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2023 HSR&D/QUERI National Conference Abstract

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1042 — Achieving Greater Value for Veterans Through Cost Transparency in Primary Care

Lead/Presenter: Victor Agbafe,  COIN - Ann Arbor
All Authors: Agbafe VC (Center for Clinical Management Research, Ann Arbor), Metzger N (Center for Clinical Management Research, Ann Arbor) Garlick BR (Center for Clinical Management Research, Ann Arbor) Caverly T (Center for Clinical Management Research, Ann Arbor) Saini SD (Center for Clinical Management Research, Ann Arbor) Kerr EA (Center for Clinical Management Research, Ann Arbor) Matloub S (Center for Clinical Management Research, Ann Arbor) Kullgren JT (Center for Clinical Management Research, Ann Arbor)

Objectives:
The COVID-19 pandemic led to increased use of telephone and video primary care encounters in the Veterans Health Administration and many other healthcare systems. One important difference between these virtual modalities and traditional face-to-face (F2F) encounters is the copay, travel, and time costs that patients face. Making these costs of different modalities transparent to patients and clinicians could improve healthcare value by facilitating selection of encounter modalities that are not only clinically appropriate but also consider the full costs that patients will face.

Methods:
We conducted a proof-of-concept pilot study at the VA Ann Arbor Healthcare System (VAAAHS) to assess the feasibility, acceptability, and preliminary effectiveness of providing transparent personalized estimates of the copay, travel, and time costs for different primary care encounter modalities to Veterans and their primary care clinicians. For F2F visits, the total estimated costs were calculated to be the sum of estimated copays, driving costs, and time costs. For telephone and VA Video Connect (VVC) visits, the estimated total costs were the estimated time costs based on the scheduled appointment duration as copays did not apply for telephone or VVC visits during our study. We used VA Corporate Data Warehouse (CDW) data to generate personalized estimates of Veterans’ copay, travel, and time costs for F2F, telephone, and VVC primary care visits. We then invited 11 VAAAHS primary care physicians (PCPs) to receive this information at the point of care via Microsoft Teams and 10 agreed. We recruited 96 patients of these PCPs with an upcoming primary care F2F, telephone, or VVC appointment. Before the appointment, these Veterans were sent a personalized handout that estimated their copay, travel, and time costs for different primary care encounter modalities. After the appointment, participants were surveyed by telephone about their perceptions of the handout and their primary care encounter.

Results:
The median estimated total cost for the 96 Veteran participants was $57 for F2F visits and $12 for telephone and VVC visits. Sixty-five Veterans (68%) completed the post-visit survey. Most (44/65, 70%) recalled receiving the cost handout before their visit; of these individuals nearly all (40/44, 93%) reviewed it before their visit. Among the 40 who reviewed the handout, 11 (26%) used it with their PCP during the visit. Veterans who used the handout in their visit rated highly its helpfulness and willingness to receive it in the future (median 10/10 for both).

Implications:
We found that it was feasible to generate and deliver personalized cost estimates in advance of primary care visits, that this information was acceptable to Veterans, and that Veterans who used cost estimates during a visit found this information helpful and would want to receive it again in the future.

Impacts:
Making the copay, travel, and time costs of different visit modalities transparent to Veterans and their clinicians should be evaluated more broadly as a strategy to achieve VA policy and research priorities to improve access, inform personalized decisions, expand use of virtual care, and optimize healthcare value for Veterans.