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Site of Care Optimization: what is it and what do you need to know?
Celine Orabi
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Site of Care Optimization: what is it and what do you need to know?

Site of Care (SOC) Optimization is one of the top strategies for reducing the cost of specialty biologic medications; it seeks to lower costs associated with certain infused or injected drugs by encouraging the use of clinically appropriate, lower-cost care settings. SOC optimization encourages patients to move away from high-cost facilities, such as hospitals, to these lower-cost settings, such as stand-alone infusion offices like CIVIC. CIVIC maintains high quality standards while being more affordable and accessible in comparison to hospitals.

Would you pay $50,000 for a car from one dealer that you could buy from a different dealer for $25,000? Would you pay $2000 for an economy seat on an airline when you could pay $1000 to fly first class? As ridiculous as those questions appear, a parallel exists today in our healthcare delivery system. The cost of an infused drug could vary by more than 100%, depending on where patients go to receive their infusions. Not only that, but because hospital outpatient services—including office-based services that are owned by a hospital—are able to charge a separate facility fee, the cost of care in these settings can be significantly greater.

Consider infliximab (Remicade): it is no longer typical for an otherwise healthy Crohn’s patient to be admitted to the hospital to receive their infusion, but they may be treated in a hospital outpatient department (HOPD), a physician’s office, an infusion office, or even at home. However, the payments for the same drug and same service can vary significantly with HOPD rates 2-3x higher than that of alternate treatment sites. After identifying the high costs of the HOPD—often double the cost compared to other settings—commercial health plans are increasingly shifting care out of the HOPD when clinically appropriate.

The use of alternate sites of care typically result in significant cost-savings for payers and for patients, and in an overall increased experience for the patients. Patients can receive acute and chronic infused medications in the alternate site of care, and infusion suites are being built throughout the country, in locations such as within an infusion pharmacy, within a retail pharmacy, at an employer site, within a medical clinic, or as a stand-alone dedicated site like CIVIC. The flexibility of alternate sites also contributes to a higher quality of life by improving patient access to care, reducing time away from work or school, and offering a degree of independence to patients living under otherwise rigid medical parameters.

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