From Volume to Value: Safeguarding the Future of Oncology

In oncology, we stand at a precarious intersection. On one side, we have the incredible promise of technological advancement—proton therapy, radiopharmaceuticals, and adaptive radiation—offering patients better outcomes with less toxicity. On the other side, we face the harsh reality of economic constraints: shrinking reimbursement, administrative burdens like prior authorization, and an aging population that demands more care with fewer resources.

As a physician executive who has spent time in investment banking at Credit Suisse before donning the white coat, and now as a leader at Luminis Health and ASTRO, I view these challenges through a dual lens. I see the patient in the exam room, but I also see the spreadsheet in the boardroom.

The transition to Value-Based Care (VBC) is no longer a distant hypothesis; it is the current operating reality. Protecting our oncology service lines—and by extension, our patients' access to care—requires us to stop viewing VBC as a threat and start utilizing it as our primary defensive strategy.

Here is how we can navigate this shift.

1. Shift the Mindset: Per Patient, Not Per Fraction

For decades, radiation oncology thrived on a fee-for-service model that rewarded volume. However, the future of reimbursement is moving toward bundled payments and case rates. I have spoken frequently, including at SCAROP, about the necessity of shifting our economic focus from "per fraction" to "per patient".

To protect our service lines, we must embrace hypofractionation and shorter treatment courses where clinically appropriate. While this may seem counterintuitive to revenue generation in the short term, it aligns with payer goals and improves patient convenience. By proactively adopting these models, we demonstrate value, making our service lines indispensable partners to payers rather than cost centers to be managed.

2. Data is Your Strongest Negotiating Tool

You cannot manage what you do not measure. At Luminis Health, leading the Commission on Cancer accreditation process underscored the importance of quality metrics. In a value-based world, data is currency.

Service line leaders must rigorously track outcomes, toxicity rates, and patient satisfaction. When we approach the C-suite for capital purchases—whether for a new LINAC or AI software—we must frame the request not just on clinical need, but on Return on Investment (ROI) via efficiency and quality incentives. We must prove that high-quality oncology care reduces total cost of care by preventing hospitalizations and managing side effects effectively.

3. Combat Leakage through Strategic Partnerships

One of the greatest threats to an oncology service line is network leakage. Patients often leave a system because of gaps in service or lack of care coordination.

My approach has been to aggressively build partnerships with regional academic centers and payers. By broadening our research offerings and ensuring we have the full spectrum of care available—either on-site or through seamless referral channels—we build brand loyalty. Furthermore, expanding into neglected areas, such as creating a program for Low Dose Radiation Therapy for benign diseases, diversifies revenue streams while meeting genuine community needs.

4. Advocacy is a Leadership Duty

We cannot passively wait for policy to happen to us. As Chair of the Health Policy Council for ASTRO, I have seen firsthand how engagement with Washington shapes our reality.

Initiatives like the Radiation Oncology Case Rate (ROCR) model are attempts to stabilize payment and protect meaningful access to care in rural and underserved areas. Protecting your service line means getting involved in advocacy. We must educate policymakers on why stable reimbursement is a prerequisite for equitable, high-quality cancer care.

The Path Forward

Bridging the gap between medicine, management, and mission is the only way to build financially sustainable models of care. The transition to value-based care is turbulent, but for the prepared oncology leader, it is an opportunity to redesign a system that works better for our institutions and, most importantly, for our patients.

For more discussions on the intersection of healthcare policy, finance, and reform, tune in to my podcast, Value Health Voices.