Optimizing Oncology Outcomes Through Aligned Payer-Provider Strategies

Leaders from the world of reimbursement explored the complex relationship between payers and providers in oncology, focusing on the promises and pitfalls of value-based care, data transparency, and regulatory reform, during a panel discussion at the 2025 Patient-Centered Oncology Care Conference in Nashville, Tennessee.

Moderated by Jeremy Friese, MD, MBA, founder and CEO of Humata Health, the discussion highlighted the shared desire to improve patient outcomes while navigating the nuances of collaboration and reimbursement. Friese, who described himself as a physician focused on resolving the challenges of prior authorization, opened the session with a candid poll of the audience, revealing that only a single attendee reported having a productive relationship with a payer. This observation set the tone for a pragmatic yet hopeful conversation about the future of payer-provider collaboration.

Friese was joined by Tracy Spinks, chief of staff and director, value-based care, at Optum Health and former executive at The University of Texas MD Anderson Cancer Center and the National Quality Forum; Vishnukamal Golla, MD, vice president of clinical technologies and performance at Evolent Health and attending urologist at Duke Health; and Ray Parzik, a veteran of value-based contracting and former executive at Blue Cross and Blue Shield of Florida.

When asked to describe the current state of payer-provider collaboration, Spinks characterized it as improving but still inconsistent, Golla described it as optimistically evolving, and Parzik expressed hope that progress would continue. Together, their perspectives reflected cautious optimism about the potential for meaningful reform.

Barriers to Collaboration

Panelists identified data silos, financial benchmarks, and regulatory constraints as major impediments to effective partnership. Spinks noted that even well-resourced initiatives struggle to move beyond transactional relationships between payers and providers.

Golla emphasized the persistent lack of data transparency, explaining that although both payers and providers share a common goal of improving patient care, the separation of data systems continues to create barriers. Parzik added that misaligned incentives and inconsistent performance metrics make it difficult to measure what truly matters to patient outcomes.

“There is nothing that changes the fact that health care is costly, that it’s not sustainable, [and] that we have to work together to try to keep patients first and keep them in our mindset so that people aren’t left out,” Parzik said. “We’re basically being active and saying, ‘Hey, we know this system isn’t working. We have to adjust it.’ I think it’s also going to require a continual policy influence.”

Opportunities for Alignment and Transparency

Despite these challenges, the panelists agreed that opportunities exist in shared benchmarking, technology innovation, and care coordination. Golla identified performance measurement as a key area for collaboration, emphasizing the importance of developing clinically meaningful and actionable benchmarks. Parzik discussed the growing potential of artificial intelligence to streamline prior authorizations and identify care gaps, whereas Spinks highlighted the need for patient-centered design that simplifies access to care and integrates wraparound services to improve quality of life.

“I think we all agree [that] we need to make it easier. I also think continuing to focus on how we can make things better for patients [and] how we can make sure that…we’re not duplicating what the providers are doing but really looking for those opportunities to create that wraparound support that they need will ultimately benefit everyone,” Spinks said.

Despite challenges, the panelists agreed that progress has been made in improving data transparency, largely due to recent regulatory changes. Golla noted that continued collaboration and trust-building are essential for progress. “One area that we need to continue to push on is the level of transparency for our patients, so really understanding what their treatment plan [is], what their care plan [is], what their benefits [are], [and] what their financial exposure [is],” he said. “There [are] these ideas of digital front doors and being able to bring that information to them, but there’s still quite a bit of work to get to that place where we can share that with patients. I think that component needs to be better.”

Parzik pointed to the issue of data lag, explaining that delayed reporting limits the usefulness of analytics in clinical decision-making. Spinks emphasized the need for real-time data tools and clinical support systems to help providers better understand their performance.

Policy, Reform, and the Path Forward

The discussion turned to regulatory and legislative reform, including efforts to address pharmacy benefit manager (PBM) practices that can hinder efficient care delivery. Golla encouraged continued advocacy to address these systemic issues, describing them as ongoing barriers to effective oncology care.

Friese noted that both payers and providers face financial pressures that necessitate collaboration. Parzik underscored the importance of proactive engagement, urging stakeholders to participate in shaping the evolution of value-based care rather than responding to external mandates.

An audience participant expressed concern about the effectiveness of current value-based care models, noting that these frameworks often fail to deliver consistent value for patients or sustain independent practices. The panelists agreed that value-based care models must be restructured to better support both patients and providers while promoting long-term financial and clinical sustainability.

The panelists concluded with 4 key action items, including the following:

• Restructure value-based care models to support both patients and providers
• Develop common clinical pathways jointly agreed upon by payers and providers
• Enhance transparency in treatment plans, benefits, and patient financial exposure
• Continue advocacy for reforms, including PBM transparency, to remove barriers to patient-centered care

The session closed on an encouraging note from Friese: “Part of why I’m optimistic is, because of this shared challenge, there is also more of a shared appetite and interest in doing some of the things that we’ve talked about around data sharing and around solving some of these problems together, recognizing that if we don’t, both sides will just continue to struggle.”