Transcript Slide 1

Solving Insurance and Healthcare Access Problems | since 1996
An Introduction to the
Patient Advocate Foundation
An Overview of Program and Services
Presented by
Alan Richardson
Patient Advocate Foundation
Chief Development Operations Officer
ADAP Advocacy Association Annual Conference
August 20, 2012
Who is Patient Advocate
Foundation (PAF)?
• PAF is a National 501(c) 3 Nonprofit Organization
• Headquartered in Hampton, Virginia
• Offices in VA, FL, IA, CA, and TX
• Over 175 employees
• Facilitates Access to Healthcare for Americans with chronic or
life threatening diseases
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Our Mission: To Serve Patients
& Ensure Access to Healthcare
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 their diagnosis of life
threatening or debilitating diseases.
Our
Impact
• Since our inception in 1996, PAF has provided direct,
sustained patient assistance to more than 780,000
patients and touched millions more American lives
through the PAF website, online chats and outreach
events.
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Statement of Need
Patient Advocate Foundation served 103,112 patients in 2011
all of whom had issues with the following:
 Access to care issues
 Lack of coverage resulting in no access to care
 Inability to afford medical and pharmaceutical co-payments and
coinsurance
 Lack of access to required healthcare due to cost, transportation
issues and coverage denials
 Employment challenges including loss of income and compromised
benefits that impact access
 Medical debt crisis that has impacted or stopped required care
 Cost of living debt crisis that forced many to choose between paying for
treatment or paying for their essential costs of living, often resulting in a
decision to go off therapy
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Many Voices
It is through the experiences
relayed by the patients we
serve and the extensive
documentation recorded by
PAF throughout the service
process that we are able to
create the Annual Patient Data
Analysis Report (PDAR)
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Impacting Lives – 2011
103,112 FY 06-07
Patients provided direct, sustained assistance from PAF
MADE 307,619
1,292,288PAF
Contacts
made by PAF staff on behalf of patients to relevant
CONTACTS FOR CASE
stakeholders in order to resolve healthcare access issues
RESOLUTION
$24.3M
176,747
857
404,605
Value of debt relief obtained for PAF patients through
negotiated write offs, charity care access and coding/billing
error resolutions
Pieces of educational materials distributed to patients,
caregivers and healthcare professionals this year
Outreach and Education events completed by PAF Staff
People reached through PAF Education and Outreach events
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Patient Services Growth
2010 vs. 2011
24.3% Increase in Patient Case
Count
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Analysis of PAF Patients
Ethnicity
Gender
Blended Race Middle Eastern
0.5%
0.9%
American
Indian/Alaska Native
0.5%
Asian
2.0%
Hispanic/Latino
10.8%
Caribbean Islander
0.4%
Native
Hawaiian/Other
Pacific Islander
0.2%
African American
18.0%
Male 36.8%
Female 63.2%
Caucasian
66.8%
Source: 2011 Patient Data Analysis Report
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Insurance Coverage of PAF Patients
2011
Medicaid
9.8%
Military Benefits
0.9%
Commercially-Insured
33.5%
Uninsured
27.4%
Medicare
28.5%
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PAF Patients with an HIV/AIDS Diagnosis
2011
Ethnicity
Hispanic/
Latino
2.53%
Native
Hawaiian/
Other
Pacific
Islander
Asian
1.27%
1.27%
Gender
Female
26.51%
Caucasian
44.30%
African
American
50.63%
Male
73.49%
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PAF Patients with an HIV/AIDS Diagnosis
2011
Age
Income
Over 65
1.27%
56 to 65
8.86%
26 to 35
13.92%
$48,000 $59,000
9.09%
$36,000 $47,000
9.09%
46 to 55
50.63%
$60,000 $71,000
1.30%
$84,000 $95,000
2.60%
$96,000 $107,000
2.60%
Less than
$11,000
32.47%
36 to 45
25.32%
$24,000 $35,000
18.18%
$12,000 $23,000
24.68%
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PAF Patients with an HIV/AIDS Diagnosis
2011
Employment Status
Full-time
student
1.25%
Retired
2.50%
Insurance Status
Selfemployed
1.25%
Employed
40.00%
Unemployed
25.00%
Uninsured
14.10%
Medicaid
7.69%
Commercial
Insurance
55.13%
Disabled
30.00%
Medicare
23.08%
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Words from a PAF patient
Hector was a blessing. He was
able to speak with Medicare on
our behalf and get my father
enrolled in Medicare 3 months
early. Now my Dad can finally go
to the best cancer facilities in
Arizona. We are grateful for PAF
and Hector!
Robert Bidot
Stage III Prostate Cancer
Phoenix, AZ
Valentina, Daughter of Patient
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PAF Mission Analysis
Mission Analysis
Healthcare
Access
Cases
34.5%
Medical Debt Crisis Issue Analysis
Employment
Cases
2.0%
Disability Issues
7.6%
Uninsured/Unpaid
Medical Bills
10.0%
Debt Crisis/Cost of
Living Issues
47.2%
Medical
Co-Payment
Assistance
13.9%
Medical Debt
Crisis Cases
63.5%
Pharmaceutical
Co-Payment
Assistance
21.4%
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Charity Navigator
Administrative
Expenses
5.0%
Fundraising
Expenses
3.2%
•Charity Navigator is America's premier independent charity
evaluator and works to advance a more efficient and responsive
philanthropic marketplace by evaluating the financial health of
over 5,500 of America's largest charities
•PAF was awarded, for the third consecutive year, a top rating of
4 stars. Only 9% of the charities rated have received a 3 year
consecutive 4-star evaluations, indicating that PAF outperforms
most other charities in America.
•PAF is ranked #19 out of 5,500 other charities.
•In January 2012, the personal finance website, MainStreet as
reported on MSN Money, named PAF as the second highest rated
national charity in America.
Program
Expenses
91.7%
•In FY10/11, $.91.7 cents of every dollar donated to PAF went to
support a direct patient service program offered to the public by
PAF.
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PAF Services &Programs
Case Management Services
For 16 years, PAF has been providing sustained case management services to
patients who are facing healthcare access issues as a result of their diagnosis of a
chronic, life threatening or debilitating disease. For more information visit
www.patientadvocate.org or call (800) 532-5274.
 Resolving debt crisis issues related to diagnosis
 Negotiation of access to pharmaceutical agents, chemotherapy, medical devices,
surgical procedures
 Negotiating pre-authorization approvals and resolutions to coding and billing errors
 Providing assistance in expediting applications for Supplemental Security Income
(SSI) and Social Security Disability Insurance (SSDI)
 Resolving insurance enrollment issues in both the public and private sectors
 Coordinating benefits among agencies, non-profits, and federal and state programs
 Providing assistance in expediting appeals for insured patients
 Negotiating insurance coverage for clinical trials and emerging therapies
Assistance with application to co-pay and free drug programs
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PAF Services &Programs
Med CareLine
The Med CareLine is a patient/provider hotline designed to provide sustained
assistance to patients who have a specific illness and are seeking direct
assistance with access issues including reimbursement support. The Med
CareLine currently includes the Colorectal CareLine (www.colorectalcareline.org)
and the Narcolepsy CareLine (www.Narcolepsy.PAFCareline.org)
Pharmaceutical Access Program
The Pharmaceutical Access Program is a full service program that facilitates the
identification of , screening for and enrollment into appropriate medication
assistance programs and/or identifies alternate coverage options for uninsured,
underinsured and insured patients.
Co-Pay Relief Program (CPR)
The CPR program offers direct financial support to insured patients who
financially and medically qualify to access pharmaceutical co-payment
assistance. For more information, visit www.copays.org or call (800) 512-3861.
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PAF Programs and/or Initiatives
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NATIONAL HISPANIC LATINO OUTREACH PROGRAM
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Disparate Population Outreach
Programs
National Hispanic Latino Outreach Program bilingual case
managers serve Spanish speaking patients nationwide and
conduct targeted outreach on a weekly basis.
Office locations include: Virginia, Texas, California, New York
2001: 1.24% of PAF patients were Hispanic/Latino
2011: 10.8% of PAF patients were Hispanic/Latino
The National African American Outreach Program educates
specifically on diseases which are high risk for this
population by attending and speaking at local and national
meetings.
2004: 13.92% of PAF patients were African American
2011: 18.0% of PAF patients were African American
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Recent PAF Media Coverage
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Our Mission: To Serve Patients &
Outperform All Others
CPR Mission
• The PAF Co-Pay Relief Program
(CPR) exists to provide direct
financial assistance to insured
patients who cannot afford the copayments and co-insurance
required to access prescribed
pharmaceutical therapies.
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CPR Impacting Lives and
Fulfilling Our Mission
• Successfully completed 8 years of operation in April 2012
• Served more than 65,000 patients since inception
• Allocated more than $150M in patient assistance; mobilizing
$600M in insurance reimbursement to providers
• Built capacity to successfully and efficiently process in excess of
120,000 expenditures annually
• Brought to bear years of expertise and best practices to serve as a
transparent service provider to administer another co-payment
assistance program
• Developed personal relationships with thousands of healthcare
providers and pharmacies
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CPR Program Goals:
Experience and Expertise
PAF’s CPR program: a high touch, full service patient oriented
program. All policies and procedures have been designed
with three goals in mind:
– To leverage our years of high touch patient and provider service
expertise and state of the art technology to expedite the process of
patient access to prescribed pharmaceutical therapies while insuring
the process is as fiscally efficient as possible
– To provide Co-pay patients support through the PAF Case
Management team when their needs go beyond direct Co-payment
support. This program feature positions PAF uniquely in the Co-pay
vertical.
– To maintain compliance with the OIG Opinion as it provides protection
to PAF and each donor to the CPR program
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Our Mission: To Serve Patients and Out
Perform All Others
• Top Co-Pay Foundation Attributes 2: What is Excellence?
 Ease of Accessing Funding- PAF has four entry points and handles
120,000 expenditure transactions a year
 Availability of Funding- PAF offers 1st come 1st served processing of
expenditures
 Patient Advocacy- PAF and NPAF are national patient advocacy leaders
• Co-Pay Foundation Rankings: Who is at the Top?
 PAF CPR was the top ranked co-pay program by practice managers in
2011 for being best at helping their patients. 3
 PAF CPR was the top ranked co-pay program by providers in 2009 for
customer service and ease of program use and received top marks by
Oncologists in 2010 for customer service and ease of program use,
second only to LLS. 1,2
1.
2.
MattsonJack DaVinci, Oncology Market Access, 2009
Kantar Health, Oncology Market Access, 2010
3. Kantar Health, Oncology Market Access, 2011
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CPR Program Governance and
Compliance
•
CPR was established in April 2004, under OIG opinion, #04-15. Our
program is the 2nd oldest CPR program in the nation
•
CPR offers assistance to
– Government Beneficiaries including those covered by:
• Medicare – All co-payments made by PAF count towards a patients True Out-OfPocket expense (TrOOP) from the first dollar expended
• Medicaid
• Tricare/VA Benefits
– Commercially insured beneficiaries
•
PAF’s CPR was granted an Evergreen Clause in 2008 as part of a
modification to our opinion issued by the OIG which allows PAF, under
the protection of the OIG, to open additional disease states beyond
those specifically approved by the OIG in their opinion without having to
seek approval from the OIG so long as the new silos are established
and administered in accordance with the guidance provided in the 2004
OIG opinion. PAF is the only co-pay program with an Evergreen
Clause.
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CPR Disease Funds
CPR currently offers assistance in 16 disease funds including:
•
•
•
•
•
Breast Cancer
Cutaneous T-Cell Lymphoma
Electrolyte Imbalance
Hepatitis C
Hormone Suppression
Therapy
• Multiple Myeloma
• Myelodysplastic Syndrome
(MDS)
• Non-muscle invasive Bladder
Cancer
• Non-Squamous Non-small
cell Lung Cancer
• Osteoporosis
• Pain
• Renal Cell Carcinoma
Capable of opening any disease state silo as long as it is managed within OIG opinion
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How to Access CPR
Four (4) Program Entry Points
 Toll Free by Phone~ 866-512-3861
 8:30am-5:00pm EST
 Online Portals~ http://www.copays.org
 24 hours a day, 7 days a week
 Patient Portal
 Provider Portal
 Pharmacy Portal
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CPR Operations:
Technology Capabilities
CPR leverages state-of-art technology solutions to deliver a high degree
of automation efficiency to program users including:
 Electronic signature capability is integrated into the online application process at all
points where a signature is now required
 Document import capabilities are integrated into the online application process
including the capability for a user to upload documents directly or auto import faxed
documents
 Bar code recognition for faxed documents is available for those users who do not have
electronic documents available
 System automatically attaches documents to an application when uploaded or faxed
using the system generated fax coversheet that includes the users unique bar code
 All three web-based portals are available 24 hours a day, including the new pharmacy
portal
 All eligible expenditures are processed on a first come first serve basis, based on
available funding, and may be submitted electronically
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2011 CPR Demographics
Insurance Type
Medicaid
0.6%
Age
Military
Benefits
0.2%
Birth to 18
0.2%
CommerciallyInsured
28.3%
Over 65
55.1%
19 to 25 26 to 35
0.4%
1.9%
36 to 45
5.2%
46 to 55
14.0%
56 to 65
23.1%
Medicare
70.8%
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2011 CPR Demographics
Ethnicity
Hispanic/Latino
7.6%
African
American
13.2%
American
Blended Race Indian/Alaskan
0.6%
Native
0.4%
Asian
1.2%
Expenditure Payout
Middle Eastern
0.3%
Patients
14.9%
Native
Hawaiian/Other
Pacific Islander
0.2%
Pharmacies
28.6%
Providers
56.5%
Caucasian
76.4%
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Co-Pay Relief Patient Testimonial
“I was overwhelmed to receive
notification of your financial and
emotional support. Just to
know you are behind me gives
me more hope for the fight.
With the ovarian cancer drugs
Taxol and Doxil, the side
effects are always anemia and
neutropenia, so the injection
follows. I am doing very well
and
responding
to
the
treatment which is every
Wednesday. Thank you for
helping me through this
journey. You have helped me
and my family with your
generosity and concern.”
Mary Lee Schuetz
Ovarian Cancer
North Venice, FL
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National Patient Advocate
Foundation is a national non-profit
organization dedicated to providing
the patient voice in improving
access to, and reimbursement for,
high-quality healthcare through
regulatory and legislative reform at
the state and federal levels.
NPAF – 725 15th Street, NW, 10th Floor – Washington, DC 20005 – www.npaf.org
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State Government Affairs
NPAF Patients’ Voice Network
The Patients’ Voice Network is comprised of patients,
caregivers, physicians, nurses, attorneys, patient
advocates, and patient services professionals. The
purpose of this Network is:
• Educating elected officials at both the state and federal levels about policy and
legislative reform that improves, restores, and/or maintains access to care.
• Educating the public on free patient services available from Patient Advocate
Foundation
Advocacy Activities
• Action Alerts, Community Outreach, Patient Advocate Proclamations, Annual
Patient Congress, and Town Hall Meetings.
• Sign on to volunteer at NPAF.org
NPAF – 725 15th Street, NW, 10th Floor – Washington, DC 20005 – www.npaf.org
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National Underinsured Resource
Directory
http://patientadvocate.org/help4u.php
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www.insureustoday.org
contact us at (866) 207-8023
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Patient Educational Opportunities
PAF Publications
• insureUStoday.org
• National Underinsured Resource Directory: An Interactive Tool
• Managed Care Answer Guide
• Your Guide to the Appeals Process
• The National Financial Resources Guidebook for Patients: A State-by- State Directory
• First My Illness, Now Job Discrimination
• Your Guide to the Disability Process
• Promoting a Healthier African American Community
• Promoting a Healthier American Indian & Alaskan Native Community
• “A Greater Understanding” Pamphlet Series of 19 Pamphlets
• Lighting the Way: A Practical Guide to Clinical Trials
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Contact Us
421 Butler Farm Road
Hampton, VA 23666
421 Butler Farm Road
Hampton, VA 23666
Phone: (800) 532-5274
Phone: (866) 512-3861
Fax:
Fax:
(757) 873-8999
(757) 952-0118
Internet: www.patientadvocate.org
Internet: www.copays.org
E-Mail: [email protected]
E-Mail: [email protected]
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