Leslie Busby, M.D., senior vice president and chief medical officer of The US Oncology Network, discussed the changing oncology landscape, including practice consolidation, value-based care, precision medicine and policy pressures, in a conversation with Managed Healthcare Executive. The US Oncology Network, a subsidiary of McKesson Corporation, comprises about 2,700 providers in 31 states.
Dr. Busby began practicing at Rocky Mountain Cancer Centers in Boulder, Colorado, in 2002. She joined The US Oncology Network Pharmacy & Therapeutics Committee around 2005, later chaired the committee for six years and assumed the chief medical officer role in July 2025. Despite expanded administrative duties, she continues to see patients one day a week.
She describes consolidation as a response to limited capital and rising costs that leave many independent practices vulnerable. Private equity and hospital systems offer capital and scale but often require practices to cede autonomy. The US Oncology Network follows a hybrid model that aims to help practices remain independent while sharing financial risk and providing management support.
Policy and payment shifts concern Dr. Busby, particularly incentives that favor hospital settings, where outpatient services can command higher prices. Consolidation, she says, has accelerated and placed independent practices at a competitive disadvantage.
On value-based care, The US Oncology Network has run a pathways program for more than 15 years, now called Value Pathways and powered by the National Comprehensive Cancer Network (NCCN). Originating from work by former network CMO Marcus Neubauer, the program emphasizes “science first, toxicity second and cost third.” According to Dr. Busby, the approach streamlines care, reduces denials and improves consistency. She cautions that accelerated regulatory approvals can introduce drugs with limited evidence, so the network takes a conservative approach before adding such agents to pathways.
Pathway adherence aligns closely with NCCN guidelines, with most physicians reaching more than 75% adherence to the network’s pathways and often more than 90% adherence to NCCN. Dr. Busby says that alignment should ease payer interactions, but prior authorization processes remain inefficient. She advocates for interoperable systems that would allow payers to automatically approve guideline-concordant regimens.
Dr. Busby highlighted innovations such as CAR-T cell therapy and gene therapies as transformative but resource-intensive. CAR-T can be curative for some patients but requires substantial infrastructure and comes with high costs. Gene therapies for conditions like sickle cell disease present similar challenges. Bispecific antibodies may offer a more manageable, phased-cost alternative while clinical experience grows.
Next-generation sequencing (NGS) and precision medicine are expanding, she noted, with NGS standard in lung cancer and increasing use in breast, colon and other cancers. The main challenges are keeping clinicians up to date and ensuring timely results. Emerging AI applications could accelerate mutation detection and improve treatment matching, potentially transforming how therapies are selected.
Dr. Busby expressed concern about recent drug pricing policies. While capping patient out-of-pocket costs has value, new laws and regulations can strain the financial stability of independent providers when reimbursement does not reflect care costs. She said manufacturers are shifting toward biologics and antibody-drug conjugates after the Inflation Reduction Act limited exclusivity for oral small-molecule drugs and allowed price negotiations beginning seven years postapproval. Practices can face cash-flow risk when placed between reimbursement streams, and uncertainty around average sales price–based payments remains unresolved.
Looking ahead, Dr. Busby identified balancing innovation with affordability as the central challenge in oncology. She called for robust data to justify new therapies, streamlined payer processes to reduce administrative burden, and policy reforms that preserve the viability of independent practices. If incentives and infrastructure can be better aligned, she said, precision medicine and AI could make oncology care more personalized, efficient and effective.
Leave a Reply