A conversation with Debra Patt, MD, PhD, MBA, oncologist and executive vice president at Texas Oncology.
Community oncology has never had more to offer patients — and has never faced more pressure to survive.
New targeted therapies. CAR-T programs moving into community settings. 170 oral oncology agents approved since 2001. A patient population growing faster than the workforce that serves it. And a policy environment that can shift the financial viability of a practice with a single regulatory change.
Dr. Debra Patt has spent her career at the intersection of all of it — as a practicing breast oncologist, the EVP of the largest community oncology practice in the country, the president of the Community Oncology Alliance, and a board member of ASCO. In this conversation with Reimagine Care Medical Director Dr. Pallav Mehta, she offers one of the most candid and comprehensive assessments of where community oncology stands today — and what it will take to survive what’s coming.
“CAR-T is like a Ferrari that doesn’t have a highway to drive on. Less than 20% of patients who would be eligible for those therapies will have access to them — for reasons that have to do with clinical infrastructure, reimbursement, patient education, and operational coverage.”
— Debra Patt, MD, PhD, MBA, President, Community Oncology Alliance
What this episode covers
The forces reshaping community oncology From the 340B drug discount program and its unintended market consequences to the growth of clinically integrated networks like US Oncology and OneOncology — Dr. Patt traces the structural shifts that have transformed community practice over 30 years and explains why consolidation was not a failure of the community model, but a survival response to market forces.
Why public policy remains the greatest threat IRA implementation, GLOBE, GUARD, and the mechanics of drug payment — Dr. Patt explains why policy uncertainty is now the single biggest operational risk facing community oncology practices, and what legislation is in flight that could hold physicians harmless from the most damaging impacts.
The advanced therapy infrastructure gap CAR-T and bispecific therapies represent an extraordinary leap forward for patients. But delivering them safely in community settings requires clinical infrastructure that most practices don’t have — after-hours symptom support, toxicity monitoring, caregiver education, and operational coverage that runs around the clock. The highway has to be built before the Ferrari can drive.
Build vs. buy — and why most practices will need to partner Texas Oncology has spent over a decade building 100 virtual nurses to manage patient symptoms. Most practices haven’t — and won’t. Dr. Patt is direct: practices that want to offer advanced therapies are going to need clinical infrastructure partners to do it safely and sustainably.
Digital transformation as an execution challenge, not a technology challenge Texas Oncology has 122 digital transformation projects in flight over the next three years. Dr. Patt’s candid assessment: choosing the right vendor is the easy part. Implementation and change management are where organizations succeed or fail — and most will need help getting there.
The workforce reality Nursing shortages. Physician burnout accelerating early retirements. Fewer clinicians entering full-time practice. The staffing constraints facing oncology aren’t temporary, and they aren’t fixable by asking people to do more. Efficiency and smart delegation aren’t optional — they’re the only path forward.
Dr. Patt’s call to action for 2026 This is the year to chart the course. Build or buy a virtual care team. Plan for advanced therapy infrastructure. Attend the COA Innovation Hub in Orlando in April. Because, as Dr. Patt puts it, “this year it will be slow, and then it will be very fast.”
“Most practices aren’t going to have the ability to stand up the infrastructure to respond to patients’ symptoms for advanced therapies like CAR-T in a timely fashion. They’re going to need partners — organizations like Reimagine Care — to offer this nursing support after hours, to support these patients, to try to build the infrastructure of this highway so we can take that Ferrari out for a drive.”
— Debra Patt, MD, PhD, MBA
About the guests
Pallav Mehta, MD — Host Dr. Mehta is a medical oncologist specializing in breast cancer and the Medical Director of Reimagine Care. He practices at MD Anderson Cancer Center at Cooper and serves as an assistant professor of medicine at Cooper Medical School. He brings nearly 20 years of clinical experience to his work at the intersection of oncology and virtual care.
Debra Patt, MD, PhD, MBA — Guest Dr. Patt is Executive Vice President of Texas Oncology — the largest community oncology practice in the United States, with 300 sites of service — and the 2025–2026 President of the Community Oncology Alliance. She serves on the board of ASCO and is board-certified in clinical informatics. Dr. Patt has led Texas Oncology’s digital transformation office, built one of the country’s most advanced virtual nursing programs, and is widely recognized as one of oncology’s leading voices on public policy, AI adoption, and the future of community cancer care.
How Reimagine Care addresses the infrastructure gap Dr. Patt describes
Dr. Patt names Reimagine Care directly in this conversation — not as a sponsor, but as an example of the kind of clinical infrastructure partner that community practices and health systems will need to deliver advanced therapies safely and at scale.
The gap she identifies is specific: after-hours symptom support, toxicity monitoring, and clinical coverage for patients on CAR-T and bispecific therapies that most practices cannot staff on their own. Building that infrastructure takes years. Buying it — through a partnership with an oncology-native virtual care platform — is how practices get there now.
Reimagine Care provides exactly that infrastructure:
What we provide:
- 24/7 oncology-trained clinicians available via text, phone, and video
- Advanced Therapy Management — dedicated clinical programs for CAR-T and bispecific antibody patients
- Automated symptom check-ins and ePRO collection between visits
- AI-assisted triage through Remi — built for oncology, not adapted from general-purpose tools
- Connected device monitoring — temperature, blood pressure, pulse oximetry
- Real-time clinical dashboards and EMR documentation for care teams
- Caregiver education and engagement support
We partner with community practices, integrated networks, and health systems to build the highway that makes advanced therapy delivery safe, sustainable, and scalable — without requiring every practice to staff a 24/7 clinical team from scratch.
Ready to build the highway for your advanced therapy program?
Whether you’re evaluating CAR-T infrastructure, looking to extend your clinical team beyond office hours, or navigating the operational demands of a growing oncology program — we’d welcome the conversation.
More from the Treating Together series
This is part of a four-part series featuring Dr. Pallav Mehta on Targeted Oncology’s Treating Together podcast.
- Part 1: Community Oncology at a Crossroads — with Debra Patt, MD (you are here)
- Part 2: Precision Hope: The New Frontier of AI-Driven Oncology — with Douglas Flora, MD
- Part 3: Beyond the Hospital Walls — with Jorge Garcia, PharmD
- Part 4: Leveraging AI, Social Media, and Virtual Care — with Sanjay Juneja, MD