Synergies Identified Between Health Systems and Home Infusion Pharmacies

Henry Ford once said, “Coming together is a beginning. Keeping together is progress. Working together is success.”

It is a great quote to show the necessary steps on the path to achieve success. It also shows that success is not often achieved alone, but instead takes a team approach through an established network that provides specific patient care duties.

Currently, hospitals are constantly striving for greater efficiencies and high-quality patient care. With reimbursement in flux due to potential penalties for inefficiencies, it is so very important to be strategic in how you build your team. Traditionally, payers have forced the acute care setting to drive down costs and increase profitability. However, with growing challenges in that area, many have begun to expand into the outpatient setting, as well. This most often results in an acute care hospital becoming a “jack of all trades and master of none.”

Considering that hospitals are benchmarked against facilities of similar sizes and service offerings with comparable case mix indexes, it remains a dangerous proposition for a hospital to try to master serving patient needs and billing for services in the home setting.

Adding members to your team who can support an overall continuum of care and operate in the patient’s best interest is paramount to success. To this end, it is obvious that integrating with an independently owned and managed home infusion pharmacy will allow you to provide better patient care. It is paramount to create opportunities that allow for improved efficiency with your transition of care through the discharge process, and to be impactful in managing unplanned 30-day hospital readmissions to create positive patient satisfaction and outcomes.

Opportunity

Partnerships are key between home infusion and hospitals to alleviate costs on the health system. Transitioning patients to home infusion is the preferred and most cost-effective site of care available. Home infusion shortens a hospital stay that costs, on average, between $1700 and $2300 per day. This demonstrates that the daily cost of home infusion therapy could be more than 10-fold less than if that same patient was in a hospital bed. If you are a patient who can afford the cost of health care on your own, then this option is clearly better, from both the expense and satisfaction standpoints. If you are an insurance company paying for this health care, then it allows you to keep your premiums lower and manage your risk. From the hospital perspective, it allows you to free up a bed to take care of another patient, resulting in optimal patient throughput.

Solution

Home infusion pharmacies represent a solution within the uncertain current health care economy in the United States. Inpatient pharmacies have been recognized within health systems as cost centers for more than 2 decades. The combination of salary and benefit expenses continue to challenge shrinking margins for health systems. Therefore, why not develop efficient and cost-effective strategies to transition inpatients to an outpatient provider equally interested in hospital avoidance?

Simply stated, hospitals benefit by having a full census, while optimizing patient throughput and limiting unplanned 30-day hospital readmissions. Home infusion pharmacies can aid in “hand-holding” the patient to meet their care needs in a continued effort to avoid reentry into the most expensive portal in health care: the emergency department. The current expectation of the chief pharmacy officer or director of pharmacy across the United States is to limit drug spend. The best way to achieve this goal is to avoid drug purchase and additional employee cost altogether. Hospitals should focus on acute patient care—what they do best—as this allows them to focus on their strength, instead of taking attention off the primary focus of getting patients back to their daily living activities. The alternate site of care, such as the home infusion pharmacy, can then support patient needs and further support health system efforts to maintain the compliance of CMS core measures.

Results

The insurance company perspective

Insurers notice that their average cost to service a patient admitted to the hospital with a skin or pulmonary infection is between $3800 and $7400. With a home infusion pharmacy partnership, that inpatient stay is reduced, along with the occurrence of readmission that inevitably requires less payment to a provider for ancillary services required, due to inefficient and nonstandardized care.

The hospital/prescriber perspective

The hospital notices that their Hospital Consumer Assessment of Healthcare Providers and Systems scores are going up because patient satisfaction is increasing, outcomes are improving, and readmissions are decreasing. The length of stay across multiple diagnosis-related groups (DRGs) is decreasing. The ability of pharmacy liaisons to work alongside the discharge planners for the purposes of coordinating services and patient education is optimal. Profits increase and new revenues from superior patient turnover are available for reinvestment.

The community perspective

Communities are healthier and more active through the support of outpatient clinics and their physicians by implementing hospital avoidance protocols enacted by home infusion pharmacies. Clinics run more efficiently, and hospital emergency departments are no longer utilized to care for nonemergent situations. Patients avoid having to be admitted to the hospital. Instead, they can remain in their homes to receive health care, where they are more comfortable being able to sleep in their own bed, eat their own food, and return to productive lifestyles.

Solution with implementation

When outpatient pharmacies can integrate into the hospital system, they subsequently can provide a higher level of service in every facet, from assisting with a quicker transition to providing better patient care at home. This higher level of service and observation from pharmacy services helps contribute to lower readmission rates for high-touch patients, such as patients with chronic obstructive pulmonary disease. It also can help mitigate a higher level of hospital-acquired infections and increased profitability by reducing the average length of stay across multiple DRGs, while capturing optimal reimbursement accomplished by reduced hospital exposure.

This level of integration requires management across the continuum to be heavily committed to implementation and integration in regards to both personnel and therapeutic options. These hospital and home infusion pharmacy relationships should be continually fine-tuned to accomplish synergistic and positive patient outcomes that are sustained.

Next Steps

To determine whether a home infusion-focused partnership with health systems is applicable in your market, begin with a market analysis of health systems and home infusion pharmacies in your area. When reaching out to health systems, you will find that directors of case management are often a good resource to help you understand any needs the health system may have regarding patient transitions of care. If you find an opportunity to provide a needed service, then the next step is determining how to most efficiently launch and operate a home infusion pharmacy practice.