Despite considerable talk about change and new initiatives, the U.S. healthcare system continues to rely heavily on the traditional fee-for-service healthcare model that rewards quantity over quality and health. Time and again, we see that this focus on churning individual visits leads to the provision of reactive, episodic care and, ultimately, poorer patient outcomes. It’s important to note that many providers don’t like this any more than patients who have grown weary of it. And as the reality of unsustainable total cost sets in—along with continued physician burnout—more and more providers are seeing the value in moving away from the “maximum number of visits” mentality to the path of guiding patients on a journey of wellness. For that journey to be successful, however, it’s critical for patients and providers to develop trusting relationships that are facilitated by quality time, ongoing communication, and whole-person care management, all driven by the ability to achieve and demonstrate positive outcomes.
This need to refocus care foundations on trusting relationships is timely. According to the American Board of Internal Medicine Foundation (ABIM), physician trust decreased during the COVID-19 pandemic, and rebuilding it is needed. A special report on health and trust in 2022 revealed that people’s confidence in their ability to find answers about healthcare questions and make informed decisions about their health has declined steeply over the past five years. Those with lower trust in the health ecosystem are both less likely to be fully vaccinated and are less likely to be engaged in preventive health care, including routine check-ups.
Trusted relationships, the foundation of provider-member primary care engagement, are absolutely fundamental to preventive care, treatment provision, and the resultant outcomes for the patient. The strong relational notion that grows with establishing and meeting expectations, maintaining communication, and facilitating cooperation enables providers to encourage necessary behavioral changes and permits patients greater autonomy in making decisions about their treatment. At Crossover, our care model was built on the concept that a strong relationship between the care team and member will guide the path to achieving optimal wellbeing. Quality time, open and ongoing communication, and outcomes-based care management will establish trust and deepen the vital relationship, as healthcare evolves to meet both individual and community health needs.
Quality time builds the foundation for trust
Regardless of the speciality or patient need, quality time spent between provider and member cannot be underestimated. At Crossover, we’ve considered this in multi-faceted ways, down to our “design everything” nature that includes the layout of clinic rooms, for instance, which are designed to promote active engagement between providers and members, with a table and chairs for comfortable, open conversation. This approach extends beyond our physical health centers to structuring the schedules of our providers, who have time for care coordination built into their day—outside of member visits—enabling them to be present and connected in each appointment.
An American Board of Internal Medicine survey of trust revealed that 25% of patients say the doctor spent too little time with them. Similarly, 14% report that their doctors don’t listen to them, and another 14% think their doctors don’t know them. The fact is, primary care physicians (PCPs) spend an average of only 18 minutes with their patients, according to Medical Care, whose authors note, “Longer appointments are critical for clinically complex patients.” At Crossover, where the standard appointment time is much longer at 30 minutes—after an initial 60 minute visit—we believe that every patient deserves quality time to talk about their health and their lives.
Open communication yields invaluable health discovery
In a world of increasing physician and nurse burnout, one of their biggest complaints is lack of time to educate patients on next steps of treatment. More time to do this enables clearer instructions and detailed discussion for clearing up uncertainties. As our care teams engage in both 30-minute visits and hour-long annual physicals, I am fascinated by the way member stories ebb and flow over the course of visits. While conversations may begin with discussion of a minor health concern, they often evolve to include various difficulties and ailments, including environmental challenges and mental health struggles. The additional time affords us the ability to listen closely, recognize vulnerabilities, and help mitigate inequities through various means of support. As we look ahead, we must consider that time and relationship-building occur both through traditional in-person interaction and virtual visits, as well as through messaging and phone calls in between care episodes—a true hybrid approach for meeting members exactly where they are. As healthcare must continue to move from a sickness model to a health model, health discovery through trusted dialogue will be key.
Furthermore, additional time with members allows us to explore social determinants of health (SDOH). With every Crossover member, we open the door to important conversations about well-being, preferences, and barriers to health. If a member does not complete certain treatment recommendations—from healthy eating to preventive screenings—it’s important that we, as providers, understand why. Trusting relationships between patients and PCPs help ensure patient preferences are considered, mitigating racial and economic inequities.
The power of clear outcomes will solidify the patient-provider relationship
At the end of the day, what patients want most is to be healthy. Whether that comes directly from a one-on-one patient-provider encounter, or through an extended team and via care navigation and referrals, it’s the end result that matters most. One of our members recently shared her positive comments on a review site, saying, “The staff here at Crossover Health…have gone beyond the call of duty for my medical needs! They actually care and really listen…and ask a lot of questions and also check other prevention issues in the same visit.”
Research shows that through trusted relationships, continuity of care is associated with improved patient outcomes and lower overall costs. As healthcare provision evolves to uphold a sense of community between patients and care teams, we’ll see a greater emphasis on clinical care navigation. Vital facilitators will ensure that patients understand next steps of care and are connected to vital screenings and services. A commitment to continuity of care through relationships ensures that no one falls through the cracks of the care system.
Patient-provider relationships in primary care will be only as effective as their roots are strong in trust. A patient engagement survey found that even in the midst of the pandemic, the majority of primary care patients continued to value a relationship with their care clinician, citing desires to be known as individuals, ascertain help in understanding current concerns, and maintain a safe haven for asking important questions. Eighty-three percent expressed distress at the thought of losing that relationship. As healthcare grows its ability to provide high-quality, whole-person, integrated, accessible, and equitable care, trusted relationships will sustain patients’ health and wellness needs across diagnoses, settings, and communities.