OneOncology Leaders Say Structure Allows Growth While Keeping Independence

Edward “Ted” Arrowsmith, MD, MPH, said that when his Chattanooga oncology practice merged with Tennessee Oncology many years ago, the change happened with growth in mind. “We needed more scale and scope; we needed infrastructure expertise. We had outgrown our financial and [revenue cycle management] capabilities,” he recalled.

At the time, Arrowsmith said he told Jeff Patton, MD, who was CEO of Tennessee Oncology, that the acquiring practice might someday need its own umbrella organization to manage big picture needs, such as marketing, recruitment, and higher-level technology. “And that’s what happened,” he said.

Today, OneOncology, with Patton as CEO, is that entity, providing services to 33 oncology practices. “We wanted to do more exciting things…like bispecific cellular therapy, radioligands, and value-based care.” Arrowsmith said. These require specialized expertise and access to capital, which the larger entity has been able to achieve. Arrowsmith is OneOncology’s medical director for clinical pathways and retains a leadership role in therapeutics within Tennessee Oncology, which helped found OneOncology in 2018.

Three other leaders from OneOncology joined Arrowsmith at the 2025 Patient-Centered Oncology Care® conference in Nashville, Tennessee, to discuss the group’s success in keeping community oncology practices independent by providing expertise in technology, advocacy, and clinical advances. They were:

• Johnetta Blakely, MD, MS, MMHC, executive vice president of quality and clinical operations at Tennessee Oncology, who moderated the discussion;
• Lisa Raff, PharmD, BCPS, vice president of pharmacy services at OneOncology; and
• Barry Russo, MBA, who is CEO of The Center for Cancer and Blood Disorders in Dallas-Fort Worth, Texas.

Blakely articulated OneOncology’s core value proposition: “OneOncology is a mechanism to allow the practices that are involved to focus on patient care. And that’s one thing that I really like about it…. I get to focus on patient care and how we can do that better.” This patient-centered philosophy permeates every aspect of the network’s operations, she said, from clinical program development to administrative support, distinguishing it from other consolidation models that prioritize corporate objectives over clinical excellence.

Strategic Growth and Market Positioning

Russo said his practice offered a case study of OneOncology’s impact on growth. Despite the Texas-sized disclaimer that “those of us who live on the Fort Worth side would rather be shot than ever go to Dallas,” he explained the strategic challenge: To have any clout for managed care contracting in the Dallas-Fort Worth market, the practice had to make inroads into Dallas. Joining OneOncology let this happen, but it was a huge step for some “very fiercely independent physicians.”

“We knew we needed assistance in that process, and we didn’t really need a lot of infrastructure,” Russo said. “We needed growth and development to be a relevant player.”

The Center for Cancer and Blood Disorders had 22 physicians when it joined OneOncology in October 2020; today, there are 46. “We’ve done that through both acquisitions as well as recruitment and organic growth,” Russo said, noting that recruitment became “much better and easier” with OneOncology’s sophisticated support infrastructure.

Pharmacy Services and Practice Extraction

Raff was the first pharmacist hired at OneOncology, tasked with working with Arrowsmith on pathways and working with Chief Medical Officer Davey Daniel, MD, on pharmacy and therapeutics. The network now provides comprehensive support, which includes shared clinical question inboxes that take in inquiries multiple times daily as well as quarterly pharmacy committee meetings that facilitate knowledge sharing.

A memorable story involves helping a group of physicians leave hospital employment. “Last year,” Raff said, “we brought 6 medical oncologists out of a hospital system in the Charleston, [South Carolina], area, and we set up 4 clinics that they could practice in. And it was literally on a Friday, the hospital turned them off. And on Monday, we had 4 clinics up and running.” These clinics were complete with laboratory services, drug mixing capabilities, medication dispensing, and infusion operations.

Blakely offered context for the significance of this step. “In this age where so many community practices are being bought by hospitals, this is an example of where we were able to help them go the other way and become independent,” she said, noting the episode runs counter to the trend of hospital consolidation threatening the existence of community-based care.

A defining characteristic of OneOncology is its respect for practice independence, Blakely said. “I’m able to add things and do things for Tennessee Oncology, which doesn’t always match what OneOncology wants us to do. And so, Davey [Daniel] and I sometimes butt heads, but at the end, we’re friends, and he understands that [for] some initiatives [for which] Tennessee Oncology may not be ready, for others, we are happy to take the lead or that sort of thing.” This flexibility allows practices to adopt innovations at their own pace while learning from network peers.

Expanding Access to Research, Therapy

Panelists touted the focus on clinical research, with clinical trials representing care options, not just research opportunities. Said Russo, “We’ve had a phase 2, phase 3 program in our practice as long as I’ve been there and maybe a little longer, and it’s been fairly static, meaning it hasn’t necessarily grown or done anything tremendous. And we’ve talked about wanting a phase 1 program for a long time, but standing up a phase 1 program, even for a business guy like me, I know that’s going to be difficult and hard and requires a lot of infrastructure and resources.”

“Tennessee Oncology, with our former partner, the Sarah Cannon Research Institute [in Nashville, Tennessee], has a long history of having clinical research at the center of our mission,” Arrowsmith said. “We have always said that participation in a clinical trial is the best care for a patient, and we’ve always wanted that.” Critically, he emphasized that “clinical trials shouldn’t just be for the people who can get on a private jet” or those who can easily travel long distances. Today, Tennessee Oncology operates the Greco-Hainsworth Centers for Research in Nashville as well as a clinic in Dalton, Georgia, that primarily serves Spanish-speaking patients, exemplifying their commitment to equitable access.

“Therapies aren’t innovative unless they can get to patients,” Raff said. The network has operationalized this philosophy impressively, with Raff reporting that two-thirds of the practices are doing step-up dosing for bispecifics in the outpatient setting and that 3 practices are doing chimeric antigen receptor (CAR) T-cell therapy. “We expect, over the next year, 3 more practices to be doing complete outpatient CAR T,” she said.

Advocacy and Legislative Success

Blakely emphasized the importance of state-level advocacy. “Being part of a network is really important. Because, quite frankly, the changes that we see in legislation happen locally more so than at the federal level. The federal level is like the slowest snail that ever existed.”

Russo described a victory on legislation that will expand access to CAR T-cell therapy in his state: “Texas actually passed, and the governor signed, a CAR T bill...that allows CAR T to be provided in any location, no longer requiring FACT [Foundation for Accreditation of Cellular Therapy] accreditation.” He noted that “Aaron Lyss from OneOncology [director of strategic payor relations] actually came down to Austin, [Texas], and testified to the panel based on his experience here in Tennessee,” demonstrating how network practices share successful strategies across jurisdictions.

Sharing Notes on Technology and AI

Russo said that with the flood of artificial intelligence (AI) products coming to the market, having partners to run tests helps increase comfort levels before widespread adoption. Not using AI is not an option, he warned.

“If you’re running a practice and you’re not testing and looking at AI, you need to wake up and rethink that,” he said. “There is no way we can accommodate the ongoing volume and program development without some AI automation.” His practice tests numerous solutions, including ambient notetaking software, which he noted Blakely has also tested at Tennessee Oncology. “We’ve...looked at DeepScribe. We’re looking at Notable.... We’re using meMR for mobile medical record processing. We’re looking at Apollo.”

Arrowsmith highlighted how collaboration benefits resource-constrained practices: “In OneOncology, we have a practice that’s in rural Idaho, and they’re just swamped seeing patients. They don’t really have the infrastructure to be checking out every AI vendor.” However, they can benefit from innovations tested by larger practices.

The concept of OneOncology, Arrowsmith said, allows a business leader with Russo’s experience to benefit physicians thousands of miles away “who are up to their eyeballs seeing new patients and trying to learn about all the exciting new therapies and how to get them to ranchers who live 100 miles away from the nearest clinic.” Of course, he added, the flip side is sharing that expertise. “I do want to try to have a meeting in Idaho during ski season…. Can we work on that, please?”