Implementation of Site of Care Optimization Program for Ambetter Health Members: Effective 10/01/2025

Fecha: 29/09/25

Effective October 1, 2025, Ambetter Health will implement a Site of Care 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 Site of Care Program?

Our Site of Care 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.

Why This 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.

Need Assistance?

Our care coordination team can assist with patient identification, referral processes, and coverage considerations. Call us at (866) 861-6269.

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

To access additional resources related to the Site of Care Program, click here.