5 steps to implement a specialty infusion therapy program employees will actually use

Picture two employees in the same health plan. Both were prescribed the same infusion therapy the same month. 

The first employee calls her Leap Care Guide the day the referral comes through, gets scheduled within two weeks, and her claim never sees a hospital markup. 

The second doesn't make that call to Leap for months. Instead: 

• The referral sits. 
• Prior authorization stalls.
• She gets infused at the hospital outpatient department (HOPD), where her employer is still paying full markup on every dose.

Same employer. Same benefit. Same drug. Two completely different outcomes on next year's renewal.

That gap has a name, and it’s called utilization. Every benefit is only providing value if employees are actually using it. 

Selecting a vendor that strips the markup out of specialty drug claims is a financial decision. Getting members to actually use it is an operational one, and it's the one that determines whether the savings show up at all. 

Choosing the right vendor helps you understand the savings that are possible. But the right implementation and buy-in from your employees helps you achieve those savings. Here’s a five-step framework to drive employee engagement with a new specialty infusion solution: 

Step 1: Set your baseline before you launch, not after

Once you know which members are strong candidates for the benefit, capture exactly what their care costs today, drug by drug and member by member, before the new benefit goes live. This gives you a clear benchmark to measure against after program launch. 

The right specialty infusion solution, such as Leap, will provide you with an impact analysis before you choose them. If you have that, then you should have the baseline you need. 

Step 2: Identify the members driving the most spend

With specialty medicine, just 1% to 2% of members typically drive 10% to 15% of total healthcare costs. Pull your claims data and look at J-code and Q-code claims for high-cost drugs like Keytruda, Ocrevus, Entyvio, and Gammagard. These drugs are often susceptible to hidden drug markups. 

Step 3: Get member communication right

Employees may not want to switch to a benefit they don't understand or trust, particularly for employees receiving complex care. Communication should explain, in plain language: 

• What's changing (the site of care, the point of contact). 
• What isn't changing (their plan, their ID card, their prescriber, their coverage). 

It should also set a real expectation for how quickly the process moves and make clear that participation is optional. Members who feel educated and confident are more likely to trust the benefit. 

Leap employers a variety of tactics to support, including a dedicated sign-up page for an employer's population. Members also get the same Care Guide from their first point of contact and onwards.

Additionally, this a great opportunity to inform employees of any incentives you're offering them to use the new benefit rather than receiving costlier infusion therapy through a hospital outpatient setting.

Step 4: Build care coordination into the rollout

For a specialty infusion benefit to work, there can be hurdles around prior authorization, prescriber communication, pharmacy logistics, and scheduling on top of everything else a member is managing. Whatever vendor you've selected, ask directly: who owns the member's experience from referral to first infusion, and what happens when something goes wrong at 6 p.m. on a Friday?

At Leap, a dedicated Care Guide serves as the care coordination quarterback for members. Care Guides are assigned to every member the moment they're referred. The Care Guide handles:

• Benefits review
• Prior authorization
• Prescriber coordination
• Pharmacy logistics
• Scheduling
• Follow-up after every infusion

One Leap member put it this way: "Having my Care Guide made things so much less complicated. It's taken the stress off me and my family. Less to worry about with insurance and scheduling."

Step 5: Track utilization and adjust accordingly

Once the program is live, it’s important to monitor utilization of it. If utilization rates aren’t where you’d like to see them, there could be additional levers you can pull to help drive engagement and savings for the health plan, such as financial incentives for participation. 

If you're evaluating where your own population sits today, request an impact analysis and see the dollar opportunity drug by drug, member by member. 

Would you like a transparent view of how much you could save with Leap? Request an impact analysis now with your own data.