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Trust is critical to public health. People who mistrust the health care system put their health and lives at risk because they are less likely to visit a physician, less forthcoming in conversations with clinicians, and less likely to comply with medical advice and prescriptions. Such mistrust can undermine physician-patient interactions, leading to deteriorating patient outcomes and increased physician burnout.
Conversely, when a physician can build trust, patient satisfaction improves. That matters: Evidence shows a direct correlation between exceptional health care experiences and quality outcomes.
Yet research shows that trust in the U.S. health care system — like that in other areas of American society, including government, science, and media — is declining. Factors include failures of leadership, growing inequality, political polarization, and an increasing skepticism regarding our collective ability to tackle society’s toughest challenges and advance well-being for all. Given the stakes, rebuilding public trust in the U.S. health care system, which plunged during the pandemic, must be a priority. This article will offer recommendations for how that can be done.
The Pandemic’s Impact on the Public’s Trust
The Covid-19 pandemic served as a stress test for the public’s trust in the U.S. health care system, and it exposed systematic gaps. Of those polled in the United States, 48% said the pandemic eroded their confidence that our health care system is well-equipped to handle major health crises, according to the 2022 Edelman Trust Barometer: Trust and Health. This sentiment is hardly surprising given that U.S. deaths from Covid-19 have surpassed 1 million, the highest of any industrialized country.
Multiple factors contributed to this loss of trust, including vacillating directives and a lack of coordination at federal, state, and local levels. The pandemic also showed that when our public health infrastructure is not appropriately supported, it is ill-equipped to handle major health crises. For example, in some areas around the country, the public health communications network was forced to rely on outdated technology such as fax machines that were overwhelmed by the torrent of Covid-19 test results.
Further fueling the cycle of mistrust, the Covid-19 crisis revealed the effects of longstanding disparities in access to health care among Hispanic, American Indian and Alaska Native, and Black people. Those disparities contributed to higher rates of Covid-19 infection and death among these groups compared to their white counterparts.
Finally, long before the pandemic, the decline of the rural health care system and the erosion of local news outlets fostered the growth of medical and news deserts, which left many rural residents with limited sources of reliable information about health care, including vaccines, despite the prevalence of cell phones and social networks. This almost certainly has contributed to lower vaccination rates among people who live in rural areas when compared to people living in urban centers.
Rural residents also tend to be older, poorer, and have underlying conditions, all of which contribute to higher rates of Covid-19 infection, hospitalization, and death. This population, along with low-income Americans, has the lowest level of trust in the health care sector, according to a recent survey.
Physicians and health care organizations can address factors contributing to the erosion of trust in the health care system by taking the following five steps:
1. Support the move to value-based care.
Accelerate the shift away from the dominant “fee-for-service” model, which incentivizes more care, but not necessarily better care — and move to “value-based” payment models that focus on the quality of care provided to patients. Because prepaid, value-based health care models give organizations flexibility to develop new capabilities that improve care delivery, those that have them, including Kaiser Permanente, demonstrated during the pandemic that they were better prepared to respond to major disruptions and other market dynamics. That is because their priorities are in the right place: the patient’s best interests.
For example, Kaiser Permanente made upfront investments in maximizing technology — including web, mobile, and video platforms — over the past two decades. That is why we were well positioned to respond to the Covid-19 pandemic, enabling us to continue to see and treat patients virtually when shelter-in-place orders brought the daily operations of many other health care organizations to a halt.
Value-based organizations also understand that building trust with patients requires cultural competency and are willing to invest in tailoring services to meet an individual’s cultural and language preferences. Building trust has been especially important in underserved communities, where mistrust of health care organizations is commonplace and where cultural and language differences can present barriers to accessing health care.
Kaiser Permanente’s attention to cultural and language competency facilitated its efforts to reach and win over unvaccinated patients in such communities during the Covid-19 pandemic. It installed pop-up vaccine clinics in local settings, including barber shops, churches, and community centers, where community organizations shared clear, accurate information about vaccines in languages patients could understand.
2. Reimagine the public health infrastructure.
The United States needs to build a public health care technology infrastructure that facilitates communication among public and private health care institutions, enabling them to provide real-time data about emergency department visits, hospital admissions, and deaths of those with Covid-19 or similar public health threats.
Physician leaders who advocate for improvements to the public health system that result in greater affordability, access, and support for population health initiatives are also more likely to cultivate public trust.
Widespread demand from the U.S. health system for such actions likely contributed to support for health care appropriations earlier this year that included $8.5 billion — an increase of $582 million — in allocations to the Centers for Disease and Prevention (CDC). There was a particular emphasis on improving the nation’s public health infrastructure, including data collection and monitoring.
3. Leverage technology to improve access.
Encourage adoption of technologies that engage and serve patients by making health care more convenient and more connected such as telehealth, remote monitoring, and digital diagnostic tools. These types of technologies have been shown to increase access to care while also making care more continuous and less episodic.
Much of the conversation around telehealth is focused on simply making care more accessible and convenient for patients who have grown used to the ease of meal-delivery and ride-sharing apps. But the telehealth spectrum is much broader than that. With technology, we can rapidly and seamlessly move wisdom and expertise, not people, and that can significantly improve care delivery as well as patient engagement to improve outcomes.
For example, in helping recovered heart attack patients, Kaiser Permanente’s virtual cardiac rehabilitation program allows care teams to use an app coupled with a digital watch to monitor the progress of these patients with exercise, tasks, medications, and heart metrics. Patients enrolled in the program were nearly twice as likely to complete the recommended course of rehabilitation than those in traditional face-to-face interactions.
4. Shift more hospital-level care into the home.
Close gaps in health care access by appropriately moving more care onto the phone and into the home. Kaiser Permanente’s advanced care at home program enables patients who may not have ready access to a hospital to receive acute-level care in the convenience and safety of their own home. During the pandemic, such care was vital for connecting patients with the acute care they needed. It kept them safe, while reserving hospital beds and staff for patients with Covid.
Treating patients at home can lead to better outcomes and high patient satisfaction rates: More than 90% of patients give the programs top marks. And research shows that patients treated at home have lower rates of readmissions and complications than those receiving traditional in-patient care.
For such care-at-home programs to continue, the U.S. Congress must act to extend the Acute Hospital Care at Home waivers issued by the Centers for Medicare & Medicaid Services (CMS). Those waivers enabled the expansion of access to safe, hospital-quality, at-home care for patients across the country during the pandemic.
Kaiser Permanente is among the 110 health care organizations that belong to the Advanced Care at Home Coalition, which supports the proposed Hospital Inpatient Services Modernization Act. That bill would extend the waivers and provide a more certain path for the development and expansion of hospital-at-home programs.
5. Cut the red tape and keep patients engaged.
Health care institutions should build systems and structures to facilitate the engagement of patients and make sure their voices are heard. Clinicians and health care organizations should also respond to patient feedback with options that align with patient priorities and values, which builds the trust required for physicians and patients to participate in shared decision-making.
No patient should have to wade through layers of red tape or unnecessarily endure long commutes in traffic to get their health care needs met. Health care systems that are not meeting patients where they are lose out to health care organizations that make it easier for patients to engage with their physicians and health care teams. Multiple domestic and international studies have shown that higher patient engagement leads to better health outcomes.
To better meet patient demand for timely care options, Kaiser Permanente provides easy-to-navigate online tools that guide patients to the most convenient way to address their needs — from self-care and emailing their physician to ask questions to scheduling office visits, video visits, or e-visits.
Every encounter with a patient is an opportunity to build trust. It is critical — now more than ever — that clinicians and health care organizations make every moment count.
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