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The Trust Gap in Healthcare: Findings from the 2016 Healthcare Trust Index

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In Campaign 2016, a recurring theme to date has been the trustworthiness of the leading candidates. As they debate for the third and final time this week, each will attempt to allay voter concern about their trust-gap and widen apprehension about the other’s.

In politics and business, trust is the most valuable asset candidates and companies own. Lacking trust between a candidate and voters or an organization and its customers and trading partners means elections aren’t won and a company’s, long-term sustainability is compromised.

Healthcare is an industry wherein trust is foundational. We trust our physicians to recommend treatments based solely on their effectiveness and appropriateness to our diagnosis. We trust our drugs and technologies are used solely because they work best. We trust our hospitals are safe and our insurance will help pay the bills. When we learn otherwise, we rationalize they’re the exceptions until recurring doubt leads to distrust. Stories about fraud, price gauging, denials of coverage and excessive profit cast doubt on our system and compromise trust in our healthcare system. The frequency of stories about these and social media lend to the growing distrust in healthcare.

Trust is like quality of care: it’s hard to build and invaluable, and when lost, hard to repair. Merriam-Webster defines it as a “firm belief in the reliability, truth, ability, or strength of someone or something.”

Trustworthiness is aspirational for every organization–for profit and not for profit, local and national, large and small. The most successful organizations jealously guard their reputations and address breeches of trust with energetically. Surveillance of social media, exit interviews with departing employees, verification of credentials and customer surveys about perceived performance are standard fare for organizations that value trust and are protective of their reputation.

Understanding trust between trading partners is table stakes. When trust between trading partners is weak, operational performance is suboptimal, value creation is less-than otherwise achievable and customers are harmed.

Arguably, trust between health providers, physicians and hospitals, and health insurers is among the most trading partner dynamics in our health system. Recently, Revive Health, a national healthcare marketing communications firm, released its 2016 Trust Index Survey–an analysis of the level of trust between these trading partners. Their survey compared views along three dimensions of trust: “this organization makes every effort to honor its commitments”, “this organization is accurate and honest in representing itself and its intentions” and “this organization balances its interest with ours and doesn’t routinely take advantage of us”.

The findings are enlightening: they underscore the distrust that’s pervasive in relationships between providers and payers. Highlights:

  • The major trading partners in healthcare do not hold strong feelings of trust toward others.
  • Insurers tend to trust providers more than providers trust insurers.
  • Hospital leaders have wide ranging views about insurers, especially in negotiation around rates and contracts. By contrast, physicians’ views that are more widely held: their range of opinion is much narrower than views held by hospital leaders.
  • In general, organizations that are investor-owned are less trusted than those that operate as not for profits.
    ReviveHealth Trust Index Survey

screen-shot-2016-10-18-at-10-07-02-amSource: “Revive Health-Catalyst Healthcare Research Trust Index Survey” The 10th Annual ReviveHealth Trust IndexTM  2016. http://thinkrevivehealth.com/topic/trust/

What’s the key takeaway from this survey? Distrust in providers and payers is a systemic challenge in our system. The data show some organizations perform better than others but pervasive distrust is a problem for all organizations.

Can it be remedied? Theoretically, yes. It requires parties on all sides to be transparent in business dealings and understand perspectives other than their own. It means negotiations that result in win-win are sought and desire to understand before being understood shared among key leaders. It means objective data is the basis for decision-making, and strongly held opinions lacking facts dismissed.

The trust gap between insurers and providers is wide and long-standing. It did not happen overnight nor will it be solved quickly. In the new world order of healthcare, shared risk arrangements between the parties is now the norm. Unless and until distrust is addressed, these efforts will disappoint and results will be negative.

This week, the major party candidates will attempt to chip away at their own trust gap. We will see the results of their effort in 22 days. In healthcare, the trust gap equally problematic. Like the election, those who stand to lose most if not remedied are our voters—the individuals we serve as patients in our system of health.

Trust Index Survey-

Methodology: The trust measures included in the survey were informed by academic literature on the subject and used a five-point agreement scale – from “strongly disagree” to “strongly agree” applied to three statements: this organization makes every effort to honor its commitments (behavioral reliability); this organization is accurate and honest in representing itself and its intentions (honesty); this organization balances its interests with ours and doesn’t routinely take advantage of us (fairness). For each question, a Trust Index Score value was calculated on a scale from 0 for “Strongly disagree” to 100 for “Strongly agree” wherein “Neither” was valued at 50 and “Don’t know” responses were excluded from the analysis.

Samples: Health Plan: 56 complete responses were collected through an online survey of health insurance executives between May 12 and July 9, 2016: Hospital: 143 responses were collected from hospital and health system leaders via online survey between April 25 and May 27, 2016; Physicians: 602 complete responses were collected through an online survey of Primary Care Physicians and Physician Specialists between July 8 and July 19, 2016.

Source: “Revive Health-Catalyst Healthcare Research Trust Index Survey” The 10th Annual ReviveHealth Trust IndexTM  2016. http://thinkrevivehealth.com/topic/trust/

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William Palmer MD
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William Palmer MD

I’m not sure trust is the right word. We have 300 + million folks all with separate interests. To expect that large groups of these people would have behaviors aligned with the best interests of a single patient is not very realistic. Large majoritarian agreements on professional standards is about as good as we can expect, I think. But even here, you don’t want too much agreement in thinking so that creativity is thwarted. We should be wise enough to accept a few heretics.

Peter
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Peter

With doctors I trust and verify. Hospitals is minimal trust and verify. Insurance is mistrust and verify. Drug companies – total mistrust. Never let up your guard.

rmcnutt
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rmcnutt

Worried of the validity of survey. The numbers don’t matter, how you garnered the numbers matters. Also, patients need to start trusting themselves to make choices. They are the ultimate reason and solution to medical care issues. http://www.uncpress.unc.edu/browse/book_detail?title_id=3788