Over the course of my accident-prone life, I’ve visited an above average number of doctor’s offices, emergency rooms, and hospitals. I’ve talked to my health care providers about the appropriateness of certain courses of treatments, gotten clarification about follow-up care, discussed lifestyle choices, and even explored the implications of the Affordable Care Act on their work. One topic, however, almost never comes up in these encounters: the cost of my care.
It turns out, even though cost is often front-of-mind for many patients as they interact with the health care system, cost-of-care conversations rarely happen in clinical settings. I’ve written at length about the significant costs associated with my recent hospital stay and the birth of my daughter, and have highlighted some price transparency tools that help health care consumers make informed decisions about where they receive their care. Most of these tools and other health insurance literacy efforts put the onus on the patient to shop around for services or better understand their insurance so they don’t get stuck with bills they can’t pay.
A new research initiative, funded by the Robert Wood Johnson Foundation (RWJF), is exploring a different approach. Through a $1.9 million investment, RWJF aims to develop clinical standards and best practices to give providers the tools and messages they need to initiate and lead cost-of-care conversations with vulnerable patients. It has become clear that both providers and patients want to talk about cost during clinical visits, but there remain many challenges to doing so, including lack of information, discomfort, and lack of trust.
CCMU is excited about this new approach and sees great need for these conversations in Colorado. Along with the Department of Family Medicine at the University of Colorado Health (UCHealth), we are thrilled to be co-leading one of eight funded projects through this innovative initiative. Our project, Cost of Care Conversations in Adams County, will work directly with patients and providers to develop and test messages about cost-of-care that resonate with patients and open the door to deeper conversations. CCMU and UCHealth, along with the Colorado Consumer Health Initiative, will work with patients and providers in three community care settings—a safety net clinic (Clinica Colorado), a community-based wellness initiative (Cultivando), and a school-based health center (Kids First Health Care).
Our project’s central premise can be boiled down to four words: let the patient lead. Using a process called Boot Camp Translation, we’ll take the lead from patients in these various care settings as they choose the words, metaphors, and images that best relate to their community members around the cost of health care. These messages will then be tested in clinical and community care settings over the course of several months. At the end of the project, we hope to have a better understanding of when, why, and how cost-of-care conversations happen in care settings, and most importantly, what types of messages work.
As we continue to tackle the intractable problems inherent to our health care system, patient-centered approaches to health system redesign are critical. Through my experiences with the health care system, professionally and personally, I can attest that patients have a great desire to better understand the health care system and be more involved in their own care, as well as invaluable insights into how it can improve. And, this patient definitely looks forward to the day his provider is prepared for and welcomes that dreaded cost-of-care conversation.