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Research

Cancer Patient Financial Navigation

    Cancer Patient Financial Navigation

    With more than one-third of cancer patients delaying or forgoing recommended care due to cost, cancer programs must find a way to reduce the "financial toxicity" of cancer care.

    This study includes 17 best practices plus six downloadable templates and worksheets to help patients understand and manage their financial responsibilities, in turn improving your program’s revenue capture.

    DOWNLOAD THE STUDY

    Despite the prevalence of financial distress among cancer patients, many are reluctant to share those concerns with their care team. But a passive approach hurts both parties. Cancer programs need to create multiple mechanisms for surfacing financial concerns and connecting patients to financial counseling resources.

    The first step? Increasing patients’ awareness of available financial resources. Programs also should provide patients with access to financial counseling multiple times along the continuum of care. Best-in-class programs even standardize financial counseling appointments for all new patients.

    Ideal financial navigation for cancer patients

    Educate your patients—and optimize coverage

    At a foundational level, patients need to understand the basics of health insurance and their own specific benefits. And they’re apt to welcome the information. Over two-thirds of cancer patients say they want to know their out-of-pocket costs before treatment—visibility that’s likely to decrease their anxiety and increase the chance that they will pay for at least a portion of their care. This study outlines three ways to produce out-of-pocket cost estimates, along with considerations for communicating them to patients with the utmost sensitivity.

    Programs also should identify and reach out to patients who are eligible for new or improved health coverage. Coverage expansion has brought more health plan options but also more complexity. Patients need help finding the most appropriate plan. It’s also important to coordinate the start of treatment with the start of coverage and hardwire monthly insurance checks.

    Even patients with comprehensive coverage may struggle with out-of-pocket costs. There are many external sources of financial support for these individuals, but most programs aren’t making the most of them. We’ve outlined four ways to increase the number of patients receiving assistance from nonprofit foundations, pharmaceutical companies, and individual donors.

    Improve patient collections

    Finally, as providers’ revenue increasingly depends on patient payments, programs need to improve their ability to collect on patients' financial responsibilities. Point-of-service (POS) collections represent the biggest opportunity to decrease bad debt; yet, only 35% of hospital leaders say their organization consistently collects from cancer patients at the point of service.

    Programs can increase POS collections by notifying patients in advance how much they will owe at each appointment and by training cancer program staff to manage patients’ questions about the costs of their care. Cancer programs can further improve collections by working with patients to develop realistic payment plans.


    Introduction: The Need for Financial Navigation

    Chapter 1: Connect Patients to Financial Navigation

    • Tactic #1: Capture Patients from Multiple Channels
    • Tactic #2: Hardwire Financial Checkpoints
    • Special Report: Make the Case to Expand Financial Navigation

    Chapter 2: Educate Patients About Their Financial Responsibility

    • Tactic #3: Conduct Comprehensive Benefits Review
    • Tactic #4: Provide Patients with Out-of-Pocket Cost Estimates
    • Tactic #5: Script Compassionate Conversations

    Chapter 3: Optimize Patient Coverage

    • Tactic #6: Screen Patients for Coverage Eligibility
    • Tactic #7: Enhance Partnership with Medicaid Assistance Agency
    • Tactic #8: Coordinate Treatment Start with Clinical Team
    • Tactic #9: Hardwire Monthly Insurance Checks

    Chapter 4: Maximize External Assistance

    • Tactic #10: Screen for Assistance Program Eligibility Up Front
    • Tactic #11: Automate Patient Eligibility Screening
    • Tactic #12: Assign Billing Point Person for Copay Assistance
    • Tactic #13: Foster Best Practice Sharing Among Financial Navigation Staff

    Chapter 5: Improve Patient Collections

    • Tactic #14: Increase Patient Awareness of Point-of-Service Collections
    • Tactic #15: Train Staff for Point-of-Service Collections
    • Tactic #16: Develop Staff Incentive Program for Point-of-Service Collections
    • Tactic #17: Build Realistic Payment Plans

    Appendix

    • Financial Checkpoints Worksheet
    • Financial Conversations Scripting
    • Understanding Your Health Benefits
    • Insurance Verification Worksheet
    • Insurance Eligibility Reference Guide
    • Payment Plan Worksheet

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