For Raja Mehdi, the problem was buying the medicine. At Hope Cancer Care of Nevada, the oncologist faced drug costs that were becoming prohibitive for a small practice. Then came the insurance companies. Treating cancer required medical judgment; keeping the doors open required an increasingly demanding second occupation.
Mehdi joined American Oncology Network in 2019. In an AON case study, he described the relief: “It’s like I just became a real doctor all over again.” The attraction was practical. He could keep making treatment decisions while somebody else took on more of the purchasing, personnel and paperwork.
- AON combines local cancer practices with shared clinical and business services.
- Its network now includes more than 350 providers across 21 states.
- Cencora’s proposed acquisition values it at up to $2.4 billion; closing still requires approvals.
The expensive business of staying small
AON’s proposition begins with a tension. A patient may want a doctor nearby, but the machinery behind that doctor increasingly rewards size. Drug procurement, insurance negotiations, cybersecurity and specialist recruitment each demand expertise. Building every capability inside every small practice is an expensive way to repeat yourself.
Formed in 2017 and operational from September 2018, AON brought together executives with experience at Florida Cancer Specialists. Brad Prechtl was its initial chief executive; Todd Schonherz started as president and chief operating officer, taking over as CEO in 2021. Their expertise was running oncology practices, including the unglamorous details that determine whether a practice can collect what it is owed.
The company sells a partnership to physicians and delivers care through affiliated practices to patients with cancer and blood disorders. That creates two audiences with overlapping needs. Physicians need a sustainable business and clinical discretion. Patients need appointments, treatment, medicines and help navigating the spaces between them.
Keep the judgment. Share the machinery.
AON supplies centralized specialty pharmacy, pathology, laboratory support, care coordination and clinical research infrastructure. Its administrative offering covers technology, human resources, marketing and recruitment. Its growth services include drug purchasing, payer negotiations and revenue cycle management, the work of turning patient encounters into collected payments.
The pharmacy is more than a dispensing counter. In the Nevada case study, patients received medicines at home, while the pharmacy team communicated about prescriptions and transfers. The practice also gained support for on-site blood draws. Small conveniences matter when a patient already has enough appointments to organize.
The business model follows those services. AON’s filings describe revenue primarily from patient encounters and pharmacy prescription shipments, with smaller contributions from clinical trials, data contracts and service arrangements. This is a care delivery and practice management business. Its integrated services can keep more of a patient’s care within the network while adding revenue opportunities for practices.
The distinction AON emphasizes is physician leadership and clinical autonomy. Similar alternatives include McKesson’s US Oncology Network, OneOncology and hospital affiliation. Autonomy alone is therefore an insufficient comparison. A practice needs to examine which services it receives, who controls decisions and how the economics work under its particular agreement.
The machinery behind a local doctor increasingly rewards size.
A billion dollars can still leave little room
Consider 2024. AON reported $1.759 billion in revenue, up 37.5% from 2023. Patient encounters increased 21.4%; revenue per encounter also rose, reflecting drug-related reimbursement and improvements in collections. Growth came from both acquired practices and existing operations.
Yet cost of revenue reached $1.642 billion. General and administrative expenses added $133.9 million. The result was an operating loss of approximately $17.4 million. Adjusted EBITDA was positive at roughly $29 million, but that measure excludes costs included in the reported loss. Revenue makes the network look enormous. The income statement shows how expensive it is to operate.
93.3% of revenue was absorbed by cost of revenue, before administration and other operating expenses.
Capital helped fund expansion. AEA Growth invested $65 million in 2023, followed by a $51 million equity financing in 2024. AON also went public through a SPAC transaction in September 2023. By June 2024, it had voluntarily left Nasdaq for OTCQX. Its explanation included limited analyst coverage, inactive trading and reporting costs. Public-market access had brought obligations the board decided outweighed the benefits.
The next appointment is getting more ambitious
The operational story kept moving. Oncology Consultants joined in March 2026, adding a South Texas practice with 18 locations. In April, Maryland partner The Center for Cancer and Blood Disorders announced it was treating its first community-setting CAR T-cell patient following authorization. Its program coordinates with local hospitals for monitoring and safety.
These details set a useful boundary around the promise of care close to home. Advanced treatment needs trained teams, suitable facilities and hospital relationships. Membership cannot make every therapy appropriate for every clinic or patient.
AON also widened support beyond treatment. Its June 2026 Colla Health partnership began at two practices, with network-wide availability planned by year-end. CanCare added free, one-to-one emotional support from trained survivors and caregivers. The work increasingly includes what happens when the appointment ends.
The $2.4 billion test
On October 21, 2026, Cencora announced an agreement to acquire AON at an enterprise value of up to $2.4 billion: $2.3 billion at closing and up to $100 million contingent on conditions. Already an investor, Cencora said clinical decisions would remain with AON physicians. Regulatory clearances and shareholder approval were still required.
The lesson for another business owner is tangible: identify the costly work everybody repeats, pool it, and keep consequential local decisions close to the customer. It depends on shared systems actually reducing friction and incentives supporting care. For AON, the next test is whether a larger corporate owner can preserve the room in which Mehdi felt like a doctor again.