Oncology Utilization Management: Optimizing the Site of Care
Patients can receive infusions of anticancer drugs in multiple settings, including hospital outpatient clinics, physician offices, standalone infusion clinics, and at home (via home infusion providers). Not all of these options cost commercial health plans the same: Hospitals tend to be the most expensive sites, compared with other settings. (That said, Medicare payments for outpatient chemotherapy do not vary much by site of care.) Site of care optimization is an increasingly popular strategy that many commercial health plans are using to contain costs. Specifically, they are implementing policies to transition more patients from receiving infusions in hospital settings to less costly settings that are still clinically appropriate.