Mistrust is pervasive in Connecticut policymaking and it’s blocking progress. In this year’s survey, Connecticut healthcare thoughtleaders rated the state of trust in policymaking at 26 points out of 100.
Last year, outside consultants hired to develop a health reform plan for Connecticut found “the top barrier was lack of trust among stakeholders” and that trust is a “linchpin” for states that have been successful in health reform. A recent systematic review found that “Governments cannot function effectively without the trust of citizens, nor can they successfully carry out public policies, notably more ambitious reform agendas.” The literature is clear that “high trust is associated with cooperative behavior, while low trust is associated with resistance, even to things that seem to be in the person’s overall best interest.”
We need progress in our state’s health care system and we need to protect the progress we’ve made. Private health insurance is too expensive in Connecticut, prices are too high, health care quality needs significant improvement, and consumers have little choice. Trendy but risky payment reform models are being adopted with abandon in our state despite poor results in other states.
In contrast, Connecticut’s Medicaid program offers hope. By shifting from a risky financial model to one that coordinates care and rewards quality, we’ve engaged more providers, improved quality, and saved almost half a billion dollars so far. But that model is fragile and constantly being undermined by our mistrustful policy environment.
So how did we get here and what can we do?
Fortunately, thoughtleaders gave us clear and repeated answers to these questions. Across hospitals, doctors, payers, consumers, advocates, community organizations, businesses, brokers, academics, labor, and media — thoughtleaders said that policymakers need to listen and respond to input. Processes must be transparent and inclusive — sneaking policies through just ensures failure.
People are very concerned about conflicts of interest and political motives; neither has any place in policymaking. Even the perception that only a select group has a voice or gets any benefits is poisonous to trust. Outsiders have no reason to engage in the hard work and risks of cooperation and insiders also have no reason to make any effort — even if they don’t perform, they can rest assured they will get the next opportunity anyway.
Connecticut’s typical, quick-fix, state government-centered response to mistrust is not working. The state has regular restructuring exercises where existing agencies are shuffled under new letterheads, “new” committees composed of the same insiders are created to address the problem, all folded under the same entrenched leadership. It hasn’t worked.
Thoughtleaders gave us real answers.
• “Open the process, even if you don’t like what you hear”
• “Understand the consumer experience”
• “Start with data rather than start with desired outcomes and then look only for data that supports the outcome”
• Communication (echoed over and over)
• “State agencies need to hold themselves to the same standards they expect of others”
• “Eliminate financial incentives from policy makers’ decisions”
• “Honor commitments” and “keep promises”
Trust erodes just a bit more every time an agreement falls apart, decisions are not data-driven but made to benefit a few, or intelligent, honest voices are excluded and ignored. Connecticut’s health system needs work. Trust is the problem and we can’t afford not to fix it. Thankfully we know how to do that.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
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