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Resources from other RWJF Grantees and a Summary of the Research

RWJF Grantees: A Summary of the Research

In 2017, the Robert Wood Johnson Foundation funded eight exploratory research projects designed to increase the awareness of the importance of cost-of-care conversations and to develop approaches to integrating these discussions into patient/provider interactions, especially with vulnerable and underserved populations. RWJF has continued this work with coordinated efforts to expand and disseminate this work by funding four partners with specific audiences. This site is a forum for presenting the work done by the RWJF grantees and partners  and sharing new ideas, best practices and pertinent data related to cost-of-care  discussions. We will continue to add to the site as the work progresses and invite your contributions to this site.

For more information, see the special Annals of Internal Medicine Supplement:

These are brief summaries of the eight exploratory research projects that RWJF grantees carried out. There were two overarching goals for these projects. Clinical Workflow: To establish best practices for how tools/resources that support cost-of-care conversations can be better embedded into clinical workflow and patient/caregiver “life flow.”

  • Kaiser Permanente Washington Health Research Institute
  • University of Southern Maine
  • University of Rochester Medical Center
  • Sinai Urban Health Institute

Vulnerable Populations: To test specific messages, best practices and other principles for improving cost conversations between clinicians and vulnerable populations.

  • Consumers Union
  • Migrant Clinicians Network
  • Center for Health Progress
  • University of Alabama Birmingham

Integrating Cost-of-care Resources into the Clinical Workflow Project Orca Kaiser Permanente-Washington Health Research Institute University of Washington Nora B. Henrikson, PhD, MPH Matthew Barnegas, PhD, MPH This two-part human centered design project was designed to document and improve clinical workflows related to cost-of-care conversations. Part one included ethnographic observations and interviews of health system staff across numerous clinical and operational departments. That information was then used to develop three patient journeys, in storyboard format, that illustrate how patients experience having their financial concerns addressed.

Plan-Do-Study-Act: Engaging Vulnerable Populations to Optimize Cost-of-care Conversations. Consumers Union Susan Perez This study conducted eight focus groups in five communities, rural and urban, in California and New York. 57 one-on-one interviews with consumer and physicians throughout the United States and surveyed 621 providers. The goal was to identify barriers to cost-of-care conversations and provide a basis for establishing best practices to guide providers as to when and how to have these conversations and make it easy for patients to express their preference and values on these key issues.

Implementing a Team-Based Approach to Integrating Cost of Medication Conversations into Primary Care Practices University of Rochester AAFP National Research Network Kevin Fiscella, MD, PhD This study assessed whether a single training session would increase conversations specifically related to the cost of medication between patients and primary care providers. Most primary care providers do not routinely screen patients for concerns related to the costs of their medications and patients may be reluctant to bring up these issues. Investigators surveyed 50 patients and providers before and after the intervention, a 60-minute training session for clinicians and staff on cost of medication conversations.

Enhancing Cost-of-Care Conversations for Low Back Pain Treatment Using Publicly Reported Cost Information University of Southern Maine Kimberly Fox, MPA The goal of this project was to use Maine’s price transparency website, CompareMaine, to help facilitate cost-of-care conversations on treating low back pain. The project was piloted in six primary care practices in two health systems and included training for practices and tailored workflows as well as consumer materials that encourage patients to ask questions about the cost of their treatments and apply this information to making treatment decisions.

Clear on the Cost: Optimizing Conversations between Health Center Patients and Their Providers about Cost-of-care to improve Adherence Migrant Clinicians Network Douglas Bradham, DrPh, MA, MPH Deliana Garcia, MA This study explored the current extent and content of cost-of-care conversations in four health care centers treating primarily immigrant and migrant populations in Texas, Pennsylvania and Puerto Rico. It included bilingual interviews with 85 patients as well as staff interviews and physician surveys. The research team also visited three sites for multi day observations and interviews.

Let’s Talk about the Cost of Cancer Care: Finding What is Understandable and Useful for Patients and Providers University of Alabama at Birmingham Maria Pisa. PhD This study examined patient and provider perspectives on the essential elements of cost-of-care conversations. Investigators interviewed 42 patients being treated for breast cancer as well as 20 providers and identified three critical elements for these conversations: reassurance, action and resources.

Integrating a User-Centered Tool to Facilitate Cost-of-care Conversations in an OB/GYN Clinic on the Southside of Chicago Sinai Urban Health Institute Kim Erwin, MDes Veronica Fitzpatrick, DrPh The goal of this study was to facilitate cost-of-care conversations with for clinicians and patients in an OB/GYN clinic in South Chicago. The researchers sought to identify the attributes of an effective conversation and to design a tool that fits the usual care and enabled cost-of-care conversations at a time when patients are vulnerable. The study used human-centered design principles to address cost burdens that pregnant face during their pregnancy not directly related to their medical care.

Cost-of-care Conversations in Adams County Optimizing Cost-of-care Conversations between Clinicians and Vulnerable Patients Center for Health Progress Karl Mader, MD, MPH Joe Sammen, MPH This group worked with community health centers serving largely uninsured, primarily Latino populations. Patients, providers and staff members participated in focus groups and card studies before and after implementing messaging related to cost-of-care. The goal was to improve these conversations using targeted messaging.


See summaries of the research the eight RWJF grantees did in a special supplement to the Annals of Internal Medicine.

See or print the NPAF ebook Guide to Cost of Care Conversations for Health Professionals, Case Managers and Advocates by clicking here.

Read NPAF Advocate Sa’brina Davis’ blog,

See the highlights of NPAF’s Fall Policy Consortium focusing on Cost of Care Conversations. See the full agenda.

Journal of Clinical Pathways features NPAF Columns on Cost-of-care This two-part column written by Alan Balch examines the importance of cost-of-care conversations and provides information on how to implement these discussions as parts of clinical pathways. Read the full articles.

Read the Team Blog Post in Health Affairs, “Talking about Costs: Innovations in Clinician-Patient Conversations”

See America’s Essential Hospitals Resource Repository

Read Avalere’s Insights Article: “Providing Resources to Facilitate Cost-of-Care Conversations Between Patients and Clinicians.” 


RWJF Cost-of-care Partners

American College of Physicians will assist in the dissemination of cost-of-care research findings to physicians. America’s Essential Hospitals is focusing on its more than 325 hospitals serving vulnerable populations across the country. AES will target medical and administrative leadership to raise awareness of the importance of cost-of-care discussions and the resources available to address financial toxicity issues. Avalere will leverage insights and outputs from the cost-of-care initiative to assure that providers feel supported by their systems to raise cost-of-care issues and connect patients with appropriate resources, to make sure that patients feel supported in raising these issues, and that policy makers are aware of the barriers to cost-of-care discussions and can take steps to address these barriers. National Patient Advocate Foundation/Patient Advocate Foundation will focus its efforts on disseminating cost-of-care information to a broad spectrum of stakeholders, including patients, advocates, navigators and advocacy organizations as well as providers and policy makers.

Cost-of-care Practice Briefs Summaries Avalere developed these Practice Briefs synthesizing the themes across the research of the eight RWJF grantees. Each brief deals with a critical issue related to cost-of-care conversations. The purpose of the briefs is to provide actionable approaches to implementing cost-of-care discussions. While these briefs draw on the work of all grantees, the primary sources are listed for each one.