Navigating the Future of Infusion Therapy with Tim Affeldt

Summary

Becker’s Healthcare Podcast: Navigating the Future of Infusion Therapy with Tim Affeldt

Date: August 17, 2025
Guest: Tim Affeldt, Health System Leader, Fairview Health System
Host: Scott Becker

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Episode Overview

This episode features Scott Becker in conversation with Tim Affeldt, a leading figure in ambulatory pharmacy at Fairview Health System in Minnesota. The discussion centers on current trends and future directions in infusion therapy, the shift toward home-based care, the complexities of reimbursement and cost, as well as leadership insights from Tim’s notable career.

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Key Discussion Points and Insights

1. Introduction to Tim Affeldt and His Role (00:21)

• Tim’s Position: Oversees ambulatory and specialty pharmacy operations, including all pharmacy-related infusion initiatives at Fairview Health System.
• Focus Area: Ambulatory pharmacy and infusion therapy management.

2. Major Trends in Infusion Therapy (00:49)

• Integrated Infusion Strategy: Emphasis on comprehensive approaches that account for all patient care sites, reflecting payer and patient preferences.

• Shift in Therapy Modalities: Growth in subcutaneous (sub Q) therapies, many of which replace or supplement traditional IV therapies.

• Expansion of Home-based Therapies: Significant industry movement toward delivering infusion therapies to the home, driven by advances in specialty therapeutics and preferences of payers and patients.

  “The trends really are around a lot more therapies that are becoming sub Q that are healthcare administered… and lots of movement towards treating patients in the home.”
  — Tim Affeldt (00:56)

3. Cost, Reimbursement, and Site-of-Care Implications (02:03)

• Home Infusion as Cost-Saver: Home administration is often the lowest-cost option for payers, increasingly favored for both economic and patient satisfaction reasons.

• Infrastructure Considerations: Building and operating physical infusion centers is capital-intensive; steering patients to home care reduces overhead.

• Strategic Shifts: Moving more therapies and patients into the home is both a clinical and financial priority.

  “Instead of building a bunch of infusion centers and tying up a bunch of capital, a good strategy again is to just move more and more of those patients to the home.”
  — Tim Affeldt (02:39)

4. Patient Experience and Clinical Complexity in Home Infusion (03:04)

• Two Patient Categories:

  • Acute Therapies: Often post-hospital discharge; patients/caregivers trained to self-administer, with periodic nursing visits.
  • Chronic or Specialty Therapies: Higher risk of adverse events; generally require a nurse present for every dose.

• Balancing Independence and Safety: Efforts focus on maximizing patient autonomy while ensuring clinical oversight for safety.

  “For a lot of acute therapies, we can teach the patient or patient’s caregiver to dose on their own…if you get into some of the specialty infusions...it’s usually best practice...to have a nurse in the home for every dose.”
  — Tim Affeldt (03:17 & 03:45)

5. Looking Ahead: 2025 Priorities and Opportunities (04:04)

• Regulatory Environment: Monitoring policy changes, such as those resulting from the Inflation Reduction Act.

• Growth in Specialty Pharmacy: Rising importance of health system-based specialty pharmacies, recognized by payers, pharmaceuticals, and providers as pivotal to successful patient outcomes.

  “Really what we’re probably most excited about is just the continued trend...when it comes to specialty therapies and specialty care…patients can do the best…if they can use the pharmacy that is part of the health system.”
  — Tim Affeldt (04:27)

6. Leadership Advice for Healthcare Professionals (05:09)

• Cultivating a Broad Perspective: Emphasizes networking, interdisciplinary understanding, and curiosity beyond one’s immediate role.

• Holistic Decision-Making: Understanding the motivations of payers, pharma, and providers is key to impactful leadership.

  “Just focus on your network...try to get outside of just what you know…if you have that type of an approach and understanding, it really helps you be a better leader.”
  — Tim Affeldt (05:16 & 05:45)

7. Personal Moments & Lighter Conversation (06:07)

• College Sports Fandom: Tim shares the quirks of being a Golden Gophers fan.

• Host camaraderie: Exchange about sports allegiances and the communal joys and struggles of being dedicated fans.

  “I love my Gophers, but it hasn’t always been the easiest to be a Gopher fan.”
  — Tim Affeldt (06:18)

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Notable Quotes

• “There’s been really a trend towards home infusion — that is one of the lowest, if not the lowest, places to treat patients.” (Tim Affeldt, 02:12)
• “For a lot of acute therapies, we can teach the patient or patient’s caregiver to dose on their own.” (Tim Affeldt, 03:17)
• “We really are realizing that patients can...have the most successful journey with their disease state if they can use the pharmacy that is part of the health system.” (Tim Affeldt, 04:38)
• “If you have that type of an approach and understanding, it really helps you be a better leader.” (Tim Affeldt, 05:45)
• “I love my Gophers, but it hasn’t always been the easiest to be a Gopher fan.” (Tim Affeldt, 06:18)

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Important Timestamps

• [00:21] – Tim Affeldt’s role and scope at Fairview Health System
• [00:49] – Key trends in infusion therapy
• [02:03] – Cost trends and the economics of infusion therapy
• [03:04] – Complexity and patient experience with home infusion
• [04:04] – Priorities for 2025 and specialty pharmacy growth
• [05:09] – Leadership insight and career advice
• [06:07] – Personal reflections, sports, and lighter moments

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Summary

This concise yet insightful episode offers an overview of how infusion therapy is rapidly evolving—driven by payer pressures, patient preferences, and regulatory changes—to favor home-based care and health system specialty pharmacies. Tim Affeldt underscores the operational, financial, and clinical factors influencing these shifts, all while providing actionable advice for emerging healthcare leaders. A must-listen for anyone interested in infusion therapy, pharmacy operations, or strategic health system leadership.

Transcript

[A]

This is Scott Becker with the Becker's Healthcare Podcast. I'm thrilled today to be joined by a brilliant health system leader, Tim Affelt. And Tim's going to talk to us about what he sees, what trends he's watching, and a lot more. Tim, can you take a moment to introduce yourself and tell us a bit about what you do?

[B]

Yeah, absolutely. So, thank you. So, Tim Appelt and I am the, like you said, a health system leader. I'm here at the Fairview Health System based in Minnesota and I live in the ambulatory pharmacy space and in my role I oversee all of the operations related to our specialty pharmacy and then everything we have going on with infusion that is pharmacy related.

[A]

Thank you. And what are some of the trends you're watching in infusion? What's going on in the world of infusion therapy? Tell us a bit about that.

[B]

Yeah. If you think about health system infusion, really the trends are how are health systems set up to think about their total infusion strategy across all sites of care and do they have all sites of care for infusion in terms of not only where patients want to be treated, but also where do the payers want them to be treated? So that's what we're thinking about. And the trends really are around a lot more therapies that are becoming sub Q that are healthcare administered, maybe formally iv, more of an IV or a one hour iv and then certainly a lot going on in terms of the pipeline and therapies, in terms of specialty therapies and lots of movement towards treating patients in the home.

[A]

Thank you. And when you look at sort of the cost benefit, the profits, the issues, what's going on in the cost trends of infusion therapy and reimbursement versus cost and so forth. Any thoughts there?

[B]

Yeah, really it's, you know, like most in health care, you want to treat patients where they can be successful, but do it at the lowest possible cost. And I think that's why there is the move or been really been a trend towards home infusion that is one of the lowest, if not the lowest place to treat patients. Certainly for payers, that is most likely the the lowest place to treat Pat. So that has been pushing more and more therapies. And then that also is combined with the fact that it's very expensive to build, you know, brick and mortar infusion centers. So instead of building a bunch of infusion centers and tying up a bunch of capital, a good strategy again is to just move more and more of those patients to the home and when.

[A]

You look at doing home infusion, how complicated is that for the patient? Do they need a nurse or some kind of healthcare provider when they're doing it, or can they do it by themselves? What does that look like?

[B]

Yeah, a little bit of both. You know, in home infusion, it's good to understand there's both acute therapies usually coming out of a hospital or maybe an emergency room, and then there is chronic therapies coming out of clinics. And for a lot of acute therapies, we can teach the patient or the patient's caregiver to dose on their own. So you still may send out a nurse to, you know, weekly to check on how it's going, how that line is doing, and how the patient caregiver is doing. But other than that, they don't. You don't need a nurse in the home every day or with every dose. But then if you get into some of the specialty infusions where there's a little bit more chance of maybe an adverse reaction, it's usually best practice at that point to have a nurse in the home for every dose.

[A]

Thank you. When you look at the rest of this year and what you're building, what you're doing, what are you most focused on and excited about?

[B]

Yeah, I'd say for us, there's a lot going on. You know, you're monitoring, you know, different things coming out of the, you know, maybe federal government. So we're thinking about how things could change in the new year with the inflation Reduction Act. So I think a lot of folks are preparing for that. But really what we're probably most excited about is just the continued trend kind of upward when it comes to specialty therapies and specialty care. And really the growth of health system, specialty pharmacy and health system pharmacy overall. I think, you know, not only payers or pharma and even our own systems, we really are realizing that patients can do the best they can, have the most successful journey with their disease state if they can use the pharmacy that is part of the health system.

[A]

Fantastic. And you've had a terrific health care leadership career. Take a moment and tell us a little bit about what advice you would give to others. Trying to have a terrific health care leadership career.

[B]

Yeah, I would say, you know, one. Just focus on your network and meeting people and, you know, really trying to learn, trying to understand, try to get outside of just what, you know, have a better understanding of kind of the. The complete health system ecosystem. You know, why do payers make the decisions they make? Why does pharma make the decisions they make and why are we making decisions we make as providers? I think if you have that type of an approach and understanding, it really helps you be a better leader when you make decisions and when you try to help your teams make the best decisions when it comes to taking care of patients.

[A]

Thank you. Take a moment. This is going to be a complex question, so let me know if you're ready for a more complex question.

[B]

Absolutely.

[A]

So the question is, Golden Gophers fan or not?

[B]

Well, unfortunately, yes. I always tell my dad that if you just stayed in Wisconsin, I would have had so much more enjoyment because of badgers going to the Rose bowl and my Gophers not going to the Rose bowl since the 1960s. So I love my Gophers, but it hasn't always been the easiest to be a Gopher fan.

[A]

Well, isn't that the truth? And I know that as an Illini fan, some years are good, some years are bad, you know, but. But God hates the packers either way, so it's all okay.

[B]

Isn't that the truth?

[A]

It really is. Tim, I want to thank you so much for joining us today on the Beckers Healthcare podcast. What a remarkable career. You're right in the middle of something that's so important, this infusion therapy world and the updates in it. So thank you so much for taking time to join us today. Thank you very, very much.

[B]

Yes, you bet. Thank you for having me.