Project Orca (2016-2018) ORCA (Funded RWJF: PI Henrikson; co-I Banegas): Integrating cost communication into clinical care, IRBNet #1008668-4. In this study, we conducted a two-part human centered design study to document and improve clinical workflows related to cost-of-care conversations and to explore patient experiences and preferences related to conversations and workflows. This study took place at both of the CAFÉ study sites (KPWA and KPNW).
First, we conducted ethnographic observations and interviews with health system nursing, medical, and pharmacy staff, as well as those in relevant operational departments, such as member services and patient financial services, at both KPWA and KPNW. We analyzed these findings to design three patient journeys illustrating how patients might experience having their financial concerns addressed within the oncology setting. Second, we conducted home-based interviews with patients (n=20) to understand their cost of care experiences and elicit feedback on the experiences.
We synthesized findings into a set of requirements that care teams can use to plan workflows for addressing cost of care conversations, including (1) organizational recognition of the need for clinic-based cost of care conversations and (2) access to cost and health plan benefits data to support each conversation pathway; (3) clear roles and responsibilities for addressing cost of care concerns, and (4) pursue a patient experience that includes a clinical culture where cost questions are normal, each patient's values, preferences, and privacy are respected, patients know who to go to with cost questions; patients' concerns are documented to minimize repetition to multiple team members, and patients learn their expected OOP costs before treatment begins (REF)).