When pharmacy leaders at Yale New Haven Health System (YNHHS) decided to start their own home infusion pharmacy, they did so well aware of the favorable environment for the initiative.
“The market is shifting toward care in ambulatory and community environments due to a multitude of reasons,” Vinay Sawant, RPh, MPH, MBA, the executive director of system pharmacy services for Yale New Haven Health, in Hamden, Conn., told Specialty Pharmacy Continuum. “With access being one of the strategic pillars for YNHHS, we wanted to make sure we are there for our patients in a variety of settings. One of the settings is home infusion.”
The effort is paying off: Aggregate outpatient revenue share of total hospital revenues has increased from 48% in 2018 to 60% in 2021, said Dr. Sawant, citing unpublished data from CarepathRx, a specialty pharmacy and infusion consultant working with YNHHS.
Finances, however, are not the sole driver of the outpatient initiative. In the wake of the COVID-19 pandemic, more patients want to be at home, and hospitals trying to reduce length of stay are turning to innovative remote monitoring and hospital-at-home programs, Mr. Sawant explained.
Fortunately, Yale New Haven Health is well positioned to add outpatient services because it has a retail and specialty pharmacy, he noted. As for why home infusion was a logical addition, “it’s because our patients with chronic disease states or getting discharged from an acute hospital stay may need any one or all of these three services at different points, and we wanted to make sure there were no gaps in the continuity of care.”
As a bonus, clinicians referring patients for home infusion would be able to keep tabs on them through updates in the electronic health record. That is an important feature “because physicians tell us they would like to have more visibility on their patients’ progress,” Mr. Sawant said. “Currently, this is a gap directly expressed by our clinicians as home infusion gets managed by outside agencies.”
The YNHHS home infusion pharmacy service was designed to be agnostic to the health system so the pharmacy could accept patients from the health system as well as new patients referred from external providers, Mr. Sawant added.
The pharmacy team worked with CarepathRx on various aspects of the home infusion pharmacy initiative. For example, the company continues to handle intake and billing for the Yale home infusion pharmacy because of the complex nature of billing for the services, noted Nicholas LaRiviere, PharmD, MBA, YNHHS’s director of home infusion pharmacy.
Next, YNHHS created a business plan to present to hospital executive leadership, an effort spearheaded by LeeAnn Miller, PharmD, MS, CPEL, the vice president and chief pharmacy officer, and supported by Lorraine (Lori) Lee, MHA, BPharm, the senior vice president of clinical operations. The plan included estimates for the number of post-acute stay and specialty referrals, drug expenses, operational expenses, and expenses related to pharmacy and nursing labor, along with capital dollars.
Once approved, in 2019, YNHHS planned to occupy several thousand square feet of available, allotted space within an existing regional operations center on campus, including cleanroom space and clinical/shipping and storage areas. They worked with an architect and internal staff who had previous experience with cleanroom construction to design the space. Then everything came to a halt with the pandemic. Meanwhile, for staff engagement and to keep some momentum, the team supported existing pharmacy operations. They also started building and training pharmacy and nursing teams along with developing policies and procedures, “so that once construction resumed, we were ready to hit the ground running,” Dr. LaRiviere said.
Construction resumed in 2022 and was completed in February 2023, at which time the pharmacy team went through additional steps including cleanroom certification, accreditation from the Accreditation Commission for Health Care and employment of 18 full-time staff, including pharmacists, pharmacy technicians and nurses. Besides hiring their own nurses, they also contracted with local nursing agencies for additional capacity, Dr. LaRiviere said.
In other preparations, they:
- entered into contracts with governmental, commercial and pharmacy benefit manager payors;
- purchased and set up software programs for compounded products in the cleanroom, 340B tracking, telephone services and more; and
- met with practice site and care managers in various hospital departments to alert them of the new service line.
At Launch, a Wide Range of Therapies Provided
Full business operations went live in October 2023, Mr. Sawant said. To date, the pharmacy has provided medications for more than 200 patients and has more than 100 patients on service. They administer acute infusion therapies such as anti-infectives, hydration products, inotropic agents and steroids, as well as products for chronic diseases such as bleeding disorders, immunodeficiencies and rheumatologic disorders. Having their own integrated home infusion pharmacy allows for optimal transitions of care and ensures clinical continuity from care to therapy, he said. It also offers some reduced administrative burden for clinicians because the pharmacy can take over helping patients apply for financial assistance from manufacturers, and more.
The speakers said health-system pharmacies looking to expand into home infusion should make sure to gain buy-in from key stakeholders. Such pharmacies also should analyze the data provided in their business plans based on some unique nuances associated with the home infusion business, such as manual referrals and per-diem charges.
“Home infusion is kind of unique for health systems,” Dr. LaRiviere said. “We’re used to having data on everything under the sun, but the world of home infusion is still stuck on paper and faxes, and we don’t have that level of detail. You can’t just trust your assumptions on the pool of patients that you could be drawing from.”
That reliance on fax and paper is partly why tracking and reporting financial and clinical outcomes of the YNHHS outpatient home infusion program “is a mountain we still hope to climb,” Mr. Sawant said. “Our primary goal is to provide a consistent Yale signature-of-care to our patients across inpatient and outpatient settings.”
The speakers reported no relevant financial disclosures. This article is based in part on a session at the NASP 2023 Annual Meeting & Expo, in Grapevine, Texas.
This article is from the April 2024 print issue.