Leslie Busby, M.D., senior vice president and chief medical officer of The US Oncology Network, discussed the changing oncology landscape with Managed Healthcare Executive, addressing independent practice models, consolidation pressures, value-based care, and recent policy and pricing shifts. The US Oncology Network, a McKesson subsidiary, comprises about 2,700 providers in 31 states.
Busby began practicing at Rocky Mountain Cancer Centers in Boulder, Colorado, in 2002. She joined The US Oncology Network Pharmacy & Therapeutics Committee around 2005, focusing on drug safety, electronic health record regimen development and pharmacy operations. She later chaired the committee for six years and became chief medical officer in July 2025. Despite expanded administrative duties, she continues to see patients one day a week.
Independent oncology practices face mounting financial and operational pressures from rising costs, constrained capital and payment disruptions, including those caused by cyberattacks. Private equity and hospital system affiliations offer capital and scale but can require loss of autonomy. The US Oncology Network uses a hybrid model that provides financial risk-sharing and management support to help physician practices remain independent while retaining control.
Policy incentives and payment differentials favor hospital-based care in many cases, allowing hospitals to charge more for outpatient services and accelerating consolidation. Busby warned that such trends disadvantage independent practices and heighten sustainability concerns.
Value-based care in the Network is driven by a pathways program now called Value Pathways, developed in partnership with NCCN. The program, originating from clinical work on lung cancer, emphasizes prioritizing scientific evidence, minimizing toxicity and considering cost. Pathways aim to streamline care, reduce denials and improve consistency. While targeted therapies have produced dramatic results in some cancers, accelerated approvals with limited data pose adoption challenges; the Network applies a conservative review before incorporating new agents into pathways.
Pathways closely align with NCCN guidelines, and most Network physicians exceed 75 percent adherence to internal pathways and often surpass 90 percent adherence to NCCN. Despite this alignment, prior authorization remains a time-consuming manual process. Busby advocates for interoperable systems that would allow payers to automatically approve guideline-consistent regimens.
Emerging therapies present both promise and complexity. CAR-T cell therapies offer curative potential for some patients but require significant infrastructure and carry high costs. Gene therapies for conditions such as sickle cell disease are similarly transformative but come with multimillion-dollar price tags. Bispecific antibodies may offer a more manageable cost and toxicity profile by spreading expenditures over time as clinical experience grows.
Precision medicine and next-generation sequencing have become standard in lung cancer, with uptake exceeding 90 percent, and are expanding into other tumor types. Challenges include keeping clinicians up to date and obtaining timely results. Advances in artificial intelligence and genomic testing may soon enhance mutation prediction and treatment selection, potentially reshaping how patients are matched to therapies.
Recent changes in drug pricing policy present concerns for community oncology. While capping patient out-of-pocket costs is beneficial, new pricing and reimbursement rules can undermine the financial viability of independent providers if payments do not reflect true costs. Busby noted shifts by manufacturers toward biologics and antibody-drug conjugates following provisions in the Inflation Reduction Act that limit exclusivity for oral drugs. Uncertainty around average sales price–based reimbursement and the resulting cash flow risks for practices raise worries about unintended consequences for innovation and patient choice.
Looking ahead, Busby identified balancing innovation with affordability as the central challenge. She emphasized the need for robust data to justify new therapies, streamlined payer processes to reduce administrative burdens, and policy reforms that protect independent practices. With aligned incentives and improved infrastructure, she said, precision medicine and AI could make oncology care more personalized, efficient and effective.
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