Commercial Payors

In 2022, The National Home Infusion Association (NHIA) began focused efforts to work with commercial payors to improve how home and specialty infusion services support health plans and their beneficiaries. NHIA held its inaugural Home & Alternate Infusion Payor Summit, hosting payor representatives with responsibilities for benefit structure, network decisions, value-based programming, and specialty pharmacy policy. Every effort has been made to incorporate feedback from meeting attendees in releasing NHIA's 2023 Home and Alternate Site Infusion Contracting Recommendations for Payors.

2023 Home & Alternate Site Infusion Contracting Recommendations for Payors

NHIA has developed recommendations for commercial, Medicaid and Medicare Advantage payors to reduce administrative burden and remove barriers to accessing certain infusion services.

Designed to be incorporated into contracts between health plans and home and alternate site infusion providers, the recommendations deal with issues such as specialty networks for certain drugs; coordinating the provision of drug, supplies and services; covering preventative services; streamline authorization procedures; and more. Each recommendation includes a detailed rationale and proposed metrics to promote data collection by providers as a means of assessing the success of these proposed policy changes.

By removing barriers to outpatient infusion services, 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.

NHIA Home & Alternate Infusion Payor Summit

NHIA's 2023 Payor Summit was held August 23, 2023 in Dallas, TX. The summit, exclusive to leaders from commercial payors, provided an interactive forum to learn about current trends in home and alternate site infusion to help improve how these services support health plans and their beneficiaries.

The meeting is mostly beneficial to commercial payors with responsibilities for benefit structure, network decisions, population health, value-based programing, specialty infusion policy and medical directors.

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