The challenge

Payers are increasing restrictions on infusion services for high-cost specialty medications. Health system leaders report that these policies threaten patient safety and the financial sustainability of hospital-based infusion centers. However, many health systems lack the internal coordination to assess the impact of these policies. Additionally, payer contracts and infusion site-of-care decision-making typically fall to teams without the knowledge or tools to act in the best interest of the health system.

The organization

Avera Health is a fully integrated health system with 35 hospitals. It’s based in Sioux Falls, South Dakota. Avera’s pharmacy services include in-home and hospital-based infusion operations, a fully accredited specialty pharmacy, as well as retail, long-term care, and compounding pharmacies.

The approach

Avera Health’s pharmacy leader took a multipronged approach to streamlining site-of-care decision-making. She collaborated with critical health system leaders on understanding the options for ensuring that the right site-of-care decisions can be made in the moment. The leaders were then able to coordinate the right support for the teams responsible for making infusion decisions.

The results

Avera’s initiatives led to a significant increase in home infusion specialty drug revenue, a substantial decrease in unreimbursed infusion center drug costs, and improved payer contracts. The initiatives have also received positive feedback from Avera staff and led to an improvement in patient experience.