The shape of the home infusion industry

The National Home Infusion Association (nhia.org; Alexandria, VA) represents the hundreds of businesses across the country that provide nursing and pharmacy services to homebound patients requiring pharmaceutical therapy that is typically infused. As such the organization sits at the crossroads of the booming specialty pharma distribution business (see story, p. 26), as well as the ongoing movement toward individualized outpatient services. For the first time, NHIA has undertaken a survey of its membership; while no one knows for sure just how many home-infusion service companies there are, NHIA believes that its 730 members represent the vast majority of service providers.

“It’s hard to measure overall infusion services, because many of them are provided by hospitals, who may manage patients both within the facility and as outpatients; in fact, 20% of our membership is hospitals,” says Russell Bodoff, president of NHIA. “But this study is the first phase of a program that we hope will help analyze the overall industry.”

Home infusion is further complicated by the range of services offered, notes Nancy Kramer, VP of clinical affairs for the group. She explains that services can be short-term or chronic, and can combine a variety of infused therapies, such as anti-infectives along with chemotherapy or parenteral nutrition. The common element is that the infusion is typically managed by a nurse. “A professional nurse is key,” says Bodoff. “They assess the patient condition, deliver the therapy, and make decisions about the course of treatment. The goal is to provide the highest level of independent living possible for the patient, which can be very patient-specific.”

NHIA analyzed its member data according to three types of members: single-site, multi-site and national. Single-site and multi-site refer to the number of locations that a business operates; multi-site organizations tend to be regionally focused. Single sites are also more common in rural areas; multi-site or national in more urban areas. The “site” is where drug therapies are compounded; they often need to be tailored to individual patient needs. All these sites (including within hospitals) operate according to USP 797 standards, which require clean rooms and ultrasanitary conditions for compounding the dosages.

Fig. 1 shows the variations in types of services, by type of provider. Providers are often chosen by insurers; some prefer to work with a national provider. Specialty-pharmacy and anti-infective therapies tend to administered most by national organizations, while enteral nutrition and pain management tend to be delivered by single-site providers. Drugs that have limited or controlled distribution strategies (i.e., most specialty drugs) tend to favor the national providers, NHIA conjectures.

The single-largest revenue source for home infusion providers is specialty pharmacy drugs paid for by commercial health plans, which represents nearly $1.4 billion in annual revenue nationally. Self-paying patients represent the smallest revenue stream (no surprise there) at $59 million.

Home-infusion providers use a variety of methods to get drugs deliverd to patients; beyond the obvious method of the nurse administering the drug bringing it themselves, it often works best to have the drug delivered by a courier or parcel-post company, especially in cases where patients are self-admnistering while under a nurse’s supervision. Fig. 2 shows the breakdown of how deliveries are transported.

Bodoff says that the survey will become a first milepost for subsequent surveys that will track the evolution of home infusion business, specifically growth rates. For now, he says, member business is growing well, and, as evidenced by a markedly high level of interest among private-equity firms who are looking at the business opportunities in home infusion, a bigger part of the drug-delivery landscape.

The study, 2010 NHIA Provider Survey Comprehensive Analysis Report, is available for purchase here. PC