A summary of insights from the recent healthcare panel “340B Service Providers” featuring our CEO, Monique Lappas, at the 340B Coalition Summer Conference
TL;DR
- Philanthropic funding programs give hospitals powerful tools to help patients afford their medications and provide measurable benefits for 340B program transparency.
- Qualify Health CEO, Monique Lappas, outlined four key philanthropic funding options: foundation programs, copay cards, patient assistance programs, and specialty programs.
- These solutions help insured patients who face high deductibles and out of pocket costs, as well as uninsured and undocumented patients.
- Healthcare organizations can demonstrate quantifiable 340B savings benefits while reducing bad debt by up to 70% and improving patient access to lifesaving medications.
Table of Contents
Patients, even those with insurance coverage, are facing greater financial pressures. High deductibles and large out-of-pocket costs have created significant barriers to care. This is increasing bad debt at hospitals and preventing patients from accessing needed medications.
Our CEO, Monique Lappas, shared valuable insights on how healthcare organizations can leverage philanthropic funding to address these challenges AND also provide measurable benefits for 340B program transparency.
Understanding Philanthropic Funding in Healthcare
Philanthropic funding refers to a range of programs designed to help patients cover their healthcare expenses through external financial support. These programs serve as a powerful complement to 340B pricing. They provide additional resources to ensure patients can afford the medications they need.
Philanthropic funding is just using programs like copay cards, foundations, and patient assistance programs to help patients cover their expenses…. that you can use to help ensure your patients are able to afford the medications that they need.
Patient financial responsibility has increased and the significance of philanthropic programs has grown substantially. As Lappas noted, the majority of bad debt now comes from insured patients who simply cannot afford their high deductibles and copayments.
Four Key Philanthropic Funding Options
Lappas identified four primary categories of philanthropic funding that healthcare organizations can utilize to support their patients:
1. Foundation Programs
These are disease-based and income-dependent programs. They are particularly valuable for Medicare Advantage patients who often have limited options for financial assistance. Foundations periodically open application windows for specific conditions, providing substantial support to eligible patients.
2. Copay Cards
Manufacturer-sponsored copay programs represent what Lappas calls “low-hanging fruit” in patient assistance. These programs cover patient expenses related to specific treatments. They eliminate financial barriers that might otherwise prevent patients from starting or continuing necessary medications.
I used to wonder why manufacturers would do this, why would they cover the first five thousand dollars of my treatment... I came to realize that copay is a barrier to entry for patients.
These programs are typically available to patients with commercial insurance regardless of income level, making them broadly accessible and easy to implement.
3. Patient Assistance Programs (Free Drug Programs)
These programs are particularly valuable for:
- Self-pay patients
- Undocumented individuals
- Patients needing medications without prior authorization
Lappas anticipates greater reliance on these programs with the upcoming changes to Medicaid eligibility and self-pay subsidies. She emphasized that most patient assistance programs for undocumented patients don’t require residency proof to qualify, making them accessible to vulnerable populations.
One compelling example involves off-label use of high-cost medications:
We know of hospitals administering Keytruda, pretty much one of the biggest cost centres for hospital pharmacies, off-label, and the hospital just can't afford the bill for that drug.
4. Medical Devices and Specialty Programs
Philanthropic funding extends to medical devices like stents and pacemakers, as well as specialty items like nutritional supplements.
Lappas shared a striking example: “A hospital in Texas said, ‘We can’t discharge the patient because they’re going to have food security issues when they get home. Is there anything you can do?’ Turns out Abbott has a program for self-paid patients. They will ship Ensure to that patient’s home every month.”
Direct Patient Benefits of Philanthropic Funding
The impact of philanthropic funding programs extends far beyond financial metrics. They deliver real-life benefits to patients struggling with healthcare costs:
- Reduced financial toxicity: Alleviate the stress and fear associated with medical bills
- Improved medication access: Ensure patients can obtain and adhere to prescribed treatments
- Enhanced health outcomes: Support timely care without financial delays
- Increased patient satisfaction: Create positive experiences and goodwill toward providers
One patient’s experience perfectly illustrates these benefits. After receiving notification of $14,000 in assistance for her lung cancer treatment, she initially thought it was a scam. Upon confirmation, she called in tears, saying: “I’ve heard of miracles happening, but I’ve never experienced one myself until this day.”
Implementing a Philanthropic Funding Program
Healthcare organizations can implement these programs through two primary approaches:
1. Direct FTE Model
This approach requires dedicated staff members, including:
- Enrollment coordinator: Obtains patient consent and initiates applications
- Claims coordinator: Accesses billing information and submits required documentation
- Billing coordinator: Tracks payments and manages financial processes
- Pharmacy coordinator: Handles drug-specific requirements for assistance programs
- Department manager: Oversees operations and quantifies program benefits
2. Vendor Managed Model
- Technology platforms: Software that identifies eligible patients and streamlines processes
- Outsourced services: Vendors that handle enrollment, submissions, and billing
- Hybrid solutions: Combinations of internal staff and external support
Quantifiable Benefits for 340B Transparency
One of the most compelling aspects of philanthropic funding programs is their ability to provide measurable benefits that support 340B program transparency. These programs allow healthcare organizations to:
- Document direct patient benefits: Track exactly how much financial assistance each patient receives
- Quantify bad debt reduction: Measure the decrease in write-offs and collections
- Calculate investment returns: Compare program costs to financial benefits
- Demonstrate community impact: Show how 340B savings directly support patient care
Real World Results
Lappas shared examples from various hospitals across the country, demonstrating significant financial impacts:
- A Northwestern hospital secured approximately $1.6 million for insured patients with high balances
- A safety net hospital obtained about $1 million in assistance, primarily for Medicare Part B patients without supplements
- Another facility saved substantial amounts through free drug programs for self-pay patients, including those receiving high-cost treatments like Keytruda
These results illustrate how philanthropic funding can transform both patient experiences and organizational finances.
Triple Win
Philanthropic funding programs offer a unique opportunity for healthcare organizations to simultaneously support patients and strengthen financial performance. By connecting patients with external funding sources, providers can:
- Reduce financial barriers to care
- Decrease bad debt and improve cash flow
- Provide quantifiable evidence of 340B program benefits
- Enhance patient satisfaction and community relationships
As healthcare costs continue to rise and patient financial responsibility grows, these programs represent an essential strategy for organizations committed to both compassionate care and financial sustainability.
For healthcare leaders seeking to implement or optimize philanthropic funding programs, Qualify Health offers technology-enabled solutions that streamline the process, maximizing benefits for both patients and providers.
Want to learn more about how to take advantage of philanthropic funding without any extra overhead to your team? Get an instant estimate, calculate how much you could recover.
