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An Oncology Pathways Pioneer Paves the Way for Pathways Across Medicine

Authored by

JCP Editors


J Clin Pathways. 2018;4(suppl 2):S14.

McAnenyIn 2012, Dr Barbara L. McAneny was awarded a $19.76 million grant by the Center for Medicare & Medicaid Innovation to develop the Community Oncology Medical Home (COME HOME) model and implement that model in seven practices across the country. The model proved successful in improving patient care, outcomes, and satisfaction while dramatically reducing costs, and it led to the evolution of the Oncology Care Model (OCM), now adopted by hundreds of practices and multiple payers across the country.

Dr McAneny, now president of the American Medical Association, shared insights and best practices from her experience as one of the earliest adopters of clinical pathways at this year’s Congress. She also outlined her plans to help extend a value-based approach to other areas of medicine.

The COME HOME model was one of the first to use clinical pathways. How are pathways used in this model? 

The diagnostic and therapeutic pathways are the clinical pathways that help with decision support, helping us to decide which treatment to use at which point and for which cancer. The speakers at this conference are absolutely correct—none of us can keep [all of that information] in our brains.

The triage pathways are the heart of the COME HOME model, and that is how we generated the savings. These are nurse-level decision support, which are absolutely key. So, we have the physician-level [pathways] for diagnosis and therapy. On the other hand, we have the triage pathways, which are nurse-level decision support. I have not read into other triage pathways that are truly decision support like we created for COME HOME. The other pathways or triage tools that I have seen are pretty much documentation tools.

What disease states other than oncology are most in need of clinical pathways?

I think that any clinical situation where people are managing chronic disease that has acute exacerbations is right for pathways. If you can intervene early in acute exacerbations, you can probably keep people healthier and keep them out of hospitals as well as emergency departments. Pathways are very useful for pinpointing that. 

As data from performance period 2 of the OCM have recently been released, do you believe the OCM has been successful thus far?

I think that the OCM is accomplishing wonderful things in terms of transforming the way we take care of patients. Practices across the country are stopping and thinking about how to manage patients better to keep them out of the hospital. I think that is hugely important to patients. The risk part of OCM is a bit problematic, because the targets are not sufficiently accurate, and practices are not willing to “bet their practice,” so to speak, on hitting a target that includes things that they cannot control.

Do you this the OCM will be sustainable, or do you think practices may opt out of OCM participation in favor of other programs like the Merit-based Incentive Payment System (MIPS)?

I am hoping that, whether or not practices opt out of OCM, they will continue to do the medical home types of processes, because those benefit patients. I think many practices will either be thrown out because they did not make a financial target, or they will opt out when they realize that they cannot tolerate the level of financial risk. After all, they cannot control who walks into their practice and therefore cannot control which risk factors they are going to have to manage.

The smartest thing for us to do would be to go to the next phase for OCM. I am actually working on something like that called MASON (Making Accountable Sustainable Oncology Networks), which I am putting in front of the Physician-Focused Payment Model Technical Advisory Com-mittee in hopes of being able to use data science to create really accurate targets so that we can continue the gains we have made over the OCM. 

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