Effectiveness of Out-of-Pocket Cost COMmunication and Financial Navigation (CostCOM) in Cancer Patients

项目总结 癌症治疗的高额自付费用(OOPC)和收入损失导致经济困难。的确有 令人信服的证据表明，由金融导航和咨询补充的OOPC沟通将 通过使癌症患者能够预期和适应治疗费用和 积极寻求财政援助。重要的是，这一干预措施符合医疗保险和医疗保险中心的要求 医疗补助服务(CMS)价格透明授权。我们将评估一项创新的 个性化干预旨在通过开展一项 OOP成本沟通和金融导航(CostCOM)与 NCI社区肿瘤学研究计划(NCORP)实践的增强型日常护理(EUC)。我们的 多学科团队对拟议干预的所有方面都有经验，包括进行临床干预 在NCORP Practice的试验。CostCOM包括四个1小时的咨询会议，以传授：(1)OOPC 使用价格估算工具，对预期的OOPC进行个性化、针对患者的沟通教育； (2)金融导航，实时专业指导，确定将 减少护理费用，并讨论提高保险覆盖面的信息；以及(3)财务咨询，以 解决患者的一系列经济问题，并让患者参加经济援助计划。我们会 招募720名新诊断的实体瘤患者(1：1非转移性与转移性)，他们计划接受 参加NCORP实践之一的抗癌治疗。CostCOM ARM患者将参加四项 在基线、3个月、6个月和12个月期间，与远程财务顾问进行电话或视频会议 在每次会议上交付的CostCOM组件。在登记时，EUC ARM患者将得到常规护理 通过提供描述服务和患者联系信息的教育手册进行了增强 倡导基金会(PAF)，一个全国性的非营利性金融导航组织。患者将完成 在注册后3个月、6个月和12个月进行基线调查。我们的目标是(1)比较 CostCOM与EUC在12个月时报告的患者报告的与成本相关的癌症护理不遵守，定义为 自我报告的因成本问题而延误、放弃、停止或更改癌症护理的事件，以及(2) 患者报告的物质经济困难、经济担忧和生活质量；以及(3)进行一个过程 评估实习提供者和CostCOM ARM患者对干预和治疗的满意度 他们对CostCOM交付(对供应商)或收据(对患者)的障碍和促进者的看法。一个 成功的CostCOM是一个可扩展且在财务上可持续的计划，可在 系统、条件和人口，并改善癌症护理提供、患者体验和健康 结果。

PROJECT SUMMARY High out-of-pocket costs (OOPC) of cancer treatment and lost income result in financial hardship. There is compelling evidence that OOPC communication complemented by financial navigation and counseling will decrease financial hardship by enabling cancer patients to anticipate and accommodate treatment costs and proactively seek financial assistance. Importantly, this intervention aligns with the Centers for Medicare and Medicaid Services (CMS) price transparency mandate. We will evaluate the effectiveness of an innovative personalized intervention designed to improve cost-related cancer care non-adherence by conducting a randomized controlled trial of OOP cost communication and financial navigation (CostCOM) vs. enhanced usual care (EUC) at NCI Community Oncology Research Program (NCORP) practices. Our multidisciplinary team has experience with all facets of the proposed intervention including conducting clinical trials at NCORP practices. CostCOM comprises four 1-hour counseling sessions to impart: (1) OOPC communication, individualized, patient-specific education of the anticipated OOPC using a price estimator tool; (2) Financial navigation, real-time professional guidance to identify financial assistance programs that will alleviate costs of care and discuss information to improve insurance coverage; and (3) Financial counseling to address the range of patients’ financial concerns and enroll patients in financial assistance programs. We will recruit 720 patients with newly diagnosed solid tumors (1:1 non-metastatic vs. metastatic) who plan to receive anticancer therapy at one of the participating NCORP practices. CostCOM arm patients will participate in four phone or video sessions with a remote financial counselor at baseline, 3, 6, and 12 months, with all three components of CostCOM delivered at each session. At enrollment, EUC arm patients will receive usual care enhanced by providing an educational brochure describing services and contact information of the Patient Advocate Foundation (PAF), a national non-profit financial navigation organization. Patients will complete surveys at baseline, 3, 6, and 12 months after enrollment. Our goals are to (1) compare the effectiveness of CostCOM vs. EUC at 12 months on patient-reported cost-related cancer care nonadherence, defined as any self-reported incident of delay, forgo, stop or change in cancer care due to cost concerns, as well as (2) patient-reported material financial hardship, financial worry, and quality of life; and (3) conduct a process evaluation to examine practice providers and CostCOM arm patients’ satisfaction with the intervention and their perceptions of barriers and facilitators to CostCOM delivery (for providers) or receipt (for patients). A successful CostCOM is a scalable and financially sustainable program that can be disseminated across systems, conditions, and populations and improve cancer care delivery, patients’ experience, and health outcomes.