Affording Care: Whom to Ask?
Recent studies published in the Annals of Internal Medicine found that while patients are deeply concerned about the costs of health care, they are reluctant to engage in cost discussions at the point of care, when it can be most useful.
A 2013 study led by Consumer Reports found that three main reasons that patients are reluctant to bring up cost-of-care issues with their clinicians are limited time with them, a belief that physicians aren’t responsible for discussing costs, and a lack of awareness that physicians can engage in such discussions.
However, a new toolkit that helps health systems better navigate these conversations was just released. It’s called Right Question, Wrong Person. The suggestions in it are based on the findings of a nationwide survey of 523 health system personnel from 14 health systems that have already implemented the Choosing Wisely campaign; it provides health systems with a roadmap for being responsive to issues and questions of affordability and medical necessity.
“It is important to have dedicated staff that understand both the insurance perspective and what medication assistance programs are available,” reads one quote from the toolkit. “Clinical staff should be trained with the basics of programs available and know who to triage patients to for these types of questions.”
Key findings of the survey include:
- Patients are regularly asking about costs – specifically out-of-pocket costs;
- Pharmacists, physicians, health insurance companies, and health systems are best positioned to discuss treatment and medication costs with patients;
- Cost conversations should be normalized and not depend on patient initiative;
- For some, the racial, ethnic and socioeconomic composition of the staff influenced whether the patient asked providers about costs; and,
- While most health system staff members have not been trained to discuss costs with patients, they would like to be trained to have such conversations.
Beccah Rothschild, MPA, principal of Health Engagement Strategies and one of the toolkit authors, noted that “it was especially encouraging to see the types of questions that health care personnel reported patients are asking about costs of care – and equally encouraging to see the creative suggestions that health care personnel had in terms of how to improve the outcomes of these conversations. We hope that our toolkit provides health systems with resources to be able to better respond to cost questions, which can often mean redirecting those questions to the appropriate health system personnel.”
This project was administered by America’s Essential Hospitals and funded by the Robert Wood Johnson Foundation. The research was led by Susan Perez, MPH, PhD, and the toolkit was written and developed by Ms. Rothschild. In-kind support for the development and dissemination of the survey and toolkit was provided by the ABIM Foundation.
Download the toolkit here.