Three ways health systems are transforming infusion services | NASP 2025 insights

1. Choose the right business model

Driven by emerging therapies, an aging population, and the rising prevalence of chronic conditions, demand for infusion therapy continues to climb.³ But growth alone doesn’t guarantee sustainability. Reimbursement and payer policies now determine viability as much as patient need. In today’s environment, it is essential for health systems to develop a comprehensive infusion site of care strategy that thoughtfully incorporates all three alternate care settings in order to balance payer policy, patient convenience, and clinical appropriateness.

The economics are compelling: the average cost per infusion in hospitals ranges from $5,500 to $11,500 per treatment, while home infusion ranges from just $1,700 to $3,500.⁴ Although the traditional hospital outpatient department (HOPD) model offers the highest reimbursement for the most complex patient population, it faces increased site of care pressure from payers. Three alternate care settings that can help health systems meet growing demand while managing site of care restrictions are: 1) Ambulatory infusion centers (AIC), which are provider-based, lower-overhead facilities that can often balance reimbursement and cost efficiency. 2) Home infusion pharmacies, which offer convenience to patients while enabling continuity of care, though specialized accreditation and infrastructures are required, and 3) Ambulatory infusion suites (AIS), which act as an extension of the home infusion pharmacy, providing a controlled clinical setting for medication administration.  However, they cannot serve the Medicare population, adding reimbursement complexity. 

Given the nuances of each alternate care setting, a sound business model must carefully evaluate payer mix, reimbursement structures, and the suitability of alternate care settings to your physical footprint, to ensure both patient access and financial sustainability. As Cody Lemoine, Accelerate Pharmacy Solutions’ Managing Consultant for Infusion Strategy, said, “To succeed, you need to align your care delivery model with the realities of reimbursement, balancing patient needs, clinical appropriateness, and payer policies.”

2. Meet sterile compounding standards

As health systems build their model, determining the scope of infusion treatments provided in alternate sites of care is a key step. For alternate sites of care where compounding is part of the workflow, adherence to USP <797> isn’t negotiable. Non-compliance can trigger shutdowns, financial penalties, and, most critically, can adversely affect patient outcomes.

There are varying approaches that span from a full clean room to immediate use compounding. A full clean room, featuring an ISO 5 hood and adjoining anteroom, supports broader compounding capacity and longer beyond-use dating (BUD) but carries higher build-out and maintenance costs. A segregated compounding area (SCA) is simple and less expensive, though limited to basic preparations and very short BUD windows. Immediate use compounding is done chair-side and has the shortest dating of them all and additional requirements.

Compliance goes far beyond room design. It lives in documentation and discipline such as validated cleaning routines, material transfer procedures, continuous air and surface monitoring, and training for every staffer stepping inside the controlled environment.

Corrie Masoni, Accelerate Pharmacy Solutions’ Director of Pharmacy Practice Solutions, pointed out an all-too-common mistake. “Many organizations fail to maintain verifiable cleaning and monitoring logs, exposing themselves to avoidable risk.” Early recognition of the importance of meticulous documentation can help you stay ahead of potential risks. USP <797> requires that a designated person be responsible and accountable for oversight at each facility.  Your USP <797> designated person should be the expert on every nuance and own compliance end-to-end, from process to documentation. The key is to assign clear accountability, invest in training, and ensure leadership visibility into quality metrics. 

3. Achieve and maintain accreditation

Even with the right model and airtight compounding practices, health systems can’t unlock reimbursement without accreditation. Insurers increasingly require it, and payers and patients alike view it as a signal of quality and trust.

According to Brenda Matthews, Accelerate Pharmacy Solutions’ Director of Infusion Strategy, “The first accreditation is the hardest. After that, it’s all about maintaining systems and good habits. You can preserve your accreditation and manage costs by focusing on good financial planning, cost-effective practices, and efficient operation.” 

Selecting the right pathway to accreditation, such as Utilization Review Accreditation Commission (URAC) or Accreditation Commission for Health Care (ACHC), depends on your care model and footprint. Both URAC and ACHC support patient-centered care, quality improvement, and operational compliance, enabling models for chronic disease management and specialty pharmacy. URAC has a strong focus on population health and pharmacy-related services, while ACHC is often used to support home-based care delivery. Once a pathway is chosen, the next step is to take a project-managed approach conducting gap analyses, aligning policies with standards, and establishing governance bodies to oversee compliance and quality while budgeting realistically for staff training, quality management software, and ongoing audits.

Engaging an external consultant, like Accelerate Pharmacy Solutions, for the first accreditation cycle pays off in speed and precision. Mock surveys and competency checks can also instill a “permanent readiness” mindset which is crucial as survey cycles tighten and standards evolve.

Lay the foundation for long-term success

Business modeling, compliance, and accreditation are interdependent disciplines that reinforce one another: A strong business model depends on compliance readiness. Compliance enables accreditation. Accreditation unlocks payer access and revenue stability.

Addressing these disciplines with four strategic moves can position your health system for success:

 1. Assess the payer mix and referral patterns.
 2. Align the infusion delivery model to both clinical need and financial viability.
 3. Appoint a compliance owner with authority and accountability.
 4. Invest early in internal or external accreditation expertise.

The opinions expressed in this article are solely those of the author and do not constitute legal advice. Cencora, Inc., strongly encourages readers to review available information related to the topics discussed and to rely on their own experience and expertise in making decisions related thereto.

¹U.S. Census Bureau. 2023 National Population Projections Tables: Main Series. Census.gov. November 2023. Accessed 24 October 2025. Available online at: https://www.census.gov/data/tables/2023/demo/popproj/2023-summary-tables.html

²Jusufi, Herolind and Boivin, Nicholas. Navigating Access and Optimizing Medication Infusions in an Academic Medical Center: A Quality Improvement Study. Pharmacy: a journal of pharmacy education and practice. June 30, 2023. Accessed 16 September 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10366736/

³Mertz Taggart. Infusion Therapy Market Overview. Infusioncenter.org. 2024. Accessed 23 October 2025. Available online at: https://infusioncenter.org/wp-content/uploads/2024/06/Infusion-Industry-Overview.pdf

⁴Ibid.