The CSO & CPO Relationship: Giving Pharmacy a Seat at the Strategic Table

Historically, pharmacy was seen as a cost center. But with the growth of specialty and infusion therapies—and a shift toward ambulatory care—it has become a strategic driver of revenue, access, and differentiation.

For today’s chief strategy officer (CSO), that shift is critical. Ambulatory pharmacy now represents a powerful lever for growth. This evolution is why CSOs and pharmacy leaders must partner with health systems aspiring to be market leaders.

Getting to Know the Modern Chief Strategy Officer

Understanding your health system’s CSO is the first step in building a partnership that turns pharmacy from a cost center into a margin engine. Ten years ago, hospital strategy was largely about volume growth (adding facilities, acquiring practices, and capturing market share). Today, it’s about enterprise transformation: integrating care, advancing value, and shaping the footprint required to support a financially sustainable, high-performing health system.

The modern CSO’s role is to turn vision into an actionable, measurable, and future-proof strategy.

Most CSOs come from one of three backgrounds:

Strategic & Analytical: Trained in finance, planning, or consulting and comfortable with data and modeling.
Operational: Leaders who know how to turn ideas into executable realities.
External to Healthcare: Bringing fresh perspective from industries like tech, retail, or consumer services.

Regardless of background, successful CSOs share these defining traits:

Exceptional communicators who translate complexity into clarity.
High emotional intelligence, allowing them to navigate politics and build consensus.
The ability to balance visionary thinking with operational discipline.

Great CSOs think like futurists, act like operators, and communicate like marketers. In an environment where health systems are making fewer but higher-stake bets, the CSO is part market analyst, part deal-maker, part architect, and part change champion.

Connecting Pharmacy & Strategy: An Essential Relationship for Health System Success

The relationship between the CSO and the Chief Pharmacy Officer (CPO) may be the most critical of all C-suite relationships. Still, it is often the most underdeveloped. In far too many systems, pharmacy continues to operate at the periphery, disconnected from enterprise planning. Leaving pharmacy out of strategy is not an oversight. It is a strategic liability.

What Makes the CSO–CPO Relationship So Important?

A CSO’s strategic mandate varies by organization and region, but most fall into four broad categories of value creation:

Financial Sustainability: Optimizing revenue, cost, and efficiency.
Organic Growth: Expanding services or markets.
Transformation: Implementing new solutions, models or technologies.
Scale & Systemness: Aligning strategy, culture, governance, technology, and operations.

A strong CSO–CPO relationship provides the opportunity for the CSO to understand the potential for pharmacy to serve as a strategic differentiator in meeting all four mandates. Additionally, the CPO’s wide-ranging expertise makes them a key ally to the CSO in building strategies that span the full care continuum.

Why Now: Pharmacy’s Strategic Inflection Point

The economics and stakes of pharmacy have changed. Ambulatory pharmacy is a high-leverage asset with the power to advance all four pillars of CSO strategy: financial sustainability, organic growth, transformation, and system alignment.

Specialty and infusion services are driving significant shifts in how and where care is delivered. While these spaces offer meaningful margin potential, they’re also increasingly targeted by for-profit disruptors operating outside the traditional health system.

This creates a rare window for strategic advantage. For organizations willing to move, ambulatory pharmacy can drive margin, improve retention, and expand the system’s footprint of care.

If you’re a CPO, your opening conversation with the CSO should be clear and compelling: “The industry has shifted. We can materially impact the top and bottom line, and keep more patients in our system, if we act now.”

10 Ways CPOs Can Accelerate the CSO Relationship

The CSO–CPO relationship is one of the most powerful drivers of system transformation (but only if it’s built with intention). These strategies help CPOs elevate their voice, align with enterprise priorities, and become a trusted partner in shaping strategy.

1. Understand Ambulatory Planning

To effectively support ambulatory care growth, the CPO must understand the CSO’s current objectives and strategic priorities. One emerging challenge is the rise of for-profit infusion providers, which are capturing patient volume and revenue outside the health system. Like ambulatory surgery centers, urgent care clinics, and freestanding imaging centers before them, these infusion providers represent the latest wave of strategic disruption.
By aligning pharmacy initiatives with enterprise priorities, the CPO can help the health system compete more effectively. Understanding the organization’s build, buy, or partner preferences based on previous disruption decisions also positions the pharmacy leader as more strategic and closely connected to system-level strategy.

2. Use Data Like a Strategist

Operational metrics are only the starting point. Strategic value comes from interpreting the data to uncover trends, identify root causes, and connect outcomes to organizational priorities.

Strategy teams are increasingly using claims data to understand patient traffic patterns and how care is accessed across settings. Pharmacy should take a similar approach by examining where specialty prescriptions are filled and where infusion services are delivered. While data may start the conversation, actionable insight is what drives influence and informs decision-making.

3. Connect Policy to Strategy

CSOs are continuously assessing payer dynamics, regulatory shifts, and political developments. Pharmacy leaders can add strategic value by delivering forward-looking insights on key policy areas (such as drug pricing reform, 340B program changes, and evolving reimbursement models).

Position pharmacy intelligence as a critical input to scenario planning. Bring prepared perspectives: “If 340B reform advances, here’s the operational pivot,” or “If PBM consolidation accelerates, here’s how the specialty platform captures opportunity.” In today’s healthcare landscape, policy fluency is strategic currency.

4. Invest in Storytelling

Modern CSOs are expert communicators; CPOs should match that skill. You can’t assume others understand your value. Build a simple, repeatable story about how the pharmacy footprint drives enterprise success: clinical outcomes, patient trust, financial resilience, innovation leadership. Then repeat it until it sticks.

5. Co-lead a Strategic Initiative

Select a high-impact initiative and offer to co-lead it with the CSO. Visible, enterprise-level collaboration builds strategic credibility quickly.

6. Embrace the Word “No”

Strategy is about choice. One of the CSO’s toughest challenges is practicing strategic deselection (saying no to good ideas in order to protect great ones). The CPO can be a valuable ally in this work by helping the organization identify and step away from initiatives that don’t advance strategic priorities, keeping focus and resources aligned with what matters most.

7. Build Bridges Before They’re Necessary

Strategy today is cross-functional with the CSO directing a diverse orchestra of health system leaders. Develop genuine working relationships with marketing, payer contracting, access, finance, supply chain, revenue cycle, clinical, and operations. When the CSO calls for system alignment, you’ll already have the coalition in place.

8. Take Initiative in Strategic Planning

CPOs who step into strategic conversations early change how their organizations perceive pharmacy from cost containment to value creation. Show up with data and ideas on market forces, innovation opportunities, and the role of pharmacy in driving value.

9. Help Them Succeed

Find one of the CSO’s priorities that pharmacy can accelerate—launch timing, market analytics, or physician alignment. When they succeed, they’ll pull you into future initiatives.

10. Start with Strategy, Then Schedule Regular 1:1s

Request an initial meeting focused on ambulatory pharmacy strategy. This creates space to share your vision, highlight market shifts, and connect pharmacy’s potential to enterprise priorities. Once that foundation is set, establish a regular 1:1 cadence. These short, focused meetings are far more valuable than another standing committee.

Leading Together: Embedding Pharmacy in Enterprise Strategy

The most successful health systems no longer separate planning from execution or strategy from operations. The CSO–CPO partnership is where integration happens.

The health systems that thrive in 2026 will be the ones where the CSO and CPO operate as partners, to turn strategy into measurable results in the following five areas:

Start the Shift. Lead With Strategy.

The future of health system success hinges on bold, collaborative leadership—and the CSO–CPO partnership is one of the most untapped strategic assets. By embedding pharmacy into enterprise strategy, health systems can move beyond incremental improvement and toward true transformation. Visante helps organizations operationalize this vision by leveraging pharmacy as a transformational lever in delivering strategic impact for the health system.

If you’re ready to make pharmacy your health system’s strategic engine, contact Visante.

Subject Matter Expert: Jim Jacobsohn

January 5th, 2026

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