Feature

Software platform reduces patients’ financial toxicity, increases hospital revenue

Photo of Clara Lambert
Clara Lambert

A novel software platform improved financial navigation, decreasing patients’ financial toxicity while increasing revenue at a community cancer center, according to results of a pilot study.

“Although financial navigation programs have been implemented across cancer centers ... the manual nature of financial navigation limits the ability to assist patients at risk for financial toxicity and demonstrate value for both patients and the health care organization,” Clara Lambert, BBA OPN-CG, oncology financial navigator with Bhorade Cancer Center at Advocate Good Samaritan Hospital, and colleagues wrote.

Researchers assessed the effect of automating the financial navigation program at a community cancer center using the TailorMed Financial Navigation Platform.

Of the 4,616 patients receiving treatment, the system identified 244 “high-priority” patients based on high out-of-pocket expenses, risk for financial toxicity and qualification for available navigation opportunities.

Among these patients, 74% received one or more forms of assistance based on financial opportunities identified by the platform. In addition, the researchers observed improvements in productivity, a trend toward proactiveness of workflow, and improvements in internal organization alignment.

HemOnc Today spoke with Lambert about the study, the implications of the findings, how the technology platform works and the potential role of such platforms in improving financial navigation across cancer settings.

 

Question: Can you describe the challenge of financial toxicity in the community cancer setting?

Answer: There are a few challenges. One is that people do not understand their insurance benefits. There have been so many changes and so many different places to purchase insurance — whether through an employer, the health insurance marketplace or Medicare. A lot of people are simply choosing a plan because it has a lower premium. They do not know how it will work if they end up with cancer or a chronic disease, which will cause them to maximize their benefits. Poor choices sometimes are made due to the high costs of health care. Patients end up having high out-of-pocket expenses and this turns into a financial hardship.

 

Q: How does the technology platform work?

A: In a manual situation, a financial navigator has to look at the schedule to see who is coming in for an office visit, check their insurance benefits to see if the patient will need the navigator, and then find all the resources to help the patient. TailorMed streamlines the process from start to finish. The platform proactively identifies the patients with the highest financial risk, shows the funding opportunities and uses information that is already in the system to fill in the application for the patient. The platform also looks at patient-specific things, such as ways to improve the patient’s insurance plan or choose a better health care plan when open enrollment comes around.

 

Q: How did you conduct the pilot study?

A: We conducted the study for 8 months. We designed key performance metrics to evaluate how the platform worked. We allowed the platform to check schedules and gather information from the electronic health record so that, when we came to work, we knew who we needed to see and what we would be discussing with them.

Q: What did results show?

A: The platform allowed us to assist more patients and increase their access to care. In addition, we were able to ensure that the information we were collecting was wanted and would be valuable in the future. Financial navigators secured a combined total of $3,553,453 in approved savings, of which $1,524,562 were accounted for community benefit and $259,593 as increased revenue.

Q: What are the implications of the results?

A: Automating some of the processes in financial navigation is a definite help to financial navigators and, in turn, to patients and the facility treating the patients. We were able to focus our attention on the patients who needed us. We also found additional resources for patients that we had not had the time to search for when we were working manually.

Q: Moving forward, what role might technology platforms have in improving financial navigation in the cancer setting?

A: Right now, there are a lot of different people with different titles performing the function of financial navigation. However, financial navigation is not streamlined across institutions. This platform helps streamline the process for hospitals and patients. We were initially working in a reactive state but, with this platform, we were able to work more proactively.

Q: Is there anything else that you would like to mention?

A: The Association of Community Cancer Centers’ Financial Advocacy Guidelines would be valuable for any facility looking to implement a financial navigation program. For more information on TailorMed Financial Navigation Platform, visit www.tailormed.co. – by Jennifer Southall

 

For more information:

Clara Lambert, BBA, OPN-CG, can be reached at Advocate Good Samaritan Hospital,

3815 Highland Ave., Downers Grove, IL 60515; email: clara.lambert@advocatehealth.com.

 

Disclosure: Lambert reports serving as a developmental consultant for TailorMed.

Photo of Clara Lambert
Clara Lambert

A novel software platform improved financial navigation, decreasing patients’ financial toxicity while increasing revenue at a community cancer center, according to results of a pilot study.

“Although financial navigation programs have been implemented across cancer centers ... the manual nature of financial navigation limits the ability to assist patients at risk for financial toxicity and demonstrate value for both patients and the health care organization,” Clara Lambert, BBA OPN-CG, oncology financial navigator with Bhorade Cancer Center at Advocate Good Samaritan Hospital, and colleagues wrote.

Researchers assessed the effect of automating the financial navigation program at a community cancer center using the TailorMed Financial Navigation Platform.

Of the 4,616 patients receiving treatment, the system identified 244 “high-priority” patients based on high out-of-pocket expenses, risk for financial toxicity and qualification for available navigation opportunities.

Among these patients, 74% received one or more forms of assistance based on financial opportunities identified by the platform. In addition, the researchers observed improvements in productivity, a trend toward proactiveness of workflow, and improvements in internal organization alignment.

HemOnc Today spoke with Lambert about the study, the implications of the findings, how the technology platform works and the potential role of such platforms in improving financial navigation across cancer settings.

 

Question: Can you describe the challenge of financial toxicity in the community cancer setting?

Answer: There are a few challenges. One is that people do not understand their insurance benefits. There have been so many changes and so many different places to purchase insurance — whether through an employer, the health insurance marketplace or Medicare. A lot of people are simply choosing a plan because it has a lower premium. They do not know how it will work if they end up with cancer or a chronic disease, which will cause them to maximize their benefits. Poor choices sometimes are made due to the high costs of health care. Patients end up having high out-of-pocket expenses and this turns into a financial hardship.

 

Q: How does the technology platform work?

A: In a manual situation, a financial navigator has to look at the schedule to see who is coming in for an office visit, check their insurance benefits to see if the patient will need the navigator, and then find all the resources to help the patient. TailorMed streamlines the process from start to finish. The platform proactively identifies the patients with the highest financial risk, shows the funding opportunities and uses information that is already in the system to fill in the application for the patient. The platform also looks at patient-specific things, such as ways to improve the patient’s insurance plan or choose a better health care plan when open enrollment comes around.

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Q: How did you conduct the pilot study?

A: We conducted the study for 8 months. We designed key performance metrics to evaluate how the platform worked. We allowed the platform to check schedules and gather information from the electronic health record so that, when we came to work, we knew who we needed to see and what we would be discussing with them.

Q: What did results show?

A: The platform allowed us to assist more patients and increase their access to care. In addition, we were able to ensure that the information we were collecting was wanted and would be valuable in the future. Financial navigators secured a combined total of $3,553,453 in approved savings, of which $1,524,562 were accounted for community benefit and $259,593 as increased revenue.

Q: What are the implications of the results?

A: Automating some of the processes in financial navigation is a definite help to financial navigators and, in turn, to patients and the facility treating the patients. We were able to focus our attention on the patients who needed us. We also found additional resources for patients that we had not had the time to search for when we were working manually.

Q: Moving forward, what role might technology platforms have in improving financial navigation in the cancer setting?

A: Right now, there are a lot of different people with different titles performing the function of financial navigation. However, financial navigation is not streamlined across institutions. This platform helps streamline the process for hospitals and patients. We were initially working in a reactive state but, with this platform, we were able to work more proactively.

Q: Is there anything else that you would like to mention?

A: The Association of Community Cancer Centers’ Financial Advocacy Guidelines would be valuable for any facility looking to implement a financial navigation program. For more information on TailorMed Financial Navigation Platform, visit www.tailormed.co. – by Jennifer Southall

 

For more information:

Clara Lambert, BBA, OPN-CG, can be reached at Advocate Good Samaritan Hospital,

3815 Highland Ave., Downers Grove, IL 60515; email: clara.lambert@advocatehealth.com.

 

Disclosure: Lambert reports serving as a developmental consultant for TailorMed.