Institutional Approaches to Value-Based Care


Oncology has emerged as a subspecialty particularly amenable to clinical pathways. As value-based care continues to gain in prominence and importance in practices across the United States, individual providers and medical groups have sought ways to best maximize value while minimizing costs. Because clinical pathways are not a one-size-fits-all operation, each practice has approached the implementation of these programs in a slightly different manner.

In that respect, Journal of Clinical Pathways spoke with Editorial Advisory Board member Ayman Elfiky, MD, MSc, MPH, about how clinical pathways are used at Dana-Farber Cancer Institute (Boston, MA), where he serves as an attending physician in medical oncology, and as a member of the prostate cancer program. Dr Elfiky described how the health care reform, consumer-driven market practices, and the move toward precision oncology have shaped the implementation of clinical pathways and other areas of value-based care. He further explained why clinical pathways and oncology have enjoyed a synergistic relationship for many years, and will continue to grow together as medical and treatment trends evolve and grow.

What inspired you to work in oncology?

Unlike with any other clinical subspecialty, I have long appreciated the intimacy of trust and dedication to the sanctity of life that can grow in oncology over the course of each provider-patient relationship. Increasing scientific knowledge and insights about the nature of cancer development and propagation has inspired new perspectives on the human experience of cancer. Indeed, the more we appreciate cancer as representing a diseased manifestation of a fundamental “loss of balance” within our system, the more we appreciate and are humbled by the complex interplay of finely balanced biochemical processes and systems that embody the amazing human enterprise.

My cross-disciplinary training gave me the tools to bring to light those forces and processes that impact at the individual and structural levels and come to manifest as adverse health outcomes. As my vision for the future of health care matured, I see the dire need for principled managers and leaders who can affect meaningful changes in their organizations and policies which dictate people’s care experiences and sustainability of health.

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