Ashley Ochoa, MBA, CFHP, CRCR, CPC, COC, CMOM-HEMONC, Munson Healthcare, Traverse City, Michigan, highlights the essential role of financial navigation in sustaining a healthy oncology outcome and revenue cycle in rural healthcare settings at the 2025 Academy of Oncology Nurse & Patient Navigators (AONN+) Annual Conference in New Orleans, Louisiana.

She explains how financial navigators help patients optimize insurance, access community resources, and reduce financial toxicity, improving both patient compliance and outcomes and hospital reimbursement.

Transcript:

My name is Ashley Ochoa. I am a coordinator with the business team at Munson Healthcare. We oversee various operations related to the oncology revenue cycle. I love everything about the oncology revenue cycle because front end supports the back end work, and all of it supports patient care. Getting a prior authorization or optimizing someone's insurance doesn't just impact the bottom line, but it impacts care.

One thing we're going to really talk about today is how to implement and sustain a financial navigation program in a rural healthcare setting. Often our rural healthcare settings are facing exponential issues as far as reimbursement and maintaining a healthy revenue cycle, especially with the challenges facing us today. Financial navigation is essential for a healthy revenue cycle. If you do not have financial navigators, you do not have a healthy revenue cycle.

Some of the things we utilize our financial navigators for at Munson Healthcare is really the complex issues. They help coordinate care or coordinate assistance with places like United Way. They also help with Pink Fund, cancer-related assistance programs, local assistance such as here in Michigan we have Angels of Hope. It's a nonprofit that will fund 3 months of patient's bills. Just knowing those programs is essential—not only knowing those programs but being able to help patients optimize insurance. 

Now, this is where it gets beneficial for your healthcare organization. Patients don't want bad debt. They don't want to not be able to pay their bills. They do not want to not be able to pick up their oral prescriptions. However, this is the case when they don't have optimized insurance.

What our financial navigation program does—we have a vendor called Tailor Med that does help us with our copay cards and copay grants, and they help collect the reimbursement from that. We're not losing that and that's not going towards the patient. We're not really taking on any added FTEs. We're partnering with somebody else. Then our employee Munson Healthcare financial navigators, what they really do is the complex, nitty gritty stuff, the insurance optimization, and then the partnering with community resources.

When I say insurance optimization, this is so, so essential for so many different reasons. You get a patient that has Medicare part A and part B only. No Medigap, no supplemental care, you're going to have a continuous 20% out of pocket and then they can't pick up their oral prescriptions because they have Part D. There are various special enrollment periods that if you have a good financial navigator in your network, you can really, really pull those special enrollment periods in along with other benefits to the patient. One thing that our financial navigators look at as the Medicare Savings Program, this program helps patients pay their part B premium. This can save a patient $180 to $200 per month. I think next year it’s going to be $200, every single month, until they no longer are eligible because they make too much money. 

With Medicare Savings Program, these are usually retired to disabled people that are not going to increase their income beyond the cost of living. Then you have the extra help that helps patients pay their Part D premium and also opens up special enrollment periods and these are just things that a good financial navigator, having someone in your system can really help.

However, if you do not have a financial navigator in your system, but you still want to help these patients, there are various community resources that you can leverage. One of those is your SHIP services. That is the state health insurance program. Many states have this program in place to help their patients optimize their insurance. At least here in Michigan, this is available at Area on Aging. I believe most states have this, look and if you have a patient that has Medicare and is just not fully optimized, doesn't have all the parts they need or supplemental, send them there. 

Find out who in your community will help with this because it will not only help your patient stay compliant, but it will help your patient really get the care they deserve. We look at local nonprofits, insurance programs, and have the patient call the insurance, ask, do you have a caseworker I could speak with? Caseworkers can give them resources that you don't have available as a rural healthcare provider. They have a lot more money to do a lot more things with than you do.

One thing we do here at Munson is we have a foundation called the Munson Healthcare Foundations, and they help us quite a bit be able to bridge the gap between the crisis portion of the cancer financial toxicity to being able to sustain a healthy way forward. Some of the things they provide is a wig program. Every patient that comes in gets a free wig, so they don't have to worry about, is my insurance going to cover a wig or not? They're already worrying about feeling less of a woman. Most patients that come in asking for a wig they don't need to worry about all that other stuff. 

Another thing our foundation helps with that is each patient will be evaluated for a possible grant to help with living expenses. This is handled by our financial navigations. They figure that out between the 3 of them and they can use a credit card, and they pay it and it all works great and the patients get what they need immediately.

They also help us with a program called Fuel for Recovery. Fuel for Recovery is a program that I put in place recently, and this helps patients get food they need, even if they are in a grocery desert. What we do with this is my financial navigators work with the registered dietician. The registered dietician places orders at Walmart, Myers, whatever grocery store is local to that patient, and makes sure the food is nutrient-dense food, or if they need supplements such as vitamin C because they're on a specific treatment and they can't afford it. [They ensure that] those kinds of items are put into a cart. 

We have a process set up so that the registered dietician can pay for these items right there. The patient can either pick them up or have them delivered to their house so that we can make sure that they are obtaining those essential nutrients that help pull them through the cancer treatment that is just not available in rural areas at the food bank. So often, most people are donating expired stuff and high carb [items] and just not really what our cancer patients need.

We also leverage pharmacy assistance programs such as Cost Plus. If you have not heard of Cost Plus—I am not financially affiliated with Cost Plus at all, but I highly, highly recommend you looking at them in conjunction with GoodRx and manufacturer programs along with your regular copay assistance foundations. Checking, does your state allow for a cancer repository? This is use of donated drugs here in Michigan. We are lucky to have a program called SRX.

The last point I want to make is that it is so easy to justify a financial navigation position because it does affect not  just patient care, but your hospital's bottom line. These drugs are so expensive. As we talked earlier, you have that patient that's Medicare A and B only, no part D, no Medigap. You have them in expensive chemotherapy regimen. Let's say even Opdivo Yervoy—it's not as expensive as it used to be, but the 20% for the patient is still going to be about $4,000 to $5,000 per month every 21 days for the first 4 months. Then it'll probably drop down to about $2000 when they come off the Yervoy. 

But you're still looking at a bill of somewhere around $20,000 per year, when if you had a good financial navigator, they could get the patient into an advantage plan. That's no additional cost to the patient. This caps them out at approximately $4,500 this year. Next year it's going to go up to about $8,000. Then your facility is receiving the reimbursement after that. If your facility also has an internal assistance program.

A lot of us nonprofits have to do so much community service, provide so many community benefits, so this internal assistance allows facilities to do that by also providing care. It's also when getting these patients into those internal assistance programs for the facility and the patient, because the patient no longer has to worry about it going to bad debt. Facility doesn't have to chase it, they don't have to send it to the collection agency and split any reimbursement the collection agency gets. 

There is just so much behind the work and trying to get AR paid and having it go straight to write-off to a community benefit is so much easier and just so much better. I like to also kind of lay out a patient, the same patient. Let's say we got them into something that capped them at $4,500. We also got them into a hundred percent financial assistance. They now owe nothing. 

Instead of owing over $30,000, they owe nothing. Plus, maybe they had kids at home, and they lost their income. This opens up so many resources. It's crazy how many resources are available to a situation like that, but most patients won't know. Most patients get overwhelmed because they don't know what programs they'll qualify for or which ones will really work with them. 

Our financial navigators instantly will know a patient comes in a certain income, they will know, ‘Okay, we can have this patient apply for this and this and this program.’ Then it's just not a cat and mouse game. It's just so good for the patient. Financial navigation is not just good patient care, it's good business. 

Source:

Ochoa A. Financial Navigation. Presented at AONN+ Annual Conference; November 6-9, 2025. New Orleans, LA.