Change Happens at the Speed of Trust

By Jill Zorn

Map of Connecticut

In the midst of the Affordable Care Act (ACA) repeal fight, which still rages on as I write this, I attended the Connecticut Health Council program on April 12, Change in DC-What it Means for Connecticut’s Health Sector.

Given the diverse roster of speakers at the program, there was remarkable agreement about the problems we face and the goals we seek to achieve.  But as the program also made clear, reaching those goals is going to be extremely challenging and require a tremendous amount of collaboration and trust.

Speakers included US Senator Chris Murphy, Congressman John Larson and Congresswoman Elizabeth Esty who gave an update on the latest bad news from Washington.  Attendees also heard from Kevin Counihan, who shared his perspective about the health care landscape from his recent position as CEO of healthcare.gov.

Today’s blog focuses on two panel discussions at the conference, a panel of state government officials and a second one of payers and providers.  Both panels talked about how their organizations are navigating today’s turbulent health care environment, highlighting their efforts to reduce costs and improve value.

Areas of agreement

All speakers took as a given that our health care system is too expensive and that our outcomes aren’t what we would like them to be.

Several panelists mentioned that shifting costs onto patients, in the form of higher and higher co-pays and deductibles, is not an effective way to reduce costs.  Too many patients simply cannot afford these expenses and end up avoiding needed care.

Each panel discussed that socioeconomic factors have a huge impact on health.  There was general agreement that we need to address them as well as provide better care coordination and system navigation if we are going to succeed in improving population health in our state.

All agreed that the tremendous uncertainty, emanating from Hartford due to Connecticut’s budget challenges and from ongoing efforts in Washington to make major cuts and regulatory changes to health care programs, makes it even more challenging to meet the goals of better care, better health and lower costs.

Areas of tension

One noticeable area of disagreement was the extent to which some speakers chose to emphasize personal responsibility as a major frame for addressing health problems.  Other panelists pushed back, pointing out that blaming sick people for their poor health is not a constructive approach.  Reducing chronic illness requires a broad, multi-sector strategy that improves the delivery system, changes payment incentives, but also focuses on social and economic determinants.

The overriding tension in the air is the fact that, as the moderator pointed out, costs must be taken out of the system; not just shifted among the key stakeholders of payers, providers and, of course, patients.

Although there were many areas of agreement, a certain lack of trust was also in the air.  This was most evident in how the private sector views the public sector.  But tension also was evident between payers and providers.  Their worlds are starting to have more overlap, as payers purchase provider groups and providers increasingly take on new payment models where medical expenses must be more carefully controlled.

Collaboration and trust

Themes that emerged throughout the day included the need for public-private partnership, collaboration and trust.

The word trust has come up a lot lately.  When the Health Care Cabinet studied other states that have been successful in implementing innovative health policies, the ability to build trust among stakeholders and been the public and private sector was identified as a common success factor.  The Connecticut Health Policy Project published a new policy brief: Mistrust in Connecticut health policy-making – Thought leaders, public weigh in on the problem and potential solutions.

I’m also reminded of a panelist’s statement during a discussion about state government leadership in health care reform during our 2015 Reform to Transform (R2T) summit.  John Colmers, a Vice President at Johns Hopkins University and Chair of the Maryland Health Services Cost Review Commission said, “Change happens at the speed of trust.”

In these times of intense uncertainty and severe funding threats, trust is not easy to come by.  So it was good to be in a room of diverse stakeholders and see how much fundamental agreement we  have on goals.  Now we just need to work together and, keeping the best interests of patients and consumers in mind, find agreement on how to reach those goals.

Notes and Resources

Founded by the MetroHartford Alliance, the Connecticut Health Council is an “association of health sector leaders” dedicated to “promoting Connecticut as a center of health excellence and the health sector as a primary driver of economic and employment growth in our State.”  The Council aims to “foster collaboration, education, entrepreneurship and networking among leaders of for-profit and non-profit health sector entities.”

For videos of the first two panels of the conference, go here.

To read the Health Care Cabinet’s Recommended Health Care Cost Containment Strategies Report go here and scroll down to the January 10, 2017 meeting where a copy of the report is posted.

For more on the Reform to Transform (R2T) summit, Sparking Bold Action, go here.

For the R2T summit video of the panel, “When Government Leads,” go here.

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