How Highlands Oncology Group Transformed its Financial Navigation Program, Quickly Boosting Revenue

Background

The practice's four clinics offer access to advanced treatment options, multi-disciplinary cancer teams, and industry-leading clinical studies. Highlands is a member of the Quality Cancer Care Alliance, the first clinically integrated network of independent community oncology practices in the United States.

Challenge

As part of its commitment to improve care equity for the underserved in its community, Highlands established a dedicated team of financial navigators to proactively identify financially at-risk patients and procure medication assistance for them. The team relied on manual workflows, spreadsheets, and sticky notes to manage an average of 800 enrollments per year. Each day, staff printed out and manually reconciled visit schedules to identify patients in need and prepare assistance applications, a process that took four to five hours per employee.

Solution

In Phase 1 of the project, Highlands implemented TailorMed to centralize program management, optimize team workflows, and serve patients better. TailorMed Platform has transformed the team's daily workflow by running out-of-pocket projections on upcoming visits to help identify vulnerable patients, matching eligible patients in this queue to the most relevant copay card programs, and auto-populating enrollment applications without ever leaving the platform.



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In Phase 2, Highlands implemented TailorMed’s tech-enabled support service, TailorMed Complete. TailorMed's remote team of expert navigators took on enrollment and associated claims for government - and commercially insured patients. This partnership enabled the Highlands team to meet with more patients and provide high-touch financial care.

Results

• Efficiency gains enable the team to stay ahead of claims follow-up and ensure payments are received
• Automatic patient identification and program matching so opportunities are never missed
• Significant improvement on care access, patient benefits, and financial performance

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