OPT-IN Pilot Project Increases Clinician Understanding of Treatment Prices

Meg Barbor, MPH

August 2016, Vol 6, No 8 - Quality Care


Patients with cancer increasingly wish to discuss costs with their oncologists, whose knowledge of treatment costs is limited. At the 2016 ASCO Quality Care Symposium, Nora B. Henrikson, PhD, MPH, of Group Health Research Institute, Seattle, WA, presented the results from a pilot project called OPT-IN, which aims at increasing clinician access to treatment prices in the clinical setting.

“Healthcare costs are increasingly shifting to patients, and now financial distress is a recognized toxicity of cancer treatment,” said Dr Henrikson. “We think that earlier and more transparent communication about cost may be a first step in helping with this.”

Group Health Cooperative is an integrated healthcare system in Washington State serving approximately 1700 new cancer cases annually in 4 oncology clinics. All price questions currently go to a central customer service line, with limited capacity to address oncol­ogy-specific questions from patients or chemotherapy costs, said Dr Henrikson.

“We have over 250 protocols provided through the Epic system that provide an itemized list of chemotherapy drugs and supportive care options,” Dr Henrikson said. “However, drug prices are difficult to locate for clinical staff, and when they are locatable, they are not translatable to patients,” she added.

OPT-IN Pilot Project

Dr Henrikson and her team developed the OPT-IN pilot project for 4 oncology clinics in Washington State. The online worksheets include codes and prices for all cancer treatments—encompassing drugs, supportive care drugs, tests, and professional services. The researchers audited the cost accuracy against billed patient charges.

“We knew going in that we wanted to be able to provide patients with their personal out-of-pocket costs, but we could not do that for this particular pilot,” Dr Henrikson said. “But we were able to work very closely with our colleagues in customer service and provide them codes and do a handoff, so the patients could have a good idea of what their out-of-pocket costs would be.”

Benefits in Clinical Setting

“We launched it, and it is feasible,” Dr Henrikson stated. The researchers surveyed 10 pharmacists, 10 nurses, 3 physicians, and 7 customer service staff to assess the OPT-IN tool. Overall, 33% of the respondents reported using the cost sheets at least once weekly, and 53.3% reported >1 patient request weekly for costs. The most useful features included improved access to cost information; treatment protocol–based layout; and service of previously unmet patient needs.

The staff reporting of patient response was positive or neutral, with no reported unfavorable effects. Planning for expenses was the most frequently reported reason for patient cost requests.

“I know we often think about shared decision-making or acute financial assistance needs, but really from a patient-centered perspective, a lot of people just want to have some reduced uncertainty about this one thing,” Dr Henrikson said.

The OPT-IN pilot project was shown to build capacity in oncology service and bridges between departments, by addressing a clear need and demonstrating high overall value.

“Most responders like OPT-IN, because it makes it easy to access price information at the point of care, and they like the protocol-based layout, which makes it easy to talk to patients,” said Kelvin Kar-Wing Chan, MD, MSc, Odette Cancer Research Program, Toronto, Ontario, Canada. “It serves a previous unmet need for patients.”

“For the busy practitioner, it is really important to know that this innovation does not impact workload,” Dr Chan added. “This is very important for ongoing long-term sustainability of this intervention.”