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An Introduction to the Patient Advocate Foundation An Overview of Program and Services

An Introduction to the Patient Advocate Foundation An Overview of Program and Services. Presented by Alan Richardson Patient Advocate Foundation Chief Development Operations Officer ADAP Advocacy Association Annual Conference August 20, 2012. Who is Patient Advocate Foundation (PAF)?.

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An Introduction to the Patient Advocate Foundation An Overview of Program and Services

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  1. An Introduction to the Patient Advocate FoundationAn Overview of Program and Services Presented by Alan Richardson Patient Advocate Foundation Chief Development Operations Officer ADAP Advocacy Association Annual Conference August 20, 2012

  2. Who is Patient Advocate Foundation (PAF)? • 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

  3. Our Mission: To Serve Patients & Ensure Access to Healthcare

  4. Statement of Need • 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

  5. Many Voices 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)

  6. Impacting Lives – 2011 • 103,112Patients provided direct, sustained assistance from PAF • 1,292,288 Contacts made by PAF staff on behalf of patients to relevant stakeholders in order to resolve healthcare access issues • $24.3MValue of debt relief obtained for PAF patients through negotiated write offs, charity care access and coding/billing error resolutions • 176,747Pieces of educational materials distributed to patients, caregivers and healthcare professionals this year • 857Outreach and Education events completed by PAF Staff • 404,605People reached through PAF Education and Outreach events FY 06-07 PAF MADE 307,619 CONTACTS FOR CASE RESOLUTION

  7. Patient Services Growth 2010 vs. 2011 24.3% Increase in Patient Case Count

  8. Analysis of PAF Patients Ethnicity Gender Male 36.8% Female 63.2% Source: 2011 Patient Data Analysis Report

  9. Insurance Coverage of PAF Patients 2011

  10. PAF Patients with an HIV/AIDS Diagnosis 2011 Ethnicity Gender

  11. PAF Patients with an HIV/AIDS Diagnosis 2011 Age Income

  12. PAF Patients with an HIV/AIDS Diagnosis 2011 Employment Status Insurance Status

  13. 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 • Robert Bidot • Stage III Prostate Cancer • Phoenix, AZ

  14. PAF Mission Analysis Mission Analysis Medical Debt Crisis Issue Analysis

  15. Fundraising Administrative Expenses Expenses 3.2% 5.0% Program Expenses 91.7% 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.

  16. PAF Services &Programs • Case Management Services • For 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

  17. PAF Services &Programs Med CareLine The 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 Program The 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.

  18. PAF Programs and/or Initiatives . National Hispanic Latino outreach program

  19. Disparate Population Outreach Programs 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 York 2001: 1.24% of PAF patients were Hispanic/Latino 2011: 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 American 2011: 18.0% of PAF patients were African American

  20. Recent PAF Media Coverage

  21. Our Mission: To Serve Patients & Outperform All Others

  22. CPR Impacting Lives and Fulfilling Our Mission • 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

  23. CPR Program Goals: Experience and Expertise 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

  24. Our Mission: To Serve Patients and Out Perform All Others • 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 • MattsonJack DaVinci, Oncology Market Access, 2009 3. Kantar Health, Oncology Market Access, 2011 • Kantar Health, Oncology Market Access, 2010

  25. CPR Program Governance and Compliance • 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.

  26. CPR Disease Funds • Non-muscle invasive Bladder Cancer • Non-Squamous Non-small cell Lung Cancer • Osteoporosis • Pain • Renal Cell Carcinoma • Breast Cancer • Cutaneous T-Cell Lymphoma • Electrolyte Imbalance • Hepatitis C • Hormone Suppression Therapy • Multiple Myeloma • Myelodysplastic Syndrome (MDS) CPR currently offers assistance in 16 disease funds including: Capable of opening any disease state silo as long as it is managed within OIG opinion

  27. How to Access CPR 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

  28. CPR Operations: Technology Capabilities CPR leverages state-of-art technology solutions to deliver a high degree of automation efficiency to program users including:

  29. 2011 CPR Demographics Insurance Type Age

  30. 2011 CPR Demographics Ethnicity Expenditure Payout

  31. Co-Pay Relief Patient Testimonial “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.” Mary Lee Schuetz Ovarian Cancer North Venice, FL

  32. 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

  33. 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 Patients’ Voice Network NPAF – 725 15th Street, NW, 10th Floor – Washington, DC 20005 – www.npaf.org

  34. National Underinsured Resource Directory http://patientadvocate.org/help4u.php

  35. www.insureustoday.org contact us at (866) 207-8023

  36. Patient Educational OpportunitiesPAF Publications • 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

  37. 421 Butler Farm Road Hampton, VA 23666 Phone:  (866) 512-3861 Fax: (757) 952-0118 Internet: www.copays.org E-Mail: cpr@patientadvocate.org Contact Us 421 Butler Farm Road Hampton, VA 23666 Phone: (800) 532-5274 Fax: (757) 873-8999 Internet: www.patientadvocate.org E-Mail: info@patientadvocate.org

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