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The Current State of Clinical Pathways: Results From the Inaugural Benchmarking Survey

October 26, 2018

Winston Wong, PharmD, explained the findings of the first JCP clinical pathways benchmarking survey, including respondents’ reasons for pathway implementation, barriers to implementation, and potential for clinical pathways outside of oncology.s

Survey results were presented at the Clinical Pathways Congress (October 26, 2018; Boston, MA).

Dr Wong began the session by noting the key reasons for disseminating the survey. Pathways have become an integral component of oncology care, he stated, and they will increase in use as the focus on value-based care continues to occur. A total of 87 individuals responded to the survey, among which 78% were direct care providers (ie, oncologists, Pas, NPAs, nurses, pharmacists, and other clinicians) and 22% were practice administrators. Respondents acknowledged affiliations with community practices (35%), multi-specialty group practices (16%), institutional-based practices (46%), and other organizations (2%).

Among the most prevalent payment model used by respondents was traditional fee-for-service, though MIPS and OCM maintain a significant share of the percentage. Pay-for-performance continues to be a growing financial model among commercial payers, Dr Wong noted, and delegation of financial risk and bundled payments is still in the early stages.

The evidence sources most frequently used in the development of pathways include treatment guidelines and medical literature, though FDA approvals are often strongly considered. In terms of the frequency of pathway updates, 52% of pathways are re-evaluated when new information becomes available at least quarterly and 83% of pathways are updated at least annually.

In regard to how off-pathway treatment decisions are handled, most practices self-govern off-pathway treatment selection through a peer-review or appeals process.

 

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Dr Wong noted that while approximately 80% of practices access pathways electronically, most practices (57%) access pathways separate from their prior authorization system. Patient demographic systems are still fragmented and operating independent of each other, he continued. This trend has led to significant administrative burden.

The conversation then moved into the challenges related to pathways, to which the respondents disclosed overwhelming issues with provider buy-in and administrative burden. Systems integration, monitoring adherence, financial return, and payer reimbursement also fell into this category.

In his concluding remarks, Dr Wong stated that pathways have been implemented for a variety of reasons that are aligned with the diversity of provider practices represented in the survey. Pathways have a long way to develop into a basis for value-based care, he added, and current pathways fall short in addressing many areas of patient care. There are many barriers that continue to exist for practices to implement a pathways program, though value-based care models will improve patient care, outcomes, and satisfaction while reducing cost and continuing their transition into other therapeutic areas.—Zachary Bessette

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