Health systems are facing a hard question: as site-of-care pressure pushes more infusion volume away from the hospital outpatient department (HOPD), how do they keep appropriate care inside the system?
The infusion market keeps growing — spending is projected to climb from roughly $112 billion to $142 billion — even as more care shifts to ambulatory infusion centers, home infusion, and other alternate sites.¹ At the same time, payers keep expanding site-of-care programs to push clinically appropriate treatment toward those lower-cost settings.
For health systems, this isn’t just a reimbursement issue. It’s an enterprise retention issue. The shift isn’t a future risk — in many markets, it’s already underway. The real question is whether the system has a strategy to retain appropriate care as that shift plays out.
Cannibalization Isn’t the Real Risk
When health systems weigh expanding into ambulatory or home infusion, cannibalization is usually the first concern: will these programs just pull volume from the HOPD, create internal competition, or undercut current performance?
Those are fair questions. But they can distract from a bigger one: whether appropriate care stays in the system at all, as payer-driven shifts accelerate.
The data backs this up. A peer-reviewed study of more than 52,000 infusions found HOPD costs ran about 42% higher than alternate sites when HOPD treatment wasn’t medically necessary — with no meaningful difference in short-term safety.² As evidence like this accumulates, payers have more justification to expand site-of-care programs into additional therapies.
“The strategic question is not whether infusion volume will move. In many cases, market and payer dynamics are already driving that movement,” said Matt Hinchey, Vice President, Portfolio Strategy — Infusion and Market Access at Accelerate Pharmacy Solutions. “The question health systems need to answer is whether they have the visibility, referral controls, and site-of-care strategy needed to retain appropriate care within the enterprise.”
In other words, standing still doesn’t stop the leakage. The greater risk isn’t moving too fast into alternate sites — it’s losing referrals altogether because there’s no integrated infusion strategy in place.
Retaining Care Takes an Enterprise Strategy
Organizations adapting well to site-of-care pressure have stopped treating infusion as a set of separate locations. They treat it as one enterprise service line.
A strong infusion strategy isn’t about protecting one site over another — it’s about keeping appropriate care inside the health system, wherever it’s ultimately delivered. That takes a coordinated site portfolio, referral tracking that shows where volume is actually going, and governance that ties clinical, operational, and financial decisions together.
Done well, this lets health systems get ahead of the shift: understanding where care is going, weighing site-of-care opportunities, and deciding deliberately where care should live — instead of reacting after referrals have already left.
Questions Health System Leaders Should Be Asking
As site-of-care pressure grows, three questions matter most:
- Do we know where our infusion referrals are going today?
- Can we tell true cannibalization apart from referrals that would have left the enterprise anyway?
- Do we have the site portfolio, referral tracking, and governance to retain appropriate care in-system?
Looking Ahead
The health systems that come out ahead will be the ones that can coordinate care across settings, respond to payer requirements, and retain appropriate care within the enterprise.
Many organizations sense the pressure building but lack visibility into where referrals are going, how much volume may already be leaving, and what that means for future performance. That’s the gap Accelerate Pharmacy Solutions’ Infusion Strategy offering is built to close.
Do you know where your infusion referrals are going? Health system leaders who want to see how peers are approaching infusion strategy — retaining appropriate care in-system and responding to payer site-of-care pressure — can explore insights at Accelerate Pharmacy Solutions | Infusion Strategy.
For organizations trying to understand where referral leakage may be occurring, contact our team for an initial conversation
