Payer Contracts Should Support Systems That Deliver Higher-Quality, Lower-Cost Cancer Care: Brian Mulherin, MD

Providers want payer contracts that support systems and practices enabling patients to receive higher-quality, lower-cost care by establishing the necessary infrastructure, care patterns, drug prescription practices, and comprehensive total-person care, says Brian Mulherin, MD, a hematologist-oncologist at the American Oncology Network.

Watch parts 1 and 2 of this interview from the Patient-Centered Oncology Care® conference to learn what matters to patients, practices, and payers in outcome-driven oncology, as well as how providers can help patients navigate access challenges resulting from recent cuts under President Donald Trump's One Big Beautiful Bill.

This transcript has been lightly edited; captions were auto-generated.

Transcript

From a payer perspective, what role do reimbursement models play in incentivizing outcome-driven care?

Again, historically, it's been all fee-for-service. If there has been an effort to improve quality, it was really more on the prior authorization side, which is really more on the denial end. You're not as directly subsidizing people to do the right thing, to practice quality care. It's more that you don't want to do bad quality care, or you're going to get dinged; you're going to get a slap on the wrist.

Looking at it from the positive direction, ideally, we want a contract with a payer that encourages systems and practices that create the infrastructure, the practice patterns, the drug prescription patterns, and the overall total-person care to allow people to get higher-quality care for a lower cost.

For example, reducing [emergency department (ED)] visits. The number one reason cancer patients visit the [ED] is actually pain. We know that, because of the opioid epidemic and a variety of other things, pain is typically not well controlled in many of our patients.

If you have ways to better address some of these unmet needs, potentially using the EMR [electronic medical record], reminders, and AI [artificial intelligence], focusing on trying to keep some of these patients out of the [ED], think of the downstream impact that could have, not just for our patients, but also for the system at large.

Pain is just one of many examples. Contracting on drugs could also be constructed in that same way. It can potentially be predicated on performance or used to steer people towards certain outcomes. If we have 2 drugs, for example, and one is 5% more than the other, but the outcomes are equivalent, obviously, simpler things like that can enter into the equation as well.

How can patients, practices, and payers collaborate to create meaningful metrics that improve care without compromising individualized treatment?

This is a really, really complex question. We have to keep the patient at the center of everything we do, listening to patients and patient advocacy; I think that's critical. I think sometimes their voices can be lost in all the din of everything else that we're listening to.

One example is asking what patients are most concerned about. For many patients with cancer, overall survival is the most important thing they care about, but it's not the only thing. Avoiding certain [adverse] effects, it can be avoiding alopecia, or neuropathy, or even what has been called time toxicity, avoiding regimens of other [treatments] that exist that require more frequent administration. So, the burden of administration is high. I would argue that that is a key critical component of that as well.