Tag Archives: financial advocacy

Snapshot of a Case-Based Financial Advocacy Network Workshop

By Joseph Kim, MD, MPH, MBA

Hands-creating-circle-of-supportACCC recently held its first Financial Advocacy Network (FAN) Case-Based Workshop of 2016.  Attendees representing a wide range of professionals working in financial advocacy joined in lively discussions across the continuum of cancer care in the community. Even today, many cancer programs do not have enough dedicated financial advocates providing support and assistance to cancer patients who struggle to pay for their care. As a result, social workers continue to shoulder the bulk of the responsibility of identifying financial resources and assisting patients with the process of completing online applications and forms for patient assistance programs.

Solving Real-World Scenarios

At the May 23 workshop held in Cleveland, Ohio, participants jumped right into dynamic case-based discussions, drilling down into specific scenarios that required them to uncover clues and develop customized plans for patients based on the unique circumstances presented case by case. Throughout the day, several key themes emerged:

Medicare:  Discussions touched on improving health insurance coverage for patients who are on Medicare. There is clear need to educate both providers and patients about the complexity of Medicare and the different options that range from Medicare Advantage, Medicare Supplement (Medigap), Medicare Select, Medicare Savings Program, Medicare Low Income Subsidy (Extra Help), and much more. Some cancer programs hold dedicated education and outreach events around the Medicare Open Enrollment Period so that patients understand their options.

Improving Communication: Another issue that resonated with most attendees was the need to improve communication about patients’ financial concerns across all the members of the cancer care team. Since this information is often not clearly documented in the patient’s chart, it may be difficult for nurses, and medical oncologists to truly understand the total impact the costs of treatment may have on a patient’s life. Improving those lines of communication could lead to creative and innovative ways to reduce the financial burden placed on cancer patients.

Tracking Savings: Almost every cancer program helps patients find various drug assistance programs, but many may not be effectively tracking their savings across their entire financial advocacy department. Attendees remarked how they were using manual spreadsheets to record the direct amounts received from patient assistance programs, drug replacements, and donations from foundations and other charitable organizations. Some track how their hospital-based charity programs are helping cancer patients with their costs of treatments. There are also savings that can be measured when financial advocates help patients improve their insurance coverage options, but these savings are not frequently being tracked.

Growing Need for Financial Advocacy: Throughout the workshop, attendees agreed on the need to strengthen and grow their financial advocacy programs. The complexity of cancer care is rising and the out-of-pocket costs are becoming significant burdens that may impact how patients receive care.

If you missed the FAN Workshop in Cleveland, be sure to mark your calendars for the upcoming FAN Workshops in Dallas, Texas, on August 17, 2016, and in Philadelphia, Pennsylvania, on September 29, 2016. Learn more and register here.

In the meantime, check out the resources available to financial advocates on the ACCC Financial Advocacy Network section of the ACCC website.

_______________________________________________________

Guest blogger Joe Kim, MD, MPH, MBA, is serving as the facilitator for the 2016 ACCC FAN Case-Based Workshops.  Dr. Kim is President of Xaf Solutions.

 

 

 

Financial Advocates: Helping to Close the Gap

Amanda Patton, ACCC Communications

Hands-creating-circle-of-supportThe just-released 2016 CancerCare Patient Access and Engagement Report provides the oncology community with a comprehensive look at cancer patients’ perspectives of real-world issues that accompany patients along the care continuum from diagnosis through treatment and beyond. The landmark study encompasses six surveys capturing responses from 3,000 cancer patients representing a broad diversity of ethnicity, income, education, geography, age, insurance, cancer type, and treatment stage.

Cancer program staff who serve as financial advocates helping patients navigate the economic challenges cancer brings will not be surprised by the results of Survey 4: Financial and Insurance Issues. Among the survey’s key findings:

  • Only about half of respondents report understanding their health insurance coverage for their cancer care “completely” or “very well.”
  • 58% of respondents reported being distressed about their finances during treatment.
  • 20% to 30% of patients reported having trouble estimating their out-of-pocket costs before incurring medical expenses.
  • To afford treatment, one-third of respondents (ages 25 to 54) reported cutting back on daily necessities, including groceries and transportation, and/or borrowed from family members and friends.

As these findings show, financial toxicity remains a top-level issue for patients with cancer, and the need to close the gaps in addressing the economic impact of cancer on patients and their families is critical.

At many cancer programs today, financial advocates are helping to close these gaps by:

  • Helping patients understand the costs of care;
  • Facilitating pre-authorizations and pre-certifications;
  • Connecting patients with patient assistance programs, copay support programs, and foundation support;
  • Accessing community resources to meet patient financial needs, and more.

The ACCC Financial Advocacy Network (FAN) is a partner in this effort bringing training, resources, and peer-to-peer support to oncology financial navigators and advocates.  The  Financial Advocacy Network (FAN) Case-Based Workshops bring these professionals together to share effective practices and strategies for the evolving healthcare coverage landscape, and to join in collaborative problem solving.  Learn more and view upcoming workshop schedule here.

A Financial Advocate’s Six Steps to Cost Transparency

By Clara Lambert, Oncology Financial Navigator

Form-with-stethoscopeThe challenges of today’s healthcare environment mean that every patient with cancer can benefit from financial navigation. At some point during their treatment, most patients will have questions about their billing, and how it will affect their personal finances. Make sure your financial navigation process includes meeting with each new patient face-to-face. Whether this meeting is scheduled after their first appointment with the oncologist, or after their chemotherapy teaching and prior to beginning treatment, this face-to-face conversation is an opportunity for financial advocates to introduce themselves, explain their role, and help the patient feel more comfortable asking questions about costs of care early on rather than later when it may be too late to access assistance.

Here are six steps financial advocates can take toward cost transparency.

Step 1. Review All Insurance Benefits.

Before meeting for the first time with a new patient, financial advocates should review all of the patient’s insurance benefits.  This should be a comprehensive review conducted with the patient’s treatment plan in mind. Look at all hospital, medical, and pharmaceutical benefits, as the patient’s treatment could encompass some or all of these benefits.

Step 2. Work with Your Pharmacist & Chargemaster to Develop Price Estimates for More Common Treatments.

Developing price estimates for common treatments can help financial advocates streamline the financial navigation process.  At my facility, our pharmacist worked with our oncologists to develop the most common treatments for each diagnosis following NCCN Guidelines. The financial team is then able to work with that information to develop the price estimates.

Step 3. Personalize the Price Estimate to the Patient.

Taking the insurance review and the previously developed price estimates into account,  financial advocates can develop a personalized price estimate specific to each patient. You may want to develop a form to populate with this information so if the patient wants a copy of the information, it’s ready to go.

Step 4. Always Have a Plan in Mind.

Now that you have reviewed the patient’s benefits and prepared a personalized price estimate for the patient, you are almost ready for that first meeting.  Before meeting with a patient, you should prepare a plan outlining potential assistance.  Be sure your plan includes all of the qualification requirements for financial assistance and also verify that the fund is still open and accepting new applications. This advance work will help streamline the patient meeting, and allow you to start any applications immediately if the patient qualifies and is interested in pursuing financial assistance.

Step 5. Meet With The Patient.

From your very first meeting with the patient, it’s important to build a relationship. In this face-to-face meeting you will be getting to know the patient, as well as letting the patient know that you are there to help. You will need to make sure that your conversations are compassionate and understanding.

During the meeting, you will review the patient’s insurance benefits and the cost estimate for their plan of treatment.  There is often some patient education to help the patient understand his or her insurance benefits. As part of this meeting, complete a financial screening and begin the application process for the programs that the patient qualifies for.  The patient may be feeling overwhelmed with information, so preparing a checklist for the patient to identify any missing items will help them comply with supplying the information. It is best to submit an application for financial assistance when everything is complete, as many foundations will not look at an application until they have received all the required information.

Step 6. Follow Up & Track.

Many programs provide instant approval. For those programs that do not, you will need to set a follow-up reminder.  I typically follow up weekly.  If you receive a denial that you disagree with, know the appeal process, and begin immediately.  Once the application has been approved, make sure you notify the patient and billing personnel, and track the information to show the cost savings to your patient and your facility.

Guest blogger ACCC member Clara Lambert is an oncology financial navigator with Cancer Services at Munson Medical Center, and an active member of the ACCC Financial Advocacy Network (FAN).  Learn about upcoming ACCC FAN Case-Based Workshops here. Explore all of the ACCC FAN resources for oncology financial advocates here.

Discussing Healthcare Reform 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 second 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

At the recent 2014 ACCC National Oncology Conference, a Think Tank focused on the healthcare marketplace was held to discuss how recent changes have impacted oncology care. Since the Affordable Care Act (ACA) was signed into law on March 23, 2010, the evolving market forces have driven community cancer centers, hospitals, and oncology providers to focus more on affordability, access, quality, and accountability. The ACA has made it possible for millions of Americans to purchase health insurance through new employer requirements, the Health Insurance Marketplace, and the expansion of public programs like Medicaid.

  • In 2014, it is estimated that up to 32 million people will receive health insurance coverage through the ACA.
  • More than 8 million have selected a marketplace plan since enrollment began in October 1, 2013.
  • Adults lacking health insurance was 18% in the third quarter of 2013 and dropped to 13.4% in May of 2014.

Growing Need for Patient Navigation

The oncology community continues to face tremendous pressures and challenges as new patients enter the system. Many first-time insurance purchasers need assistance navigating the process of signing up for healthcare coverage and they remain confused about newly encountered terms like deductible, co-pay, co-insurance, and out-of-pocket maximum. As cancer patients evaluate treatment options and the total cost for treatment, some will enroll in patient assistance programs while others will lean heavily on family members for financial support. Although some cancer programs are staffed adequately to educate and counsel patients through this process, others are struggling to fill these critical positions as they anticipate a rapid influx of new patients. ACCC has developed a set of resources around cancer patient navigation and patient assistance programs, as well as the Financial Advocacy Network with resources for both clinicians and administrators.

Pharmaceutical patient assistance programs continue to be a valuable resource for cancer patients who are being treated by expensive new therapies. Medicare lists most of the programs by drug name.

The Patient Access Network Foundation (or PAN Foundation) is another helpful resource that also provides information about co-pay assistance programs.

New Patients Remain Functionally Uninsured

Although Medicaid expansion is one of the key ways that uninsured patients will gain health coverage through the ACA, not every state is participating. Currently, 28 states (including Washington, D.C.) are implementing Medicaid expansion, 2 states are in open debate, and 21 states are not expanding. As a result of the Medicaid expansion, approximately 10.5 million new patients will receive health insurance coverage. However, many of these patients will remain “functionally” uninsured because they will lack access to providers who are willing to accept new Medicaid patients. (Less than half of physicians are accepting new Medicaid patients.) Think Tank participants also emphasized the growing importance of care coordination in oncology since more patients are living longer with a cancer diagnosis and are requiring care by other specialists such as cardiologists or psychiatrists.

Value in Oncology

Think Tank participants agreed that the growing focus around the “value” of healthcare can be difficult to measure in the area of oncology. The measurement of subjective clinical endpoints can be challenging when cancer patients are dealing with severe nausea or vomiting, fatigue, rashes, or pain. Cancer programs and oncology clinicians are also noting the growing importance of focusing on patient satisfaction scores, since these metrics are directly impacting reimbursement.

Conclusion

Think Tank participants also acknowledged that other complex and intertwined issues related to healthcare reform are directly impacting cancer providers and patients. There are ongoing discussions about the 340B Drug Pricing Program, the consolidation and acquisition of oncology practices, and of creative ways for achieving patient-centered care in oncology.

Stay tuned for Think Tank #3 Discussing Personalized Medicine at #ACCC2014.

Genentech-logo

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lessening the Financial Side Effects of Care

by Amanda Patton, Manager, Communications, ACCC

Health Care ReformNo one would argue with the fact that stresses related to the financial burden of the cost of cancer treatment are the last thing cancer patients and their families need.  And yet, according to the most recent ACCC Trends in Community Cancer Centers survey, 88 percent of respondent cancer programs reported seeing more patients needing help with prescription drug expenses, co-pays, and co-insurance.

According to a study from Duke University, many cancer patients would  like to talk about the cost of treatment with their healthcare providers, but for a variety of reasons, these conversations often do not happen.

However, this may be changing.  Along with renewed emphasis on the importance of distress screening and meeting the psychosocial needs of patients comes an increased awareness of the importance of enabling patients to focus on healing rather than on struggling with the financial side effects of care. Many cancer programs are adding staff to serve as financial advocates to help patients and their families; others are working to provide these services with existing staff.

ACCC’s newly released 2014 Patient Assistance and Reimbursement Guide is a user-friendly resource designed to help cancer programs in this effort. This is the fourth year ACCC has published the guide, which is available in both a print and digital format and includes links directly to patient assistance programs, the forms patients and providers need, and much more. The guide includes information on pharmaceutical and non-pharmaceutical patient assistance programs and reimbursement resources, as well as:

  • Financial counselor and patient advocate position descriptions
  • A tool to estimate patient responsibility of treatment costs
  • A charge capture flow chart
  • A patient assistance checklist for uninsured patients
  • A co-pay assistance checklist.

ACCC offers additional resources through its Financial Information and Learning Network, which includes online courses and tools for providers to help in providing patients with financial assistance services. Finally, an upcoming session on “Financial Advocacy: Improving the Patient Experience”  at the ACCC 40th Annual National Meeting will discuss strategies to meet patients’ evolving financial advocacy needs.