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Pathways as a Tool to Improve the Patient Journey and Advance Alternative Payment Models

Authored by

JCP Editors

Citation

J Clin Pathways. 2020;6(7):21-23.

OCPCThe health care sector is undergoing a shift in the way care is delivered, in the way outcomes are measured, and in how services are reimbursed. The movement has been toward more data-driven science with an emphasis on high-quality outcomes at less cost. The current COVID-19 pandemic has accelerated this shift in many ways, pushing health care and health policy professionals to rethink care delivery and explore new approaches.  

Amid such changes, payers and providers alike seek to ensure clinical decisions are based foremost on the best and latest evidence across all settings. Most failures in care delivery are due to deficiencies in systems and processes, not in failures of the individuals; if providers can streamline and standardize care, there is the potential to reduce unnecessary variation in care, which saves money and improves outcomes.1

Successfully implemented, clinical pathways enable widespread and consistent evidence-based practice of medicine by incorporating the most up-to-date clinical guidelines with efficacy and, when appropriate, financial considerations. Clinical pathways programs can vary greatly, for example, in terms of granularity, platform integration, and quality measurement. But a common feeling of “what’s next” is now emerging among pathways users. As mature programs have demonstrated clear return on investment, pathways champions are now ready and able to leverage their successes in larger and more varied ways in the realms of technology integration and reimbursement.

Now in its fifth year and converted into a fully virtual experience, the Oncology Clinical Pathways Congress (OCPC) serves as a forum for oncology care professionals interested in utilizing clinical pathways as a tool to facilitate more value-based care delivery in their facilities. This year’s agenda features sessions on leveraging clinical pathways to assist in prior authorizations and in alternative payment models; the role of big data and data science in evidence-based care; and meaningful integration of the patient voice in pathways.

Steering committee members include Robin T Zon, MD, FACP, FASCO, former chair, American Society of Clinical Oncology Pathways Task Force; Wui-Jin Koh, MD, senior vice president, chief medical officer, National Comprehensive Cancer Network; and Frederick M Schnell, MD, FACP, chief medical officer, Community Oncology Alliance. 

The more convenient virtual program will also feature opportunities to network with peers and exhibitors as well as to participate in live Q&A. All registrants will receive on-demand access to this exclusive content for 12 months following the Congress, allowing ample time to earn 11+ CME/CNE credits.

Among the most anticipated sessions for 2020 are the following sessions:

The Evolving Paradigm Change in Prior Authorization: Improving Patient Outcomes and Managing Costs

Amy Schroeder, BPharm, RPh, Avalere Health; Roy Beveridge, MD, Avalere Health

Prior authorization is a commonly used—and criticized—cost-control process that can pose both administrative and clinical challenges. In 2018, the American Medical Association (AMA), along with a handful of other organizations, released a “Consensus Statement on Improving the Prior Authorization Process.” While prior authorization is meant to ensure appropriate, cost-effective health care, it frequently creates barriers and administrative burdens for providers, payers, and patients. This session will explore the considerations and challenges facing providers and health care professionals, and explore opportunities for improving this process through the utilization of clinical pathways. Quote

Value-Based Insurance Design in Cancer Care: Right Drug, Right Person, Right Time, Right Price, Parts 1-4

Magda Rusinowski, Business Group on Health; Andrew Hertler, MD, FACP, New Century Health; Ray Page, DO, PhD, FACOI, FASCO, The Center for Cancer and Blood Disorders, University of North Texas Health Science Center; Sibel Blau, MD, Northwest Medical Specialties; Marcus Neubauer, MD, The US Oncology Network; Sonali Fonesca, PhD, Elsevier ClinicalPath (formerly Via Oncology).

In this 4-part series of presentations, experts will discuss examples of current value-based care programs and share strategies to achieve high-value care in your practice or institution. Speakers representing various stakeholders will share their input on value, including perspectives of the employer, payer, provider, and pathway vendor. Attendees will see how different pathway vendor organizations measure value within their respective oncology clinical pathway programs as well as how data is being shared with the end user to facilitate improved outcomes and cost savings. A dedicated 30-minute Q&A session will take place following part 4 of this series, so that attendees can pose questions to presenting faculty.

Big Data, Oncology Quality, and Pathways

Robert Daly, MD, MBA, Memorial Sloan Kettering Cancer Center; Brian Bourbeau, MBA, Practice Health Initiatives, American Society of Clinical Oncology; Neal Meropol, MD, Medical and Scientific Affairs, Flatiron Health.

In the field of oncology, big data can contribute to developing and reshaping disease prevention strategies, as well as monitoring the effects of specific therapies and calculating cost-efficiency. Various tools have been developed that allow practices and health care systems to monitor their quality of care and automate data collection and quality reporting in order to inform subsequent care decisions. This session will address the broad impact of big data use to help inform clinical, financial, genomic, and sociodemographic choices and focus cancer care management resources through clinical pathway use.


QAQ&A

Journal of Clinical Pathways (JCP) spoke with a few of the OCPC 2020 presenting faculty to hear more about what they hope to share in their sessions and why they value the Congress. 

Big Data, Oncology Quality, and Pathways

Robert Daly, MD, MBA, Memorial Sloan Kettering Cancer Center 

In what ways do practices and health care systems use big data?

Dr Daly: I think it’s an area that’s currently really under investigation, and systems are figuring out the best way to use it. One area is in predictive analytics, so identifying cohorts of patients who have specific needs that you can then tailor programs or interventions for.

In oncology care, it could be identifying those patients who are at high risk for developing symptoms or toxicities and then providing further support to these patients to help them navigate through their cancer treatment.

Can you briefly discuss some of the tools that are available for practices to utilize big data?

Dr Daly: The tools that practices are using are being provided both organically, so their own institutions are creating them, and then there are also private vendors in this space.

They’re looking at creating predictive models, so point-of-care models, that help the clinicians identify these patients who could be potentially at risk for symptoms or at risk for admission.

The value of them will become more apparent as they get better integrated into current clinical workflows and figuring how best to implement them within the electronic medical record. That’s where I see these tools developing.

How can the use of big data combined with clinical pathways improve the quality of oncology care?

Dr Daly: Within clinical pathways, the ways in which big data can be very helpful is that we’re collecting more and more data on these patients who are getting certain treatments in the real-world setting.

We could hopefully link those back to outcomes to see if patients with this specific tumor type, comorbidities, or profile did particularly better or particularly worse with this type of therapy, and then being able to use that to iteratively improve how we treat patients.

There are certain databases that are very rich in understanding patients’ treatments in the real-world setting that are allowing us to gain this understanding so that we can improve how we deliver cancer care.

Clinical Pathways, Cancer Care, and COVID-19

Barry Russo, The Center for Cancer and Blood Disorders

How has the pandemic impacted cancer care?

Mr Russo: The COVID-19 pandemic has transformed health care delivery around the world. Cancer care can’t stop, even in the midst of a pandemic. Oncology care providers are quickly implementing practice-wide changes in response to the evolving state. 

What can attendees learn from your session?

Mr Russo: Our discussion focuses on the changes that oncology practices are facing operationally, financially, and in the patient care process in light of COVID. I hope the audience will come away with some practical ideas/strategies they can implement to assist with the changes needed for oncology in a COVID/pandemic-focused environment. 

The State of Clinical Pathways: Journal of Clinical Pathways Benchmarking Survey

Winston Wong, PharmD, Editor-in-Chief, Journal of Clinical Pathways

What are you looking forward to at the Congress this year?

Dr Wong: After every conference, I seem to really get re‑energized and more passionate about the concept of clinical pathways. It’s exciting to me to go and see this continued evolution toward more comprehensive personalized pathways, especially as we talk about the patient aspects, such as socioeconomic factors.

As we start talking about the value‑based benefit or contracting benefit designs for patients from the payers, the use of comprehensive clinical pathways is going to be, I believe, a necessity for practices to be able to go and survive the alternative payment models that we are going to be seeing in the future. υ 

Reference

1. McKinney M. Oncology clinical pathways: the Yale experience. J Clin Pathways. 2019;5(5):29-31. doi:10.25270/jcp.2019.06.00085

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