- Navigating the Whole Patient: Optimizing Financial Navigation
- Screening For and Addressing Health-Related Social Needs
Navigating the Whole Patient: Optimizing Financial Navigation
Financial navigators are among a patient’s most powerful ally when it comes to heading off financial toxicity. During this session, 4 financial navigators used case studies and anecdotes to show how they have assisted patients during their cancer diagnosis, treatment, and survivorship. They also provided a road map for individuals who want to build a business case for proactive financial navigation within their organization, as well as actionable steps to optimize assistance programs.
More and more, organizations are recognizing the value of having someone who can help their patients tackle the many financial challenges that often accompany a cancer diagnosis. What this role looks like, however, varies from place to place.
Panelist Dan Sherman, MS, LPC, Financial Navigator and Consultant with The NaVectis Group, opened this session by explaining the 3 types of professionals who may work with patients in this capacity: financial counselor, financial advocate, and financial navigator.
While the first 2 roles can provide the patient with some level of financial support, it’s the financial navigator who will benefit them the most, he explained.
“The financial navigator has the expertise and deep understanding for the complicated health insurance system and can navigate the patient through that system to try to overcome the problem,” he said. “They can lower the patient’s out-of-pocket responsibility and essentially cure the problem rather than putting a Band-Aid over it.”
He advocates for a proactive approach to helping patients with cancer. “We’re going to be very intentional; we know that financial toxicity is going to be occurring because of the type of treatments they’re receiving and what type of insurance they have, so we will get out in front of this, so it doesn’t cause a problem down the road,” said Mr Sherman.
Building the Business Case for a Financial Navigator
“We know that financial navigation programs can increase patient satisfaction, increase patient outcomes, and give an organization a substantial return on investment,” said Tanya Suter, MBA, Independent Revenue Cycle Consultant. “So I’m going to tell you how to build your business case to get C-Suite buy-in.”
Ms Suter says that the first step is to start a committee. This should include a financial navigator, and representatives from your organization’s pharmacy, tumor registry, revenue cycle, marketing, and IT departments.
Next, she said, you have to ask some questions:
- What are the concerns and challenges?
- For your financial navigation program, do you have processes that are standardized and repeatable?
- Do you have processes that are work-arounds?
- What is your most prevalent disease site?
- Can you outline your patient population?
- What percentage of your patients are commercial or Medicaid?
- What are your average out-of-pocket expenses?
- What are your gaps in your patient population?
- Will this initiative decrease bad debt overall?
Then, define your opportunities and the financial navigation program’s value for the organization.
“We tend to underutilize financial resources,” explained Ms Suter. “We never take the whole patient and look at what we can do for them financially. We always kind of fall short. So how do we bridge that gap? You want to show leadership that financial navigation impacts every area of the organization.”
She suggested creating a journey map to help identify patient touchpoints and areas of strength and weakness.
“If you can optimize the patient from the minute they’re consulted to the time they’re in survivorship, then bad debt will ultimately be reduced,” said Ms Suter.
Finally, she said you need an executive sponsor, someone who understands and is passionate about what you’re doing, who has a direct connection to the C-suite, and who has business acumen. According to Ms Suter, they are going to be your voice and advocate on your behalf with leadership.
“It’s been proven that financial navigators – excellent ones – allow organizations to introduce new treatments, get new equipment, get skilled staff, and above all, support the patients,” she added. “This is the message we have to send to our executives.”
Proactive Financial Navigation
“Proactively navigating patients is really starting at the point of diagnosis,” said panelist Aimee Hoch, MSW, LSW, OSW-C, FACCC, Financial Navigator, Grandview Health. “This is where our relationship with the patient begins, and we have to build trust in a very short period of time. So we provide education about their insurance coverage and the potential for their costs to increase. This helps normalize financial toxicity.”
According to Ms Hoch, the financial navigator needs to not only consider what is in front of the patient in terms of expenses, but what the patient brings to the table. These include things like food insecurity, income level, preexisting conditions, and even what’s happening with family members in the home that may impact the situation.
In her organization, Ms. Hoch said she hosts a weekly Teams meeting with the treatment team to discuss new patients. This helps them avoid the Band-Aid approach and take a long-term look at healing the financial toxicity. “This role really considers the whole person,” she said.
Opportunities in Financial Navigation
To close the conversation, Moderator Clara Lambert, CPH, BBA, OPN-CG, Director of Financial Navigation at TailorMed, asked the panel to weigh in on a few high-level questions.
When asked how financial navigators might go about defining their role, Ms Hoch referenced the ACCC guidelines as a starting point.
Mr Sherman agreed and added, “This role is going to become more and more important within health systems. There are multiple disease states out there where financial navigation services are critical. So this role is going to expand and offer many opportunities.”
“I think you need to have someone with empathy,” added Ms Suter. “The financial navigator has to be able to have that difficult conversation with the patient but understand where they’re coming from.”
Ms Lambert next asked about other important things to include in the business case that hadn’t yet been discussed.
“I track the number of patients and the savings I create for the hospital in a spreadsheet,” said Ms Hoch. “I also find it really impactful to have a few patient stories to share with my case.”
“The CFO is always metric-driven, they want to see the bottom line, they want to see that you’ve brought money in the door,” added Ms Suter. “So we need to also consider programs and resources that may be out there to help affect the bottom line.”
Finally, Ms Lambert asked about tools that the financial navigator should have in their toolbox. “For me, it’s been networking with my colleagues and knowing that I’m not alone,” she shared.
“I’m going to use the word passion,” said Mr Sherman, “because if you don’t have passion, you’re going to fall behind quickly. There could be changes coming that may not be in the best interest of some of our patients, so staying up-to-date and having the passion to do that, I think is number 1.”
Individuals who are working in financial navigation or interested in pursuing this area of practice, are encouraged to check out AONN+’s new Financial Navigation Virtual Network.
Screening For and Addressing Health-Related Social Needs
Diversity and inclusion in clinical trials are essential to our understanding of diseases and conditions. However, they’ve historically relied almost exclusively on White male participants. Here, 4 presenters discuss how their cancer centers used patient navigation to increase awareness of and enrollment in relevant clinical trials among the diverse communities they serve.
According to the National Institute on Minority Health and Health Disparities (NIMHD), “People may experience the same disease differently. It’s essential that clinical trials include people with a variety of lived experiences and living conditions, as well as characteristics like race and ethnicity, age, sex, and sexual orientation, so that all communities can benefit from scientific advances.”
However, according to the NIMHD, clinical trials, historically, have relied “almost exclusively on White male study participants,” which has led to gaps in our understanding of diseases and conditions, including the effectiveness of prevention and treatment methods, across populations.
Here, 4 presenters discuss how their cancer centers used patient navigation to increase awareness of and enrollment in relevant clinical trials among the diverse communities they serve.
A Bilingual Clinical Trial Navigator
As Dallas County’s public hospital, Parkland Memorial Hospital serves an urban population with a high percentage of Hispanic and Black residents, according to presenter Fabian Robles, MS-HLM, CHI, a research patient navigator at the Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, which is also in Dallas.
In 2020, the Simmons Cancer Center launched a pilot program in which a bilingual clinical trial navigator was sent to Parkland Memorial Hospital to explain the value, importance, and benefits of clinical trials to not only patients and their caregivers but also physicians, residents, fellows, and clinic nurses.
This education was the first step of a multistep strategy that was designed, ultimately, to increase the number of minority patients enrolled in clinical trials at the Simmons Cancer Center. As part of this process, the navigator also identified barriers to these trials, including a general distrust of healthcare professionals, financial concerns, and a fear of deportation.
One by one, Mr Robles and his team came up with solutions for each barrier, which he discusses in detail here. As a result, the number of patients enrolled in Simmons Cancer Center clinical trials rose, in the program’s first year, from 36 to 78, a 110% increase.
A Data-Driven Approach
L. Tiffany Collins, MPH, director of social drivers of health navigation services at the Virigina Commonwealth University Massey Comprehensive Cancer Center, described a reimagining of the center’s mission to “reduce the cancer burden for all Virginians by addressing the confluence of biological, social, and policy drivers through high-impact and cutting-edge research, and patient-centered care across the continuum, from prevention to survivorship.”
A “data-driven approach helps us to tailor initiatives that effectively meet the unique needs of our populations, ensuring that their efforts are relevant and impactful,” Ms Collins said.
More specifically, she said the center systematically collects health-related information in the 66 counties that comprise its catchment area. It then analyzes this information so that it can “identify trends, measure outcomes, and make informed decisions” about its programming.
One such initiative is the multifaceted recruitment of clinical trial participants in which a nurse and research coordinator screen candidates and a dedicated patient navigator addresses the socioeconomic barriers that could influence a candidate’s consent. There’s also a community outreach navigator who works with participants throughout a trial to ensure they remain eligible and invested.
Ms Collins describes the approach as “collaborative,” among both the various healthcare professionals who are involved in carrying it out and between the navigators and participants.
A Bidirectional Conversation
Dorothy Rhoades, MD, MPH, a clinical professor of medicine at the Oklahoma University College of Medicine and the director of the Native American Center for Cancer Health Equity at the Stephenson Cancer Center in Oklahoma City, highlighted the center’s “bidirectional” blueprint for generating greater awareness of – and, in turn, interest in – clinical trial participation among the state’s extensive network of Native American tribes.
The incidence of cancer and mortality rates among this diverse population are well above the national averages, Dr Rhoades said. She then displayed a bar graph that illustrated national participation in clinical trials by race. “You have to have a magnifying glass” to note the bar representing Native Americans, she said.
As the only cancer center in Oklahoma with a program designed specifically for Native American patients – a state in which close to 10% of the population identifies as Native American, according to the United States Census Bureau – navigators there assist with complex logistical and cultural barriers, which include interacting with the federally administered Indian Health Service, Dr Rhoades said.
She was recruited to the center, which opened in 2011, to help develop a research program that would address the center’s “significant health disparities.” Their research led to the creation of a tribal advisory council, which assists the center with developing “respectful” ways to conduct its outreach and research among local Native American tribes.
“There is a long history of culturally specific research abuses that have occurred,” Dr Rhoades said. “Most [Native Americans] are aware of it, and a lot of people within the regular healthcare system are not.”
Central to addressing this abuse was discussing the value of Native American participation in current and upcoming clinical trials, which was intentionally done in person because it enabled navigators like Sheryl Buckner, PhD, RN, ANEF, an assistant professor at the University of Oklahoma College of Nursing, to listen to patients’ “lived experiences” and concerns. These were referred to as “bidirectional” conversations.
While each cancer patient is vulnerable, Native American patients with cancer are especially so, according to Dr Buckner, a part-time nurse navigator at the Stephenson Cancer Center, because they’re typically far from home and on their own.
“Our [Native American] patients come from really complex backgrounds, and it influences their ideas and decisions,” she said, “so we just need to support them and tell them that it’s OK.”
