Conversations with Perry and Friends: Daniel Mullins, Ph.D.

In this latest episode of his “Perry and Friends” podcast, Perry Cohen, Pharm.D., a member of the Managed Healthcare Executive editorial advisory board, spoke with C. Daniels Mullins, Ph.D., a professor and chair of the Pharmaceutical Health Services Research Department at the University of Maryland School of Pharmacy in Baltimore and a pioneer in incorporating the patient point of view into research.

As executive director of the PATIENTS program, C. Daniel Mullins, Ph.D., has devoted a large part of his career to overcoming the patient mistrust of researchers and health providers. Now the University of Maryland School of Pharmacy professor is seeing cost as an issue weighing on people’s minds.

“People are much more aware of how much money is being spent on them, even if it's not out of pocket,” Mullins said during the “Perry and Friends” podcast. “A lot of patients now are saying, ‘My goodness, healthcare has just gotten too expensive, not just for me, but for our country, and we need to do something about that,’ and I think right now that's almost bubbling up ahead of trust.”

Mullins and the podcast’s host, Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, had a wide-ranging discussion that touched on everything from Mullins’ decadeslong career as a healthcare researcher to his thoughts on the role of insurers to his predictions for 2026, which include the continued rise in consumerism. The theme of the episode was the changing role of the patient in healthcare.

In the past, Mullins noted, clinicians and patients were limited to only one option in many healthcare scenarios. “If you only have one option, you have to buy it,” Mullins said to Cohen. “But when you have a couple options now, consumerism is going to be on the rise. I keep hearing from the pharmacists who graduated from the University of Maryland School of Pharmacy that more patients are coming into their pharmacy now and saying, ‘Is there another alternative?’”

Mullins is widely credited with having a major influence on health economics and outcomes research by developing ways to collect insights and information from communities, particularly those that have been underserved. The PATIENTS program was created in 2013 with a $5 million grant from the federal Agency for Healthcare Research and Quality. Mullins and his colleagues published a widely cited and used 10-step framework for continuous patient and stakeholder engagement in JAMA in 2012.

In his conversation with Cohen, Mullins spoke about broadening his cost-effectiveness research to take into account not just drugs but screening programs that might identify patients who would benefit from the drugs; he gave hypertensive drugs and programs that screen people for hypertension as examples. He said he also started to be working with insurers “to redesign how we did cost-effectiveness, to really have it be from the lens of a payer.”

Mullins described the PATIENTS program as a “research infrastructure where we bring people who are affected by disease in as research partners so that research answers their questions, and they can understand what research is all about.”

Cohen and Mullins discussed the differences between being a patient, member and consumer. Mullins said people, as healthcare consumers, should be encouraged to think about maintaining their health, not just wait for illness to occur. “You shouldn't wait until you get sick to start thinking about your health. You should start thinking about your health while you're healthy, so you can stay healthy a little bit longer,” Mullins said. Incentives can help, he said. Mullins gave as examples eliminating copayment for wellness visits and decreasing out-of-pocket costs for drugs as a way to increase adherence.

In addition to more consumerism in healthcare, Mullins told Cohen that he expects more consideration of different healthcare choices people might make near the end of life. “I think more and more people have seen someone extend their life by a few weeks and question whether, in hindsight, the patient really would have chosen that if they understood what was about to happen,” he told Cohen. Mullins said his mother, who died 30 years ago, did not want to go back to the hospital even though hospital care might have extended her life. “She understood that, but she wanted to stay at home in her bed,” Mullins said.