What is the Site of Care (SOC) Program?
The SOC Program identifies patients receiving specialty or infusion therapy in high-cost settings (e.g., hospital outpatient departments) and evaluates whether they may be safely transitioned to clinically appropriate, lower-cost alternatives, such as home infusion or freestanding infusion centers.
Why is this program being implemented?
The goal is to improve patient experience, reduce total cost of care, and support alignment with value-based care models and payer policies. Many infusions administered in hospitals can be safely delivered in alternative settings at significantly lower cost without compromising quality.
What are examples of alternative sites of care?
- Ambulatory Infusion Suites (AIS)
Is the SOC program guided by a clinical policy?
Yes. This program is based on Centene Clinical Policy: Infusion Therapy Site of Care Optimization NY.CP.PHAR.493, which outlines appropriate criteria for site of care decisions and drugs eligible for redirection. What types of therapies or patients are targeted?
The program focuses on select high-cost specialty and infusion drugs where alternative sites of care are safe and effective. Eligibility is determined based on clinical criteria, treatment regimen, benefit design, and geographic access to alternate sites.
How are patients selected?
Patients are identified through claims data, clinical profiles, and coordination with prescribers. Our team will engage with you before outreach to the patient begins, to ensure clinical appropriateness and continuity of care.
Is participation in the SOC program mandatory? Are there any exceptions?
Yes, participation is required when clinically appropriate and supported by policy. IF a patient qualified for redirection under the Centene Clinical Policy NY.CP.PHAR.493, transitioning to an alternative site of care is expected.
However, we understand that every patient’s situation is unique, and exception may apply. Our Site of Care team carefully reviews each case. If an exception is warranted, it will be evaluated in accordance with the policy criteria. Providers will be notified when redirection applies to a patient and will be consulted throughout the process to ensure continuity and quality of care.
What if my patient is hesitant to switch infusion sites?
It’s not uncommon for patients to have questions or concerns about changing their treatment location. As a provider, you play a key role in helping them understand that the alternative site offers the same clinical quality. Our Site of Care team is available to support both you and your patient during the transition.
What is expected from prescribers?
We ask for your partnership in:
- Reviewing patient eligibility
- Supporting transitions when appropriate
- Prescribing to preferred infusion providers if applicable
- Maintaining communication to ensure seamless care delivery
Additionally, when submitting a prior authorization (PA) request, please indicate the intended site of care. This helps streamline the process, reduce administrative burden, and avoid follow-up requests. Our Site of Care team is available to assist in identifying nearby, clinically appropriate infusion sites that meet policy and patient needs.
Will this disrupt patient care?
No. Transitions are coordinated carefully with prescribers, patients, and infusion providers. The same medications and dosing regimens are maintained. Only the site of administration changes, when clinically safe and approved.
What are the benefits to the patients?
The Site of Care program is designed with the patient in mind – offering meaningful advantages that support both quality and experience of care:
- Lower Out-Of-Pocket Costs: Alternative sites may come with reduced patient cost-sharing. Lower costs can improve adherence to treatment, leading to better clinical outcomes
- Greater Convenience & Flexibility: Appointments at alternate sites can be scheduled around the patient’s lifestyle – including options for evenings or weekend visits – minimizing disruption to work, school, or family responsibilities.
- Reduced Time Commitment & Hospital Exposure: Alternative sites typically offer faster check-in, shorter wait times, and lower risk of hospital-related infection exposure, making the overall experience safer and more efficient.
- Improved Patient Satisfaction: Patients redirected to alternate sites consistently report higher satisfaction levels, citing increased comfort, reduced stress, and more personalized care experience.
Who can I contact for more information?
If you have questions about the Site of Care program or need support with a specific patient case, our Utilization Management Site of Care team is here to help.
📞 866-861-6269
📧 CPS_UM_SOC@centene.com
We’re available to assist with eligibility reviews, site referrals, prior authorizations, and any other program-related inquiries.