The Promises and Pitfalls of Real-time Benefit Tools: A Qualitative Study of Primary Care Providers.

Abstract

Real-time benefit tools (RTBTs) are federally mandated clinician-facing applications embedded in the electronic health record (EHR) that display the out-of-pocket costs of prescribed medications and lower-cost alternatives, if available. RTBTs may be useful for primary care providers (PCPs), whose patients often take numerous medications; however, RTBTs may also add time to visits that are already complex and compressed. To explore PCP experiences with and attitudes toward RTBTs. We conducted a qualitative descriptive study of PCPs with access to an RTBT at primary care clinics affiliated with two large academic health systems. Semi-structured interviews elicited (1) attitudes toward medication cost transparency, (2) RTBT training, (3) experiences using RTBTs, and (4) perceived effects of RTBT use on decision-making and administrative burden. Primary care physicians and advance practice providers with ≥ 1 year of practice. Thematic analysis of interview transcripts. We interviewed 35 PCPs. Most were physicians (25/35) and female (23/35), and had ≥ 10 years' experience (19/35). We identified three themes. First, PCPs received minimal education on RTBTs and were open to more training. Second, PCPs believe RTBTs have the potential to improve patient care by facilitating cost conversations and reducing administrative burden. Third, several pitfalls have hindered use, including incomplete information, inaccurate cost estimates, and clinically inappropriate lower-cost suggestions. Two study sites, both of which use the same EHR. While PCPs generally saw the RTBT as a promising tool that can facilitate compassionate, cost-conscious care, they identified problems that limited their desire to use it. For utilization to improve, EHR developers and insurers must ensure that RTBT information is actionable, clinically appropriate, and time saving.