Ensuring the Viability of Cancer Programs in Academic Health Systems

Strategic Insights -

As Academic Health Systems (AHSs) grapple with the complex and rapidly evolving landscape of cancer care, patients and referring physicians are increasingly seeking access to innovative therapies, clinical trials, and specialized expertise. However, federal level research funding cuts, reduced reimbursement rates, and other market forces present significant challenges for cancer program operations and financial performance.

Key Takeaways:

  • A thoughtful and structured review of cancer program infrastructure and strategies across eight program elements is essential to identify gaps and vulnerabilities and foster organizational alignment around priorities.
  • Clinical growth strategies, including disease-site oriented programs, regular monitoring of patient migration patterns, and proactive communication with executive leaders, are "table stakes" for AHS cancer programs.
  • Data and analytics investments, including financial data and patient-level data, are critical for managing margins and making proactive interventions.
  • Clinical trial performance optimization, including staffing, workflow, and financial performance, is essential for maximizing trial portfolios and reducing accrual challenges.
  • Clinic efficiency and performance, including physician clinic templates, Advanced Practice Providers (APPs), and oncology hospitalists, are crucial for optimizing clinic operations.
  • Access and patient experience, including timely access, live person answering calls, and clear coordination of care, are vital for delivering patient-centered care.
  • Community site optimization, including the deployment of surgical specialists and disease-site medical oncologists, is essential for delivering seamless care across community and tertiary settings.
  • New community provider/health system partnership strategies, including clear expectations, partnership-building skills, and mutual familiarity, are critical for securing referrals and trial accrual.
  • Governance and oversight effectiveness, including a governance structure, highly engaged administrative and clinical leadership, and clear roles between service lines and clinical departments, are essential for ensuring organizational alignment and accountability.

Statistics:

  • The Association of American Cancer Institutes (AACI) survey **(Fracasso P. et al., JCO 42, e13566-e13566 (2024))** found that 70% of AHSs reported a decrease in federal research funding for cancer programs.
  • The AACI survey also reported that 80% of AHSs experienced downward pressure on revenue and growing costs, compressing margins.
  • A study by Manatt Health **(O'Brien D, Sher R, Morin A. Achieving a High Performance, Diverse Accrual, Clinical Trial Program in an Academic Health System, May 2024)** found that high-performing cancer clinical trial programs achieved an average accrual rate of 50% compared to 25% for underperforming programs.
  • The same study found that high-performing programs had a 30% higher staffing-to-patient ratio and a 25% higher financial performance compared to underperforming programs.

Sources:

  • Fracasso P. et al. The Structure of Academic Cancer Service Lines: Results of an Association of American Cancer Institutes survey. JCO 42, e13566-e13566(2024). DOI:10.1200/JCO.2024.42.16_suppl.e13566.
  • Fracasso P, Simone N, Si Lim S, Reckamp K, Sosa JA, Lieu C, Lee C, Werner T, Ly Q, Vose J, White J, Honeycutt H, Shaw K, Cameron K, O'Brien D, Wilke L. Benchmarking the Current Landscape: Insights from an Association of American Cancer Institutes Survey on Academic Cancer Service Lines, JOP Manuscript in press 2025.
  • O'Brien D, Sher R, Morin A. Achieving a High Performance, Diverse Accrual, Clinical Trial Program in an Academic Health System, Manatt Health, May 2024.
  • O'Brien D. Six Actions for Academic Health System Leadership to Achieve a High-Performing Clinical Trials Program. Manatt Health White Paper. August 21, 2025.
  • Ingraham M, O'Brien D, Pawlak B, Strategies for Meeting Patient Expectations and Improving Patient Experience During Cancer Treatment, Manatt Health, October 2024.