Clinical pathways slowly gain ground

By Mari Edlin

Although national guidelines for many disease states have become standard practice, clinical pathways are only slowly gaining ground in adoption by physicians. Cancer care is receiving the most attention because of its high-cost drugs and variability in oncologists’ choice of treatment regimens.   

David Friend, MD, chief transformation officer for BDO Consulting’s Healthcare Advisory practice, says there is a conundrum related to guidelines. 

”Physicians say they want them but then they question them,” he says. If practitioners are part of an integrated health system, Friend explains, they are likely to be more familiar with the role of a team player and are more readily accepting of standardized care plans established by the system, while most physicians are trained to be solo players.

“Making the transition to a more integrated system is a cultural challenge for some when deciding whether to closely follow a clinical pathway or question it,” he says. 

Friend applauds the law that mandates drug sponsors to register and report results for publicly- and privately-supported clinical trials of human participants despite study results. He also is optimistic that with big data and better science behind pathways, physicians will adopt them more easily.

Carrie Hallock, director, product management, GetWellNetwork, a provider of interactive patient care solutions based in Bethesda, Maryland, considers clinical pathways to be valuable tools for improved management of heart failure, asthma and other chronic diseases, particularly when it comes to guiding patients through a personalized care plan. 

“Today, more providers are using pathways centered around technology to invite patients to learn about their condition at the appropriate time and engage them to complete their prescribed interventions,” she says. “The providers who are leveraging technology in this way are reporting greater patient activation, improved transitions of care and more empowered patients.”

Technology is key

Last year, McKesson Specialty Health and The US Oncology Network joined forces with the National Comprehensive Care Cancer Network (NCCN) to develop Value Pathways Powered by NCCN. The collaboration seeks to develop enhanced oncology pathways delivered through innovative technology, with the goal of strengthening standards in evidence-based, high-quality cancer care and enabling new forms of transparent provider and payer relationships, according to NCCN.

Marcus Neubauer, MD, medical director, oncology services for McKesson Specialty Health and The US Oncology Network, says that although The Network has followed oncology pathways for years, it sought the extra validation from NCCN, whose Clinical Practice Guidelines in Oncology serve as a national standard.

“The idea is to have pathways from a recognized organization that all payers could use,” he says, “instead of being payer- or provider-specific.” 

As many as 90% of the medical oncologists in The US Oncology Network-comprised of 1,000 oncologists representing about 30 independent physician-owned practices-follow the pathways, which Neubauer says tend to be more succinct than guidelines. Pathways only make sense if they deliver the best possible outcomes and are cost-effective, he adds. 

McKesson Specialty Health anticipates expanding Value Pathways Powered by NCCN, which currently focus on chemotherapy, to radiology later this year and to imaging and surgery in the future. 

“Our primary goal is to keep pathways current and to ensure that we get both their content and associated technology into the hands of oncologists, inside or outside of The US Oncology Network,” he says.

In addition, the company has developed Clear Value Plus, a clinical decision-support tool that allows physicians to access transparent, evidence-based clinical content at the point of care. It is embedded in the company’s electronic health record. 

Incentives reward, improve quality

Roy Moore, senior director, Decision Resources Group in Burlington, Massachusetts, says pathways are built on guidelines, but are usually broader and are often what physicians would do anyway.  Payers should consider providing financial incentives to reimburse physicians for using evidence-based pathways. 

For example, WellPoint developed a program to reward oncologists in its network for identifying cancer treatment therapies that are highly effective and provide greater value.

The WellPoint Cancer Care Quality Program, developed in collaboration with AIM Specialty Health, a WellPoint subsidiary, identifies certain cancer treatment pathways based on current medical evidence, peer-reviewed published literature, consensus guidelines and WellPoint’s clinical policies, such as designating which specialty drugs require prior authorization. 

Jennifer Malin, MD, WellPoint oncology medical director, says the program helps support oncologists and their large staffs with enhanced reimbursement to offset the lower fees they receive from prescribing less-expensive drugs. Oncology practices that follow pathways can earn a $350 one-time fee at the start of treatment planning and care coordination, along with $350 per month for each patient actively receiving therapy based on pathways.  

Mari Edlin is a freelance writer based in Sonoma, Calif.