Texas Oncology's Travis Brewer, vice president of payer relations, discusses how collaboration between primary care providers and oncologists can improve population health outcomes by focusing on payer initiatives and strategies.
Aligning public health with payer initiatives is a challenge, especially in states with high rates of uninsured individuals, says Travis Brewer, vice president of payer relations at Texas Oncology.
How do payers address disparities in access to high-value oncology care and ensure equitable outcomes for diverse patient populations?
That's really a work in progress right now. I will say that the payers have done a better job. You hear the old cliche that a lot of health care is local. So, there are some payers that have done a very good job partnering with local community organizations to help with things like food insecurity, housing issues, and transportation. But it's kind of a mixed bag. Different payers do different things in different markets.
We're seeing a lot more of it, which is a positive thing, and we do try to assist in those programs where we can. We have social workers in a lot of our sites that can help coordinate access to different community resources that might be out there, and we do that in conjunction with the payers and their programs as much as we can.
What are the challenges and opportunities in aligning public health strategies with payer initiatives in oncology care to improve population health outcomes?
Public health is a little tougher. Being in Texas, the most uninsured state in the union, and coupled with the fact that we have a lot of our current Medicaid population that's in danger of losing that coverage, the alignment with public health becomes a touch more difficult.
I think the payers do what they can, but they are somewhat reticent to do a lot of work in the specialty space in our experience, simply because the nature of either patients jumping from health plan to health plan year over year, either from an employer-based plan or through the health care exchange, they tend not to want to invest as much because they may be losing that patient as a member in a subsequent cycle, so they don't necessarily, in their mind, see the benefit of the work that goes into it. But it's a slow process. And until we probably do a better job as a state around provision of access to care for some of the lower-income populations and stabilize the Medicaid population, I think we’ll continue to struggle in that space.
How is Texas Oncology partnering with primary care providers to improve patient outcomes while managing cost?
That really is the key. The payers do a better job of value-based care if they start with the primary care as the foundation vs trying to start something in any one specialty space. So, partnering with those primary care organizations that are large and sophisticated enough to handle risk, to handle capitation, and who understand what it takes to manage care in a total cost of care environment, and partner with the right specialists in order to manage the cost effectively. It's very important to find those primary care organizations that have established ACOs [accountable care organizations] and partner with them. And we have had some success in that space.
Every opportunity we get, we will talk to anybody who's willing to do the work. And it is that; it's work. But I do believe ACOs are better positioned to begin with primary care as the foundation and then allow those more sophisticated risk-bearing entities to decide who the specialty providers that they work with should be, and then collaborate together for the best possible patient outcomes.