What the Post-COVID Future Looks Like for Home Infusion Providers

The pandemic brought a lot of change to the home infusion industry—and a trend toward value-based care promises more to come. Connie Sullivan, president and CEO of the National Home Infusion Association (NHIA), sat down with HomeCare during NHIA’s annual conference in Nashville to talk about the most pressing issues for home infusion pharmacists and nurses and what the future might look like for at-home infusion services.

HomeCare: I want to start off by talking a little about the amount of change that you’re seeing, and where you think things are going generally in the industry in terms of home infusion.

SULLIVAN: You know, the pandemic highlighted the need for and the advantages of home-based care. I think that patients themselves have become more aware of their options and are reaching out and advocating for their own choices to receive care at home. That’s a positive. I also think regulators are more aware of home infusion and how it works and the benefit of having that option—and home infusion providers will help fill some of the gaps.

And I think that the one thing I have heard more and more is that this is one of the ways to actually fulfill the new emphasis on equity. You know, the conversation has emerged about reaching patients in rural areas, reaching diverse communities, reaching people who have financial difficulties or transportation issues or can’t take off work—just generally, about improving access across the board. I think that is where the infusion industry is going to start helping more people, because it’s so impactful for a patient who has been taking a day off work and driving hours to a specialty office to get an infusion to be able to do that at home. I think we have always filled that gap and now people are learning more about how to tap into home fusion and how to do a better job of it.

HomeCare: What about challenges? What are home infusion providers’ biggest pain points?

SULLIVAN: I think when it comes to challenges, one of the main things is staffing shortages, of course—I’ve heard this from many people. The last few months particularly been really hard.

HomeCare: Is that mostly on the registered nurse (RN) side of things?

SULLIVAN: Not just RNs. Technicians, warehouse staff, administrative support, billing staff. I think this whole trend of moving to a remote work society has made it more difficult to hire people who need to come into the office to accomplish tasks that can’t be done at home. Home infusion providers are trying to move as many things to remote work as they can, but not everything can be done that way. Some people just have to be there.

HomeCare: Are there concerted efforts to attract people to the field? I hate to say it, but it’s probably not the sexiest thing out there in health care.

SULLIVAN: I think our industry has to get really proactive to recruit nurses and technicians. It’s usually accidental in some of the ways you run into home infusion, whether you work for a hospital and they have a home infusion [operation], or maybe you’re exposed in school. But I will say, one thing I’ve noticed is that there are a lot of young professionals here, and a lot of people here for the first time. And I am really encouraged by that. I think that’s a great sign for our industry; it’s great for NHIA and that has me more excited and optimistic. Providers are facing a lot of challenges right now, and it’s good that we are a desirable pathway, especially with all the discussion about burnout that’s been happening in health care generally and at the nurse level specifically. I mean, it’s certainly not for everyone, but hopefully over the next couple of years we can weather that.

HomeCare: Is the home infusion industry struggling with supply chain issues like everyone else? And what kinds of products or equipment are causing problems?

SULLIVAN: It’s tubing, it’s IV solutions, it’s electrolytes, it’s nutrition. It’s a lot of everything, and it evolves and it is this thing one month, and tomorrow it will be something else. And it is everywhere, but it’s really exhausting and it’s taking resources away from other things that providers would rather be doing.

HomeCare: Tell us a little bit about the data program NHIA has been developing?

SULLIVAN: I am so encouraged by our ability to gather standardized, high-quality data across the industry. Because we’re small and we started early, we are going to be in a really great position. When value-based payment models start to include more things—and we are very much in favor of being part of that type of system—we think we have the data to contribute to show that the home infusion option brings a benefit, for it just gives physicians and the at-risk providers more tools to keep the cost down, to keep people at home, and to prevent adverse events. So I really think we’re in a good place. You know, we have a lot going on and it’s hard right now because we’re still in the early phases of becoming automated. But we’ve been working with software vendors to get to the point to where the data can be transferred to NHIA automatically.

We are able to say definitively that home infusion patients have a great experience. The nurses are highly effective at training them. They’re very satisfied with the services they’re getting. They’re not discharging because of adverse events or unplanned hospitalizations at any significant rate. We’re able to say this with really large sample sizes, because we can combine the data from different companies and get to a sample size that’s really meaningful. And we’re publishing that data now in our journal, but we’re also taking this data outside of the NHIA bubble. We’ve been presenting posters at other conferences; we have a poster coming up at the national comprehensive cancer network conference about outcomes and cancer patients.

HomeCare: What’s up on your priorities list? Where would like to be in three years?

SULLIVAN: You know, in three years, I would like to see Medicare working toward a comprehensive home infusion benefit. You know, first and foremost, fix this Part B problem. It’s not working, it’s clearly not successfully reaching patients. Geographically, there are so many gaps in coverage. There are no providers in three or four states; there are many states with just one provider. … We hope we can convince them that they need to recognize all the services that are provided by the pharmacy and to restructure to help build a model that can be scaled and expanded someday; whether that’s more of a demonstration down the road or more legislation, we’re not sure yet how we get there. We want to have a lot of different strategic options.

HomeCare: There’s been a move to telehealth during the pandemic. Is that happening in home infusion, and will it stick around?

SULLIVAN: I don’t think it can fully replace all nursing visits, but it’s encouraging that they’re using more technology because that can expand the resources they have to patients. I don’t think most providers, if they’re doing it, have any way to get paid for it. That is something we might work on with commercial payers. And we are going to be kicking off an initiative to modernize our commercial billing costs … they really haven’t changed in any significant way since they were introduced in the early 2000s. There are a lot of new therapies that didn’t exist 20 years ago, and there’s really not an effective way to contract for the services.

HomeCare: Are there new therapies coming down the road as well?

SULLIVAN: There are more every year. Take monoclonal antibodies—that’s not something most people had heard about until pretty recently, and now, with COVID-19, everyone has. The data from CMS says there have been well over a million treatments, and it’s not a long period of time. I don’t know of any specific timelines, but I’m encouraged by the investment in new antibiotics. Cancer care is also an area we pay close attention to, and I think a lot of oncologists are looking at the home as a potential option for some patients.