Reducing Financial Toxicity for Cancer Patients with a Mobile App
Today we are interviewing Dr. Yousuf Zafar, Associate Professor of Medicine and Public Policy, and MD with the Duke Cancer Institute and Ian Manners, CEO of Vivor to learn more about their exciting project to support cancer patients though the use of mobile technology. Together they have created the Bridge app which helps patients reduce the financial burden of cancer care.
Interview conducted by Katie D. McMillan, MPH
Can you give us an overview of the Bridge app? What are the key functions?
Ian: Bridge connects patients to financial assistance that can reduce their out-of-pocket costs for expensive cancer medications. Through an interface we created with Duke’s Epic EMR, Bridge is able to pull in relevant clinical and insurance details for each patient who consents to participate. Then, behind the scenes, Vivor’s technology matches the patients to exactly the right sources of financial assistance – whether it’s from a pharmaceutical company or a non-profit foundation. We send patients text messages to ask them for any relevant information we don’t already have, like household size and income, then display the results in any easy-to-understand format. When a patient sees financial assistance that he or she would like to secure, Bridge makes it easy to ask a Duke FCC (Financial Care Counselor) for help applying.
What challenge to patients are you trying to solve?
Yousuf: I recently met a patient who had been newly diagnosed with cancer. We spent about 45 minutes discussing the details of his cancer and treatment. Just as I was about to leave the room, he asked, “One more question – will I be able to afford all of this on a teacher’s salary?” Questions like this are what spur me on to help make cancer care more affordable.
Over the many years of studying the problem of cancer-treatment related financial burden, I’ve learned that cost is one of the biggest problems patients face today is an inability to afford care despite having health insurance. In fact, even some of the “best” insurance plans can still incur out-of-pocket costs for patients receiving cancer treatment. Because of these costs, our research suggests that patients are spending savings, selling property, and forgoing live-saving treatment to make ends meet. Until we have a long-term policy solution to reduce treatment costs, we are working towards a patient-level solution to make cancer care more affordable.
What sparked your interest in using a mobile technology to engage with cancer patients?
Ian: When patients come to the cancer center there is so much information for them to absorb that financial concerns often get missed entirely. Our idea was to get patients thinking about financial resources whenever it is most convenient for them, potentially with the help of a family member or other caregiver at home. Mobile technology allows us to offer proactive, personalized information in a way that wouldn’t be possible through other methods.
What is the potential impact of this project?
Yousuf: Today, patients are paying thousands of dollars out of pocket for drugs when, in many cases, financial assistance is available. Our goal is to put that information in patients’ hands at the time of treatment decision-making. If patients have access to financial assistance information prior to the start of treatment, they could potentially avoid medical debt, and are more likely to be adherent to their treatment.
How long will this study run and what are your future plans?
Ian: We’ll be enrolling patients in the study for one year (into 2019) and following each patient for six months to see how Bridge affects out-of-pocket costs. If Bridge successfully reduces out-of-pocket costs, then Vivor plans to take the technology to our existing customers and new customers across the country. For hospitals that already use Vivor’s provider-facing platform, Bridge represents a new and exciting way to improve their financial navigation services.
What are some of your lessons learned from going through the app development process that you’d like to share with other Duke innovators?
Ian: On the technology side, one of our most valuable lessons was about the process of developing an interface with the EMR – which we successfully completed before going live with Bridge, in collaboration with the ACE team at Duke. Initially we weren’t sure if an interface would be feasible within the timeline and budget constraints of a study. But while it can be time-consuming and complex to work out the details, EMR integration is absolutely worth the investment when it results in an app that can scale more efficiently at Duke and other academic medical centers.
Yousuf: Collaborating with a small business (Vivor) has been incredibly rewarding. Ian and his team have pushed my and my team to think beyond the walls of academia as we develop and test Bridge. Together, we were able to secure NIH funding to test our app on a large scale. That aspect of app development, alone, has taught me more than I would have learned trying to solve this problem alone.