The principles and structures of Kaiser Permanente and the National Institute for Health and Care Excellence may represent future models of care.
Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD—Column Editor
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.
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.
For professionals creating a clinical pathway for a disease state, it is important to understand the various stakeholder biases in real-world contexts, so that appropriate prompts may be integrated into the pathway in order to achieve the best outcomes.
Clinical pathways have begun including financial and accountable outcome measures. As we go into 2018, these issues are expected to undergo major changes as a result of legislation and regulations coming out of Washington.
As a retail provider, CVS not only has its pharmacies, which have prescribing authority in several states and can act as treatment providers in certain areas, such as vaccination. It also has the ability to operate clinics in many locations.
Using clinical pathways to direct exactly where and when care can be best provided is critical to population health management success.
Should the Trump administration succeed in rolling back many ACA key policies, clinical pathways will need to mitigate the costs from patients, providers and payers.
The author highlights the potential benefits of prescribing specific sites of care in clinical pathways.