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A study by American Cancer Society researchers published last week found that more than half of Americans— approximately 137 million adults— reported medical financial hardships (for example, affordability, stress, or delayed care due to cost) in the past year.1 With increases in cost-sharing and the growing prevalence of high-deductible health plans, the potential financial toxicity of a cancer diagnosis continues grow.
In response, many oncology programs and practices have added financial navigators to their staff. These team members help beleaguered patients and caregivers navigate the twists and turns of the healthcare maze and work to lessen the economic havoc that can result from a cancer diagnosis. Financial navigators (also known as financial counselors or advocates) provide a range of patient services, including explaining health insurance coverage, benefits, and costs of care, and— if needed— identifying assistance programs and helping eligible patients with enrollment.
All too often, however, financial advocacy services are triggered reactively when patients—even those who are well insured—have begun to experience financial distress. Patients who would qualify for help but do not know to reach out for assistance often sustain significant medical debt that can negatively affect their treatment plans and even clinical outcomes. If financial navigators could proactively identify patients who qualify for assistance and the specific programs that may help them, their efforts could go farther. In 2018, Cowell Family Cancer Center did just that.
Automating Part of the Process
In an attempt maximize the efforts of their financial navigators, the Cowell Family Cancer Center at Munson Healthcare—the largest healthcare system in northern Michigan—piloted an automated financial navigation platform for eight months in 2018.
Like financial advocates at many cancer programs, Cowell’s navigators spent the bulk of their time responding to patient requests for financial help by manually searching for programs, determining patient eligibility, and monitoring applications for assistance. That left little time to proactively identify other patients who might also need financial help.
To make better use of their financial navigators’ time, Cowell decided to conduct a pilot using a web-based software solution that interfaces with a cancer center’s electronic health record and then uses clinical, insurance, and demographic data to project a patient’s out-of-pocket expenses. It automatically identifies patients who may qualify for financial assistance and then matches them with specific programs, such as insurance optimization, financial assistance programs, pharmaceutical-patient assistance programs, and government plans. With this platform, Cowell’s financial navigators can directly access any opportunity for which a patient qualifies, and patient applications for assistance are automatically monitored by the software.
In 2018, the software vendor selected by Cowell analyzed 4,616 patients at Cowell Family Cancer Center and identified 244 “high priority” individuals based on their out-of-pocket responsibilities, risk for financial toxicity, and qualification for assistance opportunities. Of those 244 patients, 181 received one or more forms of assistance from the programs identified by the software. The cancer centers’ two financial navigators achieved a combined total of more than $3.5 million (or about $19,000 per patient) in savings. Besides being able to quickly identify patients who may qualify for financial assistance, Cowell’s navigators reported improvements in productivity, workflow, and internal organization alignment.
With the multitude of patient assistance programs available today—and the varying degrees of awareness about them—manually identifying patients in need of financial help and the programs they may qualify for can only go so far in maximizing assistance opportunities. This cancer program found that automated software can play a significant role in enabling financial navigation services to reach patients proactively before they experience a financial crisis.
Reference
1. Yabroff KR, Zhao J, Han X, et al. Prevalence and correlates of medical financial hardship in the USA. J Gen Intern Med. Online first: 01 May 2019. https://doi.org/10.1007/s11606-019-05002-w
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This blog was adapted from an article published in Oncology Issues, "Technology Unlocks the Untapped Potential in a Financial Navigation Program" (Jan/Feb 2019). Access the full article here. Learn about ACCC's Financial Advocacy Network here.