Dr. Sara Pastoor: Want young people to trust healthcare? Invest in primary care now

This is a version of an article authored by Elation's Director of Primary Care Advancement, Sara Pastoor, MD. The article recently appeared as a guest post: "Industry Voices - Want young people to trust healthcare? Invest in primary care now" on Fierce Healthcare. 

Nina thought she’d found the ideal solution to straighten her teeth.

After researching online, the 24-year-old MHA graduate and manager of primary care advancement chose a digital health solution that promised to send affordable aligners to her front door—no visits to the orthodontist’s office necessary.

As the treatment progressed, Nina’s jaw began to hurt. Her online orthodontist assured her that her bite was settling correctly, but when the pain didn't stop, she grew concerned. She reached out for guidance again toward the end of her treatment. Weeks passed without a response. With little recourse, she consulted an orthodontist in person.

The remote treatment, she learned, hadn’t improved her dentition at all. Instead, it threw her bite even further out of alignment. No one caught the issue early enough to prevent the damage. Recovery was possible, but it would take more time and money. When the digital health company finally responded, their best offer was a partial refund that would be issued only after Nina signed a nondisclosure agreement.

“I knew they were trying to keep me quiet,” Nina told me. “And I learned that this is happening all the time. Patients who experience these issues sign the agreement and these remote healthcare organizations continue to turn a profit, taking advantage of those in a vulnerable situation.”

Nina’s story typifies a healthcare trend that will worsen in 2023 if we don’t act soon. Frustrated by impersonal, inaccessible primary care services, Generation Zers and millennials are searching online to find healthcare solutions that promise convenience. Sometimes at odds with best practices and scientific evidence, these shortcuts can lead to negative health outcomes and financial consequences.

According to industry surveys, more than a third of Gen Zers and millennials are dissatisfied with the location or channel of their care and nearly half report dissatisfaction around the effectiveness of their treatments. Pursuing alternatives to traditional care, many younger people lose opportunities to develop relationships with primary care providers who can guide them through critical health decisions. A 2021 University of Michigan study, for example, found that third-party direct-to-consumer telemedicine visits “are most commonly performed by clinicians who work for national for-profit companies with whom the patient has no existing relationship and who lack access to prior medical records.” This rise in remote, “drive-thru-style care” may improve access, but it threatens the healthcare system by intensifying fragmentation and introducing preventable costs.

To better serve Gen Zers and millennials, the healthcare industry must invest in sustainable primary care run on payment models that incentivize value instead of transactions. This approach prioritizes patient health that meets patients where they are, thereby reducing system fragmentation and improving the convenience that younger people demand.

As part of the mission, we must demonstrate that primary care is vital to long-term health. Patients like Nina don’t typically expect to find an advocate at the doctor’s office because, as a nation, we’ve undervalued and underinvested in primary care.

The U.S. commits only 5% to 7% of its total healthcare spend on primary care, compared to the 14% average of nations in the Organization for Economic Co-operation and Development, according to a report (PDF) from Primary Care Collaborative. At the same time, the prevailing fee-for-service reimbursement model incentivizes doctors to shorten and stack consultations.

The result: overworked doctors, a crushing bureaucracy and long waits for limited services that don’t always match younger people’s needs, which include mental health, substance abuse care and alternative treatments. Ultimately, the disjointed healthcare journey erodes trust and hurts health outcomes.

Is it any wonder that Gen Zers and millennials are abandoning relationships with primary care providers at alarming rates? A second Primary Care Collaborative study (PDF) found that the percentage of people aged 18 to 34 in the U.S. without a regular source of care increased from about 38% in 2014 to 46% in 2019, the highest rate of any age group. The study lists possible causes for this spike: Younger, healthier patients may have fewer reasons to visit doctors. The group may be more likely to seek medical information online, and some may lose insurance through their parent’s plans at age 26.

We will only gain younger generations’ trust and close the widening rift between people and the care they deserve when we promote sustainable primary care. The most critical step in this journey is moving to value-aligned payment models that reward better health outcomes, not overloaded schedules. These models improve patient well-being and have been shown to help reduce overall costs while promoting prevention and wellness.

Next, the care must be omnichannel, accessible and convenient. We must ensure that virtual care allows patients to access a primary care provider from anywhere with a cellphone or Wi-Fi signal. And telemedicine needs to integrate patient information across all points of care so that critical data never fall through the cracks.

Sustainable primary care with these attributes will support a type of practitioner that I like to call “the grand integrator.” These well-resourced advocates partner with patients, providing immediate, transparent, coordinated and customized care. They are a grounding force amid the health system’s chaos, integrating information and insights while quarterbacking care across touch points.

Patients will trust their grand integrator to offer comprehensive care at the right place and time. And they’ll know that their doctors understand their individual needs and history well enough to build tailored treatment plans as health issues arise.

Building this system takes time; we can see glimpses of a brighter future in the healthcare landscape today.

First, the expansion of digital healthcare during the pandemic proved that patients can access care remotely, breaking down a significant barrier to convenience. For example, my 18-year-old daughter can securely text her primary care doctor, which has created trust in their doctor-patient relationship and given her a sense of autonomy over her own health.

Second, innovators like Crossover Health show that an alternative payment model focused on value is not only possible, it’s the foundation for the sustainable care Gen Zers and millennials demand and we all deserve.

The medical group meets the diverse needs of the generations by combining primary care with physical therapy, mental health and health coaching. It meets the demand for convenience by prioritizing access through in-person and virtual care. And it enhances services with data analytics and a focus on social determinants of health.

Without more options like Crossover Health, we can’t blame Gen Zers and millennials for falling into the marketing funnels of dubious online health services or making lunchtime visits to urgent care centers. It’s the world they know.

But that world is not sustainable.

As these groups age, they need partners to help them navigate ongoing and complex health issues. We must continue prioritizing innovative primary care now to prevent what could become a massive healthcare crisis when these groups reach their 50s, 60s and 70s.

The health of generations is at stake.