Assessment of Accuracy and Usability of a Fee Estimator for Ambulatory Care in an Integrated Health Care Delivery Network | Electronic Health Records | JAMA Network Open | JAMA Network
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    Original Investigation
    Health Policy
    December 13, 2019

    Assessment of Accuracy and Usability of a Fee Estimator for Ambulatory Care in an Integrated Health Care Delivery Network

    Author Affiliations
    • 1Sutter Health Center for Health Systems Research, Palo Alto, California
    • 2Palo Alto Medical Foundation Research Institute, Palo Alto, California
    • 3Sutter Health Office of Patient Experience, Sacramento, California
    • 4Hill Physicians Medical Group, San Ramon, California
    • 5Stanford Center for Biomedical Informatics Research, Stanford, California
    JAMA Netw Open. 2019;2(12):e1917445. doi:10.1001/jamanetworkopen.2019.17445
    Key Points español 中文 (chinese)

    Question  Can a cost estimation tool provide accurate, user-friendly, personalized information for ambulatory procedures via an online patient portal?

    Findings  This quality improvement study included 4610 estimates during a 10-month period and found that the new tool showed an accuracy rate of 83.9%. A survey of a subset of users found that most respondents were satisfied with their experience using the tool and would recommend it to others.

    Meaning  These findings suggest that a cost estimation tool can be easy to use and provide accurate real-time estimates integrated into the online patient portal.


    Importance  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.

    Objective  To assess accuracy and initial user 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 payers.

    Design, Setting, and Participants  This quality improvement study included patients aged 18 years and older at an integrated health care 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 brief survey completed online or via postal mail. Data were analyzed from April 15, 2019, to October 11, 2019.

    Main Outcomes and Measures  Tool accuracy and user experience and satisfaction.

    Results  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 estimates (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). Survey respondents included 92 (73.6%) women, 72 (57.6%) non-Hispanic white participants , 91 participants (72.8%) with a college degree or higher, and 55 participants (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 participants (87.2%) would use it again, and 100 participants (80.0%) would recommend it to others. Seven participants (5.6%) reported contacting a clinician about the estimate, and 12 participants (9.6%) changed their decision based on the estimate.

    Conclusions and Relevance  This quality improvement study is the first report of an online cost estimator in an integrated health care delivery network. The findings suggest that the tool, informed by real-time data feeds from third-party payers, was easy to use and provided accurate results. Increasing the number of searchable services and sharing best practices with other health care systems who share the same portal platform are the next steps for the tool.