The Journey

Transforming the Patient-Provider Experience

Written, edited and curated by Loyale founder Dan Peterson, The Journey explores ideas and innovation to enrich the patient-provider relationship

Addressing Patient Financial Toxicity for the Oncology Industry

Posted by Kevin Fleming, Chief Executive Officer on Oct 15, 2019 10:59:54 AM

The financial impact of cancer treatment can be so severe for patients and their families that it’s been described as “financial toxicity”. For oncologists, a thoughtful patient financial strategy is critical to patient and provider well-being.


Worried patient image


In his Pulitzer-Prize winning book "The Emperor of All Maladies", physician and author Siddartha Mukherjee points out that “cancer reshapes a life like no other episode in healthcare”. As an oncologist, Dr. Mukherjee knows first-hand how deeply a cancer diagnosis affects an individual and that individual’s family.


Cancer and its treatment present challenges in every dimension of the human experience - emotional, social, logistical, spiritual, and financial. The financial impacts of cancer treatment are especially troublesome, not least because financial distress can aggravate and amplify the other impacts. For survivors, the financial effects of treatment can extend well beyond their care and recovery. Too often, these effects are life altering.


It’s relatively easy to explain why the cost for cancer treatment is so high. To begin with, costs for healthcare in the U.S. are already recognized as being the highest among developed countries. Cancer treatment is particularly susceptible to high costs for a number of reasons. One is a predisposition among highly skilled, specialized physicians and their patients to choose costly, aggressive treatment regimens.


Another is the rapid advancement of new therapies made possible by large public and private investments in research and development. These advancements have contributed to better survivor outcomes. Cancer death rates fell 26% from 1991-2015 according to the National Cancer Institute (NCI). The advancements have also led to some very sophisticated and expensive therapies. Therapies that are sometimes excluded by insurers and that nearly always hit an insured patient’s maximum deductible.


In a report from PDQ published by The National Cancer Institute*, the financial effects of cancer treatment are referred to as “Financial Toxicity” or Financial Distress. The report’s in-depth analysis consolidates research from a wide variety of sources to help quantify the scope of financial toxicity and its impact on patient behavior. It goes on to offer guidance for providers to ease their patients’ financial distress.


The report finds that high out-of-pocket costs for patients, including deductibles and copays, are compounded by loss of income and other circumstances. These financial stressors can lead to asset depletion, debt accumulation and eventual bankruptcy. In the report, representative statistics from multiple, variable studies assert that financial distress constitutes an additional burden on patients and families that are already bearing the weight of a difficult, life-changing event. They include:


  • 32% - 80% of cancer survivors use savings to pay
  • 33.6% of survivors went into debt. Of these, 9.1% were forced into bankruptcy
  • Cancer survivors are 2.7 times more likely to file for bankruptcy than individuals with no cancer history
  • 63.8% of cancer survivors had worried about paying large bills
  • 39.7% had to make financial sacrifices in order to meet their financial obligations.
  • 22.5% - 45% of survivors reported experiencing financial distress


Apart from its impacts on household finances and personal well-being, financial distress can also lead to Medical Distress. Depending on their circumstances, some patients who face unaffordable expenses for their cancer treatment report that they are “more likely to change their prescription drug use by not filling their prescriptions or skipping doses”. As one would expect, this deviation from prescribed therapy is likely to lead to adverse health outcomes.


The financial distress, or toxicity, that patients experience is exacerbated by the fact that most patients are not prepared for the financial dimension of their treatment experience. The above referenced PDQ report notes that the majority of cancer survivors wanted to discuss the costs of care with their provider, but less than one third reported having a discussion about cost.


Bridging the Financial Gap Between What Cancer Patients Need and What Their Providers Deliver


Most patients report experiencing financial distress. They also report that they did not have the opportunity to discuss the financial aspect of their care with their provider, something they wanted to do. Cancer treatment presents patients and their families with some of life’s most formidable challenges. As the research cited here affirms, these challenges are worsened by the high cost of cancer care and the financial toxicity it inflicts on them.


By addressing this gap, oncology companies and practitioners can help alleviate one important contributor to patient suffering. By delivering financial care that is as personal and compassionate as their clinical care, cancer-care providers can help ensure that treatment is sought, therapies are adhered to, and outcomes are optimized.


In order to engineer the most favorable financial experiences for cancer patients, Loyale Healthcare developed our Patient Financial Engagement platform. Its highly interoperable technology helps healthcare providers deliver best-in-class financial experiences to patients. These experiences include patient- and provider-friendly tools that deliver transparency, affordability and clarity to help address patients' most pressing financial concerns. 


In our experience, successful financial engagement between oncology providers and their patients calls for five key elements. They include:


  • A seamless experience – both clinical and financial: By integrating clinical and financial patient portals and offering single sign-on access to both, patients and their families gain easy access to information about their care and its cost, without the frustration that often accompanies healthcare billing interactions.
  • Personalized, compassionate communications: Oncology patients often find themselves facing a life threatening, life-changing challenge. A platform like Loyale’s automatically adjusts the frequency and tone of messages and the channel over which those messages are delivered. So patients get what they need when they need it, the way they want it – email, text, phone or chat.
  • Payment options that work for each patient - Out-of-pocket costs for cancer care are high, nearly always hitting a covered patient’s deductible maximums. Additionally, patients are often exposed to ongoing or unanticipated costs. To relieve patient anxiety about costs and minimize distractions that could impair their care, it is imperative for providers to offer an appropriate suite of discounts, payment plans and third-party financing options. Much larger patient balances often require deep integration with a 3rd party lender capable of serving the patient as compassionately as the provider would.
  • Consistent financial interactions between caregivers, staff and patients - Given the huge clinical and financial challenges an oncology patient faces it is vital that person-to-person interactions with patient financial counselors, advocates, shared services call center reps , etc. are as clear, concise and caring. The Loyale platform arms staff with the right answers for patients with guidance for the right communication style. So no matter where or when the patient chooses to engage financially, they can expect the same high-performance standards
  • Highly intuitive access to presumptive charity - Oncology provider policies vary, with many accepting all patients with the understanding that some patients will not be able to satisfy most or perhaps all of their balances. Intelligent workflow routing from Loyale helps improve the probability of payment for appropriate patients while minimizing or eliminating the inefficiencies that often accompany charity-eligible care.


Loyale relieves patient frustration and anxiety by making it possible for providers to consolidate a patient’s entire financial experience into one, seamless online presentation. Easy to understand and easy to pay, the system supports interactive communications (even chat), so patients can get their questions answered and their problems solved quickly.


For oncology patients and their families, a cancer diagnosis can be devastating. While survival and cure rates are improving every year, the financial burden for treatment represents a potentially crippling burden for families who are already stressed. But by adopting innovative technology and patient-centered financial practices, providers can reduce or eliminate the occurrences financial toxicity among their patients. In our view, that’s a win-win.


* PDQ® Adult Treatment Editorial Board. PDQ Financial Toxicity and Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated 09/18/2019. Available at: https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq. Accessed 10/10/2019.

Topics: patient experience, healthcare consumerism, patient affordability, Healthcare cost disclosure, Patient Financial Engagement

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