Trends Shaping the Business of Oncology in the Year Ahead: Part 1

Host Gordon Kuntz and guest Dr Bryan Loy explore key oncology trends for 2025, including provider and payer consolidation, the shift to value-based care, and patient access challenges, emphasizing the importance of collaboration, infrastructure, and innovation to enhance care delivery and maintain the patient experience.

Gordon Kuntz: Welcome to Oncology Innovations, a Journal of Clinical Pathways podcast, focusing on candid discussions with innovators dedicated to enhancing quality, value, and the role of clinical pathways in the evolving cancer care ecosystem. I'm your host, Gordon Kuntz. I am a consultant with 20 years of experience in oncology clinical pathways and the business of oncology.

I've worked with oncology practices, pharma, payers, group purchasing organizations (GPOs), and pathway developers—basically every aspect of the oncology ecosystem. I'm also a member of the Journal of Clinical Pathways editorial board, as is our guest today. Today's podcast is a special one. We are here today with Bryan Loy, medical director at Humana, and we'll be talking about some key trends impacting oncology that we see for 2025.

I've known Bryan for many years. He leads Humana's oncology initiatives and has been a longtime innovator in the cancer space. As Bryan and I prepared for this episode, we landed on 3 key trends that will shape the business of oncology in the next 12 months: consolidation among providers—but also payer consolidation—the ongoing shift from volume to value in cancer care payment, and patient access restrictions.

Let's dive right in and talk about consolidation. A few years ago, I would have described oncology care as more of a cottage industry with owner-operators serving their communities. Not to date myself too much, but maybe 10 years ago or so, if I remember correctly, the average size of a community cancer practice was about 4 oncologists.

Now we have Florida Cancer with over 250 oncologists and Texas Oncology with at least that many. On top of that, US Oncology, as a network, will have close to 3000 oncologists nationwide when they add Florida Cancer Specialists. OneOncology has grown to well over 500 oncologists, and OncoCare is rapidly approaching 500 as well. 2024 saw some significant practices joining networks, acquisitions by distribution, and practices merging. Bryan, what do you see in 2025 regarding potential future consolidation in oncology practices?

Bryan Loy, MD, MBA: You're right, Gordon, it does look like we've gone through a lot of change in a fairly short amount of time, especially in the community oncology world. I think you've described a lot of the growth in the form of consolidations in those groups. I think it's going to be really hard to maintain a small practice and thrive in that type of an environment.

But in terms of answering your question—what do I see going forward—I think a couple of things that I'll be on the lookout for include additional integration. We've seen practice consolidation largely around a core of medical oncology practices and some vertical integration from distributors, but I think there are additional opportunities.

When you think about defragmenting an ecosystem, there are a lot of additional services, such as the ancillary providers, radiation oncologists, radiologists, laboratory, genetics, etc, consultants that are specializing oncology, we're seeing a whole new breed of cardiology in the form of oncocardiology that is beginning to arise. I think folks are really acknowledging that there is a role for behavioral health.

We can also see some intermediaries. I think that there are enough additional plays where folks who understand medical oncology can share information and probably recruit what I will call adjacencies—such as gynecologic oncology, for example. But at the end of all this, consolidation will lead to folks beginning to ask the question: now that you're consolidated, what sort of value do you bring that you were anticipating bringing before you embarked on this journey? Those are the things that I'll be looking for.

Kuntz: One of the things that's behind this level of consolidation is a bit of a defensive maneuver on the part of distribution to make sure that they maintain or improve their GPO and distribution relationships. When you have these very large practices representing a significant portion of a distributor's business, they don't want to lose that. There's a little bit of that.

But there are 2 types of consolidation that are occuring. One is the outright acquisition. The other is alignment in these networks. I see that as being driven more by a need to be able to respond to value-based care, to use tools that are more expensive and share best practices, frankly, among these small practices. When you think about OncoCare, most of those practices aren't particularly big. They're very sophisticated, but they're not very large as compared to a Florida Cancer or Texas Oncology, for example. But together, they're able to share resources, they're developing pathways, and they're able to really share some infrastructure across a group of 500 oncologists.

What else is driving that, do you think?

Dr Loy: There are a number of stakeholders that could have some divergent interests, and it would just be good to call them out. You've got private equity—they’re investing—and you've got the practice. Then, of course, there are the payers and the acquired and to-be-acquired groups.

So I think there are a number of dynamics that are in play. I respect the leadership, and I hope the physician leadership of these big practices are maintaining—and I believe they are. I think these are well-seasoned individuals who, at their core, patient interest at heart, which is extremely important to maintain. As we begin to go down that, I'll call it continued transition, they'll be looking for value to capitalize on infrastructure, scales of scope, and maintaining scales of economy in such a way that they can still maintain that community-based feel for the member experience or the patient experience.

I think what we don't need is an inability to care not only for the patient, but to care about the patient. And I think that's one of the luxuries that we've enjoyed in community-based oncology for a good long while. I hope that doesn't get lost in all of this.

Going back to the stakeholder issues that I raised, obviously, private equity is looking for a return. Practices have to make payroll and remain profitable. Payers have to maintain accountability, and they have to be profitable as well. But I think everyone that's in this space is all aligned around what it is that we can do to maintain, perfect, or improve upon the member experience in a way that we've really struggled with in fee-for-service—holistic care, social determinants of health, and health literacy.

Looking at the out-of-delivery experience, I look for two things to happen. One, practices will begin taking that on, and I applaud Centers for Medicare & Medicaid Services (CMS) for being the icebreakers in insisting upon that. But I think practices are probably going to either take that on themselves if they're more mature or rely on some intermediaries to be able to accelerate that, to be able to get into that world of taking care of the whole patient, rather than just relying on transactional processes. I look for, rather than having two feet in two different boats, so to speak—as many have described it—as more of a “we've got to cut some ties with fee for service and manage towards this new value-based environment.”

Kuntz: You mentioned private equity, and private equity is behind a lot of these deals, especially those where there's an outright acquisition, either directly as a full owner or in partnership with the distributor or somebody else along the way. One of the things that we've observed in private equity's entrance into the health care market is that—and not all deals are like this, I want to be clear—there are some really good players that have done a lot to support groups like OneOncology when they first got started in 2018 and some of the things that have spun out of that, but not all private equity has that greater interest at heart.

As you mentioned, they're looking for return on their investment. At the end of the day, that's what they're after. The question that I would have is, what's your perception of that? What you're talking about is improving quality, and I think that's a goal that, if you ask any oncologist over a drink, they would be absolutely behind. But when they cash out and they sell to a private equity firm, there's somebody who's asking some tough questions—either monthly or quarterly—about how are we doing? Where's the profitability? You're spending too much on X or Y and, again, we've seen in some of the hospital and long-term care involvement of private equity, some real detriment to the patient quality. Is there a risk of that, do you think?

Dr Loy: To say "No, there's no risk of that" would be disingenuous. There's always risk, but I do foundationally believe that doctors go into practice to take care of patients. Doctors realize that, at some point in their lives, they may become patients. That drives a lot of the guardrails for many of the concerns that you're describing. That's not to say that it can't happen. I also think that, in this new world, payers have an interest in trying to make sure that their members aren't getting on the short end of that stick—that there is good access to care, geographic access, that your networks aren't so narrow that somebody has to travel an extraordinary amount of time or wait an extraordinary amount of time, because I think payers are very sensitized to delays in care, for example.

I think there will be a number of measurement systems that we haven't had in place before that will at least make sure that we've got our fingers on the pulse of what's happening from the member experience perspective.

I think there are other guardrails that need to be in place. We might want to touch on this a little more in depth, but in a world where we were looking for pathways, for example, to promote the highest level of care, we may be using that on both ends of that spectrum to ensure that members and patients are getting adequate care or standard of care or contemporary care—that they're not being shortchanged, so to speak. Looking for those things will require the development of new collaborations, more robust data analytics systems in place, and sharing of that information to identify outliers before they crop up and present problems.

Kuntz: Let's talk a little about value-based care, which I think that actually ties into in many ways. What do you see as the outlook in 2025? We've got the Enhance Oncology Model (EOM) from CMS, that really hasn't gotten widespread acceptance by any stretch of the imagination. There are obviously a lot of individual payer programs, where do you see that going in the next year or two?

Dr Loy: I think that the more mature practices will continue to learn their way into it. I still feel like we're on the front end of this. We didn't get this way overnight with fee-for-service, and this is a journey. We'll continue to learn from the flagship groups that have made those investments.

I think a lot of that learning will then be passed along to the groups that are maybe a little further behind in that journey. I don't look for an onslaught of groups joining those that have been waiting in the wings, but I do believe that it'll begin to help practices get the permission space to develop processes for practice transformation. Much of that might manifest in their relationships with other payers besides just the government payers, for example. I see us still taking steps forward. I don't see us saying "That was just a failed experiment and let's go backwards." There are lessons to be learned that can be shared across practices.

Taking this back to our original discussion around consolidation, I think there's a grand opportunity here for newly acquired practices to enjoy some of the benefits and learn from the pitfalls that some of the flagship practices have already gone through. It lessens the barrier for that learning to take place and to accelerate as they become acquired and become standardized to get rid of some of the irrational variation in practice, as well as promoting the quality, member experience, and the patient-reported outcomes. A lot of that will be lifted up and accelerated by some of the infrastructure that's already been created.

Kuntz: That's interesting because, obviously, the larger practices have moved into value-based care contracting much earlier than the small practices. They're just in a much better position to take risk. They're in a much better position to have the infrastructure and the systems necessary to really succeed in that. Since most of us have gotten gobbled up already, a lot of the acquisitions and alignments that are happening are with smaller practices, those that have 3, 4, 5 physicians. Some of those remaining small practices are either aligning with groups like OncoCare or joining groups. Even some of the recent additions to the US Oncology Network are not nearly as big as Minnesota Oncology or Rocky Mountain Cancer Center. They're, again, in the under-5-position realm.

But being aligned with those larger groups gives them capabilities. I'm thinking that we might be approaching a bit of a tipping point where it's really going to take getting all the remaining small practices into alignment with one of the half dozen networks that we'll end up with, and essentially put the whole industry on a footing where we can move forward where we've been constrained before. There was maybe the desire but not the capabilities, or the capabilities and not the desire, and now we're finally getting those two things aligned.

Dr Loy: The capabilities that you're describing—to the extent that an acquiring group can take a small practice, as you described, and share infrastructure with them—can be an accelerant, along with the willingness of the practice. This is no small task.

The other thing that is starting to crop up—and we probably will see more of—are these intermediaries in various forms and fashions that become accelerants to say, "Hey, we can help you with your resources. Hey, we can extend your office hours and relieve you of some of the calls. Or hey, we can help you with care coordination." To the extent that they can do it more effectively and efficiently and help these smaller practices further along in their journey, I think it does offer additional opportunities, like you're saying.

I think there are administrative inefficiencies that happen both on the practice side and the payer side, as well as in that interface between practice and payer that. As practices get larger and more standardized, and you can demonstrate through your data that this is the care that we all have been looking for anyway—at a price point—then I think we get rid of some of the processes that will help us reinvent prior authorization and utilization management, for example. So, I think there will be a lot of opportunity depending on how well we execute.

Kuntz: This is going to wrap up our episode of Oncology Innovations, a Journal of Clinical Pathways podcast. A big thank you, Bryan, for sharing your insights on the key trends shaping oncology in 2025, from consolidation and the shift to value-based care, to the evolving landscape of patient access restrictions. As always, our goal is to bring you candid conversations with industry leaders, like Bryan, who are driving innovation and shaping the future of oncology care.

If you enjoyed the discussion, be sure to subscribe, leave a review, and share this episode with your colleagues. For more insights on oncology clinical pathways, value-based care, and payer dynamics, visit the Journal of Clinical Pathways and follow Oncology Innovations for future episodes. I'm Gordon Kuntz. Thanks for listening. Until next time, stay informed, stay engaged, and keep driving innovation in oncology care.