Site of care: “where” matters.

November 20, 2018

“Site of care” is exactly what it sounds like: the physical site, or location, where members receive infusion treatment. In health care, “site of care” (SOC) and “site of care solutions” refer to where these treatments are administered, and how we help manage the member’s location options.  

Why “where” matters so much

Infused drugs are administered intravenously through a needle or a catheter. While the conditions that require infused drugs vary widely, the treatments all share one thing: the importance of the site where care is delivered. While there may be some exceptions, infusions can take place within:

  • A doctor’s office
  • An infusion suite or center
  • Hospitals
  • The member’s home

Where members go for care can have a drastic impact on costs. For commercial members, there are very few standards and no oversight of how reimbursement rates are determined across sites — and hospital outpatient facilities can be 2-3 times more expensive than other options.

The cost and quality of “where” can be managed

Prime Therapeutics’ (Prime) SOC program targets high cost, infused specialty medications that span several therapeutic classes including autoimmune, enzyme deficiencies, lung disorders, and more. We focus on members who are receiving infusion services at hospitals and help transition them to a lower-cost site.

We collaborate with our health plans to incorporate member case managers to help support a smooth transition. Transitioning a member from a hospital outpatient facility to home infusion can save money and could also increase safety and add convenience to the member.  

Smarter decisions driven by data

Prime’s SOC program is adaptable to meet the needs and complexities of your business. From home infusion network to facilitating reviews via medical utilization management, we make smarter recommendations based on:

  • Robust prospective and retrospective reporting and analytics capabilities
  • Prime standard SOC policy focused on new drug eligibility as well as the medical necessity and quality of care
  • SOC reviews integrated within our medical utilization management process

Our integration bridges the medical and pharmacy divide to reveal savings that no one else can find. And our ability to configure for our health plan clients makes this program work that much better.

Most importantly — we will work with you on your site of care initiatives to meet your needs.

To learn more about site of care solutions, contact your Prime representative.