COVID-19

The Need for Measuring Clinician-Patient Cost-of-Care Conversations

By MORENIKE AYOVAUGHAN, NELLY GANESAN, EMMY GANOS, and JOSH SEIDMAN

It is no surprise that beyond COVID-19 health risks, the pandemic has also caused significant disruption to the lives of everyone in America. It has caused exacerbating financial pressures and ongoing job losses. An estimated 42 million people have lost their job since March 2020, which has increased the number of uninsured. The loss of coverage has the potential to yield catastrophic healthcare costs for those seeking care during the period.

It is no surprise that beyond COVID-19 health risks, the pandemic has also caused significant disruption to the lives of everyone in America. It has caused exacerbating financial pressures and ongoing job losses. An estimated 42 million people have lost their job since March 2020, which has increased the number of uninsured. The loss of coverage has the potential to yield catastrophic healthcare costs for those seeking care during the period.

While the pandemic has exacerbated coverage challenges, it also highlights gaps that existed long before the outbreak. Prior to COVID-19, average out-of-pocket costs were on the rise with an estimated 24% of Americans spending over $1,000 per year on direct medical care and surprise medical billing. The pandemic-induced economic disruption reinforces the need for physicians and patients to embrace conversations regarding cost in the clinical setting; avoiding such discussion may result in patients foregoing care and not realizing their options.

Patients should be able to rely on their clinicians to help them understand the costs of their care, including losses associated with the time away from work and transportation expenses for visits. Our past research, and the research of others, has demonstrated that these conversations are valued and can be impactful in helping patients understand their options to address concerns upfront. And yet, the concept of having a Cost-of-Care (CoC) conversation is merely optional. These conversations are not typically supported with access to price information, nor are they consistently viewed as a routine part of practice. Cost conversations are not consistently documented, lack standardization, and structure. Furthermore, physicians have not adequately been trained to address CoC conversations with their patients.  

Our work to date as shown that patients feel supported by clinicians and care teams when the clinical staff addresses cost concerns and can connect patients to financial resources to help them make decisions regarding their care. Measurement is one mechanism to encourage these conversations. In partnership with patients and clinicians, Avalere Health, the National Patient Advocate Foundation and Robert Wood Johnson Foundation are exploring the feasibility of quality measures to normalize and improve the quality of CoC conversations in the clinical setting.

Implementation of meaningful quality measures allows health care system leaders and policymakers assess whether clinicians are engaging in respectful conversations about costs with patients, and whether patients’ concerns about costs are being addressed. We also know measurement alone will not drive improvement. Measures can be used to support quality improvement and systems change.

Based on our research and a growing body of literature, we are exploring measure concepts to facilitate CoC conversations between patients/caregivers and their care teams and to assess their impact. We need to ensure these measure concepts meet three main goals. First, they need to resonate with patients; the measures need to address issues that really matter to individuals who are trying to make decisions about their care. Second, the measures should have some impact on holding clinicians accountable; normalizing CoC conversations – asking clinicians to do something patients want but is only happening a quarter of the time – requires accountability for their actions. Third, we want these measures to drive improvement; the measures need to provide information that guide clinicians and the organizations they work in on what steps they can take to make conversations respectful, responsive, and effective. Based on existing gaps and our knowledge of the clinical workflow, the concepts we are exploring address: discussion of CoC during a clinic visit, documentation of CoC concerns and a patient-reported assessment of the CoC conversation.

Having a CoC conversation requires a shift in how a clinician prioritizes how to use their time with patients. This shift will need to be addressed and implemented by clinicians, care teams, payers, and policymakers. Only then will patients see a meaningful change to their experiences in care delivery. Our partners are very excited to test, implement and evaluate these measures in a real-world setting, we’re hopeful that introducing quality improvement in this space will enhance cost transparency and put more pressure on policymakers and regulators to advance the use of measures to address barriers to CoC conversations.

Morenike AyoVaughan, MPH, is a Consultant II at Avalere Health, Nelly Ganesan, MPH, is a Principal at Avalere Health, Emmy Ganos, PhD, is a Senior Program Officer at the Robert Wood Johnson Foundation, and Josh Seidman, PhD, is a Managing Director at Avalere Health.

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  1. “Patients should be able to rely on their clinicians to help them understand the costs of their care”

    Wrong approach and only in America. Patients should not have to worry about their cost of care at all. Medicare for all would solve that.

    And by the way, it’s not “cost” of care, it’s the price of care.

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