Essential patient care faces multiple challenges
Infusion pharmacy care is essential for patients with acute needs and those with complex conditions such as inflammatory, gastrointestinal and immunodeficiency diseases, hemophilia and cancer.
More than 3 million patients depend on home and alternate site infusion services, a 300% growth in utilization since 2008.1 But this specialized type of advanced care is facing strong headwinds through increased costs, workforce shortages and supply disruptions.
To create a sustainable future for infusion therapy and the patients who depend on it, payers, providers, employers, pharmaceutical manufacturers and advocates must work together to address and resolve these challenges.
A standard of care delivering unique value
Infusion pharmacies have played a unique role in the health care system for more than 40 years. Considered the standard of care for many medical conditions, infusion medications are delivered directly into the bloodstream, bypassing the digestive system. For patients who require intravenous medications — such as chemotherapy or antibiotics — to treat serious infections and those who rely on parenteral nutrition (PN), access to infusion therapies and other specialty services are necessary to sustain life.
Optum Infusion Pharmacy offers a safe, cost-effective and full-service option for patients needing both acute and chronic infusion therapy outside of a hospital setting. Patients overwhelmingly prefer to receive infusions at home rather than in medical settings.2 Our vast network of infusion suites, infusion pharmacies and at-home options means easy access for patients, who can choose the site that works best for them.
Patient safety is a top priority. Patients have 24/7 access to clinicians and are monitored throughout their treatment for drug interactions, medication tolerance and clinical status. Infusion nurses are specially trained to provide personalized, disease-specific care. They educate patients and their caregivers about the conditions and treatments they face, signs and symptoms of complications and how to care for their intravenous access device at home.
Optum also offers services to help patients navigate their insurance benefits, out-of-pocket costs and site of care selection. Addressing these pain points for patients — along with convenient scheduling, expert care, and continuous monitoring — has led to a 99% patient satisfaction rate.3
High costs and pressure on reimbursements creating strong headwinds
Just like food and energy costs, health care costs have increased dramatically over the last 2–3 years, putting significant pressure on infusion providers. Infused medications can be more costly than oral or injectable medications, as they require sterile compounding by a qualified pharmacy, specialized clinicians to support home administration and rigorous clinical in partnership with the prescriber. Further, some infused products, like immunoglobulin, are developed from human blood, a complex and expensive process requiring thousands of plasma donors in addition to special handling and storage. These products are also subject to strict regulatory requirements that add to operating costs.
Shortages of critical medications, disposable infusion supplies and ingredients for PN have made the situation worse over the last decade. In 2021, shortages in essential infusion products such as drugs, pumps and disposables, catheter care and supplies needed for compounding led to average annual cost increases of nearly 10%, double the normal rate. The cumulative five-year price increase per bag or one day dose of PN is more than 50% higher than it was in 2016.4 This poses a significant challenge for providers who are paid a flat per diem or per day rate for the standard ingredients and supplies in PN. Shortages are stressful for patients, who worry about whether they will receive the nutrients they need or if a provider will be available, and pharmacy staff, who spend hours trying to source needed items from a limited supply chain.
Workforce shortages in nursing are further driving up costs. More than 100,000 nurses left the workplace between 2020 and 2022 due to the stress of the COVID-19 pandemic, and 610,000 more plan to leave by 2027.5 As a result, both hiring and turnover rate costs for qualified nurses have risen dramatically.
But these costs must be paid. The importance of qualified nurses to infusion therapy cannot be overstated. Infusion therapy is labor-intensive at both the pharmacy and at the patient’s home or infusion suite. Clinical management of patients is as critical to the success of therapy as the infused medications. Without proper nursing expertise, there is a higher risk of medical mistakes and infusion-related complications. Optum is making strategic investments in nursing, including higher compensation, free access to courses required for infusion licensure and reimbursement for obtaining and maintaining advanced certification. But more must be done system wide to address the rising costs.
Even as costs to deliver infusion pharmacy care have risen dramatically, there is increasing pressure from health system payers to reduce reimbursement. As high-deductible health plan enrollments increase, the challenge is that the impact of reduced reimbursement falls most heavily on the patients who rely on these costly, life-sustaining therapies. If payers do not take the higher costs of providing infusion therapy into account in their reimbursement structure, patients are at risk of receiving lower quality service or losing service altogether. When outpatient and home infusion therapies are not available or covered, hospitalizations go up, significantly increasing the cost of care and the risk for hospital-associated infections.
The bottom line
Infusion pharmacy plays a crucial role in disease management for patients with acute or complex needs. Advances in medication therapy, an aging population and the accessibility of infusion pharmacy means more patients will rely on infusion than ever before.
Higher costs, workforce and medication shortages and reduced reimbursement pose a major threat to the infusion industry. To sustain this much-needed — and patient preferred — service for the future, it is imperative for payers, providers, employers, manufacturers and advocates to find creative ways to address these challenges.