Dr Natalie Dickson Discusses Challenges for Tennessee Oncology, Community Oncology


Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses challenges for Tennessee Oncology and community oncology in general.

Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses government policy changes, utilization management, and other challenges for oncology care.


What are some of the biggest challenges ahead for Tennessee Oncology specifically and for community oncology more broadly over the next several years?

Government policy changes and the burden of utilization management remain our biggest risk and challenge. Government policy changes can have sweeping effects on our reimbursement, such as the recently abandoned most-favored nation policy and the recent update on the in-office ancillary services exception. Utilization management—including things like step edits, prior authorization, formulary control—these remain really burdensome for practices, especially practices like ours who are already investing in and adherent to evidence-based clinical pathways. It's really important for community oncology to continue to advocate through CORe [Clinical Oncology Research system] and our specialty societies.

But we face many more challenges. PBMs [pharmacy benefit managers] redirecting patients away from our in-practice pharmacies prevent our patients from benefiting from our practice's compliance and toxicity monitoring. Obtaining access to real-time patient data is challenging, but it's really necessary to be able to participate successfully in value-based care programs and it is critical if a practice is taking on downside risks. And then don't forget the cost of a data warehouse. This is often prohibitive for small practices. Practices are being bombarded by a multitude of technology and service vendors, and it's hard to evaluate and determine their value, and many practices don't have the expertise to take this on. Tennessee Oncology is able to leverage the expertise of OneOncology to help in this regard.

And then, of course, there are new players on the market. Some of them pose some level of competition and others just increase the complexity of the management of our cancer patients; so things like infusion centers or pathology groups that are vying for access to a patient's tissue.

But despite all this, if we remain patient focused and true to our mission, and we remain engaged in health policy reform, I am confident that community oncology will weather the storm and the many challenges to come.

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