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

As executive director of the PATIENTS program, C. Daniel Mullins, Ph.D., has devoted a large part of his career to overcoming patient mistrust of healthcare researchers and providers. Now the University of Maryland School of Pharmacy professor is noticing that costs are looming large as a healthcare issue for many people.

“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 “Conversations With 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 during the latest episode of Cohen's podcast. They 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 in U.S. healthcare.

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 changing health economics and outcomes research by developing ways to systematically collect insights and information about healthcare from the patient and community perspective, especially from patients and communities that have been traditionally 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, an MIT- and Duke-trained economist, spoke about broadening his research early in his career to take into account not just the cost-effectiveness of drugs but also screening and other 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 took steps to make his research useful to insurers.

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 in the patient, member and consumer medical personas that individuals may assume. Mullins said people, as healthcare consumers, should be encouraged to think about maintaining their health. “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 added. Mullins gave as examples eliminating copayment for wellness visits and decreasing out-of-pocket costs for drugs to increase adherence.

In addition to the continuing rise in consumerism, Mullins told Cohen that he expects to see changes in the healthcare choices people 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.