Home is Where the Healing Is

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For patients who need intravenous drug therapy, KabaFusion brings it home

There’s no place like home. For patients in need of infusion therapy services, this expression has an added dimension of meaning. In the past 30 years, the efficacy of life saving intravenous therapies has been well established; some patients may need IV antibiotics after a hospital stay, and others are living with diseases that require IV treatments to keep them healthy. But until fairly recently, getting these services at home was a difficult proposition.

In 1992 when Dr. Sohail Masood, Pharm.D, and his wife Mona Masood, R.Ph, founded their first venture, Ultracare, the home infusion industry was in its infancy. Today, the sector has carved an important place in medicine, and Dr. Masood is hailed as a pioneer in the development and delivery of home infusion care. In 2022, Dr. Masood received the Gene Graves Lifetime Achievement Award from the National Home Infusion Association for his contributions to the discipline.

KabaFusion, a pharmacist-owned, patient-focused home infusion company specializing in intravenous immunoglobulin, subcutaneous immunoglobulin, and acute home-infusion IV therapies, was founded by Dr. Masood in 2010. Today, KabaFusion is a $1 billion enterprise, operating state-of-the-art compounding pharmacies in 30 states with a staff of 1,500, a third of whom are nurses.

During the HIV-AIDS epidemic in the mid-1980s, home infusion was the salvation for patients too ill to endure repeated outings to hospitals and clinics. “I was still at school, and I just loved going to patient homes and meeting with those individuals whose families didn't understand AIDS and HIV,” he recently told BOSS. At the time, fear and misinformation around the disease ran rampant. “I’d go in with my nurse and we would fight on behalf of the patients and humanize their condition. That really deepened my passion and commitment for the home infusion business.”

In the early ’90s there were no written protocols or policies for infusion therapy; the accreditation bodies that certify today’s home infusion operators for quality and safety, such as the Joint Commission, did not extend their oversight to home infusion operations, and the drugs used were not FDA-approved for some of the diagnoses. “There was really no true standard of how to provide care to the patients at home consistent with the same services they were getting in the hospital,” he said.

While IVIG is indicated for many different diseases, it is commonly used to treat neuromuscular diseases such as myasthenia gravis, multiple sclerosis, stiff person syndrome, and small fiber neuropathy. It is used in the treatment of primary immune deficiency, as well as dermatological disorders such as pemphigus and pemphigoid diseases. New indications for IVIG are discovered frequently, such as for seizure disorders and illnesses secondary to Down’s syndrome.

Depending on the treatment protocol, infusions may be needed multiple times a month. “These are long IV infusions,” Dr. Masood said. “Imagine if the doctor or the hospital doesn’t tell the patient that you can get it done at home. They have to drive all the way to the hospital or doctor's office for these therapies, whereas we can provide this treatment to them in the comfort and convenience of their home.”

For patients who are immunocompromised, receiving treatment at an ambulatory center or hospital increases their risk of exposure to harmful bacteria. “Ninety percent of patients will say, ‘If you can do it at home, I would rather get it there instead of coming to a very busy center where I may be getting a secondary infection,’” he added.

The market has matured, as has the way IV drugs are prepared. In the early days, clean rooms were rudimentary. Today, the drugs are mixed in highly sophisticated clean rooms. That necessity makes it very difficult to establish new home infusion pharmacies, as the clean room alone may cost at least $500,000 to create.

The technology has improved, but it also requires providers in the U.S. to share a great deal of data and patient information to insurance companies and doctors. “It’s a very data driven industry now and there is a continuous need for that,” he said. Administrative processes have been developed, but the actual dispensation of the IV drugs is essentially the same as it was when Dr. Masood first took interest in the therapies.

Dr. Masood is leading the charge on the data collection that today is absolutely necessary to have insurance companies cover these kinds of treatments. “We have very sophisticated systems in the company where we get all that data and we submit it to the insurance company through our intake department, which is run by a clinician.”

The steep cost of IV drug compounds makes it difficult to get authorization from insurance companies.

KabaFusion handles the prior authorizations required to approve coverage for infusion therapy. “Once diagnosed, a patient may have a hard time getting the drug approved. We have the expertise to get the drug authorized, and that in itself is a benefit for the patients we serve,” he stressed. “We excel in getting authorization for disease states where there is not a whole lot of written clinical data to support the therapy but positive outcomes from the drugs are shown.”

To help patients with the complexity of getting these expensive drugs funded, KabaFusion’s billing and intake department works very closely with patients so they understand their financial obligations and explore payment options, and in some cases may offer financial assistance.

When Covid hit, most of the facilities providing infusion services discharged their patients. “We went in and started taking care of them at home,” Dr. Masood said. The entire KabaFusion workforce were voluntarily vaccinated. “They were all vaccinated: nurses, pharmacists, delivery drivers, salespeople, people going to the doctor's office and hospitals,” he recalled. “I'm very proud of that achievement. Patients at home depend on us.”

Patients also benefit from KabaFusion’s approach to care. “We assign one nurse to a patient and the same nurse will infuse the drug as many times as the patient needs,” he explained. Other companies may not have their own nursing staff and may use outside nursing agencies, having no control over which nurse infuses the drug to the patient. “Our patients see the same person every time they get their IVIG infusions, and that is how we create the quality of care. We are always looking at how we can improve patients’ lives and make sure their experience with us is stellar.”

In Dr. Masood’s view, IVIG is a miracle drug. “I’ve always said that, and I still believe in it. There are so many new indications, which is another reason for the growth of KabaFusion.

“We really believe in patient care, and we are truly patient-centric. That’s really the beginning and the end of how we think of KabaFusion – not just myself as CEO and founder, but all of our employees. If you talk to them, they will say that patient care is what we do.”