Robin Farmanfarmaian

Robin Farmanfarmaian

The Shift in Healthcare Delivery

Improving Patient Outcomes While Reducing Costs

We’re seeing a dramatic shift in healthcare delivery, enabled by a number of new technologies and regulations. Virtual doctor, therapist and nurse visits, clinical grade medical devices accessible to patients, and the return of the house call are changing the way patients interact with their healthcare, and for the better.

CMS (Medicare) estimates that $1T of the $3.5T US healthcare system costs are attributable to hospitals. Hospitals are incredibly important, and there are a lot of things are great for the hospital setting: operating rooms, Intensive Care Units, ERs, and major trauma centers - places that serve those patients who require immediate, intensive hands-on-healthcare in situations that could potentially be the difference between life and death. But what about other patient needs that are more routine or repeatable, like imaging, IVs, and primary care?

This article discusses shifting IV medications into the home for patients who are medically stable.

Hospitals have such high overhead, fixed, and labor costs, anything a patient does in a hospital system will cost more than if they were to do it in-home, virtually, or independent clinic.

Since the patient doesn’t need to leave home, their experience is significantly better than wasting hours traveling to a clinic, parking, checking in, sitting in the waiting room - and potentially being exposed to infectious disease. It’s similar to the difference between buying sparkling water through online grocery delivery (Instacart / Amazon) or an airport. With online grocery delivery, you typically pay less than $1 for a 16oz bottle. In an airport, for the same brand of sparkling water, you will pay $5 to $8! The end product is exactly the same, the experience and costs are the only difference.

The same thing happens in healthcare - the medication infusion is the exact same drug no matter where it is administered, it’s the prices charged and the experience that is the difference.

4 years ago, my insurer UnitedHealthcare helped move some of my healthcare into the home, including my Remicade IV infusion for Crohn’s (done every 6 weeks). I assumed it would just save me money and time. Surprisingly, it also impacted the way a medication works and the side effects experienced. Turns out, the environment in which a medication is administered can have an impact on how the patient feels during the infusion and afterwards.

I used to require 8 days to recover from the Remicade infusion when I had it done in the hospital, now that has reduced to a mild 3 days in the home. The reason is likely 2-fold. My home is a calm environment set up for me - quiet, natural light, comfortable furniture - and my kitchen stocked with my favorite foods.

The hospital infusion clinics are loud with IVs beeping, TVs blaring, tons of conversations happening - the one I used for 6 years had no windows, and 16 patients in one giant room, where you could hear everyone else’s medical problems (so much for privacy).

The second reason is that hospitals and infusion clinics carry a high risk of spreading infectious disease, purely because it is a place immunocompromised and infectious people congregate. Spending 5 hours in a busy infusion clinic is like sitting at airport security for 5 hours - stressful, loud, and you could potentially catch an infectious disease.

On the cost side, infusion clinics in hospitals have to mark the cost of the medication up, going back to the fact that hospitals are just that expensive to run, they need to raise the price of medications (among other things) in order to cover the extensive overhead of a hospital. By switching from a hospital infusion clinic to a full service pharmacy, my insurer went from being billed $28,000 per treatment to $2,100. Over 5 years, that comes out to a difference of 1 million dollars!

A full-service pharmacy typically has low overhead, and may only employ pharmacists, nurses, and administrative staff in a small, inexpensive brick and mortar building, so they can charge significantly less than hospitals. The way they work is the pharmacy has the medication delivered to the home in a temperature controlled cooler, and then deploys a nurse to mix it on-site and administer it.

Clinical trials are making the jump to in-home care as well. Science 37 and Marken (the clinical supply chain for UPS) both deliver clinical trial medications in the home. The way Science 37 works is the same way a full service pharmacy works. Science 37 supplies a tablet so that trial check-ins happen by video. Clinical trials are no longer limited to the geographic location of their clinical trials site, and patients from all over the country can join a clinical trial, no longer limited to their immediate vicinity.

There are many people who have to get regular medication by IV. This includes conditions and diseases like cancer, autoimmune, HIV, some antibiotic therapies, and more.

The ways this may improve patient outcomes include:

  • Avoiding clinics reduces exposure to infectious disease
  • Reduce top line billing and patient co-pay
  • The patient doesn’t need to waste time in a clinic waiting, they can relax at home instead, reducing stress
  • Better environment overall, as most people's homes are set up for their comfort
  • Personalized food at home
  • One nurse completely dedicated to the patient for the duration of the infusion, with no distractions or shift changes

Shifting IV medication into the home for patients who are medically stable can be beneficial in multiple ways, and help reserve the busy hospitals for patients who require the level of medical care only a hospital can provide. 

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