Financial Navigation Program
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1 Financial Navigation Program Dan Sherman, MA, LPC Clinical Financial Consultant
2 Conflict of Interest Founder and President of The Navectis Group Employed at Saint Mary s Health Care
3 Learning Objectives 1. Identify opportunities for improved access to care for the uninsured and underinsured patient. 2. Understand options in aligning insurance coverage instruments with the patients medical needs. 3. Understand the skills and background needed for the ideal financial navigator candidate.
4 Current Reality Recent data from the Community Oncology Alliance shows that more cancer patients demonstrate a major source of anxiety over the cost of treatments than over dying from their disease. Oncology Times, August 2009 One in eight people with advanced cancer turned down recommended care because of the cost and one in four cancer patients or their families said they used up all or most of their savings to pay for treatment. Kaiser Foundation. 2011
5 Financial Navigation Current Reality According to Bloomberg s BGOV Barometer, hospitals uncompensated care in 2010 had risen to $39.3 billion, an 82 % increase since The American Hospital Association reports that uncompensated care, including charity and unpaid bills made up 5.8% of hospitals expenses last year
6 Current Reality At present, few cancer programs have a systematic process in place to identify patients in need and to develop a plan to meet their cost of care. Rather, financial counseling services are typically fragmented, with responsibility for various aspects of the process divided among registration staff, social workers, business office staff, and clinicians. As a result, many miss opportunities to assist patients and improve revenue capture Oncology Roundtable, 2009
7 Opportunities PHARMACUTICAL ASSISTANCE PROGRAMS CO-PAY ASSISTANCE PROGRAMS PATIENT PROTECTION AND AFFORDABLE CARE ACT MEDICARE GUIDANCE PREMIUM ASSISTANCE PROGRAM
8 Patient Assistance Programs Pharmaceutical Assistance Patient Assistance Programs (PAP) Replacement Programs Some replacement programs are retroactive back one year. A significant portion of the replacement drugs received are for patients who are fully insured.
9 Co-Pay Assistance Programs Co-Pay Assistance Programs These assistance programs provide money to help with copays in connection with infusion services and high dollar prescriptions. Some also assist with Health Insurance Premiums.
10 Health Care Reform Patient Protection and Affordable Care Act. The CBO estimates 4-14 million people will not comply with enrolling into health insurance provided through the exchanges. If no Medicaid Expansion then.. Patients with incomes below 133% of FPL and not eligible for Medicaid will not be eligible for premium subsidy in the exchanges Out of Pocket limits are estimated to be $6,250 per individual
11
12 Medicare Medicare confusion harms you re your patient and health care practice. Patients enroll in underinsured plans Non-participation in specific Medicare Advantage Plan Patients are confused about their financial responsibility based upon lack of knowledge of their health plan. 16% of Medicare beneficiaries have an income below the federal poverty level ($10,830). 47% fall bellow twice that level. Kaiser Family Foundation Feb 2010
13 Medicare Medicare A and B only 11% of the Medicare population Medicare Advantage Plans (MAPD) 24 % of the Medicare population Medicare with Medicaid Spendown Intervention of an improved MAPD plan or a Medigap policy
14 Premium Assistance Program Under certain circumstances aid can be made available that will assist patients with health insurance premiums. COBRA High Risk Pool Health Insurance Exchanges (unknown at this time) Facility considers premium assistance Needs to qualify for financial aid from the hospital Patient signs premium assistance agreement Co-pay assistance foundations
15 Expected Outcomes Reduction of barriers to the uninsured and underinsured patient Cost savings for the patient and hospital Increased revenue for the hospital Increased Patient Satisfaction Improved physician relations Increased readiness for implementation of health care reform in 2014.
16 Recommendations Dedicated Financial Navigator (1.0 FTE) Skill set Required: Masters Prepared Clinical background combined with financial acumen Good communications skills Ability to establish a high level of trust Needs to have a high level of competency in health insurance policies
17 QUESTIONS?
18 Contact Information Dan Sherman, MA, LPC www. NaVectis.com
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