Cost-of-Care Conversations During Prenatal Care
Low-income pregnant patients often defer care over cost, but little research existed on how to raise cost openly during time-limited prenatal visits.
Summary
Guideline-based prenatal care requires 12 to 27 visits, and even when care is nominally free under Medicaid, indirect costs such as transportation, parking, childcare, and lost wages can exceed $2,500 over a high-risk pregnancy. Published in Annals of Internal Medicine in 2019, this framework and tool were developed through a human-centered design process engaging 20 pregnant and postpartum women and 24 clinical and administrative staff, to help patients and providers have cost-of-care conversations during prenatal visits — surfacing the frequency and duration of appointments as an under-recognized cost driver early enough for patients to plan around it.
Why it’s important
Per the project page, patient-provider communication about costs is viewed as integral to high-value care, but low-income patients are especially likely to defer care over cost, making cost-of-care conversations a health-equity issue. Guideline-based prenatal care requires 12–27 visits, and even when care is “free” under Medicaid, indirect costs (transportation, parking, childcare, wage loss) can exceed $2,500 during high-risk pregnancies.
Real-world impact
The resulting tool was designed to surface an under-recognized driver of cost — the frequency (13–27 visits) and duration (up to 4 hours per visit) of prenatal appointments — early enough for patients to plan around it. Physician time to complete the tool was under 90 seconds. Patients and providers identified 16 distinct benefits of the tool. Under separate funding, it was pilot-tested across three Chicago clinics in a series of 14-week pilots; a related factor-analysis study (Rivelli, Fitzpatrick, Shields, Erwin, 2023) further evaluated the tool’s benefits with 71 prenatal patients across three clinics.
To learn more: https://www.acpjournals.org/doi/10.7326/M18-2207
Adapted from: Erwin K, Fitzpatrick V, Norell S, Gilliam M. “Development of a Framework and Tool to Facilitate Cost-of-Care Conversations With Patients During Prenatal Care.” Annals of Internal Medicine, 170(9 Supplement), May 7, 2019. https://doi.org/10.7326/M18-2207. Authors: Kim Erwin, MDes; Veronica Fitzpatrick, DrPH; Sarah Norell, MDes, MFA; Melissa Gilliam, MD.