Removing patient financial barriers to care
Every year, healthcare affordability becomes increasingly difficult as Americans struggle with lack of coverage, stagnant incomes and the rising cost of care. For patients, this can mean high out of pocket expenses, financial distress and poorer clinical outcomes. This particularly impacts those who are economically disadvantaged, creating inequities in accessing care, or need to discontinue work due to their treatment. For providers and pharmacies, the increased patient financial responsibility means a lower propensity to pay and increased bad debt. Our technology solves this two-sided issue by predicting patient propensity to pay and automatically connecting patients to available assistance funds, new insurance options and living expense funds to help them get the care they need, when they need it. By proactively addressing these challenges upstream, patients will be able to receive the care they need without worrying about how they may afford it.
TailorMed provides a patient-focused solution that makes it profitable to do good by aligning the financial needs of the healthcare organization and patient. The platform identifies financial barriers to care as early as the patient’s first visit using algorithms and advanced technology to predict each patient’s out-of-pocket-costs across his/her medical journey. The platform then eliminates patient barriers by automatically enrolling patients into assistance programs and suggesting optimal coverage options to ensure that a patient never has to make the trade-off between their care and their holistic well-being. Given that barriers to care can’t be resolved with a one-time fix, our platform monitors patients throughout their entire medical journey from re-enrollment to ordering free medications and supporting the provider revenue cycle management process to reduce the heavy lift of managing patient collections for assistance programs. Knowing that talking about costs can be daunting and overwhelming, our team of financial navigation experts are on-call to meet patients where they are. Each financial navigator guides patients through the assistance options available to them including pharmaceutical co-pays, national foundations, local non-profits, government assistance programs and new coverage options.
First and foremost, our solution is focused on alleviating the immediate financial barriers between patients and their care. This mission drives the product innovation and heart of our company. Second, our platform proactively identifies patients with high financial risk. It predicts patient financial risk, creates a curated set of financial assistance programs for each patient, and stratifies patient populations based on financial risk. This allows healthcare teams to quickly identify the highest risk patients and automatically enroll them into financial resource programs. The platform provides access to over 5,000 financial programs that’s updated in real time. Clients have reported that the platform’s proactive notifications have enabled staff to match and enroll patients in funding opportunities even before a foundation announced their availability. Additionally, our solution has brought value across multiple patient populations and healthcare organizations. We have worked with organizations ranging from community oncology practices and specialty pharmacies to large integrated health systems; across diagnoses from heart failure, COPD and multiple sclerosis to cancer; and have been able to assist patients across the income, insurance and geographic landscape. Whether a patient is uninsured or has an employer-sponsored plan, our platform can help them get over the financial mountain to access care. Lastly, we are able to deliver clear ROI for healthcare organizations and improve patient quality of life by ensuring that providers are able to capture revenue from previously uncollected services and patients receive the funding for medical expenses at the time they need it.
Over the last few years, we've analyzed over 1 million patients, 50 hospitals and over 200 clinics and 300 pharmacies. We've generated an average $2,500 in revenue per patient per provider organization and provided an average of $30,000 per patient in free medications and financial grants. These two clients are representative of our platform’s impact. Providence Oregon created a Medication Assistance Program (MAP) to help low income, underinsured, and uninsured patients who need access to prescription drugs. Leveraging our platform, they successfully enrolled 1,941 patients in 2,970 financial resource programs from March 2020 through April 2021. They achieved $20.0M in patient benefit, while delivering $48.3M in cost avoidance. Augusta Oncology, believing in no cancer patients left behind, started using TailorMed’s platform to tackle the high cost of cancer care. Augusta Oncology surpassed its 2020 patient financial resource enrollments in just the first 6 months of 2021. Halfway into the year, they’ve created $3.1M in patient benefit. For both organizations, TailorMed helped their staff proactively identify patients at risk of not affording treatment, uncover matching financial resources – such as copay cards and free drug programs – and quickly enroll them. The platform also met their needs by alerting them of top funding opportunities for patients with the highest financial risk, monitoring and acting on pending renewals, and tracking funds. According to Augusta Oncology’s CEO, Tracy Duffie, “TailorMed has enabled us to create opportunities for more patients in our communities without financial resources.”
We believe that we are uniquely poised to elevate the issues around patient cost by demonstrating our ability to understand that cost is a factor in every patient’s medical journey but it does not have to be a barrier to care.