Editor’s Note: Munson Healthcare is Northern Michigan’s largest and leading health system, with eight award-winning community hospitals and related organizations serving people in 29 counties. Since 2016, Munson has provided state-of-the-art cancer services through its Cowell Family Cancer Center and its Regional Cancer Network.
Our collaboration with Munson began in 2018, when Cowell became TailorMed’s first cancer center client. Today, the partnership continues to grow and expand. After achieving significant success with TailorMed’s platform—including $49 million in approved patient resources—Munson decided to implement our tech-enabled support service, TailorMed Complete, in fall 2022. TailorMed Complete pairs our technology with our expert team of financial navigators. With the combined approach of tech power and people power, Munson has scaled its navigation efforts and strengthened its ability to provide holistic patient care.
We sat down with Ashley Ochoa, Coordinator, Coding Operations, Oncology Service Line, to chat about how the collaboration has benefited Munson’s patients as well as its staff.
TailorMed: What were some of the challenges that motivated the Munson team to use our support service, TailorMed Complete?
Ashley Ochoa: It was 100% staffing issues. Finding a financial navigator is extremely difficult. You need someone who understands finance, but who also wants to be in social work. It’s hard to find a person who marries those two worlds.
We had two FTEs (full-time employees) approved, but no one ever applied. At times, I was by myself. The navigator before me was alone for three years, and then she left. We could never get fully staffed.
We had a bunch of claims for approved copay assistance out there, but we didn’t have the time or resources to do claims follow-up. It got to the point where I wasn’t even signing patients up for copay cards. I was mostly relying on free drugs.
TailorMed: Can you tell us a bit more about how claims management created an administrative burden for your team?
AO: Before TailorMed Complete, we would always have a pile of claims. We’d send the forms via interoffice mail and fax, and that’s how we did follow-up. The process involved paper, files, Outlook, and lots of phone calls with copay foundations. Then, there were constant interruptions with patients stopping by and nurses coming in, asking, “Where is this medication? We need this free drug.”
As a result, we had all these claims sitting in our AR (Accounts Receivable). Sometimes, we’d have to bill patients even after we told them they wouldn’t be responsible for the costs. We also did quite a bit of writing off. The delays were frustrating because we needed to get patients their medications first and foremost.
TailorMed: What were some of your team’s goals with TailorMed Complete and how has this solution helped you achieve them?
AO: Financial toxicity is a horrible thing, and we need to address it, but at the same time, we only have so many resources. By having TailorMed Complete, we’ve been able to utilize those resources in other spots.
Our team wanted to focus on insurance optimization—and have TailorMed take over copay assistance and claims management. Copay cards are fantastic, but it’s like putting a Band-Aid on a big, gaping wound. There are so many other ways to help patients. For example, we could get qualifying patients enrolled in Medicare Part D coverage before they even start treatment. We could also get them enrolled in our internal assistance program.
By taking copay and claims follow-up out of equation, we’ve been able to spend our time getting patients enrolled in insurance plans where they can afford their medications. Now, we can focus on what we do best, because TailorMed is doing the other work behind the scenes.
TailorMed: How would you say TailorMed Complete has impacted the Munson staff as well as your program outcomes?
AO: Patients want to get treated and do well. If there’s a barrier there, we need to do anything we can to help remove it. Having TailorMed pick up the slack has enabled us to offer a more holistic approach.
We’re working with together for better outcomes. I tell patients all the time, “I’m going to transfer you to our copay card team,” and that’s when I lean on TailorMed Complete. TailorMed can answer billing questions and manage claims and assistance, which allows our team to do what we love. For example, our navigators can meet with community foundations that help support our patients. They can communicate with insurance carriers to make sure patients have the coverage they need. Many Medicaid HMOs have community care workers; we’re going to start working with these individuals to make sure they have socioeconomic resources available for our patients. We’re also helping with transportation, making sure patients can get to their appointments. The goal is to have our private duty pick them up and then bill Medicaid for reimbursement. That’s next if we have time.
TailorMed: What would you tell other healthcare leaders who might be looking for solutions to scale their financial navigation program?
AO: With the current healthcare situation, we need to think outside the box by leveraging any and all tools at our disposal.
The best way to maximize a solution like TailorMed Complete is to work with your staff’s strengths. At Munson, we’ve been able to delegate the areas that aren’t our strengths to the TailorMed team. For instance, my two co-workers have degrees in psychology. You don’t go into psychology to do claims follow-up.
By having TailorMed in place, our team can look beyond copay assistance and free drugs. We’re focusing on insurance optimization to help patients long-term. We’re also taking it a step further by signing patients up for supplemental coverage like “Extra Help” and the Medicare Savings Program. Right there, I could save a patient hundreds of dollars per month. With these savings, the patient can relax and pay for transportation and other expenses a little easier.
It’s also made it easier for us to recruit. When a staff member leaves and we hire someone new, we don’t worry because we have the TailorMed team to fall back on.
When you think of how many patients we’ve been able to help, the partnership has been amazing. We’re helping them better afford not only their oncology drugs, but all their medications going forward.
To learn more about how Munson Healthcare optimized financial navigation with technology and expert support, read our case study.