Outcomes From Horizon BCBS of New Jersey Oncology Home Infusion Program | AMCP Nexus 2023

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The program yielded savings of $25,000 per patient in its pilot phase but is not expected to produce savings as a routine offering because reimbursement for home infusion was matched to reimbursement at a facility. Horizon executive Timothy O’Shea, Pharm.D., M.S., says cost savings were a “secondary outcome” of the program and noted the high patient satisfaction.


A new Horizon Blue Cross Blue Shield of New Jersey program that allows cancer patients to infusions at home instead of a clinic or doctor’s office cut costs in the early going.

During its pilot phase when 40 Horizon members participated, the savings worked out to about $25,000 per patient, which adds up to $1 million in savings, Timothy O’Shea, Pharm.D., M.S., manager, clinical pharmacy, at Horizon, said in an interview with Managed Healthcare Executive.

But the cost savings were a “secondary outcome,” said O’Shea, who spoke about the program during a session yesterday at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 meeting in Orlando. Saira A. Jan, Pharm.D., M.S., vice president and chief pharmacy officer at Horizon, was a co-presenter with O’Shea. He discussed the program with MHE in a Zoom interview prior to the meeting.

After the pilot phase was over, O’Shea said Horizon and the provider it worked with, RWJBarnabas Health and the Rutgers Cancer Institute of New Jersey (CINJ) discussed the possibility of an episode of care model that would have involved shared savings. But that fell by the wayside when Horizon and CINJ came to agreement that starting at the beginning of this year the reimbursement for drugs administered in a facility matched the reimbursement for drugs delivered in the home infusion program.

As a result, O’Shea said the program was not expected to yield cost savings for Horizon. O’Shea mentioned, though, that a survey showed high patient satisfaction. "There was a 98% patient satisfaction score. Patients liked it. It was well received," he said.

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