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How do you win the trust of the underserved?

June 03, 2022 | Health Equity

A stethoscope bridges a chasm allowing people to walk over it.

People pushed outside of the health care system mistrust it the most. But some approaches can build a bridge.

In a recent poll, about 70% of Black respondents said they believed racial discrimination takes place in health care. About one in five said they had experienced it themselves, and about half didn’t trust the system1. Their reasoning is not hard to understand.

“Health care leaders often look at history as the problem,” says Joneigh Khaldun, M.D., M.P.H., the first chief health equity officer of CVS Health®. “But I would ask you to look at the day-to-day frustrations. That’s where we’re losing trust.”

Underserved groups may not see practitioners who look like them or understand them, she says. The system is hard to navigate and they may feel judged. “So it’s not surprising when they’re less likely to engage,” she says.

How do you build a bridge? Khaldun is a strong believer in starting with data. Before CVS Health, Khaldun served as the chief medical executive for the state of Michigan, a job where she learned the value of hard numbers when looking at bias.

For instance, a current audit at CVS Health is looking at prior authorizations — a step where a health insurer checks on a patient record before approving payment. The audit is looking for differences that might fall along racial lines. If they’re found, it’s a chance to ask what’s going on and fix it. Those kinds of investigations can happen at every level of the system.

But even where data sends up a flag, solutions won’t be one-size-fits-all. “I've led public health in Baltimore and Detroit,” Khaldun says. “And I know from hard experience that you cannot just pick up what you did in one city and find it workable in another.”

How do you build a bridge? Khaldun is a strong believer in starting with data.

In practice, that sometimes means meeting with community leaders and influencers to build a more local plan.

One example is playing out at the Ebenezer Baptist Church, a landmark in Pittsburgh’s Black community. The church has opened its doors to services from outside providers — assistance with résumé building, clothing and food banks, and community health clinics. On site, CVS Health also runs a mock pharmacy as a way to help with job training.

“These are the relationships you need to build before a crisis hits,” says Khaldun. “You can’t just drop into a community in the middle of a crisis and expect to get sudden results.”

Trust also comes from knowing the lives of the underserved well — and what will actually help. “Medicaid members deserve ease,” is a mantra of Kelly Munson, president of Aetna Medicaid.

For instance, about three quarters of Medicaid recipients work, often in challenging front-line jobs with odd hours. “About 96% of them have smartphones, and most would prefer to see the doctor digitally,” Munson says. “They don't have time to go to the office. They don’t want the stigma of standing at a desk, saying they’re on Medicaid. Can you make it easier for them to get care? We can.”

Erasing those kinds of barriers leads to trust in other ways, Munson says. “Our research shows that Medicaid members trust their doctors more when they engage on a regular basis. So part of our job needs to be just helping them get to those appointments,” she says.

Medicaid recipients might lack access to transportation, have trouble with paperwork or face caregiving obstacles. By addressing those problems directly, through creative housing, childcare or transportation, trust grows, medical care is more consistent and costs go down.

Often the trust problem boils down to showing empathy for health care journeys. “Many times, they just need to hear, ‘I have a full understanding of you as a person. And I understand the barriers you're facing outside of health,’” says Munson. “That’s the first step to bringing someone in.”