The National Home Infusion Association (NHIA) has developed a set of eight recommendations for commercial payers as well as Medicaid and Medicare Advantage for reducing administrative burdens and improving patient access to certain infusion services.
By removing barriers to outpatient infusion services, NHIA says payors can reduce the total cost of care by avoiding hospital stays and emergency room visits, limiting hospital outpatient department use, and preventing admission to long-term care facilities.
The 2023 recommendations are designed to be incorporated into contracts between health plans and home and alternate site infusion providers. They deal with issues such as specialty networks for certain drugs; coordinating the provision of drug, supplies, and services; covering preventive services; and streamlining authorization procedures.
Each recommendation includes a detailed rationale and proposed metrics to promote data collection by providers as a means of assessing the success and impacts of these proposed policy changes.
“NHIA appreciates the receptiveness from payors to suggestions for how infusion providers can better support health plans and their beneficiaries,” said Connie Sullivan, BSPharm, NHIA’s president and CEO. “Many health plans already recognize the value of outpatient and home-based infusion therapy, and we look forward to ongoing collaboration with payors to further align infusion contracts with the patient care capabilities of our members.”
