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Addressing Patient Needs Around the Cost of Care
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Addressing Patient Needs Around the Cost of Care

Surabhi Dangi-Garimella, PhD
A key takeaway from a panel discussion at the Patient Access Network Foundationís second cost-sharing roundtable was the need for educating stakeholders.
Pointing to the existence of a reality gap, Baer added that decision makers may not necessarily be aware of the patient’s financial struggles. Baer trusts in patient empowerment to be able to bring up these conversations with their treating physician.

Richards, who was representing Partners for Better Care—which works to influence policy on cost-efficient and transparent healthcare—said, “We are working to develop a system to translate qualitative data into a language that patients can understand and navigate.”

The organization, whose members include patient advocacy groups, health plans, and pharma, has developed peer support programs to support patients. They also provide case management, and case work includes healthcare diagnosis and financial navigation support.

Doshi explained that high-deductible health plans are on the rise, even among employer-sponsored insurance. For Medicare patients, until they hit $4000, which is their annual out-of-pocket maximum, they face significant cost sharing.

Goodman asked Yeung whether cost-effectiveness ratio or value-based piecing can ease this burden a bit.

“We have diversity of health plans, which allows experimentation,” Yeung said. He believes that binary coverage—meaning “yay” or a “nay” coverage decisions seen in the United Kingdom and in Canada—may not be suitable for the United States.

“Patients with advanced cancer receive counseling around whether getting additional, more expensive treatment,” Shankaran said, and that standard-of-care treatments provide some room to discuss drugs that may be similar in efficacy but might have a significant cost difference. “Physicians can take a lead here to help the patient make a decision,” she added.

Highlighting the importance of a peer support group, Baer said that while several providers share information on numbers that patients can call for decision support, the patient may not have the time or energy for it. “When you are at a critical juncture in life, emotional and physical support from peers can help decision making,” she explained.

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