Empowering Health Care Consumers

Grantee Name

I.M. Research and Service Corporation for the New York Chapter, American College of Physicians (NYACP); New York State Academy of Family Physicians (NYSAFP); and Avalere Health

Funding Area

Empowering Health Care Consumers

Publication Date

June 2021

Grant Amount

$249,626 to NYCAP; $200,971 to NYSAFP; $25,000 (2018) and $89,907 (2019) to Avalere Health

Grant Date:

February 2018- April 2020

Patients are increasingly responsible for growing out-of-pocket spending for care, and they have a right know, upfront, how much their care will cost.

A national and State-level survey, co-funded by NYSHealth, found that the majority of Americans are searching for price information in health care. Most respondents indicated that they want to know how much a medical service will cost them before receiving care, but they are unsure of where to look. Many people are also unaware that quality information also currently exists to support their information needs and decision-making. Despite the availability of cost and quality websites and tools, their use is low.

As a result, consumers continue to look to their physicians as a source of price and quality information. But a range of barriers make it difficult for conversations about cost and quality to happen during clinical encounters, including time constraints, competing priorities, and lack of training. One way to address these barriers is to equip clinicians and staff members with the tools and skills needed to have these conversations with patients.

In 2018, NYSHealth launched the Connecting Consumers to Information initiative to put price and quality tools into the hands of primary care physicians and staff members and encourage their use among patients. Through this initiative, NYSHealth awarded grants to the New York Academy of Family Physicians (NYSAFP) and the New York Chapter, American College of Physicians (NYACP) to help primary care providers in their large member networks hold these cost-of-care conversations with patients and connect them to resources. NYSHealth also awarded complementary grants to Avalere Health in 2018 and 2019 to provide ongoing guidance and technical assistance to the member networks.

Outcomes and Lessons Learned

Under this grant, 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 resources, including vetted decision-assistance and screening tools, to help physicians direct patients to price and quality tools such as GoodRx, Fair Health, and Choosing Wisely.
  • Launched an early adopter mini-grant program for physicians and other nonclinical staff to better engage patients in cost-of-care and quality conversations and assist them in making informed decisions. Activities included:
    • Selected a total of 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 widely through newsletters, webinars, podcasts, and social media, including conversation guides, self-assessment questionnaires, and sample workflows.

Under this grant, 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 showed 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 and are using them more frequently (e.g., GoodRx, NeedyMeds, pharmacy programs).

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 barriers to spreading and scaling the initiative emerged during the project, such as physicians’ lack of time and knowledge for having these conversations. Physicians often found 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 fewer 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, broad patient satisfaction surveys were outside the scope of the project. Patient input on how they felt about these conversations was anecdotal. In the future, a more formal way to assess patient feedback is needed.

There were also instances when it was unclear to NYSAFP and NYSACP on how to best engage with Avalere Health’s resources and technical assistance. As a result, Avalere Health had fewer opportunities than planned to provide strategic counsel to practices. In some cases, the associations themselves had access to their own centralized capacity-building resources, and it was difficult to find additional time to participate in technical assistance activities with Avalere Health. Ultimately, the three groups identified helpful ways to collaborate with each other. Avalere Health began providing monthly updates on literature and tools, as well as co-developed an educational resource for patients and providers to encourage cost/quality conversations.

NYSAFP, NYACP, and Avalere Health continue to use lessons learned from the initiative to engage patients in conversations about cost and quality. NYAFP and NYACP are actively disseminating project resources and tools to members, and many member practices that participated in the mini-grant program plan to continue these conversations with patients. For example, NYSAFP reported that 90% of participating practices will continue elements of the project. Avalere Health has also built on its work with NYSHealth. With funding from the Robert Wood Johnson Foundation (RWJF), it has synthesized learnings from other practices 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.

Co-funding and Additional Funds Leverage: N/A