For the last year, Deliana Garcia, MA, MCN’s Director of International Projects and Emerging Issues, has spent time as part of a research team at four Community Health Centers (CHCs) in Texas, Puerto Rico, and Pennsylvania to better understand whether clinicians have conversations with their patients about the cost of care (CoC), and whether those conversations are effective. With funding from the Robert Wood Johnson Foundation, the research, spearheaded by Douglas D. Bradham, DrPH, MA, MPH, Health Economist and Principal Investigator, and aided by Alma Galván, MHC, MCN’s Senior Program Manager and Corey Erb, Research Assistant and Executive Associate, showed a wide spectrum of conversations and an even more diverse set of patient reactions to the conversations.
“When question about ‘how sensitive’ discussions of personal finances and the ability to pay for health care with their health care provider felt, 50 percent indicated that they were ‘not sensitive,’” Garcia said. “However, nearly a quarter of respondents said these discussions were ‘highly sensitive,’ indicating that health care providers need to approach the topic carefully, with no expectations as to the openness of the patient to a conversation around cost.
Based on previous MCN research on highly charged conversations, the researchers posited that a cost of care conversation — one in which the clinician lays out the treatment options with their associated financial implications — will be most successful when the clinic environment includes:
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Access to language-appropriate informationmaterials on possible out-of-pocket costs;Access to language-appropriate informationmaterials on possible out-of-pocket costs;
- An expectation that a routine part of the exam room encounter includes the discussion of emotionally-charged financial topics, including an outline of items that the clinician would cover; and,
- Clinicians and staff who are provided trainings to know how to anticipate and encourage meaningful CoC discussions.
Research efforts aimed to view the conversation around CoC from different perspectives. Health Network team members Tanya Snyder Salgado, Olivia Hayes, Sophia Galewsky, and Rob Corona assisted the researchers in data collection, completing bilingual interviews of 85 low- and mid-income patients whose age makeup reflected the overall distribution of ages in the 2016 data inputted by CHCs to the Uniform Data System (UDS). A total of 67 patients then agreed to be shadowed by a researcher-observer during their visit. To get another view of the conversation around costs, clinicians’ impressions on the encounters were also reviewed.
The results of the observed interactions suggest that a majority of the patients interviewed rated their clinician very high on trust determinants. Additionally, almost half (48.8%) of the patients were encouraged to ask cost of care questions, but 18.6% say they were not encouraged.
While few clinicians responded to the survey that captured their own perspective on what was covered in the conversation and how patients responded, it was, nonetheless, determined that having clinicians engage in a cost of care conversations with their patients can help one in ten patients to make more informed decisions around health care, knowing the potential out-of-pocket costs. This is based on a review of the literature that indicated that ten percent of patients delay or avoid medical intervention because of cost, and a conversation that sought solutions would help these individuals potentially achieve a different outcome.
Watch MCN’s archived webinar about Clear on the Cost to learn more: https://www.migrantclinician.org/archivedwebinars.html.
Read this article in the Summer 2018 issue of Streamline here!
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