As healthcare increasingly moves toward ambulatory facilities, pharmacy departments at several health systems are expanding into the outpatient space, including Walnut Creek, Calif.-based John Muir Health.
In 2024, John Muir opened a cancer infusion center to centralize care for oncology patients. The site is only the beginning, according to Amy Gutierrez, PharmD, John Muir’s vice president and chief pharmacy officer.
The system is in the early planning stage for expanding infusion services for other disease states, such as rheumatology, neurology and dermatology, as well as embedding pharmacists into clinics.
When evaluating the business case for an infusion pharmacy, there are several factors to consider, including the payer reimbursement environment and risk of site-of-care denials, Dr. Gutierrez said. Convenience is another.
“Our patient experience now is so important, as we are in an environment where patients can get their groceries delivered in an hour,” she said. “They expect convenience. So we have to cater to that patient experience to stay competitive in the market.”
At-home infusion pharmacy services are one way to deliver on this expectation. Several systems, including New Orleans-based Ochsner Health, Minneapolis-based Fairview Health Services and Boise, Idaho-based St. Luke’s Health System, offer home infusion.
At a Becker’s conference, Dr. Gutierrez attended a presentation where a speaker said many patients did not want home infusions, though, as it brought an added stress of needing to clean the house beforehand.
“To them, it was more convenient just to stop at the [closest] strip mall and get their infusion and then go do some grocery shopping,” she said. “So it’s interesting, because you have to really assess your environment.”
Another way for pharmacy departments to join the industry’s push into outpatient care is by integrating pharmacists throughout an organization’s network.
Leaning on her experience, Dr. Gutierrez is working to increase ambulatory care pharmacy support within the system’s medical group clinics, starting with the cardiology clinic. Before joining John Muir in 2025, she served as vice president of pharmacy and chief pharmacy officer at UCHealth — an 18-hospital system based in Aurora, Colo. — where she led a similar effort.
When pharmacy departments show their value in improving quality of care, the organization often performs better financially.
“If you look at how much revenue pharmacies are driving across the country, it’s not unusual for pharmacy to drive 25% to 50% of a hospital’s revenue, just because of all of the margins that you can get with infusion, with the 340B program, and it’s become a big driver that is supporting hospitals when payer reimbursements are declining,” Dr. Gutierrez said.
