NYSAFP and NYACP:
- Provided training and raised awareness about cost-of-care and quality concepts and tools among their membership networks, which represent 18,000 physicians, residents, and medical students.
- Surveyed members at the start and end of the initiative to understand changes in knowledge and receptiveness of cost-of-care conversations, as well as guide the development of resources. For example, 33% of NYSAFP respondents reported never having a cost-of-care conversation at the beginning of the initiative; by the initiative’s end, only 5% reported never having this kind of conversation.
- Assessed and compiled online and hard-copy price and quality resources, including tools such as GoodRx, Fair Health, and Choosing Wisely.
- Launched an early adopter mini-grant program for both physicians and nonclinical staff. Activities included:
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- Recruited 23 physician practices (10 NYSAFP members and 13 NYACP members) to participate in the mini-grant program. These practices incorporated the use of cost estimate tools into their culture and trained staff to have cost and quality conversations with patients.
- Tracked measures including frequency of financial screening; type of conversation and tool used (i.e., quality, cost, or both); and the number of patient interactions. In total, participating physician practices initiated more than 25,000 conversations and nearly 30,000 financial screenings with their patients.
- Held trainings and shared resources through newsletters, webinars, podcasts, and social media, including conversation guides, self-assessment questionnaires, and sample workflows.
Avalere Health:
- Provided member networks with counsel and hosted roundtable sessions for physicians to share best practices.
- Gathered ongoing feedback from the member networks and developed a curriculum for providers to have cost-of-care conversations with patients.
- Monitored and assessed the needs of the member networks and created educational resources in English and Spanish.
- Synthesized lessons learned from the member networks’ efforts into a report with recommendations for similar cost and quality initiatives in the future.
Surveys throughout the project period confirmed that physicians understood the value in having these conversations. They reported that these discussions strengthened relationships and trust with their patients and could lead to improved health outcomes. On the whole, physicians responded positively to having resources in hand to help them initiate these discussions. Practices also reported creative ways for integrating conversations at their sites before, during, and after patient visits and as part of administrative activities. Medication costs were most frequently discussed, in part because physicians were the most familiar and comfortable with that topic. Over the course of the project, other topics emerged, including preventive care, labs, and imaging. Patients and practices reported that they became more aware of medication cost tools (e.g., GoodRx, NeedyMeds, pharmacy programs) and are using them more frequently.
Many practices identified physician champions and developed new roles and responsibilities among staff members, including case workers and patient representatives. Oftentimes, questions about financial concerns also revealed other patient stressors such as food, housing, and childcare. Several practices implemented strategies using case workers or navigators to assist patients with addressing these concerns—and reported better patient adherence to medical plans as a result.
Recognizing the critical importance of educating physicians early in their careers, NYSAFP and NYSACP also developed a supplementary residency training program to increase awareness and use of cost tools and concepts among medical students and residents.
Some obstacles emerged during the project. Physicians often reported that the tools were not data-specific enough for their facility and patients to be helpful. They also noted that linguistic and cultural barriers were difficult to overcome because many tools were only available in English. There are few existing tools to guide quality conversations, as well as wide variation in defining what comprises quality. As a result, most patient conversations focused on cost. In addition, patient satisfaction surveys were outside the scope of the project. Patient input on how they felt about these conversations was anecdotal; a more formal way to assess patient feedback would have been an improvement.
The relationships between NYSAFP and NYSACP with Avalere were bumpy at first. In some cases, the associations had access to their own centralized capacity-building resources, and didn’t see the need to participate in technical assistance activities with Avalere. Ultimately, the three groups identified helpful ways to collaborate with each other. Avalere began providing monthly updates on literature and tools, and co-developed an educational resource for patients and providers to encourage conversations about cost and quality.
NYSAFP and NYACP continue to promote physician-patient conversations about cost and quality. They are actively disseminating project resources and tools to members, and many member practices that participated in the mini-grant program are continuing the work. NYSAFP reported that 90% of participating practices will continue elements of the project. Avalere Health has also built on its work with NYHealth. With funding from the Robert Wood Johnson Foundation (RWJF), it has synthesized learnings to create additional materials and guidance for clinicians. It is also partnering with RWJF to assess opportunities to normalize cost-of-care conversations by using quality measures and emphasizing the notion of value.
Co-Funding and Additional Funds Leveraged: N/A
