Dr Saira Jan Explains Oncology Therapeutics Home Infusion Pilot Program

Saira Jan, PharmD, MS, of Horizon Blue Cross Blue Shield of New Jersey provides an overview of their collaborative oncology therapeutics home infusion pilot program with Rutgers Cancer Institute of New Jersey and RWJ Barnabas Health. She explored the program and its findings during the AMCP Nexus session, "Implementation of a Novel Oncology Home Infusion Model," on October 18.

At Horizon Blue Cross Blue Shield of New Jersey, Jan is the vice president and chief pharmacy officer. She is also professor emerita at Rutgers University's Ernest Mario School of Pharmacy.

Transcript

Could you please provide an overview of the oncology therapeutics home infusion pilot program?

The oncology pilot that we started in 2020 was actually something that we always wanted to do, but oncology home infusion has always been very controversial. When the pandemic happened, that really instigated for us to think differently in how the delivery systems for oncology drugs had to change because the members were unable to go to the hospitals for infusions. It was a big gap, not getting an infusion for chemotherapy, and having the pandemic leading to that gap was a tremendous opportunity for us to start thinking differently.

We started working with our partner, which was Robert Wood Johnson Cancer Institute of New Jersey. The CEO of the cancer institute, Dr. Libutti [Steven K. Libutti, MD, FACS], and I basically connected, and I said to him that we really want to do that. It's sad that the pandemic instigated this kind of a project, but this was, I would always say, a positive of the pandemic, which was a negative thing.

Dr Libutti really brought the idea. I wanted this project to be a collaboration with a provider. Oncology is a condition, and the drugs that are utilized have to be monitored; there are a lot of safety concerns. So, a provider partnership is the key to the success of this pilot. The whole premise at that point was to really improve access for the members who needed the treatment and understand what the logistics were, what the operational challenges were, and what pieces needed to be put together to really accommodate everything from a safety perspective, from a member perspective, from a monitoring perspective in this pilot.

The pandemic really infused it, but then, we had to really do it in a way that had all aspects of management covered, not only from a hospital perspective, infusion perspective, but also from a benefit design perspective, from a payer perspective. So, we established a few workgroups from a medical policy perspective, from an operational perspective, to really understand when the member comes in, how will that work? Will they get the first infusion in the hospital? What the process would be.

We were lucky that Robert Wood Johnson had a home infusion company, and that was another group that had to be skilled to really infuse this, establishing the process of monitoring remotely when the nurse went in the patient's home to infuse the chemotherapy, any side effect profile.

One key component of this pilot was not only to establish the operation and execution of home infusion but also understand the member feedback, the provider feedback. As we went through the pilot, we infused the feedback as we were developing the pilot throughout. I think that was a big focus: to improve quality, improve access, improve the convenience and member experience in chemotherapy, and then use this opportunity to introduce an innovative model of delivery for oncology. Because remember that a lot of drugs that are infused in the hospital are now infused in patients' homes or infusion centers. Traditionally, oncology has been limited to hospitals. This was a great opportunity for us to show that it could be done outside the hospital.

Think of members who have cancer; there are a lot of side effects. I've had stories from patients with chemotherapy thwhoat, first of all, drive a couple of hours, or an hour, to the institute or a hospital to get the infusion and then on the way back, they're throwing up, lots of nausea. So, if you can simplify that and have this infused in a patient's home, or an infusion center close to the patient, that would really take away the negative aspect of the adverse events. That was also an area that I think helped us to really move forward with this.