According to a survey by the Patient Advocate Foundation, 63% of seriously ill patients consider financial distress to be a fate worse than death.
This startling statistic illustrates what has come to be a defining characteristic of healthcare in the United States, which is that people are often unable to afford it.
While many cancer centers recognize the challenge of affordability and have created programs to address it, the work of optimizing these programs has only just begun.
Faced with a lack of guidance on how to manage financial assistance programs, community oncology practices were among the first to step up. The Association of Community Cancer Centers (ACCC) released their first set of guidelines for delivering financial advocacy services to people with cancer in 2018, and released an updated version last year.
Even with these guidelines, however, many financial assistance programs are struggling. Limited scope is a major concern. Oncology practices tend to treat financial toxicity as strictly a cancer problem, but oftentimes, patients are dealing with other costly conditions such as heart disease or diabetes. These practices have yet to realize that financial navigation should support the whole patient, not just their cancer.
Plagued by additional problems such as decentralization, lack of resources, and organizational misalignment, financial assistance programs aren’t functioning as well as they could be—and patients are paying the price.
Optimizing your practice’s financial assistance program starts with taking a clear-eyed, expertly guided look at how mature it is. Understanding the stages of maturity can help you assess where your program stands—and where it needs to go.
Program Maturity in Four Stages
The maturity of a financial assistance program can be broken down into four stages: initial, progressive, mature, and optimized.
1. Initial
During the initial stage, your cancer center is just beginning to develop a financial navigation program. While you’ve taken the most important step in establishing the need for financial navigation, your program has no strategy or long-term vision, and you have yet to align the program with your organization’s overall business objectives.
In terms of human resources at this stage, team members are likely tasked with multiple roles and responsibilities. For example, if your program is part of your cancer center’s revenue cycle, team members may be responsible for obtaining prior authorizations. If it’s housed within the pharmacy, technicians may also be busy processing prescriptions and calling insurances. These tasks limit staff’s time to search for and match patients with assistance.
Communication and coordination are lacking, and program results aren’t consistently tracked. Staff members from various departments may be involved in financial assistance, but they’re operating in silos and their efforts aren’t coordinated or centralized.
Processes during the initial stage are manual, loosely defined, and inefficient. You haven’t yet established Key Performance Indicators (KPIs) for analysis and insight, nor have you strategically leveraged financial navigation with the help of technology solutions.
Three Ways to Level Up:
- Form a financial navigation team with clearly defined roles and responsibilities. If multiple teams have been handling navigation, align these teams and delineate roles.
- Standardize KPIs that will reflect the health of your processes and correct deficiencies.
- Streamline processes and procedures across your organization by leveraging end-to-end financial navigation solutions.
2. Progressive
While it’s still the early days of your organization’s financial navigation program, you may have begun to reap the benefits. Efforts to scale the program systemwide, however, may not yet be coordinated across leadership, and Standardized Operating Procedures (SOPs) haven’t been defined or reported.
You’re likely facing staffing gaps at this stage, since clear roles and responsibilities haven’t yet been established and assigned. Few staff members know and understand the processes of your program, which aren’t yet formally structured and lack crucial components such as flow and documentation.
Still in its infancy, your program’s structure doesn’t meet all of your needs. You are still relying on cumbersome and time-consuming methods of program management, setting you up for mistakes and missed opportunities.
Three Ways to Level Up:
- Enlist leadership to drive a systemwide strategy with clear ownership.
- Begin assessment of current processes and design roadmaps to revitalize them.
- Implement a technology solution that will enable you to standardize processes, optimize patient savings, increase efficiency, and boost revenue.
3. Mature
At this stage, your organization has built a financial navigation program with clearly defined processes and a strategy that is supported by leadership. Your program’s steering committee—which includes leadership, executive sponsors, influencers, and end users—tracks and reports performance metrics.
Roles and responsibilities are clearly defined and progress initiatives are closely monitored, as are KPIs. Processes are standardized, optimized, and benchmarked.
Your leadership recognizes the value of technology and may support expansion, but your program still hasn’t fully leveraged or integrated technology solutions to optimize results.
Three Ways to Level Up:
- Continue checking processes for standardization and enhancement opportunities.
- Build a framework for a program that spans all major departments, such as patient support services, revenue cycle, and pharmacy.
- Review and audit your technology regularly to ensure it stays aligned with leading practices.
4. Optimized
Congratulations! Your organization has built a world-class financial navigation program that is embedded across the system and leveraged by multiple departments and service lines to improve patient experience and increase your bottom line.
Your program has essential support staff in place that operates within a “patients first” culture of care. The entire organization, from leadership to navigators, stands behind your program.
Processes are standardized, optimized, and benchmarked. KPIs, which are consistently monitored, track efficiency.
Your technology and architecture are optimized for scalability and audited regularly to ensure leading practices are in place.
Three Ways to Stay Optimized
- Identify opportunities for expansion in other departments.
- Keep your team motivated and actively involved in program execution.
- Develop a plan for determining which departments to prioritize for expansion.
How Mature is Your Program?
Curious about your organization’s stage of maturity? Ready to move forward but aren’t sure how?
Contact our team and we’ll be happy to help. Based on your program’s maturity stage, we offer personalized and detailed suggestions to take your efforts to the next level.
