Caroline E. Sloan, MD; Peter A. Ubel, MD
Given the financial burdens that can result from medical care, health care providers should talk to their patients about out-of-pocket costs. However, these conversations do not routinely take place. This supplement was developed under the Cost Conversation Initiative from the Robert Wood Johnson Foundation (RWJF) in partnership with the American College of Physicians, as well as America's Essential Hospitals, Avalere Health, and the National Patient Advocate Foundation. The 8 projects discussed here provide early evidence for best practices and have inspired the editorialists to propose 7 habits of highly effective cost-of-care conversations.
Ann Intern Med. 2019;170(9_Supplement):S33-S35. doi:10.7326/M19-0537
C. Jessica Dine, MD, MSHP; Domitilla Masi, MS; Cynthia D. Smith, MD
This commentary describes resources to support conversations with patients about costs of care during clinical encounters developed by the 8 project teams whose work is presented in this supplement.
Ann Intern Med. 2019;170(9_Supplement):S36-S38. doi:10.7326/M19-0778
Susan L. Perez, PhD, MPH; Arlene Weissman, PhD; Susan Read, PhD; Cynthia Daisy Smith, MD; Lisa Colello, MPA; Doris Peter, PhD; Wendy Nickel, MPH
Rising out-of-pocket health care costs are creating a need for patients and physicians to discuss costs of care, but little is known about physician attitudes toward such conversations. This study conducted in-person interviews with internists and surveyed a second sample to gather information about the factors that influence physicians to discuss costs with patients during clinical encounters.
Ann Intern Med. 2019;170(9_Supplement):S39-S45. doi:10.7326/M18-2136
Jennifer K. Carroll, MD, MPH; Subrina Farah, MS; Robert J. Fortuna, MD, MPH; Angela M. Lanigan, MPA, RD; Mechelle Sanders, BA; Jineane V. Venci, PharmD, MS-CI; Kevin Fiscella, MD, MPH
The costs of medications are a burden to many U.S. patients but are not routinely discussed during outpatient clinical encounters. This study surveyed patients in 7 primary care practices about out-of-pocket medication costs and the frequency of conversations about medication costs during clinical encounters and before and after a single, 1-hour staff training session on that topic. Qualitative interviews were conducted with practice staff after the intervention.
Ann Intern Med. 2019;170(9_Supplement):S46-S53. doi:10.7326/M18-2011
Maria Pisu, PhD; Yu-Mei Schoenberger, PhD; Ivan Herbey, MD; Aquila Brown-Galvan, MPH; Margaret I. Liang, MD; Kevin Riggs, MD; Karen Meneses, PhD, RN†
Despite recommendations to discuss costs of care with patients with cancer, little formal guidance is available on how to conduct these sensitive conversations. This qualitative study explores perspectives on the optimal timing, content, and personnel of these discussions among breast cancer survivors and cancer center staff at the University of Alabama.
Ann Intern Med. 2019;170(9_Supplement):S54-S61. doi:10.7326/M18-2117
Kim Erwin, MDes; Veronica Fitzpatrick, DrPH; Sarah Norell, MDes, MFA; Melissa Gilliam, MD
Costs of care can influence patients' adherence to prenatal care, but little is known about how to integrate effective cost-of-care conversations into practice. This project developed a framework and tool to assist with cost-of-care discussions with low-income pregnant women during prenatal care.
Ann Intern Med. 2019;170(9_Supplement):S62-S69. doi:10.7326/M18-2207
Nora B. Henrikson, PhD, MPH; Matthew P. Banegas, PhD, MPH; Leah Tuzzio, MPH; Catherine Lim, MDes; Jennifer L. Schneider, MPH; Callie Walsh-Bailey, MPH; Aaron Scrol, MS; Stephanie M. Hodge, MA
Patients often have questions and concerns about costs of care during clinical visits, but their physicians and other members of the health care team may be unprepared to address them. This project used ethnographic observation and patient interviews in oncology and primary care practices in 2 integrated health systems in the U.S. Pacific Northwest to better understand how clinical workflows might be improved to facilitate cost-of-care discussions.
Ann Intern Med. 2019;170(9_Supplement):S70-S78. doi:10.7326/M18-2227
Kari Mader, MD, MPH; Joseph M. Sammen, MPH; Christopher Klene, BA; Jessica Nguyen, MPH; Matthew Simpson, MD, MPH; Sandra L. Ruland, DVM, MS; John M. Westfall, MD, MPH
Little is known about how to promote cost conversations in health care settings, particularly those that serve low-income Latino patients. This project developed and conducted a preliminary evaluation of community-based messages to promote patient–provider discussion of costs of care.
Ann Intern Med. 2019;170(9_Supplement):S79-S86. doi:10.7326/M18-2140
Douglas D. Bradham, DrPH, MA, MPH; Deliana Garcia, MA; Alma Galván, MHC; Corey Erb, BS
Little is known about the frequency or content of discussions about costs of care that occur during outpatient clinical encounters, particularly in settings that care for vulnerable patients. This study observed encounters in 4 Federally Qualified Health Centers to explore this issue.
Ann Intern Med. 2019;170(9_Supplement):S87-S92. doi:10.7326/M18-1608
Kimberley S. Fox, MPA; Carolyn E. Gray, MPH; Martha Elbaum Williamson, MPA; Jennifer A. MacKenzie, BA
Public Web sites that offer cost information have the potential to inform patient–provider discussions about costs of care. This study aimed to evaluate tools to facilitate the use of publicly available cost information using CompareMaine.org during clinical visits for low back pain.
Ann Intern Med. 2019;170(9_Supplement):S93-S102. doi:10.7326/M18-2223
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