Stepping into the Cost of Care Conversation

Clinic staff and clinicians typically assume that “someone else” on the care team or health center staff are addressing the Cost of Care (CoC) concerns of patients, or that simply confirming insurance status is sufficient to address patients’ cost conversation needs. Both patient and providers report a willingness to engage in conversations about healthcare costs, yet there are frequent instances of misunderstanding by patients of their financial responsibility for certain costs. Patients’ trust levels for staff and clinicians varies. Clinic workflow prioritized patient throughput rather than proactively exploring patient understanding of costs of copayments and deductibles or 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 of clinicians and the costs to patients. Clinicians can play a larger role in facilitating conversations about costs with patients, especially those with low health literacy. More frequent discussion of CoC concerns may provide adherence, and thereby outcomes. To assist with practice level improvement, administrators and staff can document CoC issues and better support patients’ understanding.