Evaluating the early impact of adding a financial counselor to an Oncology Care Model pilot program.

Abstract

67 Background: The Oncology Care Model (OCM) emphasizes the importance of patient costs. Our practice identified a need for patient financial counseling (Plan) and added a financial counselor to the care team (Do). Our objective is to describe the financial counseling process and evaluate (Study) the impact of adding a financial counselor to address financial burden among cancer patients. Methods: New treatment orders trigger a task to the financial counselor who mails a letter including personalized insurance benefit information (i.e., deductible, out of pocket maximum, amount met to date), estimated out of pocket cost for prescribed chemotherapy regimen, and additional financial resources. The health care team can also place referrals for identified needs. Data on patient characteristics, referral patterns, and services delivered was abstracted from the electronic medical record. Results: The financial counselor contacted 157 cancer patients from 4/2018-4/2019, including 134 (85%) OCM patients. The average age was 68 years old (range 22-91); 93 (59%) patients were female; 39 (25%) patients identified as black. Out of 32 patients with documented income, the average annual household income was $25,000. Most patients had Medicare Part D coverage (67/73, 92%) and secondary insurance (59/77, 77%). The financial counselor contacted patients by mail (52/77, 68%), phone (13/77, 17%), in-person at clinic (7/77, 9%), e-mail (1/77, 1%), or using multiple methods (4/77, 5%). Actions taken included mailing insurance benefit and estimated out of pocket cost letters (60/72, 83%), referring to social workers or lay navigators (5/72, 7%), or reviewing insurance benefits (4/72, 6%). Co-pay applications through foundation grants were submitted by the financial counselor for 27 patients of which most (23/27, 85%) were approved. Conclusions: Financial counselors provide diverse services to cancer patients to reduce financial burden, including to patients without secondary insurance who were noted to have additional financial needs. Patient satisfaction surveys and accounting for the dollar amount returned to patients and the health system represent next steps for our new program (Act).