Some patients don’t question the cost of care or medications, for fear they might alienate their physicians or invite lesser-quality options. Some providers also avoid talking about cost, because patients might interpret it as related to insurance company tactics to save money.

In a recent webinar, presenters offered ways to break down these barriers to cost conversations using research and tools developed with funding from the Robert Wood Johnson Foundation.

Susan Perez, PhD, MPH, a consultant who worked with Consumer Reports, described the research behind these resources: focus groups and interviews with patients and physicians and “secret shopper” medical visits, in which patients tested the conversation tools and reported on their experience. This work revealed 5 Tips on How to Talk to Patients about Cost of Care:

    1. Screen to make it routine. Screen for financial sensitivity to identify patients with concerns about paying for treatment. Reassure patients that all patients are screened, that they’re not being singled out, and that the purpose is to get them the care they need.
    2. Empower patients to ask. Patients often believe that if their physician recommends something, they shouldn’t question it, even if it poses a cost concern. By initiating the conversation about cost, physicians can give patients “permission” for the conversation.
    3. Identify lower cost options. Opportunities for cost conversations often follow a trigger, such as a prescription or referral, that creates questions about the affordability of a recommended action and the existence of more affordable and equally effective options.
    4. Change the care plan. Work with patients to identify a lower-cost course of action, when needed.
    5. Ramp up your (verbal and nonverbal) communication skills. Although physicians often are open to cost conversations, their words and body language don’t always communicate it. That takes practice.

Kellie Slate-Vitcavage, MS, project manager at Maine Quality Counts, and Carolyn Gray, MPH, research associate at University of Southern Maine, shared their experience with a cost of care conversations pilot program that leveraged the “5 Tips” in its training and education materials. A collaboration among the Muskie School of Public Service at the University of Southern Maine, Quality Counts, and the Maine Health Data Organization (MHDO), the Maine project focused on enhancing cost-of-care conversations for low back pain treatment using publicly reported cost information.

MHDO operates the website, which allows users to compare the cost and quality of more than 200 common health care procedures at Maine health care facilities. Participating practices received funding support, training and technical assistance, tailored workflows, and educational materials for staff and patients. Patient materials, developed with patient input, included posters and cards detailing low back pain treatment options and costs, along with information about the website.

No one person in the practice can be responsible for fostering cost of care conversations; it requires a culture change throughout the practice — from the front desk to the exam room. Posters in the waiting room and scripts for front desk staff, medical assistants, and providers helped prime the conversation and support a team-based approach to resolving patients’ cost concerns. The clinical workflow diagram — refined in consultation with the practices involved — helped modify staff routines.

While the project focused on low back pain, Slate-Vitcavage and Gray realized that the Maine pilot would have worked better to target cost considerations among all patients. The diagnosis-specific focus applied to too few patients and presented problems in identifying the relevant patients at the applicable points in the workflow. This narrow scope presented both a lesson and a great opportunity to raise the topic of cost with all patients.

Other lessons learned:

  • In many cases, providers already were having cost conversations.
  • Providers were more comfortable talking about relative costs (e.g., an MRI vs an X-ray) as opposed to specific costs, given that costs change and vary by patient insurance status.
  • Some providers were wary of raising the cost topic, because it might be perceived as related to insurer efforts to save money.
  • It can be challenging integrating cost conversations into the practice workflow, particularly without a trigger question in the electronic health record.
  • Timing matters. It turned out not to make sense for the medical assistant to raise the issue of cost before the patient had discussed care options with the provider.
  • Many patients were unaware of the cost transparency tools and found them valuable.
  • Take the time to develop, tailor, and roll out materials — first on a small scale, and then for the whole practice.
  • Ensure all partners and participants have a shared agreement on what constitutes “costs of care,” and how to measure success.

For an exploration of more tools, join the next Cost of Care Conversations webinar on Wednesday, March 27.

Also, visit for these and other tools to aid your cost of care conversations.