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09/12/2018 Jennifer Pauly Patient care

Helping Patients Handle the Financial Aspects of Care

It can be a difficult call for anyone to make — the call that results in a first appointment at MSK and officially makes someone a patient.

For many people, everything that follows that initial call is made easier when Ana Lajara enters the picture. Ana is a Patient Financial Coordinator (PFC) who has worked in Patient Financial Services (PFS) for more than nine years. She is one of the first people that patients and prospective patients encounter when they reach out to MSK.

Ana's job includes engaging with patients, putting them at ease, and gathering information about the financial aspects of their care, including details about their insurance.

Lately, according to Ana, the tone of these conversations has changed. "I heard the smile through the phone," she says, remembering a patient whom she had recently helped get an insurance approval.

"Patients used to call us back after their appointment and there would be confusion about their insurance, about next steps. But now when they call us back, they're usually grateful. There's more communication, more interaction, and information is more accessible to patients."

What changed? PFS has reshaped the conversation about insurance at MSK and placed the patient's need for information and support at the center of the PFS universe. Here's how they've done it:

  • Creating one central point person when it comes to insurance and finances: The Patient Access Coordinator, or PAC, is a relatively new role, first introduced in 2014, that provides dedicated support for patients and clinicians throughout a patient's health care experience.

"When we looked long and hard at the average patient's experience with insurance – the complexity of navigating insurance and the time it requires of patients – it made us rethink the totality of patient care," says Robyn Walsh, Vice President of Patient Financial Services.

"Caring for our patients extends beyond controlling and curing their disease. It includes helping them address insurance questions and connecting them with the resources that they need so they can focus on getting well."

And so, the PAC was born. Since the first PAC was introduced to Kimmel in 2014, MSK has hired another 22 PACs who are placed within Memorial Hospital and at outpatient sites, including BAIC, Kimmel, 53rd Street, 64th Street, 60th Street, Basking Ridge, Monmouth, Commack, and Westchester. Patient Financial Services already anticipates hiring another five PACs by the end of 2017.

In the past, Patient Financial Services was typically only brought into conversations with patients when there was a problem. Now, with the advent of PACs, patient concerns about insurance and payments are addressed up front.

PACs work closely with PFCs – like Ana. The PFC registers patients and, at the same time, provides any financial counseling they may need in the moment. As a result, PFS can identify early on those patients who should be referred to MSK's financial assistance program — before they ever even get a bill.

Alphabet Soup: What's the Difference between a PAC and a PFC?

While a PFC initiates the conversation about insurance with patients, a PAC's role is to continue that conversation and close the gap between PFS and a patient's clinical team. PACs are available to discuss insurance questions that a patient may have at any point after receiving their first bill. They can walk a patient through insurance changes and serve as a primary point of contact for patients who are experiencing financial hardships. A PAC can also help patients by connecting them with financial resources at MSK and outside organizations.

Another difference is location: PACs are embedded in clinical teams so the services they provide are seen by patients as another component of the care they're receiving. If a patient raises a concern about finances, the PAC is there to address it.

"With the creation of the PAC role, patients are learning that they have someone onsite that they can lean on," says PFS Supervisor, Chris Acidera. "It's building a tremendous amount of trust. They go to the PAC for everything."

For some patients, issues with insurance can take months to resolve. PACs may be able to reduce that waiting time by escalating a patient's concerns within Patient Revenue. A PAC can work collaboratively with MSK's billing team and insurance carriers to try and get faster answers to a patient's questions. Like most things at MSK, coordinating insurance reimbursement often requires a team approach.

Being Part of the Clinical Team

Being in constant contact with patients and making day-to-day decisions helps Sana Kayani, a PAC at the Breast and Imaging Center, identify and address patient needs and improve communication with clinicians.

"Patient care is the big picture," say Sana. "It drives the decisions I need to make." As Sana has discovered, focusing on patient care means working with clinicians as much as with patients.

"One of our biggest changes is in how we walk physicians through a patient's unique insurance concerns before the patient even comes in," says Sana. "The physician is then able to effectively communicate insurance options and set expectations to the patient from the outset."

For instance, PACs are now notified by doctors in advance when the doctor has prescribed a particularly expensive drug that will require authorization from the insurance company. And when those requests for authorization are occasionally turned down, the PAC is there to discuss it with the patient while the doctor develops an alternative treatment plan.

As the concept of patient care continues to expand, and as the healthcare landscape becomes increasingly complex, the need to help patients cope with questions about insurance and finances will only increase.

Fortunately, the PACs and PFCs aren't going anywhere.

Top row (from left): Ana Lajara and Sana Kayani; Bottom row (from left): Robyn Walsh and Chris Acidera

Top row (from left): Ana Lajara and Sana Kayani; Bottom row (from left): Robyn Walsh and Chris Acidera

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