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Reflections From the Congress: From Year 1 to Now

October 30, 2019

Journal of Clinical Pathways spoke with Winston Wong, PharmD, president, W-Squared Group (Longboat Key, FL) at the Oncology Clinical Pathways Congress (October 11-13, 2019; Boston, MA) regarding his take on the most notable lessons gleamed from the Oncology Clinical Pathways Congress.

The most notable lessons to be taken from the Oncology Clinical Pathways Congress...

Dr Wong: First of all, I guess what I could say is this is the fourth conference. After every conference, I seem to really get re‑energized and more passionate about the concept of clinical pathways. What I gleamed as major advances in this year's conference is that, looking over the 4 years, I actually see clinical pathways continuing to evolve.

I remember the first year it was basically just talking about treatment‑decision support. Now we're bringing in major themes of this year of bringing in the full comprehensiveness of, first of all, treatments like surgical oncology, radiation oncology, but also bringing in the patient aspect.

Alan [Balch] each year goes and really never ceases to expand me to go and think more and more about the patient aspect. When we start talking about personalized treatment pathways, I usually think more towards the diagnostics. Bringing in all the other patient aspects that Alan [Balch] brought in yesterday definitely is a new thought.

It's exciting to me to go and really see this continued evolution towards more comprehensive personalized pathways, especially as we talk about the patient aspect that Alan [Balch] brought up yesterday.

Seeing the Genie presentation of doing all the analysis, which I think ultimately is going to lead to true, personalized treatments and personalized medicine in the future as well as even leading to more drug development.

The growth of the Congress and the importance of continued growth in comprehensive pathways...

Dr Wong: Thinking back to the first year, one of the major barriers that we've always seen and even I saw it when I started getting into pathways some12 years ago is that electronic accessibility. The integration of the pathways into the electronic medical record, so seeing what Moffitt has done, seeing what Dana‑Farber has done in terms of building their own systems.

Getting the engagement of their physicians to buy into putting a pathway together and then internally developing their own system for accessibility is truly remarkable. If I compare today to what was there 4 years ago, to what was there 10 years ago, definitely major advancements.

Definitely something that needs to occur in the future to go and truly make clinical pathways become a standard. Ultimately, as we start talking about the value‑based benefit or contracting benefit designs for patients from the payers and stuff, ultimately the reimbursement to these practices are going to be really slimmed down.

As we alluded to, the use of clinical pathways, comprehensive clinical pathways, is going to be I believe a necessity for these practices to be able to go and survive the alternative payment models that we are going to be seeing in the future.

Whether financial barriers will keep practices from developing in-house comprehensive pathways...

Dr Wong: As I alluded to in the state of clinical pathways presentation, looking at the small to medium independent cancer centers and practices. Truly, there is very minimal clinical pathway used in those practices.

Most of that is really because of a physician engagement factor. But mostly because it's cost prohibited for these practices to put in the systems that are needed to go, and truly make the clinical pathway process or program successful. It is going to be mostly in the medium to large. I think, it's going to be mostly driven by the academic centers such as the Moffitt, and such as the Dana‑Farber.

However, that's not a bad thing because ultimately what we've been seeing over the past 10 years is that there is that reducing of the community independent practice and that moving into the more integrated care systems, the health systems. You have the small practices who aren't able to go and put the clinical pathway program in.

What we did find in that study earlier this year is that as they're getting integrated into the health systems, the health systems are now taking their clinical pathway programs or platforms, and extending it out to that small practice. The penetration of clinical pathways is growing. It's growing by consolidation as opposed to adoption.

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