Developing consensus-based oncology financial advocacy services guidelines.

171 Background: In 2018, the Association of Community Cancer Centers (ACCC) developed the Financial Advocacy Services Guidelines to support cancer programs and practices with proactively addressing patients’ financial concerns along the cancer care continuum. Since then, research on financial hardship has expanded and the field of financial advocacy has continued to grow and evolve, necessitating new guidelines. Methods: To assess the current landscape of cancer financial advocacy interventions, ACCC conducted a literature scan of articles published between 2016 and 2021 using key words including financial advocacy, navigation, toxicity, oncology, and cancer. In May 2022, ACCC convened a multidisciplinary group of 49 national experts to begin developing new guidelines through a consensus-based Delphi process. To identify changes and additions to the 2018 guidelines, the panel completed a brief qualitative survey that asked which services are most important to include as a part of financial advocacy programs and necessary resources for effective delivery. Responses were compiled in a document and grouped by similarity using a rapid qualitative analysis approach. Results: The literature scan yielded a total of 55 articles. Several key recommendations emerged including the need to further integrate financial advocacy into care planning services, more training across team members to address financial toxicity, and ensuring services are accessible and equitable. Additional areas for research were ways to leverage technology to enhance services, when and how to screen for financial distress, and the development of care models. From the survey, responses clustered in the following domains and sub-domains: Financial Advocacy Services and Functions (Benefits Verification, Pre-Authorization, & Insurance Optimization; Financial Distress Screening; Patient Communication & Education; Financial Assistance); Program Management Functions (Staffing/Roles & Responsibilities, Staff Training, Infrastructure & Information Exchange, Monitoring & Evaluation); and Stakeholder Management Functions. Conclusions: Early input from the panel illuminated numerous areas for defining new guidelines to increase comprehensiveness, incorporate an explicit focus on health equity, and begin to tease out minimal and optimal services and program components and structure. The information from the literature scan and survey are being used by ACCC and a guidelines task force of field experts to draft new financial advocacy services guidelines, which will then go through at least two rounds of rating by the Delphi panel in order to find areas of consensus. ACCC will also hold a series of roundtables with patient advocacy, commercial, and pharmaceutical stakeholders to allow an opportunity to comment on the guidelines as well. The finalized guidelines are expected to be released before June 2023.

25 Background: Financial advocates (also known as navigators/counselors) are an increasingly important role on the multidisciplinary team to improve equitable access to care by assessing and addressing risks of financial distress for people with cancer and their families. The Association of Cancer Care Centers (ACCC) recently published consensus-driven guidelines for delivering financial advocacy (FA) services, but the field still lacks standard definition of roles, responsibilities, metrics, and benchmarks. ACCC’s Financial Advocacy Network Census survey provides an opportunity to monitor FA workforce trends over time. Methods: ACCC worked with an expert multidisciplinary committee to guide development of a Census survey. It was distributed electronically via Qualtrics to a subset of ACCC members (clinical and non-clinical staff involved in delivering FA services) in May-June 2023. Exploratory analysis was performed on 2023 Census data and results were compared to 2019-2020 Census data. Results: 95 respondents representing 70 unique cancer centers participated in the 2023 Census, compared respondents from 153 unique in 2019-20. Sample size varied between the two time points due to length of recruitment time. Most respondents were financial advocates (36% in 2023 vs 53% in 2019-20), followed by administrators (34% 3%), and nurses/nurse navigators (14% vs 21reported that their cancer center did not have any dedicated financial advocates (4% vs 10%). There was a decrease in the percentage of respondents reporting that their current level of FA staffing was sufficient to meet patient demand (13% vs 30%). A smaller proportion of respondents indicated that their cancer center did not track any FA metrics (17% vs 23%). More respondents reported receiving formal FA training (77% vs 30%). Conclusions: Despite variability in sample size across the Census time points, the trends are clear. There is growth in FA staffing since 2019, but patient demand for FA services appears to have outpaced workforce growth. There appears to be increased tracking of the impact of FA services, which can be used to support the business case for additional staff. Cancer centers can use ACCC’s FA Services Guidelines and corresponding assessment tool to measure how their current level of service delivery aligns with expert guidelines and specific standards for program metrics and training. Engagement in formal FA training has increased substantially, but an opportunity remains to reach more staff that support FA services to provide training (eg ACCC’s Financial Advocacy Network Boot Camp).

The face of the mature market for financial services has been changing. Because of the increase in life expectancy, today’s consumers at retirement age are likely to have different needs for financial services than previous generations. When it comes to marketing financial services to older adults, financial service providers should be cognizant of the diversity of older consumer needs, although their needs for convenience and personal relationships with financial vendors’ representatives are of outmost importance regardless of type of service or vendor. The importance of providing a diversity of traditional and nontraditional financial services along with membership and loyalty programs is also highlighted as gateways to cross-selling more profitable services. In order to capitalize on developments that affect the market for financial services as they relate to the aging population, financial marketers need information about the needs, preferences and habits of older Americans as they apply to financial services. This chapter presents research on older consumers’ attitudes and habits with regard to financial products and services.. Based on this information, as well as information presented in the first four chapters of this book, marketing strategies are suggested for efficient and effectual delivery of financial services to satisfy older consumers financial needs and help promote their long-term well-being.

Digital financial services continue to expand and replace the delivery of traditional financial services to the customers. The purpose of the study is twofold. First, to consider the growing interest in price modelling for financial assets. The second goal is to trace the role of digitisation in finance on changes in the methodology of both modelling and pricing of financial assets. Digitisation automates financial products and services, as a result of which the quality of financial services is increasing, the set of offers is expanding, and the financial markets are growing numerically. The transformation of finance to 'digit' allows us to provide a real basis for the widespread introduction of Bayesian methods of modelling and valuation of financial assets. The article introduces preliminary premises for the demarcation of classical and digital finance, as well as traditional and new methods of pricing and predictive modelling in connection with the wide implementation of 'big data' and 'digit'.

The number of older adults diagnosed with cancer is steadily rising, and measures for equitable, high-quality care in oncology are relatively undefined. The Association of Community Cancer Centers (ACCC), in collaboration with the Institute for Healthcare Improvement (IHI), led the first oncology-focused cohort guided by the 4Ms Framework for Age-Friendly Health Systems. Representatives from 22 cancer programs across the United States participated in a learning and action period to collaborate on building a program that provides optimal care for the older adult population. The Action Community consisted of a six-part didactic webinar series led by subject matter experts in geriatric oncology to apply the 4Ms model: What Matters, Mobility, Mentation, and Medication. ACCC asked sites to evaluate their program’s alignment with current standards using the ACCC Geriatric Gap Assessment tool and IHI’s 4Ms Care Description. Throughout the webinar series, participating sites in hospital and ambulatory settings identified a multidisciplinary team to improve workflows. The respondents answered questions regarding the frequency of assessments, documentation, and addressing inequities in their cancer program. Through a webinar poll, 90% of the participants from the multidisciplinary cancer team stated that medication was the most challenging “M” to implement and that further guidance from faculty experts was needed. More than half of the sites are progressing to earn level one (participant) or level two (committed to care excellence) recognition in the Age-Friendly Health Systems movement. ACCC has provided and will continue to provide health systems with resources for scale-up in their Age-Friendly journey.

PurposeThis paper analyses financial support services (loans and grants) from the perspective of beekeepers in Fiji's Northern Division.Design/methodology/approachA mixed-method, case study approach was used with key informant interviews, focus groups, semi-structured interviews and questionnaires.FindingsFinancial support was found to be an appropriate intervention. While beekeepers have access to loans, matching grants or small business grants to assist the establishment and growth of their activities, the appropriateness of these services varies based on the experience and skill of beekeepers. Capacity building was an important shortcoming in all financial services. It is recommended beekeeping clients undertake outcome-based, practical and/or mentorship-styled training to ensure beekeepers have the appropriate skills to maintain a viable enterprise.Research limitations/implicationsThis study was limited by a small sample size. Further research is needed to understand long-term impacts of financial support services and the availability and appropriateness of these within and between regions.Social implicationsRecommendations are provided to encourage effective financial support for beekeepers to improve the productivity, profitability and sustainability of their activities. This can impact beekeepers' livelihoods by increasing household income and income security.Originality/valueThere is a paucity of literature on the effectiveness of financial interventions to support beekeeping enterprises. This is the first study to compare financial support services from the perspective of beekeepers in the Pacific region.

6041 Background: Most cancer patients are diagnosed and treated in the community but clinical trial accrual rate is low. Published data on trial accrual from community-based cancer centers throughout the U.S. are limited. The Association of Community Cancer Centers (ACCC) is a national multidisciplinary education and advocacy organization that maintains a membership caring for over 60% of all patients with cancer in the U.S. In order to determine the clinical trial accrual patterns in the community across various geographic regions in the U.S., we performed a retrospective study utilizing the data from ACCC membership maintained at their web site. Methods: Data available from the most recent year (2003–2005) were obtained from 621 centers throughout the U.S., representing 49 states (no data for WY) and the DC. We investigated the number of patients (new and old) accrued into trials per year relative to the number of new analytical patients seen in the same year, a value we termed accrual ratio (AR). In addition, we studied the effects of geographic location, size of the cancer program, number of affiliations with National Cancer Institute sponsored cancer cooperative groups, and the number of medical/support/data management staffs on trial accrual. Results: A total of 670,215 new patients were seen across the ACCC membership with 43,743 patients accrued into trials for a median AR of 6.5% (range, 0.3–16.9). The top and bottom 5 accruing states were VT, MD, SD, LA, ID and KS, ND, VA, NH, AR, respectively. Regionally, the AR for Midwest, Middle Atlantic, West, South, Southwest, and New England were as follows: 7.4%, 7.0%, 6.2%, 6.0%, 5.7%, and 5.4% (p < 0.001). One hundred (16.1%) centers representing 11.8% of all new patients were not affiliated with any of the cooperative groups. This group had the lowest AR (3.1%). AR increased when centers were affiliated with more cooperative groups (p < 0.001) or cared for more new patients (p < 0.001). The number of medical, support, and data management staffs did not influence accrual. Conclusions: Overall, clinical trial accrual in the U.S. community cancer centers is low. Accrual patterns differed significantly among various geographic locations. Better access to trials is needed in order to improve participation of cancer patients. No significant financial relationships to disclose.

Population health issues are addressed by various regional initiatives in the Canadian province of Nova Scotia (NS). A need for research on the root causes of health inequities suggests there may be a lack of evidence to inform current initiatives within the region. To address this gap, a three-phase sequential mixed methods study called Advancing Health Equity in NS by Exploring Gaps in Healthcare Delivery will operationalize Intersectionality Theory and employ an integrated knowledge translation approach to identify and explore gaps in health service delivery. This will promote a better understanding of how to improve the integration of health equity in health service and delivery systems and thus population health and well-being. The following objectives will be addressed in each phase: 1) create an inventory of NS-relevant knowledge that relates to health equity, 2) examine the integration of health equity in NS health service and delivery systems using a context-specific health equity lens, and 3) mobilize knowledge on how gaps in service delivery can be addressed to improve the integration of health equity and better meet the needs of people living in NS. The study results from this protocol will be used to integrate health equity in NS health service and delivery systems, enhancing the quality of care for populations rendered vulnerable by structural inequalities, and working to prevent negative impacts to health and wellbeing.

The Committee on Trade in Financial Services (hereinafter, Committee or CTFS) is a committee subsidiary to the Council for Trade in Services (CTS), which itself reports to the General Council of the WTO. Shortly after the WTO Agreement entered into force, the CTS established the Committee in its Decision on Institutional Arrangements for the General Agreement on Trade in Services (Institutional Decision). The Committee acts primarily as a forum for dissemination of regulatory information specific to the often opaque financial services sector. This permits a meeting of national finance ministers and experts, as opposed to (mere) trade negotiators and representatives, who may not be in a position to understand the unique nature of national financial regulation. Fundamentally, a state's finance sector underlies all other sectors of international trade, since any transaction for goods or services requires compensation, usually monetary, thereby making the financial sector function as a sort of central nervous system for global trade. The financial services sector, therefore, is peculiar among WTO trade sectors. Indeed, the regulatory constellation for financial services within WTO law is unique: it includes two annexes to the General Agreement on Trade in Services (GATS) and two Protocols to GATS, negotiations extended well beyond the Uruguay Round and the Marrakesh Agreement's entry into force, and there is asui generisset of heightened commitments called the Understanding on Commitments in Financial Services. The Committee also acts as a monitoring body, overseeing both the implementation of legal commitments under the relevant Protocols and the specific progress of China under the Protocol on the Accession of the People's Republic of China.

Colorectal cancer (CRC) has the fourth highest death rate among patients diagnosed with cancer in the United States. More than half of incidence occurs in the Medicare-eligible population; Data shows higher rates of incidence of CRC among the Black population compared to other races/ethnicities. More than 80% of cancer care is delivered in community outpatient settings. The Association of Community Cancer Centers (ACCC), a member community of more than 28,000 multidisciplinary practitioners and 2,100 cancer programs and practices nationwide, estimates that its members treat about 65% of the nation's cancer patients. Data have shown that a lack of access to cancer treatment may contribute to inferior clinical outcomes among certain demographic populations. Understanding proximity to community cancer care is critical to improve outcomes and reduce disparities. Research question: What is the geographic relationship between ACCC members relative to Medicare Fee-for-Service (MCR-FFS) beneficiaries living with CRC? Methods The authors examined CRC claims in MCR-FFS relative to ACCC member locations, using claims data from the 2019 Medicare Beneficiary Summary (MBSF) file for CRC. Records included were for beneficiaries with “at least 1 inpatient/SNF claim or 2 HOP/carrier claims with DX codes” for any diagnosis of CRC, irrespective of stage (“qualified CRC claims”). Only zip codes showing 11 or greater beneficiaries with qualified CRC claims (“eligible zip codes”) were included due to data suppression. The ACCC member database was queried to obtain geocoded member locations. The Colorectal Cancer Index™ was used to map the data from both sources. Prevalence estimates are considered point prevalence: a numerator shows a count of beneficiaries with qualified CRC claims over a denominator of all beneficiaries in the selected geography, expressed as a percentage. CMS standard demographic definitions are used for race/ethnicity: Asian, Black, Hispanic, North American Native, White, and Other. Preliminary Findings A total of 382,295 MCR-FFS beneficiaries with CRC were identified, residing in 10,280 zip codes; 56,062 people of color (POC) reside in 1,247 eligible zip codes.A total of 663 ACCC member providers were identified. The CRC prevalence (mean average) across the 10,280 eligible zip codes was 0.98%; Prevalence in 5,826 zip codes exceeded 0.98%. The CRC prevalence (mean average) across the 1,247 POC-eligible zip codes was 0.76%; Prevalence in 941 eligible zip codes exceeded 0.76%. ACCC members are located in 663 of all 10,280 eligible zip codes (6.4%) 251 ACCC members serve the 5,826 high prevalence eligible zip codes (4.3%). 72 ACCC members are located in the 941 eligible zip codes of high prevalence among CRC patients of color (7.5%) Conclusions Regions of high CRC prevalence appear to be potentially underserved by cancer programs in terms of direct geographic proximity. Additional analysis is ongoing to understand the significance of these findings as they relate to navigating MCR-FFS beneficiaries to timely diagnosis and care. Citation Format: Michael DeSalvo Solarte, Beatriz De Lucas Sacristan, Leigh Boehmer, Lola Fashoyin-Aje, Kristin Hobbs. An analysis comparing the geographic distribution of community cancer center providers to CRC prevalence rates among Medicare beneficiaries [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A014.

390 Background: HCC incidence continues to rise and presents a myriad of complex challenges involving multi disciplines to screen, diagnose, and provide personalized therapy. Recent advances in diagnostics and therapies necessitate a well-coordinated multidisciplinary approach in managing HCC patients, signaling a need to understand care within community care. The study aimed to understand how multidisciplinary cancer programs were structured to manage HCC care and to identify challenges and practices for management of HCC, a cancer less commonly seen in community care settings. Methods: The Association of Community Cancer Centers (ACCC) developed a survey to identify factors associated with delivery and coordination of care for HCC patients. The survey deployed electronically in July 2018 to multidisciplinary providers, representing 17 oncology professions. Of responses (n = 31), 69% identified their care setting as a “non-teaching community hospital, freestanding cancer center, private practice or other.” Results: 61% of respondents indicated their cancer programs do not have specialized hepatobiliary multidisciplinary team. Among those who have hepatobiliary multidisciplinary teams the composition and degree of specialization varied. 85% of respondents that do not have a specialized hepatobiliary team indicated that HCC patients are managed in consultation with a general tumor board. 52% indicated their program discussed participation in clinical trials with all HCC patients, and 55% of cancer programs conducted HCC clinical trials. 52% indicated their program had a formal pathway that outlines adherence to the NCCN guidelines for HCC management, 5% were in the process of developing and 43% were not in the process of developing such a pathway. Of respondents that reported barriers their program faces (n = 13) 31% indicated lack of psychosocial services, lack of screening and no/limited access to clinical trials. 23% responded delayed treatment and 15% responded delayed diagnosis as challenges. Conclusions: Review of multidisciplinary care delivery for HCC patients revealed unique protocols and challenges within primarily community-based settings.

563 Background: The benefits of remote patient monitoring (RPM) in oncology for reporting of adverse effects to improve patient outcomes are well-documented. To assess real-world use and perceptions of RPM, including its role with patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Analysis was performed and responses compared using two-tailed Fisher’s exact test. Results: Of 128 staff respondents (52% MDs, 23% admin/managers, 22% other clinicians, 3% other cancer program staff), 40% worked in community, 38% academic/NCI-designated, and 20% private/physician practice settings. 34 U.S. states were represented. There was a high level of endorsement of RPM in the entire cohort; 86% of community and academic program staff agreed that RPM supplemented provider visits and informed clinical decision-making and patient/caregiver conversations. Among respondents using RPM (45%), 68% of community programs reported incorporating patient input into RPM program planning (vs 100% academic). (p=0.02). Compared to community programs, more academic programs reported planning/implementing RPM (57% vs 32%; p=0.02) and trended to have greater familiarity with RPM (80% vs 94%, p=0.07 NS). More community respondents (vs. academic) indicated concerns regarding patient comfort with RPM (80% vs 59%, p=0.05), access to a smartphone/computer (69% vs 45%, p=0.03), as well as barriers to RPM including securing funding (82% vs 57%, p=0.01) and EHR integration (61% vs 37%, p=0.02). In qualitative responses, 18% of community and 4% of academic staff described needs for provider education. Conclusions: Oncology staff across community and academic settings endorse the value of RPM to improve patient communication and clinical decision-making. There were more concerns and barriers to RPM planning and implementation reported by community programs. Nearly a third of community program staff indicated no incorporation of patient input to inform RPM planning. Further research into implementation barriers is needed, including funding/reimbursement strategies and tailoring patient/provider education to more equitably incorporate RPM across diverse cancer program settings.

The study was conducted in Wakiso District Local Government. The main purpose was to investigate the relationship between financial management and service delivery in public institutions. Specific objectives were; to establish the relationship between budgeting and service delivery in public institutions; to assess the relationship between financial records and service delivery in public institutions and to examine the relationship between financial reporting and service delivery in public institutions. Financial management was looked at from various dimensions including budgeting, financial records and financial reporting, while service delivery was determined by reliability, assurance, responsiveness, tangibility and empathy. The research design was a case study based on both quantitative and qualitative approaches in relation to cross section, correlation and regression as research designs. The methods used for data collection were questionnaires and interviews. The sample study involved Administration and Heads of departments, District Finance, and Sub County & Town Council Finance Departments, Internal Audit, District Public Accounts Committee, Resident Auditors, District Executive, Sub County & Town Council Executive with a population of 111 and a sample of 103 respondents. Data was analyzed through the use of SPSS Version 20 for quantitative purposes and grouped into categories and themes for qualitative analysis. The conclusions were drawn from tables. Based on the data and research findings, there was a positive relationship between budgeting, financial records, financial reporting and service delivery in public institutions. The study established a positive relationship between financial management and service delivery in public institutions. Hence, it made recommendations such as; Leaders and managers of Local Governments should ensure that there is effective financial management to facilitate realistic budgets, up-to-date records on finances that could be traced in service areas and they should facilitate regular financial reporting and follow-ups in Local governments so as to identify areas that they could address and ensure that services related to the reports are verifiable. The study, therefore, concludes with a call to the stakeholders in Wakiso District Local Government to enhance financial management in form of budgeting, financial records and financial reporting since it enhances service delivery

Inclusive financing strategy is the delivery of financial services at affordable costs to sections of disadvantaged and low-income segments members of the society. Previously, the main stream Commercial Banks had left out low income earners who constitute a big percentage of the Kenyan population. Development through Financial Inclusion in Kenya aims at improving the standard of living of the people. Improvement in living standards has not been confined to economic gains, or increments in per capita income. It has certainly involved improvements of people to social, cultural and political spheres of life. Rural development involves the transformation of the economic, social, cultural and political conditions of the rural people for the better in order to enable them actively participate, consciously bring about their development, take their own share of benefits and sustain such benefits for long. Surprisingly, however, two notable issues remain constant across the foregoing half-a century in attempts to address poverty and equal opportunity. About one billion people globally earn per capita income of less than one dollar per day. Increasingly poverty worsens the problems of the poor in the world today. Particularly in Sub Saharan Africa, a sharp contrast of increasing disparity between the rich and the poor, men and women or urban and rural people. Financial inclusion Strategy is the delivery of financial services at affordable costs to sections of disadvantaged and low-income segments members of the society. As a result, companies in India have developed m-payment systems on the lines of M-PESA, a mobilebased financial service, in Kenya, to increase financial inclusion by providing deposit and withdrawal services to customers in remote areas. These have increased mobilization of money in form of capital for investment to rural areas which is inaccessible by big commercial banks.

PurposeGiven that managers play a crucial role in developing and deploying AI for marketing financial services, this study was aimed at better understanding their awareness regarding AI and the challenges they are facing in providing the attendant technologies, as well as highlighting key stakeholders and their collaborative efforts in providing financial services.Design/methodology/approachExploratory, inductive research design. The data was gathered through semi-structured interviews with 47 bank managers in both developed and developing countries, including the United Kingdom, Canada, Nigeria and Vietnam.FindingsManagers are aware of the prospects of AI and are making efforts to address AI as a business need but find that there often exist certain challenges in accelerating AI adoption. The study also presents a conceptual framework of AI in relation to financial service marketing, which captures and highlights the interactions among the customers, banks and external stakeholders, as well as the regulators.Research limitations/implicationsBanks must understand their business objectives, the available resources and the needs of their customers. Managers should keep the ethical implications of their working relationships in mind when selecting a team or collaborating with partners. In addition, managers should be trained and assisted in comprehending AI in relation to financial services, while the regulators must be involved in the development of AI for financial service marketing. Finally, it is critical to communicate the prospects for AI to consumers.Originality/valueThis study provides empirical insight into the opportunities, prospects and challenges pertaining to the use of AI in the area of financial service marketing. It also specifically calls into question certain preconceptions regarding AI and its role in financial services, the chatbots adopted for financial service delivery and the role of marketing managers in developing AI.