Avera Home Infusion Pharmacy (AHI) is a small, rural South Dakota pharmacy that is one of the only suppliers of specialty intravenous infusions in its area. The pharmacy’s vast footprint is challenged by geographical distances between patients from the pharmacy and ancillary agencies, inclement weather conditions, payer site-of-care restrictions, and limited availability of staff trained and available to administer infusions needed to treat complex conditions.
With the need for specialty infusions increasing, AHI chose to meet these challenges by collaborating with its own home health agencies and outpatient infusion centers to develop solutions. Its goals are increasing the number of patients serviced by home infusions, increasing the availability of homecare staff, streamlining costs for the pharmacy and patients through copay assistance programs, and ensuring optimal care. To determine effectiveness of the methods trialed, data was collected from the pharmacy including the number of specialty infusions divided amongst the homecare agencies assigned to each, and by surveying homecare agencies. Partnering with ancillary agencies decreased gaps in care by evaluating staff shortages, comfortability, and education needs. Evidence demonstrates increased volume of
patients needing specialty infusions, greater numbers of homecare agencies available, and higher patient satisfaction through care and cost savings.
AHI has created a highly skilled team to assist patients transitioning to home infusion. The staff includes: five Pharmacy Technicians, four Pharmacists, one Patient Advocate, one per-diem and three full-time RN Case Managers, one full-time Specialty Infusion Nurse, and two intake Insurance Specialists, all of which are overseen by the Pharmacy Director (see Figure 1). At the Infusion Nurses Society (INS) Conference in May 2024, we had 14 staff members. Currently AHI has 17 staff members.
AHI Case Managers triaged patients either to themselves, or to outpatient infusion centers.
This would allow a homecare nurse to be available for specialty infusions if needed.
AHI’s Case Managers created an ongoing monthly liaison group meeting with Avera Home health nurses and leaders to discuss and provide education based on each agency’s questions and concerns regarding specialty infusions.
Figure 2 shows the AHI specialty patient census, sorted by each home health agency performing the infusion from March 2022 to December 2024. Note the steady incline in the specialty infusion patient census. When presenting at the INS conference in May 2024 AHI provided specialty infusion for 145 patients. In December, AHI provided specialty infusion for 175 patients, that is a 20% increase in 7 months. Also of note, there was an overall increase in home health agencies completing specialty infusions. In 2022, there were only four home health agencies capable of administering specialty infusions. Currently, twelve agencies in the Avera region can administer specialty infusions. One of the twelve agencies is Avera @ Home in Pierre, South Dakota, which is in a remote area often challenged by staffing issues and winter weather conditions. During AHI presentation at INS IN May 2024, Avera @ Home in Pierre increased their specialty infusion patients from zero to seven. Now Avera @ Home in Pierre provides specialty infusions for 10 patients.
Specialty infusion drugs cost an average of thousands of dollars per dose. AHI also has Patient Advocates to assist and ensure each patient who qualifies is enrolled in a copay drug assistance program. In 2022, AHI invoiced $508,000 to copay savings cards 6. As impressive as that sounds, AHI saw an increase in specialty infusions and billed over 1 million dollars to copay savings cards in 2023.
By utilizing home infusion and collaborating with home health staff, AHI ensures that patients can get infusions in a cost-effective manner with top-notch care in the comfort of their homes.
AHI now has the ability to administer specialty infusions to patients who previously did not have this option by helping them to overcome geographical, staffing, financial, and other barriers to receiving specialty infusions at home.
Figure 1. Avera Home Infusion Staff and Workflow
Figure 2. Current Home Infusion Patient Census by Therapy Type
Table 1. Avera Home Infusion Specialty Infusion Growth
Table 2. Current Home Agency’s Doing Specialty Infusions
| Nursing Agency  | Number of Patients  |
| AHI-Infusion Nurse  | 93  |
| A@H – Mitchell  | 23  |
| A@H – SWMN  | 17  |
| A@H – Aberdeen  | 12  |
| A@H – Pierre  | 10  |
| A@H – Yankton  | 9  |
| Prairie Lakes  | 6  |
| A@H – Estherville  | 5  |
| A@H – Milbank  | 3  |
| Hegg  | 2  |
| Redfield Memorial  | 1  |
| Sioux Center  | 1  |
