SAN FRANCISCO – World Class Health (WCH), the AI-native Specialty Care Centers of Excellence platform for self-insured employers, health plans and third-party administrators, has expanded into specialty infusion, where site of care drives most of the cost. WCH is the first specialty care platform to bring surgery, imaging and infusion together under a single clinical team.
Specialty drugs account for roughly half of all pharmacy spend while being used by about 2% of patients, and gross specialty costs per member are projected to rise another 32% by 2028. The same drug can cost several times more in a hospital outpatient suite than in a member's home, at an identical standard of care. Most members are referred directly into a hospital infusion chair, where a single treatment can consume up to six hours of a workday, and are never told the therapy is available at home on an evening or a weekend.
The WCH care team identifies eligible members from claims and prior authorization data, confirms each member's out-of-pocket cost before treatment is scheduled, and transitions care to a clinically appropriate home or suite setting. The network delivers home infusion in all 50 states and includes hundreds of infusion suites for members whose therapy or preference calls for a facility. Both settings offer evening and weekend appointments, and members can often keep working during a home infusion.
"Specialty infusion is one of the many healthcare purchases where members are flying blind on both their options and their cost," said Sid Nambiar, Chief Executive Officer of World Class Health. "A member who needs an infusion calls our team, gets the same treatment at home on their own schedule, and pays nothing, while their employer pays a fraction of the hospital price."
Infusion therapy is a logistics project for most members. It requires finding an in-network infusion suite, scheduling visits during working hours, keeping prior authorizations current, and updating the prescribing physician after each treatment. Each step is a place therapy can stall.
A dedicated Nurse Navigator, one of the licensed nurses who manage every WCH case, owns the full course of therapy: site selection, scheduling, re-supply, re-authorization, and delivery of results to the prescribing physician. The member's only responsibility is to show up for treatment.
"When you take the friction out, members stay on therapy and get treated at home instead of losing a workday in a hospital chair," Nambiar added. "That is better for them clinically and cheaper for the employer paying the bill."
WCH eliminates buy-and-bill margin by moving treatment out of the hospital and into the home or a lower-cost suite. Savings average roughly 46% against commercial hospital outpatient benchmarks, or $30,000 to $50,000 a year for each patient moved. Each case is measured against the member's own prior treatment cost where a claim exists, and against the published outpatient benchmark for the member's market where one does not, so employers and their advisors can audit every case.
Infusion is available now to WCH clients and their benefits advisors. Contracts are expandable by service line, so employers already working with WCH on surgery or imaging can activate infusion without a new agreement.
The platform covers orthopedics, spine, cardiac, bariatric surgery, general surgery, gynecologic surgery, imaging and infusions.
