Infusion Strategy a Top Priority in 2023

A comprehensive infusion strategy will be essential for health systems to generate new revenue, care for patients, support care team workflows, and may even be required for patients to receive needed infusions through the health system.

Health systems should evaluate their broader infusion strategy portfolio considering continued payer and market forces. Systems should consider expansion across multiple infusion sites of care including hospital outpatient, physician’s office, infusion suite, and home infusion locations. A combination of multiple options implemented in a coordinated fashion is needed. For systems that are not focused on this area, multiple factors will likely continue to drive infusion business out of the health system.

Factors shifting infusion opportunities away from a health system are primarily payer driven strategies to decrease spend. These include vertical integration, shift to a lower-cost site of care and white bagging. Payer-mandated policies for specialty infused medications continued to expand in 2022, including some national payers identifying oncology immunotherapies as targets to move out of hospital-based infusion settings. These factors led to significant care fragmentation, financial risk, delays in care and waste.

Additionally, we have seen an increased presence of private equity investment into external infusion suite options to capture infusions leaving hospitals due to these policies. In 2023, as financial pressures impact employers and negative media attention revolves around high drug costs, efforts by payers to implement and expand these policies seem inevitable; continued investment in the infusion space is expected to increase competition where alternate options don’t exist.

In 2022, Coram and Optum Infusion closed a significant number of branches across the country. These players are expected to reduce their focus on traditional infusion services like antibiotics, parenteral nutrition and tube feeds. While these services can be profitable as part of a broad strategy, the national for-profit organizations recognize increased local competition and high costs to maintain necessary local relationships with referral sources. This exit will create additional challenges for care coordination when patients leave hospital settings on these therapies.

The view that expanding into alternate site infusion service options will cannibalize hospital outpatient (HOPD) infusion revenue for an organization can be seen as an antiquated one. Already, payer policies are leading to leakage out of the systems – expansion of external infusion suites is a good marker that this is happening enough to justify investment. This leakage outside health system infusion centers is frequently not quantified by the electronic health records. Additionally, HOPD capacity issues resulting in significant lead times for patients often lead to further erosion to outside providers that promise shorter lead times and “easy” access. The volume and impact of leakage is driven by the infusion site of care options a system supports and how well a system manages services and stakeholder coordination.

What can health system leaders do?

Payer mandates and benefit designs that financially incentivize the patient to receive high-cost infusion medications outside of the hospital in lower cost settings are likely here to stay. Additionally, 2023 will bring new challenges to discharge care coordination for hospitals. There are, however, great strategies health systems can employ to maintain patient access, support care coordination and mitigate the financial impact. Visante recommends that health system leaders take the following actions to maximize patient care, safety, and convenience:

• Move swiftly to create an internal home infusion program with freestanding infusion suites within the organization’s pharmacy enterprise. This will provide two new sites of care within the system, enabling the organization to more effectively negotiate with payers to keep high-quality, affordable care within the system.
• Collaborate with senior leadership and managed care leadership. Pharmacy leaders must partner with managed care teams to negotiate payer contracts that are inclusive of all internal sites of care. Seek support to consider innovative shifts in care delivery, such as home infusion and infusion suites as described above, and billing under the pharmacy benefit as described below.
• Negotiate for in-network health system specialty pharmacy. To ensure optimal continuity of care, health system specialty pharmacy should become in-network with payers for patients served by the health system.
• Take a bold stance on white bagging in your organization. Prohibit this practice and collaborate with managed care, medical staff and other clinicians to ensure policy compliance.
• Expand support of prior authorization and medication access services for all medications including hospital infusion, home infusion and specialty pharmacy. Measure the impact of site of care and prior authorization denials to identify changes that may impact financial and operational performance. Utilize insights around medication access to help measure and drive utilization of your health system pharmacy services.
• Get engaged. Support local and national efforts to address the unsafe practice of white bagging.

Here at Visante, we help hospitals and health systems to make the most of their programs and optimize savings. Contact us at solutions@visante.com to talk to one of our team members.