A Clinic-Based Financial Navigator Approach to Reducing Financial Hardship From Cancer

Mateo Banegas, PhD, MPH, University of California San Diego, La Jolla, CA, presents work from an ongoing randomized controlled trial of a novel financial navigation intervention being carried out at Kaiser Permanente that aims to reduce financial hardship among newly diagnosed patients with cancer.

This study was presented at the 2022 ASCO Annual Meeting. 

Transcript:

Hi, my name is Mateo Banegas. I'm an associate professor in the department of radiation medicine and applied sciences at the University of California, San Diego. And I'm also a member of the Moores Cancer Center.

This abstract presents work from our ongoing randomized controlled trial of a novel financial navigation intervention. The trial is called Cancer Financial Experience, or CAFE, and it's co-led by myself and Dr Nora Henrikson. The trial is a three-arm, randomized trial, of a financial navigator intervention that's being carried out at Kaiser Permanente, Northwest in Portland and Kaiser Permanente, Washington in Seattle. We are rolling patients, newly diagnosed with cancer, and the goal is to provide intervention for those randomized to the intervention arm for six months. And with the aim to reduce financial hardship from cancer at 12 months. So that's the core trial or the parent trial.

The work that we're presenting here is really the developmental work that we did to build this financial navigation intervention and the role of the financial navigator. What this entailed, was us really trying to think about the mission of a multidisciplinary team approach. And we based that, we embraced, I should say core principles of care coordination. Which are clear communication, shared goals, role clarity, and the concept of a warm handoff. So this is kind of what we had in mind, and these were our goals as we aim to build this role for our financial navigator.

So what we did is we really were influenced by the principles of human-centered design, right? The approach where you work with partners in our case, within the healthcare system, to really develop again, this role of the financial navigator. But more importantly, the workflows that these individuals would take on as part of this clinic based intervention.

There are three key pathways that are a part of our intervention. These pathways are those which participants may have a financial need. So they are acute financial need. So for instance, there’s a case where, a participant may be at the clinic and unable to afford their prescription medication for an oral cancer med, right? So that's an acute care need. That's an example for the acute care pathway. Second is planning and budgeting, right? So that's one where we would like to provide information about the cost of care to the participant so that they can plan and think through about their budget of how can they afford the cost of their care. Third is decision making, right? So this is information about the cost of care that we aim to provide. So that in an instance where the participant has, let's say more than one treatment option, they can make an informed decision that includes cost of care information.

So those three key pathways, human-centered approach, if you will. We engaged in multiple stakeholder interviews and, I would say work processes to really find out what are the structures within the system and within individual units in the healthcare system. What are the processes and the workflows related to information and or how we may go about helping our participants in each of these three key pathways. Now, what we did is we focused these interviews on healthcare, clinical staff. So, physicians, nurses, social workers, non-clinical healthcare staff. So patient navigators in our system, we call them community health navigators. And then in addition to that, some of the more healthcare operations or business operations staff. So those would include people like financial counselors or revenue services, kind of the business operations folks. So those were kind of the three big buckets of stakeholders who we engaged with to help us in developing again, these workflows and just an understanding of the system as it relates to that role of the financial navigator.

In the end, we ended up interviewing and working with approximately 40 healthcare staff across 15 units or departments in the system. And I would say there are three kind of key products that we came away with. One, which was essential, were the workflows for our financial navigator. So if you can envision a map of a city bus or of a city subway, that's basically what we put together. If these are color coordinated maps for each of the three key pathways that I mentioned. That outline, the sequence and the unit that we need to contact to address a need in any of these key trial pathways.

That included points of contact like the actual individual again, and as well as any kind of key information about that process that the navigator could use as part of their tools.

The second key product was a resource directory that outlines and describes in detail. The, let's say a particular need within any of the pathways, detailed information about the point of contact. So not only information about who they are, their name, but their phone number, their email, or any other way for us to contact them with information about what's the best way to reach this individual quickly if we need it. And then lastly, that had also information about the role of the financial navigator. What's important about that is we really wanted to develop this intervention to where it enhances the processes and their staff that we already have as part of this system. Right? So, an additive service, that could really help our patients with the focus on issues related to their finances.

So that's why we kind of wanted to have those, those pieces of information in this resource directory. Not only so it doesn't duplicate any services that are existing, but that's so the scope of work is well defined. And if asked, our navigator can provide that information to an individual on the healthcare team. The third was really these partnerships with different stakeholders across the system. We really wanted to develop this intervention to where the financial navigator would be at the center of these care processes. Specific to issues related to finances of their cancer care. So if you will kind of like the primary care provider in this instance, where they're helping the patient, not only engaging with them to understand their needs, but then working to obtain the information or make these referrals, these warm handoffs to key resources within the system.

And ultimately, I would say in addition to the evidence that we hope our trial will provide to the field, hopefully it'll prove to be effective at reducing financial hardship. But more importantly, it gives us a sense of how do we truly develop a sustainable and an efficient financial navigator role within oncology. Which I think is something that a lot of healthcare systems are trying to come up with right now. Of course this will be specific to our health system. However, by us developing this information and being able to share it with others, we hope that others can adapt it and, or adopt it to fit their particular clinic or healthcare system. All with the patient at the center, right. Really trying to work again as a broader healthcare team with this new role of an oncology specific financial navigator. To reduce financial hardship and hopefully overcome any other barriers that our patients may experience

I'd like to thank the Journal of Clinical Pathways for this opportunity ASCO for providing the venue. Of course, our research team, we have an incredible research team that really enabled us to do this work. Our partners in the healthcare system at Kaiser Permanente, across the various units clinical and non-clinical and in the health plan. And of course our funder, the National Cancer Institute.