Separating Cost From Cancer Pathways: Edward Arrowsmith, MD, MPH

OneOncology keeps cost out of its formal clinical pathway process and handles economic decisions separately, an approach that reflects how much payer landscapes vary across the country, according to Edward "Ted" Arrowsmith, MD, MPH, of Tennessee Oncology and OneOncology. In an interview at the Patient-Centered Oncology Care® 2026 conference hosted by The American Journal of Managed Care^® in Nashville, Tennessee, September 24-25, 2026, Arrowsmith discussed how OneOncology structures its pathways and how the network drives adoption at the point of care.

Why OneOncology Keeps Costs Out of Its Pathways

OneOncology's pathway program differs from others in that cost is not considered at all in the formal pathway process, Arrowsmith explained. The pathways are used exclusively by OneOncology practices and are not promoted or sold outside the network.

Economic decisions, such as efforts to reduce the total cost of care or meet the terms of a value-based arrangement, are handled through a separate process. The clinical team, which includes many members of the pathway team, works with OneOncology's business and contracting teams to evaluate each specific value-based care arrangement and achieve the most value for patients within it.

That separation reflects the reality that cost inputs vary by region, Arrowsmith said. "Certainly the payer landscape is very different here in Tennessee than it is in California," Arrowsmith said. "We sort of do the clinical pathway part and the economic part as two separate but interrelated processes."

How Pathways Are Put Into Practice

Changing clinical behavior is one of the most studied and most difficult parts of any type of care, and it is particularly important in oncology, where treatments can be very effective but also very toxic, according to Arrowsmith. OneOncology uses a multipronged approach to bring its pathways to life.

First, the disease groups include thought leaders from each practice, who serve as go-to resources for colleagues. A physician at a practice in Fort Worth, Texas, with a question about breast cancer can turn to the local expert who is already aware of the latest pathway update. OneOncology also distributes educational programs, ranging from informal resources to formal programs, to keep physicians informed.

The most important tool, and the easiest to update, may be a customized version of Flatiron Assist, a point-of-care ordering system for chemotherapy and immunotherapy, Arrowsmith said. When nearly any OneOncology physician orders treatment for a condition such as multiple myeloma, the network's pathway regimens appear at the moment of ordering.

"They don't need to do work," Arrowsmith said. "It happens at the point of care, and it's updated immediately."