Treatment prices at the point of care: Pilot.

Abstract

4 Background: People with cancer increasingly wish to discuss cancer care costs with clinicians. In our organization all price questions go to a central customer service line with limited capacity to address oncology-specific questions. We aimed to improve clinician access to treatment prices to assist them in responding to patient concerns about prices. Methods: We developed, launched, and evaluated a pilot tool and accompanying workflow for four oncology clinics in an integrated delivery system in WA. The online tool included a series of 50 printable worksheets for the most commonly ordered cancer treatment protocols accessible directly from the electronic health record. The worksheets included codes and prices for all drugs, supportive medications, tests, and professional services for one treatment cycle presented in patient-friendly language. We audited the accuracy of the cost information against patient bills. The worksheets did not provide patient-level cost-shares. We evaluated the resource’s launch, initial use, and acceptability through a convenience survey of initial users. Results: The project was successfully launched. Initial web traffic to price sheets exceeded the number of treatments being ordered during the launch period. A third of survey respondents (33%) reported using the cost sheets at least once a week. Reported most useful features were improved access to cost information, treatment protocol-based layout, and the service of previously unmet patient needs. Seventy percent (70%) reported that the resource had no impact on their workload. The mean value of the resource (1 lowest and 10 highest value) was 7.9 (value to patients); 7.8 (to oncology service line), 7.7 (to Group Health) and 6.5 (to own work or practice). Staff reporting of patient response was generally positive. Suggested improvements included provide patient-level cost share (63%) followed by expanding the project to include more protocols (33%). Conclusions: The pilot was feasible, built capacity to locate price data, and did not adversely impact staff workload. It addressed a clear need and demonstrated high potential overall value, especially its protocol-based format. The resource’s lack of personalized estimates of out-of-pocket charges was the biggest gap reported.

A Conceptual Model of Financial Toxicity in Pediatric Oncology

“…Some institutions have developed online tools that draw from the electronic health record to create worksheets with prices for the therapeutic agents that comprise the treatment regimen, supportive medications such as anti-emetics, associated laboratory tests, and professional services for one cycle of established treatment protocols for breast cancer. Oncologists use these sheets to facilitate discussions with patients and families about cost (Henrikson et al, 2016). Treatment for childhood cancer is highly protocol driven, which facilitates application of this innovation to pediatric oncology.…”