From hospital to home: The specialty infusion experience your members are missing

A woman with rheumatoid arthritis drives 90 minutes to a hospital outpatient department for her Inflectra infusion every eight weeks.

Parking is a hassle to find. Check-in runs 30 minutes past her appointment time. Her infusion nurse is monitoring four other patients in a shared bay, so pre-medication starts 40 minutes behind. The seat next to her is being used by a patient on antibiotics for a systemic infection. 

Five hours later, she orders an Uber home because the diphenhydramine makes it unsafe to drive. She misses a full workday and her daughter’s swim meet. Meanwhile, her employer pays for a bundled claim without any cost breakdowns, including the drug markups. 

This is what specialty infusion care looks like for most people receiving it today. It doesn't have to.

Only about 1.4% of specialty infusions currently happen in members' homes, according to Leap's analysis of claims data from 2024 and 2025. And yet up to 40% of infusions were rated as clinically safe to be delivered at home. The gap between what's clinically appropriate and what's actually happening runs to tens of billions of dollars annually and to tens of thousands of hours of unnecessary member time.

Why does specialty care often occur in hospitals?

Members are typically referred to the hospital outpatient department their prescriber happens to be affiliated with. Once the first infusion happens there, subsequent doses and a routine develops. The member is often not told there's another option. Their employer is often not told what that first dose costs, either on the buy-and-bill markup embedded in the J-code claim or on the member time that shows up as absenteeism and reduced productivity.

The employer cost when infusion therapy is delivered at hospitals

In an August 2026 survey, employers cited drug prices, high-cost claims, and hospital prices as the top threats to healthcare cost increased. Infusion therapy delivered at hospitals represents all three of those expected threats. 

Infusion therapy claims at hospitals show up on the medical side under HOPD (hospital outpatient department) as a single J-code or Q-code line. While these codes don’t show specifically what hospitals paid to acquire the drug and how much they’re charging to deliver it, hospitals typically procure these drugs under a buy-and-bill arrangement. 

For a self-insured employer, a handful of members can single-handedly move the needle on renewal and, in some cases, trigger stop-loss exposure, all while the plan has no visibility into whether the price it's paying reflects the actual cost of the drug or a markup with no corresponding clinical value. 

Site of care adds a second, separate cost layer on top of the markup. Hospital outpatient departments (HOPDs) are among the highest facility and administration fees an employer experiences within their healthcare claims. So even before anyone looks at what a specific drug cost to acquire, where the infusion happens is already driving a meaningful part of the bill.

What’s needed to transition care from hospitals to homes?

Published research consistently shows equivalent safety outcomes across hospital and home infusion settings. For example, for patients on immunoglobulin therapies for primary immunodeficiency, home infusion is actually associated with lower infection rates than shared-chair hospital environments.

Closing that gap requires more than telling members "we cover home infusion." It requires an operating model that removes friction at every step: 

• A Care Guide who quarterbacks the whole journey.
• A qualified nurse network that spans all 50 states.
• A scheduling system that fits the member's busy schedule.
• Clinical governance that decides case-by-case whether home is appropriate. 

What changes when infusion moves to the home

In a hospital infusion bay, one nurse is managing multiple members at once. In a home infusion setting, every member gets a 1:1 nurse for the duration of the treatment. That nurse is scheduled to the member's calendar, including evenings and weekends when it's most convenient for the member. Once a member has a good first visit with a nurse, that same nurse comes back for every subsequent dose unless something changes. 

Leap operates a national network of more than 10,000 licensed infusion nurses across roughly 15 partner agencies, which is what makes 50-state coverage possible at that level of continuity.

A few things improve immediately:

• The commute disappears. No parking, no wayfinding through a large building, no hospital navigation. The nurse arrives; the member stays home.
• The schedule fits the member's busy schedule. Members choose the day and time, including nights and weekends. The infusion center's hours stop dictating the member's calendar.
• Nurse attention is undivided. One patient in one room. Pre-medication, IV access, monitoring, and post-infusion assessment all get the full attention of a nurse whose only job that shifts is that member.
• Privacy is the default. Immunocompromised members don't share air with patients being treated for active infection. Members who want to work through their infusion can work; members who want to spend quality time with family can do so.
• Recovery happens at home. Post-infusion fatigue and pre-medication sedation happen where the member already lives. No unsafe drive, no ride coordination, no missed workday on the back end.

Members who move from hospital to home get equivalent or better clinical outcomes, plus the time back, plus a lower cost for their employer. The Leap operating model was built to deliver that specifically.

The Care Guide’s role

Kacie Keith, PharmD, is a Leap Infusion Care Guide and one of the team's original members. Her role is easier to describe by what it isn't than by what it is: it isn't a case manager who checks in periodically, it isn't a scheduler who books appointments, and it isn't a call-center rep who answers whatever question is in front of them. It's a single Infusion Care Guide who coordinates the member's complete infusion journey from the first phone call through ongoing treatment.

A day in the Care Guide role includes: 

• Handling prior authorizations.
• Coordinating with the prescriber's office.
• Managing pharmacy logistics.
• Scheduling the nursing visit.
• Following up after the infusion.
• Being available by text, email, or phone for anything the member needs in between. 

The Care Guide is the person the member calls when they don't know who to call.

Kacie's approach to a first call shows what separates Leap's Care Guide model from a benefits hotline:

She reads the member's communication preference within the first minute of the call. Some members prefer text; others prefer phone; some prefer email. Some are ready to enroll on the first call, and others need three or four calls so they can learn more before switching to at-home care. Both outcomes are valid, and both get the same follow-through.

Care Guides also respond to other common questions, such as:

• What does the copay look like? 
• Which specialty pharmacy is closest? 
• What if the member has a reaction? 
• What happens if the member wants to travel and receive an infusion in a different state? 

The Care Guide is the single point of contact for all of it, and the member never has to reintroduce themselves to a new person for the same problem.

The clinical safety framework: Home is the default, not the only answer

Home infusion isn't right for every member on day one, and Leap's clinical model is explicit about it. Sofia Shrestha, PharmD, CSP, Leap's Senior Director of Clinical Strategy, built the intake assessment that decides whether a member is home-appropriate. It covers:

• Treatment history and tolerance. Members who have had a stable maintenance regimen on a well-characterized biologic are typically strong home candidates from day one.
• Comorbidities. High-acuity comorbidities that raise reaction risk can warrant a controlled setting for the first dose.
• Home environment. Reliable electricity, clean water, refrigeration for cold-chain medications, and a safe indoor space for the nurse to set up.
• Caregiver presence and emergency access. Distance to the nearest emergency department matters, especially for first doses of certain therapies.
• Reaction history. Members with a history of infusion reactions on a specific therapy are typically better served in a clinical setting until stability is established.

When home isn't appropriate on day one, Leap routes the member to an ambulatory infusion center in the Leap Transparency Network, which spans 37 states and is rapidly expanding. The care model stays the same: same Care Guide, same continuity, same coordination. Only the setting changes. When the member stabilizes on their treatment, they can transition to home for future doses if they want to.

The nurse network is also intentionally credentialed. Every Leap-partner nurse is licensed and infusion-trained. The network maintains active RN licensure and BLS/ACLS certification as required minimums, with CRNI, VA-BC, OCN, and IgCN as recommended specialty certifications. Partner agencies are accredited by the Joint Commission, ACHC, or equivalent. Reaction kits, standing orders, and 24/7 clinical support are standard on every home visit.

Managing concerns from providers

Not every prescriber immediately embraces home infusion, and Leap's Care Guides handle that conversation honestly. Some of their concerns are clinical: a prescriber may not know that Leap's home nurses are all registered nurses, or may not know that a reaction kit is on-site, or may want to confirm the drug procurement channel before signing off. Those questions get direct answers and typically resolve within a call.

Some concerns are economic. The prescriber's clinic may run an infusion suite, and moving the member out of that setting is a revenue loss for them. Kacie's approach in those cases is to keep the prescriber in charge of the care plan and to give the member their options. Leap doesn't try to displace the prescriber. When a prescriber is unwilling to write a home-infusion order and the member wants home care anyway, the Care Guide helps the member find another in-network specialist or an online specialty clinic that can write a compatible order. The member decides.

One example from Kacie's caseload: A member juggling school and three kids wanted home infusion, and her rheumatologist refused. There was no clinical reason for the refusal. Kacie verified the member's benefits, located 12 in-network rheumatologists within a 30-mile radius, and introduced her to an online rheumatology clinic that Leap had worked with before. The member had her online visit, orders came in the same day, and home infusion was scheduled that week.

"She had a whole list of 12 rheumatologists in her area if the online clinic didn't work. She wasn't stuck. And her treatment wasn't delayed any longer than it already had been."

— Kacie Keith, PharmD, Infusion Care Guide, Leap

Feedback loops built into the model

Every member receives a post-treatment survey after their infusion. It takes fewer than five minutes and asks the questions that actually shape service quality: 

• Was the nurse on time?
• Was the space set up correctly? 
• Did the member feel safe?
• Did the Care Guide follow through on what she said she'd do?

Care Guides review the responses daily and adjust in real time. Members can also text or call their Care Guide directly after an infusion for immediate follow-up.

The aggregate result is a 92 patient Net Promoter Score, 98% patient satisfaction, and roughly three hours saved per infusion encounter compared with the hospital experience the member came from. Over 95% of Leap members choose to receive their infusions at home when given the choice between in-home therapy versus at an infusion clinic.

What plan sponsors and consultants should be asking

Five questions worth bringing to your next benefits strategy conversation or your next stop-loss review:

• What share of our specialty infusion spend is currently delivered in a hospital outpatient setting? If you don't know the answer, that's the answer. Ask for J-code and Q-code level data by site of care.
• What share of our members on infusion therapy have been offered home infusion as an option? In most self-insured plans, the answer is "very few or none." That gap is the opportunity.
• Who is the single point of contact for a member navigating specialty infusion? If the answer involves three or more phone numbers, the member is doing coordination work your plan should be doing for them.
• What does our current partner do when a prescriber pushes back on home infusion? The right answer is: They keep the prescriber, or help the member find an alternate specialist. The wrong answer is: They take the "no" and stop.
• How is the member experience actually being measured? Ask for the specific patient satisfaction and NPS numbers. Ask how frequently they're measured and how the results feed back into service.

None of these questions requires a change in vendor. They require an honest audit of what's happening today.

How Leap delivers a coordinated home infusion experience

Leap is structurally different. We negotiate specialty drug pricing directly with manufacturers and specialty pharmacies, bill the drug at true acquisition cost with no buy-and-bill markup, and itemize every claim so employers see the drug, the coordination, and the clinical delivery as separate line items rather than one bundled allowed amount.

The care model sits on top of that structural improvement:

• A dedicated Infusion Care Guide for every member. Single point of contact from the first phone call through ongoing therapy.
• A qualified national nurse network of more than 10,000 licensed infusion nurses across all 50 states, with continuity of care as a default rather than an accident.
• The Leap Transparency Network of ambulatory infusion centers in 37 states for members who need or prefer a clinical setting.
• Clinical governance with intake assessments, home safety criteria, and reaction protocols consistent across every visit.
• Utilization-based fees. Leap only earns when care is delivered. No PMPM, no PEPM, no retainer.

Leap works with self-funded employers, unions, health plans, and third-party administrators to deliver this care as a voluntary option inside the existing medical benefit. There's no change to the member's plan, ID card, carrier relationship, or prior authorization process. The first step in any engagement is a claims-based impact analysis, which surfaces the actual J-code spend on the plan, the drug-by-drug variance, and the specific opportunity available. It sets realistic targets before any commitment.

To learn more about how Leap can improve your members' specialty infusion experience while lowering your plan's specialty drug spend, visit leaphealth.com.

Experts

Kacie Keith, PharmD, Infusion Care Guide, Leap. Kacie is a licensed pharmacist with more than 15 years of experience across hospital, retail, and long-term acute care pharmacy. She joined Leap as one of the founding Infusion Care Guides and works one-on-one with members on the full arc of their specialty infusion journey.

Nicole Dixon, RN, Clinical Manager, Leap. Nicole leads Leap's day-to-day clinical operations and Care Guide support. Before Leap, she was Director of the Virtual Care Unit at Contessa Health leading home-based acute care coordination, and earlier held nursing leadership roles at Vanderbilt University Medical Center in chemotherapy infusion and cardiovascular intensive care.

Katie Hakemi, Senior Director of Consultant Relations, Leap. Katie leads Leap's consultant relations across national and regional benefits advisory firms, working with employer clients on integration, engagement, and results measurement.