Just a few months into 2024, one thing is clear: Healthcare in the U.S. remains unaffordable.

About half of U.S. adults find it difficult to pay for healthcare, and one in four have had to delay or forgo necessary care due to costs. 

Patients and healthcare organizations are paying the price.

In my four-plus years at TailorMed, we’ve been dedicated to eliminating financial barriers to care for all impacted parties. To realize this goal, we recognize the need to continually listen to our clients, identify their pain points around financial assistance, and innovate new solutions to address them.

One significant challenge surrounded providers’ and specialty pharmacies’ internal assistance programs. Our platform already enabled healthcare organizations to proactively match patients with external resources, including drug manufacturer copay assistance, foundation grants, and more. However, we realized the importance of enabling our clients to manage their internal programs as well.

According to my colleague Clara Lambert, Director of Financial Navigation and Product Subject Matter Expert, internal assistance programs typically fall into two categories:

  • Charity assistance (also known as uncompensated care or internal hardship): All not-for-profit hospitals are legally required to provide this type of aid. It primarily assists uninsured or underinsured patients. The application process, conducted through the revenue cycle, involves submitting a significant amount of documentation, such as bank statements and household income.

    Approved patients receive a discount for a specified period, often six months or a year. Some hospitals cover the patient’s entire bill, while others operate on a sliding scale. In compliance with federal laws, all charity assistance is considered a business loss to the hospital or health system.
  • Philanthropic Funds: This type of aid stems from individual or corporate donations to hospital foundations. Donors typically contribute to specific funds designated for non-medical expenses like transportation, living expenses, or groceries. These funds help address social determinants of health (SDOH). Unlike charity assistance, they have a limit based on donations raised. The approval process is also generally much easier than for charity assistance.

While the foundations oversee these funds, financial navigators often handle bookkeeping tasks, such as determining how much funding patients receive and alerting foundations to low balances.

Recognizing the significance of both types of assistance, our teams – including Product, R&D, and Customer Success – worked together to develop a new solution, Funds Management. Built in partnership with CARTI (one of our valued cancer center clients), this feature empowers users to: 

  • Add internal programs, benefits, and eligibility criteria to automatically discover and match patients without leaving our platform.
  • Create and manage patient applications and claims for approved applicants.
  • Monitor available funds and receive alerts for low balances.
  • Generate reports on usage, application and claim statuses, and approvals.

In essence, Funds Management empowers navigators and other healthcare professionals to manage all resources – internal and external – in a single, unified platform. Last year, fueled by growing interest from providers and specialty pharmacies within our network, we decided to enhance it. We developed an even better understanding of our clients’ diverse needs, allowing us to create a more seamless and streamlined experience.

The result is a solution we hope will become widely used across our network, especially considering the evolving landscape of drug manufacturers’ copay assistance programs. We may find navigators, pharmacy techs, and other staff relying on internal assistance programs even more in the months and years ahead. Healthcare leaders can and should use every tool at their disposal to efficiently manage these vital programs.

Technology has an important role to play. As always, we remain committed to removing roadblocks that prevent far too many patients from accessing the assistance they need.

Interested in learning more about Funds Management and other solutions that can help your organization optimize financial assistance? Get in touch with us.