Community Oncology Delivers Strong Outcomes: Nicolas Ferreyros

Community oncology practices deliver equal to or better survival and outcomes for the patients treated there, and new real-world evidence is now being used to make the case for community practices as a preferred site of service, according to Nicolas Ferreyros, managing director of policy, advocacy, and communications at the Community Oncology Alliance (COA).

In an interview with The American Journal of Managed Care^®, Ferreyros discussed a COA real-world evidence study, the effects of health system consolidation on cost and access, and the payment barriers that keep community practices from offering chimeric antigen receptor (CAR) T-cell therapy.

What the Real-World Survival Data Show

Earlier this year, COA released a study in partnership with Flatiron Health that examined survival and outcomes in community oncology practices.¹ Ferreyros described it as the first real-world evidence study of its kind, designed to address the misconception that community oncology is a lesser or lower-quality site of service. The study found that community practices deliver equal to or better survival and outcomes for patients.

COA is already putting the findings to use. Ferreyros said the organization is talking with purchasers, employers, and payers about making community oncology a preferred site of service for their covered lives. COA is also bringing the data to policymakers, with the message that community oncology provides care that is local, affordable, and accessible, with high-quality patient experience and outcomes.

"We are using this in a lot of different things in our advocacy, in our policy work, and we think we're going to continue this research because it's critically important to continue to demonstrate the quality of community oncology," Ferreyros said.

How Consolidation Affects Cost and Access

Ferreyros pointed to health system consolidation as a driver of the problems community oncology faces. In the majority of US markets, only 1 or 2 major hospital systems dominate, which makes it difficult for purchasers to negotiate good contracts and has contributed to excess spending. Patients also feel the effects, Ferreyros noted, because they often must travel farther to reach more expensive sites of service that are not convenient for them.

Ferreyros said site-disparate payments, the 340B Drug Pricing Program, and other public policies have fueled that consolidation by giving hospitals more money and resources to buy independent community practices or force them to close.

"I would argue that consolidation is a huge, if not one of the number one, problem that has afflicted our health care system over the last couple of decades," Ferreyros said.

There is momentum to address the issue, according to Ferreyros. An adjustment to 340B reimbursement policies is expected to take effect next year, and Ferreyros expressed hope for a move toward more aggressive site-neutral payment policies, under which the same service is paid the same price no matter where it is delivered.

Why Payment Limits CAR T-Cell Therapy in Community Practices

When asked about delivering novel therapies such as CAR T-cell therapy in the community, Ferreyros named reimbursement as the single biggest challenge. Many practices are forced to rely on single-case agreements, which Ferreyros said are not sustainable at scale because they demand significant time, money, and effort.

That burden makes it hard for an independent practice to invest in the infrastructure and training needed to deliver new treatments, Ferreyros said.

References

1. Study: cancer patients experience longer survival in community oncology settings. News release. COA. April 28, 2026. Accessed October 8, 2026. https://mycoa.communityoncology.org/press-releases/news-updates/community-oncology-alliance-partner-with-flatiron-on-study-of-cancer-patients-experience-longer-survival-in-community-oncology-settings-