In an increasingly resource-constrained healthcare environment, clinical pathways have emerged as a mechanism to reduce unwarranted variance in care, optimize outcomes, and contain healthcare costs, while providing high-quality, evidence-based care.
Clinical pathways are, by necessity, nuanced and include multiple stakeholder positions and perspectives, according to James N. Frame, MD, FACP, Medical Director, Charleston Area Medical Center Cancer Center, WV, and a member of the American Society of Clinical Oncology (ASCO) Task Force on Clinical Pathways.
“Within the practice setting, there is a recognition of value for pathways as a comprehensive patient care, but there are also emerging concerns regarding pathways design, implementation, and use,” Dr Frame said at the 2016 ASCO annual meeting, presenting the oncology practice perspective on pathways during a session on pathways.
Dr Frame presented results from a survey of council representatives and state societies, conducted by the ASCO State Affiliate Council, on practice perspectives related to provider and payer clinical pathways.
- 49% of respondents had some exposure to or currently use provider pathways, 32% were unsure, and 19% had no experience with provider pathways
- 79% of respondents will use provider pathways in the next 2 years, and 47% will do so within 6 months to 1 year
- Positive aspects of implementing provider pathways include streamlining prior authorization (72%), clear direction regarding treatment (67%), and the ability to achieve compliance benchmarks (61%)
- The top 3 negative aspects of implementing provider pathways include administrative burden (84%); limiting treatment options in a practice setting, either less expensive or less effective drugs (63%); and complicating prior authorization requirements (54%)
- Gaps in coverage, delays in care, and financial impact on clinical practices were identified as additional concerns regarding provider pathways.
State affiliate members had less experience with payer pathways.
- 29% of respondents had no experience with or were unsure about payer pathways
- Positive aspects of these pathways were streamlining prior authorization (63%), the ability to achieve compliance benchmarks (32%), and a clear direction in treatment (26%)
- Limiting treatment options was identified as a potential negative aspect of payer pathways.
In addition, some council members thought that medical decisions should be left to the medical community, not to payers.
Value and Concerns Related to Pathways
Overall, 33% to 50% of respondents had pathways experience, but a significant proportion of respondents had no experience with clinical pathways.
Streamlined prior authorization requirements, clear treatment decision, and the ability to achieve compliant benchmarks were identified as positive aspects of clinical pathways. Increased administrative burden, treatment limitations, and prior authorization requirements were identified as negative aspects of clinical pathways.
“Based on these results, ASCO should define characteristics needed for a high-quality pathway program and support the development of a pathway certification and endorsement process,” Dr Frame advised.