Table 2.

Strategies and Future Directions to Mitigate Financial Burden and Financial Distress in Chronic Liver Disease Care

	Screening for Financial Burden and Distress	Health-System Strategies	Proposed Policy Changes and Future Directions
Financial Burden	Identify High-Risk Populations Unemployed Low socioeconomic status Underinsured or no insurance Limited English Proficiency Lower educational attainment Lower health literacy Hepatic encephalopathy Hepatocellular carcinoma Multimorbidity Liver transplant candidates/recipients	Deprescribing Switching to generic formulations Discussing lower-cost alternative approaches Early referral to co-pay and prescription drug assistance programs Interdisciplinary collaboration with pharmacists Telehealth and hospital-at-home care models Transportation and parking vouchers for clinic visits Early referral of caregivers to local and national support programs	Expanding insurance coverage for high-cost medications in chronic liver disease care Value-based drug pricing Legislation to expand paid family/medical leave and informal caregiving compensation
Financial Distress	Screen for Financial Distress Single item: “Are you having difficulty paying for your medical care?”40 American College of Physicians “Costs of Care Conversations” tools and financial screening questions42,43 Comprehensive Score for Financial Toxicity (COST) measure41	Early referral to social work services Universal screening for financial distress during clinic visits Routine costs of care conversations when developing treatment plans	Financial navigation and assistance programs specific to chronic liver disease Community health workers and patient navigators to maximize social support Comparative effectiveness and cost effectiveness studies in hepatology to inform practice guidance