Change Happens at the Speed of Trust
I’m pleased to share with you some great news. The Washington Health Alliance was recently recognized as a national leader by the American Board of Internal Medicine (ABIM) Foundation (best known for its Choosing Wisely® program) in the launch of its new initiative, Building Trust, focused on improving relationships within the health care system. It was the work of the Alliance’s Quality Improvement Committee (QIC), particularly its work on the first national public reporting of results on low-value care at the medical group level for the First, Do No Harm report, that won the accolades.
I still vividly recall the meeting on June 13, 2019 where the QIC members previewed the initial results of the analysis using the Milliman MedInsight Health Waste Calculator™ of 47 test, procedures, and treatments commonly recognized as overused. After looking at the general results, a member asked whether it would be possible to report the findings in more detail, by individual medical group. After re-running the data and reviewing de-identified results, the QIC was then asked at its next meeting, on September 19, 2019, whether the group was comfortable with the Alliance publishing the results identifying medical groups.
This group of clinical leaders from around the state, who are fierce competitors in the business of medicine, answered quickly and decisively. Their unanimous response, “Not only should you release results by group name, you are obliged to do so.” That choice illustrates the high level of trust the QIC members have with each other, with the Alliance’s work, and with the broader medical community, as well as their commitment that providing this information serves the greater good. Close collaboration and striving for high quality care is a hallmark of the provider community in our state, a characteristic about which we should all be very proud.
“We are fortunate in Washington state to have this kind of reporting and the QIC is pleased to be recognized for our role in helping lead these efforts on the Alliance’s behalf,” said current chair of the QIC, Dan Kent, Chief Medical Officer of UnitedHealthcare Community Plan. “The Alliance’s commitment to careful stewardship of the data from multiple providers, with total patient confidentiality, has created trust among providers and users of the reports. Users appreciate the ability to see variation among providers and communities, across many quality of care measures, with analyses for Medicaid and for people with commercial health care coverage.”
We cannot underestimate the importance of trust in the health care system. Its presence (or lack) is evident in just about every interaction and location, in the exam room and rehabilitation centers between patients and physicians, in the halls of hospitals between clinicians, and in the offices of insurance plans and government agencies. A recent poll sponsored by ABIM Foundation surveyed consumers’ and physicians’ trust in the U.S. health care system and how COVID-19 has played a part had some interesting findings.
Of the 600 physicians and more than 2,000 consumers surveyed, roughly the same amount, 63% of physicians and 64% of the public, reported having trust in the health care system. 94% of doctors reported that they trust other physicians at their workplace and nurses more than facilities. 85% of consumers rated nurses the highest and 84% rated doctors the highest. Organizations that provide direct care fared better, 72% of the public and 60% of physicians said they trusted hospitals. 78% of physicians and 56% of the public expressed trust in government agencies.
However, like so many things the survey shows that trust breaks down along racial and economic demographics. People’s trust in their primary care physician increases with age and income and Black and Hispanic patients report lower levels of trust than White patients. For people who made more than $100k a year, 89% reported having trust in their primary care physician, compared to 66% for those earning less than $30k a year. Only 51% of Black patients identified physicians as a trusted partner to distribute COVID vaccines but 20% said they slightly or completely distrusted them, compared to 75% of Asian patients who expressed viewing physicians as a trusted partner in vaccine distribution and 7% did not.
For change to happen in the health care system, there must be trust and I am proud of this recognition by the ABIM Foundation, the work of the QIC and all of our committees, and for you, our members and allies.
We appreciate your trust and will continue to do all that we can to earn it every day.
All the best,