Michael Zeglinski, CEO, Optum Specialty & Infusion Pharmacy

The word “home” took on new meaning last year as we navigated the changes and challenges of the COVID-19 pandemic. Fewer people seeking outpatient medical visits resulted in fewer prescriptions administered in a provider setting and an uptick in pharmacy-administered drug use.

Pharmacies offered fast home delivery of medications for free or low cost and the health care system witnessed the rapid growth of home health services. Even before COVID-19, surveys showed that patients preferred virtual visits that cut back on travel time and made their lives easier.

Home infusion of specialty medications was an outpatient service offered to patients before the pandemic started; however, with COVID-19, home infusion became more important than ever by allowing patients the safety of remaining in their own home and reducing their risk of exposure. Providers know that patients who choose to receive therapy at home are receiving comprehensive care that can increase compliance and adherence.

Not only is home infusion safer and more convenient for patients, there are benefits for everyone, including providers and payers. Research shows that 99% of patients using Optum home infusion services remain infection-free, compared to 97% for patients who receive their treatments in a hospital setting.

Additionally, in a safe home environment, payers know that their members are receiving excellent care at the lowest cost, with results showing that home infusion saves between $1928 and $2974 per treatment—and can save the US health care system $40 billion over 10 years.

Looking Ahead: Additional Home Care Trends and Drivers

As we start to emerge from COVID-19 in the United States, patients are beginning to use home care in new ways. Several trends have come to light that are expected to continue influencing adoption and drive use of home care services, especially in specialty pharmacy for patients requiring high-touch care.

: Services such as telehealth, in-home care, and infusions result in greater cost-savings—consumers can save between $19 and $121 for every telemedicine visit.

 It’s also often safer and more convenient.

Seamlessly delivering care that is adaptable from in-home to in-person visits and offering a connected network of integrated services is a key driver of home-care trends. The tools and technology to make these services possible will undoubtedly continue to improve and expand.

Innovations for remote patient monitoring, telemedicine delivery channels, and stronger collaborations between providers, pharmacists, long-term care facilities, and clinics are refining the telehealth of tomorrow.

Prior to COVID-19, there were several restrictions mandated at the federal level regarding the types of service covered in a telehealth setting. As the need to support overburdened hospital systems and provide greater safety precautions became apparent, more than 80 new medical services were authorized by the Centers for Medicare and Medicaid Services to allow coverage for telehealth visits, including mental and behavioral health, ophthalmology, and cardiology.

Even at the federal level, evolving telehealth policies allow greater access to services and delivery technologies. Of the 60%–90% of providers who are using telehealth, half are a result of COVID-19.

Home medication delivery also increased during the pandemic and continues to play an important role in remote-based health care. Patients who receive prescriptions via virtual visits can have their medications delivered, often at no charge, and sometimes within 24 hours.


Integrated Mental and Behavioral Health Care: 

A recent poll from the Kaiser Family Foundation found that 4 in 10 US adults reported symptoms of anxiety or depression during the pandemic, up from 1 in 10 adults in 2019. COVID-19 and the drastic lifestyle changes that followed succeeded in shining a light on the importance of mental health as part of a holistic care experience.

Receiving care in the comfort and convenience of the home has been shown to improve patients’ physical and mental wellbeing. In addition to telepsychiatry options, OptumRx integrates mental health checks with patients and can seamlessly refer them to care through Genoa pharmacies to treat the whole patient and realize improved health outcomes.

COVID-19 resulted in many changes to the health care landscape. As we continue to navigate the future of home health care options, it is important to keep in mind that the biggest barrier to care is cost. It’s no secret that the rising cost of health care, especially in specialty medicine, is a concern across the board.

One of the benefits—and reasons for growing adoption of home health services—is that it drives affordability for patients and payers. With the benefits far outweighing any hurdles or challenges, home care services will continue to be a vital option for specialty patients for years to come.

COVID-19 Complicates Access to Provider-Administered Autoimmune Treatments

https://www.unitedhealthgroup.com/newsroom/posts/2019-09-09-reducing-specialty-drug-costs.html

https://www.ama-assn.org/practice-management/digital/telehealth-s-post-pandemic-future-where-do-we-go-here

https://www.ajemjournal.com/article/S0735-6757(18)30653-3/fulltext

https://www.genoahealthcare.com/insights/blog-post/serving-our-communities-during-the-pandemic/

Articles

Home infusion of specialty medications was an outpatient service offered to patients before the pandemic started; however, with COVID-19, home infusion became more important than ever.

Navigating Patient Home Care During COVID-19 and Beyond

The ongoing challenges of the coronavirus disease 2019 (COVID-19) pandemic are disproportionally affecting specialty patients with chronic medical conditions, including high-risk populations such as the elderly and immune-compromised. Patients taking a specialty drug often rely on enhanced clinical services to ensure safe use of the drug and optimize therapeutic outcomes.

As some restrictions to stop the spread of COVID-19 are being eased, protecting patients’ access to safe and effective medications is critical to continuity of care.

The health care system has the opportunity to use its existing patient-centric approach in new ways to meet the current needs of specialty patients during this evolving time. From providing infusion services in patients’ homes to expanding telehealth and virtual treatment, flexibility in how patients receive the care they need will be instrumental in keeping people safe and adherent to therapy during and after the outbreak.

Ensuring patients continue receiving life-sustaining infusions traditionally administered in the hospital or hospital clinic settings is of the upmost importance. In-home infusions have been a safe and dependable way to meet clinical needs while reducing public exposure risk.

Home infusion services deliver patient safety, satisfaction, and positive clinical outcomes, while facilitating convenience and reducing travel time to care sites. In fact, many patients prefer home infusion, reporting higher levels of physical and mental wellbeing and less disruption of family and personal responsibilities.

Research shows that a home setting for infusion services can help prevent infections. While receiving treatment in a hospital setting, approximately 3% of people acquire an infection.

One study showed that patients administered intravenous immunoglobulin (IVIG) treatments at home had lower rates of pneumonia and bronchitis than those treated in a hospital outpatient infusion center.

On top of the clinical benefits, at-home access delivers significant cost savings for patients and health plans.

Optum research shows that moving patients out of the hospital to other care sites—such as the home, infusion clinics, and the physician’s office&mdash;can help lower medical and pharmacy costs by up to 52% and delivers up to $37,000 in savings per patient depending on disease state and site of care.

While leveraging an at-home model for infusion therapies, it is crucial that nurses and patients take action to ensure they are following best practice guidelines to prevent exposure to the novel coronavirus. Personal protective equipment (PPE) such as masks and disinfecting supplies must be provided to nurses when caring for patients suspected of, or diagnosed with, COVID-19.

But this action is not enough, as face masks are recommended to be worn by nurses and patients in all other visit scenarios to reduce the risk of asymptomatic exposure. These precautions, along with other guidances such as frequent handwashing and resources from the CDC, promote the safety of the patient and nurse.

At the same time, the health care system can empower providers with education not only on the benefits and dependability of home infusion services, but how to effectively transition patients to this care to ensure seamless continuity. Providers also must be made aware of all the flexible services that may be available, like at ambulatory suites with extended hours, and how treatment options are able to adapt as the pandemic continues to evolve.

One Optum patient has managed his chronic inflammatory demyelinating polyneuropathy (CIDP), a neurological disorder that targets the body’s nerves, with IVIG therapy for 5 years. Given his familiarity with home infusion therapy, when COVID-19 shut down his home state of Florida, he was able to contact his Optum home health nurse to immediately develop a plan of action and discuss his safety concerns. Managing a rare disease such as CIDP put him in the high-risk category.

To protect the patient and herself, the Optum home health nurse wears PPE when she visits twice a week for his home infusions and double disinfects equipment and the areas. They remain in close contact if there are any unusual symptoms to ensure they both feel safe and comfortable with coming into the home to provide the needed therapy.

For specialty patients, staying adherent to prescription medications is essential and even more critical during a pandemic. Missing a dose or stopping a medication can result in adverse health effects and increased health care costs.

While physical access to pharmacies and doctor offices may have shifted, Optum remains focused on continued access to medications and care to ensure patients are able to easily obtain their medication and effectively manage their chronic conditions. This includes policies evolved to extend prior authorizations on certain medications or alerting patients of options for medication home delivery so they don’t have to leave their home.

In addition, it is also important to continue monitoring the drug supply chain in order to secure adequate amounts of critical medications as needed and use anticipatory analysis to determine if, and when, the pharmacy needs to expand to maintain the necessary supply.

Both patients and caregivers likely have concerns about in-person doctor visits. Fortunately, many providers and pharmacists are available to address questions, elevated symptoms and provide diagnosis or support via phone, tablet, or computer. Video-enabled devices, for example, allow for a visit like an in-person appointment would. Although certain providers may not have previously offered telehealth options, many are now integrating telehealth into their practice.

Along with any subsequent medication discussions, specialty pharmacists are also able to consult patients on medication-specific questions, concerns and options. A virtual visit streamlines the sharing of information as well, allowing patients and their caretakers to access informative and educational content more easily.

With Optum Connections virtual visits, patients gain a better understanding of the educational materials included with their prescriptions.

The COVID-19 pandemic has left many seeking information about their medication access, safe options for obtaining refills and needed infusions, and telehealth offerings. During a time like this, the importance of our work and our ability to serve patients and address the needs of the health care system are more sharply in focus.

As part of UnitedHealth Group, Optum Specialty and Infusion Pharmacy remains focused on strengthening continuity of care and bringing more robust pharmacy services to those we serve. As patients, clients and communities need our expertise and capabilities more than ever, we are acting swiftly and deliberately to ensure we continue to provide safe and appropriate access to medications and pharmacy care services.

Home Infusion: Safe, Clinically Effective, Patient Preferred, and Cost Saving.

Impact of Site of Care on Infection Rates Among Patients with Primary Immunodeficiency Diseases Receiving Intravenous Immunoglobulin Therapy

“Administering Specialty Drugs Outside Hospitals Can Improve Care and Reduce Costs by $4B Each Year” UnitedHealth Group 2019 Study

Ensuring patients continue receiving life-sustaining home infusions that were traditionally administered in the hospital or hospital clinic settings is of the upmost importance.