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OneOncology Leads Community Practices in Innovation, Pathway Development

At the Community Oncology Alliance (COA) Annual Meeting (April 4-5, 2019; Orlando, FL), Journal of Clinical Pathways sat down with three of the leaders of OneOncology – a new partnership of independent community oncology practices that is physician-driven and utilizes a unified platform to enable physicians to care for patients through the entire course of care. OneOncology was started with  three leading community oncology practices: Tennessee Oncology, West Cancer Center, and New York Cancer & Blood Specialists.

Tracy L Bahl, president and chief executive officer of OneOncology, Jeff Vacirca, MD, FACP, chief executive officer and managing partner of New York Cancer & Blood Specialists, and Robin Shah, chief development and marketing officer of OneOncology, provide the details of what makes OneOncology different than other leading community practice collaborations as well as how it is built to withstand hospital consolidation.

Just to begin, I want to start with you, Mr Bahl. OneOncology is described as a physician‑led organization that empowers doctors to have real decision‑making authority. My immediate thought is that this structuring may have some innate friction with standardized care endeavors. Can you speak to whether doctors in your network are encouraged to make decisions based on high-quality evidence and informed guidelines or clinical pathways, rather than personal preference?

Mr Bahl: Of course. When you think about physician leadership, I think you can reflect back on lots of other companies that suggest they might be "physician‑led." In reality, those physicians are beholden to something other than real clinical evidence and real clinical expertise that guides the appropriate course of treatment for their patient.

At OneOncology, we have built mechanisms—formal and informal—that allow physicians to continue to do what they do best, which is to treat people with cancer.

The formal mechanisms, even at the top governance level of the company, include having four of our board members being physicians, three of them being medical oncologists, including Dr Vacirca, who is our board member of one of the founding visions of this company.

There are three of those physicians. Three of those medical oncologists are involved in the day‑to‑day leadership of the company, including Drs Vacirca, Patton, and Schwartzberg. We have just appointed Dr Lee Schwartzberg as our chief medical officer and we are really excited to have Dr Schwartzberg in that role. He will organize and put forth a governing body called “OneCouncil,” which will include physician leadership from each of the practices in the company.

They and they alone will determine pathways, drug regimen and drug selection, and clinical policy and direction, all of it based on evidence and data that we are able to provide through the economies of scale and intelligence that OneOncology brings.

I am not sure what other factors should be included in clinical decision making, but I am pretty sure that those physicians expertise, backed by clinical evidence and data, will liberate them to do what they have always wanted to do, which is treat people with cancer.

I am curious about this “OneCouncil” idea. How many members are you expecting on the council?

Mr Bahl:  There will be one per practice. Right now we have three practices. We expect to have many more in, over time, each of those. Important in our structure, remember, in our relationship with the practices, the practices keep their practice. They keep their tax ID number, and they keep complete independent clinical decision‑making authority. That is not something I am equipped to, nor would I ever want to engage OneOncology in.

Dr Vacirca, as CEO and managing partner of New York Cancer & Blood Specialists, what was the impetus for you to join OneOncology? What opportunities and benefits did this network provide in comparison to others?

Dr Vacirca: I think what you will find that is unique about the three practices that got together, it is not your typical mishmash of dysfunctional groups that get together purely for financial gain. None of us did that. All of us have very successful practices. We are all very clinically integrated. We all have robust research departments. But we all were hungering for the same thing. That is a different culture and a different delivery model for cancer care. We have sat back, all of us, and have done the best that we have been able to do over the years of trying to change it individually, and have realized we need to be more collective if we are going to change how we each take care of patients. This goes back 20 years. I walked into my first Amerisource meeting, and I met probably to me, the four visionaries that guided my career, and have allowed me to get to where I am today. First one that I met was Lee Schwartzberg, and then it was Jeff Patton, it was Bill Harwin, and Stan Marks.

Still to this day, those four guys I reach out to whenever I have a question about business. They help me guide my practice to where it is today. To have the opportunity to work with the two of them to form something better than any of us could do separately is remarkable.

Back to that question about friction, I hope there is friction. There should be friction. Friction goes to discourse, which gets to discussion, which gets to presenting of all that clinical data. That is how you come up with great pathways, which was not something we have seen before.

I'm interested in ways in which OneOncology differs from the other networks of community oncology practices. What is the marketing strategy for getting this out and bringing in more practices into OneOncology?

Mr Shah: It is a great question and something that we hear a lot of at OneOncology. The entire marketplace is starting to evolve in terms of community oncology. There are a lot of organizations that are coming to the space. I think it is great for community oncology and one of the reasons why we are so excited about what we are doing at OneOncology.

A couple of the important, key differences for OneOncology and how we compare to every other companies out there is that number one, we are focused on being an organization that is led by physicians. One of the things that we always talk about is, as in politics, things are local. That is equally true in cancer care. When we think about working with our practices, the physicians maintain a lot of the local autonomy; they maintain and own their practices. They run how the operations work within that clinic and within that organization, and we at OneOncology are just there as support to them. So, one of the things we think is a pillar to OneOncology is our physician-centric autonomy model. We think that the physicians maintaining the clinical decision-making, as well as how they operate within their market, is going to allow them to be successful within that market.

The second biggest differentiator in OneOncology is our investment in technology. It has been pointed out that we have a strong relationship with Flatiron. We really think that data-powered technology is a critical enabler to the success of all the practices within OneOncology. Leveraging a common platform across all of our practices and then taking that data and learning from each other is the way that we are going to be able to build an organization focused on constant improvement on quality, cost, access, and patient experience. Having this integrated model will allow not only the physicians to be successful and improve over time, but also all of the staff within our clinics: operational, financial and billing, and all the clinical staff that are non-physicians.

The last thing I will talk about is our culture; this is one of the differentiators that excites me the most. Everyone within our organization is focused on improving the lives of everyone living with cancer. We believe that it does not just start and end with a physician and a patient, but includes the family of the patient, all of the staff within the clinic, the community that we are in, and everyone that is impacted or touched by the lives of our patients. We are building a culture to bring everyone into the loop to improve on the entire ecosystem.

Mr Bahl: I think this distinction is really important. This, with the first question you asked, probably distinguish us from all standing other models in the marketplace. First, the physician leadership and physician centricity of our business model is reflected in each of the mechanisms I described, and then second, the investment in this common platform.

There are other models out there that are simply a multiple arbitrage transaction. We are going to consolidate practices at a low multiple and sell the consolidated entity at a higher multiple. That is not what this is about. There are business models out there that consolidate scale for the sole purpose of distributing drugs. That is the principal financial interest. That is not what we are about.

If we were about those things, we would not invest the immense amount of capital we are in building a common infrastructure. Not just a technology infrastructure, but an analytics and data infrastructure, an operational, process, and collaborative infrastructure. We can use the economies of scale that consolidated infrastructure brings, and the economies of intelligence that data and best practices it derives, to identify ways to advance the science and practice of cancer care. When we identify those great things, go back into that single platform and make the change once.

If we had 132 points of care delivery, that none of them were integrated, and we had to go back and make 132 changes, it would never get done. The impact of your best practice becomes diluted in the morass of your confusion. In this model, we can identify a best practice, make one change, and drive it across the entire network. It is a significant investment, but we think it is worth it in driving the real raw vision of the company

Dr Vacirca: I think from the ground floor, from the physician's side, the biggest difference...and the other models that are out there, there are practices for everyone. Our goal is to keep practices from being part of the hospital consolidation. It is the same thing that the other two models are out there. I think it is wonderful.

I think a bigger difference is, in addition to being physician‑led, this is physician‑owned. The physicians that come into this company have ownership in the company. When you have skin in the game, you care more, you do more, you work better, your quality standards are much higher because it is your name.

The practices keep their tax ID number. They do not lose their identity on the local side. But at the same time, they are going to have behind them a national brand that is going to be known for quality to back them up in their decision‑making.

I was going to ask about the Flatiron influence of what you are doing, but I think we have covered that for the most part. I do want to just ask quickly – can you speak to pathway use?

Dr Vacirca: That is the whole point of Lee Schwartzberg. You bring in a brilliant clinical mind and researcher, who develops a council that involves the physicians. That is the first step to developing the best clinical pathways.

Mr Bahl: Dr Schwartzberg has been involved in the company from day one as one of the principal physicians at West Cancer, and has begun conversations with Dr Vacirca and Dr Patton around the consolidation and rationalization of pathways. This process is already underway. The important thing is it is being driven by data and our doctors.

Dr Vacirca: You step back, and you look at now between the 250 oncologists within our group, the breadth of expertise that is in there. I mean, it is remarkable what we will be able to turn out in the ways of pathways. Turning out a pathway is not complicated. It is staying on top of it a week later when the next drug comes out.

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