NHIA Releases Commercial Payer Recommendations

ALEXANDRIA, Virginia—The National Home Infusion Association (NHIA) has developed recommendations for commercial, Medicaid, and Medicare Advantage payors to reduce administrative burden and remove barriers to accessing certain infusion services. By removing barriers to outpatient infusion services, payors can reduce the total cost of care by avoiding hospital stays and emergency room visits, limiting hospital outpatient department use, and preventing admission to long-term care facilities, the group said. 

The 2023 recommendations, designed to be incorporated into contracts between health plans and home- and alternate-site infusion providers, deal with issues such as specialty networks for certain drugs; coordinating the provision of drugs, supplies and services; covering preventive services; streamlining authorization procedures; and more. Each recommendation includes a detailed rationale and proposed metrics to promote data collection by providers as a means of assessing the success and impacts of these proposed policy changes. 

The recommendations are largely the result of the association’s first payor summit, held in the fall of 2022. At that meeting, payor representatives with responsibilities for benefit structure, network decisions, value-based programing, and specialty pharmacy policy were invited to discuss ways to improve access and efficiencies associated with home and alternate site infusion services. 

“NHIA appreciates the receptiveness from payors to suggestions for how infusion providers can better support health plans and their beneficiaries,” said Connie Sullivan, NHIA’s president and CEO. “Many health plans already recognize the value of outpatient and home-based infusion therapy, and we look forward to ongoing collaboration with payors to further align infusion contracts with the patient care capabilities of our members.” 

Among NHIA’s eight recommendations, the association encourages payors to establish distinct specialty networks of locally based, full-service infusion providers to offer infused and health care professional-administered medications, which will reduce delays in treatment, improve adherence, and minimize waste. 

NHIA also recommends payors add codes for placing and managing vascular access devices (VAD), which can help avoid or shorten hospital stays and minimize emergency room utilization. Most home infusion contracts lack coverage for VAD insertions despite the fact that many providers can offer this service, which reduces the burden on hospital outpatient departments and can reduce total cost of care. 

The summit was a new step for NHIA as it expands outreach to commercial payors. Given the success and reception of the inaugural meeting, the association is preparing for a 2023 Payor Summit later in the year.