P0041 - Client Perspectives for Informing Integration of Medical Financial Partnerships (MFPs) into a Medical Home

Background/Purpose

MFPs are collaborations in which health care systems and financial service organizations work to improve health by reducing patient financial stress. It remains unclear how to best leverage the clinical space to optimize the impact of economic support services. It is imperative to seek the voice of those served. Our objective was to elicit MFP client insights on intended use of tax refunds and perspectives on how health care systems can support their personal financial growth.

Methods

We recruited clients who utilized free tax preparation services at a large, urban, pediatric clinic in Philadelphia in 2019. We used a convenience sample of those who provided written consent for follow-up. Clients completed brief, semi-structured telephone interviews, which were informed by the Integrated Behavior Model. Two coders performed inductive & summative qualitative content analysis to derive categories and content frequency from the data. We resolved coding discrepancies by consensus and generated themes.

Results

119 individuals had federal tax returns transmitted, 61 individuals consented to outreach and 33 (54%) completed interviews. The sample comprised 30 (90%) females and 17 (52%) people with clinic affiliation (patient, patient family, or employee); 18 (54%) were new to using a volunteer income tax assistance program. 3 key themes emerged for use of refunds: family spending (home goods, clothes, child-related expenses, etc.); utilities; and managing debt/building savings. 11 (34%) reported spending money on healthcare; co-pays were the most common expense (Table 1). Elicited definitions of financial counseling consistently included budgeting and being advised on finances by a professional (Table 2). 27 (82%) people endorsed that financial counseling is a service that belongs in a pediatrician's office and 23 (70%) personally endorsed willingness to work with a counselor. The preferred structure of sessions was 1-on-1, with group settings the second preference though often in combination with 1-on-1 offerings (Table 2).

Conclusion

Our results indicate that tax refunds are most utilized for non-specific family costs, utilities, and managing debt/building savings. Respondents showed consistency in defining financial counseling. Counseling in a clinical setting has high acceptability. While services can utilize group settings, clients want individualized counseling. Program development should focus on integrating these client insights to ensure highest uptake and impact of offered MFP services.