Amid the recent political changes in the United States, there has been plentiful discussion about what the future of health care will look like. Certain policies brought about as a result of the Patient Protection and Affordable Care Act of 2010 are predicted to be rolled back, with other initiatives favored by Republicans are ex- pected to be ushered in. Still, many anticipate that the current trend toward making care more value-based will continue unabated.
Scott Guerin, PhD, and Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, predict that it is simply the approach to improving value that is likely to change, in that there will be a greater focus on the consumer—that is, the patient (page 37). A consumer-driven clinical pathway, they argue, is one that contains a high degree of patient centricity, appealing to patients and caregivers by providing greater transpar- ency around care decision-making and therapeutic selection, and managing intra- provider care coordination more effectively.
On the other hand, according to Cynthia Terrano, CPA, and Karen K Fields, MD, clinical pathways should address the whole continuum of cancer care to make the health system more accountable and become truly patient-centered (page 39). Im- proving overall cost-effectiveness, avoiding redundancies and inappropriate care, and improving care quality should be the goals of pathways in a consumer-driven health care environment.
As the health system evolves in a direction that caters more to patients’ defini- tions of value, it will become increasingly important to incorporate patient-reported outcome (PRO) measurements into research and clinical practice. Currently, there is wide variability in PRO measurement practices, presenting a dilemma to health care providers looking to embrace this shift. RahmaWarsame, MD, and MicheleY Halyard, MD, share their experiences with implementing PRO collection and discuss the key considerations for success, including appropriate measure selection, achieving buy-in from health care providers, and utilizing PRO data in clinical practice (page 43).
Although the shift from fee-for-service to value-based payment systems is likely to continue, new policies are likely to mean patients will have greater decision-making au- thority—but also greater interest in the cost of care, due to increased out-of-pocket ex- penses. Clinical pathways catering to this new environment will not only allow patients to better understand their treatment options, and the associated out-of-pocket costs, but also the impact of care choices on quality of life and other patient-centered outcomes.