Optum is turning to technology to bring down special infusion spend. Others have tried a variety of ideas to achieve this goal going back to the early 2000s with limited results….. but the old saying goes….. Try…. Try…. And Try Again.
Optum is optimistic that they can deliver sustainable savings in the difficult-to-manage infusion settings where placing constraints on hospitals and physicians are often impossible. Instead, the new platform being touted by Optum, branded as Specialty Fusion, makes it ‘easier for clinicians to cut wait time for multiple treatment regimens to be approved, support navigating patient treatment plans, and optimizing health benefits’.
Perhaps one area where Specialty Fusion will help push platform adoption is in the area of cost containment. They say they can realize savings of 17%! The announcement did not address the elephant in the room, the fact that hospital infusions generally cost twice that for the same infusion in an infusion clinic or physician’s office. One would think that even greater saving could be realized by tackling that thorny issue.
As with a lot of new technology, the Specialty Fusion portal will need to be very user friendly and offer meaningful clinical and operational information to gain provider support.
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Optum unveils new platform for managing specialty drug costs
Optum has launched a new solution aimed at the specialty drug market.
Specialty Fusion arms payers and providers with real-time insights into which specialty therapies are the most effective for the patient at the lowest cost. The platform leads to quicker treatment approvals for patients as well as a similar experience for providers at the point of care, Optum said in an announcement.
Internal analysis of the solution suggests it can drive cost savings of 17%.
“The average specialty patient sees more than five care providers per year, while taking more than 10 drugs on average. They often have to wait for multiple treatment regimens to be approved and need better support navigating their treatment plan and health benefits,” said Kerri Tanner, senior vice president at Optum Rx, in a statement.
“We developed a new comprehensive, benefit-agnostic solution that supports streamlined treatment decision-making for care providers, helping patients get on their therapies faster, while driving down high costs,” Tanner said.
Specialty Fusion is currently available to all large health plans, Optum said.
Specialty drugs account for an increasing amount of healthcare spending, with costs expected to reach $505 billion by 2023, Optum said. Finding ways to ensure people can access therapies that they need at a manageable cost has been of critical concern in the pharmaceutical space.
Through Specialty Fusion, providers can kickstart prior authorization through a single portal, and see comparisons for other lower-cost and clinically appropriate options for the patient. The platform is designed to reduce administrative effort and connect patients with these treatments 50% quicker, Optum said.
For example, a doctor could prescribe an immunosuppressive drug that is covered by the patient’s insurance, with a cost of about $1,200. Specialty Fusion would identify alternatives, bringing the cost down by $700 on average.
In addition, the platform arms docs with information on pharmacy networks, best sites of care, dosage management policies and other levers they can use to further lower costs.
“Managing specialty drugs at the earliest possible moment is critical to improving care, clinical outcomes and the patient experience,” said Sarah Dye, senior vice president at Optum Health, in a statement. “Optum Specialty Fusion uniquely partners with the provider to change the status quo of prior authorization, reduce their administrative pain and ultimately help them provide better care for their patients.”
