Almost 25 percent of patients choose to forgo care due to cost, and 11 percent don’t take their prescribed medications due to cost. Evidence shows that reducing out-of-pocket costs for medications can increase medication adherence, particularly for vulnerable populations. However, most clinicians do not routinely screen patients for cost of medication (COM) concerns. A recent webinar shared research findings and tools for increasing those conversations.
A joint University of Rochester and American Academy of Family Physicians research project aimed to increase COM conversations in primary care settings by training providers. Study co-investigator Mechelle Sanders, PhD, shared that the training targeted the entire care team, including doctors, nurse practitioners, physician assistants, nurses, and administrative staff.
The study team provided a 60-minute interactive training session for each of seven practices across New York, California, and Georgia. Five sessions were conducted in-person and two were conducted online. The training focused on why, when, and how to pose a single question: Is the cost of any of these medications a burden for you?
The training included time for participants to identify existing efforts to support COM conversations and to formulate a plan to carry out such efforts more routinely. The training also supplied tools and resources for clinicians, patients, and care managers to reduce patients’ COM without compromising health outcomes.
Before the training, COM conversations occurred in about 17 percent of visits at the seven practices. Four months after the training, the rate of COM conversations rose to 32 percent. Follow-up interviews revealed a wide variation in workflows across practices. Primary care practices that took time to outline specific implementation details saw greater application than those that only approached the topic generally in the training.
Sanders’ study was one of eight research projects funded in 2016 by the Robert Wood Johnson Foundation to study how to improve cost of care conversations between patients and clinicians. Domitilla Masi, senior manager at Avalere Health’s Center for Healthcare Transformation, noted that four grant projects examined best practices for embedding cost of care conversations into clinical workflow, while the other four focused on developing messages specifically for vulnerable populations. Avalere synthesized the results of all eight research endeavors into a series of practice briefs on seven key topics.
Varying patient needs require different cost conversations. For example, patients with acute financial needs (e.g., inability to afford immediate out-of-pocket health care expenses) necessitate a different conversation than those with a planning or budgeting need or a need to engage in clinical decision-making. One practice brief breaks down the key elements of a cost conversation — reassurance, action, and resources — and explains how to balance them to meet varying patient needs.
The projects that focused on vulnerable populations also revealed important lessons. First, it is important to hold cost conversations with all patients — and to let them know you do so — to reduce bias and stigma. Second, providers must consider the effect of nonmedical costs of care — including transportation, food at time of appointments, child care, and lost wages — on vulnerable populations. Another practice brief summarizes tips for facilitating cost conversations with vulnerable patients.
In addition to screening patients and leading conversations, providers also can empower patients to initiate their own conversations about cost of care.
For additional provider training modules and tools, visit America’s Essential Hospitals’ Cost of Care Conversations resource library at TalkCostofCare.org.