Cleveland Clinic Cancer Center Takes a Comprehensive Approach to Financial Toxicity for Patients

Financial burdens can keep cancer patients from accessing the treatment they need in a timely manner. In the past five years, Cleveland Clinic Cancer Center has stepped up its efforts in developing a comprehensive and sophisticated program to help patients navigate the financial burdens of cancer care. Here we talk to Taussig Cancer Institute Administrator Kim Bell, whose team recently released a white paper to explain its patient-focused approach to addressing issues related to financial toxicity.

The white paper states: As a best practice, Cleveland Clinic Cancer Center regards complete financial disclosure, along with financial assistance and supportive services, as of equal importance to medical care.

What has driven the development of this program?

For more than two decades, we have been working to help patients navigate the rising costs and complexities of receiving cancer care. In recent years, payers have increased premiums and out-of-pocket expenses dramatically. Medications for cancer care can be anywhere from $30,000 to $1 million. This means many patients avoid care – or they may come for care with late-stage cancer, which can cost even more. This program is the right thing for the patient and the right thing for the organization.

How does it work?

We help patients when they are out of network and have high deductibles. We start working to assess people’s financial situation as soon as they walk in the door. We have a Cancer Answer Call Center that gets the process started for many patients. Our goal is to match cancer patients with the appropriate place for care for their situation, which isn’t always us. We talk to people diagnosed with cancer about out-of-pocket expenses and drug replacements to help decrease costs. Our goal is to identify all possible sources of patient financial assistance.

Who are you helping?

Our goal is to help every person who comes to Cleveland Clinic Cancer Center for a diagnosis, care or consultation. We have touched nearly 100% of these cancer patients. Of these initial consults, 30% have gone on to receive care in their home city, while about 70% have stayed with us for treatment. There is a perception that we are just helping the poor. This is not the case. We see middle-class families and the younger generation, who often can’t afford cancer care. Our goal is to assess the situation and connect patients with the resources and care they need. This program also helps our physicians by allowing them to focus on the clinical care, while we are managing the financial burden and the psycho-social issues of a cancer diagnosis.

How do you provide the assistance?

It is a multidisciplinary team that includes the revenue cycle team, nurse practitioners, administration and schedulers. Having everyone at the table allows us to have a full understanding of each patient’s needs, including the psycho-social component. When making decisions, we always want to know the patient’s story. To give an example, we had one young man, age 26, who came to us from Texas with metastatic colon cancer. We would normally have helped him to find care in his home state, but when we found out that his family lived here in Ohio, the decision was made to care for him here in Cleveland. His support system was here and this was in his best interest.

Our financial assistance team and a treatment team work together in what we call team huddles. Our huddles started in 2014 and the program has matured over time. As I noted these huddles include clinicians, financial counselors, schedulers and administrators to review what needs to be done to help patients overcome financial barriers, be it high deductibles or out-of-network authorizations.

Can you explain the revenue cycle team members’ roles?

We have financial counselors who help patients to understand their expenses and work with payers for treatment, medication authorizations and more. A patient financial advocate (PFA) is the first person to work with the patient, once diagnosed, to get a comprehensive understanding of their needs. Then, the financial navigator works with the PFA and stays with the patient at each stage of their treatment process to manage and explore all options for financial help as needed. The navigator works to find copayment assistance dollars and even free medications through patient-assistance programs (PAPs) that are sponsored by drug manufacturers.

Our financial navigators are familiar with revenue cycle management and they have excellent customer (or patient) service skills. A social worker is also assigned to work with each patient who stays in our system to address their psychosocial concerns, connecting them with community resources, such as support groups, housing and food; and philanthropic funds may also be used to help pay for mortgages, home repairs and utilities, when needed. We even have a medical Uber system we can connect them with for transportation, and for some patients, our virtual visits work well.

How have you operationalized your work?

We have created a structured initiative to address the issues as comprehensively as we can. The team uses a number of technological tools to find and keep track of all financial assistance and costs. This is no small feat. In 2017, a secure database was created for Cleveland Clinic Cancer Center specifically for nonclinical needs so that we are able to pull information from electronic medical record to manage the workflow and metrics. We have set up standard operating procedures so the entire institute is educated, informed and part of the process.

Any final thoughts?

Patients can have many barriers to care, from getting payer approval for tests and treatments, to lack of transportation and/or housing during treatment. The team supports the whole patient. And we continue to make improvements to our systems so that we can be more efficient in managing volumes and the financial impact for cancer patients now and into the future.