Physician Perspectives on Implementation of Real-Time Benefit Tools: A Qualitative Study

Abstract

Objective Congress and Medicare have required real-time benefit tools (RTBT) to provide patient-specific medication price information during prescribing to decrease the cost of medications. We sought physicians’ perspectives on how these tools might most effectively improve their selection of low-cost medication. Methods We conducted 15 semi-structured interviews of physicians from varied medical specialties and identified key themes across interviews during coding and analysis. Results Though physicians saw value in real-time medication price information, they were wary of the complexity of obtaining specific information and the potential for inaccuracies. Physicians described how medication price information would be used in various prescribing scenarios including simple substitutions (different drug formulation) to more complex decisions (different drug classes). In more complex situations, physicians were concerned that price information might only be available after discussing options with the patient, which would be too late to inform decisions. Concern about adding more information to the electronic health record was common. Conclusions While most physicians saw value in implementation of RTBTs, they also expressed concerns related to the accuracy of information, the availability of information at the right time in the clinical workflow, and the most effective format for information. Many concerns raised paralleled the “Five Rights of Clinical Decision Support” and indicate the need for additional design work to achieve benefit from RTBTs. Beyond the public policy that has supported the availability of RTBTs, substantial development will be required to ensure that information is used to improve prescribing decisions.

“Worth it if you could afford it”: Patient perspectives on integrating real‐time benefit tools into drug cost conversations

“…Prescribers similarly differ in their views on whether they should discuss costs 22 . We previously interviewed physicians for their perspectives on the implementation of RTBTs and identified concerns based on the complexity of the information, potential for inaccuracies, and when the information would be available in the clinical workflow 23 . The uncertainty of some patients and health care providers regarding the appropriateness of having a medication cost conversation during a clinical encounter, along with EHR alert fatigue, and limited time during clinical encounters may complicate the adoption and routine use of RTBTs and limit their benefits in practice.…”

Patients want to talk about their out‐of‐pocket costs—Can real‐time benefit tools help?

“…The authors conducted qualitative interviews with a diverse group of patients to evaluate their views of cost‐of‐care conversations and the role that RTBTs might play in facilitating them. The findings from this article, as well as the same group's previously published article on clinicians' perspectives of RTBTs, 4,15 suggest that several important actions should be taken to ensure that RTBT use is practical and helps improve patient care, especially for complex patients like Ms. Smith.…”

“…15 Cost estimates could be useful even when lower-cost alternatives are not available because they might help patients and clinicians have more informed discussions about the financial implications of their decisions. 15 Mattingly and colleagues' findings illustrate that RTBT use and cost-ofcare conversations should be tailored to each patient's circumstances, including their desire to discuss costs, their financial situation, the importance they place on costs when making medical decisions, and their prior positive and negative experiences with cost-of-care conversations. 4 Clinicians could be given access to scripted language or training modules that would help them incorporate out-of-pocket costs into complex clinical decisions when appropriate.…”

“…Both patients and clinicians worry that RTBT use will prolong clinical encounters and/or take time away from other important clinical matters. 4,15 Prior analyses of audio-recorded encounters have found that cost-of-care conversations typically last only 1 or 2 min, 17 but these analyses were conducted prior to the existence of RTBTs. Now that real-time cost information is available, cost-ofcare conversations may take longer and be more nuanced as clinicians and patients discuss the tradeoffs of various medications with varying cost, efficacy, and side effect profiles.…”

“…Clinicians have expressed concern that RTBT alerts may interrupt their workflow too much or at inappropriate times, decreasing their utility and causing alert fatigue. 15,20 As the main users and beneficiaries of RTBTs, patients and clinicians should have a seat at the table when health systems decide what information their RTBTs present and when that information is presented.…”