Dr Dax Kurbegov on Gaps Between Payers, Health Systems, and Providers in Oncology

Dax Kurbegov, MD, senior vice president of Sarah Cannon Cancer Network, discussed factors contributing to divides between payers, health systems, and oncology care providers, as well as the impacts they can have on patient outcomes.

Transcript

From your perspective, what are the key factors driving the divide between payers, health systems, and providers in oncology care?

I don't know that I've got earth-shattering news here. I think we have a pretty good understanding of what some of the gaps are that really preclude us—between health system, provider, and payer—working as effectively as we can in support of the best patient outcomes, right?

The first is simply misaligned incentives, that we're not always on the same page. And we don't always incentivize the type of coordination or collaborative activity that we know is patient centered and leads to better care. A very tangible manifestation of that is just how siloed we are from a data perspective. You know, the recognition that the acute care setting, where I spend most of my time, has very limited insight—in most oncologic circumstances—to what happens on the outpatient side, or particularly in terms of long-term outcomes. My doctors, our teams all the time really, want to look at long-term outcomes, relapse-free survival, overall survival. And yet, obviously, from my perspective, much of that occurs outside of the hospital. And yet, we should have a vested interest in knowing what happens there so that we can achieve the best outcome.

The last piece, [that's] probably not always called out, is just the fact that we we don't do as good a job as I think we should in incentivizing, encouraging, and achieving patient enrollment in clinical trials. I'm a big fan of clinical trials, one because the very least that our patients get when they participate in clinical trials—and that might not be the right word—is the best care that we know how to give for that situation, for that cancer, at the time. And the most exciting possible outcome is that they're receiving a cutting-edge therapy that's going to prove to be more effective, less toxic, and more durable than historical therapy. And you know, in those circumstances, patients win, providers win, the research community and the field wins. And of course, because those drugs are often provided as part of the clinical trial, the overall cost of care is reduced. If we can make those offerings available close to home, we win on many fronts.

How can this divide affect patient outcomes, particularly in cases where time and access to cutting-edge treatments are critical?

The first one is exactly what your question asks, right? If we don't address those gaps, then we have functionally reduced access that patients have to cutting-edge therapy. If you don't know what's available to you and where it's available, then you can't make informed decisions. If you don't understand the treatment options and the benefits and risks associated with those different treatment options, then you can't make good decisions as to where best to pursue therapy.

If we don't have the kind of dialogue that we referenced earlier—that is, if we don't look at where the patient is, what their circumstance is—then we functionally can't address the barriers that might exist for them to receive cutting-edge therapy, whether those are local barriers, just in terms of childcare or finances, or whether those are broader barriers in terms of ability to travel or ability to come in daily for therapy where that's necessary.