Financial Advocacy

Recommendation: 

Financial advocacy services are a critical component of oncology care to help mitigate the economic burden of cancer for patients, providers, and programs.

The Association of Community Cancer Centers (ACCC) recommends that every cancer program or practice offer financial advocacy services and identify a central system and/or dedicated staff member to coordinate and liaise with the oncology treatment team to ensure streamlined communication and access to needed care for the patient.

Overview

In 2018, ACCC released Financial Advocacy Services Guidelines, which outline the following goals for financial advocacy services:

  • Proactively identify and evaluate how to maximize the patient's health insurance benefits.
  • Proactively reduce economic barriers to care by having working knowledge of available patient assistance programs, financial advocacy tools, and resources.
  • Accurately explain insurance coverage and assistance options and skillfully communicate with patients and their caregivers focusing on issues of cost of care, patient assistance support, and additional resources.
  • Manage, track, and report on all financial advocacy and patient access services interactions.
  • Ensure that providers and cancer program staff are aware of ongoing policy requirements from payers for coverage of services.
  • Help mitigate institutional financial toxicity.

Resources to Help

ACCC offers an online Financial Advocacy Boot Camp, as well as robust resources through its Financial Advocacy Network, including peer-to-peer discussion forum. The GW Cancer Institute Oncology Patient Navigator Training is relevant to Financial Advocates.

Caseload Benchmarks

There are no benchmarks for caseload or recommendations to show the number of financial navigators/advocates needed in a clinic. Caseload varies depending upon the clinic/facility size and the workload requirement for an individual navigator/advocate. Once a Financial Advocacy program is started, it is recommended to track metrics and pulse-check on a regular basis to identify increases or decreases in denial rates. Reasons for these fluctuations can reveal gaps that may demonstrate need for increased staffing.

Insurance Considerations

Financial navigation/advocacy is not a reimbursed service. Providing financial advocacy services helps to reduce patient financial-related distress and mitigates the economic burden of cancer for patients and families, providers, and programs.

 

ACCC Member Program: St. Luke’s Mountain States Tumor Institute, Boise, Idaho

St. Luke’s Mountain States Tumor Institute (MSTI) launched its Patient Financial Advocate (PFA) program in 2009 within its five hospital-based clinics spanning over 300 miles. Since then, the PFA team has grown 33 percent. Claim denials have decreased and patient satisfaction and participation is up. The oncology care program is highly valued in the state for this total patient supportive care model.

The original goal of the St. Luke’s MSTI PFA program was to focus on the prior authorization process for oncology care and control claim denials. The outcome has been a stronger bridge between the billing office and the clinic, which has benefited all involved including the patient who now feels more supported.