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Case Study

How Avera Health Took Control of Infusion Site-of-Care Decisions

10 Minute Read

Key Takeaways

The challenge

Payers are increasing restrictions on infusion services for high-cost specialty medications. Health system leaders report that these policies threaten patient safety and the financial sustainability of hospital-based infusion centers. However, many health systems lack the internal coordination to assess the impact of these policies. Additionally, payer contracts and infusion site-of-care decision-making typically fall to teams without the knowledge or tools to act in the best interest of the health system.

The organization

Avera Health is a fully integrated health system with 35 hospitals. It’s based in Sioux Falls, South Dakota. Avera’s pharmacy services include in-home and hospital-based infusion operations, a fully accredited specialty pharmacy, as well as retail, long-term care, and compounding pharmacies.

The approach

Avera Health’s pharmacy leader took a multipronged approach to streamlining site-of-care decision-making. She collaborated with critical health system leaders on understanding the options for ensuring that the right site-of-care decisions can be made in the moment. The leaders were then able to coordinate the right support for the teams responsible for making infusion decisions.

The results

Avera’s initiatives led to a significant increase in home infusion specialty drug revenue, a substantial decrease in unreimbursed infusion center drug costs, and improved payer contracts. The initiatives have also received positive feedback from Avera staff and led to an improvement in patient experience.

 

Approach

How Avera Health took control of infusion site-of-care decisions

At Avera Health, a pharmacy leader convened and educated key stakeholders across the health system about pharmacy site-of-care issues. The resulting multidisciplinary work group developed strategies to support more appropriate site-of-care decisions. The connections forged through this work group have better prepared Avera Health to respond to future payer challenges.

 

The three elements

There are three key elements to Avera Health’s process of determining infusion site-of-care decisions:

  • Element

    Form strategic work group to engage key stakeholders

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  • Element

    Invest in infusion advocates to proactively tackle payer restrictions

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  • Element

    Provide pharmacy support to strengthen payer contracting

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Results

In addition to better internal collaboration and improved payer contracting, Avera Health has seen positive financial implications as well as satisfaction among patients and staff.

Realized hard-dollar value in savings, revenue

Infusion advocates help the system avoid approximately $30K per week in unreimbursed drug costs by ensuring scheduled infusions have an active prior authorization. They also generate additional revenue by limiting leakage of infusions otherwise sent to external providers. The infusion advocate’s impact extends to increases in home infusion specialty drug revenue and prescription volume.

300%

Increase in average home infusion specialty drug revenue in the first half of 2020 compared to the first half of 2019

Improved patient experience

The results also go beyond financial implications. Infusion advocates have improved the patient experience by identifying financial assistance and managing site-of-care issues before they impact patients. This has led to a notable decrease in patient calls and unpaid claims.

Promoted staff well-being

Infusion advocates enable Avera’s clinical staff to spend more time delivering patient care by taking over tasks related to appeals, prior authorization, and financial assistance. The role is also an additional opportunity along the pharmacy technician career ladder.

$442K

Total value of financial assistance identified for Avera infusion patients

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