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The Role of Trust in Healthcare Reform

By: Jennifer Brinkmann | 05/12/2009

The healthcare industry made a bold move yesterday, committing to reduce trillions in dollars in costs in exchange for a seat at the table on healthcare reform. They say the reduction in costs will come in part from the usage of electronic medical records and better coordinated care. For those of us who have been around healthcare for a while, these are not new solutions. Maybe with the industry's back against the wall, it is prepared to invest in these initiatives at a new level, allowing us to finally realize the human and financial benefits of a well-coordinated healthcare system.  

Yet the improvements outlined yesterday are evolutionary, not revolutionary. In our own family experience, some of our doctors have started using medical records, and some are more proactive than others about coordinating with specialists. And some doctors assume no responsibility in coordinating care.   

As an example, this week my mother-in-law has to call her cardiologist to make sure he agrees that her heart is strong enough to endure a knee replacement surgery. The orthopedic surgeon is not willing to make that call for her and confer on the topic doctor to doctor. Maybe it's because the two doctors are at two different hospitals in two different health systems. Or maybe it's because the doctors do not want to assume the role of coordination. They just want to practice their specialty in isolation of the patient's other health issues.  

Historically, the primary care physician has been well positioned to perform this role of coordination. In the case of my mother-in-law, her primary care physician knows little about her heart condition and nothing about her arthritic knee. To ask her PCP to study each of her medical conditions to help coordinate her care, would increase the immediate cost of her care, which is subsidized by Medicare.

As policy makers debate the role of government and private insurance in financing medical care, I hope they are spending time debating who is responsible for coordinating care. Who knows the most about each of my mother-in-law's medical conditions? Most likely, it is Medicare. If a Medicare physician would study her claim history, he or she would know more about her medical history than any one of her personal physicians. Maybe the payors should be coordinating our care? That would be a revolutionary move. 

But can any of us trust payors - government or private - to coordinate our medical care? They do not have a good track record. When a payor talks about coordinating care, we automatically think they want to reduce our access to care. We believe their motivation is purely financial. The current discussion in Washington seems to involve a solution where government and private insurance compete with one another.  For either of them to be successful in improving care and reducing cost, they are going to have to earn the trust of patients. 

For now, I'm still going to rely on the doctors who I trust to coordinate my family's medical care. It isn't cost efficient, and it probably doesn't always create the best medical outcomes, but I trust them.

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