New Career, New Guidelines: Oncology Financial Navigator

Pam Harrison

April 03, 2018

New guidelines that serve as a "roadmap" for the education and training of financial advocates who help oncology patients in the United States have now been released from the Association of Community Cancer Centers (ACCC).

Some cancer center staff may act as financial navigators and not even fully realize it, suggested an ACCC spokesperson.

"Over the past 10 years, the role of financial navigator has emerged within cancer care. While some facilities have dedicated financial navigators, there are lots of people who are playing this role within a hospital or cancer center or oncology practice, like nurses and social workers," explained Clara Lambert, BBA, chair, ACCC financial advocacy network advisory committee.

Lambert works as an oncology financial navigator for the Cowell Family Cancer Center in Traverse City, Michigan

Financial navigator is a "new career path" that needs "guidance and direction" — hence the need for the new document, she told Medscape Medical News.

Anyone doing this work will discover that receiving treatment and adjunctive services in the United States is often costly, according to an ACCC statement about the guidelines.

Who is best qualified to offer financial advocacy services likely depends on the practice setting or even the patient population, but navigators need not be limited to credentialed financial advocates or counselors, the ACCC suggests.

Nevertheless, the new guidelines suggest that financial advocates should have at least a bachelor's degree in business, life sciences, or finance and need some knowledge of insurance rules and regulations.
Financial advocates should also preferably have 1 to 3 years of experience in a financial advocacy capacity and a basic understanding of oncology practice.

Most important, the ACCC recommends that every cancer program or oncology practice offer financial advocacy services.

There is a "huge need" for these services, said Jennifer Singleterry, senior analyst, the American Cancer Society Cancer Action Network, who was not involved with the guidelines. Singleterry told Medscape Medical News that the role is also known as a financial advocator or patient advocate.

"As health insurance gets more and more complicated and more and more costs are being shifted to the patient, this role is very needed for cancer patients," Singleterry said.

The ACCC says these services can be provided through a central system or a dedicated staff member whose job it is to liaise with the oncology team and then with patients to help them gain access to needed care.

However the service is provided, financial advocates must initially identify how patients can maximize their health insurance benefits, says the ACCC.

At the same time, navigators need to reduce economic barriers to patient care by being familiar with patient assistance programs, financial advocacy tools, and resources.

Financial advocates also must be able to explain insurance coverage and options for assistance to patients and their families. These professionals also need to keep track of and report on all of the service interactions proffered.

Cancer care providers also must be aware of policy requirements expected by payers for coverage of services.

Whoever is involved, training is necessary to maintain their knowledge base, as the ACCC guideline authors stress.

"At least one member of the financial advocacy team should meet with the patient and their family/caregiver upon diagnosis and prior to the start of treatment to discuss the patient's health insurance benefits, estimated costs of the prescribed treatment regimen, and available patient assistance programs," the authors advise.

The same team member or members should also stay in touch with patients and schedule meetings or at least touchpoints as patients proceed through the continuum of care.

During these meetings, "the financial advocacy team member(s) should be prepared to identify and explain the patient's out-of-pocket costs, which may include: co-insurance, deductibles, and co-pay amounts," the guideline authors write.

Advocates also must identify ancillary expenses, such as transportation to care and lodging if patients need to travel in order to receive care. They should also be able to recommend patient assistance programs that can help patients with ancillary treatment costs; helping patients apply to these programs is another task ACCC guideline authors suggest navigators fulfill as well.

Importantly, too, advocates need to help patients make a payment plan to reimburse those to whom costs were incurred during their treatment, and this plan should be signed by the patient.

Again, provision of these interactions should be tracked and managed, the guideline authors indicate.

Insurance and Assistance Services

To minimize disruption in patient care, financial navigators need to verify insurance specification and subsequent preauthorization with third-party payers.

They also must make sure demographic, insurance, and eligibility information is up to date and find a way to document precertification of therapies to ensure all treatments are authorized before patients receive them.

Financial advocates also need to monitor patients on an ongoing basis so that they can better anticipate whether patients are at risk of getting into financial difficulty.

If there are requirements for enrolling patients in company, state, medication, or disease-specific assistance program, advocates need to familiarize themselves with these programs.

These include Medicare prescription benefits and Social Security low-income subsidy programs, along with state or federal assistance subsidies for which patients may be eligible. The advocates then need to work with patients or their family to apply to any of the programs for which they may be qualified, the authors note.

"Over the past 4 years as I have been doing this program at my cancer center, I have had other programs reach out to me on a regular basis either because they are thinking about starting a financial navigation team or they just want to streamline their team," guideline coauthor Lambert explained.

"So I really think these guidelines are just what cancer programs have been looking for, and I believe they will be readily accepted," Lambert said

The statement was developed and issued by the 2018 ACCC financial advocacy network advisory committee and members of the ACCC executive committee.

Complicated

The American Cancer Society Cancer Action Network's Singleterry said that patients with cancer are often forced to access not just one benefit but all kinds of benefits in order to get the full spectrum of care they need.

While employer insurance can be fairly generous, "if cancer patients are in transition because they have to stop working because of their diagnosis, the financial navigator has to figure out how they can get this patient insurance," Singleterry said.

Right now, navigators may be able to do so through individual market offerings, although this insurance can be both complicated and costly, she added.

A proposal under debate would permit expanded use of so-called short-term, limited-duration insurance plans and allow people to buy plans for longer periods.

However, these plans do not have to meet any of the patient protections that Affordable Care Act plans have to meet, Singleterry explained.

"This means that these plans can limit coverage, they don't have to cap spending, they don't have to cover essential health benefits, so we are definitely worried that in a year or two, if this proposal goes through, there could be cancer patients showing up in a financial navigator's office with insurance that they thought was good health coverage but it actually doesn't cover a lot of treatments they need," Singleterry cautioned.

"So I definitely think a patient would be very happy to have someone in front of them who is trained in this and can help them navigate their insurance and plan out their costs," she added.

The guideline authors and Singleterry have disclosed no relevant financial relationships.

For more from Medscape Oncology, follow us on Twitter:  @MedscapeOnc

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