International patients seeking cancer treatment in the United States face a number of unique barriers to care, according to Elizabeth Paucar Harris, MBA, chief executive officer at H.O.P.E., Helping Our People Everywhere.
An international patient is one traveling from abroad to the United States to specifically access medical services and treatments. They might be on vacation, in the United States for work or school, or undocumented and in need of medical care.
Oncology navigation is about breaking down barriers to care, Ms Harris said at the 2022 AONN+ Midyear Conference, and when it comes to navigating the complex healthcare system in the United States, international patients need all the help they can get. That’s where H.O.P.E. comes in.
What Does H.O.P.E. Provide?
H.O.P.E. offers patient concierge and navigation services to both local and international patients, with many traveling from South and Central America, the Caribbean, Mexico, Canada, and other countries.
“We are a private and for-profit company based in Miami,” she noted. “But importantly, we don’t turn anyone away, regardless of whether or not they can pay.”
The organization works with a network of healthcare providers, hospitals, outpatient centers, and private practices in all specialties. But according to Ms Harris, she and her team have a passion for serving patients with cancer, as most of their international patients are seeking oncology care.
She pointed out that the H.O.P.E. team does not include physicians, but together, they possess years of administrative experience within oncology. “But most importantly, we have the heart to help people,” she said. “That’s our secret to success.”
Understanding the Needs of International Patients
According to the Medical Tourism Association, about 400,000 patients travel to the United States yearly for medical treatment (usually seeking cancer and cardiology care), but this is not including patients who travel under “vacation” to access medical care.
“They usually have an overall perception that the US healthcare system offers better quality and a faster response to their medical needs,” she said. “They also come from countries where oncology treatments are not readily available due to a lack of current or relevant technology—like chemotherapies and immunotherapies—or a lack of expertise.”
She pointed out that these patients are often very sick when they arrive in the United States, as typically their local medical team has already exhausted all available resources. They may also have complex illnesses or advanced-stage cancers that require high-level medical care.
International Barriers to Care
Seeking healthcare in another country is daunting under any circumstances, but particularly when navigating cancer. Barriers faced by international patients can be psychological (ie, stress, fear, frustration navigating the US healthcare system), logistical (language barriers, extensive paperwork, lack of medical records access, passport/visa requirements, etc), or financial, as there are many unknown and unforeseen expenses related to medical care and travel.
If the patient is insured, understanding their insurance benefits, coverage details, and their own financial responsibility can be its own challenge, but if uninsured, cost becomes even more of a deciding factor when seeking care in the United States.
Ms Harris noted that many patients do not fully understand their insurance coverage. “They might only be responsible for 20% of payment, but 20% of $1 million is a lot different than 20% of $100,” she said. “Every case is different, but educating them and helping them make informed decisions is our job.”
Barriers might also be related to communication challenges, such as a lack of cultural sensitivity in many healthcare provider settings. “Patients can feel this as nonwelcoming, cold, and very transactional,” she said. “Be a cushion for them—a buffer—so they don’t have to feel all of that.”
Facilitating doctor-to-doctor case discussions with their home/local physician team is another aspect of the navigator’s role, as is communicating any necessary change in the patient’s course of treatment, all while managing their expectations, she added. “They may have already had a preliminary referral,” she noted. “But a new PET-CT after arriving in the US might change that initial plan, and it becomes a different ball game.”
Even more potential barriers concern treatment time, follow-up (what happens when they get home?) and survivorship. “Patients experience changes in their mind, body, and relationships—both personally and professionally—after a cancer diagnosis,” she said. “Providing a support system, even if it’s virtually, is part of what we do.”
How Does H.O.P.E. Help International Patients?
Compared with local patients, international patients have unique needs, and the US healthcare environment is already challenging and complex, she said. Some of the hallmarks of H.O.P.E. that help them serve international patients so efficiently are their personalized service, tight case coordination, consistent follow-up, and speed in addressing patient needs. “We are quick!” she said. “Cancer doesn’t wait, so we can’t wait either.”
Patient navigators at H.O.P.E. assess each case individually and provide patients with options for quality healthcare, whether that patient needs preventive services and/or treatment, and whether they’re insured or uninsured. They also access the most cost-effective discounts available for services and therapies, allowing more patients to get treated.
According to Ms Harris, the most valuable resource offered by H.O.P.E. is their special program for second opinions. “We work with an oncology team that reviews cases virtually for our international patients every day and provides complimentary second opinions,” she explained.
This network of oncology providers reviews each case and provides their opinion for treatment and/or next steps, usually within 48 hours (this service can only be provided when medical records are available).
“Sometimes their advice is that the patient should not come to the US for treatment,” she noted. “We don’t want them wasting their resources, but there’s always something that can be done for the patient.”
Often, patients are only looking for peace of mind through these second opinions and do not end up traveling to the United States for treatment, she said, adding that H.O.P.E. Concierge & Access Membership is an annual program with a yearly fee, but a complimentary assessment call or e-mail review, as well as second opinions, are provided free of charge.
H.O.P.E. also provides services for local patients who are struggling to pay for treatment. “We’re constantly researching financial aid, patient assistance programs, and grants,” she said. “Our local patients—as well as many local oncology practices—seek us out for these services, so we search daily for new or reopened funding and grant programs that benefit the many patients who can’t afford to pay.”
According to Ms Harris, COVID actually helped their organization in increasing their capacity to serve more patients, because virtual visits are now much more commonplace and accepted than they were prior to the pandemic. However, a personal touch remains crucial in providing top-notch care to patients navigating cancer; it requires follow-through and follow-up with all providers, and keeping patients abreast and engaged in all decisions involving their care, she said.