Employer Health Benefits, Pharmacy Benefits

Calls for Transparency are Really Cries for Trust

Earlier this week, I was meeting with an employer client as we prepared for a joint presentation we’ll be delivering. Our presentation is centered on strategies and tactics employers can deploy to influence healthcare costs and outcomes for members of their health plans. A recurring theme in our conversation centered on how difficult it has become to trust the information, recommendations, and intentions in so many interactions across the health and benefits continuum.

The healthcare word is ablaze with calls for transparency. Transparency in pricing is chief among them. Purchasers of healthcare services want to know what they are paying for and how much it actually costs. Sounds reasonable to me. Wait a minute, that’s actually a problem? Yes it is.

Transparency in relationships is another call ringing across our health and benefit landscape. Purchasers of healthcare services want to know who is getting paid by whom to provide services. Once again, yes, we actually have to ask those who advise us who is paying them to influence our decisions.

Where else are we demanding transparency? In the data we receive. It seems that purchasers of healthcare want to know the results of the trillions invested in such services. It is surreal to think that such data is withheld, edited, and frequently manipulated to obfuscate reality. However, that is our world and the truth of many of our situations.

What is truth? What is the reality of our situation? So desperate have we become that we have started passing laws requiring “transparency” in healthcare pricing and the tangled web of relationships and incentives permeating it. Our reality is that we feel we need to pass laws to force suppliers of healthcare services and benefits to tell us the truth.

That’s really what transparency means. It is a cry for truth; for the reality of the situation. The truth of the contract, pricing, rebates, efficacy, quality, and myriad other factors that affect how we procure and consume the health services we need to live. Those of us who subsidize health benefits for our employees want to know the truth of our situation and what we can be doing about it.

Ultimately, the laws we pass demanding transparency are pointing to the fact that we don’t trust that what we’re being told is the truth. Our healthcare and benefits world is rife with obscuring words like discount, rebate, wholesale, average, and even transparency. Words highjacked to hide or obscure reality in the name of profit.

Ultimately, we cannot legislate trust. Sure, we can work to narrow definitions and behaviors to some degree but ours is a wily and resourceful lot. There is no way to define every situation or protect the unsuspecting from every behavior. The truth is that our $4 trillion healthcare economy has become bigger than our ability to control it or the people within it.

Trust is earned. Trust develops with time and experience. Trust is strengthened through difficult times and reinforced in good times. Trust is born through shared values, aligned cultures, and clarity of motivations. Trust happens when we see honesty, particularly when it is a difficult truth or seems to weaken the bearer’s position. Trust cannot be bought, contracted, legislated, or fabricated. Trust must be built and re-earned time and again.

Trust really isn’t a complicated process. Do what you say you’re going to do. Be honest, or at the very least, don’t lie. Work for the good of the other simply because that is the right thing to do. Seek win-win situations. Treat others as you want to be treated.

Not sure who to trust? Watch what they do over time. Watch what they do under duress. Watch what they do when they feel you are no longer worth something to them. What about organizations? Same thing. Some cultures are just better at fostering and following through on trust. Some cultures foster the behaviors that are short-sighted, obfuscating, and untrustworthy by rewarding their results.

The big unseen movement happening within our healthcare and benefits world is not really about transparency. It’s about trust. There is a massive shift underway in the fundamentals around what is acceptable and unacceptable in a space that has become comfortable with dishonesty, hidden deals, fuzzy rebates, and an attachment to the obfuscation of the truth through muddled words and misleading definitions.

I am very encouraged by various employer and union movements to deconstruct the structures that have created such massive gaps in trust. Calls for transparency, the criticism of hidden rebates, the demand for clarity on incentives, and increasing pressure for more accountability are all the result of the groundswell from our community of self-funded plan sponsors who have begun to recognize that they have options and a responsibility to demand more.

In a world short on “angels,” there are still opportunities to forge ties based on trust and mutual respect. There are still plenty of places to earn a living, price services responsibly, and be a force for good in the business of healthcare and benefits. Plenty. We don’t have to be perfect but we do need to be trustworthy. We don’t have to wait for angels, but we do need to expect more from those serving our organizations and our members. The truth is there and trust isn’t far behind.

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