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Q+A with RWJBarnabas Health and Rutgers Cancer Institute of New Jersey: Medication Adherence Program for uninsured or underinsured patients
March 1, 2024
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Workflow depiction of the Medication Adherence Program.
What is the Medication Adherence Program and why is it important?
Beyond the cost of standard treatment drugs administered in a clinic setting, patients may be responsible for obtaining prescribed premedication to be taken prior to treatment. This can be an unforeseen expense that uninsured or underinsured patients are unable to cover. As part of the grantee’s work through the Alliance for Equity in Cancer Care, the Medication Adherence Program was developed by RWJBarnabas Health, in partnership with Rutgers Cancer Institute of New Jersey, the state’s only NCI-designated Comprehensive Cancer Center. The program helps underinsured or uninsured patients, as well as charity care participants, who may be unable to afford premedications or simple medical equipment, such as a thermometer.
How are charity care patients identified for the program?
RWJBarnabas Health is New Jersey’s largest provider of charity care and the state’s largest provider of care to beneficiaries of the Medicaid program. Through its Oncology Access Center, cancer patients are connected to a nurse navigator within 24 hours of scheduling an appointment. The patient is assessed for social determinants, or drivers, of health (SDOH) that may negatively affect their care or treatment plans, including financial challenges, during the navigation intake. Patients with financial obstacles are referred to the Alliance for Equity in Cancer Care navigation team for intervention. The bilingual team of non-clinical navigators can aid the patient with the charity care process, completion of medical forms and scheduling of appointments to help address their practical, or non-medical, barriers.
How was the need for intervention identified as part of your work with the Alliance? How do you hope it will improve patient care access overall?
A nurse navigator working in an underserved community initially identified the need to assist patients with medication and supplies when an uninsured patient did not obtain their premedication for treatment due to financial barriers. Despite patient education on the importance of their premedication, the patient was unable to afford the copayment, and thus, was non-adherent to the treatment plan. While patient assistance funds are in place across the health system, the issue was predominantly addressed for individuals receiving inpatient care, not those in an ambulatory or outpatient setting. Following a case study presentation at a navigation team meeting and outreach to the Alliance team, there was a clear consensus that this issue was relevant across several patient populations.
This non-clinical intervention is an ideal resource to support patients in these scenarios. Alliance navigators receive a referral from the nurse navigator when a patient is uninsured or underinsured and premedication for chemotherapy is ordered. A prescribed pathway is followed to validate that the patient obtains the medication through the Medication Adherence Program. According to a systematic review published in Pharmaceutics in 2021, medication adherence leads to improved treatment and patient outcomes.
What makes this program unique?
The Medication Adherence Program utilizes non-clinical patient navigation to address a practical issue in a cancer patient’s care. The concept is similar to the historic use of a nursing assistant in a hospital, where a nurse addresses the clinical concerns while the assistant extends the support to help with practical care, including transportation, housing or scheduling. In this model, the Alliance navigator helps overcome issues with obtaining medication and provides solutions to common barriers, such as providing transportation for a patient to pick up the prescriptions.
How is this approach being integrated into health system-level policies and other workflows?
After a thorough three-month pilot and monthly evaluation, the program will be extended to all 12 oncology locations in the grantee’s health system. The team is also working with health system leadership to expand support services beyond financial and transportation support to provide delivery services for medications, medical-surgical equipment and even groceries.
What social drivers of health are measured or evaluated as part of the initial navigator assessment? What tools are used to identify, track and address these issues?
As part of the initial intake, the navigation program follows our organization's identified SDOH: food insecurity, housing, safety, utilities and transportation. The navigation program uses language adapted from the Centers for Medicare/Medicaid Services. The assessment provides a comprehensive, holistic view of the patient's needs. Beyond the traditional questions about finances, language and transportation, the evaluation includes religious needs, advanced directives, primary care, mental health and lifestyle. All patient caseloads, barriers and interventions are tracked through an electronic health record, managed through Epic.
How has your work through the Alliance helped improve access to quality cancer care?
The Alliance has heightened our awareness of barriers our patients are facing and the need to create a process that supports underserved patients and equity for all patients. The institutional navigation program began in 2019, and like many programs, is limited by staffing. Support from the Alliance provides the resources to take the program further and provide practical resources to underserved patients.
What has been the biggest takeaway or lesson learned that other grantees may benefit from?
Medical financial hardship is prevalent in cancer care, especially for underserved minorities, or patients that are uninsured or underinsured. Utilizing nurse and non-clinical navigators to address financial barriers in obtaining complementary medication is a strategy to improve patient treatment compliance and outcomes.
Written by: The National Program Office in collaboration with RWJBarnabas Health and Rutgers CINJ