navigating patients through financial toxicity...financial toxicity clara lambert, bba opn -cg...
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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