Editor’s Note: In the video above, TailorMed’s Director of Financial Navigation Clara Lambert highlights what it takes for healthcare organizations to build a mature financial assistance program. Watch the video and read on to learn how to evaluate and optimize your program’s maturity.

Financial navigation is a crucial component of whole-person care. One hundred million Americans live with medical debt. A quarter of adults skipped or delayed care in the past year due to costs. Fortunately, numerous financial resources exist to help patients offset treatment costs. Navigators play an essential role in matching and enrolling patients in vital assistance programs, boosting affordability and reducing financial toxicity. “Navigators and other professionals want to help as many patients as humanly possible,” said Clara Lambert, Director of Financial Navigation at TailorMed.

What does it take to help as many patients as possible find as much assistance as possible? Above all, it takes a mature financial navigation program. Whether operating within a health system, a pharmacy, or another type of healthcare organization, an assistance program’s maturity is essential. “Understanding where opportunities for growth and improvement exist is critical to your success,” Lambert explains.

According to Lambert, there are four key pillars of program maturity: strategy, people, processes, and technology. To assess program maturity, advocacy professionals should evaluate each pillar and consider these important questions:

 1. Strategy

  • Does your program have an overall strategy that aligns with your organization’s business objectives? While improving affordability and expanding patient access are critical goals for many organizations, these objectives alone may not suffice for executive leadership. For example, if an assistance program operates within the revenue cycle, the CFO may also be gauging success based on the program’s ability to improve revenue capture and reduce bad debt. Ensuring a program’s goals are aligned with business objectives is key to its maturity—and to gaining leadership buy-in.
  • Does your program have a center of excellence? A center of excellence, or COE, is a team that provides leadership, best practices, training, and ongoing support. This group can help build out processes and develop expertise in financial navigation. It also makes it easier to centralize assistance across an organization. Ideally, a COE should be cross-disciplinary, drawing on the skill sets and expertise of multiple departments. For example, your COE might include members of the revenue cycle, pharmacy, operations, and IT teams.

2. People

  • Is your program missing critical team members? Financial navigation is an emerging field, combining aspects of social work, finance, medical billing, and other professions. Navigators and other advocacy professionals have the knowledge and the skills to comprehensively evaluate cost-saving opportunities and match patients with appropriate assistance. When programs are missing these roles, assistance may be handled by staff who lack the time, resources, and experience to assist patients effectively.
  • Do you have a training system in place? Even if your team includes experienced navigators or advocates, ongoing training is essential. From the Inflation Reduction Act to alternative funding programs, advocacy professionals must keep up with significant changes that impact assistance. Programs should not only provide training for new staff, but continuing education for all team members to keep them informed of the latest developments and best practices.
  • Do teams communicate between departments? Far too many programs operate in silos, lacking coordination and cooperation across the organization. One department or service line may have a certain way of handling financial assistance, while another department has different processes in place. This leads to decentralization and inconsistency.

 3. Processes

  • Does your program have proactive processes? The best assistance programs are proactive rather than reactive: They assist patients on the frontend instead of the backend. This means ensuring patients have the necessary funding before treatment starts or medication is dispensed. Proactive assistance creates a win-win for patients and organizations. It allows organizations to capture revenue faster and avoid having to send patients to collections after the fact.
  • Are processes standardized? When processes vary by department or site, it drastically increases the time needed to complete a task. When the task is finding financial assistance, days can turn into weeks; patients may choose to forgo treatment rather than wait, leading to poor patient experiences and outcomes. Lambert suggests “reviewing processes site by site and creating a process standardization template for all to follow.”
  • Are processes written and communicated to the team? Having a process is one thing, but communicating it is another. Ensuring all team members understand the process improves efficiency and reduces time to assistance dispersal.
  • Does the program have KPIs in place? Key performance indicators, or KPIs, are quantifiable measures of performance over time. These metrics provide navigation teams with targets to shoot for, milestones to gauge progress, and insights to illustrate success and areas for improvement. KPIs might include increasing the number of patients assisted as well as program enrollments by a certain percentage over a set time period.

4. Technology

  • Are your processes manual or automated? With so many different assistance programs, each with its own eligibility criteria and application process, navigators often rely on manual, labor-intensive workflows. For example, they may find resources and track program enrollments using a combination of Google searches, Post-Its, and Excel spreadsheets. These systems drain team members’ time and capacity. They also limit staff’s ability to maximize available assistance—especially when funding windows open and close quickly. By streamlining workflows, end-to-end technology solutions enable teams to capture more assistance for more patients in less time. These solutions also allow teams to focus on what matters most—their patients—rather than backend tasks.
  • Does your solution integrate with your EHR? Seamless data integration gives navigators and other professionals the information they need at their fingertips, improving productivity and efficiency.

Assess Your Program’s Maturity

Based on how well an assistance program has established the pillars for success, it will fall into one of four stages of maturity:

  • Initial: This is typically where new programs rank.
  • Progressive: At this stage, the program may have seen limited success, and the organization recognizes its value.
  • Mature: This means the program is well-defined with use cases across most, if not all, departments. Value is not only recognized, but also tracked.
  • Optimized: The program is world-class with all departments driving affordability at scale and complete leadership buy-in.

Take Assistance to the Next Level

How can you evaluate your program’s maturity? Take TailorMed’s maturity assessment. Our quick multiple-choice survey reveals where your program currently stands. Participants will receive an instant snapshot of results along with expert recommendations to level up.