For two decades, the “Trust Barometer” from the Edelman company has looked at public faith in institutions. Lately, its findings have been concerning. Trust in media, government and other sectors dropped around the world during the COVID-19 pandemic.1 In the United States, those numbers are among the lowest on the list.
The health care sector, despite all its heroic work throughout the pandemic, must also work to meet this challenge. Back in 1966, more than 70% of Americans said they had trust in the health care system. Last year that number slipped to 44%.2 Frustration with pandemic living is one cause, but there are others.
Some people are frustrated with care seeming more impersonal. Others, fueled by online misinformation, are skeptical about science. And many of those who have lost the most trust — people of color and the underserved — simply feel left behind.3
If there’s a silver lining to the crisis, it’s that plenty of trust remains for individual providers. Americans have confidence in the people who provide their day-to-day care. Three out of four Americans have faith in their primary care physician, according to work from the Pew Research Center.4 Nurses, medical doctors and pharmacists all sit comfortably among the most trusted five professions on Gallup’s annual lists.5
Why does trust matter? In health care, trust saves lives because it leads to people getting vaccines, taking their medications and showing up for screenings. A major 2017 study showed that trust between a patient and a health care provider led to better outcomes and healthier behaviors.6 On the flip side, a loss of trust can be as concerning as an epidemic disease.
For that reason, providers and leaders from across the industry are intensely focused on turning the trust tide — building on areas where trust is strong and finding out where it has failed.
Deeper connections, bigger teams
“You can’t build and strengthen what you can’t measure,” says Sree Chaguturu, Executive Vice President and Chief Medical Officer at CVS Health. The company began defining the problem through surveys with customers and employees, looking at data patterns to identify where relationships might be breaking down.
For Chaguturu, it’s also important to consider what trust means in practice to the health care consumer. “For me, trust has to do with vulnerability. If I need your help and I can rely on you to be there for me — not just today, but in an ongoing manner — that’s a cornerstone,” he says.
Research supports that idea of provider care and attention. According to a 2021 study from NORC at the University of Chicago, about half of mistrust toward providers is driven by feelings that they aren’t listening, aren’t understanding or aren’t spending enough time7 with the patient.
More connection — more touchpoints, each one driven by a knowledge of the patient’s health journey — would be a way to address that head on. Programs from CVS Health have historically worked to add those kinds of interactions, including health coaching and digital nudges. But a more recent approach is rethinking care from the ground up.
A new primary care program at CVS Health will be “different than the traditional relationship” between patients and physician, says Chaguturu. Instead of seeing a doctor once a health issue arises, the CVS Health model uses a multidisciplinary team including nurses, social workers and pharmacists to help patients prevent health issues from arising.
Mental health services, a critical and unmet need, will also be included. “We can treat the whole person — manage chronic conditions, check in on their life situation and move them towards well-being,” says Chaguturu. “Not only can this build trust, but it will almost certainly lead to higher quality of care and lower medical costs.”
The program will be initially focus on Medicare seniors, who are often juggling several chronic conditions. That should help with another major driver of consumer distrust — the feeling that the system is impersonal and overly complicated.
“Our patients will have relationships with a team that helps them navigate care across multiple channels,” says Chaguturu. “It’s a natural evolution of how we should all provide care.”
The life-saving advantage of local care
One other lesson from the past year: neighborhood points of care are an overlooked bedrock of patient trust.
“Staying open in local communities, day in and day out, allowed a tremendous relationship to unfold,” says Michelle Peluso, Chief Customer Officer of CVS Health and Co-President of CVS Pharmacy. “We were able to vaccinate as many people as we did — more than 59 million shots — because we stayed present in people’s lives.”
About half of all vaccine doses were given at local pharmacies, and CVS Health became the nation’s largest provider of COVID-19 services, Peluso says. More importantly, “we used the neighborhood presence of our stores and other grassroots efforts to get to underserved and high-risk populations,” she says.
Underserved populations saw the greatest suffering from COVID-19. Unsurprisingly, they also mistrust health care providers the most. But according to Peluso, the staff of pharmacies are often “of and for and by these communities,” a local representation that can break down barriers, she says. Peluso notes that a high percentage of BIPOC people chose to get their vaccines at CVS. In 2021, one third of all CVS Health-administered vaccines were provided to underserved communities.
Local points of care — pharmacies, clinics and wellness centers — can also show up in other ways. At CVS Health, for instance, the company runs free screenings and services through Project Health, and it takes stands on issues important to its customers — not selling tobacco products, for instance, or banning retouched images of women in its beauty section.
“In times like this, it’s important to lean into that community presence,” says Peluso “This is where we start to regain trust. This is where we make a difference.”