Learning Labs: Assessing & Improving Financial Advocacy Services

As the cancer care landscape changes and treatment costs continue to rise, many cancer programs are revisiting their financial assistance services. More than just adding financial advocates to their staff, cancer programs are integrating their financial services into the continuum of care to ensure their patients have adequate access to the treatments they require. This two-part blog explores the ACCC Financial Advocacy Learning Lab held at the Fred & Pamela Buffett Cancer Center.

ACCC's Financial Advocacy Network provides tools, resources, and training to help ACCC member programs and practices proactively address their patients’ financial concerns. As part of that network of services, ACCC Learning Labs are customized workshops that help cancer programs identify strategies to strengthen their patient financial navigation services. In 2018 and 2019, the Financial Advocacy Network traveled to three member programs.

In November 2018, ACCC brought a Learning Lab to the Fred & Pamela Buffett Cancer Center in Omaha, Neb. Part of the Nebraska Medicine Cancer Network and the University of Nebraska Medical Center (UNMC), the Fred & Pamela Buffett Cancer Center opened in 2017. It consists of a 10-story cancer research tower and an 8-story inpatient hospital and outpatient center that includes medical, surgical, and radiation oncology clinics; a 24/7 infusion center; radiology services; lab services; radiation therapy; and surgical services. The cancer center also provides clinical care to patients at multiple sites across the Omaha metro area and into southwest Iowa—regions served by the Nebraska Medicine Cancer Network. The Fred & Pamela Buffett Cancer Center provides financial advocacy services to more than 40 patients per week.

The Learning Lab in Action
The Learning Lab began with a pre-workshop questionnaire in which participants were asked to identify barriers to their program’s delivery of optimal financial assistance services.

Prior to the workshop, participants recognized three areas for improvement:

• Insufficient number of dedicated financial advocates/counselors/navigators on staff;
• Delayed or inconsistent assessments of patient financial need; and
• No effective process for tracking the results of the program’s financial advocacy services.

During the on-site Learning Lab at the cancer center, a visiting faculty member from the ACCC Financial Advocacy Network guided participants in reviewing the cancer center’s baseline financial advocacy data; discussing their current financial advocacy practice; and developing a process improvement plan to address gaps and barriers in their center’s patient financial services. Participants worked together to identify effective strategies to address the areas they had identified for improvement. Ten members from the cancer program participated, including its patient access operations director, director of cancer clinics, nurse manager, patient access lead, financial counselors, pharmacy financial counselor, medical social worker, and case managers.

At present, the Fred & Pamela Buffett Cancer Center employs four financial counselors who are shared among the medical center’s other specialties. The access team at the cancer center reviews bad debt, charity percentages, point-of-service collections, and drug assistance enrollment organization-wide. The team also measures productivity and quality for each individual financial counselor. But the medical center does not currently capture metrics specific to its oncology unit.

During the workshop, participants noted that the medical center’s EHR creates obstacles to collecting patient information, which presents difficulties when providing cost estimates to patients during initial contact and follow-up meetings. Staff also said they have difficulty identifying who is responsible for which tasks during financial counseling, such as determining whether free drug programs are available.

To address these concerns and others, participants created a process improvement plan driven by two primary strategies: 1) delineating roles via a matrix spreadsheet to be distributed among members of the multidisciplinary team and new employees as part of the onboarding process, and 2) determining how to best measure and report outcomes to demonstrate the impact of financial advocacy/navigation services.

Three months after the Learning Lab, participants met with stakeholders and leadership to report on their efforts to take a more proactive approach to financial advocacy. Learn what they accomplished in our next blog post.