Demand for home infusion services is rising as healthcare payers and systems shift patients from hospitals to lower-cost settings to accelerate discharge. While this transition reduces overhead, providers face significant scaling obstacles, including restrictive insurance “site of care” mandates, nursing shortages, and a lack of standardized commercial contracting, according to industry experts reported by Home Health Care News.
Home infusions involve the administration of intravenous (IV) medications in a patient’s residence rather than a clinic or hospital. This model is increasingly used for both acute treatments—often continuing a regimen started in a hospital—and the long-term management of chronic inflammatory diseases. Sofia Shrestha, senior director of clinical strategy and affairs at Leap Health, reported a fivefold increase in utilization over the last decade, citing improved safety data and cost-savings for payers.
The shift toward home-based care is driven by financial incentives to utilize the least expensive care setting. Michael Ahrendt, senior vice president of infusion services at CommonSpirit Health at Home, stated that the drive to move patients into the home is a primary catalyst for the industry’s growth. CommonSpirit, which provides care across 24 states, reports that approximately two-thirds of its home infusions consist of IV antibiotics, while the remaining third includes hydration, pain management, enteral therapies, and parenteral nutrition.
Operational Pressures and the “Sicker Patient” Trend
The acceleration of hospital discharges has compressed the window for home care coordination. Ahrendt noted that while providers previously received one to three days’ notice before a patient was discharged, it is now common to receive a request at 9 a.m. for a patient to be set up for home infusion by 4 p.m. the same day. This requires rapid verification of insurance coverage and the immediate deployment of nursing staff.
Providers are also treating patients with higher clinical acuity. Ahrendt observed that patients are being sent home while still very sick due to the incentive to clear hospital beds faster. This increase in acuity places additional pressure on the operational infrastructure required to maintain safety and efficacy outside a clinical setting.
Staffing remains a critical bottleneck. Kelley Hill, senior vice president of clinical operations at BrightStar Care, identified the lack of qualified nurses as the primary obstacle to scaling, particularly in rural or smaller geographic areas. BrightStar Care, which operates from 440 locations across 41 states, reports an average 24-hour turnaround time from the receipt of a referral to the start of care. In 2025, the company administered over 102,000 home infusions.
Insurance Restrictions and Site-of-Care Mandates
A significant barrier to growth is the “site of care” restriction. According to the Hematology/Oncology Pharmacy Association, this is an insurance mandate that specifies where a medication must be administered—whether at a physician’s office, an infusion center, or at home. While the association argues that allowing patient choice leads to more affordable options, some payers restrict certain specialty drugs to clinical settings.
Jaya White, partner in the healthcare-focused legal practice Quarles’ Health & Life Sciences Practice, explained that these payer agreements can conflict with a physician’s clinical plan of care. If a payer requires a drug be delivered to an ambulatory suite rather than the home, it can create friction in the patient’s treatment trajectory. White suggests that providers must negotiate payer agreements that allow for exceptions based on clinical determination.
Reimbursement Variability and Legal Compliance
The financial landscape for home infusion is fragmented. CommonSpirit utilizes risk-based models where the health system is financially responsible for providing high-quality care at the lowest cost, which naturally incentivizes home-based infusions. However, commercial insurance remains a challenge. Lisa Slama, senior vice president of enterprise growth at BrightStar Care, stated that the variability across commercial plans is a constraint because billing conventions shift by market and lack a standard contract.
To manage this variability, some providers have formed partnerships with specialty pharmacies. In the BrightStar Care model, pharmacies handle the referral and hold the necessary drugs, while BrightStar provides the clinical staff to administer the infusion. Additionally, platforms like Leap Health manage the administrative burden of prior authorizations, copay assistance, and pharmacy coordination to reduce the stress on the patient.
Licensing also presents a complex legal challenge. White noted that despite Medicare creating the Part B home infusion therapy enrollment over five years ago, the industry remains in a “gray area” regarding scope of practice and licensure. Requirements vary by state; for example, Illinois may require a home nursing agency license, while Maryland may require a residential service agency license. Failure to adhere to these specific state laws can expose providers to penalties under the False Claims Act.
Strategic Growth and the Role of Medicare
Despite these challenges, home infusion is a core growth segment for major providers. CommonSpirit plans to expand its footprint and move into chronic therapy treatments that may last for years or a lifetime. Ahrendt predicts a future increase in ambulatory infusion sites to better triage patients, alongside more robust services for rural populations.
Industry leaders argue that the current Medicare framework is insufficient. Ahrendt characterized the current Medicare home infusion therapy component as “very, very limited.” He stated that the next five years will be critical for trade associations to push the federal government to expand Medicare coverage for the full range of home infusion services to ensure broader patient access.
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