Background: A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Many HDHP enrollees, particularly those with chronic conditions, face significant access barriers and out-of-pocket costs. These challenges could be mitigated by cost-conscious behaviors such as discussing costs with providers, saving for medical expenses, and using online tools to compare prices. A novel behavioral intervention could help HDHP enrollees with chronic conditions engage in cost-conscious strategies, but it is unknown what intervention features they would find most useful.

Methods: In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 telephone interviews and then surveyed 432 participants of a national internet survey panel. The interviews and survey assessed participant experiences and preferences for the content, modality, and frequency of interaction for an intervention to support engagement in cost-conscious behaviors.

Results: Some interview participants faced barriers to engaging in cost-conscious strategies, including finding them to be too time-consuming, and not knowing where to find information. Those who discussed costs with providers, saved for medical expenses, and used online comparison tools often found these strategies helpful. Survey participants were most interested in learning to compare prices and quality using a web-based intervention that they would access multiple times a year.

Conclusion: An intervention that overcomes barriers to use of cost-conscious strategies could help HDHP enrollees with chronic conditions better manage their high cost-sharing. These findings will inform development of a novel behavioral intervention that will support engagement in cost-conscious behaviors in this patient population.