Transitioning infusion therapy patients from hospital outpatient or medical office settings to home care, when appropriate, can result in significant reductions in medical drug spending.


As payers struggle to rein in the runaway costs of specialty medications, one area of significant cost savings could be better site-ofcare management for infused therapies. Infused therapies are typically used for immune deficiency and inflammatory conditions such as rheumatoid arthritis (RA). About 40% of infused therapies for inflammatory conditions and 38% for immune deficiency are administered in a hospital outpatient setting, where they can cost significantly more than home infusion.

CASE STUDY: IVIG
Intravenous (IV) immune globulin (IG)—also referred to as IVIG—is an IV treatment administered to people who have deficient or dysfunctional immune systems or who have autoimmune diseases. While treatment varies, most patients with primary and secondary immune deficiencies receive treatment monthly and each infusion can take from 1 to 4 hours.

Medical drug spending billed for outpatient setting is on the rise. The challenge for payers is that the cost of IG administration in outpatient settings is frequently inflated by claims for charges that are common in institutional infusion settings, but either do not exist or are not traditionally charged for in home care service, such as:
  • Office visit charges
  • Exam charges
  • Prophylactic and diagnostic injection charges
  • Venous access charges
  • Infusion pump cassette/bag charge
  • Diagnostics, such as white blood and red blood counts
  • Saline infusion
  • Dextrose water
  • Heparin sodium
  • Shipping, handling, and transfer charges


LOWERING COSTS
The cost of an infusion of IVIG at Accredo in the home infusion setting is 62% lower than medical office administration costs and 87% lower than hospital outpatient administration costs.

Plan sponsors can switch their patients to Accredo home infusion services in 2 ways:
  • Benefit design change: High expected penetration, but requires system changes
  • Voluntary member transition: Members are educated on safety and convenience of home care, and the switch is made with the physician’s permission



BENEFIT DESIGN CHANGE
A change in the benefit plan design that limits use of hospital outpatient services and requires members to use home infusion services, where available and applicable, can ensure optimal transitions and savings for the plan sponsor.
  • Members are identified through a medical claim review
  • The physician is approached about transitioning to home care
  • Once the plan provides authorization and confirmation of member eligibility and benefit verification, member transition ensures continuity of care
VOLUNTARY MEMBER TRANSITIONS
Through member and physician outreach and education about the benefits of home care, the program enables voluntary transition from expensive outpatient hospital setting to home care.
  • Members are identified through medical claim review
  • Patients are sent communications (via mail and telephone) educating them on the safety, convenience, and comfort of home care
  • Outreach is conducted to physician for a prescription change
  • With member and physician permission, member transition is completed to ensure continuity of care
BENEFITS OF HOME INFUSION SERVICES
Accredo has trained pharmacists and nurses that follow therapy-specific clinical protocols to close gaps in care and provide optimal medication doses. Patients have an initial consultation and are guided through the entire process. Accredo also coordinates any steps that need to be taken with the physician to ensure a smooth transition.

Nurses go to the patient’s home to administer the medication and remain present throughout the IV infusion. The nurses train the patient on specific medication administration and visit multiple times, as needed, until the patient is fully comfortable with self-administration. Patients receive a step-by-step guide and also have access to a 24-hour call center.

This home care has a 98% patient satisfaction rate, and 99.7% of all infusions are managed through completion. In addition to IVIG, Accredo offers home care services for medications for other conditions, including enzyme deficiencies, bleeding disorders, pulmonary arterial hypertension, inflammatory conditions such as RA, and other rare diseases. SPT

References
  1. Percentage point increase of medical drug spend in the outpatient hospital setting by region, Thompson Reuters MarketScan Commercial Database, 2006-2010. Express Scripts 2011 Drug Trend Report. http://digital.turn-page.com/i/70797/43.
  2. Tankersley MA, Phillips WG, Schupp EM, Caputi, S. Comparative costs by site of administration for intravenous immune globulin: factors that impact differences. Accredo Health Group; 2010.

About the Author
Benjamin Slen, MBA, is senior director of specialty market development for Express Scripts. In this role, Ben helps health plans and large self-funded employer groups with the challenging area of managing specialty drug spend. Ben and his team develop new products and programs that clients use to reduce specialty drug spending while improving patient outcomes. Ben has been in the health care product development area for more than 10 years, including roles in new product strategy, product management, product operations, and market development. He has a master of business administration from the University of Maryland, College Park, and a bachelor of arts from Indiana University, Bloomington.