The Pathways Guys

Journal of Clinical Pathways is proud to introduce The Pathways Guys podcast, hosted by Gordon Kuntz and Bryan Loy—a new podcast series exploring the real-world impact of clinical pathways on oncology policy, payment, and practice.

In the launch episode, Gordon and Bryan examine:

• Why payers develop and depend on pathway programs
• How pathways align cost management, quality, and innovation
• The connection between clinical pathways, medical policy, and formularies
• What “quality care” truly means from a payer perspective

Why it matters:

• Pharma market access teams: Understand the framework shaping access and coverage decisions
• Oncology practices: Gain insight into the payer perspective on pathway adoption
• MSLs and product leaders: Strengthen stakeholder conversations with payer-informed context
• Pathway developers: Learn how payers evaluate value and make pathway decisions

Prior auths are almost always approved—but they still create delays, costs, and frustration for oncology practices and patients. In this episode, Bryan Loy and Gordon Kuntz unpack why payers rely on prior authorizations, what they’re really trying to learn that claims can’t show, and where the current system breaks down. As Gordon puts it: “If you ask 100 oncologists about prior authorization… 130 to 150 of them would say they hated it.” They also explore what it would take to reduce burden without losing accountability—especially as value-based care expands.

Oncology is moving steadily toward value-based care—but “total cost of care” is one of the most challenging (and misunderstood) concepts in these arrangements. In this episode of The Pathways Guys, host Gordon Kuntz (provider pathways veteran) and Bryan Loy (payer-side leader) unpack what total cost of care really means, why defining boundaries is so difficult, and how attribution can create unintended consequences.

They explore:

• What to include vs. exclude when measuring “total cost of care”
• Concentric rings of accountability (services billed, ordered, referred, and beyond)
• The tension between utilization vs. unit cost—and lack of provider visibility into pricing
• Care fragmentation risks when incentives aren’t aligned
• Why analytics, trust, and better measurement systems matter
• The patient perspective—and the real fear of “remission and bankruptcy” happening at the same time

Listen now, and subscribe for more conversations at the intersection of pathways, payers, and value-based oncology.

FDA approval is just the beginning.

In this episode of The Pathway Guys, Gordon Kuntz and Bryan Loy are joined by Susan Weidner to unpack how payers evaluate new oncology therapies — and what it really takes to move from approval to patient access.

They discuss:

• How clinical trials are designed — and where evidence gaps create real-world uncertainty
• The challenges of accelerated approval and balancing innovation with unanswered questions
• The growing role of real-world evidence, biomarkers, and minimal residual disease (MRD)
• Evaluating therapies in complex diseases like non-small cell lung cancer and multiple myeloma
• What payers want to hear (and don’t want to hear) from pharma

This episode offers practical, behind-the-scenes insight for professionals in oncology, pharma, market access, pathways, and payer strategy who want to better understand how coverage decisions really get made.

They explore key topics including PBM formulary strategy, payer influence, prior authorization, and step therapy, and how these tools shape access to oral oncology drugs and specialty pharmacy treatments. The discussion highlights the growing importance of value-based care, total cost of care, and clinical pathways—and where misalignment between formularies, medical policy, and oncology pathways can create challenges for providers and patients.

Gordon and Bryan also examine real-world issues like drug pricing, rebates, biosimilars, patient affordability, medication adherence, and administrative burden, along with the expanding role of PBMs in both oral and infused cancer therapies.

If you work in oncology, managed care, market access, or pharma strategy, this episode offers essential insights into how Part D coverage decisions are made—and how they ultimately affect patient outcomes.

In this episode of The Pathways Guys, Gordon Kuntz and Bryan Loy explore what truly makes a therapy “practice-changing,” especially in oncology. Drawing on perspectives from pathways, clinical practice, and payers, they discuss how new therapies are evaluated, what happens when enthusiasm outpaces evidence, and why survival, quality of life, convenience, and financial toxicity all matter in decision-making. They also dig into off-label use, accelerated approvals, real-world evidence, and the guardrails needed to support responsible adoption of innovation. It’s a thoughtful conversation about balancing urgency, caution, and patient-centered care in a rapidly evolving treatment landscape.

Drawing on decades of payer-side experience, Craig explains how payers and providers are using increasingly sophisticated tools—including AI—to review claims, manage denials, support coding, and reduce administrative burden. The discussion explores where these systems can improve efficiency, where they may create new risks, and how the “arms race” between payers and providers ultimately affects patients through delayed care, unexpected bills, and rising costs.

The conversation also examines prior authorization, post-payment review, provider abrasion, value-based care, EMR access, and whether AI is best suited as a support tool rather than a decision-maker. Ultimately, the episode asks what it would take to move toward a healthcare system focused less on financial gamesmanship and more on timely, high-quality, accurately paid care.

In this episode of The Pathways Guys, Gordon Kuntz and Bryan Loy discuss the growing role of community oncology practices in delivering advanced therapies such as bispecifics and CAR T-cell therapy. They explore the trade-offs between care at experienced academic centers and care closer to home, including patient access, continuity of care, safety concerns, adverse event monitoring, payer considerations, and the financial realities of site-of-care decisions. The conversation also examines the potential for remote monitoring, stronger coordination between hospitals and community practices, and certification models that could help build confidence in safe, high-quality delivery of these complex treatments.

Where should cancer treatment happen—and how do patients, providers, and payers determine the best setting for care?

In this episode of The Pathways Guys, Gordon Kuntz and Bryan Loy explore the evolving landscape of oncology site of care, from community oncology practices and hospital-based cancer centers to emerging models such as home infusion and remote patient monitoring. They discuss the benefits and challenges of each setting, including patient access, financial and time toxicity, care coordination, safety considerations, and the growing role of technology in supporting cancer care outside traditional clinical environments.

The conversation also examines how community oncology has evolved over the past two decades, the unique strengths of academic cancer centers, and why maintaining a patient-centered approach remains critical as care delivery models continue to change. Along the way, Gordon and Bryan share perspectives on value-based care, oncology medical homes, health literacy, and the opportunities—and risks—associated with bringing more cancer care closer to home.

Whether you're a clinician, payer, industry professional, or patient advocate, this episode offers a thoughtful look at one of the most important questions facing oncology today: how can we deliver the right care, in the right place, at the right time?

Key Topics

• Community vs hospital-based oncology care
• Financial toxicity and patient experience
• Academic cancer centers and specialized treatment
• Home infusion and remote monitoring
• Oncology Medical Home and value-based care
• Patient-reported outcomes and health literacy
• The future of oncology care delivery

What role should comprehensive genomic profiling play in modern cancer care—and what's standing in the way of broader adoption?

In this episode of The Pathways Guys, Gordon Kuntz and Bryan Loy welcome Dr Ira Klein, Vice President of Medical Affairs for Payer Relations at Tempus AI, for an in-depth discussion on how next-generation sequencing (NGS) is reshaping precision oncology. Together, they explore the growing role of comprehensive genomic profiling in identifying targeted therapies, improving clinical trial enrollment, reducing unnecessary treatments, and supporting more personalized care.

The conversation also examines the challenges that remain—from payer coverage and reimbursement to workflow inefficiencies, provider adoption, and regulatory complexity. Looking ahead, Dr Klein shares how AI, RNA sequencing, and multi-omic technologies could help streamline cancer care while allowing clinicians to spend more time focused on patients.

Key Topics:

• Why comprehensive genomic profiling is becoming the standard of care in oncology
• How genomic testing supports more precise treatment decisions and clinical trial matching
• The payer perspective on balancing testing costs with long-term value
• Current barriers to adoption across community and academic oncology settings
• How AI and advanced diagnostics may transform oncology workflows and improve patient care

Whether you're involved in oncology, managed care, precision medicine, or health care innovation, this episode offers valuable insights into where cancer diagnostics—and cancer care—are headed.