On day one of the 2018 Clinical Pathways Congress (October 26, 2018; Boston, MA), Bobby Daly, MD, MBA, Memorial Sloan Kettering Cancer Center (New York, NY), and Robin Zon, MD, FACP, FASCO, Michiana Hematology-Oncology, PC, (Mishawaka, IN), discussed the origins of the ASCO Pathways Task Force Development of Criteria for High-Quality Pathways and their findings after assessing existing pathway programs in relation to their criteria.
The ASCO Clinical Pathways Taskforce, established in 2015, determined it was essential to elevate awareness that no current mechanism existed to ensure integrity, efficient implementation, and outcome assessment for these care management tools. Thus, they began determining what these criteria should entail. They then compared the established criteria to the pathways programs of Anthem, eviCore, eviti, New Century Health, Value Pathways (NCCN), and Via Oncology.
Through their discussions with these organizations, Dr. Daly said they learned that the criteria was interpreted literally; that the criteria can only be used for qualitative analysis; that there is a need for a clear definition of what defines a pathways program as well as vendor goals; and that criteria alone does not remedy all of the concerns raised by ASCO.
Dr. Daly remarked that they would have liked to interview and work with many more institutions for the study had resources permitted, but he hopes to speak with more in the future to help evolve and enhance the criteria to better serve institutions and providers.
Dr. Zon picked up the conversation and transitioned to the topic of utilization management strategies in care systems and how to perform a return on investment analysis when determining whether to buy or build a pathways program. She commented on the many utilization management strategies that providers are expected to work under on a daily basis and proposed that clinical pathways could be used to underpin and improve those strategies while not adding to administrative burden.
In order for pathways to be used effectively in this manner, it is essential to understand the goals of each stakeholder involved, including the patient, provider, payer, employer, and system. While many of their goals overlap, they, of course, have varying requirements to meet. She touched on each element of interest to each individual party.
She then broke down the key buy-vs-build elements to consider. She began by emphasizing that the ASCO analysis was not designed to advise people on whether to buy or build a pathway; it is just a resource to evaluate pathways. Other important considerations included financial cost of buy vs build, which is contingent on the size of one’s practice; ownership of data (arguably the most valuable asset of a pathway program, she said); managing conflicts of interest (present in both vendor pathways or provider-created); product evolution; and what outcomes to track for your practice’s needs.
She ended by explaining other ways in which pathways and the data pathways collects can be used to improve other care processes. For example, in the ASCO patient-centered oncology payment (PCOP) model pathway compliance serves as a quality metric, pathways monitor resource utilization (eg, drugs), and pathways can serve as a surrogate for stage, bio/molecular/genomic marker data submission (ie, reduces data submission).—Amanda Del Signore