6 Ways to Ease Financial Stress for Patients with Chronic Liver Conditions
Dr. Nneka Ufere is a transplant hepatologist at Massachusetts General Hospital and an Assistant Professor of Medicine at Harvard Medical School. Her research focuses on health services and patient-centered outcomes in the areas of hepatology, transplant, and palliative care. She also tests supportive care interventions to increase the quality of life and care for cirrhosis patients and families as a clinical trialist. In 2024, Dr. Ufere received the Young Physician Scientist Award from the American Society for Clinical Investigation.
Dr. Ufere has published more than 70 peer-reviewed publications. Her recent publications are featured in journals like Kidney360, Hepatology Communications, and Liver Transplantation. The full list of Dr. Ufere’s publications can be viewed here.
Dr. Ufere spoke with GLI about the financial insecurities of patients with chronic liver disease. In her experience, the decision to seek medical care often boils down to affordability, at the end of the day. “The loss of household income due to medical costs may force patients to have to make tradeoffs between paying for their medications to manage their chronic liver disease or paying for their basic necessities, such as housing or food – a critical sign of financial distress. This leads to a feedback loop of worsening health and worsening financial burden, which can lead to adverse outcomes such as worsening health-related quality of life, increasing hospitalizations, and increasing caregiver burden, which are signs of financial toxicity.”
Read on to learn 6 ways healthcare facilities can ease the financial burdens faced by patients with chronic liver conditions.
1. Implement standard screening during clinic visits for financial stress
Integrating universal screening for financial burdens during clinic visits, particularly in rural or low-income areas, can better support patients and their families. Creating a standardized scoring system can help identify reasons why patients may struggle to access healthcare services, allowing for tailored accommodations, especially for those managing chronic conditions. Dr. Ufere suggests incorporating questions such as:
- Are you having difficulty paying for your medical care?
- Do you have obstacles that would make it difficult to pay for medical care?
- Have you delayed getting care in the past 12 months because you did not have transportation?
Leveraging nonprofit organizations and local networks can also aid in conducting thorough analyses of the financial challenges patients encounter as well. Through these measures, it will be easier to identify why patients are not coming to get the care they need and also accommodate bringing them to their check-ups.
2. Deprescribe unnecessary medications and discuss lower-cost alternatives to reduce out-of-pocket expenses
On average, patients with chronic liver conditions may take anywhere from three to 10 medications simultaneously, with costs varying based on insurance coverage. Healthcare professionals need to monitor medication responses and discontinue unnecessary ones promptly. This not only saves the patients from spending extra money on unnecessary medication but also prioritizes patient health. Dr. Ufere also suggests exploring the use of websites like costplusdrugs.com for affordable alternatives. Patients must be informed of all available options, considering the large financial impact medications can have. Providers should explore alternatives with their patients and should openly discuss effective options like using a generic.
3. Discuss the pricing of medication transparently and provide early assistance for prescription drug prices
Often, patients are only aware of their medication costs once they reach the pharmacy counter. To adhere to their medication regimen effectively, patients need to know the costs and have the chance to plan accordingly. Dr. Ufere’s scoping review on financial burden outlines various strategies to aid liver disease patients and their families. One effective strategy involves early referral to co-pay and drug assistance programs, facilitated by pharmacy services. This initiative assists patients in managing prescription costs upon diagnosis, while also facilitating informed decisions about their medication based on affordability.
4. Collaborate with financial navigators early
Due to the limited accessibility of information, liver disease patients often struggle to find resources to manage the financial burdens associated with their condition. Patients with liver disease have expressed a desire for early financial navigation support. Financial navigators help patients comprehend the costs related to their illness and identify strategies and resources like employment assistance or disease-specific funds to mitigate financial strain. Dr. Ufere recommends that healthcare providers and the health system collaborate with financial navigators to address patient needs.
5. Provide transportation and parking vouchers for clinic visits
Adults with chronic liver conditions with transportation insecurities have a significantly higher risk of mortality, approximately double the risk compared to those without. The main factors contributing to these challenges are often the costs associated with public transportation, gas, and parking. Hospital systems and networks should consider offering community-appropriate services such as:
- Hospital shuttles that make home visits
- Free or reimbursed parking for clinic visits
- Coupons for rideshare programs
These resources can alleviate the burden of arranging transportation for clinic visits. Dr. Ufere stresses that “many specialized healthcare facilities for chronic liver conditions are limited and located in areas where transportation costs are high or too far away; therefore, providing patients with these resources will ease the strain for patients who may not always have the means to travel independently.”
6. Provide caregiver support and training to allow them to give better care
Financial burdens put a strain on caregivers as well. Increased out-of-pocket costs and increased hospitalizations associated with advanced chronic liver disease can elevate caregiver burden. Caregivers can also experience wage loss if they have to take time off work to travel to specialist appointments. Dr. Ufere says that providing caregivers with support and training on how to care for their loved ones can show them how to efficiently manage medical care while minimizing unnecessary expenses. Initiatives like a support group for caregivers can help them identify strategies to better support their loved ones.
For more information about the Pediatric and Rare Liver Diseases Council or to learn more about joining, please visit our webpage or email pedsrare@globalliver.org.