Option Care

Practice Setting

Option Care is a national home infusion company, with approximately 80 pharmacies across the United States. We service patients in the home setting and can have as many as 50,000 patients on service any given day. We service Medicare, Medicaid and Private Insurance patients as well as the indigent population. We have 8 PGY-1 Pharmacy Resident openings at our company each year and are located all over the country. We provide Parenteral Nutrition, Anti-Infectives, Chemotherapy, Hydration, Inotropics, Specialty Medications, Immune Globulin and Enteral therapies to patients at home. Each patient is called weekly by a pharmacist or a pharmacy technician. During the weekly call, we run through a series of questions to clinically assess the patient, determine they are having any ADR/SE and how they are responding to therapy. Our nurses visit our patients in the home at the beginning of therapy and weekly to change their dressing on the IV access, draw blood for labs and do an assessment of their status, progress and response to therapy. Pharmacists have relationships with the nurses and communicate on a regular basis to complete the entire patient care circle with the physician.

Why was the pharmacy service developed?

Over forty years ago, a physician wanted to send a pediatric patient home on parenteral nutrition, instead of staying in the hospital to get the treatment. Working with that physician, a pharmacist devised a way to get the patient to be discharged from the hospital and into their home to safely continue parenteral nutrition. It was much better for this patient, and hundreds of thousands of patients afterwards to be in the comfort of their own home for their therapy instead of being in the hospital or traveling to an infusion center daily for therapy. Our Home Infusion Plus services help patients reach treatment goals. We have collected outcomes data and have seen a 99.9% clinician-reported adherence rate, that 99% of our patients are free of infusion-related adverse drug reactions, and 99.7% of our patients are free of bloodstream infections.

_{(Review of Option Care patient data, October 2009-­February 2011. Based on an average 39,978 patients per month. Review of Option Care patient data, October 2009-­February 2011. Based on an average 35,731 patients per month).}

What training, certification, credentialing, and practice agreement is utilized by the practice setting pharmacist(s)?

Our pharmacists attend a corporate clinical training upon hire and are also put through rigorous training at their local facility that includes taking the Critical Point Course offered by Clinical IQ, training and education on the therapies that we provide, reviewing annual in-services and passing the post-tests, learning sterile compounding training and then performing competency on sterile compounding, training on the dispensing system, learning how to monitor and care for patients, and learning how to be on-call. We operate 24/7 and a pharmacist is always on duty. Certifications for our pharmacists include Board of Pharmacy Specialties in Nutrition, Infectious Disease, Pediatrics or Sterile Compounding. Many of our pharmacy technicians are PTCB Certified and some have already taken and passed the Sterile Compounding Certification from PTCB as well. We utilize practice agreements locally with physicians since each state has different rules and regulations. Most of our practice agreements are concentrated on infectious disease and nutrition, where our pharmacists manage aminoglycosides, vancomycin and parenteral nutrition patients. This allows our pharmacists to clinically monitor and care for patients closely with the physicians and give recommendations for therapy and order changes.

What outcomes are being measured to evaluate the model's success?

Our infusion company is constantly reviewing patient outcomes to ensure that patients are well-cared for and we are being cost-effective while providing the care. We monitor patient satisfaction, contracts and revenue plus review clinical practices and enhance them as needed. Some of the outcomes we review include hospital readmission rates, patient central line infections and clinical interventions during therapy.

How have you made this service sustainable?

Even though reimbursement margins for home infusion therapies are getting smaller and smaller through private insurance and Medicaid, we provide this service in the best interest of the patient and ensure that they are getting the best care possible in their home. Medicare does not cover many therapies for home infusion and Medicare D covers only the medications, which is a struggle for patients since they need more than just the medication in order to administer their drug at home. Patients need supplies and sometimes an infusion pump as well and this is not covered by Medicare D. However, we do our best to get the patient to pay as little out of pocket as possible and work with insurance companies to keep their expenses as low as possible.

How did you gain support of administrators, providers, and other key stakeholders to implement your practice model?

Our company's Vision Statement says it all: "Passionate People, Partnering in Health to Deliver Extraordinary Care". Our Executive Leadership Team supports our clinical staff to make sure they are fully competent to care for patients in the home setting by investing in our training programs for our clinicians and technological advances. It is truly an exciting time to be a home infusion pharmacist, especially at our company.

What are some lessons learned while implementing your practice model that you would like to share with other pharmacists?

The patient always comes first. Do what you can to make sure the patient is cared for. Work with insurance companies to make sure everything is in order in order to get paid. Never assume anything. Ensure you understand what the patient resources are, what they are capable of and what support the patient has at home. Do your best, double check everything; if someone questions anything, double check it again.