00:00:04:08 - 00:00:29:07 Adam Hocking Welcome to The Rounds, a podcast of Marshfield Clinic Health System. I'm your host, Adam Hocking. The Rounds brings together medical experts to discuss fresh, fascinating and important topics from the world of health care. Learning you've been diagnosed with cancer is one of the hardest and most frightening experiences any of us can have. It's a time marked by new medical jargon, coordinating dozens of appointments and for many physically taxing treatments. 00:00:29:16 - 00:00:53:16 Adam Hocking But it's not just your physical health that cancer changes. It also impacts your social life, your work, your emotional health, and your financial well-being. Because this can be such a demanding time, many health care providers employ patient navigators to connect people with important resources, answer questions, and generally guide someone through their cancer care journey. Amanda Boreen and Amy Severson are two such patient navigators. 00:00:53:17 - 00:00:59:03 Adam Hocking They join me today to go beyond the diagnosis and discuss navigating the cancer care journey. 00:01:02:19 - 00:01:06:04 Adam Hocking Amy Severson and Amanda Boreen, thank you for joining us today on the rounds. 00:01:06:17 - 00:01:07:15 Amy Severson Thank you for having us. 00:01:07:15 - 00:01:08:16 Amanda Boreen And thank you for having us. 00:01:09:05 - 00:01:28:03 Adam Hocking A question for both of you. When we talk about navigation services, whether it's a breast cancer navigator like you, Amanda, or patient financial navigation, in your case, Amy, can you talk a little bit about what your roles are and just kind of expand on what it is that you do to serve patients every day? 00:01:29:13 - 00:01:54:18 Amy Severson Sure. My background is I'm a registered nurse with specialized training in breast health and breast care. So I really have a vast background in health care as well as with navigation. So I'm available to help patients with whatever they should need throughout their journey and also their support persons. So that really encompasses a lot of things from initial diagnosis all the way through survivorship care. 00:01:55:17 - 00:02:28:09 Amanda Boreen I've been in the medical background for about 15 years now, but the Marshfield Clinic for a year and a half, the Patient Financial Navigator position encompasses financial needs. As far as we have a financial assistance application, we work with foundations, we work with grants to sometimes get you free drug. We also work with the marketplace and I have to get my CAC certification so I can get you whatever you need for your insurance needs and so on. 00:02:28:13 - 00:02:38:23 Adam Hocking Hmm. And can you talk to me about now, Amy, do you work with patients all over the spectrum? I mean, regardless of of diagnosis or is it mostly with cancer patients? 00:02:39:12 - 00:02:54:01 Amanda Boreen It's mostly cancer patients. And there they try to have me work mainly with the Stevens Point patients. I do help out with other patients throughout. But as far as meeting with patients, it kind of has to be here at the Stevens Point campus. Sure. 00:02:54:09 - 00:03:05:13 Adam Hocking And Amanda first and then I'll go to Amy. At what point in the diagnosis do you first see a patient or when does that happen? Where, Amanda, you make your first patient contact. 00:03:06:00 - 00:03:28:07 Amy Severson Sure. When a patient is notified of their diagnosis, so the radiologist gives them their biopsy results and explains what that means. Then they in turn call me. So then I call the patient right away. I try to call them as quickly as possible. Explain my role in our program, and then I start to get them set up with their consultations and we move forward from there. 00:03:28:08 - 00:03:48:16 Amy Severson Then I ask them if they have any questions about the biopsy or pathology results that they were just given. I know it's overwhelming and they may have not written it down or heard it correctly. So to review that and then right away it’s, who is your support team? You know, who's going to be there for you, and see what that dynamic looks like. 00:03:49:07 - 00:04:06:11 Amy Severson Then it's, you know, our our next appointments are to see oncology and surgery. We'd like to get you scheduled as soon as possible. What is your availability? And most of the time, women will say, I'll make it happen. You know, they'll have communication with their employer or their family and if they need to clarify that first, it's okay. 00:04:06:11 - 00:04:20:17 Amy Severson I'll call you back in a couple of minutes. Then I'm able to coordinate those consultations as efficiently as possible. And then I do my first in office visit after they see their oncologist for education and some some teaching of resources. 00:04:21:02 - 00:04:42:22 Amanda Boreen I probably don't meet with them right away. I do more background work. I would say we do what they call parse, which is the nurses set down what are going to be the chemo regimen and the chemo plans. And then I have to call the insurances and find out if I need prior authorizations, what kind of benefits and so on. 00:04:42:22 - 00:05:08:10 Amanda Boreen The patient has. And we do a financial screening intake for the financial assistance aspect of it. And basically that goes over the number of people, the household and what kind of income you have, what kind of insurance you have. And then we do a breakdown and then I can see what assistance programs are out there that maybe can help you, because there's more than just our financial assistance here. 00:05:09:04 - 00:05:28:04 Amanda Boreen There's angel funds. There is, like I said, the foundation funds, depending on what kind of chemo drug you're on and that type of stuff. And then I guess I just kind of go forward from there and then sometimes I have to meet with them and have to have them sign on some paperwork and that type of stuff for the financial assistance. For the insurance, 00:05:28:04 - 00:05:36:06 Amanda Boreen That's a bit different. That's that's a lot more me I don't get in much contact with the patient unless there's a delay in treatment. 00:05:37:06 - 00:05:59:16 Adam Hocking And what does that first? Amanda Maybe it's a little more emotionally raw in your case because you're meeting with that patient sort of right after the diagnosis. But in both your cases, I guess I'm curious, what is that first meeting like with a patient? Does it tend to be emotional? Amanda, are you are you seeing a lot of that sort of people coming to grips with their diagnosis? 00:05:59:18 - 00:06:01:09 Adam Hocking What's that first meeting like with patients? 00:06:01:09 - 00:06:27:06 Amy Severson Sure. It's very overwhelming. To put it easy, they're not expecting a cancer diagnosis or or maybe they kind of were. But still, it's always a shock to them. So really, it's initially finding out, you know, what are their needs, what is their support system like? What do we need to do to help them move forward efficiently so that they can get more information and then we can be a guide for them. 00:06:27:12 - 00:06:43:13 Amy Severson So really having a breast care coordinator or some sort of navigator is really beneficial because they have one person to come back to. So they always call me in no matter what they need. I'm the person that they communicate with and then I get them where they need to go. Or you know, whatever services they might need. 00:06:44:12 - 00:07:05:11 Adam Hocking And from a financial perspective, it's got to be almost equally as overwhelming for for a patient. I mean, I'm kind of thinking about what I would feel like in that situation. I've never had a personal, serious illness, but the financial aspect has to be in addition to everything else you're trying to navigate. The financial piece has to be huge. 00:07:05:18 - 00:07:13:08 Adam Hocking How do you sort of help people process not just working through that, but sort of, I guess the emotions related to the financial piece? 00:07:14:04 - 00:07:43:21 Amanda Boreen The financial piece? Well, when we get the parse we take a look at it, and then we see if there's, depending on the diagnosis, if maybe there's a foundation out there that can help and then it rolls in to what kind of insurance that they have and then after that, sometimes when they come in for their first treatments or even during their office consults, they may say something like, you know, right off the bat, you know, I can't afford this. 00:07:44:03 - 00:08:07:13 Amanda Boreen Then they'll get me involved right away and then we'll look at maybe the financial assistance piece of it, or even patients that don't have any type of insurance. We try to get them enrolled in insurance, so we kind of just take over the reigns and say, you know, we want to take all this pressure off of you. You worry about getting better and your treatments, and we'll try to do our best on the back side to get everything we can for you. 00:08:08:11 - 00:08:16:20 Adam Hocking And do you both do you notice a sense of relief after you're able to kind of establish that relationship with patients? Or does it does it take a while for them to to relax a little bit? 00:08:17:07 - 00:08:35:18 Amanda Boreen I don't know. I think it kind of varies. You know, I had some I've had a couple of people, you know, want to give me a hug right away because they just they just they did they felt relieved. And they and they just they're like, you know, thank you so much for helping. And they they do they it makes them feel a little bit better about things. 00:08:35:18 - 00:08:49:16 Amanda Boreen And and they'll even have nurses call after the fact. If I go down to the room and speak with them, you know, they'll say they're just they feel a sense of hope as far as financial goes and that type of reasoning and everything. 00:08:49:16 - 00:09:12:21 Amy Severson So, yes, to elaborate just a little bit further, to say, I work mainly, mainly with women. So women who have a new breast cancer diagnosis and as women were moms and caretakers and we have jobs and and all of these other things. So not always was health care up front. So some women not only are they overwhelmed with a diagnosis, but now how am I going to take care of of everything else? 00:09:13:09 - 00:09:32:20 Amy Severson And that can be financially, of course, with the financial navigator as well. But looking into all those resources so that they know, yes, we do have help, that is it, you know, a sense of relief or they don't know what their insurance plans cover or they know it's a high deductible. So even going into it, it's you know, the first thing is, how am I going to, you know, go to work? 00:09:32:20 - 00:09:43:14 Amy Severson How am I going to, you know, get groceries and things like that? So really tapping into our resources, financial navigators being, you know, a really staple part in that is really beneficial. 00:09:44:19 - 00:09:58:03 Adam Hocking So you're really both an extension of the care team in the sense that whether it's a nurse or a doctor or, you know, a surgeon or a primary care doc, they all have different roles, but they work together to support the patient. And that would very much be your role as well. 00:09:58:05 - 00:10:05:18 Amy Severson Mm hmm. Right. Really act as the hub between the physicians, the patients, the support systems. You know, just who needs who needs what? 00:10:05:18 - 00:10:17:22 Adam Hocking When does your work change? I'm sure it does. Patient to patient. But based on the severity of of the diagnoses that you deal with, might your approach be quite different for a patient that was much more seriously ill? 00:10:18:16 - 00:10:37:16 Amy Severson It could be in a sense that everyone's going to go through their diagnosis and cancer journey differently. So there's that aspect of it. But some patients treatments may take months, some may take more than a year. So when they do know their treatment plan, they're really looking at, okay, what do I need to do today? But what's going to happen next year? 00:10:37:16 - 00:10:47:20 Amy Severson So in that helping them kind of plan for that or think about some of those things at the appropriate time is also important. 00:10:47:20 - 00:11:11:19 Adam Hocking I'm curious how the role of the family kind of plays in here and do you both, especially Amanda, you mentioned bringing a mom in who, you know, obviously has kids, is working and the illness doesn't affect just mom or just dad. Do you have a lot of interaction with with families or at least are a lot of your patients questions about what should I do for my family? 00:11:11:19 - 00:11:14:13 Adam Hocking What you know, is that a big focus for you guys? 00:11:15:00 - 00:11:46:19 Amanda Boreen I wouldn't say they're... They're not as worried about their family as they come in with their families. So they have a second person hearing what you're saying. But I don't I wouldn't say that they're concerned about them, but they just want them to know exactly what the situation is and, you know, what what kind of plan we're going to take, you know, and all avenues so they don't have to, I guess, go home and repeat themselves or just to have that support system as well. 00:11:48:06 - 00:12:08:06 Amanda Boreen I know we do have support groups that we have here that meets I think it's once or twice a month. They meet and then we have social workers to if and that that they can also meet with you if they're having, if the family and the patient are having problems. You know, you know, adjusting to the diagnosis and everything. 00:12:08:06 - 00:12:09:06 Amanda Boreen So that's helpful. 00:12:10:19 - 00:12:28:06 Amy Severson And then, yes, you're absolutely right. The patient goes through the diagnosis and the physical journey, but really the support persons and the family also go along on that journey. So it is also, you know, what do what do they need to cope? What do they need to help out? Again, being a woman who maybe always did the grocery shopping. 00:12:28:06 - 00:12:52:21 Amy Severson Now she's wondering, is my husband going to be able to fulfill all of these other roles while I'm not able to so really providing them support and and tools and resources as well. A majority of the resources are focused on the patient and their care. But we really know we need to, you know, take care of of everyone. And sometimes, you know, women think I just have to deal with this and make this work and we're there to say no, what do you need? 00:12:52:21 - 00:13:05:23 Amy Severson You know, we can help you with this. And, you know, it is short term help for you. You know, it's this isn't necessarily life long that you need this assistance, but it's important now to get you through. We need to keep you healthy and to get through this. 00:13:06:12 - 00:13:30:15 Adam Hocking I'm curious to ask both of you, when someone gets the diagnosis, probably their first thought is, oh, my gosh, I'm sick, or am I going to live? Or, you know, you have those those immediate fears. But I would imagine also, as the reality of the cancer diagnosis sets in and you've you know, you realize that you have time or it's going to be a manageable disease or whatever the situation will be. 00:13:30:15 - 00:14:03:16 Adam Hocking I would imagine your thoughts then turn to how am I, who's going to be my care team and how do I navigate the health system and how do I pay for it? And like you said, you know, how do I how do I make sure that my husband knows what he needs to do while I'm getting care? So I guess I'm wondering, I'm not looking for a percentage or anything so specific, but I'm wondering in your experience, how much of the how much of a person's stress comes from the actual diagnosis and the illness, and how much of a person's stress comes from all the other things that go with it. 00:14:03:16 - 00:14:07:17 Adam Hocking Navigating the health care system, the financial piece, I guess I'm just curious your thoughts on that. 00:14:08:09 - 00:14:37:06 Amanda Boreen I was going to say, I think it's probably a 50/50 thing, you know, I mean, they they're just I think they're just overwhelmed in general. You know, they think about the diagnosis and then they switch their thoughts over to the financial side of it. And that's where we come in and just say, don't worry about it. Don't, you know, focus on getting better and focus on your treatments and and try to give them a positive attitude and a positive outlook that they don't have to worry about it. 00:14:37:20 - 00:14:51:20 Amanda Boreen I know it's always going to it'll be there, you know, until everything is said and done with the treatments and everything. But we just try to help them in that aspect. But I don't really know a percentage, so I would say so. 00:14:51:20 - 00:15:20:20 Amy Severson And it really is, you know, based on the the situation and kind of what are the family dynamics like beforehand. Sometimes there are some underlying things that can make it a little bit more complicated, which life in general that happens. But having a navigator or someone to help facilitate your communication with your care team or to reiterate or review what happened, you know, during that visit is really important for that, for that continuity of care. 00:15:20:20 - 00:15:39:18 Amy Severson So knowing that is really beneficial to women to get going and that can be a sense of relief. There's always the kind of the hurry up and wait, I like to say. You know, get the diagnosis. We want to get, you know, the patients in within a day or so if we can just so they can get the information from the doctor and start making that plan. 00:15:39:18 - 00:15:57:17 Amy Severson And so there aren't so many unknowns. But then, of course, there's you know, we know the next step pulling out to wait and then, you know, go to that step. So looking at things one step at a time and how are we going to get through that step or get to that step is important when looking at the overall care and family support and such as well. 00:15:58:15 - 00:16:22:09 Adam Hocking Can you both talk about some of the barriers that do exist for patients or some of the challenges that you help them navigate through? I'm wondering if you can just off the top, your had a couple specifics where maybe it's something patients don't really expect that they're going to run into or they just don't anticipate. And that's what you're kind of there for, to help remove that barrier, connect them with that resource. 00:16:22:15 - 00:16:24:14 Adam Hocking Do you have some sort of specifics that you could share? 00:16:25:05 - 00:16:48:11 Amanda Boreen I know for myself, we've had a couple that their insurance is not in network with us. So we have to hustle because they want to do their care with Marshfield Clinic. So we have to hustle around with the marketplace, more so, or Badger Care to get them the right HMO or the right marketplace to be in network with us, or prior authorizations. 00:16:48:11 - 00:17:05:05 Amanda Boreen And sometimes they they take a bit longer than than needed and they know the doctor wants to start as soon as possible. So sometimes we have to delay treatments because of the prior authorizations, because we've got to have those in place before we can start treatment, because we want to be sure that it's going to be covered. 00:17:06:17 - 00:17:30:15 Amy Severson Some of the barriers that I see is there can be choices in in health care as far as treatment options or surgical options. And one doesn't necessarily expect that you go to the doctor with a diagnosis, ABCDE is what we're going to do. But you can have A or you can have B or whatever. So at times there are choices, not always, but at times there are so really we have some good mentor programs that can help with that. 00:17:30:20 - 00:17:53:08 Amy Severson Sometimes the woman just needs to talk it through with someone else who's really been through, you know, what they're anticipating, they're going to go through. Mentor programs also help because there is many different kinds of breast cancer. Not everyone knows that. So, you know, someone diagnosed with breast cancer, could be an invasive ductal carcinoma and the other one could be ductal carcinoma in situ or other treatment plants could be very different. 00:17:53:15 - 00:18:02:07 Amy Severson But one could say they both have breast cancer. So navigating through that and finding support in some of that education is important. 00:18:03:04 - 00:18:17:06 Adam Hocking And how ongoing is the is the nature of your relationships with patients? I'm sure it's again, different for for each patient and probably depends on what they need and want to. But how often are you touching base and communicating with with your patients? 00:18:17:17 - 00:18:43:23 Amy Severson I have certain timelines that I contact each patient for, so of course they're welcome to contact me in between. But from that initial diagnosis and getting things set up through their surgery, through chemotherapy, through radiation, if indicated, and then I do survivorship visits with the women. So we really recap what happened since diagnosis and all throughout treatment and then know what to expect in that follow up plan or survivorship. 00:18:43:23 - 00:18:55:08 Amy Severson So at that time it's a good ending for me. I couldn't follow every patient forever, but I can always be a resource to them in the future, no matter when they have finished. 00:18:55:08 - 00:19:17:21 Amanda Boreen I would say the same for me in the beginning as well. I have more contact just, you know, for their financial needs or if they have other needs. We give out gas cards, we can give out goodwill cards. Then towards the end of their treatment. It's just more of a follow up. If I have to follow up with if they got a free drug, sometimes it's infusions that they have every six months. 00:19:17:21 - 00:19:20:20 Amanda Boreen So we just have to follow up every six months and so on. 00:19:21:18 - 00:19:30:21 Adam Hocking I'm curious to ask both of you why you like doing what you're doing and sort of why you're passionate about about navigation services. 00:19:32:00 - 00:19:46:23 Amanda Boreen For me, I just I like helping people. I like to take the burden off their shoulders and give them a sense of relief. It's just I guess it's just my nature and and I, I enjoy helping with that. 00:19:47:12 - 00:20:03:09 Amy Severson Mine is very similar. We can make a difference. You know, if someone has a question, we can get it answered or someone, you know, has a barrier, we can find a resource. So really being that go to person and having that education and knowledge and in really knowing what to do is a good, a good feeling to help. 00:20:04:06 - 00:20:07:01 Adam Hocking Anything that I didn't ask that you guys would like to talk about? 00:20:07:15 - 00:20:29:09 Amy Severson Oh, I just wanted to say, no matter what the diagnosis or health care need is, there's no silly questions. So always ask. Sometimes patients think, well, this is my diagnosis or this is my symptom and just going to have to live with that and really until you, you know, start asking those questions, you're not going to find out if there are resources or if there is something else that we can do. 00:20:29:09 - 00:20:34:01 Amy Severson So I always, always ask questions, write them down and bring them with you to office visits. 00:20:34:14 - 00:20:38:20 Adam Hocking That's great. Amanda Boreen, Amy Severson, thank you so much for joining us on the rounds today. 00:20:39:04 - 00:20:40:06 Amy Severson Thank you for having us again. 00:20:40:11 - 00:20:48:08 Amanda Boreen Thank you. 00:20:48:08 - 00:21:12:23 Adam Hocking The Rounds is produced by Ryan Maderic and supported by the Marketing and Communications Department of Marshfield Clinic Health System. You can subscribe to The Rounds and download episodes via iTunes or by visiting Shine 365 dot Marshfield Clinic dot org. I'm Adam Hocking and I hope you'll join us next time on The Rounds.