Solving Insurance and Healthcare Access Problems | since 1996

An Introduction to the An Introduction to the Patient Advocate FoundationPatient Advocate Foundation

An Overview of Program and ServicesAn Overview of Program and Services

Presented byAlan Richardson

Patient Advocate Foundation Chief Development Operations Officer

ADAP Advocacy Association Annual ConferenceAugust 20, 2012

• PAF is a National 501(c) 3 Nonprofit Organization

• Headquartered in Hampton, Virginia

• Offices in VA, FL, IA, CA, and TX

• Over 175 employees

• Facilitates Access to Healthcare for Americans with chronic or life threatening diseases

Who is Patient Advocate Foundation (PAF)?

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Our Mission: To Serve Patients & Ensure Access to Healthcare

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Patient Advocate Foundation served 103,112 patients in 2011 all of whom had issues with the following:

Access to care issues Lack of coverage resulting in no access to care Inability to afford medical and pharmaceutical co-payments and

coinsurance Lack of access to required healthcare due to cost, transportation

issues and coverage denials Employment challenges including loss of income and compromised

benefits that impact access Medical debt crisis that has impacted or stopped required care Cost of living debt crisis that forced many to choose between paying for

treatment or paying for their essential costs of living, often resulting in a decision to go off therapy

Statement of Need

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It is through the experiences relayed by the patients we serve and the extensive

documentation recorded by PAF throughout the service process that we are able to

create the Annual Patient Data Analysis Report (PDAR)

Many Voices

FY 06-07 PAF MADE 307,619 CONTACTS FOR CASE RESOLUTION

Impacting Lives – 2011

103,112 Patients provided direct, sustained assistance from PAF1,292,288 Contacts made by PAF staff on behalf of patients to relevant

stakeholders in order to resolve healthcare access issues$24.3M Value of debt relief obtained for PAF patients through

negotiated write offs, charity care access and coding/billing error resolutions

176,747 Pieces of educational materials distributed to patients, caregivers and healthcare professionals this year

857 Outreach and Education events completed by PAF Staff

404,605 People reached through PAF Education and Outreach events

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24.3% Increase in Patient Case Count

Patient Services Growth2010 vs. 2011

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Source: 2011 Patient Data Analysis Report

Ethnicity

Analysis of PAF Patients

Gender

Male 36.8%Male 36.8%

Female 63.2%Female 63.2%

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Insurance Coverage of PAF Patients 2011

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PAF Patients with an HIV/AIDS Diagnosis 2011

Gender

Ethnicity

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PAF Patients with an HIV/AIDS Diagnosis 2011

Income

Age

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PAF Patients with an HIV/AIDS Diagnosis 2011

Insurance Status

Employment Status

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Robert BidotStage III Prostate CancerPhoenix, AZ

Words from a PAF patient

  Hector was a blessing. He was able to speak with Medicare on our behalf and get my father enrolled in Medicare 3 months early. Now my Dad can finally go to the best cancer facilities in Arizona. We are grateful for PAF and Hector!

Valentina, Daughter of Patient

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PAF Mission Analysis

Mission AnalysisMedical Debt Crisis Issue Analysis

Charity Navigator

•Charity Navigator is America's premier independent charity evaluator and works to advance a more efficient and responsive philanthropic marketplace by evaluating the financial health of over 5,500 of America's largest charities

•PAF was awarded, for the third consecutive year, a top rating of 4 stars. Only 9% of the charities rated have received a 3 year consecutive 4-star evaluations, indicating that PAF outperforms most other charities in America.

•PAF is ranked #19 out of 5,500 other charities.

•In January 2012, the personal finance website, MainStreet as reported on MSN Money, named PAF as the second highest rated national charity in America.

•In FY10/11, $.91.7 cents of every dollar donated to PAF went to support a direct patient service program offered to the public by PAF.

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Program Expenses

91.7%

FundraisingExpenses

3.2% Administrative

Expenses5.0%

Case Management ServicesFor 16 years, PAF has been providing sustained case management services to patients who are facing healthcare access issues as a result of their diagnosis of a chronic, life threatening or debilitating disease. For more information visit www.patientadvocate.org or call (800) 532-5274.

Resolving debt crisis issues related to diagnosis Negotiation of access to pharmaceutical agents, chemotherapy, medical devices, surgical procedures Negotiating pre-authorization approvals and resolutions to coding and billing errors Providing assistance in expediting applications for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) Resolving insurance enrollment issues in both the public and private sectors Coordinating benefits among agencies, non-profits, and federal and state programs Providing assistance in expediting appeals for insured patients Negotiating insurance coverage for clinical trials and emerging therapies Assistance with application to co-pay and free drug programs

PAF Services &Programs

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PAF Services &Programs

Med CareLineThe Med CareLine is a patient/provider hotline designed to provide sustained assistance to patients who have a specific illness and are seeking direct assistance with access issues including reimbursement support. The Med CareLine currently includes the Colorectal CareLine (www.colorectalcareline.org) and the Narcolepsy CareLine (www.Narcolepsy.PAFCareline.org)

Pharmaceutical Access ProgramThe Pharmaceutical Access Program is a full service program that facilitates the identification of , screening for and enrollment into appropriate medication assistance programs and/or identifies alternate coverage options for uninsured, underinsured and insured patients.

Co-Pay Relief Program (CPR)The CPR program offers direct financial support to insured patients who financially and medically qualify to access pharmaceutical co-payment assistance. For more information, visit www.copays.org or call (800) 512-3861.

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PAF Programs and/or Initiatives

NATIONAL HISPANIC LATINO OUTREACH PROGRAM

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National Hispanic Latino Outreach Program bilingual case managers serve Spanish speaking patients nationwide and conduct targeted outreach on a weekly basis. Office locations include: Virginia, Texas, California, New York2001: 1.24% of PAF patients were Hispanic/Latino2011: 10.8% of PAF patients were Hispanic/Latino

The National African American Outreach Program educates specifically on diseases which are high risk for this population by attending and speaking at local and national meetings. 2004: 13.92% of PAF patients were African American2011: 18.0% of PAF patients were African American

Disparate Population Outreach Programs

Recent PAF Media Coverage

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Our Mission: To Serve Patients & Outperform All Others

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• Successfully completed 8 years of operation in April 2012

• Served more than 65,000 patients since inception

• Allocated more than $150M in patient assistance; mobilizing $600M in insurance reimbursement to providers

• Built capacity to successfully and efficiently process in excess of 120,000 expenditures annually

• Brought to bear years of expertise and best practices to serve as a transparent service provider to administer another co-payment assistance program

• Developed personal relationships with thousands of healthcare providers and pharmacies

CPR Impacting Lives and Fulfilling Our Mission

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PAF’s CPR program: a high touch, full service patient oriented program. All policies and procedures have been designed

with three goals in mind:– To leverage our years of high touch patient and provider service

expertise and state of the art technology to expedite the process of patient access to prescribed pharmaceutical therapies while insuring the process is as fiscally efficient as possible

– To provide Co-pay patients support through the PAF Case Management team when their needs go beyond direct Co-payment support. This program feature positions PAF uniquely in the Co-pay vertical.

– To maintain compliance with the OIG Opinion as it provides protection to PAF and each donor to the CPR program

CPR Program Goals: Experience and Expertise

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• Top Co-Pay Foundation Attributes 2: What is Excellence? Ease of Accessing Funding- PAF has four entry points and handles

120,000 expenditure transactions a year Availability of Funding- PAF offers 1st come 1st served processing of

expenditures Patient Advocacy- PAF and NPAF are national patient advocacy leaders

• Co-Pay Foundation Rankings: Who is at the Top? PAF CPR was the top ranked co-pay program by practice managers in

2011 for being best at helping their patients. 3

PAF CPR was the top ranked co-pay program by providers in 2009 for customer service and ease of program use and received top marks by Oncologists in 2010 for customer service and ease of program use, second only to LLS. 1,2

1. MattsonJack DaVinci, Oncology Market Access, 2009 3. Kantar Health, Oncology Market Access, 20112. Kantar Health, Oncology Market Access, 2010

Our Mission: To Serve Patients and Out Perform All Others

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• CPR was established in April 2004, under OIG opinion, #04-15. Our program is the 2nd oldest CPR program in the nation

• CPR offers assistance to– Government Beneficiaries including those covered by:

• Medicare – All co-payments made by PAF count towards a patients True Out-Of-Pocket expense (TrOOP) from the first dollar expended

• Medicaid• Tricare/VA Benefits

– Commercially insured beneficiaries

• PAF’s CPR was granted an Evergreen Clause in 2008 as part of a modification to our opinion issued by the OIG which allows PAF, under the protection of the OIG, to open additional disease states beyond those specifically approved by the OIG in their opinion without having to seek approval from the OIG so long as the new silos are established and administered in accordance with the guidance provided in the 2004 OIG opinion. PAF is the only co-pay program with an Evergreen Clause.

CPR Program Governance and Compliance

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• Breast Cancer• Cutaneous T-Cell Lymphoma• Electrolyte Imbalance• Hepatitis C• Hormone Suppression

Therapy• Multiple Myeloma• Myelodysplastic Syndrome

(MDS)

• Non-muscle invasive Bladder Cancer

• Non-Squamous Non-small cell Lung Cancer

• Osteoporosis• Pain• Renal Cell Carcinoma

CPR currently offers assistance in 16 disease funds including:

CPR Disease Funds

Capable of opening any disease state silo as long as it is managed within OIG opinion

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Four (4) Program Entry Points

Toll Free by Phone~ 866-512-3861 8:30am-5:00pm EST

Online Portals~ http://www.copays.org 24 hours a day, 7 days a week

Patient Portal Provider Portal Pharmacy Portal

How to Access CPR

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Electronic signature capability is integrated into the online application process at all points where a signature is now required

Document import capabilities are integrated into the online application process including the capability for a user to upload documents directly or auto import faxed documents

Bar code recognition for faxed documents is available for those users who do not have electronic documents available

System automatically attaches documents to an application when uploaded or faxed using the system generated fax coversheet that includes the users unique bar code

All three web-based portals are available 24 hours a day, including the new pharmacy portal

All eligible expenditures are processed on a first come first serve basis, based on available funding, and may be submitted electronically

CPR leverages state-of-art technology solutions to deliver a high degree of automation efficiency to program users including:

CPR Operations: Technology Capabilities

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Insurance Type Age

2011 CPR Demographics

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Ethnicity

Expenditure Payout

2011 CPR Demographics

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“I was overwhelmed to receive notification of your financial and emotional support. Just to know you are behind me gives me more hope for the fight. With the ovarian cancer drugs Taxol and Doxil, the side effects are always anemia and neutropenia, so the injection follows. I am doing very well and responding to the treatment which is every Wednesday. Thank you for helping me through this journey. You have helped me and my family with your generosity and concern.”

Co-Pay Relief Patient Testimonial

Mary Lee SchuetzOvarian CancerNorth Venice, FL 

National Patient Advocate Foundation is a national non-profit organization dedicated to providing

the patient voice in improving access to, and reimbursement for,

high-quality healthcare through regulatory and legislative reform at

the state and federal levels.

NPAF – 725 15th Street, NW, 10th Floor – Washington, DC 20005 – www.npaf.org 32

State Government Affairs

The Patients’ Voice Network is comprised of patients, caregivers, physicians, nurses, attorneys, patient advocates, and patient services professionals. The purpose of this Network is:• Educating elected officials at both the state and federal levels about policy and

legislative reform that improves, restores, and/or maintains access to care.

• Educating the public on free patient services available from Patient Advocate Foundation

Advocacy Activities• Action Alerts, Community Outreach, Patient Advocate Proclamations, Annual

Patient Congress, and Town Hall Meetings.

• Sign on to volunteer at NPAF.org

NPAF – 725 15th Street, NW, 10th Floor – Washington, DC 20005 – www.npaf.org

NPAF Patients’ Voice Network

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http://patientadvocate.org/help4u.php

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National Underinsured Resource Directory

contact us at (866) 207-8023

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www.insureustoday.org

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• insureUStoday.org • National Underinsured Resource Directory: An Interactive Tool• Managed Care Answer Guide• Your Guide to the Appeals Process• The National Financial Resources Guidebook for Patients: A State-by- State Directory• First My Illness, Now Job Discrimination• Your Guide to the Disability Process• Promoting a Healthier African American Community• Promoting a Healthier American Indian & Alaskan Native Community• “A Greater Understanding” Pamphlet Series of 19 Pamphlets• Lighting the Way: A Practical Guide to Clinical Trials

Patient Educational Opportunities Educational OpportunitiesPAF PublicationsPAF Publications

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421 Butler Farm Road Hampton, VA 23666

Phone: (800) 532-5274

Fax: (757) 873-8999

Internet: www.patientadvocate.org

E-Mail: info@patientadvocate.org

421 Butler Farm Road Hampton, VA 23666

Phone:  (866) 512-3861

Fax: (757) 952-0118

Internet: www.copays.org

E-Mail: cpr@patientadvocate.org

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