Cost Conversations

STEPS FOR IMPLEMENTATION – FACULTY

1. As a faculty mentor: familiarize yourself with the provided resources
2. Discuss the different categories of resources/tools in separate sessions with your students given the breadth and depth of what is provided. Choose between these suggested activities, or create your own based the HELPFUL RESOURCES below
   1. Session 1: Resources and training for providers
      1. Overview of clinician perspectives on cost conversations based on published data
      2. Role-play scenarios: assign some students to be patients with financial concerns and some students to be clinicians screening for distress and responding to concerns. Resources to use:
         1. ACP Cost Conversation Guide, Cost Distress Identification Tool
         2. Essential Hospitals’ “How to Welcome Cost-of-Care Conversations in Your Practice,” “Structuring the Conversation: How to Talk to Your Patients About the Costs of Their Care,” “Screening for Cost Burden”
         3. Costs of Care modules :“First, Do No (Financial) Harm” “GOTMeDS”
         4. Discovering Value Based Health Care modules: “Enhancing Affordability For Patients” and “High-Value Communication”
      3. Prescription cost comparison: provide students with a list of commonly prescribed medications in different clinical scenarios (e.g. type 2 diabetes care visits, mental health visits, pediatric inpatient discharges for asthma) and have them explore the costs associated with these prescriptions. Resources to use:
         1. ACP Steps to Estimate the Cost of Care
         2. GoodRx
         3. WellRx
      4. High-value clinical decision-making: have students practice “presenting” ambulatory or hospitalized patients with a specific focus on value. Resources to use:
         1. SOAP-V
         2. The High-Value Care Rounding Tool
         3. HV3C Rounding Tool
         4. Mayo Clinic Diabetes Decision Aid
         5. ACP HVC Educational Prescription
   2. Session 2: Resources for patients
      1. Overview of financial impact of medical care on patients/families and patient perspectives on cost conversations based on published data
      2. Cost Transparency Tools: Assign students different tests and procedures and ask them to determine how much it would cost them to obtain these services as a patient. Resources to use:
         1. FairHealth Consumer
         2. Healthcare Bluebook
         3. Your home institution’s cost estimator (if applicable) or other publicly available cost estimators (e.g. University of Utah Health, Stanford Health Care)
         4. HealthValueLab
      3. Anatomy of Insurance: have students explore the specifics of their health insurance plans so they can better help patients understand theirs. Resources to use:
         1. ACP Know Your Health Insurance
         2. CMS Coverage to Care
         3. Anatomy of a Bill
   3. Session 3: Resources for system-level interventions
      1. Know your institution: Help your students explore your EHR (ideally in the training environment!) to demonstrate what aspects of cost transparency have been employed (e.g. relative costs associated with orders, antibiograms, prescription orders, social determinants of health dashboard). Have your students reach out to the financial counselors/navigators, billing department, and/or social work to understand local workflows and available resources. Have them discuss with the team that supports your EHR what tools are available for implementation to support financial screening or cost transparency. Resources to use:
         1. Epic User Web (if you are an Epic institution) – search
      2. Plan a High-Value Care Intervention: Discuss a hypothetical (or real) low-value issue and discuss with your students how to design an intervention to address it. Resources to use:
         1. Costs of Care “COST” framework
         2. ACP High Value Quality Improvement
      3. Journal club with a cost focus: Hold recurring journal clubs where students review articles about low value care, then calculate costs associated with the care described. Resources to use:
         1. JAMA Internal Medicine “Teachable Moment”
         2. Journal of Hospital Medicine “Things We Do For No Reason”
         3. Hospital Pediatrics “Bending the Value Curve”

View Helpful Resources

Cost Conversations Clinician Perspectives

Cost Conversations Patient Perspectives