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Real estate agents are fond of saying that the three most important things are location, location, location. It’s becoming more important in health care, too. Patients, providers and health plans are finding that treatment provided outside of a hospital location carries many benefits.

One type of treatment that is no longer exclusive to hospitals is infusion therapy. Infusion typically refers to a drug given intravenously. But it may also refer to drugs delivered through other non-oral routes, such as intramuscular injections and epidurals near the spinal cord.1 Many patients now receive infusion therapy in their own homes or in outpatient infusion suites.

The most common use of home infusion is for antibiotics prescribed for various infections.2 Other uses can include pain medication and nutrition. Many home infusion patients using these types of treatments can administer their medications themselves after a nurse trains them.

Home infusion treats chronic conditions like rheumatoid arthritis, some cancers, congestive heart failure, Crohn’s disease, multiple sclerosis and immune system disorders.3

According to many health care experts, the scope and range of treatments handled by home infusion will continue to expand in coming years.4

Home infusion can be a cornerstone in site-of-care management for health plans.

– Ted Kramm, CEO of BriovaRx Infusion Services
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Patient perspective: Improved outcomes, lifestyle advantages

Ted Kramm, CEO of BriovaRx Infusion Services, said the psychological and clinical advantages of receiving infusion care in the home setting are great.

For example, research shows that a home setting or infusion suite can help prevent infections. While receiving treatment in a hospital setting, about 3 percent of people acquire an infection.5 A recent study showed that patients getting immunoglobulin IV treatments at home had lower rates of pneumonia and bronchitis than those treated in a hospital outpatient infusion center.6

Bill Noyes, vice president of health information policy at the National Home Infusion Association, highlighted the psychological advantage for patients of home treatment. “With home infusion, they can stay out of the hospital environment, go about their lives and spend time with their families,” he said.

Health plan perspective: Reduced costs, equal or greater efficacy

“Home infusion can be a cornerstone in site-of-care management for health plans,” Kramm said. “The cost for providing specialty infusion drugs in the home versus infusing in a hospital outpatient setting commonly is less than half.”

And all this is happening while preserving optimal patient outcomes. A recent study found that home infusion had the same or better quality, higher patient satisfaction and lower costs.7

One area of concern is Medicare. Until recently, Medicare covered home infusion, but only the medication itself under Part D. The other costs, including supplies and labor, were not covered. 8

Congress has recently taken several steps toward creating a broader Medicare reimbursement for home infusion services that recognizes remote professional services. The 21st Century Cures Act, which goes into effect in 2021, and the Balanced Budget Act of 2018 created a temporary reimbursement beginning January 2019. Both acts work toward that goal.9

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A hybrid model: infusion suites

Home infusion companies such as BriovaRx have recently expanded beyond the home to include standalone infusion suites. These suites are not part of a hospital.

Infusion suites are emerging partly because of a growing number of patients with chronic conditions using medications that have potentially serious side effects. Physicians must monitor these medications in a medical facility.

One option currently in development is to deliver infusions at select Optum MedExpress care centers. With a full medical team, each MedExpress provides high-quality and low-cost health care at nearby neighborhood medical centers.

Adding infusion care to the existing MedExpress package could yield potential savings of 30 to 50 percent per infusion, when compared to a hospital outpatient setting.

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What’s ahead

“Most people don’t understand what home infusion is all about until they need it,” Noyes said. “It can be a way to receive high-quality health and pharmacy benefits coverage at a fraction of the cost for in-hospital treatment. And with the right care team in place, it can make patients and caregivers as self-sufficient and confident as possible.”

Home infusion services are helping to make the health system work better. As more infusion treatment options become available, home infusion solutions will become an even more critical part of the health care landscape.

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References

  1. U.S. Centers for Medicare and Medicaid Services. Home Infusion Therapy Services. Last updated Nov. 20, 2018. Accessed Feb. 11, 2019.
  2. Pharmacy Times. Ambulatory Infusion Therapy. Published Sept. 14, 2015. Accessed Feb. 11, 2019.
  3. U.S. Centers for Medicare and Medicaid Services. Home Infusion Therapy Services. Last updated Nov. 20, 2018. Accessed Feb. 11, 2019.
  4. Consult QD at ClevelandClinic.org. Overcoming the Challenges of Home-Infusion Pharmacy Care. Published Sept. 26, 2017. Accessed Feb. 11, 2019.
  5. CDC. HAI and Antibiotic Use Prevalence Survey. Updated Dec. 10, 2018. Accessed Nov. 20, 2018.
  6. Journal of Clinical Immunology. Impact of Site of Care on Infection Rates Among Patients with Primary Immunodeficiency Diseases Receiving Intravenous Immunoglobulin Therapy. Published Feb. 3, 2017. Accessed Feb. 11, 2019.
  7. Healthcare. Home infusion: Safe, clinically effective, patient preferred, and cost saving.  Published 2016. Accessed Feb. 11, 2019.
  8. Journal of the American Geriatrics Society. Medicare’s Variation in Out-of-Pocket Costs for Prescriptions: The Irrational Examples of In-Hospital Observation and Home Infusion. Published Sept. 28, 2018. Accessed Feb. 11, 2019.
  9. The Hill. Medicare policy is failing home infusion therapy patients. Published October 3, 2018. Accessed March 18, 2019.