We recently hosted a webinar featuring Dan Sherman with the NaVectis Group. The webinar focused on How to Navigate Patient Financial Toxicity. Financial toxicity is one of the newest side effects of complex disease (cancer, chronic heart failure, stroke, etc) treatment for both patients and programs. With a growing underinsured patient population and rising costs of care, the need to prepare patients for financial burdens is crucial. Benefit from the latest trends, effective practices, and strategies to better position your program to support patients as they deal with the financial issues surrounding complex disease diagnosis and treatment.
1. What about people who are still undergoing work-up and diagnosis who cannot access these external assistance programs?
You are correct, external assistance programs, for the most part, are not available for patients in the pre- diagnosis or pretreatment phase. This is where optimizing insurance can play a huge role in alleviating potential financial toxicity. If insurance optimization can take place then it is at this early stage that it will have the most significant impact.
2. How much financial questioning should be done at the time of the Psychosocial Distress Assessment?
I think it depends on several factors. (1) Is the patient in financial distress and expressing a need for assistance. (2) Is the financial navigator anticipating financial toxicity due to dx, treatment plan and current insurance coverage. These factors should be considered when assessing the patient for distress. At the time of diagnosis patients may be worried about the financial implications of the disease but often do not understand the full impact that financial toxicity will have on their lives. From my perspective it should be the role of the financial navigator to understand this and help patients find the best methods of reducing the pending toxicity. The earlier they do this the better as the best solutions are often dependent on intervening prior to initiation of treatment.
3. Our center is currently working on implementing a financial counselor program. However, I feel that we are being pulled in all directions beside the financial counseling. As our roles. we obtain prior authorizations, benefits, eligibility, copay assistance, enroll patient's in charity/Medicaid. We find our roles to be exhausting. How do you suggest the financial counselor role be divided? Shouldn't we divide the work into sections so everyone can focus on their role as a counselor vs trying to do everything?
I agree with your statement. When the role gets blended like you describe it moves away from true financial navigation services to more of a role for back end services. Financial counselors often end up doing insurance verification, prior authorization and providing estimate for patients. However, this is not “financial counseling”. This work is important, but it misses the point in regards to counseling or navigating patients. My recommendation is that the tasks of prior authorization, benefit investigation and cost estimates should be one role and the tasks of insurance optimization and external assistance optimization should be another. The skill set is completely different for these two roles. With separating the tasks, you also foster a higher level of expertise within these specific roles.
4. Do you have resources and recommendation for training our financial counselors?
5. How many Financial counselors do you have at your cancer center? How many physicians and oncology nurse navigators do you have?
We have 1.6 FTE Financial Navigator and 1 FTE Financial Counselor. We see approximately 1400 new analytic cases per year. We have 5 nurse navigators. We have 8 oncologists.
6. Any suggestions for courses to take - online or in person? Or are there any conferences Dan would suggest? Also, any specific suggestions for learning more about navigating Medicare?
The NaVectis Group provides 1:1 training for the financial navigator. This training incorporates the concepts of insurance optimization (Medicare, ACA and Medicaid) and Optimizing External Assistance Programs such as PAP, Co-Pay assistance and Premium Assistance. The Financial Advocacy boot camp has an online program that discusses the fundamentals of financial advocacy. There is also good website www.q1Medicare.com where you can get more information regarding Medicare.
7. Where do your consults come from? The physician? Nursing staff? Navigators? Financial staff?
I receive referrals from all of these sources. However….I try not to rely on referrals for the program. I seek out specific patient populations where I am predicting that financial toxicity will occur. I then proactively see these patients and address the issue prior to the toxicity occurring.
8. What would be an acceptable work load for one financial counselor?
It depends on how you define the role. If it is defined as I have described in the question asked previously then I recommend 1 FTE Financial Navigator for every 800 new analytic cases your system sees.
9. How are you calculating the estimated out of pocket treatment costs for patients?
For the most part this is done electronically. In our setting the staff person doing the prior authorization and benefit investigation process feeds the Financial Navigator this information.
It is eerie how similar the issues are here in Canada. Many treatments in oncology do not fall under universal health care and $ impact to patient is similar. Our drug access navigators also are not formally trained. Given the lack of available training or certification, are there core competencies or education that you would look for if hiring a financial navigator?
The core competencies that I often look for is having some financial acumen and some clinical background. However, a quality that I put very high on the list is passion for the role. Without this passion it becomes very difficult to grow within the position. Due to constant changes within the health insurance market it is vital that the financial navigator stays on top of these changes. A person with passion for the role will be motivated to learn and adapt to these changes. I prefer someone with a degree in the passion, at minimum at bachelor’s degree.
10. I just checked with Celgene and they told me that Medicare advantage plans are considered "Medicare" products thus they will not qualify for co-pay assistance programs or even foundation assistance.
You are correct that a Medicare Advantage plan is a Medicare plan and therefore will not qualify for co-pay assistance cards made available directly from the manufacturer. However, depending on the patient’s income, diagnosis and treatment plan most Medicare beneficiaries are eligible for foundation co-pay assistance.
11. Do you have a recommended caseload per navigator if we are looking to expand our FTE to assist all patients proactively?
Once again this depends on how you define the role of the financial navigator. If it is focused on optimizing insurance and extremal assistance programs then I recommend 1 FTE for every 800 new analytic cases per year. This may also depend on what type of oncology services are being provided, such as Med Onc only or a combination of Med Onc, Rad Onc and Surg Onc services.