The State of Payer-Provider Relationships
Healthcare leaders convened at the 2025 Patient-Centered Oncology Care Conference in Nashville, Tennessee, to address the critical challenges facing payer-provider collaboration in oncology. The panel, moderated by Jeremy Friese, MD, MBA, founder and CEO of Humata Health, brought together industry experts to explore value-based care implementation, data transparency requirements, and necessary regulatory reforms.
The discussion opened with a revealing poll showing only one audience member reported maintaining a productive relationship with a payer. This stark reality underscored the urgent need for systemic improvements in how payers and providers work together to deliver oncology care.
Panel experts included Tracy Spinks, chief of staff and director of value-based care at Optum Health; Vishnukamal Golla, MD, vice president of clinical technologies at Evolent Health; and Ray Parzik, a value-based contracting veteran. Their combined perspectives offered cautious optimism about meaningful reform possibilities.
When describing current collaboration states, Spinks noted improvement but continued inconsistency, Golla expressed optimistic evolution, and Parzik voiced hope for sustained progress. These assessments reflected realistic acknowledgment of existing challenges while maintaining forward-looking perspectives.
Key Barriers to Effective Collaboration
Data Silos and Transparency Issues
Panelists identified fragmented data systems as fundamental obstacles preventing effective partnerships. Despite shared goals of improving patient outcomes, payers and providers operate with separated information systems that create significant coordination barriers.
Golla emphasized that data transparency remains persistently inadequate. While both parties aim to enhance patient care, isolated data systems prevent the information sharing necessary for coordinated treatment decisions and outcome tracking.
Misaligned Financial Incentives
Financial benchmarking disconnects and misaligned incentives compound collaboration difficulties. Parzik explained that inconsistent performance metrics make measuring truly meaningful patient outcomes challenging. Without standardized evaluation frameworks, payers and providers struggle to align on what constitutes successful care delivery.
Regulatory and Performance Challenges
Even well-resourced initiatives struggle moving beyond transactional relationships, according to Spinks. Regulatory constraints and varying performance standards create additional complexity layers that impede genuine partnership development.
“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,” Parzik stated. “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 continual policy influence.”
Opportunities for Strategic Partnership
Shared Benchmarking and Performance Metrics
Despite challenges, panelists agreed significant opportunities exist through shared benchmarking initiatives. Golla identified performance measurement as crucial collaboration territory, emphasizing developing clinically meaningful and actionable benchmarks that both payers and providers can utilize effectively.
Technology Innovation and AI Integration
Parzik discussed artificial intelligence’s growing potential for streamlining prior authorizations and identifying care gaps. These technological advances could significantly reduce administrative burdens while improving care quality and timeliness.
Patient-Centered Care Coordination
Spinks highlighted patient-centered design importance, advocating for simplified care access and integrated wraparound services enhancing quality of life. “I think we all agree [that] we need to make it easier,” Spinks said. “We’re not duplicating what providers are doing but really looking for opportunities to create wraparound support that ultimately benefits everyone.”
Advancing Data Transparency in Oncology
Recent regulatory changes have driven data transparency improvements, according to panelists. However, significant work remains. Golla stressed transparency needs around treatment plans, care plans, benefits, and financial exposure for patients.
“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,” Golla explained.
Parzik highlighted data lag issues, noting delayed reporting limits analytics usefulness in clinical decision-making. Spinks emphasized real-time data tools and clinical support systems necessity for helping providers understand performance metrics effectively.
Policy Reform and PBM Accountability
The discussion addressed pharmacy benefit manager (PBM) practices that hinder efficient care delivery. Golla encouraged continued advocacy addressing these systemic issues, describing them as ongoing barriers to effective oncology treatment.
Both payers and providers face financial pressures necessitating collaboration, Friese noted. Parzik underscored proactive engagement importance, urging stakeholders to actively shape value-based care evolution rather than merely responding to external mandates.
Restructuring Value-Based Care Models
An audience participant expressed concerns about current value-based care model effectiveness, noting these frameworks often fail delivering consistent patient value or sustaining independent practices. Panelists agreed value-based care models require restructuring to better support patients and providers while promoting long-term financial and clinical sustainability.
Four Action Items for Progress
The panel concluded with critical action recommendations:
- Restructure value-based care models to simultaneously support 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, removing patient-centered care barriers
The Path Forward
Friese closed on an encouraging note: “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.”
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