Conversations about Cost During Weight-Prioritized Visits in Primary Care

<h3>Context:</h3> Cost is a critical consideration in weight management, but cost conversations can be challenging for clinicians to initiate. Most studies of cost conversations rely only on participant recall methods rather than on recordings of actual conversations, limiting our understanding of how these conversations occur. PATHWEIGH is an integrated approach to support primary care practices in delivering evidence-based weight management and includes modifications to the EpicTM medical record for guidance on treatment alternatives, support for provider-patient communication, billing and coding support, and a new visit type called a Weight Prioritized Visit (WPV). <h3>Objective:</h3> To identify communication strategies for initiating conversations about cost during WPVs. <h3>Study Design and Analysis:</h3> Qualitative study using content analysis to analyze interviews and conversation analysis (CA) to analyze videos. <h3>Setting or Data Set:</h3> Semi-structured interviews conducted with clinicians and staff between February 2021 and August 2023 and video recordings of a subset of WPVs. <h3>Population Studied:</h3> Patients who self-selected to schedule an initial or ongoing WPV. Practice members from 57 primary care practices in one Colorado health system who participated in the PATHWEIGH study. Intervention/Instrument: Semi-structured interview guide and video recordings of WPVs across primary care practices. Outcome Measures: Key themes related to cost conversations in weight management. <h3>Results:</h3> Interview participants included clinicians and staff (n=220) from 52 practices. Videos of WPVs (n=16) were collected from 8 practices. Interviewees reported that discussions about cost are frustrating due to constant fluctuations in insurance coverage and available treatments, requiring them to continuously reassess their approach to providing care and discussing costs. CA findings expanded on interviews and identified three approaches that clinicians use to initiate cost conversations: 1) cost-related pronouncements (“I’m gonna prescribe this as X so it’s covered by insurance”), 2) cost-related inquiries (“Do you still have the GoodRX coupon?”), and 3) generic inquiries (“Any issues?”). These strategies can be used in combination to address both ongoing and new cost-related concerns. <h3>Conclusion:</h3> Using all three strategies identified can facilitate conversations about cost both in current and future visits, which may help clinicians navigate discussions about changing costs for weight management.