1. Listening to patient feedback is an important part of providing high-quality, patient-centered, and cost effective care. This toolkit was created in response to personal anecdotes from physicians and patients submitted through Costs of Cares annual essay contest. We incorporated specific quotes and supplemented with our own research to suggest practices adoptable for the primary care setting. Strong, high-quality primary care practices are essential to ensuring patient satisfaction, continuity of care, and lower costs. Quotes from Costs of Cares 2010-2012 Essay Contest Submissions A prescription for an antibiotic is no good when there is no money, let alone food, at home. Are doctors really prescribing only the absolute necessities, and aware of the costs of their decisions? I wish my doctors had informed me about my options – Indu Voruganti (RI) Patient Doctors can have their staff send emails to patients to remind them when they are due for a visit, test, or procedure. This is a cost saving method for doctors and a potentially life- saving measure for patients - Fran Ginsberg (CA) Medical Office Manager A provider who takes the time to fully explain the benefits and drawbacks of testing is likely to find that patients are much less desirous of exhaustive testing than they originally seem. In doing so, they are doing a favor for both the patient and the health care system that bears the cost of unnecessary testing - Erin Plute (GA) Medical Student If a health care worker could ask the questions we dont, the kind of questions to illicit needed, thorough information, it would illuminate the way forward and eliminate higher costs. If doctors and insurance companies would enhance the others ability to function and serve the patient this journey wouldnt feel like driving into a storm. – Arnold L (PA) Patient I was able to complete the paperwork and with my doctors signature and a copy of my income taxes, I was enrolled in the discount program. This truly was a lifesaver as I got my very expensive medicine for a small fraction of the shelf price – Doray Sitko (MA) Patient Allow Opportunities for Questions Set aside time for patients to ask questions. Explaining procedures in a one-on- one setting and utilizing shared decision-making can help patients achieve a sense of control as well as eliminate any surprises regarding costs. Prescription Price Comparisons Encourage patients to price shop between pharmacies before filling medications. Taking the time to find the least expensive prescriptions can increase the chances of consumption and refilling in a timely manner. Contextual Information Inquire about a patients daily lifestyle, living environment, and day-to-day stressors. Understanding these components can help to identify any opportunities for low-cost wellness measures. Ensure Insurance Coverage Verify that any prescriptions or tests are covered by a patients insurance, or that they are able to pay out-of-pocket for the cost. This establishes transparency and encourages patients to become informed about their healthcare decisions. Coordination with Social Support Services Refer patients to regional support and discount programs to help cover the cost of care in cases where there is an inability to pay. Facilitating enrollment in financial aid programs is an important part of quality health care provision. Cost Conversations Speak candidly with patients about the price of co-pays, diagnostic tests, and medications prior to and during their visit to allow them to prepare in advance as well as to eliminate unintentional financial burden. Communicating about costs directly can also help instill trust in the healthcare system. Electronic Referrals Send recommendations for follow up care and referrals electronically to avoid any miscommunication and eliminate opportunities for over testing. Streamlining information prevents medical error and important details from slipping through the cracks. Integrating Costs of Care in Everyday Treatment Sydney Howland Consultant Costs of Care sph11@duke.edu