials are more likely than Boomers to make fitness activities part of their regular routines, according to Goldman Sachs analysts, they are by and large underemployed, over-indebted and stressed out. In fact, the 2015 c2b Consumer Diagnostic, a national study of healthcare consumer attitudes and behaviors, found that Millennials are statistically more likely (95% confidence) than all other generations to indicate an Extremely/High Level of Stress.  Many — even after college graduation — still live with their parents, either because they cannot afford to live on their own or because they are attempting to save or pay down debts. Those Millennials who are independent and working have realistic fears (given the tight labor market) about job security, and those fears often keep them from taking time off to seek care from a primary care doctor.

Millennials often prioritize convenience over proper care.

Many younger adults rely on after-hours ED, urgent care or retail clinic visits to address their healthcare needs. Indeed, many members of this age cohort prefer to turn to convenient retail clinics for their primary care.

The problem with that, from a provider's perspective? The lack of a cohesive primary care record can mask health trends and make diagnosis of developing chronic conditions exceedingly difficult.

The continuing lack of transparency in healthcare pricing also keeps many young-to-middle-aged adults away from traditional care delivery channels. According to a 2015 PNC Healthcare survey, 80 percent of Gen X and Millennial respondents agreed that healthcare costs are (a) too high and (b) too unpredictable.

The lack of ability to shop and meaningfully compare costs across providers or across facilities, coupled with the prospect of getting socked with an unaffordable bill — due to higher deductibles, higher co-pays or other factors— drives many younger adults to wait until the last possible moment to seek care.

That translates into many Millennials foregoing appropriate preventative care and/or post-acute follow-on care. And that, in turn, can lead to higher initial acuity upon future presentations.

Although Millennials' reasons for delaying care aren't irrational, per se, they must be addressed because there are clear negative consequences for patients and for providers. In an era in which hospitals are being heavily penalized for readmissions and, concurrently, incentivized for preventative care, the industry must find a way to overcome Millennials' recalcitrance.

It comes down to differences in communication styles.

According to Becker's Hospital Review, the most glaring differences between Boomers and Millennials lie in their respective levels of directness, sociability and digital savvy.

Although more than half of Boomers will tell a provider directly if they are unsatisfied with their care, Millennials are more likely to forego telling the provider and will instead vent to their age-peers. That probably means that Millennials are less likely than Boomers are to give healthcare providers an opportunity for service recovery.

Younger adults are much more likely than Boomers to consult their friends or family members for recommendations when searching for a provider. They tend to crowdsource comparisons about quality of care or in-clinic experiences and outcomes. They're also more likely than Boomers to search online for provider recommendations (hence, the rise of sites like HealthGrades) or for healthcare information (e.g., WebMD).

Psychographics also influence Boomer vs. Millennial communication styles.  Psychographics pertain to people’s values, attitudes, personalities and lifestyles, and are a key to understanding a healthcare consumer’s motivations and communication preferences.  Psychographic segmentation groups like-minded healthcare consumers according to these characteristics.  c2b solutions developed a psychographic segmentation model that is 91.1% predictive as to which segment a healthcare consumer belongs.   The five psychographic segments, in order of most proactive and wellness-oriented to least, are as follows:

  • Self Achievers: Self Achievers invest what is necessary toward their health and appearance. Self Achievers may actually have health issues, but they stay on top of them with regular medical check-ups, health screenings, and research. Self Achievers are task oriented, and will tackle a challenge if they are given measureable goals.
  • Balance Seekers: Balance Seekers are generally proactive in their health and wellness-oriented. Balance Seekers are open to many ideas, sources of information, and treatment options when it comes to their healthcare. However, Balance Seekers themselves – not healthcare professionals – define what success looks like in their health. A directive healthcare professional can be a turn-off for Balance Seekers, as they prefer more suggestive approaches.
  • Priority Jugglers: Priority Jugglers are very busy with many responsibilities. Because of these responsibilities, Priority Jugglers may not take the time to invest in their own wellbeing and are reactive when it comes to health issues. However, Priority Jugglers are very proactive when it comes to their family’s health and will make sure their loved ones receive the care they need.
  • Direction Takers: Direction Takers are reactive with their health and look at their physician and other healthcare professionals for direction and guidance because of their expertise and credentials. Direction Takers are more likely to go to the doctor at the first sign of health concerns. However, Direction Takers may not always follow a physician’s advice, because it is often difficult to work these recommendations into their daily routine.
  • Willful Endurers: Willful Endurers live in the moment and believe there are more important things to focus on than improving their health for the future. Willful Endurers are self-reliant, and while they are not necessarily unhealthy, they do what they like, when they like.  They typically have a difficult time changing their habits, going to the doctor only when they absolutely must.

These segments appear across all populations, regardless of age, gender, ethnicity, health condition, etc., and respond to unique messaging to activate positive health behaviors.  However, the distribution of the psychographic segments varies across generations: 

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The psychographic segments are fairly evenly distributed across the Baby Boomer generation, but the Willful Endurer segment is over-developed among the Millennials.  This segment is the most challenging to activate positive health behaviors, but it can be done with the right motivational engagement. Again, the key with all psychographic segments is to employ segment-specific messaging and preferred communication channels (e.g., face-to-face, text/SMS, email, phone call, etc.)  Such insights can be found with the 2015 c2b Consumer Diagnostic.

America's embrace of healthcare consumerism demands that hospitals, provider organizations and health insurers pay attention to these differences. Communications and marketing should consider the circumstances individuals in each generation face, as well as the ways those circumstances are likely to color consumer outlooks within each cohort.

The consumer healthcare landscape can be shaped with nuanced messaging. And psychographic segmentation can help you to develop those messages.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change

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