Costs of Care has developed multiple national affordability frameworks that highlight key components for healthcare systems to develop initiatives focused on improving patient affordability.
Our Costs of Care team has developed the “COST” (Culture, Oversight accountability, System support, and Training) framework to guide value improvement project design and educational efforts. This approach leverages principles from implementation science to ensure that value improvement projects successfully provide multi pronged tactics for overcoming the many barriers to high-value care delivery.
Interventions
Description
Example
List Predisposing Factors (Barriers or Assets) in Your Clinical Enviroment
List Potential Strategies to Apply in Your Local Clinical Enviroment
C
Valuing cost-consciousness and resource stewardship as practiced standards of medical professionalism at the individual and team level.
Hospital-wide campaign led by peer-champions to raise awareness regarding appropriate transfusion preactices.
O
Requiring accountability for cost-conscious decision-making at both a peer and organizational level.
Regular audit and feedback, using data visualization strategies, regarding individual and team-based transfusion practices.
S
Creating supportive systems to make cost-concious decisions using institutional policy, decision-support tools, and evidence based clinical guideline.
Ordering system in the electronic health record that provides default options and adviced based on pre-transfusion hemoglobin level.
T
Providing the knowledge, skills, and tools clinicians need to make cost-conscious decisions in their clinical environments.
Lecture or workshhop providing the evidence behind appropriate transfusion practices and harms of excessive transfusions.
In 2013, our Costs of Care team put forth a framework for integrating the concept of “financial harm” into clinical decision-making, with an article in JAMA called “First, Do No (Financial) Harm.” The article advocated for four general steps that physicians can take to help avoid patient financial harm:
Screen for Screen for financial harm
Adopt a universal approach
Understand financial ramifications and value of recommendations
