Addressing Patient Needs Around the Cost of Care

The Patient Access Network Foundation’s second cost-sharing roundtable, held February 24, 2017, gathered health policy researchers and patient advocates for open discussion on the best way to initiate a doctor-patient conversation around the stress of healthcare costs. The key takeaway from the discussion was a need for educating all involved.

Participants on the panel included Andrea Baer, MS, director of patient advocacy at Mended Hearts, Inc; Jalpa A. Doshi, PhD, associate professor of medicine at the University of Pennsylvania; Mary Richards, executive director at Partners for Better Care; Veena Shankaran, MD, MS, associate professor in the Division of Medical Oncology at the University of Washington; and Kai Yeung, PharmD, PhD, scientific investigator I at the Group Health Research Institute.

Clifford Goodman, PhD, senior vice president at the The Lewin Group, moderated the panel and asked the health policy researchers to describe how their work would influence the doctor-patient interaction on the topic of healthcare costs.

Shankaran, whose research includes developing strategies to improve the financial literacy of patients, indicated that while there is growing awareness, and physician organizations like the American Society of Clinical Oncology have been working toward improving the conversation, the process to achieve this end goal remains ambiguous.

“Do we speak about the specifics or do we just acknowledge that the cost is substantial? What is this communication about?” asked Shankaran. She believes that health systems need to develop strategies that will inform and educate patients.

The question is, are doctors up to speed to handle these discussions?

“Most clinicians are caring and they recognize that patients are struggling with the cost of care,” Shankaran said. “However, a lot depends on patients bringing up this issue.”

The first step is acknowledging that there’s a problem and then creating a team that can help address it.

Goodman wanted to understand the importance of peer support for these discussions.

“When we talk about what we can do, we need to understand the [mindset] of ‘average’ people making these decisions,” said Baer. Her organization, Mended Hearts, is a nonprofit that partners with hospitals around the country to provide heart patients and their family givers a peer-to-peer support network.

Pointing to the existence of a reality gap, Baer added that decision makers may not necessarily be aware of the patient’s financial struggles. Baer trusts in patient empowerment to be able to bring up these conversations with their treating physician.

Richards, who was representing Partners for Better Care—which works to influence policy on cost-efficient and transparent healthcare—said, “We are working to develop a system to translate qualitative data into a language that patients can understand and navigate.”

The organization, whose members include patient advocacy groups, health plans, and pharma, has developed peer support programs to support patients. They also provide case management, and case work includes healthcare diagnosis and financial navigation support.

Doshi explained that high-deductible health plans are on the rise, even among employer-sponsored insurance. For Medicare patients, until they hit $4000, which is their annual out-of-pocket maximum, they face significant cost sharing.

Goodman asked Yeung whether cost-effectiveness ratio or value-based piecing can ease this burden a bit.

“We have diversity of health plans, which allows experimentation,” Yeung said. He believes that binary coverage—meaning “yay” or a “nay” coverage decisions seen in the United Kingdom and in Canada—may not be suitable for the United States.

“Patients with advanced cancer receive counseling around whether getting additional, more expensive treatment,” Shankaran said, and that standard-of-care treatments provide some room to discuss drugs that may be similar in efficacy but might have a significant cost difference. “Physicians can take a lead here to help the patient make a decision,” she added.

Highlighting the importance of a peer support group, Baer said that while several providers share information on numbers that patients can call for decision support, the patient may not have the time or energy for it. “When you are at a critical juncture in life, emotional and physical support from peers can help decision making,” she explained.