Building new possibilities for infusion care

Few things exemplify Optum’s mission to make health care work better for everyone than our longstanding commitment to providing industry-leading home parenteral nutrition (PN) therapy.

Formerly known as total parenteral nutrition or TPN, PN is an infused therapy delivering a full complement of fluids and nutrients directly to the blood stream, bypassing the GI tract. Patients needing PN have a variety of conditions ranging from bowel obstructions, Crohn’s disease or short bowel syndrome. PN is also often required for critically ill patients with conditions such as chronic pancreatitis. Cancer patients with or at risk of malnutrition while undergoing chemotherapy or radiation therapy also commonly receive PN. Thus, while some patients may require PN for a short time others may require it for a lifetime.

Given the multitude of reasons for the utilization of PN, patients also vary widely by age. While many conditions requiring PN are seen with older adults, an estimated 43% of PN patients are children or newborns.¹

As the number of patients receiving home PN or Home Parenteral Nutrition (HPN) continues to increase, the PN market continues to evolve. Much like other areas of healthcare, it has always been very patient-centric. Like many therapies that were once performed largely in hospitals and outpatient facilities, PN has been administered in the home for decades but has evolved tremendously, with parenteral formulas now safer and easier to administer with newer pump technology and all-in-one, or pre-mixed manufactured preparations. That’s why in addition to nationwide network of infusion branches and specialized clinicians, Optum Infusion Pharmacy® continues to invest in capabilities designed to not only help patients to receive PN in the convenience of their homes but also enable them to take charge of their life goals which often include work, school, exercise and travel.

The Optum advantage

Our leading position in the HPN market is a result of decades of hard work assembling the resources necessary to redefine the standard of care. Beyond leveraging the latest hardware such as compounders, pumps and tubing, we have invested in the people necessary to take care to the next level.

From day one, our HPN patients are paired with an experienced nutrition support team consisting of pharmacists, dietitians and nurses who work in concert to meet their unique needs. Another vital member of the care team is the patient/caregiver liaison. Being on HPN can be an overwhelming or scary experience for those new to therapy. Our liaisons all have personal experience living with PN and are dedicated to guiding others through common challenges they will face while receiving therapy. This can include everything to help maintain or improve their quality of life from preparing for doctor appointments, to advice on coping, and planning transportation or family vacations. Our internal patient advocacy team also hosts monthly workshops designed to educate patients, foster discussion and appraise them of external resources such as benefits afforded by the Americans with Disabilities Act or the Centers for Medicare and Medicaid Services. Beyond meeting the basic needs of HPN patients, one differentiated offering is the Optum Intestinal Rehab (OIR) program. This 12-week, home-based program provides targeted diet education and medication management instruction for those with short bowel syndrome. Armed with these strategies, OIR patients can reduce their need for PN and/or additional IV hydration therapy including the need for less days or less volume of therapy per week. A study found that OIR patients decreased their PN needs by 2 days per week and tallied a 28% reduction in infusion volume. In addition to benefits such as improved sleep and more energy for OIR patients, this program also saves money for payers.²

The nationwide reach of Optum Infusion Pharmacy enables a depth and breadth of expertise unmatched in the industry. While cost and supply challenges and lingering reimbursement questions have caused others to retreat from the industry, Optum Infusion Pharmacy remains steadfast in our commitment to providing this vital therapy. True to our mission, we look forward to continuing to serve the needs of all HPN patients, including those with the most complex PN requirements.

• Our tenured staff, available 24/7, are experts in answering patient questions and providing comprehensive education from nursing, pharmacy and nutrition so that patients can safely infuse PN in the home.
• Beyond creating a critical mass of expertise, our national footprint aims to ensure patients will have the exact prescription of intravenous nutrients when they need it. Given consolidation amongst manufacturers and other supply chain changes, sourcing vital nutrients has become increasingly challenging over the past decade. Supplies of seeming commonplace PN additives such as multivitamins, calcium gluconate, sodium chloride, sodium phosphate and even sterile water have become constricted.³ In recent years, competition for the limited supplies of these life-sustaining intravenous ingredients has only risen in response to rising demand from the “hydration bar” industry.
• Optum Infusion Pharmacy has the resources and logistical expertise needed to shift resources where they are needed most, helping to manage and mitigate potential PN component shortages before they impact our patients. With as many as 40 separate ingredients sometimes contained in a PN bag, the magnitude of the supply challenge is considerable.

This laser focus on the patient is also a considerable advantage for payers. Helping patients stay compliant with their therapy lowers the chance they will be readmitted to the hospital. Estimates show keeping a patient out of the hospital can save at least $3,000 - $4,000 to per day in hospital charges.⁴

Talk to your Optum Infusion Pharmacy representative to learn more about how we are investing to meet the future HPN needs of patients and clients.

References:

1. American Society for Parenteral and Enteral Nutrition. What Is Parenteral Nutrition?
2. The Feasibility of Weaning PN in Patients with Short Bowel Syndrome Enrolled in a Home Intestinal Rehabilitation Program. American Society for Parenteral and Enteral Nutrition: Clinical Nutrition Week 2016, Austin, Texas
3. Pharmacy Practice News. No Sign of Relief for PN Component Shortages.
4. Optum. Reducing risk of readmission: Clinical interventions made by the home nutrition support team.

STATEMENT REGARDING FINANCIAL INFLUENCE:

This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.