Addressing the cost of health care from the front lines of psychiatry

The potential impact of introducing a cost tool to facilitate cost-of-care conversations in routine OB care: Lessons from the CONTINUE pilot study

Objective

The objective of the CONTINUE study is to gather preliminary data on the potential impact of implementing a "Cost Tool" in routine obstetrics (OB) care. It is hypothesized that by providing prenatal patients with an ability to forecast their care plan, they would be better able to anticipate and plan for the costs associated with their prenatal care.

Methods

Pilot data from interviews and surveys were collected from 71 prenatal patients across three clinics throughout Chicago, IL.

Results

As compared to privately insured prenatal patients, prenatal patients with public insurance reported the most benefit in Cost Tool use. Specifically, that the Cost Tool helped to navigate insurance more effectively (OR 4.49, p=0.0254), see the "Big Picture" and link it to the family budget (OR 4.25, p=0.0099), and make the financial tradeoffs needed to get through pregnancy (OR 5.50, p=0.0305).

Conclusion

The CONTINUE study provides preliminary signals of the Cost Tool's potential to help publicly insured prenatal patients better navigate the costs associated with their care plan.

Innovations

The CONTINUE study contributes valuable preliminary data about the utility of a cost tool in routine OB care, especially as it may benefit low-income prenatal patients navigate prenatal care better.

Training Residents in High-Value, Cost-Effective Care: a National Survey of Psychiatry Program Directors

OBJECTIVE

The goal of this study was to explore how prepared psychiatry programs are to teach residents to practice resource management and high-value, cost-effective care.

METHODS

An anonymous online survey was sent to 187 psychiatry training directors between July and September 2015.

RESULTS

Forty-four percent of training directors responded to the survey. While most training directors who responded (88%) agreed that that graduate medical education has a responsibility to respond to the rising cost of health care, fewer than half agreed that that their faculty members consistently model cost-effective care (48%), that residents have access to information regarding the cost of tests and procedures (32%), and that residents are prepared to integrate the cost of care with available evidence when making medical decisions (44%). Only 11% reported providing training in resource management. Barriers cited to teaching cost-effective care included a lack of information regarding health care costs (45%), a lack of time (24%), a lack of faculty with relevant skills (19%), and competing training demands and priorities (18%). Training directors also noted a lack of available curricular resources and assessment tools (21%). Another 12% cited concerns about cost containment overriding treatment guidelines. Ninety percent of training directors agreed that they would be interested in resources to help teach high-value, cost-effective care.

CONCLUSIONS

Most psychiatry programs do not provide formal training in resource management but are interested in resources to teach high-value, cost-effective care. Curricula for residents and faculty may help meet this need.

Using Public Cost Information During Low Back Pain Visits: A Qualitative Study

BACKGROUND

Patients desire information about health care costs because they are increasingly responsible for these costs. Public Web sites that offer cost information could inform provider-patient discussions of costs at the point of care.

OBJECTIVE

To evaluate tools to facilitate the use of publicly available cost information during clinical visits for low back pain (LBP).

DESIGN

Qualitative study using individual and group interviews and surveys.

SETTING

6 rural primary care practices in 2 health systems in Maine.

PARTICIPANTS

Practice staff (n = 50) and adult patients with LBP (n = 72).

INTERVENTION

Participating health systems and practices were offered financial incentives, a series of trainings, and technical assistance to pilot tools for discussing costs of LBP care using CompareMaine.org, Maine's cost and quality transparency Web site.

MEASUREMENTS

Integration of tools into workflow, awareness and value to providers, and patient experience were identified through 11 group interviews with practice staff (n = 25) and health system leaders (n = 11), provider (n = 25), and patient (n = 47) surveys; patient interviews (n = 5); and administrative data.

RESULTS

The intervention increased provider and consumer awareness of CompareMaine.org, but minimally changed use in clinical discussions as a result of fewer-than-expected patients with LBP, limited system support, workflow barriers, and providers' reluctance to adopt the tools because of perceptions of limited value for their patients. In contrast, patients valued cost conversations and found the tools useful, and over one half reported intending to use CompareMaine.org during future care decisions.

LIMITATIONS

Generalizability was limited by the small number of practices and participants. Lower-than-anticipated participation precluded examination of the effect of the tool on the frequency of cost-of-care conversations.

CONCLUSION

This multicomponent intervention to introduce publicly reported cost information into LBP clinical discussions had low provider uptake. Whereas cost conversations and CompareMaine.org were perceived as useful by participating patients with LBP, providers were uncomfortable discussing cost variation at the point of care. Successful use of public cost information during clinical visits will require normalizing use to a broader group of patients and greater provider outreach and health system engagement.

PRIMARY FUNDING SOURCE

Robert Wood Johnson Foundation.