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7 Steps to Hold Cost-of-Care Conversations With Your Patients

Analysis  |  By Christopher Cheney  
   May 20, 2019

With higher out-of-pocket costs, patients face significant financial side effects from their care.

With proactive communication and engagement, clinicians can ease the financial burden of their patients.

Out-of-pocket costs such as high-deductible health plans have expanded over the past decade. In 2018, 29% of patients with private insurance were enrolled in high-deductible health plans, up 25 percentage points from 2006. More than a quarter of Americans have trouble paying medical bills.

In this month's edition of Annals of Internal Medicine, researchers provide seven approaches to having effective cost-of-care conversations with patients:

1. Patient engagement: Most physicians take a passive approach to discussing patient finances. Months can be wasted before clinicians find out patients can't afford their medications. Patients should be screened for financial hardship.

2. Cost estimates: Clinicians make medical prognoses that allow patients to plan for their care, and they should make financial prognoses that help patients plan financially. Discussing costs early in care boosts awareness of available resources and increases patients' ability to plan for expensive treatments. Clinicians should consider financial burden as a side effect of medical treatment and try to prevent it.

3. Anticipate costs: Most patients are concerned about the indirect costs of their medical appointments such as lost income, transportation, and childcare. Through communication with patients, these costs should be anticipated.

4. Make exploring out-of-pocket costs routine: Hospitals and physician practices can give patients information about health insurance availability, local health-related resources, and tools for initiating cost-of-care conversations during clinic visits. Implementing a cost-conversation screening system should engage patients, ease shame patients feel about financial problems, and give patients options to speak with clinicians or ancillary staff.

5. Adjusting workflows: Clinicians should work cost-of-care conversations into their daily workflows. Effective strategies include assigning one staff member to serve as the out-of-pocket cost problem-solver to develop expertise and efficiency, using the electronic health record (EHR) to document patients' financial need, and mining the EHR for cost data and insurance coverage.

6. Ancillary staff play central role: Most practices involve ancillary staff—medical assistants, nurses, front desk staff, and financial counselors—in cost-of-care conversations. Ancillary staff generally have more flexibility in their workflows to accommodate financial conversations with patients, and their views on cost of care often align closely with patient views compared to clinician views.

7. Practice makes perfect: As clinicians conduct more cost-of-care conversations, the discussions become more effective and efficient. Clinicians who conduct cost-of-care conversations are more likely to consider cost in medical decisions.

Christopher Cheney is the CMO editor at HealthLeaders.


More than a quarter of Americans struggle with medical bills.

Patients should be screened for financial hardship.

Exploration of out-of-pocket costs should be routine at hospitals and physician practices.

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