December 2015 Vol 6, NO 6

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Financial Navigation

Expert Financial Navigation Is Critical for Patients’ Well-Being

Financial distress and toxicity are ongoing issues for patients with cancer, Dan Sherman, MA, LPC, Founder/President, The NaVectis Group, Caledonia, MI, explained in his presentation about the importance of financial navigation at the 2015 Association of Oncology Social Work 31st Annual Conference in Seattle, WA. The top concern of patients with cancer is no longer a fear of dying, but fear of the financial obligations. “Forty-two percent of insured cancer patients express a significant or catastrophic financial burden…. That’s almost 50% of the oncology population saying this is catastrophic,” he said.

“I am not seeing the patient when they get the bill. That’s the wrong approach. I had to fight to see them on the day of consult.”

Patients with cancer are 2.5 times more likely to file for bankruptcy, and, if they have copays exceeding $54, are 70% more likely to discontinue treatment within 6 months. To address this financial burden, Mr Sherman recommends including a financial navigator in oncology practices. “I am not going to argue that we’re going to get rid of all the financial toxicity,” he emphasized. “That’s going to be impossible….These numbers could change, because a lot of inappropriate financial counseling is happening to our patients.”

Filling the Need for Financial Guidance

If healthcare providers do not deliver adequate financial solutions to their patients, it becomes more difficult to address patients’ emotional needs. “If paying attention and doing financial navigation isn’t done well, you’re going to have a lot of needless suffering, both emotional and physical, and the basic needs of the patients are not going to be addressed in a direct way,” Mr Sherman explained. He further argued that there is a profound need for financial expertise in oncology care. “When a patient comes into your system and they have some significant out-of-pocket responsibilities, usually they are referred either outside of the multidisciplinary team [or] they’re referred down to the financial counseling office, who knows nothing about the patient’s clinical needs.” Mr Sherman added, “If you don’t understand all the rules and regulations within the Affordable Care Act [ACA], your patients are going to suffer, I guarantee it. There is a need for expert knowledge in these programs in order to apply them to the appropriate patient at the appropriate time.”

Reducing Costs with Financial Navigation

The ACA has helped some patients with their financial burdens, but many patients are still facing significant out-of-pocket responsibilities. Mr Sherman described one patient, a single mother with 2 young children, who was diagnosed with lymphoma and needed ≥6 months of chemotherapy. She purchased a policy on her own, where she had a $320 monthly payment that covered her family, and a $12,700 out-of-pocket responsibility.

“I knew she was not going to be able to work. I’ve already had that conversation with the physician, so we talked about short-term disability. She did have short-term disability benefits available to her from her employer. She was going down to 60% of her pay,” Mr Sherman said.

She and Mr Sherman then called the ACA marketplace and reported that her income was decreasing with short-term disability. Her monthly premium then decreased to $122, and her out-of-pocket costs decreased to $1450. Mr Sherman also contacted the Leukemia & Lymphoma Society, and the patient applied for copay assistance.

“I met with the patient on the day of the consult, understood what was going on from a medical standpoint, then was able to meet with the patient and have a dialogue about going on disability, and then we were able to get these out-of-pocket [costs] down,” Mr Sherman said. “I am not seeing the patient when they get the bill. That’s the wrong approach. I had to fight to see them on the day of consult. I know the patient is overwhelmed on the day of consult, but what do we know about the number 1 stress around oncology patients? It’s financial. We can’t ignore it.”

Mr Sherman’s primary goal is to decrease patients’ distress, not to save money for the hospital. “However, if you do it well, 99% of the time it benefits the hospital,” he said. “I’m a strong advocate for having an individual dedicated in this position. No longer can we accept that it’s a side issue. It just isn’t fair to the patient.”

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