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      Improving Nonclinical and Clinical-Support Services: Lessons From Oncology

      research-article
      , PhD, MBA a , b , , , MD c , , PhD d
      Mayo Clinic Proceedings. Innovations, Quality & Outcomes
      Elsevier
      MA, medical assistant

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          Abstract

          Nonclinical and clinical-support personnel serve patients on the front lines of care. Their service interactions have a powerful influence on how patients perceive their entire care experience, including the all-important interactions with clinical staff. Ignoring this reality means squandering opportunities to start patients out on the right foot at each care visit. Medical practices can improve the overall care they provide by focusing on nonclinical and clinical-support services in 5 crucial ways: (1) creating strong first impressions at every care visit by prioritizing superb front-desk service; (2) thoroughly vetting prospective hires to ensure that their values and demeanor align with the organization's; (3) preparing hired staff to deliver excellent service with a commitment to ongoing training and education at all staff levels; (4) minimizing needless delays in service delivery that can overburden patients and their families in profound ways; and (5) prioritizing the services that patients consider to be most important. We show how cancer care illustrates these principles, which are relevant across medical contexts. Without nonclinical and clinical-support staff who set the right tone for care at every service touchpoint, even the best clinical services cannot be truly optimal.

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          The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience.

          Cancer patients carry rising burdens of health care-related out-of-pocket expenses, and a growing number of patients are considered "underinsured." Our objective was to describe experiences of insured cancer patients requesting copayment assistance and to describe the impact of health care expenses on well-being and treatment. We conducted baseline and follow-up surveys regarding the impact of health care costs on well-being and treatment among cancer patients who contacted a national copayment assistance foundation along with a comparison sample of patients treated at an academic medical center. Among 254 participants, 75% applied for drug copayment assistance. Forty-two percent of participants reported a significant or catastrophic subjective financial burden; 68% cut back on leisure activities, 46% reduced spending on food and clothing, and 46% used savings to defray out-of-pocket expenses. To save money, 20% took less than the prescribed amount of medication, 19% partially filled prescriptions, and 24% avoided filling prescriptions altogether. Copayment assistance applicants were more likely than nonapplicants to employ at least one of these strategies to defray costs (98% vs. 78%). In an adjusted analysis, younger age, larger household size, applying for copayment assistance, and communicating with physicians about costs were associated with greater subjective financial burden. Insured patients undergoing cancer treatment and seeking copayment assistance experience considerable subjective financial burden, and they may alter their care to defray out-of-pocket expenses. Health insurance does not eliminate financial distress or health disparities among cancer patients. Future research should investigate coverage thresholds that minimize adverse financial outcomes and identify cancer patients at greatest risk for financial toxicity.
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            The Management of Customer-Contact Service Employees: An Empirical Investigation

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              Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis.

              Much has been written about the relationship between high medical expenses and the likelihood of filing for bankruptcy, but the relationship between receiving a cancer diagnosis and filing for bankruptcy is less well understood. We estimated the incidence and relative risk of bankruptcy for people age twenty-one or older diagnosed with cancer compared to people the same age without cancer by conducting a retrospective cohort analysis that used a variety of medical, personal, legal, and bankruptcy sources covering the Western District of Washington State in US Bankruptcy Court for the period 1995-2009. We found that cancer patients were 2.65 times more likely to go bankrupt than people without cancer. Younger cancer patients had 2-5 times higher rates of bankruptcy than cancer patients age sixty-five or older, which indicates that Medicare and Social Security may mitigate bankruptcy risk for the older group. The findings suggest that employers and governments may have a policy role to play in creating programs and incentives that could help people cover expenses in the first year following a cancer diagnosis.
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                Author and article information

                Contributors
                Journal
                Mayo Clin Proc Innov Qual Outcomes
                Mayo Clin Proc Innov Qual Outcomes
                Mayo Clinic Proceedings. Innovations, Quality & Outcomes
                Elsevier
                2542-4548
                04 July 2018
                September 2018
                04 July 2018
                : 2
                : 3
                : 207-217
                Affiliations
                [a ]Department of Marketing, Mays Business School, Texas A&M University, College Station, TX
                [b ]Institute for Healthcare Improvement, Cambridge, MA
                [c ]Center for Health Research, Kaiser Permanente Northwest, Portland, OR
                [d ]Monash Business School, Monash University, Melbourne, Australia
                Author notes
                [] Correspondence: Address to Leonard L. Berry, PhD, MBA, Department of Marketing, Mays Business School, 4112 TAMU, College Station, TX 77843. berryle@ 123456tamu.edu
                Article
                S2542-4548(18)30046-8
                10.1016/j.mayocpiqo.2018.05.002
                6132219
                30225452
                584b30c6-dfa0-422d-8615-44c7ab8ff669
                © 2018 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 2 March 2018
                : 3 May 2018
                : 16 May 2018
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