he economics of community oncology are changing. The answer cannot simply be fighting harder to preserve the economics of the past.
Community oncology is entering another period of significant economic transformation.
The Inflation Reduction Act, Medicare drug price negotiation, continued pressure on drug margins, 340B policy changes, payer consolidation, site-of-service initiatives, value-based care, rising labor expenses, and increasing capital requirements are collectively changing the financial foundation upon which oncology practices have historically operated.
Beginning in 2028, Medicare’s Drug Price Negotiation Program will also expand to include selected drugs payable under Medicare Part B, bringing physician-administered therapies directly into the evolving drug-pricing environment.
For community oncology, this matters.
The buy-and-bill model has long been intertwined with the economics of medical oncology. Changes in drug acquisition costs, reimbursement methodologies, manufacturer economics, payer policies, and Medicare payment therefore have implications extending well beyond pharmacy.
But focusing exclusively on reimbursement misses the larger strategic question.
What should the community oncology enterprise look like when the economics supporting the traditional model begin to change?
The answer cannot simply be negotiating another few percentage points from payers, protecting existing drug margins, or waiting for the next reimbursement policy.
Community oncology needs to begin building the economic model that comes next.
Clinical research may become an increasingly important part of that model.
Cancer Care Is Already in the Community. Research Should Follow.
A substantial portion of cancer care in the United States is delivered outside major academic medical centers.
Patients receive chemotherapy, immunotherapy, radiation therapy, imaging, laboratory services, supportive care, survivorship services, and increasingly sophisticated precision oncology services in their own communities.
Yet the infrastructure supporting clinical research has historically been disproportionately concentrated within academic and large research institutions.
That creates an important disconnect.
If we ultimately intend for innovative therapies to be delivered broadly within community oncology, there is tremendous value in studying those therapies in the same environments and patient populations where they will eventually be used.
Community-based research can potentially expand access to innovative therapies, improve the diversity and representativeness of clinical-trial populations, accelerate patient enrollment, and generate evidence reflecting real-world oncology delivery.
Most importantly, it can allow more patients to participate in clinical research without requiring them to travel significant distances to major academic centers.
For many patients, particularly those living in rural and underserved communities, geography itself can become a barrier to clinical-trial participation.
Moving research closer to patients is therefore not simply an economic opportunity.
It is an access strategy.
But We Cannot Simply Move the Academic Research Model Into the Community
Expanding community-based clinical research sounds straightforward until the operational requirements are examined.
Clinical research requires infrastructure.
Practices need research nurses and coordinators. Pharmacy workflows must accommodate investigational therapies. Regulatory and compliance capabilities must exist. Data must be captured accurately and consistently. Patients must be identified, screened, consented, enrolled, monitored, and followed.
Physicians must have protected time to participate.
Infusion capacity must be available.
Financial systems must appropriately account for research-related services, standard-of-care services, sponsor obligations, payer responsibilities, and patient financial exposure.
Technology must connect clinical information, genomic information, research protocols, patient identification, and outcomes.
Those capabilities require people, technology, space, governance, and capital.
Simply asking community oncology practices to absorb these responsibilities within their existing infrastructure will not create a scalable national research model.
The infrastructure has to follow the patient.
The Economics of Research Must Also Work
This may be one of the most important elements of the conversation.
If clinical research is going to scale meaningfully across community oncology, we need a much better understanding of the true cost of conducting research in the community setting.
That includes much more than the direct cost of a research coordinator.
The economic model must recognize physician time, nursing resources, pharmacy operations, infusion capacity, regulatory administration, technology, contracting, data management, patient navigation, revenue cycle requirements, facilities, and organizational overhead.
In other words, we should approach research infrastructure similarly to how we should approach the economics of cancer care itself:
Understand the entire delivery model before determining what constitutes sustainable payment.
Pharmaceutical manufacturers need efficient enrollment and high-quality data.
Research organizations need reliable sites capable of executing protocols consistently.
Community oncology practices need sufficient resources to build and maintain research infrastructure without subsidizing it through already constrained clinical operations.
And patients need access to innovative therapies without unnecessarily leaving their communities.
A sustainable model has to create value for all four.
This Is Bigger Than Another Revenue Stream
There is a danger in framing clinical research simply as another opportunity to diversify practice revenue.
The opportunity is much larger.
Community oncology is gradually evolving from a collection of individual clinical services into something closer to an integrated oncology enterprise.
That enterprise can include medical oncology, infusion, pharmacy, radiation oncology, imaging, laboratory services, precision medicine, molecular diagnostics, theranostics, supportive care, navigation, revenue integrity, value-based care, and clinical research.
When these capabilities operate independently, organizations frequently create additional complexity.
When they operate as an integrated enterprise, something very different becomes possible.
Clinical data can identify potential research patients.
Molecular testing can connect patients with targeted therapies and trials.
Pharmacy can support investigational products.
Infusion infrastructure can support protocol delivery.
Radiation oncology can participate in multidisciplinary research.
Revenue integrity can appropriately distinguish research-related and standard-of-care services.
Analytics can measure outcomes.
And enterprise governance can ensure that research supports both the clinical mission and long-term sustainability of the organization.
That is no longer simply a clinical-trial program.
It is research embedded into the operating model of the oncology enterprise.
Pharma and Community Oncology Have an Opportunity to Build Something Different
The pharmaceutical industry should also consider what this transformation means.
Historically, trials have often been designed first and operationalized second. Community practices are then asked to determine whether they can accommodate protocols developed within an infrastructure very different from their own.
There may be a better approach.
Pharmaceutical companies, community oncology organizations, research networks, technology companies, CROs, and healthcare investors could begin designing research infrastructure specifically for community delivery.
That means asking different questions earlier.
What staffing will the protocol require?
What pharmacy capabilities must exist?
What burden will fall on physicians?
How much infusion capacity will be consumed?
Can technology automate patient identification?
Can decentralized components reduce unnecessary patient travel?
What does the trial actually cost the community practice to execute?
And can the model scale beyond a handful of sophisticated sites?
Organizations such as The US Oncology Network, Sarah Cannon Research Institute, OneOncology, Ontada, Flatiron Health, Tempus, Community Oncology Alliance, major pharmaceutical manufacturers, and many others are already contributing pieces of this evolving ecosystem.
The opportunity now is to think about how those pieces fit together.
Building the Oncology Enterprise That Comes Next
Healthcare organizations frequently respond to economic pressure by trying to preserve existing reimbursement.
Sometimes that is necessary.
But reimbursement protection cannot substitute for business-model transformation.
The next generation of successful community oncology organizations will likely have more diversified capabilities, stronger data infrastructure, deeper clinical integration, more sophisticated revenue integrity, greater participation in value-based arrangements, and new partnerships across research, technology, diagnostics, and therapeutics.
Clinical research should increasingly be considered within that strategy.
Not as an ancillary department.
Not simply as another revenue stream.
And not as something reserved for academic medicine.
It can become a core capability of the accountable community oncology enterprise.
The economics of oncology are changing.
The organizations that thrive over the next decade may not be those that become best at defending yesterday’s reimbursement model.
They will be the organizations willing to build the oncology model that comes next.
At Bridge Oncology, we believe the future of cancer care will require organizations to look beyond individual departments, reimbursement methodologies, and traditional service-line boundaries. The opportunity is to build integrated oncology enterprises where clinical operations, economics, research, technology, revenue integrity, and patient access are designed as parts of the same system.
Because ultimately, the objective is not simply to create a more sustainable oncology business model.
It is to create a sustainable model capable of keeping high-quality cancer care—and increasingly cancer innovation—closer to the patients and communities that need it.