Will Cancer Care Come Home by 2030? PCOC Panelists Differ on Strategy

A discussion on what cancer care will look like over the next decade asked where care should occur: should drugs now infused or injected in community oncology clinics be administered in patients’ homes?

And if payers push for this, should practices resist—or find ways to make home therapy work?

The exchange came during “Focus on the Future: The Next Decade of Patient Care,” the final session of Patient-Centered Oncology Care 2026, on September 25 in Nashville, Tennessee. Moderator Alti Rahman, MHA, MBA, CSSBB, chief strategy and innovation officer of the American Oncology Network, shortened the horizon at the outset. “We're thinking like 3 to 5 years, actually,” he said.

Home therapy surfaced when Rahman asked what practices need operationally to deliver newer, more complex treatments. Lekan Ajayi, PharmD, chief operating officer of Highlands Oncology in Northwest Arkansas, cited patient monitoring, Saturday clinic hours, and hospital partnerships. Then Ajayi turned to intravenous and subcutaneous drugs, saying practices need to look at home administration.

"Rather than us fighting against this, is this an opportunity for us to figure this out and embrace it?" Ajayi asked. "We know that the payers are going to drive towards home therapy. So, how do we get ahead of these conversations with them?"

Rahman then encouraged more discussion, although he later acknowledged, “I tried to start a little bit of a fist fight with the home health care discussion.”

“A Slippery Slope”

Glenn Balasky, retired executive director of Rocky Mountain Cancer Centers, pushed back on economic grounds. “The drug margin is still carrying our day,” he said. Practices are already dealing with multiple forces chipping away at the percentage of cancer drug costs that support practices. As that ebbs, Balasky said, delivering services will be what sustains practices.

“If you tell a payer we're willing to do this, you start a slippery slope, and then they're going to want to send more and more to the home,” he said.

Balasky compared the prospect with patients whose oral drugs are filled by a specialty pharmacy. “We have to take care and watch and monitor and manage the patient, but we don't get any added recovery from that," he said. Giving therapies away makes care “harder to manage, harder to deliver,” and “fractures the patient experience.”

Indeed, community practices have pushed back against “white bagging,” which requires a health plan specialty pharmacy to deliver drugs to the oncology practice for administration, and “brown bagging,” which send drugs to a patient’s home to be brought the clinic.^1,2 Brown bagging, in particular, has raised issues of chain of custody and spoilage, while in-house oncology pharmacists say both practices lead to care delays and waste because they do not allow for late dosing adjustments.^1,2

Danielle Geiger, MSN, APRN-NP, AOCNP, chief operating officer of Nebraska Cancer Specialists, said she “couldn't agree more,” with Balasky, but sees a path if practices control the home care process. Practices pushed back on white bagging and brown bagging, she noted, and her practice found an approach it calls “clear bagging” that works better for patients and the practice. Clear bagging makes use of the health system’s internal specialty pharmacy to avoid chain of custody issues.³

“If we can be the ones reaching out to the Medicare Advantage plans,” Geiger said, “if I can be in the driver's seat, I can dispense the drug and work with somebody to give that medication in the home or control who's doing that. That sounds like it could be a win-win.”

Ajayi concurred. "My experience has been we've always reacted” to market shifts, he said. "How do we get ahead?"

Jennifer Pichoske, MS, EMBA, AOCNP, CEO of Hematology-Oncology Associates of CNY, returned to “the heart of it all, patient safety.” She said that home administration should be tested first with nononcology drugs. “It's got to be a win-win for practices, for the patient, and for the payers,” she said.

Safety Objections and a Payment Problem

The panelists' caution echoes positions that emerged in 2020 during the COVID-19 pandemic.

The Community Oncology Alliance said at that time that it “fundamentally opposes home infusion of chemotherapy, cancer immunotherapy, and cancer treatment supportive drugs because of serious patient safety concerns,” citing rapid-onset adverse reactions, the absence of emergency resources in the home, and loss of "the expertise and team approach to cancer care.”⁴

ASCO said the same year that it did not generally support moving anticancer infusions into the home, called for independent research on safety, and said the decision should be made only when the treating physician and patient agree.⁵ ASCO updated its statement in 2024 after revisions to the ASCO/Oncology Nursing Society antineoplastic therapy administration safety standards, allowing for home administration for suitable regimens if the home environment is conducive, if patient and family readiness had been assessed, if nurse safety would be assured, and if compounding met all regulatory, licensure, and safety standards.⁶

Neither statement resolves the problem Balasky raised. Medicare Part B pays practices the average sales price of an infused drug plus a 6% add-on intended to cover overhead and staffing, a system set up by law in 2003 (with the add-on now 4.3% due to sequestration).⁷

Because revenue is tied to a percentage of drug cost, it leaves the clinic when administration does, while responsibility for monitoring and managing the patient stays. Meanwhile, community oncology practices face what some call “practice-ending” revenue threats due to the impact of the Inflation Reduction Act, with no resolution to the decades-old structure in sight.⁸

ASCO's 2020 statement touched on the gap, saying teleconferences between physicians and nurses administering home infusions “should be adequately reimbursed.”⁵ What the exchange in Nashville pointed to is still missing: a payment structure that rewards care management and monitoring by physicians wherever a drug is given.

Redesigning the oncology payment structure is not limited to management of therapeutics. During ASCO 2026, COA President Debra Patt, MD, PhD, MBA, FASCO, pointed to the need for CMS to reimburse practices that are investing in remote monitoring technology to care for patients who have received novel therapies, including bispecifics; monitoring helps these patients avoid serious adverse events and hospital stays.⁹

Technology and Transportation

Subcutaneous drug delivery has advanced in recent years. Since 2024, the FDA has approved subcutaneous versions of 3 checkpoint inhibitors: atezolizumab (Tecentriq Hybreza; Genetech), nivolumab (Opdivo Qvantig; Bristol Myers Squibb), and pembrolizumab (Keytruda Qlex; Merck). All require administration by a health care professional, which allows nurse-administered home delivery but not self-injection. In July, the FDA approved subcutaneous isatuximab (Sarclisa Escena; Sanofi) in multiple myeloma, which Sanofi calls the first anticancer treatment given through an on-body injector.^10,11 In the phase 3 IRAKLIA trial, median injection time was 13 minutes in the clinic and at home.¹² Investigators studying home-administered subcutaneous atezolizumab have paired nurse visits with telemedicine and wearable trackers.¹³

Home administration also speaks to a persistent access barrier. In a 2023 study in the Journal of the National Cancer Institute, cancer survivors who reported transportation barriers were more than twice as likely to use the emergency department and had about twice the risk of death.¹⁴

Rahman tied these threads to consumer expectations, describing the “Amazonification” of health care and a drone delivery he ordered to see how it worked. Patients, Balasky had said earlier, now behave as consumers who “can get anything at any time.”

Beyond the Home: Workforce, Teams, and AI

The 2030 landscape. Ajayi predicted that site-neutral payment could bring care back to community practices and said practices must prepare for patent expirations and biosimilars. Pichoske asked how practices will sustain quality with fewer physicians, noting that advanced practice providers (APPs) are “becoming more instrumental.” Balasky said referrals will depend on whether a practice surfaces when a patient queries an artificial intelligence (AI) tool.

“I probably have the rose-colored glasses,” Geiger said, “in hope that, despite all the chaos and despite all these challenges, we'll see that our care becomes even more convenient for patients, more patient-centered.”

Complex therapies. Ajayi said the supportive infrastructure his practice built for the Oncology Care Model now underpins delivery of bispecific antibodies. Hospitals are approaching practices about joint ventures, he added, perhaps to hedge against changes to the 340B program and site neutrality.

Team-based care. Balasky offered insights into staffing challenges: most practices have grown from about 5 employees per physician to as many as 12, and he suspects most practices have as many APPs as doctors. Yet physicians have not been told, “You're leading a team now.” Physician-centric care, he said, is not sustainable.

Pichoske called payroll one of a practice's largest expenses and urged faster, better training so staff are empowered. Ajayi recalled a new physician telling him, “Nobody taught me how to manage a team.”

Innovation and disparities.Asked whether AI will narrow or widen gaps, Geiger said it depends on access and affordability for practices and patients: “Can we do it? Yes, but should we do it?”

Balasky envisioned bots assembling a patient's records and ambient scribing freeing physicians to talk with patients; in fact, ambient scribing is already freeing up hours a week for many oncologists.

“We all have to be risk managers and [tools] can help us identify that risk, mitigate the risk, and also help clinicians not miss something important that would increase that risk,” Pichoske said.

But Ajayi warned, "There's always a huge chance that we're going to leave people behind."

Looking Into the Crystal Ball

Panelists were asked: what will have changed a decade from now?

Care will be “more proactive vs reactive,” Geiger said.

“One of my hallmarks would be physicians have moved the needle from individualism to more collectivism,” Balasky followed. “We're going to have to act as a team, but it's going to have to start with them because we can't drive teamwork in a practice if they don't act as a team.”

Pichoske said like Geiger, she is optimistic. “I'm going to predict that there's going to be less stress for clinicians,” because practices are going to make strides in driving better care, efficiency and most of all balance—which will drive better patient outcomes. “They're going to be diagnosed sooner, and their treatment options are going to be create a better quality of life while they're on treatment.”

References

1. Traynor K. White bagging a growing concern for health systems. ASHP News Center. March 23, 2021. Accessed October 6, 2026. https://news.ashp.org/news/ashp-news/2021/03/22/white-bagging-a-growing-concern-for-health-systems
2. The future of white bagging and brown bagging in oncology pharmacy. ACCC. March 15, 2021. Accessed October 6, 2021. https://www.accc-cancer.org/view/the-future-of-white-bagging-and-brown-bagging-in-oncology-pharmacy?
3. White, brown, clear, and gold bagging. AMCP. June 27, 2024. Accessed October 6, 2026. https://www.amcp.org/legislative-regulatory-position/white-brown-clear-and-gold-bagging
4. Community Oncology Alliance. Home infusion position statement. April 8, 2020. Accessed October 6, 2026. https://communityoncology.org/wp-content/uploads/2020/04/COA_HomeInfusion_PosStmt_04-08-20_FINAL.pdf
5. Slater H. ASCO releases statement regarding home infusion of anticancer therapy. Cancer Network. August 3, 2020. Accessed October 6, 2026. https://www.cancernetwork.com/view/asco-releases-statement-regarding-home-infusion-of-anticancer-therapy
6. Oncology Nursing Society. Administration, infusion and injection of antineoplastic therapies in the home. ONS. August 2024. Accessed October 2026. https://bit.ly/4j3Bw8j
7. Caffrey M. Part B losses to oncologists due to IRA could total $12B through 2032 across Medicare, commercial plans. AJMC. September 17, 2024. Accessed October 6, 2026. https://www.ajmc.com/view/part-b-losses-to-oncologists-due-to-ira-could-total-12b-through-2032-across-medicare-commercial-plans
8. COA applauds technical fix to IRA drug pricing policy. Community Oncology Alliance. July 9, 2025. Accessed October 6, 2026. https://mycoa.communityoncology.org/news-updates/press-releases/coa-applauds-technical-fix-to-ira-drug-pricing-policy
9. Caffrey M. Patt: RTM in oncology should be “standard of care,” sees guidelines coming—and billing should be next. Am J Manag Care. 2026;32(Spec No. 8):SP420.
10. FDA approves isatuximab-irfc for subcutaneous injection for multiple myeloma indications. FDA. July 9, 2026. Accessed October 6, 2026. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-isatuximab-irfc-subcutaneous-injection-multiple-myeloma-indications
11. Caffrey M. Could on-body delivery of isatuximab bring more competition in anti-CD38 myeloma treatment? Am J Manag Care. 2025;31(Spec No. 9):SP556-SP558
12. Sanofi's Sarclisa subcutaneous approved in the EU as the first anticancer treatment administered via an on-body injector. Sanofi. June 8, 2026. Accessed October 6, 2026. https://www.sanofi.com/en/media-room/press-releases/2026/2026-06-08-05-00-00-3307781
13. Hollasch M. Addressing the logistics of at-home cancer care with subcutaneous administration of immunotherapy. OncLive. June 25, 2024. Accessed October 6, 2026. https://www.onclive.com/view/addressing-the-logistics-of-at-home-cancer-care-with-subcutaneous-administration-of-immunotherapy
14. Jiang C, Yabroff KR, Deng L, et al.Transportation barriers, emergency room use, and mortality risk among US adults by cancer history, JNCI: J Natl Cancer Inst. 2023;115;7:815–821, https://doi.org/10.1093/jnci/djad050