Author(s):
ACCC will welcome more than 500 attendees from October 9-11 to Minneapolis, Minnesota this week for the highly anticipated 41st National Oncology Conference. Day 1 of the meeting included a Pre-Conference focused on the ACCC Financial Advocacy Network (FAN) and building sustainable patient navigation, followed by the exhibition of 24 posters demonstrating innovative solutions to key challenges in cancer care.
The Association of Cancer Care Centers (ACCC) will welcome more than 500 attendees over a 3-day span (October 9-11) to Minneapolis, Minnesota this week for the highly anticipated ACCC 41st National Oncology Conference. Day 1 of the meeting included a Pre-Conference focused on the ACCC Financial Advocacy Network (FAN) and building sustainable patient navigation, followed by the exhibition of 24 posters demonstrating innovative solutions to key challenges in cancer care.
In opening the ACCC FAN Pre-Conference, Jordan Karwedsky, FACCC, financial counselor, chair of the FAN Advisory Committee, and Angie Santiago, BBA, CRCS, FACCC, senior business manager, Medical Oncology, member of the FAN Advisory Committee, outlined ACCC’s Financial Advocacy Services and Guidelines Assessment Tool. This resource provides guidance for cancer centers of any size and resource level for building and expanding financial advocacy programs, and acts as an interactive assessment tool to identify programs’ strengths and opportunities for growth.
“Think of the assessment as your financial advocacy coach,” said Santiago. “The assessment evaluates your current game plan against the FAN guidelines…to take your program to the next level and set the stage for future greatness.”
Next to take the stage was Heather Simpson, patient financial advocate, Allina Health Cancer Institute, who walked through her organization’s journey using the assessment tool. “Our vision and commitment to whole person care was our motivation to establish a financial navigation program that was patient-centered,” said Simpson. Financial distress screening, staff training, monitoring and evaluation, and partner engagement were identified as areas for improvement. From there, the team examined the current state of each domain, reviewed them with leadership, created a quality improvement plan, and identified which areas would be most impactful to target. For Allina Health Cancer Institute, those 2 areas were financial distress screening and staff training.
“One of the biggest goals of our program was to decrease financial distress, so we had to make sure we were asking the right questions at the right time,” stressed Simpson. “We must look at the big picture and not isolate ourselves to one avenue of care.” Simpson also discussed the importance of educating staff members. “As financial navigators, we need to do our research and know the latest updates so we can explain this difficult information to an aging population, patients for whom English is not their first language, and younger populations who may be hearing and learning about this information for the first time.”
The FAN Pre-Conference concluded with a discussion of tips for prioritization and quality improvement, led by Christie Mangir, MS, vice president of Rhizome. Mangir laid out the Institute for Health Improvement Model for Improvement, which included the following tactics: setting aims, establishing measures, selecting changes, and testing changes using the Plan-Do-Act cycle. She also spoke to the importance of making quality improvement safe, effective, patient-centered, timely, efficient, and equitable.
“Bring a diverse group of stakeholders together—administrators, financial advocacy staff, clinicians, community members—as you think about prioritizing opportunities,” encouraged Mangir. “Map your opportunities based on impact and feasibility.” She then discussed gathering qualitative data throughout the process. “This will support your ability to demonstrate progress and the impact you’re able to make. Seek data and input from both community members (patients, caregivers, community health workers, social workers) and staff.”
Shanthi Sivendran, MD, MSCR, MBA, senior vice president, Cancer Treatment Support, and Bonny Morris, PhD, MSPH, RN, vice president, Patient Navigation, from the American Cancer Society (ACS) were joined by Jordan Henderson, BSN, RN, OCN, ONN-CG, director, Program Development of the Academy of Oncology Nurse & Patient Navigators (AONN+) to lead an engaging discussion of the key components of a business case for navigation and resources that participants can leverage, including a toolkit and templates developed specifically for navigation.
Patient navigation is an evidence-based intervention that improves clinical outcomes and quality of life, yet it has traditionally relied on timebound grant funding or operational funds. “Patient navigation overcomes barriers to care and increases access to timely and appropriate cancer care. It’s a process that advances health equity,” Dr. Sivendran emphasized. “Despite knowing this, there hasn’t been a reliable pathway for sustaining these services.”
Traditionally, navigation is sustained through philanthropy dollars, which often means navigation is inequitably distributed throughout the US. But with the introduction of a more sustainable funding pathway through the CMS 2024 Physician Fee Schedule Principal Illness Navigation (PIN) codes, oncology programs and practices can now construct a diverse funding strategy to make the case for navigation. “Now that there’s a potential payor reimbursement, this offers an unprecedented opportunity for oncology providers to create, enhance, or expand their navigation services,” Dr. Sivendran explained.
Building an effective business case for navigation is critical to securing the funding needed to create or expand navigation programs. In the spring of 2024, ACS, LION, and AONN+ held the Navigation Business Case Bootcamp, through which they created a Navigation Business Case Toolkit. As Dr. Sivendran learned, the language of medicine is not the same as the language of business; the latter requires demonstrating value to acquire buy-in. For navigation, this means understanding where it intercepts the cancer care continuum. “As you plan and pitch navigation services, you have to understand how these align with broader care your institution is trying to provide and the financial pressures of your organization,” noted Dr. Sivendran.
Dr. Morris then took the stage to discuss program design and defining navigation services based on population needs. The community needs assessment provides a systematic approach to ensuring that a program or health system’s resources are improving the health of the population in the most efficient way. “Design your care delivery around the patient’s problems and individual needs,” Dr. Morris urged. “The goal with this assessment is to identify disparities, barriers, and gaps in care to prioritize the design of your patient navigation program.” Identifying those needs is the first step; then providers need a robust database of resources with which they can connect patients.
Shifting towards policy and reimbursement, Dr. Sivendran then outlined the evolution of payment for care management in the last several years, explaining in detail the use of PIN codes. PIN services assist Medicare enrollees with high-risk conditions in identifying and connecting with clinical and support services. Before PIN services can begin, there must be an initiating visit with the physician and patient consent must obtained and documented in the medical record. “This step is necessary because Medicare has a cost sharing component to it,” Dr. Sivendran explained. “Patients may be responsible for up to 20% of the bill, and the consent needs to outline that.”
The session closed with Henderson’s discussion on measuring navigation value through metrics. “Navigators go above and beyond for their patients so it’s important that they tell their stories of how they’ve helped patients,” she emphasized.
The following strategies for implementing navigation metrics were laid out:
The end goal is to define how the program’s success will be measured, including specific indicators that are timebound outcomes of the program, and who will be responsible. “Performance improvement is a process that helps organizations increase effectiveness, empower employees, and streamline decision making,” Henderson explained. “Navigators are doing this work every day; we just need to put it into the right metrics and the right words to be able to tell that story.”
Stay tuned for the upcoming FAN ecourse Practical Approaches to Financial Advocacy for Patients. For more information regarding the new PIN reimbursement codes, watch ACCC’s recent 4-part webinar series hosted by Teri Bedard.
