Patient attitudes about where they receive care are changing. A 2019 study showed a 300% increase in alternate site care since a similar study was published in 2008. Accelerated by the COVID-19 pandemic, an overwhelming 78% of patients surveyed in 2020 said they would be willing to have a clinician visit their home for chronic care.
Whether burdened by the lingering effects of the pandemic or buoyed by the flexibility of remote work, the ability to receive routine care in the comfort of their own home appeals to consumers. With this in mind, plan sponsors should embrace site of care redirection solutions for certain conditions and procedures.
Site of care redirection entails moving the dispensing and administration of specialty drugs from outpatient facilities like hospitals, clinics and doctors’ offices to patients’ homes via a specialty pharmacy and in-home nursing support.
A lower cost option for both patients and payers, site of care redirection also creates added convenience for patients who don’t have to travel, miss work or be exposed to other potentially ill patients as they get the clinically-vetted care they need for conditions like hemophilia, blood cell deficiency and inflammatory issues.
Health care spending differs greatly depending on the site of care
Compared to the cost of outpatient facilities and physician offices, the savings generated by in-home care can be enormous.
One of the primary reasons is that nearly half of specialty medications are billed under the medical benefit, where plan sponsors implement fewer cost controls. On average, physician offices charged 22% more than pharmacies for the same drugs, while hospitals charged double. Absent those cost controls, plan sponsors are paying significantly more for their members’ specialty treatment.
For example, immune globulin—an infused treatment for patients with antibody deficiencies—is often four times as expensive when billed as an outpatient claim than when it’s administered at home through a specialty pharmacy.1
The potential savings from site of care redirection are reinforced by recent data that shows how often hospitals upcharge for treatment. Based on their own publicly-reported data, National Cancer Institute-designated hospitals charge anywhere from a 118% to 633% markup on the top 25 cancer therapies. A 2021 analysis found hospitals markup drug prices by 250% on average, including:
- Neulasta, for chemotherapy patients, by 364%
- Remicade, for a variety of inflammatory conditions, by 464%
- Epogen, for anemia, by 533%
Safety is a key concern with in-home treatment
One potential stumbling block when it comes to transferring patients to in-home care is a perceived lack of safety. Will they receive the same quality of care that they would at an infusion suite or hospital? What happens if there is an adverse event (AE) that requires further medical attention?
A recent Accredo clinical research study focusing on home-infused maintenance doses of infliximab, a monoclonal antibody used to treat inflammatory diseases, demonstrated a very low incidence of patient AEs or reactions to therapy:
- 94.3% of patients reported zero AEs
- The AE rate of 4.5%—all events that could be managed at home—was half of infliximab’s product labeling rate of 9%
- The rate of serious AEs, including shortness of breath and changes in blood pressure, was only 0.35%
Another study examined 4,155 patients receiving infusions of intravenous immunoglobulin at home over a 10-month period under the clinical care of a specialty pharmacy. This review showed an AE rate of 0.53%, well below the literature benchmark of 5-55%.
This data supports the notion that redirecting specialty care to the home can be both safe and effective especially for established patients on maintenance doses of therapy.
Implementing an in-home health care plan
Through Accredo Convenient Care, there are two paths for plan sponsors who want to direct their members to lower-cost sites of care: voluntary and mandatory redirection.
Voluntary redirection involves educating the patient on the benefits of home treatment and receiving their physician’s approval before transferring care. While this is a less-disruptive method of redirection, it has a success rate of moving members to the home of only about 8%.
Mandatory redirection requires coordination to block outpatient claims from coverage and has a 75% conversion rate, but a higher risk of patient and physician abrasion. Many plans choose to begin with a voluntary approach before transitioning to a mandatory strategy for greater savings.
In-home care services as a win-win solution
Site of care redirection delivers a rare win-win proposition: lower costs for payers and increased care for patients. As plan sponsors avoid costly markups, members experience:
- A 1:1 ratio of nurses to patients, providing focused care that other infusion sites generally can’t meet
- Increased comfort and less disruption in their daily lives
- No compromise in safety or nursing experience
Moving forward, plan sponsors should recognize that utilizing an alternate site of care strategy is a cost-saving, safe and member-friendly way to optimize care.
1 Accredo 2010