Infusion Therapy – Making Its Way Home

July 17, 2017 By Michael D. Cantor, MD, JD Chief Medical Officer, CareCentrix
I was at dinner recently with a friend who has Crohn’s Disease. He is treated monthly with an intravenous medication called infliximab (Remicade).  Every month he drives to the hospital and spends several hours receiving his medication. When I asked why he didn’t get his medication at home instead, he didn’t know the option existed. 

My friend’s case is not unique – every month thousands of patients receive intravenous medications at infusion centers or doctors’ offices instead of getting infusions at home. 

CareCentrix helps health plans make it easier for their members to receive home infusions when clinically appropriate.  Home infusions offer value: high-quality care with lower costs.  A recent article reviewing the medical literature on home infusion found four key advantages:

1. For many patients, home infusions are as safe as infusions given in facilities. These patients did not have more reactions or side effects than patients receiving infusions in facilities. 

2. Clinical outcomes of home infusions are as good as or better than medications given in facilities.
 
3. Home infusions are less expensive than facility-based treatments. The medical review identified thousands of dollars in savings per treatment course.

4. Patients prefer to get their infusions at home and report feeling better and less stressed because home infusion is less disruptive to their lives.

Despite these advantages, there will always be a role for facility-based infusions, especially for patients who are starting on a medication and need to be observed, or if they require medications that cannot be given safely at home.

Home infusion could play a much larger role if it weren’t for current barriers. These include: Lack of knowledge by patients, insurance benefit designs that do not adequately cover home infusion costs, and the complexity of delivering infusions requires a high degree of coordination.

The first barrier, lack of patient knowledge, should be relatively easy to overcome.  When my friend considered how much time and parking money he could save by having his infusions at home, he wanted to talk to his doctor immediately. Many patients would choose a home setting if available.

The second barrier – insurance benefits – also limits home-based infusion. Medicare currently doesn’t offer a home infusion benefit – except for certain patients. Congress passed the 21st Century Cures Act last December to offer a home infusion benefit.  Unfortunately, the Act delayed the start of the new benefit until 2021, and because of reimbursement changes that took effect in January of this year, made it more difficult for patients already receiving Medicare-covered home infusions. 

The Congressional Budget Office estimates that this benefit will save $372 million in Medicare spending by 2026. Many Medicare Advantage plans currently cover home infusions, as do commercial health insurance plans.  What varies among health plans is how actively they encourage home infusions. Some leave it up to doctors and patients to decide, while others prefer certain medications to be given at home and require justification for facility-based care. 

Our experience at CareCentrix shows that when patients are offered home infusions, only 30 percent or so will take the offer. When the health plan mandates a “home first” approach, 70 percent or more of eligible patients get their treatments at home.

The third barrier to home infusions is the complexity of coordinating the medications, infusion equipment and nursing services.  Drugs must be prepared and delivered in a timely manner. A home infusion nurse must travel to the patient’s home – a challenge in rural areas. And the right equipment is required in the home.

CareCentrix maintains a large national home infusion network. We review the patient’s medical and social situation to determine the best treatment location, and collaborate with home infusion providers to ensure high quality care. We also respond to patient questions and issues immediately.

Even though home infusion is increasingly available, there are still opportunities to expand its use. Insurers are recognizing the value of home infusion therapy and are developing and implementing the benefits packages and medical guidelines to support infusion in the home. Most importantly, the new Medicare home infusion benefit will improve access for millions of Americans.

Expanding home infusion is a rare opportunity to generate cost savings, increase quality of care, and enhance patient satisfaction. It is a great example of why CareCentrix is committed to providing integrated care in the home for post-acute and chronic conditions.

 

Tags: Healthcare, home-based care, homecare, homehealth, medical devices

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