Navigating Home Infusion

Former CPR+ Co-Founder & CEO, Jeff Johnston, and WeInfuse Marketing Lead, Brittany Hancz, have collaborated to bring forth insightful advice and tips regarding the home infusion industry. Jeff remains a top expert in the field as he guides WeInfuse’s growing home infusion therapy (HIT) and specialty pharmacy software platform.

Many healthcare professionals are entering the home infusion sector as a means to dispense medications, including specialty biologics, such as Remicade and Ocrevus. While ambulatory infusion centers (AICs) remain a popular choice for patients and clinicians, home infusion continues to make headway for many treatments within the field of infusion therapy.

The following blog covers three main topics:

1. Home infusion therapy defined.
2. An overview of the home infusion market within the U.S.
3. A Q&A session with our guest author and WeInfuse Strategic Advisor, Jeff Johnston, who shares his history running a successful software platform and thoughts regarding this niche.

Home Infusion Therapy Defined

The home infusion industry can be complex, complicated, and expensive. Operating a company in this specific area takes thorough knowledge, an experienced team, and well… maybe a little bit of grit; but home infusion is a win for the provider, the health insurance company as the payer, and a win for patients. To succeed over the long term, it’s important to stay up-to-date on the ever-evolving home infusion space. 

First, let’s deep dive into the distinction between AICs and home infusion pharmacies.

AICs are typically provider-based (e.g. physician or nurse practitioner), whereby AICs host patients and deliver infusion therapy onsite within their building–meaning, patients travel to the site-of-care to be treated. AICs remain separate from pharmacies and hospitals. Here, patients receive their medication through a monitored environment that delivers infusion therapy, including specialty drugs.

On the other hand, home infusion pharmacies dispense medications to the home where the patient receives their medication intravenously or by injection. Home infusion therapy companies deliver all necessary drugs, supplies, and equipment to the patient’s home. Depending on the medication, therapy, and circumstances, care may be delivered by:

• • a home health agency nurse.
  • a nurse who works directly for the home infusion pharmacy.
  • the patient and/or the patient’s family member
    

Home infusion necessitates that medications, equipment and other components be brought to the home. The home infusion pharmacy in conjunction with the home infusion nursing team must ensure the delivery of the correct pre and primary medications; infusion pumps; sufficient medical supplies such as tubing and catheters; trained infusion nurses; proper clinical and patient education, and more. Before in-home treatments commence, home infusion also requires coordination between the patient, his or her physician(s), the hospital discharge planners, the patient’s health insurance plan(s), the home infusion pharmacy, and the HIT nursing team (Centers for Medicare & Medicaid Services).

The Home Infusion Therapy Market Overview

Home infusion continues to grow across the United States. Home infusion pharmacies date back to the 1980s and have since flourished. In addition to traditional HIT therapies, like antibiotics and Immunoglobulin, the rise of COVID-19 has helped increase the popularity and need of home infusion services. The increasing number of patients with cancer, diabetes, chronic pain, autoimmune disorders, and gastrointestinal diseases are another factor for the rise of HIT.

Option Care, Paragon, Soleo, Healix, and TwelveStone have paved the way for home infusion and specialty pharmacies across the United States and act as examples for future providers to come.

Additionally, the following organizations and non-profits continue to advocate, educate, and spread awareness of the growing AIC and home infusion therapy markets:

• • Infusion Technology Advisory Council (ITAC) – ITAC assembles industry leaders from the infusion center, home infusion, specialty pharmacy, and healthcare technology sectors to bring together expertise and guide technological advancements in the infusion space.
  • National Home Infusion Association (NHIA) – NHIA is the leading organization providing education, information, advocacy, and resources to the nation’s home and alternate site infusion provider community. NHIA also brings together manufacturers, suppliers, and service companies that support the field. 
  • National Association for Home Care & Hospice (NAHC) – NAHC is a nonprofit organization that represents home care & hospice organizations and advocates for more than two million nurses, therapists, aides, and other caregivers employed by such organizations to provide in-home services.
  • Infusion Nurses Society (INS) – INS is an international nonprofit organization representing infusion nurses and other clinicians who are engaged in the specialty practice of infusion therapy.
    

Stay Educated with Former CPR+ CEO & Co-Founder Jeff Johnston–A Leading Expert in Home Infusion Software

Alongside well-known nonprofits, organizations, and providers in the industry, reliable software organizations are also vital to the success of home infusion and specialty pharmacies.

We asked former CPR+ CEO & Co-Founder, Jeff Johnston, to highlight his time operating a successful software platform dedicated to the infusion industry. Jeff continues to be a thought leader in this space, and he now works with WeInfuse as a strategic advisor and serves on ITAC. 

Q&A Section-

Briefly explain your history and why you decided to pursue the home infusion path when founding CPR+.

Way back in 1991, I was working as a home infusion nurse for the largest home infusion provider in Columbus, Ohio. At the time, our “information systems” consisted of a basic label maker that the pharmacists used to create IV labels, a spreadsheet for tracking all new patient referrals & current patient census, and a basic billing program that printed HCFA 1500s. We did everything else manually through photocopied paper forms. It was extremely labor-intensive and very inefficient. I was familiar with software companies that served the HME and Home Health Agency markets; therefore, I assumed there had to be software available for home infusion providers. I was wrong–a 6-month search resulted in nothing. Turns out, there was no commercially available software that was specifically designed for the unique needs of a home infusion provider.

As luck would have it, just after my failed search, I met my backyard neighbor, Stuart Crane. He was a computer programmer. “This could be interesting,” I thought, because I knew absolutely nothing about writing software, and he knew nothing about home infusion therapy. Still, we believed we could build a software program that would automate and dramatically simplify all the manual processes and tedious paperwork we were doing by hand. We convinced my boss to let us give it a try, and he even agreed to pay us a small monthly fee! We worked tirelessly in Stuart’s basement nearly every night and most weekends, while we both had full-time day jobs, and created the prototype for what became CPR+. We started with the basics using a “new” patient as our example, and created a new patient record that covered demographic info, doctor, diagnosis, insurance coverage, ordered therapy, etc. Then we progressed to filling a prescription,

creating a label, printing a delivery ticket, and generating an invoice. Every week or so, as we accomplished tasks, I would update our office computers and show everyone what we’d built. It was easy to use and soon the entire staff loved it. Of course, they always wanted more, more, more: “Can you add this report?”, “Can you help us track the pumps?”, “Can we add billing notes to document our collection calls?” The requests were never-ending, so we just kept on building. After about a year, we knew we had something that other home infusion providers would love too. So, we took the plunge.

We “quit our day jobs” and formed our software company. We called our application CPR+ (Complete Patient Records).

What pain points did you notice in the home infusion world, and how did you work to remove these barriers through your software platform?

In the early ‘90s, home infusion therapy was just becoming a mainstream industry.

Administering IV medications to patients in their homes was a pretty radical concept, but once the insurance companies saw the efficacy and cost savings of this method of care, it grew quickly. There were a few large national providers, lots of small “mom-and-pop” companies, and a good number of new companies starting up all over the country. They all struggled with the same issues–trying to stitch together disparate pieces of software and various manual processes to manage the business. Because nothing was integrated, the same patient often had to be entered multiple times and getting accurate reports was next to impossible. Having to “share” the one physical copy of the patient’s chart also meant that if a nurse was documenting a visit from the night before, the pharmacist had to wait to start preparing tomorrow’s prescription. Still, margins in home infusion were good and even with all this inefficiency, businesses could still make money. That didn’t mean they weren’t looking for ways to save money.

When we officially launched CPR+ in April of 1993, there were two other software companies in the market, Management By Information (MBI) based in Little Rock and Specialized Clinical Services (SCS) from California. Of course, back then (in the days before the internet), the software was shipped out on floppy disks and installed on the customers’ office computers. On top of that, our competitors were pricey . . . charging $30-40K or more for their software. That’s why we priced CPR+ between $5-10K, depending on the number of employees/users the client had. Because most of these providers were privately owned start-ups, they were always interested in saving money! We also let them “kick the tires” by giving them a fully functional copy of the software to use for free for 30 days. Once they started using it and saw how much time it saved them, they rarely decided to give it back. From 1994 through 1997, we averaged over 120 new customers per year!

If someone wants to start a home infusion pharmacy, what are some of the must-knows or must-haves to consider when going down this path? 

Obviously, every business needs a steady stream of customers. For home infusion providers, this means patient referrals. It will be critical to form relationships with as many physicians as possible in the area–especially when they serve patients that most likely need home infusion therapy services. Infectious disease doctors, oncologists, and many other specialists treat patients who will require home infusion therapy. These physicians need to be aware of your service and feel confident that you are ready and able to take excellent care of their patients. The same is true for hospital discharge planners and social workers.

When a patient is being discharged from the hospital and the attending physician prescribes home infusion therapy, they may or may not indicate a preference for who provides the service. The discharge planner will ask the patient if they have a preferred home infusion provider, but most will not, leaving the decision up to the discharge planner. Discharge planners are busy people, coordinating home care services for dozens of patients per day. Therefore, it is critical to make sure your intake staff are friendly, reliable, and efficient. The last thing a discharge planner wants to do is wait on hold, play phone tag, or speak to someone who is unable to answer questions about the service or therapy being ordered. The whole process should be as frictionless as possible. The referring physician and discharge planner will also appreciate timely updates after therapy has been started (how the patient tolerated the first dose at home, etc.). An email follow-up the day after the start of care will go a long way toward building their confidence with you as a provider, resulting in more referrals down the road. Of course, the patient’s insurance plan may also determine which provider gets the referral. That is why it’s imperative to sign as many payer contracts as possible. All of these steps will help you build a successful home infusion therapy company.

What are some common mistakes people make in home infusion, and how can they be avoided?

I think a fairly common mistake, especially among new start-ups, is to select a software package and then to skimp on the training and implementation. This mistake mostly happens when there are hundreds of decisions to make, limited time & financial resources, and not enough hours in the day. After seeing various demos, the tendency is to make a decision (too often based on price) and believe that you can “figure it out later.” Too many people check the box and move on to the next decision without completely thinking it through. Waiting until you start getting patient referrals is NOT the time to start learning the software.

Everything that is important to your business is stored and documented in your business management software–your patients, physicians, referral sources, payer contracts, inventory, A/R, and more. If your staff is not properly trained on how to fully use the software, they will be far less efficient and mistakes will likely occur. Accurate reporting is dependent on having complete and timely data in your system. As they say, garbage in, garbage out. Make sure that all staff learn and use the system fully.

Finally, don’t skimp on ongoing training. Software companies are always adding new features and in some cases, changing functionality. Invest in regular, ongoing training and identify an internal “super user” who is totally proficient in all aspects of the system. Encourage staff to attend the webinars, read the release notes, and go to the annual conference. Trust me, this investment will pay huge dividends in time.

How do you stay updated and informed on new developments and advancements in the infusion space?

One of the best ways to stay informed is to join and support the National Home Infusion Association (NHIA). NHIA does a great job promoting the industry, lobbying in Washington, and communicating new trends and opportunities to members. NHIA’s annual conference is an outstanding way to network with other home infusion professionals and learn about new offerings from leading industry vendors. Their educational tracks are role-specific, with in-depth curricula for nursing, pharmacy, sales, revenue cycle management, and administration. Continuing education credits are also offered.

Becoming active in your state’s home care association is also an excellent way to stay informed about trends in the industry. These organizations also offer home infusion professionals the chance to interact with home care companies in the home health nursing and home medical equipment industries. Finally, attending your software vendor’s annual user conference is also an excellent way to network with other industry colleagues from across the country.

Why did you choose to join WeInfuse as a strategic advisor? 

Joining WeInfuse was an easy decision for me. Stuart and I were extremely passionate about the home infusion and specialty pharmacy industries. Our mission was to offer our customers the best possible support services and the most feature rich and intuitive business management software on the market. We knew that our success was directly tied to their success, and were humbled every day that so many providers trusted their business to CPR+.

After selling our business in 2013, I’ve continued to hear from dozens of former customers who have expressed frustration with their current home infusion pharmacy solutions. So, when I met Reece and Bryan, it was clear that they had the same commitment to building great software and providing outstanding customer service that I had when forming CPR+. Therefore, I am honored and excited to join the WeInfuse team as a strategic advisor and member of the Infusion Technology Advisory Council (ITAC). 

WeInfuse is the market-leading software platform for ambulatory & outpatient infusion centers, which is a testament to their customer-focused mindset. It is clear that they are fully committed to continually building a robust, easy-to-use software dedicated to the home infusion and specialty pharmacy industry, while providing outstanding customer service. I am thrilled to lend my voice and experience to help further their efforts.

About WeInfuse

WeInfuse is the premier technology and consulting provider for infusion therapy and medication delivery in the U.S. The WeInfuse software platform powers over 700 infusion centers across the country. Backed by decades of experience, WeInfuse consulting services guide clients through the dynamic infusion landscape.

WeInfuse has expanded its software platform to include a complete home infusion and specialty pharmacy workflow. WeInfuse software helps organizations operate efficiently, maximize profitability, decrease burnout, and improve clinical outcomes. Its powerful, intuitive features for infusion workflows and a robust reporting & analytics engine help take the confusion out of infusion. To learn more, email marketing@weinfuse.com or visit www.weinfuse.com.