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Changing clinical pathways to incorporate the full spectrum of the patient experience requires a significant shift in how pathways are thought about, how they are developed, and what stakeholders provide during development.
Insights from payers and health systems shed light on drivers of the interest in value-based contracting, important barriers to implementation, and implications for manufacturers seeking to engage in successful value-based agreements.
The principles and structures of Kaiser Permanente and the National Institute for Health and Care Excellence may represent future models of care.
Making the transition from fee-for-service reimbursement to value-based models of care and payments will be slow and difficult.
Health systems increasingly have an inpatient, health plan, and now outpatient formulary, each with their own rules, priorities, and application. These differences and complexities are important to consider to optimize clinical pathway outcomes.
As initial gene and cellular therapies come to market, debate is growing as to the best ways to evaluate the associated economic impact, specifically in the context of the shift to value-based reimbursements.
It is an exciting time in oncology care as innovative cellular and gene therapies come to market, with many more to come in the near future.
While clinical pathways have been narrowly focused historically, steps can and should be taken by providers and stakeholders to ensure that patients and their individual preferences are adequately represented in pathway development.
With the arrival of clinically validated software technologies designed to treat disease, or “digital medicines,” comes a plethora of uncertainties related to how stakeholders will value these products relative to traditional medicines and how they will fit into today’s health care system.
More comprehensive clinical pathways may be one way to address the aging health care workforce and high burnout rate due to increasing administrative responsibilities, decreasing compensation, and more demands from patients and payers.