Learning What Matters to Patients as Therapies Become More Complex

As community oncology practices compete in the era of chimeric antigen receptor T-cell therapy and bispecific antibodies, one thing is clear: Delivering care will only become more complex, not less. Figuring out how to bring novel therapies to patients where they live and determining how to achieve the financial lifts to do this are both pieces of the outcome-driven mission of the American Oncology Network (AON), with its leaders discussing “What Matters Now to Patients, Practices, and Payers” during the Patient-Centered Oncology Care® (PCOC) conference in Nashville, Tennessee.

Puneeth Indurlal, MD, MS, AON’s senior vice president for strategic operations, moderated the discussion, which included the following members of AON leadership:

• Steve Swart, executive vice president of practice operations
• Brian Mulherin, MD, hematologist/oncologist and medical director
• Alti Rahman, MHA, MBA, CSSBB, chief strategy and innovation officer
• Melody Chang, MBA, RPh, BCOP, vice president of pharmacy operations

The oncology landscape has transformed since AON formed in 2018, Swart said. Created to give smaller practices the ability to share resources at scale as technology and centralized management became more critical in practice survival, AON now spans from Maryland to Hawaii. Swart, who comes from an accounting background, explained his perspective: “How can we be patient-centric? How can we make sure we’ve got the finances aligned so that we can continue delivering on our mission?”

The fee-for-service model is dying, Mulherin said, and patients have clear outcomes in mind: “What matters most to patients is surviving, but surviving with a good quality of life, and hopefully not getting themselves and their children bankrupted in the process.” The goal is to “deliver high-quality care in the community, close to home, close to where the patients live, but then also delivering that in the most cost-effective way possible.”

Rahman brings a public health perspective to his work, and he offered that insight at PCOC. “It’s what happens before the diagnosis that impacts what happens after the diagnosis,” he said. “So how do you connect upstream care interventions to downstream oncology experience?” This connection, he argued, is where practices will discover how to combine clinical quality with cost initiatives.

For Chang, the mission is ensuring that “every patient gets the right drug at the right dose, at the right time; at the same time, we have to think about the measurable outcome.” She added, “The best medicine is the medicine that works and that we can afford.”

Lessons From Value-Based Care Programs

AON has embraced payment reform, with many participating practices taking part in both CMS’ former Oncology Care Model and the current Enhancing Oncology Model (EOM). The network offers a unique financial model in which practices enroll in the payment model under a single tax ID number, which allows better risk pooling and prevents a single expensive case from wreaking havoc on financials—especially helpful for some of the smaller practices that are part of AON.

Rahman explained that value-based care fundamentally revolves around risk and leverage. He drew a critical distinction between federal and private programs: “From a federal program, it’s not just the methodology that’s important; it’s the perception of whether or not it’s working for constituents.... It’s just as much politics as it is methodology.”

An essential lesson, he said, has been recognizing that “the oncology experience doesn’t just start at the diagnosis.” Rahman expressed optimism about connected care models that link patients, their data, and providers: “I’m bullish that I think there’s going to be a resurgence of the importance of [physician hospital organization] models, clinically integrated networks, and [accountable care organizations (ACOs)].” The future lies in plugging into local ACOs with AON’s rich oncology management experience.

Operational Implementation of the Regional Pharmacy Model

Chang described AON’s centralized regional clinical pharmacist model as essential for EOM governance. “We really need governance, centralized governments, so that way everybody has the same playbook,” she said. Regional pharmacists execute standardized protocols while “getting the feedback from the regions, because every region might have a different practice environment, so we can adjust accordingly.”

Swart emphasized the delicate balancing act that is required to make this all work. “Physicians and practices want to maintain a certain level of profitability or earnings, so you’ve got to balance the immediate needs of practice finances and protecting the margins, the profitability, the physician earnings.” This challenge is tougher for single-site practices than larger organizations, he said, and the solution requires “wraparound services” while remaining “cognizant when you’re having those conversations, how are we going to maintain that financial stability in the present, recognizing that the future is going to be different.”

Despite these challenges, Swart emphasized core principles. “There’s job stability in there with all these new programs and all the changes going on.... It challenges all of us each day to sharpen our pencils and to figure out how to do all of this. Why? Most importantly, continuing to serve the patient and having those patient-centric concepts at the center of everything we do.”

Complex Therapies Create New Challenges

Mulherin explained how value-based care programs tangibly influence clinical practice. “If a patient is, for example, in the EOM, that’s certainly going to impact what drugs you might select for that, which biosimilar might be used, [and] potentially the dosing of a drug, the dosing frequency of a drug.” However, practices must simultaneously keep an eye on the financials.

The challenge intensifies with complex therapeutics, such as bispecifics. Mulherin walked the group through the extensive infrastructure required to set up and offer these therapies, from preparing the emergency department (ED) and addressing education needs to readying units from intensive care to neurology.

But bispecifics are coming, so practices have little choice. With “over 600 ongoing clinical trials for bispecifics, and most of them are actually for solid tumors,” he said, the use of these therapies will only expand.

Balancing Innovation Needs With Cost Pressures

The panel addressed tensions between adopting innovative therapies and managing costs. “We want to keep the patient at the center of what we do,” Mulherin said. “For many patients, there really aren’t other options that are available by the time they get to these.” Although infrastructure costs create tension, “at the end of the day, the best therapy for the patient is the one that’s going to give them the best response.” Less effective therapy leading to progression means “they’re probably going to end up at the [ED],” likely increasing total costs.

Chang explained that today, biosimilars are being developed for cost savings only and the newer 505(b)(2) pathway represents “a special FDA drugs approval pathway that’s in between the branded drug and the generic drugs” that shortens approval timelines.¹ AON embeds selections in the electronic medical record to save providers time while delivering “much more of the cost-saving efficiency.”

Rahman noted that “payers translate these categories...very nuanced toward just what is the cost.” Without bandwidth to understand therapeutic nuances, payers increasingly rely on intermediaries. He highlighted how 2021 price transparency laws are changing dialogue, enabling more meaningful conversations about financial and time toxicity alongside clinical variables.

Sustaining Community Oncology by Meeting Patient Needs

Chang sees pharmacists as bridges “between the cost and the care,” and the panelists’ forward-looking visions included maintaining patient centricity, achieving precision, fostering connectivity, and ensuring community oncologists thrive. Chang looked forward to seeing community oncologists thrive and for systems to evolve “for [patients] to get the treatment close to home.”

Patient requests are basic, Mulherin said. “They want to live,” he said, “but they want to have a good quality of life, and they don’t want to bankrupt themselves or their community or their heirs in the process.”

A patient’s time matters. And a physician’s time matters too. The future, Mulherin said, means “being paid not just for things that you don’t do…but for things that you are doing right.”

Reference

1. Hippensteele A. Understanding recent changes to 505(b)(2) drugs and reimbursement. Pharmacy Practice in Focus: Oncology. June 23, 2025. November 22, 2025. https://www.pharmacytimes.com/view/understanding-recent-changes-to-505-b-2-drugs-and-reimbursement