A conversation with NICA’s Executive Director on in-office infusions and the importance of research studies

The National Infusion Center Association (NICA) is an Austin-based advocacy organization dedicated to improving patient access to in-office infusions. We caught up with Brian Nyquist, NICA’s Executive Director, to talk about the work they’re doing to achieve this goal, and why research studies remain critical to providing optimal patient care.

Can you tell us a bit about National Infusion Center Association? What’s your mission?

The National Infusion Center Association is a national nonprofit advocacy organization with the mission of improving patient access to office-administered intravenous and injectable medication. We were formed to support a historically underrepresented segment of the infusion delivery model (in-office), to improve access to care. By in-office, we mean both specialty physician office-based infusion facilities (where prescribing and administration happen) and the standalone infusion centers (where the focus is administration). There are benefits to in-office, non-hospital care settings over the hospital care setting alternatives, so we’re working to translate these benefits into improving access to intravenous and injectable products. We take a patient-centric approach to achieving this mission, and focus on providers as necessary to preserve the current level of access to care as we work to expand it.

And how are you working to achieve this mission?

We work on this mission in three areas: advocacy, education, and resource development. In terms of advocacy, we work to identify, address, and overcome barriers to access or threats to this medication delivery channel before they become disruptive to care. This allows infusion providers to focus on providing the safe, high-quality care that patients need, and patients to focus on living their lives and relying on their ability to sustainably get the care they need in this more economical and accessible care setting. We also educate providers and patients on this delivery model — for providers, we offer educational materials on how best to communicate with patients, and for patients, we share content to empower them to be as active and collaborative in their care decision making as possible. And of course, part of this education is resource development; we connect infusion providers and their staff with resources and tools they need to improve care and their capacity to care for patients.

Why is in-office better?

First and foremost, it’s much more economical when compared to hospital care, particularly for a commercially insured patient. The cost disparity can be 4x higher in hospital for same drug and same patient — that’s significant.

In addition, in-office infusions are typically more accessible and offer reduced wait times. There’s also an element of compassion that is important — we’ve heard from patients who have been getting infusions at the same facility for ten years, and have developed a strong relationship with their care team and other patients. They schedule their infusions together and form a support network. By contrast, in a hospital, many patients tend to feel like just a number.

Of course, there is an argument to be made for in-hospital settings for certain types of infusions, or in certain communities. Ultimately, we want patients to get the care they need, wherever they can get it. If there are office-based alternatives, we advocate for those care settings versus the hospital for the reasons I’ve shared.

As part of your mission, you collaborate with health plans and government contacts to address some of the major challenges to access to office-based infusions. Can you talk a bit about the role each of those stakeholders play in improving access?

With insurers, we’ve been trying to work with them to overcome some of the utilization management strategies that they’re using that ultimately restrict or disrupt patient access to care, which would increase the annual per capita economic burden of disease. For example, we work to help overcome barriers to access by helping to get patients into care and stable on therapy as quickly as possible for as long as possible. In many cases, take autoimmune conditions for example, it’s imperative to halt or delay progression in order to minimize the economic burden of disease. In addition, we work with payers from a site of care optimization perspective. We’ve seen great success with incentive-based site of care optimization strategies shifting patients from hospital care settings to office-based alternative sites of care, so we are exploring how we can collaborate with payers to leverage this success.

In terms of the government, we work with CMS [Center for Medicare & Medicaid Services] at the public payer level, and also engage at the legislative levels in both state and federal settings, to try to preserve and expand the in-office delivery channel. We’re really focused on sustainability, so if there are potential changes to the landscape that would be disruptive and force patients into the hospital, we work to overcome those issues. We find that highlighting the cost differential can be a really powerful tool for these audiences, so try to emphasize that as much as we can.

If I’m a patient and I get in touch with NICA to try to access my office-based infusion options, what services do you provide? How do you help patients?

On our website, we have an infusion center locator resource — we built it to help connect patients to the delivery channel, especially if their prescribing clinician doesn’t deliver infusions in their office. We have over 3,000 in-office infusion facilities across all 50 states, the District of Columbia, and Puerto Rico included the locator.

We also provide some helpful educational materials. Right now, it’s at a foundational level — we’re offering Infusion 101 type educational modules that address questions such as: “What is an infusion?” and “What types of conditions are treated via infusion?” We also include a lot of information about what to expect with an infusible product, which patients find really helpful. For example, many of these medications are administered at room temperature or colder, so patients need to be prepared and bring thick socks and blankets to be comfortable while being infused. We also offer patients some educational materials on insurance — how to shop for a plan on the Exchange, what’s Medicare and Medicaid, what is a deductible, etc. A lot of patients just look at their monthly premium as primary selection criteria for insurance when they need to be looking at balancing monthly premium, deductible, OOP max, coinsurance rate, what’s covered, etc. But benefits plans are riddled with jargon so we’re trying to empower patients who need infusion therapy take a more active role in advocating for access to care.

I know you heard about us through Lupus and Allied Diseases Association. Can you share a bit about how you work with therapeutic-area specific organizations to support patients?

NICA works with many different organizations in a variety of capacities. Ultimately, we want to work with organizations that focus in a disease state or specialty in which in-office infusion is relevant. So, we partner with organizations such as Lupus and Allied Diseases Association, the US Pain Foundation, Global Healthy Living Foundation, etc. Synergy is an incredibly powerful concept. There’s immense value in partnering to leverage their expertise and focus it in through that in-office infusion lens. We serve as a resource for their communities on the topic of in-office infusions. And, being nonprofit organizations, we’re trying to allocate resources as efficiently and responsibly as possible, so replicating and duplicating effort doesn’t align with that philosophy. Building partnerships with organizations that have educational content or great resources that our stakeholders can use is important to us. It’s great to have these mutually beneficial partnerships working towards patient-centric access to care.

I know you’ve recently begun to work with Antidote on helping connect patients to clinical trials. Can you talk about the role of research in your work and why it’s important to you to help make those connections?

In many of the conditions we work in (e.g., autoimmune diseases), it’s imperative to diagnose as early as possible and get on therapy as quickly as possible. So, it’s critical that patients participate in research studies to help develop new screening methodologies and new ways that we can diagnose these conditions as early as possible, so that we can intervene earlier to delay progression that much longer. And, in addition to new screening methodologies, if we have any hope of finding a cure or a new, novel, innovative therapeutic option, there’s an inherent research component that requires patients. Every technologic advancement in every industry is driven by research. If you’re not measuring it, you can’t improve it. If we’re not researching new diagnostics, we can’t expect to discover new diagnostics. If we’re not researching new therapeutic options, we can’t expect to expand the array of available treatment options. We have to do research — clinical trials are absolutely important to the advancement of screening technology and drug development. We need volunteers and that is why we are excited to partner with Antidote. Developing partnerships to expand capabilities so we can continue to improve patients’ access to care. It’s the [not so] secret sauce for maintaining forward momentum.

To learn more about NICA, please visit https://infusioncenter.org/. And, if you’d like to search for a clinical trial today, get started below: