Everyone can agree the health care system is complex. It involves a high level of collaboration and cooperation that extends well beyond physicians, nurses and other care providers. So much expertise has to be corralled. So many regulations and procedures have to be followed. So many stakeholders have to move in the same direction to ensure patients receive the best possible treatments and outcomes.
One of the big reasons AOM Infusion is a leading provider of infusion therapy is because it has distinguished itself as a trusted partner that patients, physicians, pharmaceutical manufacturers and insurance payors can depend upon. While all of AOM Infusion’s partners are important, working quickly and collaboratively with payors can be the difference between patients experiencing a disruption in vital treatment and getting the therapy they need without delay.
Early on, AOM made the decision that delays would not be acceptable if they could do anything about it. So, they made the strategic choice to treat a wide breadth of complex, chronic health conditions. Today, the company offers therapies for more than 80 health conditions — a fact that sets it apart from competitors.
“Our intense focus on a growing list of chronic health conditions and disease states solidifies our standing as a major treatment provider in this space,” affirms Hayden Cook, vice president of payor strategy and contracting.
“For payors, our deep expertise means AOM is willing to take on some of the most complex cases and provide high-quality care to their members. The way we deliver that care is key in reducing overall treatment costs,” adds Murrie Fichtner, vice president of revenue cycle management.
Nuancing a Patient-Centric Care Model
From its genesis, AOM Infusion has focused on a patient-centric care model that places the well-being of patients first. Despite remaining laser focused on patients, AOM has also considered payor concerns.
“Payors pay for patient care,” says Cook. “They work with physicians and AOM to ensure their member patients receive care at the right place, in the right manner, and at the right time. So it’s in the patients’ best interest that we create a process flow that works to everyone’s benefit.”
AOM streamlined the review and authorization process, which in turn reduced patient wait times for treatment.
“We have a reimbursement department staffed by insurance specialists who quickly verify coverage for specialty infusion therapy and obtain pre-certification and authorizations for services,” explains Misha Sturns, senior director of business development at AOM Infusion. “We work with most major insurance carriers and have active contracts with a variety of commercial payors. One of our goals is to quickly give care providers who refer patients to us a clear answer about our ability to service their patients, which includes meeting payor criteria. In most cases, we provide an answer in one to two hours.”
The response time is no small feat considering 72 to 96 hours is the norm. In that lightning-quick time frame, AOM submits documentation and checks off all the necessary boxes to secure prior authorization from the payor so patients don’t experience any delay in treatment.
Streamlining specialty pharmacy wait times is another efficiency both payors and patients appreciate. Shaving wait times from the customary two weeks to just three days may seem akin to magic, but AOM’s decision to secure a pharmacy license in all 50 states was another strategic choice that made the abbreviated timeline possible.
“It allows us to essentially serve patients in every corner of the country,” says Cook. “Our national reach expands payors’ pharmacy and home-infusion networks. Geography is a key factor payors evaluate when choosing providers. AOM’s national coverage is certainly a value-add for payors. Our speed of service aids us as we enter new markets and when we renegotiate contracts.”
Lowering the Cost of Chronic Conditions
Of course, the costs of prescription medications are always an important consideration. From the beginning, AOM’s patient-centric care model has focused on home infusion therapy. “Not only do patients appreciate receiving treatment in the comfort of their own homes, payors appreciate home infusion for the cost savings it delivers,” Cook explains. “Home infusion is the most cost efficient in terms of site care when compared to in-hospital infusion.”
While AOM is the gold standard of home infusion, it understands that a home setting is not always the best treatment setting for every patient. It’s the reason we’re investing in new, state-of-the-art ambulatory infusion suites (AIS),” says John Vlahopoulos, AOM chief clinical officer. “Each offers a safe and comfortable environment with inviting amenities while giving patients more flexibility, more independence, and a sense of community.”
Payors enjoy savings gleaned from AOM’s proactive monitoring of manufacturer contracts. “We want to ensure we receive the best pricing and alter our contracts as needed,” Cook explains. “This includes hitting performance incentives to maximize rebate opportunities we can pass along through the supply chain.”
“Karmen Stowe, our vice president of trade relations, and her team have cultivated outstanding relationships with our IVIG (intravenous immunoglobulin) manufacturers,” Fichtner reveals. “Together, they work closely with more than 40 different manufacturers to ensure we not only keep our costs in line so savings are passed down the supply chain to the patient, but that we don’t miss partnership opportunities when new drugs hit the market.”
Every Patient Relationship Is Priceless
Perhaps the most significant way payors benefit from entrusting AOM Infusion is through the close, positive relationships the infusion provider has with thousands of patients it currently serves.
“Because AOM is a home infusion pharmacy, we have the capability to treat the whole patient and not just their chronic condition, when the need presents itself,” says Fichtner.
Cook agrees. “I believe payors appreciate our laser focus on our patients — their members. They know we ultimately do what’s best for the patient. They appreciate that despite our size and national reach, we have the ability to be nimble. Our approach is collaborative when we work with them as a partner. We effectively track patient outcomes and metrics.”
The data AOM shares not only keeps payors well informed about services, care paths, workflows, etc., but also provides real-time insights and outcomes so they get a sense of the overall health of their membership.
“These metrics will become increasingly important as AOM builds out its population health capabilities and enters into value-based and pay for performance contracts with payors,” Cook notes. “These agreements will not only include quality metrics but metrics that incentivize us to save money for the payor and the patient.”
It’s all integral to what everyone at AOM strives for: a very collaborative approach with all payors.
“By working closely together, we ensure our patients — and their health plan members — receive the right care, at the right place, at the right time,” Fichtner reasons. “Collaboration is the key to delivering attentive, accessible, individualized treatment plans that improve health outcomes and lower overall chronic care costs.”
Let’s Connect
At AOM Infusion, we’re always eager to partner with dedicated payors committed to serving patients in the best possible way. We’d love to talk with you about the cost-efficient services we can offer you and your member population. To connect with us, contact us here.
