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Webinar Summary: The First 360-Degree View of Trust in Healthcare

For the 11th year straight, ReviveHealth conducted the only research focusing on the B2B aspects of trust in healthcare. We recently held a Webinar, in which our CEO, Brandon Edwards and research partner, Dan Prince of SMG Catalyst Research unpacked this year’s Trust Index implications. If you missed it, you can still get a recording, but we’ve also summarized some key findings in this blog.

how it works

To develop our Trust Index, we measure three key elements of trust: fairness, reliability, and honesty among key players in healthcare to measure the degree to which:

  • Health systems executives trust health plans
  • Health plans executives trust health systems
  • Physicians trust health plans
  • Physicians trust health systems

what is new

This year, we added consumers to the mix, measuring their level of trust health systems, physicians, and health plans. After a decade of small tweaks to the research, we suspected that consumers get caught in the line of fire in B2B trust. Results from this year’s consumer trust survey confirmed our suspicion.

what it means

Turmoil in DC is causing chaos in the exchange markets and shrinkage of provider margins, and we’re seeing a movement to a different phase in payor-provider relationships. This new phase will usher more cost-constraints for those who pay for care and those who provide care. It’s the next wave of cost-constraints in the health industry.

what we learned this year

  • Health plans’ trust in health systems has spiked, while health systems’ trust in health plans has eroded. This is the same relationship we’re talking about… How can two parties have such a different impression of their own B2B trust? We think it points to power. In a payor-provider relationship, it’s most common for the health plan to hold the majority of the negotiating power. After all, the health plan operates as the bank for the health system – essentially controlling their profitability. With this in mind, it seems obvious that health plan trust in health systems would be set on an upward trajectory: because it’s easier to trust someone on the weaker side of the negotiating table.
  • Health plans have self-organized into three trust tiers. When it comes to health systems’ trust in health plans, we’re beginning to see three very distinct tiers with two health plans in each. In tier one with the highest levels of trust assigned to them, Aetna and Cigna are leading the charge. In tier two, Humana and local Blue Cross Blue Shield show lower levels of trust, but certainly not the lowest. It’s important to note that the Blues have a wide range of variability within. For example, in states like North Carolina, the local Blue plan is horribly distrusted, and in some other markets, they’re the most trusted plan, bar none. On average, they come up about in mid-pack. In tier three, United and Anthem bring up the rear with truly dismal trust scores. One takeaway worth noting is that Aetna and Anthem found themselves in similar situations in early 2017, failing to push through mega-merger deals. However, they seemed to take very different routes in order to recover — Aetna to build up their trust levels with providers, and Anthem with a seemingly deliberate approach to dismantle any trust they may have previously had by instating controversial reimbursement changes in medical imaging and emergency room services.
  • Physicians distrust all health plans alike. While many other trust scores in this study have a wide range of answers, physicians’ trust in health plans is low, and has less than a six-point range in answers. This suggests that physicians are almost in lockstep when it comes to their complete distrust in health plans, and they don’t experience much – if any – of the tiered differentiation that health systems experience.
  • Health systems and health plans define value-based care differently. We asked both health system executives and health plan executives about the traction that value-based payment is making in their organizations. Like last year, health plans indicated a much higher level of implementation of value-based contracts than health systems. This confirms a host of industry truths we’ve been hearing recently from our clients.The vast majority of health systems see value-based care as something they are being pushed into, and most will reluctantly transition as slowly as possible.Health plans see opportunity in value-based contracts – they shift risk on the provider, and strengthen their negotiation leverage.
  • Uncertainty in DC is making it tough on everyone, but especially providers. Healthcare organizations of all types are burdened with the lack of decisiveness in D.C. Health systems and health plans alike make decisions on capital deployment, services, acquisitions, and deployment of technologies on very long time horizons – five, ten, or even twenty years. Meanwhile, changes in healthcare policy and the underlying economics of healthcare are possible at a much quicker clip: on a two-year congressional election cycle.This causes hesitancy across the board, but especially providers who lack the luxury of insulating against uncertainty that health plans. Providers must negotiate contracts on a two, three, or even five-year contract basis with health plans – a painfully standard norm in healthcare today that has slowly become more risky in an unstable political environment.
  • Consumers are specific in their distrust of each player. Though consumers trust their physicians most and their health plans least, they have qualms with all three parties included in the survey. Those who expressed distrust were specific as to why.Where consumers lack trust in health systems, it was because they questioned the health system’s competence.Where consumers lack trust in health plans, it was because they questioned the health plan’s motives.Where consumers lacked trust in physicians, it was due to a mixture of both competence and motives.
  • Consumers believe the GOP will replace the ACA, and that the replacement will be worse. The majority (67%) of the consumers surveyed thought the GOP would actually replace the ACA. However, less than a quarter of respondents thought the GOPs long-awaited replacement would make things better. Essentially, these results show that consumers absolutely believe that congress is going to change the ACA, and they have just-as-absolute confidence that they’ll screw it up worse than it is now.
  • Most of Americans would vote for a bill that introduces “Medicare for all.” No doubt, Medicare is an easy system to navigate as a consumer, and hospital faculty overwhelmingly cite Medicare as their easiest payor to deal with. However, if this finding is not a wake-up call for those of us working in this industry, we don’t know what will be. Patients are advocating for a system that almost every hospital loses money on, and that is run by the Federal government. How will we rise to the challenge?

what it means for you

It’s easy to read these results and think, “Okay, but what could I possibly do to change this?” Well, we actually don’t think that’s a rhetorical question. To find out where we see each type of healthcare organization fitting into the trust equation, and to see our recommended five steps to move toward better trust, view the recording of our Trust Index webinar, and download the slides.

We’ll be diving into this topic and other hot trends at our 11th annual thought leadership event, The Summit (January 29-30, 2018). For more information about this event, click here.

May 25, 2018
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