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Actionable Resources to Facilitate Cost Conversations Between Patients and Clinicians

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As part of the Robert Wood Johnson Foundation Cost Conversation projects, Avalere led the development of a set of practice briefs that provide actionable resources to healthcare providers about how to improve the value and frequency of cost conversations with patients.

With growing healthcare spending and increasing patient out-of-pocket (OOP) costs, there is an urgent need to ensure that patients are having productive conversations with their care teams about the expected costs of their care. Over the past decade, the percentage of patients spending $1,000 or more OOP annually has increased from 17 to 24%.1 This amount is significant given that 46% of Americans report not being able to provide upfront payment for a $400 emergency expense.2 Patients also incur huge indirect costs associated with healthcare needs, including travel, childcare, and lost wages. Moreover, recent research found that 70% of Americans would like to discuss the costs of their care with their clinicians or other staff. Only 28%, however, have reported doing so.3

What are the RWJF Cost Conversation Projects?

The Robert Wood Johnson Foundation (RWJF) launched the Cost Conversation projects in December 2016 to support exploratory research to improve the frequency and value of cost-of-care conversations between patients and their care teams. Building on foundational work that Avalere and RWJF conducted in early 2016, RWJF provided $1.9M in funding to 8 research teams. These researchers focused on developing and testing messaging and new workflows to support cost-of-care conversations, often with a focus on more vulnerable populations, such as low-income women with high-risk pregnancies, low- and moderate-income cancer patients, and patients for whom English is not their primary language.

Access the full list of research grantees and summaries.

Earlier this year, the Cost Conversation projects also welcomed 3 new partners—America’s Essential Hospitals, National Patient Advocate Foundation, and the American College of Physicians—that are focused on spreading the grantees’ research findings.

What are Cost-of-Care Conversations?

This project defines cost-of-care conversations as discussions regarding all the costs that patients and their families face, from OOP to indirect costs (e.g., transportation, child care, and lost wages) for a healthcare option. Although important to discuss financial trade-offs, cost-of-care conversations should always be held within the context of the quality of a healthcare option.

What are the Practice Briefs?

As part of the Cost Conversation projects, Avalere worked closely with the RWJF grantees to synthesize the key themes and findings across their studies and create 7 practice briefs. These actionable resources support clinicians, staff, and practice administrators interested in increasing the value and frequency of cost-of-care conversations in the clinical setting. The briefs cover topics such as how to:

  • Welcome and structure cost-of-care conversations
  • Talk to patients about the hidden costs of healthcare
  • Facilitate cost-of-care conversations with vulnerable patients
  • Integrate cost-of-care conversations into the clinical workflow
  • Address common barriers to implementation

The briefs are available on America’s Essential Hospitals’ website.


  1. Bradley Sawyer, Cynthia Cox, and Gary Claxton, “An analysis of who is most at risk for high out-of-pocket health spending,” Kaiser Family Foundation (2017; accessed November 20, 2018).
  2. Board of Governors of the Federal Reserve System, Report on the Economic Well-Being of U.S. Households in 2015 (2016; accessed November 20, 2018), 1.
  3. David Schleifer, Rebecca Silliman, and Chloe Rinehart, “Still Searching: How People Use Health Care Price Information in the United States, New York State, Florida, Texas, and New Hampshire,” Public Agenda (2017; accessed November 20, 2018): 7.
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