Home Infusion Demand Accelerates As Providers Navigate Mounting Challenges 

Demand for home infusions is growing as payers and health systems increasingly seek to move appropriate patients into lower-cost settings and accelerate discharge — but operational and reimbursement challenges, including site of care restrictions and a lack of standardized contracting, complicate the path to scale.

This shift is increasing demand for in-home infusions, but the model depends on rapid care coordination, payer agreements that support clinically appropriate care in the home and Medicare expansion, experts told Home Health Care News.

“There’s just that overall driver to try to get patients in the least expensive care setting possible, and almost always that’s an infusion at home,” CommonSpirit Health at Home’s senior vice president of infusion services, Michael Ahrendt, told HHCN.

Chicago-based CommonSpirit Health at Home provides home health and personal care services across 24 states. The organization formed from a realignment between Catholic Health Initiatives and Dignity Health in 2019.

Home infusions involve administering intravenous medication within a patient’s home, as opposed to a hospital or physician’s clinic. Acute home infusions often continue treatments that once began in a hospital, Ahrendt said.

About two-thirds of CommonSpirit’s home infusions entail delivering intravenous antibiotics. The other third of infusions includes parenteral nutrition, enteral therapies, hydration and pain management.

Sofia Shrestha, senior director of clinical strategy and affairs at Leap Health, a New York City-based company and infusion care coordination platform, also noted an increase in demand for home infusions. Shrestha reported a fivefold increase in utilization in the past decade.

“There’s a lot more data now on the safety of administering these infusions [at] home, and I think more individuals and payers are also realizing the cost savings of moving patients to an equally high-quality site,” Shrestha told HHCN.

Leap coordinators most commonly provide infusions for chronic and inflammatory disease treatment. Leap Health manages patients with Crohn’s disease, ulcerative colitis, rheumatoid arthritis, eligible at-home cancer treatments and neurology conditions such as multiple sclerosis.

Navigating obstacles

The growing demand for lower-cost therapies has ramifications for providers, such as shortening the notice period for the service.

Ahrendt said that, previously, when there was little incentive to move patients out of a hospital, CommonSpirit would receive one to three days’ notice before a patient is discharged home.

“Now, it’s very common at nine in the morning to say, ‘Hey, the doctor wants this patient to go home at 4 o’clock today. Can you do that? Can you make sure they have the insurance coverage for that? And can you get everything set up, including the nursing, to be available to get them going that evening in the home?’” Ahrendt said.

Patients are also often leaving the hospital with more acute care needs, he added.

“We see patients who are still sometimes very sick being sent home, and so we’re taking on sicker patients with that incentive to try to get them pushed out of the hospital faster and faster,” Ahrendt said.

Staffing, which is a perennial challenge across the home-based care industry, also creates difficulties for home infusion providers, according to Kelley Hill, senior vice president of clinical operations at BrightStar Care.

“The biggest obstacle to successfully scaling home infusion is having enough qualified nurses to staff infusion patients, especially in smaller or rural areas,” Hill told HHCN.

BrightStar Care currently has an average 24-hour turn-around time from receipt of referral to the start of at-home care, Hill said.

Ensuring all the necessary equipment and processes are in place ahead of home infusion administrations also represents an operational obstacle, Hill said. This process involves confirming that medications and administrative supplies are in place, as well as securing hazardous waste disposal, comprehensive care coordination and clear communication with pharmacies.

Chicago-based BrightStar Care provides home-based care services from 440 locations across 41 states. In 2025, BrightStar administered over 102,000 home infusions, the company’s senior vice president of enterprise growth, Lisa Slama, told HHCN.

Along with increased acuity and shorter notice periods, home infusion providers also face potential challenges related to site-of-care restrictions.

Site of care describes an insurance mandate specifying which medication infusions or injections may occur at an infusion center, physician’s office, home or another alternative location, according to the Hematology/Oncology Pharmacy Association, a nonprofit professional organization based in Milwaukee, Wisconsin. Allowing patients to choose care sites enables more affordable treatment options, according to the organization.

However, some site-of-care restrictions exist for certain specialty drugs, which can limit at-home infusions.

Jaya White, partner in the healthcare-focused legal practice Quarles’ Health & Life Sciences Practice, notes seeing site-of-care limitations for specialty drug infusions that can chafe against a patient’s care plan.

“You may see payer agreements that require that the drugs either be delivered to an ambulatory infusion suite or a physician’s office rather than to the patient’s home, which may create issues if the requirement to deliver to an alternate site or the home [that] is not consistent with a patient’s clinical need or physician’s plan of care,” White told HHCN in an email.

Home infusion providers should be aware of these site-of-care restrictions and aim to negotiate a payer agreement that allows for exceptions to account for clinical determination of appropriate site of care, which can involve select drugs or therapies, White added.

Reimbursement and licensing difficulties

While certain reimbursement agreements favor home infusions, the lack of consistency across payer agreements can add administrative burdens for home infusion providers.

CommonSpirit has many payer agreements involving risk-based models, which prompt the health system to be financially responsible for providing high-quality care at the lowest possible rate. These arrangements therefore encourage the use of lower-cost home infusions.

But commercial insurance agreements are highly varied, creating another barrier for providers to contend with.

“The variability across commercial plans is a real constraint for everyone in this space, since billing conventions shift market to market and there’s no standard to contract against,” Slama said.

To overcome variability-related challenges, BrightStar has developed partnerships with specialty pharmacies. Many of these pharmacies receive the patient’s referral and can place needed drugs on hold, but do not have the clinical staff to administer home infusions. BrightStar’s home infusion staff step in to deliver care.

Patients can also struggle with navigating payer requirements for home infusions. Care coordination services can help streamline the process, Shrestha said.

“With managing prior authorization, coordinating with the pharmacy, with the nurse, copay assistance, billing, we kind of take all of that administrative burden on our end, so patients can really focus on getting their treatment,” she added.

Home infusions are increasing, but they also exist in a legal gray area, White said.

“While Medicare created the Part B home infusion therapy enrollment over five years ago, the home infusion industry is still a very gray area when it comes to appropriate licensure and scope of practice,” White said. “Whether a home health agency license is required is dependent on the state definition and the services provided by the provider.”

For instance, different states require different or separate licensing requirements for home infusion providers, such as the home nursing agency in Illinois or the residential service agency license in Maryland, White said.

As a result, White emphasizes the importance of licensing home infusions. “Make sure to understand the state licensure requirements for a home infusion provider, along with scope of practice for individuals under each state’s laws.”

Without proper licensure, providers face significant compliance risk and penalties under the False Claims Act.

The future of home infusions

With demand for home infusions growing, companies plan to scale their service lines to meet the needs.

Slama noted that home infusions are one of BrightStar’s fastest-growing segments. Leap plans to expand its treatment options and to increase transparency for patients.

Ahrendt said home infusions are a “significant” part of CommonSpirit’s growth strategy, and that the company “had recent discussions about how to increase our footprint across the organization even more.”

In addition to its current home infusion offerings, CommonSpirit plans to expand into chronic therapy treatments that can last for years or a patient’s lifetime, Ahrendt said.

On the macro-level for the industry, Ahrendt predicted a proliferation of ambulatory infusion sites so that providers can better triage care for a patient, in addition to establishing more robust home infusion services for individuals in rural areas.

While the home infusion industry is already growing, changes to Medicare are needed to facilitate improved access to home infusion services.

“Medicare has a very, very limited home infusion therapy component right now,” Ahrendt said. “Seeing the federal government look at the value that we bring has been an ongoing push for the trade associations associated with home infusion. The need to have Medicare cover more of what home infusion does will be key the next five years to making this work.”

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