Jun 22nd 2019

How Physicians Can Integrate Cost-of-Care Conversations

In our healthcare system, we are accustomed to discussing the ills of the body, but not necessarily the challenges of the costs of care—and that can make for some difficult conversations with patients. Healthcare today offers many new challenges with patients facing higher deductibles and healthcare shifting toward a value-based care model where reimbursement is tied to improved patient outcomes.

Physicians can help patients become more engaged in their healthcare by bringing up the cost of care—taking a proactive approach that helps their patients prepare to navigate the often opaque realm of healthcare costs.

Yet, according to a 2016 study, patients reported their physicians having these conversations with them only about 30% of the time. The researchers found that physicians responded to their patients’ financial concerns in one of two ways—they either failed to acknowledge their concerns, or only partially addressed them with short-term or temporary solutions. Without long-term treatment plans, patients are at risk for not taking their medications or taking them irregularly.

When physicians do engage in these conversations, 44 percent of the time patients and physicians find strategies to reduce out-of-pocket expenses.

Fortunately, physicians can help to facilitate a reduction of costs and improve the care experience at the same time. Here are some helpful strategies:

Standardize the conversation. 

The best way to help patients address costs of care is to use a standardized script or approach to the topic, and to raise these questions with all patients. To facilitate this process, the Robert Wood Johnson Foundation in association with Avalere Health has created a series of briefs to help physicians with these conversations. The briefs include recommendations such as:

Be educated about estimated costs

Proactively open the conversation about costs of care 

Offer financial assistance resources

Document the patient's financial need so other providers can be sensitive to it

Discuss options and cost/benefit trade-offs

Discuss a patient's personal preferences (how often they want to be seen, receive treatment, prioritize comfort).

It's important to explain to all patients that cost-of-care conversations are increasingly a standard practice, so that no patient feels singled out or stigmatized over financial need. Additionally, physicians should be compassionate and especially sensitive to patients who may fear that their financial need means they will receive inferior medical care.

It's also good to know who's most at risk. A 2017 analysis of out-of-pocket healthcare expenses showed that people with high-cost or chronic illnesses, such as cancer and or diseases of the “blood organs," as well as women and the elderly, are all at greater risk of paying higher out-of-pocket expenses.

The more that a physician practice or hospital can use a “team approach” to integrate the cost-of-care conversations into the standard workflow, the more effective they will be. For example, front-desk staff and medical assistants can help to identify patients who may be experiencing financial hardship right at check-in. 

Recognize hidden or indirect costs of care

It's important to remember that some of the causes of out-of-pocket costs associated with receiving healthcare treatment are hidden or indirect. It is helpful to be prepared to discuss:

Cost of travel or transportation (e.g., gas, parking) 

Cost of child or elder care when the patient is seeking care 

Wages lost due to taking time off work

Administrative burden (e.g., time spent communicating with insurance company, coordinating care) 

Required wellness activities (e.g., diet modifications and regular exercise).

As much as possible, it is important to help patients understand where services are not covered by their insurance or where co-pays may be higher than usual.

Turn patients toward price-transparency tools 

Physicians can also empower patients to understand their own insurance and deductibles and compare prices if they aren't getting the coverage they need. A 2018 study found that when patients had the option to view price estimates before having a procedure, they were more inclined to choose healthcare facilities with lower price estimates.

Today new tools are emerging to allow patients to look up and compare the prices of procedures at different facilities or with different insurers. The Centers for Medicaid and Medicare Services (CMS) offers a procedure price lookup tool. Experian uses one called Patient Estimates, and there are a slew of other tools available in the marketplace. 

For patients most at risk, assess the of out-of-pocket spending

To help determine which patients are most at risk for financial hardship, physicians can screen patients for what are known as social determinants of health. Questions about whether the patient is having trouble paying for the costs of basic needs such as food, energy, or housing could be added to intake forms. Or, these questions could be added to a follow-up form if patients check “yes" to having financial hardship. 

This information can help physicians identify patients who are experiencing significant competing costs, encourage them to hold more specific cost-of-care conversations, and refer the patients to appropriate resources. 

Offer cost-of-care solutions and payment options

The worst outcomes of cost-of-care conversations tend to occur when physicians are caught off-guard without resources or information for patients experiencing financial hardship. 

eviCore is helping to provide as much education as possible about financial alternatives and resources for patients. Where medically appropriate, solutions can include: 

Changing the timing and mode of care administration 

Facilitating co-pay assistance

Providing free samples of medications

Changing/adding insurance plans that are accepted

Switching to lower-cost alternative therapies/diagnostics

Switching from brand name to generics

Changing dosage/frequency of medication.

In addition, physicians can consider offering patients a choice in how they would like to pay for their treatments and medications. These could include payment plans, physician charge accounts (similar to a credit card account), health savings account plans, and other alternatives.

The bottom line

Cost-of-care conversations are no longer just incidental to a clinical visit. The more that the various components of the healthcare system can integrate them into routine conversations, the better the outcomes will be for all stakeholders.