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Ambetter Health Launches Site of Care (SOC) Optimization Program on Oct. 1

Date: 08/19/25

Starting October 1, 2025, Ambetter Health will implement a Site of Care (SOC) Optimization Program to support improved care delivery and cost-effectiveness for Ambetter Health members.

Under this program, providers with members currently receiving infusions in outpatient hospital settings will be contacted to select an alternative home infusion or ambulatory infusion suite (AIS) option. Participating providers will receive outreach via fax or a phone call beginning in September.

This outreach will request preferred site-of-care selections for individual members.

What is the SOC Program?

Our Site of Care (SOC) program focuses on patients receiving infusion therapies or specialty drugs in high-cost setting, such as hospitals. The goal is to transition eligible patients to clinically appropriate lower-cost alternatives — like home infusion or freestanding infusion centers — when suitable.

Program Overview

The SOC optimization program aims to transition provider-administered infusion therapies from outpatient hospitals and clinics to home-based or AIS settings, when clinically appropriate. If infusion at an outpatient facility or prescriber’s office is deemed medically necessary, the drug may still be shipped from a preferred Ambetter specialty pharmacy — such as AcariaHealth — to the administering site.

This initiative focuses on therapies for conditions such as:

  • Immune globulin disorders
  • Crohn’s disease
  • Rheumatoid arthritis
  • Psoriasis
  • Multiple sclerosis
  • Rare diseases

The goal is to ensure high-quality, cost-effective care and improve access, particularly for members in rural or underserved communities.

Infusion Providers

  • National Infusion Providers: AcariaHealth, Accredo, Coram, KabaFusion, NuFactor, Option Care, and Soleo Health.
  • Local Infusion Providers: BioHealth, Capstone Vital Care, Paragon Infusion and Prosper Infusion.
  • Visit the Find a Provider search tool for a complete list of contracted providers.

Why it Matters

  • Improved patient experience: Patients often prefer care closer to home or in lower-acuity settings, with greater comfort and convenience.
  • Reduced total cost of care: Shifting treatment to lower-cost sites may help reduce drug administration costs while maintaining high clinical standards.
  • Streamlined referrals: We offer support for identifying qualified alternative sites and facilitating transitions, minimizing administrative burden.
  • Better clinical alignment: This approach reflects industry best practices, payer expectations, and value-based care models.

How You Can Help

  • Refer patients to in-network, lower-cost infusion sites when appropriate.
  • Engage with our team re: questions about eligibility or help with referrals.
  • Educate patients on their options and benefits of optimized site placement.
  • Share feedback on operational/clinical considerations to improve programs for success.

Benefits of Home Infusion

  • Reduced risk of hospital-acquired infections for immunocompromised members.¹
  • Comparable safety to facility-based infusion.²
  • Enhanced convenience, privacy, and comfort in a familiar setting.
  • One-on-one care and continuity with a dedicated infusion nurse.
  • Expanded access outside standard business hours, including evenings and weekends.
  • Fewer barriers related to transportation, work schedules, or childcare.

Infusion Nurses Are Trained To:

  • Monitor and support treatment adherence.
  • Manage pre-medication and emergency protocols.
  • Provide patient education.
  • Follow the Centers for Disease Control and Prevention (CDC) infection prevention guidelines.
  • Deliver Pediatric Advanced Life Support (PALS) care for children.

SOC Assistance

Our care coordination team can assist with patient identification, referral processes, and coverage considerations. Starting September 2, call us at 1-866-861-6269.

For more information about the SOC program or to discuss member-specific details, please contact our Pharmacy Provider Liaison by calling 1-866-861-6269 or emailing CPS_UM_SOC@centene.com.

Together, we can enhance patient care while reducing healthcare costs across the system.

Questions?

Ambetter Health has a wealth of resources available to help answer your questions and address your concerns:

References

  1. ‌Supatida Tengsupakul, MD; Chief Editor: Russell W Steele, MD (Updated Feb. 13, 2025). “Hospital-Acquired Infections: Practice Essentials, Background, Pathophysiology.” EMedicine.
  2. Susman, E. (Dec. 7, 2022). ”Infliximab Maintenance Home Infusion Appears Safe.” Medpagetoday.com; MedpageToday.
  3. Rentala, M., Andrews, S., Tiberio, A., Alagappan, K., Tavdy, T., Sheppard, P., and Silverman, R. (July 2016). “Intravenous Home Infusion Therapy Instituted from a 24-Hour Clinical Decision Unit for Patients with Cellulitis.” The American Journal of Emergency Medicine, 34(7), 1273–1275.