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Our Health Care Leaders’ Forum determined that in order for the transformation of our health care system to begin, trust must be established across the continuum of care.

Navigating health reform

Health Care Transformation Depends on Trusting Relationships

  • 12/18/2014

This past September in Chicago, CliftonLarsonAllen’s inaugural Health Care Leaders’ Forum brought together executives from across the health care continuum to discuss how to drive transformation. Attendees were provided peer-to-peer, roundtable discussions on how to tackle the challenges of an evolving health care landscape. The discussions that followed over the next two days were quite interesting, if not exactly what we were expecting.

Here we were with executives, owners, CEOs, and CFOs from health care organizations ranging from $25 million in revenue to $2 billion, and it was evident that there was a lot of discourse and discontent in the world of health care in the United States. It was also evident that most knew what had to be done in order to transform health care, but didn’t know where to start. It will involve many different organizations working together on multiple fronts while reaching across traditional boundaries. In order for any of this transformation to begin, we all agreed trust must first be established across the continuum.

Challenges facing transformation

Along with trust, several other issues emerged during the forum. One significant topic was the large and continuous investment in information technology that organizations have made over the past 10 years. Unfortunately, many of the information systems do not communicate with each other without significant manual assistance, and the result is a complete lack of efficiency. As a result, there is a huge cost burden for providers of all types, since they must spend money just to “stay in the game.”

Another issue raised was how to coordinate health systems to manage and take on risk as the payer models change to more of an “episodic” or “total care” arrangement. Whether it is an accountable care organization, bundled payment, or a pure capitated model, the participants pointed out that there must be coordination between providers “caring” for the patient.

We also discussed “Super Utilizers,” the top 10 percent of patients who account for more than 50 percent of the costs. And we wrestled with the fact that 40 percent of health care costs are post-acute dollars. All of our discussions focused on the challenges — or symptoms — of the system we currently have.

Transformation begins with trust

After much discussion, it is obvious that to address these issues, problems, and sticking points, there must be relationships built between the providers at all stages in the continuum of care. We all know that successful relationships are built on trust. The only way the complex problems and issues can be addressed in the future is to develop those trusting relationships now. What will it take to build up the trust that is needed to transform health care?

It will involve a lot of hard work from the people in leadership positions at all levels of an organization. Currently that trust isn’t there in most situations. Trust comes from incrementally building up faith in one another in order to demonstrate that we will be there to support each other when needed. We all need to be confident that we will act in the best interest of the mission at hand. The providers that can start building this type of culture internally and with other providers will be able to finally address information technology issues, and seamlessly coordinate patient care as they move through the different levels of treatment. And based on trusting cultures and relationships, these providers will accomplish it in the most efficient and cost effective way.

How can we establish trust

Trust is critical to any lasting change. Though in our forum we didn’t create a blueprint of how to successfully reach across the continuum to transform our health care environment, we clearly established that without trust, there will be no transformation. In order to establish trust, there must be the following:

  1. Transparency and communication — We must start the conversation in order to break down barriers. There must be a shared openness and faith in others in order to bring us together.
  2. Selflessness and a commitment to broader goals that benefit everyone — Each organization will need to see outside its own walls in order to bring about real change. Embracing a new perspective only happens when we are committed to changing together and are emotionally invested in each other’s success as much as our own.
  3. Addressing issues and viewpoints that are different than our own — The most powerful component to a successful collaboration is listening. When we listen to others we are establishing trust by the very act of being open to hear them. We must embrace our differences in order to move health care forward.
  4. Putting aside individual preferences and compromising for the betterment of the entire health care environment — Trust occurs when each party gives a little. We can learn from each other’s successes and challenges to reach a much more powerful conclusion than we would have separately. I believe the forum clearly demonstrated this.

Trust among providers means having the confidence that all the people involved are performing their roles in ways that are professional, meaningful, efficient, and for the betterment of the patient. Organizations that accomplish this will be the survivors in the provider world. Trust me on this one.