Development of a tool to assess financial advocacy service delivery.
Authors: Kajdic Hodzic Rifeta , Mangir Christina , Schneider Lori , Karwedsky Jordan , Santiago Angie , Liang Margaret Irene , Hoch Aimee , Waugh Wendi , Carroll Emily Hope , Kisiel Molly , Lile Ashley , Plotkin Elana 
Published: September 2024

21

Background:
In 2023, the Association of Cancer Care Centers (ACCC) Financial Advocacy Network published Financial Advocacy Services Guidelines developed through an expert-led, consensus-driven process (1). The Guidelines provide a framework for equitable delivery of financial advocacy (FA) services to address patients’ financial concerns. The Guidelines cover 3 domains: financial advocacy services and functions, program management functions, and partner engagement functions. ACCC adapted the Guidelines into a Financial Advocacy Services Assessment Tool to help cancer care organizations assess and improve service delivery and to advance research of organization-level FA practices across the U.S.
Methods:
ACCC convened an expert task force to guide this work. ACCC conducted a scan of implementation science literature and health care organizational assessments to inform the development of a rating system for each of the 43 guidelines. Four service delivery levels were identified, and a score was assigned to each level (Table). The tool was programmed in Qualtrics to provide a total score and average score per guideline for each FA domain and sub-domain. The task force added unscored questions about organizational demographics, barriers, and readiness to enable aggregate research and sub-group analysis. ACCC invited members of the Financial Advocacy Network to participate in a pilot via email invitation and provided opportunities for open-ended feedback.
Results:
20 cancer centers participated in the pilot between March-May 2024. 15% were academic institutions and 85% were community-based programs (18% of which are directly affiliated with an academic institution). Respondents reported the tool was easy to use and informative for quality improvement efforts. See Table 1 for total scores for initial pilot.
Conclusions:
Pilot results reflect that all participating cancer centers are already engaged in some level of FA services. Broader dissemination and analysis is ongoing. The assessment provides centers with a practical resource to assess alignment to guidelines and identify opportunities for quality improvement. Regular review of aggregate results will help ACCC provide benchmarks for areas of service delivery, identify barriers to implementation, and monitor trends in FA staffing. 1. Kajdic Hodzic R, Liang MI, et al. Developing consensus-based oncology financial advocacy services guidelines. JCO Oncol Pract. 2023;19(suppl 11):38.

Levels of FA service delivery and pilot total scores.

Level
Description
% of pilot cancer centers

Level 1
Not performing financial advocacy services.
0%

Level 2
Making progress with financial advocacy services, but it is done informally or inconsistently.
35%

Level 3
Performing financial advocacy services consistently in at least one key area of the organization.
60%

Level 4
Reliably performing financial advocacy services across all key areas of the organization.
5%