Patients diagnosed with serious medical conditions can expect to hear their doctors talk a lot about treatment options, side effects, and prognosis. But their healthcare providers might not be as quick to discuss a concern that quickly rises to the top: how to pay for it.
Along the continuum of care are various points when patients with high-cost conditions are most likely to experience some financial distress. Financial navigators can help by identifying those critical times when affordability challenges may arise—and finding ways to address them.
Pressure Exerted by the Growing Cost of Care
Advances in science have resulted in huge leaps in the development of innovative medical treatments. People who thought they didn’t have a prayer for an effective treatment for a chronic condition or rare disease now have a ray of hope at long last.
But the hope comes with a giant price tag. According to a recent study, the median launch price of a new drug in 2021 was $180,000. In fact, 47% of new drugs were initially priced above $150,000 per year during the 2020-2021 period.
Unfortunately, patients are shouldering more and more of the cost of treatment through higher deductibles, coinsurance, copays, and out-of-pocket expenses.
That cost shift has significant implications for patients’ financial well-being, their psychosocial health, and their ability to cope with the challenges of undergoing treatment. When patients can’t afford their treatment—or think they can’t afford it—they may take risks. They might skip important appointments, decline procedures, or not take their medication as prescribed. They may also resort to making hard financial choices, like selling possessions, reducing spending on food and other essentials, or depleting their savings, all of which takes an additional toll on their lives.
Financial navigators are especially well-positioned to help patients with expensive conditions confront the cost of healthcare. With the support of technology solutions, they can identify patients at risk and step in at challenging points during their medical journeys.
Most Common Financial Pain Points
Here are the most common financial pain points when a navigator can help patients access cost-saving resources:
Financial navigators, advocates, and other professionals can get the process started by running reports from their health system’s electronic medical records (EMR) to identify all the patients who are scheduled that week. The system could be pre-programmed to flag patients who may be at especially high risk, such as those who already have an outstanding balance or have missed payments. However, the goal is to proactively identify patients on the front end–before they receive a bill they cannot pay. This is where technology solutions can play an important role.
Once a patient has been flagged, the navigator should schedule a meeting early on. According to Clara Lambert, TailorMed’s Director of Financial Navigation, many patients are unaware of their exact financial need—but they’re also unaware of available assistance. They may also be embarrassed to ask for help—or uncertain about who to ask. Some patients may even fear that their treatment will be interrupted or stopped if they express concern about costs.
2. Beginning of Treatment
Ideally, the navigator should meet with the patient during the first week of treatment. During this meeting, they can talk to the patient about a myriad of financial options. They can start by helping the patient better understand their insurance coverage, including their benefits and their cost responsibility. Most patients don’t fully understand their insurance coverage. In fact, a 2022 survey found that more than 75% of insured Americans could not define key insurance terminology.
The navigator should review the patient’s coverage and ensure they’re enrolled in the most cost-effective plan. Next, the navigator can connect eligible patients with financial assistance programs. At this stage, technology platforms can be invaluable by automatically identifying opportunities to optimize the patient’s benefits, producing a comprehensive list of relevant funds, and facilitating enrollment.
3. During Treatment
As the patient undergoes treatment, the navigator can keep an eye out for signs of impending financial distress. It might be when the first bill arrives, which can be quite a shock for patients. Some may begin to second guess the decision to pursue treatment. They might even worry about burdening family members with a mountain of debt. The navigator can watch for that distress and then provide important education about the need for continuing care, as well as assistance available to help pay for it.
During treatment, the financial navigator can also be a resource for patients should anything unexpected happen, such as a change in health insurance benefits or other circumstances. For example, some patients may be worried about losing employer-based health coverage because they’re unable to work during treatment. This would be an opportunity to educate the patient about the Family Medical Leave Act (FMLA), short- and long-term disability plans, Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits, and other government protections.
4. Change in Treatment
A change in treatment can be a significant financial pain point for anyone undergoing costly treatment. A patient may start taking a different drug or undergoing treatment on a different schedule, which can affect the cost. The navigator can provide a revised cost estimate and update the patient’s financial assistance to accommodate the change. If necessary, the navigator can connect them with additional resources, such as internal or external assistance programs, to offset some of the new cost.
5. End of Treatment
Concluding treatment for a serious condition like cancer is often a cause for celebration for many patients. Survivorship is the next stop on the journey, and they hope to spend a long time enjoying it. But the end of treatment is also prime time for an episode of financial distress. Many patients who have experienced financial toxicity may be worried about what happens next, such as the long-term effect on their credit. Financial navigators can help them chart a course to avoid late payments, surging credit card balances, and other incidents that may decrease their credit score.
6. Long-Term Care
Patients who have a high-cost chronic condition, such as multiple sclerosis (MS) or rheumatoid arthritis, may require financial support on an ongoing basis. A navigator can help them manage costs by scheduling an annual meeting at the beginning of the patient’s insurance plan year. These meetings provide an opportunity to check in with patients and address any life events or treatment changes that may affect their financial responsibility. Navigators should also monitor and touch base with chronic care patients when their financial assistance may need to be renewed.
Steering Patients Toward Financial Health
Ultimately, every patient embarking upon treatment for a high-cost medical condition can benefit from working with a well-prepared financial navigator who knows the most common financial pain points—and how to address them.
By taking a proactive, technology-supported approach, navigators can flag patients in need and match them with the right resources at the right time. They’ll be ready to answer the questions that often arise during those key pain points and steer their patients toward a healthier financial future.