Reducing Frustration in Oncology Utilization Management Through Payer, Provider Collaboration: Vishnukamal Golla, MD, MPH

The oncology utilization management process in oncology can create frustrations for patients and payers, but how providers and payers are collaborating to address these challenges, explained Vishnukamal Golla, MD, MPH, vice president of clinical technology and performance at Evolent, during an interview with The American Journal of Managed Care^® (AJMC^®) at this year's Patient-Centered Oncology Care® (PCOC) conference in Nashville, Tennessee.

He expanded on these topics today at PCOC during the discussion "Payer Perspectives: Collaborating for Progress," moderated by Jeremy Friese, MD, with fellow panelists Tracy Spinks, BBA, and Ray Parzik, MS.

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

Transcript

How would you describe the utilization management process in oncology? What drives frustration among patients and payers?

Utilization management is, obviously, a very triggering process for all parties involved. [It was] originally designed to be a quality and cost containment tool. I think at some points it really wanted to lead with quality, and I think the process has become really fragmented and difficult for providers, for payers, and, most importantly, for patients.

We're seeing a lot of progress in terms of where these areas are improving, so we're seeing codes that are honestly adding undue burden being removed from the utilization management process. I think what's really exciting is finding ways to embed the new technologies that we have in [large language models] or [artificial intelligence] technology, in general, to bring some of the best aspects of utilization management at its core, which is quality improvement, right to the fingertips, without a lot of the administrative burden that's out there.

I think we're going to continue to see progress in the arena. There's a lot of commitment from the payers and providers, [as well as] for organizations that are helping deliver quality and cost tools to improve that process overall.

Could you elaborate on the strategies that help payers and providers collaborate more effectively to make this process less frustrating?

Again, leaning into the idea that, at its core, how do we bring the best quality of evidence to the fingertips of the practitioners? I think there's a lot of data that show that if an oncologist wants to keep up with just the new information that comes down the pipeline, that's about 40 hours per week, just on keeping up with the right information.

Being able to embed some of that best-of-clinical-quality evidence, whether it's pathways, whether it's the latest in trials, or whether it's drug dosing, embedding that right into the point-of-care decision, either into the provider's [electronic medical record], or finding a way to bring all those insights together so the provider and the doctor have that information right at their hands when they're talking to the patient, is really powerful.