A comprehensive infusion strategy will be essential for health systems to generate new revenue, care for patients, support care team workflows, and may even be required for patients to receive needed infusions through the health system.
Health systems should evaluate their broader infusion strategy portfolio considering continued payer and market forces. Systems should consider expansion across multiple infusion sites of care including hospital outpatient, physician’s office, infusion suite, and home infusion locations. A combination of multiple options implemented in a coordinated fashion is needed. For systems that are not focused on this area, multiple factors will likely continue to drive infusion business out of the health system.
Factors shifting infusion opportunities away from a health system are primarily payer driven strategies to decrease spend. These include vertical integration, shift to a lower-cost site of care and white bagging. Payer-mandated policies for specialty infused medications continued to expand in 2022, including some national payers identifying oncology immunotherapies as targets to move out of hospital-based infusion settings. These factors led to significant care fragmentation, financial risk, delays in care and waste.
Additionally, we have seen an increased presence of private equity investment into external infusion suite options to capture infusions leaving hospitals due to these policies. In 2023, as financial pressures impact employers and negative media attention revolves around high drug costs, efforts by payers to implement and expand these policies seem inevitable; continued investment in the infusion space is expected to increase competition where alternate options don’t exist.
In 2022, Coram and Optum Infusion closed a significant number of branches across the country. These players are expected to reduce their focus on traditional infusion services like antibiotics, parenteral nutrition and tube feeds. While these services can be profitable as part of a broad strategy, the national for-profit organizations recognize increased local competition and high costs to maintain necessary local relationships with referral sources. This exit will create additional challenges for care coordination when patients leave hospital settings on these therapies.
The view that expanding into alternate site infusion service options will cannibalize hospital outpatient (HOPD) infusion revenue for an organization can be seen as an antiquated one. Already, payer policies are leading to leakage out of the systems – expansion of external infusion suites is a good marker that this is happening enough to justify investment. This leakage outside health system infusion centers is frequently not quantified by the electronic health records. Additionally, HOPD capacity issues resulting in significant lead times for patients often lead to further erosion to outside providers that promise shorter lead times and “easy” access. The volume and impact of leakage is driven by the infusion site of care options a system supports and how well a system manages services and stakeholder coordination.
What can health system leaders do?
Payer mandates and benefit designs that financially incentivize the patient to receive high-cost infusion medications outside of the hospital in lower cost settings are likely here to stay. Additionally, 2023 will bring new challenges to discharge care coordination for hospitals. There are, however, great strategies health systems can employ to maintain patient access, support care coordination and mitigate the financial impact. Visante recommends that health system leaders take the following actions to maximize patient care, safety, and convenience:
- Move swiftly to create an internal home infusion program with freestanding infusion suites within the organization’s pharmacy enterprise. This will provide two new sites of care within the system, enabling the organization to more effectively negotiate with payers to keep high-quality, affordable care within the system.
- Collaborate with senior leadership and managed care leadership. Pharmacy leaders must partner with managed care teams to negotiate payer contracts that are inclusive of all internal sites of care. Seek support to consider innovative shifts in care delivery, such as home infusion and infusion suites as described above, and billing under the pharmacy benefit as described below.
- Negotiate for in-network health system specialty pharmacy. To ensure optimal continuity of care, health system specialty pharmacy should become in-network with payers for patients served by the health system.
- Take a bold stance on white bagging in your organization. Prohibit this practice and collaborate with managed care, medical staff and other clinicians to ensure policy compliance.
- Expand support of prior authorization and medication access services for all medications including hospital infusion, home infusion and specialty pharmacy. Measure the impact of site of care and prior authorization denials to identify changes that may impact financial and operational performance. Utilize insights around medication access to help measure and drive utilization of your health system pharmacy services.
- Get engaged. Support local and national efforts to address the unsafe practice of white bagging.
Here at Visante, we help hospitals and health systems to make the most of their programs and optimize savings. Contact us at email@example.com to talk to one of our team members.
With a 300% increase in the past 10 years, the infusion therapy marketplace continues to expand and is expected to experience continued dramatic growth for years to come. The enduring burden of chronic diseases, the rising number and costs of specialty infusion drugs, the promotion of home-based care, and the ongoing pressure to simultaneously decrease costs are all key factors in market growth.
With these challenges, there has been a great opportunity for the growth of home infusion and ambulatory infusion sites as part of broader health system infusion strategies, all of which can help deliver exceptional patient care while driving substantial financial gains for your health system.
Here’s a closer look at the benefits of establishing your own home infusion therapy program and how to begin doing so.
Why Home Infusion?
Originally, home infusion helped patients transition from the hospital setting and into a location where they can heal on their own terms to receive therapies for antibiotics, hydration, and parenteral nutrition. With expansion of services, home infusion has also helped health systems to reduce length of stay and overall cost, while effectively managing transitions of care for complex patients. Patients have also become more comfortable with home care recently due to the global pandemic.
More recently, many insurance companies have begun to preferentially require infusions for high-dollar medications to be provided in non-hospital-based locations, such as the home or an ambulatory infusion suite through site-of-care policies. Alternatively, hospitals may be required to administer medications received via a white-bag process from an external specialty pharmacy.
Home Infusion vs. Hospital-Based Infusion
Many health systems today have limited infusion options for patients, outside of hospital infusion clinics. This can lead to a lack of structure and options as far as where to send patients with new insurance company policies. With this historical infusion structure and rapidly evolving payer policies, many patients are sent to external pharmacies outside the health system, or significant clinician time is spent to obtain insurance overrides. This leads to a loss of revenue, a decline in patient experience, and additional operational challenges for clinic staff and prior authorization teams.
Health systems and the patients they serve benefit the most when infusion services are provided and managed by the health system – not by an outside organization who reaps the financial benefits that belong to the health system.
Standing up your own home infusion therapy program provides:
- Access, convenience, and quality patient care
- Immediate and new revenue sources for future growth
- Decreased revenue leakage risk
- Financial and operational attainability by nearly all health systems
- Minimal barriers to entry
Contrary to what many pharmacy leaders believe, establishing a well-designed infusion services program and making it operational in less than six months is a realistic and very achievable goal – and Visante can help.
Start Building Your Own Home Infusion Therapy Program with Visante
Visante is here to help you begin building a home infusion program tailored to the unique needs of your health system. Our team of consultants begins by conducting a thorough assessment, creating a detailed business plan, and helping you build a well-constructed home infusion site-of-care strategy that begins delivering positive ROI quickly while setting you up for a sustainable, profitable program.
Unlike firms that outsource infusion services and reap the financial benefits for themselves, Visante is firmly committed to helping you stand up your own infusion site-of-care strategy. We are firm believers that your infusion services program should serve you, your providers, and your patients well in the long term. Our approach ensures patient care benefits, significant cost reductions, and access to a strong revenue stream stay within your health system to strengthen your organization today and for years to come.
Contact us today to learn more about a system infusion assessment, site-of-care and white-bagging challenges, or about building your own home infusion therapy program.