As health plans seek to lower drug spending, they are introducing an increasing number of requirements for infusion services such as site of care and drug source. These requirements not only threaten a health system's bottom line, they also create risks for care disruptions and medication-related adverse events. More details on the implications of payer requirements on patient care can be found in this recent Advisory Board blog post.
At the end of the day, payer requirements are changing the infusion landscape and health systems need to fundamentally rethink their infusion strategy if they want to remain a provider of choice for infusion care. Read on for a breakdown of the key steps that can help organizations reapproach how they are leading infusion services.
Consider your approach to alternative sites of infusion care
Health systems need to develop a comprehensive infusion strategy that evaluates the need for, and potentially coordinates across, multiple sites of infusion care, including:
- Hospital-based infusion centers
- Provider- and community-based infusion centers
- Home infusion services
- Internal specialty pharmacy-supported injections (and potentially infusions)
It may not be possible or even necessary for an organization to invest in all four sites of infusion care. For example, your organization may have a partnership that limits its ability to develop home infusion services.
However, infusion leaders need to make sure that the health system is making that decision a strategic choice and not a default "because this is the way it's always been." This means understanding the home infusion market and evaluating whether your organization has the capacity to be successful in this space.
Developing a comprehensive, system-wide infusion strategy is achievable, but it requires thoughtful consideration of all the puzzle pieces. Even if the decision is ultimately no, a transparent decision-making process can help leaders optimize their strategy across alternative sites of care.
Elevate infusion leadership to the system level
Traditionally, various parts of the organization, including pharmacy, oncology, and patient access/revenue cycle, have played a hand in overseeing infusion. Infusion services can play an important role in a health system's strategy for patient access and home-based care.
To tap into these strategic synergies, and more, leaders over infusion services need to be positioned with a system-wide, rather than site-based, perspective.
Even when health systems do not provide infusion services across all four types of locations, executives at the system-level should be involved in developing the infusion strategy to ensure that it supports long-term system goals. In some organizations, the chief pharmacy officer, VP of ambulatory pharmacy, or VP of oncology oversees and unites infusion strategy across all infusion sites.
Establish new collaboration channels
When responding to challenges with white bagging, site-of-care requirements, and high-cost drugs, health system leaders need to work together across functional areas to ensure continuity of care for their patients and reimbursement for the health system.
Knowledge about infusion care is often siloed, which limits the health system's ability to identify critical trends and respond strategically. For example, revenue cycle teams know how often the health system is writing off denials; managed care teams know which health plans are pushing site-of-care requirements; pharmacy teams know how often clinics dispense white-bagged drugs; and provider teams know how these policies impact patients. This information only gains power to inform health system infusion strategy when it is shared across stakeholders.
Health systems can take a variety of approaches to facilitate collaboration. It may be useful to establish regular meetings for revenue cycle, managed care, and pharmacy, and impacted service lines to touch base, or to select champions from each group to form a pharmacy finance council. For some health systems, hiring a pharmacy finance expert to liaison can help build a bridge across teams.
Evaluate the opportunity to expand non-hospital infusion care
The questions below can help identify which infusion sites of care make the most sense for a health system to invest in.
Quantifying demand for non-hospital infusion care:
- How many of our patients have already moved or are likely to move to alternative sites of care based on current and anticipated payer policy changes?
- Which patients need to continue receiving care in the hospital-based infusion center (due to their risk factors, disease state, treatment complexities), and where do we draw the line?
- Are there any patient segments that we should consider proactively moving to alternative sites of care to improve convenience or lower costs?
Assessing the opportunity for health-system-owned non-hospital infusion care:
- What community-based infusion resources, such as freestanding infusion centers, infusion suites, or home infusion providers, already exist in our market(s)? How do these resources align geographically with eligible patient populations?
- What internal resources could our health system leverage to build out community- or home-based infusion services?
- Can the infusions and patients impacted by payer requirements be safely moved to non-HOPD sites of care?
- Can we achieve a positive return on investment if we establish a new site of infusion care?
Health systems need to have a strong infusion strategy to ensure that they can promptly and appropriately respond to any health plan requirement that may impact patient care. The following resources may be useful as you begin to rethink your infusion strategy.
- The infusion center pro forma can help leaders test if an infusion center (HOPD, non-excepted HOPD, and freestanding) would breakeven in five years.
- Advisory Board's home infusion market trends and investment considerations, can help leaders determine the best opportunities for their organization.
- Educate non-infusion collaborators with the Specialty medication glossary and Ready-to-use slides on payer trends in infusion services.
Thank you to the participants of Advisory Board's recent white bagging workshop, whose conversation pushed our thinking on this topic.