Strengthening Pathway-Driven Care Through Payer Collaboration

In this episode of Oncology Innovations, Gordon Kuntz and Dr Lalan Wilfong discuss the evolving role of payers and value-based care intermediaries in oncology, emphasizing the importance of whole-person support, coordinated care, and aligning treatments with patient goals to improve outcomes and reduce total cost of care.

Gordon Kuntz: Welcome to Oncology Innovations, a Journal of Clinical Pathways podcast focusing on candid discussions with innovators dedicated to enhancing quality, value, and the role of clinical pathways in the evolving cancer care ecosystem. I'm your host, Gordon Kuntz. I'm a consultant with 20 years of experience in oncology clinical pathways and the business of oncology. I've worked with oncology practices, pharma, payers, group purchasing organizations (GPOs), and pathway developers—basically every aspect of the oncology ecosystem.

Today we're joined by Lalan Wilfong, MD, senior vice president of value-based care at Thyme Care. Dr Wilfong has been in this role since August 2024, having previously served as senior vice president for payer and care transformation at McKesson. Lalan is a pathways expert and a longtime innovator in oncology care, and I've had the pleasure of working with him on a variety of projects over the last several years. I'm looking forward to our conversation today.

Today we're going to be talking about payers, value-based care in oncology, how practices are adapting to this new world, as well as the Predictable Cost of Care Initiative. Let's jump on in. Welcome, Lalan.

Lalan Wilfong, MD: Thanks, Gordon.

Kuntz: You've been an oncologist for a little over 20 years, and you've worked in the administrative side of oncology, value-based care, etc, for about half that time. Through the oncology medical home and value-based care, it seems that oncology practices have a lot of capabilities to effectively take care of patients throughout their cancer journey.

What do you see as the role for payers in providing this whole-person care? What are they doing right and what needs to improve?

Dr Wilfong: That's a great question. I go back to the beginning of my career, when I started practice and really wanted to provide more robust care for patients, recognizing that a lot of the things that happened to them outside of the clinic we weren't addressing very well. It quickly came up that there is no payment for helping with those things.

Luckily, I worked at Texas Oncology and we had a strong commitment to helping patients with whatever they needed through their cancer journey. It was a commitment from the entire organization that we were going to focus on those things and provide resources, even though the resources weren't typically enough. For example, where I practiced, we didn't have a social worker for probably about 15 years after I started. We didn't have a dedicated social worker for our patient population, which just wasn't reimbursable.

What people have recognized—specifically over the past 10 years—is that time away from the clinic is so critical to patient's outcomes. When a doctor sits in front of the patient and sees them when they're getting the infusions in our clinic, our staff do a really good job taking care of that patient, managing them, and helping them through their cancer. But it's those times away from the clinic, and those things that we don't ever really address, that are the biggest problems. Payers are recognizing that too, and people are finally starting to recognize that if we actually do address those things and spend money addressing those things, the total cost of care goes down. If we're making people better, then we spend less money. It's been a hard concept.

Watch full video here.