Effective Cost-of-Care Conversations with Patients

Patients face significant financial side impact from their care when their out-of-pocket cost is high. To release the financial burden of patients, providers have to keep proactive communication and engagement with patients. Out-of-pocket costs such as high-deductible health plans have expanded over the past 10 years. In CY 2018, almost 29% of patients with private insurance were enrolled in high-deductible health insurance plans.

Health insurance plans with deductibles are becoming a usual practice everywhere. A new analysis from the Kaiser Family Foundation (KFF) shows that about 85 percent of covered workers had a plan with a deductible in 2018 compared to 59 percent ten years prior. The average deductible has risen by over 150 percent from 2009 to 2018, according to KFF reports.

How to integrate cost-of-care conversations into daily workflows?

The provider has to create workflows and resources required for routine patient financial responsibility, this can be the first step to having effective cost-of-care conversations that can boost the cashflow and patient outcomes. Actually, providers do not have a system to calculate cost-of-care conversations.

Patients wish to discuss costs in the clinical setting, but providers and teams may be unprepared to incorporate cost discussions into existing workflows.

Workflow requirements include organizational recognition of the need for clinic-based cost-of-care conversations; access to cost and health plan benefit data to support each conversation pathway; clear team member roles and responsibilities for addressing cost-of-care concerns; a patient experience where cost questions are normal and each patient’s preferences and privacy are respected; patients know who to go to with cost questions; patients’ concerns are documented to minimize repetition to multiple team members, and patients learn their expected out-of-pocket costs before treatment begins.

Clinic-based workflows for cost-of-care conversations that optimize patients’ care experience require an organizational commitment to addressing cost concerns, clear roles and responsibilities, appropriate and complete data access, and a team-based approach.

Explore Out-of-pocket costs

Hospitals and physician practices can do eligibility verification and can give patients more information about their health insurance availability, local health-related resources, and tools for initiating cost-of-care conversations during clinic visits. Implementing a cost-conversation screening system should engage patients and this will be easy for patients to arrange finances before the visit, and also it gives patients options to speak with clinicians or ancillary staff.

The effective cost-of-care strategy includes assigning one staff member to solve patients out-of-pocket cost problems to develop expertise and efficiency, using the electronic health record (EHR) to document patients’ financial requirements, and mining the EHR for cost data and insurance coverage.

As providers conduct more and more cost-of-care conversations, the discussions can be more effective and efficient. Physicians who conduct cost-of-care conversations are more likely to consider cost in medical decisions.

Cost Estimations

Having a discussion of cost early in care will definitely boost awareness of available resources and increases patients’ ability to plan for expensive treatments. Physicians should consider financial burden as a side effect of medical treatment and try to prevent it with the cost-of-care strategies.

The national organization of internists advises that providers should ask some questions to their patients and if the patient says yes to any of the questions, then the provider should engage in a cost-of-care conversation immediately. The questions as follows:

• Are you disturbed about your current financial situation due to your healthcare needs?
• Are you worried about your out-of-pocket expenses?
• Do you feel financially worried because of your current healthcare needs?
• Do you want to discuss your healthcare cost with your provider at today’s visit?

Physicians should screen all patients for cost distress and be prepared to have an in-depth discussion about the cost of care.

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