An Inside Look at ASCO’s Evaluation of Pathway Vendors
The review details the fact that oncology clinical pathways as a whole are lacking clear and achievable outcomes as well as reporting of public metrics. Why do you think this is the case? Do administrative burden or strict adherence thresholds factor into this trend?
The limitations in public reporting of performance metrics might have more to do with the preferences of these vendors’ customers. Providers and payers are just starting to understand, assess, and learn from their pathway data and, prior to public reporting, this analysis needs to occur.
With respect to administrative burden, the analysis demonstrates that while many of these vendors plan for integration into commonly used electronic health records and automated prior authorizations, there is still much work to be done in achieving this goal. Seamless integration with the electronic health record to provide decision support at the point of care, reduce administrative burden, and facilitate patients receiving their anti-neoplastic treatment through expedited prior authorization would benefit providers and patients and are key criteria that ASCO emphasized in its work on pathways.
What is the most important takeaway from the review for oncology practices that are considering employing these pathway programs?
Pathway programs continue to evolve, and in many respects have aligned with some of the original recommendations and criteria over time. That being said, there are many more pathway programs that were not evaluated. ASCO’s resources, including the checklist “Evaluating Oncology Clinical Pathways Programs,” can assist stakeholders in analyzing such programs. Overall it is important to acknowledge that as pathway programs continue to evolve—which involves self-analysis of quality outcomes and cost-effectiveness, and integration of new scientific knowledge as well as real-world evidence—they represent an opportunity for improving care in a manner supporting high-quality, non-disparate, cost-effective care.
How can pathway programs take this information and improve their practice?
Practices may choose pathway implementation for a number of reasons, such as reducing ED visits and hospitalizations (important for payers and patients and the health care system budget), improving quality of life measures, optimizing practice efficiencies, reducing administrative costs and resource use, improving patient flow efficiencies, chair-time management, triage nurse efficiencies, and pre-certification processes. There may be opportunity for reimbursement benefits as well as in contracting with payers and employers. Additionally, as the volume of knowledge and treatments increase, along with the promise of real world evidence, pathway programs which integrate this (as per ASCO’s pathways criteria) could potentially serve as invaluable tools at the point of decision making for the provider, while also assisting in the education of the patient (Read “When Investment Meets Return” for more).