In my last blog post, Infusion Alphabet Soup Part 1, I discussed the various infusion acronyms as distinct categories (e.g. distinct service locations and distinct classes of trade). You may need to go back and read that past blog post to fully understand the meaning of the acronyms used here.
The OIC, AIC, HIP, SpecRx, etc. models exist today often as distinct organizations operating in most major and outlying cities throughout the United States. However, it is becoming more common for innovative thinking organizations to combine a core model, like HIP, by adding on a SpecRx or AIC. There are many combinations of models operating today, and many more savvy entrepreneurs and businesses are creating new combinations each year.
Something New – the “MDP”
I have never known what to call these hybrid like / combination models, so I am just making this up right here. I am just going to call this combined model a MDP or “Medication Delivery Platform”. At a minimum, I think that a company qualifies as a MDP if it combines some form of a pharmacy (home infusion or specialty) with an ambulatory provider model (physician-based infusion suite (OIC) or stand-alone infusion center (AIC)). When I think about MDPs, several industry leading organizations come to mind, such as TwelveStone, Vivo, Flexcare, Soleo, Palmetto, and Paragon.
Often consisting of multiple distinct subsidiary entities under a parent umbrella company or umbrella brand, this MDP model is the most dynamic, flexible, and capable model being developed across the country. There were just a few of these MDPs operating in pockets starting in the early 2000s, but today I am seeing more and more of these platform models being created as private equity and larger strategic operators have purchased and housed these various classes of trade and places of service under one company logo.
Commonly, the basic MDP model combines a traditional HIP and AIC. This combination allows a company to pretty much say “yes” to almost any patient referred by a physician across almost any specialty. A MDP has the ability and flexibility to care for a patient in the environment that is best for them, whether it be in a patient’s home or an outpatient infusion center.
An even more flexible MDP takes the model above and adds on a SpecRx (specialty pharmacy). This is by far my favorite combination as it allows the company to not only say “yes” to almost any referral, but also increases the odds that the company will be able to keep that patient through the lifetime of their medication journey.
A Case for the MDP
Patients with chronic conditions and autoimmune disorders are the primary population in any infusion model. These patients are people, so their lives and their diseases are dynamic. This means that they will change jobs, marriage status, and income levels over many years. Those changes mean that their insurance coverage for their medications will also change. Combine those changes with the fact that many patients will also change their specialty medications at least one or two times in their lifetime–if not more–and you have several obstacles to keeping that patient on service under a single company logo.
Some insurance coverage and some medications have better coverage in the home setting, while others are best in the infusion center setting. Some medications are only provider-administered, while others are patient self-administered. Each of the distinct models we discussed in our previous blog has its very own advantages and disadvantages when it comes to insurance coverage, medication administration requirements, and place of service.
A MDP model ensures that not only can the company say “yes” to the original referral, but chances are a MPD organization can continue to say “yes” to that same patient as they navigate the complexities of their life and their disease treatment changes.
Example Patient Journey with a MDP
Consider a young patient diagnosed with PIDD (primary immunodeficiency disorder). Let’s say that the patient was originally prescribed Gamunex® IVIG (intravenous immunoglobulin). Gamunex is commonly a provider-based infusion medication that is not typically self-administered; most Gamunex patients will need the services of an outpatient infusion center (e.g. HOPD, OIC, AIC or AIS).
After many years, maybe the patient changes jobs with new insurance, or maybe they move farther out of town away from their infusion center or suite. Whatever the reason, the patient changes to Gamunex subcutaneous (SubQ) as a self-administered option at home. The patient is no longer going to the infusion center and Gamunex SubQ is typically acquired through a specialty pharmacy.
Let’s fast forward several years again, and the patient has now reached the age where they no longer feel capable of doing self-administered SubQ IG in the home. At this point, depending on their coverage, they may qualify to have a nurse come to their home to administer Gamunex IVIG. Likely, this will require the services of an HIP coupled with a home health agency.
As you can see from this one example, a single MDP organization was able to service this patient through many changes in the patient’s medication journey from the infusion center to home. For the patient, they were able to work with the same parent company that is familiar with the patient’s history and guide them through the many changes to keep them on their treatment plan in close coordination with the patient’s ordering provider.
Had the company only had one operating model, they would not have had the opportunity to keep this patient on service for so many years. There are obvious advantages to operating a MDP given that it allows the company to say “yes” and keep servicing a broader portion of the patient population over time.
Setting up and operating a MDP is not a small task by any means. As a MDP, you will be operating multiple entities, under multiple licenses, and under multiple regulatory frameworks all at the same time. We don’t have time to go through all of the requirements of each model here (HIP vs. SpecRx vs. AIC), but let’s just say they all independently require a healthy amount of knowledge to get off the ground. One of the greatest challenges is getting the key payor/insurance contracts needed to be relevant in the region that you are operating in.
Another challenge will be systems. Traditionally, each of the various services under an MDP have their own specialized software offering meant just for that service (Home Infusion, Speciality Pharmacy, Etc). A particular pain in this model is the lack of a single workflow system designed to mange a patient through all of the places of service of an MDP. It’s quite possible I might know a company who is very close to having this offering, so check back with me if you are interested in that information (wink, wink 🙂 )
MDP Tailwinds (Maybe a slight breeze for now)
There are some signs that operating a MDP is getting at least a little bit easier in the past few years. This type of model, once a close-kept secret, is now becoming more well-known by insurance companies, medication manufacturers, and distributors. This means that those parties are getting more open about the types of contracts and programs they offer that are more targeted to this new type of model. In addition, we have seen some increased flexibility in the regulatory frameworks in some states for these types of arrangements.
I hope you enjoyed learning about the different types of infusion and medication delivery models in this two part blog series.
Missed the first part? Find Infusion Alphabet Soup Part I: Understanding Infusion Delivery Models Today here.
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