Apr 25 2023
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With a rapidly aging U.S. population and a significant shift from hospital-based care to post-acute settings, the home infusion industry is experiencing growth into a new line of business. Ambulatory infusion centers and suites (AICs and AISs) have carved a unique space around the need for complex infusion therapies that are outside the hospital setting and supported by home or specialty infusion providers.
AIC and AIS models include pharmacy-owned or managed services. Pharmacy models can be led by physicians, nurse practitioners or registered nurses. The reimbursement differs between the two care models as well, with some pharmacies providing drug and supplies to a physician-owned infusion clinic and others providing nursing services. The National Infusion Center Association (NICA) is a nonprofit trade association and the nation’s voice for non-hospital, community-based infusion providers. They are helping pharmacies navigate the changing landscape of the infusion industry.
The ambulatory infusion therapy market is estimated to currently represent between $9 billion and $11 billion in annual U.S. healthcare expenditures. Infused drugs making up roughly $35 billion of the specialty drug market (according to CVS/caremark’s Insights 2013 Specialty Drug Trend Report).
Pharmacies are beginning to recognize the value in offering both home infusion and alternate-site infusion services to reduce costs and increase capacity which also expands the drugs they can provide, given the manufacturer guidelines for site of care administration and payor requirements. Patients are often being treated with ongoing, lengthy infusion treatments for chronic diseases and complex conditions, which include but are not limited to:
Some common diagnoses requiring infusion therapy for infections are intravenous (IV) antibiotics prescribed for cellulitis, sepsis, osteomyelitis, urinary tract infections, pneumonia, sinusitis, along with many others. The nursing shortage is another catalyst for the shift to offer a combination of home and clinic infusion services. Patients are often taught to self-infuse in the comfort of their own home, but are seen in the clinic for nursing assessments, lab drawings, or IV dressing changes.
|Manage the authorization and care coordination to maximize speed to therapy
When patients get discharged from a facility, hospital or nursing home, coordination of care is key to avoid unnecessary readmission. The management of infusion therapies requires special attention and expertise to ensure drugs are maintained in their ideal environment, given in accurate doses, and administered with appropriate devices and care.
A referral process management tool that provides communication, visibility into patient onboarding, and task accountability can decrease denials and the need for peer-to-peer reviews. Offering an easy way to collaborate using technology elevates the patient’s experience and helps pharmacies win limited distribution drug contracts.
Throughout this detailed process, it’s also important for pharmacies to perform comprehensive patient assessments and educate patients on care plans and goals. Maintaining compliance and recognizing drug reactions and proper infusion techniques are paramount to achieving success. These are highly technical therapies provided outside of the hospital, so it’s essential that pharmacies engage patients and meet regulation and professional standards of practice when specialty infusion services are provided in the home or infusion clinic settings.
|Document patient response to therapy to support the drug and dose prescribed
For specialty infusion drugs, payors often want proof that the lowest dose and most appropriate frequency of a drug is being given to the patient. The push for formulary controls on the pharmacy side and formulary restrictions by payors have the patient caught in the middle of the approval process to get the therapy they need. Implementing patient data collection processes to find out how long their last dose provided protection or relief from of their symptoms and how they tolerated their current administration, can allow the pharmacy to have supporting documentation to request a change or maintain the current plan. Keep patients on therapy by giving them an opportunity to share their experience and quickly intervene if they have side effects that could be resolved with a change of the specialty drug.
Talk to a CitusHealth expert to learn how the right digital tools can help pharmacies lean into the shift toward infusion outside of the hospital.