The Ripple effects of payors shifting where patients receive infusions

The Ripple effects of payors shifting where patients receive infusions

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With drug costs on the rise, payors are starting to shift where patients receive infusions. Instead of hospital settings, they’re opting for ambulatory infusion centers and suites or home infusion. According to UnitedHealth Group, administering specialty drugs in non-hospital settings can reduce costs by $4 billion each year. As this shift continues to rise, industry players need to consider the impact it can have on their businesses.

Here are four ripple effects of this shift on key industry stakeholders.

1. The payors
For payors, this shift can’t just be about cost — it must also factor in quality care. Since payors are the main drivers of site-of-care infusions, they need to consider the quality and safety of the patient experience, as well as maintaining their contracted network of providers.

2. The health systems
For hospitals and health systems, there’s a lot at stake. Non-oncology infusions are being moved out of hospital settings at a rapid rate, so these systems need to prepare by working to better understand these changes, potentially offering infusions at their own freestanding facility, investing in a home infusion program, and reclassifying sites of care when billing.

3. The patients
While patients have different preferences and diagnoses, and may be impacted in different ways, shifting infusion sites of care can still disrupt the care journey. Communication is key to maintain comfort and trust. Receiving infusions outside of the hospital may be more convenient, but patients still need to be engaged and connected with their care teams.

4. The pharmaceutical companies
With shifting sites of care, prescribers are still the primary customer of pharmaceutical companies — but these companies will still be impacted in several other ways. Impacts include specialty drug coverage by PBMs, the need for new drug education and support, and a market for more user-friendly products compatible with home care.

The shift to administering infusions in out-of-hospital settings is clear, but is your business ready to scale in order to meet these demands? Home infusion and infusion therapy providers must consider why this shift is happening and prepare for a changing industry.

Talk to a CitusHealth expert to learn how streamlining your operations can help scale your business and lean into the shift toward infusion outside of the hospital.


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