Addressing Financial Concerns at the Outset to Improve Patient Outcomes

Laura Joszt

Being proactive about identifying potential financial burdens and preparing patients who have a disease for the costs of their treatment helps to ensure that patients will be adherent to their medication and have the best possible outcomes, according to a panel of providers at the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care® on February 23, 2018, in Washington, DC.

Before patients receiving infusions even come into the office, Erin Hughes, BS, financial advisor at Abington Cancer Care Specialists at Abington-Jefferson Health, reviews their insurance and their benefits. This is important because she estimates about 90% of patients don’t understand their medical benefits. It’s rare when patients know their out-of-pocket maximum, she explained.

“They usually say, ‘I have insurance,’” Hughes said, and they think that’s all they need to know.

She starts from the ground with patients and explains their coinsurance, co-payments, and what they are expected to pay. They view it as being proactive to avoid complete shock later on.

Margaret “Peg” O’Grady, RN, administrative director of Oncology Services Line at Abington-Jefferson Health, added that it’s better to have those financial conversations at the beginning rather than when they get a $95,000 bill later on. Patients are so surprised that they “shut down” and don’t come back for treatment.

“We have patients who are so completely overwhelmed,” with things like psychosocial and financial issues or if they’ll go back to work and how they’re going to tell their children about their disease, “that it’s completely numbing to them,” O’Grady said.

However, when the financial staff at Abington-Jefferson approaches the patient to support them at the beginning, patients feel like they can breathe, she said.

Regional Cancer Care Associates (RCCA) starts looking for financial assistance for anyone who has a co-pay of more than $10, explained Eileen R. Peng, PharmD, director of pharmaceutical services at RCCA.

These financial discussions are so important, that RCCA trains its physicians not to discuss finances, because they aren’t trained properly. Instead, RCCA tells the physicians to focus on the medical discussions, and let the trained financial staff handle the cost discussions.

Cesar A. Santa-Maria, MD, MSCI, assistant professor at Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, agreed with the approach. When he sees a patient in the clinic, he doesn’t have access to his or her financial records, so all he can do is give them the medical recommendation he feels is best for that patient. He admitted that understanding the financial challenges a patient is facing can affect clinical decisions.

The panelists also discussed how the conversation can’t be about just the patient and his or her treatment. Santa-Maria pointed out that getting diagnosed with a disease like cancer affects people at many levels, including their job and their family. Being worried about missing work or whether or not they have child care in place can affect patients’ ability to receive treatment.

O’Grady also discussed how being proactive also means that clinics can tailor services to the communities they are part of.

“Are we targeting the right communities that need more upfront screening? More Meals on Wheels for nutrition?” she asked. It’s also about keeping a community healthy, because people who are eating well and who are educated on vital screening will be healthier.

Patients don’t always realize that there are different charity organizations out there that will help them get food, keep the lights on in their house, or provide transportation, Peng said. Providing that information and those resources to patients helps ease their anxiety and keep them calm.

“We need to spend more time educating patients,” Peng said. “They are really lost. Even providers, they need to be educated. Physicians in the past didn’t really [understand] financial toxicity.”
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