Marc Boutin Discusses Cost of Care and Patient Decision Making

Patients, especially those with complex chronic conditions, factor in a lot of different things when making care decisions, and increasingly cost is a huge issue, said Marc Boutin, JD, chief executive officer of the National Health Council.

Transcript (slightly modified for readability)

How much does cost factor into patient decision making, and how much does clinical efficacy?

So patients will factor in a lot of different things when they’re looking at their care, especially people with complex chronic conditions. Cost is increasingly a huge issue for this population. Currently, patients are paying for about 22% of the cost of their care. So increasingly they’re spending a lot of money. And what we’re seeing is that patients are making deicion by not seeking care because the cost barriers become too high. So we haven’t got this granular enough so that we can use cost to drive patients to appropriate care, what we’re doing is driving them away from care.

When it comes to care that is effective, patients, especially people with chronic conditions, have become quite savvy. They learn what works for them, what is aligned with their personal goals. They begin to learn what they’re capable of doing given their life circumstances, and if they don’t receive that from their provider, they will look for another one who will provide it. And what you see is they will go from one doctor to another, again driving up cost.

It would make a lot more sense to have the system focus in on what journey they’re willing and able to take, and what motivates them, and then to provide clinically appropriate care under those circumstances.

It’s a very different model, but we have to align the quality measures and the financing around it.