Supporting Continuity of Care for High-Risk Patients

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.

Bringing Infusion Services to the Home

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.¹

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.²

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.³ 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—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.⁴

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.

Patient-centric Approach in Action

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.

Continued Access to Medications

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.

Expanding Access to Telehealth

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.

Supporting Patients

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.

References

• Healthcare. Home Infusion: Safe, Clinically Effective, Patient Preferred, and Cost Saving. Published March, 2017.
• CDC. HAI and Antibiotic Use Prevalence Survey. Updated Dec. 10, 2018.
• Journal of Clinical Immunology. Impact of Site of Care on Infection Rates Among Patients with Primary Immunodeficiency Diseases Receiving Intravenous Immunoglobulin Therapy. Published Feb. 3, 2017.
• “Administering Specialty Drugs Outside Hospitals Can Improve Care and Reduce Costs by $4B Each Year” UnitedHealth Group 2019 Study