Technology Unlocks Untapped Potential in a Financial Navigation Program

Abstract

Background: Patients with cancer are experiencing rapidly rising out-of-pocket costs. The term financial toxicity has emerged to describe the negative impact of these costs on patients with cancer, such as impact on quality of life, treatment adherence, and greater risk of mortality. As patient out-of-pocket expenses have increased, hospitals have increasingly incurred bad debt resulting from unpaid financial obligations. Cancer programs have implemented financial navigation programs to ease the negative impact of financial toxicity on patients and the negative impact of lost revenue on healthcare organizations. The manual nature of financial navigation, however, has limited the ability for navigators to assist patients at risk for financial toxicity and demonstrate value for both patients and healthcare organizations. Though efforts are made to identify financially at-risk patients, most patients self-select into these types of programs. As a result, those with the greatest financial need or collection risk may not receive available assistance.

Objective: The objective of the pilot study was to analyze the effect of automating financial navigation programs using the TailorMed Financial Navigation Platform (tailormed.co).

Methods: The TailorMed Platform analyzed 4,616 patients at the Cowell Family Cancer Center, Traverse City, Mich. The software identified 244 “high-priority” patients based on high out-of-pocket responsibility, risk for financial toxicity, and qualification for available navigation opportunities. Financial navigators pursued assistance opportunities for these patients using the TailorMed Platform and accounted for the different forms of awarded assistance in patient benefits and organizational financial performance.

Results: The study ran for 8 months, during which 244 patients were reviewed by Cowell Family Cancer Center financial navigators. Of the 244 patients, 181 (74 percent) received one or more forms of assistance based on financial opportunities identified by the software. Financial navigators secured a combined total of $3,553,453 in “approved savings” (defined as the total value of aid secured through the financial navigation process); $1,524,562 of this savings accounted for community benefit (defined as direct patient benefits such as aid to offset living expenses, transportation costs, provide free or replacement drugs, or aid for services that are not billed by the hospital, such as oral drugs); and $259,593 contributed to revenue increase (a direct benefit to the cancer center). The financial navigation team also reported improvements in productivity, workflow, and internal organization alignment.

Conclusion: Technology can play a major role in advancing financial navigation programs by freeing financial navigators to focus on proactive financial counseling, decreasing out-of-pocket costs for patients, increasing revenue for healthcare organizations, and automatically tracking that value creation for management.

Additional information

Notes on contributors

Clara Lambert

Clara Lambert, BBA, OPN-CG, is one of the founding oncology financial navigators for the Cowell Family Cancer Center, Traverse City, Mich., currently working at Advocate Good Samaritan Hospital, Bhorade Cancer Center, Downers Grove, Ill.

Scott Legleitner

Scott Legleitner, BA, LPhT, SST, is an oncology financial navigator at the Cowell Family Cancer Center, Traverse City, Mich.

Kathleen LaRaia

Kathleen LaRaia, MS, is the executive director of the Cowell Family Cancer Center, Traverse City, Mich.