Stepping into the Cost of Care Conversation

Clinic staff and clinicians typically assumed that others on the care team are addressing Cost of Care (CoC) concerns of patients, and expected that simply confirming insurance status is sufficient to address patients’ cost conversation needs. Both patients and providers report discomfort with conversations about healthcare costs and there are frequent instances of misunderstanding by patients of their financial responsibility for certain costs. Patients’ trust levels for staff and clinicians varied. Clinic workflow prioritized patient throughput rather than proactively exploring patient understanding of costs of copayments and deductibles, out-of-pocket costs for care or medications. Assessment of indirect costs of illness such as lost work time or transportation for treatments is often minimal. Additionally, the communication of patients’ CoC issues between staff across the steps of the medical visit is minimal.

The current state of cost-of-care conversations at many clinics leads to frequent misunderstandings and unmet CoC needs, which may ultimately increase the work and costs for both patients and their healthcare providers. Clinicians can play a larger role in facilitating conversations about costs with patients, especially those with low health literacy and their patients trust their insights. More frequent discussion of CoC concerns may improve adherence, and thereby outcomes. To assist with practice level improvement, administrators and staff can document CoC issues and better support patients’ understanding.