A Better Health-Care System Begins with Trust

I’ve watched our industry move through cycles of innovation, frustration, and reform. When the frustration builds, I understand the instinct to ask whether we’d be better off starting over.

There’s plenty I would change. I also don’t think starting over is the answer.

Health care often costs too much and can be difficult to navigate. Patients and clinicians still spend too much time dealing with administrative burden. A Harris Poll survey found that US adults spend the equivalent of an eight-hour workday each month coordinating care for themselves or loved ones.

I believe building trust between payers, providers, regulators, and other parts of the system must come first.

Recognizing the hard work ahead, I remain confident, having seen more positive change in the past 24 months than I’ve seen in the prior decade. 

Value-based care has brought plans and providers into closer alignment around outcomes, experience, and affordability. We’re building on that foundation at Aetna. 

The fact remains that someone can have access to excellent coverage and still struggle to understand what’s covered, how to find the right doctor, or what happens next after a diagnosis. As an industry, we need to stop pointing fingers, stop putting members in the middle, and start helping them navigate their personal health-care journey. 

For me, it comes down to one question: How does our industry, and the current US health-care system, earn patients’ trust by reducing friction, increasing transparency, and improving the overall experience?

I believe building trust between payers, providers, regulators, and other parts of the system must come first. This will create connective tissue in health care, earned through lasting relationships among members, clinicians, health plans, and various partners. 

We now have technology that can strengthen those connections by making information easier to share. Trust grows when people don't have to repeat themselves, get simple answers quickly, and encounter fewer unnecessary obstacles along the way.

At Aetna, we call it trust-based care. We see it as the next evolution, building on value-based care with greater attention to the patient’s experience with the health-care system. For me, that means concentrating on three outcomes:

• Make health care easier to navigate, so people can get to the right care at the right time. 
• Make health care more human, advocating for people when they need help making sense of their care.
• Reimagine the relationship between plans and providers, replacing finger-pointing with shared responsibility so members don’t get stuck in the middle.

We regularly survey our provider partners, and have seen provider–payer trust make a meaningful improvement over the past year. It’s a good sign, but we have more work to do.

Prior authorization is a good example of why I resist all-or-nothing thinking. It serves an important purpose: helping ensure care is appropriate and supported by clinical evidence. How we execute prior authorizations to deliver care needs to improve. 

That is why Aetna is moving to a single prior authorization for all cancer diagnoses rather than requiring a series of individual approvals along the care process. For someone who has just learned they have cancer, an important clinical review still takes place, with an average of three fewer administrative steps.

Health care has no shortage of information. The challenge is that too much of it is still in different places. In an earlier survey, clinicians estimated they could save up to an hour a day and more than 10 minutes per appointment if they didn’t have to cross-check patient information.

Ten minutes with a patient is meaningful. It creates room to listen, explain, and notice something that might otherwise be missed. AI and other technologies can bring those pieces together and take on routine work, giving clinicians more of the information they need when making decisions.

We need to hold ourselves to a higher standard in health care. When someone is sick or worried about a family member, they shouldn’t be focused on paperwork or experiencing friction. Our responsibility is to remove the administrative work that gets in the way of caring for people. 

We show up in the moments that matter, offering accurate information, simpler answers, and an advocate who is there to listen. 

After nearly four decades in the industry, I’m optimistic. We’ve made real advances across health care, and the opportunity now is to bring more of them directly to the patient, so care feels easier, simpler, and more human. We need to continue to build on what works while being candid about where there are opportunities to do better.

When someone trusts the clinicians and organizations supporting their care, they have greater confidence to engage, follow clinical guidance, and take the next step. That's how we make better health accessible and affordable for more people.