Abstract: Given increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools are needed. To assess accuracy and experience of a cost estimation tool for ambulatory procedures delivered via an online patient portal and informed by real-time data feeds from third- party payors.

This quality improvement study included patients aged 18 years and older at an integrated health system in Northern California. Data from patients who used the cost estimator tool from August 21, 2018, to April 9, 2019, and who had matching explanation of benefits statements were used to assess accuracy of the tool. User experience was assessed with a survey completed online or via postal mail. Data were analyzed from April 22, 2019, to July 16, 2019. As of April 30, 2019, 4610 estimates (3569[77.4%] via internet; 1041[22.6%] via telephone) were produced using the cost estimator tool. Among 342 individuals who had an estimate and a matching explanation of benefits statement, 287(83.9%) were accurate. All 342 individuals with an estimate and an explanation of benefits statement were invited to participate in a user survey, and 125 individuals completed the survey (36.5% response rate). Respondents included 92(73.6%) women, 72(57.6%) non-Hispanic white participants, 91(72.8%) with a college degree or higher, and 55(44.0%) with an income of $100 000 per year or higher. Mean (SD) age was 46.8(13.1) years. Ninety-nine participants(79.2%) found the tool easy to use, 109(87.2%) would use it again, and 100(80.0%) would recommend it to others. Seven(5.6%) reported contacting a clinician about the estimate, and 12(9.6%) changed their decision based on the estimate. This is the first report of an online cost estimator in an integrated healthcare delivery network. The findings suggest that the tool, informed by real-time data feeds from third-party payors, was easy to use and provided accurate results.

Describe the new knowledge and additional skills the participant will gain after attending your presentation.: - Socio-technical steps required for successful implemenation of a cost estimator
- Positive benefits on patient experience of highly accurate cost estimates, based on real-time data feeds from payors
- Few anticipated negative impacts from cost estimates such as avoidance of care


Cheryl Stults, Sutter Health
Jiang Li, Sutter Health
Dominick Frosch, Sutter Health
Hari Krishnan, Sutter Health
Gregg Smith-McCurdy, Hill Physicians Medical Group
Veena Jones, Sutter Health
Albert Chan (Presenter)
Sutter Health