Tag Archives: ACCC National Oncology Conference

ACCC 33rd National Oncology Conference: “How To’s” for Patient-Centered Care

NOC 2016 Crowd

Attendees at the 33rd National Oncology Conference.

Nearly 600 attendees came together in St. Louis last week for the 33rd ACCC National Oncology Conference and companion pre-conferences. Across sessions the focus was on practical, proven “how to’s” for improving the delivery of patient-centered care in today’s challenging healthcare environment. Echoed throughout presentations were key messages for improving patient-centered care that apply regardless of cancer program size, structure, or geographical setting:

Listen to our Patients.

From a pre-conference Metastatic Breast Cancer Symposium to Thursday morning’s powerful opening session with speakers Niklaus and Lucy Steiner from the Be Loud! Sophie Foundation and Lauren Lux, LCSW, from the UNC Lineberger Comprehensive Cancer Center, to Friday morning’s inspiring session with New York Times columnist Suleika Jaouad, to the ACCC President’s theme panel on “Empowering Patients, Engaging Providers,” the message was loud and clear. Providers need to elicit and listen to the patient’s story.

“You’ve got to get to know the patients. . . . That’s something we’ve moved away from with [all of the] time constraints,” [Empowering Patients, Engaging Providers Panel].

“We have to take the time to ask the patients about [their] needs, wants, expectations…” [Empowering Patients, Engaging Providers Panel].

“You can’t have true patient-centered care unless you make the patient an active part of the conversation,” Suleika Jaouad.

Break Down Siloes.

To improve patient-centered care delivery, oncology needs to bridge existing healthcare siloes. This was the message in Anabella Aspiras’ conceptual talk on “Bringing the Cancer Moonshot Down to Earth” and the real-world experience described by ACCC 2016 Innovator Award winner Cone Health System, which described how to use data to identify “hot spotter” patients, assess gaps in care, and then connect across disciplines to improve care.

Connect with Existing Resources & Partnering Opportunities.

Innovator Award Winners

2016 ACCC Innovator Award Winners at the National Oncology Conference.

Multiple presenters focused on ways to connect and engage with community partners and resources to benefit the communities they serve. For example, Amy Montgomery and Robin Hearne, RN, from 2016 ACCC Innovator Award winner Outer Banks Hospital described steps to engage their county health department and school district leaders as strategic partners in a multi-faceted educational campaign that led to improved HPV vaccination rates for adolescents in their community.

Communicate. Communicate. Communicate.

It’s important to look for opportunities to improve communication not just outside the walls of the cancer program with primary care providers and other specialists, but within all members of the cancer care team. Explore strategies to leverage your program’s EHR to streamline information sharing among disciplines and team members.

Recognize the need for training for difficult conversations, not just between providers and patients, but internally among the oncology care team.

One-size-fits all communication does not work for a diverse population of cancer patients. In particular, it’s important to pay attention to opportunities to improve communication with underserved or under-recognized patient populations such as metastatic breast cancer patients and adolescent and young adult patients (AYAs).

Featured speakers addressing gaps in care for AYA patients provided practical suggestions for connecting with these young adults. In her dynamic, down-to-earth talk on “Helping AYAs BE LOUD,” Lauren Lux, LCSW, UNC Lineberger Comprehensive Cancer Center, shared that in communicating with AYAs it’s important to be:

  • authentic
  • flexible
  • compassionate
  • honest
  • willing to get to know the PERSON (who they are, what’s important, what drives them) and not just the PATIENT.

Be Ready for Culture Change.

On the business side, the culture shift to value-based payment reform is already underway.

From the patient perspective, the move is toward more patient-directed care. At the conclusion of Friday’s “Empowering Patients, Engaging Providers” discussion, panelists were asked what patient-centered care might look like in five years.

“I think patients want to get more involved with their biological information,” said ACCC President Jennie R. Crews, MD, MMM, FACP. “I think we’re going to see more patient insistence on ownership of the process.” Providers need to engage with patients as this culture shift is occurring, she said, as patients become more engaged, informed, and connected.

Upcoming blog posts will provider a closer look at takeaways from some key conference sessions. Stay tuned.

HPV Vaccination: Engaging Community Partners for Success

By Amy Montgomery

ACCCBuzz guest blogger Amy Montgomery is Senior Administrator of Operations at The Outer Banks Hospital in Nags Head, North Carolina.

Innovator Seal16singularThe recent American Cancer Society (ACS) endorsement of the U.S. government’s HPV vaccination recommendation signals the start of a new and refreshing conversation.  The updated (ACS) guideline supports the Centers for Disease Control and Preventions (CDC) Advisory Committee on Immunization Practices (ACIP) recommendation to vaccinate both males and females at ages 11 to 12 to protect against HPV.

We have known for years that the vaccine was designed to prevent the human papilloma virus (HPV), which is associated with the vast majority of cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancers.  What we have done, to some degree, is avoid the topic all together.  Until recently, the HPV vaccine was a conversation about whether or not giving the vaccine to a child would lead to early sexual behavior.  Simply put, early sexual behavior is a scary topic for most parents of preteen children.  So, the conversation stopped there.  In the doctor’s office, at the bus stop, at book club – all the places where the topic might come up – it most likely turned toward early sexual behavior, with the cancer prevention benefits of the vaccine left unexplored.

Not any longer.  With the guidance of the CDC and the leadership of the American Cancer Society, the common ground upon which most of us can agree is that HPV vaccination is a powerful tool in our cancer prevention kit.  This is a message that resonates with parents.  The conversation starts like this, “If you could prevent your child from developing a certain type of cancer as an adult later in life, would you do it?”  As a parent, you had me at “prevent my child from getting cancer.”  The door is now open to how, when, and where can I have my child vaccinated.

The Outer Banks Hospital Cancer Committee began using this new conversation when we undertook an initiative to increase the HPV vaccination rate among students enrolled in our local public schools.  This approach helped us gain the support of key community partners including our hospital president, the school system superintendent, and local health department director.  This approach also resonated with parents, demonstrated by the increase in our vaccination rates from 6 percent to 16 percent among 8th grade students in just one year.

Some strategies we used to start this new conversation included:

1)      a cover story in our hospital’s community newsletter

2)      a letter to local physicians from our Cancer Committee physician liaison

3)      flyers sent home in report cards

4)      presentations at back-to-school parent meetings

We also found modest success with older students.  Our efforts increased the vaccination rate from 20 percent to 23 percent among rising high school seniors.  What we learned is that different strategies are needed to encourage catch-up vaccines for this age group.  That is something our team will be exploring as we continue this cancer prevention work.

The Outer Banks Hospital is honored to be a recognized with a 2016 ACCC Innovator Award for our initiative on HPV Vaccination: Engaging Community Partners for Success. At the upcoming  ACCC 33rd National Oncology Conference October 19-21, in St. Louis, Missouri,  we will be describing  how we worked with our community partners to encourage conversation about HPV vaccination and cancer prevention.  Watch our short Innovator Award video to learn more about our initiative.

Join us and all of the 2016 ACCC Innovator Award winners in St. Louis, and hear inspirational, real-world approaches to complex challenges in delivering quality care to serve our communities. View the conference agenda and register today!


The Power of Sharing Your Story

One in an occasional blog series on topics from Oncology Issues, the journal of the Association of Community Cancer Centers.

By Susan van der Sommen, MHA, CMPE, FACHE, ACCC Editorial Committee Chair

Talking heads At the upcoming ACCC 33rd National Oncology Conference October 19-21, in St. Louis, Missouri, the 2016 ACCC Innovator Award winners will be showcasing their pioneering efforts aimed at improving the provision of care to cancer patients with initiatives that can be replicated in other community cancer programs.

Spreading the Word

In addition to speaking at the National Oncology Conference, every ACCC Innovator Award winner has the unique opportunity to write a feature article for Oncology Issues, ACCC’s bi-monthly journal.  The just-released July/August 2016 issue presents in-depth, “how we did it” articles from several of the 2015 Innovator Award winning programs. But opportunities for ACCC members to share their cancer program’s initiatives and successes are not limited to Innovator Award winners. Oncology Issues features insightful articles from ACCC member programs throughout the country – large and small. And every issue includes a “Spotlight” article profiling an ACCC Cancer Program member.

For instance, in the January/February 2016 issue, authors from two ACCC Cancer Program member institutions wrote about how to “Unlock the Potential of the Cancer Registrar,” describing the integral role their cancer registrars are playing in their organizations’ lung screening programs. And the May/June 2016 issue featured an article from ACCC Cancer Program Member The Valley Hospital’s Blumenthal Cancer Center on its Oncology Nursing Fellowship Program. In feature articles such as these, ACCC members share their real-world strategies for overcoming challenges and improving oncology care delivery, enriching the oncology community as a whole.

What better way to feature your cancer program’s success than through an article or profile published in a journal with national coverage? Many of our colleagues have used the opportunity to garner local media coverage in their respective markets; others have showcased their work among their peer group – which sometimes includes much larger centers.

In a recent ACCC Communications Survey, ACCC members were polled on the association’s journal, Oncology Issues:

  • 90% said that Oncology Issues is the “primary benefit of ACCC membership.”
  • 98% said that Oncology Issues “contains practical information, insights, ideas, and tools.”
  • 92% said that Oncology Issues “contains information that I do not find in other sources.”
  • 88% said that Oncology Issues “helps my cancer program stay ahead of the competition.”
  • 88% said that Oncology Issues is “must reading for me to stay ahead in my profession.”

What makes the Oncology Issues so successful? Input from ACCC cancer program members like you! To help spread the word to ACCC members about opportunities to contribute to the journal and how Oncology Issues’ content can be leveraged to benefit your program, this year’s National Oncology Conference will feature a new agenda item – “Oncology Issues Live!” hosted by members of ACCC’s Editorial Committee. Interesting in learning more about contributing or having your program featured in Oncology Issues? Want to be part of the Editorial Committee? Come to “Oncology Issues Live!” at the ACCC 33rd National Oncology Conference, October 19-21 in St. Louis, and connect with us.

 

National Oncology Conference—Keep the Conversation Going

dr. peter bach

Featured speaker Peter Bach, MD, MAPP, delivers the opening presentation of the ACCC National Oncology Conference.

By Amanda Patton, ACCC, Communications

From the opening presentation by featured speaker Peter Bach, MD, MAPP, to the final sessions focused on cancer survivors and the workplace and providing survivorship services on a shoestring budget—last week’s ACCC National Oncology Conference covered challenges large and small facing cancer programs and practices across the country.

Macro challenges—occurring at the health system and population health level—are well known to the oncology community. Among these are the high cost of cancer drugs and new therapies, the transformative shift in payment from volume to value, workforce shortages, reimbursement constraints, and the many issues tied to ever-increasing demands for data collection and reporting.

Micro challenges—occurring at the service line and individual provider and patient level—range from adapting delivery infrastructures to meet the evolving treatment landscape, to determining  metrics to track and how to best to communicate these to leadership, to ensuring patient access to supportive care services that remain unreimbursed, to fostering a holistic, patient-centric culture of care.

Common themes across conference sessions and conversations: Collaboration, integration, evidence-based medicine, and value.  Five key takeaways from the conference:

Cancer programs and providers must collaborate outside the box and across the care continuum.
Attendees heard first-hand from programs that are already making this work—from implementing virtual tumor boards, to engaging primary care physicians in survivorship care, to collaborating across disciplines to provide cancer prehabilitation services, and more.

There are formal & informal operational pathways to create integrated delivery networks with stakeholders for quality patient care.
Panelists in the Advancing Quality Care session agreed: to achieve a truly integrated delivery network transparency and trust between all partners is needed.

Oncology programs are increasingly turning to dynamic dashboards to demonstrate value to payers and patients.
Solutions and tools may exist outside the oncology service line. Reach out to the data analytics team or business intelligence team within your organization. Take advantage of or adapt existing resources and tools.

From personalized medicine to immuno-oncology, cancer treatment is undergoing a transformative shift.
For both providers and the patients they serve, the value proposition presented by genomic medicine is that it allows clinicians to make better therapeutic decisions.

Patients are key stakeholders in healthcare integration efforts.
“Successful integration will depend on aligned patient-centered care, patient-focused care, and patient engagement,” said ACCC President Elect Jennie Crews, MD, in the panel discussion on Advancing Quality Care.  Panelists touched on the findings included in a new ACCC white paper released at the National Oncology Conference that outlines forward-looking essential steps to ensure quality patient care in the increasingly integrated healthcare environment.

ACCC encourages members to keep the conversation going by sharing your key conference takeaways in our members-only online community ACCCExchange.

Save the date and join us in Washington, D.C., March 2-4 for the ACCC Annual Meeting: CancerScape 2016.

National Oncology Conference: Framing Issues & Finding Answers

ACCC President Steven D'Amato, BSPharm, BCOP, welcomes attendees to National Oncology Conference

ACCC President Steven D’Amato, BSPharm, BCOP, welcomes attendees to National Oncology Conference

by Amanda Patton, ACCC, Communications

Featured speaker Peter Bach, MD, MAPP, addressed a packed room in the opening session of the ACCC National Oncology Conference on Oct. 22, in Portland, Oregon.  Dr. Bach is Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center.

Dr. Bach’s remarks centered on four prime issues challenging oncology today: the cost of cancer drugs, the need for oncology to do a better job on comparative outcomes research, the 340B drug pricing program, and the importance of incorporating end-of-life care into cancer program services.

Finding a rational way to address drug costs matters on both the macro level [in terms of the impact of healthcare costs nationally] and on the micro level at point of care when “drugs are being left at the pharmacy counter because patients can’t afford the copay,” he said.

 

Conference sessions throughout the day focused on challenges and innovative solutions that can have powerful micro- and macro-level impacts on cancer programs and providers, and the patients they serve: From “how to” sessions on benchmarking salaries, applying lean principles for staffing, establishing a virtual tumor board, distress screening, and preparing for alternative payment models, and more, to a big picture session on Advancing Quality—from Oncology Medical Homes to Integrated Delivery.  One cross-cutting takeaway message: work across disciplines and siloes—think about how to collaborate outside the box and across the care continuum.

Stay tuned for more conference highlights. Follow conference on Twitter at #ACCCNOC.

Pre-Conferences Kick Off ACCC National Oncology Conference

by Amanda Patton, ACCC, Communications

OPEN Pre-Conference attendees listen to session on biosimilars

OPEN Pre-Conference attendees listen to session on biosimilars

Cancer care professionals from across the country are gathering in Portland, Oregon, this week for the ACCC 32nd National Oncology Conference.

Yesterday’s pre-conferences set the stage with sessions on oncology pharmacy issues and a program designed for administrators new to oncology.

One hot topic under discussion at the Oncology Pharmacy Education Network (OPEN) pre-conference: Institutional Review of Biosimilars. Jim Koeller, MS, PharmD, of the University of Texas at Austin, told attendees that “nationally, what we hope to create…we’re really trying to get to is a national standard on how biosimilars should be reviewed [by institutions].”  Until that time, what can P&T Committees do to be ready for institutional review? Setting up a subcommittee or working group for biosimilars is an important first step, Koeller  said.

While biosimilars will be less expensive, they will still be costly and reimbursement for biosimilars will “take a long time to figure out,” Koeller warned.

Key takeaways for oncology pharmacists and the oncology pharmacy:

  • Biosimilars are not generics: Use of biosimilars will require clinical review by a multidisciplinary team through the P&T Committee or other mechanism
  • A systematic review process will be necessary, looking at product, manufacturing, and institutional factors
  • Interchangeability is generally a state issue; keeping up with state laws will be essential.

A common theme across both pre-conferences: Oncology today requires multidisciplinary leadership.

“Almost everything in oncology practice is interdisciplinary,” said presenter John Hennessy, MBA, CMPE, in a New to Oncology session on Leadership and Organizational Structure. To succeed, oncology programs must have processes in place for identifying and training future leaders and aligning incentive across all team members, he said.

Stay tuned for more from the ACCC National Oncology Conference.  Follow the conference on Twitter at #ACCCNOC.

Key Takeaways from NCCN Summit on Value, Access, & Cost of Cancer Care

By Maureen Leddy, JD, Manager, Policy and Strategic Alliances, ACCC

Java PrintingOn September 11, 2015, the National Comprehensive Cancer Network (NCCN) convened healthcare experts for a policy summit on “Value, Access, and Cost of Cancer Care.” ACCC policy staff was in attendance, along with a host of provider and patient organizations. The summit explored methods to achieve optimum cancer patient care while considering rising care costs, and NCCN’s work groups on Value, Access and Cost also reported their findings. Some key takeaways follow.

Views on Value

The discussion on value centered on appropriate measures for value from the patient, provider, and payer perspectives. Panelists generally agreed that a broader view of healthcare is necessary to assess value. This includes consideration of the continuum of care, rather than just a specific episode of care. The full cost burden of cancer care on patients must also be addressed, and may include employment, caregiver, and housing and transportation issues.

Access Issues

Panelists explored access issues, focusing on the growing demand for cancer care services and its impact on access. Health exchange plans were identified as a source of disparate care, in that enrollees choose plans based on cost and then, upon cancer diagnosis, are faced with inadequate provider networks and prescription drug coverage. The discussion also touched on recent legislation driving providers to value-based reimbursement, and projected impacts on patient access to academic cancer centers. For the employer-insured population, one panelist commented on a shift to contracts with specific hospitals for second opinion and potential treatment of specific malignancies.

Cost Control

Among potential methods for curbing costs, panelists cited caution in use of high-cost diagnostics, treatments and therapies; avoidance of hospitalizations and emergency room use; and increased emphasis on palliative and end-of-life care. The panel noted that savings in provider care costs are possible, particularly through increased care planning and patient navigator uptake.

In discussing the cost of anti-cancer therapies, panelists pointed out that oncology is unique in that there is currently maximum use of generics with little opportunity for shifting to lower-cost prescription drugs until the further introduction of biosimilars. While drug costs make up just 15% of cancer care costs, they represent the fastest rising cost in cancer care. The panel acknowledged the challenges to containing prescription drug costs, and noted that some pharmacy benefit managers (PBMs) are looking to employ an indication-based formula for drug pricing, reimbursing for drugs by value and differentiating claims by condition. In the context of biologics, greater approval and high usage rates of biosimilars will be important to cost containment in the coming years.

The policy team at ACCC will continue to engage in this discussion of rising cancer costs and challenges in patient access to care.

Continue the Conversation

Join ACCC in Portland, Oregon, Oct. 21-23, at the 32nd National Oncology Conference and continue the conversation in sessions that will explore issues of value, cost, and patient access to care including:

Patient Access and the Cost of Cancer Care Across Specialties
Peter B. Bach, MD, MAPP, Center for Health Policy and Outcomes,
Memorial Sloan Kettering Cancer Center

What Will It Take? Must-Haves for Alternative Payment Models
Erich Mounce, MSHA, The West Clinic, PC

Palliative Care Models: Solutions for Programs of All Sizes
Moderator: Michael Kolodziej, MD, FACP, Aetna; Amy J. Berman, BS, RN, The John A. Hartford Foundation;
Sibel Blau, MD, Northwest Medical Specialties; and Brad Smith, Aspire Health

The full conference agenda and registration information is available here.

 

Discussing Molecular Tumor Boards at #ACCC2014

Person in information spaceACCC’s recent 31st National Oncology Conference featured 45-minute “think tanks,” supported by a grant from Genentech, on four hot topics in oncology. This is the final post in a four-part ACCCBuzz blog series recapping these discussions from Think Tank facilitator, Joseph Kim, MD, MPH, of MCM Education.

By Joseph Kim, MD, MPH, Guest Blogger

We now live in an era of molecular testing, genomic analysis, and personalized medicine in oncology. Hence, the “molecular tumor board” is emerging as a way to get input from additional members of an expanded multidisciplinary team that includes experts in the field of molecular pathology, bioinformatics, tumor genetics, and basic science research.

At the 2014 ACCC National Oncology Conference, a Think Tank focused on molecular tumor boards was held to discuss how this new trend is impacting cancer care in the community. Most cancer centers continue to hold traditional tumor boards each week, but have not yet invested the time and the resources to focus specifically at a panel of molecular mutation markers that may be actionable targets for treatment or may help to identify patients for clinical trials.

A Published Case Example

The University of California San Diego Moores Cancer Center published their molecular tumor board experience in the May 2014 issue of the Oncologist. Their oncology team held 1-hour molecular tumor boards every two weeks and they found that their cancer patients (n = 34) had received a median of 3 prior therapies. Patients had a median of 4 molecular abnormalities found by next-generation sequencing tests, but the clinicians did not act on all these mutations by prescribing targeted therapies. The most common reasons that clinicians did not act on the molecular diagnostic results were that patients were ineligible for clinical trials, patients could not travel to the clinical trial locations, or health insurance companies would not cover the cost for the experimental therapies.

Identifying New Drug Targets

Accelerating developments of cancer treatments are leading more cancer centers to hold molecular tumor boards and discuss how experimental treatment approaches may benefit their patients. Molecular tumor boards are not simply academic exercises. In the community setting, cancer centers are forming partnerships with academic research centers so that they can have access to experts in molecular pathology, bioinformatics, and tumor genetics. Input from these additional experts can guide oncology clinicians in clinical decision-making as they interpret results from genetic mutation panels. Community oncologists are also subscribing to resources like the NCCN Biomarkers Compendium to see how specific biomarker tests may provide actionable information that aligns with NCCN Guidelines for specific cancers.

Reserve for Salvage Therapy?

During the Think Tank, participants questioned when a patient’s case should be discussed at a molecular tumor board. Some cancer centers are reserving comprehensive biomarker testing for when patients have not responded to first- or second-line therapies. Others are instituting molecular tumor board discussions about patients even before first-line therapies have been selected to see if patients should be referred for clinical trials. Think Tank participants agreed that key considerations around the appropriate timing of the molecular tumor board discussion may need to include the patient’s ability to enroll and access clinical trials, the patient’s level of interest in participating in clinical trials, and the cancer center’s ability to interpret the results of the molecular tests and make appropriate treatment recommendations.

Conclusion

As molecular testing becomes ubiquitous for different tumor types, cancer centers in the community will be forming partnerships with major research centers that can provide scientific expertise and resources around molecular test result interpretation, care pathways, clinical trial recruitment, and much more. Molecular tumor boards can be a valuable educational exercise, and they can also serve a practical purpose and guide treatment decisions around patients who have cancers with complicated mutation matters.

 

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5 Key Tips for Financial Advocates

By Amanda Patton, ACCC Communications

cost disparitiesACCCBuzz is in San Diego this week for the ACCC 31st National Oncology Conference.

On Wednesday, at ACCC’s Financial Advocacy Network Pre-Conference, financial advocates from cancer programs around the country gathered for a one-day session focused on challenges and solutions to helping patients with issues around the costs of care.

Increasingly, the term “financial toxicity” is being used to recognize a potentially devastating side effect of cancer—the financial burden on patients and their families related to the cost of their care.

In 2012, the U.S. spent close to $3 trillion on healthcare, speaker Mark Rukavina, MBA, told attendees. Of this, $328 billion was estimated to have been paid out of pocket (for both uninsured and insured consumers). “We don’t have good cost containment strategies in place,” Rukavina said. As  a result, people face out of pocket costs beyond their budgets and are exhausting their savings.

“One of the most troubling effects of financial toxicity is its impact on patients’ care seeking behavior,” he  said.

Without question, the last challenge cancer patients need to face is the double whammy of serious health issues and serious financial issues.

Cancer care providers today are often on the front lines, helping patients and their families with financial issues surrounding the diagnosis and treatment of cancer. As ACCC’s 2014 Trends in Cancer Programs survey reveals, 90 percent of respondents report offering financial assistance services to patients, and 84 percent report having a financial specialist on staff.

Key session takeaways for oncology financial advocates include:

  • Financial advocates need to know their place in the revenue cycle—barriers can crop up anywhere along the line.
  • All patients should be screened for financial issues—coverage and financial assistance needs.
  • Conversations about costs should take place early on in the care process.
  • A lot of work needs to be done to educate newly insured patients about coverage they are purchasing through the insurance Marketplaces, including assistance in understanding health insurance terminology. For example, many newly insured consumers may not understand the meaning of terms such as “premium,” “deductible,”  “co-payment,” and “co-insurance.”
  • Metrics are key. Financial advocates should:

-Track out-of-pocket coverage metrics
-Measure results of their work and communicate results internally both to justify the position and show the value of the financial advocate services
-Practice continual learning, staying educated about changes in Medicare, state laws, ACA coverage, and more.

Stay tuned for upcoming ACCC Financial Advocacy Network regional meetings November 6 in Schaumburg, Illinois, and December 9 in Seattle, Washington. Find more resources for financial advocates at www.accc-cancer.org/financialadvocacy.