Americans are delaying medical care at record rates—and financial barriers are often to blame. With rising healthcare costs and economic uncertainty, the proportion of patients who did not seek care because of affordability concerns rose to new highs in 2022—according to the latest Gallup poll. 

In this climate, the role of financial navigation has never been more crucial. By helping patients optimize their insurance and reduce out-of-pocket costs, financial navigation plays a critical role in providing holistic, patient-centric care. It also benefits hospitals’ and health systems’ bottom lines, reducing the likelihood of uncompensated care and bad debt.

Many U.S. hospitals have financial advocates and counselors. However, as reported by the Advisory Board, few organizations have “a systematic process in place to identify patients in need and to develop a plan to meet their cost of care.” As a result, financial counseling services are often fragmented, and many organizations miss opportunities to help patients and boost revenue.

Healthcare organizations should adopt a centralized, technology-supported approach to financial navigation.

But at a time when many health systems are facing financial challenges, how can patient advocates, business managers, and other staff get buy-in from their executive leadership teams? 

Here’s a step-by-step guide for building a strong business case:

Step 1: Align with Peers

When financial assistance is decentralized—as is often the case—various aspects of the process are divided among registration staff, social workers, revenue cycle management (RCM) teams, pharmacy staff, and clinicians, among others. In addition, different medical specialties and service lines, such as oncology, neurology, and rheumatology, may have different approaches to dealing with patient affordability. 

A good starting point is to gather like-minded colleagues to create a committee of advocates. Colleagues in different departments can form alliances, so that when you speak to senior leadership, you already have common concerns and a potential path forward. This committee-based, interdepartmental approach will help you establish the fact that affordability is not an “oncology problem” or a “specialty drug problem.” It’s a systemwide issue that requires a comprehensive solution.

Step 2: Identify Challenges and Pain Points

Collaborate with colleagues and counterparts to determine where your health system is falling short when it comes to financial assistance:

  • How does the organization identify financially at-risk patients?
  • Which teams and departments are involved with helping patients secure assistance? Is there communication between them?
  • Do they have standardized processes in place?
  • Do they rely on manual, time-consuming, error-prone methods (such as Excel spreadsheets and Post-its) to find and enroll patients in assistance programs?
  • What percentage of patients who need financial assistance receive it?
  • How does this impact patient experience and outcomes?

You should also attempt to quantify what this means for the organization’s bottom line:

  • How much in unpaid medical bills does the health system absorb annually?
  • What are the sources of those charges?
  • What is the lost revenue opportunity from patients who delay or skip care because of costs?

Step 3: Define Opportunities and Value

Once you establish the scope of the problem, you can explore the potential of underutilized financial resources:

  • Is your organization taking full advantage of cost-saving resources such as drug manufacturer copay assistance and foundation grants?
  • How much money is your organization leaving on the table?

You can then look at your organization’s overall goals, mission, and vision—and illustrate how a centralized financial navigation program will deliver value. For example, points of value might include:

  • Improved patient financial experience
  • Better treatment adherence and patient outcomes
  • Improved patient access and health equity
  • Lower rates of bad debt
  • Greater operational efficiencies
  • Stronger staff morale
    … and many more

Step 4: Enlist Outside Partners

In recent years, new technologies have enabled healthcare organizations to proactively identify financially at-risk patients—and automate the process of matching and enrolling them in relevant financial resources. A technology platform can help your organization bring its financial assistance activities together under one initiative, transforming a disconnected, manual process into a streamlined, digitized one.

A technology partner can also support you in making the business case to executive leadership. For example, TailorMed can analyze your organization’s current program and highlight how much additional assistance the platform could help secure for patients—and how much revenue the organization could potentially recover. 

Step 5: Find Your Executive Sponsor

An executive sponsor is someone on your leadership team who will support and advocate for your new financial navigation program. When approaching a potential sponsor, be sure to note how affordability not only impacts patients, but stakeholders across your health system. 

You can then discuss gaps in your current financial assistance processes and how a centralized, tech-driven approach will help solve them. Focus on why the new approach is necessary and the broad support you’ve already received from colleagues.

Once you’ve grabbed your potential sponsor’s attention, you can explore how to get the right team and technology in place to make the program effective. This may mean evaluating current staff and assessing new hiring needs; the National Association of Medication Access & Patient Advocacy (NAMAPA) is an excellent source of information on relevant roles. 

Step 6: Create Your Pitch

Now it’s time to gather all the information and data points you’ve compiled (based on the steps above) into a comprehensive leadership pitch. Work alongside your executive sponsor, as well as your technology partner, to ensure your presentation will resonate with your leadership team’s long-term plans and goals. 

The more your proposal aligns with your leadership’s objectives, the more successful you will be at gaining their buy-in. For inspiration, watch this short video in which Tanya Sutor, Director of Authorizations at Mary Bird Perkins Cancer Center, describes how she tailored her pitch to appeal to different stakeholders.

Creating Champions for Centralization

Soaring healthcare costs and skyrocketing rates of medical debt have had a devastating effect on patients’ finances and health systems’ bottom lines. In this climate, a centralized financial navigation capability is essential. By following the steps outlined above, healthcare professionals can make the case to their leadership—and help transform manual, reactive systems into an automated, proactive approach. Their efforts will help ensure that patients secure every possible dollar in assistance, which, in turn, will boost their organization’s financial health. 

We’re here to help you make the business case for financial navigation. Contact us to schedule an opportunity assessment and learn more about how we can support your program. 

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