If payers can agree on consensus criteria to improve care quality or costs, that will help physicians remember and try to be compliant, said Samyukta Mullangi, MD, MBA, incoming medical director at Thyme Care.
Samyukta Mullangi, MD, MBA, incoming medical director at Thyme Care, explained that, when a greater proportion of patients in a physician's practice are attributed to a particular payer, that physician is more likely to prescribe on-pathway regimens for their patients.
How can providers align their incentives alongside oncologists to affect prescribing behavior?
I would say the best thing that payers can do is to align incentives and metrics with each other before necessarily standing up a program that impacts physicians and tries to standardize or influenced their prescribing behavior. So we actually just published on this very question. We partnered with Elevance Health, a large multi-state payer, which has its own payer-led clinical pathway program. Payer-led pathways have really proliferated in the last few years as payers in general are trying to get a handle on what they perceive as these runaway costs in oncology, all related to drug prescribing. But if you look at the uptake of these payer-led pathways, they're pretty dismal. They've been reported as low as 50% to 60%, so it's really a coin toss whether a physician is prescribing something that's on a pathway or not.
So we built a regression model, trying to understand what factors are associated with uptake, and what factors can payers use to try and influence like, "Let's optimize on these sorts of things." We found—and this sounds very intuitive, but it's nice to be backed by empirical data—we found that, when a payer has greater penetration onto a physician's panel, so when a greater proportion of patients in a physician's practice are attributed to a particular payer, that physician is more likely to prescribe on-pathway regimens. And it makes sense, right? They're just a little bit more familiar with them. In their current iteration, payer-led pathways are not real-time decision support; they're just kind of after-the-fact paperwork that physicians have to fill out, particularly when they're submitting prior [authorization] paperwork, etc. So when it's not built into your clinical workflow, it really helps in terms of the motivation to try and remember what's on-pathway when it affects a great proportion of your patients.
I think, to the extent that this influences programmatic design, if payers can align with each other on saying, "Here's some consensus criteria," some things that we all agree would be helpful in terms of improved patient care quality or cost of care, then aligning on that will honestly help physicians remember and try to be compliant. So yeah, that alignment, I think, is critical.