Robin Zon: The Next Big Developments in Clinical Pathways


Journal of Clinical Pathways spoke with Robin Zon, MD, FACP, FASCO, about her role with the ASCO Task Force and her presentation, "ASCO'S Policy on Clinical Pathways - Future Direction" (September 8-10, 2017; Washington, DC).

My name is Robin Zon and I am affiliated with Michiana Hematology and Oncology as the vice president, chair of the finance committee, and chair of quality committee.

Can you tell us about the main takeaways from your presentation?

The ASCO task force on pathways was formed in January 2015. Since then, we have developed a recommendation policy, as well as published criteria defining high quality pathway. We have since embarked on another aspect of our journey in helping our members navigate the pathway arena by applying the criteria to pathways they are interested in. The takeaway is that in a very brief period of time, the ASCO task force has been able to develop tools and resources that we believe is helpful for all stakeholders, including the payer, the provider, the patient, and even the employer as they try to navigate the pathway arena for improving care of our patients.

Where do you think is the next big development in clinical pathways?

The next big developments in clinical pathways would include the opportunity to use pathways to reduce the administrative burden for all providers. Administrative burden is considered by providers of all specialties to be a great concern, adding unnecessary hours of work to their day, contributing to burnout, and contributing to early retirement, which affects the looming workforce shortage we are facing. That being said, I think the next big development is somehow working with the providers and payers – perhaps even legislatively – to try to deem pathways so we can reduce the administrative burden of individuals that are required to or choose to use pathways in their provider-payer relationship.

In addition, I think what hasn’t been discussed much is what’s going to happen when other specialties develop their clinical pathways? Are they going to be easily integrated and mirror the pathways in the oncology world, which seems to be far ahead of other specialties? There’s going to need to be collaboration and oversight to make sure that the pathways are synergizing and are not antagonistic with each other.

What do you believe the next specialty on the horizon is that would be most adaptable to clinical pathways?

That’s a difficult question to answer because I think there are many specialties where I think pathways can be very easily implemented and maybe already exist. That could include pathways in the emergency room for physicians. That could include pathways in gastroenterology, especially when it comes to the therapies surrounding hepatitis B and hepatitis C, for example. I could see other specialties easily using pathways as well, such as ophthalmology. I think the AMA will be very instructive in helping the pathway arena better understand who in fact is developing pathways, but more importantly taking that in concert with the development of the alternative payment model, by which MACRA and the QPP (Quality Payment Program) is wishing that all providers eventually migrate to and transfer to. Pathways, in fact, can be the crux of the APM model and be able to ensure not only best outcomes, but monitor toxicities as well as reduce variation of care and cost.