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Editor's Page

Quantifying Resource Use and the Role of Pathways in Reimbursement

Authored by

Winston Wong, PharmD, Editor-in-Chief


J Clin Pathways. 2019;5(1):13.

WongThe delivery of cancer care is inevitably influenced by payment forces. In the ongoing transition from volume- to value-based payment, clinical pathways can serve as an integral tool for successful and streamlined reimbursement models. With the use of comprehensive pathways to reduce variation in care and decrease unnecessary resource utilization, alternative payment models may become more common. The articles in this issue of Journal of Clinical Pathways explore opportunities for better utilization of resources and break down the specific elements of pathways that can be optimized to better align with new reimbursement models. 

Many patients with recurrent ovarian cancer are observed without further treatment after their second-line platinum treatment. There is little research on the burden of illness during “watchful waiting” periods—observational periods when patients do not receive maintenance treatments but are actively surveilled. Previous studies conducted during watchful waiting have focused on surveillance costs or the cost effectiveness of maintenance therapies. Brooke Harrow, PhD, and colleagues conducted a retrospective cohort study using claims data to quantify the use of health services during the watchful waiting period after second-line platinum-based therapy among patients with ovarian cancer. 

Clinical pathways initiatives have taken different forms under fixed payment, capitation, and fee-for-service incentives. Bundled payment models have emerged nationwide as a novel model to address the cost of care for procedures and conditions encompassing a broad range of clinical areas. Conceptually, the episodic design of bundled payments provides a naturally aligned payment model for clinical pathways. Both bundles and pathways focus on specific patient populations and condition- or procedure-specific care. Joshua M Liao, MD, MSc, FACP, and Christopher Chen, MD, MBA, explain how providers can optimize several pathways criteria to succeed in bundled payments.

We are also excited to announce the launch of 2 new JCP sections for 2019: a new print column series titled “Tools for Transformation” and an online exclusive series called “Cancer Center Spotlight.” In the former series, Gordon Kuntz will leverage his 30 years’ experience working with payers and providers on oncology clinical pathways programs to bring readers concrete strategies and advice on the use of pathways. Mr Kuntz’ first installment in this issue gets back to basics by reiterating the basic terms and aims of pathways today. The Cancer Center Spotlight series will profile top US cancer centers’ clinical pathways teams to give readers an in-depth look at their programs. This issue features an interview with Moffitt Cancer Center’s chief operating officer and president, Jack Kolosky, CPA, MBA, as a sneak peak of this forthcoming online series. 

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