Tag Archives: financial toxicity

Financial Advocates: Sharing Insights & Strategies

By Joseph Kim, MD, MPH, MBA

ThinkstockPhotos-507273299Last week nearly 100 financial advocates gathered in Philadelphia, Pennsylvania, for the September 29 ACCC Financial Advocacy Network (FAN) Case-Based Workshop.  Whether from academic research cancer centers or community hospitals or practices, participants unanimously agreed that the entire cancer community needs to invest more resources to improve financial advocacy services in cancer programs throughout the country.

During the workshop, participants discussed the practical challenges they face every day and shared creative approaches to helping cancer patients experiencing financial hardships.  These included:

Navigating the Maze around Medicare. Open enrollment for Medicare starts October 15 and runs through December 7. This period is often a confusing time for Medicare enrollees and family members as they navigate the maze of options surrounding their healthcare coverage. During the workshop, participants discussed the pros/cons of Medicare Advantage for cancer patients and also touched on certain types of special enrollment periods (SEPs) that may open up based on unique circumstances.

For patients on Medicare with no supplemental coverage (i.e., no Medigap insurance), out-of-pocket responsibilities are to “typically pay 20% of the Medicare-approved amount for most doctor services.” When it comes to paying for the costs of treatment they are about to receive, these cancer patients are effectively underinsured. The resulting high out-of-pocket burden often leads to cancer patients to filing for personal bankruptcy.

Workshop participants agreed that cancer programs must take a more proactive approach when they see that a new patient on Medicare has no supplemental coverage. Hospital financial counselors often know to meet with such patients. Similarly, outpatient cancer programs must be sure to have reliable processes that trigger financial counseling referrals as soon as underinsured patients enter the system.

Another area of agreement: Cancer programs need to spend more time training their internal staff about the complexities surrounding Medicare coverage. Many consumers continue to confuse Medicare Advantage (also called Medicare Managed Care, Medicare Part C) and Medicare Supplement (also called Medigap or Medicare Select). A Medicare Supplement policy is different from a Medicare Advantage Plan. Medicare Advantage (MA) plans are ways to get Medicare benefits, while a Medigap policy only supplements an individual’s Original Medicare benefits.

Patient-Friendly Billing. Although financial advocates in cancer programs typically do not work in the hospital’s billing department, they may still be able to influence the type of billing process patients may experience.  According to the Advisory Board Company, the average American has $1,766 in overdue medical debt. Several workshop participants described how they have been offering different loan programs for their cancer patients. Some financial institutions offer patients 0% interest loans and affordable monthly payments. One such program offered by many hospitals is run by ClearBalance, and this program has been shown to reduce bad debt and increase patient collections. Other similar programs are designed to achieve a friendly billing process for patients who are already experiencing a tremendous amount of psychological stress and financial hardship.

Playing an Active Role in the Care Team. Many financial advocates and financial counselors have formal training in social work or financial services, but some also come with a clinical background in nursing. At some programs, pharmacy technicians are also assuming the financial advocate role, focusing on finding assistance programs around oral oncolytic agents. Given that financial advocates and counselors often have diverse backgrounds, they can learn from one another and from members of the clinical care team. By playing an active role as a member of the cancer care team, financial advocates can help inform key decisions around the course of treatment and potentially improve the patient’s outcome around important psychosocial factors such as financial toxicity. In many cancer programs, financial advocates may not see themselves as integral members of the care team, but this culture is changing.  Today, more financial advocates are attending tumor boards and speaking with clinicians to offer insights and assistance.

Since cancer care is rapidly evolving, hospitals and other cancer programs in the community must be properly equipped to ensure that patients receive the appropriate guidance and assistance as they prepare to start their treatment journey. Navigating the financial decisions around health insurance coverage remains confusing and many patients need help finding and applying for assistance programs.

ACCC Financial Advocacy Network (FAN) Resources

ACCC remains committed to providing ongoing financial advocacy resources in 2017. Based on member feedback, ACCC has been developing an online Financial Advocacy Certificate Program that will launch in 2017 and members will be able to access these modules on the ACCC eLearning portal. Stay tuned for more details as ACCC continues to expand its Financial Advocacy Network (FAN) program and be sure to visit accc-cancer.org/FAN often for the latest resources and updates from ACCC. Look for the 2017 ACCC Patient Assistance and Reimbursement Guide coming in January 2017.


Guest blogger Joseph Kim, MD, MPH, MBA, is president of Xaf Solutions. Dr. Kim served as facilitator for the Philadelphia ACCC FAN Case-Based Workshop.

 

Financial Advocacy Services—A Patient’s Perspective

Hands-creating-circle-of-supportScott Steiner’s experience working with oncology financial navigator Dan Sherman, MA, at Mercy Health Lacks Cancer Center, started nearly nine years ago in 2007, when Scott was first diagnosed with a rare gastrointestinal cancer.

Recently Scott was interviewed for a Washington Post article on the growing field of financial advocacy for cancer patients, Tackling the Financial Toll of Cancer, One Patient at a Time.  One reason he’s telling the story of his experience is to spread the word about the difference these services can make for a patient.  In this conversation with ACCCBuzz Scott shares his perspective on the importance of financial advocacy services for patients with cancer.

ACCCBuzz: How did you first start working with Dan?

Scott Steiner:  I kind of stumbled across financial advocacy by good fortune. Dan was actually assigned to me as my social worker, my case worker, when I was first diagnosed with cancer.

ACCCBuzz: What was the process like, working together?

Scott Steiner: The first obstacle that we ran into was the treatment that was prescribed was not approved by my insurance company. Dan actually found that out before I did. He told me before I’d even submitted the claim to the insurance company that it would be refused. And then Dan told me not to worry, that there were options available and that he would help me walk through it to get the situation figured out.

Dan contacted my insurance company to appeal (again) the need for the treatment. They again refused coverage.  Then Dan secured free drugs from the pharmaceutical company as they provided assistance for off-label use. Over the last eight years we have also used multiple co-pay assistance programs when my physician put me on treatments that were covered by my insurance but the co-pays were unaffordable for me. So I have always been able to get access to all of my treatments via free drugs from the manufacturer or via co-pay assistance programs when my co-pays were too costly.

ACCCBuzz: So basically having someone knowledgeable about the resources instead of having to go it alone?

Scott Steiner: Absolutely.  A little bit about our experience. . . about four or five months before I was diagnosed, my son-in-law was diagnosed with cancer, and I had heard so many horror stories from my daughter about how she was battling to get any assistance at all, and they were doing everything themselves. They were contacting the drug manufacturers. They were contacting insurance companies. They were doing all of the leg work.

You don’t know what you don’t know, when you’re going into it. You don’t know the answers to the questions. You don’t even know what questions to ask. You don’t know what help is available. You don’t know the different organizations that are available to help with the different types of cancers. You don’t know which manufacturers have which financial assistance programs. You just aren’t aware of that information unless someone is there to tell you that it’s available.

ACCCBuzz:  You seem to have a collaborative relationship in terms of Dan working with you as you’ve moved through care.

Scott Steiner: It always felt like Dan was a step or two ahead of me, helping me to know what was coming next.  For example, he’s the one who recommended that I apply for disability. I really fought that at first. There’s the pride issue of wanting to provide for your family. And, if at all possible, I wanted to do that. But over the course of a few months, Dan walked me through that whole process and got me to a place where I agreed to go ahead with the disability application. Dan told me that most likely the first response would be denial. He told me what to expect. These are things that I know other people who are going through the disability process and the application process just give up on. You get denied, who wants to keep going?

You’re already fighting enough battles and having to process enough information. There is just so much going on. For either the patient or family to have the resources and time to fight these additional battles, it’s just overwhelming.

ACCCBuzz: What would you tell new oncology financial advocates who are just getting started in the field?

Scott Steiner: I think that financial navigators who know what patients are going to face have to understand that they are not just helping us to navigate the pitfalls that are coming. They have to educate us to know that there are pitfalls that we have to be aware of—especially when it comes to providing for your family. There may come a point with the cancer journey where you just can’t. Patients have to understand that. What Dan has always been good about helping me understand and work through is that the financial aid that is available, the disability that I paid into when I was working, these are all ways for me to provide for my family. And by not taking advantage of these resources, I put my family at risk.

ACCCBuzz:  Why do you feel it’s important to spread the word about the impact of financial advocacy services?

Scott Steiner:  I’ve been battling this for so long. I’ve been part of support groups. I’ve journeyed it with my own family. My son-in-law and then my sister were diagnosed [with cancer]. We lost her a few years ago.  We had so many contacts with people who were in the cancer journey; the more I learned about their battles, the more I realized what I had at Lacks Cancer Center and especially with Dan was not the norm. It’s not what was done at a lot of cancer centers. I just realized what a blessing it had been to me, and that there really is this need [for these types of services]. It’s a need; it’s not an option. There’s just way too much to handle when you’re dealing with cancer. If you can get the financial challenges off your plate, that’s a huge help because that’s what sinks you. If the disease doesn’t get you, the finances will.

ACCCBuzz: Any final thoughts that you want to add?

Scott Steiner:  Financial navigation doesn’t just help the patient. It helps the cancer center or the hospital. They are helping themselves [by reducing write offs and bad debt].

I think hospitals [and] cancer centers need to understand that these services need to be part of their care for their patients—just like they help by connecting us with psychological help when we need it, or transportation, or support groups. Financial assistance is just as important, if not more important, than all of those other services they offer help with.

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Oncology financial navigator Dan Sherman, MA, LPC, serves on the Advisory Committee for the ACCC Financial Advocacy Network (FAN). Learn more about resources and training for financial advocates available through the ACCC Financial Advocacy Network.

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.

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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.

Financial Advocates—Working to Curb the Economic Impact of Cancer

By Amanda Patton, ACCC Communications

Healthcare costsThe financial burden of a cancer diagnosis impacts patients and families at all income levels—insured and uninsured, young and old alike, city folks and those in rural areas. Perhaps nothing communicated this reality more powerfully than last month’s CNN interview with Vice President Joe Biden when he shared the story of how his own family was challenged by the economic impact of his son’s cancer diagnosis. Concerned about providing for his son’s family, the Vice President related how at one point he had considered selling his home and how President Obama offered his financial help.

“Without question, the last challenge cancer patients need to face is the double blow of serious health issues and serious financial issues. Yet “financial toxicity” is increasingly recognized as a potentially devastating side effect of cancer,” writes ACCC President Steven D’Amato, BSPharm, BCOP, in “Curbing Financial Anxiety on the Road to Recovery.”  (The article was published in a special supplement to USA Today distributed in select cities nationwide.)  He describes how many cancer programs across the country are working to curb financial toxicity by adding a new member to the team—the financial advocate—to help patients and providers understand and mitigate the economic burden of cancer.

Increasing Complexity

Since 2012, the Association of Community Cancer Centers, through the ACCC Financial Advocacy Network (FAN), has been creating tools and resources to support these newest members of the multidisciplinary cancer care team. In a healthcare economic environment that is increasingly complex and challenging to navigate—for patients and providers alike—the skill set and role of the financial advocate must change, says Dan Sherman, MA, LPC, clinical financial consultant, at ACCC member cancer program The Lacks Cancer Center.  “. . . we need improvement in this area because even though most hospital settings that provide oncology care having financial counselors who have been tasked to deal with the problem, nonetheless, the problem remains,” he said in an interview published in the 2016 ACCC Patient Assistance & Reimbursement Guide.  Mr. Sherman is a member of the ACCC FAN Advisory Committee.

Evolving Resources

Look for new education opportunities from the ACCC Financial Advocacy Network in 2016 to help cancer programs identify areas of improvement in helping patients and providers cope with the economic implications of a cancer diagnosis, including:

  • Case-Based Workshops providing high-level analysis and fostering collaborative peer-to-peer problem solving. Learn more and register here.
  • Soon-to-be-launched certificate program for financial advocates.
  • Results from the 2015 FAN learning labs for process improvement in financial advocacy services.

According to findings from the 2015 ACCC Trends in Cancer Programs survey, 74 percent of respondents report having a financial specialist on staff.  The ACCC Financial Advocacy Network is here to support these professionals as they work in cancer programs across the country helping patients and families navigate the economic impact of cancer.

Making the Case for Oncology Financial Navigation

Dan-Sherman-150x170By Dan Sherman, MA, LPC, Guest Blogger

Yes, it’s that time of year again. Open enrollment for health insurance plans spans the range of employer-based policies, ACA policies, and the host of Medicare options available to Medicare beneficiaries. For many this is a dreaded period of time; they are forced to make important decisions about their finances and health coverage without having a core understanding of insurance terminology and how these policies will affect their access to care. For many there is little understanding of how the basic terms “deductible,” “max out of pocket,” “co-pays,” and “co-insurance” may affect the financial well-being of the enrollee. Nor do many understand the differences between HMO, PPO, POS, HSA, or PFFS, and how these differences may play a major role in the financial well-being and access to care for the oncology patient. Unfortunately, for far too many patients confusion leads to decision paralysis; they end up making no choice at all, or keeping the plan they have even though it may not be in their best interest. A time that should be viewed as an opportunity ends up being a time of dread and frustration, resulting in less than optimal coverage for care the patient desperately needs.

Changing the Paradigm

We, who are in the business of assisting oncology patients, also need to be in the business of changing this scenario from a time of dread and angst to a time of opportunity and hope. However, in order to accomplish this, many in the oncology community need to take ownership of the fact that we have aided in the mass confusion that our patients experience when it comes to understanding their health insurance policy. How often do we respond to a confused patient with the well thought out answer, “You will need to call your insurance company with that question”? How often do well-intentioned staff encourage patients to go through the cumbersome process of applying for Medicaid even though they do not qualify for this benefit in the first place? Have you tried to make sense of an itemized bill? It’s time that we in the medical field acknowledge that we are often just as confused about the health insurance policies as our patients.

Facing the Problem

Acknowledging this problem is the first step toward solving the problem of financial toxicity. So, let’s face it! Navigating the financial ramifications of cancer care is complex! If it were simple, we would be seeing much less financial toxicity in the oncology setting. Patients and providers alike are getting lost in a maze of health insurance policies, enrollment guidelines, and assistance programs, all requiring different information for successful enrollment. The rules governing Medicare Part D, with the initial coverage, coverage gap, catastrophic coverage levels, co-pay assistance guidelines, and steps to qualify for extra assistance programs, are overwhelming for most individuals. Up to 35 percent of new oncology products are oral medications covered by Part D, with 11 out of 12 of these medications costing more than $100,000 a year. It is essential that we understand the core benefits of patients’ insurance policies and help these patients apply for programs that are the most appropriate and readily available to meet their specific needs. All too often I have seen patients refuse oral treatment recommendations due to cost; only to find out that if these patients had received comprehensive financial navigation, they would have had access to these medications without significant cost-sharing responsibilities.

Then there is the complexity of choosing Medicare plans. Have you tried to explain the coverage differences between Medicare Advantage, Medigap, employer-based plans, and Medicaid? The fact is that Medicare beneficiaries who choose from a list of 30 to 60 different coverage options, many with significant cost-sharing responsibilities, need advice from someone with significant experience with these options, particularly in terms of how those policies cover cancer treatments. The oncology community is seeing similar trends with the health insurance exchanges under the Affordable Care Act (ACA). Patients are overwhelmed and confused about the enrollment process and the choices of coverage policies available to them.

Helping Patients Navigate the Maze

When patients are left on their own to wade through the 50+ Medicare options; the extra help program for Part D; co-pay assistance programs; premium assistance programs; ACA enrollment guidelines; the choices of bronze, silver, gold, or platinum plans; and available out-of-pocket subsidies, they will likely experience financial toxicity as they journey through cancer treatment. One of the main tools I use when providing financial navigation services to oncology patients is taking advantage of open enrollment and educating the patient on better options available to them in the context of their medical condition. Our patients need not only high-quality medical care provided in a compassionate environment, they need expert financial navigation services to help reduce the very real side effect of financial toxicity.

I contend that we need to see open enrollment as an opportunity for education and a way to decrease financial toxicity. So, let’s change the mindset of open enrollment from a time of dread to a time of opportunity so our patients suffer less, and providers get paid for the services they provide.

An important resource in this effort is ACCC’s Financial Advocacy Network, which provides tools, resources, and education for oncology team members involved in helping patients with issues related to the costs of cancer diagnosis and treatment.

Dan Sherman, MA, LPC, is a clinical financial consultant for Mercy Health Saint Mary’s, The Lacks Cancer Center, Grand Rapids, MI. He is also founder and president of The Navectis Group, a consulting company that assists oncology providers in implementation of financial navigation programs. Mr. Sherman serves on the Advisory Committee for ACCC’s Financial Advocacy Network.

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.

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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.