Kids these days.

Annual giving directors from private and public institutions of all sizes tell us that millennials have them scratching their heads. A socially conscious generation, they’re quick to open up their wallets for a variety of causes, but also skeptical about giving back to universities. 75% of millennials say that they’d donate to another nonprofit before making a gift to their alma maters.

Why the disconnect?

For many young people, it comes down to impact. As a young alumna from Augustana College told us, “It would never cross my mind to give to my school. If I can only give $100, you get to see that go so much farther with a smaller, more localized cause. If you give $100 to a school you might get a thank-you note. It almost feels like giving your money to the mall.”

And we all know what’s happening to malls.

Annual funds can avoid similar fates by capitalizing on this shift in motivation toward cause-based giving. Keep reading to learn three strategies for cultivating young alumni by connecting them to causes they care about.

Millennial alumni skeptical about giving to higher ed

1. Solicit for “common denominator” causes

Donors increasingly want to have a direct impact on beneficiaries’ lives, and too often, solicitations make broad, institutional asks that don’t align with their passion to do so. To solve this problem, advancement staff need to identify gift designations that a large number of alumni find meaningful.

Rather than guess which causes would motivate alumni to give, the Massachusetts Institute of Technology (MIT)—in partnership with Evertrue—analyzed social media engagement data to identify top-performing Facebook posts. MIT found that a student robotics group generated intense enthusiasm from alumni non-donors, and followed up by soliciting all non-donors for a gift to the robotic group’s crowdfunding campaign. 

The solicitation brought an additional 90 donors to the project, including one $20,000 gift from a non-donor who had never before taken a visit with MIT. 

2. Enfranchise campus partners

Central advancement staff struggle to identify alumni interests, and even if they can link to particular affinities, sending an appeal from the annual giving office probably won’t draw enough attention to inspire action.

That’s why tapping into campus partners’ visibility into the alumni experience is crucial: the resultant messaging and designations align with “hidden affinities” that advancement staff might otherwise overlook.

Under Texas Christian University’s ambassador-driven outreach initiative, a diverse group of campus partners—ranging from a rhinoceros researcher to the school’s director of first-year experience—help annual giving staff identify target groups of young alumni and craft meaningful solicitations that appear to come from ambassadors’ personal accounts. Although central staff send the appeal, each solicitation seems customized to individual donor experience.

3. Put donors in the driver’s seat

Ultimately, no one knows what motivates a donor to give better than the donor herself. Alumni need to be able to easily access designated fund information online—and burying that information in annual giving websites can mean potential donors fail to find something they feel passionate about supporting.

Advancement and IT staff can combat this problem by overhauling the institution’s giving page to better guide donors toward a cause that motivates them. User-friendly layouts should present site visitors with photos, customized cases for support, progress bars, and other multimedia elements that help sustain momentum through the completion of the gift.

Recently, the University of California, Los Angeles (UCLA) put donors in the driver’s seat by launching a new giving website that allows alumni to browse through a range of funds from all across campus. Instead of traditional drop-down designation lists divided between colleges or schools, UCLA organized its funds by 14 causes that range from the arts to technology. Each fund displays a progress bar that tracks donations, allowing donors to visualize the impact of their gift.

We understand young donors. With one more click, you can too.

Your most recent alumni are often the hardest to engage. Subscribe to our Advancement Blog for updates from our experts to ensure your advancement strategy keeps pace with your youngest alumni.

Millennials. It seems that they’ve done everything from kill the movie-going experience to spend all their retirement money on avocado toast. 

Whether these claims are true or not, one thing is clear: it's becoming harder and harder to obtain and count on millennial alumni giving.

The challenge: Turning intentions into gifts

While 73% of millennial donors intend to give to their alma mater in the future, actual giving from millennial donors remains inconsistent. They engage with their alma mater’s fundraising appeals at a similar rate as their older counterparts—but 39% of young donors fail to renew gifts each year.

It’s clear young alumni are consumed by the attention economy. Advancement officers must make giving easier through targeted, monthly campaigns that speak to millennial interests and giving that is automatically renewed to tackle conversion problems.

Eager and engaged, yet unpredictable, millennial donors create a need for new approach to sustained giving. Our research revealed several schools who chart these waters in new and successful ways.

Frame monthly giving for the millennial mindset

At William & Mary, advancement officials launched a monthly giving campaign specifically for young alumni that emphasized how regular gifts align with millennial passions and preferences via both convenience and the power of collective impact.

Through these efforts, the school’s advancement staff increased young alumni donors by 288% from 2014 to 2016. During the same period, the monthly donor renewal rate averaged 86%, resulting in $468,000 in annual recurring donor revenue. Young alumni recurring donors at William & Mary even surpassed their one-time-giving counterparts by the end of the program.

How UT turned a senior class gift into lifelong giving

At the University of Tennessee, the advancement office wanted to solve that ephemeral problem: the retention gap in young alumni giving. Although their senior gift program was extremely successful, very few people returned to give after their first year as alumni.

What was the solution? By simply adding a "recurring gift" option to their senior gift form, advancement officers were able to increase retention. Fundraisers approached seniors at events and in email solicitations in order to prompt them to fill out the form. 

In 2016, 10% of graduating senior donors opted to sign the recurring gift pledge. As a result, the overall retention rate for the graduating class of 2017 is predicted to increase 7% over the previous year's retention rate.

Four frequent challenges to recurring giving

Although they can be successful, monthly and recurring giving campaigns do not come without challenges of their own. Check out the most common roadblocks—and solutions—for a successful campaign:

1. Credit card expirations can leave the advancement office with inaccurate payment information, resulting in lost gifts. 
   Solution: Ensure proactive outreach to donors with upcoming expiration for pre-renewal cultivation.

2. Fraud cases can lead to unexpected credit card cancellations. 
   Solution: Formalize plans for multiple renewal reminders through diverse channels.

3. Donors may become comfortable with a low level of giving. 
   Solution: Solicit for larger monthly gifts on donation anniversaries.

4. The gift system may be unequipped to handle perpetual, recurring payments. 
   Solution: Set the default pledge length to exceed credit card expiration date as a technical workaround.

By solving these common pitfalls, advancement offices can use monthly and recurring giving to predict—and keep!—the unpredictable millennial giver.

Unplanned readmissions are costly, adding up to an estimated $12 billion a year for Medicare. Small steps, such as ensuring that patients leave the hospital with clear discharge instructions, can decrease the likelihood of readmissions by 30%. Yet, 91% of chronically ill patients do not receive a written care plan at discharge, and 72% leave the hospital without scheduling a follow-up appointment.

A novel cancer readmission reduction project

To improve patient transitions, the Cleveland Clinic implemented a cancer readmission reduction project for patients admitted to its palliative medicine and solid tumor inpatient units. As illustrated below, their intervention consists of two key elements:

• Follow-up appointments with patients’ primary oncologists are scheduled within five days of discharge

• Follow-up calls by nurse coordinators placed within 48 hours of discharge assess patient well-being, verify that the patient understands discharge instructions, and remind patients of their upcoming follow-up appointment

Cleveland Clinic’s cancer readmission reduction project

Results: A decrease in readmissions and increase in cost savings

This approach resulted in a 16% decrease in unplanned readmissions, amounting to $1 million in annual cost savings to payers. Importantly, the Cleveland Clinic did not have to hire additional staff to implement the readmission reduction project.

When it comes to kid-friendly imaging, safety concerns are often top-of-mind. Pediatric imaging providers regularly note the challenges associated with sedating children and seek ways to reduce the need for sedation and its associated risks whenever possible.

We took a deeper look at the way pediatric imaging programs are decreasing the need for sedation—and effective strategies one organization put into practice.

Five tactics to mitigate need for pediatric sedation

Tools like faster technology, physician training, or standardized protocols are often used to reduce the need for sedation, but imaging programs can do more with five main process improvements that reduce the frequency with which they have to sedate young patients. These tactics work in one of two ways: educating patients before the exam to decrease anxiety or comforting them during the exam to prevent movement.

• Child life specialists: Child life specialists are staff members who work with children and their families to make them feel more comfortable with their health care experiences. In imaging, these professionals can help children prepare for exams or be present during the exam with the child. 

• Toy models: The models are toy-sized versions of imaging scanners that help familiarize children with the scan before their procedure and ease patient anxiety. 

• Audio-visual goggles: These goggles allow children to watch movies and listen to music during procedures, which can cancel out the loud noises and distract from the small space of the MRI machine, making it easier for children to stay still. 

• Sound acclimation: Simulations of MRI sounds can be played for children before their exams, either at home or in the hospital, to reduce the initial shock of the MRI noise. 

• Child-friendly themes: Scan rooms can be designed to create the feeling of an adventure, such as a jungle or sea, as opposed to a medical procedure. At Children’s Hospital of Pittsburgh, these adventure rooms have reduced sedations for CT scans of pediatric patients by 99%.

How one children’s hospital put these tactics into practice

One children’s hospital we spoke with uses a combination of the above approaches to help reduce the need for sedation with CT scans. Since CT scans are markedly shorter than MRIs, they focused their efforts on helping children manage them with techniques other than sedation.

A combination of approaches to mitigate need for sedation

This hospital uses child life specialists to help both child and parent feel as comfortable as possible. Child life specialists work to build a relationship with the child and parent before the procedure by using visual aids, like toy models, to give the child a sense of control over what’s to come. For example, if the child will need contrast, they use a small toy frog to show how the child’s leg will be positioned for the catheter insertion.

Our client hospital has also invested in pediatric-specific technology to create a more comfortable environment for children, such as fire-truck and under-the-sea themed scanners. These environments reduce anxiety by removing children from the sterile environment of a hospital, which is often intimidating even for adults!

This combination of approaches has reduced our client hospital’s need for sedation during CT scans, and we’re confident that your institution can adopt similarly creative approaches to this problem in order to make imaging safer and more comfortable for kids and their families.

With the announcement of Vice President Biden’s Cancer Moonshot earlier this year, there’s been a resurgence of national interest in cancer research—and for good reason. Clinical trials are responsible for most of the advances we’ve made in cancer treatment so far. We know that they’ll be critical in continuing to improve treatment.

But our researchers have noticed a disturbing trend. Despite the importance of clinical trials, relatively few cancer patients participate in them. To figure out why, Memorial Sloan Kettering surveyed almost 2,000 consumers and providers—keep reading to find out what they learned. 

Survey finds many consumers unlikely to enroll in clinical trials

Memorial Sloan Kettering Cancer Center commissioned a national survey of more than 1,500 Americans aged 18-69 and almost 600 practicing physicians in October and November of 2015. They found that only 35% of consumers were “likely” to enroll in a clinical trial and only 40% had positive overall impressions of clinical trials.

Concern about side effects, safety, and finances top barriers to trial enrollment

The survey also asked why consumers might hesitate to participate in a clinical trial. Concern over potential side effects and safety was the top barrier to participation among Americans (55%). This comes as no surprise to physicians, since 63% of them reported that when discussing clinical trials with their patients, this fear was the biggest barrier to enrollment.

Notably, a lack of understanding about clinical trials persists, with 46% of respondents indicating concern over receiving a placebo. Outside of the trial mechanisms themselves, almost half of consumers cited financial concerns and inconvenience of trial locations as key stumbling blocks.

Barriers to clinical trial participation among Americans

Physician practices also contribute to low clinical trial participation

Consumer concerns aren’t the only barrier to clinical trial enrollment. Memorial Sloan Kettering’s survey also asked practicing physicians about their views on clinical trials. More than half of them said that they only considered clinical trials late in treatment, and 28% reported that they viewed clinical trials as a last resort treatment option. Only 32% of surveyed physicians indicated discussing clinical trial options with their patients at the start of treatment.

Education key to increasing enrollment

The good news is that education can make a difference. The survey also found that the number of consumers with a positive perception of clinical trials increased by 50% after they read a simple statement defining clinical trials, a result suggesting that providers can take simple steps to improve knowledge about and acceptance of trials.

Similarly, we need to educate physicians that clinical trials are not just a last resort treatment option for cancer patients. It’s important that they discuss clinical trials with patients from the beginning of the treatment process—and move us all closer to better standard treatments in cancer care.

For several years now, you’ve certainly been hearing about the transition to value-based payment. But enough talk. At the end of the day, are providers really taking on downside financial risk with payers?

Our colleagues at the Financial Leadership Council surveyed over 100 CFOs to answer this question—and the short answer is yes and no: yes, there’s been movement toward value-based payment, but no, hospitals aren’t putting a lot of dollars at risk through these types of contracts.

With that in mind, let’s take a moment and dispel some of the most common myths we hear about value-based payment.

Myth #1: Very few providers are voluntarily entering value-based payment

Reality: According to our survey data, a vast majority of hospitals—around 90%—had at least one voluntary alternative payment contract in 2015, and just over two-thirds reported having at least two. While we believe our survey cohort is comprised of some pretty progressive hospitals, these numbers represent an increase from what we saw in our 2011 and 2013 surveys. Participation in voluntary alternative payment models is on the rise.

Number of alternative payment models

Myth #2: Most providers in alternative payment models take on downside financial risk with payers

Reality: Though many providers have opted in to alternative payment contracts, very few of their payer contracts actually require them to take on any downside financial risk. Case in point—over 90% of provider ACOs participating in the voluntary Medicare Shared Savings Program (MSSP) have opted for Track 1, which is “upside only.” And further proving their aversion to downside risk, participation in the Bundled Payment for Care Improvement (BPCI) program dropped off significantly when CMS introduced new tracks requiring it.

Myth #3: The majority of hospitals’ reimbursement is now tied to value-based payments

Reality: Actually, more than half of our survey respondents reported that over 60% of their total revenue still comes from fee-for-service (FFS) contracts. While they think pure FFS-contract revenue will decline over the next five to ten years, many still expect about half of their revenue to come from FFS or FFS-like arrangements.

Hospital revenue projections: Survey average

Myth #4: While the value-based care payment movement started with government payers, commercial insurers have followed suit with the same, if not more, aggression

Reality: Private payers have pursued value-based-care contracts, but much less aggressively than anticipated. While CMS is focused on bundled payment and total cost of care contracts, commercial payers are pursuing more pay-for-performance contracts. 77% of these reward providers for strong performance, while just 16% penalize providers for weak performance. In other words, an overwhelming majority of these commercial pay-for-performance contracts are upside-only.

So is “value-based care” much ado about nothing?

No—but government and commercial payers are still trying to figure out value-based care. Our take is that while the transition has been slower than expected, providers and payers will continue to pursue value-based care contracting. What does this mean for you?

• Providers are taking on risk at different levels. The onus is on you to do your homework and ask the right questions to figure out where a provider is in their transition to value-based payments.

• Those providers who are taking on more downside risk might be more likely to be open to risk-sharing or performance-based contracts with suppliers and service providers.  

• This is still a steep learning curve, but we believe that providers will continue to make this transition. It’s important for you to meet provider customers where they are, but also help them get up this learning curve faster.