Community Oncology’s Next Chapter: What Comes After Growth 

Community oncology networks (CONs) are expanding rapidly—and with that expansion comes a shift in how care is delivered, how decisions are made, and who holds influence. As private equity, payers, and artificial intelligence (AI)-driven care models reshape the landscape, the next five years will bring dramatic changes that ripple across stakeholders. 

This transformation will not be linear. Economic pressures, policy shifts, and evolving technology will interact in complex ways. Below are five forces to watch as CONs continue to grow their role as central players in oncology care. 

Financial Pressures Will Fuel Continued Consolidation 

Practice consolidation will likely accelerate, driven by a confluence of financial and structural pressures. Many physicians, facing decreasing reimbursement and retirement, are selling equity stakes in their practices. The Inflation Reduction Act (IRA), particularly its provisions for Part B drug price negotiation in 2028, will catalyze a significant revenue decline in physician reimbursement, prompting further consolidation among CONs and health systems. 

The rise of CONs like US Oncology Network, OneOncology, American Oncology Network, and Navista will continue, offering economies of scale and administrative capabilities that small practices may not be able to sustain on their own. These dynamics may create a tipping point for independent oncology practices, pushing them to seek stability in affiliation models​. 

Artificial Intelligence Will Influence Drug Selection and Pathways 

AI’s footprint in oncology is expanding. Initially focused on reducing administrative burden, AI integration efforts are beginning to support clinical decision-making by offering personalized or optimal treatment pathways for complex patient populations​. 

As these technologies mature, expect CONs to increasingly incorporate AI into pathway design, potentially reducing variation and cost across providers while also reinforcing their leverage with payers and manufacturers. 

Site of Care Shifts Will Redefine Access and Economics 

Complex therapies such as bispecific antibodies, CAR-T and gene therapies, and radioligand therapy, historically more commonly administered in hospitals, are expanding into community oncology practices. Due to the intricate nature of these treatments, additional infrastructure and economic resources are required to offer them. Given access to such resources, larger practices or those affiliated with CONs may be better positioned to facilitate expanded access to these therapies in the community setting. 

Meanwhile, therapies that were once infused—such as immunotherapies—are increasingly available in subcutaneous formulations, and some patients may even have these administered in the home setting. With policymakers and advocates considering expanded support for home infusion, CONs must prepare operationally and strategically to compete or collaborate with these lower-acuity settings. 

Value-Based Care Models Will Get Simpler, Smarter—and Stickier 

New value-based care models will return to a simpler design than the total cost of care models implemented in the past several years. Burdened by administrative costs, complexity, and challenges in measuring value beyond the cost of care, models like the Enhancing Oncology Model have lost favor. In their place, new arrangements are emerging that reward core quality metrics and integrate AI for process tracking, giving them the power to gain traction and stay in place​. 

Importantly, these shifts align with broader payer trends. Commercial and Medicare Advantage (MA) plans increasingly prioritize adherence to pathways, triage programs, and bundled payments, offering community oncology new levers for reimbursement and partnership. 

Payer Management Will Continue to Influence Decision Making 

As payers tighten control to manage costs under the IRA and beyond, CONs that demonstrate both quality and efficiency will be best positioned to win favorable contracts and patient access. 

Payer consolidation and the continued rise of MA enrollment are expanding utilization management (UM) efforts across oncology. While historically less affected by payer management, oncology is now seeing step edits, prior authorizations, tighter formulary management, and preferred drug status for both pharmacy and medical benefits.  

Actionable Takeaways for Stakeholders 

Over the next five to ten years, manufacturers, payers, and providers alike will need to: 

• Prepare for increased aggregation and shifting ownership models
• Anticipate AI’s role in influencing treatment decisions 
• Evaluate product portfolios and support programs for compatibility with new care sites 
• Simplify value-based care offerings while aligning with pathway-driven care 
• Strengthen payer engagement strategies, particularly with MA plans 

Patient advocacy organizations should also monitor these trends to ensure that patients with cancer can maintain access to care in a timely and safe manner. 

How Avalere Can Help 

Avalere supports clients navigating the evolving oncology landscape through tailored market assessments, scenario planning, and strategy development. Whether you’re evaluating the impact of the IRA, building value-based models, or assessing products that fit in CONs, we provide clarity and direction to complex challenges.