Clara N. Lambert
It has gotten more difficult to find sources of funding to cover patients’ needs for cancer care. Just ask Clara N. Lambert, oncology financial navigator for the Cowell Family Cancer Center in Traverse City, Michigan. Funding availability tends to go in 7-year cycles, and right now, the sine curve is in the low region, she says. One of the reasons for this may simply be that the demand for expensive new treatments has eroded the supply of funding. Even so, a persistent financial navigator, armed with the right tools and knowledge, should be able to find money to address most patients’ needs, according to Lambert.
Lambert and other members of the Association of Community Cancer Centers (ACCC) have created an online course called Financial Advocacy Boot Camp, which is designed to give experienced and novice financial navigators a review of essential knowledge for finding patient funds. The 4-hour program is offered in several modules, so participants don’t have to complete it all at once, and there is no cost, Lambert says.
Although it is relatively short course on financial navigation, experienced healthcare workers are sure to find useful material that will make it worth their while. “It’ll give them confidence in what they already know,” Lambert says. “It’ll reinforce what they know and answer any questions they may have.” Those who haven’t been working as financial navigators and want to learn about the job also should enroll, she recommends. Lambert is one of the founding oncology financial navigators for the Cowell Center. She has been influential in the development of the role over the past 4 years, having worked in insurance verification and financial counseling for 13 years.
The decline in funding availability is exemplified by 1 case in particular, Lambert says. In previous years, there were a handful of foundations that provided funding for treatment with lenalidomide (Revlimid) for multiple myeloma. That number dwindled to just a single source of funding: The Leukemia & Lymphoma Society.
Lambert says that although the funding cycle may be in a down phase, there’s still a lot of assistance out there for patients who have advocates who are willing to search for it. “I may not be able to get them the help that they need immediately, but if I keep looking and I’m persistent, I might be able to find them something.”
Some assistance programs are quite generous, Lambert notes. For patients who are going to start taking trastuzumab (Herceptin), Genentech, the drug’s manufacturer, offers copay assistance up to $25,000. This is vital for patients who may have to miss work to undergo cancer treatment or who may not have enough money on hand to cover their copay costs, Lambert says. “Genentech is going to pay us as soon as we send them the information on how much the patient’s amount is.”
But knowing that the money is out there is not enough. Lambert has noticed in her own practice that when patients travel to Florida for the winter and continue their treatment there, they may not be able to receive the same quality of financial navigation in that state that they have enjoyed at the Cowell Center. The ACCC course was designed partly with that problem in mind, so that the consistency of financial navigation services can be improved across the country, without the need for busy financial navigators to travel long distances for the training they may need.
People who become financial navigators come from different backgrounds. Some are social workers and some have served as financial counselors. Both of these backgrounds can be complementary to successful performance in the role of financial navigator. Lambert had a degree in business and healthcare administration when she began doing financial navigation. Her mentor in the role was a social worker, which made Lambert come to realize the importance of that set of skills for navigators. “They need to have compassion and empathy.”
Lambert recommends that financial navigators be dedicated personnel, rather than general office staff who share the task of finding patient assistance funds. Appropriate navigators should also have a comprehensive understanding of insurance that includes Medicare and Medicaid, commercial plans, and COBRA (Consolidated Omnibus Budget Reconciliation Act), which is a federal law that enables individuals to continue their group health coverage for a limited time after a loss of employment or other factors.
Insurance issues can be complicated. “I received a lot more training on Medicare than I had before I came into this position,” Lambert said. Keeping up with the Affordable Care Act also has been a challenge, she said. “It’s definitely a specialized field.”
Whereas a budget-conscious practice administrator may quail at the thought of hiring a dedicated financial navigator, Lambert says that it is worth it. “We pay for ourselves. A lot of what we do is finding financial assistance and copay assistance. We’re optimizing insurance. Practices will almost immediately see an increase in revenue or an increase in cost savings from what we do.” Lambert keeps a spreadsheet on which she tracks the number of patients she has helped and the money that she has brought into the system for them. This helps her to demonstrate the value she is creating for her clinic.
Essential resources that a financial navigator needs include access to the practice billing system and the electronic medical record. Some websites, such as NeedyMeds.org, provide information on where to find funding and indicate the qualifications needed to obtain those funds. Separately, Lambert is working with a company to develop software that will do an independent search for available funding.
The typical process for helping patients breaks down as follows: initially, a navigator sits down with the patient to review available health coverage options. At this point, it is essential that the navigator makes sure that the patient knows how these benefits work for them, Lambert says. Next, an effort is made to find out how much of the patient’s treatment is going to be covered by available health benefits.
If it turns out that a patient’s out-of-pocket expenses are going to be more than the patient can afford, attempts will be made to obtain better coverage. “Can we get them Medicaid, or are they at a point where they can change to a better insurance plan?” Lambert says.
After that, the navigator turns back to out-of-pocket costs to see whether assistance is available from pharmaceutical companies or co-pay foundations. The Cowell Center sees patients from a wide geographical area, so Lambert also tries to find sources of funding to cover transportation and lodging expenses.
Lambert says financial navigators could be more helpful to themselves as well as patients by filling out drug-specific applications completely, because this information goes back to the pharmaceutical companies that are some of the best sources of assistance funding for patients. When funds dry up, pharmaceutical companies are often quick to see that they are replenished, but that will only happen if they have an understanding of the need for assistance that exists in the treatment community.
Financial navigators are relatively new to the oncology profession, having established themselves over the past 5 to 10 years, Lambert says. Where there are no financial navigators, per se, there are nurse navigators and patient navigators doing some of the job. Social workers and counselors help, and patients and their caregivers also search for funding opportunities. But in the past 5 years, financial navigators have become a much more prominent part of the average care team as awareness of financial toxicity in the context of cancer care has grown.
“I think our field is still fairly new and not totally understood by the providers,” Lambert says. Providers should establish a good quality financial navigation programs and support their navigators with staffing, software, and other tools needed to continue their education and do their jobs to the best of their abilities, she added.
The navigator boot camp offered by the ACCC covers the following topics: financial advocacy fundamentals, enhancing communication, improving insurance coverage, maximizing external assistance, and developing and improving financial advocacy programs and services.
The ACCC recommends the course for financial advocates, nurses, nurse and patient navigators, social workers, pharmacists, pharmacy techs, medical coders, administrative staff, cancer program administrators, and other healthcare professionals involved in financial advocacy for patients with cancer.
For more information, visit the ACCC website.