Value-Based Care Offers Solutions to Patient Access Challenges: Brian Mulherin, MD

To help patients navigate access challenges stemming from cuts under President Donald Trump's One Big Beautiful Bill, Brian Mulherin, MD, a hematologist-oncologist at the American Oncology Network, recommends that providers collaborate with community partners and encourage patients to participate in value-based care plans and clinical trials.

Watch part 1 of this interview from the Patient-Centered Oncology Care® conference in Nashville, Tennessee, to learn what matters to patients, practices, and payers in outcome-driven oncology.

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

Transcript

What operational or logistical challenges do practices face in implementing outcome-driven care models, and how can they overcome them?

Well, unfortunately, fee-for-service has been the predominant model and still is in many instances. The EOM [Enhancing Oncology Model], for all its flaws, is a step in the right direction. There are a number of flaws with that model, the way it's calculated, and the way it's being executed, but there are others that are moving beyond that. We participate in a value-based care plan with Anthem, and there are several others, as well. All of this is trying to move toward not just getting paid for every single drug that's administered, or every single lab test or scan that you do, or a fraction of radiation.

What we really want to do is pay for outcomes. Basically, the system has a vested interest in having the best outcomes as possible and keep costs low to allow the economics of all that to work out. That is a totally different model than most of the system and most of the system was built on, but this is the future, and this is the way that we are moving toward this.

Moving toward a value-based system can be challenging. It requires an impressive amount of data analytics to do that. Potentially, for example, you could conceive of different formularies to manage 2 different populations of the fee-for-service and the value-based care model. It requires lots of physician education, physician buy-in, and a lot of support from the administration, as well. It really is a long process; this is not something that just happens overnight.

How are disparities in access and outcomes being addressed in outcome-driven care? What strategies have shown measurable success?

We know that certain groups, non-Whites, people who have less generous insurance, LGBTQ individuals, etc, a number of these just do not historically have the same kind of access as people who have regular commercial insurance. Certain disease sets can affect these populations at higher rates. Three good examples are triple-negative breast cancer with disproportionate effects on African Americans, multiple myeloma, and also prostate cancer. Even when controlling for other factors, there is something specific about the biology there.

In our current world, most insurance is tied to employment. Many people still have employment-based insurance if they aren't over the age of 65. We have had the ACA [Affordable Care Act] and also Medicaid. Of course, now, we're worried about what's going to happen over the next couple of years, given the impacts of the cuts that we've seen with the One Big Beautiful Bill and maybe the impact of ACA subsidies going away; that is going to make access more challenging.

How do you try to overcome that? It's trying to work with community partners. For example, if the access is maybe about transportation, maybe you can work with some local agencies for that. Actually, participating in value-based care plans is a great option for those patients. It's actually usually easier to get them coverage in that setting.

I'd also say, looking toward the future, clinical trials. If a patient is being treated in the context of a clinical trial, there's no billing for the drug. So, it's a way to deliver cutting-edge care, but it's also less burdensome economically for the patient and for the system at large. There are many, many others; those are just a few examples.