The steady growth in home infusion is a testament to increasing recognition of its multiple benefits. Receiving vital infusion therapy in the comfort of their own homes is appealing to patients. High-touch, high-quality home infusion has been shown to improve patient outcomes and reduce costs.
In addition to improved quality of life, home infusion allows patients to leave the hospital sooner. Reducing patients’ time in the hospital also decreases their risk of hospital-acquired infection. This is a significant benefit, particularly for patients with compromised immune systems, many of whom receive infusion therapy.
With its clear benefits to all stakeholders, the market for home infusion is expanding, driven by an aging population and growing incidence of chronic conditions, complex new medications and increased access to care for previously uninsured patients via the ACA.
But that doesn’t mean there have not been a few speed bumps along the road. For example, many physicians who were not familiar with home infusion initially were skeptical, wondering whether it was safe and effective. As evidence of the benefits has grown, physicians have become more comfortable prescribing home infusion. Hospital purchases of physician practices created another roadblock, in many cases driving the provision of infusion therapy to outpatient infusion clinics. However, this, too, is changing as hospitals see that home infusion provides excellent outcomes, reducing readmissions.
The most challenging hurdle is incomplete Medicare coverage. While Medicare reimburses most medications under Part D, supplies, pumps and other items and services necessary for the infusion are not covered. This gap in reimbursement requires patients to pay out of pocket, prompting many to receive the therapy in an outpatient hospital center or skilled nursing facility, or switch to a potentially less effective oral medication. Proposed legislation under consideration by Congress would resolve these issues.
But ultimately, as the health care reimbursement model shifts from fee-for-service to value-based, home infusion is poised for growth.
Variety of Therapies
Many infusion therapies are costly and complex, requiring comprehensive clinical management to ensure effective care. Among the many conditions treated with infusion therapies are infectious diseases, nutritional and gastrointestinal disorders, cancer and blood disorders, primary immune deficiencies, hemophilia and other bleeding disorders, autoimmune disorders and end-stage organ failure. Infusion therapies also are used for pre- and post-transplantation support.
So what does high-quality home infusion of those therapies look like? To begin with, it is provided by highly skilled and trained clinicians, including infusion pharmacists, infusion nurses and dietitians. Quality care is provided through a robust clinical management program that features:
- Personalized treatment plans
- Ongoing patient monitoring
- Outcomes tracking to identify best practices
- Extensive patient education focusing on self-care and the importance of taking medications as directed
- Access to a broad range of therapies and medications, including limited-distribution drugs, which require knowledge to provide and monitor
- Local intake resources and nationwide coverage
The Evidence for Home Infusion
It is logical that these features would result in improved care. In fact, mounting evidence demonstrates that this level of care translates into other significant benefits, including:
- Safety—Adverse drug events (ADEs) where rare and serious ADEs were nonexistent during the course of a two-year study of 1,866 infusions of infliximab (Remicade) provided to 291 Option Care patients with autoimmune disorders. By far the largest majority of ADEs in the study were mild, such as nausea or headache. Why: The Option Care nurse observes the patient throughout every infliximab infusion, monitors vital signs (from pulse to blood pressure) and watches for signs and symptoms of an infusion-related reaction. If the nurse observes a potential problem, the infusion is stopped immediately.
- Better outcomes—A first-of-its-kind study showed patients receiving immunoglobulin (IG) home infusion with a high level of clinical oversight have better outcomes compared to a large national database. Serious bacterial infections were significantly lower (.16 vs. .29 per patient per year) and serious adverse events such as renal impairment and anaphylaxis were more than four times lower (.08 vs. .34 per patient per year). Why: A high level of clinical oversight and personalized care by specially trained infusion nurses helps ensure problems are less likely to occur.
- Cutting-edge care—When registered dietitians manage home nutrition therapy, patients benefit by transitioning from home parenteral (intravenous) nutrition (HPN) to home enteral (feeding tube) nutrition (HEN) or an oral diet sooner, according to a study. The study showed that as the percentage of patients whose care was managed by registered dietitians increased during the five years of the study, the average number of days patients received HPN decreased, meaning patients transitioned off HPN earlier, as recommended by the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines. Because HPN is 10 times as expensive as HEN, this saves costs, too. Why: Option Care follows a multidisciplinary team approach to care, including infusion nurses, pharmacists and dietitians certified in nutrition support who work closely with physicians to provide quality care to HPN and HEN patients. The program includes a registered dietitian at each of its infusion pharmacies.
- Cost savings—Infusion provided at home or at an alternate treatment site (ATS) costs 50 percent less than infusion provided at hospital outpatient facilities. An Option Care study of 124 HPN and 126 HEN patients shows high-touch home infusion prevents hospitalization, saving millions in costs and improving patient care. The study showed dietitians managed electrolyte imbalance and hypoglycemia and prevented rehydration, among other interventions, resulting in an estimated 957 hospital days avoided and more than $1.9 million in savings. Why: Close monitoring by the multidisciplinary team ensures complications are identified early and remedied quickly. Costs are contained through dose optimization and recommended therapy changes, such as transitioning to lower-cost therapies.
Payers See Benefits
Recognizing the significant patient and cost benefits of home infusion, payers are increasingly focusing on shifting treatment to the lower cost site of care, known as site-of-care optimization. In a recent survey of 58 commercial health plans (representing more than 140 million people), 44 percent said they implemented site-of-care optimization programs in 2015.
Health plans are taking various approaches to shifting more patients to home infusion, according to the same survey. More than two-thirds (68 percent) require their members to use the preferred site of care; 44 percent said they contact members directly to recommend the lower-cost sites of care and 32 percent use cost-sharing incentives. That 40 percent use more than one of these mechanisms demonstrates the recognized value of home and ATS infusion.
The implementation of home infusion programs results in significant cost savings. For example, one large regional payer (covering more than 2 million lives) saved $3.1 million annually by moving patients to the lower-cost sites of care.
The quality of life, care and cost benefits of quality home infusion are clear. Patients appreciate receiving therapy in the comfort of their own homes. High-touch, high-quality home infusion has been shown to improve patient outcomes at significantly lower costs. As patients, providers and payers increasingly recognize those benefits, there is no doubt that demand for home infusion will continue to rise.