Transcript Patient Advocate Foundation

Our Mission
• Patient Advocate Foundation seeks to safeguard patients through
effective mediation assuring access to care, maintenance of
employment and preservation of their financial stability relative to
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their diagnosis of chronic, life threatening or debilitating diseases
Our Impact
• Since our inception in 1996, PAF has provided direct, sustained
patient assistance to more than 800,000 patients and touched
millions more American lives through the PAF website, online chats
and outreach events
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Patient Assistance at PAF takes on multiple forms, two of
which are the source of data in this presentation:
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Case Management – sustained,
one-on-one help with
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barriers to access and affordability (no direct financial
support)

Copay Relief – direct financial support for specific
disease areas operated under an OIG certification.
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80,596
Patients who have received direct, sustained assistance
505
Patient Diagnoses served through case management
56.1%
Case management patients who contact PAF do so related to
a Medical Debt Crisis
$40,253,500
Total amount of debt relief obtained on behalf of patients and
their providers
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Case Management as “Precision Charity” – right assistance at
the right time.
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Starts with a comprehensive needs assessment that
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identifies the practical problems
being experienced by the
patient.
The case is then assessed and assigned to a case manager
who is dedicated to helping that patient overcome their
most immediate and urgent access and affordability issues.
Our mantra is “one patient at a time”
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Debt Crisis Assistance
• Navigation to financial support: co-pay, discount and indigent drug programs,
transportation, housing, food, utility shut off, charity care, negotiate payment
plans
Screening and Enrollment Assistance
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• Eligibility screening and enrollment: Medicare and Medicaid, SCHIP, SSI and SSDI
eligibility screening and enrollment, ACA enrollment support
Insurance Navigation Assistance
• Insurance utilization: benefit review, preauthorization, clinical appeals, hospital
billing and coding issues
• A baseline level of employment related support as needed (e.g., FMLA COBRA,
ADA guidance)
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Age Groups
Birth to 18
2%
19-25
3%
26-35
9%
36-45
12%
46-55
23%
56-65
26%
Over 65
17%
Ethnicity
Caucasian
African American
Hispanic/Latino
Asian
Blended Race
American Indian
Middle Eastern
Native Hawaiian/Pacific
Caribbean Islander
57%
17%
11%
2%
1%
1%
<1%
<1%
<1%
Data captured are self-reported and not vetted for accuracy unless required for program eligibility.
Patient Advocate Foundation does not mandate that patients provide data for all data variables. As a result of missing values, exhibit data may sum to less than 100%.
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Insurance Coverage
Commercially Insured
32%
Medicare
26%
Uninsured
16%
Medicaid
12%
Military Benefits
1%
Household Income
Less than $11,000
$12,000-$23,000
$24,000-$35,000
$36,000-$47,000
$48,000-$59,000
$60,000-$71,000
$72,000-$83,000
$84,00-$95,000
$96,000-$107,000
$108,000-$119,000
$120,000 or More
25%
23%
13%
7%
4%
3%
1%
1%
1%
<1%
2%
Data captured are self-reported and not vetted for accuracy unless required for program eligibility.
Patient Advocate Foundation does not mandate that patients provide data for all data variables. As a result of missing values, exhibit data may sum to less than 100%.
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The FoundationACCESS Careline program is
dedicated to patients and providers get access to
targeted therapies.
We help patients overcome access and affordability
barriers.
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Personalized case management services to patients
who face challenges related to accessing care
consistent with the genetic characteristics of their
disease.
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426 patients to date assisted through this
program.
 Many patients and providers abandon their
efforts to get access to novel therapies
 About 10% of patients die.
 When we are able to complete the case work,
there is about a 60% success rate for gaining
access to treatment through some means.
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 PAF / FoundationACCESS referred cases have
required an average of 49.72 contacts per case to
achieve a positive resolution, more than twice
the PAF global average of 19.89 contacts per case
for all PAF patients.
 58.50% of PAF/ FoundationACCESS patients had
incomes of less than $60,000 per year, and
64.54% of PAF / FoundationACCESS patients were
either disabled or retired.
By Telephone
 Call the FoundationACCESS Careline Program at: (866)
460-1928 8:00 AM to 8:00 PM EST Monday through
Thursday – 8:00 AM to 7:00 PM EST Friday
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By Secure Online Portal
 Enter the following web address:
https://foundationone.pafcareline.org
 Complete the data fields as requested.
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The top five financial issues patients asked Patient
Advocate Foundation case managers for help with in
2015 were:
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co-pay assistance associated with hospital and doctor visits (10.5%),
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transportation expenses (9%),
co-pay assistance for pharmaceutical products (7.5%),
inability to afford rent or mortgage payments (6.3%),
inability to afford utilities for (4.8%).
Note: The diversity of issues reported by patients by case managers are so diverse that
the top 5 only reflect about 39% of all the issue resolutions.
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Metastatic Breast Cancer
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Metastatic Melanoma
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Metastatic Lung Cancer
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Multiple Myeloma
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In the past year, have you experienced a financial
hardship due to the cost of your medical care?
◦ 90% said yes
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15 this financial hardship was
How severe would you say
for you?
◦ Extremely severe, unable to manage = 40%
◦ Somewhat severe, very difficult to manage = 43%
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Recent survey data from PAF noted that the following tope
four healthcare costs were identified by roughly 50% to 60%
of respondents as a healthcare cost that impacted their
financial hardship (no statistical difference between them):
 prescriptions
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 office visits to physicians
 visits to other medical providers
 laboratory services
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What impact did the financial hardship have on your medical care?
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Had to stop or postpone treatment
26%
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Did not follow medical advice as prescribed
26%
(spread out medications, delayed follow up visits, etc.)
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Forced me to change the way I pay for care
(insurance to charity care)
25%
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No impact on medical care
24%
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Shifted care to a different treatment location
13%
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What impact did the financial hardship have on your
financial situation?
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I cut or reduced other non-critical household expenses
My utility bills were paid late
I was unable to afford groceries
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I missed rent or mortgage payments
I missed car payment(s)
I filed or am in the process of filing for bankruptcy
62%
40%
37%
25%
13%
8%
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Annual out-of—pocket costs
by those experiencing medical debt
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Disease Fund
Breast Cancer
Cervical Cancer
Chronic Pain *
Cutaneous T-Cell Lymphoma *
Electrolyte Imbalance
Hepatitis B
Hepatitis C
HIV, AIDS and Prevention
Homozygous Familial Hypercholesterolemia
Disease Fund
Inherited or Acquired Lipodystrophy
Metastatic Colorectal Cancer *
Metastatic Gastric Cancer *
Metastatic Prostate Cancer *
20Multiple Myeloma
Multiple Sclerosis *
Myelodysplastic Syndrome
Non-Muscle Invasive Bladder Cancer *
Non Small Cell Lung Cancer *
Osteoporosis *
Ovarian Cancer
Renal Cell Carcinoma *
* Fund closed to new applications
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Program Eligibility Criteria
Household income
of 400% or less of
FPG, adjusted for
COLI
(300% for Osteo)
Verified qualifying
diagnosis
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Insurance coverage
with pharmaceutical
coverage
Medications Supported
Prescribed
Therapeutic
Medications
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Prescribed Ancillary
Medications
Generic Medications
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Application Process
Instant Decision
• Applicants receive an instant eligibility decision at the time of
submission based on the information supplied and availability of
funding
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Online Portals – Pharmacy, Provider & Patient
• Pharmacies and Providers can apply on behalf of patients
via specific Pharmacy and Provider Portals
• Patients can apply directly through our Patient Portal
• CPR Specialists are available for all via phone toll free
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Ethnicity
 African American
 Caucasian
 Hispanic/Latino
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9%
83%
7%
What is your annual household income?
 Less than $12,000
8%
 $12,000 - $35,000
53%
 $35,000 - $59,000
27%
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Without charitable assistance I would
have to…? (responses of 20%)
Because of the charitable co-pay support I am
able to? (all responses above 33%)
Take on significant debt
63%
Receive optimal treatment for my
condition
Struggle to afford – housing,
food, transportation, etc.
49%
Borrow money to pay for RXs
33%
Afford basis necessities – food,
housing, transportation, etc.
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Avoid
extreme financial distress
Stop treatment entirely
29%
Afford to pay for the drug(s) that
have been prescribed
38%
Change treatments
21%
Stay on therapy
37%
Avoid being hospitalized
36%
Maintain a normal lifestyle
34%
Continue to work
33%
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58%
47%
46%
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How severe was this financial hardship?
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What specific services costs have
impacted your financial hardship…?
(multiple responses allowed – top
items)
Extremely severe, unable to
manage
12%
Somewhat severe, very difficult
to manage
40%
Somewhat severe, but
manageable
41%
Hospital bills
30%
Not vey severe, manageable
7%
Prescriptions
39%
Other medical providers
27%
Laboratory services
26%
Office visits (specialists, PCP
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35%
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What impact did the financial hardship have
on your financial situation?
(top responses above 25%)
What impact did the financial hardship have
on your medical care…? (multiple responses
allowed – top items)
Cut or reduced non-critical
household expenses
(entertainment, personal, etc.)
42%
No impact on medical care
29%
Forced to use credit cards or bank
loans
30%
Forced to change the way I pay for
care (e.g., insurance to charity
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care)
21%
Unable to follow medical advice
(e.g., spread out medications,
delayed follow-up visits, etc.)
16%
Cut or reduced critical household
expenses (house repair, car repair,
etc.)
29%
Utilities bills paid late and or
turned off
25%
12%
Forced to borrow money from
family or friends
Had to stop or postpone
treatments
25%
Shifted care to a different
treatment site
5%
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How much do you estimate you currently
owe or have in outstanding balances for
your healthcare costs?
In the last 12 months how much have you
paid out of your own pocket for your
healthcare outside of premiums?
Less than $700
23.3%
Less than $700
15.0%
$700 - $1,999
22.5%
$700 - $1,999
17.2%
$2,000 - $6,500
35.7%
$2,000 - $6,500
48.5%
$6,501 - $25,000
16.5%
$6,501 - $25,000
18.1%
Over $25,001
2.1%
Over $25,001
1.5%
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PAF
Direct
patient
support
programs
and
services
One patient at a time
SCOPE
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Partnership
and
Education
NPAF
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Data
Collection,
Analysis,
and
Reporting
The Multiplier
Our Value Add
Patient
Advocacy
and Policy
Millions of patients
SCALE
Patient Advocate Foundation - Confidential
421 Butler Farm Road
Hampton, VA 23666
Phone: (800) 532-5274
Fax:
(757) 873-8999
Internet: www.patientadvocate.org
E-Mail: [email protected]
725 15th Street, NW, 10th Floor
Washington, DC 20005
Phone:
(202) 347-8009
Fax:
(202) 347-5579
Internet:
www.npaf.org
421 Butler Farm Road
Hampton, VA 23666
Phone: (866) 512-3861
Fax:
(757) 952-0118
Internet: www.copays.org
E-Mail: [email protected]
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