Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want

Karalyn A Kiessling; Bradley E Iott; Jessica A Pater; Tammy R Toscos; Shauna R Wagner; Laura M Gottlieb; Tiffany C Veinot

doi:10.1093/jamiaopen/ooac007

Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want

JAMIA Open. 2022 Feb 24;5(1):ooac007. doi: 10.1093/jamiaopen/ooac007. eCollection 2022 Apr.

Authors

Karalyn A Kiessling¹, Bradley E Iott^{1

2}, Jessica A Pater³, Tammy R Toscos³, Shauna R Wagner³, Laura M Gottlieb⁴, Tiffany C Veinot^{1

2}

Affiliations

¹ School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
² School of Information, University of Michigan, Ann Arbor, Michigan, USA.
³ Parkview Mirro Center for Research & Innovation, Parkview Health, Fort Wayne, Indiana, USA.
⁴ Social Interventions Research and Evaluation Network, University of California San Francisco, San Francisco, California, USA.

Abstract

Objective: To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development.

Materials and methods: We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes.

Results: Providers lacked access to information about: patients' ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information's quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges.

Discussion: These findings can inform the next generation of informatics tools for minimizing patients' out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources.

Conclusion: Results identified opportunities to fill multidisciplinary providers' information gaps and ways in which new tools could better support medication affordability for patients.

Keywords: drug costs; electronic prescribing; health; information seeking behavior; insurance; social determinants of health.