Better Cost Data Key to Patient-Provider Communication on Affordability

Healthcare providers need more—and better—information to be able to facilitate the patient-provider communication patients desire about their out-of-pocket costs, according to two new studies from the University of Michigan.

The studies, both published in the Journal of the American Medical Informatics Association (JAMIA), indicate that providers cannot deliver on conversations patients want and need to have about the cost of healthcare.

In the first of the two studies, informed by 18 qualitative interviews with patients at a health system in the Midwest, patients said discussing the cost of healthcare would help them navigate their own financial responsibility.

“Cost conversations don’t necessarily happen and we were trying to understand why,” Olivia Richards, a U-M doctoral student who worked with patient interview data, said in a statement.

Currently, most providers are saving cost conversations for patients with serious illnesses like cancer, or other illnesses that notoriously are linked to high patient costs.

“You might have that conversation more about a chronic illness like diabetes as well because treatment is expensive,” Karalyn Kiessling, another U-M doctoral student who worked on the research, pointed out in the press release.

This comes even as both patients and providers express a desire to chat about the high cost of healthcare and how patients will be able to afford their medical care or medications. Particularly, the patient interviews showed that conversations around costs could be helpful especially when they centered on medications.

Providers who can take financial constraints into account when prescribing can help patients navigate the system better; for instance, by prescribing a generic or a lower-cost alternative. After all, the best medication to prescribe patients is the one they can afford and will therefore fill and take as prescribed.

Patients said they don’t always feel like they have the time to explain their financial situations, the interviews revealed. Cash-strapped patients have to jump through a number of hurdles to access their healthcare—obtaining time off work, paying for childcare, finding transportation—in addition to the price tag of the procedure or treatment. Explaining those social determinants of health can take a while, patients acknowledged.

“Patients would look up at the clock, and think ‘I don’t think there’s time for me to explain that I had a death in my family, I had to take four buses to get here, I don’t know if I can come back in two weeks,’ or whatever the situation might be,” Richards said.

Moreover, patients said they do not think their providers have access to the information necessary to make cost-conscious prescribing decisions, anyways. Limited access to streamlined or interoperable information is getting in the way.

Providers corroborated that in the second JAMIA study. The researchers spoke with 38 providers, ranging from physicians to social workers to administrators, and found more and better information will be key to holding the cost conversations patients want and need.

Although clinicians want to discuss cost with patients and acknowledge the benefits of doing so, they do not have adequate information for holding these conversations or ameliorating patient care access barriers.

Clinicians specifically said they don’t know enough about a patient’s ability to pay for healthcare, the true cost of a procedure or treatment, or how cost might change based on patient insurance coverage.

There are some tools that attempt to tackle these issues, providers acknowledged, but those tools are not always updated with patient insurance information. Some respondents also questioned the quality of the information in those tools. Additionally, data fragmentation got in the way of accessing the most pertinent information, clinicians said.

Access to cost-compare tools, list charges, and summaries of patient affordability challenges would be helpful, clinicians told the researchers.

Limited access to information tools that can facilitate patient-provider communication about cost is ultimately harming the patient experience, according to Tiffany Veinot, associate dean and professor at the U-M School of Information.

“There’s harm being caused by the way the system works right now. It’s not really designed in a patient-centered way,” said Veinot, adding that there is an intense social cost for some patients. “It can be very embarrassing for people to get to the pharmacy, and then suddenly they have to refuse a prescription because they can’t afford it.”