Navigating Patients Through Financial ToxicityCLARA LAMBERT, BBA OPN-CGONCOLOGY FINANCIAL NAVIGATOR

Description It is important that a patient is able to concentrate on the health portion of their journey for optimal healing. A financial navigator can make a difference throughout a patient's journey by navigating the financial portion of the journey.

Objectives

Understand how Financial Navigators make a difference in a patient’s oncology journey

Address the challenges and barriers for cancer survivors navigating the complex healthcare system

Work with a patient to protect them from bankruptcy and other financial hardship

Implement up a proactive financial navigation program in order to protect a patient’s psychological health and immune system from the ill effects of worrying about debt, bills, and impending medical costs

Explore Resources for Oncology Financial Navigation Keep up with the ongoing changes in healthcare coverage and reimbursement

A Deeper Look at Financial Toxicity

Changing Our Viewpoint We all work through these

steps daily, so they are normal to us

A patient may be on their first journey in the healthcare system, each step is unique and complicated from a patient viewpoint

The questions and concerns that each of these steps raises for a patient or their caregiver are usually very different than we think they will be

What will my illness mean to my family?Emotionally?Financially?

How do I find the care that gives me the best chance to survive?

Will my insurance cover it?How much will it cost me?

Who should I tell – and not tell?Will I lose my job if my employer finds out?

Will I be able to keep working?I have to keep working to keep my insurance/afford my treatment

Can I pay the bills?Even if I can’t work or have to cut my hours?

What if I don’t recover?Will I leave my family with a mountain of medical debt?

Financial Thoughts and Concerns

The Financial Burden

Financial Pain Points for Cancer Patients

Diagnosis Treatment Survivorship

Unableto work

Insurancebenefits change

Treatmentchange

Receipt of

first bill

Insurancecoverage

lost

Caregiverincome change

Initial Diagnosis &

Financial Questions

Reasons Patients do not Access Financial Assistance

Unaware of their financial need

Embarrassed to ask for help

Unaware that cancer program has resources to help

Scared that treatment will be interrupted or withheld

Financial Distress Screening NCCN Distress Tool

https://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf

COST Financial Distress Screening http://costofcancercare.uchicago.edu/

Implementation Resources

Association of Community Cancer Centers Financial Advocacy Network – Toolkit

Advisory Board – Oncology Roundtable Networking with Colleagues

Knowledge Base of Financial Navigator

Comprehensive understanding of Government Funded Insurance/Programs

Comprehensive understanding of Commercial Insurance Programs Comprehensive knowledge of insurance optimization opportunities Understanding of Enrollment Periods

Understanding of COBRA, FMLA, and other protections Understanding of External Assistance Programs Understanding of Internal Assistance Program

Knowledge of Local, Regional, State, and National Resources Understanding of Disease Process and Treatments Understanding of Psychosocial Distress

Background of Financial Navigators

Social Work Nurse Navigator Patient Navigator Business Office/Patient Accounts Pharmacist Pharmacy Tech

Cultivate Revenue Cycle Relationships

Oncology Financial

Navigators (Advocates)

Physician & Scheduling

Registration, Insurance

Verification, POS

Collections

Caregivers, Discharge

Planners, Social Work,

Pharmacy

Charge Capture & Coding

Billing, Appeals, Denial

Management

Patient Accounts & Collections

Insurance SolutionsReview Insurance BenefitsCAC - Certified Application Counselors -ACAMedigapMedicare Part D & Extra HelpMedicaid Applications

Prescription Drug AssistanceDirect Applications with Pharmaceutical CompaniesPrescription Assistance Direct to Patient or Infusion PharmacyReplacement Product

CoPay Assistance

Direct from pharmaceutical companiesDisease Specific Foundations

Premium AssistanceDisease Specific FoundationsDirect from Cancer Center

Internal AssistanceHospital Financial AssistancePayment Plans

External AssistanceLife ExpensesTransportation

Benefits of Financial Navigation

Proactive Approach

IDENTIFY

EDUCATE

PLAN

FACILITATE

COMMUNIATE

MEASURE

Comprehensive Insurance Review

Don’t Just check eligibility – check the benefits

Make sure you have the proper authorizations in

place

Get help from the Drug Manufacturer if needed

Potential red Flags

Medicare with no Supplement High Out of Pocket Maximums Disease Progression where patient may be

unable to continue working Past medical bad debt Cancelation of appointments due to cost Nearing Medicare eligibility

Out of Pocket Estimates – A

Discussion Opener

Research Potential Assistance

Tools to Research Options

Resources to Purchase

AssistPoint TailorMed Vivor

Free Resources

Needymeds.org Pharmaceutical Programs

Disease Specific Foundations•PAN Foundation•Patient Advocate Foundation

Financial Navigation Program

Facilitate Applications

Assist all patients in completing their applications Fill out application

Obtain Diagnosis & Treatment Information

Obtain Physician Signatures

Facilitate gathering financial information

Use Portals for submitting Applications Follow Up on Applications

CoPay Assistance Claims

Financial Navigator Submits Watch for EOB’s for Treatments

Fill out Claim forms

Submit on Portal or Send in

Follow Up

Make sure funds are applied correctly

(Patient will likely still receive bill)

Submitted by Billing Team Add an insurance carrier for

CoPay Assistance

After insurance pays – claim drops to copay program

Goes on worklist of assigned team member

Funds are applied to claim

Patient does not get bill until after copay assistance has paid

Free Drug Programs

Patient Assistance Programs Drug is sent in advance from

manufacturer

Can only be used for the patient specified

Make a worklist so you order 5 business days prior to patient treatment

Contacts in pharmacy

Cannot bill patient/insurance for free drugs

Replacement Programs Drug is sent after treatment to

replace stock used

Make a worklist to order replacement drug for your patients

Make sure it is received

Make sure account is credited

reading body language

Eyes

Facial Expressions

Hand Gestures

Active listening

Pay Attention

Withhold judgement

Reflect

Clarify

Summarize

Share

Internal Communication

Insurance Optimization = Potential Insurance Changes = Communicate with Insurance Verifiers/Pre-Auth Specialists/Biling Department

CoPay Assistance = Communicate with Billing/Accounts Receivable

Free Drug = Communicate with Pharmacy/Billing Department

Tracking and Reporting

Benefits NavigatorTracking Enrollments to follow up, obtain additions, renewWorklists for copay/free drug programsMonitor Workload

Benefits AdministrationShow return on investmentCommunity Benefit Reporting

Training Resources

Association of Community Cancer Center –Financial Advocacy Network Bootcamp –Original and Advanced Modules

Triage Cancer George Washington Cancer Institute

Patient Navigation Training

Technology Tools

Assistpoint TailorMed Vivor

Continuous Investigation

Patient Resources Network with Colleagues Community Resources State Resources Healthcare Law and Policy Disease Process

Advocate for Your Patients

Stay current on political topics pertaining to healthcare

Know and understand your facilities stand

Call and visit your Representatives/ Senators