Financial Navigation: Lessons From a Program in Practice

Introduction: The Emergence of Financial Navigation in Cancer Care

Ever since CMS updated its physician fee schedule in 2024 and introduced new reimbursement codes for navigation—the Principal Illness Navigation codes¹—a lot of ink has been spilled by various media outlets expounding on the value of such navigation services in furthering health equity in cancer care.

Financial navigation² is a specific subtype of this broader concept, a system-level intervention that is both an acknowledgment and a response to the fact that the cost of cancer treatment can pose formidable challenges for patients and is a significant enough problem that it necessitates dedicated and trained personnel to address it. Financial toxicity—a term describing the distress and hardship caused by medical expenses—does not suffer from a lack of data describing its extent. Study results showed almost three-fourths of patients reported experiencing serious financial hardship in the first year of diagnosis.³

In addition, patients with cancer are 2.5 times more likely to file for bankruptcy,⁴ and patients with cancer who go bankrupt are 80% more likely to die than patients who don’t.⁵ The roots of financial navigation in cancer care trace back to the broader movement toward patient advocacy and holistic care in the late 20th century.⁶ Initially, financial assistance was often limited to charity care programs or one-off interventions through philanthropic organizations. However, the escalating costs of novel cancer therapies and the growing complexity of health insurance systems led to the need for a structured approach.

Over the years, financial navigation programs have become pivotal in mitigating these challenges⁷ by providing patients with tailored support to manage their financial responsibilities while accessing lifesaving treatments—inclusive but not limited to finding assistance for medical co-payments; handling nonmedical costs related to care such as transportation, lodging, and meals; managing employment; and navigating disability benefits.

Most comprehensive financial navigation programs, which equitably identify patients at risk and provide assistance proactively, are limited to larger health systems because of resource constraints.⁸ For example, a 2017 survey of community oncology practices found that less than half of practices had staffed a program to routinely provide patients with this service.⁹ Thus, this essay presents Tennessee Oncology’s program as a model for other community oncology practices seeking to build or enhance their financial navigation services.

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