At many health systems, infusion services operate across multiple sites with varying workflows and approval processes. At Cone Health, based in Greensboro, N.C., pharmacy leaders have spent the past year aligning those services — particularly outside of oncology — as infusion becomes a growing part of how patients access care.
That effort has been a major focus for Nick Gazda, PharmD, director of pharmacy for oncology and infusion at Cone Health. He oversees six cancer centers across urban and rural areas, along with a growing number of non-oncology infusion sites.
“In the beginning of 2025, we identified the need to get an interdisciplinary group of stakeholders together to really align our non-oncology infusion services across the organization,” Dr. Gazda said on a recent episode of the “Becker’s Pharmacy Leadership Podcast.”
That work brought together nursing, acute care, revenue cycle, finance and physician leaders to discuss standardization, patient access and service expectations from both provider and patient perspectives. The goal, Dr. Gazda said, was to improve how infusion services function across the organization rather than at individual sites.
Over the past year, Cone Health centralized authorization and medication access services, standardized processes and used technology to support more consistent workflows. Those changes increased infusion capacity, improved turnaround times and reduced denials.
“We’ve seen 30 to 40% growth in infusion volumes, denials less than 2% and generally high patient and employee satisfaction,” he said.
Infusion has become a growing area of focus at Cone Health as demand increases and more therapies move into outpatient settings.
“Infusion services are just incredibly important strategic opportunities for health systems across the country,” Dr. Gazda said.
Part of that importance comes from the cross-functional nature of infusion services. Like pharmacy, infusion involves coordination across multiple teams to function well.
“You can’t do it without nursing. You can’t do it without transitions of care and acute care. You can’t do it without physician champions,” he said. “So really being able to get everyone to the table is important.”
That coordination is becoming more critical as therapies grow more complex. Cone Health has historically operated as a community-based cancer center, but treatments such as CAR-T and bispecific antibodies are increasingly being delivered in outpatient settings and showing up earlier in clinical guidelines.
As infusion services expand, Cone Health is also evaluating alternative sites of care as part of a broader, value-based approach.
“Value is really simple,” Dr. Gazda said. “Value is increase in quality and service and decrease in cost.”
The organization is exploring care models such as home infusion, infusion suites and clinic-based options that are clinically appropriate while reducing costs and the travel burden for patients.
At the same time, financial and regulatory uncertainty is shaping how the system manages drug spend and reimbursement. Dr. Gazda said Cone Health is placing renewed emphasis on pharmacy revenue cycle, biosimilar optimization and net cost recovery to sustain services.
“We’re focusing on formulary decisions not just in acute care, but in the ambulatory space as well,” he said, with the goal of reinvesting those gains into patient care.
Internally, that shift has required a change in how pharmacy teams think about their role. Dr. Gazda said Cone Health is working to build financial acumen alongside clinical expertise, while being more transparent about sustainability and change management.
“In the past it may have felt taboo,” he said. “But now we’re being transparent around the things we’re doing and how sustainable they are moving forward.”
For Dr. Gazda, the most meaningful outcome is the effect on patients.
“When patients don’t have to travel an hour and a half for their care anymore, and we’re able to provide state-of-the-art care closer to home, that’s really rewarding,” he said.
